bluuebunny/crossref_metadata_2025 huggingface dataset:
DELIBERATE SELF‐HARM USING YEW LEAVES (Taxus baccata)
Authors: Stebbing J , Simmons HL , Hepple J
Published: April 2023

SUMMARY In this report describing a case of deliberate self‐harm using yew leaves, there is a brief discussion of the rarity of self‐harm using plant toxins and of the toxic effects of Taxus baccata itself.
PRIMARY PERITONITIS IN A PARAPLEGIC PATIENT
Authors: Irving SO , Hardy S , Bundred NJ
Published: April 2023

SUMMARY This report of a paraplegic patient with a primary peritonitis illustrates the difficulty in diagnosis and management these patients pose.
INFECTED HYDROCELE COMPLICATING ACUTE APPENDICITIS
Authors: Andrews BT
Published: April 2023

SUMMARY This report illustrates how a previously unrecognised patent processus vaginalis may have acted as a conduit for intra‐abdominal sepsis to pass into the scrotum.
QUALITY OF LIFE AND CARE IN PARKINSON'S DISEASE
Authors: Clarke CE , Zobkiw RM , Gullaksen E
Published: April 2023

SUMMARYSeventy‐two parkinsonian patients attending a subregional movement disorder clinic completed a novel questionnaire designed to examine their quality of life and care. Significant problems with housing, travel, holidays and hobbies were identified. Financial difficulties due to premature retirement and the complex benefit system were found. Many carers were ill but, even when hospitalised, patients were cared for in the community by friends and relatives. Few patients had been referred for paramedical therapies, in spite of considerable disability in some cases. Aids and adaptations were commonly in use without advice from an occupational therapist. The specialised clinic and Parkinson's disease nurse advisor were welcomed by many patients. Most were satisfied with their hospital care and general practitioner, but follow‐up arrangements with general practitioners were variable. It is suggested that further research concentrates on the roles of physiotherapy, speech therapy, nurse advisors and social workers in the management of Parkinson's disease, and on the value of increased carer support, including respite care.
TREATMENT OF MAJOR DEPRESSION IN GENERAL PRACTICE: A DOUBLE‐BLIND COMPARISON OF PAROXETINE AND LOFEPRAMINE
Authors: Moon CAL , Vince M
Published: April 2023

SUMMARY A six‐week, double‐blind, randomised study was used to compare the efficacy, tolerability, safety and effect on cognitive function of paroxetine with that of lofepramine in the treatment of 138 patients with major depression in general practice. Efficacy was assessed using the Montgomery and Asberg Depression Rating Scale (MADRS) and Clinical Global Impression (CGI) scale. Effect on cognitive function was assessed using the paired associate learning test and the serial ‘E’ cancellation test. The results showed that the antidepressant efficacy of paroxetine was comparable to that of lofepramine in the treatment of depressed patients. Similar improvements in mean total MADRS scores were observed in both treatment groups, but a significantly greater improvement was seen in the CGI with paroxetine at weeks 2 and 4. The effect of treatment on cognitive function did not differ significantly across the two treatment groups, nor did the number of adverse events reported nor the overall tolerability.
UMBILICAL COILING INDEX: IS IT A MARKER FOR THE FOETUS AT RISK?
Authors: Ercal T , Lacin S , Altunyurt S , Saygili U , Cinar O , Mumcu A
Published: April 2023

SUMMARY The aim of this study was to determine the relationship between the number of coils in the umbilical cord and perinatal outcome. The umbilical cords and delivery records of 147 liveborn neonates were prospectively studied. The umbilical coiling index (UCI) of each cord was calculated by dividing the total number of complete umbilical vascular coils by the umbilical cord length. Subjects with UCIs below the 10th percentile, above the 90th percentile, and between the 10th and 90th percentiles were defined as hypocoiled, hypercoiled, and normocoiled, respectively. Several different parameters were used to measure neonatal outcome. The mean UCI was 0.20 ± 10 (SD). No relationship was noted between UCI and maternal age, gravidity, parity, oligohydramnios, or birth weight. When we compared the hypocoiled group (n=30) with the normocoiled group (n=87), we detected a statistically significantly higher incidence of meconium staining, interventional delivery, apgar scores, fetal blood pH and intrapartum fetal heart rate disturbances. As a result, we concluded that the UCI has a strong relationship with perinatal outcome and may be used antenatally as a marker for identifying the fetus at risk.
METHOTREXATE IN THE TREATMENT OF CHILDREN WITH CHRONIC ARTHRITIS — LONG‐TERM OBSERVATIONS OF EFFICACY AND SAFETY
Authors: Huang J‐L
Published: April 2023

SUMMARY In a study to investigate the efficacy and toxicity of long‐term methotrexate (MTX) therapy in children with chronic arthritis, the medical records of 26 children (seven boys and 19 girls) with juvenile rheumatoid arthritis (JRA) were reviewed retrospectively. The patients received MTX therapy for a mean of three years (range, six months to six years). A clinically significant response occurred in 19 children (73.1%): remission in ten (38.5%) and improvement (25% reduction in the number of actively inflamed joints) in nine (34.6%). Concomitant prednisolone therapy was reduced in 13 out of 14 children (93%). Haemoglobin levels and erythrocyte sedimentation rates were statistically significantly improved over baseline after MTX therapy. Six (23%) children experienced toxic effects during MTX therapy. One patient discontinued the MTX treatment after 18 months because of jaundice and raised liver enzymes. It is concluded that the study confirms the efficacy, and acceptable toxicity profile, of MTX given over a period of several years to children with JRA.
PSEUDOEPHEDRINE TOXICITY IN RENAL FAILURE
Authors: Lyon CC , Turney JH
Published: April 2023

