bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sensitivity Analysis and Power for Instrumental Variable Studies
Authors: Wang Xuran , Jiang Yang , Zhang Nancy R. , Small Dylan S. 
Published: March 2018

Summary
In observational studies to estimate treatment effects, unmeasured confounding is often a concern. The instrumental variable (IV) method can control for unmeasured confounding when there is a valid IV. To be a valid IV, a variable needs to be independent of unmeasured confounders and only affect the outcome through affecting the treatment. When applying the IV method, there is often concern that a putative IV is invalid to some degree. We present an approach to sensitivity analysis for the IV method which examines the sensitivity of inferences to violations of IV validity. Specifically, we consider sensitivity when the magnitude of association between the putative IV and the unmeasured confounders and the direct effect of the IV on the outcome are limited in magnitude by a sensitivity parameter. Our approach is based on extending the Anderson–Rubin test and is valid regardless of the strength of the instrument. A power formula for this sensitivity analysis is presented. We illustrate its usage via examples about Mendelian randomization studies and its implications via a comparison of using rare versus common genetic variants as instruments.
Preschoolers' conformity (and its motivation) is linked to own and parents' personalities
Authors: Hellmer Kahl , Stenberg Gunilla , Fawcett Christine 
Published: March 2018

Previous studies on conformity have primarily focused on factors that moderate conformity rates overall and paid little attention to explaining the individual differences. In this study, we investigate five‐factor model personality traits of both parents and children and experimentally elicited conformity in 3.5‐year‐olds (N = 59) using an Asch‐like paradigm with which we measure both overt conformity (public responses) and covert opinions (private beliefs after conformist responses): A correct covert opinion after an incorrect conformist response results from a socially normative motivation, whereas an incorrect covert opinion results from an informational motivation. Our data show (1) low parental extroversion is associated with participants' overall rate of conformity, (2) and low participant extroversion and high openness are associated with an informational instead of a normative motivation to conform. This suggests that sensitivity to the social context or social engagement level, as manifested through extroversion, could be an important factor in conformist behaviour.
Statement of contribution

What is already known on this subject?

We all conform, from early in life – and even when we should know better

We can conform for normative and informational motivations

Some are more prone to conform than others

What does this study add?

This is the first study to take an individual differences approach to developmental conformity

Social engagement (extroversion) is an important factor in conformity
Longitudinal associations between younger children's humour styles and psychosocial adjustment
Authors: James Lucy Amelia , Fox Claire Louise 
Published: March 2018

Whilst a multitude of studies have examined links between different styles of humour and aspects of adjustment, longitudinal research is noticeably lacking. Following a study which identified bidirectional associations between humour styles and psychosocial adjustment in older children, the current research aimed to investigate these associations in younger children. In total, 413 children aged 8–11 years completed the humour styles questionnaire for younger children (HSQ‐Y) alongside measures of psychosocial adjustment in both the autumn and the summer over the course of a school year. Findings across the school year suggested that children's adjustment may impact significantly on their use of different styles of humour. Further longitudinal research over a longer time period would now be beneficial to further increase our understanding of the associations between humour styles and adjustment throughout development.
Statement of contribution

What is already known on this subject?

Research has identified associations between children's humour styles and psychosocial adjustment.

Research with older children has also identified longitudinal associations.

What does this study add?

This is the first study to identify longitudinal associations between humour styles and adjustment in younger children.

This allows for stronger statements to be made about causal relationships.
Training of parental scaffolding in high‐socio‐economic status families: How do parents of full‐ and preterm‐born toddlers benefit?
Authors: Gärtner Kim Angeles , Vetter Verena Clara , Schäferling Michaela , Reuner Gitta , Hertel Silke 
Published: March 2018

