bluuebunny/crossref_metadata_2025 huggingface dataset:
Preoperative frailty and outcome in patients undergoing radical cystectomy
Authors: van der Vlies Ellen , Los Maartje , Stijns Pascal E.F. , van Hengel Marike , Blaauw Nynke M.S. , Bos Willem Jan W. , van Dongen Eric P.A. , van Melick Harm H.E. , Noordzij Peter G.
Published: June 2020

Objective

To determine the value of preoperative frailty screening in predicting postoperative severe complications and 1‐year mortality in patients undergoing radical cystectomy (RC).

Patients and Methods

Prospective cohort single‐centre study in patients undergoing RC from September 2016 to December 2017. Preoperative frailty screening was implemented as standard care and was used to guide shared decision‐making during multidisciplinary team meetings. Frailty screening consisted of validated tools to assess physical, mental and social frailty. Patients were considered frail when having two or more frailty characteristics.

The primary endpoint was the composite of a severe complication (Clavien–Dindo Grade III–V) within 30 days and 1‐year all‐cause mortality. The secondary endpoints included any complication (Clavien–Dindo II–V), length of stay, readmission within 30 days, and all‐cause mortality. Logistic regression analysis and the concordance statistic (c‐statistic) were used to describe the association and predictive value of preoperative frailty screening.

Results

A total of 63 patients were included; 39 (61.9%) were considered frail. Preoperative frailty was associated with a seven‐fold increased risk of a severe complication or death 1 year after RC [adjusted odds ratio (OR) 7.36, 95% confidence interval (CI) 1.7–31.8; 22 patients]. Compared to the American Society of Anesthesiologists (ASA) score and Charlson Comorbidity Index, frailty showed the best model performance (Nagelkerke R2 0.20) and discriminative ability(c‐statistic 0.72, P < 0.01) for the primary endpoint. After adding frailty to the conventional ASA risk score, the c‐statistic improved by 11% (P < 0.01). Overall survival was significantly worse in frail patients (23.2 months, 95% CI 18.7–30.1) vs non‐frail patients (32.9 months, 95% CI 30.0–35.9; P = 0.01).

Conclusions

Frail patients undergoing RC are at high risk of postoperative adverse outcomes including death. Preoperative frailty screening improves preoperative risk stratification and may be used to guide patient selection for RC.
Children's experiences of food poverty in Portugal: Findings from a mixed‐method case study approach
Authors: Ramos Vasco
Published: June 2020

While observers acknowledge that the 2007–2008 crisis increased food insecurity, few studies considered how being food poor affects children's daily lives. In this paper, I discuss how children from low‐income families in Portugal experience food and deal with food scarcity. I draw on data from a larger European study, which employed a case study approach with a combination of semi‐structured interviews and photo‐elicitation. Children's accounts reveal how food poverty is embedded in their lives, affecting the quality and quantity of food, reducing opportunities to socialize with kin and friends and creating emotional stress. Visual methods added depth to our understanding.
Effects of cognitive behavioral therapy on anxiety and depression in patients with chronic obstructive pulmonary disease: A meta‐analysis and systematic review
Authors: Zhang Xuemei , Yin Changchun , Tian Wuguo , Lu Dongbing , Yang Xiumu
Published: June 2020

Objective

Symptoms such as depression and anxiety are common psychiatric symptoms in patients with chronic obstructive pulmonary disease (COPD). Cognitive behavioral therapy (CBT) is still controversial in the treatment of anxiety and depression in patients with COPD. We conducted a meta‐analysis and systematic review to evaluate the effect of CBT on anxiety and depression in patients with COPD, with a view to providing some guidance for clinical application.

Materials and methods

Computer search Web of Science, EMbase, PubMed, Cochrane Library, search time limit from the establishment of the library to August 2019. Collect the randomized controlled trial (RCT) for this topic. Two investigators independently screened the literature according to inclusion and exclusion criteria, extracted the data and assessed the risk of bias in the included studies. Meta‐analysis using RevMan5.3 software.

Results

A total of 10 studies were included in a total of 1278 patients. Meta‐analysis shows that CBT can improve depression and anxiety in patients with COPD. Subgroup analysis showed that intervention time ≥8 weeks had significant differences in improving anxiety, while intervention time <8weeks had significant differences in improving depression.

Conclusions

Cognitive behavioral therapy may possibly relieve depression in COPD patients in a short period of time, and it takes longer to improve anxiety. Therefore, clinical practice can choose the appropriate intervention time according to the patient’s psychological condition.
Predictive value of mixed antigen screen beads in pre‐transplant assessment of HLA immunization in solid organ transplant recipients
Authors: Snanoudj Renaud , Siemowski Jérémy , Amankwa Elizabeth , Kheav Vissal‐David , Arzouk Nadia , Galichon Pierre , Matignon Marie , Legendre Christophe , Delahousse Michel , Caillat‐Zucman Sophie , Taupin Jean‐Luc
Published: June 2020

