bluuebunny/crossref_metadata_2025 huggingface dataset:
Framing the news on the Syrian War: A comparative study of antiwar.com and cnn.com editorials
Authors: Alitavoli Rayeheh
Published: May 2019

This study identifies the dominant frames presented in opinion articles published from 20 August to 17 September 2013 on the alternative website – antiwar.com – and the mainstream website – cnn.com; this timeframe includes articles published a week before and a week after the US administration’s decision to attack and withdraw from Syria. The article employs qualitative content analysis and Entman’s framing theory to code the data and extract the themes and dominant frames present in a total of 87 opinion articles. The study concludes that cnn.com provided frames that presented Bashar al-Assad as a ‘brutal villain’ who uses chemical weapons on his own people, while providing frames that stress Barack Obama’s incompetency in carrying out a strategic plan and highlight the negative consequences of a strike. However, antiwar.com articles are more resonant and consistent than cnn.com articles, and provide frames that encourage readers to protest against engaging in another war, reminding them of the failures of similar past wars such as the Iraq War and its negative consequences, as well as stressing the major players that benefited from a military intervention.
The FRAIL-FIT study: Frailty’s relationship with adverse-event incidence in the longer term, at one year following intensive care unit treatment – A retrospective observational cohort study
Authors: Hewitt David , Booth Malcolm G
Published: May 2019

Introduction

Frailty is a syndrome of decreased reserve and heightened vulnerability. Frailty scoring has potential to facilitate more informed decisions in the intensive care unit. To validate this, its relationship with outcomes must be tested extensively. This study aimed to investigate frailty’s impact on adverse outcomes after intensive care unit admission, primarily one-year mortality.

Methods

This single-centre retrospective observational cohort study examined prospectively collected data from 400 intensive care unit patients. Frailty was assessed using the Clinical Frailty Scale and defined as Clinical Frailty Scale ≥ 5. Unadjusted and adjusted analyses tested the relationships of frailty, covariates and outcomes.

Results

Of 400 eligible patients, 111 (27.8%) were frail and 289 (72.3%) were non-frail. Compared to non-frail patients, frail patients were older (62 vs. 56, p < 0.001) and had higher Acute Physiology and Chronic Health Evaluation II scores (22 vs. 19, p < 0.001). Females were more likely to be frail than males (34.1% vs. 22.9% frail, p = 0.018). Frail patients were less likely to survive the intensive care unit (p = 0.03), hospital (p = 0.003) or to one year (p < 0.001). Frailty significantly increased one-year mortality hazards in unadjusted analyses (hazard ratio 1.96; 95% confidence interval 1.41–2.72; p < 0.001) and covariate adjusted analyses (hazard ratio 1.41; 95% confidence interval 1.00–1.98; p = 0.0497). Frail patients had more hospital admissions (p = 0.014) and longer hospital stays within both one year before (p = 0.002) and one year after intensive care unit admission (p = 0.012).

Conclusions

Frailty was common and associated with greater age, female gender, higher sickness severity and more healthcare use. Frailty was significantly associated with greater risks of mortality in both unadjusted and adjusted analyses. Frailty scoring is a promising tool which could improve decision making in intensive care.
Metabolomics analysis of blood identifies potential biomarkers and possible treatment targets for nocturia
Authors: Kira Satoru , Mitsui Takahiko , Miyamoto Tatsuya , Ihara Tatsuya , Nakagomi Hiroshi , Hashimoto Yuka , Takamatsu Hajime , Tanahashi Masayuki , Takeda Masahiro , Sawada Norifumi , Takeda Masayuki
Published: May 2019

Background:

Our aim was to investigate the association between serum metabolites and nocturia.

Methods:

A total of 66 males aged 65–80 years were enrolled in this study and stratified according to micturition behavior, which was characterized in terms of the 24 h frequency volume chart (FVC) for 3 consecutive days, the International Prostate Symptom Score (IPSS), and quality-of-life score. The nocturia group included participants with any total IPSS and ⩾1.5 micturitions/night as the mean of 3 nights, while the control group included participants with total IPSS < 8 and <1.5 micturitions/night. We conducted a comprehensive capillary electrophoresis time-of-flight mass spectrometry (CE-TOFMS) study of plasma metabolites. Between-group comparisons of metabolite levels employed the Welch t test. The relationship between nocturia and metabolite profiles was determined using multivariable logistic regression analysis.

Results:

Of 66 participants, 45 were included in the nocturia group and 21 in the control group. There were no differences in background factors between the two groups. FVC analysis revealed that urine production during night-time, as well as micturition frequency during daytime and night-time were significantly higher in the nocturia group. CE-TOFMS identified eight metabolites whose plasma levels differed between the two groups. Multivariate analysis indicated that increased levels of lauric acid and imidazolelactic acid, as well as decreased levels of thiaproline and glycerol, contribute to the etiology of nocturia in aged men.

