bluuebunny/crossref_metadata_2025 huggingface dataset:
Label-free quantitative screening of breast tissue using Spatial Light Interference Microscopy (SLIM)
Authors: Majeed Hassaan , Nguyen Tan Huu , Kandel Mikhail Eugene , Kajdacsy-Balla Andre , Popescu Gabriel
Published: November 2017

Breast cancer is the most common type of cancer among women worldwide. The standard histopathology of breast tissue, the primary means of disease diagnosis, involves manual microscopic examination of stained tissue by a pathologist. Because this method relies onqualitativeinformation, it can result in inter-observer variation. Furthermore, for difficult cases the pathologist often needs additional markers of malignancy to help in making a diagnosis. We present aquantitativemethod for label-free tissue screening using Spatial Light Interference Microscopy (SLIM). By extracting tissue markers of malignancy based on the nanostructure revealed by the optical path-length, our method provides an objective and potentially automatable method for rapidly flagging suspicious tissue. We demonstrated our method by imaging a tissue microarray comprising 68 different subjects - 34 with malignant and 34 with benign tissues. Three-fold cross validation results showed a sensitivity of 94% and specificity of 85% for detecting cancer. The quantitative biomarkers we extract provide a repeatable and objective basis for determining malignancy. Thus, these disease signatures can be automatically classified through machine learning packages, since our images do not vary from scan to scan or instrument to instrument, i.e., they represent intrinsic physical attributes of the sample, independent of staining quality.
Enhancing knowledge sharing in high-tech firms
Authors: Chiu Chou-Kang , Lin Chieh-Peng , Tsai Yuan-Hui , Teh Siew-Fong
Published: November 2017

Purpose

The purpose of this paper is to explore the development of knowledge sharing from the perspectives of broaden-and-build theory and expectancy theory. Its research purpose is to understand how knowledge sharing is driven by such predictors as optimism, pessimism, and positive affect through their complex interactions with collectivism or power distance. In the proposed model of this study, knowledge sharing relates to optimism and pessimism via the partial mediation of positive affect. At the same time, the influence of optimism, pessimism, and positive affect on knowledge sharing are moderated by the national culture of collectivism and power distance, respectively.

Design/methodology/approach

This study’s hypotheses were empirically tested using data from high-tech firms across Taiwan and Malaysia. Of the 550 questionnaires provided to the research participants, 397 usable questionnaires were collected (total response rate of 72.18 percent), with 237 usable questionnaires from Taiwanese employees and 160 usable questionnaires from Malaysian employees. The data from Taiwan and Malaysia were pooled and analyzed using: confirmatory factor analysis for verifying data validity, independent samplet-tests for verifying the consistency with previous literature regarding cultural differences, and hierarchical regression analysis for testing relational and moderating effects.

Findings

This study demonstrates the integrated application of the broaden-and-build theory and expectancy theory for understanding optimism, pessimism, and positive affect in the development of knowledge sharing. The test results confirm that positive affect partially mediates the relationship between optimism and knowledge sharing and fully mediates the relationship between pessimism and knowledge sharing. Moreover, collectivism and power distance have significant moderating effects on most of the model paths between knowledge sharing and its predictors except for the relationship between pessimism and knowledge sharing.

Originality/value

This study extends the expectancy theory to justify how optimistic and pessimistic expectations are stable traits that dominate the way employees share their knowledge sharing. This study shows how collectivism and power distance of Hofstede’s cultural framework can be blended with the broaden-and-build theory and expectancy theory to jointly explain knowledge sharing. Besides, this study provides additional support to the adaptation theory of well-being that suggests psychosocial interventions, which manage to enhance well-being by leveraging positive affect, hold the promise of reducing stressful symptoms and boosting psychological resources among employees.
Lessons identified by the Joplin School Leadership after responding to a Catastrophic Tornado
Authors: Goswick Jeri , Macgregor Cynthia J. , Hurst Beth , Wall Patricia J. , White Renee
Published: November 2017

Natural disasters affect millions of lives each year devastating educational institutions and their communities. This case study identifies lessons learned by school leadership in the aftermath of a devastating tornado that destroyed one‐third of the city, injured over 1,000 people, and took the lives of 158 people including members of the school community. The data were collected through personal interviews with 10 district administrators and educators who were directly affected by the crisis. The findings presented identify a set of lessons learned that may guide other educational institutions to be more prepared in a crisis situation including the importance of hiring expert help, creating a plan to receive resources, and establishing practices of communication that support communities in crisis situations.
A step‐wise approach to developing indicators to compare the performance of maternity units using hospital administrative data
Authors: Geary RS , Knight HE , Carroll FE , Gurol‐Urganci I , Morris E , Cromwell DA , van der Meulen JH
Published: November 2017

Hospital administrative data are attractive for comparing performance of maternity units because of their often large sample sizes, lack of selection bias and the relatively low costs of accessing these data compared with conducting primary data collection. However, using administrative data to develop indicators can also present challenges including varying data quality, the limited detail on clinical risk factors and a lack of structural and user experience measures. This review illustrates how to develop performance indicators for maternity units using hospital administrative data, including methods to address the challenges that administrative data pose.

