bluuebunny/crossref_metadata_2025 huggingface dataset:
Dysmorphic Neurofilament-Positive Ganglion Cells in the Myenteric Plexus at the Proximal Resection Margin Indicate Worse Postoperative Prognosis in Hirschsprung’s Disease
Authors: Zhu Jin , Zhang Ying , Wang Yi , Yu Shanshan , Chen Yanling , Guo Zhenghua , Zhao Yong
Published: October 2019

Background

Hirschsprung’s disease (HD) is a congenital disorder affecting neonates that presents with distal intestinal obstruction. It is the most common type of anorectal malformation. Treatment of HD consists of surgical removal of the distal colon including the most distal aganglionic segment, the transitional zone, and a prudent length of proximal colon that is determined during the surgical procedure to be normally ganglionated by intraoperative demonstration of normal ganglion cells up to and including the surgical resection margin.

Methods

In a retrospective study of formalin-fixed paraffin-embedded colon tissue from the proximal resection margin (PRM) of 209 HD patients, we made morphometric measures and detected immature ganglion cells defined as dysmorphic by immunohistochemical demonstration of cytoplasmic neurofilament (NF).

Results

The majority of NF-positive ganglion cells in HD patients appeared immature, with less cytoplasm. Occasional positive ganglion cells in the same patients appeared mature with abundant eosinophilic cytoplasm, Nissl bodies, prominent nucleoli, and adjacent glial cells. Patients with NF-positive ganglion cells in the myenteric plexuses at the PRM may have poor postoperative recovery.

Conclusion

We propose that NF expression in dysmorphic ganglion cells at the PRM may predict poor outcome after pull-through surgery for HD.
The Effects of Dietary Polyphenols on Circulating Cardiovascular Disease Biomarkers and Iron Status: A Systematic Review
Authors: Speer Hollie , D’Cunha Nathan M , Botek Michal , McKune Andrew J , Sergi Domenico , Georgousopoulou Ekavi , Mellor Duane D , Naumovski Nenad
Published: October 2019

The prevalence of cardiovascular disease (CVD) is rising worldwide, remaining the major cause of death in developed countries. Polyphenols have been shown to have cardioprotective properties; however, their impact on iron bioavailability and potential impact on other aspects of health is unclear. A systematic review was undertaken to evaluate the current status of the relationship between habitual polyphenol consumption, iron status, and circulating biomarkers of CVD. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2009 guidelines, searches were performed across 5 electronic databases (PubMed, Cochrane Library, Scopus, Web of Science, and CINAHL) to identify randomized controlled trials which investigated the effects of polyphenol consumption on inflammatory markers, serum lipid profile, and iron absorption and bioavailability. In total, 1174 records were identified, with only 7 studies meeting the inclusion criteria. The selected studies involved 133 participants and used a variety of foods and supplements, including olive oil and cherries, rich in polyphenols including hydroxytyrosol, quercetin, and resveratrol, as well as catechin enriched drinks. The duration of the studies ranged from between 56 and 145 days, with total polyphenolic content of the food items and supplements ranging from 45 to 1015 mg (per 100 g). Polyphenols did not appear to interfere with iron status, and most studies reported improvements in inflammatory markers and lipid profile. While these results are promising, the limited number of studies and considerable heterogeneity across the interventions support the need for more extensive trials assessing the relationship between polyphenol intake, iron bioavailability, and CVD risk.
Developing the system architecture for conducting synchronous paediatric feeding assessments via telepractice
Authors: Raatz Madeline , Ward Elizabeth C , Marshall Jeanne , Burns Clare L
Published: October 2019

Introduction

Telepractice systems should be acceptable to users and meet end-user needs. Whilst the system requirements to conduct adult dysphagia assessments via telepractice are established, key differences exist between adult and paediatric swallowing assessments. This study was conducted to develop the system architecture required to conduct paediatric feeding assessments in patient homes via telepractice.

Methods

The study used a four-phase iterative design, informed by human-centred design principles. In Phase 1, two telepractice researchers and two paediatric feeding clinicians identified assessment tasks and explored potential system design solutions. Initial system testing was completed using clinical simulations (Phase 2). Live trials with 10 typically developing children were then conducted (Phase 3). Phase 4 involved user-centred feedback from clinicians and parents. Feedback from the development team, clinicians and parents was used to continuously refine the model.

Results

A combination of synchronous and asynchronous methods enabled all assessment components to be successfully completed. Clinician and parent feedback established the optimal technology (e.g. phone, tablet) and key camera positions necessary to optimise visual/auditory information for the online clinician. End-user feedback identified greater time efficiencies could be achieved through collecting some data (e.g. intra-oral pictures) via asynchronous methods prior to the session. Information sheets were deemed necessary to enhance the user experience. Clinicians and parents responded positively to the final system design.

Discussion

Modifications to standard videoconferencing were necessary to develop a clinically viable process for conducting paediatric feeding assessments in the home via telepractice. End-user feedback was integral to the design of the final model.
Impact of school-based allied health therapy via telehealth on children’s speech and language, class participation and educational outcomes
Authors: Langbecker Danette H , Caffery Liam , Taylor Monica , Theodoros Deborah , Smith Anthony C
Published: October 2019

Introduction

Access to telehealth services for children living in rural and remote areas of Australia is very limited. The delivery of allied health therapies to children in school via telehealth may help reduce inequality and improve academic outcomes over time.

