bluuebunny/crossref_metadata_2025_split huggingface dataset:
Global incidence of surgical site infection after appendectomy: a systematic review and meta-analysis
Authors: Danwang Celestin , Bigna Jean Joel , Tochie Joel Noutakdie , Mbonda Aimé , Mbanga Clarence Mvalo , Nzalie Rolf Nyah Tuku , Guifo Marc Leroy , Essomba Arthur 
Published: February 2020

BackgroundAlthough surgical site infection (SSI) is one of the most studied healthcare-associated infections, the global burden of SSI after appendectomy remains unknown.ObjectiveWe estimated the incidence of SSI after appendectomy at global and regional levels.DesignSystematic review and meta-analysis.ParticipantsAppendectomy patients.Data sourcesEMBASE, PubMed and Web of Science were searched, with no language restrictions, to identify observational studies and clinical trials published between 1 January 2000 and 30 December 2018 and reporting on the incidence of SSI after appendectomy. A random-effect model meta-analysis served to obtain the pooled incidence of SSI after appendectomy.ResultsIn total, 226 studies (729 434 participants from 49 countries) were included in the meta-analysis. With regard to methodological quality, 59 (26.1%) studies had low risk of bias, 147 (65.0%) had moderate risk of bias and 20 (8.8%) had high risk of bias. We found an overall incidence of SSI of 7.0 per 100 appendectomies (95% prediction interval: 1.0–17.6), varying from 0 to 37.4 per 100 appendectomies. A subgroup analysis to identify sources of heterogeneity showed that the incidence varied from 5.8 in Europe to 12.6 per 100 appendectomies in Africa (p<0.0001). The incidence of SSI after appendectomy increased when the level of income decreased, from 6.2 in high-income countries to 11.1 per 100 appendectomies in low-income countries (p=0.015). Open appendectomy (11.0 per 100 surgical procedures) was found to have a higher incidence of SSI compared with laparoscopy (4.6 per 100 appendectomies) (p=0.0002).ConclusionThis study suggests a high burden of SSI after appendectomy in some regions (especially Africa) and in low-income countries. Strategies are needed to implement and disseminate the WHO guidelines to decrease the burden of SSI after appendectomy in these regions.Prospero registration numberCRD42017075257.
Evaluating follow-up and complexity in cancer clinical trials (EFACCT): an eDelphi study of research professionals’ perspectives
Authors: Jones Helene Markham , Curtis Ffion , Law Graham , Bridle Christopher , Boyle Dorothy , Ahmed Tanweer 
Published: February 2020

ObjectivesTo evaluate patient follow-up and complexity in cancer clinical trial delivery, using consensus methods to: (1) identify research professionals’ priorities, (2) understand localised challenges, (3) define study complexity and workloads supporting the development of a trial rating and complexity assessment tool (TRACAT).DesignA classic eDelphi completed in three rounds, conducted as the launch study to a multiphase national project (evaluating follow-up and complexity in cancer clinical trials).SettingMulticentre online survey involving professionals at National Health Service secondary care hospital sites in Scotland and England varied in scale, geographical location and patient populations.ParticipantsPrincipal investigators at 13 hospitals across nine clinical research networks recruited 33 participants using pre-defined eligibility criteria to form a multidisciplinary panel.Main outcome measuresStatements achieving a consensus level of 70% on a 7-point Likert-type scale and ranked trial rating indicators (TRIs) developed by research professionals.ResultsThe panel developed 75 consensus statements illustrating factors contributing to complexity, follow-up intensity and operational performance in trial delivery, and specified 14 ranked TRIs. Seven open questions in the first qualitative round generated 531 individual statements. Iterative survey rounds returned rates of 82%, 82% and 93%.ConclusionsClinical trials operate within a dynamic, complex healthcare and innovation system where rapid scientific advances present opportunities and challenges for delivery organisations and professionals. Panellists highlighted cultural and organisational factors limiting the profession’s potential to support growing trial complexity and patient follow-up. Enhanced communication, interoperability, funding and capacity have emerged as key priorities. Future operational models should test dialectic Singerian-based approaches respecting open dialogue and shared values. Research capacity building should prioritise innovative, collaborative approaches embedding validated review and evaluation models to understand changing operational needs and challenges. TRACAT provides a mechanism for continual knowledge assimilation to improve decision-making.
Local and systemic morbidities of de novo metastatic prostate cancer in Singapore: insight from 685 consecutive patients from a large prospective Uro-oncology registry
Authors: Tan Yu Guang , Pang Leonard , Khalid Farhan , Poon Randy , Huang Hong Hong , Chen Kenneth , Tay Kae Jack , Lau Weber , Cheng Christopher , Ho Henry , Yuen John 
Published: February 2020