Tweetable abstract

How to develop maternity indicators from administrative data.
Temporal Trends in Rainwater Tank Suicides in Rijeka, Croatia—A 30‐year Study
Authors: Ferenčić Antun , Šoša Ivan , Cuculic Drazen , Stemberga Valter , Byard Roger W.
Published: November 2017

Although drowning in rainwater tanks is a generally rare phenomenon, this method for suicide has been observed in parts of Croatia. Review of autopsy records at the University of Rijeka, Croatia, was undertaken from 1987 to 2016 to examine this phenomenon. Of 469 drowning deaths, there were 35 suicides in rainwater tanks (7.5%). Overall drowning deaths showed no temporal trends. In contrast, suicidal drownings in rain water tanks showed a marked decline over the years, with 15 cases in 1987–1991, seven in 1992–1996, six in 1997–2001, six in 2002–2006, one in 2007–2011, and none in 2012–2016. Thus, suicidal drowning cases as a percentage of overall drownings dropped from 18% to zero (p<0.001). This study reports a very unusual method of suicide that may have occurred because of the ready availability of large water reservoirs in homes. The recent fall in numbers may relate to less reliance on domestic reservoirs of water.
The post‐politics of transport: establishing a new meeting ground for transport politics
Authors: Legacy Crystal
Published: November 2017

This paper brings together two disparate but critical bodies of literature about contemporary citizen participation in the Australian city: transport politics and post‐politics. The argument is advanced that state and citizen actor relations—as they exist in the governance and management of Australian urban transport—have taken on characteristics of post‐politics. By conceiving of citizen participation in this manner, new ways of understanding it are generated and it is possible to appreciate how such participation is shaped by state actors both across time and in response to the politicisation of transport proposals. The paper illustrates the extent to which citizen engagement has become a new focal point in transport politics, particularly given citizens' capacities to politicise proposals and transport trajectories. It achieves such ends by drawing upon key‐informant interviews conducted between 2013 and 2016 with public transport advocates, select resident groups, and local and state level planning officials from Melbourne, Australia.
Integrating evolutionary biology with digital arts to quantify ecological constraints on vision‐based behaviour
Authors: Bian Xue , Chandler Tom , Laird Warwick , Pinilla Angela , Peters Richard
Published: November 2017

Motion vision is crucial in the life of animals, in controlling locomotion, in foraging, for predator evasion and in communication. However, information on the conditions for motion vision in natural environments is limited. Advancing knowledge of the ecological limitations that affect functional behaviour requires novel methodologies.

To explore motion ecology in more detail we describe an innovative method that integrates evolutionary biology with digital arts. A visualization tool that simulates three spatial dimensions plus movement through time, 3D animation is an innovative approach to understand dynamic environments. Animal signalling systems have provided useful insights into ecological limitations on behaviour, and we demonstrate the utility of our approach by examining motion displays of lizards surrounded by plant motion noise.

The effectiveness of signals in noise was considered under different circumstances, and in each case, we had complete control over the simulations. We used these scenarios to both validate our approach and to demonstrate its potential. The relevance to motion signalling of prevailing wind and resultant plant motion is now well established and we begin by replicating this effect and illustrate how we can explore this in quantitative detail. We further demonstrate its utility by providing novel insights into the benefits of signalling in the right place and at the right time, by manipulating immediate signalling backgrounds, variation in signaller–plant distances and light environments. Each of these simulations provide opportunities for investigation that would be impossible in nature.

Systematic measurements of motion ecology in detail are now achievable. In addition to insights into the evolution of motion signals, 3D environmental reconstruction will provide a test bed for other topics in the field of motion ecology, and a resource to enhance public engagement with science.
An open‐population distance sampling framework for assessing population dynamics in group‐dwelling species
Authors: Schmidt Joshua H. , Rattenbury Kumi L.
Published: November 2017

Effective wildlife management and conservation depends on a detailed understanding of population dynamics at large spatial scales. Distance sampling is an efficient tool for landscape‐scale monitoring, and the recent development of the open‐population distance sampling framework for analysis allows efficient estimation of population parameters for unmarked populations.

Applications of open‐population distance approaches are relatively rare, and further development is required to generalize this powerful class of models for use in complex sampling scenarios.

Here, we extend this class of models to situations where individuals occur in groups and address: the incorporation of group composition information, fluctuations in aggregation among individuals into groups, and non‐repeated survey designs. We also describe a new parameter, κ, representing the change in the rate of aggregation of individuals into groups over time. Using simulations, we assess the performance of this extended framework, and demonstrate its utility through an applied example using a Dall's sheep (Ovis dalli dalli) dataset collected in Alaska from 2009 to 2016.

Our simulation study demonstrated that our extended model reliably recovered the data‐generating parameter values without bias. In the applied example, we found that an abrupt decline in abundance observed in the Dall's sheep population was driven primarily by reductions in lambs and ewe‐like sheep that coincided with the late onset of spring conditions in 2013. Rams were much less affected, suggesting declines in the ewe‐like class drove overall population trajectory in this population.

This work demonstrates how ecological questions related to the dynamics of group‐dwelling species may be assessed in complex sampling situations using an open‐population distance sampling framework. The resulting framework is broadly applicable to a variety of species and will be especially useful for evaluating population dynamics in unmarked populations of group‐dwelling species at large spatial scales.
Stroke identification by criteria based dispatch – a register based study
Authors: Ellensen E. N. , Naess H. , Wisborg T. , Hunskaar S. , Zakariassen E.
Published: November 2017

Background

Rapid and precise dispatch of resources is a key element in pre‐hospital emergency medicine. Emergency medical communication centres (EMCCs) dispatch resources based on protocols and guidelines, balancing the acute need of the individual and the resource allocation of the pre‐hospital emergency medical system. The aim of this study was to determine the validity of stroke identification by the Norwegian dispatch guidelines.

