bluuebunny/crossref_metadata_2025 huggingface dataset:
Using the NLN Faculty Preparation for Global Experiences Toolkit for Successful Application for the Fulbright Scholar Award
Authors: Samawi Zepure , Capps Lisa , Hansen Ruth
Published: October 2018

With an increasingly global world and the migration of diverse populations, nurse faculty have opportunities to learn and share varied perspectives through involvement internationally in research, teaching, and practice. The National League for Nursing (NLN) joins with the World Health Organization and the International Council of Nurses to promote international nursing standards. One way in which nursing faculty can contribute to this goal is by pursuing international education, research, and service as a Fulbright scholar. The NLN Faculty Preparation for Global Experiences Toolkit complements resources offered through the Fulbright program in the preparation of a competitive Fulbright application.
An Integrative Literature Review of Evidence-Based Teaching Strategies for Nurse Educators
Authors: Breytenbach Cecile , ten Ham-Baloyi Wilma , Jordan Portia J.
Published: October 2018

AIM

The aim of the study was to explore and describe the best available literature on evidence-based teaching strategies that can be used by nurse educators.

BACKGROUND

Evidence-based teaching strategies in nursing education are fundamental to promote an in-depth understanding of information. Although some teaching strategies for nurse educators were identified, no integrative literature review was found summarizing the best teaching strategies for nurse educators.

METHOD

Integrative literature review.

RESULTS

Sixteen studies were included encompassing eight teaching strategies (e-learning, concept mapping, Internet-based learning, web-based learning, gaming, problem-based learning, case studies, and evidence-based learning). Of these, three (concept mapping, Internet-based learning, and evidence-based learning) significantly increased student knowledge.

CONCLUSION

All teaching strategies increased knowledge in some way, indicating that faculties should use a variety of teaching strategies. However, more research is needed to compare the impact of a variety of teaching strategies and the best use of different teaching strategies.
Development and Psychometric Evaluation of the Facilitator Competency Rubric
Authors: Leighton Kim , Mudra Vickie , Gilbert Gregory E.
Published: October 2018

AIM

The purpose of the study was to evaluate the psychometric properties of the Facilitator Competency Rubric (FCR).

BACKGROUND

The FCR was developed to fill a deficit in tools available to holistically evaluate competency of simulation facilitators.

METHOD

The FCR has five constructs: preparation, prebriefing, facilitation, debriefing, and evaluation. Benner's novice-to-expert theory was used to categorize subcomponents. Expert panel validation was sought. Participants from four baccalaureate nursing programs completed 107 observations of facilitators using the FCR.

RESULTS

Interrater reliability as assessed using generalizability theory was good. G coefficients ranged from good to excellent (.80 to .99). FCR items appeared to be well constructed. Term, day of the week, time of day, and simulation type were significant predictors of the FCR global score.

CONCLUSION

The FCR is a valid, reliable tool that can be used for formative or summative evaluation of simulation facilitators. Scores can guide and prioritize faculty development.
Parent Engagement Correlates With Parent and Preterm Infant Oxytocin Release During Skin-to-Skin Contact
Authors: Vittner Dorothy , Butler Samantha , Smith Kelsey , Makris Nefeli , Brownell Elizabeth , Samra Haifa , McGrath Jacqueline
Published: October 2018

Background:

Preterm infants remain increasingly neurodevelopmentally disadvantaged. Parental touch, especially during skin-to-skin contact (SSC), has potential to reduce adverse consequences.

Purpose:

To examine relationships between parental engagement and salivary oxytocin and cortisol levels for parents participating in SSC intervention.

Methods:

A randomized crossover design study was conducted in a neonatal intensive care unit; 28 stable preterm infants, mothers, and fathers participated. Parental engagement was measured using the Parental Risk Evaluation Engagement Model Instrument (PREEMI) prior to hospital discharge. Saliva samples for oxytocin and cortisol levels were collected 15-minute pre-SSC, 60-minute during-SSC, and 45-minute post-SSC.

Results:

Data were analyzed using Pearson's correlation to measure relationships between parental engagement composite scores and salivary oxytocin and cortisol levels. A significant negative correlation between paternal engagement and paternal oxytocin levels (r = −0.43; P = .03) and a significant negative correlation between infant oxytocin levels and maternal engagement (r = −0.54; P = .004) were present. Adjusted linear regression models demonstrated that as infant oxytocin levels increased during SSC, maternal engagement scores significantly decreased at discharge (β = −.04; P = .01). Linear regression, adjusting for infant oxytocin and cortisol levels, showed that as paternal oxytocin levels increased, there was a significant decrease in paternal engagement (β = −.16; P = .03) and as paternal cortisol levels increased, there was a significant decrease in paternal engagement (β = −68.97; P =.05).

Implications for Practice:

Significant relationships exist between parental engagement and salivary oxytocin and cortisol levels. Defining parent engagement facilitates identification of parent risks and needs for intervention to optimize preterm outcomes.

Implications for Research:

The PREEMI can serve as a standardized instrument to examine parent engagement.
Urinary Tract Infection After Hysterectomy for Benign Gynecologic Conditions or Pelvic Reconstructive Surgery
Authors: El-Nashar Sherif A. , Singh Ruchira , Schmitt Jennifer J. , Leon Daniel Carranza , Arora Chetna , Gebhart John B. , Occhino John A.
Published: October 2018

OBJECTIVE:

To report rates and identify risk factors for urinary tract infection (UTI) after hysterectomy for benign conditions or combined with pelvic reconstructive surgery.

