bluuebunny/crossref_metadata_2025 huggingface dataset:
Similar local recurrence and survival in patients withT1radial growth phase melanoma on head and neck treated with 5 or 10 mm margins: A retrospective study
Authors: Maurichi Andrea , Barretta Francesco , Patuzzo Roberto , Miceli Rosalba , Gallino Gianfranco , Mattavelli Ilaria , Leva Andrea , Harwood Catherine , Bergamaschi Daniele , Borg Tiffanie‐Marie , Shimonovitz‐Moore Michal , Spadola Giuseppe , Tolomio Elena , Barbieri Consuelo , Queirolo Paola , Manganoni Ausilia Maria , Pellacani Giovanni , Espeli Vittoria , Mangas Cristina , Leoni‐Parvex Sandra , Cossa Mara , Belotti Alessia , Valeri Barbara , Cortinovis Umberto , Santinami Mario
Published: March 2023

Background

Melanoma guidelines recommend surgical excision with 10 mm margins for T1 melanomas (invasive melanomas with Breslow thickness ≤1 mm), including those in radial growth phase, which are without metastatic potential; however, such margins may be problematic on head‐and‐neck.

Objective

We compared outcomes of wide (10 mm margins) versus narrow (5 mm margins) excisions in patients with radial growth phase T1 melanoma on head‐and‐neck including face.

Methods

We retrospectively examined 610 consecutive patients excised with wide versus narrow margins, from 2001 to 2018, at six European centres. In all cases, radial growth phase, and clear margins with 5 or 10 mm of clearance, were ascertained histologically. Multivariable models investigated associations of margins and other factors with overall survival and local recurrence.

Results

Three hundred and sixteen (51.8%) patients received wide excision, 219 (69.3%) with primary wound closure, 97 (30.7%) with reconstruction; 294 (48.2%) patients received narrow excision, 264 (89.8%) with primary wound closure, 30 (10.2%) with reconstruction (p < 0.001). Median follow‐ups were 88 months (wide) and 187 months (narrow) (inter‐quartile ranges 43–133 and 79–206, respectively). Ten‐year overall survival (95% confidence interval) was 96.7% (94.2%–99.3%) in wide and 98.2% (96.4%–100%) in narrow patients. Ten‐year local recurrence incidence was 6.4% (4.1%–10.1%) in wide and 7.8% (5.3%–11.6%) in narrow groups. Lentigo maligna melanoma subtype appeared associated with increased risk of local recurrence in narrow versus wide patients (15.0% vs. 7.5%;p = 0.190).

Conclusions

Narrower excision margins for T1 radial growth phase melanoma are not associated with worse overall survival (hazard ratio 0.97,p = 0.996) or increased local recurrence (subdistribution hazard ratio: 0.87;p = 0.751) compared to wider margins, and may be safely applied to such lesions, although caution may be required in the presence of lentigo maligna melanoma.
Identification of (E)‐ and (Z)‐11‐tetradecenyl acetate as sex pheromone components of the currant pest Euhyponomeutoides albithoracellus
Authors: Svensson Glenn P. , Anderbrant Olle , Öberg Elisabeth , Jirle Erling V. , Hellqvist Sven , Löfstedt Christer
Published: March 2023

The currant bud moth Euhyponomeutoides albithoracellus is a destructive pest in black currant orchards in Northern Sweden and Finland. The larvae feed on the buds, and at high densities, the species can cause severe yield losses. Sex pheromone components of the bud moth were identified via solvent extraction of excised female pheromone glands, analyses by gas chromatography with electroantennographic detection and gas chromatography–mass spectrometry and field trapping experiments. Antennae of males responded strongly and consistently to two compounds in extracts, identified as (E)‐11‐tetradecenyl acetate and (Z)‐11‐tetradecenyl acetate. Weaker and less consistent responses were observed to the corresponding alcohols, (E)‐11‐tetradecenol and (Z)‐11‐tetradecenol, and tetradecyl acetate. Field tests showed strong attraction of bud moth males to a 1:1 blend of (E)‐11‐tetradecenyl acetate and (Z)‐11‐tetradecenyl acetate. Adding the alcohols to the binary acetate blend reduced trap catches drastically, whereas tetradecyl acetate had no statistically significant impact on male attraction when added to that binary blend. Finally, testing different compositions of the binary acetate blend revealed highest catch in traps baited with a 25:75 or 50:50 ratio of the E:Z acetate isomers. The identification of sex pheromone components of the bud moth contributes to developing sustainable control of this pest via monitoring and mating disruption with sex pheromone.
Changes in overwintering ground of small yellow croaker (Larimichthys polyactis) based on MaxEnt and GARP models: A case study of the southern Yellow Sea stock
Authors: Li Guodong , Xiong Ying , Zhong Xiaming , Song Dade , Kang Zhongjie , Li Dongjia , Tang Jianhua , Wang Yanping , Wu Lei
Published: March 2023