Pre‐transplant serum screening of anti‐HLA antibodies is recommended for solid organ transplantations. Many laboratories use the less expensive bead‐based screening assay as the main technique and, if positive, turn to single‐antigen beads (SAB). We studied the correlations between these two immunoassays. We re‐analyzed the raw data of the two assays in 3030 first organ transplant recipients, explored with the two tests. We performed a ROC curve analysis of the screening ratio to predict a positive SAB assay. The AUC were 0.72 and 0.64 for class I and class II. The optimal thresholds of screening ratios were 3.28 (class I) and 2.11 (class II). Whatever the class, the negative predictive value was low, around 40%, with 36% of discordant sera, as defined by negative screening and positive SAB. Testing class I discordant sera on acid‐treated SAB showed that 54% of antibodies reacted against denatured HLA molecules. However, these screening‐negative sera may contain donor‐specific antibodies in 13.9% and 28.7% of cases for class I and class II, respectively, involved in antibody‐mediated rejection with the same frequency as non‐discordant sera. Given the low predictive value of screening, both assays should be performed at least once on the same serum before transplantation.
Outcome implications of benzodiazepine and opioid co‐prescription in kidney transplant recipients
Authors: Lam Ngan N. , Schnitzler Mark A. , Axelrod David A. , Xiao Huiling , McAdams‐DeMarco Mara , Segev Dorry L. , Massie Allan B. , Dharnidharka Vikas R. , Naik Abhijit S. , Muzaale Abimereki D. , Hess Gregory P. , Kasiske Bertram L. , Lentine Krista L.
Published: June 2020

The outcomes of benzodiazepine and opioid co‐prescription are not well‐defined in transplant populations. We examined linked national transplant registry and pharmaceutical records to characterize benzodiazepine and opioid use in the years before and after transplant in large US cohort of kidney transplant recipients (2007‐2016; N = 98 620), and associations (adjusted hazard ratio, LCLaHRUCL) with death and graft failure. Among the cohort, 15.6% filled benzodiazepine prescriptions in the year before transplant, and 14.0% filled benzodiazepine prescriptions in the year after transplant (short‐acting, 9.5%; long‐acting, 3.3%; both 1.1%). Use of short‐acting benzodiazepines in the year before transplant was associated with a 22% increased risk of death in the year after transplant (aHR, 1.081.221.38), while use of all classes in the year after transplant was associated with increased risk of death from >1 to 5 years (aHR: short‐acting 1.291.391.48; long‐acting 1.121.251.40; both 1.461.742.07). Recipients who used benzodiazepines were also more likely to fill opioid prescriptions. Recipients who filled both classes of benzodiazepine and the highest level of opioids had a 2.9‐fold increased risk of death compared to recipients who did not use either. Co‐prescription of benzodiazepines and opioids in kidney transplant recipients is associated with increased mortality. Ongoing research is needed to understand mechanisms of risk relationships.
Improving Outcomes Among Young Adults with type 1 diabetes: The D1 Now Randomised Pilot Study Protocol
Authors: Casey B. , Byrne M. , Casey D. , Gillespie P. , Hobbins A. , Newell J. , Morrissey E. , Dinneen S. F.
Published: June 2020

Background

Young adults (18‐25 years old) living with type 1 diabetes mellitus often have sub‐optimal glycaemic levels which can increase their risk of long term diabetes complications. Informed by health psychology theory and using a (public and patient involvement) young adult‐centred approach, we have developed a complex intervention, entitled D1 Now, to improve outcomes in this target group. The D1 Now intervention includes three components; 1) a support‐worker, 2) an interactive messaging system and 3) an agenda setting tool for use during clinic consultations.

Aims

The aim of the D1 Now pilot study is to gather and analyse acceptability and feasibility data to allow us to (1) refine the D1 Now intervention, and (2) determine the feasibility of a definitive Randomised Control Trial (RCT) of the intervention.

Methods

Diabetes clinics on the island of Ireland will be recruited and randomised to a D1 Now intervention arm or a usual care control arm. For a participant to be eligible they should be 18‐25 years old and living with type 1 diabetes for at least 12 months. Participant outcomes (influenced by a Core Outcome Set) include change in HbA1c, clinic attendance, number of episodes of severe hypoglycaemia and of diabetic ketoacidosis, diabetes distress, self‐management, quality of life and perceived level of control over diabetes; these will be will be measured at baseline and after 12 months follow‐up for descriptive statistics only. An assessment of treatment fidelity, a health economic analysis and a qualitative sub‐study will also be incorporated into the pilot study. ISRCTN (ref: ISRCTN74114336).
Complication rate among people with diabetes at low risk of foot ulceration in Fife, UK: an analysis of routinely collected data
Authors: Heggie R. , Chappell F. , Crawford F. , Martin A. , Gupta S. , Hawkins N. , Horne M. , Leese G. P. , Lewsey J.
Published: June 2020

Aims

To estimate the rate at which people with diabetes and a low risk of foot ulceration change diabetic foot ulceration risk status over time, and to estimate the rate of ulceration, amputation and death among this population.

Methods

We conducted an observational study of 10 421 people with diabetes attending foot screening in an outpatient setting in NHS Fife, UK, using routinely collected data from a national diabetes register, NHS SCI Diabetes. We estimated the proportion of people who changed risk status and the cumulative incidence of ulceration, amputation and death, respectively, among people with diabetes at low risk of diabetic foot ulceration at 2‐year follow‐up.

Results

At 2‐year follow‐up, 5.1% (95% CI 4.7, 5.6) of people with diabetes classified as low risk at their first visit had progressed to moderate risk. The cumulative incidence of ulceration, amputation and death was 0.4% (95% CI 0.3, 0.6), 0.1% (95% CI 0.1, 0.2) and 3.4% (95% CI 3.1, 3.8), respectively.

