bluuebunny/crossref_metadata_2025 huggingface dataset:
What is in a Name? Parent, Professional and Policy-Maker Conceptions of Consent-Related Language in the Context of Newborn Screening
Authors: Nicholls Stuart G , Etchegary Holly , Tessier Laure , Simmonds Charlene , Potter Beth K , Brehaut Jamie C , Pullman Daryl , Hayeems Robin Z , Zelenietz Sari , Lamoureux Monica , Milburn Jennifer , Turner Lesley , Chakraborty Pranesh , Wilson Brenda J
Published: April 2019

Newborn bloodspot screening programs are some of the longest running population screening programs internationally. Debate continues regarding the need for parents to give consent to having their child screened. Little attention has been paid to how meanings of consent-related terminology vary among stakeholders and the implications of this for practice. We undertook semi-structured interviews with parents (n = 32), healthcare professionals (n = 19) and policy decision makers (n = 17) in two Canadian provinces. Conceptions of consent-related terms revolved around seven factors within two broad domains, decision-making and information attainment. Decision-making comprised: parent decision authority; voluntariness; parent engagement with decision-making; and the process of enacting choice. Information ascertainment comprised: professional responsibilities (including disclosure of information and time to review); parent responsibilities; and the need for discussion and understanding prior to a decision. Our findings indicate that consent-related terms are variously understood, with substantive implications for practice. We suggest that consent procedures should be explained descriptively, regardless of approach, so there are clear indications of what is expected of parents and healthcare professionals. Support systems are required both to meet the educational needs of parents and families and to support healthcare professionals in delivering information in a manner in keeping with parent needs.
Centre effects and case-mix in early rheumatoid arthritis observational cohorts: a narrative review
Authors: Yates Mark , Bechman Katie , Norton Sam , Nikiphorou Elena , Galloway James
Published: April 2019

Objectives

Observational cohort studies in early RA are a key source of evidence, despite inconsistencies in methodological approaches. This narrative review assesses the spectrum of methodologies used in addressing centre-level effect and case-mix adjustment in early RA observational cohort studies.

Methods

An electronic search was undertaken to identify observational prospective cohorts of >100 patients recruited from two or more centres, within 2 years of an RA or early inflammatory arthritis diagnosis. References and author publication lists of all studies from eligible cohorts were assessed for additional cohorts.

Results

Thirty-four unique cohorts were identified from 204 studies. Seven percent of studies considered centre in their analyses, most commonly as a fixed effect in regression modelling. Reporting of case-mix variables in analyses varied widely. The number of variables considered in case-mix adjustment was higher following publication of the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement in 2007.

Conclusion

Centre effect is unreported or inadequately accounted for in the majority of RA observational cohorts, potentially leading to spurious inferences and obstructing comparisons between studies. Inadequate case-mix adjustment precludes meaningful comparisons between centres. Appropriate methodology to account for centre and case-mix adjustment should be considered at the outset of analyses.
DIELECTRIC PROPERTIES OF POLY (VINYLIDENE FLUORIDE)/BARIUM TITANATE NANOCOMPOSITES UNDER GAMMA IRRADIATION
Authors: Waree K , Pangza K , Jangsawang N , Thongbai P , Buranurak S
Published: April 2019

The main focus of this study is to investigate the effect of gamma irradiation on the electrical properties of PVDF/BT nanocomposites. A 1.25 MeV gamma-ray was delivered to the composite films with different BaTiO3-volume fraction, ƒBT = 0–0.4, and with different absorbed doses ranged 50–2500 Gy. Dielectric properties of PVDF/BaTiO3 composites under frequencies ranged from 100 Hz to 10 MHz at room temperature were investigated using an impedance analyser. An increase of 28% in the dielectric constant and a decrease of 15% in the loss tangent were observed in the PVDF/BT 40 vol% nanocomposite film under the accumulated dose of 1500 Gy. Scanning electron microscopy provided no significant difference in microscopic structures between non-exposed and gamma-exposed materials. Fourier-transform infra-red spectroscopy provides gamma-induced transition of PVDF-crystalline forms as alpha-PVDF into beta-PVDF/gamma-PVDF which has been reported as one of the main factors affected the change of dielectric constant in polymers. UV–visible spectrophotometry has been observed gamma-induced red shift in the absorption edge of the PVDF/BT 40 vol% nanocomposite film from 400 nm to 420 nm under the accumulated dose of 1500 Gy. However, a blue shift is observed with increase the accumulated dose up to 2000 Gy.
Multimodal Magnetic Resonance Imaging Data Fusion Reveals Distinct Patterns of Abnormal Brain Structure and Function in Catatonia
Authors: Hirjak Dusan , Rashidi Mahmoud , Kubera Katharina M , Northoff Georg , Fritze Stefan , Schmitgen Mike M , Sambataro Fabio , Calhoun Vince D , Wolf Robert C
Published: April 2019