Methods

A service delivering speech and language therapy (SLT) and occupational therapy (OT) via videoconferencing to children at five rural schools was prospectively evaluated. Each child’s teacher rated their speech and language, participation in class and educational outcomes at the beginning and end of semester. Change in the summative teacher-rating index over the first and subsequent semesters in which a child received therapy was examined. Independent predictors of change were identified using multivariable linear regression.

Results

Over two years, 1029 sessions of SLT and 531 sessions of OT were delivered to 98 children (67% male, 38% in Prep at commencement) via telehealth. In their first semester of therapy, 57 children received SLT, 37 OT and four both therapies. The mean teacher-rating index significantly improved from the beginning (35.05 ± 10.68) to end (40.02 ± 11.75) of the first semester of therapy ( p < 0.001). In multivariable linear regression, grade, school and baseline rating were significantly associated with the end-of-semester teacher-rating index.

Discussion

Delivering allied health therapy by videoconference may enable children to better engage with schooling. Differences in improvements by grade suggest improvements may be maximised by targeting therapy at certain year levels. This model may be useful in areas with limited access to allied health services.
A usability study to test the effectiveness, efficiency and simplicity of a newly developed Internet-based Exercise-focused Health App for Lung cancer survivors (iEXHALE): Protocol paper
Authors: Henshall Catherine , Davey Zoe , Jacelon Cynthia , Martin Clare
Published: October 2019

The Internet-based Exercise-focused Health App for Lung cancer survivors (iEXHALE) is a mobile web app being developed to provide lung cancer survivors with an algorithm-based, tailor-made, self-management programme to inform their exercise choices and improve symptom severity. The aim of this protocol paper is to detail the plan for conducting the usability study to test the effectiveness, efficiency and simplicity of an exercise-focused self-management mobile web app for lung cancer survivors. The mixed methods study will consist of three consecutive phases, each interspersed with elements of data analysis and app prototype redevelopment. The study will take place in Oxford, United Kingdom. Ethical approvals have been obtained. The study will contribute to lung cancer survivorship research and is important in the app developmental process. This study contributes to the international forum for the exchange of practice, innovation and research, increases transparency in mobile health developmental processes and contributes to the methodological evidence base.
The Moral Foundations of Public Engagement: Does Political Science, as a Discipline, Have an Ethics?
Authors: Flinders Matthew , Pal Leslie A
Published: October 2019

In recent years, the discipline of political science has been the focus of extensive criticism from observers based both within and beyond the academy. This is reflected in a sizable number of scholars who have called for the discipline to recognize its obligations to the public, and especially to supporting active citizenship, promoting democratic participation and addressing major social challenges. This emphasis on ‘making political science matter’ has also been stressed beyond the academy as funders, politicians and potential research-users place ever-greater emphasis on incentivizing and rewarding ‘impact’, ‘relevance’ and demonstrable ‘public value’. The central argument of this article is that what has been missing from this debate is any sense of clarity around whether what is being demanded is greater engagement by political science as a discipline or greater engagement by political scientists as individuals. This raises distinctive questions about the moral foundations and professional ethics of political science which we explore not through a traditional focus on defending or sustaining liberal democracy but through a deeper and more subtle emphasis on the praxis of ‘doing’ political science.
Novel (Multilevel) Focus Group Training for a Transdisciplinary Research Consortium
Authors: Hebert-Beirne Jeni , Kane Low Lisa , Burgio Kathryn L. , Hardacker Cecilia T. , Camenga Deepa R. , James Aimee S. , Newman Diane K. , Rudser Kyle , Nodora Jesse
Published: October 2019

Health researchers are increasingly turning to qualitative research for a nuanced understanding of complex health phenomena. The quality and rigor of qualitative research relies on individual data collector skills, yet few guidelines exist for training multidisciplinary, multi-institution qualitative research teams. Specific guidance is needed on qualitative research practices that ensure scientific rigor by optimizing diverse experience and expertise across research centers. We describe our systematic approach to training a cohort of 15 focus group moderators from seven universities in the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium’s Study of Habits, Attitudes, Realities, and Experiences (SHARE). SHARE’s aim was to explore women and girls’ experiences, perceptions, beliefs, knowledge, and behaviors related to bladder health and function across the life course. Drawing on adult education and action-learning best practices, a three-phase curriculum was designed to maximize moderator proficiency and qualitative research expertise. The phases involved online, interactive web-based education, in-person didactic training with experiential components, and tailored supplemental online training. Evaluative feedback was collected before, during, and after the training. Feedback was used to identify emergent training needs. This training approach may be used by transdisciplinary research teams conducting multisite research to assure qualitative research credibility and trustworthiness.
Peoplemeter Technologies and the Biometric Turn in Audience Measurement
Authors: Hessler Jennifer
Published: October 2019