ObjectiveTo evaluate the incidence and management of local and systemic complications afflicting patients with de novo metastatic prostate cancer (mPCa) in Singapore.DesignRetrospective analysis of a large prospective Uro-oncology registry of mPCa.SettingThis study is carried out in a tertiary hospital in Singapore.ParticipantsWe reviewed our institution’s prospectively maintained database of 685 patients with mPCa over a 20-year period (1995–2014). Patients with non-mPCa or those progressed to metastatic disease after previous curative local treatments were excluded.Primary and secondary outcome measuresThe primary outcome was to evaluate the systemic and local morbidity rates associated with mPCa. Local complication was defined as the need for palliative procedures to relieve urinary obstruction, worsening renal function or refractory haematuria, while systemic complication was related to radiographic evidence of skeletal-related pathological fractures. Secondary outcomes analysed were the management and overall survival patterns over 20 years.Results237 (34.6%) patients required local palliative treatments. 88 (12.8%) patients presented with acute urinary retention, 23 patients (9.7%) required repetitive local palliative treatments. On multivariate analyses, prostate-specific antigen >100 (p=0.02) and prostate volume >50 g (p=0.03) were independent prognostic factors for significant obstruction requiring palliative procedures. 118 (17.2%) patients developed skeletal fractures, with poor Eastern Cooperative Oncology Group Performance (ECOG) status (p=0.01) and high volume bone metastasis (p<0.01) independently predictive of skeletal fractures. Altogether, 653 (95.3%) patients received androgen deprivation therapy (ADT), with the median time to castrate resistance of 21.4 months (IQR 7–27). The median overall survival was 45 months (IQR 20–63), with prostate cancer mortality of 81.4%. Improved overall survival was observed from 41.6 months (1995–1999) to 47.8 months (2010–2014) (p<0.01).ConclusionMorbidities and complications arising from mPCa are more common and debilitating than we thought, often requiring immediate palliative treatments, while many necessitate repeated interventions with progression.
Physical activity trails in an urban setting and cardiovascular disease morbidity and mortality in Winnipeg, Manitoba, Canada: a study protocol for a natural experiment
Authors: Hobin Erin , Swanson Anders , Booth Gillian , Russell Kelly , Rosella Laura C , Smith Brendan T , Manley Ed , Isaranuwatchai Wanrudee , Whitehouse Stephanie , Brunton Nicole , McGavock Jonathan 
Published: February 2020

IntroductionAspects of the built environment that support physical activity are associated with better population health outcomes. Few experimental data exist to support these observations. This protocol describes the study of the creation of urban trials on cardiovascular disease (CVD)-related morbidity and mortality in a large urban centre.Methods and analysisBetween 2008 and 2010, the city of Winnipeg, Canada, built four, paved, multiuse (eg, cycling, walking and running), two-lane trails that are 5–8 km long and span ~60 neighbourhoods. Linking a population-based health data with census and environmental data, we will perform an interrupted time series analysis to assess the impact of this natural experiment on CVD-related morbidity and mortality among individuals 30–65 years of age residing within 400–1200 m of the trail. The primary outcome of interest is a composite measure of incident major adverse CVD events (ie, CVD-related mortality, ischaemic heart disease, stroke and congestive heart failure). The secondary outcome of interest is a composite measure of incident CVD-related risk factors (ie, diabetes, hypertension and dyslipidaemia). Outcomes will be assessed quarterly in the 10 years before the intervention and 5 years following the intervention, with a 4-year interruption. We will adjust analyses for differences in age, sex, ethnicity, immigration status, income, gentrification and other aspects of the built environment (ie, greenspace, fitness/recreation centres and walkability). We will also assess trail use and trail user profiles using field data collection methods.Ethics and disseminationEthical approvals for the study have been granted by the Health Research Ethics Board at the University of Manitoba and the Health Information Privacy Committee within the Winnipeg Regional Health Authority. We have adopted an integrated knowledge translation approach. Information will be disseminated with public and government partners.Trial registration numberNCT04057417.
Professional values and behaviours of younger and older general practitioners in Scotland: a cross-sectional survey
Authors: Foster Trudy Lynn , Bowie Paul 
Published: February 2020

