bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment Foster Care Oregon for Delinquent Adolescents: A Systematic Review and Meta-Analysis
Authors: Åström Therese , Bergström Martin , Håkansson Kickan , Jonsson Ann Kristine , Munthe Christian , Wirtberg Ingegerd , Wiss Johanna , Sundell Knut
Published: December 2019

Purpose:

To examine the effects of Treatment Foster Care on youth with serious behavior problems.

Method:

Included studies are controlled trials with high or medium quality, published between 1990 and September 2017. The control group consists of youth with serious behavior problems in group care, and the follow-up time was at least 12 months. The review also examines ethical and economic aspects.

Results:

A total of eight controlled studies were included, consisting of 633 young people and 55 effect sizes. All studies examined the same model, Treatment Foster Care Oregon (TFCO). There is moderate certainty of evidence that TFCO reduces the risk of future criminal behavior and the number of days in locked settings. Furthermore, there is low certainty of evidence that TFCO reduces the risk of delinquent peer associations, drug use, and depression.

Discussion:

TFCO is to be preferred to group care for youth with serious behavior problems. Ethical and economic implications are discussed.
Parent–Child Relationship Satisfaction: The Influence of Family Communication Orientations and Relational Maintenance Behaviors
Authors: Aloia Lindsey S.
Published: December 2019

This study examined emerging adults’ satisfaction with parent–child relationships as a function of family communication orientations and relational maintenance behaviors. Two hundred and eleven emerging adults completed measures assessing family communication orientations (conversation and conformity), relational maintenance behaviors (shared tasks, shared networks, positivity, openness, and assurances), and satisfaction with parent–child relationships. Results demonstrated that family conversation orientation and relational maintenance behaviors were positively associated with relationship satisfaction; family conformity orientation was not related to relationship satisfaction. Furthermore, findings indicated support for a model in which positivity and openness mediated the association between family conversation orientation and children’s satisfaction with parent–child relationships.
Diagnostic Utility of BCOR Antibody in Clear Cell Sarcomas of Kidney
Authors: Khan Muhammad Zeeshan , Akhtar Noreen , Hassan Usman , Mushtaq Sajid
Published: December 2019

Purpose. Clear cell sarcoma of the kidney (CCSK) is an uncommon malignant renal tumor. It is the second most common renal pediatric renal malignancy after Wilms tumor. It exhibits a heterogeneous morphology, with overlapping features with its close differentials, which results in diagnostic challenges. There was no specific immunohistochemical marker in the past, to help in this regard. BCOR antibody has recently been suggested to be helpful in the differential diagnosis. We aim to study the utility of the BCOR antibody in the diagnosis of CCSK. Methods. We selected a total of 27 cases of CCSK (n = 12), Wilms tumor (n = 12), and congenital mesoblastic nephroma (n = 3). All cases were evaluated for the extent and intensity of nuclear labeling for BCOR antibody by immunohistochemistry (IHC). Results. We found that BCOR IHC was positive in 11 out of 12 cases with diffuse and strong staining in 8 of the cases. None of the cases of Wilms tumor and congenital mesoblastic nephroma were positive. Only 2 cases of Wilms tumor showed minimal and weak staining in <5% of cells. Conclusion. Diffuse and strong nuclear staining for the BCOR antibody is highly specific for CCSK among common pediatric renal malignancies. Our study confirms that BCOR IHC is a good IHC marker for the diagnosis of CCSK.
Coagulation Factor Xa (Recombinant), Inactivated-Zhzo (Andexanet Alfa) Hemostatic Outcomes and Thrombotic Event Incidence at an Academic Medical Center
Authors: Stevens Victoria M. , Trujillo Toby , Mueller Scott W. , MacLaren Robert , Reynolds Paul M. , Kiser Tyree H.
Published: December 2019

Andexanet alfa is approved for the reversal of factor Xa inhibitors in patients with major bleeding events. We aimed to review the incidence of effective hemostasis with andexanet alfa in a real-world environment. This retrospective cohort included patients hospitalized for a major bleed that resulted in andexanet alfa administration. The primary outcome was effective hemostasis at 12 hours after andexanet alfa treatment. Thromboembolic events and mortality within 30 days were also assessed. Over a 14-month period, 13 patients received andexanet alfa with a mean age of 69 ± 10 years, 54% male, 69% exposed to apixaban (31% rivaroxaban), and had intracranial (46%) and nonintracranial (54%) bleeding sites. Effective hemostasis was observed in 10 (77%) patients. Four (31%) patients experienced 5 thromboembolic events with a median time to event of 6.5 days (range: 0.5-29). Four thrombotic events occurred during the period in which anticoagulation (prophylaxis or therapeutic) was not restarted. Mortality rate was 15%. Andexanet alfa was effective in obtaining hemostasis in a majority of patients. However, the incidence of thromboembolic events was high and may be attributed to a delay in restarting anticoagulation.
1-Methylcyclopropene maintains postharvest quality in Norwegian apple fruit
Authors: Falagán N , Terry LA
Published: December 2019

