[Head-to-head studies on radiographic progression in axial spondyloarthritis]

In this review article four clinical comparative studies in axial spondylarthritis (axSpA) are presented and discussed. SURPASS as the only head-to-head study investigated the effect of adalimumab biosimilar disease-modifying antirheumatic drug (bsDMARD) or secukinumab on radiographic progression over a time period of 2 years. Overall, the radiographic progression of the spine was low and no significant difference between adalimumab bsDMARD or secukinumab was noted. The three other studies were not constructed as direct head-to-head studies but compared the efficacy of non-steroidal antirheumatic drugs (NSARD) with and without simultaneous treatment with biological DMARDs (bDMARD). The CONSUL study showed no statistically significant difference in the delay of radiographic progression of the spine over 2 years in radiographic axSpA (r-axSpA) patients, who underwent either combined treatment with golimumab and celecoxib or treatment with golimumab alone over 2 years. The ESTHER study showed that patients with early axSpA active inflammatory lesions, which were detected by whole-body magnetic resonance imaging (MRI), showed a significantly greater improvement under treatment with etanercept than those treated with sulfasalazine. The INFAST study showed that patients with early active axSpA who received a combined treatment of infliximab and naproxen, achieved a clinical remission twice as frequently as those who only received naproxen. Therefore, for the endpoint of radiological progression no difference could be shown in the inhibition of radiological progression between the mechanisms of action investigated. The comparative data for the endpoint of clinical efficacy showed that patients with bDMARDs showed a clearly better response to treatment than patients with NSAR or conventional synthetic DMARDs (csDMARD).

Healthcare provision for medical tourism: A comparative review

Providing quality services, using modern technologies, having effective marketing, and providing services at an international level have led to the globalization of hospital services. This study aimed to identify the components of health services in developing countries that provide services to international patients. A comparative review was conducted by searching in PubMed, Scopus, Web of Science, Google Scholar, Google, and the websites of the World Medical Tourism Organization, the World Bank, and the Ministry of Health of the selected countries from 2000 to 2022. Iran, Turkey, Jordan, Costa Rica, the UAE, and Singapore were selected. The data were collected and analyzed using a comparative table. Different strategies were used to develop the medical tourism industry among the studied countries, but the main challenges in this field included the inappropriateness of the quality of the services provided or the provision of services that did not meet the needs of patients, the lack of expert human resource, not using medical facilitation companies, communication problems with patients, insufficient government support for medical tourism, and strict laws regarding business. The development of activities in the medical tourism industry requires planning in various dimensions. It seems that developing the medical marketing and activities of facilitator companies to facilitate patient admission, monitoring the quality of services provided, improving interdepartmental coordination, and considering a single trustee for this industry will improve the medical tourism status in Iran.

Social ecological determinants of the mental distress among Syrian refugees in Lebanon and Turkey: A transnational perspective

OBJECTIVE

Refugees are frequently shown to have worse mental health outcomes than non-displaced populations. This fact is commonly attributed to traumatic pre-displacement experiences. While important, the focus on trauma risks overlooking the role socioeconomic living-conditions in different arrival and transit contexts can play in determining refugees' mental distress. Building on the ecological model of refugee distress, we investigate how social ecological conditions relate to the mental distress of Syrians in Lebanon and Turkey. Both countries present important spaces of arrival and transit for millions of displaced Syrians, each with a specific historical, political, social and economic context.

METHODS

The empirical analysis is based on data gathered in early 2021 in face-to-face surveys among displaced Syrians in Lebanon (N = 1127) and Turkey (N = 1364). Individual mental distress is evaluated using the Patient Health Questionnaire (PHQ-8) score as the dependent variable in a multivariate regression analysis.

RESULTS

Social ecological factors do not only differ in their extent of deprivation between Lebanon and Turkey. They also differ in their relationship with individual mental health outcomes. In Lebanon, limited access to the health care system and having family in the same city are major risk factors for elevated mental distress, whereas in Turkey, these are low education, poverty, unemployment as well as employment as day laborer. Discrimination and social isolation emerge as relevant predictors in both countries.

CONCLUSION

Based on this analysis, we argue that a context-specific understanding of mental distress amidst the social ecology refugees face in countries of refuge and transit is necessary. This approach needs to be pursued to provide adequate support and alleviate refugees' mental distress both, in the country of first refuge and after possible onward migration. In addition to clinical implications, the study particularly highlights the important role anti-discrimination and social inclusion policies could play in promoting refugee mental health.

Evaluation of clinical practice guideline-derived clinical decision support systems using a novel quality model

Over the last decade, clinical practice guidelines (CPGs) have become an important asset for daily life in healthcare organizations. Efficient management and digitization of CPGs help achieve organizational objectives and improve patient care and healthcare quality by reducing variability. However, digitizing CPGs is a difficult, complex task because they are usually expressed as text, and this often leads to the development of partial software solutions. At present, different research proposals and CPG-derived CDSS (clinical decision support system) do exist for managing CPG digitalization lifecycles (from modeling to deployment and execution), but they do not all provide full lifecycle support, making it more difficult to choose solutions or proposals that fully meet the needs of a healthcare organization. This paper proposes a method based on quality models to uniformly compare and evaluate technological tools, providing a rigorous method that uses qualitative and quantitative analysis of technological aspects. In addition, this paper also presents how this method has been instantiated to evaluate and compare CPG-derived CDSS by highlighting each phase of the CPG digitization lifecycle. Finally, discussion and analysis of currently available tools are presented, identifying gaps and limitations.

Are domesticated animals dumber than their wild relatives? A comprehensive review on the domestication effects on animal cognitive performance

Animal domestication leads to diverse behavioral, physiological, and neurocognitive changes in domesticated species compared to their wild relatives. However, the widely held belief that domesticated species are inherently less "intelligent" (i.e., have lower cognitive performance) than their wild counterparts requires further investigation. To investigate potential cognitive disparities, we undertook a thorough review of 88 studies comparing the cognitive performance of domesticated and wild animals. Approximately 30% of these studies showed superior cognitive abilities in wild animals, while another 30% highlighted superior cognitive abilities in domesticated animals. The remaining 40% of studies found similar cognitive performance between the two groups. Therefore, the question regarding the presumed intelligence of wild animals and the diminished cognitive ability of domesticated animals remains unresolved. We discuss important factors/limitations for interpreting past and future research, including environmental influences, diverse objectives of domestication (such as breed development), developmental windows, and methodological issues impacting cognitive comparisons. Rather than perceiving these limitations as constraints, future researchers should embrace them as opportunities to expand our understanding of the complex relationship between domestication and animal cognition.

Raising the 'environmental question' in social work in Canada and Scotland

This article contributes a comparative review of social work in Canada and Scotland to international conversations about social work and the environment. The 'environmental question' of the 21st century is a radical challenge to social work developed in relation to the 'social question' of the 19th century. Work to begin to include the natural environment within high-income state social work can expect to encounter established infrastructures of thinking and doing that will be difficult to shift. We, therefore, compare guiding social work policy documents and identify points of tension that are likely to be shared across wealthy national contexts.

Comparison of treatment outcomes and complications of coil embolization in elderly and very elderly patients with cerebral aneurysms: a propensity score matching analysis

PURPOSE

This single center study aims to compare the treatment outcomes and procedure-related complications of coil embolization in elderly patients (60-79 years) and very elderly patients (aged 80 years or older) with cerebral aneurysms.

METHODS

Data was collected from 504 elderly patients aged 60 years or older who underwent coil embolization for intracranial aneurysms from 2018 to 2021. The study evaluated patient-related and anatomical factors and assessed various outcomes, comparing results between groups using statistical analysis and propensity score matching.

RESULTS

A total of 503 cerebral aneurysms were analyzed from individuals aged 60-79 years (n = 472) and those aged 80 years or older (n = 31). The majority of the aneurysms were unruptured with an average size of 3.5 mm in height and 3.4 mm in width. The patients were compared using 1:1 propensity score matching, and no significant differences were found in factors other than age and aortic elongation. Logistic analysis revealed that being over 80 years old and having a severe aortic arch elongation were identified as risk factors for procedure-related events in both total and unruptured cases.

CONCLUSIONS

The study compared coil embolization treatment for cerebral aneurysms in patients aged 60-79 and over 80, finding no significant difference in treatment outcomes except for procedure-related events. Procedure-related events were associated with severe aortic arch elongation and being over 80 years old. Coil embolization can be considered safe and effective for patients over 80, but further trials are needed for accurate conclusions.

