bluuebunny/crossref_metadata_2025 huggingface dataset:
Coloring plastinated specimens
Authors: Iliff Stanley , Concha Ismael , Chereminskiy Vladimir , Henry Robert W.
Published: November 2019

In the early days of plastination, plastinate Color was the usual grey/brown familiar to formalin‐fixed biological specimens. Initially, trials with Kaiserling's, Klotz, Jore's and McCormick's fixative solutions were disappointing. Vascular injections with Colored epoxy were a great breakthrough in the 1980s. Biodur AC10® stain was the first stain of note to be applied to gross specimens to be plastinated and was applied in the last acetone bath. As plastination became more popular, specimen Color became an important and necessary aspect. Reactivation of the normal Color of red blood cells within a formalin‐fixed specimen was introduced as a mechanism to restore Color to plastinated specimens. Painting of plastinated vessels was tried with some success, and finally, a superior new proprietary type of silicone coloration was developed. More recently, a versatile red pigment stain was developed. All of these have added aesthetically to the plastination processes and will certainly be a reality in the years to come. The various methodologies to Color plastinates are presented. Time will tell how effective these may or may not be.
Filial piety dilemma solutions in Chinese adult children: The role of contextual theme, filial piety beliefs, and generation
Authors: Zhang Mingyan , Lin Tian , Wang Dahua , Jiao Wei
Published: November 2019

Although some studies have revealed that traditional filial piety belief is weakening, few have explored whether and how the role of the belief in social life has changed correspondingly. The present study used questionnaires to examine solutions to filial piety dilemmas and the roles of contextual theme, filial piety beliefs, and generation in a sample of 123 young and 92 middle‐aged Chinese adults. With respect to the solutions adopted to solve parent‒child conflicts, preferences varied depending on the dilemma themes. Specifically, participants were more likely to select a self‐sacrifice (rather than an ego‐centered) solution for respect dilemmas than for caring dilemmas, and least likely to do so for obedience dilemmas. Participants were also likely to select a balancing (rather than an ego‐centered) solution for respect or caring dilemmas than for obedience dilemmas. In addition, the concordance between beliefs and solutions was exhibited in reciprocal, but not authoritarian, filial piety beliefs. Individuals with stronger reciprocal filial piety beliefs were more likely to select self‐sacrifice or balancing solutions than ego‐centered solutions whereas authoritarian filial piety showed no influence on solutions for either young or middle‐aged adults. Furthermore, the generation effect was not significant, and the solution selection did not differ between young and middle‐aged adults.
Characteristics and pathologies of the vitreo‐macular interface—results from the Gutenberg Health Study
Authors: Schuster Alexander Karl‐Georg , Kluck Anne‐Kristin , Korb Christina A. , Stoffelns Bernhard , Nickels Stefan , Schulz Andreas , Münzel Thomas , Wild Philipp S. , Beutel Manfred E. , Schmidtmann Irene , Lackner Karl J. , Peto Tunde , Pfeiffer Norbert
Published: November 2019

Purpose

We aimed to determine the prevalence of characteristics and pathologies of the vitreo‐macular interface within the general population.

Methods

The Gutenberg Health Study is a population‐based study in Germany, including an ophthalmological examination with refraction, biometry and optical coherence tomography (OCT) imaging. Characteristics of the vitreo‐macular interface were graded on volume scans including visibility of an epiretinal membrane, full‐thickness macular hole, lamellar hole and pseudohole. Overall and age‐specific prevalences including 95% confidence intervals [95%‐CI] were calculated. Association analyses were conducted to determine systemic and ocular factors that are associated with epiretinal membranes (the most common pathology) using multivariable logistic regression.

Results

A total of 1890 people aged 40–80 years were included in the study. Of these, 4.7% (95%‐CI: 3.8%–5.8%) had an epiretinal membrane in at least one eye, 0.1% a full‐thickness macular hole, 0.6% a lamellar hole and 0.6% a pseudohole. The presence of an epiretinal membrane was associated with higher age, myopic refractive error and prior retinal laser therapy, but not with gender, body height, body weight, smoking, prior cataract surgery or intraocular pressure.

Conclusions

Epiretinal membranes are more frequent in older and myopic subjects and in those with prior retinal laser therapy.
Plasma levels of inflammatory chemokines in patients with polypoidal choroidal vasculopathy
Authors: Sørensen Jakob Ørskov , Subhi Yousif , Molbech Christopher R. , Krogh Nielsen Marie , Sørensen Torben L.
Published: November 2019

Purpose

Chemokines are a group of cytokines that guide immune cell migration. We studied plasma levels of inflammatory chemokines in patients with polypoidal choroidal vasculopathy (PCV) and compared with healthy age‐matched control individuals.

Methods

This was a clinic‐based prospective case–control study of participants (n = 60) with either PCV (n = 26) or age‐matched healthy controls (n = 34). We sampled fresh venous blood and isolated plasma for analysis. We used U‐PLEX Human Assays to quantify concentrations of the inflammatory chemokines MCP‐1/CCL2, RANTES/CCL5, eotaxin/CCL11, IP‐10/CXCL10 and fractalkine/CX3CL1.