SUMMARY A case of pseudoephedrine toxicity is reported in a man with chronic renal failure. The effects of renal impairment on the metabolism of pseudoephedrine are discussed and the implications of the widespread availability of the drug in proprietary cold remedies are highlighted.
HAIRDRYER SYNCOPE
Authors: Birkinshaw RI , Gleeson A , Gray AJ
Published: April 2023

SUMMARY Six cases of hairdryer syncope are presented. This is a recurrent phenomenon, never previously described in medical literature, though it has been recognised for some time by some hairdressers. Elderly ladies sit under hood hairdryers at hairdressing salons for periods of up to 30 minutes. We observed that under these circumstances, some ladies attended the Accident and Emergency department with a history of ‘fainting‘. A brief survey of hairdressers was conducted around the Stockport area. Possible causes of hairdryer syncope are discussed.
RUPTURED DIAPHRAGM: THE LATENT PHASE
Authors: Huggon AM , Houghton A , Watson DP
Published: April 2023

SUMMARY Traumatic rupture of the diaphragm is an uncommon injury which can be missed unless there is a high index of suspicion. In the interval between rupture of the diaphragm and herniation of abdominal contents, signs and symptoms are nonspecific and the chest X‐ray may be normal.
HOW DO GENERAL PRACTITIONERS MANAGE PATIENTS AT RISK FROM STROKE?
Authors: Mead GE , Murray H , McCollum CN , O'Neill PA
Published: April 2023

SUMMARY This study assessed by means of a postal questionnaire how general practitioners (GPs) manage patients at risk from stroke. Of the 640 GPs sent a questionnaire, 294 (46%) replied. In patients with a recent transient ischaemic attack or minor ischaemic stroke, 24% of responding GPs would not arrange any investigations. Sixty‐one per cent refer under half of their patients for further investigation, although 99% of GPs would commence aspirin. Seventy‐seven per cent of GPs were aware of the benefits of carotid surgery. For patients in atrial fibrillation, most GPs (77%) thought that warfarin reduced stroke rates, but only 20% would consider commencing warfarin, although 26% would commence aspirin. In hypertensive patients, the GPs' threshold for treatment ranged from 135 to 200mmHg systolic (median 160mmHg), and from 90 to 110mmHg diastolic (median 100mmHg). Most GPs (84%) would treat isolated systolic hypertension with a median threshold of 180mmHg (range 140‐240mmHg). The results of this study suggest that some patients at risk from stroke may not receive optimal investigation and treatment in the community.
IS HORMONE REPLACEMENT THERAPY PRESCRIBED FOR POSTMENOPAUSAL DIABETIC WOMEN?
Authors: Feher MD , Isaacs AJ
Published: April 2023

SUMMARY A community‐based survey was undertaken to ascertain current hormone replacement therapy (HRT) prescription rates in postmenopausal diabetic women. From age/sex and disease registers linked to prescription data which covered 144 237 patients, details on 6867 women aged 50‐60 years were obtained. Of this group, 1684 (24.5%) were receiving prescriptions for HRT; the comparable figures for the 537 patients with hypertension and 135 (insulin‐dependent and non‐insulin dependent) diabetic patients were 117 (21.8%) and 15 (11.1%) respectively. While the presence of hypertension did not affect the likelihood of being prescribed HRT (odds ratio 0.85 [95% CI 0.68‐1.05], p>0.1), women with diabetes were less than half as likely as those from the general population to be prescribed HRT (odds ratio 0.38 [95% CI 0.21‐0.67], p<0.001). These data indicate that proportionately greater numbers of postmenopausal diabetic women, even compared with those with hypertension, another group at high risk of cardiovascular disease, are denied the potential benefits of HRT.
INTRACEREBRAL HAEMORRHAGE IN A YOUNG ADULT: CONSIDER AMPHETAMINE ABUSE
Authors: El‐Omar MM , Ray K , Geary R
Published: April 2023

SUMMARY We present the case of a young female who suffered a massive intracerebral bleed following the ingestion of a small quantity of amphetamine (speed). Physicians should be aware that amphetamine abuse can lead to cerebrovascular events in young adults.
ENDOTHELIAL DYSFUNCTION AND CARDIOVASCULAR DISEASE: THE PROMISE OF BLOCKING THE RENIN‐ANGIOTENSIN SYSTEM
Authors: Erhardt LR
Published: April 2023

As a crucial regulator of vascular function the endothelium balances a complex range of actions. Accordingly, damage to the endothelium often precedes the development of clinically manifest vascular disease. This review surveys our current understanding of risk factors involved in causing endothelial damage and the effects of lifestyle changes and pharmacotherapy on the endothelium. Our developing understanding of the intricacies of endothelial function and the effects of risk factors may aid in optimising cardiovascular prevention as well as therapy.
DEFICIT IN MOTOR PERFORMANCE CORRELATES WITH CHANGED CORTICOSPINAL EXCITABILITY IN PATIENTS WITH CHRONIC FATIGUE SYNDROME
Authors: Davey NJ , Puri BK , Main J , Nowicky AV , Zaman R
Published: April 2023