Conclusions:

Our findings suggest that abnormal serum levels of metabolites in several pathways play a role in the pathogenesis of nocturia in aged men.
Local authority instrumental music tuition as a form of neo-liberal parental investment: Findings from a deviant, idiographic case study
Authors: Purves Ross M
Published: May 2019

Local authority music services have held a central place in the UK’s music education landscape since the end of the Second World War. Nonetheless, the provision of these services has always been a non-statutory responsibility, and local levels of opportunity have varied in response to prevailing economic and political climates, along with broader developments in educational policy. The first half of this article focuses on the implications of two key policies enacted during the 1990s. Both were linked to perceived changes in the profiles of young people who engaged with music service tuition. The latter half presents an ecological study of practical implications of the second policy – the Music Standards Fund – on primary-aged children’s take-up of and persistence with the tuition in one English local authority. At both area and school levels, the children’s engagement cohered with various socio-economic and contextual factors. This coherence is considered from the perspectives of Connell’s ‘neo-liberal parent’ and related Bourdieusian-influenced theories. The conclusion offers implications from the implementation of the policy in the contemporary era of Music Education Hubs, the successor organisations to local authority music services, and the schools these Hubs serve.
The problem of strict image-based inclusion criteria for mechanical thrombectomy – an analysis of stroke patients with an initial low CBV-ASPECTS score
Authors: Schnieder M , Psychogios MN , Maier IL , Tsogkas I , Schregel K , Kleinknecht A , Knauth M , Bähr M , Liman J , Behme D
Published: May 2019

Introduction

Endovascular treatment for acute ischaemic stroke with large artery occlusion has become the standard of care. However, the question if a subgroup of patients, with a low cerebral blood volume Alberta Stroke Program Early CT score (CBV-ASPECTS) ≤ 7 should be excluded from endovascular treatment remains open. Therefore; we investigated the difference of outcome between patients who were treated by endovascular treatment vs patients who did not receive endovascular treatment.

Methods

We retrospectively analysed our stroke database for all patients who presented within six hours of onset with unfavourable imaging findings and who received endovascular treatment or best medical treatment alone. Unfavourable imaging was defined as a CBV-ASPECTS ≤ 7, which was an exclusion criterion for endovascular treatment at our institution before 2015.

Results

From 60 patients with an initial CBV-ASPECTS ≤ 7, 40 received best medical treatment and 20 were treated with endovascular treatment. Arterial hypertension and atrial fibrillation was more present in patients without endovascular treatment, the other baseline characteristics and percentage of patients treated with intravenous recombinant tissue plasminogen activator were not significantly different in both groups. At discharge, 40% of the interventional treated patients had a favourable outcome (eight of 20 (40%) vs six of 40 (15%; p = 0.031). The median values of the National Institute of Health Stroke Score and modified Rankin Scale at discharge were significantly lower in the treated cohort (6.5 (2.5–10.5) vs 16 (9.5–22.5); p = 0.006; 3 (0–5.5) vs 5 (4.5–5.5); p = 0.003).

Conclusion

Patients with a CBV-ASPECTS ≤ 7 are likely to benefit from therapy and therefore may not be excluded from endovascular treatment. Further randomised trials are warranted to validate the data.
Crushing response of circular thin-walled tube with non-propagating crack subjected to dynamic oblique impact loading
Authors: Isaac Chukwuemeke William
Published: May 2019

The dynamic oblique crushing of circular thin-walled tubes with the presence of non-propagating crack was investigated numerically. The material considered was strain rate sensitive with crack located at the distal end of the tube. Major crashworthiness parameters were obtained and the analysis of the structural response for idealized and finite element crushed thin-walled tubes was also carried out. The study shows that crack initiation on energy absorbing tubes increase their crushing force efficiency under oblique impact, decrease their crushing force efficiency under axial impact and reduce their crashworthiness performance such as the energy absorption capacity and specific energy absorption under axial and oblique impact. Results of the crashworthiness parameters, deformation modes, damage morphology, stress–strain relations, absorption energy characteristics and crushing force-displacement history were obtained. Furthermore, the numerical study reveals both the desirable and undesirable consequence of crack on the overall crashworthiness performance of energy absorbing circular thin-walled tubes.
HDL: Fact, fiction, or function? HDL cholesterol and cardiovascular risk
Authors: Allard-Ratick Marc P , Kindya Bryan R , Khambhati Jay , Engels Marc C , Sandesara Pratik B , Rosenson Robert S , Sperling Laurence S
Published: May 2019

The measurement of high-density lipoprotein cholesterol is highly utilized by clinicians to help predict cardiovascular risk, but this measure is not causally associated with atherosclerotic cardiovascular disease events. The use of Mendelian randomization studies has led to a change in investigative attention from the high-density lipoprotein cholesterol concentration to its physiological functions. High-density lipoprotein plays key roles in important pathways related to the development of atherosclerotic disease including reverse cholesterol transport, oxidation and inflammation, and endothelial function as well as in other physiological systems including immune system modulation, cellular apoptosis, and endothelial progenitor cell homeostasis. The identification of dysfunctional high-density lipoprotein may better predict future cardiovascular events compared to numerical high-density lipoprotein cholesterol and aid in enhanced clinical risk stratification. The emergence of discrete physiological measurements of high-density lipoprotein, such as cholesterol efflux capacity and the high-density lipoprotein inflammatory index, may provide an opportunity for clinical application in the future. However, the validity of these measurements and their commercial availability remain barriers to a realistic transition to clinical medicine.
Full recovery from extreme hypernatremia in an elderly woman with hyperosmolar hyperglycemic syndrome and abnormal electroencephalogram
Authors: Galili Yehuda , Gonzalez Chad , Lytle Meghan , Carlan SJ , Madruga Mario
Published: May 2019

Background:

Hyperosmolar hyperglycemic state is a life-threatening endocrine disorder that most commonly affects adults with type 2 diabetes mellitus. The condition results from an osmotic diuresis-induced loss of water exceeding that of sodium. Altered mental status, hypernatremia and hyperglycemia are characteristic features at presentation. Abnormal electroencephalogram findings have been reported. Successful therapy requires judicious fluid replacement and close monitoring.

