bluuebunny/crossref_metadata_2025 huggingface dataset:
The why and when of background checks: Situational factors moderate effects of criminal and financial stigma
Authors: Kuhn Kristine M.
Published: February 2020

Past criminal and financial transgressions, even when of questionable job relevance, can harm job‐seekers' prospects. In three hiring simulation experiments, manipulations of situational factors hypothesized to alter decision focus moderate the effect of background report information on applicant evaluations. In Study 1, emphasizing in‐role performance as a hiring goal decreases the weight placed on transgressions relative to standard qualifications. Study 2 demonstrates this context effect with a different design and experienced hiring professionals, and finds that delaying background checks heightens a transgression's impact. In Study 3, presenting novel positive information in conjunction with a criminal offense mitigates the delay effect. By adopting a behavioral decision perspective, this research illuminates how situational factors shape the impact of a widespread form of stigma.
School Integration of Migrant Children from the United States in a Border Context
Authors: Vargas‐Valle Eunice D. , Aguilar‐Zepeda Rodrigo
Published: February 2020

Since 2008, about half a million children have arrived in Mexico from the United States, most of whom are US‐born. However, due to limited statistical data, there have been few quantitative studies on their school integration. Using data from the 2017 School Integration Survey, conducted in 86 lower secondary schools in the Tijuana metropolitan area, we analyse the relationship between students’ liking of school and their binational school trajectories in this border city with high return migration. The results, based on a multivariate statistical analysis, show that students who studied in that country exhibit a lower liking of school, which correlates with a higher number of years of schooling in the U.S. and less time spent in Mexico since last arrival. Various mediating mechanisms are identified, such as limited Spanish proficiency, teacher indifference and lack of cultural identification with Mexico. The implications for education policy are also discussed.
Is aggregate volatility a priced risk factor?
Authors: Peterburgsky Stanley
Published: February 2020

This study shows that the relationships between sensitivity to changes in aggregate volatility and expected return on stocks documented by Ang et al. (Journal of Finance, 2006, 61, 259–299) for the 15‐year period from 1986 to 2000 have disappeared in the following 15‐year period. Aggregate volatility betas in the portfolio preformation month have not predicted postformation returns. Alphas from time‐series regressions of excess returns on the high‐minus‐low sensitivity to aggregate volatility portfolio with respect to the CAPM, the Fama–French three‐factor model, and the Fama–French five‐factor model have not been statistically different from zero. Finally, the price of aggregate volatility risk has not been statistically different from zero. Analysis based on high‐frequency data support these results. Thus, the importance of aggregate volatility as a factor in the presence of well‐known factors such as SMB and HML appears to be unclear.
Financial constraints and workforce environment: An international investigation
Authors: Habib Ahsan , Costa Mabel D. , Huang Hedy J. , Sun Xuan S.
Published: February 2020

We examine the association between financial constraints and workforce environment. Using data from 43 countries for the period 2002–2017, we find that financially constrained firms tend to have poor workforce environments. In addition, we investigate the impact of country‐level employment protection legislation (EPL) on this association. It is evident from our results that the investment decisions of firms under financial constraints are conditional on the strictness of EPL. Our findings provide important practical implications for international policy makers, in particular, about the significance of EPL for workforce environments. Our study also contributes to the scant literature on the determinants of workforce environment and provides robust international evidence on the detrimental effects of financial constraints on workforce environments.
Promoting satisfaction and reducing fatigue: Understanding the impact of trauma‐informed organizational culture on psychological wellness among Direct Service Providers
Authors: Keesler John M.
Published: February 2020

Background

Organizations supporting individuals with intellectual and developmental disabilities (IDD) are challenged with maintaining a viable workforce of direct support professionals (DSPs). Amid multiple factors, organizational culture based on trauma‐informed care may promote DSP retention through increased satisfaction and decreased fatigue.

Method

An online survey was used to gather data from DSPs (n = 380) across seven agencies and two online social media groups. Data were analysed using stepwise regression to identify the relationship between trauma‐informed organizational culture and professional quality of life (i.e., satisfaction, burnout and secondary traumatic stress).

Results

Trauma‐informed organizational culture was associated with increased DSP psychological wellness. Regression models explained 7.3%–40.5% of the variance in professional quality of life.

Conclusions

Although trauma‐informed initiatives have lagged in IDD services, this study provides preliminary evidence to bolster its justification, highlighting it as a possible partial response to the current workforce challenges.
Inability to capture with increasing current strength: Is this near‐field or far‐field?
Authors: Liu Fang‐Zhou , Liao Hong‐Tao , Zhan Xian‐Zhang , Shehata Michael , Ehdaie Ashkan , Chen Qiu‐Fan , Wu Shu‐Lin , Xue Yu‐Mei , Wang Xun‐Zhang
Published: February 2020

We present a case of wide‐complex tachycardia in which the clinical electrophysiological diagnosis was considered to be bundle branch re‐entry ventricular tachycardia. A series of ventricular entrainment attempts were performed from the left and right ventricular septum to confirm the diagnosis. Entrainment pacing with a general current output (10 mA) was performed from the right ventricular septum with manifest fusion and a post‐pacing interval similar to tachycardia cycle length. Thereafter, another entrainment attempt with a greater current output (20 mA) was performed from the same site. Paradoxically, concealed fusion was demonstrated by selective RB capture only, though there was no clear “RB” potential seen. In this case, we attempt to explain and illustrate the mechanism of paradoxical near‐field inability to capture with increasing current strength.
A novel nicastrin mutation in a three‐generation Dutch family with hidradenitis suppurativa: a search for functional significance
Authors: Vossen A.R.J.V. , van Straalen K.R. , Swagemakers S.M.A. , de Klein J.E.M.M. , Stubbs A.P. , Venter D.J. , van der Zee H.H. , van der Spek P.J. , Prens E.P.
Published: February 2020

Background

Mutations in the γ‐secretase enzyme subunits have been described in multiple kindreds with familial hidradenitis suppurativa (HS).