Chronic fatigue syndrome (CFS) is characterised by fatigue and musculosketetal pain, the severity of which is variable. Simple reaction times (SRTs) and movement times (SMTs) are slowed in CFS. Our objective is to correlate the day‐to‐day changes in symptomatology with any change in SRT, SMT or corticospinal excitability. Ten CFS patients were tested on two occasions up to two years apart. Motor evoked potentials (MEPs) to transcranial magnetic stimulation (TMS) of the motor cortex were recorded from the thenar muscles. Threshold TMS strength to evoke MEPs was measured to index corticospinal excitability. SRTs and SMTs were measured. The percentage change in both SRTs and SMTs between the two test sessions correlated with the percentage change in corticospinal excitability assessed according to threshold TMS intensity required to produce MEPs. This study provides evidence that changing motor deficits in CFS have a neurophysiological basis. The slowness of SRTs supports the notion of a deficit in motor preparatory areas of the brain.
MAKING PROGRESS IN STABLE PATIENTS POST STROKE OR TRANSIENT ISCHAEMIC ATTACK: IMPLICATIONS FOR GENERAL PRACTICE
Authors: Jackson G
Published: April 2023

Stroke is a major cause of morbidity and mortality. Those who survive have a one in six chance of a further stroke in the ensuing five years. The perindopril protection against recurrent stroke study (PROGRESS) is the first specific trial to address whether blood pressure lowering in hypertensive or non‐hypertensive patients with a history of stroke or transient ischaemic attack (TIA) would reduce subsequent cerebrovascular and cardiovascular events. Results show that treatment based on perindopril significantly reduces stroke (28%), cardiovascular events (26%) and heart failure (26%). Stable patients post stroke should be considered for perindopril, and indapamide if possible, along with other evidence based risk reduction treatments (e.g. aspirin, statins). Therapy can be initiated and monitored either from hospital outpatients or general practice or both in co‐operation.
ESTABLISHING PRINCIPLES FOR MIGRAINE MANAGEMENT IN PRIMARY CARE
Authors: Dowson AJ , Sender J , Lipscombe S , Cady RK , Tepper SJ , Smith R , Smith TR , Taylor FR , Boudreau GP , Van Duijn NP , Poole AC , Baos V , Wöber C
Published: April 2023

Published guidelines for the management of migraine in primary care were evaluated by an international advisory board of headache specialists, to establish evidence‐based principles of migraine management that could be recommended for international use. Twelve principles of migraine management were identified, covering screening, diagnosis, management and treatments:

Almost all headaches are benign/primary and can be managed by all practising clinicians.

Use questions/a questionnaire to assess the impact on daily living and everyday activities, for diagnostic screening and to aid management decisions.

Share migraine management between the clinician and the patient.

Provide individualised care for migraine and encourage patients to manage their migraine.

Follow up patients, preferably with migraine calendars or diaries.

Regularly re‐evaluate the success of therapy using specific outcome measures and monitor the use of acute and prophylactic medications regularly.

Adapt migraine management to changes that occur in the illness and its presentation over the years.

Provide acute medication to all migraine patients and recommend it is taken at the appropriate time, during the attack.

Provide rescue medication/symptomatic treatment for when the initial therapy fails.

Offer to prescribe prophylactic medications, as well as lifestyle changes, to patients who have four or more migraine attacks per month or who are resistant to acute medications.

Consider concurrent co‐morbidities in the choice of appropriate prophylactic medication.

Work with the patient to achieve comfort with mutually agreed upon treatment and ensure that it is practical for their lifestyle and headache presentation.
NATEGLINIDE (STARLIX®): UPDATE ON A NEW ANTIDIABETIC AGENT
Authors: Phillips LS , Dunning BE
Published: April 2023

Nateglinide is a new oral antidiabetic agent that stimulates insulin release promptly after its pre‐meal administration in a strongly glucose‐dependent fashion. Because its insulinotropic effects are short in duration, nateglinide specifically targets postprandial hyperglycaemia with a low potential to elicit hypoglycaemia or sustained hyperinsulinaemia. Nateglinide has an excellent safety and tolerability profile, and its efficacy in reducing HbA1c in monotherapy (120 mg before meals) is comparable to that of metformin, sulphonylureas, thiazolidinediones or acarbose (−0.5 to −1.5%). When combined with metformin, which primarily reduces fasting glucose levels, nateglinide's effects are additive. In our clinical experience, nateglinide is a particularly good therapeutic option in newly diagnosed, treatment‐naive patients; elderly patients in whom hypoglycaemia is a concern; patients with kidney failure or mild hepatic impairment; patients taking low‐dose sulphonylureas who encounter problems with hypoglycaemia; and patients failing to achieve adequate glycaemic control on metformin or thiazolidinedione monotherapy.
SPONTANEOUS REMISSION OF LARGE GRANULAR LYMPHOCYTIC LEUKAEMIA
Authors: Sosin MD , Handa SI
Published: April 2023

The phenomenon of spontaneous remission is one of the less well known aspects of the leukaemias. Spontaneous remission has been reported in both acute and chronic leukaemia. The mechanism is unclear but may involve immune modulation related to an intercurrent infection or transfusion of blood products. We present a rare case of spontaneous complete remission of T‐cell large granular lymphocytic (T‐LGL) leukaemia occurring in an 82‐year‐old man. The patient died two years later of an unrelated condition, with no evidence of recurrence of T‐LGL leukaemia. Elucidation of the mechanism of the phenomenon of spontaneous remission may lead to advances in the treatment of this diverse group of disorders.
SUPERIOR MESENTERIC ARTERIAL EMBOLISM: A RETROSPECTIVE STUDY OF LOCAL THROMBOLYTIC TREATMENT WITH UROKINASE IN WEST CHINA
Authors: Wang G , Lu W , Xia Q , Mao B , Wang L , Li T , Jiang L
Published: April 2023

