bluuebunny/crossref_metadata_2025 huggingface dataset:
Shared Decision Making for Syncope in the Emergency Department: A Randomized Controlled Feasibility Trial
Authors: Probst Marc A. , Lin Michelle P. , Sze Jeremy J. , Hess Erik P. , Breslin Maggie , Frosch Dominick L. , Sun Benjamin C. , Langan Marie‐Noelle , Thiruganasambandamoorthy Venkatesh , Richardson Lynne D.
Published: March 2020

Objectives

Significant practice variation is seen in the management of syncope in the emergency department (ED). We sought to evaluate the feasibility of performing a randomized controlled trial of a shared decision making (SDM) tool for low‐to‐intermediate–risk syncope patients presenting to the ED.

Methods

We performed a randomized controlled trial of adults (≥30 years) with unexplained syncope who presented to an academic ED in the United States. Patients with a serious diagnosis identified in the ED were excluded. Patients were randomized, 1:1, to receive either usual care or a personalized syncope decision aid (SynDA) meant to facilitate SDM. Our primary outcome was feasibility, i.e., ability to enroll 50 patients in 24 months. Secondary outcomes included patient knowledge, involvement (measured with OPTION‐5), rating of care, and clinical outcomes at 30 days post‐ED visit.

Results

After screening 351 patients, we enrolled 50 participants with unexplained syncope from January 2017 to January 2019. The most common reason for exclusion was lack of clinical equipoise to justify SDM (n = 124). Patients in the SynDA arm tended to have greater patient involvement, as shown by higher OPTION‐5 scores: 52/100 versus 27/100 (between‐group difference = −25.4, 95% confidence interval = −13.5 to −37.3). Both groups had similar levels of clinical knowledge, ratings of care, and serious clinical outcomes at 30 days.

Conclusions

Among ED patients with unexplained syncope, a randomized controlled trial of a shared decision‐making tool is feasible. Although this study was not powered to detect differences in clinical outcomes, it demonstrates feasibility, while providing key lessons and effect sizes that could inform the design of future SDM trials.
Alcohol use in pregnancy and its impact on the mother and child
Authors: Oei Ju Lee
Published: March 2020

Aims

To review the impact of prenatal alcohol exposure on the outcomes of the mother and child.

Design

Narrative review.

Setting

Review of literature.

Participants

Mothers and infants affected by prenatal alcohol use.

Measurements

Outcomes of mothers and children.

Findings

Prenatal alcohol exposure is one of the most important causes of preventable cognitive impairment in the world. The developing neurological system is exquisitely sensitive to harm from alcohol and there is now also substantial evidence that alcohol‐related harm can extend beyond the individual person, leading to epigenetic changes and intergenerational vulnerability and disadvantage. There is no known safe level or timing of drinking for pregnant or lactating women and binge drinking (> four drinks within 2 hours for women) is the most harmful. Alcohol‐exposure increases the risk of congenital problems, including Fetal Alcohol Spectrum Disorder (FASD) and its most severe form, Fetal Alcohol Syndrome (FAS).

Conclusion

The impact of FASD and FAS is enduring and life‐long with no current treatment or cure. Emerging therapeutic options may mitigate the worst impact of alcohol exposure but significant knowledge gaps remain. This review discusses the history, epidemiology and clinical presentations of prenatal alcohol exposure, focusing on FASD and FAS, and the impact of evidence on future research, practice and policy directions.
A mixed‐methods analysis of patient safety incidents involving opioid substitution treatment with methadone or buprenorphine in community‐based care in England and Wales
Authors: Gibson Russell , MacLeod Natalie , Donaldson Liam J. , Williams Huw , Hibbert Peter , Parry Gareth , Bhatt Jay , Sheikh Aziz , Carson‐Stevens Andrew
Published: March 2020

Background and Aims

Opioid substitution treatment is used in many countries as an effective harm minimization strategy. There is a need for more information about patient safety incidents and the resulting harm relating to this treatment. We aimed to characterize patient safety incidents involving opioid substitution treatment with methadone or buprenorphine in community‐based care by: (i) identifying the sources and nature of harm and (ii) describing and interpreting themes to identify priorities to focus future improvement work.

Design

Mixed‐methods study examining patient safety incident reports involving opioid substitution treatment with either methadone or buprenorphine in community‐based care.

Setting

Data submitted between 2005 and 2015 from the National Reporting and Learning System (NRLS), a national repository of patient safety incident reports from across England and Wales.

Participants

A total of 2284 reports were identified involving patients receiving community‐based opioid substitution treatment.

Measurements

Incident type, contributory factors, incident outcome and severity of harm. Analysis involved data coding, processing and iterative generation of data summaries using descriptive statistical and thematic analysis.

Findings

Most risks of harm from opioid substitution treatment came from failure in one of four processes of care delivery: prescribing opioid substitution (n = 151); supervised dispensing (n = 248); non‐supervised dispensing (n = 318); and monitoring and communication (n = 1544). Most incidents resulting in harm involved supervised or non‐supervised dispensing (n = 91 of 127, 72%). Staff‐ (e.g. slips during task execution, not following protocols) and organization‐related (e.g. poor working conditions or poor continuity of care between services) contributory factors were identified for more than half of incidents.