Comparative performance of microscopy, nested PCR, and real-time PCR for screening avian haemosporidian parasites in Afrotropical starlings (family Sturnidae)

Prevalence studies of avian haemosporidian parasites frequently use microscopy and the nested polymerase chain reaction (PCR) protocols for detecting infections. Newer PCR protocols to detect parasites are being developed, with the distinct advantage of reducing screening cost and time, as well as increasing efficiency and sensitivity. The detection ability of microscopy and nested PCR was compared against a real-time PCR (qPCR) protocol using genomic DNA extracted from 240 bird blood samples collected from three starling species (Cape Starling, the Greater Blue-eared Starling, and the Wattled Starling; family Sturnidae) in the Kruger national park, South Africa. All three protocols successfully detected avian haemosporidian parasites with the qPCR having a considerable edge against the other two methods. Fifteen unique cytochrome b lineages were identified of which seven were new lineages. Microscopy and nested PCR recorded similar prevalence (32.92% and 35.42% respectively). The qPCR protocol used here, although more sensitive (52.92% prevalence), is not able to differentiate between parasite genera but provides the opportunity to screen a large number of samples in large-scale studies within a specific region. This study recommends the development and adoption of new molecular protocols with increased sensitivity and accuracy in prevalence studies. Nevertheless, microscopy remains essential for the morphological description of parasites and for distinguishing between abortive and successful chronic infections. The PCR-based method displays the detection of the parasitic genome but does not reveal whether parasites have or will develop into a successful infection.

A comparative review of the mineralogical and chemical composition of African major bauxite deposits

Bauxite, which is the main raw material that aluminium is extracted from was discovered in Africa in the early 1900s. Currently, the production and export capacities of the African Bauxite ore are about a third of the World's total capacity. However, the processes leading to the final finished product of; surface mining of the ore, refining ore into alumina and finally extracting the pure aluminium metal in high energy consuming smelters that employ the Hall-Héroult electrolysis process; seldom take place inside Africa. The main goal of this work is to analyse the mineralogical and geochemical characteristics of bauxite deposits from some prominent bauxite producing and exporting countries of Africa in order to fashion out if a trend exist for the type of source rocks. Judging from the data obtained, gibbsite is found to be the main aluminium oxide in all the bauxite deposits with slight occurrence of boehmite in 3 out of the 13 deposits, while goethite is the main oxyhydroxide iron mineral. The compiled results of the various investigations highlighted the fact that the deposits are of diverse qualities with respect to world standard of major element content of bauxite; with average percentage concentration in the ranges as: Al2O3 (43.73-61.25), Fe2O3 (1.55-34.25), SiO2 (0.42-10.84); except two of the deposits with alumina content less than 40%. With evaluated silica moduli less than 8 for only two (2) of the deposits (4.76 and 6.94), the rest have higher moduli that ranges between (14.49 and 75.45). The higher percentage of iron oxide content (>20) in six (6) out of the 13 ore deposits, allowed the deposits to be grouped into three (3) categories of grades; high alumina ore, ferruginous ore, siliceous ore and combination of each. Source rock of the deposits were determined through geochemical and petrographic considerations of laterisation products of the rocks through evaluation of the weathering indices of; Chemical Index of Alteration which was in the range (97.16-99.98) while the Ruxton ratio ranged between (0.0133-0.2100); signifying the parent rock underwent intensive weathering process. This is indicative of the source rocks of the Bauxite deposits being either (i) anorthositic, (ii) argillite and dolerite, (iii) granulite and feldspathic gneiss, and/or, (iv) mafic-basaltic andesite igneous. Awareness of new and yet-to-commence emerging bauxite producing African countries was created, by highlighting the economic impact those respective countries will experience when that mining sector is developed for the aluminum industry at home and world at large.

Enrollment Lessons from a Biological Assignment Study of Marrow Transplantation versus Standard Care for Adolescents and Young Adults with Sickle Cell Disease: Considerations for Future Gene and Cellular Therapy Trials

We previously conducted a single-arm feasibility study (STRIDE1) of myeloablative bone marrow transplantation (BMT) in adolescents and young adults with sickle cell disease (SCD). The trial identified donors before entry, enrolled well, and found no unexpected regimen-related toxicity. Although many single-arm studies have been published, there are no controlled trials of either BMT or gene therapy in SCD. Therefore, we designed a comparative trial by biological assignment (available donor versus no donor). This multicenter National Institutes of Health-funded study (Blood and Marrow Transplant Clinical Trials Network 1503; STRIDE2) enrolled patients between 2016 and 2021 at 35 sites. Lagging recruitment led to study closure, and here we report the impediments to accrual. The BMT regimen and entry criteria were from STRIDE1, and 2-year survival was the primary endpoint. To minimize selection bias from prior HLA typing, STRIDE2 excluded individuals with previously identified donors. Accrual was stopped at 69% of target (138 enrolled; assigned 28 with donor, 96 with no donor). Barriers to enrollment included lower than expected frequency of HLA-matched related and unrelated donors; loss of enrollees owing to previously identified donors; conventional care arm dissuading some seeking BMT; challenging short-term endpoints in SCD, including incomplete documentation of sickle pain episodes; state Medicaid (primary insurers of SCD) denial of BMT coverage for adult SCD despite the study having secured Coverage with Evidence Development from the Center for Medicare & Medicaid Services; slowed accrual in 2019 to 2021 during the Coronavirus disease 2019 pandemic; and restriction of BMT resourcing for nonmalignant diseases by academic medical (cancer) centers. Social obstacles and access to BMT centers also limited entry, as did practitioner and participant concerns over suitability, cost, and toxicity. Planning for future controlled trials of curative therapy in SCD and other nonmalignant diseases likely will meet these enrollment challenges. Lessons from this trial may aid the development of future comparative studies.

Drug repurposing toward the inhibition of RNA-dependent RNA polymerase of various flaviviruses through computational study

Numerous pathogens affecting human is present in the flavivirus family namely west nile, dengue, yellow fever, and zika which involves in development of global burden and distressing the environment economically. Till date, no approved drugs are available for targeting these viruses. The threat which urged the identification of small molecules for the inhibition of these viruses is the spreading of serious viral diseases. The recent outbreak of zika and dengue infections postured a solemn risk to worldwide public well-being. RNA-dependent RNA polymerase (RdRp) is the supreme adaptable enzymes of all the RNA viruses which is responsible for the replication and transcription of genome among the structural and nonstructural proteins of flaviviruses. It is understood that the RdRp of the flaviviruses are similar stating that the japanese encephalitis and west nile shares 70% identity with zika whereas the dengue serotype 2 and 3 shares the identity of 76% and 81%, respectively. In this study, we investigated the binding site of four flaviviral RdRp and provided insights into various interaction of the molecules using the computational approach. Our study helps in recognizing the potent compounds that could inhibit the viral protein as a common inhibitor. Additionally, with the conformational stability analysis, we proposed the possible mechanism of inhibition of the identified common small molecule toward RdRp of flavivirus. Finally, this study could be an initiative for the identification of common inhibitors and can be explored further for understanding the mechanism of action through in vitro studies for the study on efficacy.

Early Buddhist Texts: Their Composition and Transmission

This article discusses the composition and transmission of early Buddhist texts with specific reference to sutras. After briefly summarizing the main reasons why it is likely that these oral compositions were designed to be memorized and transmitted verbatim, I will discuss the main types of changes that these texts underwent in the course of their transmission and the reasons such changes occurred, then attempt to give an account of the challenge that change, particularly intentional change, posed to the oral transmission of fixed, memorized texts.

Between virus correlations in the outcome of infection across host species: Evidence of virus by host species interactions

Virus host shifts are a major source of outbreaks and emerging infectious diseases, and predicting the outcome of novel host and virus interactions remains a key challenge for virus research. The evolutionary relationships between host species can explain variation in transmission rates, virulence, and virus community composition between hosts, but it is unclear if correlations exist between related viruses in infection traits across novel hosts. Here, we measure correlations in viral load of four Cripavirus isolates across experimental infections of 45 Drosophilidae host species. We find positive correlations between every pair of viruses tested, suggesting that some host clades show broad susceptibility and could act as reservoirs and donors for certain types of viruses. Additionally, we find evidence of virus by host species interactions, highlighting the importance of both host and virus traits in determining the outcome of virus host shifts. Of the four viruses tested here, those that were more closely related tended to be more strongly correlated, providing tentative evidence that virus evolutionary relatedness may be a useful proxy for determining the likelihood of novel virus emergence, which warrants further research.

Diagnosis of postoperative recurrence of Crohn disease with MR-enterography: Value of diffusion-weighted imaging

PURPOSE

To compare the diagnostic capabilities of MR enterography (MRE) using contrast-enhanced (CE) sequences with those of MRE using diffusion-weighted (DW) imaging for the diagnosis of postoperative recurrence at the neo-terminal ileum and/or anastomosis after ileocolonic resection in patients with Crohn disease (CD), and to clarify the role of additional DW imaging to CE-MRE in this context.