Between 1980 and 1995, audience measurement companies, including Audits of Great Britain (AGB), Nielsen, Percy, and Arbitron, competed to develop peoplemeter technologies, ranging from remote controls to ultrasonic motion detectors, infrared body heat sensors, face scanners, and wearable devices. In this article, I argue that the evolution of peoplemeter technologies during this era was shaped by the inconsistent cooperation of viewers in the task of being measured, resulting in a turn away from active peoplemeters and toward passive peoplemeter methods. In particular, it marked a preoccupation in audience measurement with biometrics, and a constant onslaught of technological experiments in search of a seamless body/machine integration. In the process, the body became itself a technology: one that, if properly disciplined and utilized in the process of commodification, could make viewers more reliable consumers.
The Family Meal Model: Influences on Family Mealtime Participation
Authors: Smith Sarah L. , Ramey Elizabeth , Sisson Susan B. , Richardson Sandra , DeGrace Beth W.
Published: October 2019

The family meal affords benefits such as positive nutritional habits, trust building, connecting, parent modeling, and teaching. During the school-aged years, families can support children’s development of health behaviors and family routines. This interdisciplinary study examined families’ experiences of mealtimes and the factors that support or hinder mealtime participation. Grounded theory methods guided data collection and analysis. Semi-structured interviews were conducted with 21 families with at least one school-aged child ( n = 68). Interviews were audio recorded and transcribed. Researchers coded and categorized data, identified themes, and generated a model. Families defined family mealtime as all family members being together at the kitchen or dining room table eating a meal. Families enjoyed being together, conversing, and connecting through family mealtime participation. The Family Meal Model proposes relationships between factors that support or hinder a family’s mealtime participation. Discussion includes support for a broadened role of occupational therapy in promoting family occupation through family meals.
“You’re Ganja Have a Good Time”: Investigating the Roots of Blunt Use Among a National Sample of Hispanic Adults
Authors: Yockey R. Andrew , King Keith A. , Vidourek Rebecca A.
Published: October 2019

Blunt use is a pressing public health problem in the United States. While most studies have focused on African American youth, there remains a paucity of research examining blunt use among Hispanic individuals. Previous findings, which are quite limited, suggest mixed results, thus warranting further investigation regarding the prevalence of blunt use among Hispanic individuals and factors associated with such use. In accord with Jessor’s problem behavior theory, we hypothesized that prior use of illicit substances and certain psychosocial risk factors pose an increased risk for blunt use among Hispanic adults. A secondary analysis examined prior substance use and psychosocial factors of 10,216 Hispanic lifetime blunt users participating in the 2017 National Survey on Drug Use and Health. Findings revealed that one in five (20.5%) Hispanic individuals reported lifetime blunt use. Significant risk factors associated with blunt use were age (18+ years or older), participation in a government assistance program, prior illicit substance use, and changes in appetite or weight. Additional research on other risk factors, prevention mechanisms, and treatment interventions for Hispanic individuals who use blunts is warranted.
Supporting Active Aging for Persons with Severe Disabilities and Their Families Across the Life Course
Authors: Reynolds Michelle C. , Palmer Susan B. , Barton Kelli N.
Published: October 2019

Individuals with severe disabilities and their families can engage in person-centered and family-centered planning for aging using a life course view. Viewing aging within the context of the family and disability is essential because many people with severe disabilities depend on their families for supports in daily living, social relationships, and for activities within communities. Since eligibility-based supports are often limited, parents and other family members play large roles both financially and socially in helping their family member move through the life course into active and healthy aging. Charting the LifeCourse is a framework that both people with disabilities and their families can use to achieve desired life outcomes over time. Issues that impact active and healthy aging for people with disabilities include the aging of caregivers, death of a caregiver, limited resources for supporting physical and health concerns, staying active in the community following retirement, and maintaining social emotional connections.
Knowledge Elicitation to Understand Resilience: A Method and Findings From a Health Care Case Study
Authors: Hegde Sudeep , Hettinger Aaron Z. , Fairbanks Rollin J. , Wreathall John , Krevat Seth A. , Bisantz Ann M.
Published: October 2019

Resilience engineering (RE) has ushered new approaches to learning about work in complex sociotechnical systems. In terms of improving safety, RE marks a shift from the traditional approach of retrospectively investigating adverse events, toward learning proactively about patterns in everyday work, including how things go well. This study applied the RE framework to the health care domain, by developing and implementing a new knowledge-elicitation protocol to learn about how frontline care providers achieve safe and effective patient care in their everyday work. Eighteen participants, including physicians, nurses, residents, and clinical leaders from a range of specialties, were interviewed using the new protocol. Qualitative analysis of the data revealed multiple themes and patterns which underlie resilient functioning of individuals, teams, and the organization as a whole. Further, a Resilience Mapping Framework (RMF) was developed based on major thematic categories to systematically represent and map various resilient capabilities—monitoring, anticipating, responding, and learning—across different levels of system scale, from the individual to the organizational. This study demonstrates new methods to identify and represent resilience not just during salient and critical “events,” but across the continuum of situations, from the everyday “normal” functioning to the critical.
Distal Radioulnar Joint Instability: Assessment of Three Intraoperative Radiographic Stress Tests
Authors: Gil Joseph A. , Kosinski Lindsay R. , Shah Kalpit N. , Katarincic Julia A. , Kakar Sanjeev
Published: October 2019

