bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring factors influencing recruitment results of nurses recruiting diabetes patients for a randomized controlled trial
Authors: Vluggen Stan , Hoving Ciska , Vonken Lieve , Schaper Nicolaas C , de Vries Hein
Published: May 2020

Background

Effective recruitment of patients by health professionals is challenging but pivotal to the success of clinical trials. Many trials fail to include the required number of participants, which affects the power of the study, generalizability of results, and timely dissemination of positive outcomes. Existing research is inconclusive regarding factors influencing recruitment results, and most research does not focus on perceptions of recruiting health professionals themselves. Therefore, thorough evaluations of recruitment facilitators and barriers in trials are needed in order to optimize future patient recruitment in trials. We observed divergent recruitment results among nurses who recruited diabetes patients to our trial, which examined the effectiveness of an eHealth programme. Therefore, we aimed to describe nurses’ recruitment results and related shifts over time, and to qualitatively explore factors influencing nurses’ recruitment results.

Methods

Nurses’ recruitment results and related temporal shifts were derived from trial data (NTR6840). Based on their recruitment results, nurses were categorized as non-, low-, medium-, or high-recruiters. Subsequently, a subset of nurses per group participated in an individual semi-structured telephone interview. Interviews were analysed using NVivo software, applying an inductive coding approach.

Results

Ninety-six nurses participated in our trial and recruited on average seven patients (range: 0–32). Fifteen nurses did not recruit any patients. Most patients were recruited close to recruitment onset. Nurses who did not recruit patients close to recruitment onset generally ended up recruiting no patients. Data show a relatively high number of early recruited patients that progressively declined over time. High-recruiters were generally successful throughout the entire recruitment period. Recruitment facilitators and barriers comprised organizational, study, patient, and especially recruiter characteristics. Contrary to non- and low-recruiters, medium- and high-recruiters reported more in-depth knowledge about the study and trial requirements, expressed more personal participation-related benefits and fewer barriers, and incorporated more recruitment activities, reminders, and barrier-focused coping strategies.

Conclusion and implications

To optimize patient recruitment to clinical trials, suggested intervention targets include the continued inclusion of recruiters after initial recruitment onset and the encouragement of early recruitment success. A personalized approach may aid recruiters to become and remain successful. Primarily, it is important to provide recruiters with sufficient information on trial requirements and to address salient benefits for participation in the trial, both for themselves and for their patients. Finally, teaching recruiters skills on how to overcome barriers may further enhance motivation and recruitment capacities.
Unburdening the Shoulders of Giants: A Quest for Disconnected Academic Psychology
Authors: Krpan Dario
Published: May 2020

In current academic psychology, scholars typically develop their research and ideas by drawing on the work of other contemporary and preceding psychological scientists and by following certain conventions of the field. I refer to this variant of psychology as connected because the emphasis is on connecting various research findings and ideas generated by different scholars (e.g., by showing how they are related to each other via referencing). In this article, I argue that, although connected psychology advances psychological knowledge, it restricts the total amount of knowledge that could eventually be produced and therefore limits the potential of the discipline to improve the understanding of psychological phenomena. As a solution, I propose that, alongside the currently existing connected psychology, disconnected psychology should be established. In disconnected psychology, researchers develop their ideas by following the main principles of psychological method, but they are disconnected from a “field” consisting of other psychologists and therefore do not follow the discipline’s norms and conventions. By drawing on one of the core constructs from information theory—information entropy—I argue that combining the two streams of psychology would result in the most significant advancement of psychological knowledge.
Does political participation in adolescence promote knowledge acquisition and active citizenship?
Authors: Grobshäuser Natalie , Weißeno Georg
Published: May 2020

Political education in school is aimed at preparing adolescents for their role as citizens, which comprises political participation as well as political knowledge. While it is generally agreed that basic knowledge about politics is a prerequisite to participation, the specific link between knowledge and participation is left unclear in normative theories of democracy and didactic approaches of political education. A study with 1324 German ninth graders tries to clarify the relationship between the two constructs. The findings show a positive effect from knowledge to the expressed willingness to participate in politics in the future. But against the expectations, already performed political participation does not increase knowledge about politics. Furthermore, girls and pupils with migration background show less knowledge and express less willingness to participate.
Hantzsch-like synthesis of novel bis(hexahydroacridine-1,8-diones), bis(tetrahydrodipyrazolo[3,4-b:4′,3′-e]pyridines), and bis(pyrimido[4,5-b]quinolines) incorporating thieno[2,3-b]thiophenes
Authors: Eid Elshimaa M , Hassaneen Huwaida M E , Elwahy Ahmed H M , Abdelhamid Ismail A
Published: May 2020

A novel series of bis(hexahydroacridine-1,8-diones), bis(tetrahydrodipyrazolo[3,4- b:4′,3′- e]pyridines), and bis(pyrimido[4,5- b]quinolines) incorporating a thieno[2,3- b]thiophene core via ether or ester linkages is prepared via a Hantzsch-like reaction.
Taking a Feminist Disability Studies Approach to Fundamental British Values
Authors: Houston Ella
Published: May 2020