Case:

A 78-year-old Hispanic female with a significant past medical history of type 2 diabetes mellitus was admitted with altered mental status, severe hypernatremia and hyperglycemia. She was diagnosed with hyperosmolar hyperglycemic state, and fluid therapy was started. A continuous electroencephalogram revealed left frontocentral and temporal periodic lateralized epileptiform discharges that resolved as her hypernatremia and dehydration were treated. She survived and was discharged after 1 week of treatment.

Conclusion:

Abnormal electroencephalogram findings consistent with nonconvulsive seizure activity may be temporary and reversible and do not suggest a poor prognosis in an elderly patient suffering from hyperosmolar hyperglycemic state and altered mental status.
Comparison of lower limb segment forces during running on artificial turf and natural grass
Authors: McMurtry Shea , Fiedler Goeran
Published: May 2019

Introduction:

Artificial turf, soon after being introduced in the 1980s, became associated with an increased injury incidence in football players. While more recent generations of artificial turf have mitigated the problem, perception of the material is still widely negative. So, the decision to play the 2015 Fe'de'ration Internationale de Football Association Women s World Cup in Canada on artificial turf was met with vocal criticism by many players. One common approach is to assess injury incidence to quantify risk differences in playing surfaces. This, however, does not account for possible confounding variables or chronic injuries. Direct measurement of ground reaction forces is difficult because conventional multicamera-based motion capture and force plate equipment are limited in its use outside of dedicated laboratories.

Methods:

We describe a method of generating realistic force data by using miniature load cells that are installed directly into the weight-bearing structure of the body.

Results:

Pilot data show a significant (p<0.01) difference in peak forces on artificial turf (272% of body weight) and natural grass (229% of body weight).

Discussion:

Invasive surgical procedures were avoided by installing the load cell into the prosthesis of an athlete with lower limb loss. As modern prosthetic devices allow a close approximation of able-bodied kinematics and kinetics, such prosthesis-based data are transferable to a general population.
T1a renal cell carcinoma on unenhanced CT: analysis of detectability and imaging features
Authors: Gobara Aiko , Yoshizako Takeshi , Yoshida Rika , Nakamura Megumi , Shiina Hiroaki , Kitagaki Hajime
Published: May 2019

Background

Increasing use of unenhanced computed tomography (CT) has been associated with the increasing incidental detection of renal cell carcinoma (RCC) at an earlier stage.

Purpose

To evaluate the characteristics in detecting and differentiating T1a RCCs on unenhanced CT.

Material and Methods

We retrospectively reviewed 68 patients with 68 T1a RCCs and 39 benign regions. Two radiologists interpreted the images on unenhanced axial CT and performed a blinded and independent review of T1a RCCs. The readers evaluated the presence of RCC and differentiated the detected lesions.

Results

The consensus of two readers detected 53 (78%) RCCs. Of the 53 detected RCCs, 42 (62%) RCCs were correctly diagnosed and 11 (16%) masses were misdiagnosed as benign. Of the 39 benign regions, 29 (74%) cysts were diagnosed correctly, but 10 (26%) cysts were misdiagnosed as malignant. The following values of the radiologists were obtained by consensus: sensitivity = 61.8% (42/68); specificity = 74.4% (29/39); positive predictive value = 80.8% (42/52); negative predictive value = 55.0% (29/55); accuracy = 66.4% (71/107). The receiver operating characteristic curve of consensus was 0.754. Inter-observer correlation was κ = 0.849. There was a significant difference in tumor size ( P = 0.019) and the contour type of tumor ( P = 0.0207) between correctly diagnosed RCCs and not correctly diagnosed RCCs.

Conclusion

Our findings showed that tumor size and contour type could affect the detection and differentiation of T1a RCC on unenhanced CT. To detect and differentiate T1a RCC on unenhanced CT is difficult. However, the findings from this study may help detection of RCCs on unenhanced CT.
Early Experience With Sacubitril/Valsartan in Adult Patients With Congenital Heart Disease
Authors: Lluri Gentian , Lin Jeannette , Reardon Leigh , Miner Pamela , Whalen Katrina , Aboulhosn Jamil
Published: May 2019

Background:

Heart failure (HF) is the leading cause of hospitalizations and death in patients with adult congenital heart disease (ACHD). Sacubitril/valsartan is a new agent in the treatment of HF, but its effects have not been assessed in ACHD.

Methods:

We retrospectively studied all 15 patients with ACHD at our center who were prescribed sacubitril/valsartan between June 2017 and June 2018. We assessed baseline characteristics and clinical and laboratory changes after initiation of sacubitril/valsartan. Adverse events, including renal function, medication intolerance, and worsening HF were documented.