METHODS:

This is a cohort study that included women who underwent hysterectomy either for benign gynecologic conditions or hysterectomy combined with pelvic reconstructive surgery from January 1, 2012, through June 30, 2014, at a single institution. The primary outcome was UTI within 8 weeks of surgery. Logistic regression modeling was used to develop a model for predicting UTI after surgery.

RESULTS:

Of 1,156 women included in the study, 136 (11.8%, 95% CI 10.0–13.8) developed UTI within 8 weeks. Women who underwent hysterectomy for a benign gynecologic condition that was not combined with pelvic reconstructive surgery had an overall UTI rate of 7.3% (95% CI 5.6–9.3) vs 21.7% (95% CI 17.6–26.4) after hysterectomy combined with pelvic reconstructive surgery. After adjusting for hormone therapy use, the following were independent variables associated with postoperative UTI: premenopausal status with an adjusted odds ratio (OR) of 1.80 (95% CI 1.11–2.99), anterior vaginal wall prolapse with an adjusted OR of 4.39 (95% CI 2.77–6.97), and postvoid residual greater than 150 mL with an adjusted OR of 2.38 (95% CI 1.12–4.36). Using this model, postoperative UTI rates ranged from 4.3% to 59.4% with high postvoid residual and presence of anterior prolapse having the strongest association.

CONCLUSION:

There are wide variations in the rate of UTI after hysterectomy for begin disease including pelvic reconstructive surgery. These variations can be explained with a model based on available preoperative data.
Long-Term Outcome of Patients With a Hematologic Malignancy and Multiple Organ Failure Admitted at the Intensive Care
Authors: de Vries Vera A. , Müller Marcella C. A. , Arbous M. Sesmu , Biemond Bart J. , Blijlevens Nicole M. A. , Kusadasi Nuray , Span Lambert R. F. , Vlaar Alexander P. J. , van Westerloo David J. , Kluin-Nelemans Hanneke C. , van den Bergh Walter M.
Published: October 2018

Objectives:

Historically, patients with a hematologic malignancy have one of the highest mortality rates among cancer patients admitted to the ICU. Therefore, physicians are often reluctant to admit these patients to the ICU. The aim of our study was to examine the survival of patients who have a hematologic malignancy and multiple organ failure admitted to the ICU.

Design:

This retrospective cohort study, part of the HEMA-ICU study group, was designed to study the survival of patients with a hematologic malignancy and organ failure after admission to the ICU. Patients were followed for at least 1 year.

Setting:

Five university hospitals in the Netherlands.

Patients:

One-thousand ninety-seven patients with a hematologic malignancy who were admitted at the ICU.

Interventions:

None.

Measurements and Main Results:

Primary outcome was 1-year survival. Organ failure was categorized as acute kidney injury, respiratory failure, hepatic failure, and hemodynamic failure; multiple organ failure was defined as failure of two or more organs. The World Health Organization performance score measured 3 months after discharge from the ICU was used as a measure of functional outcome. The 1-year survival rate among these patients was 38%. Multiple organ failure was inversely associated with long-term survival, and an absence of respiratory failure was the strongest predictor of 1-year survival. The survival rate among patients with 2, 3, and 4 failing organs was 27%, 22%, and 8%, respectively. Among all surviving patients for which World Health Organization scores were available, 39% had a World Health Organization performance score of 0–1 3 months after ICU discharge. Functional outcome was not associated with the number of failing organs.

Conclusions:

Our results suggest that multiple organ failure should not be used as a criterion for excluding a patient with a hematologic malignancy from admission to the ICU.
The effect of NSAIDs exposure on breast cancer risk in female patients with autoimmune diseases
Authors: Hung Chih-Hsing , Lin Yi-Ching , Chang Yu-Han , Lin Yu-Chih , Huang Hsin-Yi , Yeh Wei-Ju , Wu Ting-Yi , Hou Ming-Feng
Published: October 2018

Both breast cancer and autoimmune diseases (ADs) are predominant in women. NSAIDs are common medications for AD. Evidence on the association between NSAIDs use and breast cancer risk is controversial. We investigated the association between NSAIDs exposure and breast cancer risk in female patients with AD. AD patients older than 18 years of age were enrolled from Taiwan Longitudinal Health Insurance Database 2005. The NSAID users were defined as AD patients who had ever taken NSAIDs for at least 3 months between 2000 and 2009. All individuals were followed from the date of first diagnosis of AD to the end of 2013 to evaluate the risk of breast cancer. We estimated the adjusted hazard ratio (HR) using Cox proportional hazard regression after adjusting for age, comorbidities and medications. A total of 12 331 NSAID users and 12 331 non-NSAID users were included in this study after 1: 1 individual matching. The NSAID users were less likely to develop breast cancer than the non-NSAID users (adjusted HR: 0.37; 95% confidence interval: 0.27–0.50; P < 0.001), even if they used NSAIDs with low cumulative defined daily doses (adjusted HR: 0.42; 95% confidence interval: 0.34–0.53; P < 0.001). The incidence of new-onset breast cancer in NSAID users was significantly decreased in users taking selective cyclooxygenase 2 inhibitors, diclofenac, ibuprofen and piroxicam. Lower cumulative hazard rates were found in the AD patients who used NSAIDs (P < 0.001). NSAID exposure is associated with a decreased risk of breast cancer in female AD patients.
Endoscopic third ventriculostomy and ventriculoperitoneal shunt for patients with noncommunicating hydrocephalus
Authors: Jiang Lin , Gao Guangzhong , Zhou Yanfeng
Published: October 2018

Background:

The surgical methods of endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VS) for patients with noncommunicating hydrocephalus have rapidly increased in the past 2 decades. However, there is controversy regarding the efficacy and safety of these 2 surgical methods for noncommunicating hydrocephalus. The purpose of this study was to identify whether ETV is safer and more efficacious than VS for patients with noncommunicating hydrocephalus.

