bluuebunny/crossref_metadata_2025 huggingface dataset:
Preoperative nutritional status is associated with the prognosis for lung cancer
Authors: Asakawa Ayaka , Ishibashi Hironori , Matsuyama Yusuke , Fujiwara Takeo , Kobayashi Masashi , Okubo Kenichi
Published: May 2021

Background

We investigated whether preoperative nutritional indicators predicted the prognosis for patients with early-stage non-small cell lung cancer.

Methods

Data for stage I or stage IIA non-small cell lung cancer without lymph node metastasis patients who received anatomical lung resection and were followed-up at least five years after surgery ( n = 286) were analyzed. We calculated geriatric nutritional risk index, prognostic nutritional index, controlling nutritional status score, and modified Glasgow prognostic score. Multivariate Cox proportional hazard model adjusting for age, BMI, complication, pathological stage, histology of squamous cell carcinoma, T factor, diffusing capacity for carbon monoxide, surgery and smoking status was fitted to evaluate the association between these nutritional indicators and mortality and recurrence within five years.

Results

After adjusted for covariates other than type of surgery and diffusing capacity for carbon monoxide, controlling nutritional status of ≥3 was significantly associated with mortality (hazard ratio (HR) = 2.68, 95% confidence interval (CI) = 1.02, 7.01). The association remained marginally significant by adjusting for type of surgery and diffusing capacity for carbon monoxide (HR = 2.44, 95% CI = 0.92, 6.45). controlling nutritional status of ≥3 was significantly associated with recurrence (HR = 2.60; 95% CI: 1.20, 5.61) after adjusting for all covariates. Other nutritional indices did not predict the prognosis in multivariate analysis.

Conclusion

Preoperative high controlling nutritional status score was marginally and significantly associated with mortality and recurrence of non-small cell lung cancer patients after lung resection.
Single-stage open repair of severe asymmetric pectus excavatum and mitral valve replacement in connective tissue disease
Authors: Pau Cheong Ping , Chong Kee Soon , Yakub Mohd Azhari , Khalil Alizan Abdul
Published: May 2021

We present a 14-year-old boy with Loey–Dietz syndrome with severe mitral regurgitation, pectus excavatum and scoliosis. The Haller index was 25. The heart was displaced into the left hemithorax. The right inferior pulmonary vein was very close to the sternum and vertebral body. Single-stage surgery was performed. An osseo-myo-cutaneous pedicled flap was created by sterno-manubrial junction dislocation and rib resection with bilateral internal mammary arteries supplying the flap. Cardiopulmonary bypass and mitral valve replacement was performed. The defect was bridged with three straight plates. The flap was laid on top and anchored. Early outcome at three months was good.
Theory of Mind and Executive Functions in Children With Attention Deficit Hyperactivity Disorder and Specific Learning Disorder
Authors: Singh Jeetinder , Arun Priti , Bajaj Manoj Kumar
Published: May 2021

Background:

Children with attention deficit hyperactivity disorder (ADHD) and specific learning disorder (SLD) generally have difficulties in social cognition and display impairments involving emotion and face and prosody perception and reduced empathy, indicating theory of mind (ToM) impairment. The objective of this work was to assess and compare the executive functions and ToM in children with ADHD and SLD.

Methods:

Twenty children diagnosed with ADHD, 20 children diagnosed with SLD, and 20 normal healthy children in the age group of 7 to 15 years, IQ between 90 and 110 (average intelligence) of any gender, were recruited. All participants were assessed using neuropsychological tests of executive functions and ToM.

Results:

Significant differences were found on early ToM, basic ToM, advanced ToM, and mean scores on ToM inventory between ADHD and control groups (P ≤ 0.001). Similarly, significant differences were found between ADHD and SLD groups on early, basic, advanced, and mean ToM inventory scores (P < 0.001). No significant differences were found between the control and SLD groups on ToM measures. Further, in the ToM task battery, on task D and task G, significant differences were found between the SLD and control groups at P = 0.04 and P = 0.03 respectively. Differences between ADHD and control groups were also statistically significant on task D and task G at P < 0.001 and P = 0.033. Executive functions in the form of set-shifting and response inhibition were significantly poor in the ADHD group and SLD group at P < 0.001 and P < 0.05 levels, respectively, when compared to the control group.

Conclusion:

Children with ADHD displayed more deficits in the ToM inventory and tasks than children having SLD and healthy children of their similar age and educational background. Executive functions (set-shifting and response inhibition) were poorer in children with ADHD and children with SLD when compared to healthy children of their similar age and educational background.
Hindrances to recognition in Finnish music schools
Authors: Elmgren Heidi
Published: May 2021

This article examines recognition relations between students and teachers in Finnish music schools. The research is based on written texts by music school students. The texts are analysed for difficulties in recognition relations, namely, hindrances to recognition in music schools. In the texts, some of the respondents describe situations that can be analysed as hindrances to recognition. The author analyses four different types of recognition-related problems in the data, the main issue being a tension between caring for people (respecting them) and promoting musical values (emphasising esteem). In addition to discerning problems, the article attempts to alleviate this tension. This might be achieved if different kinds of excellence, rather than just one, were to be developed in music schools. Students’ different abilities and motivations might then have a chance to emerge. Caring for people in the context of studying music would mean helping them to find the musical values they can and want to promote.
Assessing the Nexus Between Employer Branding and Employee Retention: Moderating Role of Organizational Identification
Authors: Khan Nawab Ali , Bharadwaj Shubhangi , Khatoon Aaisha , Jamal Mohd Tariq
Published: May 2021