Results

Plasma levels of fractalkine was significantly higher in patients with PCV when compared to healthy controls (mean ± SD: 7291 ± 2461 pg/ml versus 5879 ± 2001 pg/ml; p = 0.021). Plasma levels of MCP‐1 (p = 0.846), RANTES (p = 0.288), eotaxin (p = 0.496) and IP‐10 (p = 0.352) did not differ significantly between the groups. To evaluate possible biomarker quality of fractalkine, we used a ROC analysis and found a positive but weak discriminatory ability (AUC = 0.68).

Conclusion

Patients with PCV have a higher plasma level of fractalkine. Although the differences do not possess strong biomarker qualities, they inform on disease processes of a poorly understood disease and suggest that the fractalkine‐CX3CR1 axis may be involved. As this study did not investigate local chemokine concentrations, we are unable to confirm or disprove any local chorioretinal interaction, and our findings should be interpreted with such caution.
Associations of cardiovascular risk factors and retinal vessel dimensions at present and their evolution over time in a healthy working population
Authors: Büttner Matthias , Schuster Alexander Karl‐Georg , Vossmerbäumer Urs , Fischer Joachim E.
Published: November 2019

Purpose

The aim of this study was to investigate whether an association between retinal vessel diameters with blood pressure and other risk factors exists in a healthy working population and whether current risk factors can be used as predictors for retinal vessel changes over time.

Methods

Retinal photographs and medical data were obtained during a voluntary work health check in 2010 and 2013. The central retinal arterial equivalent (CRAE) and central retinal venular equivalent (CRVE) were assessed using a semi‐automated software. Linear regression analysis was carried out to determine associations with systemic parameters and cardiovascular risk factors.

Results

A total of 1685 participants had gradable photographs and full medical data with a mean age of 44.8 years (SD: 10.2) and 80.8% being male; full data were obtained in both 2010 and 2013 for 365 participants allowing for longitudinal analysis. In the cross‐sectional analysis, a mean CRAE of 171.2 ±18.3 μm and a mean CRVE 215.8 ± 18.6 μm were found. A significant negative association for CRAE was seen for age, mean arterial blood pressure (MABP), body mass index (BMI) and high‐density lipoprotein (HDL), while triglycerides, spherical equivalent (SAE) and being a current smoker were positively associated. For CRVE age, MABP, HbA1c and HDL were negatively associated, while being female, low‐density lipoprotein, white blood cell count, SAE and being a current smoker showed a positive association. The linear regression model for the cross‐sectional analysis explained 31% and 21% of the variance of CRAE and CRVE, respectively. The longitudinal analysis showed a mean decrease of −1.6 μm (p = 0.04) for CRAE and −2.0 (p = 0.005) for CRVE within the three‐year time frame. Linear regression analysis with longitudinal data showed a significant association for HDL and CRAE, while for other factors no statistically significant association between current risk factors and changes in CRAE and CRVE was observed.

Conclusion

The width of both arterial and venous retinal vessels shows associations not only with arterial blood pressure but also with biochemical markers of cardiovascular risk. While such effects are partially established for elderly persons, our study results indicate that they apply also in a young population in working age with seemingly unimpaired health.
How do private transfers respond to public transfers? Evolutionary evidence from Thailand
Authors: Kananurak Papar , Sirisankanan Aeggarchat
Published: November 2019

Private inter‐household transfers and public transfers can change along with changes in social and economic conditions. However, most previous studies have examined their relationship from static perspectives. This study contributes new evidence by investigating the dynamic relationship between public transfers and private inter‐household transfers over the past three decades using a Thailand data set. The results from econometric analysis show that there is no crowding‐out effect of public transfers on private inter‐household transfers for the country as a whole as well as for urban and rural households separately; instead, inter‐household private transfers increase along with public transfers.
Midwife‐led care and obstetrician‐led care for low‐risk pregnancies: A cost comparison
Authors: Attanasio Laura B. , Alarid‐Escudero Fernando , Kozhimannil Katy B.
Published: November 2019

Objective

Low‐risk pregnant women cared for by midwives have similar birth outcomes to women cared for by physicians, although experiencing fewer medical procedures. However, limited research has assessed cost implications in the United States. Using national data, we assessed costs and resource use of midwife‐led care vs obstetrician‐led care for low‐risk pregnancies using a decision‐analytic approach.

Methods

We developed a decision‐analytic model of costs (health plan payments to clinicians) and use of medical procedures during childbirth (epidural analgesia, labor induction, cesarean birth, episiotomy) and outcomes of care (birth at preterm gestation) that may differ with midwife‐led vs obstetrician‐led care. Model parameters for obstetric procedures were generated using Listening to Mothers III data, a national survey of women who gave birth in US hospitals in 2011‐2012 and other published estimates. Cost estimates came from published or publicly available information on health insurance claims payments.

Results

The costs of childbirth for low‐risk women with midwife‐led care were, on average, $2262 less than births to low‐risk women cared for by obstetricians. These cost differences derive from lower rates of preterm birth and episiotomy among women with midwife‐led care, compared with obstetrician‐led care. Across the population of US women with low‐risk births each year (approximately 2.6 million), the model predicted substantially fewer preterm births (167 259 vs 219 427 for midwife‐led vs obstetrician‐led care) and fewer episiotomies (170 504 vs 415 686, for midwife‐led vs obstetrician‐led care).