Conclusions

At 2‐year follow‐up, 5% of people at low risk of diabetic foot ulceration changed clinical risk status and <1% of people experienced foot ulceration or amputation. These findings provide information which will help to inform the current debate regarding optimal foot screening intervals.
Unravelling gender‐specific factors that link obesity to albuminuria
Authors: Landecho Manuel F. , Alegría‐Murillo Leire , López‐Fidalgo Jesús , Colina Inmaculada , Santesteban Virginia , García‐Unciti Marisol , Beloqui Oscar , Frühbeck Gema , Cuervo Marta
Published: June 2020

Background

Obesity is a major public health problem, which continues to be diagnosed and classified by BMI, excluding the most elemental concepts of the precision medicine approach. Obesity does not equally affect males and females, even with the same BMI. Microalbuminuria is a risk marker of cardiovascular disease closely related to obesity. The aim of this study was to evaluate the gender‐dependent differences in the development of early obesity‐related disease, focusing on pathologic microalbuminuria (PMA).

Material and methods

We developed a single‐centre cross‐sectional study including 1068 consecutive adults from May 2016 to January 2018, divided into two groups: one including the first 787 patients attended, evaluated as a description population; the second group included 281 subjects analysed as an external validation population. Collected data included medical history, anthropometric measures, abdominal bioimpedance and routine laboratory tests.

Results

First, we confirmed the lack of accuracy of classic obesity measures in predicting microalbuminuria. Second, we tested the utility of a tailored evaluation to predict PMA, with an area under the ROC curve of 0.78 for females and 0.82 for males. We also confirmed the different physiology of visceral adiposity for males when compared to females, in which small variations of fat mass entail major changes in the clinical repercussion. Third, we performed an external validation of our results, achieving a 77% accuracy rate.

Conclusions

Our findings support that there is an individual threshold of fat amount necessary to develop obesity‐dependent PMA and that gender plays a major role in the interplay between PMA and adiposity.
Feasibility and tolerability of a cognitive remediation clinical service in first episode coordinated specialty care
Authors: Lewandowski Kathryn E.
Published: June 2020

Aim

Cognitive remediation is an evidence‐based intervention targeting the common and disabling cognitive deficits in people with psychosis. Findings from efficacy studies and meta‐analyses show that cognitive remediation produces medium to large effects on cognition in both chronic and first episode patients. However, clinical availability of this treatment remains scarce, reflecting a major gap between science and practice. Here we describe the development of a cognitive remediation programme in an outpatient first episode psychosis clinical service, and preliminary feasibility and acceptability outcomes.

Methods

Based on evidence from efficacy trials and assessment within the clinic of perceived benefits and barriers, we developed a CR programme that involved both internet‐based computer training exercises and a weekly in‐person therapy group. Outcomes were assessed based on data from three consecutive 12‐week group series. Feasibility outcomes included adoption, fill, cost, and utilization; tolerability outcomes were based on user survey and focus group feedback.

Results

We found evidence of feasibility including good adoption, fill, utilization, and cost. We also found good tolerability and satisfaction based on feedback from a user survey and focus groups, with more than 80% of respondents reporting high overall satisfaction with the programme and subjective cognitive and functional improvements.

Conclusions

The present report provides preliminary evidence that cognitive remediation can be translated into real world clinical practice for first episode psychosis. Systematic evaluation of implementation and dissemination of cognitive remediation is needed, and has the potential to improve access to cognitive health interventions for people with psychosis.
Fine structure analysis of perineuronal nets in the ketamine model of schizophrenia
Authors: Kaushik Rahul , Lipachev Nikita , Matuszko Gabriela , Kochneva Anastasia , Dvoeglazova Anastasia , Becker Axel , Paveliev Mikhail , Dityatev Alexander
Published: June 2020

Perineuronal nets (PNNs) represent a highly condensed specialized form of brain extracellular matrix (ECM) enwrapping mostly parvalbumin‐positive interneurons in the brain in a mesh‐like fashion. PNNs not only regulate the onset and completion of the critical period during postnatal brain development, control cell excitability, and synaptic transmission but are also implicated in several brain disorders including schizophrenia. Holes in the perineuronal nets, harboring the synaptic contacts, along with hole‐surrounding ECM barrier can be viewed as PNN compartmentalization units that might determine the properties of synapses and heterosynaptic communication. In this study, we developed a novel open‐source script for Fiji (ImageJ) to semi‐automatically quantify structural alterations of PNNs such as the number of PNN units, area, mean intensity of PNN marker expression in 2D and 3D, shape parameters of PNN units in the ketamine‐treated Sprague–Dawley rat model of schizophrenia using high‐resolution confocal microscopic images. We discovered that the mean intensity of ECM within PNN units is inversely correlated with the area and the perimeter of the PNN holes. The intensity, size, and shape of PNN units proved to be three major principal factors to describe their variability. Ketamine‐treated rats had more numerous but smaller and less circular PNN units than control rats. These parameters allowed to correctly classify individual PNNs as derived from control or ketamine‐treated groups with ≈85% reliability. Thus, the proposed multidimensional analysis of PNN units provided a robust and comprehensive morphometric fingerprinting of fine ECM structure abnormalities in the experimental model of schizophrenia.
Effectiveness and safety of perampanel monotherapy for focal and generalized tonic‐clonic seizures: Experience from a national multicenter registry
Authors: Toledano Delgado Rafael , García‐Morales Irene , Parejo‐Carbonell Beatriz , Jiménez‐Huete Adolfo , Herrera‐Ramirez David , González‐Hernández Ayoze , Ayuga Loro Fernando , Santamarina Estevo , Toledo Manuel , Ojeda Joaquín , Poza Juan José , Molins Albert , Giner Pau , Estévez María José Carlos , Castro‐Vilanova María Dolores , Zurita Jorge , Saiz‐Diaz Rosa Ana , Gómez‐Ibañez Asier , Rodriguez‐Uranga Juan , Gil‐Nagel Antonio , Campos Dulce , Sánchez‐Larsen Álvaro , Aguilar‐Amat Prior Maria José , Mauri Llerda José Angel , Huertas González Nuria , García‐Barragán Nuria
Published: June 2020

Objective

To assess the effectiveness and tolerability of perampanel (PER) monotherapy in routine clinical practice for the treatment of focal onset and generalized tonic‐clonic seizures (GTCS).