The purpose of this study is to examine the relationship between employer branding and employee retention. Moreover, this article investigates the moderating effect exerted by organizational identification in the relationship between employer branding and employee retention. The research is cross-sectional with the data gathered from Indian IT employees through a self-administered questionnaire. The data were analysed using regression and PROCESS Macro. The findings provide empirical insights on how employer branding helps in transferring to retaining employees. Also, the moderation analysis highlights the importance of organizational identification in ensuring employees’ long-term association with an organization. The results explicate the criticality of a positive identity in strengthening the effect of employer branding on employee retention. Despite numerous studies, the literature lags in understanding the role of organizational identification as a catalyst in the relationship between employer branding and employee retention.
Q-methodology identifies distinctive viewpoints of the facilitators and barriers to six-month exclusive breastfeeding in Northeast Thailand
Authors: Thepha Thiwawan , Marais Debbie , Bell Jacqueline , Muangpin Somjit
Published: May 2021

Background:

The six-month exclusive breastfeeding (EBF) rate almost halved between 2009 and 2013 in Northeast Thailand for no clear reason. Specific facilitators and barriers to six-month EBF have been identified for Thailand, but mothers’ views on these factors to continuing EBF breastfeeding until six months have not been explored in this region.

Aim:

This study aimed to prioritize mothers’ views on the identified facilitators and barriers of continuing six-month exclusive breastfeeding. Methods: Q-methodology was applied. This research was conducted at Well Baby Out-Patient Department of Khonkaen Hospital, Numphong Hospital and a private hospital. Thirty-four mothers, who had recently delivered infants aged between four and six months, were breastfeeding/had breastfed, were 20 to 40 years old, participated. Demographic data were analysed descriptively, and Q-method analysis was conducted using the PQ Method software 2.35.

Results:

There was consensus that having knowledge about the advantages of EBF was the most important facilitator of six-month EBF, and ‘not having any other responsibilities besides caring for her infant’ was the least important facilitator of six-month EBF. Three viewpoints emerged identifying different groups/clusters of mothers, namely, (1) caring for self, (2) requiring support and (3) breastfeeding knowledge. Conclusions: Despite some consensus among participants, three distinct viewpoints emerged regarding which facilitators and barriers were important to mothers. It is clear that a programme to improve the six-month EBF rate in Northeast Thailand would need to incorporate interventions or activities that address the different viewpoints identified.
Low serum lycopene, and adequate α-tocopherol levels in patients with psoriasis: A cross-sectional study
Authors: Rocha Ana C L , Bortoletto Maria C , da Costa Andréia C , Oyafuso Luiza K M , Sanudo Adriana , Tomita Luciana Y
Published: May 2021

Background:

Psoriasis is a chronic, immune-mediated skin disease. It affects skin and joints, characterized by abnormal hyperproliferation of keratinocytes. The worldwide prevalence of psoriasis ranges from 2% to 4%. Environmental factors as smoking, alcohol consumption obesity can also work as triggers. During the inflammatory process, there is an exacerbated formation of free radicals and antioxidants are required to maintain redox balance.

Aim:

Assess antioxidant profiles.

Methods:

A cross-sectional study was conducted between August/2012 and March/2014. Sociodemographic, lifestyle, and biochemical measurements, dietary intake, serum lycopene and α-tocopherol, psoriasis severity according to Psoriasis Area and Severity Index were obtained. Comparisons between serum lycopene and α-tocopherol distributions according to variables were conducted using a one-way analysis of variance. Multiple linear regression was used to investigate factors associated with serum antioxidants.

Results:

81 participants (56% female, 62% non-white), 34% without psoriatic lesions, 51% diagnosed with mild psoriasis, and 15% with moderate psoriasis. Median (IQR) age of 54 (41, 62) years, 10 (4, 11) years of education, 17% smokers, 46% overweight and 25% obesity. In total, 72% did not reach the daily recommendation of fruit and vegetable intake. Serum lycopene and α-tocopherol were 0.2 (0.1–0.3) µmol/L and 22.5 (18.5–25.6) µmol/L, respectively. Only 14% presented adequate concentration of lycopene, but adequate α-tocopherol level was observed among 88%.

Conclusions:

Patients reported a diet low in vegetables and fruits and rich in ultra-processed foods and fatty acids. Adequate circulating α-tocopherol but low serum lycopene, was observed among patients. A linear trend was observed for lycopene according to the severity of psoriasis.
Construct validity and reliability of the scales for rating the behavioral characteristics of superior students among a sample of elementary students in Qatar
Authors: Jaffal Abeer F , Abu-Hilal Maher , Al-Naimi Mariam N
Published: May 2021