In this article, Fundamental British Values (FBV) are understood as a token attempt toward societal inclusion and empowerment of all citizens. Rather than providing meaningful routes for all individuals to be included in British citizenship, FBV are built on foundations of “inclusionism”—the inclusion of marginalized identity groups in society, on the premise that existing social structures are not threatened. Disabled women’s responses to sociocultural stereotypes surrounding disability and gender are interpreted through a feminist disability studies lens. Empirical data, gathered within a larger research project which examined disabled women’s responses to the representation of disabled women in Anglo-American advertising, are drawn on and connections are made between the growing trend of promoting diversity in advertising, and superficial approaches to diversity and empowerment of all citizens, enacted in FBV. Two key themes underpin this critical discussion: participant resistance to “pity” narratives surrounding the portrayal of disabled women in advertising and disabled women’s navigation of “belonging” in exclusionary environments.
Thriving on waves of change: Case study of an agile digital business in Singapore
Authors: Teoh SayYen , Chan Calvin ML
Published: May 2020

Much has been written and said about the need to be agile for businesses to transform themselves and adapt in the dynamic digital economy. This case study traces the history of a Singaporean IT firm from its inception in 1993 to 2019. In particular, this case study illustrates how agility has enabled the company to grow from a start-up to be among the leading IT firms in Singapore albeit operating in the dynamic IT industry that has grown increasingly volatile with the emergence of disruptive digital technology and innovation. Apart from drawing insights on organizational agility and adaptation, this case study also provides illustration on the theme of entrepreneurship and leadership as manifested through the Founder and Chief Executive Officer.
hsa‐miR‐106b‐5p participates in the development of chronic thromboembolic pulmonary hypertension via targeting matrix metalloproteinase 2
Authors: Miao Ran , Dong Xingbei , Gong Juanni , Wang Ying , Guo Xiaojuan , Li Yidan , Liu Min , Wan Jun , Li Jifeng , Yang Suqiao , Wang Wang , Kuang Tuguang , Zhong Jiuchang , Zhai Zhenguo , Yang Yuanhua
Published: May 2020

Background

Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by elevated pressure in pulmonary arteries. This study was performed to explore the critical miRNAs and genes affecting the pathogenesis of CTEPH.

Methods

GSE56914 dataset (10 CTEPH whole blood samples and 10 control samples) was downloaded from the Gene Expression Omnibus database. Using limma package, the differentially expressed miRNAs (DE‐miRNAs) were acquired. After miRNA‐target pairs were obtained using miRWalk2.0 tool, a miRNA‐target regulatory network was built by Cytoscape software. Using DAVID tool, significantly enriched pathways involving the target genes were identified. Moreover, the protein–protein interaction network and transcription factor‐target regulatory network were built by the Cytoscape software. Additionally, quantitative real‐time PCR (qRT‐PCR) experiments and luciferase assay were conducted to validate miRNA/gene expression and miRNA–target regulatory relationship, respectively.

Results

There were 25 DE‐miRNAs (8 up‐regulated and 17 down‐regulated) between CTEPH and control groups. The target genes of has‐let‐7b‐3p, has‐miR‐17‐5p, has‐miR‐3202, has‐miR‐106b‐5p, and has‐miR‐665 were enriched in multiple pathways such as “Insulin secretion”. qRT‐PCR analysis confirmed upregulation of hsa‐miR‐3202, hsa‐miR‐665, and matrix metalloproteinase 2 (MMP2) as well as downregulation of hsa‐let‐7b‐3p, hsa‐miR‐17‐5p, and hsa‐miR‐106b‐5p. Luciferase assay indicated that MMP2 was negatively mediated by hsa‐miR‐106b‐5p.

Conclusions

These miRNAs and genes were associated with the pathogenesis of CTEPH. Besides, hsa‐miR‐106b‐5p was involved in the development of CTEPH via targeting MMP2.
Process Evaluation of Nutrition Intervention Strategy in a Local Philippine Setting
Authors: Viajar Rowena V. , Dorado Julieta B. , Azaña Glenda P. , Ibarra Heidenhein A. , Ferrer Eldridge B. , Capanzana Mario V.
Published: May 2020

Aims: Undernutrition among 0 to 5 years old children remains a public health problem in the Philippines. This process evaluation study documented and examined the implementation of an intervention strategy for young children. Methods: Complementary feeding of 6-month to 2-year-old children was implemented for 120 days by the municipalities of Plaridel and Pulilan in Bulacan, Philippines utilizing local-based food made of rice and mung bean along with nutrition education classes among mothers/caregivers using the developed nutrition modules. A total of 121 mother-/caregiver-child pairs were the program participants of the intervention. Pre-post design were used in the analysis of quantitative data. Qualitative data were encoded verbatim manually using emerging themes. Key informant interviews among community workers and municipal officials and focus group discussions among mothers/caregivers and community workers were conducted to gather the needed data. Results: The municipalities adhered to the program phases of planning, organizing, implementation, monitoring, and evaluation. At end-line, the weight of children participants increased in both municipalities and the mean nutrition knowledge scores of mothers/caregivers increased significantly ( P < .05). Conclusions: This process evaluation confirmed that the proposed nutrition intervention strategy for young children can be implemented at the local level. The strong support and active cooperation of the local program implementers and mothers/caregivers and adherence to program requirements were the key factors in the efficient implementation of the intervention. For sustainability, the passing of local ordinance for the adoption of intervention and budget support for implementation of the intervention is recommended.
Comparison of Clinical and Radiological Outcomes Between Transosseous Tunnel and Suture Anchor Patellar Fixation for Medial Patellofemoral Ligament Reconstruction: A Cohort Study With 2-Year Follow-up
Authors: Yoon Kyoung Ho , Kim Eung Ju , Kwon Yoo Beom , Hwang In Uk , Kim Sang-Gyun
Published: May 2020

