bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhancing quality of life in progressive multiple sclerosis with powered robotic exoskeleton
Authors: Wee Seng Kwee , Ho Chiu Yi , Tan Si Lei , Ong Cheng Hong
Published: September 2020

Wearable powered robotic exoskeleton can provide high repetitions and high-intensity gait training. It can promote a sense of well-being when the user is in upright posture to walk around different environment. We present a case of a lady with progressive multiple sclerosis who received 15 sessions of robotic exoskeleton training. Post training, she demonstrated improvement in lower limb strength, sense of well-being and self-esteem that led to improved transfer ability, increased social outings and better quality of life (QOL). Previously, she was depressed and reluctant to go out for social activities. This case suggests the potential of robotic exoskeleton to enhance QOL in people with mobility challenges.
Skin tone, life satisfaction, and psychological distress among African Americans: The mediating effect of stigma consciousness
Authors: McCleary-Gaddy Asia T , James Drexler
Published: September 2020

This study examined the indirect effect of skin tone on psychological distress via (1) stigma consciousness and (2) life satisfaction among African American adults (N = 780; %Female = 57.65%; Mage = 37.68). Results show indirect effects of (1) skin tone on life satisfaction and (2) skin tone on psychological distress, each via stigma consciousness. Specifically, those with darker (vs. lighter) skin tones reported increased stigma consciousness, which then predicted (1) lower life satisfaction and (2) lower levels of psychological distress. Life satisfaction did not predict psychological distress. Implications for African American mental health are discussed.
Intimate citizenship and mental ill health: Informal carers’ accounts of romantic relationship difficulties of people with mental health problems
Authors: Brown Brian
Published: September 2020

In this paper I take a relational approach to understanding the experiences of carers in enabling the ‘intimate citizenship’ of people with long-term mental health problems. This aspect of informal care has received little attention, yet the relational context in which intimacy occurs is important as a background to the more frequently addressed questions of sex and sexuality themselves. Thirty-one carers were asked about their experience of caring. Of those who were partners or spouses of the person cared for, a sense of diminished erotic capital and romantic potential appeared common. For those caring for a relative, there was a sense that their romantic opportunities were restricted and rendered risky by their mental health problems. The interviews suggest substantial relational activity is undertaken to make intimate life possible, which is an important area of investigation if we are to appreciate the barriers to sexual participation of people with mental health problems.
Assessing the evidence of perspective taking on stereotyping and negative evaluations: A p-curve analysis
Authors: Huang Qian , Peng Wei , Simmons Jazmyne V.
Published: September 2020

Perspective taking is conceptualized as the ability to consider or adopt the perspective of another individual who is perceived to be in need; it has shown mixed results in stereotype reduction and intergroup attitude change across many social science disciplines. The inconsistent results raise concerns about the robustness of the perspective-taking phenomenon. The present study uses p-curve analysis to examine whether evidential value existed among two sets of published experimental studies where perspective taking was operationalized in two different paradigms. Despite low statistical power, we found that both sets of studies revealed some evidential value of the effects of perspective taking. The theoretical and methodological implications of perspective-taking studies are discussed as well.
Public attitudes towards climate change: A cross-country analysis
Authors: Arıkan Gizem , Günay Defne
Published: September 2020

Addressing climate change requires international effort from both governments and the public. Climate change concern is a crucial variable influencing public support for measures to address climate change. Combining country-level data with data from the Pew Research Center Spring 2015 Global Attitudes Survey, we test whether perceived threats from climate change influence climate change concern. We distinguish between personal threat and planetary threat and we find that both threats have substantive effects on climate change concern, with personal threat exerting a greater influence on climate change concern than planetary threat. The effects of both types of threats are also moderated by Gross Domestic Product per capita, such that threats have stronger effects on climate change concern in high-income countries than in low-income countries. Our findings contribute to the existing literature and open up new debates concerning the role of threats in climate change concern and have implications for climate change communication.
The New Patterns study: coordinated measures to combat child poverty
Authors: Mølland Eirin , Vigsnes Kristine L. , Bøe Tormod , Danielsen Hilde , Lundberg Kjetil Grimastad , Haraldstad Kristin , Ask Torunn Alise , Wilson Philip , Abildsnes Eirik
Published: September 2020

Background

Child poverty rates are rising in Norway with potential negative consequences for children. Services for families with low income are often fragmented and poorly integrated, and few coordinated initiatives have been implemented and evaluated in Norway.

Aims:

The aim of the current study is to evaluate how integrated and coordinated services provided over a prolonged period by a family coordinator are related to changes across a wide range of health, wellbeing and home environment indicators for the participants.

Methods:

The study uses a mixed methods approach utilising survey and register data, as well as information from interviews and shadowing, to document and evaluate outcomes associated with the intervention and the process of implementation. Data are gathered at baseline and annually throughout the duration of the study. Participants are identified to facilitate longer-term follow-up using register data.