Objective

In this study, we report a novel nicastrin (NCSTN)mutation causingHSin a Dutch family. We sought to explore the immunobiological function ofNCSTNmutations using data of the Immunological Genome Project.

Methods

Blood samples of three affected and two unaffected family members were collected. Whole‐genome sequencing was performed using genomicDNAisolated from peripheral blood leucocytes. Sanger sequencing was done to confirm the causativeNCSTNvariant and the familial segregation. The microarray data set of the Immunological Genome Project was used for thorough dissection of the expression and function of wildtypeNCSTNin the immune system.

Results

In a family consisting of 23 members, we found an autosomal dominant inheritance pattern ofHSand detected a novel splice site mutation (c.1912_1915delCAGT) in theNCSTNgene resulting in a frameshift and subsequent premature stop. All affected individuals hadHSlesions on non‐flexural and atypical locations. WildtypeNCSTNappears to be upregulated in myeloid cells like monocytes and macrophages, and in mesenchymal cells such as fibroblastic reticular cells and fibroblasts. In addition, within the 25 highest co‐expressed genes withNCSTNwe identifiedCAPNS1,ARNTandPPARD.

Conclusion

This study reports the identification a novelNCSTNgene splice site mutation which causes familialHS. The associated immunobiological functions ofNCSTNand its co‐expressed genesARNTandPPARDlink genetics to the most common environmental and metabolicHSrisk factors which are smoking and obesity.
Cutaneous adverse events: a predictor of tumour response under anti‐PD‐1 therapy for metastatic melanoma, a cohort analysis of 189 patients
Authors: Bottlaender L. , Amini‐Adle M. , Maucort‐Boulch D. , Robinson P. , Thomas L. , Dalle S.
Published: February 2020

Introduction

Cutaneous adverse events (AEs) are the most prevalent toxicity under checkpoint inhibitors in clinical trials. In ‘real‐life’ conditions of use, skin toxicities under anti‐PD‐1 have not been described to date in a large cohort. The objective of this study was to determine the clinical features of skin toxicities in patients with advanced melanoma receiving anti‐PD‐1 therapy under ‘real‐life’ conditions of use. Secondary objectives were to evaluate the characteristics of patients with skin toxicities and to analyse associated extra‐cutaneous toxicities, progression‐free survival (PFS) and overall survival (OS).

Patients and methods

Advanced melanoma patients treated with nivolumab or pembrolizumab between August 2014 and October 2017 were included. Patients lost to follow‐up or receiving anti‐PD‐1 as part of a clinical trial were excluded.

Results

One hundred and eighty‐nine patients with metastatic melanoma (with 109 men (57.7%) were included. Cutaneous AE occurred in 39 patients (20.6%). The three most prevalent cutaneous AEs were skin eruption (macular–papular or eczematous) (n = 18, 9.5%), vitiligo (n = 16; 8.5%) and isolated pruritus (n = 5, 2.6%). Grade 3–4 skin toxicity was diagnosed in five patients (2.6%). Atopy (28.2% vs. 12.0%; P = 0.024), hypereosinophilia (20.5% vs. 8.7%; P = 0.046), thyroiditis (17.9% vs. 4.7%; P = 0.011) and renal toxicity (15.4% vs. 4%; P = 0.019) were significantly associated with cutaneous AE. Patients with skin eruption (log‐rank = 0.001), vitiligo (log‐rank = 0.001) and any type of cutaneous AE (log‐rank < 0.001) had a better overall survival.

Conclusions

Cutaneous AEs are frequent and often manageable toxicity and were a predictor of tumour response in melanoma patients under anti‐PD‐1 therapy in this cohort.
Reply to Comment on: Can Hearing Aids Delay Time to Diagnosis of Dementia, Depression, or Falls in Older Adults?
Authors: Mahmoudi Elham
Published: February 2020

This letter comments on the letter by Abiola Aanuoluwa.
The long and winding road of discontinuing long‐term use of antidepressants: Learning from my experience
Authors: Wilson Ceri
Published: February 2020

Accessible Summary

What is known on the subject?

More people experience withdrawal symptoms when weaning off antidepressants than previously thought; particularly after taking them for a long time.

What this paper adds to existing knowledge?

I explore my own experience of weaning off antidepressants; detailing conflicting advice I have received from healthcare professionals, and the mental and physical withdrawal symptoms I experienced.

I relate my experiences to a growing body of research, which have important implications for improving care.

What are the implications for mental health nursing?

