bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring the impact and experience of fractional work in medicine: a qualitative study of medical oncologists in Australia
Authors: Kirby Emma , Broom Alex , Karikios Deme , Harrup Rosemary , Lwin Zarnie 
Published: December 2019

ObjectivesFractional (part-time) appointments are becoming more commonplace in many professions, including medicine. With respect to the contemporary oncological landscape, this highlights a critical moment in the optimisation of employment conditions to enable high-quality service provision given growing patient numbers and treatment volume intensification. Data are drawn from a broader study which aimed to better understand the workforce experiences of medical oncologists in Australia. This paper specifically aims to examine a group of clinicians’ views on the consequences of fractional work in oncology.DesignQualitative, one-on-one semistructured interviews. Interview transcripts were digitally audio recorded and transcribed verbatim. Data were subject to thematic analysis supported by the framework approach and informed by sociological methods and theory.SettingNew South Wales, Australia.ParticipantsMedical oncologists (n=22), including 9 female and 13 male participants, at a range of career stages.ResultsFour key themes were derived from the analysis: (1) increasing fractional employment relative to opportunities for full-time positions and uncertainty about future opportunities; (2) tightening in role diversity, including reducing time available for research, mentoring, professional development and administration; (3) emerging flexibility of medical oncology as a specialty and (4) impact of fractional-as-norm on workforce sustainability and quality of care.ConclusionFractional appointments are viewed as increasing in oncology and the broader consequences of this major shift in medical labour remain unexamined. Such appointments offer potential for flexible work to better suit the needs of contemporary oncologists; however, fractional work also presents challenges for personal and professional identity and vocational engagement. Fractional appointments are viewed as having a range of consequences related to job satisfaction, burnout and service delivery. Further research is needed to provide a critical examination of the multiple impacts of workforce trends within and beyond oncology.
Healthy Dads, Healthy Kids UK, a weight management programme for fathers: feasibility RCT
Authors: Griffin Tania , Sun Yongzhong , Sidhu Manbinder , Adab Peymane , Burgess Adrienne , Collins Clare , Daley Amanda , Entwistle Andrew , Frew Emma , Hardy Pollyanna , Hurley Kiya , Jones Laura , McGee Eleanor , Pallan Miranda , Young Myles , Morgan Philip , Jolly Kate 
Published: December 2019

ObjectiveTo assess (1) the feasibility of delivering a culturally adapted weight management programme, Healthy Dads, Healthy Kids United Kingdom (HDHK-UK), for fathers with overweight or obesity and their primary school-aged children, and (2) the feasibility of conducting a definitive randomised controlled trial (RCT).DesignA two-arm, randomised feasibility trial with a mixed-methods process evaluation.SettingSocioeconomically disadvantaged, ethnically diverse localities in West Midlands, UK.ParticipantsFathers with overweight or obesity and their children aged 4–11 years.InterventionParticipants were randomised in a 1:2 ratio to control (family voucher for a leisure centre) or intervention comprising 9 weekly healthy lifestyle group sessions.OutcomesFeasibility of the intervention and RCT was assessed according to prespecified progression criteria: study recruitment, consent and follow-up, ability to deliver intervention, intervention fidelity, adherence and acceptability, weight loss, using questionnaires and measurements at baseline, 3 and 6 months, and through qualitative interviews.ResultsThe study recruited 43 men, 48% of the target sample size; the mean body mass index was 30.2 kg/m2 (SD 5.1); 61% were from a minority ethnic group; and 54% were from communities in the most disadvantaged quintile for socioeconomic deprivation. Recruitment was challenging. Retention at follow-up of 3 and 6 months was 63%. Identifying delivery sites and appropriately skilled and trained programme facilitators proved difficult. Four programmes were delivered in leisure centres and community venues. Of the 29 intervention participants, 20 (69%) attended the intervention at least once, of whom 75% attended ≥5 sessions. Sessions were delivered with high fidelity. Participants rated sessions as ‘good/very good’ and reported lifestyle behavioural change. Weight loss at 6 months in the intervention group (n=17) was 2.9 kg (95% CI −5.1 to −0.6).ConclusionsThe intervention was well received, but there were significant challenges in recruitment, programme delivery and follow-up. The HDHK-UK study was not considered feasible for progression to a full RCT based on prespecified stop–go criteria.Trial registration numberISRCTN16724454.
Doppler ultrasound values after liver transplantation in children and their association with graft outcomes: a protocol for a systematic review and meta-analysis
Authors: Ruiz Martha M , Alobaidi Rashid , Noga Michelle Lisa , Featherstone Robin , Shapiro James , Bhargava Ravi 
Published: December 2019