Method and material

This was a register‐based study where patients suspected for stroke were compared to those with the final diagnosis of stroke as an indicator group for the guideline validation. One EMCC and its three associated hospitals participated with 13 months of data. Four subcodes of the stroke dispatch code were defined as suspicious of stroke and further analysed. Factors associated with stroke identification were explored.

Results

The sensitivity for identifying a stroke patient at initial EMCC contact was 57.9% (51.5, 64.1), specificity was 99.1% (98.9, 99.2), positive predictive value was 45.7% (40.1, 51.4) and negative predictive value was 99.4% (99.3, 99.5). The emergency medical access telephone (113) was initial EMCC contact line in only 48% of the cases. Paralyses and admittance to a smaller hospital were associated with increased probability for stroke (OR 2.6, P = 0.001 and OR 2.7, P = 0.01), respectively.

Conclusion

The sensitivity for identification of stroke patients by the dispatch guidelines is modest, while the specificity is high. The 113 telephone line was initial EMCC access point for less than half of the stroke patients.
Do U.S. citizens support government intervention in agriculture? Implications for the political economy of agricultural protection
Authors: Moon Wanki , Pino Gabriel
Published: November 2017

The persistence of agricultural protectionism throughout the world is intriguing given the widely recognized benefits of free trade. The political economy literature over the last decades has considered groups’ interest, politicians’ preferences, and their interactions within domestic politics as the primary forces driving agricultural protection. Yet, a growing body of studies suggests that it would be judicious to weigh in consumers’ or taxpayers’ perspectives in deciphering the nature of agricultural protection. This study examines U.S. citizens’ preferences about government intervention in agriculture and trade. Results show that they are in strong support of agricultural protection and their perceptions of national food security, family farms, environmental sustainability, and multifunctionality of agriculture play a significant role in shaping their support/opposition toward government intervention. The conventional political economy literature theorizes that consumers or taxpayers would oppose public policies that increase their tax burden; however, in the case of the farm sector, they have little incentive to voice their objections given the costs of farm programs are spread across a large number of consumers and taxpayers. U.S. citizens’ support for government involvement in agriculture as reported in this and other prior studies does not lend support for such political economy explanation.
Patient‐reported experience of the impact and burden of neuroendocrine tumors: Oceania patient results from a large global survey
Authors: Leyden John , Pavlakis Nick , Chan David , Michael Michael , Clarke Stephen , Khasraw Mustafa , Price Timothy
Published: November 2017

Aim

Despite the considerable impact of neuroendocrine tumors (NETs) on patients’ lives, the patient journey is not well documented. The aim of this survey was to identify the impact and burden of NETs from the patient perspective.

Methods

This was a self‐reported global survey regarding NET knowledge/awareness, disease impact/management, interaction with medical teams, and desired improvements. One hundred thirty‐eight patients (7% of the global study) in the Oceania region answered closed‐ended questions using graded descriptors on their experience of living with NETs.

Results

The personal lives of patients were negatively impacted by NETs, including overall energy levels (72%, 99/138), emotional health (66%, 91/138), and finances (56%, 77/138). Eighty‐one percent (22/27) of patients not currently working stated that their NET was the reason they were not employed. Of those still working, taking days off work (64%, 39/61), working reduced hours (44%, 27/61) and stopping work for a period of time (31%, 19/61) were the most frequently reported outcomes of having a NET. Although most patients felt supported by their medical team (53% [73/138] reported being extremely or very supported by healthcare professionals in general), patients also identified areas for improvement in patient care. Better access to NET‐specific treatments (58%, 80/138), more awareness about NETs (58%, 80/138) and materials to help patients better explain their condition (52%, 72/138) were indicated by patients as ways to help them live better with their disease.

Conclusion

The survey demonstrated a considerable burden of NETs on patients’ lives and identified areas for improvements in long‐term management.
Point‐of‐care testing facilitates screening and treatment for anaemia in women and children in rural Pakistan
Authors: McCormack Tessa , Ayub Rukhsana , Aziz Faisal , Motta Lara , Spaeth Brooke , Shephard Mark
Published: November 2017

Objective

To use point‐of‐care testing to screen and facilitate treatment for anaemia and to establish an estimate of the prevalence of anaemia in the local population.

Design

An uncontrolled before and after study design was used to evaluate the effectiveness of the intervention on the anaemia status of participants.

Setting

This study took place in a rural mountain community (population approximately 1000) in the Haripur district in northern Pakistan.

Participants

Women of child‐bearing age (15–49 years) and children (12–14 years) were included in this study.

Interventions

The intervention included point‐of‐care testing for haemoglobin, treatment with mebendazole and oral iron supplementation, and an education campaign about anaemia delivered by community health workers and medical students.

Main outcome measures

The main outcome measure was an increase in blood haemoglobin over the study period. A secondary outcome measure was a positive change in anaemia status or classification post‐intervention.

Results

Anaemia was initially detected in 64 (53%) women and 15 (47%) children. The mean haemoglobin concentration increased significantly (P < 0.001) from 118 to 130 g L−1 (women) and 120 to 130 g L−1 (children) post‐intervention. Overall prevalence of anaemia in women (P < 0.001) and children (P < 0.001) decreased significantly (by 30% and 34%, respectively) post‐intervention.

