bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effects of cancer care pathways on waiting times
Authors: Smeds Magdalena , Poksinska Bozena Bonnie 
Published: December 2018

Purpose
The Swedish health-care system currently implements cancer care pathways (CCPs) for better and more timely cancer diagnostics. The purpose of this paper is to elucidate and define “crowding out” effects associated with the CCP implementation.

Design/methodology/approach
A document study based on implementation reports and action plans from Swedish county councils (n = 21) and a case study in one county council were conducted. Qualitative data collection and analysis were used to acquire more knowledge about the “crowding out” effects associated with the CCP implementation.

Findings
Three effects discussed under “crowding out” were defined. The first effect, called the push-out effect, occurs when other patients have to wait for care longer in favour of CCP patients. Another effect is the inclusion effect, whereby “crowding out” is reduced for vulnerable patients due to the standardised procedures and criteria in the referral process. The final effect is the exclusion effect, where patients in need of cancer diagnostics are, for some reason, not referred to CCP. These patients are either not diagnosed at all or diagnosed outside CCP by a non-standard process, with the risk of longer waiting times.

Originality/value
“Crowding out” effects are an urgent topic related to CCP implementation. While these effects have been reported in international research studies, no shared definition has been established to describe them. The present paper creates a common base to measure the “crowding out” effects and support further development of CCPs to avoid the negative effects on waiting times.
Analysing eco‐evolutionary dynamics—The challenging complexity of the real world
Authors: De Meester Luc , Brans Kristien I. , Govaert Lynn , Souffreau Caroline , Mukherjee Shinjini , Vanvelk Héléne , Korzeniowski Konrad , Kilsdonk Laurens , Decaestecker Ellen , Stoks Robby , Urban Mark C. 
Published: December 2018

Abstract

The field of eco‐evolutionary dynamics is developing rapidly, with a growing number of well‐designed experiments quantifying the impact of evolution on ecological processes and patterns, ranging from population demography to community composition and ecosystem functioning. The key challenge remains to transfer the insights of these proof‐of‐principle experiments to natural settings, where multiple species interact and the dynamics are far more complex than those studied in most experiments.

Here, we discuss potential pitfalls of building a framework on eco‐evolutionary dynamics that is based on data on single species studied in isolation from interspecific interactions, which can lead to both under‐ and overestimation of the impact of evolution on ecological processes. Underestimation of evolution‐driven ecological changes could occur in a single‐species approach when the focal species is involved in co‐evolutionary dynamics, whereas overestimation might occur due to increased rates of evolution following ecological release of the focal species.

In order to develop a multi‐species perspective on eco‐evolutionary dynamics, we discuss the need for a broad‐sense definition of “eco‐evolutionary feedbacks” that includes any reciprocal interaction between ecological and evolutionary processes, next to a narrow‐sense definition that refers to interactions that directly feed back on the interactor that evolves.

We discuss the challenges and opportunities of using more natural settings in eco‐evolutionary studies by gradually adding complexity: (a) multiple interacting species within a guild, (b) food web interactions and (c) evolving metacommunities in multiple habitat patches in a landscape. A literature survey indicated that only a few studies on microbial systems so far developed a truly multi‐species approach in their analysis of eco‐evolutionary dynamics, and mostly so in artificially constructed communities.

Finally, we provide a road map of methods to study eco‐evolutionary dynamics in more natural settings. Eco‐evolutionary studies involving multiple species are necessarily demanding and might require intensive collaboration among research teams, but are highly needed.

A plain language summary is available for this article.
Human Capital and the CAP: The Case for Radical Policy Reform
Authors: Caskie Paul 
Published: December 2018