Small yellow croaker (Larimichthys polyactis), a commercially essential fish commonly caught in China and South Korea, is now facing a severe decline in resources. The recruitment and surplus of L. polyactis depend selecting a suitable marine environment for overwintering. However, the international overwintering migration habit of L. polyactis limits the investigation of its overwintering environment preferences and suitable grounds. In this study, based on the distribution data of L. polyactis in the southern Yellow Sea in winter from 2010 to 2019 and ocean remote sensing data such as sea bottom temperature (SBT), sea bottom salinity, chlorophyll‐a concentration and water depth (Depth), we used the maximum entropy (MaxEnt) and the genetic algorithm for rule‐set production (GARP) models to investigate the overwintering grounds of the southern Yellow Sea stock (SYS). The jackknife test was used to assess the importance of various environmental factors. For modelling the overwintering ground distribution of SYS, the area under the curve values of both models ​were higher than 0.9. The overwintering ground was at 32°10′ N–33°48′ N, 122°30′ E–125°00′ E. The direction of its distribution was consistent with the Yellow Sea Warm Current in the southern Yellow Sea during the winter. Compared with the suitable overwintering area during 2010–2014, the highly appropriate overwintering area for SYS to overwinter decreased significantly during 2015–2019, showing a trend of moving to the east and north, related to the increase in fishing pressure and strengthening of the Yellow Sea Warm Current in recent years. Depth was the most significant factor for SYS overwintering, followed by SBT. The overwintering ground was at a depth of 40–65 m during the two periods. Additionally, the suitability of overwintering grounds in the coastal waters of south‐western South Korea has gradually increased. This study provides a scientific basis for formulating effective strategies to manage L. polyactis resources under the China–South Korea Fisheries Agreement.
Biological and molecular characterization of chrysanthemum stem necrosis orthotospovirus infecting sweet pepper in Brazil
Authors: Carmo Eike Yudi Nishimura , Ferro Camila Geovana , Favara Gabriel Madoglio , Kraide Heron Delgado , de Oliveira Felipe Franco , Kitajima Elliot Watanabe , de Diana Teixeira Liliane , Rezende Jorge Alberto Marques
Published: March 2023

This contribution describes biological and molecular features of an isolate of the chrysanthemum stem necrosis orthotospovirus (CSNV) found naturally infecting sweet pepper plants (Capsicum annuumL.). High‐throughput sequencing resulted in three contig sequences of 2948, 4829 and 8959 nucleotides for CSNV‐Ca small, medium and large RNAs, respectively. They shared 98.4%, 99.3% and 99.1% nucleotide identities, respectively, with the corresponding nucleotide sequences of a CSNV isolate from Slovenia. The virus was mechanically transmitted to sweet pepper and some additional test plants, and RT‐PCR confirmed the infection with specific primers for CSNV. Additionally, transmission electron microscopic analysis of ultrathin sections prepared from symptomatic sweet pepper fruit tissue showed orthotospoviruses‐like particles in elements of the endoplasmic reticulum. Studies are needed to evaluate the occurrence of CSNV infecting sweet pepper in commercial crops, to assess yield damage and develop recommendations for management.
The role of behaviour‐change theory in sleep interventions with emerging adults (aged 18–29 years): a systematic review and meta‐analysis
Authors: Pegado Ana , Alvarez Maria‐João , Roberto Magda Sofia
Published: March 2023

Previous systematic reviews and meta‐analysis of sleep interventions with young adults have not reached consensus on what contributes to their efficacy. Behaviour‐change theories may influence the efficacy of interventions; hence, the aim of this research was to investigate the role of such theories in sleep interventions with this population. Six electronic databases and reference lists were searched (April–May 2021) for published sleep behaviour‐change interventions with emerging adults (aged 18–29 years) that used control groups. A selection of 20 studies fulfilled the inclusion criteria, but only six were based on behaviour‐change theories. Meta‐analysis was run with eight studies, as the others had a high risk of bias or did not present the necessary data to calculate Hedges’ g. The estimation of a random effects model for the studies showed a small effect in the sleep quality of the participants in the experimental group (g = −0.26; 95% confidence interval −0.42 to −0.09), with low levels of heterogeneity (I2 = 21%), and a small 95% prediction interval (−0.59 to 0.08). Although we could not examine theory or any other moderators of the effect, a qualitative analysis of the behaviour‐change techniques present in the interventions leads us to hypothesise that there is not a direct link between behaviour‐change techniques and the success of the intervention. Other characteristics of the interventions may be linked to their variable levels of efficacy and should be investigated in the future, as for now there are no answers as to what the key is for successful sleep interventions.
Sensory experiences and social representation – Embodied multimodality of common‐sense thinking
Authors: Martikainen Jari , Sakki Inari
Published: March 2023

Discussions on the body frequently foreground in empirical studies of social representations. However, there is scarce theoretical literature within social representations theory focusing on embodied social representation. This paper aims to contribute to the understanding of embodied, sensory experiences as part of social representation. More precisely, it attempts to elaborate how individual, social, bodily, and material layers work together in embodied social representation. This paper approaches the topic from four viewpoints: (1) social representation as action, (2) phenomenology, (3) embodied and socially situated cognition, and (4) sensory epistemologies and sensescapes. These approaches are used to provide insight into the conscious and unconscious processes of social representation and the multimodality of social representation. The paper contributes to the understanding of the role of sensory experiences and embodiment in the theory of social representations.
Workplace‐based assessments—Articulating the playbook
Authors: Tahim Arpan , Gill Deborah , Bezemer Jeff
Published: March 2023

Introduction

A workplace‐based assessment (WBA) is a learning recording device that is widely used in medical education globally. Although entrenched in medical curricula, and despite a substantial body of literature exploring them, it is not yet fully understood how WBAs play out in practice. Adopting a constructivist standpoint, we examine these assessments, in the workplace, using principles based upon naturalist inquiry, drawing from a theoretical framework based on Goffman's dramaturgical analogy for the presentation of self, and using qualitative research methods to articulate what is happening as learners complete them.