Background:

Several surgical methods have been developed for medial patellofemoral ligament reconstruction (MPFLR). However, the question of which patellar fixation method, suture anchor (SA) or transosseous tunnel (TO) fixation, achieves better overall outcomes remains to be answered.

Hypothesis:

SA patellar fixation will present comparable clinical outcomes and a lower complication rate compared with TO patellar fixation for MPFLR.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

We retrospectively reviewed the outcomes of 46 patients who underwent MPFLR with either TO fixation (n = 21; mean age, 24.4 ± 6.1 years) or SA fixation (n = 25; mean age, 24.1 ± 12.1 years) for the treatment of recurrent patellar dislocation. Clinical findings (International Knee Documentation Committee [IKDC] subjective score, Lysholm score, and Tegner activity score), radiological findings (congruence angle and patellar tilt angle), and complications (redislocation, patellar fracture, patellofemoral osteoarthritis progression, infection, and stiffness) were compared between the TO and SA groups at the 2-year follow-up visit.

Results:

The mean postoperative IKDC subjective and Lysholm scores did not differ significantly between groups. However, postoperative Tegner activity scores were significantly higher in the TO group than in the SA group (TO, 5.8 ± 1.4; SA, 4.9 ± 1.2; P = .012). Congruence angle did not differ significantly between the groups (TO, −3.2 ± 22.8; SA, −7.6 ± 17.8; P = .464). Patellar tilt angle was lower in the TO group than in the SA group (TO, 10.5 ± 5.4; SA, 13.7 ± 2.8; P = .015). During the follow-up period, the TO group had 1 redislocation and 2 patellar fractures, whereas the SA group had no redislocations or fractures. Patellofemoral osteoarthritis progression was significantly higher in the TO group than in the SA group at the 2-year follow-up visit (TO, 9/21; SA, 2/25; P = .006).

Conclusion:

Both TO and SA patellar fixation methods for MPFLR showed improved clinical outcomes. When compared with TO fixation, SA fixation presented comparable clinical outcomes and a lower complication rate.
The kidney–cancer connection continues to grow
Authors: Perazella Mark A
Published: May 2020

Onco-nephrology is an important sub-field of nephrology, which interfaces with the fields of oncology, hematology, urology, critical care medicine, clinical pharmacology, and palliative care medicine. The unique connection that exists for kidney disease and cancer in all phases of clinical medicine continues to rapidly expand. Onco-nephrology combines the knowledge and skills of a number of specialty groups that span all areas of clinical medicine. In this issue of the Journal of Onco-Nephrology, a series of papers address the various forms of kidney disease that develop in patients with cancer and its therapy. This Onco-Nephrology Highlights series includes papers that are based on lectures delivered at the American Society of Nephrology Kidney Week Onco-Nephrology Early Program that took place in Washington, DC, in 2019. We hope you find these three papers educational and practical as you evaluate and treat patients with cancer and kidney disease in your clinical practice.
Compressive behavior and energy absorption capacity of unconstrained and constrained open-cell aluminum foams
Authors: Li Chengbing , Li Chunxing , Wang Yazhou
Published: May 2020

In practical engineering applications, while the open-cell aluminum foam as crash absorber is filled to the hollow structures, its deformation occurs under constrained stress boundaries. The experimental work was conducted to examine the effect of radial constraints on the mechanical behavior of the open-cell aluminum foam under quasi-static and dynamic compression. Results show that the radial constraints induce significant strain hardening of the open-cell aluminum foam. The open-cell aluminum foams tested with and without radial constraints show a clear strain rate sensitivity. The densification of the foam occurs earlier (showing lower densification strain) under radial constraints. The radial constraints enhance the energy absorbed per unit volume of the open-cell aluminum foam.
Quality of life, tuberculosis and treatment outcome; a case–control and nested cohort study
Authors: Datta Sumona , Gilman Robert H. , Montoya Rosario , Quevedo Cruz Luz , Valencia Teresa , Huff Doug , Saunders Matthew J. , Evans Carlton A.
Published: May 2020

Background

Global tuberculosis policy increasingly emphasises broad tuberculosis impacts and highlights the lack of evidence concerning tuberculosis-related quality of life (QOL).

Methods

Participants were recruited in 32 Peruvian communities between July 13, 2016 and February 24, 2018 and followed-up until November 8, 2019. Inclusion criteria were age ≥15 years for “patients” (n=1545) starting treatment for tuberculosis disease in health centres; “contacts” (n=3180) who shared a patient's household for ≥6 h·week−1; and randomly selected “controls” (n=277). The EUROHIS-QOL questionnaire quantified satisfaction with QOL, health, energy, activities of daily living (ADL), self, relationships, money and living place.