This study tested the construct validity and reliability of the Scales for Rating the Behavioral Characteristics of Superior Students (SRBCSS) with the purpose to have a valid and reliable measure to identify the gifted individuals. The sample consisted of 176 superior students from grades five and six in Qatar. The results revealed a high consistency in rating the students by their teachers. Confirmatory factor analysis revealed that the items clustered around the 12 subscales. Also, the indicators in form of parcels produced 12 factors and two second-order factors that represent learning/personal and verbal/artistic characteristics. The results showed that those major characteristics are highly correlated and provided support to the convergent validity of the subscales. The implication of these results indicate that the subscales can be used collectively or separately to assess students’ characteristics of superiority in the Arab milieu.
The promiscuous public? Exploring public opinion and why it matters to political actors
Authors: Soo Nikki , Anderson Alexandra , Heywood-Heath Charlie
Published: May 2021

Political actors often cite public opinion to provide support for public policy decisions. This process is made more challenging with diverse demands and perspectives of the public. How then do political actors decide which opinion gets heard? In this article, we go beyond the assumption that the practice of political representation is indistinguishable across various levels of political actors and ask, why do political actors value public opinion and how does it then influence the way in which they apply this information? Developing a multi-level approach, we employ semi-structured interviews with a wide range of political actors, including politicians, pollsters, and community activists. We find that motivations for defining and applying public opinion differs according to the hierarchy of political actors, demonstrating that the relationship between public and political actors is more nuanced and complex than what is often depicted. In particular, we find that minority views play just an important view in policymaking.
The domain expert perspective: A qualitative study into the views expressed in a standard-setting exercise on a language for specific purposes (LSP) test for health professionals
Authors: Davidson Simon
Published: May 2021

This paper investigates what matters to medical domain experts when setting standards on a language for specific purposes (LSP) English proficiency test: the Occupational English Test’s (OET) writing sub-test. The study explores what standard-setting participants value when making performance judgements about test candidates’ writing responses, and the extent to which their decisions are language-based and align with the OET writing sub-test criteria. Qualitative data is a relatively under-utilized component of standard setting and this type of commentary was garnered to gain a better understanding of the basis for performance decisions. Eighteen doctors were recruited for standard-setting workshops. To gain further insight, verbal reports in the form of a think-aloud protocol (TAP) were employed with five of the 18 participants. The doctors’ comments were thematically coded and the analysis showed that participants’ standard-setting judgements often aligned with the OET writing sub-test criteria. An overarching theme, ‘Audience Recognition,’ was also identified as valuable to participants. A minority of decisions were swayed by features outside the OET’s communicative construct (e.g., clinical competency). Yet, overall, findings indicated that domain experts were undeniably focused on textual features associated with what the test is designed to assess and their views were vitally important in the standard-setting process.
The hemodynamic effects of warm versus room-temperature crystalloid fluid bolus therapy in post-cardiac surgery patients
Authors: Bitker Laurent , Cutuli Salvatore L , Yanase Fumitaka , Wilson Anthony , Osawa Eduardo A , Lucchetta Luca , Cioccari Luca , Canet Emmanuel , Glassford Neil , Eastwood Glenn M , Bellomo Rinaldo
Published: May 2021

Introduction:

The contribution of fluid temperature to the effect of crystalloid fluid bolus therapy (FBT) in post-cardiac surgery patients is unknown. We evaluated the hemodynamic effects of FBT with fluid warmed to 40°C (warm FBT) versus room-temperature fluid.

Methods:

In this single centre prospective before-and-after study, we evaluated the effects of 500 ml of warm versus room-temperature compound sodium lactate administered over <30 minutes, in 50 cardiac surgery patients admitted to ICU. We recorded hemodynamics continuous before and for 30 minutes after the first FBT. We defined CI responsiveness (CI-R) as an CI increase >15% of baseline immediately after FBT and effect dissipation if the CI returned to <5% of baseline and MAP responsiveness as >10% increase and dissipation as return to <3 mmHg of baseline.

Results:

Hypotension (56%) and low CI (40%) typically triggered FBT. Temperature decreased >0.3°C in 13 (52%) patients after room-temperature FBT versus 0 (0%) after warm FBT (p < 0.01). CI and MAP responsiveness was similar (16 [64%] versus 11 [44%], p = 0.15 and 15 [60%] versus 17 [68%], p = 0.77, respectively). Among CI responders, CI increased more with room-temperature FBT (+0.6 [IQR, 0.5–1.1] versus +0.5 [IQR, 0.4–0.6] L/min/m2, p = 0.01). However, dissipation was more common after room-temperature versus warm FBT (9/16 [56%] versus 1/11 [9%], p = 0.02).

Conclusion:

In postoperative cardiac surgery patients, warm FBT preserved core temperature and induced smaller but more sustained CI increases among responders. Fluid temperature appears to impact both core temperature and the duration of CI response.
Systemic immune inflammation index: a novel predictor for coronary collateral circulation
Authors: Kelesoglu Saban , Yilmaz Yucel , Elcık Deniz , Kalay Nihat
Published: May 2021

Aim:

Recently, a new inflammatory and prognostic marker has emerged called as Systemic Immune Inflammation Index (SII). In the current study, we searched the relation between SII and Coronary Collateral Circulation (CCC) formation in stable Coronary Artery Disease (CAD).

Materials & methods:

449 patients with stable CAD who underwent coronary angiography and documented coronary stenosis of 95% or more in at least one major coronary vessel were included in the study. The study patients were divided into two groups according to the Rentrop score as well CCC (Rentrop 2–3) and bad CCC (Rentrop 0–1). Blood samples for SII and other laboratory parameters were gathered from all the patients on admission. The SII score was formulized as platelet × neutrophil/lymphocyte counts.