Conclusions

Point‐of‐care testing used for the detection of anaemia in this rural community helped to identify the burden of disease and to reduce this significantly by way of rapid diagnosis, education and immediate medical intervention.
Early‐life antibiotic exposure increases the risk of developing allergic symptoms later in life: A meta‐analysis
Authors: Ahmadizar F. , Vijverberg S. J. H. , Arets H. G. M. , de Boer A. , Lang J. E. , Garssen J. , Kraneveld A. , Maitland‐van der Zee A. H.
Published: November 2017

This study systematically reviewed and quantified the relationship between exposure to antibiotics during the first 2 years of life and the risk of allergies/atopies including hay fever, eczema, food allergy, positive skin prick testing (SPT), or elevated allergen‐specific serum/plasma immunoglobulin (Ig) E levels later in life. PubMed and Web of Science databases were searched for observational studies published from January 1966 through November 11, 2015. Overall pooled estimates of the odds ratios (ORs) were obtained using fixed or random‐effects models. Early‐life exposure to antibiotics appears to be related to an increased risk of allergic symptoms of hay fever, eczema, and food allergy later in life. The summary OR for the risk of hay fever (22 studies) was 1.23, 95% confidence interval (CI):1.13‐1.34; I2: 77.0%. The summary OR for the risk of eczema (22 studies) was 1.26, 95% CI: 1.15‐1.37; I2: 74.2%, and the summary OR for food allergy (3 studies) was 1.42, 95% CI: 1.08‐1.87; I2: 80.8%. However, no association was found for antibiotics exposure early in life and objective atopy measurements including positive SPT or elevated allergen‐specific serum/plasma IgE levels.
Clinical implications of mast cell involvement in allergic conjunctivitis
Authors: Elieh Ali Komi D. , Rambasek T. , Bielory L.
Published: November 2017

The conjunctiva is a common site for the allergic inflammatory response due to it being highly vascularized, having constant exposure to environmental pollutants and allergenic pollens and having a unique conjunctival associated lymphoid tissue. The primary morbidity of anterior surface conjunctival disorders that include allergic conjunctivitis and tear film disorders is associated with its high frequency of involvement rather than its severity, although the more chronic forms can involve the cornea and lead to sight‐threatening conditions. Ocular allergy is associated with IgE‐mediated mast cell activation in conjunctival tissue leading to the release of preformed mediators including histamine and proteases and subsequent de novo formation of lipid‐derived mediators and cytokines that trigger a cascade of cellular and molecular events leading to extensive migration and infiltration of inflammatory cells to the ocular surface. The trafficking of neutrophils, eosinophils, and lymphocytes to the ocular surface is due to establishing various chemokine gradients (mainly CCL11, CCL24, CCL5, MCP‐3, and MCP‐4), cell surface expression of adhesion molecules (such as VCAM‐1 the ligand for VLA‐4), and leukocyte adhesion to vascular endothelium. The release of preformed mediators underlies the acute ocular surface response while the secondary influx of inflammatory cells leading to the recruitment and activation of eosinophils and the subsequent activation of Th2 and Th1 lymphocytes at the level of the conjunctiva reflects the late‐phase reaction.
What can we learn in drug allergy management from World Health Organization's international classifications?
Authors: Tanno L. K. , Torres M. J. , Castells M. , Demoly P. ,   the Joint Allergy Academies
Published: November 2017

Drug hypersensitivity reactions (DHRs) represent growing health problem worldwide, affecting more than 7% of the general population, and represent an important public health problem. However, knowledge in DHRs morbidity and mortality epidemiological data is still not optimal and international comparable standards remain poorly accessed. Institutional databases worldwide increasingly use the WHO International Classification of Diseases (ICD) system to classify diagnoses, health services utilization, and death data. The misclassification of disorders in the ICD system contributes to a lack of ascertainment and recognition of their importance for healthcare planning and resource allocation. It also hampers clinical practice and prevention actions. To further inform the allergy community and to ensure that the revision process is transparent as advised in the WHO ICD‐11 revision agenda, we report the advances and use of the pioneering “Drug hypersensitivity” subsection of ICD‐11 and implementation in the WHO International Classification of Health Interventions (ICHI). The new classification addressed to DHRs will enable the collection of more accurate epidemiological data to support quality management of patients with drug allergies and better facilitate healthcare planning and decision‐making and public health measures to prevent and reduce the morbidity and mortality attributable to DHRs.
Geochemical and Petrographic Analysis of Late Bronze Age Cypriot Ceramics (White Slip I and II and Monochrome) from Tell Atchana/Alalakh (Hatay) in the Amuq Valley
Authors: Hacıosmanoğlu S. , Kİbaroğlu M. , Sunal G. , Kozal E. , Gutsuz P.
Published: November 2017

White Slip ware, both White Slip I and II, and Monochrome ware are Middle to Late Bronze Age Cypriot pottery types found across a large area of the Eastern Mediterranean region. A vast quantity of these wares has also been uncovered in Tell Atchana/ancient Alalakh in Hatay in southern Anatolia. We analysed a total of 56 White Slip (n = 36) and Monochrome potsherds (n = 20) from Tell Atchana using XRF, ICP–MS and petrographic thin‐section methods. The main aim of the study was to explore the compositional characteristics of the wares and to determine whether they are local imitations of the Cypriot White Slip and Monochrome wares or represent Cypriot exports to this region. The analytical results proved that White Slip I and II were produced from raw clay of mafic and ultramafic source rocks exposed in the Troodos Massif, available in the Limassol area of southern Cyprus and traded to Tell Atchana. Examples of Monochrome ware excavated in Tell Atchana were also imported to the region, most probably from east/north‐east Cyprus. These results demonstrate a close trading connection between Tell Atchana/Alalakh and southern Cyprus during the Middle to Late Bronze Age.
Measuring the impact of medicines regulatory interventions – Systematic review and methodological considerations
Authors: Goedecke Thomas , Morales Daniel R. , Pacurariu Alexandra , Kurz Xavier
Published: November 2017

Aims

Evaluating the public health impact of regulatory interventions is important but there is currently no common methodological approach to guide this evaluation. This systematic review provides a descriptive overview of the analytical methods for impact research.