BackgroundPreterm children have an increased risk regarding self‐regulation development. Given the strong link between parenting behaviour (i.e., scaffolding and sensitivity) and children's self‐regulation, parental training presents a promising way to counteract the negative consequences of preterm birth.AimsWe explored the effectiveness of parental training by comparing a basic scaffolding training and a combined scaffolding/sensitivity training to an active treatment‐control group (stress management). Basic and combined treatments should increase parents’ domain‐specific self‐efficacy (DSSE) and beliefs on parental co‐regulation and the promotion of learning (BCL) more than the control treatment should. No such differences were expected for parents’ domain‐general self‐efficacy (DGSE). We examined whether parents of preterm and full‐term children benefitted equally from training conditions.Sample(s)A total of 87 parents of full‐term and 35 parents of preterm toddlers (24–36 months of age, corrected for prematurity) participated.MethodsBased on a quasi‐experimental pre‐test–post‐test follow‐up design, parents were randomly assigned to treatments. A multimethod approach was applied, including self‐report, parent–child interactions, and standardized behavioural tasks. The presented study is limited to questionnaire data on parents’ DGSE, DSSE, and BCL.ResultsAn overall increase resulted from pre‐ to post‐test and/or follow‐up. Parents’ BCL changed significantly stronger in the combined training than in the control group. Parents of preterm and full‐term children benefitted equally from basic and combined training.ConclusionsThe combined training enhanced BCL among parents of full‐term and preterm children the most. If such training also yields improvement on the behavioural level, this finding will advance preterm aftercare.
Evaluating the impact of online discussion boards on student engagement with group work
Authors: Delaney Deborah , Kummer Tyge‐F. , Singh Kishore 
Published: March 2018

AbstractThe purpose of this study is to examine the impact of the use of an online discussion board as an assessment item on students learning performance in relation to group work based on Social Learning Theory. The study uses survey questionnaires at the beginning and end of semester together with student grade information. The data analysis consists of (1) a regression analysis to explore the relationship between student interaction and performance and (2) a repeated measures ANOVA to explore changes in attitude and perceived encouragement. Student's perceptions at the outset were found to be important as was the use of the online discussion board as a learning tool even when it is not assessed. Further, students' attitude to the online discussion board improved through the semester however the online assessment task did not encourage domestic students to be more engaged in group‐based activities. In contrast, international students were more encouraged to participate in group‐based activities at the end of the semester. The study has implications for online group activities in education.
Health‐related quality of life in active surveillance and radical prostatectomy for low‐risk prostate cancer: a prospective observational study (HAROW ‐ Hormonal therapy, Active Surveillance, Radiation, Operation, Watchful Waiting)
Authors: Ansmann Lena , Winter Nicola , Ernstmann Nicole , Heidenreich Axel , Weissbach Lothar , Herden Jan 
Published: March 2018

ObjectivesTo compare health‐related quality of life (HRQOL) between patients with localised prostate cancer in an active surveillance (AS) group and a radical prostatectomy (RP) group, as evidence shows that both groups have similar oncological outcomes. Thus, comparative findings on the patients’ HRQOL are becoming even more important to allow for informed treatment decision‐making.Patients and MethodsThe Hormonal therapy, Active Surveillance, Radiation, Operation, Watchful Waiting (HAROW) study is a prospective, observational study designed to collect data for different treatment options for newly diagnosed patients with localised prostate cancer under real‐life conditions. At 6‐month intervals, clinical data (D'Amico risk categories, Charlson Comorbidity Index) and HRQOL (European Organisation for Research and Treatment of Cancer quality of life questionnaire 30‐item core questionnaire) were collected. Data were analysed by longitudinal multilevel analysis for patients with localised prostate cancer under AS and RP.ResultsData from 961 patients (556 RP, 405 AS) were considered. The follow‐up was 3.5 years (median 2 years). The results reveal significant, but not clinically relevant advantages for patients with low‐risk prostate cancer managed with AS in contrast to RP concerning global HRQOL as well as role, emotional and social functioning over time, after controlling for age, comorbidities, and partnership status. In some, but not all HRQOL scales, RP patients start with a slightly lower HRQOL and recover up to the level of AS patients within 1–2 years after diagnosis.ConclusionHRQOL is an important aspect in the decision‐making and advising process for patients with prostate cancer. In many aspects of HRQOL, AS is associated with more favourable outcomes than RP within the first 1–2 years after diagnosis in our observational design, although the differences were not clinically significant. The result that HRQOL in AS patients is at least as high as in RP patients should be considered when advising patients about the different treatment options for low‐risk localised prostate cancer.
Low‐intensity extracorporeal shockwave therapy ameliorates diabetic underactive bladder in streptozotocin‐induced diabetic rats
Authors: Wang Hsun Shuan , Oh Byung Seok , Wang Bohan , Ruan Yajun , Zhou Jun , Banie Lia , Lee Yung Chin , Tamaddon Arianna , Zhou Tie , Wang Guifang , Lin Guiting , Lue Tom F. 
Published: March 2018