AimProfessionalism has been linked with improved patient care and reduced complaints. Our goal was to define what, if any, differences exist in the professional values and behaviours of younger general practitioners (GPs), those aged 34 years and under, compared with their older colleagues, those being aged 55 years and over.MethodAn online cross-sectional questionnaire survey of GPs in Scotland was undertaken during 2018 using a modified version of the Nijmegen Professionalism Scale, which comprises 4 domains: professionalism towards patients, towards colleagues, towards society and towards oneself. Descriptive and inferential data analysis was undertaken between responses from both GP groups.Results273 responses were obtained. Of these, 106 respondents were classed as either younger GPs (n=55; 51.9%) or older (n=51; 48.1%). The greatest number of differences were found in the Professional Distance subsection of professionalism towards patients. The greatest single disparity in responses was to distinguish between personal and professional interests in negotiations (p<0.0001). Younger GPs also reported they were less likely to bear the consequences of their own actions (p<0.02) and to be more likely to give others the blame or responsibility (p<0.006). Younger GPs report being less skilled in quality management, being less able to signal suboptimal care (p<0.006) and justify indications for making home visits (p<0.001).ConclusionWhile there were areas of similarity in relation to collaborating with colleagues, reflection on learning and dealing with emotions, differences were identified in relation to the 5 other subsections. Some differences may be explained by lack of exposure and experience, but this may not account for all the differences reported.
EFFECTIVENESS OF FLOOR MARKINGS FOR CONTROLLING CUT WIDTH DURING SIDE CUTTING TASKS IN LABORATORY EXPERIMENTS
Authors: PAN JING WEN , STERZING THORSTEN , PANG JUN WEI , CHUA YAOHUI KELVIN , KONG PUI WAH 
Published: February 2020

This study examined the effectiveness of floor markings for controlling cut width during the analysis of side cutting maneuvers. Eleven male basketball players performed two side cutting maneuvers of narrow (30[Formula: see text]cm) and wide (45[Formula: see text]cm) cut widths and were guided by floor markings. Ground reaction forces, together with ankle, knee, and hip joint ranges of motion (ROM), and respective joint moments were determined. Cut widths were verified by two approaches by calculating the actual foot-to-foot and foot-to-pelvis distances from motion data. Biomechanical lower extremity loading showed no significant differences in most kinetic and kinematic variables between narrow and wide cuts. The difference in foot-to-foot distance (15.1 [11.6, 18.7] cm, [Formula: see text] between conditions corresponded well with floor markings, however, the difference in foot-to-pelvis distance was much smaller (2.3 [0.3, 4.4] cm, [Formula: see text]. It is concluded that floor markings are not sufficient for controlling the actual anatomical cut width in laboratory experiments. Participants may adjust their body postures to maintain similar lower extremity loading when performing side cuts differing in foot placement width. Cut width should be represented by foot-to-pelvis distance and not foot-to-foot distance.
Cancer-Associated Fibroblasts Promote Immunosuppression by Inducing ROS-Generating Monocytic MDSCs in Lung Squamous Cell Carcinoma
Authors: Xiang Handan , Ramil Carlo P. , Hai Josephine , Zhang Chunsheng , Wang Huijun , Watkins Amanda A. , Afshar Roshi , Georgiev Peter , Sze Marc A. , Song Xuelei S. , Curran Patrick J. , Cheng Mangeng , Miller J. Richard , Sun Dongyu , Loboda Andrey , Jia Yanlin , Moy Lily Y. , Chi An , Brandish Philip E. 
Published: February 2020