Conclusions

A shift from obstetrician‐led care to midwife‐led care for low‐risk pregnancies could be cost saving.
The efficacy and safety of venetoclax therapy in elderly patients with relapsed, refractory chronic lymphocytic leukaemia
Authors: Eyre Toby A. , Roeker Lindsey E. , Fox Christopher P. , Gohill Satyen H. , Walewska Renata , Walter Harriet S. , Forconi Francesco , Broom Angus , Arumainathan Arvind , Brander Danielle M. , Allan John N. , Schuster Stephen J. , Hill Brian T. , Lansigan Frederick , Cheson Bruce D. , Lamanna Nicole , Coombs Catherine C. , Barr Paul M. , Skarbnik Alan P. , Shadman Mazyar , Ujjani Chaitra S. , Pearson Laurie , Pagel John M. , Jacobs Ryan , Mato Anthony R.
Published: November 2019

Elderly chronic lymphocytic leukaemia (CLL) patients treated outside of trials have notably greater toxicity with the Bruton's tyrosine kinase inhibitor ibrutinib compared to younger patients. It is not known whether the same holds true for the B‐cell lymphoma 2 inhibitor venetoclax. We provide a comprehensive analysis of key safety measures and efficacy in 342 patients comparing age categories ≥75 and <75 years treated in the relapsed, refractory non‐trial setting. We demonstrate that venetoclax has equivalent efficacy and safety in relapsed/refractory CLL patients who are elderly, the majority of whom are previous ibrutinib‐exposed and therefore may otherwise have few clear therapeutic options.
Use of gallium‐68 prostate‐specific membrane antigen positron‐emission tomography for detecting lymph node metastases in primary and recurrent prostate cancer and location of recurrence after radical prostatectomy: an overview of the current literature
Authors: Luiting Henk B. , van Leeuwen Pim J. , Busstra Martijn B. , Brabander Tessa , van der Poel Henk G. , Donswijk Maarten L. , Vis André N. , Emmett Louise , Stricker Phillip D. , Roobol Monique J.
Published: November 2019

Objectives

To review the literature to determine the sensitivity and specificity of gallium‐68 prostate‐specific membrane antigen (68Ga‐PSMA) positron‐emission tomography (PET) for detecting pelvic lymph node metastases in patients with primary prostate cancer (PCa), and the positive predictive value in patients with biochemical recurrence (BCR) after initial curative treatment, and, in addition, to determine the detection rate and management impact of 68Ga‐PSMA PET in patients with BCR after radical prostatectomy (RP).

Materials and Methods

We performed a comprehensive literature search. Search terms used in MEDLINE, EMBASE and Science Direct were ‘(PSMA, 68Ga‐PSMA, 68Gallium‐PSMA, Ga‐68‐PSMA or prostate‐specific membrane antigen)’ and ‘(histology, lymph node, staging, sensitivity, specificity, positive predictive value, recurrence, recurrent or detection)’. Relevant abstracts were reviewed and full‐text articles obtained where possible. References to and from obtained articles were searched to identify further relevant articles.

Results

Nine retrospective and two prospective studies described the sensitivity and specificity of 68Ga‐PSMA PET for detecting pelvic lymph node metastases before initial treatment, which ranged from 33.3% to 100% and 80% to 100%, respectively. In eight retrospective studies, the positive predictive value of 68Ga‐PSMA PET in patients with BCR before salvage lymph node dissection ranged from 70% to 100%. The detection rate of 68Ga‐PSMA PET in patients with BCR after RP in the PSA subgroups <0.2 ng/mL, 0.2–0.49 ng/mL and 0.5 to <1.0 ng/mL ranged from 11.3% to 50.0%, 20.0% to 72.7% and 25.0% to 87.5%, respectively.

Conclusion

The review results showed that 68Ga‐PSMA PET had a high specificity for the detection of pelvic lymph node metastases in primary PCa. Furthermore, 68Ga‐PSMA PET had a very high positive predictive value in detecting lymph node metastases in patients with BCR. By contrast, sensitivity was only moderate; therefore, based on the currently available literature, 68Ga‐PSMA PET cannot yet replace pelvic lymph node dissection to exclude lymph node metastases. In the salvage phase, 68Ga‐PSMA PET had both a high detection rate and impact on radiotherapy planning in early BCR after RP.
Microglia in neuropathology caused by protozoan parasites
Authors: Figarella Katherine , Wolburg Hartwig , Garaschuk Olga , Duszenko Michael
Published: November 2019

Involvement of the central nervous system (CNS) is the most severe consequence of some parasitic infections. Protozoal infections comprise a group of diseases that together affect billions of people worldwide and, according to the World Health Organization, are responsible for more than 500000 deaths annually. They include African and American trypanosomiasis, leishmaniasis, malaria, toxoplasmosis, and amoebiasis. Mechanisms underlying invasion of the brain parenchyma by protozoa are not well understood and may depend on parasite nature: a vascular invasion route is most common. Immunosuppression favors parasite invasion into the CNS and therefore the host immune response plays a pivotal role in the development of a neuropathology in these infectious diseases. In the brain, microglia are the resident immune cells active in defense against pathogens that target the CNS. Beside their direct role in innate immunity, they also play a principal role in coordinating the trafficking and recruitment of other immune cells from the periphery to the CNS. Despite their evident involvement in the neuropathology of protozoan infections, little attention has given to microglia–parasite interactions. This review describes the most prominent features of microglial cells and protozoan parasites and summarizes the most recent information regarding the reaction of microglial cells to parasitic infections. We highlight the involvement of the periphery–brain axis and emphasize possible scenarios for microglia–parasite interactions.
Pourquoi seules les villes sont‐elles qualifiées d'intelligentes? Un vocabulaire du biais urbain
Authors: Shearmur Richard , Charron Mathieu , Pajevic Filipa
Published: November 2019

