Effects of meal processing of black soldier fly on standardized amino acids digestibility in pigs

The aim of this study was to investigate the effect of incorporating black soldier fly (BSF) larvae and its processed form as an alternative source of protein to fish meal (FM) on the digestibility of amino acids (AA) in weaned pigs. Four cannulated pigs with an initial bodyweight of 13.25 ± 0.25 kg and aged 30 days were subjected to a 4 × 4 Latin square design with three treatments, as well as a nitrogen-free treatment. The diets used for each treatment consisted of a FM diet, a diet containing BSF larvae meal (BSFM), and a diet containing extruded BSF (BSFE). The study was conducted over four stages, with a total duration of 28 days. The apparent ileal digestibility (AID) of protein was higher in the FM treatment compared with the BSFM. Among essential AA, the AID of Arg, His, Leu, and Thr were higher in the FM compared with the BSFM and BSFE. A greater AID of Ile and Phe was observed in pigs in the FM treatment compared with the BSFM. The average AA digestibility did not show any difference between treatments. Among non-essential AA, the AID of Ala (p = 0.054) and Glu (p = 0.064) tended to be increased in the FM compared with the BSFM. Among essential AA, the standardized ileal digestibility (SID) of Arg, His, Ile, and Leu were higher in the FM compared with the BSFM. Among non-essential AA, the SID of Cys (p = 0.074) tended to be increased in the FM compared with the BSFM. In conclusion, the processing and thermal conditioning techniques utilized for BSF larvae meal showed a tendency for increased AA digestibility. Therefore, when formulating a diet, it is important to take into account the difference in AA digestibility between FM and BSFM.

A brief review of the WHO reporting system for pancreaticobiliary cytopathology

The World Health Organization (WHO), the International Academy of Cytology, and the International Agency for Research on Cancer have developed an approach to standardized reporting of pancreaticobiliary cytopathology. The WHO Reporting System for Pancreaticobiliary Cytopathology (WHO System) revises the Papanicolaou Society of Cytopathology (PSC) System for Reporting Pancreaticobiliary Cytology published in 2015 and replaces the 6 PSC categories with 7 categories: "Insufficient/Inadequate/Nondiagnostic"; "Benign/Negative for malignancy"; "Atypical"; "Pancreaticobiliary neoplasm, low risk/grade (PaN-low)"; "Pancreatic neoplasm, high risk/grade (PaN-High)"; "Suspicious for malignancy"; and "Malignant". In the PSC system, there is a single category for "Neoplastic" lesions that includes 2 groups, 1 for benign neoplasms and 1 named "Neoplastic-other", dominated by premalignant intraductal neoplasms primarily intraductal papillary mucinous neoplasms and low-grade malignant neoplasms (pancreatic neuroendocrine tumors (PanNET) and solid pseudopapillary neoplasms (SPN). In the WHO System, benign neoplasms with virtually no risk of malignancy are included in the "Benign" category and low-grade malignancies (PanNET and SPN) are included in the "Malignant" category, as per the 5th edition of the WHO Classification of Digestive System Tumors, while the non-invasive pre-malignant lesions of the ducts are divided by the cytomorphological grade of the epithelium into PaN-low and PaN-high with distinctly different risks of malignancy. Within each category, key diagnostic cytopathologic features and the ancillary studies for diagnostic and prognostic evaluation, as well as the implications of diagnosis for patient care and management, are outlined. Reporting and diagnostic management options recognize the variations in the availability of diagnostic and prognostic ancillary testing modalities in low- and middle-income countries.

On the need for standardized reporting of photophysical parameters of in vitro photodynamic therapy studies