Healthcare professionals should make patients aware of potential withdrawal symptoms they may experience before they wean off antidepressants; regularly review their progress; consider helping them access psychological support whilst weaning off; and engage in open and collaborative conversations with patients throughout.

Clinical guidance needs to be updated to provide appropriate evidence‐based information/advice/recommendations for how best to support patients when coming off of antidepressants.

A significant proportion of the UK population are taking antidepressants, and have been taking them for at least a year. Clinical guidelines have controversially stated that withdrawal symptoms when weaning off antidepressants are mild and resolve after one week, with the proviso that they can be severe only if the drug is stopped abruptly. However, recent evidence suggests this is not the case. I describe my own experiences of tapering the dose of my antidepressants after several years of taking them. I describe my encounters with healthcare professionals throughout this period, detailing conflicting advice I have received, along with describing the mental and physical withdrawal symptoms I have experienced. My experiences relate to a growing body of research, which have important implications for improving care. Potential learning outcomes are that healthcare professionals should make patients aware of potential withdrawal symptoms they may experience before they wean off antidepressants; regularly review their progress; consider helping them access psychological support whilst weaning off; and engage in open and collaborative conversations with patients throughout the process. Clinical guidance needs to be updated to provide appropriate evidence‐based information, advice, and recommendations for how best to support patients when coming off of antidepressants.
Developing a Logic Model for the Triple‐C Intervention: A Practice‐Derived Intervention to Support People with Intellectual Disability and Challenging Behavior
Authors: Tournier Tess , Hendriks Alexander H.C. , Jahoda Andrew , Hastings Richard P. , Embregts Petri J. C. M.
Published: February 2020

Partly due to a lack of evidence‐based methods to support people with intellectual disability (ID) and challenging behavior, their needs are often poorly met. One way to generate rapid evidence is to systematically describe and monitor interventions that are considered to be “good practice”—to develop evidence based on practical knowledge. This study describes the Dutch practice‐based intervention Triple‐C (Client, Coach, Competence). The intervention was developed in practice to support people with severe ID to borderline functioning and challenging behavior. The practice‐based nature of Triple‐C means that many of the professionals' actions or activities are often underpinned by their implicit knowledge about the intervention they are delivering. Consequently, as the emphasis is on practice, the professionals can find it difficult to articulate how the intervention is operationalized and positive change achieved. This study aimed to assess the practical knowledge of Triple‐C professionals and to develop an understanding of the mechanisms of change for Triple‐C to improve understanding and to inform future research about the intervention. Through an iterative process, a logic model was developed to describe the intervention and its underlying assumptions. The development of the logic model was shaped using interviews with the founders, focus groups with support staff, psychologists, managers and members of the board of a service provider, and the analysis of published accounts of the Triple‐C intervention. Data gathered from these sources were analyzed using content analysis. The logic model of the Triple‐C intervention provides insight into the key elements of the approach, such as the need for unconditional supportive relationship and carrying out meaningful activities. Moreover, the potential relationship with existing evidence‐based interventions such as Positive Behavioral Support and Active Support are described. Defining the underlying logic of a practice‐based intervention like Triple‐C is an important first step toward producing an evidence base for interventions developed from clinical practice.
Non‐invasive tests for liver fibrosis in NAFLD: Creating pathways between primary healthcare and liver clinics
Authors: Castera Laurent
Published: February 2020

Despite affecting around one‐fourth of the general population worldwide, non‐alcoholic fatty liver disease (NAFLD) remains a largely under‐recognized disease in primary healthcare, with not more than 10% of patients diagnosed with NAFLD referred to specialists. The main challenge in clinical practice is the identification of those with advanced liver fibrosis or cirrhosis, as they are at the greatest risk of developing complications. Liver biopsy appears to be an unrealistic and unsuitable option because of the large number of high‐risk patients and the well‐known limitations of this technique. This has favoured the development of non‐invasive tests, which have been an area of intensive research in the past decade. Transient elastography, FIB‐4 and the NAFLD fibrosis score are the most extensively used and best validated tests, with summary AUROC values for detecting advanced fibrosis in NAFLD patients of 0.88, 0.84 and 0.84 respectively. Although much work remains to be done to establish cost‐effective strategies for the screening for advanced fibrosis, the sequential use of non‐invasive tests (serum biomarkers, then measurement of liver stiffness using transient elastography) appears to be the most promising strategy. The next step is to establish effective pathways in primary healthcare and/or diabetes clinics where most NAFLD patients are seen, to identify those who need to be referred to liver clinics for further assessment.
EASL clinical practice guidelines for the management of occupational liver diseases
Authors: Colombo Massimo
Published: February 2020

The Clinical Practice Guidelines (CPG) on Occupational Liver Diseases (OLD) of the European Association for the Study of the Liver (EASL) have been developed to increase awareness, recognition and improve management of patients with OLD. Indeed, although workplace exposure has been associated with virtually the entire spectrum of acute and chronic liver diseases, data on the epidemiology of OLD are scarce. These diseases may be a result of high‐level accidental exposure or prolonged lower level exposure to a variety of chemicals including solvents, pesticides, metals and other agents. While acute liver diseases related to OLD are uncommon and easily recognized, chronic liver diseases are relatively more frequent but often overlooked because of their asymptomatic course and an insidious onset which is often accompanied by comorbidities. Because of the absence of data in observational studies and meta‐analyses or systematic reviews, the evidence and recommendations in these guidelines have been graded according to the Oxford Centre for Evidence‐based Medicine, which assesses evidence according to diagnostic, prevalence, aetiological, prognostic or preventive categories. They can still generate grades of recommendation even when the evidence is inconclusive.
A diabetologist’s perspective of non‐alcoholic steatohepatitis (NASH): Knowledge gaps and future directions
Authors: Cusi Kenneth
Published: February 2020