Results:

The median age was 53.2 (27.6-83.6) years, with a median follow-up duration of 69 (8-419) days. At baseline, all patients had refractory HF despite guideline-directed medical therapy, with ten (67%) patients as New York Heart Association (NYHA) class II, and five (33%) patients NYHA class III. The medication was discontinued in one (7%) patient secondary to worsening kidney function. No patients reported clinical deterioration; four NYHA class III patients with complex CHD, pulmonary hypertension, and cyanosis reported significant improvement to NYHA class II. Baseline creatinine was 1.1 (0.9-1.7) and two weeks after starting sacubitril/valsartan it was 1.3 (0.8-2.5, P = .22).

Conclusions:

Sacubitril/valsartan seems to be well tolerated in patients with ACHD who present with refractory HF symptoms. Patients with complex CHD associated with cyanosis and pulmonary hypertension could benefit the most, but larger studies are needed to assess the safety as well as the effectiveness of sacubitril/valsartan in this patient population.
Assessment of the Reconstructed Pulmonary Circulation With Lung Perfusion Scintigraphy After Unifocalization and Repair of Tetralogy of Fallot With Major Aortopulmonary Collaterals
Authors: Wise-Faberowski Lisa , Irvin Matthew , Lennig Michael , Long Jin , Nadel Helen R. , Bauser-Heaton Holly , Asija Ritu , Hanley Frank L. , McElhinney Doff B.
Published: May 2019

Background:

Pulmonary vascular supply in tetralogy of Fallot (TOF) with major aortopulmonary collaterals (MAPCAs) is highly variable. Our approach to surgical management of this condition emphasizes early repair including unifocalization and reconstruction of the pulmonary circulation, incorporating all lung segments and addressing stenoses both proximal to and within the lung, in addition to ventricular septal defect closure. At our institution, we have over 15 years of experience using lung perfusion scintigraphy (LPS) to assess the distribution of pulmonary blood flow after complete unifocalization and repair.

Methods:

We reviewed clinical and quantitative LPS data in 310 patients who underwent complete unifocalization and repair of TOF/MAPCAs from 2003 to 2018 at our institution. Postrepair relative lung perfusion distributions were determined from LPS initially obtained at our institution within 60 days after repair and thereafter.

Results:

Total lung perfusion to the right and left lungs was 58.0% ± 14.2% and 42.0% ± 14.2%, respectively. Perfusion was balanced in 75% of patients and unbalanced in 25%, including 11% in whom it was extremely unbalanced. On multivariable analysis, older age at repair, surgery other than a single-stage complete unifocalization, and native anatomy consisting of unilateral pulmonary blood supply through a ductus arteriosus were associated with unbalanced perfusion.

Conclusion:

We present our experience using LPS as an outcome measure after surgical repair of TOF/MAPCAs. Balanced lung perfusion was present in the majority of patients who had complete repair of TOF/MAPCAs performed at our center.
“If We Don’t Define Our Roles, Someone Else Will”: Professional Advocacy in School Counseling
Authors: Havlik Stacey , Ciarletta Marie , Crawford Emily
Published: May 2019

Professional advocacy in the field of school counseling is critical to promote the profession and ensure that school counselors are engaged in appropriate roles that are aligned with the American School Counselor Association (ASCA). To better understand how they are engaging in this important work, we interviewed and surveyed school counselors about their experiences with professional advocacy. Findings suggest that school counselors possess strengths and face challenges when advocating for their roles.
Attention Problems and Mindfulness: Examining a School Counseling Group Intervention With Elementary School Students
Authors: Su Yi-Wen , Swank Jacqueline M.
Published: May 2019

The researchers examined the effectiveness of a mindfulness-based attention group with elementary school students struggling with attention problems. The results revealed that students in the intervention group were more likely to improve their on-task behavior and decrease their attention problems during the group compared to students in the comparison group. The intervention group demonstrated improvements ranging from debatably effective to very effective for improving mindfulness. We discuss implications for using the intervention.
Effective nutritional status screening in orthopaedic oncology patients and post-operative complications
Authors: Eu Cheong Wei , Ajit Singh Vivek , Yasin Nor Faissal
Published: May 2019

Purpose:

This study aims to determine the prevalence of malnutrition among orthopaedic oncology patients with malignant tumour during preoperative period.

Methods:

This is a prospective observational study involving patients from the orthopaedic oncology unit who were undergoing surgery. They were assessed with Patient Generated Subjective Global Assessment (PG-SGA), Malnutrition Screening Tool (MST) and 3-minute Nutritional Screening (3MinNS) questionnaires. Anthropometric data such as body mass index, mid upper arm circumference (MUAC) and blood parameters such as serum albumin, total lymphocyte count and haemoglobin were also investigated. Patients were then followed up for 3 months. Post-operative complications were divided into infectious and non-infectious groups. Length of stay and unplanned readmission were also documented.

Results:

Prevalence of malnutrition ranged from 13.3% to 45.8% under different nutritional assessment methods. Patients who were determined as malnourished were significantly associated with both infectious and non-infectious post-operative complications ( p < 0.001). PG-SGA and 3MinNS values were also significant in univariate and multivariate analysis, respectively. Low serum albumin (<35 g/L) was associated with post-operative infectious complications, especially surgical site infection ( p < 0.001), prolonged hospital stay ( p = 0.009) and unplanned readmission ( p = 0.017). 3MinNS and Charlson Comorbidity Index were predictive of non-infectious complications, whereas serum albumin and the presence of metastasis were predictive of infectious complications.

