bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating Tau-U With Oral Reading Fluency Data and the Impact of Measurement Error
Authors: Klingbeil David A. , Van Norman Ethan R. , McLendon Katherine E. , Ross Sarah G. , Begeny John C.
Published: March 2018

Recently, researchers have argued that using quantitative effect sizes in single-case design (SCD) research may facilitate the identification evidence-based practices. Indices to quantify nonoverlap are among the most common methods for quantifying treatment effects in SCD research. Tau-U represents a family of effect size indices that were developed to address criticisms of previously developed measures of nonoverlap. However, more research is necessary to determine the extent to which Tau-U successfully addresses proposed limitations of other nonoverlap methods. This study evaluated Tau-U effect sizes, derived from multiple-baseline designs, where researchers used curriculum-based measures of reading (CBM-R) to measure reading fluency. Specifically, we evaluated the distribution of the summary Tau-U statistic when applied to a large set of CBM-R data and assessed how the variability inherent in CBM-R data may influence the obtained Tau-U values. Findings suggest that the summary Tau-U statistic may be susceptible to ceiling effects. Moreover, the results provide initial evidence that error inherent in CBM-R scores may have a small but meaningful influence on the obtained effect sizes. Implications and recommendations for research and practice are discussed.
Intergroup Leadership Across Distinct Subgroups and Identities
Authors: Rast David E. , Hogg Michael A. , van Knippenberg Daan
Published: March 2018

Resolving intergroup conflict is a significant and often arduous leadership challenge, yet existing theory and research rarely, if ever, discuss or examine this situation. Leaders confront a significant challenge when they provide leadership across deep divisions between distinct subgroups defined by self-contained identities—The challenge is to avoid provoking subgroup identity distinctiveness threat. Drawing on intergroup leadership theory, three studies were conducted to test the core hypothesis that, where identity threat exists, leaders promoting an intergroup relational identity will be better evaluated and are more effective than leaders promoting a collective identity; in the absence of threat, leaders promoting a collective identity will prevail. Studies 1 and 2 ( N = 170; N = 120) supported this general proposition. Study 3 ( N = 136) extended these findings, showing that leaders promoting an intergroup relational identity, but not a collective identity, improved intergroup attitudes when participants experienced an identity distinctiveness threat.
Outcomes of Surgical Treatment for Anterior Tibial Stress Fractures in Athletes: A Systematic Review
Authors: Chaudhry Zaira S. , Raikin Steven M. , Harwood Marc I. , Bishop Meghan E. , Ciccotti Michael G. , Hammoud Sommer
Published: March 2018

Background:

Although most anterior tibial stress fractures heal with nonoperative treatment, some may require surgical management. To our knowledge, no systematic review has been conducted regarding surgical treatment strategies for the management of chronic anterior tibial stress fractures from which general conclusions can be drawn regarding optimal treatment in high-performance athletes.

Purpose:

This systematic review was conducted to evaluate the surgical outcomes of anterior tibial stress fractures in high-performance athletes.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

In February 2017, a systematic review of the PubMed, MEDLINE, Cochrane, SPORTDiscus, and CINAHL databases was performed to identify studies that reported surgical outcomes for anterior tibial stress fractures. Articles meeting the inclusion criteria were screened, and reported outcome measures were documented.

Results:

A total of 12 studies, published between 1984 and 2015, reporting outcomes for the surgical treatment of anterior tibial stress fractures were included in this review. All studies were retrospective case series. Collectively, surgical outcomes for 115 patients (74 males; 41 females) with 123 fractures were evaluated in this review. The overall mean follow-up was 23.3 months. The most common surgical treatment method reported in the literature was compression plating (n = 52) followed by drilling (n = 33). Symptom resolution was achieved in 108 of 123 surgically treated fractures (87.8%). There were 32 reports of complications, resulting in an overall complication rate of 27.8%. Subsequent tibial fractures were reported in 8 patients (7.0%). Moreover, a total of 17 patients (14.8%) underwent a subsequent procedure after their initial surgery. Following surgical treatment for anterior tibial stress fracture, 94.7% of patients were able to return to sports.

Conclusion:

The available literature indicates that surgical treatment of anterior tibial stress fractures is associated with a high rate of symptom resolution and return to play in athletes, although the high complication rate and potential need for subsequent procedures are important considerations for surgeons and patients.
Youth Mental Health Should Be a Top Priority for Health Care in Canada
Authors: Malla Ashok , Shah Jai , Iyer Srividya , Boksa Patricia , Joober Ridha , Andersson Neil , Lal Shalini , Fuhrer Rebecca
Published: March 2018