Catatonia is a nosologically unspecific syndrome, which subsumes a plethora of mostly complex affective, motor, and behavioral phenomena. Although catatonia frequently occurs in schizophrenia spectrum disorders (SSD), specific patterns of abnormal brain structure and function underlying catatonia are unclear at present. Here, we used a multivariate data fusion technique for multimodal magnetic resonance imaging (MRI) data to investigate patterns of aberrant intrinsic neural activity (INA) and gray matter volume (GMV) in SSD patients with and without catatonia. Resting-state functional MRI and structural MRI data were collected from 87 right-handed SSD patients. Catatonic symptoms were examined on the Northoff Catatonia Rating Scale (NCRS). A multivariate analysis approach was used to examine co-altered patterns of INA and GMV. Following a categorical approach, we found predominantly frontothalamic and corticostriatal abnormalities in SSD patients with catatonia (NCRS total score ≥ 3; n = 24) when compared to SSD patients without catatonia (NCRS total score = 0; n = 22) matched for age, gender, education, and medication. Corticostriatal network was associated with NCRS affective scores. Following a dimensional approach, 33 SSD patients with catatonia according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision were identified. NCRS behavioral scores were associated with a joint structural and functional system that predominantly included cerebellar and prefrontal/cortical motor regions. NCRS affective scores were associated with frontoparietal INA. This study provides novel neuromechanistic insights into catatonia in SSD suggesting co-altered structure/function-interactions in neural systems subserving coordinated visuospatial functions and motor behavior.
Searching for Work with a Criminal Record
Authors: Smith Sandra Susan , Broege Nora C R
Published: April 2019

People with a criminal record face substantial demand-side employment barriers that have clear implications for whether or not they search for work and what strategies they use. We know relatively little, however, about whether and how penal contact affects patterns of job search and how search patterns affect search success. Using the 2001–2011 waves of the 1997 cohort of the National Longitudinal Survey of Youth (NLSY97), we find that penal contact and penal dispositions—arrest, conviction, and incarceration—reduce odds of job search, decrease the number of search methods job seekers deploy, and direct job seekers away from search methods that are generally more efficient and effective at yielding offers. Further, altered search patterns contribute significantly to post-contact job seekers’ lower odds of search success, especially for blacks. Taken together, our findings suggest that job search engagement is another key mechanism linking penal contact and poorer job search outcomes.
Behavioral and social scientists’ reflections on genomics: a systematic evaluation within the Society of Behavioral Medicine
Authors: McBride Colleen M , Graves Kristi D , Kaphingst Kimberly A , Allen Caitlin G , Wang Catharine , Arredondo Elva , Klein William M P
Published: April 2019

Clinical and public health translation of genomics could be facilitated by expertise from behavioral medicine, yet genomics has not been a significant focus of the Society of Behavioral Medicine (SBM). SBM convened a working group (WG) to lead a systematic exploration of members’ views on: (a) whether SBM should give a higher priority to genomic translation and (b) what efforts, if any, should be made to support this increased engagement. The WG used a stepped process over 2 years that began by gaining input from SBM leadership regarding key issues and suggestions for approach, engaging a cross section of membership to expand and record these discussions, followed by systematic qualitative analyses to inform priority action steps. Discussions with SBM leaders and members suggested that genomics was relevant to SBM, particularly for junior members. SBM members’ expertise in social and behavioral theory, and implementation study designs, were viewed as highly relevant to genomic translation. Participants expressed that behavioral and social scientists should be engaged in translational genomics work, giving special attention to health disparities. Proposed action steps are aligned with a “push–pull” framework of innovation dissemination. “Push” strategies aim to reach potential adopters and included linking members with genomics expertise to those wanting to become involved and raising awareness of evidence-based genomic applications ready for implementation. “Pull” strategies aim to expand demand and included developing partnerships with genomics societies and advocating for funding, study section modifications, and training programs.
Contrasting Patterns of Colonization with Verticillium longisporum in Winter- and Spring-Type Oilseed Rape (Brassica napus) in the Field and Greenhouse and the Role of Soil Temperature
Authors: Zheng Xiaorong , Pfordt Annette , Khatri Laxman , Eseola Alice Bisola , Wilch Antonia , Koopmann Birger , von Tiedemann Andreas
Published: April 2019

Oilseed rape, an important source of vegetable plant oil, is threatened by Verticillium longisporum, a soil-borne vascular fungal pathogen so far occurring in oilseed rape growing regions in Europe and Canada. Despite intensive research into V. longisporum in the last decades in controlled conditions, basic knowledge is still lacking about the time course of infection, temporal pattern of colonization, and disease development on field-grown plants. In this study, colonization of roots, stem bases, and stems with V. longisporum was followed by real-time PCR from the seedling until mature plant stages in 2-year field experiments with microsclerotia-infested plots and either spring-type or autumn-sown (winter-type) oilseed rape cultivars. The temporal pattern of plant colonization differed between greenhouse and field-grown oilseed rape and between spring- and winter-type plants in the field. Within 28 to 35 days, a continuous systemic colonization with V. longisporum was detected in roots and shoots of young plants in the greenhouse associated with significant stunting. In contrast, real-time PCR analysis of V. longisporum in field-grown winter oilseed rape plants displayed a strongly discontinuous colonization pattern with low fungal growth in roots during juvenile growth stages until flowering, whereas in spring oilseed rape, no root colonization was observed until early flowering stages. Hence, stem colonization with the pathogen required 6 months in winter oilseed rape and 1 month in spring oilseed rape from the time of initial root infection. The different patterns of stem colonization were related to soil temperature. Average soil temperatures in 5-cm depth during 7 days before sampling time points from 2 years of field experiments displayed a significant relationship with fungal colonization in the root. A climate chamber inoculation trial with soil temperature levels that varied from 6 to 18°C revealed a threshold temperature of >12°C in the soil to enable root invasion. This soil condition is reached in winter-type oilseed rape in the field in Germany either until the eight-leaf stage in early autumn or after pod stage in spring, whereas in spring-sown oilseed rape early root infection is delayed owing to the cool conditions during juvenile growth stages. The delay of stem colonization in field-grown oilseed rape may explain the lack of stunting as observed in the greenhouse and the previously reported inconsistent effects of V. longisporum on yield levels and seed quality, which were confirmed in this study.
Prevalence and Distribution of Beet Necrotic Yellow Vein Virus Strains in North Dakota and Minnesota
Authors: Weiland John J. , Bornemann Kathrin , Neubauer Jonathan D. , Khan Mohamed F. R. , Bolton Melvin D.
Published: April 2019