Norwegian fruit production is mostly destined for the local market and can suffer from poor-quality retention during storage. 1-Methylcyclopropene (1-MCP) is an inhibitor of ethylene perception used to maintain the physical and functional quality of pome fruit. Extensive work has been carried out on the effect of 1-MCP on apples, but not on cultivars grown in Norway. In this work, the potential of 1-MCP application (0.625 ml l −1 for 24 h at 0 ± 1℃) for ripening control of the apple cultivars ‘Aroma’, ‘Red Gravenstein’, and ‘Summered’ was studied during 1 and 1.5 months of cold storage; both scenarios were followed by five days of shelf life. The application of 1-MCP reduced softening by an average of 12% in ‘Aroma’, ‘Red Gravenstein’, and ‘Summered’ apples when cold stored for both 1 and 1.5 months as compared to control. External colour remained similar to initial values in 1-MCP fruit when compared to control apples, which presented a significant skin darkening. This indicated a delay in the ripening process. 1-MCP treatment did not affect total soluble solids content. ‘Aroma’ samples treated with 1-MCP showed a low sucrose hydrolysis, indicating a slower ripening process. This work confirms that 1-MCP postharvest treatment shows great potential for maintenance of apple cvs. in Norway during cold storage and shelf life.
Pricing Metrics and the Importance of Minimum and Billing Increments
Authors: Skiera Bernd , Schlereth Christian , Oetzel Sebastian
Published: December 2019

Service providers often use minimum increments and billing increments to charge for higher usage than customers’ true usage. Despite their popularity in business practice, research has largely ignored these increments and assumed that charged usage always equals true usage. We develop an overcharging index that represents the extent to which a customer is charged for units that she or he did not use and identify situations in which the overcharging index is particularly high. In three empirical studies in the highly competitive telecommunication market, we demonstrate that providers are increasingly using longer minimum and billing increments. These increments yield an average overcharge of true usage of 43.79% for customers with long increments. These increments generate additional revenues that are responsible for almost two thirds (66.2%) of the operating profits of the main providers in Germany and the United States. Customers, particularly those who are less educated, seem to not understand minimum and billing increments well, do not adjust their behavior to different increments, and often make tariff choice errors unsystematically.
Prdx6 is required to protect human corneal epithelial cells against ultraviolet B injury
Authors: Yu Huajun , Yu Yonghong , Zhao Zhenjun , Cui Longbo , Hou Jianhai , Shi Hui
Published: December 2019

Background:

The protective role of Prdx6 on rat corneal tissue against ultraviolet B injury in vivo has been confirmed previously. We further investigated the function and molecular mechanism of Prdx6 in human corneal epithelial cells under ultraviolet B radiation.

Methods:

The experimental groups were designed as follows: (1) Prdx6 RNAi, (2) Prdx6 RNAi + ultraviolet B radiation, (3) normal human corneal epithelial cells, (4) normal human corneal epithelial cells + ultraviolet B radiation, (5) wild-type Prdx6 overexpression, (6) wild-type Prdx6 overexpression + ultraviolet B radiation, (7) mutant-type Prdx6 overexpression, and (8) mutant-type Prdx6 overexpression + ultraviolet B radiation. The cell survival rate was detected by a Thiazolyl Blue Tetrazolium Bromide assay. Apoptosis, reactive oxygen species, and malondialdehyde were detected with a commercial kit. Gene expression was detected by real-time polymerase chain reaction.

Results:

We found the following results. (1) Compared to normal cells, the survival rates were 32%, 87%, and 58% under ultraviolet B radiation in the Prdx6 interference, wild-type overexpression, and mutant-type overexpression groups, respectively. The survival rates were decreased to 50% at 24 h and 31% at 48 h when the phospholipase A2 activity of Prdx6 was inhibited after ultraviolet B radiation. (2) Apoptosis, reactive oxygen species content, and malondialdehyde levels were increased when Prdx6 was downregulated. This phenomenon became more severe under ultraviolet B radiation. (3) The expression levels of apoptosis-related and antioxidant genes all changed along with the changes in expression of Prdx6.

Conclusion:

(1) Both peroxidase and phospholipase A2 activities of Prdx6 are crucial for its protective role in corneal tissue. (2) Downregulated expression of Prdx6 resulted in high endoplasmic reticulum stress. (3) Apoptosis in human corneal epithelial cells with downregulated Prdx6 coupled with ultraviolet B radiation was related to the pathways of DNA damage and the death receptor. (4) Low levels of antioxidants are sufficient for maintaining homeostasis in human corneal epithelial cells without external stimuli. Under the condition that Prdx6 was downregulated, human corneal epithelial cells were more sensitive to ultraviolet B radiation.
Outcome after osteochondroplasty and relative neck lengthening for patients with healed Legg-Calvé-Perthes disease: a retrospective cohort study of patients with hip-deformities treated with osteochondroplasty and relative neck lengthening
Authors: Risto Olof , Sandquist Sofia , Lind Stefan , Madan Sanjeev
Published: December 2019

Aims:

Our main objectives were to evaluate the effect of surgery using self-assessed health scores. Secondary objectives were to correlate outcome with grade of deformity (Stulberg classification I–V) or age at surgery and whether additional periacetabular osteotomy (PAO) is beneficial for patients with concurrent acetabular dysplasia.

Methods:

This was a retrospective cohort and in part a cross sectional study using a planned clinical and radiological follow-up of patients. All patients with healed Legg-Calvé-Perthes disease (LCPD) treated with osteochondroplasty and relative neck lengthening using surgical hip dislocation, with or without periacetabular osteotomy (PAO) were included. A total of 39 patients were identified and invited to participate (29 males and 10 females) of which 32 accepted. Radiographic assessment and Stulberg classification were obtained. The Nonarthritic Hip Score (NAHS), modified Harris Hip Score (mHHS) and the VAS scale of EQ-5D-5L were used.