IntroductionLiver graft and patient survival in children have improved substantially over the years; nevertheless, graft-related complications persist as the most important risk factor for mortality and graft loss. Doppler ultrasound evaluation is routinely used after liver transplantation; however, there is no consensus defining normal values, timing or frequency of Doppler ultrasound postoperative evaluation. Identification of patients who require an intervention or change in postoperative management is therefore challenging.Methods and analysisWe will conduct a systematic review and meta-analysis to appraise and synthesise evidence describing Doppler ultrasound measurements and their association with graft complications in children who have received a liver transplant. We will search multiple databases: Ovid Medline, Embase, Wiley Cochrane Library, Web of Science—Science Citation Index Expanded, trial registry records and meeting abstracts using a combination of subject headings and keywords for liver transplantation, Doppler ultrasound and paediatric patients. All identified titles and abstracts of studies will be assessed for potential relevance. Selected studies will be retrieved and subjected to a second phase of screening, both selection phases will be done in duplicate by two independent reviewers, and discrepancies will be documented and resolved by a third reviewer. Data extraction will be done independently by two reviewers using a standardised data extraction form. Quality of evidence and risk of bias will be assessed, synthesised and pooled for meta-analysis if possible. We will perform a subgroup analysis if enough data are available.Ethics and disseminationStrategies to disseminate our review include presenting in liver transplant review sessions, publishing in high-impact peer-reviewed medical journals, and presenting at national and international paediatric radiology and liver transplant meetings, conference presentations, events, courses and plain-language summaries. This knowledge will allow easier identification of patients with a higher risk of developing graft-related complications and could potentially improve patient and graft outcomes. We wish to disseminate our results to discover potential areas for future research and drive improved future practices and policies. Our target audience includes researchers, institutions, healthcare professionals, health system decision-makers, policy-makers and research funders community.Trial registration numberCRD42019119986.
Client-level predictors of treatment engagement, outcome and dropout: moving beyond demographics
Authors: Youn Soo-jeong , Mackintosh Margaret-Anne , Wiltsey Stirman Shannon , Patrick Kaylie A , Aguilar Silvan Yesenia , Bartuska Anna D , Shtasel Derri L , Marques Luana 
Published: December 2019

