bluuebunny/crossref_metadata_2025 huggingface dataset:
Valid statistical inference methods for a case–control study with missing data
Authors: Tian Guo-Liang , Zhang Chi , Jiang Xuejun
Published: May 2016

The main objective of this paper is to derive the valid sampling distribution of the observed counts in a case–control study with missing data under the assumption of missing at random by employing the conditional sampling method and the mechanism augmentation method. The proposed sampling distribution, called the case–control sampling distribution, can be used to calculate the standard errors of the maximum likelihood estimates of parameters via the Fisher information matrix and to generate independent samples for constructing small-sample bootstrap confidence intervals. Theoretical comparisons of the new case–control sampling distribution with two existing sampling distributions exhibit a large difference. Simulations are conducted to investigate the influence of the three different sampling distributions on statistical inferences. One finding is that the conclusion by the Wald test for testing independency under the two existing sampling distributions could be completely different (even contradictory) from the Wald test for testing the equality of the success probabilities in control/case groups under the proposed distribution. A real cervical cancer data set is used to illustrate the proposed statistical methods.
The Centrality of Events Scale in Portuguese Adolescents: Validity Evidence Based on Internal Structure and on Relations to Other Variables
Authors: Vagos Paula , Ribeiro da Silva Diana , Brazão Nélio , Rijo Daniel
Published: May 2016

We explored the measurement model of the adolescent version of the Centrality of Event Scale and its invariance across community ( n = 1,079; 42.8% male), referred for foster care ( n = 205; 58.0% male), and detained ( n = 206 male) adolescent participants. Results indicated a three-factor measurement model, including all three functions that memories of significant life events may have, as a good fit to our data, particularly for male participants. This measurement model was invariant across boys taken from those different samples but not across gender. As for the short version of the instrument, a one-factor solution was the best fit to our data. It was invariant across boys taken from those different samples and across gender. Boys and girls expressed similar experiences, whereas community male adolescents reported the lowest impact of a meaningful event, in comparison with referred and with detained boys. These findings provide evidence on the validity of the scale for use with diverse adolescent samples, which may contribute for a better understanding of the impact that significant life events may have on the development of gender-specific and group-specific vulnerabilities.
The GRIN2B and GRIN2A Gene Variants Are Associated With Continuous Performance Test Variables in ADHD
Authors: Kim Johanna Inhyang , Kim Jae-Won , Park Subin , Hong Soon-Beom , Lee Dong Soo , Paek Sun Ha , Han Doug Hyun , Cheong Jae Hoon , Kim Bung-Nyun
Published: May 2016

Objective: To examine the association between variants of N-methyl-D-aspartate (NMDA) receptor subunit-encoding genes ( GRIN2A and GRIN2B) and continuous performance test (CPT) variables in ADHD and healthy controls. Method: In all, 253 ADHD patients and 98 controls were recruited. The diagnosis, genotype, and diagnosis–genotype interaction effects for the CPT variables were examined. Results: Significant diagnosis effects were detected for all CPT variables. There were significant genotype and interaction effects on response time variability (RTV) by the GRIN2B variant. The C/C subgroup had higher RTV than the C/T + T/T subgroup in ADHD, but not in controls. There were significant genotype effects on omission errors by the GRIN2A variant. The G/G subgroup had more omission errors than the G/A + A/A subgroup in ADHD patients, but not in controls. Conclusion: These results suggest that the genetic variants of GRIN2B and GRIN2A confer an increased susceptibility to attentional impairment in ADHD patients.
The FAV-S Pilot Study
Authors: Kehm Rebecca , Hearst Mary O. , Sherman Shelley , Elwell Kate L.
Published: May 2016

The 2012 FAV-S pilot study was developed as a dietary intervention program for low-income Somali mothers grounded in the health belief model. The intervention was geared toward increasing fruit and vegetable intake among participants’ children. The purpose of this analysis was to determine the impact of the FAV-S program on participants’ (1) self-efficacy in ability to serve more fruits and vegetables, (2) knowledge and beliefs about healthy eating, and (3) perceived barriers to accessing healthy foods. Furthermore, this study assessed change in fruit and vegetable intake among participants and their children. The intervention consisted of two small group education sessions addressing nutrition, serving size, and label reading; a cooking session incorporating fruits and vegetables into traditional Somali dishes; and a grocery store session demonstrating best purchasing practices. Self-efficacy, knowledge and beliefs, and perceived barriers were assessed via surveys administered verbally in Somali pre- and postintervention. Paired t tests were used to compare pre- and postintervention survey responses. Twenty-five women participated in the pilot study; mean age was 43.6 years ( SD = 12.4). Self-efficacy significantly increased among participants postintervention ( p = .01), though there were no significant changes in knowledge and beliefs or perceived barriers. Following intervention, daily servings of fruits and vegetables significantly increased among both women and children ( p = .01 to p < .01). Findings suggest that a multistage, culturally tailored, approach is effective at increasing self-efficacy and fruit and vegetable intake in the Somali community. Continued and expanded research is needed to further develop culturally focused dietary interventions.
Pharmacological management of spasticity in multiple sclerosis: Systematic review and consensus paper
Authors: Otero-Romero Susana , Sastre-Garriga Jaume , Comi Giancarlo , Hartung Hans-Peter , Soelberg Sørensen Per , Thompson Alan J , Vermersch Patrick , Gold Ralf , Montalban Xavier
Published: May 2016

Background and objectives:

Treatment of spasticity poses a major challenge given the complex clinical presentation and variable efficacy and safety profiles of available drugs. We present a systematic review of the pharmacological treatment of spasticity in multiple sclerosis (MS) patients.