In this article we have provided a perspective on the importance and value of youth mental health services for society and argued that advancing youth mental health services should be the number one priority of health services in Canada. Using the age period of 12–25 years for defining youth, we have provided justification for our position based on scientific evidence derived from clinical, epidemiological and neurodevelopmental studies. We have highlighted the early onset of most mental disorders and substance abuse as well as their persistence into later adulthood, the long delays experienced by most help seekers and the consequence of such delays for young people and for society in general. We have also provided a brief review of the current gross inadequacies in access and quality of care available in Canada. We have argued for the need for a different conceptual framework of youth mental disorders as well as for a transformation of the way services are provided in order not only to reduce the unmet needs but also to allow a more meaningful exploration of the nature of such problems presenting in youth and the best way to treat them. We have offered some ideas based on previous work completed in this field as well as current initiatives in Canada and elsewhere. Any transformation of youth mental health services in Canada must take into consideration the significant geographic, cultural and political diversity across the provinces, territories and indigenous peoples across this country.
Acid-labile poly(ethylene glycol) shell of hydrazone-containing biodegradable polymeric micelles facilitating anticancer drug delivery
Authors: Xu Jing , Qin Benkai , Luan Shujuan , Qi Peilan , Wang Yingying , Wang Kai , Song Shiyong
Published: March 2018

Biodegradable pH-sensitive amphiphilic block polymer (mPEG-Hyde-PLGA) was synthesized via ring-opening polymerization, initiated from a hydrazone-containing macro-initiator. In this way, a pH-sensitive hydrazone bond was inserted into the backbone of block copolymer, linking hydrophilic poly(ethylene glycol) segment and hydrophobic poly(lactic-co-glycolic acid) segment. The copolymer self-assembled to form stable micelles with mean diameters below 100 nm and served as a drug delivery system for doxorubicin, with drug loading content of 5.3%. pH sensitivity of the hydrazone-containing micelles was investigated by changes in diameter and size distribution observed by dynamic light scattering measurements when the micelles were encountered to acidic medium. Small pieces and larger aggregates were found by transmission electron microscopy resulting from the disassociation of the micelles in acidic conditions. It was also noted that doxorubicin release from the pH-sensitive micelles is significantly faster at pH 4.0 and pH 5.0 compared to pH 7.4, while almost no difference was detected in the case of pH non-sensitive micelles. MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assays on HepG-2 and MCF-7 cells revealed that doxorubicin-loaded pH-sensitive micelles had higher antitumor activity than pH-insensitive ones. This pH-sensitive drug delivery system based on hydrazone-containing block copolymer has been proved as a promising drug formulation for cancer therapy.
The Secondary Traumatic Stress Scale: Confirmatory Factor Analyses With a National Sample of Victim Advocates
Authors: Benuto Lorraine T. , Yang Yueran , Ahrendt Andrew , Cummings Caroline
Published: March 2018

Secondary traumatic stress (STS) is a pattern of psychological symptoms that approximates the symptoms of posttraumatic stress disorder (PTSD) and occurs in professionals who are exposed to individuals who have experienced trauma. While victim advocates are frontline health professionals who are trained to support victims of crime and interpersonal violence and are at risk for developing STS, they have been largely neglected in the extant literature on STS. The STS Scale (STSS) is a 17-item self-report questionnaire utilized to assess frequency of symptoms of intrusion, avoidance, and arousal, specifically related to providing services to victims of trauma. The purpose of this study was to investigate the psychometric properties of the STSS with a sample of victim advocates ( N = 135) using confirmatory factor analysis (CFA). Results indicated that both a single-factor model and three-factor model were equivalent. This study represents a first attempt to validate a measure of STS among victim advocates, a unique and understudied population who are at risk for developing STS given their work with individuals who have experienced interpersonal violence. Establishing effective, easy to administer, and efficient measures of STS is important given that this population encounters secondary trauma on a regular basis in the context of their job. While additional theoretical work regarding the construct of STS is needed, the STSS did demonstrate high reliability with this population and thus can be used as part of the assessment of STS among victim advocates.
Transphobia-Based Violence, Depression, and Anxiety in Transgender Women: The Role of Body Satisfaction
Authors: Klemmer Cary L. , Arayasirikul Sean , Raymond Henry F.
Published: March 2018

Psychological processes may mediate the relationship between minority stress and mental health though limited data exist showing this pathway among trans women. Trans women’s degree of satisfaction with their body is associated with mental health outcomes. This study used a model of minority stress to explore for indirect effects on the association between transphobia-based victimization and anxiety and depression through one’s degree of body satisfaction. Analysis also explored for racial differences. Transgender women ( N = 233) were recruited in 2013 using respondent-driven sampling. Sociodemographics, transphobia-based victimization experiences such as having been physically abused, body satisfaction, and mental health were measured. Analyses assessed for direct and indirect associations while controlling for gender confirmation therapies (i.e., cross-sex hormone therapy and gender confirmation surgeries) and racial identity; 57% reported depression and 42.1% reported anxiety diagnoses. Participants averaged nearly three of six assessed violence experiences. More than 20% reported low body satisfaction. Contrary to authors’ expectations, those reporting African American and Other racial identity experienced less transphobia-based violence than whites. Transphobia-based violence was significantly associated with anxiety, depression, and body satisfaction. Body satisfaction was associated with mental health diagnoses. Bootstrapping revealed significant indirect and total effects. Body satisfaction mediated the relationship between transphobia-based violence and mental health. Clinical intervention that promotes body satisfaction including access to gender confirmation therapies, especially hormone therapy, may prevent negative mental health outcomes among trans women. Individual intervention, however, is not a panacea for structural discrimination. Attention to structural interventions that reduce gender minority stressors including transphobia-based violence is necessary.
Identity Abuse as a Tactic of Violence in LGBTQ Communities: Initial Validation of the Identity Abuse Measure
Authors: Woulfe Julie M. , Goodman Lisa A.
Published: March 2018