Methods

This multicenter, retrospective, observational study was conducted in patients aged ≥12 years treated with PER as primary monotherapy or converted to PER monotherapy by progressive reduction of background antiepileptic drugs. Outcomes included retention, responder, and seizure‐free rate after 3, 6, and 12 months and tolerability throughout the follow‐up.

Results

A total of 98 patients (mean age = 49.6 ± 21.7 years, 51% female) with focal seizures and/or GTCS were treated with PER monotherapy for a median exposure of 14 months (range = 1‐57) with a median dose of 4 mg (range = 2‐10). The retention rates at 3, 6, and 12 months and last follow‐up were 93.8%, 89.3%, 80.9%, and 71.4%, respectively. The retention rates according to the type of monotherapy (primary vs conversion) did not differ (log‐rank P value = .57). Among the 98 patients, 61.2% patients had seizures throughout the baseline period, with a median seizure frequency of 0.6 seizures per month (range = 0.3‐26). Responder rates at 3, 6, and 12 months were 79.6%, 70.1%, and 52.8%, respectively, and seizure freedom rates at the same points were 62.7%, 56.1%, and 41.5%. Regarding the 33 patients who had GTCS in the baseline period, 87.8% were seizure‐free at 3 months, 78.1% at 6 months, and 55.1% at 12 months. Over the entire follow‐up, PER monotherapy was generally well tolerated, and only 16% of patients discontinued PER due to adverse events (AEs). Female patients were found to be at a higher risk of psychiatric AEs (female vs male odds ratio = 2.85, 95% confidence interval = 1‐8.33, P = .046).

Significance

PER demonstrated good effectiveness and a good safety profile when used as primary therapy or conversion to monotherapy at relatively low doses, in a clinical setting with patients with focal seizures and GTCS.
Demographic history and genomics of local adaptation in blue tit populations
Authors: Perrier Charles , Rougemont Quentin , Charmantier Anne
Published: June 2020

Understanding the genomic processes underlying local adaptation is a central aim of modern evolutionary biology. This task requires identifying footprints of local selection but also estimating spatio‐temporal variations in population demography and variations in recombination rate and in diversity along the genome. Here, we investigated these parameters in blue tit populations inhabiting deciduous versus evergreen forests, and insular versus mainland areas, in the context of a previously described strong phenotypic differentiation. Neighboring population pairs of deciduous and evergreen habitats were weakly genetically differentiated (FST = 0.003 on average), nevertheless with a statistically significant effect of habitat type on the overall genetic structure. This low differentiation was consistent with the strong and long‐lasting gene flow between populations inferred by demographic modeling. In turn, insular and mainland populations were moderately differentiated (FST = 0.08 on average), in line with the inference of moderate ancestral migration, followed by isolation since the end of the last glaciation. Effective population sizes were large, yet smaller on the island than on the mainland. Weak and nonparallel footprints of divergent selection between deciduous and evergreen populations were consistent with their high connectivity and the probable polygenic nature of local adaptation in these habitats. In turn, stronger footprints of divergent selection were identified between long isolated insular versus mainland birds and were more often found in regions of low recombination, as expected from theory. Lastly, we identified a genomic inversion on the mainland, spanning 2.8 Mb. These results provide insights into the demographic history and genetic architecture of local adaptation in blue tit populations at multiple geographic scales.
Modeling Groundwater Inflow to the New Crater Lake at Kīlauea Volcano, Hawai'i
Authors: Ingebritsen S. E. , Flinders A. F. , Kauahikaua J. P. , Hsieh P. A.
Published: June 2020

During the 2018 eruption of Kīlauea Volcano, Hawai'i, scientists relied heavily on a conceptual model of explosive eruptions triggered when lava‐lake levels drop below the water table. Numerical modeling of multiphase groundwater flow and heat transport revealed that, contrary to expectations, liquid water inflow to the drained magma conduit would likely be delayed by months to years, owing to the inability of liquid water to transit a zone of very hot rock. The summit of Kīlauea subsequently experienced an ∼2‐month period of consistent repeated collapses, and the crater now extends below the equilibrium position of the water table. Liquid water first emerged into the deepened crater in late July 2019. The timing of first appearance of liquid water (about 14 months postcollapse) and the rate of crater lake filling (currently ∼27 kg/s) were well‐predicted by the numerical modeling done in late spring 2018, which forecast liquid inflow after 3 to 24 months at rates of 10 to 100 kg/s. A second‐generation groundwater model, reflecting the current crater geometry, forecasts lake filling over the next several years. The successful 2018 to present forecasts with both models are based on unadjusted in situ permeability estimates (1 to 6 × 10−14 m2) and water‐table elevations (600 to 800 m) from a nearby research drillhole and geophysical surveys. Important unknowns that affect the reliability of longer‐term forecasts include the equilibrium water‐table geometry, the rate of evaporation from the hot and growing crater lake (currently ∼29,000 m2 at 70‐80 °C), and heterogenous permeability changes caused by the 2018 collapse.
Cancer‐related genetic changes in multistep hepatocarcinogenesis and their correlation with imaging and histological findings
Authors: Muraoka Masaru , Maekawa Shinya , Suzuki Yuichiro , Sato Mitsuaki , Tatsumi Akihisa , Matsuda Shuya , Miura Mika , Nakakuki Natsuko , Shindo Hiroko , Amemiya Fumitake , Takano Shinichi , Fukasawa Mitsuharu , Nakayama Yasuhiro , Yamaguchi Tatsuya , Inoue Taisuke , Sato Tadashi , Yamashita Atsuya , Moriishi Kohji , Matsuda Masanori , Enomoto Nobuyuki
Published: June 2020