There is a close link between steatohepatitis (NASH) and Type 2 diabetes (T2DM). Recently, the American Diabetes Association (ADA) recommended screening for NASH and advanced fibrosis in patients with diabetes and hepatic steatosis or elevated plasma alanine aminotransferase (ALT). This is because as many as ~30% to 40% may have NASH and ~10% to 15% advanced fibrosis. The role of hyperglycemia and the natural history of NASH in diabetes remain poorly understood, as well as which diagnostic algorithm or interventions are most cost‐effective. There is significant clinical inertia and most patients today are still not receiving adequate lifestyle intervention or pharmacological treatment with diabetes agents known to be effective against NASH. Lifestyle intervention improves steatohepatitis in proportion to the magnitude of weight loss, but this trend is not as consistent for regression of fibrosis. This limited success supports the need for concomitant pharmacological therapy. Pioglitazone has been shown to consistently induce resolution of NASH in both patients with or without diabetes in a total of 498 participants in five randomized controlled trials (RCTs), but with modest effects on liver fibrosis. Proof‐of‐concept studies suggest a potential role for GLP‐1RAs and SGLT2 inhibitors. Combination therapy is on the horizon. Treating diabetes and NASH with a combination of pioglitazone, GLP‐1RAs or SGLT2i, could be a cost‐effective strategy to treat both diseases while reducing their high cardiovascular risk. Future combination therapies will likely combine existing diabetes agents with novel NASH‐spechfic drugs under development. This review highlights current knowledge gaps and proposes future directions for the treatment of NASH in diabetes.
Hepatitis C elimination – Macro‐elimination
Authors: Kåberg Martin , Weiland Ola
Published: February 2020

In 2016 the WHO set a goal to obtain an 80% reduction in new chronic HCV cases, requiring a level of diagnosis of 90%, treatment coverage of 80% and resulting in a 65% reduction in HCV‐related deaths by 2030. This goal is easier to reach in specific populations such as people who inject drugs (PWID), men who have sex with men (MSM) or blood‐transfusion recipients before screening for HCV became mandatory and in high‐income regions. It is much more difficult to achieve macro‐elimination throughout the population especially in low‐income areas with underdeveloped infrastructures, a high prevalence of HCV and limited economic resources. To achieve the WHO goals by 2030, awareness of HCV must increase and the cascade of care must be improved and implemented. Diagnostic procedures and treatment should be affordable and universally available. At the end of 2017 fewer than 15 countries were on track to reach these goals by 2030.
Future treatments for hepatitis delta virus infection
Authors: Asselah Tarik , Loureiro Dimitri , Tout Issam , Castelnau Corinne , Boyer Nathalie , Marcellin Patrick , Mansouri Abdellah
Published: February 2020

Around 15‐20 million people develop chronic hepatitis delta virus worldwide. Hepatitis delta virus (HDV) is a defective RNA virus requiring the presence of the hepatitis B virus surface antigen (HBsAg) to complete its life cycle. HDV infects hepatocytes using the hepatitis B virus (HBV) receptor, the sodium taurocholate cotransporting polypeptide (NTCP). The HDV genome is a circular single‐stranded RNA which encodes for a single hepatitis delta antigen (HDAg) that exists in two forms (S‐HDAg and L‐HDAg), and its replication is mediated by the host RNA polymerases. The HBsAg‐coated HDV virions contain a ribonucleoprotein (RNP) formed by the RNA genome packaged with small and large HDAg. Farnesylation of the L‐HDAg is the limiting step for anchoring this RNP to HBsAg, and thus for assembling, secreting and propagating virion particles. There is an important risk of morbidity and mortality caused by end‐stage liver disease and hepatocellular carcinoma with HDV and current treatment is pegylated‐interferon (PEG‐IFN) for 48 weeks with no other options in patients who fail treatment. The ideal goal for HDV treatment is the clearance of HBsAg, but a reasonably achievable goal is a sustained HDV virological response (negative HDV RNA 6 months after stopping treatment). New drug development must take into account the interaction of HBV and HDV. In this review, we will present the new insights in the HDV life cycle that have led to the development of novel classes of drugs and discuss antiviral approaches in phase II and III of development: bulevirtide (entry inhibitor), lonafarnib, (prenylation inhibitor) and REP 2139 (HBsAg release inhibitor).
New epidemiology of hepatitis delta
Authors: Vlachogiannakos Jiannis , Papatheodoridis George V.
Published: February 2020