In vitro dose escalation experiments are one of the first gatekeepers in therapeutic evaluation and development. This also holds for evaluating novel photosensitizers (PS) and Photodynamic Therapy (PDT) co-therapies as needed to provide dose response guidelines before engaging in further pre-clinical studies. The dose needed to achieve 50% cell kill (LD₅₀) is a standard metric to report the potency of a therapeutic agents that is widely accepted for single-drug therapies. In reporting results of PDT experiments, which involve delivery of both drug and light, it is inherently more complicated to identify such a convenient dose response metric that actually captures the larger space of treatment parameters. In addition to ubiquitous sources of biological variability that apply broadly in biomedical research, PDT treatment efficacy is determined by multiple key parameters that may or may not have been documented, including PS concentration and light fluence, where the latter is itself a function of the spectral properties of the light source used (often not described), not to mention dose rate, fractionation and other parameters that potentially vary between individual studies. It is impossible to compare results between two study when, for example one reports LD₅₀ PS concentration without providing essential light dosimetry details. Motivated by this challenge in comparing outcomes and establishing reproducibility of in vitro PDT studies, we endeavored to perform a meta-analysis of the reporting of PDT results by converting, where possible, the disparately reported experimental details into a consistent metric that could be used to compare across studies. In this context we adopt here the number of photons absorbed by photosensitizers per unit volume to affect a 50% decline in cell survival as a standardized metric. By choosing this metric one can acknowledge the quantum-based generation of cytotoxins. While this metric does not cover every possible source of variability between any two studies, for a PS with known optical properties, this does encapsulate PS concentration as well as irradiance and spectral properties of light delivered. For the sake of focus we adopt this approach for study of reported results with two photosensitizers, Protoporphyrin IX, either synthesized in the cells by aminolevulinic acid or administered exogenously, and Chlorin e6. A literature search was performed to identify in vitro studies with these two photosensitizers and collect necessary information to calculate the absorbed photon LD₅₀ threshold for each study. Only approximately 1/10 of the manuscripts reporting on in vitro studies provide the minimum required information to calculate the threshold values. While the majority of the determined threshold values are within a factor of 10, the range of threshold values spanned close to 7 orders of magnitude for both photosensitizers. To contrast with single-agent therapies, a similar exercise was performed for chemotherapeutic drugs targeting cellular mitosis or tyrosine kinase inhibitors resulted in an LD₅₀ or IC₅₀ range of 1-2 orders of magnitude, with LD₅₀ or IC₅₀ values for a single cell line being within a factor of 5. This review underscores challenges in the reporting of in vitro PDT efficacy. In many cases it takes considerable effort to extract the necessary methodology information to make meaningful comparison between PDT studies. Only when results between studies can be compared is it possible to begin to assess reproducibility which, as shown here, can be a major issue. Hence, guidelines need to be developed and enforced through the peer review process for meaningful reporting of preclinical PDT results in order for the most promising sensitizers and co-therapies to be identified and translated into the clinic.

The World Health Organization Reporting System for Pancreaticobiliary Cytopathology

The World Health Organization (WHO), the International Academy of Cytology, and the International Agency for Research on Cancer, with expert contributors from around the world, present an international approach to standardized reporting of pancreaticobiliary cytopathology. This reporting system is one of the first in a series from various body sites that mirror the WHO Classification of Tumours series and provides an evidence-based terminology system with associated risk of malignancy and diagnostic management recommendation per diagnostic category. The WHO Reporting System for Pancreaticobiliary Cytopathology (WHO system) revises the Papanicolaou Society of Cytopathology (PSC) system for Reporting Pancreaticobiliary Cytology published in 2015 and replaces the six-tiered system with a seven-tiered system: "insufficient/inadequate/nondiagnostic"; "benign (negative for malignancy)," "atypical," "pancreaticobiliary neoplasm of low risk/low grade," "pancreatic neoplasm of high risk/high grade," "suspicious for malignancy," and "malignant." The principal differences between the WHO and the PSC systems revolve around the classification of neoplasia. In the PSC system, there was a single category for "neoplastic" lesions that includes two groups, one for "benign neoplasms" [primarily serous cystadenoma] and one named "other," dominated by premalignant intraductal neoplasms (primarily intraductal papillary mucinous neoplasms) and low-grade malignant neoplasms [pancreatic neuroendocrine tumors (PanNETs) and solid pseudopapillary neoplasms (SPNs)]. In the WHO system, benign neoplasms with virtually no risk of malignancy are included in the "benign" category and low-grade malignancies (PanNET and SPN) are included in the "malignant" category, as per the WHO Classification of Digestive System Tumours, thus leaving in the "neoplasm" category primarily those noninvasive premalignant lesions of the ductal system. These neoplasms are divided by the cytomorphological grade of the epithelium into low risk/low-grade and high risk/high-grade, with distinctly different risks of malignancy. As with the PSC system, the WHO system advocates close correlation with imaging and encourages incorporation of ancillary testing into the final diagnosis, such as biochemical (CEA and amylase) and molecular testing of cyst fluid and bile duct brushings. Key diagnostic cytopathological features of specific lesions or neoplasms, ancillary studies for diagnostic and prognostic evaluation, and implications of diagnosis for patient care and management are discussed. In addition, the WHO system includes reporting and diagnostic management options that recognize the variations in the availability of diagnostic and prognostic ancillary testing modalities in low- and middle-income countries, where cytopathology is particularly useful and is increasingly available in the absence of histopathological services.