Conclusions:

This project will develop important knowledge about the implementation of coordinated services to families with a low income, and how this way of organizing services influences important outcomes for the family members in the short and long term.
Association between one’s own consumption and harm from others’ drinking: Does education play a role?
Authors: Beckhoff Gabriele B. , Stock Christiane , Bloomfield Kim
Published: September 2020

Introduction: We examined (a) whether risky drinking behaviour is related to experienced harm from others’ drinking (EHFOD) and (b) whether any found relationship is modified by educational level, such that those of lower socio-economic status (SES) experience more harm even when adjusted for drinking behaviour. Method: Data from the Danish national alcohol and drug survey of 2011 ( N=5133) were linked with registry data from Statistics Denmark. Eight EHFOD indicators were grouped into nuisance, harassment or harm/damage categories. Indicators for mean alcohol consumption, Alcohol Use Disorder Identification Test (AUDIT) and binge drinking were examined in relation to respondents’ EHFOD with multiple logistic regression, stratified by sex and education (proxy for SES). Results: One-year prevalence of EHFOD was 50%. We found a positive and significant relationship between own alcohol consumption and EHFOD categories of harassment as well as harm/damage. Effect modification of education was significant for harassment. Among men, odds ratios for the association between risky drinking behaviour and harassment were 5.50 (95% confidence interval (CI) 3.49–8.65) in the low educational group versus 1.42 (95% CI 0.98–2.07) in the high educational group. Conclusions: Our study confirmed an overall positive relationship between EHFOD and drinking behaviour, but it varied by type of EHFOD. Furthermore, education modified this effect for harassment, suggesting evidence of the alcohol harm paradox with respect to EHFOD. More research is necessary to understand better how drinking patterns diverge between low and high educational groups as well as sex, and how this differentially affects risk for alcohol-related harms, including EHFOD.
Does truancy make the delinquent? A situational and longitudinal analysis of the truancy–delinquency relationship
Authors: Gerth Maria
Published: September 2020

Although truancy has frequently been linked to delinquency, we still lack a proper understanding of how this relationship comes about. This study uses Situational Action Theory (SAT) to develop a more comprehensive, mechanism-based explanation of the truancy–delinquency nexus. The core argument is that the relationship is conditional on adolescents’ propensity for delinquency and their exposure to criminogenic settings. To test this argument, I use two kinds of data collected as part of the Peterborough Adolescent Development Study (PADS+). Drawing on unique situational data provided by space–time budgets, I find only weak evidence that the relationship between truancy and delinquency exists at the situational level. Analyses of multiple yearly waves of this panel study provide support for SAT’s potential as a theoretical framework for the truancy–delinquency relationship by showing that the effect of truancy on changes in delinquency is conditional on changes in adolescents’ delinquency propensity and their exposure to criminogenic settings.
Nursing errors and their causes among nursing students
Authors: Mohsenpour Mohaddeseh , Shamabadi Zahra , Zoka Amir , Borhani Fariba , Chakani Fatemeh
Published: September 2020

Introduction

Errors are inevitable in medical practice and this issue has attracted the attention of healthcare systems worldwide. Therefore, it is of utmost importance to pay attention in educational systems. The present study aimed to investigate the frequency and cause of nursing students’ errors.

Methods

This descriptive study conducted based on a cross-sectional design. The researcher provided nursing students with a questionnaire. The participants were selected through a purposive sampling method. Eventually, the collected data were analyzed by SPSS17.

Results

The mean value of errors in students was 32.83 ± 28.5 and the prevalence rate of the errors ranged from 0 to 175. In total, 2922 errors were reported by the students, the most frequent of which were wearing the same pair of gloves for the care of more than one patient (2.61 ± 2.83), negligence to wash the hands (2.41 ± 2.95) and clean the thermometer before utilization (2.19 ± 4.68). Moreover, errors in oxygen therapy (0.69 ± 1.03) and medication (0.87) obtained the lowest frequency. Furthermore, most of the students’ errors were due to not having enough knowledge about medicines (2.1 ± 7.4), lack of appropriate equipment (2.6 ± 1.7), and poor clinical skills (2.1 ± 5.6). Discussion and conclusion: The most frequent nursing students’ errors are related to hand hygiene and personal protection. In addition, the lack of enough skills and appropriate equipment are prevalent causes of nursing students’ errors. Authorities in this field should attend to these errors in nursing education, clinical practice, and nursing studies in order to promote this profession in all of these three dimensions.
Politics and International Relations: A Gendered Discipline
Authors: Thomson Jennifer , Kenny Meryl
Published: September 2020

This introduction provides an overview of the gendered nature of politics and international relations, before a brief summary of the articles that make-up this special issue.
An Evidence Synthesis of Covert Online Strategies Regarding Intimate Partner Violence
Authors: Grimani Aikaterini , Gavine Anna , Moncur Wendy
Published: September 2020