MATERIAL AND METHODS

Forty patients who underwent ileal resection for CD, and both endoscopy and MRE within the first year after surgery were included. There were 21 men and 19 women, with a mean age of 38 years±12 (SD) years (range: 18-67 years). MRE examinations were blindly analyzed independently by one senior (R1) and one junior (R2) radiologist for the presence of small bowel postoperative recurrence at the anastomotic site. During a first reading session, T2-, steady-state- and DW-MRE were reviewed (DW-MRE or set 1). During a separate distant session, T2-, steady-state- and CE-MRE were reviewed (CE-MRE or set 2). Lastly, all sequences were analyzed altogether (set 3). Performances of each reader for the diagnosis of postoperative recurrence were evaluated using endoscopic findings as the standard of reference (Rutgeerts score≥i2b).

RESULTS

Fifteen patients out of 40 (37.5%) had endoscopic postoperative recurrence at the anastomotic site. Sensitivity for the diagnosis of postoperative recurrence was 73% (95% CI: 51-96%) for R1 and 67% (95% CI: 43-91%) for R2 using set 1, and 80% (95% CI: 60-100%) for both readers using set 2. There was no significant differences in sensitivity between reading set 1 and reading set 2, for either R1 or R2 (R1, P> 0.99; R2, P=0.48). Specificity was 96% (95% CI: 88-100%) for both readers using set 1 or using set 2. Reading set 3 yielded an area under the ROC curve (AUC) of 0.93 (95% CI: 0.84-1) versus 0.89 (95% CI: 0.75-1) with set 1 (P=0.18) and versus 0.89 (95% CI: 0.78-1) with set 2 (P=0.21). No significant differences in AUC were found between set 1 or 2 and set 3 (P=0.18), nor between set 1 and 2 (P=0.76). Accuracies were 88% (95% CI: 74-95%) and 85% (95% CI: 71-93%) for DW-MRE for R1 and R2, respectively; 90% (95% CI: 77-96%) for CE-MRE for both readers; and 93% (95% CI: 80-97%) and 88% (95% CI: 74-95%) for R1 and R2 with set 3, respectively.

CONCLUSION

DW-MRE has diagnostic capabilities similar to those of CE-MRE for the diagnosis of postoperative recurrence of CD at the anastomotic site.

Corpus callosum morphology across the lifespan in baboons (Papio anubis): A cross-sectional study of relative mid-sagittal surface area and thickness

The corpus callosum enables integration and coordination of cognitive processing between the cerebral hemispheres. In the aging human brain, these functions are affected by progressive axon and myelin deteriorations, reflected as atrophy of the midsagittal corpus callosum in old age. In non-human primates, these degenerative processes are less pronounced as previous morphometric studies on capuchin monkey, rhesus monkeys, and chimpanzees do not find old-age callosal atrophy. In the present study, we extend these previous findings by studying callosal development of the olive baboon (Papio anubis) across the lifespan and compare it to chimpanzee and human data. For this purpose, total relative (to forebrain volume) midsagittal area, subsectional area, and regional thickness of the corpus callosum were assessed in 91 male and female baboons using non-invasive MRI-based morphometry. The studied age range was 2.5-26.6 years and lifespan trajectories were fitted using general additive modelling. Relative area of the total and anterior corpus callosum showed a positive linear trajectory. That is, both measures increased slowly but continuously from childhood into old age, and no decline was observed in old age. Thus, comparable with all other non-human primates studied to-date, baboons do not show callosal atrophy in old age. This observation lends supports to the notion that atrophy of the corpus callosum is a unique characteristic of human brain aging.

An investigation of the pharmacological applications used for the Ancient Egyptian systemic model 'ra-ib' compared with modern Traditional Chinese Medicine

ETHNOPHARMACOLOGICAL RELEVANCE

Ancient Egyptian texts only offer glimpses into their conceptual understandings of the inner-body and illness manifestation. Explanations of how prescribed materia medica were believed to work are rare and obscure, often resulting in modern approximations for ancient terminology such as 'ra-ib'-an ancient Egyptian classification predominantly translated as 'stomach'-leading to misunderstandings of historical texts, and therefore their use of pharmacology.

AIM OF THE STUDY

To investigate the ra-ib and the explanatory models of illness from the Egyptian perspective, and to explore the link between these and the prescribed selection of materia medica. To then compare the conceptual mechanics of these treatment strategies with those of another non-Western tradition-namely Traditional Chinese Medicine (TCM)-to provide further insight into potential conceptual frameworks.

MATERIALS AND METHODS

We conducted a case study of a unit of Ancient Egyptian texts focusing on the ra-ib. Totalling 34 prescriptions, the first stage lexicographically analysed the texts using cognitive linguistic and translation theories to produce our new understanding. This enabled our comparison of the mechanics of materia medica usage within these texts with those found in TCM outlined by the Pharmacopoeia of the Peoples Republic of Pharmacopeia of the People's Republic of China 2015 for the relevant ingredients.

RESULTS

the study demonstrated that-rather than denoting the organ 'stomach'-ra-ib instead constitutes a system running from the mouth, downward to the anus. This is best translated as 'inner thoroughfare', and changes the way in which we attempt to understand potential motivations in the selection of ingredients. By exploring common themes in the use of eleven securely translated ingredients from the Egyptian corpus and the Pharmacopoeia of the People's Republic of China-representing a modern traditional system which understands the body via a series of interconnected systems-we were able to highlight certain themes which might be 'universal' to system-based traditions; this provided new insights into the Egyptian motivations for treatment selection.

CONCLUSIONS

Having gained the ancient view of the body and illness, cultural comparisons are important for providing further potential insights and clarifications of a discontinued historical healing tradition. The new understanding of the ra-ib from our study greatly changes the way in which we understand the dynamics of Egyptian ethnopharmacological source material from this period.

Meta-analysis of Laparoendoscopic Single-site and Vaginal Natural Orifice Transluminal Endoscopic Hysterectomy Compared with Multiport Hysterectomy: Real Benefits or Diminishing Returns?

OBJECTIVE

Because minimally invasive hysterectomy has become increasingly performed by gynecologic surgeons, strategies to further improve outcomes have emerged, including innovations in surgical approach. We sought to evaluate the intraoperative and perioperative outcomes and success rates of laparoendoscopic single-site surgery (LESS) and vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy in comparison with those of conventional multiport laparoscopic (MPL) hysterectomy.

DATA SOURCES

A librarian-led search of PubMed, Scopus, CINAHL, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials was performed for case-control, retrospective cohort, and randomized controlled trials through May 2020.

METHODS OF STUDY SELECTION

The inclusion criterion was publications comparing LESS or vNOTES hysterectomy with conventional MPL hysterectomy for the management of benign or malignant gynecologic disease. Four authors reviewed the abstracts and selected studies for full-text review. The manuscripts were reviewed, separately, by 2 authors for final inclusion and assessment of bias using either the risk-of-bias assessment tool or the Newcastle-Ottawa scale. Any disagreement was resolved by discussion with, or arbitration by, a third reviewer. The titles of 2259 articles were screened, and 108 articles were chosen for abstract screening. Full-text screening resulted in 29 studies eligible for inclusion.

TABULATION, INTEGRATION, AND RESULTS

Extracted data were placed into REDCap (Vanderbilt University, Nashville, TN), and MPL hysterectomy was compared with single-port hysterectomy using meta-analysis models. The outcomes included estimated blood loss (EBL); operative (OP) time; transfusion; length of hospital stay (LOS); conversion to laparotomy; visual analog scale pain scores at 12 hours, 24 hours, and 48 hours; any complications; and 7 subcategories of complications. Random-effects models were built for continuous outcomes and binary outcomes, and the results are reported as standardized mean difference (SMD) or odds ratio (OR) and their corresponding 95% confidence intervals, respectively. Meta-analysis could not be performed for vNOTES vs MPL, given that only 3 studies met the eligibility criteria. When LESS and MPL were compared, there was a shorter OP time for MPL (SMD = -0.2577, p <.001) and lower rate of transfusion (OR = 0.1697, p <.001), without a significant difference in EBL (SMD = -0.0243, p = .689). There was a nonsignificant trend toward higher risk of conversion to laparotomy in the MPL group (OR = 2.5871, p = .078). Pain scores were no different 12 or 24 hours postoperatively but were significantly higher at 48 hours postoperatively (SMD = 0.1861, p = .035) in the MPL group. There were no differences in overall or individual complications between the LESS and MPL groups. In the vNOTES comparison, 2 studies demonstrated shorter OP times, with reduced LOS and no difference in complications.

CONCLUSION

In this meta-analysis, we identified that LESS hysterectomy has comparable and low overall rates of complications and conversion to laparotomy compared with MPL. Notably, the OP time seems longer, and the pain scores at 48 hours may be lower with LESS hysterectomy than with MPL hysterectomy. Limited data suggest that vNOTES hysterectomy may have shorter OP times and improved EBL, transfusion rates, LOS, and pain scores compared with MPL hysterectomy, but further study is needed. There remains a deficit in high-quality data to understand the differences in cosmesis among these surgical approaches. The quality of data for this analysis seems to be low to moderate.