Depuis 2010, le terme « ville intelligente » (ou « smart city » en anglais), terme vague qui renvoie à l'intégration croissante des technologies de l'information aux processus de gestion urbaine et, parfois, aux pratiques sociales et communautaires associées, est beaucoup utilisé. Or, l'adjectif « intelligent » n'est associé qu'aux villes: par implication les non‐villes (soient les régions rurales ou périphériques) ne sont pas intelligentes. Dans cet article, nous décrivons comment le terme « ville intelligente » est utilisé et montrons que des processus semblables à ceux qui rendent les villes « intelligentes » se déploient en dehors des villes. Réserver l'adjectif « intelligent » aux villes reflète donc un biais, soit le même biais qui n'associe l'innovation et la créativité qu'aux villes. En tant que géographes, nous avons pris conscience de nos biais disciplinaires coloniaux et sexistes. Cet article démontre qu'un biais urbain demeure présent et il suggère d'en prendre conscience afin de modifier notre manière de penser les différents territoires.
Identifying Liars Through Automatic Decoding of Children's Facial Expressions
Authors: Bruer Kaila C. , Zanette Sarah , Ding Xiao Pan , Lyon Thomas D. , Lee Kang
Published: November 2019

This study explored whether children's (N = 158; 4‐ to 9 years old) nonverbal facial expressions can be used to identify when children are being deceptive. Using a computer vision program to automatically decode children's facial expressions according to the Facial Action Coding System, this study employed machine learning to determine whether facial expressions can be used to discriminate between children who concealed breaking a toy(liars) and those who did not break a toy(nonliars). Results found that, regardless of age or history of maltreatment, children's facial expressions could accurately (73%) be distinguished between liars and nonliars. Two emotions, surprise and fear, were more strongly expressed by liars than nonliars. These findings provide evidence to support the use of automatically coded facial expressions to detect children's deception.
Intraocular chemotherapy for vitreoretinal lymphoma: A review
Authors: Kvopka Michael , Lake Stewart R. , Smith Justine R.
Published: November 2019

Vitreoretinal lymphomas are rare ocular cancers, and the subset of primary central nervous system lymphomas that are based in the posterior eye. These tumours are challenging to treat, and today management generally involves a multispecialty team coordinating a treatment protocol that may include intraocular chemotherapy, ocular irradiation, systemic chemotherapy and/or autologous stem cell transplantation. The ophthalmologist has specific responsibility for the intraocular chemotherapy, which is delivered to the eye by intravitreal injection. The most commonly injected drugs are methotrexate—an anti‐metabolite—and rituximab—an anti‐human B cell monoclonal antibody. A range of intraocular chemotherapy treatment schedules have been described in the medical literature, although to date there have been no randomized clinical trials of these schedules. In this article, we review the development and current status of intraocular chemotherapy for vitreoretinal lymphoma.
Parental participation in child protection case conferences
Authors: Jackson Sharon , Kelly Lynn , Leslie Brian
Published: November 2019

Child protection case conferences (CPCCs) are a fundamental part of child protection processes within the United Kingdom. They provide a mechanism for professionals and families to share information, enter an assessment dialogue, and develop a plan for intervention and support. The participation of parents is a core feature of U.K. and Scottish CPCCs. This reflects an international trend that recognizes the rights of family members to participate in the decision‐making processes of child protection. This article reports on the analysis of 11 qualitative interviews with parents who had attended CPCCs in Scotland. The findings highlight that parents were profoundly affected by these meetings, which were experienced as distressing. Parents lacked clarity about the purposes of CPCCs and found the large number of professionals in attendance intimidating. The discursive practices and structural arrangements of CPCCs acted to privilege professional voices and marginalize the voices of parents. The findings of this study raise important questions about parental participation in CPCCs in the contemporary context of child protection practice.
Informal kin caregivers raising children left behind in rural China: Experiences' feelings' and support
Authors: Hu Yang , Burton Judith , Lonne Bob
Published: November 2019

The well‐being of children in informal kinship care and their caregivers is a growing concern globally. This study explored the lived experiences of 23 kin caregivers raising children left behind in rural Northeast China while their migrant parents worked and lived in cities. The findings show that the expected authority and responsibility caregivers carry sometimes conflict with their social role of being children's grandparents. Caregivers' feelings about and understandings of these roles are shaped through their social interactions in local communities. In view of their situation and caregivers' self‐conscious attitudes towards utilizing local resources' future formal service provision and social support should take caregivers' viewpoints into account. These views are embedded in and shaped by their rural living context and relationships with community members who influence caregivers' perceptions and child rearing practices.
Comparing conventional flap‐less immediate implantation and socket‐shield technique for esthetic and clinical outcomes: A randomized clinical study
Authors: Sun Cong , Zhao Jinxiu , Liu Zhi , Tan Lei , Huang YaLi , Zhao Liang , Tao Hong
Published: November 2019

Objective

The aim of this study was to assess the esthetic and clinical outcomes of immediate implantation using the conventional flap‐less approach and the socket‐shield technique (SST).