Methods

Learners were voluntarily recruited to participate in the study from a single teaching hospital. Data were generated, in‐situ, through observations with field notes and audiovisual recording of WBAs, along with accompanying interviews with learners.

Results

Data from six learners was analysed to reveal a set of general principles—the WBA playbook. These four principles were tacit, unwritten, unofficial and learners applied them to complete their WBA proformas: (1) maintain the impression of progression, (2) manage the authenticity of the individual proforma, (3) avoid losing face with the assessor and (4) complete the proforma in an effort‐efficient way. By adhering to these principles, learners expressed their understanding of their social position in their world at that time the documents were created.

Discussion

This paper recognises the value of the WBA as a lived experience, and of the WBA document as a social space, where learners engage in a social performance before the readers of the proforma. Such an interpretation better represents what happens as learners undergo and record WBAs in the real‐world, recognising WBAs as learner‐centred, learner‐driven, meaning‐making phenomena. In this way, as a record of interpretation and meanings, the subjective nature of the WBA process is a strength to be harnessed, rather than a weakness to be glossed over.
The NLRomes of Zea mays NAM founder lines and Zea luxurians display presence–absence variation, integrated domain diversity, and mobility
Authors: Thatcher Shawn , Jung Mark , Panangipalli Gayathri , Fengler Kevin , Sanyal Abhijit , Li Bailin , Llaca Victor , Habben Jeffrey
Published: March 2023

Plant pathogens cause significant crop loss worldwide, and new resistance genes deployed to combat diseases can be overcome quickly. Understanding the existing resistance gene diversity within the germplasm of major crops, such as maize, is crucial for the development of new disease‐resistant varieties. We analysed the nucleotide‐binding leucine‐rich repeat receptors (NLRs) of 26 recently sequenced diverse founder lines from the maize nested association mapping (NAM) population and compared them to the R gene complement present in a wild relative of maize, Zea luxurians. We found that NLRs in both species contain a large diversity of atypical integrated domains, including many domains that have not previously been found in the NLRs of other species. Additionally, the single Z. luxurians genome was found to have greater integrated atypical domain diversity than all 26 NAM founder lines combined, indicating that this species may represent a rich source of novel resistance genes. NLRs were also found to have very high sequence diversity and presence–absence variation among the NAM founder lines, with a large NLR cluster on Chr10 representing a diversity hotspot. Additionally, NLRs were shown to be mobile within maize genomes, with several putative interchromosomal translocations identified.
Shedding light on latent pathogenesis and pathophysiology of mental disorders: The potential ofiPScell technology
Authors: Arioka Yuko , Okumura Hiroki , Sakaguchi Hideya , Ozaki Norio
Published: March 2023

Mental disorders are considered as one of the major healthcare issues worldwide owing to their significant impact on the quality of life of patients, causing serious social burdens. However, it is hard to examine the living brain—a source of psychiatric symptoms—at the cellular, subcellular, and molecular levels, which poses difficulty in determining the pathogenesis and pathophysiology of mental disorders. Recently, induced pluripotent stem cell (iPSC) technology has been used as a novel tool for research on mental disorders. We believe that the iPSC‐based studies will address the limitations of other research approaches, such as human genome, postmortem brain study, brain imaging, and animal model analysis. Notably, studies using integrated iPSC technology with genetic information have provided significant novel findings to date. This review aimed to discuss the history, current trends, potential, and future of iPSC technology in the field of mental disorders. Although iPSC technology has several limitations, this technology can be used in combination with the other approaches to facilitate studies on mental disorders.
Dental and medical management of the patient with bipolar disorder
Authors: Abdul‐Wasay Syed , Ouanounou Aviv
Published: March 2023

Objective

The objective of this literature review is to understand the appropriate medical management of patients with bipolar disorder (BD) which subsequently can translate into the effective dental management of patients suffering with this illness

Methods

This study was completed using three databases which included PubMed, Google Scholar and Cochrane library. Additionally, relevant dental and medical textbooks were also used to summarize more complex topics regarding BD. Descriptors used to find relevant articles included “Bipolar Disorder”, “Adverse drug effects of bipolar medications”, and “Orofacial findings with patients with bipolar disorder”. A total of 49 relevant articles and textbooks were found which were included in this literature review.

Results

BD is a mental illness which affects millions worldwide. It is characterized by alternating episodes of mania and depression. During the manic phase there is an abnormal elevation in mood whereas the depressive episodes consist of the opposite. The medical management of BD involves pharmacotherapy and psychotherapy. Common dental findings in patients with BD include caries, periodontal disease, xerostomia and adverse oral effects from the medications used to manage this illness.