Beet necrotic yellow vein virus (BNYVV) is the causal agent of rhizomania, a disease of global importance to the sugar beet industry. The most widely implemented resistance gene to rhizomania to date is Rz1, but resistance has been circumvented by resistance-breaking (RB) isolates worldwide. In an effort to gain greater understanding of the distribution of BNYVV and the nature of RB isolates in Minnesota and eastern North Dakota, sugar beet plants were grown in 594 soil samples obtained from production fields and subsequently were analyzed for the presence of BNYVV as well as coding variability in the viral P25 gene, the gene previously implicated in the RB pathotype. Baiting of virus from the soil with sugar beet varieties possessing no known resistance to rhizomania resulted in a disease incidence level of 10.6% in the region examined. Parallel baiting analysis of sugar beet genotypes possessing Rz1, the more recently introgressed Rz2, and with the combination of Rz1 + Rz2 resulted in a disease incidence level of 4.2, 1.0, and 0.8%, respectively. Virus sequences recovered from sugar beet bait plants possessing resistance genes Rz1 and/or Rz2 exhibited reduced genetic diversity in the P25 gene relative to those recovered from the susceptible genotype while confirming the hypervariable nature of the coding for amino acids (AAs) at position 67 and 68 in the P25 protein. In contrast to previous reports, we did not find an association between any one specific AA signature at these positions and the ability to circumvent Rz1-mediated resistance. The data document ongoing virulence development in BNYVV populations to previously resistant varieties and provide a baseline for the analysis of genetic change in the virus population that may accompany the implementation of new resistance genes to manage rhizomania.
Saccharum spontaneum, a Novel Source of Resistance to Root-Lesion and Root-Knot Nematodes in Sugarcane
Authors: Bhuiyan Shamsul A. , Garlick Kylie , Piperidis George
Published: April 2019

Root-lesion nematode (Pratylenchus zeae) and root-knot nematode (Meloidogyne javanica) are two important pathogens of sugarcane (Saccharum hybrid). No commercial cultivars are resistant to these nematodes in Australia. Twenty accession lines of S. spontaneum, a wild relative of sugarcane, were tested against these two nematode species. S. spontaneum lines were tested twice for resistance to root-lesion nematode and three times for root-knot nematode. Reproduction (final population/starting population) of root-lesion nematodes was significantly lower in 17 of the 20 S. spontaneum accession lines tested in two experiments compared with two commercial cultivars. Four S. spontaneum lines supported a significantly lower number of root-lesion nematodes per gram of root than that of two commercial sugarcane cultivars. Reproduction of root-knot nematodes was significantly lower in 16 S. spontaneum lines compared with two commercial cultivars. Fourteen of the S. spontaneum lines tested supported significantly fewer eggs per gram of root compared with two commercial cultivars. This study showed that S. spontaneum lines possessed resistance for root-lesion and root-knot nematodes. Targeted crossing with commercial hybrid parental lines should be conducted to introduce nematode resistance into sugarcane cultivars for the Australian sugar industry.
Response of Sorghum Enhanced in Monolignol Biosynthesis to Stalk Rot Pathogens
Authors: Funnell-Harris Deanna L. , Sattler Scott E. , O’Neill Patrick M. , Gries Tammy , Tetreault Hannah M. , Clemente Thomas E.
Published: April 2019

To increase phenylpropanoid constituents and energy content in the versatile C4grass sorghum (Sorghum bicolor [L.] Moench), sorghum genes for proteins related to monolignol biosynthesis were overexpressed: SbMyb60 (transcriptional activator), SbPAL (phenylalanine ammonia lyase), SbCCoAOMT (caffeoyl coenzyme A [CoA] 3-O-methyltransferase), Bmr2 (4-coumarate:CoA ligase), and SbC3H (coumaroyl shikimate 3-hydroxylase). Overexpression lines were evaluated for responses to stalk pathogens under greenhouse and field conditions. Greenhouse-grown plants were inoculated with Fusarium thapsinum (Fusarium stalk rot) and Macrophomina phaseolina (charcoal rot), which cause yield-reducing diseases. F. thapsinum-inoculated overexpression plants had mean lesion lengths not significantly different than wild-type, except for significantly smaller lesions on two of three SbMyb60 and one of two SbCCoAOMT lines. M. phaseolina-inoculated overexpression lines had lesions not significantly different from wild-type except one SbPAL line (of two lines studied) with mean lesion lengths significantly larger. Field-grown SbMyb60 and SbCCoAOMT overexpression plants were inoculated with F. thapsinum. Mean lesions of SbMyb60 lines were similar to wild-type, but one SbCCoAOMT had larger lesions, whereas the other line was not significantly different than wild-type. Because overexpression of SbMyb60, Bmr2, or SbC3H may not render sorghum more susceptible to stalk rots, these lines may provide sources for development of sorghum with increased phenylpropanoid concentrations.
Virulence and Molecular Diversity in the Cochliobolus sativus Population Causing Barley Spot Blotch in China
Authors: Guo Huanqiang , Yao Quanjie , Chen Lin , Wang Fengtao , Lang Xiaowei , Pang Yunxing , Feng Jing , Zhou Jun , Lin Ruiming , Xu Shichang
Published: April 2019