ObjectivesTo evaluate the therapeutic effect of once‐weekly low‐intensity extracorporeal shock wave therapy (Li‐ESWT) on underactive bladder (UAB) in the streptozotocin (STZ)‐induced diabetic rat model.Materials and MethodsIn all, 36 female Sprague–Dawley rats were divided into three groups: normal control (NC), diabetes mellitus control (DMC), and DM with Li‐ESWT (DM Li‐ESWT). The two DM groups received an intraperitoneal 60 mg/kg STZ injection to induce DM. The Li‐ESWT was applied toward the pelvis of the rats starting 4 weeks after STZ administration and lasting for 4 weeks. The Li‐ESWT was given once weekly, with an energy flux density of 0.02 mJ/mm2 at 3 Hz for 400 pulses. All rats underwent conscious cystometry, leak‐point pressure (LPP) assessment, ex vivo organ‐bath study, histology, immunofluorescence, and Western Blot analysis.ResultsConscious cystometry revealed voiding dysfunction in the DMC group, whereas the DM Li‐ESWT group showed significantly improved voiding function, reflected in a reduced post‐void residual urine volume and increased LPP compared to the DMC group. Ex vivo organ‐bath studies showed that Li‐ESWT enhanced muscle contractile activity of the bladder and urethra during electrical‐field stimulation and drug stimulation. Histologically, Li‐ESWT significantly restored bladder morphology, reflected by a reduction in the intravesical lumen area and increased muscle proportion of the bladder wall. Western Blot analysis showed higher smooth muscle actin expression in the bladder wall in the DM Li‐ESWT group compared to the DMC group. Immunofluorescence showed decreased nerve‐ending distribution, and destroyed and shortened nerve fibres in the DMC group, and recovery of neuronal integrity and innervation in the DM Li‐ESWT group.ConclusionsIn conclusion, Li‐ESWT ameliorated UAB and urinary incontinence in the diabetic UAB rat model. The improvement appears to be the result of restoration of bladder and urethral structure and function by Li‐ESWT. Li‐ESWT is non‐invasive and may become a better alternative therapy for UAB. Further investigations are warranted.
Time trends in service provision and survival outcomes for patients with renal cancer treated by nephrectomy in England 2000–2010
Authors: Hsu Ray C. J. , Barclay Matthew , Loughran Molly A. , Lyratzopoulos Georgios , Gnanapragasam Vincent J. , Armitage James N. 
Published: March 2018

ObjectiveTo describe the temporal trends in nephrectomy practice and outcomes for English patients with renal cell carcinoma (RCC).Patients and MethodsAdult RCC nephrectomy patients treated between 2000 and 2010 were identified in the National Cancer Data Repository and Hospital Episode Statistics, and followed‐up until date of death or 31 December 2015 (n = 30 763). We estimated the annual frequency for each nephrectomy type, the hospital and surgeon numbers and their case volumes. We analysed short‐term surgical outcomes, as well as 1‐ and 5‐year relative survivals.ResultsAnnual RCC nephrectomy number increased by 66% during the study period. Hospital number decreased by 24%, whilst the median annual hospital volume increased from 10 to 23 (P < 0.01). Surgeon number increased by 27% (P < 0.01), doubling the median consultant number per hospital. The proportion of minimally invasive surgery (MIS) nephrectomies rose from 1% to 46%, whilst the proportion of nephron‐sparing surgeries (NSS) increased from 5% to 16%, with 29% of all T1 disease treated with partial nephrectomy in 2010 (P < 0.01). The 30‐day mortality rate halved from 2.4% to 1.1% and 90‐day mortality decreased from 4.9% to 2.6% (P < 0.01). The 1‐year relative survival rate increased from 86.9% to 93.4%, whilst the 5‐year relative survival rate rose from 68.2% to 81.2% (P < 0.01). Improvements were most notable in patients aged ≥65 years and those with T3 and T4 disease.ConclusionsSurgical RCC management has changed considerably with nephrectomy centralisation and increased NSS and MIS. In parallel, we observed significant improvements in short‐ and long‐term survival particularly for elderly patients and those with locally advanced disease.
Implementing assessments of robot‐assisted technical skill in urological education: a systematic review and synthesis of the validity evidence
Authors: Goldenberg Mitchell G. , Lee Jason Y. , Kwong Jethro C.C. , Grantcharov Teodor P. , Costello Anthony 
Published: March 2018