Results:

The majority of the patients experienced improvement (74%, n = 27) and 21 patients (78%, n = 27) found the surgery worthwhile. Preoperative Stulberg II and III patients (83% improvement) showed better results than Stulberg IV and V patients (56% improvement) ( n = 27, p = 0.121). There was significantly better patient-satisfaction for those younger than 29 years of age (⩽18 years old (92%), 19–28 years old (89%), ⩾29 years old (67%), x2(2) = 8512, n = 27, p = 0.022) and a negative correlation for age at onset of LCPD and mHHS ( r = –0.420, p = 0.046, n = 23). Patients with concurrent acetabular dysplasia ( n = 19), 82% (9 of 11) improved after additional PAO compared to 63% (5 of 8) who were not operated on with PAO.

Conclusion:

This procedure is worthwhile in selected cases except for severe deformity (Stulberg IV and V) and patients >28 years of age.
Clindamycin-Induced Esophageal Injury: Is It an Underdiagnosed Entity?
Authors: Bestari Muhammad Begawan , Agustanti Nenny , Abdurachman Siti Aminah
Published: December 2019

There are increased reports of pill-induced esophagitis in the past 2 decades, with almost 100 different substances identified as the cause for more than 700 cases, and the overall incidence is estimated to be 0.004% per year. Antibiotics are one of the major contributors for these cases, especially tetracycline and doxycycline; other major contributors are bisphosphonates, nonsteroidal anti-inflammatory drugs, and iron pills. Clindamycin is commonly prescribed by physicians, yet side effect in the form of esophagitis is uncommon and mostly documented in case report. It is possible that these cases are mostly unnoticed due to initial consideration of common and more serious problems. Thus, patients may be assumed to be having a severe episode of acid reflux, and it is not routinely reported or recognized. In this case series, we presented 8 patients with clindamycin-induced esophagitis. The initial presentation of all patients was odynophagia, which appeared within the first day of taking the antibiotic. All patients were subjected to endoscopic examination and ulcer was found in all cases, in the form of localized solitary or multiple ulcers with sharply defined borders. Patients were treated with proton pump inhibitor and sucralfate, and the symptoms subside within 1 week. Patient education regarding the proper way of ingesting drug seems to be the key factor in the prevention of pill-induced esophagitis. The prevention of esophagitis is even more important with antibiotics as adverse effect would decrease the patient compliance in completing the regimen and would ultimately increase antibiotic resistance.
Failed transcatheter pulmonary artery embolization in a patient suffering from massive hemoptysis after thoracic endovascular aortic repair
Authors: Ishikawa Natsuya , Kikuchi Shinsuke , Ishidou Kouhei , Hirofuji Aina , Nakanishi Sentaro , Ise Hayato , Wakabayashi Naohiro , Kamiya Hiroyuki
Published: December 2019

An emergency thoracic endovascular aortic repair (TEVAR) with zone 2 landing without revascularization of the left subclavian artery was performed due to the impending rupture of a distal arch aneurysm in an old patient presenting hemoptysis. Two months later, the patient had recurrent massive hemoptyses and continued after additional zone 0 TEVAR. The lung parenchyma was considered to be the bleeding source and transcatheter pulmonary artery embolization was performed, and the episodes of massive hemoptysis appeared to have ceased. However, the patient died of sudden recurrent massive hemoptysis 40 days later. Inflammation and/or infection of the lung parenchyma adjunct to the aortic aneurysm could be cause of fatal hemoptysis, and aggressive therapy such as lung resection should be considered in such patients.
Invisible Belfast: Flat ontologies and remediation of the post-conflict city
Authors: Barrios-O’Neill Danielle , Hook Alan
Published: December 2019

[in]visible belfast was a research-driven indie alternate reality game (ARG) that ran for 6 weeks during the spring of 2011 in Belfast and was subsequently adapted, 5 years later into a fictional documentary for BBC Radio 4. The ARG is a participatory and dispersed narrative, which the audience play through. The text expands outward across both physical and digital platforms to create a mystery for the players using everyday platforms. The ARG is a product of media convergence and at its heart transmedial, defined by its complexity and modes of participation. The fictional radio documentary which remediated the ARG into a more simple linear structure, but possibly a more complex narrative form, retells parts of the story for new audiences. The premise of [in]visible belfast – the game and later the documentary – is itself an adaptation of writer Ciaran Carson’s novel The Star Factory (1997): a postmodern adventure through the complex psychogeography of Belfast. A trail through the labyrinthine text, which paints the history of Belfast in poetic prose. This article will map the concept’s journey from novel to game to radio, contextualising its development within its political and urban landscape and charting the remediation of the narratives as they fold out across multiple media and complex story arches. The article will draw together ideas from previous publications on ARG, transmediality and complex textualities from the authors and reflect on the textual trajectories that the remediation of the narrative has taken from the original book, through the ARG, into the radio documentary. Building upon recent approaches from environmental philosopher Tim Morton and games theorist Ian Bogost, the authors argue that Belfast’s history propels medial adaptations of a particular kind, characterised by a ‘flat’ ontology of space and time and a sort of diffuse and dark urban experience for designers/producers and players/listeners.
Theorizing rightist anti-consumption
Authors: Cambefort Marine , Pecot Fabien
Published: December 2019