Methods

This study included 30 adult patients who underwent anterior teeth replacement and fulfilled the pre‐defined criteria. Patients were randomly allocated to the SST (n = 15) and conventional flap‐less (control, n = 15) groups. The esthetic outcomes were evaluated by assessing the degree of soft‐tissue recession and the pink esthetic scores (PESs). Clinical parameters, including the modified plaque index, modified sulcus bleeding index (mSBI), probing depth (PD), and implant stability quotient (ISQ), were assessed. The buccal plate width (BPW) and height (BPH) were also measured.

Results

Implantation was clinically successful for all subjects in both groups. With a similar baseline, the SST group exhibited less reduction in the midfacial mucosal margins and the height of the mesial and distal papillae as well as higher BPW and BPH values compared with the control group (p < .001). The ISQ values were 76.01 ± 1.31 for the SST group and 75.56 ± 1.07 for the control group (p > .05), suggesting sufficient initial stability in both groups. At the 24‐month follow‐up, SST group patients had statistically significant lower values of PD, mSBI, and mPLI compared with the control group. There were no significant differences in the overall and individual PES values for both groups.

Conclusion

SST may improve functional and esthetic outcomes by maintaining alveolar bone volume and peri‐implant tissues. SST seems to be a promising treatment approach for implants in the esthetic zone.
Looking to aquatic species for conservation farming success
Authors: Gentry Rebecca R. , Gaines Steven D. , Gabe Jeremy S. , Lester Sarah E.
Published: November 2019

Thousands of species worldwide are threatened with extinction due to human activities. For some animals, such as elephants, totoaba, and bluefin tuna, population declines are largely driven by hunting. High prices and large profits create a strong incentive for illegal hunting, even in the face of penalties and strict international restrictions against trade. One innovative solution to help reverse the declines of such species is to farm them to increase supply, thereby reducing prices and decreasing hunting incentives. However, this idea has been criticized as impractical, though some examples exist of successful implementation. Here, we evaluate the hurdles facing endangered species farming as a market‐based mechanism to reduce illegal harvest of wild populations and provide guidance on when it is most likely to be effective. Using a simple model, we show how farming costs and enforcement of anti‐poaching measures are key drivers of success for this solution. We also argue that many of the most promising candidates are aquatic species that have been largely overlooked. Thus, while conservation farming may not be a solution for all endangered species, it should be more seriously considered for species that could be produced quickly and cost‐effectively.
CEO financial background and internal control weaknesses
Authors: Oradi Javad , Asiaei Kaveh , Rezaee Zabihollah
Published: November 2019

Research question/issue

The existing literature documents that the functional expertise of Chief Executive Officers (CEOs) in finance reduces poor performance risk, improves financial reporting quality, and mitigates audit risk. In this study, we examine the association between CEOs' financial background and internal control weaknesses (ICWs).

Research findings/insights

Using a sample of Iranian listed companies for the period 2007–2017, we find a significant negative association between CEOs with financial expertise and ICWs. Furthermore, we show that the negative association between CEO financial expertise and ICWs is stronger if the CEO is recruited from inside the firm. Our main results are robust after controlling for the potential selection issue, random effects at the firm level, and the impact of the new Iranian internal control regulations. Moreover, our results remain unchanged after controlling for other CEO characteristics, audit committee characteristics, audit fees, and using an alternative measure of financial expertise.

Theoretical/academic implications

Our study contributes to the extant literature by examining the association between CEOs' financial background and ICWs, a theme that remains largely unexplored in previous research. We also extend the literature on CEO succession origin.

Practitioner/policy implications

This study has important implications for regulators regarding the improvement of financial reporting quality and the effectiveness of internal controls, especially in the emerging markets. Particularly, our findings may be of benefit to auditors when assessing the risks regarding their clients' material weaknesses, as well as to shareholders and boards of directors when hiring a new CEO.
Small‐bowel capsule endoscopy in patients with celiac disease, axial versus lateral/panoramic view: Results from a prospective randomized trial
Authors: Branchi Federica , Ferretti Francesca , Orlando Stefania , Tontini Gian Eugenio , Penagini Roberto , Vecchi Maurizio , Elli Luca
Published: November 2019

Background and Aim

Capsule enteroscopy (CE) is recommended in the management of complicated celiac disease (CD). However, published data are derived from axial‐view capsule systems. No data are available on the use of lateral/panoramic view capsules. This study aimed at evaluating the diagnostic yield and efficacy of the lateral/panoramic versus the axial view capsule system in CD.

Methods

Consecutive CD patients were enrolled in a prospective monocentric study. Each patient ingested an axial (PillCam SB3) and a lateral/panoramic (CapsoCam Plus) view capsule with a 3‐h interval in a randomized order. Two experts blindly evaluated the CE carried out. A third expert reviewed the videos in cases of discordance.

Results

Twenty‐five CD patients were enrolled (four males, age at CE 51.2 ± 16.6 years, age at CD diagnosis 41.7 ± 20.6, years on a gluten‐free diet [GFD] 9.6 ± 9.4). Indications at CE were refractory CD in nine cases, non‐responsiveness to GFD in 10 and GFD non‐compliance in six. A positive finding was evidenced in 15 (60%) and 13 (52%) cases by CapsoCam and PillCam respectively (not significant). Atrophy was detected by both capsules. Considering the percentage of the small‐bowel mucosa presenting atrophy signs, mean values were 22% ± 35 and 20% ± 29 for lateral/panoramic and axial systems, respectively (not significant). Compared to duodenal histology, PillCam correctly identified 80% of patients with SB atrophy, whereas CapsoCam identified 73% of cases.