ObjectivesTo systematically review and synthesise the validity evidence supporting intraoperative and simulation‐based assessments of technical skill in urological robot‐assisted surgery (RAS), and make evidence‐based recommendations for the implementation of these assessments in urological training.Materials and MethodsA literature search of the Medline, PsycINFO and Embase databases was performed. Articles using technical skill and simulation‐based assessments in RAS were abstracted. Only studies involving urology trainees or faculty were included in the final analysis.ResultsMultiple tools for the assessment of technical robotic skill have been published, with mixed sources of validity evidence to support their use. These evaluations have been used in both the ex vivo and in vivo settings. Performance evaluations range from global rating scales to psychometrics, and assessments are carried out through automation, expert analysts, and crowdsourcing.ConclusionThere have been rapid expansions in approaches to RAS technical skills assessment, both in simulated and clinical settings. Alternative approaches to assessment in RAS, such as crowdsourcing and psychometrics, remain under investigation. Evidence to support the use of these metrics in high‐stakes decisions is likely insufficient at present.
Modelling cost‐effectiveness of a biomarker‐based approach to neoadjuvant chemotherapy for muscle‐invasive bladder cancer
Authors: Lotan Yair , Woldu Solomon L. , Sanli Oner , Black Peter , Milowsky Matthew I. 
Published: March 2018

ObjectivesTo model the cost‐effectiveness of a biomarker‐based approach to select patients for neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) in muscle‐invasive bladder cancer (MIBC).Patients and MethodsWe obtained data from the most recent clinical studies on patients with locally advanced MIBC treated by RC, including stage distributions, overall survival (OS) estimates, associated costs, and utilisation/response to NAC. Additionally, we estimated the putative efficacy of three biomarkers to select patients for NAC: DNA‐repair gene panel [ataxia telangiectasia mutated (ATM), retinoblastoma 1 (RB1), and Fanconi anaemia complementation group C (FANCC)], excision repair cross‐complementation group 2 (ERCC2), and ribonucleic acid (RNA) subtypes. A decision analysis model was developed to evaluate the cost‐effectiveness of biomarker‐based approaches to select patients with MIBC for NAC. Comparison of cost‐effectiveness included RC alone, unselected NAC plus RC, and NAC based on the three aforementioned biomarkers.ResultsThe DNA‐repair gene panel‐based approach to NAC was the most cost‐effective strategy (mean OS of 3.14 years, $31 482/life year). Under this approach, 38% would undergo NAC, about twice the number of patients who are currently receiving NAC for MIBC. Such an approach would improve mean OS by 5.2, 1.6, and 4.4 months compared to RC alone, a hypothetical scenario where all patients received NAC, and compared to current estimates of NAC utilisation, respectively.ConclusionsA biomarker‐based strategy to identify patients with MIBC who should undergo NAC was more cost‐effective than unselected use of NAC or RC alone. As further data becomes available, such a model may serve as a basis for incorporating biomarkers into clinical decision making.
Synchronous nephron‐sparing approaches for bilateral renal masses: peri‐operative and renal functional outcomes
Authors: Mason Ross J. , Atwell Thomas , Lohse Christine , Bhindi Bimal , Schmit Grant , Schmitz John , Leibovich Bradley C. , Boorjian Stephen A. , Thompson R. Houston 
Published: March 2018