This systematic review synthesizes evidence of how people use the internet to deploy covert strategies around escaping from, or perpetrating, intimate partner violence (IPV). Online tools and services can facilitate individuals leaving abusive relationships, yet they can also act as a barrier to departure. They may also enable abusive behaviors. A comprehensive literature search of published and unpublished studies in electronic databases was conducted. Two researchers independently screened abstracts and full texts for study eligibility and evaluated the quality of included studies. The systematic review includes 22 studies (9 qualitative and 11 cross-sectional studies, a randomized control trial [RCT] and a nonrandomized study [NRS]) published between 2004 and 2017. Four covert behaviors linked to covert online strategies around IPV were identified: presence online, granular control, use of digital support tools and services, and stalking and surveillance. The same technology that provides individuals with easy access to information and supportive services related to IPV, such as digital devices, tools, and services, also enables perpetrators to monitor or harass their partners. This review takes a rigorous interdisciplinary approach to synthesizing knowledge on the covert strategies adopted by people in relation to IPV. It has particular relevance to practitioners who support survivors in increasing awareness of the role of digital technologies in IPV, to law enforcement agencies in identifying new forms of evidence of abuse, and in enabling designers of online/social media applications to take the needs and vulnerabilities of IPV survivors into account.
Modelling and simulation studies on adaptive controller for alt-azimuth telescopes despite unknown wind disturbance and mass
Authors: Keskin Onur , Unal Ali Cem , Kararsiz Gokhan , Yilmaz Tugrul , Yesilyaprak Cahit
Published: September 2020

Numerous ground-based observatories are using small sized ground telescopes for scientific research purposes. The telescopes that are available on the market have three main problems. These issues can be listed as: positioning repeatability, tuning requirement according to different wind speeds for different seasons, and the mass changing via different scientific equipments added to the telescope. This study is aimed at resolving these issues for ground based small alt-azimuth telescopes. Establishing of a set and forget system is performed by designing an adaptive controller. Motor dynamics are taken into consideration for a realistic mathematical model. The Wind-Gust model that consists of a sum of sinusoidal disturbances with unknown phase, amplitude and frequency is used for the wind model. The purposed controller cancels the disturbance effects on the plant while operational positioning and also the makes the plant insensitive to mass changes. The Lyapunov approach is utilised when proving the asymptotic stability. The proposed controller’s success is illustrated with thorough numerical evaluation.
In vitro characterisation of ultrasound-induced heating effects in the mother and fetus: A clinical perspective
Authors: Smith Stephanie F , Miloro Piero , Axell Richard , ter Haar Gail , Lees Christoph
Published: September 2020

Introduction

The quantification of heating effects during exposure to ultrasound is usually based on laboratory experiments in water and is assessed using extrapolated parameters such as the thermal index. In our study, we have measured the temperature increase directly in a simulator of the maternal–fetal environment, the ‘ISUOG Phantom’, using clinically relevant ultrasound scanners, transducers and exposure conditions.

Methods

The study was carried out using an instrumented phantom designed to represent the pregnant maternal abdomen and which enabled temperature recordings at positions in tissue mimics which represented the skin surface, sub-surface, amniotic fluid and fetal bone interface. We tested four different transducers on a commercial diagnostic scanner. The effects of scan duration, presence of a circulating fluid, pre-set and power were recorded.

Results

The highest temperature increase was always at the transducer–skin interface, where temperature increases between 1.4°C and 9.5°C were observed; lower temperature rises, between 0.1°C and 1.0°C, were observed deeper in tissue and at the bone interface. Doppler modes generated the highest temperature increases. Most of the heating occurred in the first 3 minutes of exposure, with the presence of a circulating fluid having a limited effect. The power setting affected the maximum temperature increase proportionally, with peak temperature increasing from 4.3°C to 6.7°C when power was increased from 63% to 100%.

Conclusions

Although this phantom provides a crude mimic of the in vivo conditions, the overall results showed good repeatability and agreement with previously published experiments. All studies showed that the temperature rises observed fell within the recommendations of international regulatory bodies. However, it is important that the operator should be aware of factors affecting the temperature increase.
Redeeming the Value(s) of the Social World
Authors: Kaufmann Laurence , Gonzalez Philippe
Published: September 2020

This article discusses some of the central theses proposed by Nathalie Heinich in her book Des Valeurs ( Values). After focusing on the distinction between norms and values, and the inductive approach favoured by an axiological sociology, we will address how public values might emotionally engage actors, the specificity of moral values and of people as ‘objects of valuation’ and, finally, the ambiguities inherent in the ‘axiologically neutral’ reconstruction of an ‘axiological grammar’. Somewhat countering the ‘descriptive relativism’ that Nathalie Heinich advocates, we will argue, from a pragmatist stance, in favour of a minimal moral realism based on axiological affordances. Finally, we will show that such a stance helps to account for the normative functioning of the public sphere.
Axiological Grammar and the Sociology of Values
Authors: Martuccelli Danilo
Published: September 2020

The article offers some thoughts on Nathalie Heinich’s book, Des valeurs ( Values), and its proposal of an axiological grammar. Three main issues are addressed. First, the article revisits the issue of axiological neutrality and the interest of this posture in terms of knowledge. The article then questions the need to open the sociology of values to a sociology concerned with certain historical dimensions, particularly with regard to the attachments of actors. Finally, it compares how the sociology of values and the strategic analysis of decision-making study evaluation processes.
Towards an Axiological Sociology
Authors: Heinich Nathalie
Published: September 2020