Background: The purpose of this study is to describe three radiographic stress tests that could be used to examine for distal radioulnar joint (DRUJ) instability intraoperatively, and to determine their ability to detect DRUJ instability after sequentially sectioning the DRUJ. Methods: Eleven fresh frozen cadaveric upper extremities (mean age 52.6 ± 14.9 years) were obtained. We sequentially sectioned the DRUJ. After each component of the DRUJ was sectioned, we performed three radiographic stress tests—squeeze test, ulnar pull in coronal plane, and simulated DRUJ ballotment test. Results: The squeeze test detected a significant increase in diastasis relative to the intact DRUJ after sectioning of the foveal insertion of the triangular fibrocartilage complex (TFCC; 1.0 mm) and the distal oblique bundle (DOB; 1.2 mm). The ulnar pull test in the coronal plane detected a significant increase in diastasis relative to the intact DRUJ after sectioning of the dorsal and volar radioulnar ligaments (2 mm), the foveal insertion of the TFCC (2.6 mm), and the DOB (4.4 mm). The simulated DRUJ ballotment test detected a significant increase in dorsal translation of the ulna relative to the intact DRUJ with sectioning of the foveal insertion of the TFCC (4.9 mm) and the DOB (5.6 mm). Conclusion: The squeeze test and simulated DRUJ ballotment test detect a significant increase in diastasis after the foveal attachment of the TFCC was sectioned. The ulnar pull test in the coronal plane was the most sensitive test for detecting a significant increase in diastasis relative to the intact DRUJ.
99mTc-3PRGD2 SPECT Predicts the Outcome of Endostar and Cisplatin Therapy in Xenograft Animals
Authors: Sun Wei , He Guifu , Zhang Mingming , Zhao Yi , Yu Hongmei , Li Yi , Wu Wei , Ji Tiefeng
Published: October 2019

Aims:

Our study was designed to investigate the usefulness of 99mTc-3PRGD2 single-photon emission computed tomography (SPECT) for noninvasively monitoring the response of integrin αvβ3 expression to antiangiogenic treatment with endostar and cisplatin in xenograft animals.

Methods:

99mTc-3PRGD2 SPECT imaging was performed at days 0, 7, 14, and 21. Tumors were harvested at all imaging time points for Western blotting and histopathological analysis.

Result:

In 99mTc-3PRGD2 SPECT imaging, the radioactivity accumulation of NaCl group rised gradually in the first half and dispersed on day 21 due to the necrosis of the tumor. While the radioactivity accumulation of treated groups gradually decreased throughout the course. The downtrend of tumor to nontumor ratio in endostar-treated group was more remarkable than cisplatin-treated group. The expression of intergrin αvβ3 of treated groups was lower than NaCl group from day 14. The expression of intergrin αvβ3 of endostar-treated group was significantly lower than cisplatin-treated group from baseline onward.

Conclusion:

It’s demonstrated that the 99mTc-3PRGD2 could noninvasively visualize and semiquantify tumor angiogenesis in the xenograft model and monitor the response to the antiangiogenic therapy of endostar and cisplatin effectively. It also can predict the outcome of endostar and cisplatin therapy in xenograft animals.
Study on the reverse design of screw rotor profiles based on a B-spline curve
Authors: Cao Shu , He Xueming , Zhang Rong , Xiao Junfeng , Shi Guojiang
Published: October 2019

The female/male screw rotor profile design for a twin screw compressor poses challenges such as frequent parameter modification and a difficult-to-build performance test platform, which affect the efficiency of a rotor profile design. To address these problems, a new idea of applying a B-spline curve to a twin screw compressor rotor profile design is proposed in this article. In addition, the design result underwent fluid simulation based on fluid dynamics technology. This method overcomes the aforementioned challenges. As a meshing line has one-to-one mapping relationship with the rotor profile and reflects important performance parameters of the rotor profile, the method of deducing female and male rotor profiles for a twin screw compressor from a meshing line is proposed. Furthermore, the B-spline curve is used as a composition curve of the meshing line to achieve fast local adjustment of the rotor tooth profile. Based on existing rotor profiles, a meshing line is designed via the B-spline curve, and female and male rotor profiles are derived in reverse. The final rotor profile underwent fluid simulation via computational fluid dynamics analysis under various conditions to analyze the pattern of the internal flow field, which is compared with the results from conventional design.
Stroke burden in Guinea: Results from the Conakry Ignace Deen Hospital stroke registry
Authors: Cisse F Abass , Damien C , Haba M , Touré ML , Barry M , Djibo ABA , Bah AK , Soumah FM , Naeije G
Published: October 2019