Results:

Patients, who had developed bad CCC had a higher C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), platelets/lymphocyte ratio (PLR) and SII levels compared to those who had developed well CCC (p < 0.001, for all). Multivariate logistic regression analysis showed that high levels of SII was an independent predictor of bad CCC (OR: 1.005, 95% confidence interval (CI): 1.003–1.006, p < 0.001) together with dyslipidemia, high levels of CRP and NLR. In Receiver Operator Characteristic curve (ROC) analysis, the optimal cutoff value of SII to predict poor CCC was found to be 729.8, with 78.4% sensitivity and 74.6% specificity (area under ROC curve = 0.833 (95% CI: 0.777–0.889, p < 0.001).

Conclusion:

We have demonstrated that SII, a novel cardiovascular risk marker, might be used as one of the independent predictors of CCC development.
Ecosocioeconomies and local development: Experiences in an urban farmers market in the Brazilian Amazon
Authors: Procopiuck Mario , Sousa Roberta Maria de Moura , Sampaio Carlos Alberto Cioce , Procopiuck Ana Paula Vaz
Published: May 2021

Urban markets are a complex and unique ecosocioeconomic phenomenon, constituting micro-societies with their own social, political, and economic rationales which provide alternatives to the prevailing logic. This article analyzes the farmers market in the Amazonian city of Castanhal, Pará, Brazil from an ecosocioeconomic point of view, and is based on documentary analysis and oral statements taken from vendors. The findings show that for over three decades, this urban farmers market has functioned as a micro-society based on the emerging rationalities which result from everyday internal and external relationships; the market is a significant political and social actor within the network of urban governance and the local rural production chain. The vendors state that the market works in concert with the rules of local government are economically self-sufficient, have operational autonomy and socially constructed legitimacy, and that ecosocioeconomic relationships emerge from satisfiers which are located between the needs of work and leisure. In conclusion, this urban farmers market is socially and economically important for vendors, producers, and local residents, and its operation is linked to environmental sustainability criteria based on appropriate technologies and local knowledge.
Manufacturing space for inclusive innovation? A study of makerspaces in southern Ontario
Authors: Vinodrai Tara , Nader Brenton , Zavarella Christian
Published: May 2021

The popular discourse on making and makerspaces is laden with optimistic narratives suggesting that makerspaces act as key institutions that support more inclusive and sustainable forms of local economic development. Despite their popularity, we know little about how makerspaces actually support entrepreneurship and innovation and even less about how they advance the goals of environmental sustainability and social inclusion, particularly in the Canadian context. In an effort to redress these gaps, this paper uses a unique database of makerspaces, complemented with findings from in-depth case studies, to examine the practices of makerspaces in southern Ontario (Canada). Our study finds that while makerspaces offer access to technologies and basic skills training, we find limited evidence that makerspaces generate the promised economic or social outcomes so often attributed to them. Moreover, we find very limited evidence that makerspaces actively seek to be socially inclusive in their membership and programming or encourage environmentally sustainable practices. In other words, the potential of makerspaces, in their current form, to contribute to more inclusive and sustainable forms of local economic and community development is not yet fully realized.
Factors facilitating positive outcomes in community-based end-of-life care: A cross-sectional qualitative study of patients and family caregivers
Authors: Jiao Keyuan , Chow Amy YM , Wang Juan , Chan Iris IK
Published: May 2021

Background:

Delivery of community-based end-of-life care for patients and family members has been recognized as an important public health care approach. Despite differences in different healthcare settings and the significance of a person-centered approach, little research has investigated facilitators of community-based end-of-life care from the perspective of service recipients. In particular, there has been limited exploration of strategies to ensure positive outcomes at an operational level.

Aim:

To explore factors facilitating positive end-of-life care provision in community-based settings and how these are achieved in practice, from the perspectives of patients and family caregivers.

Design:

A qualitative cross-sectional descriptive study was undertaken through semi-structured interviews with patients and family caregivers subjected to thematic analysis.

Setting/participants:

Ten patients and 16 family caregivers were recruited from an end-of-life community care program provided by four non-governmental organizations in Hong Kong.

Results:

Seven core themes were identified: positive emotions about the relationship, positive appraisals of the relationship, care through inquiring about recipients’ circumstances, instrumentality of care (i.e. information, coaching on care, practical help, psychological support, multiple activities), comprehensiveness of care (i.e. diversity, post-death care, family-level wellbeing), structure of care (i.e. timely follow-up, well-developed system), and qualities of workers.