Conclusion:

This pilot study of patients with soft tissue and bone sarcoma of upper and lower limbs showed that malnutrition is a significant independent factor related to infectious and non-infectious complications which leads to unplanned readmission and prolonged length of stay. Periodic screening using the PG-SGA or 3MinNS questionnaires, MUAC and evaluation of serum albumin levels is recommended during clinic session and pre-surgery assessment rounds to identify those predisposed to malnutrition and help in reducing incidence of post-operative complications.
Clinical course of asymptomatic deep vein thrombosis after total knee arthroplasty in Japanese patients
Authors: Tateiwa Toshiyuki , Ishida Tsunehito , Masaoka Toshinori , Shishido Takaaki , Takahashi Yasuhito , Onozuka Atsuko , Nishida Jun , Yamamoto Kengo
Published: May 2019

Purpose:

The purpose of the present study was to follow up Japanese patients with deep vein thrombosis (DVT) after total knee arthroplasty (TKA) and also to examine factors associated with residual thrombus within the sixth postoperative month.

Methods:

DVT evaluation was performed by noninvasive venous ultrasonography. We retrospectively reviewed 88 Japanese patients (88 knees) receiving primary unilateral TKA, who had no preoperative DVT. We examined the influence of the following four factors on postoperative DVT: (1) patient factors (age, sex, body height, body weight, and body mass index), (2) surgical factors (operation time, bleeding amount, avascularization time, and anesthesia method), (3) postoperative factors (bleeding amount, period to ambulation, period of venous foot pump use, and ratio of graduated compression stocking use), and (4) DVT conditional factors (location, length, number of vein branches, and the presence of >5 mm vasodilatation).

Results:

The total prevalence of venous thromboembolism (VTE) was 62.5% (55 of the 88 patients). Among the 55 VTE patients, the rates of distal and proximal DVT were 96.4% and 3.6%, respectively. Bilateral DVT was found in 34.5%, while unilateral DVT on the surgical and nonsurgical sides were 52.7% and 12.7%, respectively. Asymptomatic pulmonary embolism was 1.8%. DVT was exacerbated in five patients (11.9%), of whom three showed additional thrombus formation. The remaining two patients had thrombus elongation or propagation from distal to proximal veins. In comparisons between thrombus-unresolved and -resolved groups within the sixth postoperative month, statistical significances were found in the incidence of bilateral DVT (50.0% vs. 15.4%, p = 0.02) and unilateral DVT (43.8% vs. 76.9%, p = 0.02). On the other hand, operation time (107.0 ± 17.3 min vs. 94.5 ± 11.9 min, p = 0.01) and avascularization time (99.8 ± 17.6 min vs. 88.0 ± 11.5 min, p = 0.01) in bilateral DVT patients were significantly longer than in unilateral ones.

Conclusion:

Our results suggest that an extended operation and avascularization time may be a risk factor for bilateral DVT and residual thrombus over 6 months.
Effect of Local Norms on Racial and Ethnic Representation in Gifted Education
Authors: Peters Scott J. , Rambo-Hernandez Karen , Makel Matthew C. , Matthews Michael S. , Plucker Jonathan A.
Published: May 2019

Educators have sought to understand and address the disproportional representation of students from certain student subgroups in gifted education. Most gifted identification decisions are made with national comparisons where students must score above a certain percentage of test takers. However, this approach is not always consistent with the overall goal of gifted education. Scholars have long argued for the use of local normative criteria to increase the diversity of students identified for gifted services, and although some districts across the country have applied such recommendations, little research has been carried out. In this study, we use a large data set to assess the extent to which identifying gifted students with either school-level norms or a combination of national and school-level norms would improve gifted education representation rates for students who are from African American and Latinx families. A preprint of this registered report and this project’s preregistration documentation are available at https://osf.io/z2egy/ .
Intersections of Language, Content, and Multimodalities: Instructional Conversations in Mrs. B’s Sheltered English Biology Classroom
Authors: Meskill Carla , Nilsen Jennifer , Oliveira Alan
Published: May 2019

The challenges inherent in mastering academic content in a new language are many. When it comes to learning science in U.S. high schools, English learners (ELs) confront these on a daily basis. In an effort to document expert language/content instructional strategies, we analyze Mrs. B’s sheltered high school biology class, made up of ELs from around the world and representing varying stages of emerging bilingualism. The aim of this 2-year case study was to detail effective teaching patterns in a high-functioning multicultural science class—a class where the myriad linguistic, cultural, and affective needs of students are expertly met—and to subsequently suggest a model for understanding and undertaking powerful language and content learning supported by multimodal referents. From a rich data set comprising class recordings, interviews, reflections from Mrs. B, course documents, student work, and survey responses emerged a model of the language/content multimodal interface for teaching ELs.
Rural Hospital Nursing Skill Mix and Work Environment Associated With Frequency of Adverse Events
Authors: Smith Jessica G. , Plover Colin M. , McChesney Moira C. , Lake Eileen T.
Published: May 2019

Introduction:

Although rural hospitals serve about one fifth of the United States, few studies have investigated relationships among nursing resources and rural hospital adverse events.