Embolism of the superior mesenteric artery (SMA) is a rare disorder. To explore the selective criteria of local thrombolysis, evaluate its efficacy and discuss the therapeutic protocol of SMA embolism, a retrospective case control study was undertaken. Sixteen cases were divided into two groups: nine cases (group A) from May 1995 to April 1999 were given traditional treatment, while seven cases (group B) from November 1999 to June 2002 received comprehensive therapy including local thrombolysis. The local thrombolytic treatment was performed without procedure‐related complications and the embolus was successfully lysed in four patients. The time between admission and diagnosis (or treatment) was shorter in group B than in group A (2.3 ± 1.2 vs 12.3 ± 9.2 hr, p=0.013). Gangrenous bowel segments in group A were much longer than in group B (159.4 ± 87.7 vs 45.7 ± 61.6 cm, p=0.009). However, mortality between the two groups was the same (p=0.282, OR=0.32, 95% Cl=0.039, 2.618) perhaps because of the small sample size. Angiography could shorten the duration from the onset of SMA embolism to therapy and certainly lowers the risk of mortality. Local fibrinolytic infusion may be an effective alternative to embolectomy in patients with SMA embolism but without intestinal infarction.
STATE OF THE ART IN β2‐AGONIST THERAPY: A SAFETY REVIEW OF LONG‐ACTING AGENTS
Authors: Rabe KF
Published: April 2023

Despite concerns in the 1970s and 1980s about the safety of short‐acting β2‐agonists, it is now generally accepted that these agents, used at appropriate doses, provide safe and effective treatment for asthma symptoms. After their introduction, β2‐agonists with a long duration of action — formoterol and salmeterol — became widely used as maintenance therapy with inhaled corticosteroids (ICS). Both β2‐agonists are well tolerated in long‐term studies, with no reduction in lung function observed over time, indicating a lack of clinically relevant tolerance development in patients with asthma and COPD. High‐dose studies have indicated that formoterol produces systemic effects of similar duration to, but less pronounced than, salbutamol and terbutaline. Formoterol produces long‐lasting bronchoprotection against exercise‐induced bronchoconstriction, even in patients receiving regular maintenance therapy; its fast onset of effect (similar to salbutamol) allows formoterol to be used as a reliever. Clinically the safety of formoterol and salmeterol has been demonstrated in several studies, both with ICS and alone. (Int J Clin Pract 2003; 57(8): 689–697)
THE TINKLE TALE
Authors: Maharaj D , Naraynsingh V
Published: April 2023

The clinical features of urinary calculi are well documented. Several textbooks state the features of passage of a stone per urethra including severe dysuria, straining and strangury. We report on three patients in whom attention was drawn to the passage of a stone by the sound made as the stone hit the bedpan during urination. (Int J Clin Pract 2003; 57(8): 719)
PARTIAL SEIZURE: AN UNUSUAL CAUSE OF RECURRENT VOMITING
Authors: Yukselen V , Yasa MH , Karaoglu AO , Bolukbasi O
Published: April 2023

Partial seizure is a rare cause of nausea and vomiting. We report an adult patient with abdominal discomfort lasting 15 years accompanied by nausea and vomiting at least twice a week. On admission, physical examination and detailed laboratory tests were normal. Abdominal ultrasound examination, upper gastrointestinal endoscopy and CT scanning of the brain did not reveal any evidence of disease. Electroencephalography revealed bilateral synchronous sharp wave discharges and spike wave activities. The diagnosis of partial seizure was considered and the patient was administered sodium valproate. The patient's symptoms subsided and he has been asymptomatic for the past 20 months. We conclude that partial seizure should be considered in patients suffering from abdominal complaints who do not have any underlying gastrointestinal disorder.
THE EFFECTS OF MELATONIN AND PROSTAGLANDIN E1 ANALOGUE ON EXPERIMENTAL HEPATIC ISCHAEMIA REPERFUSION DAMAGE
Authors: Bülbüller N , Çcetinkaya Z , Akkus MA , Çifter Ç , Ilhan YS , Dogru O , Aygen E , Özercan I , Genç K
Published: April 2023

The effects of antioxidant melatonin and a prostaglandin E1 analogue (PGE1) on hepatic ischaemia reperfusion damage were investigated. Fifty rats were divided into five equal groups: sham, control, melatonin, PGE1 and combined treatment. No procedures were applied to the sham group. In the control and treatment groups, the hepatic hilus was clamped at the level of the hepatic artery and portal vein for 60 min and reperfusion was provided for two hours. In the treatment and combined treatment groups, melatonin was administered intramuscularly at a dose of 20 mg/kg 15 mins before reperfusion, and PGE1 was administered intravenously at a dose of 25 mg/kg 1 min before reperfusion. Blood samples for SGOT, SGPT, GSH‐Px, SOD and MDA measurements and hepatic tissue samples were taken. The decrease in the plasma MDA levels was statistically significant in the melatonin and combined treatment groups, but not in the PGE1 group (p>0.025). A significant decrease was found in the tissue MDA levels of the treatment groups (p<0.025). The decrease in SGOT and SGPT levels in the PGE1 group was significant (p<0.025), but the decreases in the melatonin and combined treatment groups were not significant (p>0.025). Melatonin and PGE1 were found to be effective in reducing the hepatic ischaemia reperfusion damage in rats. However, the damage could not be reversed. Combined treatment was found not to be superior to melatonin or PGE1 alone.
Prevalence and risk factors of pre‐frailty and frailty in maintenance haemodialysis patients in China: A cross‐sectional Study
Authors: Ye Liqin , Tang Xianping , Zhang Hailin , Ge Song , Yin Lixia , Zhou Ying , Chang Jian
Published: April 2023

Aims

To examine the prevalence and risk factors of pre‐frailty and frailty in maintenance haemodialysis patients in China.