Methods

We searched MEDLINE and EMBASE for articles with an empirical analysis evaluating the impact of European Union or non‐European Union regulatory actions to safeguard public health published until March 2017. References from systematic reviews and articles from other known sources were added. Regulatory interventions, data sources, outcomes of interest, methodology and key findings were extracted.

Results

From 1246 screened articles, 229 were eligible for full‐text review and 153 articles in English language were included in the descriptive analysis. Over a third of articles studied analgesics and antidepressants. Interventions most frequently evaluated are regulatory safety communications (28.8%), black box warnings (23.5%) and direct healthcare professional communications (10.5%); 55% of studies measured changes in drug utilization patterns, 27% evaluated health outcomes, and 18% targeted knowledge, behaviour or changes in clinical practice. Unintended consequences like switching therapies or spill‐over effects were rarely evaluated. Two‐thirds used before–after time series and 15.7% before–after cross‐sectional study designs. Various analytical approaches were applied including interrupted time series regression (31.4%), simple descriptive analysis (28.8%) and descriptive analysis with significance tests (23.5%).

Conclusion

Whilst impact evaluation of pharmacovigilance and product‐specific regulatory interventions is increasing, the marked heterogeneity in study conduct and reporting highlights the need for scientific guidance to ensure robust methodologies are applied and systematic dissemination of results occurs.
Measurement tools for assessment of older age bipolar disorder: A systematic review of the recent global literature
Authors: Rej Soham , Quayle William , Forester Brent P , Dols Annemiek , Gatchel Jennifer , Chen Peijun , Gough Sarah , Fox Rebecca , Sajatovic Martha , Strejilevich Sergio A , Eyler Lisa T
Published: November 2017

Objectives

More than 50% of people with bipolar disorder will be age 60 years or older by 2030. There is a need for more data to guide assessment and treatment in older age bipolar disorder (OABD); however, interpretation of findings from small, single‐site studies may not be generalizable and there are few large trials. As a step in the direction of coordinated large‐scale OABD data collection, it is critical to identify which measurements are currently used and identify potential gaps in domains typically assessed.

Methods

An international group of OABD experts performed a systematic literature review to identify studies examining OABD in the past 6 years. Relevant articles were assessed to categorize the types of clinical, cognitive, biomarker, and neuroimaging OABD tools routinely used in OABD studies.

Results

A total of 53 papers were identified, with a broad range of assessments. Most studies evaluated demographic and clinical domains, with fewer studies assessing cognition. There are relatively few biomarker and neuroimaging data, and data collection methods were less comprehensively covered.

Conclusion

Assessment tools used in the recent OABD literature may help to identify both a minimum and a comprehensive dataset that should be evaluated in OABD. Our review also highlights gaps where key clinical outcomes have not been routinely assessed. Biomarker and neuroimaging assessment could be further developed and standardized. Clinical data could be combined with neuroimaging, genetic, and other biomarkers in large‐scale coordinated data collection to further improve our understanding of OABD phenomenology and biology, thereby contributing to research that advances care.
Enumeration and characterization of circulating multiple myeloma cells in patients with plasma cell disorders
Authors: Foulk Brad , Schaffer Mike , Gross Steve , Rao Chandra , Smirnov Denis , Connelly Mark C. , Chaturvedi Shalini , Reddy Manjula , Brittingham Greg , Mata Marielena , Repollet Madeline , Rojas Claudia , Auclair Daniel , DeRome Mary ,   The MMRF CoMMpass Network, Weiss Brendan , Sasser Amy K.
Published: November 2017

We have developed an automated assay to enumerate and characterize circulating multiple myeloma cells (CMMC) from peripheral blood of patients with plasma cell disorders. CMMC show expression of genes characteristic of myeloma and fluorescence in situ hybridisation results on CMMC correlated well with bone marrow results. We enumerated CMMC from over 1000 patient samples including separate cohorts of newly diagnosed multiple myeloma and high/intermediate risk smouldering multiple myeloma (SMM) with clinical follow‐up data. In newly diagnosed myeloma patient samples, CMMC counts correlated with other clinical measures of disease burden, including the percentage of bone marrow plasma cells, serum M protein, and International Staging System stage. CMMC counts decreased significantly from baseline when a remission was achieved due to treatment (P < 0·001). Patients with CMMC counts ≥100 at remission showed reduced survival relative to patients with CMMC counts <100. Patients with undetectable CMMC in remission showed further overall survival benefits. In the SMM cohort, there was a trend toward higher CMMC in patients with higher‐risk myeloma precursor states. Significantly higher CMMC counts were observed between intermediate/high risk SMM patients that progressed versus those without progression (P = 0·031). CMMC allow a non‐invasive means of monitoring tumour biology and may have use as a prognostic test for patients with plasma cell disorders.
Open foresight: The influence of organizational context
Authors: Wiener Melanie
Published: November 2017