Conclusions:

Improvement in service quality might be achieved through alternating the perceptions or emotional reactions of care recipients toward care providers and increased use of sensitive inquiry. Comprehensive care and positive outcomes might be facilitated by addressing the dualities of care by providing diverse choices in pre-death and post-death care.
CSF lipocalin-2 increases early in subarachnoid hemorrhage are associated with neuroinflammation and unfavorable outcome
Authors: Yu Fang , Saand Aisha , Xing Changhong , Lee Jong Woo , Hsu Liangge , Palmer Octavia P , Jackson Vanessa , Tang Lu , Ning MingMing , Du Rose , Kochanek Patrick M , Lo Eng H , Chou Sherry H-Y
Published: May 2021

Lipocalin-2 mediates neuro-inflammation and iron homeostasis in vascular injuries of the central nervous system (CNS) and is upregulated in extra-CNS systemic inflammation. We postulate that cerebrospinal fluid (CSF) and blood lipocalin-2 levels are associated with markers of inflammation and functional outcome in subarachnoid hemorrhage (SAH). We prospectively enrolled 67 SAH subjects, serially measured CSF and plasma lipocalin-2, matrix metallopeptidase 9 (MMP-9), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) on post-SAH days 1-5 and assessed outcome by modified Rankin Scale (mRS) every 3 months. Unfavorable outcome is defined as mRS > 2. Twenty non-SAH patients undergoing lumbar drain trial were enrolled as controls. Lipocalin-2 was detectable in the CSF and significantly higher in SAH compared to controls (p < 0.0001). Higher CSF LCN2 throughout post-SAH days 1-5 was associated with unfavorable outcome at 3 (p = 0.0031) and 6 months (p = 0.014). Specifically, higher CSF lipocalin-2 on post-SAH days 3 (p = 0.036) and 5 (p = 0.016) were associated with unfavorable 3-month outcome. CSF lipocalin-2 levels positively correlated with CSF IL-6, TNF-α and MMP-9 levels. Higher plasma lipocalin-2 levels over time were associated with worse 6-month outcome. Additional studies are required to understand the role of lipocalin-2 in SAH and to validate CSF lipocalin-2 as a potential biomarker for SAH outcome.
Impaired cerebral vascular and metabolic responses to parametric N-back tasks in subjective cognitive decline
Authors: Zhang Yaoyu , Du Wenying , Yin Yayan , Li Huanjie , Liu Zhaowei , Yang Yang , Han Ying , Gao Jia-Hong
Published: May 2021

Previous studies reported abnormally increased and/or decreased blood oxygen level-dependent (BOLD) activations during functional tasks in subjective cognitive decline (SCD). The neurophysiological basis underlying these functional aberrations remains debated. This study aims to investigate vascular and metabolic responses and their dependence on cognitive processing loads during functional tasks in SCD. Twenty-one SCD and 18 control subjects performed parametric N-back working-memory tasks during MRI scans. Task-evoked percentage changes (denoted as δ) in cerebral blood volume (δCBV), cerebral blood flow (δCBF), BOLD signal (δBOLD) and cerebral metabolic rate of oxygen (δCMRO2) were evaluated. In the frontal lobe, trends of decreased δCBV, δCBF and δCMRO2 and increased δBOLD were observed in SCD compared with control subjects under lower loads, and these trends increased to significant differences under the 3-back load. δCBF was significantly correlated with δCMRO2 in controls, but not in SCD subjects. As N-back loads increased, the differences between SCD and control subjects in δCBF and δCMRO2 tended to enlarge. In the parietal lobe, no significant between-group difference was observed. Our findings suggested that impaired vascular and metabolic responses to functional tasks occurred in the frontal lobe of SCD, which contributed to unusual BOLD hyperactivation and was modulated by cognitive processing loads.
Wiring and plumbing: Oligodendrocyte precursors and angiogenesis in the oligovascular niche
Authors: Arai Ken , Lo Eng H
Published: May 2021

For efficient stroke recovery, the entire neurovascular unit must be repaired. A recent study underscores this concept by highlighting the importance of cellular crosstalk for white mater remodeling. In developing brains and in brains injured by hypoxia, interactions between oligodendrocyte precursors and endothelium play an essential role for physiological and compensatory angiogenesis. Further studies are warranted to build on these emerging findings in the oligovascular niche in order to identify novel therapeutic targets for stroke and other CNS diseases.
Addressing Conflicts of Interest in Health and Medicine: Current Evidence and Implications for Patient Decision Aid Development
Authors: Thompson Rachel , Paskins Zoe , Main Barry G. , Pope Thaddeus Mason , Chan Evelyn C. Y. , Moulton Ben W. , Barry Michael J. , Braddock Clarence H.
Published: May 2021

Background

More stringent policies for addressing conflicts of interest have been implemented around the world in recent years. Considering the value of revisiting conflict of interest quality standards set by the International Patient Decision Aid Standards (IPDAS) Collaboration, we sought to review evidence relevant to 2 questions: 1) What are the effects of different strategies for managing conflicts of interest? and 2) What are patients’ perspectives on conflicts of interest?

Methods

We conducted a narrative review of English-language articles and abstracts from 2010 to 2019 that reported relevant quantitative or qualitative research.

Results

Of 1743 articles and 118 abstracts identified, 41 articles and 2 abstracts were included. Most evidence on the effects of conflict of interest management strategies pertained only to subsequent compliance with the management strategy. This evidence highlighted substantial noncompliance with prevailing requirements. Evidence on patient perspectives on conflicts of interest offered several insights, including the existence of diverse views on the acceptability of conflicts of interest, the salience of conflict of interest type and monetary value to patients, and the possibility that conflict of interest disclosure could have unintended effects. We identified no published research on the effects of IPDAS Collaboration conflict of interest quality standards on patient decision making or outcomes.

Limitations

Because we did not conduct a systematic review, we may have missed some evidence relevant to our review questions. In addition, our team did not include patient partners.