Although a large number of conceptual and empirical works on anti-consumption can be found in the marketing literature, the majority of these studies describe progressive reasons against consumption and pay little attention to rightist arguments. Building on multidisciplinary literatures, this article identifies three rightist ideological groups that are likely to engage in anti-consumption: moderate conservatives, the radical right and welfare chauvinists. We theorize rightist anti-consumption in relation to three tensions (global–national, novel–traditional, individual–communitarian), discuss the implications for marketing theory and identify possible avenues for further research. Consumer research should investigate political ideology as a dimension of anti-consumption, with particular attention paid to rightist reasons against consumption.
Accessible design and dementia: A neglected space in the equality debate
Authors: Houston Agnes , Mitchell Wendy , Ryan Kathy , Hullah Nigel , Hitchmough Paul , Dunne Tommy , Dunne Joyce , Edwards Bethan , Marshall Mary , Christie Julie , Cunningham Colm
Published: December 2019

This paper addresses the issue of accessible design in the context of dementia. It is not difficult to design buildings and outside spaces for people with dementia but you do have to follow clear design principles and values. However, unlike other disabilities, accessible dementia design is still viewed as an added extra and not a vital component of facilitating citizenship. In 2015, the World Health Organisation published guidance on human rights and dementia. People living with dementia are frequently denied their human rights even when regulations are in place to uphold them. This paper will focus on accessible design from a human rights perspective using the PANEL principles. PANEL stands for Participation, Accountability, Non-Discrimination and Equality, Empowerment and Legality. We will then conclude with recommendations for policy, practice and research to ensure that accessible design for people living with dementia does not continue to be a neglected space in the equality debate.
Improving hysteresis of a typical carbon black-filled natural rubber tread compound by using a novel coupling agent
Authors: Chowdhury Soumya Ghosh , Pal Koushik , Satpathi Hirak , Bandyopadhyay Abhijit , Mukhopadhyay Rabindra , Bhattacharyya Sanjay K.
Published: December 2019

Potential of Sumilink-200 was investigated in a typical natural rubber-based tread compound in connection with its ability to act as a coupling agent for carbon black to reduce hysteresis loss of the compound. Optimum physical properties were obtained at 2 phr loading of Sumilink-200. At this loading, tensile modulus at 300% elongation improved by 9.6% with a reduction in visco-elastic energy dissipation (loss tangent) at 60°C by 8.3% over the control compound. The abrasion resistance properties of the compounds found to remain unaffected with the introduction of Sumilink-200.
How Do Reverse-keyed Items in Inventories Affect Measurement Quality and Information Processing?
Authors: Menold Natalja
Published: December 2019

In randomized experiments, inventories with reverse-keyed items are compared with inventories in which all the items are either positively or negatively associated with the underlying concept. The results show that with reverse keying, a control of the potential bias was not sufficient; likewise, the factorial structure, reliability, and validity were negatively affected. An eye-tracking study revealed that respondents did not process information more deeply with the reverse-keyed items than with the other forms. Respondents seemed to find it difficult to process reverse keying mentally so that it is not sufficient to use it in heterogeneous samples and with short inventories.
Practice Issues for Evaluation and Management of the Suicidal Left Ventricular Assist Device Patient
Authors: Chernyak Yelena , Teh Lisa , Henderson Danielle R. , Patel Anahli
Published: December 2019

There is a high prevalence of depression among left ventricular assist device patients, who present with an increased risk of suicidality given access to means via the device either with nonadherence or disconnection. Suicidality via device nonadherence/disconnection is an underresearched clinical issue, as paradoxically this life-saving procedure can also provide a method of lethal means to patients with significant mental health concerns. A case study is used to highlight the course of an attempted suicide by ventricular assistive device nonadherence. Clinical implications and recommendations for practice include a thorough psychological evaluation presurgery, monitoring quality of life and coping styles before and after placement, psychological testing, outlining specific suicide protocols, psychiatric care considerations for patients with highly specialized medical devices, and related ethical concerns.
An Overview of Systematic Reviews: Complementary Therapies for Cancer Patients
Authors: Lee Seong Min , Choi Ho Cheol , Hyun Min Kyung
Published: December 2019

Introduction: This article critically examines the systematic reviews (SR) and meta-analysis (MA) of complementary therapies for cancer patients to appraise the evidence level, and offers suggestions for future research and practice. Methods: The Cochrane Library and MEDLINE were searched from their inception to January 2018, to identify SR and MA of complementary therapies available for cancer patients. Final selected SR and MA were methodologically evaluated for their quality by applying the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR2) instrument. Data extraction and risk of quality assessments were performed by 2 independent reviewers. Results: A total of 104 studies were included in the analysis. The majority of the individual clinical trials included in the SR and MA were performed in China (48%) and the United States (26.9%). Breast cancer was the most studied cancer type (25%), and acupuncture was the most studied intervention (21%). Side effects of cancer such as pain, depression, and fatigue were effectively managed with complementary therapies. The methodologically problematic items included not listing the excluded studies and lack of protocol or protocol registration. Conclusions: With increasing interest in research, complementary therapies appear to be beneficial in reducing side effects and raising the quality of life of cancer patients. Complementary therapies have generally been studied for all cancers, with acupuncture being the most researched, regardless of the cancer type. Since AMSTAR2 is a stricter assessment tool than before, future studies need to consider the risk of methodological bias with caution and discuss appropriate overall quality assessment tools.
Students With the Most Significant Disabilities, Communicative Competence, and the Full Extent of Their Exclusion
Authors: Kleinert Harold L.
Published: December 2019