Conclusion

BD has a significant burden on society and to effectively manage their medical and dental needs, the clinician must be well versed in their illness.
Interdependence between bacterial EPS and early grain coat development
Authors: Charlaftis Dimitrios , Jones Stuart J. , Grimm Lars , Kappler Andreas
Published: March 2023

Bacteria are the most abundant forms of life we know on our planet, able to survive in a variety of habitats, that play an important role in mineral formation and transformation processes. Here, we present laboratory experiments in which unconsolidated quartz grains were seeded with Geobacter sulfurreducens cells and exposed to a mineral medium solution for 96 hours at temperatures of between 60°C and 120°C. Experimental data show the interdependence between extracellular polymeric substances (EPS) and the early formation of grain‐coating material. The occurrence of EPS promotes the development of web and bridging structures binding the quartz grains and creating EPS‐coated surfaces. With increasing temperature, an amorphous mineral phase grows preferentially on these surfaces suggesting that EPS can act as a template for mineral nucleation. At temperatures >100°C, the order of crystallinity of the amorphous authigenic phase increases, transitioning to poorly‐ordered rosette‐like textures.
Everyday peace in a ‘post‐conflict’ African metropolis: Radio encounters, indeterminacy, fugitivity
Authors: Cante Fabien
Published: March 2023

Drawing on the ethnography of a multi‐ethnic local radio listeners' club in post‐war Abidjan, Côte d'Ivoire, the article provides an original account of everyday peace in an African metropolis. It bridges peace geographies and African urban studies to document the informal and often invisibilised practices through which residents re‐make the city in the wake of war. In doing so, the article expands existing understandings of everyday peace while reaffirming the concept's radical, decolonial proposition: to seek peace in subaltern lifeworlds, rather than in institutional and interventionist programmes that too often reproduce violent power asymmetries. Through the story of the UFARA listeners' club, emerging out of radio encounters, the article shows how everyday peace articulates a response to different forms of conjunctural and structural violence, including precarity and territorial control. It also points to indeterminacy and fugitivity as lived, affective and political figurations of peace which, while eschewing the trappings of resistance, nonetheless point to the need to imagine peace otherwise.
Calculation of dose intensity and comparison of published methods using a cohort of canine T‐cell lymphoma patients undergoing CHOP‐based chemotherapy
Authors: Lenz Jennifer A. , Benjamin Sarah E. , Walsh Koranda A. , Keuler Nicholas S. , Atherton Matthew J.
Published: March 2023

Methods of calculating and reporting dose intensity (DI) of CHOP‐based protocols in the veterinary literature vary. The goal of this retrospective study is to examine the prognostic significance of the average percentage of planned DI received in a cohort of canine T‐cell lymphoma patients treated with a modified CHOP protocol with corresponding toxicity and efficacy data. Our data set of 40 dogs was analysed using various previously published methods for calculating DI. Median progression‐free survival and overall survival were 91 and 196 days, respectively. Receiving a higher percentage of planned DI was not found to be associated with patient outcome. Outcomes remain poor for dogs with T‐cell lymphoma treated with CHOP‐based chemotherapy irrespective of received DI. Standard methods of DI calculation and reporting should be adopted in veterinary oncology to enable repeatable and rigorous comparisons of published chemotherapy protocols and to ascertain the potential prognostic relevance of DI in canine lymphoma patients.
Real-Time Hybrid Testing of a Floating Offshore Wind Turbine Using a Surrogate-Based Aerodynamic Emulator
Authors: Ransley Edward J. , Brown Scott A. , Edwards Emma C. , Tosdevin Tom , Monk Kieran , Reynolds Alastair M. , Greaves Deborah , Hann Martyn R.
Published: March 2023

Physical modeling of floating offshore wind turbines (FOWTs) is challenging due to the complexities associated with the simultaneous application of two different scaling laws, governing the hydrodynamic and aerodynamic loading on the structure. To avoid these issues, this paper presents a real-time hybrid testing (RTHT) strategy in which a feedback loop, consisting of an on-board fan and control algorithm, is utilized to emulate the aerodynamic forces acting on the FOWT system. Here, we apply this strategy to a 70th-scale IEA Wind 15 MW reference wind turbine mounted on a version of the VolturnUS-S platform. Unlike other similar methods, which directly simulate the aerodynamic loads for the fan’s control using an aerodynamic code running in parallel with the experiment, this example utilizes a surrogate model trained on numerical model data calculated in advance. This strategy enables high-fidelity numerical model data, or even physical data, to be included in the aerodynamic emulation, by removing the requirement for real-time simulation, and, therefore, potentially enables more accurate loading predictions to be used in the experiments. This paper documents the development of the real-time hybrid testing system in the Coastal Ocean And Sediment Transport (COAST) Laboratory at the University of Plymouth in the UK, including the hardware, software, and instrumentation setup, and demonstrates the power of the surrogate-based aerodynamic emulator based on numerical data calculated using OpenFAST.
Aminosilane small molecule inhibitors for area-selective deposition: Study of substrate-inhibitor interfacial interactions
Authors: Van Dongen Kaat , Nye Rachel A. , Clerix Jan-Willem J. , Sixt Claudia , De Simone Danilo , Delabie Annelies
Published: March 2023