Conclusions

Lateral/panoramic view CE is effective in the detection of small‐bowel atrophy in CD and presents good sensitivity and specificity when compared to histology.
Risk stratification in acute variceal bleeding: Comparison of the AIMS65 score to established upper gastrointestinal bleeding and liver disease severity risk stratification scoring systems in predicting mortality and rebleeding
Authors: Robertson Marcus , Ng Jonathan , Abu Shawish Walid , Swaine Adrian , Skardoon Gillian , Huynh Andrew , Deshpande Sheetal , Low Zi Yi , Sievert William , Angus Peter
Published: November 2019

Background and Aim

Risk stratification is recommended in all patients with acute variceal bleeding (AVB). It remains unclear whether liver disease severity or upper gastrointestinal bleeding (UGIB) scoring algorithms offer superior predictive ability. We aimed to validate the AIMS65 score as a predictor of mortality in AVB, and to compare AIMS65 with established UGIB and liver disease severity risk stratification scores.

Methods

International Classification of Diseases, Tenth Revision codes identified patients presenting with AVB to three tertiary centers over a 48‐month period. Patients were risk‐stratified using AIMS65, Rockall, pre‐endoscopy Rockall, Child‐Pugh, Model for End‐stage Liver Disease (MELD) and United Kingdom MELD (UKELD) scores. Primary outcomes were inpatient and 6‐week mortality and inpatient rebleeding.

Results

Two hundred and twenty‐three patients were included. Inpatient and 6‐week mortality were 13.9% and 15.5% respectively. Prediction of inpatient mortality by AIMS65 (area under the receiver‐operating characteristic curve [AUROC: 0.84]) was equivalent to UGIB (Rockall: 0.79, pre‐Rockall: 0.78) and liver risk scores (MELD: 0.81, UKELD: 0.79, Child‐Pugh: 0.78). AIMS65 score ≥3 best defined high‐ and low‐risk groups for inpatient mortality (mortality 37.7% vs 4.9%). AIMS65 (AUROC: 0.62) was equivalent to UGIB risk scores (pre‐Rockall: 0.64, Rockall: 0.70) in predicting inpatient rebleeding and superior to liver risk scores (MELD: 0.56, UKELD: 0.57, Child‐Pugh: 0.60).

Conclusions

AIMS65 is equivalent to established UGIB and liver disease severity risk stratification scores in predicting mortality, and superior to liver scores in predicting rebleeding.
Common mechanisms of executive attention underlie executive function and effortful control in children
Authors: Tiego Jeggan , Bellgrove Mark A. , Whittle Sarah , Pantelis Christos , Testa Renee
Published: November 2019

Executive Function (EF) and Effortful Control (EC) have traditionally been viewed as distinct constructs related to cognition and temperament during development. More recently, EF and EC have been implicated in top‐down self‐regulation ‐ the goal‐directed control of cognition, emotion, and behavior. We propose that executive attention, a limited‐capacity attentional resource subserving goal‐directed cognition and behavior, is the common cognitive mechanism underlying the self‐regulatory capacities captured by EF and EC. We addressed three related questions: (a) Do behavioral ratings of EF and EC represent the same self‐regulation construct? (b) Is this self‐regulation construct explained by a common executive attention factor as measured by performance on cognitive tasks? and (c) Does the executive attention factor explain additional variance in attention deficit hyperactivity disorder (ADHD) problems to behavioral ratings of self‐regulation? Measures of performance on complex span, general intelligence, and response inhibition tasks were obtained from 136 preadolescent children (M = 11 years, 10 months, SD = 8 months), along with self‐ and parent‐reported EC, and parent‐reported EF, and ADHD problems. Results from structural equation modeling demonstrated that behavioral ratings of EF and EC measured the same self‐regulation construct. Cognitive tasks measured a common executive attention factor that significantly explained 30% of the variance in behavioral ratings of self‐regulation. Executive attention failed to significantly explain additional variance in ADHD problems beyond that explained by behavioral ratings of self‐regulation. These findings raise questions about the utility of task‐based cognitive measures in research and clinical assessment of self‐regulation and psychopathology in developmental samples.
Left ventricular function after correction of mitral regurgitation: Impact of the clipping approach
Authors: Hubert Arnaud , Galli Elena , Leurent Guillaume , Corbineau Hervé , Auriane Bidaut , Guillaume L’official , Leclercq Christophe , Donal Erwan
Published: November 2019

Aims

Functional mitral regurgitation (FMR) is associated with poor outcome in systolic heart failure (HF) patients. Percutaneous edge‐to‐edge mitral valve repair (PMVR) in Mitra‐Fr study failed to prove any beneficial effect over optimal medical treatment (OMT) but win in COAPT study. Nevertheless, little is known about the effect of PMVR on LV performance and mechanics in HF patients with severe secondary MR.