Mediators of measurement-based care implementation in community mental health settings: results from a mixed-methods evaluation

Background

Tailored implementation approaches are touted as superior to standardized ones with the reasoning that tailored approaches afford opportunities to select strategies to resolve determinants of the local context. However, results from implementation trials on this topic are equivocal. Therefore, it is important to explore relevant contextual factors that function as determinants to evaluate if they are improved by tailoring and subsequently associated with changes in implementation outcomes (i.e., via statistical mediation) to better understand how tailoring achieves (or does not achieve) its effects. The present study examined the association between a tailored and standardized implementation approach, contextual factors that might mediate change, and a target implementation outcome in an initiative to implement measurement-based care (specifically the clinical integration of the Patient Health Questionnaire [PHQ-9] for depression) in a community mental health organization.

Methods

Using a cluster randomized control design, twelve community-based mental health clinics were assigned to a tailored or standardized implementation group. Clinicians completed a self-report battery assessing contextual factors that served as candidate mediators informed by the Framework for Dissemination at three time points: baseline, 5 months after active implementation support, and 10 months after sustainment monitoring. A subset of clinicians also participated in focus groups at 5 months. The routine use of the PHQ-9 (implementation outcome) was monitored during the 10-month sustainment period. Multi-level mediation analyses assessed the association between the implementation group and contextual factors and the association between contextual factors and PHQ-9 completion. Quantitative results were then elaborated by analyzing qualitative data from exemplar sites.

Results

Although tailored clinics outperformed standard clinics in terms of PHQ-9 completion at the end of active implementation, these group differences disappeared post sustainment monitoring. Perhaps related to this, no significant mediators emerged from our quantitative analyses. Exploratory qualitative analyses of focus group content emphasized the importance of support from colleagues, supervisors, and leadership when implementing clinical innovations in practice.

Conclusions

Although rates of PHQ-9 completion improved across the study, their sustained levels were roughly equivalent across groups and low overall. No mediators were established using quantitative methods; however, several partial quantitative pathways, as well as themes from the qualitative data, reveal fruitful areas for future research.

Trial registration

Standardized versus tailored implementation of measurement-based care for depression. ClinicalTrials.gov NCT02266134, first posted on October 16, 2014

Development and Assessment of Early Utilization of the Standardized Letter of Recommendation for Use in the Radiology Residency Match

RATIONALE AND OBJECTIVES

Letters of recommendation are essential for residency applications. Traditionally, narrative letters have been used. Standardized letters of recommendation (SLOR) have been developed and have benefits to the writer and reader. The goal was to develop an informative, meaningful, and efficient SLOR for the radiology residency Match and to assess its early use.

MATERIALS AND METHODS

An Association of University Radiologists (AUR) Research and Education Venture Fund Grant was awarded for the development of a SLOR for use in the radiology residency Match. Grant recipients developed the letter and modifications were based on feedback from the Alliance of Medical Student Educators in Radiology (AMSER) SLOR task force and a larger task force including additional AUR and Association of Program Directors in Radiology (APDR) members. AUR and APDR members were surveyed in 2020 to assess the radiology SLOR.

RESULTS

The radiology SLOR became available for use in September 2018. It highlights the top six traits or abilities deemed most valued in a resident candidate and guides the writer to develop a concrete narrative. Top perceived benefits of the Radiology SLOR are ease of reading and interpretation. Top perceived drawbacks are an impersonal format and concerns regarding program directors' perceptions of the new SLOR. SLOR utilization increased in the second year of availability.

CONCLUSION

The radiology SLOR was developed and first used in 2018. Its use increased over two years and will likely continue to increase given the perceived benefits and increasing awareness of the SLOR.