Conclusions

Risks of harm in delivering opioid substitute treatment in England and Wales appear to arise out of failures in four processes: prescribing opioid substitution, supervised dispensing, non‐supervised dispensing and monitoring and communication.
A latent class analysis of changes in adolescent substance use between 1988 and 2011 in Sweden: associations with sex and psychosomatic problems
Authors: Evans Brittany E. , Kim Yunhwan , Hagquist Curt
Published: March 2020

Aims

To characterize changes in patterns of adolescent substance use in Sweden between 1988 and 2011, and to assess whether sex and psychosomatic problems were associated with substance use and whether these associations changed over time.

Design

Secondary analysis of repeated cross‐sectional survey data. Survey data were collected eight times and analyzed as four cohorts (1988–91, 1995–98, 2002–05 and 2008–11).

Setting and participants

The sample included all 15–16‐year‐olds in Värmland County, Sweden (n = 20 057).

Measurements

Binary‐coded substance use measures included life‐time use of alcohol and tobacco, getting drunk and past school year use of inhalants. An eight‐item scale was used to assess psychosomatic problems.

Findings

A three‐class model fitted the data best (i.e. non/low use, mainly alcohol use and polysubstance use). The patterns of substance use were different among cohorts; most notably, adolescents in the last cohort had lower odds of being included in the alcohol and polysubstance use classes rather than the non/low use class than in the earlier cohorts (all Ps < 0.001). Males had higher odds than females of being in the polysubstance use class rather than the non/low use class among the first three cohorts (all Ps < 0.001) but not the last. Sex was not associated with inclusion in the alcohol use class rather than the non/low use class. Adolescents who reported more psychosomatic problems had higher odds of being included in the alcohol and polysubstance use classes rather than the non/low use class (all Ps < 0.001). The associations of sex and psychosomatic problems with class inclusion did not change during the study period.

Conclusions

Between 1988 and 2011, patterns of substance use among adolescents in Sweden shifted away from polysubstance use and alcohol use to non‐use or low use. Associations between patterns of substance use and sex and psychosomatic problems remained largely consistent across the study period.
Translocation for conservation: Neonates are less suitable than adults
Authors: Daniell Tara L. , Baring Ryan , Hutchinson Mark N. , Ainsley Phil , Gardner Michael G.
Published: March 2020

Animal behaviour can affect the outcome of conservation translocations. It is important to understand the behaviour of the species being considered for translocation and how its behaviour varies over life stages. There may be uncertainty about what life stages are best as founders for release back into wild populations. A technique called head‐starting whereby juvenile life stages are raised in captivity and then released is one potential pre‐release strategy. However, juveniles of many species have a dispersive role in the life cycle, potentially raising difficulties for establishing new populations due to dispersal from the intended habitat following release. For this study, we compared aspects of the behaviour of captive adult and neonate pygmy bluetongue lizards (Tiliqua adelaidensis) – an endangered species for which translocation is likely to be an important management strategy – to determine if neonate behavioural characteristics are appropriate for their translocation. We filmed adult and neonate pygmy bluetongue lizards and compared their behaviour. We also filmed adults over an activity season to compare seasonal behaviour. Behavioural parameters measured included basking time, burrow exits, burrows occupied and walking the perimeter wall. Neonates basked significantly more than adults in summer and autumn. Neonates are likely to be basking more than adults because they are in a stage of rapid growth and need to gain body mass before the winter inactivity period. Neonates exited burrows more often than adults and used a greater number of burrows. These results indicate neonate lizards are actively exploring their habitat. Neonates are unlikely to be as suitable for translocation as they are actively moving about and more likely to be predated upon or disperse from the translocation site. Our finding can be applied to other species that have active juvenile life stages and are at particular risk of predation due to their small size.
A large‐scale study to describe the prevalence, characteristics and management of functional gastrointestinal disorders in African infants
Authors: Bellaiche Marc , Ategbo Simon , Krumholz Fanny , Ludwig Thomas , Miqdady Mohamad , Abkari Abdelhak , Vandenplas Yvan
Published: March 2020

Aim

To evaluate the pattern, impact on quality of life and management of common functional gastrointestinal disorders (FGIDs) and related signs and symptoms in infants below 1 year of age in Africa.

Methods

Multicentre, cross‐sectional, observational study in 10 African countries. At the first paediatric consultation of children with gastrointestinal symptoms, the perception of paediatricians on FGIDs (infant colic, constipation and regurgitation) and gas/bloating, impact on infant quality of life and parental anxiety and patient management practices were evaluated by standardised questionnaires.

Results

Questionnaires were completed by 759 paediatricians for 10 812 infants. Overall, 49.9% of paediatricians reported ≥30% of first infant consultations each month for FGIDs or related symptoms. Infant colic was most commonly diagnosed (57.6% of infants), followed by gas/bloating (43.2%), regurgitation (39.7%) and constipation (31.4%). Overall, 53% presented >1 symptom. Mean scores for infant quality of life, sleep and parental anxiety were worse when children had multiple symptoms compared to children with a single symptom (P < .025). Prescription of medication was common (62.4%). There were no consistent differences between countries.

Conclusion

Functional gastrointestinal disorder occurrence in Africa was high with a gap between expert recommendation that emphasises parental reassurance and nutritional advice and daily practice, particularly prescription of medication.
Optimising the dose of clonidine to achieve sedation in intensive care unit patients with population pharmacokinetics
Authors: Cloesmeijer Michael E. , van den Oever Huub L.A. , Mathôt Ron A.A. , Zeeman Marieke , Kruisdijk‐Gerritsen Arriette , Bles Carmen M.A. , Nassikovker Polina , de Meijer Arthur R. , van Steveninck Fred L. , Arbouw Maurits E.L.
Published: March 2020

Aims

The aim of this study was to investigate the population pharmacokinetics (PK) of clonidine in intensive care unit (ICU) patients in order to develop a dosing regimen for sedation.