Hepatitis D virus (HDV) is a defective pathogen that needs hepatitis B virus (HBV) for infection. Co‐infection of HBsAg‐positive individuals with HDV is commonly associated with a more rapid progression to cirrhosis, a higher incidence of hepatocellular carcinoma (HCC) and increased mortality. Initial studies have shown that about 5% of chronic HBV carriers worldwide (15‐20 millions) were also infected with HDV. However, recent studies suggest that the prevalence of HDV is at least two‐ to three‐fold higher than previous estimations. Improved diagnostic techniques have shown that HDV infection remains endemic in certain areas of the world. Injection drug users, individuals with high‐risk sexual behaviour and patients co‐infected with human immunodeficiency virus (HIV) represent the major reservoir of the disease in the Western world. Although the burden of HDV infection significantly decreased in Europe in the nineties, there has been no further decrease in the last decade, probably because of migration from HDV endemic countries. Until new and more effective therapies are available, public health measures should be reinforced by increasing prophylactic HBV vaccination programs, preventing transmission of the virus among parenteral drug users and implementing universal HDV screening of all HBV‐infected individuals.
Approach to the patient with chronic hepatitis B and decompensated cirrhosis
Authors: Shiffman Mitchell L.
Published: February 2020

Patients with chronic hepatitis B virus (HBV) can develop progressive fibrosis, cirrhosis and hepatocellular carcinoma. Patients with chronic HBV and cirrhosis are at risk of developing hepatic decompensation and have high mortality without antiviral therapy and/or liver transplantation. Treatment of chronic HBV with antiviral therapy is indicated in all patients with cirrhosis whatever the HBe‐antigen status and serum alanine aminotransferase (ALT), so that hepatic decompensation can be prevented. Initiating antiviral therapy in patients with decompensated cirrhosis can improve liver function, Child‐Turcotte‐Pugh (CTP) and model for end‐stage liver disease (MELD) scores, as well as the need for liver transplantation and mortality. Patients with chronic HBV and cirrhosis who do not respond to antiviral therapy with normalization of ALT may have a co‐existent liver disorder. One of the most common co‐existent liver disorders present in patients with chronic HBV is non‐alcoholic fatty liver disease (NAFLD). Patients with chronic HBV, NAFLD and cirrhosis may be at risk of developing decompensated cirrhosis and require a liver transplant. If patients with chronic HBV require liver transplantation, infection of the liver graft with HBV can be prevented with antiviral therapy.
Micro‐elimination of hepatitis C virus
Authors: Hollande Clémence , Parlati Lucia , Pol Stanislas
Published: February 2020

Background & Aims

HCV affects about 71 million people worldwide with 1.75 million new infections a year, mainly associated with healthcare, blood transfusion before screening of donors and drug use. Hepatitis C is a systemic disease with hepatic and extrahepatic manifestations resulting in increased morbidity and mortality in HCV‐infected patients compared to cured or uninfected individuals.

Results

The goal of eliminating hepatitis C by 2030 is based on the following three main actions: strengthening and increasing outreach screening; increasing access to treatment; and improving prevention. Although the tools and the targets of HCV elimination have now been well established, micro‐elimination, a cure in high‐risk populations, is possible, but has not been achieved. These populations are mainly migrants, prisoners, drug users, HIV co‐infected patients and psychiatric patients. New tools must be developed to achieve micro‐elimination, in particular, rapid diagnostic orientation tests for better screening, delocalization of healthcare services to improve access to care, and training physicians to raise awareness of the disease, increase understanding of its pathogenesis and provide information on the availability of safe and effective treatment to cure chronic infection and reverse hepatic and extrahepatic manifestations.

Conclusion

Thus, while the goal of complete elimination of hepatitis C virus was feasible in Western countries, it was more difficult in high‐prevalence countries where improvement in the detection of chronic infection (with rapid serological and virological diagnostic tests), outsourcing of diagnostic and therapeutic care and access to direct oral antivirals are urgently needed.
What's new in portal hypertension?
Authors: Mauro Ezequiel , Gadano Adrián
Published: February 2020

Portal hypertension is defined as increased pressure in the portal venous system. The most common cause of portal hypertension is cirrhosis. In this setting, there is an increase in intrahepatic resistance leading to an increase in portal pressure. By increasing portal blood flow, splanchnic vasodilation further aggravates portal hypertension. New pathogenic pathways are being established which might result in new therapeutic strategies. The presence of varices at endoscopy and/or other abdominal portosystemic collaterals confirms the diagnosis of portal hypertension. The role of non‐invasive and imaging tests in the diagnosis and prognosis of portal hypertension has been clarified. Non‐selective beta‐blockers decrease both the risk of variceal haemorrhage and hepatic decompensation. Terlipressin, somatostatin or octreotide, in combination with early endoscopic therapy, are recommended for the treatment of acute variceal haemorrhage. Early Transjugular intrahepatic portosystemic shunt (TIPS) is effective as salvage therapy in acute variceal bleeding in selected patients and prevents rebleeding more effectively than endoscopic and medical therapy resulting in an increased survival.
Optimization of hepatitis C virus screening strategies by birth cohort in Italy
Authors: Kondili Loreta A. , Gamkrelidze Ivane , Blach Sarah , Marcellusi Andrea , Galli Massimo , Petta Salvatore , Puoti Massimo , Vella Stefano , Razavi Homie , Craxi Antonio , Mennini Francesco S. ,   PITER collaborating group
Published: February 2020

Background and Aims

Cost‐effective screening strategies are needed to make hepatitis C virus (HCV) elimination a reality. We determined if birth cohort screening is cost‐effective in Italy.