Aim

The landscape of cancer‐related genetic aberrations in hepatocellular carcinoma (HCC) has gradually become clear through recent next‐generation sequencing studies. However, it remains unclear how genetic aberrations correlate with imaging and histological findings.

Methods

Using 117 formalin‐fixed paraffin‐embedded specimens of primary liver tumors, we undertook targeted next‐generation sequencing of 50 cancer‐related genes and digital polymerase chain reaction of hTERT. After classifying tumors into several imaging groups by hierarchal clustering with the information from gadoxetic acid enhanced magnetic resonance imaging, contrast‐enhanced computed tomography, contrast‐enhanced ultrasound, and diffusion‐weighted imaging magnetic resonance imaging, the correlation between genetic aberrations and imaging and histology were investigated.

Results

Most frequent mutations were hTERT (61.5%), followed by TP53 (42.7%), RB1 (24.8%), and CTNNB1 (18.8%). Liver tumors were classified into six imaging groups/grades, and the prevalence of hTERT mutations tended to increase with the advancement of imaging/histological grades (P = 0.026 and 0.13, respectively), whereas no such tendency was evident for TP53 mutation (P = 0.78 and 1.00, respectively). Focusing on the mutations in each tumor, although the variant frequency (VF) of hTERT did not change (P = 0.36 and 0.14, respectively) in association with imaging/histological grades, TP53 VF increased significantly (P = 0.004 and <0.001, respectively). In multivariate analysis, stage III or IV (hazard ratio, 3.64; P = 0.003), TP53 VF ≥ 50% (hazard ratio, 3.79; P = 0.020) was extracted as an independent risk for recurrence in primary HCC patients.

Conclusions

Increased prevalence of hTERT mutation and increased TP53 mutation VF are characteristic features of HCC progression, diagnosed with imaging/histological studies.
How do Cochrane authors conduct web searching to identify studies? Findings from a cross‐sectional sample of Cochrane Reviews
Authors: Briscoe Simon , Nunns Michael , Shaw Liz
Published: June 2020

Background

Searching the World Wide Web using search engines and websites can be conducted to identify studies for systematic reviews. When searching to support systematic reviews, the searcher faces challenges in using the basic search interfaces of most search engines and websites.

Objectives

To describe and evaluate current practice of web searching in a cross‐sectional sample of Cochrane Reviews. The study also describes the stated aims of web searching, i.e. the identification of published or unpublished studies or both.

Methods

A six‐month cross‐sectional sample of Cochrane Reviews was identified via the Cochrane Library. Reviews were inspected for detail about web searching. Findings were described and evaluated using a framework of key principles for web searching.

Results

423 Cochrane Reviews published August 2016–January 2017 were identified of which 61 (14%) reported web searching. Web searches were typically simplified versions of the bibliographic database search. Advanced and iterative approaches were not widely used. Google Search and Google Scholar were the most popular search engines. Most reports stated identification of grey literature as their aim.

Conclusion

Basic web search interfaces necessitate simple searches. However, there is scope to use more diverse search features and techniques and a greater variety of search engines.
Consumer perceptions of financial advisory titles in the United States and implications for title regulation
Authors: Tharp Derek T.
Published: June 2020

Many professionals in the United States financial services industry refer to themselves as financial advisers despite tremendous variation in business practices, compensation methods, and duties to act in the best interest of their clients. As a result, both the Securities and Exchange Commission (SEC) and state securities regulators have recently considered title regulation aimed at promoting consumer clarity. However, there is little empirical evidence to inform how consumers actually perceive the use of such titles. This study examines consumer perceptions via two studies of U.S. consumers conducted using Amazon's Mechanical Turk. Findings from the first study (n = 665) suggest that consumers perceive common industry titles as different from one another in a manner that is consistent with the differentiation of advice professions (e.g., financial adviser, financial planner, financial counsellor, investment consultant and investment adviser) from sales professions (e.g., investment salesperson, stockbroker and life insurance agent). Findings from a second study using a higher‐income sample (n = 334) compared the influence of titles on perception to the influence of disclosure on perception. The second study again found evidence of consumer differentiation between professional titles (financial adviser and stockbroker). However, the effect sizes associated with the use of different titles were much smaller than the effect sizes associated with disclosure statements that were tested in this study, suggesting that disclosure regulation may be more effective in promoting consumer clarity than title regulation. Other implications regarding the potential efficacy of proposed regulatory frameworks are discussed.
Comparative metabolite profiling of raw milk from subclinical and clinical mastitis cows using 1H‐NMR combined with chemometric analysis
Authors: Luangwilai Mayuree , Duangmal Kiattisak , Chantaprasarn Nawanon , Settachaimongkon Sarn
Published: June 2020