Methods

We included 24 adult mechanically ventilated, sedated patients from a mixed medical and surgical ICU. Intravenous clonidine was added to standard sedation in doses of 600, 1200 or 1800 μg/d. Within each treatment group, 4 patients received a loading dose of half the daily dose administered in 4 hours. Patients gave an average of 12 samples per individual. In total, 286 samples were available for analysis. Model development was conducted with NONMEM and various covariates were tested. After modelling, doses to achieve a target steady‐state plasma concentration of >1.5 μg/L were explored using stochastic Monte Carlo simulations for 1000 virtual patients.

Results

A 2‐compartment model was the best fit for the concentration‐time data. Clearance (CL) increased linearly with 0.213%/h; using allometric scaling, body weight was a significant covariate on the central volume of distribution (V1). Population PK parameters were: CL 17.1 (L/h), V1 124 (L/70 kg), intercompartmental CL 83.7 (L/h), and peripheral volume of distribution 178 (L), with 33.3% CV interindividual variability on CL and 66.8% CV interindividual variability on V1. Simulations revealed that a maintenance dose of 1200 μg/d provides target sedation concentrations of >1.5 μg/L in 95% of the patients.

Conclusion

A population PK model for clonidine was developed in an adult ICU. A dosing regimen of 1200 μg/d provided a target sedation concentration of >1.5 μg/L.
Ensemble clustering for step data via binning
Authors: Jang Ja‐Yoon , Oh Hee‐Seok , Lim Yaeji , Cheung Ying Kuen
Published: March 2020

This paper considers the clustering problem of physical step count data recorded on wearable devices. Clustering step data give an insight into an individual's activity status and further provide the groundwork for health‐related policies. However, classical methods, such as K‐means clustering and hierarchical clustering, are not suitable for step count data that are typically high‐dimensional and zero‐inflated. This paper presents a new clustering method for step data based on a novel combination of ensemble clustering and binning. We first construct multiple sets of binned data by changing the size and starting position of the bin, and then merge the clustering results from the binned data using a voting method. The advantage of binning, as a critical component, is that it substantially reduces the dimension of the original data while preserving the essential characteristics of the data. As a result, combining clustering results from multiple binned data can provide an improved clustering result that reflects both local and global structures of the data. Simulation studies and real data analysis were carried out to evaluate the empirical performance of the proposed method and demonstrate its general utility.
The UK NCRI study of chlorambucil, mitoxantrone and dexamethasone (CMD) versus fludarabine, mitoxantrone and dexamethasone (FMD) for untreated advanced stage follicular lymphoma: molecular response strongly predicts prolonged overall survival
Authors: Bishton Mark J. , Rule Simon , Wilson William , Turner Deborah , Patmore Russell , Clifton‐Hadley Laura , McMillan Andrew , Lush Richard , Haynes Andrew
Published: March 2020

We present a long‐term follow‐up of the UK chlorambucil, mitoxantrone and dexamethasone (CMD) versus fludarabine, mitoxantrone and dexamethasone (FMD) for untreated advanced, symptomatic follicular lymphoma (FL). This trial was the first to prospectively assess molecular response and the impact on outcomes for 400 patients. The median progression‐free survival (PFS) and overall survival (OS) for CMD were 3·6 and 14·6 years vs. 3·0 and 15·7 years for FMD, respectively. Estimates for Restricted Mean Survival Time (RMST) suggested no difference in PFS or OS. For the whole cohort there was a highly significant difference in survival by POD24, with a median OS from a risk‐defining event of 3·9 years compared to 13·7 years for all others (RMST P < 0·001). Molecular remission was achieved in 25/46 patients (54·3%) in the CMD arm and 20/41 (48·8%) in the FMD arm (P = 0·6). Molecular negativity resulted in median PFS of 5·6 years vs. 2·3 years for molecularly positive (log‐rank P < 0·001) and median OS not reached versus 12·5 years (log‐rank P < 0·01). No cases of progression occurred in minimal residual disease (MRD) negative patients after six years of follow‐up. Although there was no difference in outcomes between arms, this is the first prospective study to report MRD negativity resulting in significantly improved OS.
Bortezomib maintenance after R‐CHOP, cytarabine and autologous stem cell transplantation in newly diagnosed patients with mantle cell lymphoma, results of a randomised phase II HOVON trial
Authors: Doorduijn Jeanette K. , Zijlstra Josee M. , Lugtenburg Pieternella J. , Kersten Marie Josee , Böhmer Lara H. , Minnema Monique C. , MacKenzie Marius A. , van Marwijk Kooij Rien , de Jongh Eva , Snijders Tjeerd J.F. , de Weerdt Okke , van Gelder Michel , Hoogendoorn Mels , Leys Rineke B.L. , Kibbelaar Robby E. , de Jong Daphne , Chitu Dana A. , Van’t Veer Mars B. , Kluin‐Nelemans Hanneke C.
Published: March 2020