Methods:

We performed electronic searches in PubMed, Embase, China National Knowledge Internet, and the Cochrane Library to identify studies published up to February 03, 2018. The study summary results included improvement of symptoms, major complications, hematoma, infection, reoperation, mortality, duration of surgery, and hospital stay. Odds ratios (ORs) or standard mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using random-effects models.

Results:

We identified 10 observational studies (4 prospective and 6 retrospective studies) with data collected from 2017 patients with noncommunicating hydrocephalus. First, there was no significant difference between ETV and VS for symptom improvement (OR: 0.83; 95%CI: 0.46–1.50; P = .534). Second, ETV was associated with lower incidence of major complications when compared with VS (OR: 0.31; 95%CI: 0.17–0.56; P < .001). Third, ETV has little or no significant effect on hematoma (OR: 0.65; 95%CI: 0.22–1.92; P = .433) and mortality (OR: 0.90; 95%CI: 0.11–7.72; P = .926). Fourth, ETV were associated with lower incidence of infection (OR: 0.20; 95%CI: 0.06–0.69; P = .010) and reoperation (OR: 0.22; 95%CI: 0.08–0.56; P = .002). Finally, patients who received ETV had shorter duration of surgery (SMD: -1.71; 95%CI: -3.16 to -0.27; P = .020) and hospital stay (SMD: −0.91; 95%CI: −1.45 to −0.38; P = .001).

Conclusions:

This meta-analysis provides robust evidence that ETV has greater benefits in terms of major complications, infection, reoperation, duration of surgery, and hospital stay than VS for patients with noncommunicating hydrocephalus.
Efficacy and safety of a 260-cm Amplatz Super Stiff guidewire during transradial percutaneous coronary intervention
Authors: Feng Xuguang , Zhang Xiaoyun , Dai Jun , Bin Jianping
Published: October 2018

Background

Although transradial percutaneous coronary intervention (TR-PCI) is widely used in clinical practice, guidewire-related complications are an important cause of transradial approach failure. We investigated the prognostic value of the 260-cm Amplatz Super Stiff guidewire for reducing the complication rate during TR-PCI.

Methods

Five hundred patients with positive Allen's test results were divided into 3 groups according to the type of angiography guidewire: group A, 150-cm Emerald guidewire standard J-tip (n = 160); group B, 150-cm Radifocus guidewire M (n = 176); and group C, exchangeable 260-cm Amplatz Super Stiff guidewire after placement of a 150-cm Radifocus guidewire M (n = 164).

Results

Group C had the highest success rate (P = .008) and the lowest incidence of operative complications such as radial artery spasms and hematomas (P = .030 and P = .036, respectively). In addition, the groups differed significantly in terms of fluoroscopy and catheter placement times (P = .02. and P < .001, respectively); group C had the shortest times for these occurrences.

Conclusions

The exchangeable 260-cm Amplatz Super Stiff guidewire markedly decreased the incidence of guidewire-related complications, reduced fluoroscopy times, and increased the procedural success rate. Therefore, this tool can be considered a safe, effective, and feasible exchangeable guidewire for TR-PCI.
Long-term benefits of high-intensity atorvastatin therapy in Chinese acute coronary syndrome patients undergoing percutaneous coronary intervention
Authors: Liu Hui , Dong Aiqiao , Wang Haiyan
Published: October 2018

There is lack of long-term data on high-intensity statin therapy of Chinese acute coronary syndrome (ACS) patients scheduled to undergo percutaneous coronary intervention (PCI). In this retrospective study, we compared the long-term efficacy and safety of high-intensity and conventional atorvastatin therapy in reducing low-density lipoprotein cholesterol (LDL-C) and plaque size, and improving cardiac function of ACS patients who underwent PCI.

We retrospectively analyzed the clinical records of 120 consecutive ACS patients who underwent PCI at our hospital. Group I received a loading dose of atorvastatin (80 mg/day) prior to PCI, followed by a maintenance dose of 40 mg/day for 3 months post-PCI. Group II received a regular dose of atorvastatin (20 mg/day) from the date of admission until 1 year post-PCI. The composite primary efficacy end point was the mean percent change in calculated LDL-C from baseline to week 48 in both groups and percentage of patients achieving the LDL-C target of ≤1.81 mmol/L.

Group I had significantly higher mean baseline LDL-C than group II. Moreover, 8.3% of group I patients had an LDL-C ≤1.81 mmol/L versus 43.3% for group II. At week 24, 75.0% and 90.0% of group I and II patients, respectively, achieved the LDL-C target. At week 48, 85.0% and 96.7% of group I and II patients, respectively, achieved the LDL-C target. Additionally, the mean percent changes at week 4 from baseline in LDL-C were −33.6% ± 20.0% for group I versus −12.8% ± 19.6% for group II, and −47.0% ± 25.5% at week 48 for group I versus −36.4% ± 20.2% for group II. Meanwhile, significant reduction in plaque size and marked improvement in cardiac function were seen in patients receiving high-intensity atorvastatin therapy.