SummaryAmbitious EU objectives for a more resilient, sustainable and competitive agricultural sector, cannot be achieved unless more attention is given to the development of human capital. Despite longstanding interventions to promote specialist agricultural education, farmer attainment metrics remain disappointing. Likewise participation rates in lifelong learning are much lower for farmers than for the working population generally. Based on experience in other sectors, there is potential to apply measures on minimum practitioner competency, practitioner accreditation and continuing professional development to agriculture. As part of this policy framework, a share of the future EU agriculture budget should be placed in a Knowledge Fund to be allocated in the form of Knowledge Vouchers. Given ingrained barriers to change that must be overcome, farmers using Knowledge Vouchers to finance training, skills and competency development should be rewarded with a cash payment. Farmers that do not engage in education and lifelong learning would see subsidy payments reduced. The prescribed policy change would improve overall value for public money and align with proposals for Member States to develop Strategic Plans to meet economic, environmental and social objectives, as part of post‐2020 CAP reforms.
Study Enrollment When “Preconsent” Is Utilized for a Randomized Clinical Trial of Two Treatments for Acute Agitation in the Emergency Department
Authors: Cole Jon B , Klein Lauren R. , Mullinax Samuel Z. , Nordstrom Kimberly D. , Driver Brian E. , Wilson Michael P. 
Published: December 2018

AbstractBackgroundAcute agitation in the emergency department (ED) represents a danger to both patients and their caregivers. Medication is often needed, and few high‐quality randomized trials have evaluated the optimal drugs for this vulnerable population. In the United States, as of 2017, randomized trials of drugs typically cannot be conducted under Waiver of Consent (46 CFR 45.116), and Exception From Informed Consent trials (21 CFR 50.24) are limited to life‐threatening conditions, are onerous, and require filing an investigational new drug application with the FDA. We sought to conduct a randomized double‐dummy trial of inhaled loxapine versus intramuscular haloperidol + lorazepam for acute agitation in the ED by obtaining consent in advance (“preconsent”) in patients at risk of future agitation, allowing study drug administration up to 3 years later if the patient presented with acute agitation.ObjectiveWe sought to report the successful enrollment rate of patients preconsented at an earlier ED visit for this trial.MethodsThis was an analysis of patients age 18 to 64 with bipolar I disorder or schizophrenia preconsented for enrollment in the trial (clinicaltrials.gov, NCT02877108) conducted at a single urban academic center seeing approximately 60,000 patients per year. Eligible patients were assessed for capacity to consent by trained research associates, and informed consent was obtained at an ED visit for the possibility of administering drugs for agitation within the next 3 years. In the event the patient later presented to the ED and the attending physician deemed the patient required treatment for acute agitation, preconsent was confirmed and study drug would be administered.ResultsOver 67 days, 1,461 patients were screened in the ED, 269 had bipolar I or schizophrenia, 194 of whom had a contraindication to inhaled loxapine leaving 75 eligible patients; preconsent was obtained in 43 patients. Four additional patients who had not preconsented were consented for the trial in real time (three by surrogate, one patient had capacity while agitated) resulting in a total of 47 consented patients. Of these 47, a total of 12 were later removed from the study: 10 patients had unrecognized exclusion criteria for inhaled loxapine, one preconsented patient contacted the investigators at a later date and asked to be removed, and one surrogate revoked consent immediately after providing it. Only two patients were successfully enrolled, neither by preconsent: one was enrolled via a surrogate the day of enrollment, and the other was mildly agitated and had capacity to consent. The remaining patient with a valid surrogate consent did not receive study medication.ConclusionsUtilization of preconsent to enroll patients in a randomized trial of treatments for acute agitation in the ED requires substantial resources and may not be feasible.
Reduced fear‐of‐self is associated with improvement in concerns related to repugnant obsessions in obsessive–compulsive disorder
Authors: Aardema Frederick , Wong Shiu F. , Audet Jean‐Sebastien , Melli Gabriele , Baraby Louis‐Philippe 
Published: December 2018

ObjectiveThe potential causal and maintaining role of vulnerable self‐themes and beliefs about the self in obsessive–compulsive disorder (OCD) have received increasing attention from cognitive‐behavioural theorists. This interest was translated into the development of a self‐report measurement of the feared self (the fear of who one might be or become), a construct theoretically and empirically pertinent to unwanted thoughts and impulses in OCD (i.e., repugnant obsessions).MethodThe current study aimed to provide converging evidence on the relevance of the feared self in OCD, by examining whether improvements in symptoms associated with repugnant obsessions (measured on the Vancouver Obsessional Compulsive Inventory [VOCI] obsessions subscale) would be predicted by reduced feared self‐perceptions (measured on the Fear‐of‐Self Questionnaire [FSQ]) in a sample of 93 patients receiving psychotherapy for OCD.ResultsUsing a series of hierarchical linear regression models, we found that treatment‐related reductions on the FSQ significantly and uniquely predicted reductions on the VOCI obsessions subscale and the contamination subscale.ConclusionsThe current study thus replicated previous research suggesting the relevance of the feared possible self in psychological disorders such as OCD, where negative self‐perception is a dominant theme.Practitioner points

Current results suggest that changes in feared self‐perceptions may be the mechanism through which OCD symptoms improve via therapy.