Method and results

Thirty‐seven patients with severe FMR undergoing PMVR were included and compared (according to indices of LV myocardial function and the relationship between LV‐size and the degree of regurgitation) to nineteen patients with FMR treated by OMT. Both groups were clinically comparable. At 6‐month follow‐up, cardiac index such as LV global constructive work (GCW) improved significantly in both groups (1.86 vs 2.13 L/min/m2, P = .02, 1.73 vs 2.28 L/min/m2 P = .002 and 977 vs 1101 mm Hg.%, P = .003, 967 vs 1110 mm Hg.%, P = .002 for PMVR and OMT groups, respectively) whereas left ventricular (LV) end‐systolic volume index, LV ejection fraction, and global longitudinal strain were not different. Receiver operating characteristics in PMVR with LVEF ≤ 35% subgroup analysis demonstrated that global work index (GWI) had the best ability to identify patients with worse evolution (AUC = 0.882; P = .009), confirmed by univariable logistic regression, particularly for patients with GWI < 482 mm Hg.%.

Conclusion

Echocardiographic characteristics at 6‐month follow‐up are not different when compare PMVR and OMT for HF patients with severe FMR. A low global work index might be a tool for discouraging the implantation of clips for this indication.
Projecting terrestrial biodiversity intactness with GLOBIO 4
Authors: Schipper Aafke M. , Hilbers Jelle P. , Meijer Johan R. , Antão Laura H. , Benítez‐López Ana , de Jonge Melinda M. J. , Leemans Luuk H. , Scheper Eddy , Alkemade Rob , Doelman Jonathan C. , Mylius Sido , Stehfest Elke , van Vuuren Detlef P. , van Zeist Willem‐Jan , Huijbregts Mark A. J.
Published: November 2019

Scenario‐based biodiversity modelling is a powerful approach to evaluate how possible future socio‐economic developments may affect biodiversity. Here, we evaluated the changes in terrestrial biodiversity intactness, expressed by the mean species abundance (MSA) metric, resulting from three of the shared socio‐economic pathways (SSPs) combined with different levels of climate change (according to representative concentration pathways [RCPs]): a future oriented towards sustainability (SSP1xRCP2.6), a future determined by a politically divided world (SSP3xRCP6.0) and a future with continued global dependency on fossil fuels (SSP5xRCP8.5). To this end, we first updated the GLOBIO model, which now runs at a spatial resolution of 10 arc‐seconds (~300 m), contains new modules for downscaling land use and for quantifying impacts of hunting in the tropics, and updated modules to quantify impacts of climate change, land use, habitat fragmentation and nitrogen pollution. We then used the updated model to project terrestrial biodiversity intactness from 2015 to 2050 as a function of land use and climate changes corresponding with the selected scenarios. We estimated a global area‐weighted mean MSA of 0.56 for 2015. Biodiversity intactness declined in all three scenarios, yet the decline was smaller in the sustainability scenario (−0.02) than the regional rivalry and fossil‐fuelled development scenarios (−0.06 and −0.05 respectively). We further found considerable variation in projected biodiversity change among different world regions, with large future losses particularly for sub‐Saharan Africa. In some scenario‐region combinations, we projected future biodiversity recovery due to reduced demands for agricultural land, yet this recovery was counteracted by increased impacts of other pressures (notably climate change and road disturbance). Effective measures to halt or reverse the decline of terrestrial biodiversity should not only reduce land demand (e.g. by increasing agricultural productivity and dietary changes) but also focus on reducing or mitigating the impacts of other pressures.
Interictal Hyperperfusion in the Higher Visual Cortex in Patients With Episodic Migraine
Authors: Michels Lars , Villanueva Jeanette , O’Gorman Ruth , Muthuraman Muthuraman , Koirala Nabin , Büchler Roman , Gantenbein Andreas R. , Sandor Peter S. , Luechinger Roger , Kollias Spyros , Riederer Franz
Published: November 2019

Background

Migraine pathophysiology is complex and probably involves cortical and subcortical alterations. Structural and functional brain imaging studies indicate alterations in the higher order visual cortex in patients with migraine. Arterial spin labeling magnetic resonance imaging (ASL‐MRI) is a non‐invasive imaging method for assessing changes in cerebral blood flow (CBF) in vivo.

Objective

To examine if interictal CBF differs between patients with episodic migraine (EM) with or without aura and healthy controls (HC).

Methods

We assessed interictal CBF using 2D pseudo‐continuous ASL‐MRI on a 3 Tesla Philips scanner (University Hospital Zurich, Switzerland) in EM (N = 17, mean age 32.7 ± 9.9, 13 females) and HC (N = 19, mean age 31.0 ± 9.3, 11 females).

Results

Compared to HC, EM showed exclusively hyperperfusion in the right MT+ and Cohen’s d effect size was 0.99 (HC mean CBF ± SD: 33.1 ± 5.9 mL/100 g/minutes; EM mean CBF: 40.9 ± 9.4 mL/100 g/minutes). EM with aura (N = 13, MwA) revealed hyperperfusion compared to HC in the right MT+ and superior temporal gyrus. For MT, Cohen’s d effect size was 1.34 (HC mean CBF ± SD: 33.1 ± 5.9 mL/100 g/minutes; MwA mean CBF: 43.3 ± 8.6 mL/100 g/minutes). For the superior temporal gyrus, Cohen’s d effect size was 1.28 (HC mean CBF ± SD: 40.1 ± 4.9 mL/100 g/minutes; MwA mean CBF: 47.4 ± 6.4 mL/100 g/minutes). In EM, anxiety was positively associated with CBF in the parietal operculum and angular gyrus.