Findings

Newly diagnosed tuberculosis was most strongly associated with lower QOL scores (p<0.001). Patients initially had lower QOL than controls for all EUROHIS-QOL questions (p≤0.01), especially concerning health, ADL and self. Lower initial QOL in patients predicted adverse treatment outcomes and scores <13 points had 4.2-fold (95% CI 2.3–7.6) increased risk of deathversusthose with higher QOL scores (both p<0.001). Patient QOL was re-assessed 6 months later, and for patients with successful treatment QOL became similar to participants who had never had tuberculosis, whereas patients who did not complete treatment continued to have low QOL (p<0.001). Multidrug-resistant tuberculosis was associated with lower QOL before and during treatment (both p<0.001). Contacts had lower QOL if they lived with a patient who had low QOL score (p<0.0001) or were a caregiver for the patient (p<0.001).

Conclusions

Tuberculosis was associated with impaired psychosocioeconomic QOL which recovered with successful treatment. Low QOL scores predicted adverse treatment outcome. This brief EUROHIS-QOL eight-item questionnaire quantified the holistic needs of tuberculosis-affected people, potentially guiding patient-centred care.
Risk of first and recurrent serious infection in sarcoidosis: a Swedish register-based cohort study
Authors: Rossides Marios , Kullberg Susanna , Eklund Anders , Di Giuseppe Daniela , Grunewald Johan , Askling Johan , Arkema Elizabeth V.
Published: May 2020

Serious infections impair quality of life and increase costs. Our aim was to determine if sarcoidosis is associated with a higher rate of serious infection and whether this varies by age, sex, time since diagnosis or treatment status around diagnosis.

We compared individuals with sarcoidosis (at least two International Classification of Diseases codes in the Swedish National Patient Register 2003–2013; n=8737) and general population comparators matched 10:1 on age, sex and residential location (n=86 376). Patients diagnosed in 2006–2013 who were dispensed at least one immunosuppressant ±3 months from diagnosis (Swedish Prescribed Drug Register) were identified. Cases and comparators were followed in the National Patient Register for hospitalisations for infection. Using Cox and flexible parametric models, we estimated adjusted hazard ratios (aHR) and 95% confidence intervals for first and recurrent serious infections (new serious infection >30 days after previous).

We identified 895 first serious infections in sarcoidosis patients and 3881 in comparators. The rate of serious infection was increased 1.8-fold in sarcoidosis compared to the general population (aHR 1.81, 95% CI 1.65–1.98). The aHR was higher in females than males and during the first 2 years of follow-up. Sarcoidosis cases treated with immunosuppressants around diagnosis had a three-fold increased risk, whereas nontreated patients had a 50% increased risk. The rate of serious infection recurrence was 2.8-fold higher in cases than in comparators.

Serious infections are more common in sarcoidosis than in the general population, particularly during the first few years after diagnosis. Patients who need immunosuppressant treatment around diagnosis are twice as likely to develop a serious infection than those who do not.
ICU outcomes can be predicted by noninvasive muscle evaluation: a meta-analysis
Authors: Medrinal Clément , Combret Yann , Hilfiker Roger , Prieur Guillaume , Aroichane Nadine , Gravier Francis-Edouard , Bonnevie Tristan , Contal Olivier , Lamia Bouchra
Published: May 2020

Background

The relationship between muscle function in critically ill patients assessed using bedside techniques and clinical outcomes has not been systematically described. We aimed to evaluate the association between muscle weakness assessed by bedside evaluation and mortality or weaning from mechanical ventilation, and the capacity of each evaluation tool to predict outcomes.

Methods

Five databases (PubMed, Embase, CINAHL, Cochrane Library, Science Direct) were searched from January 2000 to December 2018. Data were extracted and random effects meta-analyses were performed.

Results

60 studies were analysed, including 4382 patients. Intensive care unit (ICU)-related muscle weakness was associated with an increase in overall mortality with odds ratios ranging from 1.2 (95% CI 0.60–2.40) to 4.48 (95% CI 1.49–13.42). Transdiaphragmatic twitch pressure had the highest predictive capacity for overall mortality, with a sensitivity of 0.87 (95% CI 0.76–0.93) and a specificity of 0.36 (95% CI 0.27–0.43). The area under the curve (AUC) was 0.74 (95% CI 0.70–0.78). Muscle weakness was associated with an increase in mechanical ventilation weaning failure rate with an odds ratio ranging from 2.64 (95% CI 0.72–9.64) to 19.07 (95% CI 9.35–38.9). Diaphragm thickening fraction had the highest predictive capacity for weaning failure with a sensitivity of 0.76 (95% CI 0.67–0.83) and a specificity of 0.86 (95% CI 0.78–0.92). The AUC was 0.86 (95% CI 0.83–0.89).