Rituximab‐containing induction followed by autologous stem cell transplantation (ASCT) is the standard first‐line treatment for young mantle cell lymphoma patients. However, most patients relapse after ASCT. We investigated in a randomised phase II study the outcome of a chemo‐immuno regimen and ASCT with or without maintenance therapy with bortezomib. Induction consisted of three cycles R‐CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), two cycles high‐dose cytarabine, BEAM (carmustine, etoposide, cytarabine, melphalan) and ASCT. Patients responding were randomised between bortezomib maintenance (1·3 mg/m2 intravenously once every 2 weeks, for 2 years) and observation. Of 135 eligible patients, 115 (85%) proceeded to ASCT, 60 (44%) were randomised. With a median follow‐up of 77·5 months for patients still alive, 5‐year event‐free survival (EFS) was 51% (95% CI 42–59%); 5‐year overall survival (OS) was 73% (95% CI 65–80%). The median follow‐up of randomised patients still alive was 71·5 months. Patients with bortezomib maintenance had a 5‐year EFS of 63% (95% CI 44–78%) and 5‐year OS of 90% (95% CI 72–97%). The patients randomised to observation had 5‐year PFS of 60% (95% CI, 40–75%) and OS of 90% (95% CI 72–97%). In conclusion, in this phase II study we found no indication of a positive effect of bortezomib maintenance after ASCT.
SafeSpot: an innovative app and mental health support package for Scottish schools – a qualitative analysis as part of a mixed methods study
Authors: Punukollu Mallika , Leighton Emma L. , Brooks Anna F. , Heron Saoirse , Mitchell Fiona , Regener Paula , Karagiorgou Olga , Bell Caitlin , Gilmour Mhairi , Moya Nasreen , Sharpe Helen , Minnis Helen
Published: March 2020

Aims

The aim of the study was to investigate teachers’ and pupils’ perceptions about the effect of the SafeSpot mental health curriculum on the well‐being of young people and on their knowledge of mental health conditions. This trial intends to determine the acceptability and benefits of web and mobile technology in delivering emotional well‐being in schools, through use of the SafeSpot programme.

Background

With 10% of young people aged 5 to 16 diagnosed with a mental disorder, there is pressure for schools to address their pupils’ emotional well‐being. However, many educators report that their schools have insufficient provisions and feel inadequately equipped to support pupils’ mental health.

Methods

This qualitative analysis was embedded within a randomly allocated stepped‐wedge design, conducted in six West of Scotland secondary schools. A total of 2320 pupils (aged 11 to 14 years) and 90 teachers were included. Young people’s understanding of health‐seeking, and teacher’s confidence in delivering and accessing well‐being information was assessed qualitatively.

Results

Qualitative analysis revealed themes highlighting the beneficial nature of SafeSpot, including pupil engagement, content of tutorials, perceived impact of SafeSpot and level of training provided for teachers.

Conclusions

Web technology could potentially offer a more structured way for staff to support their pupils’ mental health, whilst reducing stigma. SafeSpot was perceived, by pupils and teachers, to be engaging.
Design and synthesis of a novel peptide for selective detection of cancer cells
Authors: Rajavenkatesh Krishnamoorthy , Padmaja Murali , Janani Indrakumar , Aishwarya Satish , Purna Sai Korrapati , Thennarasu Sathiah
Published: March 2020

Using a minimalist approach, an 11‐residue peptide (Peptide 1) tagged with rhodamine fluorophore was designed and synthesized for selective detection of cancer cells. Peptide 1 contains RGD and NGR motifs to bind, respectively, integrins and aminopeptidase CD13, which are over expressed in cancer cells. Surface tension measurements revealed that peptide 1 possess surface‐active property owing to the overall hydrophobicity and cationic nature of the peptide. Peptide 1 displays cancer cell‐selective binding at ≤5.0 µM concentrations, while peptide 2 (randomized sequence of 1) shows non‐selective binding to normal and cancer cells. Fluorescence microscopy and FACS analysis demonstrated the intracellular localization of peptide 1 in three different cancer cell lines, confirming the role of RGD and NGR motifs. Cytotoxicity assay exhibited the viability of normal and cancer cells up to 100 µM concentrations of peptide 1. Steady‐state fluorescence measurements disclosed the preferential interactions of the peptide 1 with anionic POPC/POPG bilayers rather than with zwitterionic POPC lipid bilayers. Circular dichroism studies showed minimal changes in the secondary structure of peptide 1 upon binding with the anionic lipid bilayers. Peptide 1 is largely unordered, non‐toxic, and useful for identification of cancer cells. Peptide 1 provides a template for designing drug‐loaded peptides for targeted delivery into cancer cells.
A systematic review of the incidence of thyroid carcinoma in patients undergoing thyroidectomy for thyrotoxicosis
Authors: Varadharajan Kiran , Choudhury Natasha
Published: March 2020

Introduction

Hyperthyroidism (HT) has been associated with no insignificant rates of thyroid malignancy. There are no current specific guidelines that suggest routine preoperative imaging for thyroid nodules in patients with Grave's disease. We therefore performed a systematic review assessing rates of thyroid malignancy in patients undergoing surgery for different causes of HT: Grave's disease (GD), toxic adenoma (TA) and toxic multinodular goitre (TMNG).

Methods

Major databases (MEDLINE, PubMed and the Cochrane library) were searched to identify eligible studies.

Results

After searching and appraising, 33 papers were found to be eligible for analysis. The mean overall rate of malignancy was 8.5% (range 0.8%‐32.4%). The mean rates based on histological subtype were as follows: papillary thyroid cancer (PTC), 3.1% (range 0%‐13.2%); micropapillary carcinoma (mPTC), 5.1% (range 0%‐16.9%); and follicular thyroid cancer (FTC), 0.8% (range 0%‐4.4%). In those patients who had preoperative imaging, mean malignancy rates were higher in patients with pre‐identified nodules (19.8%) compared to those without any nodules (8.7%). Mean rates were lower in patients with GD/diffuse goitre (5.9%) compared to patients with TA (6.5%) and TMNG (12%).