The objectives of this study were to characterise and compare non‐volatile metabolite profiles of raw milk from healthy, subclinical and clinical mastitis cows using a non‐targeted proton nuclear magnetic resonance (1H‐NMR) metabolomic approach. A total of 46 metabolites were identified. Multivariate analysis allowed discrimination of milk from healthy and mastitis cows according to their 1H‐NMR metabolite profiles. Significant increases in acetate, formate, lactate, benzoate, hippurate, β‐hydroxybutyrate, valerate, alanine, histidine, isoleucine, leucine, N‐acetylamino acid, phenylalanine, threonine and valine content were associated with extremely high somatic cell count and clinical mastitis status of the cows. Furthermore, significant rises in hippurate, valerate, N‐acetylglucosamine, histidine, isoleucine and leucine content could be used as potential biomarker for indicating subclinical mastitis infection of the udders. Beside the existing biomarkers for diagnosing mastitis in literatures, we found additional candidate metabolites, such as alanine, valerate and N‐acetylglucosamine, in correlation with mastitis status of Thai crossbred Holstein dairy cows.
Development of teaching, mentoring and supervision skills for basic training registrars: a frustrated apprenticeship?
Authors: Chapman Laura , Mysko Christopher , Coombridge Hannah
Published: June 2020

Background

Teaching, mentoring and supervision (TMS) are fundamental skills with a specific commitment within the Royal Australasian College of Physicians professional practice framework. The new basic training standards include ‘use of appropriate educational techniques to facilitate the learning of peers, junior colleagues and other health professionals and to provide supervision for junior colleagues’ but it is unclear how basic physician trainees and equivalent grade doctors (hereinafter ‘registrars’) will provide, learn or develop TMS skills.

Aims

To explore how registrars provide, learn and develop TMS skills.

Methods

Mixed methods approach. New Zealand registrars were invited to participate in anonymous survey regarding TMS experiences and learning. Focus groups explored skill acquisition and development more deeply.

Results

A total of 121 registrars from 16 District Health Boards responded. Registrars supervise two juniors daily (range 0–4+). Fewer than 1:4 have formal training in TMS skills. Free text and focus group themes include: informal development by observing role models plus personal experience of giving and receiving TMS, inequitable access to development opportunities and formal training, barriers include workload and unsupportive learning cultures. Some registrars lack confidence in delivering TMS.

Conclusions

Registrars are expected to teach, mentor and supervise junior colleagues but experience a ‘frustrated apprenticeship’: formal training is minimal and informal training is dependent on variable role models, opportunities and systematic support. Registrars feel unprepared and lack confidence despite wanting to succeed in this domain. Suggestions for improvement include baseline formal training, purposeful role modelling by seniors and equitable promotion of TMS opportunities.
The political constitution of labour from Donovan to Blair
Authors: Cruddas Jon
Published: June 2020

This article looks at changing patterns of labour regulation over the last 50 years ago. We begin with the contribution of the ‘Oxford School’ within industrial relations analysis and its influence on the Donovan Royal Commission. We then discuss the architecture of the British corporate state and the approach of successive Conservative administrations between 1979 and 1997. Next, we consider labour market analysis and interventions under New Labour alongside emerging European influences and rights‐based models of justice. We conclude with some final comments regarding contemporary labour market thinking.
Selective elemental concentration during the solidification of stainless steel slags for increased Cr recovery with MnO addition
Authors: Wang Zhanjun , Sohn Il
Published: June 2020

The study investigated the effect of MnO on the viscosity and the equilibrium crystallization behavior of CaO‐SiO2‐Al2O3‐Cr2O3‐MnO stainless steel slags to understand the selective concentration behavior of Cr during slag solidification. The apparent viscosity gradually decreases with higher MnO content, which act as a network modifier, resulting in simpler [SiO4]‐structural units. Due to the formation of MnCr2O4 spinel crystals, the tendency of decreasing viscosity is impeded. The equilibrium crystal phase with higher MnO content changes from the Cr2O3 phase to the MnCr2O4 spinel phase during the crystallization process. Distinct separation between Cr‐enriched phases with the amorphous phase can be observed and analysis of as‐quenched slags after thermochemical equilibrium experiments shows that the overall Cr content in the amorphous phase gradually decreases with higher MnO content and lower temperature, indicating Cr can be selectively enriched in a corresponding Cr‐containing crystalline phase. The sizes of the primary Cr‐enriched phases are < 20 μm. With a higher MnO content, the volume of the Cr2O3 phase decreases, and the corresponding volume of the MnCr2O4 spinel phase increases. Understanding the distribution characteristics of the Cr‐enriched phase and the gradually enriched Cr content can provide a new approach for the increased retrieval of stainless steel slags.
Models of prescribing, scope of practice, and medicines prescribed, a survey of nurse practitioners
Authors: Fong Jacqueline , Cashin Andrew , Buckley Thomas
Published: June 2020

Aims and Objectives

The aim of this study was to explore current Australian Nurse Practitioners (NPs) models of prescribing used and medicines prescribed within their scopes of practice.

Design

Descriptive online electronic national survey.

Methods

An online survey of Australian NPs was conducted in 2017. A total of 252 NP participants reported on their current prescribing practices.

Results

Participants reported prescribing via three prescribing models with autonomous prescribing the most frequently used, followed by prescribing under supervision and prescribing under a structured arrangement. Participants reported prescribing 298 separate medications, representative of all major drug classifications from the Australian Medicines Handbook.

Conclusions

NPs appear to engage in several modes of prescribing as relevant to their context of practice with most NPs prescribing using all models of prescribing at different times. Findings also highlight the diversity of and breath of the medicines that NP prescribes and highlight the need for NPs to have broad capability in relation to the quality use of medicines, irrespective of specialty or location of practice.