Intimate partner violence (IPV; i.e., physical, sexual, or psychological abuse by a current or former partner) remains a public health concern with devastating personal and societal costs. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals are also vulnerable to a dimension of IPV called identity abuse (IA); that is, abuse tactics that leverage systemic oppression to harm an individual. Yet, we know little about its relative prevalence in subgroups of the LGBTQ community. This study developed and evaluated a measure of IA, and explored its prevalence in a sample of 734 sexual minority adults. The sample included women (53.1%), men (27.4%), and transgender or gender nonconforming “TGNC” (19.3%) participants. The majority of participants identified as queer or pansexual (38.7%), then gay (23.6%), lesbian (22.8%), and bisexual (13.6%). Participants completed an online survey that included measures of IA and physical, sexual, and psychological abuse. The IA items formed a unidimensional factor structure with strong internal consistency and construct validity. Nearly one fifth of the sample (16.8%) experienced past year IA and 40.1% reported adult IA. Women experienced greater exposure to IA in adulthood than men, and TGNC participants reported higher rates of IA in adulthood and in the last year compared to their cisgender counterparts. The odds of queer or bisexual participants reporting IA in adulthood were almost three times higher than gay participants, and two times higher than lesbian participants. Findings have implications for advancing assessment of partner abuse in the LGBTQ community, LGBTQ-competent clinical care, and training of practitioners.
Phenotypic and genotypic characteristics of Trueperella pyogenes isolated from ruminants
Authors: Rogovskyy Artem S. , Lawhon Sara , Kuczmanski Kathryn , Gillis David C. , Wu Jing , Hurley Helen , Rogovska Yuliya V. , Konganti Kranti , Yang Ching-Yuan , Duncan Kay
Published: March 2018

Trueperella pyogenes is an opportunistic pathogen that causes suppurative infections in animals including humans. Data on phenotypic and genotypic properties of T. pyogenes isolated from ruminants, particularly goats and sheep, are lacking. We characterized, by phenotypic and genotypic means, T. pyogenes of caprine and ovine origin, and established their phylogenetic relationship with isolates from other ruminants. T. pyogenes isolates ( n = 50) from diagnostic specimens of bovine ( n = 25), caprine ( n = 19), and ovine ( n = 6) origin were analyzed. Overall, variable biochemical activities were observed among the T. pyogenes isolates. The fimbriae-encoding gene, fimE, and neuraminidase-encoding gene, nanH, were, respectively, more frequently detected in the large ( p = 0.0006) and small ( p = 0.0001) ruminant isolates. Moreover, genotype V ( plo/ nanH/ nanP/ fimA/ fimC) was only detected in the caprine and ovine isolates, whereas genotype IX ( plo/ nanP/ fimA/ fimC/ fimE) was solely present in the isolates of bovine origin ( p = 0.0223). The 16S rRNA gene sequences of all T. pyogenes isolates were clustered with the reference T. pyogenes strain ATCC 19411 and displayed a high degree of identity to each other. Our results highlight phenotypic and genotypic diversity among ruminant isolates of T. pyogenes and reinforce the importance of characterization of more clinical isolates to better understand the pathogenesis of this bacterium in different animal species.
Excess EDTA interferes with cortisol measurement using a solid-phase, chemiluminescent enzyme immunoassay
Authors: Kemppainen Robert J. , Behrend Ellen N. , Carter Stephanie F. , Cole Janeva E.
Published: March 2018

Hormone assays that use a solid-phase, automated, chemiluminescent enzyme immunoassay (CEIA) with an alkaline phosphatase–tagged hormone or antibody as a reporter are performed on serum or EDTA plasma in our laboratory. CEIA cortisol results appeared to increase in the presence of excess EDTA. We investigated the effect of the addition of different amounts of EDTA on cortisol concentrations in pooled canine serum samples. The recommended EDTA plasma concentration of 4.1 mmol/L (1.8 mg/mL) did not alter cortisol concentrations when added to serum pools; however, the addition of ≥5.1 mmol/L (2.25 mg/mL) of EDTA increased apparent concentrations of cortisol. Supplementation of serum samples with MgCl2 to 5 mmol/L reversed the effect of EDTA up to a concentration of ~8.1 mmol/L (3.6 mg/mL). Our findings show that CEIA cortisol results on EDTA plasma can be artificially increased if the EDTA concentration exceeds 5.1 mmol/L.
A Parent’s Perceptions of Physical and Emotional Sibling Violence
Authors: Perkins Nathan H. , Shadik Jennifer A.
Published: March 2018

The inclusion of parental perspectives in research on physical and emotional sibling violence has been minimal, with parents of various ethnic backgrounds being particularly absent from the literature. Drawing on witnessed interactions with her own children and her personal experiences with a sibling in childhood, this article presents a view of physical and emotional sibling violence from the perspective of an African American parent identified by social services to be at risk for child abuse and neglect. Themes emerging from the interview center around the intersection of sibling violence and parental/family stress, parental normalization of violence between siblings, witnessing community violence, sibling versus peer fighting, and ways to address/prevent sibling violence. The need for more ethnically and socioeconomically inclusive research related to physical and emotional sibling violence is highlighted along with a discussion of practice implications as mechanisms for intervention.
News Engagement on Social Media and Democratic Citizenship: Direct and Moderating Roles of Curatorial News Use in Political Involvement
Authors: Park Chang Sup , Kaye Barbara K.
Published: March 2018