Area-selective atomic layer deposition (AS-ALD) is a coveted method for the fabrication of next-generation nano-electronic devices, as it can complement lithography and improve alignment through atomic scale control. Selective reactions of small molecule inhibitors (SMIs) can be used to deactivate growth on specific surface areas and as such enable AS-ALD. To investigate new applications of ASD, we need insight into the reactions of SMIs with a broad range of technology relevant materials. This paper investigates the reactions of aminosilane SMIs with a broad range of oxide surfaces and the impact on subsequent atomic layer deposition (ALD). We compare the reactions of two aminosilane SMIs, namely, dimethylamino-trimethylsilane (DMA-TMS) and hexamethyldisilazane (HMDS), with a hydroxylated SiO2 surface and the impact on subsequent ALD processes. The DMA-TMS reaction saturates faster than the HMDS reaction and forms a dense trimethylsilyl (TMS) layer with a higher TMS surface concentration. The higher TMS surface concentration yields better inhibition and higher selectivity during subsequent TiO2 ALD. We show that a wide range of surfaces, i.e., MgO, HfO2, ZrO2, Al2O3, TiO2 (TiN/TiOx), SiO2, SnO2, MoOx, and WO3 remain reactive after DMA-TMS exposure for conditions where SiO2 is passivated, indicating that DMA-TMS can enable AS-ALD on these surfaces with respect to SiO2. On these surfaces, DMA-TMS forms residual TMS and/or SiOxCyHz surface species that do not markedly inhibit ALD but may affect interface purity. Surfaces with lower, similar, and higher surface acidity than SiO2 all show less reactivity toward DMA-TMS, suggesting that surface acidity is not the only factor affecting the substrate-inhibitor interaction. Our study also compares a hybrid inorganic-organic SnOxCyHz and inorganic SnO2 material in view of their relevance as resist for extreme ultraviolet lithography. DMA-TMS can enable selective infiltration in SnOxCyHz, as opposed to selective deposition on SnO2, indicating tunable reactivity by bulk and surface composition. These insights into the reactivity of aminosilane SMIs may aid the design of new area-selective deposition processes, broaden the material space, and enable new applications.
A common cancer at an uncommon age
Authors: Giannakis Marios , Ng Kimmie
Published: March 2023

The etiology of early-onset colorectal cancer needs to be understood to tackle rising incidence
Autoimmunity to the modified self
Authors: Santambrogio Laura
Published: March 2023

Protein posttranslational modifications can break tolerance to the self-proteome
White House budget includes push to eliminate hepatitis C
Authors: Leslie Mitch
Published: March 2023

$11.3 billion would go to treatment, testing, and education
New Thoughts on an Old Topic: Secrets of Bacterial Spore Resistance Slowly Being Revealed
Authors: Setlow Peter , Christie Graham
Published: March 2023

The quest for bacterial survival is exemplified by spores formed by some
Firmicutes
members. They turn up everywhere one looks, and their ubiquity reflects adaptations to the stresses bacteria face.
Excision of Integrated Human Herpesvirus 6A Genomes Using CRISPR/Cas9 Technology
Authors: Aimola Giulia , Wight Darren J. , Flamand Louis , Kaufer Benedikt B.
Published: March 2023

Human herpesvirus 6 (HHV-6) infects almost all humans and integrates into the telomeres of latently infected cells to persist in the host for life. In addition, HHV-6 can also integrate into the telomeres of germ cells, which results in about 80 million individuals worldwide who carry the virus in every cell of their body and can pass it on to their offspring.
Supplemental Material: Localized Cenozoic erosion o n the southern African Plateau: A signal of topographic uplift?
Authors: Stanley J.R. , Flowers Rebecca M
Published: March 2023

Methods details, Table S1 (AHe data used in the study), Table S2 (t-T points for forward models used in Figures 2 and 3), Figure S1 (date-eU plots for all samples), and Figure S2 (all labeled sample locations).
Supplemental Material: Granitoids indicating moderate to high heat production associated with oceanic subduction system in the NE Tibetan Plateau
Authors: Zou Feng-Hui , Wu Cai-Lai , al. et
Published: March 2023

Analytical methods, supporting Figures S1-S10 and Tables S1-S9.
Inequities in surgical outcomes by race and sex in the United States: retrospective cohort study
Authors: Ly Dan P , Blegen Mariah B , Gibbons Melinda M , Norris Keith C , Tsugawa Yusuke
Published: March 2023

Objective

To assess inequities in mortality by race and sex for eight common surgical procedures (elective and non-elective) across specialties in the United States.

Design

Retrospective cohort study.

Setting

US, 2016-18.

Participants

1 868 036 Black and White Medicare beneficiaries aged 65-99 years undergoing one of eight common surgeries: repair of abdominal aortic aneurysm, appendectomy, cholecystectomy, colectomy, coronary artery bypass surgery, hip replacement, knee replacement, and lung resection.

Main outcome measure

The main outcome measure was 30 day mortality, defined as death during hospital admission or within 30 days of the surgical procedure.