Sub-Saharan Africa has extremely high stroke prevalence and case fatality. Most Sub-Saharan African regions are uncharted in terms of stroke characteristics, epidemiology, and burden. We report here the results from the first stroke registry in Guinea.
Regional, sex, and age differences in diagnostic testing among participants in the NAVIGATE-ESUS trial
Authors: Arauz Antonio , Serrano Fabiola , Pearce Lesly A , Kasner Scott E , Ameriso Sebastian F , Toni Danilo , Bereczki Daniel , Siegler James , Ruiz-Franco Angélica , Cantú-Brito Carlos , Czlonkowska Anna , Lang Wilfried , Berkowitz Scott D , Mundl Hardi , Hart Robert G
Published: October 2019

Background and aim

The diagnosis of embolic stroke of undetermined source (ESUS) is based on excluding other more likely stroke etiologies, and therefore diagnostic testing plays an especially crucial role. Our objective was to compare the diagnostic testing by region, sex, and age among the participants of NAVIGATE-ESUS trial.

Methods

Participants were grouped according to five global regions (North America, Latin America, Western Europe, Eastern Europe and East Asia), age (<60, 60–74, and >75 years), and sex. Frequencies of each diagnostic test within areas of echocardiography, cardiac rhythm monitoring, and arterial imaging were described and compared across groups. A multivariable logistic regression model for each diagnostic test was fit to assess the independent influence of each of region, age, and sex and likelihood of testing.

Results

We included 6985 patients in the analysis (918 from North America; 746 from Latin America; 2853 from Western Europe; 1118 from Eastern Europe; 1350 from East Asia). Average age (highest in Western Europe (69 years), lowest in Eastern Europe (65 years)), % females (highest in Latin America (44%) and lowest in East Asia (31%)), and use of each diagnostic test varied significantly across regions. Region, but not sex, was independently associated with use of each diagnostic test examined. Transesophageal echocardiography and either CT or MR angiogram were more often used in younger patients.

Conclusion

Diagnostic testing differed by region, and less frequently by age, but not by sex. Our findings reflect the existing variations in global practice in diagnostic testing in ESUS patients.
Planning for optimal performance – What happens before the taper?
Authors: Johns Karen L , Philipson Peter M , Hayes Philip R
Published: October 2019

This study analysed the contemporary performance data of middle-distance athletes to determine (a) the number of competitive performances prior to the season’s fastest performance and (b) the time frame between their first and fastest competitive performances of that season. Using a publicly available database, data on the number of races and days between athletes first and fastest races were extracted. The analysis utilised 4800 observations from 1166 individual athletes for the period 2006–2017. Male 800 m athletes achieved their fastest performance in eight races (IQR = 4–12) distributed over 55 days (IQR = 29–87). Female 800 m athletes also required eight races (IQR = 5–12), distributed over 63 days (IQR = 34–91). In the 1500 m event, male athletes, required six races (IQR = 3–9) over 48 days (IQR = 25–76), while female athletes, required seven races (IQR = 4–10) over 56 days (IQR = 28–84). For both sexes, 1500 m athletes raced less and over a shorter period than 800 m athletes before reaching their fastest performance. Female athletes had a longer time frame and number of races than male athletes. This study provides an evidence-based indicator of when a middle-distance runner’s fastest performance is likely to occur, providing benchmarks that could act as a guide for coaches when designing competition programmes, prior to any tapering process.
Use of pressure-regulated volume control in the first 48 hours of hospitalization of mechanically ventilated patients with sepsis or septic shock, with or without ARDS
Authors: Matusov Yuri , Li Jing , Resuello Dominique , Mathers Hannah , Fried Jeffrey C
Published: October 2019

Purpose

To evaluate the impact of pressure-regulated volume control (PRVC/VC+) use on delivered tidal volumes in patients with acute respiratory distress syndrome (ARDS) or at risk for ARDS.

Materials and methods

Retrospective study of mechanically ventilated adult patients with severe sepsis or septic shock.

Results

A total of 272 patients were divided into patients with recognized ARDS, patients without ARDS, and patients with unrecognized ARDS. Over 90% of patients were ventilated with PRVC on admission, resulting in delivered tidal volumes significantly higher than set tidal volumes among all groups at all time points, even after ARDS recognition ( p < 0.001). Tidal volumes were lower for patients with pulmonary sepsis as compared to those with a nonpulmonary origin ( p < 0.001).

Conclusions

Using PRVC promotes augmented delivered tidal volumes, often in excess of 6 mL/kg ideal body weight. Correct recognition of ARDS and having pulmonary sepsis improves compliance with low-stretch protocol ventilation.
A qualitative literature review exploring the drivers influencing antibiotic over-prescribing by GPs in primary care and recommendations to reduce unnecessary prescribing
Authors: Rose Joanna , Crosbie Michelle , Stewart Antony
Published: October 2019

Aims:

This qualitative literature review aims to critically assess and analyse published literature to determine drivers influencing over-prescribing by general practitioners (GPs) in primary care, exploring their views and opinions, and also to determine how antibiotic prescribing can be improved and unnecessary prescribing reduced, thus reducing the threat to public health from antibiotic resistance. It is intended to develop new thinking in this area and add to existing knowledge concerning GPs’ antibiotic prescribing behaviour.