Social media allow users not only to read news, but also to evaluate, reconstruct, and share it. This study conceptualizes curatorial news use via social media as an important news use behavior, which involves evaluating the existing news, adding new values by reconstructing it, and then sharing it with other social media users. An analysis of survey data from 650 South Korean adults shows that curatorial news use on social media has a significantly positive association with political knowledge, internal political efficacy, and offline and online political participation. The interaction of social media news use and curatorial news use is also significantly associated with high levels of political knowledge and political participation.
A Canadian Population-Based Cohort to the Study Cost and Burden of Surgically Resected Hidradenitis Suppurativa
Authors: Mehdizadeh Ali , Rosella Laura , Alavi Afsaneh , Sibbald Gary , Farzanfar Delaram , Hazrati Ali , Vernich Lee , Laporte Audrey , Hu Howard , Bashash Morteza
Published: March 2018

Background:

Hidradenitis suppurativa (HS) is a chronic debilitating disease with long-lasting comorbidities that impose direct and indirect costs on the health care system. However, limited studies have estimated the burden of this disease in Canada, and no population-based studies have previously addressed this condition.

Objectives:

This work describes the characteristics of a population-based HS cohort to address the existing knowledge gap on the burden of HS for the Canadian health care system. This cohort will provide a foundation for further studies about clinical outcomes and risk factors of HS by providing opportunities for merging additional databases.

Methods:

Data on demographic information, morbidities, relative resource use, and the cost of sectorial services were obtained from the Institute for Clinical Evaluative Sciences (ICES). All residents of Ontario covered by the Ontario Health Insurance Plan (OHIP) between April 1, 2002, and March 31, 2013, who underwent surgery for HS, defined by OHIP billing codes, were included.

Results:

A total of 6244 cases were included in the analysis, following quality control procedures. Twice as many females were treated surgically relative to males. The majority of individuals treated were under the age of 64, with more than half having a moderate level of morbidity (according to Resource Utilization Bands defined by the Johns Hopkins Adjusted Clinical Group Classification System).

Conclusions:

This cohort study is the first population-based resource about HS in Canada. Administrative population-based databases provide essential information to assess the burden of chronic diseases and identify factors associated with higher cost.
Going back to school – An opportunity for lifelong learning for people with dementia in Denmark (Innovative practice)
Authors: Ward Alison , Alberg Sorensen Kim , Kousgaard Helle , Schack Thoft Diana , Parkes Jacqueline
Published: March 2018

The provision of lifelong learning for older people is often promoted as a way of engaging socially and maintaining cognitive function. The concept is also used with people with dementia, but is often limited to short-term programmes. Innovative practice from Denmark takes this concept further, offering people with early stage dementia the opportunity to return to school to attend classes in cognitive training, music, art and woodcraft. A pilot study conducted by the school of teaching and communication (Voksenskolen For Undervisning og Kommunikation) offers evidence for the benefits of prolonged educational programmes for people with dementia in maintaining decision-making, cognitive function and social interactions, with limited evidence of the impact on memory. Further evidence is required to understand the impact of a person with dementia attending school as a student and to understand if this concept is transferrable to a different cultural setting.
Endovascular Treatment of Symptomatic Thoracic Aneurysm Due to Periaortic Lymphoma
Authors: Raupach Jan , Vales Jan , Vojacek Jan , Hoffmann Petr , Lojik Miroslav , Kamaradova Katerina , Cabelkova Pavla , Chovanec Vendelin , Renc Ondrej , Krajina Antonin , Maly Radovan
Published: March 2018

An aggressive periaortic lymphoma could very rarely invade the aortic wall. We present a unique case of a patient with symptomatic thoracic aneurysm and imminent rupture due to the periaortic lymphoma, in which endovascular treatment using stent graft was applied. After stabilization of the aorta and histological confirmation of aggressive B-cell lymphoma by computed tomography–guided biopsy, the antilymphoma therapy was initiated. Despite the full treatment, the patient died 12 months later.
Deep Brachial Artery Pseudoaneurysm Following Arthroscopic Shoulder Debridement
Authors: Yang Andrew E. , Hall Jamie M. , Vincent Gilford S. , Chambers Lowell
Published: March 2018

Vascular injuries resulting from arthroscopic surgeries are rare with a reported incidence of 0.005% of elective orthopedic procedures. We report a case of a 49-year-old male who developed a deep brachial artery pseudoaneurysm following an arthroscopic shoulder debridement and lysis of adhesions. He was successfully embolized with resolution of the pseudoaneurysm within 6 weeks of treatment. A review of the literature demonstrates that pseudoaneurysm formation after arthroscopic procedures is rare and pseudoaneurysms of the deep brachial artery have yet to be reported.
Adolescents' mental health, help seeking and service use and parents' perception of family functioning
Authors: Moen Øyfrid Larsen , Hall-Lord Marie Louise
Published: March 2018