Conclusion

ICU-related muscle weakness detected by bedside techniques is a serious issue associated with a high risk of death or prolonged mechanical ventilation. Evaluating diaphragm function should be a clinical priority in the ICU.
Integration of sRNA, degradome, transcriptome analysis and functional investigation reveals gma-miR398c negatively regulates drought tolerance via GmCSDs and GmCCS in transgenic Arabidopsis and soybean
Authors: Zhou Yonggang , Liu Weican , Li Xiaowei , Sun Daqian , Xu Keheng , Feng Chen , Kue Foka Idrice Carther , Ketehouli Toi , Gao Hongtao , Wang Nan , Dong Yuanyuan , Wang Fawei , Li Haiyan
Published: May 2020

Background

Drought conditions adversely affect soybean growth, resulting in severe yield losses worldwide. Increasing experimental evidence indicates miRNAs are important post-transcriptional regulators of gene expression. However, the drought-responsive molecular mechanism underlying miRNA–mRNA interactions remains largely uncharacterized in soybean. Meanwhile, the miRNA-regulated drought response pathways based on multi-omics approaches remain elusive.

Results

We combined sRNA, transcriptome and degradome sequencing to elucidate the complex regulatory mechanism mediating soybean drought resistance. One-thousand transcripts from 384 target genes of 365 miRNAs, which were enriched in the peroxisome, were validated by degradome-seq. An integrated analysis showed 42 miRNA–target pairs exhibited inversely related expression profiles. Among these pairs, a strong induction of gma-miR398c as a major gene negatively regulates multiple peroxisome-related genes (GmCSD1a/b, GmCSD2a/b/c and GmCCS). Meanwhile, we detected that alternative splicing of GmCSD1a/b might affect soybean drought tolerance by bypassing gma-miR398c regulation. Overexpressing gma-miR398c in Arabidopsis thaliana L. resulted in decreased percentage germination, increased leaf water loss, and reduced survival under water deficiency, which displayed sensitivity to drought during seed germination and seedling growth. Furthermore, overexpressing gma-miR398c in soybean decreased GmCSD1a/b, GmCSD2a/b/c and GmCCS expression, which weakened the ability to scavenge O2.−, resulting in increased relative electrolyte leakage and stomatal opening compared with knockout miR398c and wild-type soybean under drought conditions.

Conclusion

The study indicates that gma-miR398c negatively regulates soybean drought tolerance, and provides novel insights useful for breeding programs to improve drought resistance by CRISPR technology.
Socioeconomic disparities in six-year incident dementia in a nationally representative cohort of U.S. older adults: an examination of financial resources
Authors: Samuel Laura J. , Szanton Sarah L. , Wolff Jennifer L. , Ornstein Katherine A. , Parker Lauren J. , Gitlin Laura N.
Published: May 2020

Background

Less educational training is consistently associated with incident dementia among older adults, but associations between income and financial strain with incident dementia have not been well tested in national samples. This is an important gap because, like education, financial resources are potentially modifiable by policy change and strengthening the social safety net. This study tested whether financial resources (income and financial strain) predict six-year incident dementia independent of education and occupation.

Methods

The National Health and Aging Trends Study is a prospective cohort study that recruited a nationally representative sample of U.S. Medicare beneficiaries aged ≥65 years. Incident dementia (2013 to 2018) was classified based on diagnosis, cognitive test scores or proxy-reported changes among participants dementia-free in 2012 (n = 3785). Baseline socioeconomic measures included income to poverty ratio (analyzed separately for those < 500% vs. ≥500% poverty threshold), financial strain, education and history of professional occupation. Discrete time survival analysis applied survey weights to account for study design and nonresponse. Coefficients were standardized to compare the strength of associations across the four socioeconomic measures.

Results

Adjusting for socioeconomic measures, demographic characteristics, home ownership, retirement, chronic conditions, smoking, BMI and depressive symptoms, higher income (hazard OR = 0.84, 95% CI: 0.74, 0.95 among those < 500% poverty) and higher education (hOR = 0.73, 95% CI: 0.65, 0.83) were associated with lower odds, and financial strain with higher odds (hOR = 1.20, 95% CI: 1.09, 1.31), of incident dementia.

Conclusion

Low income and greater financial strain predict incident dementia among older adults and associations are comparable to those of low education among U.S. older adults. Interventions to mitigate financial strain through improving access to economic opportunity and strengthening safety net programs and improving access to them in low income groups may complement other ongoing efforts to prevent dementia.
Individual and joint trajectories of change in bone, lean mass and physical performance in older men
Authors: Cawthon Peggy M. , Parimi Neeta , Langsetmo Lisa , Cauley Jane A. , Ensrud Kristine E. , Cummings Steven R. , Lane Nancy E. , Hoffman Andrew R. , Lapidus Jodi , Gill Thomas M. , McCulloch Charles E. , Stefanick Marcia L. , Kado Deborah M. , Drieling Rebecca , Orwoll Eric S.
Published: May 2020

Background

Declines in bone, muscle and physical performance are associated with adverse health outcomes in older adults. However, few studies have described concurrent age-related patterns of change in these factors. The purpose of this study was to characterize change in four properties of muscle, physical performance, and bone in a prospective cohort study of older men.