In this brief response to Agran et al., I provide data on the extent to which students with the most significant cognitive disabilities (i.e., those students participating in alternate assessments on alternate achievement standards) are separated educationally from their peers without disabilities. I further discuss additional factors that may be contributing to separate placements for students with the most significant disabilities. Finally, I provide some promising resources that may help to address these persistent issues.
The Theta/Beta Ratio as an Index of Cognitive Processing in Adults With the Combined Type of Attention Deficit Hyperactivity Disorder
Authors: Picken Christie , Clarke Adam R. , Barry Robert J. , McCarthy Rory , Selikowitz Mark
Published: December 2019

An elevated theta/beta ratio in the EEG has long been observed among individuals with Attention Deficit Hyperactivity Disorder (ADHD). The theta/beta ratio was previously hypothesised to be an index of arousal, but a number of studies failed to find any association between the ratio and indices of arousal, instead proposing that the theta/beta ratio may actually be indicative of cognitive processing. This hypothesis was tested by Clarke et al using a sample of healthy adults, with results indicating that the theta/beta ratio correlated with a marker of cognitive processing (P300 latency in an auditory oddball task), while P300 amplitude correlated with an arousal marker (alpha power). The aim of this study was to test whether similar results could be found in a sample of 41 adults with the combined type of ADHD. EEGs were recorded during an eyes-closed resting condition and an auditory oddball task. Results demonstrated that the theta/beta ratio correlated significantly with P300 latency. Absolute alpha power did not correlate significantly with P300 amplitude or P300 latency. These results support the hypotheses that the theta/beta ratio is a marker of cognitive processing capacity in both the general population and in participants with ADHD, and that the alpha/arousal linkage is anomalous in ADHD.
Surveillance After Treatment of Non-Small-Cell Lung Cancer: A Call for Multidisciplinary Standardization
Authors: Mitchell Kyle G. , Nelson David B. , Corsini Erin M. , Correa Arlene M. , Erasmus Jeremy J. , Hofstetter Wayne L. , Mehran Reza J. , Roth Jack A. , Swisher Stephen G. , Sepesi Boris , Walsh Garrett L. , Vaporciyan Ara A. , Rice David C. , Nguyen Quynh-Nhu , Antonoff Mara B.
Published: December 2019

Objective

Though interest in expansion of the use of less-invasive therapies among operable non-small-cell lung cancer (NSCLC) patients is growing, it is not clear that post-treatment surveillance has been comparable between treatment modalities. We sought to characterize institutional surveillance patterns after NSCLC therapy with stereotactic body radiation therapy (SBRT) and lobectomy.

Methods

NSCLC patients treated with lobectomy or SBRT (2005 to 2016) at a single institution were identified. Natural language processing searched data fields within axial surveillance imaging reports for findings suggestive of recurrence. Duration and patterns of institutional surveillance were compared between the 2 groups.

Results

Three thousand forty-two patients (73.5% lobectomy, 26.5% SBRT) met inclusion criteria. Patients had a longer median duration of surveillance after lobectomy (28.0 months vs SBRT 12.3 months, P < 0.001) and were more likely to undergo histopathological evaluation of clinically suspected relapse (206/274 [75.2%] vs SBRT 54/113 [47.8%], P < 0.001). Patients with clinical suspicion of recurrence had longer durations of institutional surveillance than those who did not among both cohorts (lobectomy 44.4 months vs 25.9, P < 0.001; SBRT 27.9 vs 10.3, P < 0.001). Landmark analyses at 1 and 3 years after therapy identified associations between receipt of lobectomy and ongoing surveillance at each time point (1 year odds ratio [OR] 2.10, P < 0.001; 3 years OR 1.71, P < 0.001) among all patients and those with documented stage I disease.

Conclusions

We identified potential heterogeneity in institutional surveillance patterns after treatment of NSCLC with 2 therapeutic modalities. As less-invasive treatment options for operable patients expand, it will be critical to implement rigorous surveillance paradigms across all modalities.
Application of Cerebral Protection System in Open Mitral Replacement with Extensive Calcified Left Atrial Thrombus
Authors: Ho Jacky Y.K. , Chan Joyce W.Y. , Chow Simon C.Y. , Yu Peter S.Y. , Kwok Micky W.T. , Cheung Gary S.H. , Wong Randolph H.L.
Published: December 2019

Neurological complications remain a major burden in cardiac surgery, despite various intraoperative measures attempting to reduce its occurrence. Advancement of percutaneous approach in valve replacement has brought focus to the use of cerebral protection system (CPS). We reported a novel application of percutaneous CPS in open heart surgery for a patient with an extensive calcified left atrial thrombus to reduce risk of embolic stroke. Although, there is no evidence to advocate routine use of CPS in all open cardiac surgical patients, we believe it is a technically feasible and probably safe approach for neurological protection in high-risk patients.
Teaching academic skills to students with significant intellectual disabilities: A systematic review of the single-case design literature
Authors: Cannella-Malone Helen I , Dueker Scott A , Barczak Mary A , Brock Matthew E
Published: December 2019