Compared to conventional therapy, high-intensity statin therapy is more effective in reducing LDL-C and improving cardiac function of ACS patients, with a general benign safety profile over a period of 48 weeks. Our findings support the use of high-intensity statin therapy for Chinese ACS patients to improve the proportion of patients attaining the LDL-C target and reduction in plaque size and improvement cardiac function.
Inpatient Health Care Utilization in Children With Hemophilia Before and After the Joint Outcome Study Publication
Authors: Drayton Jackson Meghan , O’Brien Sarah H. , Stanek Joseph , Dunn Amy L. , Kerlin Bryce A.
Published: October 2018

The “Joint Outcomes Study” (JOS) demonstrated improved joint outcomes for patients receiving primary prophylaxis versus on-demand therapy. The impact of primary prophylaxis on inpatient health care utilization is not well-defined. To evaluate changes in hospitalization care of children with hemophilia before and after the 2007 JOS publication, this study utilized the Pediatric Health Information System (PHIS) to evaluate admissions for patients with hemophilia A or B (age, 2 to 7) admitted between January 2002 and 2006 (pre-JOS) and January 2010 and 2014 (post-JOS). Discharge diagnosis codes and clinical transaction classifications were used to differentiate bleeding episodes, infections, bypass agent use, length of stay, and intensive care unit (ICU) management. Overall, admissions for bleeding episodes did not change (26.5% of admissions pre-JOS vs. 23.6% post-JOS, P=0.10). However, admissions for suspected infections increased (3.0% of admissions pre-JOS vs. 7.2% post-JOS, P<0.01) while confirmed infections remained stable. Meanwhile, ICU utilization decreased (7.8% of admissions pre-JOS vs. 4.9% post-JOS, P<0.01). The necessity for ICU care in children with hemophilia has decreased since publication of the JOS. However, expanded adoption of primary prophylaxis is associated with more hospitalizations for suspected systemic infections, likely due to utilization of central venous catheters to deliver clotting factor concentrates.
Duration and Time Trends in Hospital Stay for Very Preterm Infants Differ Across European Regions*
Authors: Maier Rolf F. , Blondel Béatrice , Piedvache Aurélie , Misselwitz Bjoern , Petrou Stavros , Van Reempts Patrick , Franco Francesco , Barros Henrique , Gadzinowski Janusz , Boerch Klaus , van Heijst Arno , Draper Elizabeth S. , Zeitlin Jennifer
Published: October 2018

Objectives:

To compare duration and changes over time in length of hospital stay for very preterm and extremely preterm infants in 10 European regions.

Design:

Two area-based cohort studies from the same regions in 2003 and 2011/2012.

Setting:

Ten regions from nine European countries.

Patients:

Infants born between 22 + 0 and 31 + 6 weeks of gestational age and surviving to discharge (Models of Organising Access to Intensive Care for Very Preterm Births cohort in 2003, n = 4,011 and Effective Perinatal Intensive Care in Europe cohort in 2011/2012, n = 4,336).

Interventions:

Observational study, no intervention.

Measurements and Main Results:

Maternal and infant characteristics were abstracted from medical records using a common protocol and length of stay until discharge was adjusted for case-mix using negative binomial regression. Mean length of stay was 63.6 days in 2003 and varied from 52.4 to 76.5 days across regions. In 2011/2012, mean length of stay was 63.1 days, with a narrower regional range (54.0–70.1). Low gestational age, small for gestational age, low 5-minute Apgar score, surfactant administration, any surgery, and severe neonatal morbidities increased length of stay. Infant characteristics explained some of the differences between regions and over time, but large variations remained after adjustment. In 2011/2012, mean adjusted length of stay ranged from less than 54 days in the Northern region of the United Kingdom and Wielkopolska, Poland to over 67 days in the Ile-de-France region of France and the Eastern region of the Netherlands. No systematic decrease in very preterm length of stay was observed over time after adjustment for patient case-mix.

Conclusions:

A better understanding of the discharge criteria and care practices that contribute to the wide differences in very preterm length of stay across European regions could inform policies to optimize discharge decisions in terms of infant outcomes and health system costs.
The Effect of Pelvic Floor Muscle Contraction on Detrusor Overactivity Pressure in Neurogenic and Nonneurogenic Women During Urodynamic Study
Authors: Lúcio Adélia , Lourenço Christiane Boaventura , Damasceno Benito Pereira , de Moraes Lopes Maria Helena Baena , D'ancona Carlos Arturo Levi
Published: October 2018

Objective

The aims of this study were to investigate whether detrusor overactivity can be influenced by a pelvic floor muscle contraction in multiple sclerosis–associated overactive bladder and idiopathic overactive bladder volunteers and to compare urodynamic findings between the two groups.

Design

Eighteen women with multiple sclerosis–associated overactive bladder and 17 women with overactive bladder responded the overactive bladder V8 questionnaire and performed urodynamic study with electromyography of pelvic floor muscle to confirm the presence of a 15-sec pelvic floor muscle contraction during a detrusor overactivity, when present. Variables were the following: overactive bladder-V8 questionnaire, maximum cystometric capacity, volume at first detrusor overactivity, maximum detrusor overactivity amplitude, and percentage of detrusor overactivity pressure reduction.

Results

All participants had a reduction in detrusor overactivity pressure when pelvic floor muscle contraction was requested. Multiple sclerosis–associated overactive bladder group showed significant higher detrusor overactivity amplitude than overactive bladder group (P= 0.02). Overactive bladder group had their detrusor overactivity pressure reduced in a greater extent when compared with multiple sclerosis–associated overactive bladder group (P= 0.01).