Open foresight (OF)—a new approach for companies to jointly look into the future—is a response to the limitations of traditional corporate foresight. In an OF process, the companies involved share their understanding and interpretation of future developments. This reduces their uncertainty about the future and helps the companies design and assess development trajectories toward the future, including scenarios, action plans, and innovation ideas. First suggested as a new approach around 2006, OF is still surrounded by many questions. One of these questions concerns the organizational settings needed to enhance the success of OF. This paper focuses on three elements. First, organizational culture has been found to be critical for successful corporate foresight, but no clear evidence on the design of a "foresight‐friendly" culture has so far been presented. Furthermore, top management involvement and commitment has been widely reported as one of the factors of success in innovation processes. What role top management plays in OF has not yet been researched. Finally, OF is a creative process conducted by a team in which all companies involved are represented. In the innovation literature, ample evidence can be found on the importance of team heterogeneity for creativity, but does the same hold for OF processes? Based on an explorative in‐depth case study of an OF process, tentative theory is formulated in the form of four propositions for further research: OF (1) is enhanced by a culture with strong adhocracy and medium weight clan values, (2) requires top management commitment, and (3) is best conducted in a team that is heterogeneous in terms of individual diversity, but (4) homogeneous in terms of management levels involved.
Evaluating an Agricultural Extension Program Aimed at Improving Biodiversity in Alberta, Canada
Authors: Rollins Curtis L. , Simpson Stephanie R. , Boxall Peter C.
Published: November 2017

We evaluate an agricultural extension program aimed at increasing on‐farm biodiversity in Alberta. Using reports prepared for program participants by the extension agency, customized surveys were used to collect data on whether recommended practices were adopted. Data were also collected from producers who were willing but unable to participate in the program due to its unexpected cancellation. A count model compared the number of practices adopted by participants and nonparticipants to evaluate the program's efficacy, and a probit model using participants’ adoption data were used to understand factors affecting adoption. Simple, low‐cost, and easily trialed practices were adopted at high rates, though some higher cost practices associated with observable benefits were also adopted at moderate or high rates. Farm‐specific characteristics, such as size, tenure, or group membership were also significantly linked to the likelihood of adoption. Results suggest that the extension program was successful in encouraging adoption of environmentally beneficial practices with caveats; project completion and quality were not verified, and decreasing marginal returns to extension efforts may have been realized within the small participant pool.

Nous évaluons un programme d'éducation permanente en agriculture visant l'augmentation de la biodiversité fermière en Alberta. Utilisant des rapports préparés par les agences d'éducation pour les participants de programmes, des sondages individualisés ont servi à la collecte de données concernant l'adoption de pratiques recommandées. Des données ont aussi été recueillies auprès de producteurs qui auraient voulu participer mais qui n'ont pas profité du programme suivant son annulation inattendue. Un modèle de comptage a servi à comparer le nombre de pratiques adoptées par les participants et non‐participants pour évaluer l'efficacité du programme, et un modèle probit basé sur les données d'adoption par les participants a servi à comprendre les facteurs ayant un impact sur l'adoption. Les pratiques simples, peu coûteuses et faciles à tester ont été hautement adoptées. Certaines pratiques à coûts plus élevés, associées à des avantages observables, ont aussi vu des taux moyens et élevés d'adoption. Les caractéristiques spécifiques aux exploitations agricoles comme la taille, la longévité et l'adhésion à un groupe se sont aussi trouvées liées de façon significative aux probabilités d'adoption. Les résultats suggèrent que le programme d'éducation permanente a réussi à encourager l'adoption de pratiques bénéfiques pour l'environnement avec quelques bémols: la réalisation des projets et leur qualité n'ont pas fait l'objet de vérification, et la diminution des rendements marginaux en fonction des efforts d'éducation pourrait avoir été réalisée dans le cadre d'un petit bassin de participants.
Evolution of soft palate surgery techniques for obstructive sleep apnea patients: A comparative study for single‐level palatal surgeries
Authors: Rashwan Mohamed S. , Montevecchi Filippo , Cammaroto Giovanni , Badr el Deen Mohamed , Iskander Nagi , El Hennawi Diaa , El Tabbakh Mohammed , Meccariello Giuseppe , Gobbi Riccardo , Stomeo Francesco , Vicini Claudio
Published: November 2017

Objectives

To compare the results of tissue preservation techniques of soft palate surgeries including expansion sphincter pharyngoplasty (ESP) and barbed reposition pharyngoplasty (BRP) for patients suffering from obstructive sleep apnoea (OSA) with the traditional uvulopalatopharyngoplasty (UPPP).

Design

Interventional comparative study.

Setting

Morgagni‐Pierantoni Hospital.

Participants

Seventy‐five patients were included in the study, divided into three groups with 25 patients per group: UPPP, ESP or BRP.

Main outcomes measures

Polysomnography was carried out for all patients pre‐ and postoperatively; the postoperative results were recorded at least 6 months after surgery. All patients were assessed preoperatively using drug‐induced sleep endoscopy. Epworth Sleepiness Scale and body mass index (BMI) were registered for all patients before and after surgery.