COVID-Related Functional Difficulties and Concerns Among University Students During COVID-19 Pandemic: A Binational Perspective

The COVID-19 pandemic has created a sense of threat, and stress that has surged globally at an alarming pace. University students were confronted with new challenges. This study examined university students’ functional difficulties and concerns during COVID-19 pandemic in two countries: Israel and Ukraine. Additionally, it examined the similarities and differences in prediction of COVID-related concerns in both countries. Two large samples of university students were drawn from both countries. Results showed that students’ main functional difficulties in both countries were: worries about their family health status and their learning assignments. In both countries, COVID-related functional difficulties and stress associated with exposure to the media added a significant amount of the explained variance of COVID-related concerns after controlling for background variables. In conclusion—while the level of exposure and difficulties may differ by country and context, their associations with students’ concerns seem robust. Additionally, repeated exposure to media coverage about a community threat can lead to increased anxiety.

Editors' Review and Introduction: Learning Grammatical Structures: Developmental, Cross-Species, and Computational Approaches

Human languages all have a grammar, that is, rules that determine how symbols in a language can be combined to create complex meaningful expressions. Despite decades of research, the evolutionary, developmental, cognitive, and computational bases of grammatical abilities are still not fully understood. "Artificial Grammar Learning" (AGL) studies provide important insights into how rules and structured sequences are learned, the relevance of these processes to language in humans, and whether the cognitive systems involved are shared with other animals. AGL tasks can be used to study how human adults, infants, animals, or machines learn artificial grammars of various sorts, consisting of rules defined typically over syllables, sounds, or visual items. In this introduction, we distill some lessons from the nine other papers in this special issue, which review the advances made from this growing body of literature. We provide a critical synthesis, identify the questions that remain open, and recognize the challenges that lie ahead. A key observation across the disciplines is that the limits of human, animal, and machine capabilities have yet to be found. Thus, this interdisciplinary area of research firmly rooted in the cognitive sciences has unearthed exciting new questions and venues for research, along the way fostering impactful collaborations between traditionally disconnected disciplines that are breaking scientific ground.

Exploring Variation Between Artificial Grammar Learning Experiments: Outlining a Meta-Analysis Approach

Artificial grammar learning (AGL) has become an important tool used to understand aspects of human language learning and whether the abilities underlying learning may be unique to humans or found in other species. Successful learning is typically assumed when human or animal participants are able to distinguish stimuli generated by the grammar from those that are not at a level better than chance. However, the question remains as to what subjects actually learn in these experiments. Previous studies of AGL have frequently introduced multiple potential contributors to performance in the training and testing stimuli, but meta-analysis techniques now enable us to consider these multiple information sources for their contribution to learning-enabling intended and unintended structures to be assessed simultaneously. We present a blueprint for meta-analysis approaches to appraise the effect of learning in human and other animal studies for a series of artificial grammar learning experiments, focusing on studies that examine auditory and visual modalities. We identify a series of variables that differ across these studies, focusing on both structural and surface properties of the grammar, and characteristics of training and test regimes, and provide a first step in assessing the relative contribution of these design features of artificial grammars as well as species-specific effects for learning.

Evaluating cervical artery dissections in young adults: a comparison study between high-resolution MRI and CT angiography

To compare the diagnostic values of high-resolution magnetic resonance (HR-MRI) with computed tomographic angiography (CTA) in young adults with ischemic stroke due to cervical artery dissections. Totally 42 symptomatic patients were recruited in this study. All the 42 patients underwent both HR-MRI and CTA, including 28 patients with dissections confirmed by Digital Subtraction Angiography (DSA) and 4 patients with vertebral artery dissections diagnosed by follow-up. CTA and HR-MRI images were separately and blindly analyzed by two radiologists. The sensitivity, specificity, positive and negative predictive value of HR-MRI and CTA were calculated. The receiver operating characteristic (ROC) curves and AUC of each imaging modality were generated. A total of 20 carotid artery dissections, 12 vertebral artery dissections and 10 non-dissected cervical arteries were involved. The inter-observer concordance of HR-MRI and CTA was good (κ = 0.806 vs. 0.776). The sensitivity and specificity of HR-MRI and CTA on detecting the dissections were 87.5% vs. 62.5%, and 90.0% vs. 80.0%, respectively. Area under the ROC curve of HR-MRI [0.94 (95% CI 0.86-0.97)] was greater than that of CTA [0.87 (95% CI 0.71-1.0)]. Compared to CTA, HR-MRI is more sensitive and specific for the diagnosis of cervical artery dissections in high-risk symptomatic patients. This study supports the value of HR-MRI in non-invasive diagnosis of young adults with cervical artery dissections.

Evolutionary lability in Hox cluster structure and gene expression in Anolis lizards

Hox genes orchestrate development by patterning the embryonic axis. Vertebrate Hox genes are arranged in four compact clusters, and the spacing between genes is assumed to be crucial for their function. The genomes of squamate reptiles are unusually rich and variable in transposable elements (TEs), and it has been suggested that TE invasion is responsible for the Hox cluster expansion seen in snakes and lizards. Using de novo TE prediction on 17 genomes of lizards and snakes, I show that TE content of Hox clusters are generally 50% lower than genome‐wide TE levels. However, two distantly related lizards of the species‐rich genus Anolis have Hox clusters with a TE content that approaches genomic levels. The age distribution of TEs in Anolis lizards revealed that peaks of TE activity broadly coincide with speciation events. In accordance with theoretical models of Hox cluster regulation, I find that Anolis species with many TEs in their Hox clusters show aberrant Hox gene expression patterns, suggesting a functional link between TE accumulation and embryonic development. These results are consistent with the hypothesis that TEs play a role in developmental processes as well as in evolutionary diversifications.

Comparison of ABC/2 estimation and a volumetric computerized method for measurement of meningiomas using magnetic resonance imaging

INTRODUCTION

Measurement of tumor growth rates over time for patients with meningiomas has important prognostic and therapeutic implications. Our objective was to compare two methods of measuring meningioma volume: (1) the simplified ellipsoid (ABC/2) method; and (2) perimetric volume measurements using imaging software modules.

METHODS

Patients with conservatively managed meningiomas for at least 1.5 years were retrospectively identified from the VCU Brain and Spine Tumor Registry over a 10-year period (2005-2015). Tumor volumes were independently measured using the simplified ellipsoid and computerized perimetric methods. Intra class correlations (CC) and Bland-Altman analyses were performed.

RESULTS

A total of 26 patients representing 29 tumors were identified. Across 146 images, there were 24 (16%) images that were non-measurable using standard application commands with the computerized perimetric method. The mean volume obtained using the ABC/2 and computerized perimetric methods were 3.2 ± 3.4 cm³ and 3.4 ± 3.5 cm³, respectively. The mean volume difference was 0.2 cm³ (SE = 0.12; p = 0.10) across measurement methods. The concordance correlation coefficient (CCC) between methods was 0.95 (95% CI 0.91, 0.98).

CONCLUSIONS

There is excellent correlation between the simplified ellipsoid and computerized perimetric methods of volumetric analysis for conservatively managed meningiomas. The simplified ellipsoid method remains an excellent method for meningioma volume assessment and had an advantage over the perimetric method which failed to allow measurement of roughly one in six tumors on imaging.

The social location of harm from others' drinking in 10 societies

AIMS

Survey data from 10 diverse countries were used to analyse the social location of harms from others' drinking: which segments of the population are more likely to be adversely affected by such harm, and how does this differ between societies?

METHODS

General-population surveys in Australia, Chile, India, Laos, New Zealand, Nigeria, Sri Lanka, Thailand, United States and Vietnam, with a primary focus on the social location of the harmed person by gender, age groups, rural/urban residence and drinking status. Harms from known drinkers were analysed separately from harms from strangers.

RESULTS

In all sites, risky or moderate drinkers were more likely than abstainers to report harm from the drinking of known drinkers, with risky drinkers the most likely to report harm. This was also generally true for harm from strangers' drinking, although the patterns were more mixed in Vietnam and Thailand. Harm from strangers' drinking was more often reported by males, while gender disparity in harm from known drinkers varied between sites. Younger adults were more likely to experience harm both from known drinkers and from strangers in some, but not all, societies. Only a few sites showed significant urban/rural differences, with disparities varying in direction. In multivariate analyses, most relationships remained, although some were no longer significant.

CONCLUSION

The social location of harms from others' drinking, whether known or a stranger, varies considerably between societies. One near-commonality among the societies is that those who are themselves risky drinkers are more likely to suffer harm from others' drinking.

Effects of assisted sit-up exercise compared to core stabilization exercise on patients with non-specific low back pain: A randomized controlled trial

BACKGROUND

Traditional sit-up exercise is a simple method to strengthen core muscles. However, it can increase the potential of lumbar spine injury during the bending process.