The adolescent population is facing mental-health challenges such as depression and anxiety. The aim of this study was to describe and investigate the mental health of adolescents, their relation to their parents, who they contact for help and their healthcare service use. A further objective was to describe and investigate family functioning in parents. A cross-sectional design was employed using register data from a survey of adolescents ( n = 46,961), and surveys were conducted of two groups of parents – one group of parents with children with attention deficit hyperactivity disorder ( n = 264) and one group of parents with school children ( n = 157). Descriptive and comparative statistics were used. Of the adolescents, 5.65% were quite distressed. This group of adolescents would be less likely to seek help from friends and parents than the other adolescents. They were also more likely to use all types of healthcare services, and parents reported that they avoided discussing fears and concerns. School nurses are low-threshold professionals who can contribute in early support and interventions, providing service to all school pupils with an open-door policy. The use of family conversations focusing on strengths and resources may help the families to talk about difficult matters and highlight the resources in the family.
Postoperative Delirium After Esophagectomy: The Efficacy of Continual Monitoring Using the NEECHAM Confusion Scale
Authors: Ono Hiroshi , Doki Yuichiro , Miyata Hiroshi , Yamasaki Makoto , Takahashi Tsuyoshi , Endo Yoshimi , Umeshita Koji
Published: March 2018

Abstract Background

Although a majority of nurses understand that delirium is a major issue in perioperative care, professional barriers to routine monitoring using delirium assessment tools exist. The aim of this study was to assess the effectiveness of continual monitoring of postoperative delirium in patients that have undergone esophagectomy using the Neelon and Champagne (NEECHAM) Confusion Scale (NCS).

Methods

Demographic data and case histories were obtained from medical records. We conducted NCS scoring for 1 week after surgery and verified the daily changes in scores. Patients were classified into normal, neurocognitive-change, and complication groups for the analysis of the influence of preoperative neurocognitive changes and postoperative complications.

Results

Data from 19 patients were analyzed. NCS scores decreased sharply on the first day and then significantly recovered each day. The normal group exhibited a steady recovery process, but the other groups deviated from this progression. The incidence of delirium was highest on the first day. The incidence in the normal group decreased each day, but other groups developed delirium for an extended time. In the NCS subscale score analyses, the information processing score was low in the neurocognitive-change group. The complication group exhibited delayed recovery of the physiologic control score.

Conclusions

We observed the recovery process of mental function after esophagectomy as well as the impact of preoperative neurocognitive changes and postoperative complications. Continual monitoring of postoperative mental function may predict postoperative delirium. For early detection and prevention of delirium, nurses should monitor postoperative mental function via daily observation.
Selumetinib in Combination With Dacarbazine in Patients With Metastatic Uveal Melanoma: A Phase III, Multicenter, Randomized Trial (SUMIT)
Authors: Carvajal Richard D. , Piperno-Neumann Sophie , Kapiteijn Ellen , Chapman Paul B. , Frank Stephen , Joshua Anthony M. , Piulats Josep M. , Wolter Pascal , Cocquyt Veronique , Chmielowski Bartosz , Evans T.R. Jeffry , Gastaud Lauris , Linette Gerald , Berking Carola , Schachter Jacob , Rodrigues Manuel J. , Shoushtari Alexander N. , Clemett Delyth , Ghiorghiu Dana , Mariani Gabriella , Spratt Shirley , Lovick Susan , Barker Peter , Kilgour Elaine , Lai Zhongwu , Schwartz Gary K. , Nathan Paul
Published: March 2018

Purpose

Uveal melanoma is the most common primary intraocular malignancy in adults with no effective systemic treatment option in the metastatic setting. Selumetinib (AZD6244, ARRY-142886) is an oral, potent, and selective MEK1/2 inhibitor with a short half-life, which demonstrated single-agent activity in patients with metastatic uveal melanoma in a randomized phase II trial.

Methods

The Selumetinib (AZD6244: ARRY-142886) (Hyd-Sulfate) in Metastatic Uveal Melanoma (SUMIT) study was a phase III, double-blind trial ( ClinicalTrial.gov identifier: NCT01974752) in which patients with metastatic uveal melanoma and no prior systemic therapy were randomly assigned (3:1) to selumetinib (75 mg twice daily) plus dacarbazine (1,000 mg/m2 intravenously on day 1 of every 21-day cycle) or placebo plus dacarbazine. The primary end point was progression-free survival (PFS) by blinded independent central radiologic review. Secondary end points included overall survival and objective response rate.

Results

A total of 129 patients were randomly assigned to receive selumetinib plus dacarbazine (n = 97) or placebo plus dacarbazine (n = 32). In the selumetinib plus dacarbazine group, 82 patients (85%) experienced a PFS event, compared with 24 (75%) in the placebo plus dacarbazine group (median, 2.8 v 1.8 months); the hazard ratio for PFS was 0.78 (95% CI, 0.48 to 1.27; two-sided P = .32). The objective response rate was 3% with selumetinib plus dacarbazine and 0% with placebo plus dacarbazine (two-sided P = .36). At 37% maturity (n = 48 deaths), analysis of overall survival gave a hazard ratio of 0.75 (95% CI, 0.39 to 1.46; two-sided P = .40). The most frequently reported adverse events (selumetinib plus dacarbazine v placebo plus dacarbazine) were nausea (62% v 19%), rash (57% v 6%), fatigue (44% v 47%), diarrhea (44% v 22%), and peripheral edema (43% v 6%).