Spot blotch, caused by the fungal pathogen Cochliobolus sativus, is a limiting factor for barley (Hordeum vulgare) production in northeast China, which causes significant grain yield losses and kernel quality degradation. It is critical to determine the virulence diversity of C. sativus populations for barley resistance breeding and the judicious grouping of available resistance varieties according to the predominant pathotypes in disease epidemic regions. With little information on the barley pathogen in China, this study selected 12 typical barley genotypes to differentiate the pathotypes of C. sativus isolates collected in China. Seventy-one isolates were grouped into 19 Chinese pathotypes based on infection responses. Seventeen isolates were classified as pathotype 3, which has only been identified in China, whereas most (52 of 71) were classified as pathotype 1. All of the tested isolates had low virulence on the North Dakota (ND) durable, resistant line ND B112. Using 22 selected amplified fragment-length polymorphism (AFLP) primer combinations, genetic polymorphism was used to analyze 68 isolates, which clustered into three distinct groups using the unweighted pair group method average with the genetic distance coefficient. No relationship was found between the virulence of isolates and their origins. Isolates of the same pathotype or those collected from the same location did not group into clusters based on the AFLP analysis.
The Influence of Prior Performance Information on Ratings of Current Performance and Implications for Learner Handover: A Scoping Review
Authors: Humphrey-Murto Susan , LeBlanc Aaron , Touchie Claire , Pugh Debra , Wood Timothy J. , Cowley Lindsay , Shaw Tammy
Published: April 2019

Purpose

Learner handover (LH) is the sharing of information about trainees between faculty supervisors. This scoping review aimed to summarize key concepts across disciplines surrounding the influence of prior performance information (PPI) on current performance ratings and implications for LH in medical education.

Method

The authors used the Arksey and O’Malley framework to systematically select and summarize the literature. Cross-disciplinary searches were conducted in six databases in 2017–2018 for articles published after 1969. To represent PPI relevant to LH in medical education, eligible studies included within-subject indirect PPI for work-type performance and rating of an individual current performance. Quantitative and thematic analyses were conducted.

Results

Of 24,442 records identified through database searches and 807 through other searches, 23 articles containing 24 studies were included. Twenty-two studies (92%) reported an assimilation effect (current ratings were biased toward the direction of the PPI). Factors modifying the effect of PPI were observed, with larger effects for highly polarized PPI, negative (vs positive) PPI, and early (vs subsequent) performances. Specific standards, rater motivation, and certain rater characteristics mitigated context effects, whereas increased rater processing demands heightened them. Mixed effects were seen with nature of the performance and with rater expertise and training.

Conclusions

PPI appears likely to influence ratings of current performance, and an assimilation effect is seen with indirect PPI. Whether these findings generalize to medical education is unknown, but they should be considered by educators wanting to implement LH. Future studies should explore PPI in medical education contexts and real-world settings.
Scoping Review of Entrustable Professional Activities in Undergraduate Medical Education
Authors: Meyer Eric G. , Chen H. Carrie , Uijtdehaage Sebastian , Durning Steven J. , Maggio Lauren A.
Published: April 2019

Purpose

Entrustable professional activities (EPAs) are a hot topic in undergraduate medical education (UME); however, the usefulness of EPAs as an assessment approach remains unclear. The authors sought to better understand the literature on EPAs in UME through the lens of the 2010 Ottawa Conference Criteria for Good Assessment.

Method

The authors conducted a scoping review of the health professions literature (search updated February 2018), mapping publications to the Ottawa Criteria using a collaboratively designed charting tool.

Results

Of the 1,089 publications found, 71 (6.5%) met inclusion criteria. All were published after 2013. Forty-five (63.4%) referenced the 13 Core Entrustable Professional Activities for Entering Residency developed by the Association of American Medical Colleges (AAMC). Forty (56.3%) were perspectives, 5 (7.0%) were reviews, and 26 (36.6%) were prospective empirical studies. The publications mapped to the Ottawa Criteria 158 times. Perspectives mapped more positively (83.7%) than empirical studies (76.7%). Reproducibility did not appear to be a strength of EPAs in UME; however, reproducibility, equivalence, educational effect, and catalytic effect all require further study. Inconsistent use of the term “EPA” and conflation of concepts (activity vs assessment vs advancement decision vs curricular framework) limited interpretation of published results. Overgeneralization of the AAMC’s work on EPAs has influenced the literature.