OBJECTIVE

To evaluate the effect of assisted sit-up exercise (SUE) using a new training device, HubEX-LEX®, on strengthening core muscles and improving non-specific low back pain (NSLBP) compared to conventional core stabilization exercise (CSE).

METHODS

Subjects with chronic NSLBP were randomly divided into two groups: SUE (n= 18) or CSE (n= 18). They participated in 12 sessions of the exercise program. Before and after the training, thickness and activity of core muscles were measured using ultrasonogram and surface electromyography respectively. Pain and disability were assessed using two questionnaires.

RESULTS

Thickness ratios (contracted/rest) of rectus abdominis and external oblique in the SUE group and those of transversus abdominis in the CSE group showed statistically significant difference between before and after exercise (p< 0.05). The ratio of activation of internal oblique relative to rectus abdominis and all measurements for pain and disability showed statistically significant improvement in both groups (p< 0.05).

CONCLUSIONS

Assisted SUE using new training device can be an effective therapeutic exercise to strengthen dynamic abdominal muscles and improve core muscle activation pattern in NSLBP patients.

Ultra-low-dose unenhanced chest CT: Prospective comparison of high kV/low mA versus low kV/high mA protocols

PURPOSE

To qualitatively and quantitatively compare unenhanced ultra-low-dose chest computed tomography (ULD-CT) acquired at 80kVp and 135kVp.

MATERIALS AND METHODS

Fifty-one patients referred for unenhanced chest CT were prospectively included. There were 29 men and 22 women, with a mean age of 64.7±11.6 (SD) years (range: 35-91 years) and a mean body mass index of 26.2±6.3 (SD) (range: 17-54.9). All patients underwent two different ULD-CT protocols (80kVp-40mA and 135kVp-10mA). Image quality of both ULD-CT examinations using a 5-level scale as well as assessability of 6 predetermined lung parenchyma lesions were blindly evaluated by three radiologists and compared using a logistic regression model. Image noise of the two protocols was compared with Wilcoxon signed-rank test.

RESULTS

The mean dose-length product at 80kVp and at 135kVp were 14.7±1.8 (SD) mGy.cm and 15.6±1.9 (SD) mGy.cm, respectively (P<0.001). Image noise was significantly lower at 135kVp (58.9±12.4) than at 80kVp (74.7±14.5) (P<0.001). For all readers and for all examinations, the 135kVp protocol yielded better image quality than 80kVp protocol, with a mean qualitative score of 4.5±0.7 versus 3.9±0.8 (P<0.001). The 135kVp protocol was significantly more often of diagnostic quality than the 80kvp protocol (92.3% versus 77.8%, respectively) (P<0.001) and was less prone to image quality deterioration in obese patients. Parenchymal lesions were never better depicted on the 80kVp protocol than with the 135kVp protocol.

CONCLUSION

Unenhanced chest ULD-CT should be acquired at a high kilovoltage and low current, such as 135kVp-10mA, over a low kilovoltage and high current protocol.

A new approach for sample size calculation in cost-effectiveness studies based on value of information

Background

Value of information is now recognized as a reference method in the decision process underpinning cost-effectiveness evaluation. The expected value of perfect information (EVPI) is the expected value from completely reducing the uncertainty surrounding the cost-effectiveness of an innovative intervention.

Among sample size calculation methods used in cost-effectiveness studies, only one is coherent with this decision framework. It uses a Bayesian approach and requires data of a pre-existing cost-effectiveness study to derive a valid prior EVPI. When evaluating the cost-effectiveness of innovations, no observed prior EVPI is usually available to calculate the sample size.

We here propose a sample size calculation method for cost-effectiveness studies, that follows the value of information theory, and, being frequentist, can be based on assumptions if no observed prior EVPI is available.

Methods

The general principle of our method is to define the sampling distribution of the incremental net monetary benefit (ΔB), or the distribution of ΔB that would be observed in a planned cost-effectiveness study of size n. Based on this sampling distribution, the EVPI that would remain at the end of the trial (EVPI_n) is estimated. The optimal sample size of the planned cost-effectiveness study is the n for which the cost of including an additional participant becomes equal or higher than the value of the information gathered through this inclusion.

Results

Our method is illustrated through four examples. The first one is used to present the method in depth and describe how the sample size may vary according to the parameters’ value. The three other examples are used to illustrate in different situations how the sample size may vary according to the ceiling cost-effectiveness ratio, and how it compares with a test statistic-based method. We developed an R package (EBASS) to run these calculations.

Conclusions

Our sample size calculation method follows the value of information theory that is now recommended for analyzing and interpreting cost-effectiveness data, and sets the size of a study that balances its cost and the value of its information.

Electronic supplementary material

The online version of this article (10.1186/s12874-018-0571-1) contains supplementary material, which is available to authorized users.

Can administrative health utilisation data provide an accurate diabetes prevalence estimate for a geographical region?

AIM

To validate the New Zealand Ministry of Health (MoH) Virtual Diabetes Register (VDR) using longitudinal laboratory results and to develop an improved algorithm for estimating diabetes prevalence at a population level.

METHODS

The assigned diabetes status of individuals based on the 2014 version of the MoH VDR is compared to the diabetes status based on the laboratory results stored in the Auckland regional laboratory result repository (TestSafe) using the New Zealand diabetes diagnostic criteria. The existing VDR algorithm is refined by reviewing the sensitivity and positive predictive value of the each of the VDR algorithm rules individually and as a combination.

RESULTS

The diabetes prevalence estimate based on the original 2014 MoH VDR was 17% higher (n = 108,505) than the corresponding TestSafe prevalence estimate (n = 92,707). Compared to the diabetes prevalence based on TestSafe, the original VDR has a sensitivity of 89%, specificity of 96%, positive predictive value of 76% and negative predictive value of 98%. The modified VDR algorithm has improved the positive predictive value by 6.1% and the specificity by 1.4% with modest reductions in sensitivity of 2.2% and negative predictive value of 0.3%. At an aggregated level the overall diabetes prevalence estimated by the modified VDR is 5.7% higher than the corresponding estimate based on TestSafe.

CONCLUSION

The Ministry of Health Virtual Diabetes Register algorithm has been refined to provide a more accurate diabetes prevalence estimate at a population level. The comparison highlights the potential value of a national population long term condition register constructed from both laboratory results and administrative data.

Statistical methods to derive efficacy estimates of anti-malarials for uncomplicated Plasmodium falciparum malaria: pitfalls and challenges

The Kaplan-Meier (K-M) method is currently the preferred approach to derive an efficacy estimate from anti-malarial trial data. In this approach event times are assumed to be continuous and estimates are generated on the assumption that there is only one cause of failure. In reality, failures are captured at pre-scheduled time points and patients can fail treatment due to a variety of causes other than the primary endpoint, commonly termed competing risk events. Ignoring these underlying assumptions can potentially distort the derived efficacy estimates and result in misleading conclusions. This review details the evolution of statistical methods used to derive anti-malarial efficacy for uncomplicated Plasmodium falciparum malaria and assesses the limitations of the current practices. Alternative approaches are explored and their implementation is discussed using example data from a large multi-site study.

Evaluation of dietary intake assessed by the Dutch self-administered web-based dietary 24-h recall tool (Compl-eat™) against interviewer-administered telephone-based 24-h recalls

Self-administered web-based 24-h dietary recalls (24 hR) may save a lot of time and money as compared with interviewer-administered telephone-based 24 hR interviews and may therefore be useful in large-scale studies. Within the Nutrition Questionnaires plus (NQplus) study, the web-based 24 hR tool Compl-eat™ was developed to assess Dutch participants’ dietary intake. The aim of the present study was to evaluate the performance of this tool against the interviewer-administered telephone-based 24 hR method. A subgroup of participants of the NQplus study (20–70 years, n 514) completed three self-administered web-based 24 hR and three telephone 24 hR interviews administered by a dietitian over a 1-year period. Compl-eat™ as well as the dietitians guided the participants to report all foods consumed the previous day. Compl-eat™ on average underestimated the intake of energy by 8 %, of macronutrients by 10 % and of micronutrients by 13 % as compared with telephone recalls. The agreement between both methods, estimated using Lin's concordance coefficients (LCC), ranged from 0·15 for vitamin B₁ to 0·70 for alcohol intake (mean LCC 0·38). The lower estimations by Compl-eat™ can be explained by a lower number of total reported foods and lower estimated intakes of the food groups, fats, oils and savoury sauces, sugar and confectionery, dairy and cheese. The performance of the tool may be improved by, for example, adding an option to automatically select frequently used foods and including more recall cues. We conclude that Compl-eat™ may be a useful tool in large-scale Dutch studies after suggested improvements have been implemented and evaluated.