BackgroundDespite the availability of evidence-based treatments for posttraumatic stress disorder (PTSD), significant heterogeneity in the effectiveness of PTSD treatment persists, especially in community settings. Client demographics used to understand this variability in treatment outcome and dropout have yielded mixed results. Despite increasing evidence for the importance of attending to treatment engagement in community settings, few studies have explored client-level predictors.AimThe purpose of this study is to explore client-level predictors of treatment outcome and dropout beyond client demographics, and to identify client-level predictors of treatment engagement in community settings.MethodSecondary data analysis was conducted with data collected as part of an implementation-effectiveness hybrid study of cognitive processing therapy (CPT) for PTSD in a diverse community health centre. Providers (n=19) treated (n=52) clients as part of their routine clinical care. Non-demographic client-level predictors included barriers to treatment, quality of life, session-level language and employment history assessed at baseline. Treatment engagement included number of weeks in the study, number of sessions with repeated CPT content, number of unique CPT sessions attended, frequency of session attendance and consistency of session attendance.ResultsResults showed language as a significant predictor of treatment engagement. There were significant differences between Spanish and English-speaking clients, with the former having a tendency to repeat more session content than the latter (β=1.4 sessions, p=0.003), and also less likely to attend treatment frequently (r=0.62, p=0.009) and consistently (r=0.57, p=0.027) if high logistical and financial barriers were endorsed. Irrespective of language, clients who reported high quality of life at baseline were less likely to repeat CPT session content (β=−0.3, p=0.04), and those with increased baseline barriers to treatment had deceleration in PTSD symptom improvement over time (β=−0.62, p<0.05). In terms of treatment engagement moderators impacting treatment outcome, clients who repeated more session content were more likely to complete treatment (OR=1.84, p=0.037).ConclusionIdentification of client-level predictors of treatment engagement, outcome and dropout is essential to optimise treatment, particularly in community settings.
Scattering of compactlike structures
Authors: Bazeia D. , Mendonça T. S. , Menezes R. , de Oliveira H. P. 
Published: December 2019

AbstractWe investigate the collision of a new class of topological defects that tends to become compact as a control parameter increases to larger and larger values. These new compactlike defects have, in general, more than one internal discrete mode depending on the value of the control parameter and, as usual, there is a critical velocity above which the defects escape after the collision. We noticed that below the critical velocity there are the windows of escape presenting fractal structure. An interesting novelty is the appearance of metastable structures with the formation of compactlike defects, maintaining a fixed distance from each other. Another new feature is the formation of boosted localized distributions of the scalar field which we called moving oscillons. These oscillons carry away almost all scalar field energy producing a complete disruption of the compactlike defects. The pattern of the moving oscillons depends on the control parameter, and becomes more complex as we increase its value. We conjecture that the new effects may be connected with the presence of more than one vibrational mode in the spectrum of the stability potential of the model under investigation.
Transcranial alternating current stimulation attenuates BOLD adaptation and increases functional connectivity
Authors: Kar Kohitij , Ito Takuya , Cole Michael W. , Krekelberg Bart 
Published: December 2019

Transcranial alternating current stimulation (tACS) is used as a noninvasive tool for cognitive enhancement and clinical applications. The physiological effects of tACS, however, are complex and poorly understood. Most studies of tACS focus on its ability to entrain brain oscillations, but our behavioral results in humans and extracellular recordings in nonhuman primates support the view that tACS at 10 Hz also affects brain function by reducing sensory adaptation. Our primary goal in the present study is to test this hypothesis using blood oxygen level-dependent (BOLD) imaging in human subjects. Using concurrent functional magnetic resonance imaging (fMRI) and tACS, and a motion adaptation paradigm developed to quantify BOLD adaptation, we show that tACS significantly attenuates adaptation in the human motion area (hMT+). In addition, an exploratory analysis shows that tACS increases functional connectivity of the stimulated hMT+ with the rest of the brain and the dorsal attention network in particular. Based on field estimates from individualized head models, we relate these changes to the strength of tACS-induced electric fields. Specifically, we report that functional connectivity (between hMT+ and any other region of interest) increases in proportion to the field strength in the region of interest. These findings add support for the claim that weak 10-Hz currents applied to the scalp modulate both local and global measures of brain activity. NEW & NOTEWORTHY Concurrent transcranial alternating current stimulation (tACS) and functional MRI show that tACS affects the human brain by attenuating adaptation and increasing functional connectivity in a dose-dependent manner. This work is important for our basic understanding of what tACS does, but also for therapeutic applications, which need insight into the full range of ways in which tACS affects the brain.
Phytoestrogens and Thyroid Cancer Risk: A Population-Based Case–Control Study in Connecticut
Authors: Wang Qian , Huang Huang , Zhao Nan , Ni Xin , Udelsman Robert , Zhang Yawei 
Published: December 2019

Abstract

Background:
Very few previous studies have examined the relationship between thyroid cancer risk and intake of phytoestrogens (PE); furthermore, these studies have reached inconsistent results.