Conclusions

The results suggest that pelvic floor muscle contraction is able to reduce detrusor overactivity pressure in multiple sclerosis–associated overactive bladder and overactive bladder population.
Comprehensive Complication Index Validates Improved Outcomes Over Time Despite Increased Complexity in 3707 Consecutive Hepatectomies
Authors: Cloyd Jordan M. , Mizuno Takashi , Kawaguchi Yoshikuni , Lillemoe Heather A. , Karagkounis Georgios , Omichi Kiyohiko , Chun Yun Shin , Conrad Claudius , Tzeng Ching-Wei D. , Odisio Bruno C. , Huang Steven Y. , Hicks Marshall , Wei Steven H. , Aloia Thomas A. , Vauthey Jean-Nicolas
Published: October 2018

Objective:

The aim of this study was to evaluate trends over time in perioperative outcomes for patients undergoing hepatectomy.

Background:

As perioperative care and surgical technique for hepatectomy have improved, the indications for and complexity of liver resections have evolved. However, the resulting effect on the short-term outcomes over time has not been well described.

Methods:

Consecutive patients undergoing hepatectomy during 1998 to 2015 at 1 institution were analyzed. Perioperative outcomes, including the comprehensive complication index (CCI), were compared between patients who underwent hepatectomy in the eras 1998 to 2003, 2004 to 2009, and 2010 to 2015.

Results:

The study included 3707 hepatic resections. The number of hepatectomies increased in each era (794 in 1998 to 2003, 1402 in 2004 to 2009, and 1511 in 2010 to 2015). Technical complexity increased over time as evidenced by increases in the rates of major hepatectomy (20%, 23%, 30%, P < 0.0001), 2-stage hepatectomy (0%, 3%, 4%, P < 0.001), need for portal vein embolization (5%, 9%, 9%, P = 0.001), preoperative chemotherapy for colorectal liver metastases (70%, 82%, 89%, P < 0.001) and median operative time (180, 175, 225 minutes, P < 0.001). Significant decreases over time were observed in median blood loss (300, 250, 200 mL, P < 0.001), transfusion rate (19%, 15%, 5%, P < 0.001), median length of hospitalization (7, 7, 6 days, P < 0.001), rates of CCI ≥26.2 (20%, 22%, 16%, P < 0.001) and 90-day mortality (3.1%, 2.6%, 1.3%, P < 0.01). On multivariable analysis, hepatectomy in the most recent era 2010 to 2015 was associated with a lower incidence of CCI ≥26.2 (odds ratio 0.7, 95% confidence interval 0.6–0.8, P < 0.0001).

Conclusion:

Despite increases in complexity over an 18-year period, continued improvements in surgical technique and perioperative outcomes yielded a resultant decrease in CCI in the most current era.
Laparoscopic Versus Open Resection for Rectal Cancer
Authors: Acuna Sergio A. , Chesney Tyler R. , Ramjist Joshua K. , Shah Prakesh S. , Kennedy Erin D. , Baxter Nancy N.
Published: October 2018

Objective:

To determine whether laparoscopic surgery is noninferior to open surgery for rectal cancer in terms of quality of surgical resection outcomes.

Background:

Randomized clinical trials (RCTs) have evaluated the oncologic safety of laparoscopic versus open surgery for rectal cancer with conflicting results. Prior meta-analyses comparing these operative approaches in terms of quality of surgical resection aimed to demonstrate if one approach was superior. However, this method is not appropriate and potentially misleading when noninferiority RCTs are included.

Methods:

MEDLINE, EMBASE, and Cochrane were searched to identify RCTs comparing these operative approaches. Risk differences (RDs) were pooled using random-effects meta-analyses. One-sided Z tests were used to determine noninferiority. Noninferiority margins (ΔNI) for circumferential resection margin (CRM), plane of mesorectal excision (PME), distal resection margin (DRM), and a composite outcome (“successful resection”) were based on the consensus of 58 worldwide experts.

Results:

Fourteen RCTs were included. Laparoscopic resection was noninferior compared with open resection for the rate of positive CRM [RD 0.79%, 90% confidence interval (CI) −0.46 to 2.04, ΔNI = 2.33%, P
NI = 0.026], incomplete PME (RD 1.16%, 90% CI −0.27 to 2.59, ΔNI = 2.85%, P
NI = 0.025), and positive DRM (RD 0.15%, 90% CI −0.58 to 0.87, ΔNI = 1.28%, P
NI = 0.005). For the rate of “successful resection” (RD 6.16%, 90% CI 2.30–10.02), the comparison was inconclusive when using the ΔNI generated by experts (ΔNI = 2.71%, P
NI = 0.07), although no consensus was achieved for this ΔNI.

Conclusions:

Laparoscopy was noninferior to open surgery for rectal cancer in terms of individual quality of surgical resection outcomes. These findings are concordant with RCTs demonstrating noninferiority for long-term oncologic outcomes between the 2 approaches.
Is Less More? A Microsimulation Model Comparing Cost-effectiveness of the Revised American Thyroid Association's 2015 to 2009 Guidelines for the Management of Patients With Thyroid Nodules and Differentiated Thyroid Cancer
Authors: White Craig , Weinstein Milton C. , Fingeret Abbey L. , Randolph Gregory W. , Miyauchi Akira , Ito Yasuhiro , Zhan Tiannan , Ali Ayman , Gazelle G. Scott , Lubitz Carrie C.
Published: October 2018

Objective:

To assess relative clinical and economic performance of the revised American Thyroid Association (ATA) thyroid cancer guidelines compared to current standard of care.