No evidence that kin selection increases the honesty of begging signals in birds

Providing plausible mechanisms to explain variation in the honesty of information communicated through offspring begging signals is fundamental to our understanding of parent–offspring conflict and the evolution of family life. A recently published research article used comparative analyses to investigate two long‐standing hypotheses that may explain the evolution of begging behavior. The results suggested that direct competition between offspring for parental resources decreases begging honesty, whereas indirect, kin‐selected benefits gained through saving parental resources for the production of future siblings increase begging honesty. However, we feel that evidence for a role of kin selection in this context is still missing. We present a combination of arguments and empirical tests to outline alternative sources of interspecific variation in offspring begging levels and discuss avenues for further research that can bring us closer to a complete understanding of the evolution of offspring signaling.

ENIGMA-Viewer: interactive visualization strategies for conveying effect sizes in meta-analysis

BACKGROUND

Global scale brain research collaborations such as the ENIGMA (Enhancing Neuro Imaging Genetics through Meta Analysis) consortium are beginning to collect data in large quantity and to conduct meta-analyses using uniformed protocols. It becomes strategically important that the results can be communicated among brain scientists effectively. Traditional graphs and charts failed to convey the complex shapes of brain structures which are essential to the understanding of the result statistics from the analyses. These problems could be addressed using interactive visualization strategies that can link those statistics with brain structures in order to provide a better interface to understand brain research results.

RESULTS

We present ENIGMA-Viewer, an interactive web-based visualization tool for brain scientists to compare statistics such as effect sizes from meta-analysis results on standardized ROIs (regions-of-interest) across multiple studies. The tool incorporates visualization design principles such as focus+context and visual data fusion to enable users to better understand the statistics on brain structures. To demonstrate the usability of the tool, three examples using recent research data are discussed via case studies.

CONCLUSIONS

ENIGMA-Viewer supports presentations and communications of brain research results through effective visualization designs. By linking visualizations of both statistics and structures, users can gain more insights into the presented data that are otherwise difficult to obtain. ENIGMA-Viewer is an open-source tool, the source code and sample data are publicly accessible through the NITRC website ( http://www.nitrc.org/projects/enigmaviewer_20 ). The tool can also be directly accessed online ( http://enigma-viewer.org ).

Heterotypic mouse models of canine osteosarcoma recapitulate tumor heterogeneity and biological behavior

Osteosarcoma (OS) is a heterogeneous and rare disease with a disproportionate impact because it mainly affects children and adolescents. Lamentably, more than half of patients with OS succumb to metastatic disease. Clarification of the etiology of the disease, development of better strategies to manage progression, and methods to guide personalized treatments are among the unmet health needs for OS patients. Progress in managing the disease has been hindered by the extreme heterogeneity of OS; thus, better models that accurately recapitulate the natural heterogeneity of the disease are needed. For this study, we used cell lines derived from two spontaneous canine OS tumors with distinctly different biological behavior (OS-1 and OS-2) for heterotypic in vivo modeling that recapitulates the heterogeneous biology and behavior of this disease. Both cell lines demonstrated stability of the transcriptome when grown as orthotopic xenografts in athymic nude mice. Consistent with the behavior of the original tumors, OS-2 xenografts grew more rapidly at the primary site and had greater propensity to disseminate to lung and establish microscopic metastasis. Moreover, OS-2 promoted formation of a different tumor-associated stromal environment than OS-1 xenografts. OS-2-derived tumors comprised a larger percentage of the xenograft tumors than OS-1-derived tumors. In addition, a robust pro-inflammatory population dominated the stromal cell infiltrates in OS-2 xenografts, whereas a mesenchymal population with a gene signature reflecting myogenic signaling dominated those in the OS-1 xenografts. Our studies show that canine OS cell lines maintain intrinsic features of the tumors from which they were derived and recapitulate the heterogeneous biology and behavior of bone cancer in mouse models. This system provides a resource to understand essential interactions between tumor cells and the stromal environment that drive the progression and metastatic propensity of OS.

Editors' choice: We developed a system that recapitulates the heterogeneous biological behavior of bone cancer in mouse models and describe novel methods to study tumor–stromal interactions in these models.

Diagnostic performance of digital breast tomosynthesis with a wide scan angle compared to full-field digital mammography for the detection and characterization of microcalcifications

OBJECTIVES

To assess the diagnostic performance of digital breast tomosynthesis (DBT), with a wide scan-angle, compared to full-field digital mammography (FFDM), for the detection and characterization of microcalcifications.

METHODS

IRB approval was obtained for this retrospective study. We selected 150 FFDM and DBT (50 benign and 50 malignant histologically verified microcalcifications, 50 cases classified as BI-RADS 1). Four radiologists evaluated, in separate sessions and blinded to patients' history and histology, the presence of microcalcifications. Cases with microcalcifications were assessed for visibility, characteristics, and grade of suspicion using BI-RADS categories. Detection rate and diagnostic performance were calculated. Visibility, lesions' characteristics and reading time were analysed.

RESULTS

Detection rate and visibility were good for both FFDM and DBT, without intra-reader differences (P=0.510). Inter-reader differences were detected (P<0.018). Only two lesions were not detected by any reader on either FFDM or DBT. Diagnostic performance with DBT was as good as that of FFDM, but a significant inter-reader difference was found (P=0.041). High inter-reader variability in the use of the descriptors was found. Reading time for DBT was almost twice that for FFDM (44 and 25s, respectively).

CONCLUSION

Wide scan-angle DBT enabled the detection and characterization of microcalcifications with no significant differences from FFDM. Inter-reader variability was seen.

Factors associated with severe maternal morbidity in Kelantan, Malaysia: A comparative cross-sectional study

Background

Knowledge on the factors associated with severe maternal morbidity enables a better understanding of the problem and serves as a foundation for the development of an effective preventive strategy. However, various definitions of severe maternal morbidity have been applied, leading to inconsistencies between studies. The objective of this study was to identify the sociodemographic characteristics, medical and gynaecological history, past and present obstetric performance and the provision of health care services as associated factors for severe maternal morbidity in Kelantan, Malaysia.

Methods

A comparative cross-sectional study was conducted in two tertiary referral hospitals in 2014. Postpartum women with severe morbidity and without severe morbidity who fulfilled the inclusion and exclusion criteria were eligible as cases and controls, respectively. The study population included all postpartum women regardless of their age. Pregnancy at less than 22 weeks of gestation, more than 42 days after the termination of pregnancy and non-Malaysian citizens were excluded. Consecutive sampling was applied for the selection of cases and for each case identified, one unmatched control from the same hospital was selected using computer-based simple random sampling. Simple and multiple logistic regressions were performed using Stata Intercooled version 11.0.

Results

A total of 23,422 pregnant women were admitted to these hospitals in 2014 and 395 women with severe maternal morbidity were identified, of which 353 were eligible as cases. An age of 35 or more years old [Adj. OR (95 % CI): 2.6 (1.67, 4.07)], women with past pregnancy complications [Adj. OR (95 % CI): 1.7 (1.00, 2.79)], underwent caesarean section deliveries [Adj. OR (95 % CI): 6.8 (4.68, 10.01)], preterm delivery [Adj. OR (95 % CI): 3.4 (1.87, 6.32)] and referral to tertiary centres [Adj. OR (95 % CI): 2.7 (1.87, 3.97)] were significant associated factors for severe maternal morbidity.

Conclusions

Our study suggests the enhanced screening and monitoring of women of advanced maternal age, women with past pregnancy complications, those who underwent caesarean section deliveries, those who delivered preterm and the mothers referred to tertiary centres as they are at increased risk of severe maternal morbidity. Identifying these factors may contribute to specific and targeted strategies aimed at tackling the issues related to maternal morbidity.

Preoperative detection of hepatic metastases from colorectal cancer: Prospective comparison of contrast-enhanced ultrasound and multidetector-row computed tomography (MDCT)

PURPOSE

The goal of this study was to prospectively compare the sensitivity of contrast-enhanced ultrasound (CEUS) with that of multiphase multidetector-row computed tomography (MDCT) in the preoperative detection of hepatic metastases.

MATERIALS AND METHOD

Forty-eight patients, with a mean age of 62years old (range: 43-85years) were prospectively included. All patients underwent CEUS following intravenous administration of 2.4mL of an ultrasound contrast agent (Sonovue(®), Bracco, Milan, Italy) and multiphase MDCT. Intraoperative ultrasound examination (IOUS) was used as the standard of reference.

RESULTS

A total of 158 liver metastases were identified by IOUS, 127 by preoperative MDCT (sensitivity; 80.4%) and 102 by CEUS (sensitivity, 64.5%). The 15.9% difference in sensitivity between CEUS and MDCT was statistically significant (P=0.002). There was a disagreement between IOUS and CEUS in 23 patients (47%) and in 13 patients (27%) between IOUS and MDCT. MDCT identified one or more additional metastases in 10 patients (20%) resulting in a change in the surgical strategy.

CONCLUSION

Based on an unselected patient cohort and using multiphase MDCT, CEUS is significantly inferior to MDCT for the preoperative detection of hepatic metastases of colorectal cancer.