Methods:

Controlled trials and observational studies were identified. Scientific evidence was evaluated according to pre-specified levels of certainty.

Results:

The evidence supports the use of baclofen, tizanidine and gabapentin as first-line options. Diazepam or dantrolene could be considered if no clinical improvement is seen with the previous drugs. Nabiximols has a positive effect when used as add-on therapy in patients with poor response and/or tolerance to first-line oral treatments. Despite limited evidence, intrathecal baclofen and intrathecal phenol show a positive effect in severe spasticity and suboptimal response to oral drugs.

Conclusion:

The available studies on spasticity treatment offer some insight to guide clinical practice but are of variable methodological quality. Large, well-designed trials are needed to confirm the effectiveness of antispasticity agents and to produce evidence-based treatment algorithms.
Understanding parents’ and professionals’ knowledge and awareness of autism in Nepal
Authors: Heys Michelle , Alexander Amy , Medeiros Emilie , Tumbahangphe Kirti M , Gibbons Felicity , Shrestha Rita , Manandhar Mangala , Wickenden Mary , Shrestha Merina , Costello Anthony , Manandhar Dharma , Pellicano Elizabeth
Published: May 2016

Autism is a global phenomenon. Yet, there is a dearth of knowledge of how it is understood and its impact in low-income countries. We examined parents’ and professionals’ understanding of autism in one low-income country, Nepal. We conducted focus groups and semi-structured interviews with parents of autistic and non-autistic children and education and health professionals from urban and rural settings ( n = 106), asking questions about typical and atypical development and presenting vignettes of children to prompt discussion. Overall, parents of typically developing children and professionals had little explicit awareness of autism. They did, however, use some distinctive terms to describe children with autism from children with other developmental conditions. Furthermore, most participants felt that environmental factors, including in-utero stressors and birth complications, parenting style and home or school environment were key causes of atypical child development and further called for greater efforts to raise awareness and build community capacity to address autism. This is the first study to show the striking lack of awareness of autism by parents and professionals alike. These results have important implications for future work in Nepal aiming both to estimate the prevalence of autism and to enhance support available for autistic children and their families.
Manipulating a synchronous or separatist group orientation to improve performance on a hidden profile task
Authors: Kolb Miranda R. , van Swol Lyn M.
Published: May 2016

Effective use of available information is a problem that plagues group decision-making tasks. Groups heavily favor shared information, or information that is known to all group members, which can lead to incorrect decisions and selection of inferior alternatives. However, groups may be less prone to overlooking unshared information if they are focused to value uniqueness and novel input from group members. The present research demonstrates that groups that value uniqueness, or a separatist orientation, correctly solved a hidden profile task more often than groups with a synchronous orientation, or groups that value similarity. Separatist groups repeated more unshared information than synchronous overall. Separatists also repeated more shared information than synchronous groups. Further, groups with a correct minority member also repeated more unshared information than groups with either a majority correct or no correct members. Results are discussed in terms of group focus and biases that affect the discussion of information.
Probability-based progressive collapse-resistant assessment for reinforced concrete frame structures
Authors: Li Yi , Lu Xinzheng , Guan Hong , Ren Peiqi , Qian Lanping
Published: May 2016

Progressive collapse is a form of disproportionate damage, which is induced by an initial local failure that propagates throughout a large portion or the entirety of structural systems. The initial local failure may occur anywhere in a structural system, which consequently exhibits different collapse behaviors. However, the progressive collapse resistance is an inherent property of the entire structural system regardless of any specific initial local failure. This article proposes a collapse probability index to assess the progressive collapse resistance of reinforced concrete frame structures. Such an index is capable of measuring all typical initial local failures instead of any specific ones. The collapse fragility curve is further established based on the collapse probability index, which varies with an increase in the nominal gravity. The structural redundant resistance to progressive collapse can be assessed by the fragility curve. Furthermore, a simplified assessment method is proposed to measure the collapse probability indices feasibly of reinforced concrete frames under different nominal gravity levels. The proposed method based on the collapse probability index can comprehensively evaluate the progressive collapse resistance of reinforced concrete frames which is validated through analysis of a single four-story and a group of eight-story reinforced concrete frame structures.
Determination of the transfer function between the injected flow-rate and high-pressure time histories for improved control of common rail diesel engines
Authors: Ferrari Alessandro , Salvo Emanuele
Published: May 2016