Interventions specifically aimed at changing feared self‐perceptions may prove effective in improving cognitive‐behavioural treatments for OCD.

One limitation of the current study is the lack of behavioural measures of OCD to supplement self‐report measures of OCD.

Another limitation is that the small number of patients receiving some of the treatments precludes investigations into which treatments may be more effective in altering feared self‐perceptions.
Bendamustine as part of conditioning of autologous stem cell transplantation in patients with aggressive lymphoma: a phase 2 study from the GELTAMO group
Authors: Redondo Alba M. , Valcárcel David , González‐Rodríguez Ana P. , Suárez‐Lledó María , Bello José L. , Canales Miguel , Gayoso Jorge , Colorado Mercedes , Jarque Isidro , del Campo Raquel , Arranz Reyes , Terol María J. , Rifón José J. , Rodríguez María J. , Ramírez María J , Castro Nerea , Sánchez Andrés , López‐Jiménez Javier , Montes‐Moreno Santiago , Briones Javier , López Aurelio , Palomera Luis , López‐Guillermo Armando , Caballero Dolores , Martín Alejandro ,   the Grupo Español de Linfomas y Trasplante Autólogo de Médula Ósea (GELTAMO)
Published: December 2018

SummaryWe conducted a phase 2 trial to evaluate the safety and efficacy of bendamustine instead of BCNU (carmustine) in the BEAM (BCNU, etoposide, cytarabine and melphalan) regimen (BendaEAM) as conditioning for autologous stem‐cell transplantation (ASCT) in patients with aggressive lymphomas. The primary endpoint was 3‐year progression‐free survival (PFS). Sixty patients (median age 55 [28–71] years) were included. All patients (except one who died early) engrafted after a median of 11 (9–72) and 14 (4–53) days to achieve neutrophil and platelet counts of >0.5 × 109/l and >20 × 109/l, respectively. Non‐relapse mortality at 100 days and 1 year were 3.3% and 6.7%, respectively. With a median follow‐up of 67 (40–77) months, the estimated 3‐year PFS and overall survival (OS) were 58% and 75%, respectively. Patients in partial response at study entry had significantly worse PFS and OS than patients who underwent ASCT in complete metabolic remission, and this was the only prognostic factor associated with both PFS (Relative risk [RR], 0.27 [95% confidence interval {CI} [0.12–0.56]) and OS (RR, 0.40 [95% CI 0.17–0.97]) in the multivariate analysis. BendaEAM conditioning is therefore a feasible and effective regimen in patients with aggressive lymphomas. However, patients not in complete metabolic remission at the time of transplant had poorer survival and so should be considered for alternative treatment strategies.
Outcome of sirolimus‐based immunosuppression, fifteen years post–live‐donor kidney transplantation: Single‐center experience
Authors: Hamdy Ahmed F , Elhadedy Muhammed A , Donia Ahmed F , Taha Noheir M , Bakr Mohamed A 
Published: December 2018

AbstractIn a prospective randomized controlled trial, between May 2001 and January 2003, 132 live‐donor kidney transplant recipients were randomized to receive sirolimus primary immunosuppression, either in combination with low dose tacrolimus (Tac group) or in combination with mycophenolate mofetil (MMF group). We have previously reported on 2‐ and 5‐year follow‐up results, with favorable patient and graft outcomes obtained in both groups. In view of recent published reports of increased risk of inferior outcomes among sirolimus‐treated patients, we herein present results of an observational extension of the previously randomized patients 15 years post‐transplantation. Mortality rates were 10.8% and 3% in Tac and MMF groups respectively after mean follow‐up period of 11.2‐11.8 years. Comparable graft survival rates were obtained in both groups ranging from 60% to 62.7%. The (MMF) group continued to have the advantage of remaining on primary plan of immunosuppression (56.7% of patients) as well as to maintain better graft function in terms of serum creatinine level. Herein, we presented longest term published data for sirolimus‐based immunosuppression among live‐donor kidney transplants with favorable outcome in terms of survival and graft function.
Uptake of direct acting antiviral therapies for the treatment of hepatitis C virus among people who inject drugs in a universal health‐care system
Authors: Butler Kerryn , Larney Sarah , Day Carolyn A. , Burns Lucinda 
Published: December 2018