FOVEA: a new program to standardize the measurement of foveal pit morphology

The fovea is one of the most studied retinal specializations in vertebrates, which consists of an invagination of the retinal tissue with high packing of cone photoreceptors, leading to high visual resolution. Between species, foveae differ morphologically in the depth and width of the foveal pit and the steepness of the foveal walls, which could influence visual perception. However, there is no standardized methodology to measure the contour of the foveal pit across species. We present here FOVEA, a program for the quantification of foveal parameters (width, depth, slope of foveal pit) using images from histological cross-sections or optical coherence tomography (OCT). FOVEA is based on a new algorithm to detect the inner retina contour based on the color variation of the image. We evaluated FOVEA by comparing the fovea morphology of two Passerine birds based on histological cross-sections and its performance with data from previously published OCT images. FOVEA detected differences between species and its output was not significantly different from previous estimates using OCT software. FOVEA can be used for comparative studies to better understand the evolution of the fovea morphology in vertebrates as well as for diagnostic purposes in veterinary pathology. FOVEA is freely available for academic use and can be downloaded at: http://estebanfj.bio.purdue.edu/fovea.

Comparing writing style feature-based classification methods for estimating user reputations in social media

In recent years, the anonymous nature of the Internet has made it difficult to detect manipulated user reputations in social media, as well as to ensure the qualities of users and their posts. To deal with this, this study designs and examines an automatic approach that adopts writing style features to estimate user reputations in social media. Under varying ways of defining Good and Bad classes of user reputations based on the collected data, it evaluates the classification performance of the state-of-art methods: four writing style features, i.e. lexical, syntactic, structural, and content-specific, and eight classification techniques, i.e. four base learners—C4.5, Neural Network (NN), Support Vector Machine (SVM), and Naïve Bayes (NB)—and four Random Subspace (RS) ensemble methods based on the four base learners. When South Korea’s Web forum, Daum Agora, was selected as a test bed, the experimental results show that the configuration of the full feature set containing content-specific features and RS-SVM combining RS and SVM gives the best accuracy for classification if the test bed poster reputations are segmented strictly into Good and Bad classes by portfolio approach. Pairwise t tests on accuracy confirm two expectations coming from the literature reviews: first, the feature set adding content-specific features outperform the others; second, ensemble learning methods are more viable than base learners. Moreover, among the four ways on defining the classes of user reputations, i.e. like, dislike, sum, and portfolio, the results show that the portfolio approach gives the highest accuracy.

[Is (chemo)radiotherapy really the future standard in the treatment of oropharyngeal carcinoma?]

Treatment of patients with oropharyngeal squamous cell carcinoma (OPSCC) requires interdisciplinary collaboration. Besides oncologic control, organ and function preservation are important priorities. One treatment option is primary concomitant chemoradiotherapy (CRT), particularly for locally advanced head and neck cancer. Another option is sequential CRT, where induction chemotherapy may be followed either by radiation alone or by CRT. An important aspect of these modalities is the development of functional sequelae with regards to swallowing as a direct consequence of radiogenic fibrosis, as well as tissue ctoxicity associated with cisplatin-based chemotherapy. Conventional open surgical approaches are being increasingly replaced by transoral surgical modalities with less treatment-related morbidity. As a further, equally important goal of appropriately indicated surgery, adjuvant (C)RT may be omitted or the dose significantly reduced. The advantages of primary surgery over primary CRT may be less obvious in cases still requiring adjuvant treatment, although not necessarily completely eliminated. For patients with human papillomavirus (HPV)-driven OPSCC, it is important to note that primary surgery may provide comparable or even increased survival benefit. To date, there is no evidence for a clear advantage of primary CRT over primary surgery in this group. In these cases, a de-escalated treatment package may be the preferred option. Here, the application of radioimmunotherapy as well as a reduced radiation dose may minimize long-term treatment-related morbidities.

Occasional cooperative breeding in birds and the robustness of comparative analyses concerning the evolution of cooperative breeding

Cooperative breeding is a widespread and intense form of cooperation, in which individuals help raise offspring that are not their own. This behaviour is particularly well studied in birds, using both long-term and comparative studies that have provided insights into the evolution of reproductive altruism. In most cooperatively breeding species, helpers are offspring that remain with their parents beyond independency and help in the raising of younger siblings. However, many cooperatively breeding species are poorly studied, and in 152 species, this behaviour only has been observed infrequently (i.e., occasional cooperative breeding). Here we argue that the parental care mode of these 152 species needs to be treated with caution, as factors associated with occasional cooperative breeding may differ from those associated with "regular" cooperative breeding. In most cooperatively breeding species, helpers provide alloparental care at the nests of their parents or close relatives; however, only in one occasionally cooperatively breeding species do offspring remain into the next breeding season with their parents. Accordingly, different factors are likely to be associated with regular and occasional cooperative breeding. The latter behaviour resembles interspecific feeding (i.e., individuals feed offspring of another species), which occurs when birds lose their brood and begin feeding at a nearby nest, or when birds mistakenly feed at another nest. Thus, we advise researchers to exclude occasional cooperative breeders in comparative analyses until their status is clarified, or to categorize them separately or according to the typically observed parental care mode. This approach will increase the robustness of comparative analyses and thereby improve our understanding of factors that drive the evolution of cooperative breeding.

Comparative analytical evaluation of the respiratory TaqMan Array Card with real-time PCR and commercial multi-pathogen assays

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Viral and bacterial real-time PCR oligonucleotides were spotted on TaqMan Array Cards.

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Analytical sensitivity was compared with standalone laboratory PCR assays.

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TaqMan Array Card sensitivity was generally one log lower.

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Reproducibility across six independent testing sites was within one log.

In this study, a multicenter evaluation of the Life Technologies TaqMan^® Array Card (TAC) with 21 custom viral and bacterial respiratory assays was performed on the Applied Biosystems ViiA™ 7 Real-Time PCR System. The goal of the study was to demonstrate the analytical performance of this platform when compared to identical individual pathogen specific laboratory developed tests (LDTs) designed at the Centers for Disease Control and Prevention (CDC), equivalent LDTs provided by state public health laboratories, or to three different commercial multi-respiratory panels. CDC and Association of Public Health Laboratories (APHL) LDTs had similar analytical sensitivities for viral pathogens, while several of the bacterial pathogen APHL LDTs demonstrated sensitivities one log higher than the corresponding CDC LDT. When compared to CDC LDTs, TAC assays were generally one to two logs less sensitive depending on the site performing the analysis. Finally, TAC assays were generally more sensitive than their counterparts in three different commercial multi-respiratory panels. TAC technology allows users to spot customized assays and design TAC layout, simplify assay setup, conserve specimen, dramatically reduce contamination potential, and as demonstrated in this study, analyze multiple samples in parallel with good reproducibility between instruments and operators.

Traditional Chinese and Thai medicine in a comparative perspective

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It is a comprehensive comparison between two traditional medicines.

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The spread of modern medicine do impacted the rise and fall of traditional medicines.

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Deepening exchanges and cooperation between China and Thailand are beneficial.

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Traditional medicines can serve for upgrading healthcare tourism.

The work presented in this paper compares traditional Chinese medicine and traditional Thai medicine, expounding on origins, academic thinking, theoretical system, diagnostic method and modern development. Based on a secondary analysis of available literature, the paper concentrates on two crucial historical developments: (1) the response to, and consequences of, the impact of the Western medicine; and (2) the revival of traditional medicine in these two countries and its prospects. From a comparative perspective, the analysis has led to the conclusion that the rise and fall of traditional medicine is an issue closely related with social and political issues; and the development of traditional medicines requires national policy and financial support from governments, human resource development, the improvement of service quality, and the dissemination of traditional medicine knowledge to the public. In addition, this paper also suggests deepening exchanges and cooperation between China and Thailand, strengthening cooperation between traditional medicine and medical tourism.

Comparison of 3D turbo spin-echo SPACE sequences with conventional 2D MRI sequences to assess the shoulder joint

PURPOSE

To determine the accuracy and reliability of three-dimensional (3D) T1- and proton density (PD)-weighted turbo spin-echo (TSE) sampling perfection with application-optimized contrasts using different flip-angle evolution (SPACE) compared with conventional 2D sequences in assessment of the shoulder-joint.

MATERIALS AND METHODS

Ninety-three subjects were examined on a 3-T MRI system with both conventional 2D-TSE sequences in T1-, T2- and PD-weighting and 3D SPACE sequences in T1- and PD-weighting. All examinations were assessed independently by two reviewers for common pathologies of the shoulder-joint. Agreement between 2D- and 3D-sequences and inter-observer-agreement was evaluated using kappa-statistics.