Methods

A model was developed to quantify screening and healthcare costs associated with HCV. The model‐estimated prevalence of undiagnosed HCV was used to calculate the antibody screens needed annually, with a €25 000 cost‐effectiveness threshold. Outcomes were assessed under the status quo and a scenario that met the World Health Organization's targets for elimination of HCV. The elimination scenario was assessed under five screening strategies.

Results

A graduated birth cohort screening strategy (graduated screening 1: 1968‐1987 birth cohorts, then expanding to 1948‐1967 cohorts) was the least costly. This strategy would gain approximately 144 000 quality‐adjusted life years (QALYs) by 2031 and result in an 89.3% reduction in HCV cases, compared to an 89.6%, 89.0%, 89.7% and 88.7% reduction for inversed graduated screening, 1948‐77 birth cohort, 1958‐77 birth cohort and universal screening, respectively. Graduated screening 1 yielded the lowest incremental cost‐effectiveness ratio (ICER) of €3552 per QALY gained.

Conclusions

In Italy, a graduated screening scenario is the most cost‐effective strategy. Other countries could consider a similar birth cohort approach when developing HCV screening strategies.
Time spent in distinct life history stages has sex‐specific effects on reproductive fitness in wild Atlantic salmon
Authors: Mobley Kenyon B. , Granroth‐Wilding Hanna , Ellmén Mikko , Orell Panu , Erkinaro Jaakko , Primmer Craig R.
Published: February 2020

In species with complex life cycles, life history theory predicts that fitness is affected by conditions encountered in previous life history stages. Here, we use a 4‐year pedigree to investigate if time spent in two distinct life history stages has sex‐specific reproductive fitness consequences in anadromous Atlantic salmon (Salmo salar). We determined the amount of years spent in fresh water as juveniles (freshwater age, FW, measured in years), and years spent in the marine environment as adults (sea age, SW, measured in sea winters) on 264 sexually mature adults collected on a river spawning ground. We then estimated reproductive fitness as the number of offspring (reproductive success) and the number of mates (mating success) using genetic parentage analysis (>5,000 offspring). Sea age is significantly and positively correlated with reproductive and mating success of both sexes whereby older and larger individuals gained the highest reproductive fitness benefits (females: 62.2% increase in offspring/SW and 34.8% increase in mate number/SW; males: 201.9% offspring/SW and 60.3% mates/SW). Younger freshwater age was significantly related to older sea age and thus increased reproductive fitness, but only among females (females: −33.9% offspring/FW and −32.4% mates/FW). This result implies that females can obtain higher reproductive fitness by transitioning to the marine environment earlier. In contrast, male mating and reproductive success was unaffected by freshwater age and more males returned at a younger age than females despite the reproductive fitness advantage of later sea age maturation. Our results show that the timing of transitions between juvenile and adult phases has a sex‐specific consequence on female reproductive fitness, demonstrating a life history trade‐off between maturation and reproduction in wild Atlantic salmon.
Two Phytophthora parasitica cysteine protease genes, PpCys44 and PpCys45, trigger cell death in various Nicotiana spp. and act as virulence factors
Authors: Zhang Qiang , Li Weiwei , Yang Jiapeng , Xu Junjie , Meng Yuling , Shan Weixing
Published: February 2020

Proteases secreted by pathogens have been shown to be important virulence factors modifying plant immunity, and cysteine proteases have been demonstrated to participate in different pathosystems. However, the virulence functions of the cysteine proteases secreted by Phytophthora parasitica are poorly understood. Using a publicly available genome database, we identified 80 cysteine proteases in P. parasitica, 21 of which were shown to be secreted. Most of the secreted cysteine proteases are conserved among different P. parasitica strains and are induced during infection. The secreted cysteine protease proteins PpCys44/45 (proteases with identical protein sequences) and PpCys69 triggered cell death on the leaves of different Nicotiana spp. A truncated mutant of PpCys44/45 lacking a signal peptide failed to trigger cell death, suggesting that PpCys44/45 functions in the apoplastic space. Analysis of three catalytic site mutants showed that the enzyme activity of PpCys44/45 is required for its ability to trigger cell death. A virus‐induced gene silencing assay showed that PpCys44/45 does not induce cell death on NPK1 (Nicotiana Protein Kinase 1)‐silenced Nicotiana benthamiana plants, indicating that the cell death phenotype triggered by PpCys44/45 is dependent on NPK1. PpCys44‐ and PpCys45‐deficient double mutants showed decreased virulence, suggesting that PpCys44 and PpCys45 positively promote pathogen virulence during infection. PpCys44 and PpCys45 are important virulence factors of P. parasitica and trigger NPK1‐dependent cell death in various Nicotiana spp.
Towards a relational conceptualization of empathy
Authors: van Dijke Jolanda , van Nistelrooij Inge , Bos Pien , Duyndam Joachim
Published: February 2020