Having proposed a 10-point summary of her book Des valeurs. Une approche sociologique ( Values: A Sociological Approach), Nathalie Heinich responds to the comments of Laurence Kaufmann and Philippe Gonzalez, Danilo Martuccelli, and Louis Quéré, as well as to Hervé Glevarec’s review published in the same issue of Questions de communication. Nine themes are successively addressed: issues of vocabulary, the relevance or irrelevance of certain problems (nature, religion), the issue of emotions, the ontological status of valuation, the epistemological status of an ‘axiological grammar’ and its explanatory or comprehensive purpose, the historicity and contextuality of values, the place of the sociology of power relations, the issue of behaviour and empirical observability, and, finally, the controversy about ‘axiological neutrality’.
Crime Scene Analysis Through DNA Testing of Canine Feces—A Case Report
Authors: Somnay Vishal , Duong Thomas , Tsao Ray-Young , Prahlow Joseph A.
Published: September 2020

Forensic DNA testing can play a critical role in homicide investigations. Selecting the appropriate evidence on which to perform DNA testing requires foresight and reasoning based on experience and science. Although successful DNA testing can occur using many substrates, including blood, hair, and sweat/epithelial cells, positive results can also result from testing various unorthodox samples. The authors report on a triple-murder investigation where DNA testing of dog feces at the crime scene matched DNA testing of feces found on the shoe of a suspect resulting in successful prosecution of the case.
Drill-Cored Artificial Rock Pools Can Promote Biodiversity and Enhance Community Structure on Coastal Rock Revetments at Reclaimed Coastlines of Penang, Malaysia
Authors: Chee S. Y. , Wee J. L. S. , Wong C. , Yee J. C. , Yusup Y. , Mujahid A.
Published: September 2020

Coastlines are drastically altered globally due to urbanisation and climate-related issues. As a response, communities build coastal defence structures to protect people and property. Although these infrastructures fulfil engineering demands of coastal defences, the trade-off to nature includes a decrease in biodiversity able to live on these structures because of the lack of topographic complexity. Several studies have tried to increase the surface complexity on coastal defence structures through eco-engineering habitat enhancements that mimic nature. However, few of these studies have been conducted in tropical regions where effects are more pronounce due to desiccation and extreme heat. In this study, water-retaining structures (in the form of rock-pools at depths 12 cm, and 5 cm) were drill-cored into coastal defence structures (i.e. granite rock revetments) on reclaimed coastlines in Penang Island, Malaysia. We found greater species richness and an increase in community structure in the drill-cored rock pools regardless of the depth of these artificial rock-pools. Positive habitat selection also occurred within micro-habitats of this scale. The drill-cored artificial rock pools in these tidal exposed revetments also provided niche-spaces for marine organisms found in low-tide or sub-tidal areas. These findings demonstrate the potential of this eco-engineered habitat enhancement as a means of promoting biodiversity on granite rock revetments, which can be applied either during design phase of a coastal development or retrospectively.
Pathways to reparations: land and healing through food justice
Authors: Gilbert Jessica L. , Williams Rebekah A.
Published: September 2020

While mainstream efforts for reparations center financial compensation via legislation and litigation, social movements expand this conceptualization in order to address critical and yet often overlooked components of reparations. Equitable access to land and opportunities to heal from intergenerational trauma are two of these reparations demands that social movements prioritize. However, there is a dearth of scholarly literature exploring the role and impact of social movements on reparations. Therefore, we seek to develop this important conversation. In doing so, we elucidate the ways in which these two foci of reparations overlap with those of other social movements; food justice initiatives, in particular, also emphasize the connections between racial justice, land justice, and healing. We thus synthesize social movement, food justice, and reparations literatures to examine the overlaps between the goals of food justice initiatives and social movements for reparations. Using two case studies, Tierra Negra and Soul Fire Farm, we demonstrate the ways in which food justice initiatives support social movements for reparations. Contextualizing our analysis within reflections on personal experiences, we argue that through their efforts to transform systems of oppression, food justice initiatives provide an alternative pathway to achieving reparations.
Assesment of Prelacrimal Recess in Patients With Maxillary Sinus Hypoplasia Using Cone Beam Computed Tomography
Authors: Duman Suayip Burak , Gumussoy İsmail
Published: September 2020

Background

The prelacrimal recess approach, is frequently preferred in creating a minimally invasive surgical corridors.

Objective

The aim of this study was to evaluate the Prelacrimal recess (PLR) anatomy using Cone Beam Computed Tomography in patients with Maxillary Sinus Hypoplasia.

Methods

The paranasal Cone Beam Computed Tomography series of 84 adults were analyzed retrospectively. The antero-posterior and mesio-distal widths of the PLR and the antero-posterior width of the naso-lacrimal duct were measured. The patients were divided into three groups according to the antero-posterior width of PLR to evaluate the feasibility of prelacrimal recess approach as Type 1 (0-3 mm), Type 2 (>3–7 mm) and Type 3 (>7 mm).

Results

The mean antero-posterior width of PLR was 3.11 ± 1.49mm in the patients and 4.77 ± 1.76 mm in the controls. The mean mesio-distal width of PLR was 7.64 ± 1.49 mm in the patients and 3.17 ± 2.05 mm in the controls. The mean antero-posterior width of naso-lacrimal duct was 9.58 ± 2.80 mm in the patients and 9.46 ± 2.42 mm in the controls.