Theoretical and experimental methodologies have been proposed and illustrated to determine the transfer function between the injected flow-rate and the rail pressure for common rail injection systems. An analytical transfer function has been calculated in the frequency domain, utilizing a previously developed lumped parameter model of the overall hydraulic layout of a common rail system. The predicted transfer function has been compared, in a Bode diagram, with an experimental estimation of the transfer function, based on the measured rail pressure and injected flow-rate time histories that were acquired at the hydraulic rig for different working conditions. The experimental estimation of the transfer function has been worked out by applying a selective spectral technique in order to reduce the effects of measurement noise on the rail pressure and injected flow-rate time histories. The accuracy of the model-derived transfer function has been improved significantly by integrating a pressure control system sub-model, which includes the action of the electronic control unit on the rail pressure time history through the pressure regulator, in the hydraulic model of the common rail circuit. Finally, the time histories of the rail pressure, predicted by means of the complete injection apparatus model, have been compared with the corresponding experimental traces at different working conditions and a very satisfactory agreement has in general been found. The methodologies proposed for the accurate evaluation of the transfer function between the injected flow-rate and the rail pressure time histories can be applied to diesel engines in order to implement innovative closed-loop strategies for the injected mass control.
Organization, operations, and success of environmental organized crime in Italy and India: A comparative analysis
Authors: Rege Aunshul , Lavorgna Anita
Published: May 2016

Despite the devastating short- and long-term consequences of resource-related environmental crimes, rampant illegal soil and sand mining continues worldwide. In countries such as India and Italy, organized crime groups have emerged as prominent illegal suppliers of soil and sand. The proposed study focuses on an understudied research area at the intersection between organized crime and environmental crimes, and offers a trans-comparative study of illegal soil and sand mining conducted by Indian and Italian organized crime groups with two main objectives. First, a comparative analysis of the organizational mechanisms, operational practices, threat management, and supporting cultural, regulatory, and policing factors is conducted. Second, a discussion of how these groups reflect mainstream models and theories of organized crime is offered.
Systematically Improving Tobacco Cessation Patient Services Through Electronic Medical Record Integration
Authors: Karn Shelley , Fernandez Alejandra , Grossberg Lou Ann , Robertson Trina , Sharp Barry , Huang Philip , Loukas Alexandra
Published: May 2016

The Health Information Act of 2010 has presented an opportunity to discuss, establish, and promote innovative ways to incorporate tobacco cessation assistance to patients in the health care setting. This article provides an overview of the development and implementation of an electronic tobacco cessation protocol (the eTobacco protocol), into an electronic medical record (EMR) system, while evaluating the barriers and benefits encountered. The protocol was developed to facilitate the process of electronically referring patients to a state-funded quitline service by establishing a one-click connect for providers to use within the EMR system. While evaluating the implementation of the protocol, findings indicate that several barriers were encountered including disruption of clinic workflow, EMR limitations, and training complications. In spite of the barriers, the protocol shows promising results by increasing referrals to the quitline from 7 patients the year prior to implementation to 1,254 patients after the implementation of the electronic solution. Health care systems that have the ability to modify their EMR system can help lower tobacco use rates among their patients while meeting Meaningful Use requirements. Future research should examine if referrals through the eTobacco protocol are directly associated with patients’ tobacco cessation rates.
Motivational Interviewing in an Obesity Prevention Program for Children
Authors: Ige Teminijesu John , DeLeon Patrice , Nabors Laura
Published: May 2016

After-school programs are an ideal setting for childhood obesity prevention interventions. This qualitative study examined the implementation of a training technique in the Children’s Healthy Eating and Exercise Program: motivational interviewing. Participants included 19 children in Grades 3 through 5, nine coaches enrolled in university health education classes, and four parents. Nine lessons were presented during the fall session (N = 5) and eight during the spring (N = 14), with five individual coaching sessions per child. From September, 2014 through April 2015, child and coach perceptions were assessed using goal sheets, surveys, a focus group, and the analysis of the video recording of a health habit commercial created by teams of children grouped by gender. Children developed weekly eating and exercise goals with coaches and reported on their progress the following week. Following the intervention, children reported improved eating and exercise habits and coaches reported they learned more about healthy food options for themselves. Overall, children responded positively to the motivational interviewing. Involving teachers may allow for dissemination of lessons and reinforcement for healthy choices during the school day. Involving parents in training may remove roadblocks to healthy lifestyle changes for children for nonschool hours and when packing lunches.
The Obesity Paradox in Type 2 Diabetes and Mortality
Authors: Tobias Deirdre K. , Manson JoAnn E.
Published: May 2016

The obesity paradox for survival among individuals with type 2 diabetes has been observed in some but not all studies. Conflicting evidence for the role of overweight and obesity in all-cause mortality may largely be a result of differences in study populations, epidemiological methods, and statistical analysis. For example, analyses among populations with long-term prevalent diabetes and the accrual of other chronic health conditions are more likely to observe that the sickest participants have lower body weights, and therefore, relative to normal weight, overweight and even obesity appear advantageous. Other mortality risk factors, such as smoking, also confound the relationship between body weight and survival, but this behavior varies widely in intensity and duration, making it difficult to assess and effectively adjust for in statistical models. Disentangling the potential sources of bias is imperative in understanding the relevance of excess body weight to mortality in diabetes. In this review, we summarize methodological considerations underlying the observed obesity paradox. Based on the available evidence, we conclude that the obesity paradox is likely an artifact of biases, and once these are accounted for, it is evident that compared with normal body weight, excess body weight is associated with a greater mortality risk.
Polypropylene/Maleic Anhydride Grafted Polypropylene (MAgPP)/Coconut Fiber Composites
Authors: Techawinyutham Laongdaw , Frick Achim , Siengchin Suchart
Published: May 2016