Results

Postoperative mortality overall was higher in Black men (1698 deaths, adjusted mortality rate 3.05%, 95% confidence interval 2.85% to 3.24%) compared with White men (21 833 deaths, 2.69%, 2.65% to 2.73%), White women (21 847 deaths, 2.38%, 2.35% to 2.41%), and Black women (1631 deaths, 2.18%, 2.04% to 2.31%), after adjusting for potential confounders. A similar pattern was found for elective surgeries, with Black men showing a higher adjusted mortality (393 deaths, 1.30%, 1.14% to 1.46%) compared with White men (5650 deaths, 0.85%, 0.83% to 0.88%), White women (4615 deaths, 0.82%, 0.80% to 0.84%), and Black women (359 deaths, 0.79%, 0.70% to 0.88%). This 0.45 percentage point difference implies that mortality after elective procedures was 50% higher in Black men compared with White men. For non-elective surgeries, however, mortality did not differ between Black men and White men (1305 deaths, 6.69%, 6.26% to 7.11%; and 16 183 deaths, 7.03%, 6.92% to 7.14%, respectively), although mortality was lower for White women and Black women (17 232 deaths, 6.12%, 6.02% to 6.21%; and 1272 deaths, 5.29%, 4.93% to 5.64%, respectively). These differences in mortality appeared within seven days after surgery and persisted for up to 60 days after surgery.

Conclusions

Postoperative mortality overall was higher among Black men compared with White men, White women, and Black women. These findings highlight the need to understand better the unique challenges Black men who require surgery face.
Maternal opioid treatment after delivery and risk of adverse infant outcomes: population based cohort study
Authors: Zipursky Jonathan S , Gomes Tara , Everett Karl , Calzavara Andrew , Paterson J Michael , Austin Peter C , Mamdani Muhammad M , Ray Joel G , Juurlink David N
Published: March 2023

Objective

To examine whether maternal opioid treatment after delivery is associated with an increased risk of adverse infant outcomes.

Design

Population based cohort study.

Setting

Ontario, Canada.

Participants

865 691 mother-infant pairs discharged from hospital alive within seven days of delivery from 1 September 2012 to 31 March 2020. Each mother who filled an opioid prescription within seven days of discharge was propensity score matched to a mother who did not.

Main outcome measures

The primary outcome was hospital readmission of infants for any reason within 30 days of their mother filling an opioid prescription (index date). Infant related secondary outcomes were any emergency department visit, hospital admission for all cause injury, admission to a neonatal intensive care unit, admission with resuscitation or assisted ventilation, and all cause death.

Results

85 675 mothers (99.8% of the 85 852 mothers prescribed an opioid) who filled an opioid prescription within seven days of discharge after delivery were propensity score matched to 85 675 mothers who did not. Of the infants admitted to hospital within 30 days, 2962 (3.5%) were born to mothers who filled an opioid prescription compared with 3038 (3.5%) born to mothers who did not. Infants of mothers who were prescribed an opioid were no more likely to be admitted to hospital for any reason than infants of mothers who were not prescribed an opioid (hazard ratio 0.98, 95% confidence interval 0.93 to 1.03) and marginally more likely to be taken to an emergency department in the subsequent 30 days (1.04, 1.01 to 1.08), but no differences were found for any other adverse infant outcomes and there were no infant deaths.

Conclusions

Findings from this study suggest no association between maternal opioid prescription after delivery and adverse infant outcomes, including death.
Problem-based shared decision-making in diabetes care: a secondary analysis of video-recorded encounters
Authors: Ruissen Merel M , Montori Victor M , Hargraves Ian G , Branda Megan E , León García Montserrat , de Koning Eelco JP , Kunneman Marleen
Published: March 2023

Objectives

To describe the range of collaborative approaches to shared decision-making (SDM) observed in clinical encounters of patients with diabetes and their clinicians.

Design

A secondary analysis of videorecordings obtained in a randomised trial comparing usual diabetes primary care with or without using a within-encounter conversation SDM tool.

Setting

Using the purposeful SDM framework, we classified the forms of SDM observed in a random sample of 100 video-recorded clinical encounters of patients with type 2 diabetes in primary care.

Main outcome measures

We assessed the correlation between the extent to which each form of SDM was used and patient involvement (OPTION12-scale).

Results

We observed at least one instance of SDM in 86 of 100 encounters. In 31 (36%) of these 86 encounters, we found only one form of SDM, in 25 (29%) two forms, and in 30 (35%), we found ≥3 forms of SDM. In these encounters, 196 instances of SDM were identified, with weighing alternatives (n=64 of 196, 33%), negotiating conflicting desires (n=59, 30%) and problemsolving (n=70, 36%) being similarly prevalent and developing existential insight accounting for only 1% (n=3) of instances. Only the form of SDM focused on weighing alternatives was correlated with a higher OPTION12-score. More forms of SDM were used when medications were changed (2.4 SDM forms (SD 1.48) vs 1.8 (SD 1.46); p=0.050).