Conclusions

The findings of this review have implications for the management of conflicts of interest not only in patient decision aid development but also in clinical practice guideline development, health and medical research reporting, and health care delivery.
Are We Improving? Update and Critical Appraisal of the Reporting of Decision Process and Quality Measures in Trials Evaluating Patient Decision Aids
Authors: Trenaman Logan , Jansen Jesse , Blumenthal-Barby Jennifer , Körner Mirjam , Lally Joanne , Matlock Daniel , Perestelo-Perez Lilisbeth , Ropka Mary , Stirling Christine , Valentine Kathrene , Vo Ha , Wills Celia E. , Thomson Richard , Sepucha Karen
Published: May 2021

Background

In 2014, a systematic review found large gaps in the quality of reporting of measures used in 86 published trials evaluating the effectiveness of patient decision aids (PtDAs). The purpose of this study was to update that review.

Methods

We examined measures of decision making used in 49 randomized controlled trials included in the 2014 and 2017 Cochrane Collaboration systematic review of PtDAs. Data on development of the measures, reliability, validity, responsiveness, precision, interpretability, feasibility, and acceptability were independently abstracted by 2 paired reviewers.

Results

Information from 273 measures was abstracted, and 109 of these covered the core domains of decision processes ( n = 55) and decision quality including informed choice/knowledge ( n = 48) and values-choice concordance ( n = 12). Very few studies reported data on the performance and clinical sensibility of measures, with reliability (23%) and validity (6%) being the most common. Studies using new measures were less likely to include information about their psychometric performance compared with previously published measures.

Limitations

The review was limited to reporting of measures in studies included in the Cochrane review and did not consult prior publications.

Conclusion

There continues to be very little reported about the development or performance of measures used to evaluate the effectiveness of PtDAs in published trials. Minimum reporting standards have been published, and efforts to require investigators to use them are needed.
Continuing Costs: The Impact of Continuing Resolutions on Federal Contracting
Authors: Kasdin Stuart Roy
Published: May 2021

Are there unintended consequences from Congress’ use of continuing resolutions (CRs), which are designed as short-term funding to bridge the period before regular appropriations are completed? During a CR, agencies are restricted in their ability to issue contracts, and after the CR ends, agencies may rush to complete their contracting before the fiscal year ends. To expedite contracting, we hypothesize that CRs encourage agencies to use sole-source contracts, rather than on a competitive basis, as well as to use cost-reimbursement contract designs, rather than fixed-price contracts. The Obama Administration found that these contracting practices result in “wasted taxpayer resources, poor contractor performance, and inadequate accountability for results . . .” We anticipate that the longer a CR is in effect, the greater the incentive to use sole-source contracts and cost-reimbursement contract designs. There are implications both for future attempts at contracting reforms, as well as for efforts to establish automatic CRs.
Bob Lusch: Mentor and Friend
Authors: O’Brien Matthew
Published: May 2021

I recall the importance of Robert F. Lusch to both my professional and personal life.
Safety and efficacy of right portal vein embolization in patients with prior left lateral liver resection
Authors: Van den Bosch Vincent , Pedersoli Federico , Keil Sebastian , Neumann Ulf P , Kuhl Christiane K , Bruners Philipp , Zimmermann Markus
Published: May 2021

Background

In patients with bilobar metastatic liver disease, surgical clearance of both liver lobes may be achieved through multiple-stage liver resections. For patients with extensive disease, a major two-staged hepatectomy consisting of resection of liver segments II and III before right-sided portal vein embolization (PVE) and resection of segments V–VIII may be performed, leaving only segments IV ± I as the liver remnant.

Purpose

To describe the outcome following right-sided PVE after prior complete resection of liver segments II and III.

Material and Methods

In this retrospective study, 15 patients (mean age = 60.4 ± 9.3 years) with liver metastases from colorectal cancer (n = 14) and uveal melanoma (n = 1) who were scheduled to undergo a major two-stage hepatectomy, were included. Total liver volume (TLV) and volume of the future liver remnant (FLR) were measured on pre- and postinterventional computed tomography (CT) scans, and standardized FLR volumes (ratio FLR/TLV) were calculated. Patient data were retrospectively analyzed regarding peri- and postinterventional complications, with special emphasis on liver function tests.

Results

The mean standardized post-PVE FLR volume was 26.9% ± 6.4% and no patient developed hepatic insufficiency after the PVE. Based on FLR hypertrophy and liver function tests, all but one patient were considered eligible for the subsequent right-sided hepatectomy. However, due to local tumor progression, only 9/15 patients eventually proceeded to the second stage of surgery.  

Conclusion

Right-sided PVE was safe and efficacious in this cohort of patients who had previously undergone a complete resection of liver segments II and III as part of a major staged hepatectomy pathway leaving only segments IV(±I) as the FLR.
Hepatobiliary phase images of gadoxetic acid-enhanced MRI may improve accuracy of predicting the size of hepatocellular carcinoma at pathology
Authors: Dong San-Yuan , Yang Yu-Tao , Wang Wen-Tao , Zhu Shuo , Sun Wei , Zeng Meng-Su , Rao Sheng-Xiang
Published: May 2021

Background

Gadoxetic acid-enhanced magnetic resonance imaging (MRI) has been widely used in clinical practice. However, scientific evidence is lacking for recommending a particular sequence for measuring tumor size.