Conclusions

The width of the antero-posterior PLR in patients with Maxillary Sinus Hypoplasia was found to be significantly lower in comparison to individuals with normal maxillary sinuses in the measurements performed on paranasal Cone Beam Computed Tomography scans. Hence, while planning a Functional Endoscopic Sinus Surgery with prelacrimal recess approach for maxillary sinus, the anatomical structure of the naso-sinusoidal region should be carefully analyzed, and individual anatomical variations such as Maxillary Sinus Hypoplasia should not be ignored.
Twenty-Two-Year Outcome of Cartilage Repair Surgery by Perichondrium Transplantation
Authors: Janssen Maarten P. F. , van der Linden Esther G. M. , Boymans Tim A. E. J. , Welting Tim J. M. , van Rhijn Lodewijk W. , Bulstra Sjoerd K. , Emans Peter J.
Published: September 2020

Objective

The main purpose of the present study was to assess the risk for major revision surgery after perichondrium transplantation (PT) at a minimum of 22 years postoperatively and to evaluate the influence of patient characteristics.

Design

Primary outcome was treatment success or failure. Failure of PT was defined as revision surgery in which the transplant was removed, such as (unicondylar) knee arthroplasty or patellectomy. The functioning of nonfailed patients was evaluated using the International Knee Documentation Committee (IKDC) score. In addition, the influence of patient characteristics was evaluated.

Results

Ninety knees in 88 patients, aged 16 to 55 years with symptomatic cartilage defects, were treated by PT. Eighty knees in 78 patients were eligible for analysis and 10 patients were lost to follow-up. Twenty-eight knees in 26 patients had undergone major revision surgery. Previous surgery and a longer time of symptoms prior to PT were significantly associated with an increased risk for failure of cartilage repair. Functioning of the remaining 52 patients and influence of patient characteristics was analyzed using their IKDC score. Their median IKDC score was 39.08, but a relatively young age at transplantation was associated with a higher IKDC score.

Conclusions

This 22-year follow-up study of PT, with objective outcome parameters next to patient-reported outcome measurements in a unique group of patients, shows that overall 66% was without major revision surgery and patient characteristics also influence long-term outcome of cartilage repair surgery.
Long-term safety and efficacy of lasmiditan for acute treatment of migraine: Final results of the GLADIATOR study
Authors: Brandes Jan Lewis , Klise Suzanne , Krege John H , Case Michael , Khanna Rashna , Vasudeva Raghavendra , Raskin Joel , Kudrow David
Published: September 2020

GLADIATOR was a prospective, randomized, open-label, phase 3 study of lasmiditan 100 mg or 200 mg dosed intermittently for up to 1 year in patients with episodic migraine. Most patients had completed one of two single-attack studies before participation. A total of 2030 patients received ≥1 lasmiditan dose and 19,879 migraine attacks were treated. Safety results were similar to the previously reported interim analysis. The most frequently reported treatment-emergent adverse events (TEAEs) included dizziness (18.5%), somnolence (8.5%), and paresthesia (6.8%), with frequency of adverse events appearing to decrease with subsequently treated attacks. At 2 h post-dose, 26.7% and 32.2% of all attacks treated with lasmiditan 100 mg and 200 mg, respectively, were pain free. This pattern was generally consistent across study quarters and treated attacks. In conclusion, during a 1-year treatment period, intermittent lasmiditan for episodic migraine treatment was associated with generally decreasing TEAEs and consistent efficacy.
RACE-trial: neoadjuvant radiochemotherapy versus chemotherapy for patients with locally advanced, potentially resectable adenocarcinoma of the gastroesophageal junction - a randomized phase III joint study of the AIO, ARO and DGAV
Authors: Lorenzen Sylvie , Biederstädt Alexander , Ronellenfitsch Ulrich , Reißfelder Christoph , Mönig Stefan , Wenz Frederik , Pauligk Claudia , Walker Martin , Al-Batran Salah-Eddin , Haller Bernhard , Hofheinz Ralf-Dieter
Published: September 2020

Background

Despite obvious advances over the last decades, locally advanced adenocarcinomas of the gastroesophageal junction (GEJ) still carry a dismal prognosis with overall 5-year survival rates of less than 50% even when using modern optimized treatment protocols such as perioperative chemotherapy based on the FLOT regimen or radiochemotherapy. Therefore the question remains whether neoadjuvant chemotherapy or neoadjuvant radiochemotherapy is eliciting the best results in patients with GEJ cancer. Hence, an adequately powered multicentre trial comparing both therapeutic strategies is clearly warranted.

Methods

The RACE trial is a an investigator initiated multicenter, prospective, randomized, stratified phase III clinical trial and seeks to investigate the role of preoperative induction chemotherapy (2 cycles of FLOT: 5-FU, leucovorin, oxaliplatin, docetaxel) with subsequent preoperative radiochemotherapy (oxaliplatin weekly, 5-FU plus concurrent fractioned radiotherapy to a dose of 45 Gy) compared to preoperative chemotherapy alone (4 cycles of FLOT), both followed by resection and postoperative completion of chemotherapy (4 cycles of FLOT), in the treatment of locally advanced, potentially resectable adenocarcinoma of the gastroesophageal junction. Patients with cT3–4, any N, M0 or cT2 N+, M0 adenocarcinoma of the GEJ are eligible for inclusion. The RACE trial aims to enrol 340 patients to be allocated to both treatment arms in a 1:1 ratio stratified by tumour site. The primary endpoint of the trial is progression-free survival assessed with follow-up of maximum 60 months. Secondary endpoints include overall survival, R0 resection rate, number of harvested lymph nodes, site of tumour relapse, perioperative morbidity and mortality, safety and toxicity and quality of life.