Natural fiber composites consisted of homopolymer polypropylene, polyoxymethylene, maleic anhydride–grafted polypropylene, and coconut fibers were produced by co-rotating twin screw extruder. The mechanical and thermomechanical properties of the polypropylene composites were determined by uniaxial tensile, impact, and flexural tests; thermogravimetric analysis; and differential scanning calorimetry. The dispersion of the coconut fibers in the polypropylene was studied by optical microscopy and scanning electron microscopy. It was found that the increase in coconut fiber led to an increase in brittleness and stiffness of the polypropylene composites. The addition of maleic anhydride–grafted polypropylene content to polypropylene matrix contributed to the increase in tensile strength of the related composites compared to neat polypropylene.
Research on the application of the improved genetic algorithm in the electroencephalogram-based mental workload evaluation for miners
Authors: Hongxia Li , Hongxi Di , Jian Li , Shuicheng Tian
Published: May 2016

Electroencephalogram is the electrical phenomena in the cerebral cortex or the scalp surface due to the electrophysiological activity of brain cells. Electroencephalogram has great theoretical and practical significance in measuring mental workload of people. More precise electroencephalographic is a precondition to study mental workload of miners. In this article, based on the actual situation of the electroencephalographic measurement of miners, the particle swarm optimization is introduced to improve the standard genetic algorithm, and put forward a combined method integrating the genetic algorithm with particle swarm optimization for achieving electroencephalogram-based measures of miners' mental workload. Moreover, the MATLAB simulation platform is used for simulation testing. Testing results prove the effectiveness of the combined method.
Changing the face of medicine, alternating the meaning of human
Authors: Nádasi Eszter
Published: May 2016

Seasons 11 and 12 of the popular medical drama series Grey’s Anatomy (2005–) present potentially revolutionizing medical innovations and fields of research that are discussed in this article in terms of academic debates about posthumanism. Doctors in Grey’s Anatomy believe their work can change the face of medicine and change what it means to be human. By means of content analysis of three storylines, this essay explores representations of medical innovations in the show. Since medical dramas have a proven capacity to raise awareness about medical issues, this article argues that Grey’s Anatomy is able to educate its audience about potentially life-changing medical developments.
Argon plasma coagulation compared with stent placement in the palliative treatment of inoperable oesophageal cancer
Authors: Sigounas Dimitrios E , Krystallis Christoforos , Couper Graeme , Paterson‐Brown Simon , Tatsioni Athina , Plevris John N
Published: May 2016

Background

Self‐expandable metal stents (SEMSs) are the main palliative modality used in inoperable oesophageal cancer. Other palliative modalities, including argon plasma coagulation (APC), have also been used.

Objective

The purpose of this study was to assess the relative efficacy of SEMS and APC regarding the survival of patients with inoperable oesophageal cancer, not receiving chemo/radiotherapy.

Methods

Single centre, retrospective analysis of all patients (n  = 228) with inoperable oesophageal cancer between January 2000 and July 2014, not receiving chemo‐radiotherapy, treated with SEMS (n  = 160) or APC (n  = 68) as primary palliation modalities. Cox regression analysis was performed to identify individual factors affecting survival and Kaplan–Meier curves were created for patients treated with APC and SEMS for stage III and IV disease. Survival intervals were compared by the log‐rank test.

Results

Type of treatment was the only statistically significant factor affecting survival, after disease stage stratification (hazard ratio (HR): 1.36, 95% confidence interval (CI): 1.13–1.65 of SEMS over APC, p : 0.002). Median survival for patients treated with APC and SEMS was 257 (interquartile range (IQR): 414, 124) and 151 (IQR: 241, 61) days respectively in stage III disease. It was 135 (IQR: 238, 43) and 70 (IQR: 148, 32) days respectively in stage IV disease. Both differences were statistically significant (p  = 0.02 and 0.05 respectively).

Conclusions

APC is a promising palliation modality in inoperable oesophageal cancer, when patients are not candidates for chemo‐radiotherapy. A randomized controlled trial will be needed to confirm those results.
The use of enteral access for continuous delivery of levodopa‐carbidopa in patients with advanced Parkinson’s disease
Authors: Cheron Julian , Deviere Jacques , Supiot Frederic , Ballarin Asuncion , Eisendrath Pierre , Toussaint Emmanuel , Huberty Vincent , Musala Carmen , Blero Daniel , Lemmers Arnaud , Van Gossum André , Arvanitakis Marianna
Published: May 2016

Background

Continuous delivery to the jejunum of levodopa‐carbidopa is a promising therapy in patients with advanced Parkinson’s disease, as it reduces motor fluctuation. Percutaneous endoscopic gastrostomy and jejunal tube (PEG‐J) placement is a suitable option for this. However, studies focused in PEG‐J management are lacking.