Design

A cross‐sectional study.

Method

From January to July 2017, using the convenience sampling method, a total of 503 maintenance haemodialysis patients from six hospitals in Lianyungang, China, were recruited for this study. The participants' socio‐demographic, lifestyle factors and health information were assessed using a general information questionnaire. Frailty was evaluated based on the Fried frailty phenotype. Multi‐categorical logistic regression was performed to examine factors associated with pre‐frailty and frailty in this population, including age, sex, living alone, employment, educational level, body mass index, per capita monthly household income, smoking status, exercise status, primary diagnosis, dialysis age, frequency of dialysis, vascular access, congestive heart failure, other cardiac diseases, cerebrovascular disease, peripheral blood diseases, pain, albumin level and haemoglobin level.

Results

Among the 503 participants with an average age of 53.02 years (standard deviation 14.99), 178 had pre‐frailty (35.3%) and were mostly young and middle‐aged. The prevalence of pre‐frailty among participants <60 years old was more than 40%. Regression analysis showed that lack of exercise, dialysis age ≤12 months, congestive heart failure and other cardiac diseases were positively associated with pre‐frailty. Two hundred and eighteen participants were frail (43.3%), most of whom were aged ≥60. The prevalence of frailty in participants ≥60 was 71.4%. Regression analysis showed that advanced age, being female, obesity, low per capita monthly household income, lack of exercise, diabetes as the primary disease, dialysis age ≤12 months, congestive heart failure, other cardiac diseases, pain and low albumin level, were positively associated with frailty. In addition, more than half of the participants hardly exercised (64.6%), while lack of exercise was a risk factor for pre‐frailty and frailty. A third of the participants had pain (33.4%), while pain was an independent risk factor for pre‐frailty and frailty in these participants.

Conclusion

Pre‐frailty and frailty are common in patients with maintenance haemodialysis. Most of the elderly maintenance haemodialysis patients are frail, and most of the young and middle‐aged patients are pre‐frail. Clinicians should actively screen the pre‐frailty and frailty among patients with maintenance haemodialysis, especially those with dialysis age ≤12 months. Many factors affect pre‐frailty and frailty in this population. Tailored intervention measures should be designed and implemented based on these factors, giving priority to exercise guidance and pain management for patients to help them prevent or reverse pre‐frailty and frailty.
Exploring the psychometric properties of self‐report instruments used to measure health‐related quality of life and subjective wellbeing of adolescents with intellectual disabilities: A Consensus‐based Standards for the Selection of Health Measurement Instruments (COSMIN) systematic review
Authors: Maguire Stephanie , Davison Jenny , McLaughlin Marian , Simms Victoria , Bunting Brendan
Published: April 2023

Background

Studies that have systematically reviewed the psychometric properties of health‐related quality of life (HRQoL) and subjective wellbeing instruments for adolescents with intellectual disabilities narrowly focus on disease or health‐specific conditions. This review aimed to critically appraise the psychometric properties of self‐report instruments used to measure HRQoL and subjective wellbeing of adolescents with intellectual disabilities.

Method

A systematic search was undertaken in four databases. The quality of the included studies and their psychometric properties was assessed according to the COnsensus‐based Standards for the selection of health Measurement Instruments Risk of Bias checklist.

Results

Seven studies reported psychometric properties of five different instruments. Only one instrument identified as having potential to be recommended for use but requires further validation research to assess its quality for this population.

Conclusions

There is insufficient evidence to support the recommendation of a self‐report instrument to assess HRQoL and subjective wellbeing of adolescents with intellectual disabilities.
Are breeding activities risky for northern bobwhites? An assessment of survival costs of reproduction
Authors: Behney Adam C.
Published: April 2023

Behaviors associated with breeding can increase mortality risk. This increased risk can be thought of as a cost of reproduction. Increased movements prior to breeding are common as individuals search for food and breeding sites. These increased movements are thought to entail greater predation risks as individuals travel through unfamiliar areas but few studies have looked at how these prebreeding movements affect survival, especially at a fine temporal resolution. Costs of reproduction may also occur during reproduction. For birds, incubation and brood‐rearing can increase predation risk because individuals spend most of their time at nest sites or with broods, which may make them more easily detected and captured by predators. Using time‐ and individual‐specific predictors of survival, I examined the relationship between survival, movements, habitat use and breeding status of northern bobwhites Colinus virginianus in Colorado, USA. I found that prebreeding ranges were larger for breeders (29 ha) than non‐breeders (18.7 ha) but daily movement distance was not different (163 m). Range size did not affect survival; however, longer recent daily movement distances (within 10 days) resulted in higher survival. Breeding status also affected survival; laying individuals experienced the highest daily survival rates followed by incubating, non‐breeding and brood‐rearing individuals. Overall, there appears to be a survival cost of reproduction for individuals during brood‐rearing, but I found no evidence that increased movements results in decreased survival.
Small solitary atrial fractionated electrogram zone as a novel ablation target for persistent atrial fibrillation
Authors: Yamaji Hirosuke , Kawafuji Souhei , Sano Masaya , Higashiya Shunichi , Murakami Takashi , Kawamura Hiroshi , Murakami Masaaki , Kamikawa Shigeshi , Kusachi Shozo
Published: April 2023

Introduction

Various adjunctive approaches to pulmonary vein isolation (PVI) have been attempted for persistent atrial fibrillation (perAF) and longstanding persistent AF (ls‐perAF). We aimed to identify the novel zones responsible for perpetuation of AF.