Conclusion

Hyperthyroidism is associated with notable rates of thyroid cancer, although the mechanisms for this are not clear. The presence of nodules increases this risk. This review raises the question for considering preoperative assessment of nodules in all patients undergoing surgery for HT, in order to correctly assess and evaluate any patients with suspected concurrent thyroid malignancy, before proceeding with surgery.
CONSTRAINING COMPETITION WITH STATE MANDATED FACILITY REQUIREMENTS
Authors: Harrington David E. , Treber Jaret
Published: March 2020

We find that state mandated facility requirements may constrain the size and location of funeral homes. Many states have funeral regulations that require funeral homes to have embalming rooms, chapels, and casket display rooms. Often these facilities go unused, providing no discernible benefit to consumers while imposing unnecessary costs on firms. Using a case study, we present evidence that Arizona's more extensive facility requirements reduce the number of small funeral homes relative to Florida and prevent them from locating in shopping centers. We estimate that eliminating Arizona's cumbersome facility requirements would save consumers approximately 14% on their funeral expenditures. (JEL L51, L84, L88)
Impact of middle hepatic artery reconstruction after living donor liver transplantation using the left lobe
Authors: Harada Noboru , Yoshizumi Tomoharu , Uchiyama Hideaki , Ikegami Toru , Itoh Shinji , Takeishi Kazuki , Toshima Takeo , Nagao Yoshihiro , Yoshiya Shohei , Mori Masaki
Published: March 2020

Introduction

The aim of this study was to clarify the impact of middle hepatic artery reconstruction on the outcomes of duct‐to‐duct biliary anastomosis after living donor liver transplantation (LDLT) using the left lobe.

Materials and Methods

Among 258 patients who underwent LDLT using the left lobe, 216 patients who underwent hepatic artery reconstruction and one hepatic duct reconstruction with duct‐to‐duct interrupted anastomosis were divided into three groups: Group A (n = 123), one arterial stump with left hepatic artery reconstruction; Group B (n = 32), two arterial stumps with only left hepatic artery reconstruction; and Group C (n = 61), two arterial stumps with reconstruction of the left and middle hepatic arteries. The outcomes after LDLT were compared among the three groups.

Results

No hepatic artery complications occurred. Group B had a significantly greater incidence of anastomotic biliary stricture than Group C. A multivariate analysis with Cox regression revealed that being in Group B was the only significant independent risk factor for postoperative anastomotic biliary stricture after LDLT.

Conclusions

Middle and left hepatic artery reconstruction is safe in LDLT and may prevent biliary stricture caused by dual hepatic artery reconstruction when the graft has left and middle hepatic artery stumps.
Developmental outcomes after early surgery for complex congenital heart disease: a systematic review and meta‐analysis
Authors: Huisenga Darlene , La Bastide‐Van Gemert Sacha , Van Bergen Andrew , Sweeney Jane , Hadders‐Algra Mijna
Published: March 2020

Aim

(1) To systematically review the literature on developmental outcomes from infancy to adolescence of children with complex congenital heart disease (CHD) who underwent early surgery; (2) to run a meta‐regression analysis on the Bayley Scales of Infant Development, Second Edition Mental Developmental Index and Psychomotor Developmental Index (PDI) of infants up to 24 months and IQs of preschool‐aged children to adolescents; (3) to assess associations between perioperative risk factors and outcomes.

Method

We searched pertinent literature (January 1990 to January 2019) in PubMed, Embase, CINAHL, and PsycINFO. Selection criteria included infants with complex CHD who had primary surgery within the first 9 weeks of life. Methodological quality, including risk of bias and internal validity, were assessed.

Results

In total, 185 papers met the inclusion criteria; the 100 with high to moderate methodological quality were analysed in detail. Substantial heterogeneity in the group with CHD and in methodology existed. The outcome of infants with single‐ventricle CHD was inferior to those with two‐ventricle CHD (respectively: average scores for PDI 77 and 88; intelligence scores 92 and 98). Perioperative risk factors were inconsistently associated with developmental outcomes.

Interpretation

The literature on children undergoing surgery in early infancy suggests that infants with a single ventricle are at highest risk of adverse developmental outcomes.

What this paper adds

Children with complex congenital heart disease (CHD) are at increased risk of impaired developmental outcome.

Children with single‐ventricle CHD have worse outcomes than children with two‐ventricle CHD.

Children with two‐ventricle CHD gradually grow out of their initial developmental impairment.