Use of Standardized History and Physical Examination for Neurosurgical Patients Improves Clinical Documentation and Reimbursement

BACKGROUND

Documentation is the cornerstone of good patient care and vital to proper coding and billing. Consistent and standardized documentation improves communication among physicians and can lead to better reimbursement. By understanding which elements in the neurosurgery history and physical examination are omitted the most often and the effects on the coding level, institutional-specific solutions can be implemented.

METHODS

We performed a retrospective study of neurosurgical patients at a single academic institution who undergone a neurosurgery history and physical examination for an initial inpatient admission from July 2015 to July 2016. The data collected included documentation type (typed, dictated, dynamic documentation without a template, neurosurgery history and physical examination template [NHPT]) and ultimate coding level (1, 2, or 3) determined by a review by a professional coder.

RESULTS

A total of 609 notes were reviewed. Of the 609 notes, 88 (14.4%) were missing an element of documentation. The most common missing element was the physical examination (40 of 88; 45.5%), followed by a combination (27 of 88; 30.7%), review of systems (14 of 88; 15.9%), and medical, family, and/or social history (7 of 88; 8.0%). The dynamic documentation without template notes had the highest percentage of missing elements (49 of 96; 51.0%), followed by the typed notes (7 of 49; 14.3%) and dictated notes (30 of 268; 11.2%) compared with the NHPT notes (2 of 196; 1.0%).

CONCLUSION

The most common missing elements for inpatient neurosurgery documentation were the review of systems and physical examination. The documents with the highest percentage of missing elements were those that used dynamic documentation without a template. We recommend implementing a dedicated NHPT to improve capturing these elements for improved clinical documentation. Such changes could also improve the coding level and subsequent reimbursement.

Nomenclature: Naming Your Gene-Modified Mouse

For many of us, if we are honest, nomenclature is a tedious, incomprehensible jargon that interferes with presenting and reading research data. While understanding the rules governing nomenclature involves a steep learning curve, the curve is short, and the basics, with a little effort, are grasped relatively quickly.Like a language, nomenclature is a communication tool that provides a common ground for a disparate group of people. Standardized names provide universally recognized identifiers that can be used by technicians, researchers, purchasing agents, and facility managers, in fact, anyone who uses mice. The formal nomenclature conveys information on the genetics, the technology involved in making the mutation, who created and maintained the strain, and its relationship to other strains. Using a standardized nomenclature for genes, alleles, and strains assists in the goal of reproducible science and helps to bridge the vast amount of data generated by multi-species genome projects.

Standardized Observational Cancer Research Using the OMOP CDM Oncology Module

Observational research in cancer requires substantially more detail than most other therapeutic areas. Cancer conditions are defined through histology, affected anatomical structures, staging and grading, and biomarkers, and are treated with complex therapies. Here, we show a new cancer module as part of the OMOP CDM, allowing manual and automated abstraction and standardized analytics. We tested the model in EHR and registry data against a number of typical use cases.

Standardized Treatment Strategy for Depressive Disorder

The treatment strategies of depressive disorder include pharmacological treatment, psychotherapy, and physical therapy (electroconvulsive therapy [ECT], transcranial magnetic stimulation [TMS], etc.). The updated CANMAT guidelines recommended the most second-generation antidepressants as first-line treatments for patients with a major depressive disorder (MDD) of moderate or greater severity. Before antidepressant treatment, comprehensive assessment and safety monitoring are necessary. The application of measurement-based care in the diagnosis and treatment of depression would better ensure that enough dosage and response of antidepressant is achieved at each key point, and the final outcome of disease is improved. It is recommended that antidepressant is used with monotherapy in patients with depression. Antidepressants of different types and different mechanisms could be combined to improve the efficacy for patients with treatment-resistant depression (TRD). To prevent the relapse and recurrence of disease, the long-term treatment comprised of acute treatment, consolidation treatment, and maintenance treatment must be considered for all patients.

A clinical nutritional information system with personalized nutrition assessment

BACKGROUND AND OBJECTIVE

Traditional nutrition evaluations not only require the use of numerous tables and lists to provide sufficient recommendations for patients' diets but are also very time-consuming due to cross-referencing and calculations.