Background:

Diagnosis of thyroid cancer in the United States has tripled whereas mortality has only marginally increased. Most patients present with small papillary carcinomas and have historically received at least a total thyroidectomy as a treatment. In 2015, the ATA released the revised guidelines recommending an option for active surveillance (AS) of small papillary thyroid carcinoma and thyroid lobectomy for larger unifocal tumors.

Methods:

We created a Markov microsimulation model to evaluate the performance of the ATA's 2015 guidelines compared to the ATA's 2009 guidelines. We modeled a cohort of simulated patients with demographic and thyroid nodule characteristics representative of those presenting clinically in the United States. Outcome measures include life expectancy, quality-adjusted life years, costs, and frequency of surgical adverse events.

Results:

In our base case analysis, the ATA 2015 strategy dominates the ATA 2009 strategy. The ATA 2015 strategy delivers greater discounted average quality-adjusted life years (13.09 vs 12.43) at a lower discounted average cost ($14,752 vs $20,126). Deaths due to thyroid cancer under the 2015 strategy are higher than the 2009 strategy but this is offset by a reduction in surgical deaths, leading to greater average life expectancy under the ATA 2015 strategy. The optimal strategy is sensitive to patients who experience a greater decrement in quality of life while undergoing AS.

Conclusions:

The ATA 2015 Guidelines represent a cost-effective strategy regarding AS and extent of surgery.
Medical and Surgical Complications and Health-related Quality of Life After Esophageal Cancer Surgery
Authors: Kauppila Joonas H. , Johar Asif , Lagergren Pernilla
Published: October 2018

Objective:

To evaluate the impact of postoperative medical and surgical complications on health-related quality of life (HRQOL) in esophageal cancer.

Background:

Complications after esophageal surgery negatively affect HRQOL, but it is unclear whether medical and surgical complications differ in effects.

Methods:

This Swedish population-based, nationwide, and prospective cohort study enrolled 616 patients undergoing esophageal cancer surgery during 2001 to 2005, with 10 years of follow-up. The exposure was the occurrence of the predefined postoperative medical or surgical technical complications. The study outcome was HRQOL, evaluated by European Organisation for Research and Treatment of Cancer questionnaires at 6 months, and 3, 5, and 10 years after surgery. Linear mixed models, adjusted for confounders and complications, provided mean score differences (MDs) and 95% confidence intervals (CIs) for each HRQOL scale and item.

Results:

Of the 616 patients, 217 (35%) had medical and 163 (26%) had surgical postoperative complications. In patients with medical complications, HRQOL was generally worse at all time points, with worse global quality of life (QOL) (MD −10, 95% CI −18 to −2) and dyspnea (MD 16, 95% CI 5–27) from 3 years onwards, compared with those without. Patients with surgical complications had worse HRQOL outcomes up to 5 years after surgery, for example, dyspnea at 6 months (MD 11, 95% CI 4–19) and global QOL at 3 years (MD −13, 95% CI −22 to −5), than those without.

Conclusion:

Medical complications are associated with long-lasting impairments and worsening HRQOL, whereas the negative effects of surgical complications on HRQOL seem to minimize 5 years postsurgery.
Dogs accompanied humans during the Neolithic expansion into Europe
Authors: Ollivier Morgane , Tresset Anne , Frantz Laurent A. F. , Bréhard Stéphanie , Bălăşescu Adrian , Mashkour Marjan , Boroneanţ Adina , Pionnier-Capitan Maud , Lebrasseur Ophélie , Arbogast Rose-Marie , Bartosiewicz László , Debue Karyne , Rabinovich Rivka , Sablin Mikhail V. , Larson Greger , Hänni Catherine , Hitte Christophe , Vigne Jean-Denis
Published: October 2018

Near Eastern Neolithic farmers introduced several species of domestic plants and animals as they dispersed into Europe. Dogs were the only domestic species present in both Europe and the Near East prior to the Neolithic. Here, we assessed whether early Near Eastern dogs possessed a unique mitochondrial lineage that differentiated them from Mesolithic European populations. We then analysed mitochondrial DNA sequences from 99 ancient European and Near Eastern dogs spanning the Upper Palaeolithic to the Bronze Age to assess if incoming farmers brought Near Eastern dogs with them, or instead primarily adopted indigenous European dogs after they arrived. Our results show that European pre-Neolithic dogs all possessed the mitochondrial haplogroup C, and that the Neolithic and Post-Neolithic dogs associated with farmers from Southeastern Europe mainly possessed haplogroup D. Thus, the appearance of haplogroup D most probably resulted from the dissemination of dogs from the Near East into Europe. In Western and Northern Europe, the turnover is incomplete and haplogroup C persists well into the Chalcolithic at least. These results suggest that dogs were an integral component of the Neolithic farming package and a mitochondrial lineage associated with the Near East was introduced into Europe alongside pigs, cows, sheep and goats. It got diluted into the native dog population when reaching the Western and Northern margins of Europe.
In that vein: inflated wing veins contribute to butterfly hearing
Authors: Sun Penghui , Mhatre Natasha , Mason Andrew C. , Yack Jayne E.
Published: October 2018

Insects have evolved a diversity of hearing organs specialized to detect sounds critical for survival. We report on a unique structure on butterfly wings that enhances hearing. The Satyrini are a diverse group of butterflies occurring throughout the world. One of their distinguishing features is a conspicuous swelling of their forewing vein, but the functional significance of this structure is unknown. Here, we show that wing vein inflations function in hearing. Using the common wood nymph,
Cercyonis pegala
, as a model, we show that (i) these butterflies have ears on their forewings that are most sensitive to low frequency sounds (less than 5 kHz); (ii) inflated wing veins are directly connected to the ears; and (iii) when vein inflations are ablated, sensitivity to low frequency sounds is impaired. We propose that inflated veins contribute to low frequency hearing by impedance matching.
Comparison of spatial interpolation methods to create high-resolution poverty maps for low- and middle-income countries
Authors: Wong Kerry L. M. , Brady Oliver J. , Campbell Oona M. R. , Benova Lenka
Published: October 2018