Methods

To identify novel zones acting as a source of perAF and ls‐perAF after PVI/re‐PVI, we performed fractionation mapping in 258 consecutive patients with perAF (n = 207) and ls‐perAF (n = 51) in whom PVI/re‐PVI failed to restore sinus rhythm.

Results

In 15 patients with perAF (5.8%: 15/258), fractionation mapping identified a small solitary zone (<1 cm2) with high‐frequency and irregular waves, showing fractionated electrograms (EGM). We defined this zone as the small solitary atrial fractionated EGM (SAFE) zone. The small SAFE zone was surrounded characteristically by a homogeneous area showing relatively organized activation with nonrapid and nonfractionated waves. Only one small SAFE zone was detected in each patient. This characteristic electrical phenomenon was observed stably during the procedure until ablation. AF duration, (defined as the duration between initial detection of AF and the current ablation) was longer in patients with the small SAFE zone than in those without (median, [25 and 75 percentiles]; 5.0 [3.5, 7.0] vs. 1.1 [1.0, 4.0] years, p = .0008). Longer AF cycle length was observed in patients with the small SAFE zone than in those without. The ablation of the small SAFE zone terminated AF in all 15 patients without any need for other ablations. AF/atrial tachycardia‐free rate at follow‐up was 93% (14/15) at 6 months, 87% (13/15) at 1 year, and 60% (9/15) at 2 years.

Conclusions

Using fractionation mapping, this study identified a small SAFE zone surrounded characteristically by a homogeneous, relatively organized, low‐excitability EGM lesion. The ablation of the small SAFE zone terminated AF in all patients, demonstrating it as a substrate for perpetuated AF. Our findings provide novel ablation targets in perAF patients with prolonged AF duration. Further studies to confirm the present results are warranted.
Controlling the Speededness of Assembled Test Forms: A Generalization to the Three‐Parameter Lognormal Response Time Model
Authors: Becker Benjamin , Weirich Sebastian , Goldhammer Frank , Debeer Dries
Published: April 2023

When designing or modifying a test, an important challenge is controlling its speededness. To achieve this, van der Linden (2011a, 2011b) proposed using a lognormal response time model, more specifically the two‐parameter lognormal model, and automated test assembly (ATA) via mixed integer linear programming. However, this approach has a severe limitation, in that the two‐parameter lognormal model lacks a slope parameter. This means that the model assumes that all items are equally speed sensitive. From a conceptual perspective, this assumption seems very restrictive. Furthermore, various other empirical studies and new data analyses performed by us show that this assumption almost never holds in practice. To overcome this shortcoming, we bring together the already frequently used three‐parameter lognormal model for response times, which contains a slope parameter, and the ATA approach for controlling speededness by van der Linden. Using multiple empirically based illustrations, the proposed extension is illustrated, including complete and documented R code. Both the original van der Linden approach and our newly proposed approach are available to practitioners in the freely available R package eatATA.
What innovation paths for AI to become a GPT?
Authors: Bresnahan Timothy
Published: April 2023

Early commercial applications of artificial intelligence technologies (AITs) were narrow but extremely profitable. Comparable uses of those technologies throughout the economy would lead to a growth boom. Firms which emulated the early applications successfully would make tremendous strategic gains. This is a situation familiar from earlier rounds of information and communication technology. However, for AITs to become a general‐purpose technology across many commercial applications sectors will require some new innovations. This paper examines the innovation paths that could lead to that desirable outcome, the ones that have stalled, the ones in the process now, and the ones that might occur in the future. Strikingly, early AIT use, both commercial and with technical customers, occurred where Digital Transformation was not required for it to succeed. The innovation paths all require Digital Transformation as key steps.
Metabolic constraints and individual variation shape the trade‐off between physiological recovery and anti‐predator responses in adult sockeye salmon
Authors: Lawrence Michael J. , Prystay Tanya S. , Dick Melissa , Eliason Erika J. , Elvidge Chris K. , Hinch Scott G. , Patterson David A. , Lotto Andrew G. , Cooke Steven J.
Published: April 2023

Metabolic scope represents the aerobic energy budget available to an organism to perform non‐maintenance activities (e.g., escape a predator, recover from a fisheries interaction, compete for a mate). Conflicting energetic requirements can give rise to ecologically relevant metabolic trade‐offs when energy budgeting is constrained. The objective of this study was to investigate how aerobic energy is utilized when individual sockeye salmon (Oncorhynchus nerka) are exposed to multiple acute stressors. To indirectly assess metabolic changes in free‐swimming individuals, salmon were implanted with heart rate biologgers. The animals were then exercised to exhaustion or briefly handled as a control, and allowed to recover from this stressor for 48 h. During the first 2 h of the recovery period, individual salmon were exposed to 90 ml of conspecific alarm cues or water as a control. Heart rate was recorded throughout the recovery period. Recovery effort and time was higher in exercised fish, relative to control fish, whereas exposure to an alarm cue had no effect on either of these metrics. Individual routine heart rate was negatively correlated with recovery time and effort. Together, these findings suggest that metabolic energy allocation towards exercise recovery (i.e., an acute stressor; handling, chase,etc.) trumps anti‐predator responses in salmon, although individual variation may mediate this effect at the population level.
Risk of second primary malignancies in survivors of pancreatic neuroendocrine neoplasms from 2000 to 2018
Authors: Yang Zhen , Liu Lianshuang , Leng Kaiming , Shi Guangjun
Published: April 2023

Background and Aim

As a result of improved survival, cancer survivors continue to remain at risk of developing second primary malignancies (SPMs). However, the association between first primary pancreatic neuroendocrine neoplasms (PanNENs) and SPMs has not been thoroughly investigated.