Purpose

To retrospectively compare the size of hepatocellular carcinoma (HCC) measured on different gadoxetic acid-enhanced MRI sequences using pathology as a reference.

Material and Methods

A total of 217 patients with single HCC who underwent gadoxetic acid-enhanced MRI before surgery were included. The size of the HCC was measured by two abdominal radiologists independently on the following sequences: T1-weighted; T2-weighted; b-500 diffusion-weighted imaging (DWI); and arterial, portal venous, transitional, and hepatobiliary phases. Tumor size measured on MRI was compared with pathological size by using Pearson correlation coefficient, independent-sample t test, and Bland–Altman plot. Agreement between two readers was evaluated with intraclass correlation coefficient (ICC).

Results

Correlation between the MR images and pathology was high for both readers (0.899–0.955). Absolute error between MRI and pathologic assessment was lowest on hepatobiliary phase images for both readers (reader 1, 2.8±4.2 mm; reader 2, 3.2±3.4 mm) and highest on arterial phase images for reader 1 (4.9±4.4 mm) and DWI phase images for reader 2 (5.1±4.9 mm). Absolute errors were significantly different for hepatobiliary phase compared with other sequences for both readers (reader 1, P≤0.012; reader 2, P≤0.037). Inter-reader agreements for all sequence measurements were strong (0.971–0.997).

Conclusion

The performance of gadoxetic acid-enhanced MRI sequences varied with HCC size, and the hepatobiliary phase may be optimal among these sequences.
Analysis of risk factors for different subtypes of acute coronary syndrome
Authors: Zhang Lei , Hailati Juledezi , Ma Xiaoyun , Liu Jiangping , Liu Zhiqiang , Yang Yuchun , He Pengyi , Wulasihan Muhuyati
Published: May 2021

Aims

To investigate the different risk factors among different subtypes of patients with acute coronary syndrome (ACS).

Methods

A total of 296 patients who had ACS were retrospectively enrolled. Blood and echocardiographic indices were assessed within 24 hours after admission. Differences in risk factors and Gensini scores of coronary lesions among three groups were analyzed.

Results

Univariate analysis of risk factors for ACS subtypes showed that age, and levels of fasting plasma glucose, amino-terminal pro-brain natriuretic peptide, and creatine kinase isoenzyme were significantly higher in patients with non-ST-segment elevation myocardial infarction (NSTEMI) than in those with unstable angina pectoris (UAP). Logistic multivariate regression analysis showed that amino-terminal pro-brain natriuretic peptide and the left ventricular ejection fraction (LVEF) were related to ACS subtypes. The left ventricular end-diastolic diameter was an independent risk factor for UAP and ST-segment elevation myocardial infarction (STEMI) subtypes. The severity of coronary stenosis was significantly higher in NSTEMI and STEMI than in UAP. Gensini scores in the STEMI group were positively correlated with D-dimer levels (r = 0.429) and negatively correlated with the LVEF (r = −0.602).

Conclusion

Different subtypes of ACS have different risk factors. Our findings may have important guiding significance for ACS subtype risk assessment and clinical treatment.
Identification of RORγ as a favorable biomarker for colon cancer
Authors: Pan Xiaofei , Li Bao , Zhang Gan , Gong Yuyong , Liu Rui , Chen Benxin , Li Yang
Published: May 2021

Objective

To evaluate the expression of retinoid-related orphan receptor gamma (RORγ) and its potential role in the prognosis of colon cancer.

Methods

The Cancer Genome Atlas and GSE117606 were used to evaluate to RORγ levels in colon cancer, and real-time quantitative polymerase chain reaction was applied for validation. UALCAN and MEXPRESS were used to analyze the associations of RORγ expression with clinical parameters. The survival analysis was conducted in GEPIA.

Results

RORγ expression was significantly lower in colon tumors than in adjacent normal mucosa tissues. RORγ expression was significantly associated with tumor stage, lymph node metastasis, and liver metastasis. The area under the curve for diagnosis was 0.71. Decreased RORγ expression was positively correlated with the incidence of lymphatic invasion, microsatellite instability, the presence of residual tumor, venous invasion, and copy number variation. Overall survival was longer in patients with higher RORγ expression, especially those with microsatellite instability-high features. Methylation analysis revealed that hypermethylation of the RORγ promoter was associated with the colon cancer stage.

Conclusions

RORγ downregulation could be a potential biomarker for colon cancer, especially for predicting prognosis. Decreased RORγ expression in colon tumor may be associated with promoter hypermethylation.
Product of driving pressure and respiratory rate for predicting weaning outcomes
Authors: Gong Ju , Zhang Bibo , Huang Xiaowen , Li Bin , Huang Jian
Published: May 2021

Objective

Clinicians cannot precisely determine the time for withdrawal of ventilation. We aimed to evaluate the performance of driving pressure (DP)×respiratory rate (RR) to predict the outcome of weaning.

Methods

Plateau pressure (Pplat) and total positive end-expiratory pressure (PEEPtot) were measured during mechanical ventilation with brief deep sedation and on volume-controlled mechanical ventilation with a tidal volume of 6 mL/kg and a PEEP of 0 cmH2O. Pplat and PEEPtot were measured by patients holding their breath for 2 s after inhalation and exhalation, respectively. DP was determined as Pplat minus PEEPtot. The rapid shallow breathing index was measured from the ventilator. The highest RR was recorded within 3 minutes during a spontaneous breathing trial. Patients who tolerated a spontaneous breathing trial for 1 hour were extubated.