Methods

Using repeated longitudinal data from up to four visits across 6.9 years from up to 4681 men (mean age at baseline 72.7 yrs. ±5.3) participating in the Osteoporotic Fractures in Men (MrOS) Study, we used group-based trajectory models (PROC TRAJ in SAS) to identify age-related patterns of change in four properties of muscle, physical performance, and bone: total hip bone mineral (BMD) density (g/m2) and appendicular lean mass/ht2 (kg/m2), by DXA; grip strength (kg), by hand dynamometry; and walking speed (m/s), by usual walking pace over 6 m. We also described joint trajectories in all pair-wise combinations of these measures. Mean posterior probabilities of placement in each trajectory (or joint membership in latent groups) were used to assess internal reliability of the model. The number of trajectories for each individual factor was limited to three, to ensure that the pair-wise determination of joint trajectories would yield a tractable number of groups as well as model fit considerations.

Results

The patterns of change identified were generally similar for all measures, with three district groups declining over time at roughly similar rates; joint trajectories revealed similar patterns with no cross-over or convergence between groups. Mean posterior probabilities for all trajectories were similar and consistently above 0.8 indicating reasonable model fit to the data.

Conclusions

Our description of trajectories of change with age in bone mineral density, grip strength, walking speed and appendicular lean mass found that groups identified by these methods appeared to have little crossover or convergence of change with age, even when considering joint trajectories of change in these factors.
Application of group LASSO regression based Bayesian networks in risk factors exploration and disease prediction for acute kidney injury in hospitalized patients with hematologic malignancies
Authors: Li Yang , Chen Xiaohong , Wang Yimei , Hu Jiachang , Shen Ziyan , Ding Xiaoqiang
Published: May 2020

Background

Patients who were diagnosed with hematologic malignancies (HM) had a higher risk of acute kidney injury (AKI). This study applies the Bayesian networks (BNs) to investigate the interrelationships between AKI and its risk factors among HM patients, and to evaluate the predictive and inferential ability of BNs model in different clinical settings.

Methods

During 2014 and 2015, a total of 2501 inpatients with HM were recruited in this retrospective study conducted in a tertiary hospital, Shanghai of China. Patients’ demographics, medical history, clinical and laboratory records on admission were extracted from the electronic medical records. Candidate predictors of AKI were screened in the group-LASSO (gLASSO) regression, and then they were incorporated into BNs analysis for further interrelationship modeling and disease prediction.

Results

Of 2395 eligible patients with HM, 370 episodes were diagnosed with AKI (15.4%). Patients with multiple myeloma (24.1%) and leukemia (23.9%) had higher incidences of AKI, followed by lymphoma (13.4%). Screened by the gLASSO regression, variables as age, gender, diabetes, HM category, anti-tumor treatment, hemoglobin, serum creatinine (SCr), the estimated glomerular filtration rate (eGFR), serum uric acid, serum sodium and potassium level were found with significant associations with the occurrence of AKI. Through BNs analysis, age, hemoglobin, eGFR, serum sodium and potassium had directed connections with AKI. HM category and anti-tumor treatment were indirectly linked to AKI via hemoglobin and eGFR, and diabetes was connected with AKI by affecting eGFR level. BNs inferences concluded that when poor eGFR, anemia and hyponatremia occurred simultaneously, the patients’ probability of AKI was up to 78.5%. The area under the receiver operating characteristic curve (AUC) of BNs model was 0.835, higher than that in the logistic score model (0.763). It also showed a robust performance in 10-fold cross-validation (AUC: 0.812).

Conclusion

Bayesian networks can provide a novel perspective to reveal the intrinsic connections between AKI and its risk factors in HM patients. The BNs predictive model could help us to calculate the probability of AKI at the individual level, and follow the tide of e-alert and big-data realize the early detection of AKI.
Developing quality indicators for Chronic Kidney Disease in primary care, extractable from the Electronic Medical Record. A Rand-modified Delphi method
Authors: Van den Bulck Steve A. , Vankrunkelsven Patrik , Goderis Geert , Van Pottelbergh Gijs , Swerts Jonathan , Panis Karolien , Hermens Rosella
Published: May 2020

Background

Chronic kidney disease (CKD) is a common chronic condition and a rising public health issue with increased morbidity and mortality, even at an early stage. Primary care has a pivotal role in the early detection and in the integrated management of CKD which should be of high quality. The quality of care for CKD can be assessed using quality indicators (QIs) and if these QIs are extractable from the electronic medical record (EMR) of the general physician, the number of patients whose quality of care can be evaluated, could increase vastly. Therefore the aim of this study is to develop QIs which are evidence based, EMR extractable and which can be used as a framework to automate quality assessment.

Methods

We used a Rand-modified Delphi method to develop QIs for CKD in primary care. A questionnaire was designed by extracting recommendations from international guidelines based on the SMART principle and the EMR extractability. A multidisciplinary expert panel, including patients, individually scored the recommendations for measuring high quality care on a 9-point Likert scale. The results were analyzed based on the median Likert score, prioritization and agreement. Subsequently, the recommendations were discussed in a consensus meeting for their in- or exclusion. After a final appraisal by the panel members this resulted in a core set of recommendations, which were then transformed into QIs.

Results

A questionnaire composed of 99 recommendations was extracted from 10 international guidelines. The consensus meeting resulted in a core set of 36 recommendations that were translated into 36 QIs. This final set consists of QIs concerning definition & classification, screening, diagnosis, management consisting of follow up, treatment & vaccination, medication & patient safety and referral to a specialist. It were mostly the patients participating in the panel who stressed the importance of the QIs concerning medication & patient safety and a timely referral to a specialist.