Empathy is a fundamental concept in health care and nursing. In academic literature, it has been primarily defined as a personal ability, act or experience. The relational dimensions of empathy have received far less attention. In our view, individualistic conceptualizations are restricted and do not adequately reflect the practice of empathy in daily care. We argue that a relational conceptualization of empathy contributes to a more realistic, nuanced and deeper understanding of the functions and limitations of empathy in professional care practices. In this article, we explore the relational aspects of empathy, drawing on sources that offer a relational approach, such as the field of care ethics, the phenomenology of Edith Stein and qualitative research into interpersonal and interactive empathy. We analyse the relational aspects of three prevalent components of empathy definitions: the underlying ability or act (i.e. the cognitive, affective and perception abilities that enable empathy); the resulting experience (i.e. empathic understanding and affective responsivity) and the expression of this experience (i.e. empathic expression). Ultimately, we propose four inter‐related understandings of empathy: (a) A co‐creative practice based on the abilities and activities of both the empathizer and the empathee; (b) A fundamentally other‐oriented experience; (c) A dynamic, interactive process in which empathizer and empathee influence each other's experiences; (d) A quality of relationships.
Influence of Ketorolac Supplementation on Pain Control for Knee Arthroscopy: A Meta‐Analysis of Randomized Controlled Trials
Authors: Wan Rui‐jie , Liu Shao‐fan , Kuang Zhi‐ping , Ran Qiang , Zhao Chen , Huang Wei
Published: February 2020

Introduction

The efficacy of ketorolac supplementation on pain control for knee arthroscopy remains controversial. We conduct a systematic review and meta‐analysis to explore the impact of ketorolac supplementation on pain intensity after knee arthroscopy.

Methods

We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through September 2018 for randomized controlled trials (RCTs) assessing the effect of ketorolac supplementation vs placebo on pain management after knee arthroscopy. This meta‐analysis is performed using the random‐effect model.

Results

Ten RCTs involving 402 patients are included in the meta‐analysis. Overall, compared with control group for knee arthroscopy, ketorolac supplementation is associated with notably reduced pain scores at 1 h (MD = −0.66; 95% CI = −1.12 to −0.21; P = 0.004) and 2 h (MD = −0.90; 95% CI = −1.74 to −0.07; P = 0.03), prolonged time for first analgesic requirement (MD = 1.94; 95% CI = 0.33 to 3.55; P = 0.02) and decreased number of analgesic requirement (RR = 0.41; 95% CI = 0.23 to 0.75; P = 0.003), but has no obvious impact on analgesic consumption (MD = −0.56; 95% CI = −1.14 to 0.02; P = 0.06), as well as nausea and vomiting (RR = 0.44; 95% CI = 0.12 to 0.21; P = 0.21).

Conclusions

Ketorolac supplementation is effective to produce pain relief for knee arthroscopy.
Combined 3D Printed Template to Guide Iliosacral Screw Insertion for Sacral Fracture and Dislocation: A Retrospective Analysis
Authors: Wu Chao , Deng Jia‐yan , Li Tao , Tan Lun , Yuan De‐chao
Published: February 2020

Objective

To evaluate the accuracy and safety of a combined 3D printed guide template (combined template) to assist iliosacral (IS) screw placement for sacral fracture and dislocation.

Methods

A total of 37 patients, 24 men and 13 women, age from 22 to 68 years old, diagnosed with a sacral fracture and dislocation were involved in this study for retrospective analysis from January 2016 to February 2018. There were 19 patients in the template group (42 screws) and 18 patients in the conventional group (31 screws). In the combined template group, IS screw placement was assisted by a combined 3D printed template; in the conventional group, the IS screws were placed freehand under fluoroscopy. The accuracy of the IS screw placement was evaluated by comparing the screw angle and the location of the screw entry point between the actual and the simulated screw in the combined template group. The safety of the IS screw placement was evaluated by comparing the quality of the reduction, the grading of the screws, the operation time, and radiation exposure times between groups.

Results

A total of 73 pedicle screws were placed in 37 patients: 42 screws (30 S1, 12 S2) in the combined template group and 31 screws (23 S1, 8 S2) in the conventional group. In the conventional group, 1 patient developed symptoms of L5 nerve stimulation. In the combined template group, the average operative time of each screw was 25.01 ± 2.90 min, with average radiation exposure times of 12.05 ± 4.00. In the conventional group, the average operative time of each screw was 46.24 ± 9.59 min, with an average radiation exposure time of 56.10 ± 6.75. There were significant differences in operation and radiation exposure times between groups. The rate of screw perforation was lower in the combined template group (2 of 42 screws, 0 at grade III and 2 at grade II) than in the conventional group (5 of 38 screws, 2 at grade III and 3 at grade III). In the combined template group, the mean distance between the entry points of the actual and simulated screws was 1.4 ± 0.9 mm, with a mean angle of deviation of 2.1° ± 1.6°. All patients were followed up once every 3 months and were followed for 3 to 12 months.

Conclusion

Using the combined template to assist with the insertion of IS screws delivered good accuracy, less fluoroscopy and shorter operation time, and avoided neurovascular injury as a result of screw malposition.
Comparison of Different Insertion Techniques for Lumbosacral Fixation Improvement: A Finite Element Study
Authors: Han Da‐peng , Wang Jia‐yin
Published: February 2020

Objective

We create a new S1 cortical screw trajectory technique using 3D reconstruction and the finite element (FE) method to provide a more reliable theoretical basis for clinical practices and to advance internal fixation technology for treatment of lumbosacral degenerative diseases.