Conclusions

After considering forms of SDM beyond weighing alternatives, SDM was present in most encounters. Clinicians and patients often used different forms of SDM within the same encounter. Recognising a range of SDM forms that clinicians and patients use to respond to problematic situations, as demonstrated in this study, opens new lines of research, education and practice that may advance patient-centred, evidence-based care.
Quality of care in the course of subcutaneous versus intravenous trastuzumab administration in patients with breast cancer: an integrated time–motion study with mixed-methods research
Authors: Lin Hsiang-Wen , Lin Chen-Yuan , Yeh Tzu-Pei , Lin Tien-Chao , Yeh Wan-Chen , Yang Lin-Chun , Chen Yu-Chieh , Chiu Li-Ying , Wu Chen-Teng , Chen Chih-Jung , Chen Yu-Fen , Wang Hwei-Chung , Wu Yao-Chung , Liu Liang-Chih
Published: March 2023

Objectives

This study aimed to compare the time required and concerns raised by various perspectives of participants regarding administering subcutaneous and intravenous trastuzumab for patients with breast cancer (BC).

Design

This observational time–motion study design with mixed-methods research (cross-sectional surveys and semistructured interviews) was conducted. The time spent on preparing or administering trastuzumab by different healthcare professionals (HCPs) was recorded. The data were analysed by descriptive/inferential statistical analyses, followed by thematic analyses.

Setting

Outpatient and inpatient administration units of a single medical centre in Taiwan.

Participants

The study included patients with early-stage BC who received subcutaneous or intravenous trastuzumab (n=93), and HCPs including two attending physicians, a nurse practitioner, two pharmacists and two nurses.

Result

Based on the perspectives of patients and HCPs, the subcutaneous form of trastuzumab was more efficient, less expensive and produced less discomfort in outpatient units than inpatient units. More participants preferred the subcutaneous form over the intravenous form in both outpatient and inpatient units. Pharmacists and nurse practitioners spent threefold more time on patients when preparing and administering the intravenous form in both outpatient and inpatient units. The concerns raised by patients and HCPs varied in certain aspects, including the injection skills, speed, mental distress (eg, needle phobia) and pain associated with the subcutaneous form. Almost all patients preferred receiving the subcutaneous form in outpatient units after the initial COVID-19 outbreak.

Conclusion

Patients with early-stage BC preferred receiving subcutaneous trastuzumab in outpatient units rather than inpatient units or the intravenous form before and after the COVID-19 outbreak. Such findings may serve as real-world evidence to facilitate better quality of care regarding administration of subcutaneous or intravenous trastuzumab in medical settings, and its feasible resolutions to balance the quality, concerns and efficiency of anticancer administration during the COVID-19 pandemic.
Barriers and facilitators of physical function, activity, sports and exercise in children and adolescents with spinal pain: a protocol for a systematic review and meta-ethnography
Authors: Tucker Susanna , Heneghan Nicola R , Alamrani Samia , Rushton Alison , Gardner Adrian , Soundy Andrew
Published: March 2023

Introduction

Spinal pain is one of the leading causes of disability, with the incidence of adolescent back pain estimated at 20%. Multiple barriers influence exercise participation in adolescents. However, there remains a lack of literature surrounding patients’ choice to exercise, perceived barriers and facilitators of exercise, and their relationship to participant demographics. The aim of this systematic review with meta-ethnography will be to identify the barriers and facilitators of exercise participation among adolescents with thoracic or lower back pain (LBP). The secondary aim will be to identify any trends in barriers and facilitators of exercise between different demographic groups within children or adolescents under 18 years.

Methods and analysis

The seven-phase process identified by Noblit and Hare’s meta-ethnography approach will be used. A comprehensive electronic search of databases (AMED, CINAHLplus, EMBASE, MEDLINE, SCOPUS, Nursing & Allied Health, PubMed, PsycINFO, SPORTDiscus, Social Science Database) will be completed during April 2022. Grey literature using reference lists, websites and search engines will also be searched in accordance with Peer Review of Electronic Search Strategies (PRESS) guidelines. Inclusion criteria include: (A) qualitative studies, (B) participants under 18 years experiencing thoracic or LBP, (C) identification of barriers and facilitators of exercise participation in exercise, sports or physical activity and (D) primary research. This systematic review with meta-ethnography review aims to generate theories of behaviours and interpret significance across multiple studies. This process aims to develop future physiotherapeutic behavioural interventions, inform service provision and identify possible future research questions.

Ethics and dissemination

No ethical approval was required due to the nature of using previously published work to form a systematic review paper. This systematic review and meta-ethnography will be disseminated through both conference presentations and journal publications. No funding was received for this review.

PROSPERO registration number

CRD42022314796.
Do imaging findings modify the effect of non-surgical treatment in patients with knee and hip osteoarthritis? A systematic literature review
Authors: Clausen Stine , Heerey Joshua , Hartvigsen Jan , Kemp Joanne L , Arnbak Bodil
Published: March 2023

Objectives

To review the available evidence on diagnostic imaging findings in knee and hip osteoarthritis (OA) as treatment effect modifiers in non-surgical OA interventions.

Methods

MEDLINE, Embase and The Cochrane Central Register of Controlled Trials were searched from the earliest records published to 22 March 2022. Studies in knee and hip OA reporting subgroup analyses in randomised controlled trials with imaging findings as potential treatment effect modifiers were included. Studies were critically appraised using the Cochrane risk of bias tool and a subgroup analysis quality assessment.