Perioperative factors are inconsistently associated with outcome.
Modulation of respiratory network activity by forelimb and hindlimb locomotor generators
Authors: Le Gal Jean‐Patrick , Colnot Eloïse , Cardoit Laura , Bacqué-Cazenave Julien , Thoby‐Brisson Muriel , Juvin Laurent , Morin Didier
Published: March 2020

Early at the onset of exercise, breathing rate accelerates in order to anticipate the increasing metabolic demand resulting from the extra effort produced. Accordingly, the respiratory neural networks are the target of various input signals originating either centrally or peripherally. For example, during locomotion, the activation of muscle sensory afferents is able to entrain and thereby increase the frequency of spontaneous respiratory rhythmogenesis. Moreover, the lumbar spinal networks engaged in generating hindlimb locomotor rhythms are also capable of activating the medullary respiratory generators through an ascending excitatory command. However, in the context of quadrupedal locomotion, the influence of other spinal cord regions, such as cervical and thoracic segments, remains unknown. Using isolated brainstem‐spinal cord preparations from neonatal rats and mice, we show that cervicothoracic circuitry may also contribute to locomotion‐induced acceleration of respiratory cycle frequency. As previously observed for the hindlimb CPGs, the pharmacological activation of forelimb locomotor networks produces episodes of fictive locomotion that in turn increase the ongoing respiratory rhythm. Thoracic neuronal circuitry may also participate indirectly in this modulation via the activation of both cervical and lumbar CPG neurons. Furthermore, using light stimulation of CHR2‐expressing glutamatergic neurons, we found that the modulation of the respiratory rate during locomotion involves lumbar glutamatergic circuitry. Our results demonstrate that during locomotion, the respiratory rhythm‐generating networks receive excitatory ascending inputs from the spinal circuits responsible for generating and coordinating fore‐ and hindlimb movements. This constitutes a distributed central mechanism that contributes to matching breathing rate to the speed of locomotion.
Uric acid level and risk of symptomatic intracranial haemorrhage in ischaemic stroke treated with endovascular treatment
Authors: Yuan K. , Zhang X. , Chen J. , Li S. , Yang D. , Xie Y. , Xia Y. , Wu M. , Wang H. , Xu G. , Liu X.
Published: March 2020

Background and purpose

There are limited data on the association between uric acid (UA) and symptomatic intracranial haemorrhage (SICH) in patients who have undergone mechanical thrombectomy [endovascular treatment (EVT)]. In the present study, we aimed to investigate the role of serum UA level in SICH after EVT in a real‐world practice.

Methods

Patients were selected from the Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke (ACTUAL) registry. SICH was identified using the Heidelberg Bleeding Classification. Multivariable logistic regression analysis was performed to explore the relationship between serum UA and SICH.

Results

Among 611 enrolled patients, 90 (14.7%) were diagnosed with SICH within 72 h after EVT. Patients with SICH had a significantly higher level of serum UA (median, 341.0 vs. 302.0 μmol/L; P = 0.003) than those without SICH. Univariate logistic regression analysis indicated that patients with UA levels in the fourth quartile, compared with the first quartile, were more likely to have SICH (odds ratio, 2.846; 95% confidence intervals, 1.429–6.003; P = 0.003). The association remained significant after multivariable adjustment for potential confounders. Furthermore, the multiple‐adjusted spline regression model showed an inverted U‐shaped association between UA and SICH (P = 0.047 for non‐linearity).

Conclusion

Our study indicated that increased serum UA level was independently associated with SICH after EVT in acute ischaemic stroke.
A longitudinal study on α‐synuclein in plasma neuronal exosomes as a biomarker for Parkinson’s disease development and progression
Authors: Niu M. , Li Y. , Li G. , Zhou L. , Luo N. , Yao M. , Kang W. , Liu J.
Published: March 2020

Background and purpose

The identification of reliable diagnostic and prognostic biomarkers for Parkinson's disease (PD) is urgently needed. Here, we explored the potential use of α‐synuclein (α‐syn) in plasma neuronal exosomes as a biomarker for early PD diagnosis and disease progression.

Methods

This study included both cross‐sectional and longitudinal designs. The subjects included 36 patients with early‐stage PD, 17 patients with advanced PD, 20 patients with idiopathic rapid eye movement sleep behavior disorder and 21 healthy controls (HCs). α‐syn levels were measured by electrochemiluminescence immunoassay. A subgroup of patients with early‐stage PD (n = 18) participated in a follow‐up examination with repeated blood collection and clinical assessments after an average of 22 months.

Results

The α‐syn levels in plasma neuronal exosomes were significantly higher in patients with early‐stage PD compared with HCs (P = 0.007). Differences in α‐syn levels between patients with idiopathic rapid eye movement sleep behavior disorder and HCs did not reach statistical significance (P = 0.08). In addition, Spearman correlation analysis revealed that neuronal exosomal α‐syn concentrations were correlated with Movement Disorders Society Unified Parkinson's Disease Rating Scale III/(I + II + III) scores, Non‐Motor Symptom Questionnaire scores and Sniffin' Sticks 16‐item test scores of patients with PD (P < 0.05). After a mean follow‐up of 22 months in patients with early‐stage PD, a Cox regression analysis adjusted for age and gender showed that longitudinally increased α‐syn rather than baseline α‐syn levels were associated with higher risk for motor symptom progression in PD (P = 0.039).

Conclusions

Our results suggested that α‐syn in plasma neuronal exosomes may serve as a biomarker to aid early diagnosis of PD and also as a prognostic marker for PD progression.
The development of oral ability in L2 Spanish by English‐home language learners in a TWI program
Authors: Ruiz‐Funes Marcela T.
Published: March 2020