Objectives

We report our experience regarding this technique, including technical success, adverse events and outcomes, in patients with advanced Parkinson’s disease.

Methods

Twenty‐seven advanced Parkinson’s disease patients (17 men, median age: 64 years, median disease duration: 11 years) were included in a retrospective study from June 2007 to April 2015. The median follow‐up period was 48 months (1–96).

Results

No adverse events were noted during and after nasojejunal tube insertion (to assess treatment efficacy). After a good therapeutic response, a PEG‐J was placed successfully in all patients. The PEG tube was inserted according to Ponsky’s method. The jejunal extension was inserted during the same procedure in all patients. Twelve patients (44%) experienced severe adverse events related to the PEG‐J insertion, which occurred after a median follow‐up of 15.5 months. Endoscopy was the main treatment modality. Patients who experienced severe adverse events had a higher comorbidity score (p  = 0.011) but were not older (p  = 0.941) than patients who did not.

Conclusions

While all patients responded well to levodopa‐carbidopa regarding neurological outcomes, gastro‐intestinal severe adverse events were frequent and related to comorbidities. Endoscopic treatment is the cornerstone for management of PEG‐J related events. In conclusion, clinicians and endoscopists, as well as patients, should be fully informed of procedure‐related adverse events and patients should be followed in centres experienced in their management.
Erythrocytes in multiple sclerosis – forgotten contributors to the pathophysiology?
Authors: Groen Kira , Maltby Vicki E , Sanders Katherine A , Scott Rodney J , Tajouri Lotti , Lechner-Scott Jeannette
Published: May 2016

Multiple sclerosis (MS) is an autoimmune disease characterised by lymphocytic infiltration of the central nervous system and subsequent destruction of myelin and axons. On the background of a genetic predisposition to autoimmunity, environmental triggers are assumed to initiate the disease. The majority of MS research has focused on the pathological involvement of lymphocytes and other immune cells, yet a paucity of attention has been given to erythrocytes, which may play an important role in MS pathology. The following review briefly summarises how erythrocytes may contribute to MS pathology through impaired antioxidant capacity and altered haemorheological features. The effect of disease-modifying therapies on erythrocytes is also reviewed. It may be important to further investigate erythrocytes in MS, as this could broaden the understanding of the pathological mechanisms of the disease, as well as potentially lead to the discovery of novel and innovative targets for future therapies.
Surgical Removal of Embolized Ventricular Septal Occluder Device
Authors: Vaidhya Nikunj , Mishra Amit , Siddiqui Sumbul , Joshi Harshil , Patel Hardik
Published: May 2016

Ventricular septal defect (VSD) with valvar pulmonary stenosis (PS) is a combination of cardiac defects for which treatment by means of percutaneous catheter-directed intervention is sometimes considered. Septal occluder device embolization is a rare but potentially dreadful complication. Adequate precautions are of great importance, as operator-related and anatomical factors can contribute to the risk of device embolization. In this report, we present a case of a five-year-old patient with a perimembranous VSD and valvar PS with infundibular muscle hypertrophy. The PS was treated with balloon pulmonary valvotomy, and the VSD was closed with a catheter-directed duct occluder device. Soon after deployment, the device embolized to the aortic arch, possibly as a result of the single disc device being “milked” out of VSD by dynamic contractions of hypertrophied muscle in the right ventricular outflow tract. The embolized device was successfully retrieved and removed using cardiopulmonary bypass and a period of circulatory arrest.
Advancing Health Education Pedagogy Through Life-Enhancing and Life-Saving Perspectives, and Backward Design
Authors: Crossman Joanne M.
Published: May 2016

Fulfilling a growing need to address the spectrum of problems, perceptions, and practices compromising students’ wellness, and as a tool for health promotion, new approaches to health education can enhance life quality, reduce health costs, and save lives. As one component to the broader area of health promotion, health education provides a valuable contribution to improved individual and community health. The health education course featured in this article approaches health from both life-enhancing and life-saving perspectives, integrating active learning as its primary methodology. Featured course framework, student learning outcomes, assignments, and learning activities may be adopted or refined by faculty and curriculum designers who provide students with community health education experiences including health promotion, disease/injury prevention, and sudden illness response. Course design was informed by Wiggins and McTighe’s Backward Design, national health education and American Red Cross standards, and Centers for Disease Control and Prevention recommendations. Course learning activities use health education as a strategy in health promotion and disease/injury prevention, and CPR (cardiopulmonary resuscitation)/AED (automated external defibrillator)/first aid skills to potentially sustain life, reduce pain, and minimize consequences of injury or sudden illness. Throughout the course, students review and interpret emerging research and services relevant to contemporary health concerns. Subsequently using this knowledge in ways to educate and encourage healthy practices, students design and convey health-promoting messages enhanced by various media. Students attain essential skills by using health education strategies. Additionally, American Red Cross certification may be earned through this course, further developing capacities and skills needed to build a healthier campus community.
Doctor’s follow-up after stroke in the south of Sweden: An observational study from the Swedish stroke register (Riksstroke)
Authors: Ullberg Teresa , Zia Elisabet , Petersson Jesper , Norrving Bo
Published: May 2016

Introduction

Information on follow-up practices after stroke in clinical routine are sparse. We studied the probability of doctor’s follow-up within 90, 120, 180, and 365 days after hospital discharge, and how patient characteristics were associated with the probability of follow-up, in a large unselected stroke cohort.