Discussion

The RACE trial compares induction chemotherapy with FLOT followed by preoperative oxaliplatin and 5-Fluorouracil-based chemoradiation versus preoperative chemotherapy with FLOT alone, both followed by surgery and postoperative completion of FLOT chemotherapy in the treatment of locally advanced, non-metastatic adenocarcinoma of the GEJ. The trial aims to show superiority of the combined chemotherapy/radiochemotherapy treatment, assessed by progression-free survival, over perioperative chemotherapy alone.

Trial registration

ClinicalTrials.gov; NCT04375605; Registered 4th May 2020;
The PrEPARE Pretoria Project: protocol for a cluster-randomized factorial-design trial to prevent HIV with PrEP among adolescent girls and young women in Tshwane, South Africa
Authors: Wechsberg Wendee M. , Browne Felicia A. , Ndirangu Jacqueline , Bonner Courtney Peasant , Minnis Alexandra M. , Nyblade Laura , Speizer Ilene S. , Howard Brittni N. , Myers Bronwyn , Ahmed Khatija
Published: September 2020

Background

Despite increased prevention efforts, HIV remains the leading cause of death among adolescent girls and young women in South Africa. Although research indicates important determinants of HIV acquisition at the individual and interpersonal levels, structural-level stigma and discrimination continue to be critical barriers to reaching and retaining this key population for HIV prevention and sexual and reproductive health services. Innovative and multilevel interventions are needed that can address the intersectional structural and gender issues that young women face, including stigma, alcohol and drug use, gender-based violence, and other risk factors when seeking health services. Oral pre-exposure prophylaxis (PrEP) taken daily has been found to be an effective biomedical HIV prevention tool. Testing a comprehensive gender-focused biobehavioral HIV prevention intervention that is inclusive of social ecological determinants, such as stigma and discrimination reduction in clinics, is critical for reducing HIV among adolescent girls and young women.

Methods

This project involves both a Community Collaborative Board and a Youth Advisory Board in helping to adapt the Young Women’s Health CoOp intervention and the Health Policy Project (HPP) Stigma and Discrimination (S&D) reduction training curriculum to the setting and population. This study uses a two-by-two factorial design with stratified randomization of 12 clinics, each with distinct catchment areas. The Young Women’s Health CoOp addresses substance use, sexual risk, violence prevention and sexual negotiation, condom demonstration, and problem solving with the following additions: knowledge of PrEP, the importance of PrEP adherence, and sexual and reproductive health. Adolescent girls and young women will be assessed with behavioral and biological measures at baseline, 3-, 6- and 9-month follow-up. The S&D reduction training is provided for all staff in the clinics randomized to this condition. Clinic staff will be surveyed at baseline, 4- and 8-month follow-up. We will recruit 900 AGYW from communities in the 12 clinic catchment areas.

Discussion

The study findings, if efficacious across the outcomes, will be incorporated into the gender-focused HIV prevention intervention toolkit and disseminated to inform multilevel prevention approaches.

Trial registration

ClinicalTrials.gov. Identifier:NCT04048551(Recruiting). Registered: August 7, 2019 (Retrospectively registered).
Using self-collection HPV testing to increase engagement in cervical cancer screening programs in rural Guatemala: a longitudinal analysis
Authors: Gottschlich Anna , Rivera-Andrade Alvaro , Bevilacqua Kristin , Murchland Audrey R. , Isak Ergest , Alvarez Christian S. , Ogilvie Gina , Carey Thomas E. , Prince Mark , Dean Michael , Mendoza-Montano Carlos , Meza Rafael
Published: September 2020

Background

Cervical cancer is a leading cause of death in low- and middle-income countries. Self-collection testing for human papillomavirus (HPV) is an alternative form of cervical cancer screening that can be completed privately and at home. Understanding how the use of HPV testing influences follow-up care in low-resourced settings is crucial before broad implementation. This study aimed to identify if access to self-collection HPV testing impacts participation in established cervical cancer screening programs among women in two rural communities in Guatemala.

Methods

A cohort of 956 women was recruited in 2016 and followed for 2 years for the HPV Multiethnic Study (HPV MES). At baseline, women answered a questionnaire assessing cervical cancer screening history and were offered self-collection HPV testing. Women were re-contacted yearly to determine receipt of additional screening. Statistical changes in screening behavior before and throughout study participation, stratified by self-collection status, were assessed using McNemar pair tests for proportions. Alluvial plots were constructed to depict changes in individual screening behavior. The odds of changes in Pap-compliance (screened in past 3 years), given collection status, were assessed using multivariate logistic regressions.