Conclusions

Much has been published on EPAs in UME in a short time. Now is the time to move beyond opinion, clarify terms, and delineate topics so that well-designed empirical studies can demonstrate if and how EPAs should be implemented in UME.
Breathing under Anesthesia
Authors: Bourgeois Thomas , Ringot Maud , Ramanantsoa Nelina , Matrot Boris , Dauger Stéphane , Delclaux Christophe , Gallego Jorge
Published: April 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Optimal management of anesthesia-induced respiratory depression requires identification of the neural pathways that are most effective in maintaining breathing during anesthesia. Lesion studies point to the brainstem retrotrapezoid nucleus. We therefore examined the respiratory effects of common anesthetic/analgesic agents in mice with selective genetic loss of retrotrapezoid nucleus neurons (Phox2b

27Alacki/+
mice, hereafter designated “mutants”).

Methods

All mice received intraperitoneal ketamine doses ranging from 100 mg/kg at postnatal day (P) 8 to 250 mg/kg at P60 to P62. Anesthesia effects in P8 and P14 to P16 mice were then analyzed by administering propofol (100 and 150 mg/kg at P8 and P14 to P16, respectively) and fentanyl at an anesthetic dose (1 mg/kg at P8 and P14 to P16).

Results

Most mutant mice died of respiratory arrest within 13 min of ketamine injection at P8 (12 of 13, 92% vs. 0 of 8, 0% wild type; Fisher exact test, P < 0.001) and P14 to P16 (32 of 42, 76% vs. 0 of 59, 0% wild type; P < 0.001). Cardiac activity continued after terminal apnea, and mortality was prevented by mechanical ventilation, supporting respiratory arrest as the cause of death in the mutants. Ketamine-induced mortality in mutants compared to wild types was confirmed at P29 to P31 (24 of 36, 67% vs. 9 of 45, 20%; P < 0.001) and P60 to P62 (8 of 19, 42% vs. 0 of 12, 0%; P = 0.011). Anesthesia-induced mortality in mutants compared to wild types was also observed with propofol at P8 (7 of 7, 100% vs. 0 of 17,7/7, 100% vs. 0/17, 0%; P < 0.001) and P14 to P16 (8 of 10, 80% vs. 0 of 10, 0%; P < 0.001) and with fentanyl at P8 (15 of 16, 94% vs. 0 of 13, 0%; P < 0.001) and P14 to P16 (5 of 7, 71% vs. 0 of 11, 0%; P = 0.002).

Conclusions

Ketamine, propofol, and fentanyl caused death by respiratory arrest in most mice with selective loss of retrotrapezoid nucleus neurons, in doses that were safe in their wild type littermates. The retrotrapezoid nucleus is critical to sustain breathing during deep anesthesia and may prove to be a pharmacologic target for this purpose.
Health and Economic Impact of Intensive Surveillance for Distant Recurrence After Curative Treatment of Colon Cancer: A Mathematical Modeling Study
Authors: Wanis Kerollos N. , Maleyeff Lara , Van Koughnett Julie Ann M. , H. D. Colquhoun Patrick , Ott Michael , Leslie Ken , Hernandez-Alejandro Roberto , Kim Jane J.
Published: April 2019

BACKGROUND:

Intensive surveillance strategies are currently recommended for patients after curative treatment of colon cancer, with the aim of secondary prevention of recurrence. Yet, intensive surveillance has not yielded improvements in overall patient survival compared with minimal follow-up, and more intensive surveillance may be costlier.

OBJECTIVE:

The purpose of this study was to estimate the quality-adjusted life-years, economic costs, and cost-effectiveness of various surveillance strategies after curative treatment of colon cancer.

DESIGN:

A Markov model was calibrated to reflect the natural history of colon cancer recurrence and used to estimate surveillance costs and outcomes.

SETTINGS:

This was a decision-analytic model.

PATIENTS:

Individuals entered the model at age 60 years after curative treatment for stage I, II, or III colon cancer. Other initial age groups were assessed in secondary analyses.

MAIN OUTCOME MEASURES:

We estimated the gains in quality-adjusted life-years achieved by early detection and treatment of recurrence, as well as the economic costs of surveillance under various strategies.

RESULTS:

Cost-effective strategies for patients with stage I colon cancer improved quality-adjusted life-expectancy by 0.02 to 0.06 quality-adjusted life-years at an incremental cost of $1702 to $13,019. For stage II, they improved quality-adjusted life expectancy by 0.03 to 0.09 quality-adjusted life-years at a cost of $2300 to $14,363. For stage III, they improved quality-adjusted life expectancy by 0.03 to 0.17 quality-adjusted life-years for a cost of $1416 to $17,631. At a commonly cited willingness-to-pay threshold of $100,000 per quality-adjusted life-year, the most cost-effective strategy for patients with a history of stage I or II colon cancer was liver ultrasound and chest x-ray annually. For those with a history of stage III colon cancer, the optimal strategy was liver ultrasound and chest x-ray every 6 months with CEA measurement every 6 months.

LIMITATIONS:

The study was limited by model structure assumptions and uncertainty around the values of the model's parameters.

CONCLUSIONS:

Given currently available data and within the limitations of a model-based decision-analytic approach, the effectiveness of routine intensive surveillance for patients after treatment of colon cancer appears, on average, to be small. Compared with testing using lower cost imaging, currently recommended strategies are associated with cost-effectiveness ratios that indicate low value according to well-accepted willingness-to-pay thresholds in the United States. See Video Abstract at http://links.lww.com/DCR/A921.
The advent of human papillomavirus detection for cervical screening
Authors: Morris Brian J.
Published: April 2019

Purpose of review

This review updates progress in the human papillomavirus (HPV)-based revolution in cervical screening and vaccination predicted to eventually eliminate cervical cancer.