RESULTS

Using conventional 2D TSE sequences as standard of reference, sensitivity, specificity, and accuracy values of 3D SPACE were 81.8%, 95.1%, and 93.5% for injuries of the supraspinatus-tendon (SSP), 81.3%, 93.5%, and 91.4% for the cartilage layer and 82.4%, 98.5%, and 97.5% for the long biceps tendon. Concordance between 2D and 3D was almost perfect for tendinopathies of the SSP (κ=0.85), osteoarthritis (κ=1), luxation of the biceps tendon (κ=1) and adjacent bone marrow (κ=0.92). Inter-observer-agreement was generally higher for conventional 2D TSE sequences (κ, 0.23-1.0), when compared to 3D SPACE sequences (κ, -0.33 to 1.0) except for disorders of the long biceps tendon and supraspinatus tendon rupture.

CONCLUSION

Because of substantial and almost perfect concordance with conventional 2D TSE sequences for common shoulder pathologies, MRI examination-time can be reduced by nearly 40% (up to 11 min) using 3D-SPACE without loss of information.

Genome-wide analysis of the GRAS gene family in Chinese cabbage (Brassica rapa ssp. pekinensis)

The GRAS gene family is one of the most important families of transcriptional regulators. In this study, 48 GRAS genes are identified from Chinese cabbage, and they are classified into eight groups according to the classification of Arabidopsis. The characterization, classification, gene structure and phylogenetic construction of GRAS proteins are performed. Distribution mapping shows that GRAS proteins are nonrandomly localized in 10 chromosomes. Fifty-five orthologous gene pairs are shared by Chinese cabbage and Arabidopsis, and interaction networks of these orthologous genes are constructed. The expansion of GRAS genes in Chinese cabbage results from genome triplication. Among the 17 species examined, 14 higher plants carry the GRAS genes, whereas two lower plants and one fungi species do not. Furthermore, the expression patterns of GRAS genes exhibit differences in three tissues based on RNA-seq data. Taken together, this comprehensive analysis will provide rich resources for studying GRAS protein functions in Chinese cabbage.

Favourable anatomy after end-to-side repair of interrupted aortic arch

OBJECTIVE

To evaluate cardiovascular outcomes in patients with aortic arch repair and their possible correlation with arch geometry.

METHODS

Ten patients who underwent end-to-side repair for aortic arch interruption (IAA), older than 10 years were compared to a cohort of 10 post coarctation (CoA) repair patients matched for age, sex and age at repair. Mean age at operation was 9.7±6.5 days. Patients underwent a resting and 24 h blood pressure measurements, exercise study, MRI, transthoracic echocardiography and vascular studies.

RESULTS

Seven patients developed hypertension, two from IAA group and five from CoA group. Nine patients (45%) had gothic arch geometry, three from IAA group and six from CoA group. Despite differences in arch geometry, both groups had normal LV mass, LV function and vascular function.

CONCLUSION

No differences in functional or morphologic outcomes could be demonstrated between the end-to-side repair of the arch by sternotomy and the conventional coarctation repair by thoracotomy. A favourable arch geometry can be achieved after the end-to-side repair of the aortic arch. In the present study, we could not correlate adverse arch geometry with any adverse cardio-vascular outcomes. After neonatal arch repair, the contributive role of aortic arch geometry to late hypertension remains uncertain.

Evaluating midwifery units (EMU): lessons from the pilot study

OBJECTIVE

this paper describes the pilot study that was undertaken to test the feasibility of the recruitment plan designed to recruit women who booked to give birth in two freestanding midwifery units in NSW, Australia. The pilot preceded the full prospective cohort study, Evaluating Midwifery Units (EMU), which aimed to examine the antenatal, birth and postnatal outcomes of women planning to give birth in freestanding midwifery units compared to those booked to give birth in tertiary level maternity units in Australia and New Zealand.

DESIGN

a prospective cohort study with two mutually-exclusive cohorts.

SETTING

two freestanding midwifery units in NSW and their corresponding tertiary referral hospitals.

PARTICIPANTS

a total of 146 women with few identified risk factors recruited between 13 September 2009 and 31 March 2010 whose planned place of birth was either a freestanding midwifery unit or tertiary maternity unit.

MEASUREMENTS AND FINDINGS

the pilot study identified the feasibility of relying on the booking midwife to recruit eligible women from several antenatal booking clinics to the study. Low rates of eligible women were invited resulting in a lower than expected consent rate. In addition, although mostly only low-risk women were invited to participate, some women requiring medical consultation at the time of booking were inadvertently recruited into the study. The results of this pilot study led us to revise the study protocol to find ways of including the outcomes of all women without identified risk factors who booked at either the freestanding midwifery units or the tertiary referral hospital in that area. This paper describes the revisions that were made to the study plan.

KEY CONCLUSIONS

five lessons were learned from the pilot study. We found that recruitment protocols employed for the cohort study were too complicated and required simplification to maximise the potential of the study. The study protocol needed to be changed for the main study to ensure a larger sample size and to ensure the risk profile of each cohort was as similar as possible. Sources of data needed to be expanded to produce a complete data set.

IMPLICATIONS FOR PRACTICE

pilot studies are extremely useful tools in testing methods to inform research protocols. We found that the first months spent undertaking a pilot study ensured a stronger design with the potential to show more meaningful results.

Comparative studies on the physicochemical and antioxidant properties of different tea extracts

Tea is one of the most popular drinks next to water. Tea polyphenol is one of the main bioactive constituents of tea with health functions. In order to find the most bioactive tea polyphynols, polyphenol extracts from green tea, black tea and chemical oxidation products of green tea extracts were comparatively studied on the physicochemical and antioxidant properties. Results showed physicochemical and antioxidant properties of polyphenol extracts changed greatly after the chemical oxidation. Hydrogen peroxide induced oxidation products (HOP) possessed the highest antioxidant ability among the four tea polyphenol extracts. Thirteen phenolic compounds and one alkaloid in HOP were identified by reversed phase high-performance liquid chromatography coupled to diode array detection and electrospray ionization mass spectrometry (RP-HPLC-DAD-ESI-MS). Hydrogen peroxide induced oxidation of tea polyphenol extracts could improve the antioxidant activity and could be used to produce antioxidants for food industry.

CT imaging findings of ruptured ovarian endometriotic cysts: emphasis on the differential diagnosis with ruptured ovarian functional cysts

Objective

The purpose of this study is to assess the prevalence of abnormal CT findings in patients with surgically proven ruptured endometriotic cysts, as compared with those abnormal CT findings of ruptured ovarian functional cysts.

Materials and Methods

This study included 13 retrospectively identified patients with surgically confirmed ruptured ovarian endometriotic cysts and who had also undergone preoperative CT scanning during the previous seven years. As a comparative group, 25 cases of surgically confirmed ruptured ovarian functional cysts were included. We assessed the morphologic features of the cysts and the ancillary findings based on CT.

Results

For the endometriotic cysts, the mean maximum cyst diameter was significantly larger than that of the functional cysts (70.1 mm versus 36.4 mm, respectively, p < 0.05). The endometriotic cysts frequently had a multilocular shape and a thicker cyst wall, as compared to that of functional cysts, and these differences were statistically significant. Among the ancillary findings, endometriotic cysts showed a significantly higher prevalence of loculated ascites, ascites confined to the pelvic cavity without extension to the upper abdomen, and peritoneal strandings and infiltrations (p < 0.05). Although 11 of the 25 cases of functional cysts showed active extravasation of contrast material at the ovarian bleeding site, only one of 13 cases of endometriotic cysts showed active extravasation.

Conclusion

The diagnosis of ruptured endometriotic cyst should be suspected for a woman in whom CT reveals the presence of multilocular or bilateral ovarian cysts with a thick wall and loculated ascites confined to the pelvic cavity with pelvic fat infiltrations.

Sample size estimation in epidemiologic studies

This review basically provided a conceptual framework for sample size calculation in epidemiologic studies with various designs and outcomes. The formula requirement of sample size was drawn based on statistical principles for both descriptive and comparative studies. The required sample size was estimated and presented graphically with different effect sizes and power of statistical test at 95% confidence level. This would help the clinicians to decide and ascertain a suitable sample size in research protocol in order to detect an effect of interest.

The issue of lymphadenectomy during laparoscopic gastrectomy for gastric carcinoma

Surgical resection remains the mainstay of treatment for gastric cancer. Laparoscopic assisted gastrectomy has failed to gain universal acceptance as an alternative to the open approach for a number of reasons, one of which includes the issue of oncological radicality in terms of lymph node dissection. Nodal status, which is one of the most crucial and independent predictors of patient survival, therefore has been examined both in single institutional trials and also in randomised controlled trials especially on early gastric cancer. The issue of oncological adequacy for laparoscopic lymph node harvesting for advanced gastric cancer remains a contentious issue because of the unique challenges it poses in terms of complexity, safety and time, and also the lack of randomised controlled trials in this area. It is thus imperative that good quality multicentre randomised controlled trials are designed to investigate the benefits of extended lymphadenectomy in the setting of laparoscopic surgery, especially for advanced gastric cancer and its impact on both short and long term survival.