Methods:

Thematic analysis following Braun and Clarke’s 2006 framework was used to analyse 17 qualitative studies chosen from EBSCOhost databases, focusing on GPs’ views of antibiotic prescribing in primary care, with specific search strategies and inclusion criteria to ensure study quality and trustworthiness.

Results:

Three main themes and nine sub-themes were generated from the studies. The first main theme discussed GP factors related to over-prescribing, the main drivers being GP attitudes and feelings and anxiety/fear concerning prescribing. The second theme highlighted external factors, with pressures from time and financial issues as the main drivers within this theme. The final theme marked patient pressure, demand and expectation with lack of patient education as the major drivers affecting GP over-prescribing.

Conclusion:

The findings of this research show GPs’ antibiotic prescribing in primary care is complex, being influenced by many internal and external factors. A multifaceted approach to interventions targeting the drivers identified could significantly reduce the level of antibiotic prescribing thus minimising the impact of antibiotic resistance and promoting a more efficient working environment for GPs and patients alike.
Parallel Control of an Artificial Pancreas with Coordinated Insulin, Glucagon, and Rescue Carbohydrate Control Actions
Authors: Moscardó Vanessa , Díez José Luis , Bondia Jorge
Published: October 2019

Background:

An artificial pancreas with insulin and glucagon delivery has the potential to reduce the risk of hypo- and hyperglycemia in people with type 1 diabetes. However, a maximum dose of glucagon of 1 mg/d is recommended, potentially still requiring rescue carbohydrates in some situations. This work presents a parallel control structure with intrinsic insulin, glucagon, and rescue carbohydrates coordination to overcome glucagon limitations when needed.

Methods:

The coordinated controller that combines insulin, glucagon, and rescue carbohydrate suggestions (DH-CC-CHO) was compared with the insulin and glucagon delivery coordinated controller (DH-CC). The impact of carbohydrate quantization for practical delivery was also assessed. An in silico study using the UVA-Padova simulator, extended to include exercise and various sources of variability, was performed.

Results:

DH-CC and DH-CC-CHO performed similarly with regard to mean glucose (126.25 [123.43; 130.73] vs 127.92 [123.99; 132.97] mg/dL, P = .088), time in range (93.04 [90.00; 95.92] vs 92.91 [90.05; 95.75]%, P = .508), time above 180 mg/dL (4.94 [2.72; 7.53] vs 4.99 [2.93; 7.24]%, P = .966), time below 70 mg/dL (0.61 [0.09; 1.75] vs 0.96 [0.23; 2.17]%, P = .1364), insulin delivery (43.50 [38.68; 51.75] vs 42.86 [38.58; 51.36] U/d, P = .383), and glucagon delivery (0.75 [0.40; 1.83] vs 0.76 [0.43; 0.99] mg/d, P = .407). Time below 54 mg/dL was different (0.00 [0.00; 0.05] vs 0.00 [0.00; 0.16]%, P = .036), although non-clinically significant. This was due to the carbs quantization effect in a specific patient, as no statistical difference was found when carbs were not quantized (0.00 [0.00; 0.05] vs 0.00 [0.00; 0.00]%, P = .265).

Conclusions:

The new strategy of automatic rescue carbohydrates suggestion in coordination with insulin and glucagon delivery to overcome constraints on daily glucagon delivery was successfully evaluated in an in silico proof of concept.
Twenty-Four Hour Fasting (Basal Rate) Tests to Achieve Custom-Tailored, Hour-by-Hour Basal Insulin Infusion Rates in Patients With Type 1 Diabetes Using Insulin Pumps (CSII)
Authors: Nauck Michael A. , Lindmeyer Anna M. , Mathieu Chantal , Meier Juris J.
Published: October 2019

Background:

Twenty-four hour fasting periods are being used to scrutinize basal insulin infusion rates for pump-treated patients with type 1 diabetes.

Methods:

Data from 339 consecutive in-patients with adult type 1 diabetes on insulin pump therapy undergoing a 24-hour fast as a basal rate test were retrospectively analyzed. Hourly programmed basal insulin infusion rates and plasma glucose concentrations within, below, or above arbitrarily defined target ranges were assessed for periods of the day of special interest (eg, 01:00-07:00 am, “dawn” period, 04:00-07:00 pm, and “dusk” period). Statistics: χ2-tests, paired t-tests were used.

Results:

Basal rates (mean: 0.90 ± 0.02 IU/h) showed circadian variations with peaks corresponding to “dawn” (1.07 ± 0.02 IU/h from 01:00 to 07:00 am) and, less prominently, “dusk” (0.95 ± 0.02 IU/h from 03:00 to 07:00 pm). Individual mean plasma glucose concentrations averaged 6.6 ± 0.1 mmol/L, with 53.1% in the predefined “strict” (4.4-7.2 mmol/L) target range. Interestingly, during the “dawn” period, plasma glucose was significantly higher (by 0.5 ± 0.1 mmol/L [95% confidence interval: 0.3-0.8 mmol/L; P < .0001]) and the odds ratio for hypoglycemia was significantly lower compared to the reference period.