Students with significant intellectual and developmental disabilities deserve access to instruction on academic skills in addition to functional skills. Many teachers, however, report challenges with identifying appropriate evidence-based practices to teach academics to these students. The purpose of this systematic review was to summarize and analyze literature on academic instruction for students with significant disabilities. Two hundred twenty-two articles with 225 experiments utilizing a single-case design and published between 1976 and 2018 were included in the review. Visual analysis indicated that, in most cases, interventions enabled students to make progress on targeted academic skills. The majority of studies focused on basic reading skills and included participants with moderate disabilities. Most studies used a combination of three or four evidence-based practices, with modeling, prompting, visual supports, time delay, and reinforcement being the most frequently used combination across studies.
Is Opposition to Genetically Modified Food “Morally Absolutist”? A Consequence-Based Perspective
Authors: Royzman Edward B. , Cusimano Corey , Metas Stephen , Leeman Robert F.
Published: December 2019

Genetically modified foods (GMFs) have met with strong opposition for most of their existence. According to one account—the consequence-based perspective (CP)—lay people oppose GMFs because they deem them unsafe as well as of dubious value. The CP is backed by the data and offers a clear solution for easing GMF opposition. However, several scholars have claimed that the CP is faulty, that lay opposition derives from largely nonrational factors and is consequence blind. One recent statement of this, the moral-absolutism perspective (MAP), contends that GMFs’ opponents are principled “moral absolutists” who think that GMFs should be banned no matter their value or risk. Herein we critically weigh key arguments for this proposal. We also present five new studies that probed the clearest data that seem to favor the MAP—opponents affirming the statement that GMFs should be “prohibited,” no matter their value or risk. These studies jointly show that (a) most presumed absolutists do not understand the key question and/or (b) cannot validly answer it. We show that taking due steps in clarifying the question and screening for those participants who cannot validly answer it cuts down absolutism to near zero. Finally, we demonstrate that helping GMFs’ opponents imagine a world wherein GMFs are safe and constructive makes the majority willing to welcome GMFs in this context.
“Do It Yourself” (DIY)—Automated Insulin Delivery (AID) Systems: Current Status From a German Point of View
Authors: Heinemann Lutz , Lange Karin
Published: December 2019

A group of dedicated people with a high affinity for technology and good understanding of how to treat their type 1 diabetes have developed systems that enable automated insulin delivery (AID). These persons build these AID systems only for themselves (do it yourself [DIY]) and the quality of glucose control achieved with DIY AID systems is impressively good. This overview presents the current status of this development from a German point of view. A high degree of efforts is required to start and maintain this type of therapy and the user must always remain aware of what she/he is doing in everyday life. One main obstacle is liability, because the medicinal products used by persons with diabetes for DIY AID systems are not approved for this indication. They must be regarded as experimental systems. As long as persons with diabetes build and use these systems for themselves and not for other people, they act at their own risk. If a person with diabetes expresses interest in such a system or is already using it, the diabetologist should inform him about the improper use of the medical devices and about the associated risks. The physician should document this information accordingly.
Relationship between Anatomical Risk Factors, Articular Cartilage Lesions, and Patient Outcomes Following Medial Patellofemoral Ligament Reconstruction
Authors: Holliday Charles L. , Hiemstra Laurie A. , Kerslake Sarah , Grant John A.
Published: December 2019

Objective

The purpose of this study was (1) to determine which risk factors for patellar instability were associated with the presence of patellofemoral cartilage lesions and (2) to determine how cartilage lesion presence, size, and grade affect postoperative disease-specific quality of life.

Design

Preoperative, intraoperative, and postoperative demographic, anthropometric (body mass index, Beighton score, hip rotation), radiographic (crossover sign, trochlear bump), cartilage lesion morphology (presence, size, location, grade), and outcomes data (Banff Patella Instability Instrument 2.0 [BPII 2.0]) were prospectively collected from patients undergoing isolated medial patellofemoral ligament reconstruction. For all knees ( n = 264), single and multivariable logistic regression was used to determine if any patellar instability risk factors affected the odds of having a cartilage lesion. In patients with unilateral symptoms ( n = 121), single variable linear regression was used to determine if the presence, size, or ICRS (International Cartilage Regeneration & Joint Preservation Society) grade of cartilage lesions could predict the 12 or 24+ month postoperative BPII 2.0 score.

Results

A total of 84.5% of knees had patellofemoral cartilage lesions (88.3% involved the distal-medial patella). Trochlear dysplasia (high grade: odds ratio = 15.7, P < 0.001; low grade: odds ratio = 2.9, P = 0.015) was associated with the presence of a cartilage lesion. The presence, size, and grade of cartilage lesions were not associated with 12 or 24+ month postoperative BPII 2.0 scores.