Methods:
We analyzed data from a population-based case–control study in Connecticut from 2010 to 2011, including 387 histologically confirmed thyroid cancer cases and 433 population-based controls, with compound data available concerning specific PEs. Multivariate unconditional logistic regression models were used to estimate the associations between specific PEs and the risk of thyroid cancer, adjusting for potential confounders.

Results:
An elevated risk of thyroid cancer was associated with moderate to high levels of coumestrol intake [OR = 2.48, 95% confidence interval (CI), 1.39–4.43 for 40–80 μg/day; OR = 2.41, 95% CI, 1.32–4.40 for 80–130 μg/day; and OR = 2.38, 95% CI, 1.26–4.50 for &gt;200 μg/day compared with &lt;40 μg/day], and the main elevation in risk appeared among microcarcinomas (≤1 cm). A decreased risk of papillary macrocarcinomas (&gt;1 cm; OR = 0.26, 95% CI, 0.08–0.85 for 1,860–3,110 μg/day compared with &lt;760 μg/day) was associated with moderate genistein intake among women.

Conclusions:
Our study suggests that high coumestrol intake increases the risk of thyroid cancer, especially microcarcinomas, whereas moderate amounts of genistein intake appear to be protective for females with thyroid macrocarcinomas.

Impact:
The study highlights the importance of distinguishing between microcarcinomas and macrocarcinomas in future research on the etiology of thyroid cancer.
Genetic Interactions and Tissue Specificity Modulate the Association of Mutations with Drug Response
Authors: Cramer Dina , Mazur Johanna , Espinosa Octavio , Schlesner Matthias , Hübschmann Daniel , Eils Roland , Staub Eike 
Published: December 2019

Abstract
In oncology, biomarkers are widely used to predict subgroups of patients that respond to a given drug. Although clinical decisions often rely on single gene biomarkers, machine learning approaches tend to generate complex multi-gene biomarkers that are hard to interpret. Models predicting drug response based on multiple altered genes often assume that the effects of single alterations are independent. We asked whether the association of cancer driver mutations with drug response is modulated by other driver mutations or the tissue of origin. We developed an analytic framework based on linear regression to study interactions in pharmacogenomic data from two large cancer cell line panels. Starting from a model with only covariates, we included additional variables only if they significantly improved simpler models. This allows to systematically assess interactions in small, easily interpretable models. Our results show that including mutation–mutation interactions in drug response prediction models tends to improve model performance and robustness. For example, we found that TP53 mutations decrease sensitivity to BRAF inhibitors in BRAF-mutated cell lines and patient tumors, suggesting a therapeutic benefit of combining inhibition of oncogenic BRAF with reactivation of the tumor suppressor TP53. Moreover, we identified tissue-specific mutation–drug associations and synthetic lethal triplets where the simultaneous mutation of two genes sensitizes cells to a drug. In summary, our interaction-based approach contributes to a holistic view on the determining factors of drug response.
Carta do Editor Convidado
Authors: Dória Carlos Alberto 
Published: December 2019

Posto na condição de editor convidado para dar forma a este número da Ingesta, senti-me honrado sobretudo pela confiança em que pudesse situar a nova publicação, já de início, no campo de uma historiografia de certo modo heterodoxa. Heterodoxia já garantida pela filiação da revista ao LEHDA, por si só uma entidade que nasce rompendo paradigmas ao aproximar, como campo de estudo, a alimentação daquilo que as sociedades ocidentais chamaram ao longo do tempo, ou ainda chamam no jargão policial, de “droga”. Ingesta, ao contrário, aproxima esses domínios igualando-os no tratamento. Este primeiro número deve, no meu entender, servir de chamariz para o mais amplo espectro de intelectuais voltados para o estudo da alimentação ou das drogas, de modo a sentirem que, na Ingesta, qualquer investigação com esses focos, se bem conduzida, terá abrigo em suas páginas. Ingesta quer dar sua contribuição a esse horizonte na medida em que consiga despertar múltiplos interesses entre seus leitores, colocando abaixo os cânones temáticos e as fronteiras disciplinares que hoje organizam o mundo acadêmico.
Práticas sustentáveis temperadas por memórias e experiências
Authors: Abdala Monica 
Published: December 2019