Recent findings

HPV PCR, patented by the author in 1987, has recently begun to replace cytology for primary cervical screening. I highlight the findings from large randomized clinical trials that have brought about this change, and progress with implementation. Australia was the first to introduce a national, publicly-funded HPV PCR-based program of primary screening, on 1 December 2017. The United Kingdom is set to follow, as are other countries. The widespread preference of self-sampling by under-screened women in particular will increase the effectiveness of population screening when using HPV tests. Coupled with improved vaccination now that more effective (nonavalent) HPV vaccines are being introduced, recent modeling predicts that cervical cancer will be markedly reduced, or even eliminated, in coming decades.

The recent or pending change to more accurate cervical screening by HPV detection using PCR in various countries means less frequent screening for women. Women with an aversion to having their sample collected by a physician can collect their sample themselves, either at the doctor's rooms or at home, the sample then being mailed to the testing laboratory.
The Past Informs the Present, Academic New Media Pitfalls: A Primer for Plastic Surgeons
Authors: Day Kristopher M. , Rohrich Rod J. , Spiess Alexander M.
Published: April 2019

Mass communication has undergone a “new media” revolution, which includes the rise of digital, online, and social media. The impact of new media on academic processes, however, has been underappreciated. The rise of Web-based virtual platforms has profoundly impacted the way plastic surgeons publish, store, exchange, and analyze scholarly biomedical information. This new media academic phenomenon refers to electronic mechanisms with the capacity to supplant traditional publication methods, which typically rely on printed documents in the physical domain. Although such tools can be efficient and user-friendly, they also make users vulnerable to exploitation. Notable examples reveal a relative lack of regulation, oversight, reliable rating scales, user authentication, and ethical accountability in the virtual space. As with any new technique, education is key and knowledge is power. In this article, online resources related to healthcare and the practice of plastic surgery are reviewed and summarized, including open access, mega-indices, whitelists, and electronic alerts. New media provides powerful knowledge-sharing tools that can help execute scholarly endeavors, communicate between professionals, and educate the public. However, it is essential for plastic surgeons to appreciate the caveats of new media academic processes to avoid unscrupulous practices of those that may seek to manipulate these Web-based systems. This article outlines the key pitfalls associated with online information streams to better inform plastic surgeons how to navigate new media-based scholarly processes.
Prehospital termination of resuscitation rule
Authors: Morrison Laurie J.
Published: April 2019

Purpose of review

The purpose of the review is to briefly describe the derivation, validation and implementation of the Termination of Resuscitation Rules for out-of-hospital adult cardiac arrest and to describe the controversies surrounding implementation that have been recently published.

Recent findings

New guidelines, new interventions that alter baseline survival, the use of eCPR and issues related to duration of CPR have minimal impact on the sustainability and application of the TOR rule.

Some published articles related to using only one criterion in the rule may be cavalier and miss potential survivors.

Decisions based on discretion may cause wide variation in termination rates and evidence-based decision rules are in the best interest of distributive justice for the patient and comfort for the provider.

The Universal Termination of Resuscitation Rule has a built-in sensibility to the introduction of new treatment guidelines, including emphasis on CPR metrics, changes in baseline survival rates, duration of resuscitation and new treatment options including eCPR and postarrest care. As well, the TOR rule continues to address inconsistencies in practice and improve provider comfort.
Cerebellopontine angle ependymoma in a young adult
Authors: Lan Zhigang , Richard Seidu A. , Zhang Yuekang
Published: April 2019

Rationale:

Cerebellopontine angle (CPA) ependymomas are atypical kind of ependymomas that characteristically occur in the pediatric age group. Therefore, finding a case of CPA ependymoma in a young male adult is not a common occurrence.

Patient concerns:

We present a case of a 28-year-old male who was involved in road traffic accident with suspected mild head injury. He did not have any antecedent complains before the accident.

Diagnoses:

An incidental computer tomographic scan of the head revealed an intracranial space-occupying lesion at the left CPA. Immunohistochemical staining of the specimens indicated WHO grade II ependymoma.

Interventions:

The tumor was surgically resected and the patient was further treated with radiotherapy.

Outcomes:

The patient recovered well postoperatively and 2 years follow-up revealed no tumor recurrence and the patient is currently well.

Lessons:

The diagnosis of ependymomas can be very challenging in adults because they are mostly mainly seen in the pediatric age group. We propose that one of the differential diagnosis of tumors in the CPA in a young adult should be CPA ependymoma.
Successful resuscitation of a patient with pernicious placenta previa and placenta accreta who had massive life-threatening bleeding during cesarean section
Authors: Jiang Xiaoqin , Lin Xuemei , Han Xueguang , Ma Yushan , Zhao Fumin
Published: April 2019

Rationale:

Pernicious placenta accrete (PPP) is an obstetrical complication associated with severe life-threatening hemorrhage, which is one of the leading causes of maternal mortality worldwide. Caesarean hysterectomy is the effective method to control intraoperative bleeding for this unscheduled high-risk patient. But a challenge for clinicians in this case is to determine the optimal timing of hysterectomy, because it will directly determine maternal outcome.

Patient concerns:

We here report a case diagnosed with PPP who suffered from a severe life-threatening hemorrhage during cesarean section but was successfully resuscitated and subsequently discharged from hospital after a smooth recovery.