Interpretation:

Twenty-four hour fasting periods as basal rate tests frequently unravel periods with inappropriate basal insulin infusion rates potentially responsible for fasting hyper- or hypoglycemia. Notably, the higher basal insulin infusion rate found during the “dawn” period seems to be justified and may need to be accentuated.
Overruling ‘the Salduz Doctrine’ in Beuze v Belgium: The ECtHR’s further retreat from the Salduz principles on the right to access to lawyer
Authors: Celiksoy Ergul
Published: October 2019

In November 2018, the Grand Chamber of the European Court of Human Rights delivered its judgment in the case of Beuze v Belgium. Relying on Ibrahim and Others v the United Kingdom, the Grand Chamber held that the Salduz principles require a two-stage test of analysis, and hence, ruled out that systematic statutory restriction of a general and mandatory nature would in itself constitute an automatic violation of Article 6 § 3(c) of the European Convention on Human Rights. However, the Beuze judgment appears to be very controversial, since the Grand Chamber failed to put forward any convincing reason why it departed from previous case law, particularly Dayanan v Turkey and other judgments against Turkey. In their separate opinion, the concurring Judges in Beuze were concerned that the Beuze judgment overruled ‘ Salduz itself and all other cases that have applied the Salduz test’, and thus, ‘actually distorts and changes the Salduz principle and devalues the right that the Court established previously’. This article analyses the Beuze judgment in the light of the Court’s recent jurisprudence in order to examine whether it contradicts and dilutes the principles previously set out. Further, it discusses the implications of the new standards established in Ibrahim and Others and in subsequent cases, particularly Beuze. Particular attention is paid to the questions of how ‘fair’ is the application of overall fairness assessment in every case, how may the Court’s changing direction of approach concerning the right to access to a lawyer affect the increasing trend of recognition thereof, as a rule, by the contracting states, and finally, to what extent the new principles, especially those established in Beuze, comply with Directive 2013/48/EU on the right of access to a lawyer.
Mobile communication, social presence, and perceived security on public transport
Authors: Reichow Dennis , Friemel Thomas N.
Published: October 2019

Mobile phones have become a ubiquitous phenomenon on public transport. However, little attention has been given to the effect of mobile communication on perceived security on public transport. This paper develops a model of social presence and perceived security in order to understand the widespread use of mobile phones on public transport as well as its effects. The first part of the model suggests a mediating role of social presence to understand how perceived security motivates mobile communication. The respective hypotheses are tested with a representative survey ( N = 2,267), and the results support the mediating role of social presence. The second part of the model assumes that social presence is not only a motive to use mobile communication but also helps to improve perceived security. Based on a 2-week mobile experience sampling with 86 participants and 1,264 measurement points, the effect of mobile communication and social presence obtained, as well as individual and situational factors on perceived security were tested. The respective hypotheses were partially supported but also suggest that other coping strategies might be of relevance to fully understand the relationship between mobile communication and situational perceived security. Besides the academic insights, these results suggest that public transport operators should consider expanding mobile phone coverage in their vehicles and stations to improve perceived security and make their services more attractive.
Managing the psychological sequelae of POI
Authors: Singer Dani
Published: October 2019

Premature ovarian insufficiency (POI) is a life-altering, emotionally charged diagnosis for a 1–3% of young women. Those with spontaneous premature ovarian insufficiency particularly consistently report being confronted with the shock of a completely unexpected diagnosis and confusion about the cause which currently remains largely unidentified. Even where the cause is known as in the result of medical treatment, premature ovarian insufficiency is associated with negative stereotypes of menopause and aging; the stigma of not being able to conceive unaided; anger, depression and anxiety from being robbed of choice coupled with worries over bone density, cardiovascular risk and an uncertain future. This adversely impacts self-esteem, the ability to form and maintain relationships, particularly intimate ones. In addition, premature ovarian insufficiency women report difficulty in getting a timely diagnosis and targeted treatment often from primary care practitioners who themselves are under confident in this area. Crucially, premature ovarian insufficiency is more than infertility: physical and emotional health need to be addressed prior to discussion of plans for creating a family. With better understanding of the psychological sequelae of premature ovarian insufficiency, primary care practitioners have the potential to improve both medical and psychological outcomes for this growing group in women’s health.
Zoledronic Acid Versus Denosumab for Prevention of Spinal Cord Compression in Advanced Cancers With Spine Metastasis: A Meta-Analysis of Randomized Controlled Trials
Authors: Al Farii Humaid , Frazer Abbey , Farahdel Leila , Alfayez Saud , Weber Michael
Published: October 2019

Study Design:

Meta-analysis of randomized controlled trials (RCTs).

Objectives:

The aim was to analyze the efficacy of zoledronic acid (ZA) versus denosumab in the prevention of spinal cord compression in patients with spine metastases from advanced cancers, by evaluating all available RCTs on this subject.

Methods:

A systematic search of electronic databases (PubMed and MEDLINE) was performed to identify all published RCTs comparing ZA with denosumab in prevention of spinal cord compressions in spine metastases. Risk of bias of the studies was assessed. The primary outcomes evaluated were spinal cord compression.