AbstractIntroduction and AimsDirect acting antiviral (DAA) treatment can reduce hepatitis C virus (HCV) infection incidence and mortality, although large scale uptake of these treatments is necessary to achieve those reductions. Targeting people who inject drugs (PWID) will be crucial to achieve the necessary reductions. Previously, treatment uptake has been very low (1–2%) among PWID, but these new DAAs have been subsidised in Australia since March 2016. This study describes treatment uptake among a sample of PWID in Australia and examines sociodemographic and drug use variables associated with treatment uptake.Design and MethodsAn Australian national cross‐sectional sample (n = 817) of regular PWID drawn from a convenience sentinel sample aged ≥18 years. Information on demographics, drug use, HCV antibody testing, RNA testing, recent DAA treatment initiation and DAA prescriber settings was collected via an interviewer‐administered survey.ResultsThere were 291 HCV RNA positive participants, of who one‐third reported initiating DAA treatment since the introduction of subsidised DAA medications. Current opioid substitution treatment was significantly associated with increased treatment uptake (adjusted odds ratio 2.20, 95% confidence interval 1.31, 3.68) while those with unstable housing were less likely to initiate treatment (adjusted odds ratio 0.42, 95% confidence interval 0.22, 0.82).Discussion and ConclusionsThis study found that DAA treatment uptake has increased among current PWID, a priority population for treatment. Efforts to maintain this uptake through linking current PWID with treatment providers through harm reduction services such as opioid substitution therapy, needle and syringe programs, and outreach services are required to meet incidence and mortality reduction targets.
Spatial and temporal diversity in hyperparasitoid communities of Cotesia glomerata on garlic mustard, Alliaria petiolata
Authors: Heinen Robin , Harvey Jeffrey A. 
Published: December 2018

1. Interactions between two trophic levels can be very intimate, often making species dependent on each other, something that increases with specialisation. Some specialised multivoltine herbivores may depend on multiple plant species for their survival over the course of a growing season, especially if their food plants are short‐lived and grow at different times. Later generations may exploit different plant species from those exploited by previous generations.2. Multivoltine parasitoids as well as their natural enemies must also find their hosts on different food plants in different habitats across the season. Secondary hyperparasitoid communities have been studied on cocoons of the primary parasitoid, Cotesia glomerata (Hymenoptera: Braconidae), on black mustard (Brassica nigra) – a major food plant of its host, the large cabbage white (Pieris brassicae) – which grows in mid‐summer.3. Here, hyperparasitoid communities on C. glomerata pupal clusters were studied on an early‐season host, garlic mustard, Alliaria petiolata, over ‘time’ (one season, April–July) in six closely located ‘populations’ (c. 2 km apart), and within two different ‘areas’ at greater separation (c. 100 km apart). At the plant level, spatial effects of pupal ‘location’ (canopy or bottom) on the plant were tested.4. Although large‐scale separation (area) did not influence hyperparasitism, sampling time and small‐scale separation (population) affected hyperparasitism levels and composition of hyperparasitoid communities. Location on the plant strongly increased proportions of winged species in the canopy and proportions of wingless species in bottom‐located pupae.5. These results show that hyperparasitism varies considerably at the local level, but that differences in hyperparasitoid communities do not increase with spatial distance.
Selective nonanal molecular recognition with SnO2 nanosheets for lung cancer sensor
Authors: Masuda Yoshitake , Kato Kazumi , Kida Masahito , Otsuka Jun 
Published: December 2018