Patients and methods

Data on patients living in southern Sweden, hospitalized with acute ischemic stroke or intracerebral hemorrhage 1 January 2008 to 31 December 2010, were obtained from the Swedish stroke register (Riksstroke) and merged with administrative data on doctor’s visits during the year following stroke.

Results

Complete data were registered in 8164 patients. The cumulative probability of a doctor’s follow-up was 76.3% within 90 days, 83.6% within 120 days, 88.7% within 180 days, and 93.1% within 365 days. Using Cox regression calculating hazard ratios (HR), factors associated with 90-day follow-up were: female sex HR = 1.066 (95%CI: 1.014–1.121), age: ages 65–74 HR = 0.928 (95%CI: 0.863–0.999), ages 75–84 HR = 0.943 (95%CI: 0.880–1.011), ages 85 + HR = 0.836 (95%CI: 0.774–0.904), pre-stroke dependency in activities of daily living (ADL): HR = 0.902 (95%CI = 0.819–0.994), prior stroke HR = 0.902 (95%CI: 0.764–0.872), and severe stroke HR = 0.506 (95%CI: 0.407–0.629). In patients discharged to assisted living, the following factors were associated with lower follow-up probability: living alone pre-stroke HR = 0.836 (95%CI: 0.736–0.949), and pre-stroke dependency HR = 0.887 (95%CI: 0.775–0.991).

Discussion

This study was based on hospital administrative data of post-stroke doctor’s visits, but may be confounded by attendance for other conditions than stroke.

Conclusions

One in four stroke patients was not followed up within three months after hospital discharge. Vulnerable patients with high age, pre-stroke ADL dependency, and prior stroke were less likely to receive doctor’s follow-up.
Shared treatment decision-making and empowerment related outcomes in psychosis: Systematic review and meta-analysis
Authors: Stovell Diana , Morrison Anthony P. , Panayiotou Margarita , Hutton Paul
Published: May 2016

Background

In the UK almost 60% of people with a diagnosis of schizophrenia who use mental health services say they are not involved in decisions about their treatment. Guidelines and policy documents recommend that shared decision-making should be implemented, yet whether it leads to greater treatment-related empowerment for this group has not been systematically assessed.

Aims

To examine the effects of shared decision-making on indices of treatment-related empowerment of people with psychosis.

Method

We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of shared decision-making concerning current or future treatment for psychosis (PROSPERO registration CRD42013006161). Primary outcomes were indices of treatment-related empowerment and objective coercion (compulsory treatment). Secondary outcomes were treatment decision-making ability and the quality of the therapeutic relationship.

Results

We identified 11 RCTs. Small beneficial effects of increased shared decision-making were found on indices of treatment-related empowerment (6 RCTs;g= 0.30, 95% CI 0.09–0.51), although the effect was smaller if trials with >25% missing data were excluded. There was a trend towards shared decision-making for future care leading to reduced use of compulsory treatment over 15–18 months (3 RCTs; RR = 0.59, 95% CI 0.35–1.02), with a number needed to treat of approximately 10 (95% CI 5–∞). No clear effect on treatment decision-making ability (3 RCTs) or the quality of the therapeutic relationship (8 RCTs) was found, but data were heterogeneous.

Conclusions

For people with psychosis the implementation of shared treatment decision-making appears to have small beneficial effects on indices of treatment-related empowerment, but more direct evidence is required.
Cortical thickness in obsessive–compulsive disorder: Multisite mega-analysis of 780 brain scans from six centres
Authors: Fouche Jean-Paul , du Plessis Stefan , Hattingh Coenie , Roos Annerine , Lochner Christine , Soriano-Mas Carles , Sato Joao R. , Nakamae Takashi , Nishida Seiji , Kwon Jun Soo , Jung Wi Hoon , Mataix-Cols David , Hoexter Marcelo Q. , Alonso Pino ,   OCD Brain Imaging Consortium, de Wit Stella J. , Veltman Dick J. , Stein Dan J. , van den Heuvel Odile A.
Published: May 2016

Background

There is accumulating evidence for the role of fronto-striatal and associated circuits in obsessive–compulsive disorder (OCD) but limited and conflicting data on alterations in cortical thickness.

Aims

To investigate alterations in cortical thickness and subcortical volume in OCD.

Method

In total, 412 patients with OCD and 368 healthy adults underwent magnetic resonance imaging scans. Between-group analysis of covariance of cortical thickness and subcortical volumes was performed and regression analyses undertaken.