Abstract

Cancer-associated fibroblasts (CAF) represent a functionally heterogeneous population of activated fibroblasts that constitutes a major component of tumor stroma. Although CAFs have been shown to promote tumor growth and mediate resistance to chemotherapy, the mechanisms by which they may contribute to immune suppression within the tumor microenvironment (TME) in lung squamous cell carcinoma (LSCC) remain largely unexplored. Here, we identified a positive correlation between CAF and monocytic myeloid cell abundances in 501 primary LSCCs by mining The Cancer Genome Atlas data sets. We further validated this finding in an independent cohort using imaging mass cytometry and found a significant spatial interaction between CAFs and monocytic myeloid cells in the TME. To delineate the interplay between CAFs and monocytic myeloid cells, we used chemotaxis assays to show that LSCC patient–derived CAFs promoted recruitment of CCR2+ monocytes via CCL2, which could be reversed by CCR2 inhibition. Using a three-dimensional culture system, we found that CAFs polarized monocytes to adopt a myeloid-derived suppressor cell (MDSC) phenotype, characterized by robust suppression of autologous CD8+ T-cell proliferation and IFNγ production. We further demonstrated that inhibiting IDO1 and NADPH oxidases, NOX2 and NOX4, restored CD8+ T-cell proliferation by reducing reactive oxygen species (ROS) generation in CAF-induced MDSCs. Taken together, our study highlights a pivotal role of CAFs in regulating monocyte recruitment and differentiation and demonstrated that CCR2 inhibition and ROS scavenging abrogate the CAF–MDSC axis, illuminating a potential therapeutic path to reversing the CAF-mediated immunosuppressive microenvironment.
Omission, Created Ambiguity, and Chronology in the Book of Jubilees
Authors: Halpern Amaru Betsy 
Published: February 2020

Abstract
Omission is a common strategy in ancient texts that rework biblical narratives and the author of the Book of Jubilees frequently employs the strategy. Particularly striking is the omission of chronological material, for the dating of events is a primary feature of Jubilees. This essay examines two cases in which Jubilees omits biblical chronological data. One involves the age of Noah; the other the ten years that Abram is living in the land. In each instance ambiguity within the Jubilees-created chronology accompanies the omission. In the matter of the age of Noah the created ambiguity responds to incongruities in the biblical text and supports a reworked chronology. By contrast, in the matter of the ten years the created ambiguity responds to postbiblical interpretation of the biblical text.
The influence of blood flow velocity changes to postoperative cognitive dysfunction development in patients undergoing heart surgery with cardiopulmonary bypass
Authors: Bukauskienė Rasa , Širvinskas Edmundas , Lenkutis Tadas , Benetis Rimantas , Steponavičiūtė Rasa 
Published: February 2020

Background: The aim of this study was to compare blood flow velocity changes in the middle cerebral artery before, during and after heart surgery with cardiopulmonary bypass for patients with and without postoperative cognitive dysfunction. Materials and methods: A total of 100 patients, undergoing elective coronary artery bypass grafting or/and valve surgery enrolled in the study. A neurocognitive test evaluation included Adenbrooke, Mini-Mental State Examination and Trial Making test before and 7-10 days after surgery. Middle cerebral artery mean blood flow velocity was evaluated 1 day before the surgery, after anaesthesia induction, before cardiopulmonary bypass, at the beginning, ending and after cardiopulmonary bypass, and post surgery in intensive care unit. Blood samples for glial fibrillary acidic protein were measured after anaesthesia induction, 24 hours and 48 hours after surgery. According to neurocognitive tests results patients were divided in to two groups: patients with and without postoperative cognitive dysfunction. Results: Of the 100, 86 patients completed investigation. After induction, blood flow velocity of the middle cerebral artery was lower in postoperative cognitive dysfunction group (41.2; min 27.91, max 49.47) than in the H group (41.2, min 21.9, max 84.3) p = 0.034, and during cardiopulmonary bypass, blood flow velocity of the middle cerebral artery was lower in the postoperative cognitive dysfunction group (37.35, min 26.6, max 44.02) than the H group (42.3, min 20.1, max 86.5), p = 0.001. After the surgery, blood flow velocity of the middle cerebral artery was lower in the postoperative cognitive dysfunction group (40.7, min 29.7, max 50.4) than in the H group (45.3, min 34.12, max 59.88), p = 0.05. Results of cognitive tests had weak correlation (rho, 0.391) with middle cerebral artery’s blood flow velocity after anaesthesia induction (p = 0.001) and during bypass (p = 0.018). The receiver operating characteristic analysis showed that the blood flow velocity of the middle cerebral artery during bypass (area under the curve = 0.735) was a fair predictor for postoperative cognitive dysfunction (p = 0.001). No significant correlations were found among glial fibrillary acidic protein, middle cerebral artery blood flow velocity, and cognitive tests results. Conclusion: Middle cerebral artery’s blood flow velocity was decreased after anaesthesia induction and during cardiopulmonary bypass for patients with postoperative cognitive dysfunction comparing with their blood flow velocity preoperatively. Blood flow velocity during bypass has diagnostic value for postoperative cognitive dysfunction. Brain biomarker glial fibrillary acidic protein is not helpful in diagnosing postoperative cognitive dysfunction.
Tissue sodium content in patients with systemic lupus erythematosus: association with disease activity and markers of inflammation
Authors: Carranza-León D A , Oeser A , Marton A , Wang P , Gore J C , Titze J , Stein C M , Chung C P , Ormseth M J 
Published: February 2020