Conclusion

This study provides a set of 36 EMR extractable QIs for measuring the quality of primary care for CKD. These QIs can be used as a framework to automate quality assessment for CKD in primary care.
Stereotactic ablative radiotherapy for the comprehensive treatment of 1–3 Oligometastatic tumors (SABR-COMET-3): study protocol for a randomized phase III trial
Authors: Olson Robert , Mathews Lindsay , Liu Mitchell , Schellenberg Devin , Mou Benjamin , Berrang Tanya , Harrow Stephen , Correa Rohann J. M. , Bhat Vasudeva , Pai Howard , Mohamed Islam , Miller Stacy , Schneiders Famke , Laba Joanna , Wilke Derek , Senthi Sashendra , Louie Alexander V. , Swaminath Anand , Chalmers Anthony , Gaede Stewart , Warner Andrew , de Gruijl Tanja D. , Allan Alison , Palma David A.
Published: May 2020

Background

A recent randomized phase II trial evaluated stereotactic ablative radiotherapy (SABR) in a group of patients with a small burden of oligometastatic disease (mostly with 1–3 metastatic lesions), and found that SABR was associated with a significant improvement in progression-free survival and a trend to an overall survival benefit, supporting progression to phase III randomized trials.

Methods

Two hundred and ninety-seven patients will be randomized in a 1:2 ratio between the control arm (consisting of standard of care [SOC] palliative-intent treatments), and the SABR arm (consisting of SOC treatment + SABR to all sites of known disease). Randomization will be stratified by two factors: histology (prostate, breast, or renal vs. all others), and disease-free interval (defined as time from diagnosis of primary tumor until first detection of the metastases being treated on this trial; divided as ≤2 vs. > 2 years). The primary endpoint is overall survival, and secondary endpoints include progression-free survival, cost effectiveness, time to development of new metastatic lesions, quality of life (QoL), and toxicity. Translational endpoints include assessment of circulating tumor cells, cell-free DNA, and tumor tissue as prognostic and predictive markers, including assessment of immunological predictors of response and long-term survival.

Discussion

This study will provide an assessment of the impact of SABR on survival, QoL, and cost effectiveness to determine if long-term survival can be achieved for selected patients with 1–3 oligometastatic lesions.

Trial registration

Clinicaltrials.gov identifier: NCT03862911. Date of registration: March 5, 2019,
Aqueous humour cytokines profiles in eyes with Coats disease and the association with the severity of the disease
Authors: Liang Tingyi , Xu Yu , Zhu Xiuyu , Zhang Xiang , Li Jing , Zhao Peiquan
Published: May 2020

Background

To investigate aqueous humour (AH) cytokine profiles in eyes with Coats disease and analyze the association between cytokine concentrations and the severity of the disease.

Methods

The study included 36 patients (36 eyes) with Coats disease and 15 control patients (15 eyes) with congenital cataract. AH samples were obtained preoperatively and the concentrations of 22 different cytokines were measured through Cytometric Bead Array technology. Clinical characteristics of Coats disease, including the extent of retinal exudation and exudative retinal detachment (ERD), were recorded for analysis.

Results

The concentrations of 8 cytokines (VEGF, IL-6, IL-8, MCP-1, MIP-1α, IP-10, VCAM-1 and ICAM-1) were significantly higher in the Coats disease group than in the control group (all P < 0.002). Except for VCAM-1 and ICAM-1, the concentration of the other cytokines listed above showed a significant increase from stage 2 to stage 3 (all P < 0.05). Meanwhile, the concentrations of VEGF, IL-8, MCP-1 and MIP-1α showed a significant and positive association with the extent of retinal exudation and ERD (all r > 0.4, P < 0.05). Among these, IL-8 showed a strong association with the extent of retinal exudation and ERD (all r > 0.7, P < 0.001). The concentrations of IL-1α, IL-1β, IL-2, IL-4, IL-5, IL-10, IL-12, Fractalkine, RANTES, G-CSF and GM-CSF were very low in both groups.

Conclusions

Various cytokines in the AH, including elevated VEGF, IL-6, IL-8, MCP-1, MIP-1α, IP-10, VCAM-1 and ICAM-1, may be involved in the pathogenesis and progression of Coats disease. Increasing severity of Coats disease is significantly associated with the AH concentrations of VEGF, IL-8, MCP-1 and MIP-1α. Further clinical treatment aimed to reduce vascular leakage and antagonize neovascularization and inflammation may be useful in preventing the progression of Coats disease.
Femtosecond laser assisted cataract surgery in a cataract patient with a “0 vaulted” ICL: a case report
Authors: Yu Yibo , Zhang Chengshou , Zhu Yanan
Published: May 2020

Background

Femtosecond laser assisted cataract surgery (FLACS) combined with implantable collamer lenses (ICLs) extraction has been shown to be a feasible method for patients developing cataracts after the ICL implantation. All reported cases had shallow vaults, ranging from 47 μm (μm) to 100 μm. We report for the first time, a case in which the FLACS was performed on the “0” vault eye.