Results

Significantly decreased cortical thickness was found in the OCD group compared with controls in the superior and inferior frontal, precentral, posterior cingulate, middle temporal, inferior parietal and precuneus gyri. There was also a group x age interaction in the parietal cortex, with increased thinning with age in the OCD group relative to controls.

Conclusions

Our findings are partially consistent with earlier work, suggesting that group differences in grey matter volume and cortical thickness could relate to the same underlying pathology of OCD. They partially support a frontostriatal model of OCD, but also suggest that limbic, temporal and parietal regions play a role in the pathophysiology of the disorder. The group x age interaction effects may be the result of altered neuroplasticity.
Repetitive transcranial magnetic stimulation for generalised anxiety disorder: A pilot randomised, double-blind, sham-controlled trial
Authors: Diefenbach Gretchen J. , Bragdon Laura B. , Zertuche Luis , Hyatt Christopher J. , Hallion Lauren S. , Tolin David F. , Goethe John W. , Assaf Michal
Published: May 2016

Background

Repetitive transcranial magnetic stimulation (rTMS) holds promise for treating generalised anxiety disorder (GAD) but has only been studied in uncontrolled research.

Aims

This is the first randomised controlled trial (clinicaltrials.gov: NCT01659736) to investigate the efficacy and neural correlates of rTMS in GAD.

Method

Twenty five participants (activen= 13; sham,n= 12) enrolled. rTMS was targeted at the right dorsolateral prefrontal cortex (DLPFC, 1 Hz, 90% resting motor threshold).

Results

Response and remission rates were higher in the activev.sham groups and there were significant group × time interactions for anxiety, worry and depressive symptoms, favouring activev.sham. In addition, right DLPFC activation during a decision-making gambling task increased at post-treatment for active rTMS only, and changes in neuroactivation correlated significantly with changes in worry symptoms.

Conclusions

Findings provide preliminary evidence that rTMS may improve GAD symptoms in association with modifying neural activity in the stimulation site.
A Systematic Approach to Creation of a Perioperative Data Warehouse
Authors: Hofer Ira S. , Gabel Eilon , Pfeffer Michael , Mahbouba Mohammed , Mahajan Aman
Published: May 2016

Extraction of data from the electronic medical record is becoming increasingly important for quality improvement initiatives such as the American Society of Anesthesiologists Perioperative Surgical Home. To meet this need, the authors have built a robust and scalable data mart based on their implementation of EPIC containing data from across the perioperative period. The data mart is structured in such a way so as to first simplify the overall EPIC reporting structure into a series of Base Tables and then create several Reporting Schemas each around a specific concept (operating room cases, obstetrics, hospital admission, etc.), which contain all of the data required for reporting on various metrics. This structure allows centralized definitions with simplified reporting by a large number of individuals who access only the Reporting Schemas. In creating the database, the authors were able to significantly reduce the number of required table identifiers from >10 to 3, as well as to correct errors in linkages affecting up to 18.4% of cases. In addition, the data mart greatly simplified the code required to extract data, making the data accessible to individuals who lacked a strong coding background. Overall, this infrastructure represents a scalable way to successfully report on perioperative EPIC data while standardizing the definitions and improving access for end users.
The Use of Neuraxial Catheters for Postoperative Analgesia in Neonates: A Multicenter Safety Analysis from the Pediatric Regional Anesthesia Network
Authors: Long Justin B. , Joselyn Anita S. , Bhalla Tarun , Tobias Joseph D. , De Oliveira Gildasio S. , Suresh Santhanam
Published: May 2016

BACKGROUND:

Currently, there is limited evidence to support the safety of neuraxial catheters in neonates. Safety concerns have been cited as a major barrier to performing large randomized trials in this population. The main objective of this study is to examine the safety of neuraxial catheters in neonates across multiple institutions. Specifically, we sought to determine the incidence of overall and individual complications encountered when neuraxial catheters were used for postoperative analgesia in neonates.

METHODS:

This was an observational study that used the Pediatric Regional Anesthesia Network database. Complications and adverse events were defined by the presence of at least 1 of the following intraoperative and/or postoperative factors: catheter malfunction (dislodgment/occlusion), infection, block abandoned (unable to place), block failure (no evidence of block), vascular (blood aspiration/hematoma), local anesthetic systemic toxicity, excessive motor block, paresthesia, persistent neurologic deficit, and other (e.g., intra-abdominal misplacement, tremors). Additional analyses were performed to identify the use of potentially toxic doses of local anesthetics.

RESULTS:

The study cohort included 307 neonates with a neuraxial catheter. There were 41 adverse events and complications recorded, resulting in an overall incidence of complications of 13.3% (95% confidence interval, 9.8%–17.4%). Among the complications, catheter malfunction, catheter contamination, and vascular puncture were common. None of the complications resulted in long-term complications and/or sequelae, resulting in an estimated incidence of any serious complications of 0.3% (95% confidence interval, 0.08%–1.8%). There were 120 of 307 patients who received intraoperative and/or postoperative infusions consistent with a potentially toxic local anesthetic dose in neonates. The incidence of potentially toxic local anesthetic infusion rates increased over time (P = 0.008).