This study reports on a small‐scale, longitudinal investigation on L2 Spanish oral development by English‐home language (EHL) learners in an English/Spanish Two‐Way Immersion (TWI) program in rural, eastern United States. It examined EHL learners' oral ability in L2 Spanish based on longitudinal assessment data from Kindergarten, Grade 2, and Grade 5 in two ways: (a) ratings of students' speech samples and (b) linguistic analysis of the speech samples. Ratings of the students' speech samples were elicited with the SOPA/COPE rating scale and the FLOSEM. In addition, linguistic analyses of the speech samples were performed quantitatively and qualitatively. Findings indicate steady progress from one grade level to the next, along with a marked use of codemixing in Grades 2 and 5. This article provides empirical evidence to inform curriculum design, identify areas in need of future research, and reexamine L2 oral assessment tools.
Running the trophic gauntlet: Empirical support for reduced foraging success in juvenile salmon in tidally mixed coastal waters
Authors: James Samantha E. , Pakhomov Evgeny A. , Mahara Natalie , Hunt Brian P. V.
Published: March 2020

The productivity of Fraser River sockeye salmon has declined in recent years, with 2019 being the lowest return on record. The cause of the decline is still not fully understood; however, bottom‐up drivers and trophic interactions during the early marine migration are considered to be important contributing factors. McKinnell et al. (Fisheries Oceanography, 23, 2014 and 322) developed a “trophic gauntlet hypothesis,” proposing that low biological productivity leads to an energy deficit from poor foraging opportunities in migrating salmon. When combined with poor foraging conditions in typically productive waters elsewhere on the migration, low marine survival may result. Our study examined prey availability and stomach fullness of juvenile sockeye salmon along the 120 km stretch of the coastal migration through the Discovery Islands and Johnstone Strait to determine whether this section of the migration is indeed food limited. We observed low stomach fullness throughout tidally mixed waters, providing empirical support for the trophic gauntlet hypothesis. Zooplankton abundance was high in these regions so it appeared that unfavourably small prey size may have been the cause of low foraging success. We also observed foraging hotspots at both ends of the gauntlet, indicating that such areas may be key feeding grounds for migratory salmon.
New protest history: Exploring the historical geographies and geographical histories of resistance through gender, practice, and materiality
Authors: Awcock Hannah
Published: March 2020

Over the last 20 years, the study of the history and historical geography of resistance has drawn on trends within the disciplines of history and geography to develop into a subfield known as “new protest history.” The geographical background and approach of many of the scholars in the field means that “new protest historical geography” would be a more accurate, if less eloquent, descriptor. This article defines new protest history and explores its contributions to understandings of the geographies of resistance using three key themes: gender, practice, and materiality. In the process, I identify three avenues for future research: intersectionality, taskscapes, and activist historical geography.
Usefulness of the Geriatric Nutritional Risk Index to predict the severity of cholecystitis among older patients in the emergency department
Authors: Lee Jong Seok , Jeong Ki Young , Ko Seok Hoon
Published: March 2020

Aim

We sought to investigate whether the Geriatric Nutritional Risk Index is associated with systemic organ dysfunction among older patients who present with cholecystitis to the emergency department.

Methods

This was an observational retrospective study among consecutive older patients with cholecystitis in the emergency department from 2012 to 2018. We collected baseline characteristics and laboratory data, and re‐categorized the Geriatric Nutritional Risk Index into three risk groups. We carried out univariate and multivariate analyses to identify factors associated with systemic organ dysfunction. Logistic regression was used for statistical analysis.

Results

A total of 303 patients were included in this study. The median age of participants was 74 years (interquartile range 68–79 years). The overall proportion of systemic organ dysfunction was 26.4%. The Geriatric Nutritional Risk Index was stratified as: ≥98 (n = 183, systemic organ dysfunction 15.3%), 87 to <98 (n = 90, systemic organ dysfunction 38.9%) and <87 (n = 30, systemic organ dysfunction 56.7%). Multivariate analysis using a logistic regression model showed that age, respiratory rate, temperature, geriatric nutritional risk index and quick Sepsis‐related Organ Failure Assessment score in the emergency department were independently associated with systemic organ dysfunction in patients with cholecystitis.

Conclusions

The Geriatric Nutritional Risk Index was recognized as an independent factor associated with systemic organ dysfunction in older patients in the emergency department who presented with cholecystitis. This index might be helpful in screening patient risk and deciding whether to carry out further tests. Geriatr Gerontol Int 2020; 20: 455–460.
Morphological characterization and photocatalytic efficiency measurements of pure silica transparent open‐cell sponges coated with TiO2
Authors: Löffler Frank B. , Altermann Fabian J. , Bucharsky Ethel C. , Schell Karl G. , Vera Maria L. , Traid Hernan , Dwojak Anabela , Litter Marta I.
Published: March 2020

Transparent glass sponges are a new class of materials that can potentially be used for effective light distribution in photocatalytic applications. In this work, transparent glass sponges are prepared by the polymer replica technique and coated with TiO2 to obtain a highly efficient photocatalytic material. Necessary conditions for obtaining transparent open‐celled glass sponges are presented. The structure is characterized by employing light microscopy and scanning electron microscopy. In addition, µ‐computer tomography (µ‐CT) volume image analysis was performed that allows the calculation of geometrical parameters like pore size and specific surface area (SSA) of the structure, required for application of the new material. For photocatalytic application, the sponges have been coated with titanium dioxide (TiO2) by immersion in a suspension of TiO2 nanoparticles. The activity of the resulting coatings has been tested with the model reaction of transformation of Cr(VI) to Cr(III) in aqueous solutions in the presence of EDTA at pH 2. The reaction kinetics could be adjusted to a pseudo‐first order reaction and the obtained rate constants have been employed to evaluate the photocatalytic activity. The activity of the sponges has been compared with that of samples of glass plates coated with TiO2; it has been found that the sponges exhibited a higher catalytic activity than the glass plates. The photocatalytic activity increased with the porosity of the sponges, and the optimum sample was determined based on its photocatalytic performance and its mechanical stability. The results are promissory for application in photoreactors for transformation of pollutants in water and air decontamination.
Measuring personal recovery in people with a psychotic disorder based on CHIME: A comparison of three validated measures
Authors: Vogel Jelle Sjoerd , Bruins Jojanneke , Halbersma Levi , Lieben Rianne Janine , de Jong Steven , van der Gaag Mark , Castelein Stynke
Published: March 2020