High-resolution poverty maps are important tools for promoting equitable and sustainable development. In settings without data at every location, we can use spatial interpolation (SI) to create such maps using sample-based surveys and additional covariates. In the model-based geostatistics (MBG) framework for SI, it is typically assumed that the similarity of two areas is inversely related to their distance between one another. Applications of spline interpolation take a contrasting approach that an area's absolute location and its characteristics are more important for prediction than distance to/characteristics of other locations. This study compares prediction accuracy of the MBG approach with spline interpolation as part of a generalized additive model (GAM) for four low- and middle-income countries. We also identify any potentially generalizable data characteristics influencing comparative accuracy. We found spatially scattered pockets of wealth in Malawi and Tanzania (corresponding to the major cities), and overarching spatial gradients in Kenya and Nigeria. Spline interpolation/GAM performed better than MBG for Malawi, Nigeria and Tanzania, but marginally worse in Kenya. We conclude that the spatial patterns of wealth and other covariates should be carefully accounted for when choosing the best SI approach. This is particularly pertinent as different methods capture geographical variation differently.
Coupled constitutive relations: a second law based higher-order closure for hydrodynamics
Authors: Rana Anirudh Singh , Gupta Vinay Kumar , Struchtrup Henning
Published: October 2018

In the classical framework, the Navier–Stokes–Fourier equations are obtained through the linear uncoupled thermodynamic force-flux relations which guarantee the non-negativity of the entropy production. However, the conventional thermodynamic descrip- tion is only valid when the Knudsen number is sufficiently small. Here, it is shown that the range of validity of the Navier–Stokes–Fourier equations can be extended by incorporating the nonlinear coupling among the thermodynamic forces and fluxes. The resulting system of conservation laws closed with the coupled constitutive relations is able to describe many interesting rarefaction effects, such as Knudsen paradox, transpiration flows, thermal stress, heat flux without temperature gradients, etc., which cannot be predicted by the classical Navier–Stokes–Fourier equations. For this system of equations, a set of phenomenological boundary conditions, which respect the second law of thermodynamics, is also derived. Some of the benchmark problems in fluid mechanics are studied to show the applicability of the derived equations and boundary conditions.
Bearded capuchin monkeys use joint synergies to stabilize the hammer trajectory while cracking nuts in bipedal stance
Authors: Mangalam Madhur , Rein Robert , Fragaszy Dorothy Munkenbeck
Published: October 2018

The transition from occasional to obligate bipedalism is a milestone in human evolution. However, because the fossil record is fragmentary and reconstructing behaviour from fossils is difficult, changes in the motor control strategies that accompanied this transition remain unknown. Quadrupedal primates that adopt a bipedal stance while using percussive tools provide a unique reference point to clarify one aspect of this transition, which is maintaining bipedal stance while handling massive objects. We found that while cracking nuts using massive stone hammers, wild bearded capuchin monkeys (Sapajus libidinosus) produce hammer trajectories with highly repeatable spatial profiles. Using an uncontrolled manifold analysis, we show that the monkeys used strong joint synergies to stabilize the hammer trajectory while lifting and lowering heavy hammers. The monkeys stringently controlled the motion of the foot. They controlled the motion of the lower arm and hand rather loosely, showing a greater variability across strikes. Overall, our findings indicate that while standing bipedally to lift and lower massive hammers, an arboreal quadrupedal primate must control motion in the joints of the lower body more stringently than motion in the joints of the upper body. Similar changes in the structure of motor variability required to accomplish this goal could have accompanied the evolutionary transition from occasional to obligate bipedalism in ancestral hominins.
Evaluation of microbiological safety in commercial Jeotgal
Authors: Choi Sun-A , An Seong-Eun , Jeong Hee-Gyeong , Lee Seo-Hyun , Mun Kwang-Ho , Kim Jung-Beom
Published: October 2018

This study investigated the prevalence of total aerobic bacteria, coliform and food poisoning (Bacillus cereus) bacteria in commercial Jeotgal for the evaluation of microbiological safety. The mean mass of total aerobic bacteria was 4.8±1.4 log CFU/g in Jeotgal. Coliform was detected in 17 (48.6%) of 35 seasoned Jeotgal; 14 (42.4%) of 33 low salted Jeotgal compared with three (16.7%) of 18 general salted Jeotgal; and in three (37.5%) of eight HACCP certificated Jeotgal compared with 14 (32.6%) of 43 non-HACCP certificated Jeotgal. Bacillus cereus was detected in two (12.5%) of 16 non-seasoned Jeotgal compared with 20 (57.1%) of 35 seasoned Jeotgal; in 19 (57.6%) of 33 low salted Jeotgal compared with three (16.7%) of 18 general salted Jeotgal, and in four (50.0%) of eight HACCP certificated Jeotgal compared with 18 (41.9%) of 43 non-HACCP certificated Jeotgal. Overall, our results showed that coliform and B. cereus contamination was highest in the seasoned and low salted Jeotgal. It is necessary to improve the microbiological safety low salted and seasoned Jeotgal. The HACCP system in Jeotgal is reconfirmed for the enhancement of microbiological safety.
The biggest losers: Habitat isolation deconstructs complex food webs from top to bottom
Authors: Ryser Remo , Häussler Johanna , Stark Markus , Brose Ulrich , Rall Björn C. , Guill Christian
Published: October 2018