Conclusions

Trochlear dysplasia was a risk factor for the development of patellofemoral cartilage lesions in this patient population. Cartilage lesions most commonly involve the distal-medial patella. There was no significant relationship between patellofemoral cartilage lesion presence, size, or grade and postoperative BPII 2.0 scores in short-term follow-up.
Tocotrienol-rich vitamin E improves diabetic nephropathy and persists 6–9 months after washout: a phase IIa randomized controlled trial
Authors: Tan Gerald Chen Jie , Tan Suzanne May Quinn , Phang Sonia Chew Wen , Ng Yeek Tat , Ng En Yng , Ahmad Badariah , Palamisamy Uma Devi M. , Kadir Khalid Abdul
Published: December 2019

Chronic hyperglycemia in type 2 diabetes mellitus increases oxidative stress and inflammation which contributes to long-term diabetic kidney disease. Tocotrienol-rich vitamin E, as Tocovid, has been shown to reduce oxidative stress and inflammation to ameliorate diabetes in rat models and human subjects. In this prospective, multicenter, double-blinded, placebo-controlled clinical trial, 54 patients (duration = 18.4 years, HbA1c = 8.8%) with diabetic nephropathy were randomized to receive Tocovid 200 mg or placebo for 12 weeks. Fasting blood samples were taken to measure HbA1c, serum creatinine, estimate glomerular filtration rate (eGFR), urine albumin:creatinine ratio, malondialdehyde, tumor necrosis factor receptor-1, vascular cell adhesion molecule-1 (VCAM-1), and thromboxane-B2. Patients were reassessed 6–9 months post-washout. After 12 weeks of supplementation, Tocovid significantly decreased serum creatinine levels (mean difference: –3.3 ± 12.6 versus 5.4 ± 14.2, p = 0.027) and significantly increase eGFR (mean difference: 1.5 ± 7.6 versus –2.9 ± 8.0, p = 0.045) compared with placebo. There were no significant changes in HbA1c, blood pressure, and other parameters. Subgroup analysis revealed that in patients with low serum vitamin E concentrations at baseline, Tocovid reduced serum creatinine, eGFR, and VCAM-1 significantly. After 6–9 months of washout, persistent difference in serum creatinine remained between groups (mean difference: 0.82 ± 8.33 versus 11.26 ± 15.47, p = 0.031), but not eGFR. Tocovid at 400 mg/day significantly improved renal function in 12 weeks of supplementation, as assessed by serum creatinine and eGFR, which remained significant 6–9 months post-washout.
An ecosystem perspective on care coordination: Lessons from the field
Authors: Dessers Ezra , Mohr Bernard J
Published: December 2019

The vast majority of research and efforts towards greater care coordination have taken place at the level of single, sovereign organizations, or at the level of networks formed to address the need for cross-organizational collaboration. The recently emerging ecosystem level of analysis and intervention is still under-researched, with few if any available innovation practices that match the complexity experienced at the level of care ecosystems. Beginning with the challenge of care coordination, we discuss what care ecosystems are and how they can be defined and describe the possibilities and opportunities that come when viewing care coordination through an ecosystem lens. We underpin our plea for an ecosystem approach to health and social care coordination with seven lessons, which we draw from an extensive study of 15 care ecosystem cases from seven different countries. We end the paper with an appeal for further research in this promising field.
Cultivating Innovative Pragmatic Cluster-Randomized Registry Trials Embedded in Hemodialysis Care: Workshop Proceedings From 2018
Authors: Lee Elliot J. , Patel Aakil , Acedillo Rey R. , Bachynski Jovina C. , Barrett Ian , Basile Erika , Battistella Marisa , Benjamin Derek , Berry David , Blake Peter G. , Chan Patricia , Bohm Clara J. , Clemens Kristin K. , Cook Charles , Dember Laura , Dirk Jade S. , Dixon Stephanie , Fowler Elisabeth , Getchell Leah , Gholami Nazanine , Goldstein Cory , Hahn Emma , Hogeterp Betty , Huang Susan , Hughes Michelle , Jardine Meg J. , Kalatharan Shasikara , Kilburn Shane , Lacson Eduardo , Leonard Sean , Liberty Channing , Lindsay Craig , MacRae Jennifer M. , Manns Braden J. , McCallum Janice , McIntyre Christopher W. , Molnar Amber O. , Mustafa Reem A. , Nesrallah Gihad E. , Oliver Matthew J. , Pandes Michael , Pandeya Sanjay , Parmar Malvinder S. , Rabin Elijah Z. , Riley Johnathan , Silver Samuel A. , Sontrop Jessica M. , Sood Manish M. , Suri Rita S. , Tangri Navdeep , Tascona Daniel J. , Thomas Alison , Wald Ron , Walsh Michael , Weijer Charles , Weir Matthew A. , Vorster Hans , Zimmerman Deborah , Garg Amit X.
Published: December 2019

Hemodialysis is a life-sustaining treatment for persons with kidney failure. However, those on hemodialysis still face a poor quality of life and a short life expectancy. High-quality research evidence from large randomized controlled trials is needed to identify interventions that improve the experiences, outcomes, and health care of persons receiving hemodialysis. With the support of the Canadian Institutes of Health Research and its Strategy for Patient-Oriented Research, the Innovative Clinical Trials in Hemodialysis Centers initiative brought together Canadian and international kidney researchers, patients, health care providers, and health administrators to participate in a workshop held in Toronto, Canada, on June 2 and 3, 2018. The workshop served to increase knowledge and awareness about the conduct of innovative, pragmatic, cluster-randomized registry trials embedded into routine hemodialysis care and provided an opportunity to discuss and build support for new trial ideas. The workshop content included structured presentations, facilitated group discussions, and expert panel feedback. Partnerships and promising trial ideas borne out of the workshop will continue to be developed to support the implementation of future large-scale trials.
Emergency Department Femoral Nerve Blocks and 1-Year Mortality in Fragility Hip Fractures
Authors: Polischuk Michael Darren , Kattar Nrusheel , Rajesh Ashwin , Gergis Tony , King Kieran , Sriselvakumar Sajan , Shelfoon Christopher , Lynch Genni , Campbell Kate , Cooke Cameron
Published: December 2019

Objective:

Femoral nerve blocks (FNBs) for fragility hip fractures have benefits in improving pain relief and early mobilization while decreasing opioid use and rates of pneumonia. However, no study has looked at 1-year mortality outcomes for this intervention. This study aims to provide insight into 1-year outcomes.