Diagnoses:

Although binding the lower uterine segment with a tourniquet markedly reduced bleeding in the surgical field after delivery, massive concealed vaginal life-threatening bleeding occurred immediately, and the amount of vaginal blood loss within 10 minutes was as much as 3000 mL.

Interventions:

An experienced multidisciplinary team was immediately established, and an unscheduled caesarean hysterectomy was performed immediately, and cell salvage was used.

Outcome:

The patient was successfully resuscitated and both the parturient and neonate were well and discharged.

Lesson:

If binding the lower uterine segment with a tourniquet markedly reduces bleeding in the surgical field after cesarean delivery in high-risk patients with PPP, and persistence of hypotension after active resuscitation of the circulation is detected, anesthesiologist should be vigilant enough to detect the possibility of concealed vaginal life-threatening bleeding. If this is confirmed, it should be quickly identified whether bleeding can be quickly controlled within a short period of time. If not, the preferred strategy is that the earlier the unscheduled hysterectomy, the better the outcome. A well-established multidisciplinary team and autologous blood recovery and transfusion techniques are also important in ensuring successful resuscitation of patients.
The mechanism of formation of thin-walled cystic lung cancer
Authors: Zhang Jie , Deng Hui , Wu Chong Chong , Wang Zhaoyu , Zhao Dahai , Wei Bo , Zhang Jing Yuan , Tong Xinjie , Gao Jie , Pan Lei , Xue Xin Ying
Published: April 2019

Thin-wall cystic lung cancer is becoming of increasing interest in the study of pulmonary medicine. Consequently, more and more different images and pathologic manifestations have been found. The purpose of this article is to find pathologic characteristics and try to explain the formation mechanism of thin-walled cystic lung cancer.

Sixty-five patients with this special lung cancer were analyzed retrospectively based on the review of medical records, radiologic findings, and pathologic changes.

We found 3 pathologic types: adenocarcinoma, squamous cell carcinoma, and lymphoma. There were 60 cases of adenocarcinoma, 4 cases were squamous cell carcinoma, and only 1 lymphoma. Tumor cells, pulmonary vessels, fibrous tissues, and residual bronchi are the pathologic basis of different image findings.

Thin-walled cystic lung cancers are mostly adenocarcinoma, but other pathologic types can also appear, such as squamous cell carcinoma and lymphoma. We can see that a large amount of fibrous tissues were generated by tumors around the bronchus, resulting in airway stenosis and degeneration. Tumor cells also can invade the bronchial wall and cause structural damage. All these lesions are similar to 1-way valves which can cause gas accumulation in the tumor area and result in thin-walled cystic lung cancer.
Amyloidosis secondary to intrapulmonary Castleman disease mimicking pulmonary hyalinizing granuloma-like clinical features
Authors: Wang Shao-Ting , Wang Qi-Pu , Li Ji , Zhang Ting , Zhang Lu , Mao Yue-Ying
Published: April 2019

Rationale:

Amyloidosis secondary to intrapulmonary Castleman disease (CD) is a rare benign disease diagnosed by histopathology. It seems to be associated with chronic inflammation, and large amounts of IL-6 produced in the germinal center of CD may enhance the production of precursor of amyloid.

Patient concerns:

We reported a case of an 18-year-old woman presenting with dry cough and dyspnea on exertion for 6 months and detailed exams revealed multiple pulmonary nodules, positive antinuclear antibodies, hypocomplementemia, and thrombocytopenia.

Diagnoses:

A computed tomography-guided percutaneous lung biopsy revealed the histopathological features of pulmonary hyalinizing granuloma (PHG), but video-assisted pulmonary wedge resection for biopsy with immunohistochemical stains finally demonstrated a corrected diagnosis of intrapulmonary CD with secondary amyloidosis.

Interventions:

The patient had received prednisone and Tacrolimus for 6 months.

Outcomes:

There was no significant improvement in pulmonary lesions or platelet level. Chemotherapy to CD was needed.

Lessons:

Intrapulmonary CD should be considered in patients with multiple pulmonary nodules irresponsive to corticosteroid and diagnosis of PHG should be carefully considered based on small lung biopsy sample. The treatment of amyloidosis secondary to CD remains to be uncertain.
Immune imbalance is associated with the development of preeclampsia
Authors: Ma Yu , Ye Yao , Zhang Jin , Ruan Cheng-Chao , Gao Ping-Jin
Published: April 2019

Preeclampsia (PE) is characterized by hypertension and proteinuria. It affects about 5% to 8% of pregnancies and causes maternal and perinatal mortality and morbidity. The immune imbalance and excessive inflammatory response play vital roles in the pathogenesis of PE.

In this study, we performed a case-control study to investigate the levels of cytokines, chemokines and adhesion molecules in serum and placenta of normal pregnant and PE women by Bio-Plex multiplex immunoassay and immunohistochemistry. In addition, we explored the phenotypes of monocyte and macrophage in peripheral blood and placentas in 2 groups by using flow cytometry analysis and immunohistochemistry.

Our results show that pro-inflammatory factors, including interleukin-1β (IL-1β), IL-6, IL-7, IL-8, IL-17a, monocyte chemotactic protein 1 (MCP -1), and macrophage inflammatory protein 1β (MIP-1β) were significantly increased in serum of women with PE compared with controls. In addition, we detected that IL-1β, IL-6, and MCP-1 were also increased in placentas of women with PE. We further revealed that peripheral blood monocytes showed a pro-inflammatory M1-like phenotype in women with PE. Consistently, M1 macrophage infiltration was increased in placenta of women with PE compared to that of normal pregnant women.