Results

Reported screening rates increased 2 years after enrollment compared to rates reported for the 3 years before study entry among women who collected a sample (19.1% increase, p < 0.05), received results of their test (22.1% increase, p < 0.05), and received positive (24.2% increase, p < 0.1) or negative results (21.7% increase, p < 0.05). However, most increases came from one community, with minimal changes in the other. The adjusted odds of becoming Pap compliant were higher for women who collected a sample vs. did not (OR: 1.48, 95% CI: 0.64, 3.40), received their result vs. did not (OR: 1.29, 95% CI: 0.52, 3.02), and received a positive result vs. negative (OR: 2.43, 95% CI: 0.63, 16.10).

Conclusions

Participation in self-collection HPV testing campaigns may increase likelihood of involvement in screening programs. However, results varied between communities, and reporting of screening histories was inconsistent. Future work should identify what community-specific factors promote success in HPV testing programs and focus on improving education on existing cervical cancer interventions.
Need for post-operative outpatient appointments after discharge following cervical spinal surgery - a narrative review
Authors: de Bree Karel , Atsma Femke , van Lindert Erik J. , Westert Gert P. , Bartels Ronald M. H. A.
Published: September 2020

Background

In the Netherlands most patients are currently seen in an outpatient clinic after an anterior cervical discectomy, which is an effective neurosurgical procedure with relatively low rate of severe complications. In this back sight, the need for patients returning to the post-operative outpatient clinic could be questioned. The aim of the study is to evaluate whether a post-operative outpatient appointment after anterior cervical discectomy could be replaced by an alternative or be omitted without adversely impacting, or increasing, the value of healthcare and patient satisfaction for this procedure.

Methods

A narrative review was performed to evaluate the quality of care and patient satisfaction for patients with and without a post-operative outpatient appointment after spinal surgery. A literature search of the previous ten years was performed in Pubmed, CENTRAL and EMBASE.

Results

A total of 403 articles were identified. Four studies remained after title and abstract selection by 3 independent reviewers. No papers were selected for further analysis, due to the absence of interventional studies that compared the utility of a post-operative outpatient clinic appointment with an intervention after spinal surgery.

Conclusions

Currently, there is a lack of evidence for the need of a post-operative follow-up after anterior cervical discectomy. Nor is there any literature in favor of omitting these appointments. No determinants which patients benefits from these outpatient appointments could be identified. Potential harmful and beneficial effects of omitting these post-operative follow-ups should be investigated to identify possible determinant for patients who might benefit from a post-operative appointment.
Breast papillary lesions diagnosed and treated using ultrasound-guided vacuum-assisted excision
Authors: Li Xiaohui , Gao Hua , Xu Minling , Wu Yang , Gao Dezong
Published: September 2020

Background

The management of papillary lesions of the breast remains controversial, and thus, we assessed the value of vacuum-assisted excision (VAE)-guided ultrasound in the diagnosis and treatment of breast papillary lesions.

Methods

We retrospectively reviewed the data of 108 patients with papillary lesions diagnosed using VAE between August 2014 and January 2019. Cases without postoperative breast imaging in the follow-up were excluded, and 85 cases were eligible for the study. The follow-up period ranged from 6 to 53 months, with 38 months on average. All the papillary lesions were located away from the skin or nipple with a size less than or equal to 30 mm, and the lesions categorized as C2-4b were completely excised using VAE. All VAEs were performed using an 8-gauge vacuum-assisted biopsy needle under the guidance of ultrasound using a 10 MHz linear probe.

Results

Most patients with breast papillary lesions were asymptomatic (56.5%), and when the size of the breast papillary lesion was more than 20 mm on ultrasound imaging, atypical hyperplasia may have been concomitant. Breast lesions might have been pathologically diagnosed as papilloma after biopsy when they were categorized as BI-RADS 4a on ultrasound images. The rate of underestimation was 7.7% in papillary lesions diagnosed with VAE, and the recurrence rate of papilloma after VAE was low.

Conclusions

Breast papilloma was a common lesion on ultrasonographic screening, and VAE was applicable for completely excising small papillomas, even papillomas with atypical hyperplasia, to obtain an accurate diagnosis with a low rate of underestimation and recurrence. We believe that papilloma diagnosed by VAE might not require immediate excision, and imaging follow-up may be safe for at least 3 years.
Comparison of clinicopathologic parameters and oncologic outcomes between type 1 and type 2 papillary renal cell carcinoma
Authors: Le Xiang , Wang Xiang-Bo , Zhao Hao , Chen Ren-Fu , Ge Peng
Published: September 2020

Background

To compare the clinicopathologic parameters and oncologic outcomes between type 1 and type 2 papillary renal cell carcinoma (PRCC).

Methods

This study was approved by the review board (NO.XYFY2019-KL032–01). Between 2007 and 2018, 52 consecutive patients who underwent surgery at a single tertiary referral hospital were included. Clinicopathologic and survival data were collected and entered into a database. The Kaplan-Meier method, and univariate and multivariate Cox proportional hazard regression analyses were performed to estimate progression-free survival (PFS) and cancer-specific survival (CSS).