Results

The mean of pre‐ and postoperative differences of apnoea‐hypopnoea index values was higher in BRP group than ESP: 15.76 ± 14.5 Vs 10.13 ± 5.3; P < .05 and UPPP groups: 15.76 ± 14.5 vs 6.08 ± 5.5; P < .0005. The mean of differences of oxygen desaturation index values was higher in BRP group than UPPP group: 15.09 ± 17.6 vs 7.13 ± 6.8; P < .0005, but not significantly higher than ESP group: 15.09 ± 17.6 vs 6.48 ± 7.9; P > .05. The mean of differences of ESS values was higher in BRP group than ESP group: 5.52 ± 4.1 vs 4.84 ± 3.3; P < .005 and UPPP groups: 5.52 ± 4.1 vs 1.36 ± 1.9; P < .005. Finally, the pre‐ and postoperative means of differences of lowest oxygen saturation values were not statistically significant among the three groups (P > .05).

Conclusion

Barbed reposition pharyngoplasty (BRP) can be considered an effective procedure on the basis of the postoperative outcomes. ESP still proves to be a good technique especially when performed by experienced surgeons. Both techniques proved to be superior to UPPP.
Right ventricular systolic function and mechanical dispersion identify patients with arrhythmogenic right ventricular cardiomyopathy
Authors: Åström Aneq Meriam , Maret Eva , Brudin Lars , Svensson Anneli , Engvall Jan
Published: November 2017

Purpose

To assess right ventricular (RV) regional and global systolic function using feature tracking (FT) in patients with a definite diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) and to investigate if changes in strain amplitude and mechanical dispersion indicate a propensity for arrhythmia.

Materials and Methods

Twenty‐seven patients fulfilling Task Force Criteria for ARVC and 24 healthy volunteers underwent MR at 1·5 Tesla. Steady‐state free precession cine of long‐axis slices and a short‐axis stack of the RV was acquired. Segmental longitudinal systolic strain amplitude and time‐to‐peak (TTP) strain were measured in the four‐ and two‐chamber views of the RV.

Results

Compared to controls, patients with ARVC had lower RV ejection fraction (RVEF), (53% vs 57%, P = 0·012) and lower longitudinal strain amplitude in the RV free wall (‐20·6 vs ‐26·3%, P = 0·014) and in the basal part of the RV (‐22·8 vs ‐31·7%, P<0·001). Mechanical dispersion, defined as the standard deviation (SD) of TTP of RV segments, was larger in patients with ARVC (48 ms [21–74] vs 35 ms [13–66 ms], P = 0·02). Patients with ventricular tachycardia (VT) or non‐sustained VT had lower RVEF (46% vs 55%, P = 0·008), but did not have significantly lower RV strain amplitude (−19·5% vs 21·0%, P = 0·073) and no signs of mechanical dispersion (49 ms vs 48 ms, P = 0·861) compared to patients without arrhythmia.

Conclusion

ARVC patients had lower longitudinal absolute strain amplitude in basal RV segments and increased mechanical dispersion compared to healthy volunteers, but the presence of mechanical dispersion was not predictive of ventricular arrhythmia.
Off‐Label‐Use und Entscheidungen über Anträge auf Kostenübernahme in Deutschland – eine retrospektive Analyse
Authors: Seidenschnur Karin Ellen Katharina , Dressler Corinna , Weller Karsten , Nast Alexander , Werner Ricardo Niklas
Published: November 2017

Hintergrund und Zielsetzungen

Mit dem Begriff „Off‐Label‐Use“ (zulassungsüberschreitende Anwendung) wird die Verordnung pharmazeutischer Präparate außerhalb ihrer zugelassenen Anwendungsgebiete beschrieben. Für seltene Krankheiten sind häufig keine oder kaum zugelassene Therapiealternativen verfügbar. Die Kosten für eine Off‐Label Verordnung werden von der Gesetzlichen Krankenversicherung (GKV) nur unter bestimmten, gesetzlich geregelten Voraussetzungen übernommen. Um Regressforderungen durch die Kostenträger zu vermeiden, kann vor Verordnung ein Antrag auf Kostenübernahme (‘Off‐Label Antrag’) gestellt werden.

Patienten und Methoden

Es wurde eine retrospektive Auswertung von Off‐Label Anträgen, die im Zeitraum 2010‐2012 in zwei Sprechstunden einer dermatologischen Hochschulambulanz gestellt wurden, durchgeführt (Autoimmun‐Sprechstunde, Urtikaria‐Sprechstunde). Krankenkassen, Bewilligungsraten, Gründe für Ablehnungen und die Bearbeitungsdauer wurden ausgewertet.

Ergebnisse

Die Auswertung ergab, dass 56,8 % der eingeschlossenen Off‐Label Anträge (n = 44) initial bewilligt wurden. Nach bis zu zweimaligem Widerspruch gegen die Ablehnung einer Kostenübernahme betrug die Bewilligungsrate insgesamt 75 %. Die Dauer zwischen Antragstellung und Bescheid durch die Kostenträger betrug 49 Tage (Median). Bei positivem Bescheid erfolgte die Therapieeinleitung 92 Tage (Median) nach Antragstellung.