Impact

Findings of this research add to the international literature on NP prescribing and through identification of models of prescribing and medicines prescribed inform future NP education and policy.
Impact of risk‐factor modification on arrhythmia recurrence among morbidly obese patients undergoing atrial fibrillation ablation
Authors: Donnellan Eoin , Wazni Oussama M. , Kanj Mohamed , Elshazly Mohamed , Hussein Ayman A. , Patel Divyang R. , Trulock Kevin , Wilner Bryan , Baranowski Bryan , Cantillon Daniel J , Varma Niraj , Jaber Wael , Saliba Walid I.
Published: June 2020

Background

Morbid obesity is associated with prohibitively high arrhythmia recurrence rates following atrial fibrillation (AF) ablation.

Design

This was a single‐center study comprising 239 patients with morbid obesity and symptomatic paroxysmal or persistent AF undergoing AF ablation compared to 239 patients with a body mass index less than 30 kg/m2 matched based on age, sex, ejection fraction, AF type, presence and type of heart failure, and left atrial volume index.

Methods

Our primary outcome of interest was arrhythmia recurrence.

Results

During a mean follow‐up of 29 months, arrhythmia recurrence was observed in 65% of the morbidly obese cohort compared to 27% of the control group (P < .0001). Among those with morbid obesity, sleep apnea screening, and treatment (91% vs 40%; P < .0001), blood pressure control (62% vs 53%; P = .001), glycemic control (85% vs 56%; P = .004), and weight loss more than equal to 5% (33% vs 57% in those who lost less than 5% and 83% in those who gained weight, P < .0001) were associated with lower arrhythmia recurrence. Recurrent arrhythmia was observed in one (4%) patient who accomplished all four goals, compared to 36% who achieved 3 of 4, 85% who modified 2 of 4%, and 97% of those who modified zero or one risk‐factor. Risk‐factor modification (RFM) was also associated with substantial reductions in the need for repeat ablation or direct‐current cardioversion and arrhythmia‐related hospitalization (P < .0001).

Conclusion

RFM through pragmatic noninvasive means such as blood pressure and glycemic control, sleep apnea screening and treatment, and weight loss is associated with substantially lower rates of recurrent arrhythmia among morbidly obese patients undergoing AF ablation.
Computer‐aided assessment of the chemokine receptors CXCR3, CXCR4 and CXCR7 expression in gallbladder carcinoma
Authors: Yu Xiao , Lu Wei , Ng Chan Way , Xu Shuoyu , Wu Yao , Chen Shili , Gao Yuren , Zhang Yijian , Zhang Qingqing , Xu Yuzhen , Liu Yingbin , Li Sheng
Published: June 2020

Gallbladder carcinoma (GBC) is a vicious and invasive disease. The major challenge in the clinical treatment of GBC is the lack of a suitable prognosis method. Chemokine receptors such as CXCR3, CXCR4 and CXCR7 play vital roles in the process of tumour progression and metastasis. Their expression levels and distribution are proven to be indicative of the progression of GBC, but are hard to be decoded by conventional pathological methods, and therefore, not commonly used in the prognosis of GBC. In this study, we developed a computer‐aided image analysis method, which we used to quantitatively measure the expression levels of CXCR3, CXCR4 and CXCR7 in the nuclei and cytoplasm of glandular and interstitial cells from a cohort of 55 GBC patients. We found that CXCR3, CXCR4 and CXCR7 expressions are associated with the clinicopathological variables of GBC. Cytoplasmic CXCR3, nuclear CXCR7 and cytoplasmic CXCR7 were significant predictive factors of histology invasion, whereas cytoplasmic CXCR4 and nuclear CXCR4 were significantly correlated with T and N stage and were associated with the overall survival and disease‐free survival. These results suggest that the quantification and localisation of CXCR3, CXCR4 and CXCR7 expressions in different cell types should be considered using computer‐aided assessment to improve the accuracy of prognosis in GBC.
Illustrating the importance of meta‐analysing variances alongside means in ecology and evolution
Authors: Sánchez‐Tójar Alfredo , Moran Nicholas P. , O’Dea Rose E. , Reinhold Klaus , Nakagawa Shinichi
Published: June 2020

Meta‐analysis is increasingly used in biology to both quantitatively summarize available evidence for specific questions and generate new hypotheses. Although this powerful tool has mostly been deployed to study mean effects, there is untapped potential to study effects on (trait) variance. Here, we use a recently published data set as a case study to demonstrate how meta‐analysis of variance can be used to provide insights into biological processes. This data set included 704 effect sizes from 89 studies, covering 56 animal species, and was originally used to test developmental stress effects on a range of traits. We found that developmental stress not only negatively affects mean trait values, but also increases trait variance, mostly in reproduction, showcasing how meta‐analysis of variance can reveal previously overlooked effects. Furthermore, we show how meta‐analysis of variance can be used as a tool to help meta‐analysts make informed methodological decisions, even when the primary focus is on mean effects. We provide all data and comprehensive R scripts with detailed explanations to make it easier for researchers to conduct this type of analysis. We encourage meta‐analysts in all disciplines to move beyond the world of means and start unravelling secrets of the world of variance.
Bleaching of severely darkened nonvital tooth case report—48 months clinical control
Authors: Machado Alana C. , Braga Sheila R. M. , Ferreira Daniele , Jacintho Felipe F. , Scaramucci Tais , Sobral Maria Angela P.
Published: June 2020

Objective

To record in detail, the long‐term success of a bleaching treatment employing hydrogen peroxide in a severely darkened tooth.