Methods

Using the Surveillance, Epidemiology, and End Results‐18 database, patients histologically diagnosed with PanNENs as their first malignancy between 2000 and 2018 were identified. Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) and excess absolute risks per 10 000 person‐years of SPMs were calculated to estimate the risk of being diagnosed with subsequent cancers compared with the general population.

Results

A total of 489 (5.7%) PanNENs survivors developed an SPM during the follow up, with a median latency between first and second cancer diagnoses of 32.0 months. The overall SIR of SPMs was 1.30 (95% CI: 1.19, 1.42) and the excess absolute risk was 35.67 cases per 10 000 person‐years in comparison with the general population. Age 25–64 years at PanNENs diagnosis was associated with statistically higher risks for SPMs of all cancers combined. Latency stratification was significant for elevated SPMs risk between 2–23 and 84+ months after diagnosis. White patients were found to have a significantly increased incidence of SPMs (SIR: 1.23, 95% CI: 1.11, 1.35), mainly owing to the higher risk of stomach, small intestine, pancreas, kidney and renal pelvis, and thyroid cancers.

Conclusion

Pancreatic neuroendocrine neoplasms survivors experience a significant increase in the burden of SPMs compared with the reference population. The heightened relative risk calls for careful long‐term scrutiny as part of survivorship care plans.
Recent advances in the role of exosomes in liver fibrosis
Authors: Shen Jiliang , Cao Jiasheng , Chen Mingyu , Zhang Yaping
Published: April 2023

Background and Aim

We aim to summarize the current status of research on the role of exosomes in liver fibrosis.

Methods

A review of the relevant literature was performed and the key findings were presented.

Results

Most studies focused on the role of exosomes derived from mesenchymal stem cells, other types of stem cells, and liver resident cells including hepatocytes, cholangiocytes, and hepatic stellate cells in liver fibrosis. Exosomes have been reported to play an essential role in the inactivation or activation of hepatic stellate cells through the delivery of non‐coding RNAs and proteins. In recent years, this exosome cargo has become a research hotspot.

Conclusions

Recent studies have indicated the potential therapeutic benefit of exosomes in liver fibrosis.
Towards understanding insect species introduction and establishment: A community‐level barcoding approach using island beetles
Authors: Jiménez‐García Eduardo , Andújar Carmelo , López Heriberto , Emerson Brent C.
Published: April 2023

Since Darwin put forward his opposing hypotheses to explain the successful establishment of species in areas outside their native ranges, the preadaptation and competition‐relatedness hypotheses, known as Darwin's naturalization conundrum, numerous studies have sought to understand the relative importance of each. Here, we take advantage of well‐characterized beetle communities across laurel forests of the Canary Islands for a first evaluation of the relative support for Darwin's two hypotheses within arthropods. We generated a mitogenome backbone tree comprising nearly half of the beetle genera recorded within the Canary Islands for the phylogenetic placement of native and introduced species sampled in laurel forests, using cytochrome c oxidase I (COI) sequences. For comparative purposes, we also assembled and phylogenetically placed a data set of COI sequences for introduced beetle species that were not sampled within laurel forests. Our results suggest a stronger effect of species preadaptation over resource competition, while also revealing an underappreciated shortfall in arthropod biodiversity data—knowledge of species as being native or introduced. We name this the Humboldtean shortfall and suggest that similar studies using arthropods should incorporate DNA barcode sequencing to mitigate this problem.
On‐call absences and academic recognition: A retrospective cohort analysis
Authors: Manzoor Fizza , Lefkowitz Ariel , Redelmeier Donald A.
Published: April 2023

Background

Resident call schedules require careful planning and are vulnerable to unanticipated absences from unpredictable factors. We tested whether unplanned absences from resident call schedules were associated with the likelihood of subsequent academic recognition.

Methods

We examined unplanned absences from call shifts for internal medicine residents at the University of Toronto from 2014 to 2022 (8 years). We identified institutional awards granted at the end of the academic year as an indicator of academic recognition. We defined the resident‐year as the unit‐of‐analysis that started in July and ended in June of the subsequent year. Secondary analyses examined the association between unplanned absences and the likelihood of academic recognition in later years.

Results

We identified 1668 resident‐years of training in internal medicine. In total, 579 (35%) had an unplanned absence, and the remaining 1089 (65%) had no unplanned absence. Baseline characteristics were similar between the two groups of residents. In total, 301 awards were received for academic recognition. The likelihood of receiving an award at the end of the year was 31% lower for residents who had any unplanned absence compared with those who had no absence (adjusted odds ratio = 0.69, 95% confidence interval 0.51–0.93, p = 0.015). The likelihood of receiving an award was further decreased for residents with multiple unplanned absences compared with those with none (odds ratio 0.54, 95% confidence interval 0.33–0.83, p = 0.008). An absence during the first year of residency was not significantly associated with the likelihood of academic recognition in later years of training (odds ratio 0.62, 95% confidence interval 0.36–1.04, p = 0.081).