Methods:

A single-site retrospective case–control study from 2007 to 2016 in primary fragility hip fractures compared 665 patients who received an emergency department FNB to 326 patients who did not receive an FNB. The primary outcome was 1-year mortality. Secondary outcomes included mortality, mobility, and residence at discharge, 6 months, and 1-year intervals.

Results:

There were no significant differences in preoperative characteristics. Although there was no statistically significant difference in 1-year mortality, patients who did not receive an FNB were more likely to be nonambulant at 1 year (odds ratio 1.71, 95% confidence interval, 1.14-2.57, P = .005). There were no other significant differences in mobility, residence, or mortality.

Conclusion:

There was no statistically significant difference in 1-year mortality, although individuals who did not receive an FNB were more likely to be nonambulant at 1 year.
The Management of Symptomatic Lumbar Disc Herniation in Pregnancy: A Systematic Review
Authors: Whiles Emily , Shafafy Roozbeh , Valsamis Epaminondas Markos , Horton Chris , Morassi Giuseppe Lambros , Stokes Oliver , Elsayed Sherief
Published: December 2019

Study Design:

Systematic review.

Objectives:

Lumbar disc herniation (LDH) has been reported to affect 1 in 10 000 pregnant women. There is limited evidence available regarding the optimal management of LDH in pregnant patients. We aimed to review the current evidence for the management of symptomatic LDH in pregnancy through critical appraisal and analysis of the available literature.

Methods:

Searches were conducted in Medline, Embase, PubMed, Science Direct, and The Cochrane Library from inception using predetermined search terms. All peer-reviewed studies of pregnant women with symptomatic LDH were included. The quality of eligible articles was assessed and extracted data and characteristics were pooled for analysis. References cited by studies were screened to identify other relevant publications.

Results:

Thirty studies involving 52 patients were identified. Compared to surgically managed patients, conservatively managed patients had a higher full recovery rate (61.54% vs 56.41%) and reported a lower rate of persistent symptoms (30.77% vs 38.54%). Compared to patients who were treated surgically for cauda equina syndrome, patients treated surgically for sciatica had a higher full recovery rate (80.95% vs 27.78%) and reported a lower rate of persistent symptoms (14.29% vs 66.67%).

Conclusion:

There is limited evidence to guide the management of pregnant patients with LDH. Despite a suggestion toward improved outcomes with conservative management, the presence of selection bias and the overall poor quality of current research precludes reliable conclusions from being drawn. Decision making for this patient group should be undertaken within a multidisciplinary setting.
Development of a Preoperative Adult Spinal Deformity Comorbidity Score That Correlates With Common Quality and Value Metrics: Length of Stay, Major Complications, and Patient-Reported Outcomes
Authors: Sciubba Daniel , Jain Amit , Kebaish Khaled M. , Neuman Brian J. , Daniels Alan H. , Passias Peter G. , Kim Han J. , Protopsaltis Themistocles S. , Scheer Justin K. , Smith Justin S. , Hamilton Kojo , Bess Shay , Klineberg Eric O. , Ames Christopher P. ,   the International Spine Study Group
Published: December 2019

Study Design:

Retrospective review of a multicenter prospective registry.

Objectives:

Our goal was to develop a method to risk-stratify adult spinal deformity (ASD) patients on the basis of their accumulated health deficits. We developed a novel comorbidity score (CS) specific to patients with ASD based on their preoperative health state and investigated whether it was associated with major complications, length of hospital stay (LOS), and self-reported outcomes after ASD surgery.

Methods:

We identified 273 operatively treated ASD patients with 2-year follow-up. We assessed associations between major complications and age, comorbidities, Charlson Comorbidity Index score, and Oswestry Disability Index score. Significant factors were used to construct the ASD-CS. Associations of ASD-CS with major complications, LOS, and patient-reported outcomes were analyzed.

Results:

Major complications increased significantly with ASD-CS ( P < .01). Compared with patients with ASD-CS of 0, the odds of major complications were 2.8-fold higher ( P = .068) in patients with ASD-CS of 1 through 3; 4.5-fold higher ( P < .01) in patients with ASD-CS of 4 through 6; and 7.5-fold higher ( P < .01) in patients with ASD-CS of 7 or 8. Patients with ASD-CS of 7 or 8 had the longest mean LOS (10.7 days) and worst mean Scoliosis Research Society–22r total score at baseline; however, they experienced the greatest mean improvement (0.98 points) over 2 years.

Conclusions:

The ASD-CS is significantly associated with major complications, LOS, and patient-reported outcomes in operatively treated ASD patients.