Results:

Three RCTs (5274 patients) were included. Denosumab was not significantly superior to ZA in reducing the likelihood of spinal cord compression, when all tumor types were combined (odds ratio [OR] 0.92, 95% confidence interval [CI; 0.66, 1.28], P = .66). Denosumab was not significantly favored over ZA in endodermal origin (breast and prostate; OR 0.72, 95% CI [0.43, 1.19], P = .20) and mesodermal origin tumors (solid tumors and multiple myeloma; OR 1.10, 95% CI [0.72, 1.69], P = .66).

Conclusion:

Denosumab does not significantly reduce the likelihood of spinal cord compressions in comparison to ZA in patients with spine metastases. When spinal cord compressions were grouped by tumor origin (endodermal or mesodermal), there remained no significant difference between denosumab and ZA. Further long-term studies are needed to determine the effectiveness of these treatment regimens.
Navigating Crisis: The Role of Communication in Organizational Crisis
Authors: Marsen Sky
Published: October 2019

This article introduces the special issue on crisis communication, whose aim is to bring together diverse approaches and methods of analysis in the field. The article overviews the field by discussing two main frameworks, dealing with postcrisis (reputation management) and precrisis (issue management) communication, respectively. The article then overviews some major theories of crisis communication and their different methodologies: image repair, situational crisis communication theory, rhetorical arena theory, narrative, and integrated crisis mapping. It ends with a description of some lessons learned that apply to all approaches and an overview of the contributions to the issue. By comparing and contrasting different perspectives on crisis communication, the article emphasizes the rich diversity that characterizes this branch of business communication.
The Presence of Wnt Signaling Mutations in Patients With Diabetic Retinopathy
Authors: Moinuddin Omar , Rao Prethy , Wood Edward H. , Stem Maxwell S. , Drenser Kimberly A. , Wolfe Jeremy D.
Published: October 2019

Purpose:

The relationship between poor hemoglobin A1c (HbA1c) control and risk of proliferative diabetic retinopathy (PDR) is well known. Nevertheless, some patients have discordant disease (controlled HbA1c and severe PDR or vice versa). One potential explanation for this discrepancy is the presence of underlying genetic mutations in the Wingless-related integration site (Wnt) signaling pathway. However, minimal clinical data exist on the presence of Wnt signaling mutations in patients with diabetes mellitus (DM) and the correlation with diabetic retinopathy.

Methods:

Retrospective, nonconsecutive case review of patients with type 1 or 2 DM who underwent genetic testing for at least 1 recognized Wnt signaling pathway mutation from 2011 to 2016. The clinical course and retinal images were reviewed for patients with identifiable mutations.

Results:

Thirty-six patients, ages 13 to 79 years, consented for genetic analysis. Three patients (8.3%) exhibited at least 1 recognized genetic mutation in the Wnt signaling pathway. Case 1 was a 65-year-old female with type 1 diabetes for > 20 years, HbA1c <7.0%, and no findings of diabetic retinopathy (Tetraspanin 12). Case 2 was a 13-year-old male with type 1 diabetes for 8 years, moderate HbA1c control (7.6-8.3%), and absence of diabetic retinopathy (Norrin). Case 3 was a 48-year-old male with severe PDR requiring multiple laser and antivascular endothelial growth factor (anti-VEGF) treatments despite well-controlled HbA1c (6.0%) (Frizzled-4).

Conclusion:

Wnt signaling pathway mutations exist in patients with DM. Further studies investigating the prevalence and clinical significance of these mutations in a larger diabetic population are warranted. Identification of these patients with genetic testing may enable earlier medical intervention.
Presumed Choroidal Metastasis From Oncocytic Carcinoma of the Parotid Gland: A Case Report
Authors: Cruz-Iñigo Yousef J. , De Souza Stephen A.M.
Published: October 2019

Purpose:

This article reports a case of presumed choroidal metastasis from an oncocytic carcinoma of the parotid gland.

Methods:

A 70-year-old man with history of an oncocytic carcinoma of the parotid gland presented owing to a 1-month history of progressive blurred central vision shortly after metastatic surveillance workup revealed liver, lung, and spine metastases. Fundus examination of the right eye showed a yellow choroidal mass surrounding the optic nerve and extending inferonasally, which is associated with subretinal fluid involving the foveal center. A-scan and B-scan ultrasonography were remarkable for a dome-shaped choroidal mass with medium-to-high internal reflectivity. Fluorescein angiography revealed pinpoint foci of hyperfluorescence over the choroidal lesion with late leakage. Magnetic resonance imaging of the brain showed evidence of metastatic disease to the cerebellum. While the patient underwent systemic chemotherapy, external beam radiotherapy was used to treat the eye.

Results:

Four months later, visual acuity improved, the tumor reduced in size, and the subretinal fluid resolved. Systemic workup disclosed no new metastases.

Conclusion:

Oncocytic carcinoma of the parotid gland is a rare and aggressive malignant neoplasm with frequent recurrences and distant metastases. The current case suggests that oncocytic carcinoma can metastasize to the choroid and, consequently, ocular metastasis surveillance is advised in these patients.