Conclusions

The results of this analysis suggest unplanned absences from scheduled call shifts may be associated with a decreased likelihood of academic recognition for internal medicine residents. This association could reflect countless confounders or the prevailing culture of medicine.
Examining the role of nurse executives in homecare through the lens of the Sociology of Ignorance and Critical Management Studies
Authors: Ashley Lisa , Perron Amélie
Published: April 2023

This article presents a novel theoretical approach to explore nurse executives’ paradoxical identity and agency of executive and nurse in homecare organizations. This complex phenomenon has yet to be well theorized or analyzed. Through a synthesis of literature, we demonstrate that Critical Management Studies, as informed by Foucault, and the Sociology of Ignorance, can create a different understanding of the complex interplay between knowledge and nonknowledge (ignorance) that positions nurse executives in both influential and precarious ways in homecare organizations. This theoretical framework has the potential to allow for the explicit exploration of nurse executives’ strategic epistemic and discursive positioning and highlights hierarchal power structures within homecare organizations. We posit that this framework, that spans nursing, management and sociology disciplines, sets a different understanding of homecare organizations as epistemic landscapes, exposing institutional knowledge and ignorance dynamics that remain largely concealed and unchallenged, yet are integral to understanding nurse executives’ epistemic agency.
Comparison of Effectiveness and Safety in Treating Acute Acromioclavicular Joint Dislocation with Five Different Surgical Procedures: A Systematic Review and Network Meta‐Analysis
Authors: Yan Yuan , Liao Mingxin , Lai Huahao , Xu Ziyang , Chen Haobin , Huang Wenhan , Yu Hui , Zhang Yu
Published: April 2023

This network meta‐analysis aims to evaluate the comparative effectiveness and safety of suture anchors (SA), tendon grafts (TG), hook plates (HP), Tight‐Rope (TR), and EndoButton (EB) in the treatment of acute acromioclavicular joint (ACJ) dislocation. The Embase, PubMed, and Web of Science databases were searched from their inception date to June 3, 2022. Studies included all eligible randomized controlled trials (RCTs) and cohort studies with the comparison of five different fixation systems among SA, TG, HP, TR, and EB were identified. All studies were reviewed, performed data extraction, and assessed the risk of bias independently by two reviewers. The primary outcomes are Constant–Murley score (CMS) improvement for assessing clinical efficacy, and complications. The second outcomes are visual analog scale (VAS) for assessing pain relief and the coracoclavicular distance (CCD) for assessing postoperative joint reduction. Version 2 of the revised Cochrane risk of bias tool for randomized trials (RoB 2) and the risk of bias in nonrandomized studies of interventions (ROBINS‐I) were used to assess the RCTs and non‐randomized trials, respectively. The continuous outcomes were presented as mean differences (MD), and risk ratios (OR) were used for dichotomous outcomes, both with 95% confidence intervals (CI). Surface under the cumulative ranking curves (SUCRA) results were calculated to offer a ranking of each intervention. We identified 31 eligible trials, including 1687 patients in total. HP showed less CMS improvement than TR and EB in both the Network Meta‐analysis (NMA) and pairwise meta‐analysis. HP also showed less CMS improvement than SA in NMA. For pain relief, HP performed worse than TR both in pairwise meta‐analysis and NMA. No significant differences were found for the measured value of CCD. Both TR and EB showed a lower incidence of complications than HP in pairwise meta‐analysis. The rank of SUCRA for CMS improvement was as follows: SA, TR, EB, TG, and HP; for pain relief: TR, EB, TG, SA, and HP; for CCD: HP, TR, SA, EB, and TG. For complications, HP showed the highest rank, followed by TG, EB, TR, and SA. SA shows better clinical effectiveness and reliable safety in the treatment of acute ACJ dislocation. Although HP is the most widely used surgical option currently, it should be carefully taken into consideration for its high incidence of complications.
Mindfulness for voices: An experimental analogue study of the effect of manipulating response style to simulated voices in a non‐clinical population
Authors: Jones Bradley , Muddle Sarah , Jenkins Tom , Kitapci Nice , Jacobsen Pamela
Published: April 2023

Objectives

We aimed to investigate the effects of directly manipulating response style to simulated voice hearing on emotional and cognitive outcomes in a non‐clinical population.

Design

A between‐subjects design with one independent variable, response style (with two levels: mindful acceptance vs attentional avoidance). The dependent variables were subjective distress and anxiety (primary outcomes) and performance on a sustained attention task (secondary outcomes).

Methods

Participants were randomly assigned to one of two response styles (mindful acceptance vs. attentional avoidance). They completed a computerised attention task (continuous performance task) whilst listening to a simulation of voice hearing. Participants rated their experience of anxiety and distress before and after completing the sustained attention task which was used to measure their accuracy and response times.

Results

One hundred and one participants took part (mindful acceptance (n = 54); attentional avoidance (n = 47)). There were no statistically significant group differences on post‐test distress and anxiety scores, correct response rate or response times on the computerised attention task. Participants reported a range of different response styles along the spectrum of avoidance to acceptance, but this had no association with their assigned experimental condition. Adherence to task instructions was therefore low.

Conclusions

We are unable to conclude from this study whether experimentally inducing people to respond to voices under cognitively demanding conditions in an avoidant or accepting way has an impact on their emotional or cognitive outcomes. Further research should focus on the development of more robust and reliable procedures for inducing differences in response style under experimental conditions.