Results

Among the 105 patients studied, 44 failed weaning. During ventilation withdrawal, DP×RR was 136.7±35.2 cmH2O breaths/minute in the success group and 230.2±52.2 cmH2O breaths/minute in the failure group. A DP×RR index >170.8 cmH2O breaths/minute had a sensitivity of 93.2% and specificity of 88.5% to predict failure of weaning.

Conclusions

Measurement of DP×RR during withdrawal of ventilation may help predict the weaning outcome. A high DP×RR increases the likelihood of weaning failure. Statement: This manuscript was previously posted as a preprint on Research Square with the following link: https://www.researchsquare.com/article/rs-15065/v3 and DOI: 10.21203/rs.2.24506/v3
Refractory pleural effusion as a rare complication of pulmonary vascular stenosis induced by fibrosing mediastinitis: a case report and literature review
Authors: Yang Suqiao , Wang Jianfeng , Li Jifeng , Huang Kewu , Yang Yuanhua
Published: May 2021

Fibrosing mediastinitis (FM) is a progressive, life-threatening disease characterized by extrinsic compression of mediastinal bronchovascular structures, and the clinical manifestations largely depend upon the affected structures. Pleural effusion is rarely reported in patients with FM. We herein describe a 70-year-old man who presented with recurrent breathlessness and refractory left pleural effusion. He was misdiagnosed with and treated for tuberculous pleurisy for several months. Thoracentesis revealed a transudative pleural effusion, and a contrast-enhanced computed tomography scan of the thorax showed an extensive mediastinal soft tissue mass consistent with FM. Pulmonary angiography demonstrated pulmonary artery stenosis on the right side and pulmonary vein stenosis mainly on the left side. After measurement of the pulmonary arterial pressure by right heart catheterization, the patient was diagnosed with pulmonary hypertension associated with FM. He underwent balloon angioplasty and stent implantation of the stenosed pulmonary vessels, which led to long-term improvement in his breathlessness and pleural effusion. Our systematic review of the literature highlights that pleural effusion can be an uncommon complication of FM and requires careful etiological differentiation.
Chest computed tomography imaging features in patients with coronavirus disease 2019 (COVID-19)
Authors: Darwish Hoda Salah , Habash Mohamed Yasser , Habash Waleed Yasser
Published: May 2021

Objective

To analyze computed tomography (CT) features of symptomatic patients with coronavirus disease 2019 (COVID-19).

Methods

Ninety-five symptomatic patients with COVID-19 confirmed by reverse-transcription polymerase chain reaction from 1 May to 14 July 2020 were retrospectively enrolled. Follow-up CT findings and their distributions were analyzed and compared from symptom onset to late-stage disease.

Results

Among all patients, 15.8% had unilateral lung disease and 84.2% had bilateral disease with slight right lower lobe predilection (47.4%). Regarding lesion density, 49.4% of patients had pure ground glass opacity (GGO) and 50.5% had GGO with consolidation. Typical early-stage patterns were bilateral lesions in 73.6% of patients, diffuse lesions (41.0%), and GGO (65.2%). Pleural effusion occurred in 13.6% and mediastinal lymphadenopathy in 11.5%. During intermediate-stage disease, 47.4% of patients showed GGO as the disease progressed; however, consolidation was the predominant finding (52.6%).

Conclusion

COVID-19 pneumonia manifested on lung CT scans with bilateral, peripheral, and right lower lobe predominance and was characterized by diffuse bilateral GGO progressing to or coexisting with consolidation within 1 to 3 weeks. The most frequent CT lesion in the early, intermediate, and late phases was GGO. Consolidation appeared in the intermediate phase and gradually increased, ending with reticular and lung fibrosis-like patterns.
Establishment of a prognostic model based on the Sequential Organ Failure Assessment score for patients with first-time acute myocardial infarction
Authors: Zheng Shuai , Lyu Jun , Han Didi , Xu Fengshuo , Li Chengzhuo , Yang Rui , Yao Lu , Wu Yuntao , Tian Guoxiang
Published: May 2021

Objective

This study aimed to identify the prognostic factors of patients with first-time acute myocardial infarction (AMI) and to establish a nomogram for prognostic modeling.

Methods

We studied 985 patients with first-time AMI using data from the Multi-parameter Intelligent Monitoring for Intensive Care database and extracted their demographic data. Cox proportional hazards regression was used to examine outcome-related variables. We also tested a new predictive model that includes the Sequential Organ Failure Assessment (SOFA) score and compared it with the SOFA-only model.

Results

An older age, higher SOFA score, and higher Acute Physiology III score were risk factors for the prognosis of AMI. The risk of further cardiovascular events was 1.54-fold higher in women than in men. Patients in the cardiac surgery intensive care unit had a better prognosis than those in the coronary heart disease intensive care unit. Pressurized drug use was a protective factor and the risk of further cardiovascular events was 1.36-fold higher in nonusers.

Conclusion

The prognosis of AMI is affected by age, the SOFA score, the Acute Physiology III score, sex, admission location, type of care unit, and vasopressin use. Our new predictive model for AMI has better performance than the SOFA model alone.