Results

Of the 52 patients, 24 (46.2%) were diagnosed with type 1 PRCC, and 28 (53.8%) had type 2 PRCC. The mean tumor size was 4.8 ± 2.5 cm. The two subtypes displayed different morphological features: foamy macrophages were more common in type 1 PRCC, while eosinophils and microvascular angiolymphatic invasion were more frequent in type 2 PRCC. Type 2 cases showed higher tumor stage and World Health Organization/International Society of Urological Pathology (WHO/ISUP) grade than type 1 cases (T3-T4: 43% vs 17%, P = 0.041; G3-G4: 43% vs 8%, P = 0.005). In univariate analysis, type 2 PRCC had a lower probability for PFS and CSS than patients with type 1 PRCC (P = 0.016, P = 0.049, log-rank test, respectively). In multivariate analysis, only WHO/ISUP grade (HR 11.289, 95% CI 2.303–55.329, P = 0.003) and tumor size (HR 1.244, 95% CI 1.034–1.496, P = 0.021) were significantly associated with PFS.

Conclusions

PRCC subtype displayed different morphological features: foamy macrophages, eosinophils and microvascular angiolymphatic invasion are pathologic features that may aid in the distinction of the two subtypes. Histologic subtype of PRCC is not an independent prognostic factor and only WHO/ISUP grade and tumor size were independent predictors for PFS.
“It’s really no more difficult than putting on fluoride varnish”: a qualitative exploration of dental professionals’ views of silver diamine fluoride for the management of carious lesions in children
Authors: Seifo Nassar , Cassie Heather , Radford John , Innes Nicola
Published: September 2020

Background

Despite evidence that Silver Diamine Fluoride (SDF) can be effective in managing carious lesions in primary teeth, the use of SDF in the UK remains limited. This study explored dental professionals’ views and experiences of using SDF for managing carious lesions in children. In addition, it explored what they perceived to be the advantages, disadvantages, barriers and enablers to the use of SDF in practice.

Methods

Fifteen semi-structured face-to-face or over-the-phone interviews were conducted with 14 dental professionals from NHS Tayside and NHS Grampian in Scotland. Interviews were transcribed verbatim, coded and analysed using a thematic approach.

Results

Thirteen of 14 dental professionals interviewed were familiar with, or had some existing knowledge of, SDF. Four had used it to treat patients. The majority of participants thought that the main advantage of SDF was that it required minimal patient cooperation. SDF was also perceived as a simple, pain-free and non-invasive treatment approach that could help acclimatise children to the dental environment. However, SDF-induced black staining of arrested carious lesions was most commonly reported as the main disadvantage and greatest barrier to using it in practice. Participants believed that this discolouration would concern some parents who may fear that the black appearance may instigate bullying at school and that others may judge parents as neglecting their child’s oral health. Participants thought that education of clinicians about SDF use and information sheets for parents would enhance the uptake of SDF in dental practice. Participants believed that younger children might not be as bothered by the discolouration as older ones and they anticipated greater acceptance of SDF for posterior primary teeth by both parents and children.

Conclusion

Dental professionals were aware that SDF can be used for arresting carious lesions. They pointed out that the staining effect of carious lesions is a major disadvantage and had preconceived ideas that this could be a barrier for many parents. Participants considered the application process to be simple and non-invasive and requires a minimum level of child cooperation. Participants appreciated the potential of SDF in paediatric dentistry and suggested actions that could help overcome the barriers they highlighted.
Can we predict early 7-day readmissions using a standard 30-day hospital readmission risk prediction model?
Authors: Saleh Sameh N. , Makam Anil N. , Halm Ethan A. , Nguyen Oanh Kieu
Published: September 2020

Background

Despite focus on preventing 30-day readmissions, early readmissions (within 7 days of discharge) may be more preventable than later readmissions (8–30 days). We assessed how well a previously validated 30-day EHR-based readmission prediction model predicts 7-day readmissions and compared differences in strength of predictors.

Methods

We conducted an observational study on adult hospitalizations from 6 diverse hospitals in North Texas using a 50–50 split-sample derivation and validation approach. We re-derived model coefficients for the same predictors as in the original 30-day model to optimize prediction of 7-day readmissions. We then compared the discrimination and calibration of the 7-day model to the 30-day model to assess model performance. To examine the changes in the point estimates between the two models, we evaluated the percent changes in coefficients.

Results

Of 32,922 index hospitalizations among unique patients, 4.4% had a 7-day admission and 12.7% had a 30-day readmission. Our original 30-day model had modestly lower discrimination for predicting 7-day vs. any 30-day readmission (C-statistic of 0.66 vs. 0.69, p ≤ 0.001). Our re-derived 7-day model had similar discrimination (C-statistic of 0.66, p = 0.38), but improved calibration. For the re-derived 7-day model, discharge day factors were more predictive of early readmissions, while baseline characteristics were less predictive.

Conclusion

A previously validated 30-day readmission model can also be used as a stopgap to predict 7-day readmissions as model performance did not substantially change. However, strength of predictors differed between the 7-day and 30-day model; characteristics at discharge were more predictive of 7-day readmissions, while baseline characteristics were less predictive. Improvements in predicting early 7-day readmissions will likely require new risk factors proximal to day of discharge.