AbstractSnO2 nanosheets were developed to detect nonanal gas in the order of ppb which was a marker of lung cancer. The nanosheets showed higher resistance change in nonanal gas than that in carbon monoxide (CO), nitrogen dioxide (NO2), acetone (CH3COCH3), hydrogen (H2), ethanol (C2H6O), ammonia (NH3), hydrogen sulfide (H2S), formaldehyde (HCHO), acetaldehyde (CH3CHO), or butanal (C4H8O). Crystal surfaces of the nanosheets would be effective for adsorption of nonanal molecules. Furthermore, it was shown that resistance changed with an increase in carbon number in aldehyde. The nanosheets had molecular selectivity for a series of aldehyde molecules. Molecular recognition of the nanosheets gave us a great advantage to detect nonanal gas which was produced by lung cancer.
Pediatric tinea capitis caused by Trichophyton violaceum and Trichophyton soudanense in Rochester, Minnesota, United States
Authors: Grigoryan Konstantin V. , Tollefson Megha M. , Olson Meredith A. , Newman Catherine C. 
Published: December 2018

AbstractBackgroundTinea capitis is a common pediatric dermatophyte infection. Its main pathogen in the United States is Trichophyton tonsurans accounting for greater than 95% of the infections. Other pathogens including Trichophyton violaceum and Trichophyton soudanense are common in Africa. Although rare in the United States, their prevalence is increasing, possibly because of immigration patterns. We evaluated the demographic characteristics, treatments, and resolution among pediatric patients with T. violaceum and T. soudanense infections.MethodsRetrospective chart review of patients from Mayo Clinic in Rochester, Minnesota, United States, with cultures positive for T. violaceum and T. soudanense from 1997 to 2014. Age at presentation, ethnic background, date and location of culture, and treatment were extracted.ResultsIn total, 81 children (age <18 years) were identified as positive for T. violaceum and T. soudanense (mean [range] age, 6.0 [1–17] years). Race/ethnicity of 67 patients (82.7%) was African; four, African‐American; three, white; two, Asian; and five, unknown. After culture identification, 64 patients (79.0%) received griseofulvin; five, terbinafine; and three, itraconazole; nine patients had no documented oral antifungal therapy. Of 28 patients not lost to follow‐up, median time to clinical cure was 2.3 months (interquartile range, 2.8 months).ConclusionT. violaceum and T. soudanense are tinea capitis pathogens, most common among patients of African descent. The pathogens may be underrecognized because such tinea capitis causes are rare in the United States. Most patients had direct contact with persons who had similar symptoms, suggesting contagious nature. Griseofulvin and terbinafine appear to be acceptable treatments against these organisms.
A study to investigate the impact of a blended learning teaching approach to teach pharmacy law
Authors: Nazar Hamde , Omer Usmaan , Nazar Zachariah , Husband Andy 
Published: December 2018

Abstract

Objective
To describe the implementation and assess the effect of a blended learning approach to teach pharmacy law.

Methods
Twenty didactic pharmacy law lectures were redeveloped to 9 h of flipped classroom sessions. Presession online videos delivered factual content created in-house. In-class activities explored the application and nuances of law through simulated cases. Stage 2 Pharmacy undergraduate students (n = 69) were administered the Community of Inquiry Survey, measuring the social, teaching and cognitive presence of online learning experiences across 34 items on a Likert scale 1–5 (1 = ‘strongly agree’, to 5 = ‘strongly disagree’). Four focus groups were undertaken and analysed thematically to explore student perceptions. Performance at the final summative law examination was recorded and compared to that of two previous cohorts given traditional, didactic teaching.

Key findings
Fifty-three students (76.8% response) completed the survey. The mean ranking was 3.6 ± 0.7, 3.6 ± 0.6 and 3.3 ± 0.7 for teaching, social and cognitive presence, and most positively rated statements related to material design and organization. All students passed the summative law examination performing not significantly different to the previous cohorts. Focus group discussions demonstrated that students liked the online and interactive case-study materials, but wanted more direction and preferred smaller group sessions. Students had mixed feelings about needing an online social component.

Conclusions
Blended learning transformed the pharmacy law teaching from didactic to an interactive learning experience. The student feedback was generally mixed, but offered many recommendations to optimize the design and format of the course. Examination performance appeared to be unaffected by the change in teaching style.