Objectives:

The purpose was to determine relationships among nursing skill mix (proportion of registered nurses [RNs] to all nursing staff), the work environment, and adverse events (medication errors, patient falls with injury, pressure ulcers, and urinary tract infections) in rural hospitals.

Methods:

Using a cross-sectional design, nurse survey data from a large study examining nurse organizational factors, patient safety, and quality from four U.S. states were linked to the 2006 American Hospital Association data. The work environment was measured using the Practice Environment Scale of the Nursing Work Index (PES-NWI). Nurses reported adverse event frequency. Data analyses were descriptive and inferential.

Results:

On average, 72% of nursing staff were RNs (range = 45%–100%). Adverse event frequency ranged from 0% to 67%, across 76 hospitals. In regression models, a 10-point increase in the proportion of RNs among all nursing staff and a one standard deviation increase in the PES-NWI score were significantly associated with decreased odds of frequent adverse events.

Conclusion

Rural hospitals that increase the nursing skill mix and improve the work environment may achieve reduced adverse event frequency.
Safety of endoscopic sphincterotomy in patients undergoing antithrombotic treatment: a retrospective study
Authors: Yamamiya Akira , Kitamura Katsuya , Ishii Yu , Mitsui Yuta , Yoshida Hitoshi
Published: May 2019

Background:

This study investigated the safety of endoscopic sphincterotomy in patients undergoing antithrombotic treatment.

Methods:

From January 2014 to December 2016, a single-center retrospective study was conducted. Of the 80 patients with naïve papilla receiving antithrombotic treatment who underwent endoscopic sphincterotomy, 76 patients were retrospectively analyzed. We divided the participants into two groups as follows: 45 patients who discontinued antithrombotic treatment (discontinuation group) and 31 patients who continued antithrombotic treatment (continuation group). We evaluated the safety of endoscopic sphincterotomy in patients with naïve papilla who received antithrombotic treatment.

Results:

The percentage of patients requiring emergency endoscopic retrograde cholangiopancreatography in the continuation group was significantly higher than that in the discontinuation group (55% vs 11%; p = 0.001). The incidence of adverse events did not differ significantly between the two groups. Neither bleeding nor perforation occurred in either group. The length of hospital stay did not differ significantly between the two groups.

Conclusions:

Endoscopic sphincterotomy in patients undergoing antithrombotic treatment may be safe if the guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment are followed.
Strategy to Improve Efficiency of Comprehensive Medication Reviews in a Community Pharmacy
Authors: Ching Diana , El-Khatib Hussein , Pattin Anthony J.
Published: May 2019

Background: Comprehensive medication reviews (CMRs) provide opportunities for pharmacists to perform clinical services to their patients. However, pharmacists are often not able to perform CMRs due to time constraints. Studies have shown that incorporating support staff into the CMR workflow may lead to increases in the completion of CMRs. Objective: The primary objective was to examine the change in the number of CMRs completed at the pharmacy after a new strategy was implemented to perform and prepare for CMRs. The secondary objective was to examine the changes in the revenue generated from CMRs. Methods: This study was a pre-post retrospective, observational study performed at an independent pharmacy. Data were collected and analyzed 10 months before and after implementation of a new strategy. The new strategy called for pharmacy interns to use a template for working up patients prior to CMRs. Wilcoxon signed-rank tests were run on IBM SPSS, Version 24.0, to determine the significance of the changes. Results that generated P values <.05 were considered statistically significant. Results: The total number of CMRs completed increased from 29 before the intervention to 158 after the intervention ( P = .009). The revenue generated from CMRs improved statistically ( P = .007). Conclusions: Implementing a strategic workflow that uses pharmacy interns and a patient workup template can significantly increase the number of CMRs completed in a community pharmacy. Appropriate delegation of such tasks may allow more time for pharmacists to deliver more CMRs. Additional benefits include increased compensation from delivering more CMRs.
From the pathophysiology of the human lung alveolus to epigenetic editing: Congress 2018 highlights from ERS Assembly 3 “Basic and Translational Science.”
Authors: Nikolić Marko Z. , Garrido-Martin Eva M. , Greiffo Flavia R. , Fabre Aurélie , Heijink Irene H. , Boots Agnes , Greene Catherine M. , Hiemstra Pieter S. , Bartel Sabine
Published: May 2019

The European Respiratory Society (ERS) International Congress is the largest respiratory congress and brings together leading experts in all fields of respiratory medicine and research. ERS Assembly 3 shapes the basic and translational science aspects of this congress, aiming to combine cutting-edge novel developments in basic research with novel clinical findings. In this article, we summarise a selection of the scientific highlights from the perspective of the three groups within Assembly 3. In particular, we discuss new insights into the pathophysiology of the human alveolus, novel tools in organoid development and (epi)genome editing, as well as insights from the presented abstracts on novel therapeutic targets being identified for idiopathic pulmonary fibrosis.
Attenuation analysis of heavy oil sands based on laboratory measurements
Authors: Yuan Hemin , Han De-Hua , Zhao Luanxiao , Huang Qi , Zhang Weimin
Published: May 2019