Conclusions

Our results suggest that extrastriate brain regions probably involved in cortical spreading depression are associated with CBF changes in the interictal state. We conclude that ASL‐MRI is a sensitive method to identify local neuro‐functional abnormalities in CBF in patients with EM in the interictal state.
Reappraising the Tolosa‐Hunt Syndrome Diagnostic Criteria: A Case Series
Authors: Mullen Evan , Rutland John W. , Green Mark W. , Bederson Joshua , Shrivastava Raj
Published: November 2019

Introduction

Tolosa‐Hunt syndrome (THS), a condition characterized by painful ophthalmoplegia and accompanied by cranial nerve palsies, remains as a diagnosis of exclusion. Nevertheless, the 3rd Edition of the International Classification of Headache Disorders (ICHD) has refined its diagnostic criteria to require the demonstration of granulomatous inflammation on magnetic resonance imaging or biopsy. We sought to assess the effectiveness of the new criteria in arriving at accurate diagnoses.

Methods

We extracted all patient charts from our institution’s electronic medical record associated with ICD‐9 code 378.55 (external ophthalmoplegia). We then completed the retrospective diagnostic workups to determine if subjects met ICHD‐3 criteria for THS and compared our findings with their final diagnoses.

Results

Of 62 patients associated with ICD‐9 code 378.55, 10 (16%) was identified to have presenting symptoms concerning THS. The average age at the first onset of THS‐like symptoms was 58 years. Five of the 10 (50%) met ICHD‐3 criteria for THS. Two of the 5 (40%) meeting ICHD‐3 criteria for THS were discovered to have other diagnoses. Two of the 5 (40%) patients not meeting ICHD‐3 criteria for THS nevertheless received a final diagnosis of THS.

Discussion

Our false‐negative rate of 40% is consistent with previous case series found in the literature. Our false‐positive rate of 40% is, to our knowledge, a new contribution to the literature as no other case series includes more than a single false‐positive. The false‐positive rate is most concerning, as a preliminary misdiagnosis of THS can delay treatment tailored to the true etiology. Furthermore, infectious etiologies can be exacerbated with steroid treatment.

Conclusion

Our case series suggests that ICHD‐3 criteria are suboptimal for the accurate diagnosis of THS. We recommend a close follow‐up for all patients with symptoms concerning THS until a definitive responsible etiology is discovered and we encourage further studies assessing ICHD‐3 guidelines to optimize their sensitivity and specificity in the diagnosis of THS.
Oncologist‐patient‐caregiver decision‐making discussions in the context of advanced cancer in an Asian setting
Authors: Malhotra Chetna , Kanesvaran Ravindran , Barr Kumarakulasinghe Nesaretnam , Tan Sing‐Huang , Xiang Ling , Tulsky James A. , Pollak Kathryn I.
Published: November 2019

Objective

Patient involvement in treatment decisions is recommended in clinician‐patient encounters. Little is known about how oncologists engage patients in shared decision making in non‐Western countries. We assessed the prevalence of shared decision making among Singaporean oncologists and analysed how they discussed prognosis.

Methods

We audio‐recorded 100 consultations between advanced cancer patients and their oncologists. We developed a coding system to assess oncologist encouragement of patient participation in decision making and disclosure of an explicit prognosis. We assessed patient and oncologist characteristics that predicted these behaviours.

Results

Forty‐one consultations involved treatment discussions. Oncologists almost always listed more than one treatment option (90%). They also checked patient understanding (34%), discussed pros and cons (34%) and addressed uncertainty (29%). Oncologists discussed prognosis mostly qualitatively (34%) rather than explicitly (17%). They were more likely to give an explicit prognosis when patients/caregivers asked questions related to prognosis.

Conclusion

Oncologists in our sample engaged their patients in decision making. They have areas in which they can improve to involve patients at a deeper level to ensure shared decision making. Findings will be used to develop an intervention targeting oncologists and patients to promote patient involvement in decision making.
HIV testing strategies outside of health care settings in the European Union (EU)/European Economic Area (EEA): a systematic review to inform European Centre for Disease Prevention and Control guidance
Authors: Croxford S , Tavoschi L , Sullivan AK , Combs L , Raben D , Delpech V , Jakobsen SF , Amato‐Gauci AJ , Desai S
Published: November 2019

Objectives

In recent years, new technologies and new approaches to scale up HIV testing have emerged. The objective of this paper was to synthesize the body of recent evidence on strategies aimed at increasing the uptake and coverage of HIV testing outside of health care settings in the European Union (EU)/European Economic Area (EEA).

Methods

Systematic searches to identify studies describing effective HIV testing interventions and barriers to testing were run in five databases (2010–2017) with no language restrictions; the grey literature was searched for similar unpublished studies (2014–2017). Study selection, data extraction and critical appraisal were performed by two independent reviewers following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines.

Results

Eighty studies on HIV testing in non‐health care settings were identified, the majority set in Northern Europe. Testing was implemented in 65 studies, with men who have sex with men the risk group most often targeted. Testing coverage and positivity/reactivity rates varied widely by setting and population group. However, testing in community and outreach settings was effective at reaching people who had never previously been tested and acceptability of HIV testing, particularly rapid testing, outside of health care settings was found to be high. Other interventions aimed to increase HIV testing identified were: campaigns (n = 8), communication technologies (n = 2), education (n = 3) and community networking (n = 1).

Conclusions

This review has identified several strategies with potential to achieve high HIV testing coverage outside of health care settings. However, the geographical spread of studies was limited, and few intervention studies reported before and after data, making it difficult to evaluate the impact of interventions on test coverage.