Habitat fragmentation is threatening global biodiversity. To date, there is only limited understanding of how the different aspects of habitat fragmentation (habitat loss, number of fragments and isolation) affect species diversity within complex ecological networks such as food webs. Here, we present a dynamic and spatially-explicit food web model which integrates complex food web dynamics at the local scale and species-specific dispersal dynamics at the landscape scale, allowing us to study the interplay of local and spatial processes in metacommunities. We here explore how the number of habitat patches, i.e. the number of fragments, and an increase of habitat isolation, affect the species diversity patterns of complex food webs (α-,β-,γ-diversity). We specifically test whether there is a trophic dependency in the effect of these to factors on species diversity. In our model, habitat isolation is the main driver causing species loss and diversity decline. Our results emphasise that large-bodied consumer species at high trophic positions go extinct faster than smaller species at lower trophic levels, despite being superior dispersers that connect fragmented landscapes better. We attribute the loss of top species to a combined effect of higher biomass loss during dispersal with increasing habitat isolation in general, and the associated energy limitation in highly fragmented landscapes, preventing higher trophic levels to persist. To maintain trophic-complex and species-rich communities calls for effective conservation planning which considers the interdependence of trophic and spatial dynamics as well as the spatial context of a landscape and its energy availability.
Hypoxia-induced epigenetic silencing of polo-like kinase 2 promotes fibrosis in atrial fibrillation
Authors: Künzel Stephan Reinhard , Sekeres Karolina , Kämmerer Susanne , Kolanowski Tomasz , Meyer-Roxlau Stefanie , Piorkowski Christopher , Tugtekin Sems Malte , Rose-John Stefan , Yin Xiaoke , Mayr Manuel , Kuhlmann Jan Dominik , Wimberger Pauline , Grützmann Konrad , Herzog Natalie , Küpper Jan-Heiner , Guan Kaomei , Wagner Michael , Ravens Ursula , Weber Silvio , El-Armouche Ali
Published: October 2018

Fibrosis and inflammation promote atrial fibrillation (AF) and worsen its clinical outcome. The underlying molecular mechanisms, that are relevant for effective antifibrotic drug development, are still under debate. This study deciphers a novel mechanistic interplay between polo-like kinase 2 (PLK2) and the pro-inflammatory cytokine osteopontin (OPN) in the pathogenesis of atrial fibrosis. Compared to sinus rhythm (SR) controls, right atrial appendages and isolated right atrial fibroblasts from AF patients showed downregulation ofPLK2mRNA and protein levels, which were accompanied by remarkable hypoxia-sensitive DNA-methylation of thePLK2promotor. In an experimental setting, both, genetic deletion and pharmacological inhibition of PLK2 induced myofibroblast differentiation and reduced fibroblast proliferation. Notably, proteomics fromPLK2-deleted fibroblasts revealedde novosecretion of OPN. Accordingly, we observed higher OPN plasma levels in AF patients with atrial fibrosis compared to non-fibrosis AF patients. Hence, we provide evidence for PLK2 reactivation and/or OPN inhibition as potential novel targets to prevent fibrosis progression in AF.
A normalized template matching method for improving spike detection in extracellular voltage recordings
Authors: Laboy-Juarez Keven , Ahn Sei , Feldman Daniel E.
Published: October 2018

Spike sorting is the process of detecting and clustering action potential waveforms from extracellular voltage recordings to identify spikes of putative single neurons. Typically, spike detection is done using a fixed voltage threshold and shadow period, but this approach can lead to missed spikes during high firing rate epochs or noisy conditions. We developed a novel spike detection method utilizing a computationally simple form of template matching that efficiently detects spikes from candidate single units and is tolerant of high firing rates and electrical noise without a whitening filter. Template matching was based on a sliding cosine similarity between mean spike waveforms of candidate single units and the extracellular voltage signal. Performance was tested in whisker somatosensory cortex (S1) of anesthetized mice in vivo. The method consistently detected whisker-evoked spikes that were missed by a standard fixed voltage threshold. Detection was most improved for spikes evoked by strong stimuli (40-70% increase), less improved for weaker stimuli, and unchanged for spontaneous spiking. This reflected the failure of standard detection during spatiotemporally dense spiking. Template-based detection revealed higher signal-to-noise ratio for sensory responses and sharper sensory tuning. Thus, this template matching method (and other model-based spike detection methods) critically improve the quantification of single-unit spiking activity.
An unprecedented Zr-containing polyoxometalate tetramer with mixed trilacunary/dilacunary Keggin-type polyoxotungstate units
Authors: Zhang Zhong , Wang Yue-Lin , Yang Guo-Yu
Published: October 2018

A novel zirconium(IV)-substituted tetramer polyoxotungstate, H6K4Na16[Zr4(β-GeW10O38)2(A-α-PW9O34)2]·37H2O, was synthesized hydrothermally and characterized by IR spectroscopy, elemental analysis, thermogravimetric analysis, powder X-ray diffraction, energy-dispersive X-ray spectroscopy and single-crystal X-ray diffraction. The compound crystallizes in the monoclinic P2/n space group. The most remarkable feature is that the centrosymmetric Zr-based polyoxotungstate tetramer consists of dilacunary Keggin-type germanotungstate and trilacunary Keggin-type phosphotungstate units that are linked by ZrIV ions.