Analyzing elastic and attenuation characteristics of heavy oil sand is critical for understanding and interpreting sonic and seismic data for their use in exploration and reservoir monitoring. The attenuation characteristic of oil sands is inherently complicated because of its loose frame, large porosity, and highly temperature-dependent viscosity of heavy oil. During thermal production, the attenuation of heavy oil sands undergoes significant changes due to the effects of pressure, temperature, and gas. Therefore, we have performed laboratory measurements of heavy oil sands under different physical conditions. By applying spectral-ratio method on the recorded wave signals, we are able to investigate the attenuation of the oil sands under different pressure and temperature conditions. For the measured sample, the [Formula: see text] decreases from 0.083 to 0.043 for a differential pressure increasing from 1.38 to 9.65 MPa. A peak of [Formula: see text] occurs at the middle temperature (approximately 60°C) for the wet sample, whereas the weakest [Formula: see text] occurs at the low temperature. Comparisons between the as-is (partially saturated) and wet (fully saturated) samples suggest that attenuation ([Formula: see text]) of the oil sands can be significantly affected by the presence of gas at a high temperature (greater than 60°C). In the end, the Havriliak-Negami model is used to capture the temperature-dependent attenuation characteristics of fully saturated oil sands. Although the measurements are conducted at ultrasonic frequency, the presented results indicate some implications for field-reservoir monitoring and also offer insights into applying attenuation attribute to characterize heavy oil reservoir during thermal production.
Redrawing the Lines: The Next Generation of Treatment in Metastatic Breast Cancer
Authors: Savard Marie-France , Khan Omar , Hunt Kelly K. , Verma Sunil
Published: May 2019

Although not considered curative in nature, new therapeutic advances in metastatic breast cancer (MBC) have substantially improved patient outcomes. This article discusses the state-of-the-art and emerging therapeutic options for management of MBC. BC systemic therapy targets multiple key pathways, including estrogen receptor signaling, HER2 signaling, and phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) signaling. Other therapeutic strategies include targeting DNA repair, inhibiting immune checkpoints, and developing antibody-drug conjugates. Although surgery historically was reserved for palliation of symptomatic, large, or ulcerating masses, some data suggest a possibly expanding role for more aggressive locoregional therapy in combination with systemic therapy. As technology develops, biomarker-specific, line-agnostic, and receptor-agnostic treatment strategies will redraw the current lines of MBC care. However, tumor heterogeneity remains a challenge. To effectively reshape our approach to MBC, careful consideration of the patient perspective, the costs and value of novel treatments, and accessibility (especially in developing countries) is paramount.
Evolving Landscape of Systemic Therapy for Hepatocellular Carcinoma: Breakthroughs, Toxicities, and Future Frontiers
Authors: Grieb Brian C. , Goff Laura W. , Goyal Lipika , Denlinger Crystal S.
Published: May 2019

The incidence and death rates of hepatocellular carcinoma (HCC) are rising. For more than a decade, the multikinase inhibitor sorafenib was the only U.S. Food and Drug Administration (FDA)–approved systemic therapy for HCC. However, since 2017, five additional agents have been approved in the first- or second-line setting. Although this represents an incredible victory for the field, there are no clear guidelines for agent selection on the basis of either patient or tumor characteristics. Here, we review the available systemic therapy options for advanced HCC and reported clinical data for each. We outline each agent’s unique toxicity profile, potential impact on patient quality of life, monitoring recommendations, and supportive strategies. Last, we review molecular and immunologic classifications of HCC as well as preclinical data that may serve as a basis for future biomarker enriched clinical trials to enable precision oncology care in HCC.
Molecular Testing in Breast Cancer
Authors: Litton Jennifer K. , Burstein Harold J. , Turner Nicholas C.
Published: May 2019

Molecular testing for genetic and genomic variation has become an integral part of breast cancer management. Patients with a family history of breast cancer or other tumors, bilateral breast cancers, or early-onset breast cancers warrant genetic testing to determine whether a hereditary cancer syndrome is present. The availability of PARP inhibitors—drugs that are selectively active in BRCA1/2-associated breast cancers—has created the need for hereditary cancer testing for all patients diagnosed with advanced breast cancer. Tumor genomic profiling is the standard of care for many types of malignancies and is becoming increasingly important in the management of advanced breast cancer. Targetable mutations in advanced breast cancer include PIK3CA, HER2, and rare instances of mismatch deficiency or other targets for tyrosine kinase inhibitors. The development of methods for sequencing cell-free DNA should allow for broader and easier implementation of tumor genomic testing. Transcriptome-based expression signatures have become the standard of care in the management of early-stage estrogen receptor–positive breast cancers. These assays provide prognostic significance in the setting of adjuvant endocrine therapy and are predictive for benefit from adjuvant chemotherapy. Collectively, these developments underscore the contemporary reality that molecular testing is now part of the clinical management for the majority of patients with breast cancer.
Biomarker Testing for Patients With Advanced Non–Small Cell Lung Cancer: Real-World Issues and Tough Choices
Authors: Pennell Nathan A. , Arcila Maria E. , Gandara David R. , West Howard
Published: May 2019