Conclusion

In patients with metastatic uveal melanoma, the combination of selumetinib plus dacarbazine had a tolerable safety profile but did not significantly improve PFS compared with placebo plus dacarbazine.
Randomized, Double-Blind, Placebo-Controlled, Multicenter Phase II Study of Fruquintinib After Two Prior Chemotherapy Regimens in Chinese Patients With Advanced Nonsquamous Non‒Small-Cell Lung Cancer
Authors: Lu Shun , Chang Jianhua , Liu Xiaoqing , Shi Jianhua , Lu You , Li Wei , Yang Jin-ji , Zhou Jianying , Wang Jie , An Tongtong , Yang Lei , Liu Zhe , Zhou Xiangdong , Chen Mo , Hua Ye , Su Weiguo
Published: March 2018

Purpose

Patients with advanced non‒small-cell lung cancer (NSCLC) who fail two lines of chemotherapy have unmet medical needs. The kinase inhibitor fruquintinib selectively targets vascular endothelial growth factor receptors and, hence, tumor angiogenesis and lymphogenesis. This randomized, double-blind, placebo-controlled, multicenter phase II trial evaluated the efficacy and safety of fruquintinib in patients with advanced nonsquamous NSCLC who experienced disease progression after second-line chemotherapy.

Patients and Methods

Eligible patients were randomly assigned (two to one; stratified by epidermal growth factor receptor status) to receive fruquintinib or placebo, both in combination with best supportive care. Oral fruquintinib (5 mg once daily) was given in 4-week cycles of 3 weeks of treatment followed by 1 week off. Tumor response was assessed using Response Evaluation Criteria in Solid Tumors version 1.1. The primary end point was progression-free survival (PFS) evaluated by a blinded image central review (BICR) committee. Secondary end points included investigator-evaluated PFS, objective response rate, disease control rate, overall survival, and safety.

Results

Ninety-one patients from 12 hospitals received treatment with fruquintinib (n = 61) or placebo (n = 30). Median PFS was 3.8 months with fruquintinib by both BICR and investigators’ evaluations (hazard ratio by BICR, 0.34; 95% CI, 0.20 to 0.57; P < .001). Three- and 6-month survival rates were 90.2% and 67.2% in the fruquintinib group and 73.3% and 58.8% in the placebo group, respectively. The objective response rate and disease control rate were 13.1% and 60.7% with fruquintinib, compared with 0% and 13.3% with placebo ( P = .041 and < .001), respectively. The most common treatment-emergent adverse events with fruquintinib (≥ grade 3) were hypertension (8.2%), hand-foot syndrome (4.9%), and proteinuria (4.9%).

Conclusion

Third- and fourth-line fruquintinib for advanced NSCLC was superior to placebo and had an acceptable safety profile.
Management of Chemotherapy-Induced Alopecia With Scalp Cooling
Authors: Kruse Megan , Abraham Jame
Published: March 2018

Chemotherapy-induced alopecia is a common and distressing adverse effect of many types of chemotherapy. Scalp cooling has been used since the 1970s for prevention of chemotherapy-induced alopecia; however, most data regarding this treatment modality are retrospective in nature, and use in the United States has been limited by safety concerns, specifically the potential for scalp metastases. Two prospective studies of scalp-cooling systems performed in the United States were published within the last year and add evidence supporting the efficacy and safety of scalp cooling in preventing chemotherapy-induced alopecia in patients receiving chemotherapy for solid tumor malignancies. Available data suggest that this technology is most effective for taxane-based chemotherapy regimens compared with anthracycline-based chemotherapy regimens. Two scalp-cooling devices have been cleared by the US Food and Drug Administration, and multiple cold caps are available for patient rental. The adverse effect profile of scalp cooling includes scalp pain, headache, and chills but is tolerable for most patients included in recent clinical trials. Retrospective data suggest that the incidence of scalp metastases related to scalp cooling is low and should not limit use of this technology. Logistic issues related to use of scalp cooling include availability of devices, inconsistent insurance coverage, and incorporation of use into typical infusion center workflow.
Metabolic Inflexibility Is an Early Marker of Bed-Rest–Induced Glucose Intolerance Even When Fat Mass Is Stable
Authors: Rudwill Floriane , O’Gorman Donal , Lefai Etienne , Chery Isabelle , Zahariev Alexandre , Normand Sylvie , Pagano Allan F , Chopard Angèle , Damiot Anthony , Laurens Claire , Hodson Leanne , Canet-Soulas Emmanuelle , Heer Martina , Meuthen Petra Frings , Buehlmeier Judith , Baecker Natalie , Meiller Laure , Gauquelin-Koch Guillemette , Blanc Stéphane , Simon Chantal , Bergouignan Audrey
Published: March 2018

Context

The effects of energy-balanced bed rest on metabolic flexibility have not been thoroughly examined.

Objective

We investigated the effects of 21 days of bed rest, with and without whey protein supplementation, on metabolic flexibility while maintaining energy balance. We hypothesized that protein supplementation mitigates metabolic inflexibility by preventing muscle atrophy.