Living well in spite of residual symptoms of mental illness is measured with the construct of personal recovery. The CHIME framework might be suitable to evaluate personal recovery measures and guide instrument choice. Three validated measures were evaluated in Dutch patients with a psychotic disorder (N = 52). We compared the Recovery Assessment Scale (RAS), the Mental Health Recovery Measure (MHRM), and the Netherlands Empowerment List (NEL). The measures were assessed on six criteria: content validity (based on CHIME), convergent validity with a social support measure, internal consistency, floor and ceiling effects, item interpretability, and ease of administration. The MHRM scored high on content validity with a balanced distribution of items covering the CHIME framework. The MHRM and the NEL showed moderate convergent validity with social support. In all three measures, internal consistency was moderate and floor and ceiling effects were absent. The NEL scores demonstrated a high degree of item interpretability. Ease of administration was moderate for all three measures. Finally, the CHIME framework demonstrated good utility as a framework in guiding instrument choice and evaluation of personal recovery measures. The MHRM showed the best overall result. However, differences between measures were minimal. Generalization of the results is limited by cultural and linguistic factors in the assessment for the subjective measures (i.e. content validity and item interpretability). The broad and multidimensional construct of personal recovery might lead to ambiguous interpretations. Scientific consensus on a well‐defined personal recovery construct is needed.
Construction of carbon quantum dots embed α‐Co/Ni(OH)2 hollow nanocages with enhanced supercapacitor performance
Authors: Bao Yuxiang , Liu Peng , Zhang Jiaxin , Wang Lei , Wang Minghui , Mei Hao , Zhang Qi , Chen Chao , Xiao Zhenyu
Published: March 2020

The etching strategy of metal‐organic frameworks is an effective process to prepare hollow electrode materials for enhanced electrochemical performance. But the relatively low conductivity of these electrode materials limits their further application. In this work, a series of carbon quantum dots (CQDs) embedded ZIF‐67 precursors (ZIF‐67@CQDs‐X, X = 1.25, 2.50, 5.00, 7.50) are synthesized firstly. Then, by a facile and controllable chemical etching process, the CQDs doped α‐Co/Ni(OH)2 hollow nanocages (α‐Co/Ni(OH)2@CQDs‐X, X = 1.25, 2.50, 5.00, 7.50) are successfully constructed. The optimized α‐Co/Ni(OH)2@CQDs‐2.50 electrode delivers a high specific surface area (277.99 m2 g−1) and dramatically enhanced conductivity. Therefore, α‐Co/Ni(OH)2@CQDs‐2.50 electrode presents a high specific capacitance (700 C g−1, 1 A g−1), superior rate performance (550 C g−1, 10 A g−1) and excellent cycling lifespan (retaining 79.93% of initial capacitance after 10 000 cycles). Coupled with the high‐performance PPD/rGO as a negative electrode, the fabricated Co/Ni(OH)2@CQDs‐2.50//PPD/rGO device exhibits an outstanding energy density of 57.29 Wh kg−1 at the power density of 0.375 kW kg−1. It is proved that the CQDs embedding and chemical etching strategy are an effective way for constructing hollow materials with enhanced energy storage performance.
Identification of hub genes and pathways in adrenocortical carcinoma by integrated bioinformatic analysis
Authors: Guo Jinshuai , Gu Yinzhong , Ma Xiaoyu , Zhang Lu , Li Huimin , Yan Zhongyi , Han Yali , Xie Longxiang , Guo Xiangqian
Published: March 2020

Adrenocortical carcinoma (ACC), a rare malignant neoplasm originating from adrenal cortical cells, has high malignancy and few treatments. Therefore, it is necessary to explore the molecular mechanism of tumorigenesis, screen and verify potential biomarkers, which will provide new clues for the treatment and diagnosis of ACC. In this paper, three gene expression profiles (GSE10927, GSE12368 and GSE90713) were downloaded from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) were obtained using the Limma package. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were enriched by DAVID. Protein‐protein interaction (PPI) network was evaluated by STRING database, and PPI network was constructed by Cytoscape. Finally, GEPIA was used to validate hub genes’ expression. Compared with normal adrenal tissues, 74 up‐regulated DEGs and 126 down‐regulated DEGs were found in ACC samples; GO analysis showed that up‐regulated DEGs were enriched in organelle fission, nuclear division, spindle, et al, while down‐regulated DEGs were enriched in angiogenesis, proteinaceous extracellular matrix and growth factor activity; KEGG pathway analysis showed that up‐regulated DEGs were significantly enriched in cell cycle, cellular senescence and progesterone‐mediated oocyte maturation; Nine hub genes (CCNB1, CDK1, TOP2A, CCNA2, CDKN3, MAD2L1, RACGAP1, BUB1 and CCNB2) were identified by PPI network; ACC patients with high expression of 9 hub genes were all associated with worse overall survival (OS). These hub genes and pathways might be involved in the tumorigenesis, which will offer the opportunities to develop the new therapeutic targets of ACC.