Case presentation

A 38-year-old man with anterior subcapsular cataracts underwent the FLACS combined with ICLs extraction 6 years after ICLs implantation in both eyes. In his left eye, the ICL touched the anterior capsule, existing “0” vault. During the capsulotomy, cavitation bubbles were trapped in the shallow space beneath the ICL, developing from small bubbles into big ones, which resulted in the incomplete capsulotomy. Comparatively, in the right eye, the ICL vault was measured 72 μm, and the capsulotomy was complete and no big cavitation bubbles formed. In both eyes, capsulotomy zones were manually assigned to the anterior capsule surface in the process of laser identification. However, the nuclear pre-fragmentations were unsuccessful in both eyes. Other steps of surgeries were performed uneventfully. Depending on the design of monovision, the uncorrected distance visual acuity (UDVA) was 20/32, and the near uncorrected visual acuity (UCVA) was 20/25 in both eyes postoperatively.

Conclusions

This case suggested that the surgeon should pay attention to the incomplete laser capsulotomy when using a femtosecond laser in cataractous cases with “0” vaulted ICLs, and manual adjustment was required in the process of laser identification.
Switching to Lurasidone following 12 months of treatment with Risperidone: results of a 6-month, open-label study
Authors: Mattingly Greg W. , Haddad Peter M. , Tocco Michael , Xu Jane , Phillips Debra , Pikalov Andrei , Loebel Antony
Published: May 2020

Background

Patients with a diagnosis of schizophrenia are at an increased risk for developing metabolic syndrome, which is associated with greater cardiovascular morbidity and mortality. Treatment with some commonly used antipsychotic medications may increase the risk of developing metabolic syndrome. The aim of the study was to evaluate the safety of lurasidone in patients who continued lurasidone or switched from risperidone to lurasidone. A secondary aim was assessment of the effect of long-term lurasidone on the Positive and Negative Syndrome Scale (PANSS).

Methods

The treatment sample in the current study consisted of clinically stable patients with schizophrenia (N = 223) who had completed a 12-month, double-blind study of lurasidone vs. risperidone. In the current extension study, all patients received 6 months of open-label treatment with lurasidone, either continuing lurasidone assigned during the preceding double-blind trial, or switching from double-blind risperidone to lurasidone. Safety and tolerability parameters included body weight, prolactin, and metabolic laboratory tests.

Results

Six months of OL treatment with lurasidone was generally well-tolerated, with a low incidence of parkinsonism (4.5%) and akathisia (3.1%). Overall, few adverse events were rated as severe (4.9%), and discontinuation due to an adverse event was low in the lurasidone continuation vs. risperidone switch groups (3.7% vs. 6.9%). In the lurasidone continuation versus risperidone switch groups, change from OL baseline to 6-month endpoint (observed case) was observed in mean body weight (− 0.6 vs. -2.6 kg), median total cholesterol (− 4.0 vs. + 4.5 mg/dL), triglycerides (− 4.5 vs. -5.5 mg/dL), glucose (0.0 vs. -3.0 mg/dL) and prolactin (males, + 0.15 vs. -11.2 ng/mL; females, + 1.3 vs. -30.8 ng/mL). Improvement in PANSS total score was maintained, from OL baseline to endpoint in the continuation vs. switch groups (+ 1.0 vs. -1.0; OC).

Conclusions

In this 6-month extension study, lurasidone treatment was generally well-tolerated and associated with minimal effects on weight, metabolic parameters, and prolactin levels. Patients who switched from risperidone to lurasidone experienced reductions in weight, metabolic parameters and prolactin levels commensurate with increases in these safety parameters experienced during the previous 12 months of treatment with risperidone.

Trial registration

ClinicalTrials.gov NCT00641745 (Date of Registration: March 24, 2008).
Violence rate dropped during a shift to individualized patient-oriented care in a high security forensic psychiatric ward
Authors: Urheim Ragnar , Palmstierna Tom , Rypdal Knut , Gjestad Rolf , Senneseth Mette , Mykletun Arnstein
Published: May 2020

Background

Contextual variables such as staff characteristics, treatment programs, assessment routines and administrative structures are found to influence patient violence rates in psychiatric forensic wards. The possible effects of current developments in treatment philosophy emphasizing patientsˈ perspective and treatment involvement upon violence rate have not yet been examined. The aim of this paper is to analyse associations between such developments and the occurrence of violent incidents among patients in a high security forensic psychiatric ward.

Methods

During a 17-year period with stable ward conditions, incidents of violence were systematically collected together with diagnostic, risk assessment and demographic patient characteristics. Changes in care- and organizational related variables such as nursing staff characteristics, treatment and management routines were collected. Multilevel modelling was applied to estimate the relationship between these variables and changes in violent incidents.

Results

A substantial decline in the occurrence of violent incidents paralleled with changes in the ward during the middle phase of the study period. Most of the changes, such as implementation of new treatment and care routines and an increased proportion of female staff and higher education levels, were significantly related to a decrease in the occurrence of violent incidents in the ward.

Conclusions

Findings in this study suggest that an increase in individualized, patient-oriented care strategies, delivered by well-educated nursing staff with an equally balanced gender distribution contribute to a low level of violence.