Design and Setting

Randomized crossover longitudinal study conducted at the German Aerospace Center, Cologne, Germany.

Participants and Interventions

Ten healthy men were randomly assigned to dietary countermeasure or isocaloric control diet during a 21-day bed rest.

Outcome Measures

Before and at the end of the bed rest, metabolic flexibility was assessed during a meal test. Secondary outcomes were glucose tolerance by oral glucose tolerance test, body composition by dual energy X-ray absorptiometry, ectopic fat storage by magnetic resonance imaging, and inflammation and oxidative stress markers.

Results

Bed rest decreased the ability to switch from fat to carbohydrate oxidation when transitioning from fasted to fed states (i.e., metabolic inflexibility), antioxidant capacity, fat-free mass (FFM), and muscle insulin sensitivity along with greater fat deposition in muscle (P < 0.05 for all). Changes in fasting insulin and inflammation were not observed. However, glucose tolerance was reduced during acute overfeeding. Protein supplementation did not prevent FFM loss and metabolic alterations.

Conclusions

Physical inactivity triggers metabolic inflexibility, even when energy balance is maintained. Although reduced insulin sensitivity and increased fat deposition were observed at the muscle level, systemic glucose intolerance was detected only in response to a moderately high-fat meal. This finding supports the role of physical inactivity in metabolic inflexibility and suggests that metabolic inflexibility precedes systemic glucose intolerance.
Performance of U-net based pyramidal lucas-kanade registration on free-breathing multi-b-value diffusion MRI of the kidney
Authors: Lv Jun , Huang Wenjian , Zhang Jue , Wang Xiaoying
Published: March 2018

Objective:

In free-breathing multi-b-value diffusion-weighted imaging (DWI), a series of images typically requires several minutes to collect. During respiration the kidney is routinely displaced and may also undergo deformation. These respiratory motion effects generate artifacts and these are the main sources of error in the quantification of intravoxel incoherent motion (IVIM) derived parameters. This work proposes a fully automated framework that combines a kidney segmentation to improve the registration accuracy.

Methods:

10 healthy subjects were recruited to participate in this experiment. For the segmentation, U-net was adopted to acquire the kidney’s contour. The segmented kidney then served as a region of interest (ROI) for the registration method, known as pyramidal Lucas-Kanade. Our proposed framework confines the kidney’s solution range, thus increasing the pyramidal Lucas-Kanade’s accuracy. To demonstrate the feasibility of our presented framework, eight regions of interest were selected in the cortex and medulla, and data stability was estimated by comparing the normalized root-mean-square error (NRMSE) values of the fitted data from the bi-exponential intravoxel incoherent motion model pre- and post- registration.

Results:

The results show that the NRMSE was signiﬁcantly lower after registration both in the cortex (p < 0.05) and medulla (p < 0.01) during free-breathing measurements. In addition, expert visual scoring of the derived apparent diffusion coefﬁcient (ADC), f, D and D* maps indicated there were significant improvements in the alignment of the kidney in the post-registered image.

Conclusion:

The proposed framework can effectively reduce the motion artifacts of misaligned multi-b-value DWIs and the inaccuracies of the ADC, f, D and D* estimations.

Advances in knowledge:

This study demonstrates the feasibility of our proposed fully automated framework combining U-net based segmentation and pyramidal Lucas-Kanade registration method for improving the alignment of multi-b-value diffusion-weighted MRIs and reducing the inaccuracy of parameter estimation during free-breathing.
Proprioception and vestibular alterations affect postural control in children with mild autism: A pilot study
Authors: Rosario Martin G. , López Lizzette , Méndez Michelle , Ababneh Anas F , Gonzalez-Sola Maryvi
Published: March 2018

Background: Individuals diagnosed with Autism Spectrum Disorder (ASD) exhibit some type of motor control impairment, for instance, motor apraxia and history of gross motor delay that could lead to increased risk of fall. This pilot research was designed to assess and characterize static postural stability and create a starting point to better understand and describe postural control in children with mild autism.

Method: We measured static postural control with center of pressure (COP) displacement in 10 children with mild autism during eight sensory conditions that challenge and cancel the visual, proprioceptive and vestibular systems.

Results: Our results showed that children with autism demonstrated increased postural sway in response to challenges to the proprioceptive and vestibular systems.

Conclusion: Therefore, under appropriate, challenging conditions, static postural control instability can be detected in children with mild autism.
The equine melanoma
Authors: Knottenbelt Derek C
Published: March 2018

Derek C Knottenbelt OBE, BVM&S, DVM&S, DipECEIM, DACVIM, MRCVS and Jenny Croft BVMS, MRCVS of Equine Medical Solutions discuss the diagnosis and management options
Saddle fitting for a healthy back
Authors: Paine Sue
Published: March 2018

Sue Paine City & Guilds Qualified Saddler, Member of the Society of Master Saddlers, from Dragonfly Saddlery, explains the finer points of fitting a saddle
Fragility fractures in the upper limb: proximal and distal humerus
Authors: Kumar Shyam , Sonar Ulhas , Singh Iqbal
Published: March 2018