A proposta deste artigo é apresentar uma reflexão sobre a experiência do Festival Igarapé Bem Temperado, entendendo-a como parte do mosaico de culturas e tradições de Minas Gerais, do Brasil e de um conjunto de movimentos para preservação do patrimônio cultural do estado. O reconhecimento de expressões locais, a valorização de experiências e saberes femininos relativos a conhecimentos ancestrais com foco na segurança alimentar, assim como a possibilidade tanto de resgatar identidades como de desenvolvimento econômico sustentável, constituem elementos centrais na análise. Trata-se também de investigar as diferentes formas pelas quais as tradições culinárias são ressignificadas, fazendo sentido para os grupos que as reafirmam, ao mesmo tempo que são manipuladas no bojo da reconstrução permanente do “tradicional e típico” mineiro. Mário de Andrade, Eric Hobsbawm, Carlos Dória e Marcelo Bastos, entre outros autores foram chamados ao diálogo numa tentativa de compreender a dinâmica cultural e política desse jogo de identidades e tradições mineiras.
Systematic Evaluation of the Robustness of the Evidence Supporting Current Guidelines on Myocardial Revascularization Using the Fragility Index
Authors: Gaudino Mario , Hameed Irbaz , Biondi-Zoccai Giuseppe , Tam Derrick Y. , Gerry Stephen , Rahouma Mohamed , Khan Faiza M. , Angiolillo Dominick J. , Benedetto Umberto , Taggart David P. , Girardi Leonard N. , Crea Filippo , Ruel Marc , Fremes Stephen E. 
Published: December 2019

Background:
RCTs (randomized controlled trials) are the preferred source of evidence to support professional societies’ guidelines. The fragility index (FI), defined as the minimum number of patients whose status would need to switch from nonevent to event to render a statistically significant result nonsignificant, quantitatively estimates the robustness of RCT results. We evaluate RCTs supporting current guidelines on myocardial revascularization using the FI and FI minus number of patients lost to follow-up.

Methods and Results:

The FI and FI minus number of patients lost to follow-up of RCTs supporting the 2012 American College of Cardiology/American Heart Association Guideline for the Diagnosis and Management of Patients with Stable Ischemic Heart Disease, the 2014 Focused Update of the American College of Cardiology/American Heart Association Guideline for the Diagnosis and Management of Patients with Stable Ischemic Heart Disease, and the 2018 European Society of Cardiology/European Association for Cardio-Thoracic Surgery Guidelines for Myocardial Revascularization were calculated. Of 414 RCTs identified, 160 were eligible for FI calculation. The median FI was 8.0 (95% CI, 5.0–9.0) and the median FI minus number of patients lost to follow-up was 1.0 (95% CI, 0.0–3.0). FI was ≤3, indicating very limited robustness, in 44 (27.5%) RCTs, and was lower than the number LTF, indicating limited robustness, in 68 (42.5%) RCTs. FI was significantly (all
P
<0.05) correlated with the sample size, number of events, statistical power, journal impact factor, use of intention-to-treat analysis, and of composite end points and negatively correlated with the use of percutaneous interventions in the treatment arm and the
P
-value level.

Conclusions:
More than a quarter of RCTs that support current guidelines on myocardial revascularization have a FI of 3 or lower, and over 40% of trials reveal a FI that is lower than the number of patients lost to follow-up. These findings suggest that the robustness of the findings that support current myocardial revascularization guidelines is tenuous and vulnerable to change as new evidence from RCTs appears.