ObjectivesTo evaluate the peri‐operative and renal functional outcomes of patients undergoing synchronous bilateral partial nephrectomy (PN) or percutaneous cryoablation (PCA).Patients and MethodsWe retrospectively reviewed our institutional nephrectomy and renal mass ablation registries to identify all patients with synchronous bilateral renal masses who underwent simultaneous bilateral PN (n = 76) or PCA (n = 13) between 1974 and 2013. Changes in estimated glomerular filtration rate (eGFR) as well as peri‐operative complications are descriptively reported for each procedure.ResultsThe number of treated renal masses in the 76 patients in the PN group and the 13 patients in the PCA group was 249 and 28, respectively. The median (interquartile range [IQR]) age at treatment was 62 (50, 71) years for the PN group and 67 (56, 72) for the PCA group. The median (IQR) maximum tumour sizes were 4.6 (3.4, 6.5) cm and 2.6 (2.4, 3.2) cm for the PN and PCA groups, respectively. The median (IQR) length of hospital stay was 7 (5, 8) days for the PN group and 1 (1, 10) days for the PCA group. The median (IQR) change in eGFR from baseline to discharge was −32 (−46, −15)% for the PN group and −17% (−33, −3) for the PCA group. By 3 months, median (IQR) renal function improved, with changes of −9 (−19, 0)% and −8 (−11, 15)%, respectively, compared with baseline. No patient in either group required renal replacement therapy in the peri‐operative period. Early postoperative complications (within 30 days) occurred in 16 patients (21.6%) in the PN and four patients in the PCA group. In particular, angioembolization for bleeding was required in the postoperative period in two patients (2.7%) in the PN and one patient in the PCA group.ConclusionsOur experience suggests that synchronous bilateral PN or PCA are feasible treatment options for select patients presenting with bilateral renal masses. In select cases, both approaches appear to have reasonable rates of peri‐operative complications and effects on renal function.
A study into the association between local recurrence rates and surgical resection margins in organ‐sparing surgery for penile squamous cell cancer
Authors: Sri Denosshan , Sujenthiran Arunan , Lam Wayne , Minter Janice , Tinwell Brendan E. , Corbishley Catherine M. , Yap Tet , Sharma Davendra M. , Ayres Benjamin E. , Watkin Nick W. 
Published: March 2018

ObjectiveTo evaluate the significance of close surgical margins in organ‐sparing surgery (OSS) in the treatment of penile squamous cell carcinoma (pSCC) and clinicopathological factors that may influence local recurrence.Patients and MethodsAt our tertiary referral centre, between March 2001 and September 2012, 332 patients treated with OSS for pSCC had clear surgical margins. As the focus was the impact of close clear margins on local recurrence, patients with positive margins were excluded for the purpose of this study. Our overall positive margin rate for OSS in penile cancer is 7.6% (42 patients). Analysis was carried out on an on‐going prospective database, including prospective accurate pathological recording of surgical margins. Patients underwent OSS after multidisciplinary team (MDT) discussion. Local recurrence was the primary outcome measured and Fisher's exact test and time‐to‐recurrence curves were used in the analysis. All local recurrences were scrutinised by the MDT and were categorised into: true recurrences or metachronous new occurrences (i.e. tumours arising from a background of penile intraepithelial neoplasia and forming on an epithelial surface not related to the site of initial resection). A multivariate analysis was also conducted to elucidate other factors influencing local recurrence.ResultsIn all, 64% of the patients had a <5 mm clear deep surgical margin, with 16% clear by <1 mm. Overall, 4% of patients had a true local recurrence, with a median time to recurrence of 6 months. In all, 53% were due to embolic spread, with residual occult local disease accounting for 47%. There was a statistically significant relationship between cavernosal involvement (P = 0.014) and lymphovascular invasion (LVI; P = 0.001) and local recurrence. Although multivariate analysis revealed that the extent of clear margin was not a predictor of disease (P = 0.405), we found an increased risk of local recurrence in the clear margin cohort of <1 mm compared to those of >1 mm (P < 0.001). Those patients considered to have metachronous tumours were scrutinised by our MDT, and eight patients (2.4%) were found to have new occurrences. Our overall proportion of patients therefore needing further treatment for either new occurrences or recurrent disease after OSS stands at 6.4%.ConclusionsOverall the presence of local recurrent disease in OSS in our experience is low (4%). We report an embolic mechanism of local recurrence, strongly suggested by the presence of cavernosal involvement and LVI. We conclude that a deep clear margin of >1 mm has a very low risk of local recurrence in penile OSS.