Methods

This retrospective study included patients (aged from 40 to 70 years) who needed intervertebral fusion surgery between August 2016 and August 2017. Data of patients with lumbosacral lesions was scanned and measured by 64‐row spiral CT, and were then transmitted to the GE‐AW4.3 post‐processing system for 3D reconstruction. The trajectories of the three different screws were simulated by FE software and processed by mimics software to simulate the screw path: traditional PS fixation (Model A); traditional cortical screw (Model B); and new cortical screw (Model C). The CT value of the bone around the screw canal was recorded. Biomechanical effects of the three screws were analyzed and compared.

Results

The displacement of flexion and extension, the vertebral body stress of right torsion, and the cage stress of flexion showed no significant differences among the three models (P> 0.05). The results demonstrated that cortical screws exceeded pedicle screws in stability and pullout force. Models B and C showed higher vertebral displacement in left bending (0.41 and 0.31 mm) and right bending (0.58 and 0.40 mm), lower vertebral body stress on extension (48.37 and 38.92 MPa), left bending (0.76 and 0.74 mm) and right bending (0.50 and 0.53 mm), and higher cage stress on left bending (162.19 and 160.63 MPa), right bending (150.02 and 150.05 MPa), left torsion (158.45 and 146.27 MPa) and right torsion (167.33 and 171.15 MPa) (allP< 0.05) compared to model A. Compared to Model B, Model C had higher displacement of left and right torsion, lower pressure in extension and flexion, and lower stress on cages in extension (P< 0.05).

Conclusion

The new cortical screw insertion method has similar effects to traditional cortical screw fixation. However, it demonstrated advantages in promoting lumbosacral interbody fusion, which protects vessels and nerves.
A Comparative Study of Patients' Subjective Feelings Toward Total Hip Arthroplasty with Patient‐Specific Instruments and Traditional Total Hip Arthroplasty
Authors: Xing Qi‐qi , Zhong Da , Pan Yi‐xiao , An Sen‐bo , Wang Cheng‐gong , Su Shi‐long , Wang Long , Hu Yi‐he
Published: February 2020

Objective

To determine whether differences exist in patients' subjective feelings, daily life, and surgical satisfaction between those who underwent surgery for developmental dysplasia of the hip (DDH) using patient‐specific instruments (PSIs) and those who underwent traditional surgical total hip arthroplasty (THA).

Methods

We selected 30 adult patients with various types of DDH who underwent surgery during 2016–2017 at our hospital. The patients were divided into PSI surgery group and the traditional surgery group. All patients underwent follow‐up, and we collected data on the Harris Hip Score, Oxford University Hip Score (OHS), Forgotten Joint Score (FJS‐12), Visual Analogue Scale (VAS) score, patient satisfaction score, intraoperative surgical time, amount of bleeding and postoperative complications incidence for both groups. We then performed statistical analyses on the data.

Results

The Harris Hip Score, OHS, VAS score, patient satisfaction score, and mean bleeding volume did not differ statistically significantly (t‐tests, P > 0.05). No statistically significant differences were found between surgical groups in the incidence of complication and sub‐trochanteric osteotomy, or in the surgical side (chi‐square tests, P > 0.05). For the experimental group, the FJS‐12 score was 80.0 ± 12.0, and for the control group the score was 68.5 ± 16.1. The operative time of the experimental group was 138.4 ± 32.2 min, while that of the control group was 88.9 ± 26.8 min. The values of these data differed significantly (t‐tests, P < 0.05).

Conclusions

The novel PSI designed by our group has certain advantages for the short‐term subjective feelings of patients after THA, but it may cause prolonged operative times.
Social support from nurses and non‐adherence with directly observed therapy (DOTS) maintenance phase among patients with tuberculosis in Metro Manila, Philippines
Authors: Baniqued Mikee G. , Ballecer Brylle Adrian P. , Ballesteros Blessie D. C. , Balmonte John Ray R. , Bancud Eunacia Maye F. , Rebueno Ma. Carina D. R. , Macindo John Rey B.
Published: February 2020

Objective

To determine the influence of community health nurses' social support on non‐adherence with the maintenance phase of directly observed therapy (DOTS) among patients with tuberculosis (TB).

Design

Prospective‐cohort.

Sample

One hundred purposively selected patients with TB starting with DOTS maintenance phase.

Measurements

Participants answered the robotfoto and Berlin Social Support Scale (BSSS) to assess demographics and social support provided by nurses. Non‐adherence was measured using the attendance record and documented in an abstraction form. Cox proportion‐hazards regression determined the influence of social support provided by nurses to non‐adherence.

Results

With a median adherence of 3 weeks, 15% of the sample was non‐adherent. The hazard of non‐adherence was lower with high perceived emotional support (HR = 0.25, p = .046), perceived instrumental support (HR = 0.20, p = .044), perceived support seeking (HR = 0.27, p = .045), and received emotional support (HR = 0.45, p = .045). High received emotional support increased non‐adherence (HR = 2.65, p = .039).

Conclusion

Social support from nurses influenced DOTS non‐adherence among patients with TB, a critical issue in the development of drug‐resistance. Perceived emotional, instrumental, support seeking and received emotional support decreased the hazard of non‐adherence, while received emotional support increased non‐adherence. This study highlights the need to promote positive perception of instrumental support needs. Appropriate interventions should be provided to promote support‐seeking skills.