Over the last decade, the treatment of patients with advanced non–small cell lung cancer (NSCLC) has become reliant on tissue and/or blood biomarkers to help guide treatment decisions. There are now multiple biomarker-defined patient subgroups, with evidence showing that treatment with targeted therapies has superior clinical outcomes when compared with traditional cytotoxic chemotherapy. However, rapid change in the field of precision oncology brings with it the challenge of translating recommendations into clinical practice. In this review, we discuss the major guidelines recommending biomarker testing in NSCLC, as well the logistical challenges to applying these guidelines to patients with NSCLC both in the United States and worldwide. The techniques commonly used for biomarker testing will be discussed, both for tissue- and blood-based biomarkers. Finally, we discuss the challenge of interpreting the results of biomarker testing and using these results to guide treatment decisions.
An Update on Adoptive T-Cell Therapy and Neoantigen Vaccines
Authors: Ott Patrick A. , Dotti Gianpietro , Yee Cassian , Goff Stephanie L.
Published: May 2019

Adoptive T-cell therapy using tumor-infiltrating lymphocytes (TILs) has demonstrated long-lasting antitumor activity in select patients with advanced melanoma. Cancer vaccines have been used for many decades and have shown some promise but overall relatively modest clinical activity across cancers. Technological advances in genome sequencing capabilities and T-cell engineering have had substantial impact on both adoptive cell therapy and the cancer vaccine field. The ability to identify neoantigens—a class of tumor antigens that is truly tumor specific and encoded by tumor mutations through rapid and relatively inexpensive next-generation sequencing—has already demonstrated the critical importance of these antigens as targets of antitumor-specific T-cell responses in the context of immune checkpoint blockade and other immunotherapies. Therapeutically targeting these antigens with either adoptive T-cell therapy or vaccine approaches has demonstrated early promise in the clinic in patients with advanced solid tumors. Chimeric antigen receptor (CAR) T cells, which are engineered by fusing an antigen-specific, single-chain antibody (scFv) with signaling molecules of the T-cell receptor (TCR)/CD3 complex creating an antibody-like structure on T cells that recognizes antigens independently of major histocompatibility complex (MHC) molecules, have demonstrated remarkable clinical activity in patients with advanced B-cell malignancies, leading to several approvals by the U.S. Food and Drug Administration (FDA).
Chimeric Antigen Receptor T-Cell Therapies for Aggressive B-Cell Lymphomas: Current and Future State of the Art
Authors: Abramson Jeremy S. , Lunning Matthew , Palomba M. Lia
Published: May 2019

Aggressive B-cell lymphomas that are primary refractory to, or relapse after, frontline chemoimmunotherapy have a low cure rate with conventional therapies. Although high-dose chemotherapy remains the standard of care at first relapse for sufficiently young and fit patients, fewer than one-quarter of patients with relapsed/refractory disease are cured with this approach. Anti-CD19 chimeric antigen receptor (CAR) T cells have emerged as an effective therapy in patients with multiple relapsed/refractory disease, capable of inducing durable remissions in patients with chemotherapy-refractory disease. Three anti-CD19 CAR T cells for aggressive B-cell lymphoma (axicabtagene ciloleucel, tisagenlecleucel, and lisocabtagene ciloleucel) are either U.S. Food and Drug Administration approved or in late-stage development. All three CAR T cells produce durable remissions in 33%–40% of treated patients. Differences among these products include the specific CAR constructs, costimulatory domains, manufacturing process, dose, and eligibility criteria for their pivotal trials. Notable toxicities include cytokine release syndrome and neurologic toxicities, which are usually treatable and reversible, as well as cytopenias and hypogammaglobulinemia. Incidences of cytokine release syndrome and neurotoxicity differ across CAR T-cell products, related in part to the type of costimulatory domain. Potential mechanisms of resistance include CAR T-cell exhaustion and immune evasion, CD19 antigen loss, and a lack of persistence. Rational combination strategies with CAR T cells are under evaluation, including immune checkpoint inhibitors, immunomodulators, and tyrosine kinase inhibitors. Novel cell products are also being developed and include CAR T cells that target multiple tumor antigens, cytokine-secreting CAR T cells, and gene-edited CAR T cells, among others.
Value-Added Decisions in Oncology
Authors: Tannock Ian , Presley Carolyn J. , Saltz Leonard B.
Published: May 2019

Registration of new anticancer drugs is decided too often not by their clinical value but by a p value. Approval is granted if the difference in an acceptable time-to-event outcome measure differs between experimental and control arms of a randomized controlled trial, such that the null hypothesis can be rejected based on a statistical test that meets the arbitrary criterion of p < .05. However, as stated by the American Statistical Association, a p value does not measure the size of an effect or the importance of a result; it does not provide a good measure of evidence related to a hypothesis, and policy decisions should not be made on the basis of whether a p value passes a specific threshold. Unfortunately, this statement is ignored by most journals, which emphasize p values in reporting results of clinical trials, and by regulatory agencies, such as the U.S. Food and Drug Administration and the European Medicines Agency; a significant p value is often a necessary and sufficient criterion for granting marketing approval. As a result, pharmaceutical companies often design large trials to increase the probability that a small difference in the primary outcome measure will be “significant.” Moreover, the market price set for such drugs bears no relationship to the level of their benefit; drugs with small effects on outcome are sold at roughly the same price as “good drugs” that convey substantial benefit.