Schlussfolgerungen

Die vorliegende Fallserie zeigt, dass die Kostenträger den beantragten Kostenübernahmen für Off‐Label Therapien im überwiegenden Teil der betrachteten Fälle zustimmten. Ob die identifizierten Probleme durch die gegenwärtigen Veränderungen der gesetzlichen Rahmenbedingungen (GKV‐Versorgungsstrukturgesetz, Patientenrechtegesetz) adäquat adressiert werden, sollte in einer prospektiven Studie untersucht werden.
Sweet‐Syndrom: Revision der diagnostischen Kriterien
Authors: Nofal Ahmad , Abdelmaksoud Ayman , Amer Hala , Nofal Eman , Yosef Ayman , Gharib Khaled , Albalat Waleed , Eldesouky Fatma , Ebrahim Howyda M. , Abdelshafy Ahmed Said , Fayed Hala
Published: November 2017

Die Diagnose des Sweet‐Syndroms (SS) gründet sich auf eine Reihe von Kriterien, von denen mindestens zwei Haupt‐ und zwei Nebenkriterien erfüllt sein müssen. In einigen Fällen ist die Diagnose aufgrund des Fehlens bestimmter Kriterien jedoch nicht so einfach. Ziel der vorliegenden Studie war es, die klinischen, histopathologischen und Labormerkmale der aktuellen Diagnosekriterien für das SS zu überprüfen und ihre Aussagekraft anhand der publizierten Fälle sowie bei 40 in unserem Institut behandelten Patienten zu beurteilen. Unsere umfassende Prüfung der aktuellen Kriterien für das SS ergab, dass seit seiner Erstbeschreibung im Jahr 1964 die beiden Hauptkriterien bei allen Fällen – einschließlich unserer – durchweg vorhanden waren. Andererseits gab es hinsichtlich der Nebenkriterien deutliche Unterschiede zwischen den verschiedenen Studien und bei vielen Patienten war die Bedingung, dass zwei Nebenkriterien vorhanden sein müssen, nicht erfüllt. Wir schlagen hier zwei Gruppen von revidierten Diagnosekriterien für das SS vor. Dies geschieht mit dem Ziel, die Diagnose zu vereinfachen, Fehldiagnosen zu vermeiden und eine sofortige Behandlung zu ermöglichen. Die erste Gruppe umfasst konstante klinische und histopathologische Merkmale, die vorhanden sein müssen und die per se für die Diagnose eines SS ausreichen. Die zweite Gruppe enthält veränderliche Merkmale, deren Fehlen es nicht erlaubt, ein SS auszuschließen.
Delayed‐type hypersensitivity to oral and parenteral drugs
Authors: Brandt Oliver , Bircher Andreas J.
Published: November 2017

Adverse drug reactions of the delayed type rank among the most common dermatoses and are predominantly characterized by exanthematous macular or maculopapular eruptions. However, approximately 2 % of affected individuals develop severe or even life‐threatening systemic immune reactions associated with organ involvement, requiring immediate diagnosis and treatment. Numerous drugs are capable of eliciting delayed‐type hypersensitivity reactions, with antibiotics, anticonvulsant drugs, and the xanthine oxidase inhibitor allopurinol being the most common. Apart from genetic susceptibility, predisposing factors for the development of drug hypersensitivity reactions include high drug doses, polypharmacy, long treatment duration, female gender, as well as acute or chronic infections.
A European, multicentre, retrospective, non‐interventional study (EU‐TREAT) of the effectiveness of insulin degludec after switching basal insulin in a population with type 1 or type 2 diabetes
Authors: Siegmund Thorsten , Tentolouris Nikolaos , Knudsen Søren T. , Lapolla Annunziata , Prager Rudolf , Phan Tra‐Mi , Wolden Michael L. , Schultes Bernd ,   for the EU‐TREAT study group
Published: November 2017

Aims

To evaluate the clinical effectiveness of switching to insulin degludec (IDeg) in insulin‐treated patients with either type 1 diabetes (T1DM) or type 2 diabetes (T2DM) under conditions of routine clinical care.

Materials and Methods

This was a multicentre, retrospective, chart review study. In all patients, basal insulin was switched to IDeg at least 6 months before the start of data collection. Baseline was defined as the most recent recording during the 3‐month period before first prescription of IDeg. Values are presented as mean [95%CI].

Results

T1DM (n = 1717): HbA1c decreased by −2.2 [−2.6; −2.0] mmol/mol (−0.20 [−0.24; −0.17]%) at 6 months vs baseline (P < .001). Rate ratio of overall (0.79 [0.69; 0.89]), non‐severe nocturnal (0.54 [0.42; 0.69]) and severe (0.15 [0.09; 0.24]) hypoglycaemia was significantly lower in the 6‐month post‐switch period vs the pre‐switch period (P < .001 for all). Total daily insulin dose decreased by −4.88 [−5.52; −4.24] U (−11%) at 6 months vs baseline (P < .001). T2DM (n = 833): HbA1c decreased by −5.6 [−6.3; −4.7] mmol/mol (−0.51 [−0.58; −0.43] %) at 6 months vs baseline (P < .001). Rate ratio of overall (0.39 [0.27; 0.58], P < .001), non‐severe nocturnal (0.10 [0.06; 0.16], P < .001) and severe (0.075 [0.01; 0.43], P = .004) hypoglycaemia was significantly lower in the 6‐month post‐switch period vs the pre‐switch period. Total daily insulin dose decreased by −2.48 [−4.24; −0.71] U (−3%) at 6 months vs baseline (P = .006). Clinical outcomes for T1DM and T2DM at 12 months were consistent with results at 6 months.

Conclusions

This study demonstrates that switching patients to IDeg from other basal insulins improves glycaemic control and significantly reduces the risk of hypoglycaemia in routine clinical practice.