Our results demonstrated that immune imbalance promotes an inflammatory state during PE and it may be a potential therapeutic possibility for the management of PE.
Survey of nil per os duration of patients admitted to the emergency department due to vomiting
Authors: Yang Wen-Chieh , Chang Yu-Jun , Lin Ya-Chun , Chen Chun-Yu , Peng Yi-Chin , Wu Han-Ping
Published: April 2019

During the acute phase of vomiting, even a small amount of water may not be tolerated by mouth. Early refeeding may cause re-vomiting in patients, whereas late refeeding may result in dehydration and hypoglycemia. Nil per os (NPO) may be generally recommended by primary physicians, but the appropriate NPO duration for these patients is still unclear.

The study aimed to identify the ideal NPO duration for patients with acute vomiting.

We prospectively recruited patients with vomiting who underwent NPO management and were administered antiemetic agents in the emergency department (ED) and the pediatric ED. The demographics, final diagnosis, clinical manifestations, medical management, NPO duration, and laboratory data were collected and analyzed to identify the ideal NPO duration

A total of 304 patients with vomiting who were admitted in the ED were enrolled. The major diagnosis was acute gastroenteritis (AGE) (82.9%), followed by acute gastritis and colitis. Most patients were younger than 6 years (43.8%). Apart from abdominal pain and vomiting, nausea was the most common symptom (93.1%). NPO duration of 4 to 6 hours had the lowest rate of refeeding failure (3.7%) compared to the other NPO durations.

For patients with acute vomiting who are admitted to the ED, NPO duration of 4 to 6 hours may be necessary and should be recommended by primary ED physicians.
Diagnostic accuracy of red blood cell distribution width to platelet ratio for predicting staging liver fibrosis in chronic liver disease patients
Authors: Cai Ying , Liu Dina , Cui Jing , Sha Yu , Zhou Hengyu , Tang Ni , Wang Na , Huang Ailong , Xia Jie
Published: April 2019

Background:

Red cell volume distribution width to platelet ratio (RPR), as a novel noninvasive assessment, is frequently investigated. However, the utility of RPR to evaluate the diagnostic accuracy of liver fibrosis remains controversial. We performed a meta-analysis to determine the diagnostic performance of RPR for detecting staging liver fibrosis in patients with chronic liver disease.

Methods:

MEDLINE, EMBASE, and Cochrane Library databases were systematically searched. Summary receiver operating characteristic curves (SROC), diagnostic odds ratios (DOR), pooled estimates of sensitivity, specificity, and likelihood ratios were used to assess the diagnostic accuracy of RPR. Meta-regression and subgroup analyses were also performed to identify factors that contributed to heterogeneity. The Quality Assessment for Studies of Diagnostic Accuracy Studies-2 tool was applied to assess the quality.

Results:

Fifteen studies with a total of 3346 patients were included in the meta-analysis. The area under the curve for SROC to summarize diagnostic accuracy of RPR for prediction of significant fibrosis, advanced fibrosis, and cirrhosis was 0.73 (standard error [SE] = 0.02), 0.83 (SE = 0.03), and 0.85 (SE = 0.04), respectively. Pooled DOR with corresponding 95% confidence interval (CI) was 4.93 (95% CI: 3.78–6.43), 10.27 (95% CI: 6.26–16.84), and 12.16 (95% CI: 5.85–25.28), respectively, using a random effects model. Meta-regression showed that length of liver biopsy specimen potentially contributed to heterogeneity. There was no significant publication bias observed across the eligible studies.

Conclusions:

In chronic liver disease patients, RPR presented a good performance for prediction of significant fibrosis, advanced fibrosis, and cirrhosis. More future trials are required for prospective validation.
Learning curve-cumulative summation analysis of visual estimation of left ventricular function in novice practitioners
Authors: Lee Yoonje , Shin Hyungoo , Kim Changsun , Lee Inhye , Choi Hyuk Joong
Published: April 2019

The aim of the present study was to determine the value of cumulative summation (CUSUM) analysis in assessing the proficiency of novice practitioners in estimating the left ventricular ejection fraction (EF).

Seven novice practitioners with no echocardiography experience were recruited in this observational study. Each practitioner assessed EF from echocardiographic video files of 100 cases, one by one, and received feedback and teaching. We obtained a CUSUM score through comparison of the gold standard values of EF and the EF values determined by the practitioners. Then, the practitioners underwent the same test 4 weeks later, except without feedback and teaching, using echocardiographic video files from 100 other cases.

The mean number of visual estimation cases required to pass the learning curve (LC)-CUSUM test was 56.3 ± 9.1 (95% CI 47.8–64.7). The LC-CUSUM average of the 7 novice practitioners showed improvement in visual estimation skill, with an average acceptable level achieved after a mean experience of 55 cases. In the test performed after 4 weeks, 5 of the 7 novice practitioners showed significantly good overall agreement. All novice practitioners had a kappa coefficient greater than .8, and significant and almost perfect agreement was observed. All the participants exhibited a percentage of correct answers greater than 81%.

We found that the novice practitioners could acquire an acceptable level of skill for estimating EF with short-term, self-learning-focused echocardiographic training.