Objectives Sodium (Na+) is stored in the skin and muscle and plays an important role in immune regulation. In animal models, increased tissue Na+ is associated with activation of the immune system, and high salt intake exacerbates autoimmune disease and worsens hypertension. However, there is no information about tissue Na+ and human autoimmune disease. We hypothesized that muscle and skin Na+ content is (a) higher in patients with systemic lupus erythematosus (SLE) than in control subjects, and (b) associated with blood pressure, disease activity, and inflammation markers (interleukin (IL)-6, IL-10 and IL-17 A) in SLE. Methods Lower-leg skin and muscle Na+ content was measured in 23 patients with SLE and in 28 control subjects using 23Na+ magnetic resonance imaging. Demographic and clinical information was collected from interviews and chart review, and blood pressure was measured. Disease activity was assessed using the SLE Disease Activity Index (SLEDAI). Plasma inflammation markers were measured by multiplex immunoassay. Results Muscle Na+ content was higher in patients with SLE (18.8 (16.7–18.3) mmol/L) than in control subjects (15.8 (14.7–18.3) mmol/L; p < 0.001). Skin Na+ content was also higher in SLE patients than in controls, but this difference was not statistically significant. Among patients with SLE, muscle Na+ was associated with SLEDAI and higher concentrations of IL-10 after adjusting for age, race, and sex. Skin Na+ was significantly associated with systolic blood pressure, but this was attenuated after covariate adjustment. Conclusion Patients with SLE had higher muscle Na+ content than control subjects. In patients with SLE, higher muscle Na+ content was associated with higher disease activity and IL-10 concentrations.
Supply Chain Performance and Profitability in Indian Automobile Industry: Evidence of Segmental Difference
Authors: Tripathi Saswati , Talukder Bijoy 
Published: February 2020

The automobile industry is broadly categorized into three segments—commercial vehicles, passenger vehicles and two/three-wheelers. The automobile supply chain is complex, as this includes raw material suppliers, component manufacturers, sub assemblers, final assemblers, different distribution channels, networks and end consumers. This demands a robust supply chain that can integrate all these links for cost efficiency and profitability. The objectives of this article are to find segmental differences in the supply chain performance of the Indian automobile industry and to quantify the impact of supply chain performance on the overall profitability of the firms across the segments. This article measures the performance of the supply chain of Indian automobile industry segments integrating supply chain financial metrics and supply chain operations reference key performance indicators (SCOR KPIs) through a 10-year timeline. The results are compared across segments to identify unique performance features, if any, using ANOVA. A panel data fixed effect model (least square dummy variable [LSDV]) is constructed to establish the relationship between supply chain performance and profitability and to understand whether the identified supply chain performance variables have any significant impact on profitability across the segments. This article has evidenced that though the supply chain of two/three-wheelers segment is performing better in fixed asset and inventory turnover it is more impacted by distribution inefficiency. The supply chain of the commercial-vehicles segment is impacted more by excess fixed assets, distribution inefficiency and poor inventory turnover. Although inventory turnover of passenger-vehicles segment is better than that of the commercial vehicles, the supply chain fixed assets remain a concern for this segment. Across the industry segments, the profitability of the segment is more impacted by poor distribution efficiency compared to fixed assets and inventory turnover. This article contributes towards finding key segmental supply chain performance features of the Indian automobile industry and building a panel data fixed effect model by integrating supply chain performance indicators with the profitability of the firms across the segments. This model can contribute towards effective decision-making in the automobile supply chain.