CONCLUSIONS:

Neuraxial catheter techniques for intraoperative and postoperative analgesia appear to be safe in neonates. Further studies to confirm our results and to establish the efficacy of these techniques across different surgical procedures are required. We suggest that each center that uses neuraxial anesthesia techniques in neonates closely evaluate the dose limits for local anesthetic agents and develop rigorous quality assurance methods to ensure potentially toxic doses are not used.
Acute Kidney Injury After Abdominal Surgery: Incidence, Risk Factors, and Outcome
Authors: Long Thorir E. , Helgason Dadi , Helgadottir Solveig , Palsson Runolfur , Gudbjartsson Tomas , Sigurdsson Gisli H. , Indridason Olafur S. , Sigurdsson Martin I.
Published: May 2016

BACKGROUND:

Acute kidney injury (AKI) is a serious complication after major surgical procedures. We examined the incidence, risk factors, and mortality of patients who sustained AKI after abdominal surgery in a large population-based cohort.

METHODS:

All patients who underwent open and laparoscopic abdominal surgery (excluding genitourinary and abdominal vascular procedures), between 2007 and 2014 at the University Hospital in Reykjavik were identified and their perioperative serum creatinine (SCr) measurements used to identify AKI after surgery employing the Kidney Disease: Improving Global Outcome (KDIGO) criteria. Risk factors were evaluated using multivariate logistic regression analysis and 30-day mortality compared with a propensity score–matched control group.

RESULTS:

During the 8-year period, a total of 11,552 abdominal surgeries were performed on 10,022 patients. Both pre- and postoperative SCr measurements were available for 3902 (33.8%) of the surgical cases. Of these, 264 (6.8%) were complicated by AKI; 172 (4.4%), 49 (1.3%), and 43 (1.1%) were classified as KDIGO stages 1, 2 and 3, respectively. The overall incidence of AKI for patients with available SCr values was 67.7 (99% confidence interval [CI], 57.7–78.6) per 1000 surgeries. In logistic regression analysis, independent risk factors for AKI were female sex (odds ratio [OR] = 0.68; 99% CI, 0.47–0.98), hypertension (OR = 1.75; 99% CI, 1.10–2.74), preoperative chronic kidney disease (OR= 1.68; 99% CI, 1.12–2.50), ASA physical status classification of IV (OR = 9.48; 99% CI, 3.66–29.2) or V (OR = 21.4; 99% CI, 5.28–93.6), and reoperation (OR = 4.30; 99% CI, 2.36–7.70). Patients with AKI had greater 30-day mortality (18.2% vs 5.3%; P < 0.001) compared with propensity score–matched controls.

CONCLUSIONS:

AKI is an important complication of abdominal surgery. In addition to sex, hypertension, and chronic kidney disease, ASA physical status classification is an independent predictor of AKI. Individuals who develop AKI have substantially worse short-term outcomes, including higher 30-day mortality, even after correcting for multiple patient- and procedure-related risk factors.
Formation of Ru Shell on Co/Al2O3 by Galvanic Deposition Method and Its High Catalytic Performance for Three-Way Conversion
Authors: Ohyama Junya , Ishikawa Hiroyuki , Mahara Yuji , Nishiyama Takumi , Satsuma Atsushi
Published: May 2016

A supported Ru catalyst was prepared by a galvanic deposition (GD) of Ru on Co particles supported on Al2O3 (Ru/Co-GD). The structure and chemical state of Ru/Co-GD was characterized by using a pulsed CO chemisorption technique, STEM-EDS, XAFS, XPS, CO adsorption FT-IR spectroscopy, and temperature-programed reduction (TPR) method. It is indicated that Ru/Co-GD forms Ru shell on Co nanoparticles. Such a unique structure was not formed on Ru/Co/Al2O3 prepared by a conventional sequential impregnation method (Ru/Co-seq). The Ru shell of Ru/Co-GD showed higher reducibility than Ru species of Ru/Co-seq as well as higher than Ru/Al2O3. Owing to the Ru shell having high reducibility, Ru/Co-GD showed enhanced catalytic activity for NO–C3H6 reaction. In addition, Co oxide on Ru/Co-GD exhibited high catalytic activity for CO and C3H6 oxidation. As a result, Ru/Co-GD showed superior performance for NO–C3H6–CO–O2 reaction compared to the conventional catalysts. The Ru shell structure also contributed to the suppression of Ru vaporization.
Variation of Iron Isotope Ratios in Anthropogenic Materials Emitted through Combustion Processes
Authors: Kurisu Minako , Sakata Kohei , Miyamoto Chihiro , Takaku Yuichi , Iizuka Tsuyoshi , Takahashi Yoshio
Published: May 2016

Iron isotope ratios (δ56/54Fe) of various anthropogenic materials produced by combustion processes were analyzed. It was revealed that particles emitted through combustion processes, such as fine aerosols collected from a tunnel or fly ash (extracted by 1.0 M HCl solution), yielded much lower isotope ratios than other materials on the earth’s surface environment. These results suggest that the low δ56/54Fe was caused by human activities such as combustion processes.