Clinical considerations

Tooth discoloration is an important aesthetic complain of patients. Because it is a relatively common condition, different materials and techniques capable of restoring the tooth color in a minimally invasive, conservative, and longstanding manner were developed. In this case, it was used the association between mediate (walking bleach) and immediate (internal/external) bleaching techniques using hydrogen peroxide as the main agent.

Conclusion

The association of techniques was a conservative therapeutic solution to restore the natural color of the right upper central incisor, which was darkened after an endodontic treatment performed more than twenty years ago. The bleaching protocol used presented no risk to the patient, such as cervical resorption and the color was stable over a 48 months period, showing the success of the protocol proposed for this case.

Clinical significance

There is a possibility to severely darkened teeth receive an adequate bleaching treatment protocol, which can successfully restore the aesthetics and natural color in a conservative and long lasting way.
Prophylactic clipping not effective in preventing post‐polypectomy bleeding for < 20‐mm colon polyps: A multicenter, open‐label, randomized controlled trial
Authors: Inoue Takuya , Ishihara Ryu , Nishida Tsutomu , Akasaka Tomofumi , Hayashi Yoshito , Nakamatsu Dai , Ogiyama Hideharu , Yamaguchi Shinjiro , Yamamoto Katsumi , Mukai Akira , Kinoshita Kazuo , Yakushijin Takayuki , Iijima Hideki , Takehara Tetsuo
Published: June 2020

Background and Aim

Prophylactic clipping (PC) after polypectomy has the potential to prevent post‐polypectomy bleeding (PPB). We aimed to evaluate the effectiveness of PC in preventing PPB for < 20‐mm polyps.

Methods

This multicenter, open‐label, randomized controlled trial conducted from December 2013 to June 2017 at 10 institutions randomly assigned 1080 patients with < 20‐mm colon polyps to the non‐PC and PC groups. Allocation factors were institution, antiplatelet drug use, and polyp number. The primary endpoint was differences in PPB rates between the groups. The severity of PPB and post‐procedural abdominal symptoms were also investigated. These endpoints in intention‐to‐treat and per‐protocol (PP) analyses were evaluated.

Results

We investigated 1039 patients with 2960 lesions. There was no significant difference between the groups in characteristics including age, sex, hypertension, diabetes, hyperlipidemia, antiplatelet drug use, and lesion characteristics such as type and size. Excluding the clip used in the non‐PC group, intraoperative bleeding, and deviation of protocol, 903 patients were investigated in PP analysis. There was no significant difference in the PPB rate between the non‐PC and PC groups (2.7% vs 2.3%, P = 0.6973 [intention‐to‐treat analysis]; 3.0 vs 2.4%, P = 0.7353 [PP analysis]). Severe PPB (≥ grade 3) was similar between the groups. Total procedure time was significantly shorter in the non‐PC group than in the PC group (31 vs 36 min, P = 0.0002). Post‐procedural abdominal fullness was less common in the non‐PC group than in the PC group (20.8% vs 25.6%, P = 0.0833).

Conclusion

Prophylactic clipping is not effective in preventing PBB for < 20‐mm colon polyps (UMIN000012163).
Validation of the Italian version of the Charcot‐Marie‐Tooth Health Index
Authors: Pisciotta Chiara , Ciafaloni Emma , Zuccarino Riccardo , Calabrese Daniela , Saveri Paola , Fenu Silvia , Tramacere Irene , Genovese Filippo , Dilek Nuran , Johnson Nicholas E. , Heatwole Chad , Herrmann David N. , Pareyson Davide ,   ACT‐CMT Study Group
Published: June 2020

The Charcot‐Marie‐Tooth Health Index (CMT‐HI) is a disease‐specific patient‐reported outcome measure measuring overall disease burden in Charcot‐Marie‐Tooth (CMT) patients, designed for natural history studies and clinical trials in English‐speaking affected individuals. We developed and validated its Italian Charcot‐Marie‐Tooth Health Index (I‐CMT‐HI) version. The questionnaire was translated and culturally adapted from source into Italian by two neurologists experienced in CMT and neuromuscular disorders (NMDs). The two translations were reviewed by a panel of seven experts in CMT and NMD. The provisional version was back‐translated into English by a professional translator. The definitive Italian version was developed during a consensus teleconference by the panel and a patient representative from ACMT‐Rete. A series of clinically and genetically characterized CMT patients completed the final questionnaire; 11 participated in a test‐retest reliability assessment of the instrument. The I‐CMT‐HI was administered to 30 CMT patients (13 CMT1A, eight CMTX1, two CMT1B, two CMT1E, two CMT2I, one CMT2A, one CMT2N, one distal Hereditary Motor Neuropathy), with test‐rest in 11:14 females and 16 males, aged (mean ± SD) 48.0 ± 16.4 years (range 18‐81), with CMT Examination Score (CMTES) = 10.0 ± 4.4 (range 2‐18). The I‐CMT‐HI mean total score was 29.4 ± 21.2 (range 0.1‐60.3). The I‐CMT‐HI showed a high test‐retest reliability: intraclass correlation coefficient = 0.95 (95% confidence interval, 0.84‐0.99). No patient had difficulty in completing the questionnaire and none reported any problem with the questions' formulation. The total CMT‐HI score was positively correlated with age and CMTES, with higher disease burden with increasing age and disease severity according to the CMTES. The I‐CMT‐HI is now ready for use in clinical studies in the Italian population.