The incidence of fragility fractures of the humerus is increasing worldwide. Although clinicians are aware of fractures of hips and wrists, fractures of the shoulder and elbow do not receive much attention. A considerable proportion of the elderly population (estimated at 10–24%) is dependent on walking aids. A well-functioning and pain-free shoulder and elbow is essential for use of these aids. The impact of loss of mobility in the elderly is well known, hence the overall impact of these fractures on the individual can be considerable. This article increases the awareness of these fractures among non-orthopaedic colleagues and provides a brief outline of their management. In the elderly population using walking aids, the shoulder and elbow are effectively weight-bearing joints. Fractures of the shoulder or elbow in the elderly require extra attention to maintain their mobility during this period by physiotherapy to the lower limbs and chest. In patients who mobilize using a frame, the use of a stick on the opposite side of the injury may have to be considered while recovery is in progress.
Delivering the 48-hour antimicrobial review on inpatient drug charts
Authors: Hobday Dorian , Choudhury Aklak , Asour Amani , Khan Saima , Abburu Sneha , Sood Jyotika , Jaafar Nora , Madhani Manisha , Ahmad Nazia
Published: March 2018

Background:

Prolonged or inappropriate antibiotic therapy increases the risk of health-care-associated infections and the development of resistance to antibiotics, and lengthens hospital admissions. There are clear guidelines on antimicrobial stewardship which state that antibiotics should be reviewed between 48 and 72 hours from commencement ( National Institute of Health and Care Excellence, 2015 ). Despite these guidelines this review was often not documented as having been carried out on the authors' inpatient wards.

Methods:

A quality improvement project was undertaken with the aim of improving the percentage completion of the 48-hour antimicrobial review box section of the inpatient drug charts to over 90% across two 30-bed acute respiratory wards within 7 weeks. The primary outcome measures were percentage completion of 48-hour antibiotic review and number of days on intravenous antibiotics. The quality improvement programme took place over 7 weeks and included seven interventions designed to improve completion of the 48-hour review.

Results:

During the study, the percentage completion of 48-hour review rose from a baseline median of 68% to 100% and was accompanied by a reduction in the number of days on intravenous antibiotics from a baseline median of 2.25 days to 1.5 days.

Conclusions:

This simple quality improvement project led to a greatly improved review of antimicrobial therapy which was associated with significantly reduced time on intravenous antibiotics. The quality improvement methodology could easily be adapted for other inpatient medical wards.
How to ensure optimal reproduction of pigs
Authors: Carr John , Howells Mark
Published: March 2018

Reproductive success in pig farming should be reassessed in the light of the drive towards the production of ‘antibiotic-free pigs’. This paper examines reproductive priorities for those seeking to maximise output in terms of quality pork production, using strategies to utilise the best genetic boars in terms of carcass conformation and food conversion ratio as a way to reduce the cost of production. The carbon footprint of the pig farm is also discussed. Reproductive efficiency must be couched in terms of the success of the progeny from the batch, the aim being to ensure that all the available batch finishing space is legally utilised. Monitoring using the traditional values of farrowing rate percentage and pigs per sow per year, in isolation, is outmoded.
The time is right for a new approach to leadership
Authors: Newbold Mark
Published: March 2018

General practice is facing an unprecedented set of challenges, and at the same time radical transformation of the sector is beginning. Exemplary management and leadership will be essential if the sector is to navigate the coming period successfully
Music to whose ears?
Authors: Hancock Dave
Published: March 2018

There is background music playing in most places these days – but is it right for your practice? Dave Hancock tunes in
Heroin prescribing: From hero to zero
Authors: Ainsworth Steve
Published: March 2018

Steve Ainsworth looks at the UK's problem with heroin addiction, and how attempts in Switzerland to curb addiction rates through prescribing have seen success
Data: Consent is no longer the silver bullet
Authors: Dennett Erica
Published: March 2018

The upcoming General Data Protection Regulation will affect any organisation that processes personal data. Erica Dennett of law firm Cripps reminds practice managers that this is about more than just patients
A Social Network Analysis of a Regional Automated Wood Pellet Heating Industry in Pursuing Homeowner Satisfaction
Authors: Guo Tian , Leahy Jessica , Huff Emily Silver , Danks Cecilia , Adams Maura
Published: March 2018

Our study examined relationships among pellet mills, bulk delivery companies, and high-efficiency pellet boiler equipment firms in northern New England as they relate to homeowner satisfaction, using social network analysis and the concept of supply chain management. The continual growth of supply and demand for automated pellet heating requires a careful match between innovative technologies and homeowner needs; these involve multiple factors and require collaboration among firms. Using interview data with managers from pellet mills, bulk delivery companies, and equipment firms in Maine, New Hampshire, and Vermont, we found 15 firms that are connected through both a transaction network and an informal business interaction network. The networks were characterized by short paths and no obvious sign of centralization. Network statistics reported for each network included density, clustering coefficient, and degree, closeness, and betweenness centrality. Most firms in the supply networks shared customer satisfaction information (average number of information sending ties = 3) and considered collaboration in customer services important (mean = 4.4, on a 5-point scale). However, equipment firms initiated more information sharing than other types, and bulk delivery companies were in the best position in the supply network to promote collaborative customer services. Opportunities exist to improve communication between pellet mills and equipment firms, leading to a robust automated pellet heating supply chain, strong demand, and subsequent homeowner satisfaction.