Results

Of 10 014 titles and abstracts screened, eight studies met the inclusion criteria, six on knee OA and two on hip OA. The studies investigated effect modifiers in exercise therapy, intra-articular injections and unloading shoes. Imaging findings assessed as potential treatment effect modifiers were radiographic OA severity, hip effusion (ultrasound), bone marrow lesions and meniscal pathology (MRI). Two studies fulfilled the methodological quality criteria for assessing effect modification. One reported that radiographic knee OA severity modified the effect of unloading shoes on walking pain. Those with more severe radiographic knee OA had a greater response to shoe inserts. One reported no interaction between radiographic OA severity or joint effusion and the effect of intraarticular injections of corticosteroid or hyaluronic acid in hip OA, indicating no difference in response in people with greater hip joint effusion or radiographic OA severity compared with those with less severe joint disease.

Conclusion

Overall, methodological limitations and very few studies do not permit conclusions on diagnostic imaging findings as effect modifiers in non-surgical interventions in knee and hip OA.

Radiographic severity of knee OA potentially modifies the effect of unloading shoes.

PROSPERO registration number

CRD42020181934.
Lifelong mental health service use among 15–22 years old offenders: a document-based, mixed-methods descriptive study
Authors: Huikko Eeva , Aalto-Setälä Terhi , Santalahti Päivi , Lämsä Riikka , Ahlgrén-Rimpiläinen Aulikki
Published: March 2023

Objectives

Among young offenders, psychiatric morbidity and comorbidity are common, but our knowledge about their use of mental health services during childhood and adolescence is scarce. We aimed to describe the lifelong use of mental health services of young offenders who have committed serious crimes.

Design and study setting

Using data on forensic psychiatric examinations of 42 Finnish offenders aged 15–22 years, we analysed the timing and typical patterns of their prior mental health service use with qualitative and quantitative content analysis and typification.

Results

Young offenders appeared in this study as children with plenty of perinatal and developmental risks, and risks related to their family situation and peer relations. Most subjects were described as having had emotional or behavioural symptoms, or both, since childhood. Involvement in mental health services was rare before the age of 7 years but increased markedly after that, staying on the same level during adolescence. Five categories of mental health service users were identified: (1) continuing service use around a decade (14.3%), (2) one brief fixed treatment (11.9%), (3) involuntary use of services (31.0%), (4) evasive use of services (21.4%) and (5) no mental health service use (21.4%).

Conclusions

Young offenders had symptoms from early ages, but during childhood and adolescence, involvement in mental health services appeared for most as relatively short, repetitive or lacking. To help children at risk of criminal development, a multiprofessional approach, an early evidence-based intervention for behavioural symptoms and screening for learning problems, traumatic experiences and substance use are necessary. Results can help identify children and adolescents with a risk of criminal development, to develop mental health services and to plan further research.
Pathway map development for medical device event reporting in operating theatres: a human factors approach to improving the existing system
Authors: Tase Arkeliana , Micocci Massimo , Buckle Peter , Ni Melody , Hanna George
Published: March 2023

Objectives

This study aimed to develop the actual pathway to reporting and information transfer in operating theatres in relation to medical technology malfunction/failure. This with the aim of understanding the differences with the pathway published by NHS Improvement and identification of points for improvement.

Design

This is a qualitative study involving stakeholder interviews with doctors, nurses, manufacturers, medical device safety officer and Medicines and Healthcare products Regulatory Agency.

Setting

Data were collected on reporting pathway used in operating theatres. Clinical staff who took part worked in different trusts throughout UK while manufacturers provided devices in UK and EU/USA.

Participants

Semistructured interviews were completed with 15 clinicians and 13 manufacturers. Surveys were completed by 38 clinicians and 5 manufacturers. Recognised methods of pathway development were used. The Lean Six Sigma principles adapted to healthcare were used to develop suggestions for improvement.

Main outcome measures

To identify the differences between the set pathway to reporting and information transfer to what is occurring on a day-to-day basis as reported by staff. Identify points in the pathway where improvements could be applied.

Results

The developed pathway demonstrated great complexity of the current reporting system for medical devices. It identified numerous areas that give rise to problems and multiple biases in decision making. This highlighted the core issues leading to under-reporting and lack of knowledge on device performance and patient risk. Suggestions for improvement were deduced based on end user requirements and identified problems.

Conclusions

This study has provided a detailed understanding of the key problem areas that exist within the current reporting system for medical devices and technology. The developed pathway sets to address the key problems to improve reporting outcomes. The identification of pathway differences between ‘work as done’ and ‘work as imagined’ can lead to development of quality improvements that could be systematically applied.
Abortion and the basis of equality: a reply to Miller
Authors: Bozzo Alexander
Published: March 2023

Miller has recently argued that the standard liberal and moderate positions on abortion are incapable of grounding the claim that ‘all non-disabled adult humans are equal’. The reason, he claims, is such accounts base the intrinsic moral worth of a human being on some property (or set of properties) which comes in degrees. In contrast, he argues that moral equality must reside in some binary property, such as the property of being human. In this paper, I offer three criticisms of Miller’s position.