METHODS

To personalize patient assessments, this study implemented a Clinical Nutritional Information System (CNIS) to help hospital dietitians perform their daily work more effectively in terms of time management and paper work. The CNIS mainly targets in-patients who require cancer-nutrition counselling. The development of the CNIS occurred in three phases. Phase 1 included system design and implementation based on the Nutrition Care Process and Model (NCPM) and the Patient Nutrition Care Process. Phase 2 involved a survey to characterize the efficiency, quality and accuracy of the CNIS. In Phase 3, a second survey was conducted to determine how well dietitians had adapted to the system and the extent of improvement in efficiency after the CNIS had been available online for three years.

RESULTS

The work time requirements decreased by approximately 58% with the assistance of the CNIS. Of the dietitians who used the CNIS, 95% reported satisfaction, with 91.66% indicating that the CNIS was really helpful in their work. However, some shortcomings were also evident according to the results.

CONCLUSIONS

Dietitians favoured the standardization of nutritional intervention and monitoring. The CNIS meets the needs of dietitians by increasing the quality of nutritional interventions by providing accurate calculations and cross-referencing for information regarding patients' conditions, with the benefit of decreasing the processing time, such as handwritten documentation. In addition, the CNIS also helps dietitians statistically analyse each patient's personal nutritional needs to achieve nutritional improvement.

Implementing measurement based care in community mental health: a description of tailored and standardized methods

Objective

Although tailored implementation methods are touted as superior to standardized, few researchers have directly compared the two and little guidance regarding the specific details of each method exist. Our study compares these methods in a dynamic cluster randomized trial seeking to optimize implementation of measurement based care (MBC) for depression in community behavioral health. This specific manuscript provides a detailed, replicable account of the components of each multi-faceted implementation method.

Results

The standardized best practice method includes training, consultation, a clinical guideline, and electronic health record enhancements with the goal to optimize the delivery of MBC with fidelity. Conversely, the tailored, customized and collaborative method is informed by recent implementation science advancements and begins with a needs assessment, followed by tailored training that feeds back barriers data to clinicians, the formation of an implementation team, a clinician-driven clinic-specific guideline, and the use of fidelity data to inform implementation team activities; the goal of the tailored condition is to ensure the intervention and implementation strategies address unique factors of the context. The description of these methods will inform others seeking to implement MBC, as well as those planning to use standardized or tailored implementation methods for interventions beyond behavioral health.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3193-0) contains supplementary material, which is available to authorized users.

Comparative analysis of background EEG activity in childhood absence epilepsy during valproate treatment: a standardized, low-resolution, brain electromagnetic tomography (sLORETA) study

Valproate (VPA) is an antiepileptic drug (AED) used for initial monotherapy in treating childhood absence epilepsy (CAE). EEG might be an alternative approach to explore the effects of AEDs on the central nervous system. We performed a comparative analysis of background EEG activity during VPA treatment by using standardized, low-resolution, brain electromagnetic tomography (sLORETA) to explore the effect of VPA in patients with CAE. In 17 children with CAE, non-parametric statistical analyses using sLORETA were performed to compare the current density distribution of four frequency bands (delta, theta, alpha, and beta) between the untreated and treated condition. Maximum differences in current density were found in the left inferior frontal gyrus for the delta frequency band (log-F-ratio = -1.390, P > 0.05), the left medial frontal gyrus for the theta frequency band (log-F-ratio = -0.940, P > 0.05), the left inferior frontal gyrus for the alpha frequency band (log-F-ratio = -0.590, P > 0.05), and the left anterior cingulate for the beta frequency band (log-F-ratio = -1.318, P > 0.05). However, none of these differences were significant (threshold log-F-ratio = ±1.888, P < 0.01; threshold log-F-ratio = ±1.722, P < 0.05). Because EEG background is accepted as normal in CAE, VPA would not be expected to significantly change abnormal thalamocortical oscillations on a normal EEG background. Therefore, our results agree with currently accepted concepts but are not consistent with findings in some previous studies.

The 2015 National Cancer Program in Sweden: Introducing standardized care pathways in a decentralized system

Starting in 2015, the Swedish government has initiated a national reform to standardize cancer patient pathways and thereby eventually speed up treatment of cancer. Cancer care in Sweden is characterized by high survival rates and a generally high quality albeit long waiting times. The objective with the new national program to standardize cancer care pathways is to reduce these waiting times, increase patient satisfaction with cancer care and reduce regional inequalities. A new time-point for measuring the start of a care process is introduced called well-founded suspicion, which is individually designed for each cancer diagnosis. While medical guidelines are well established earlier, the standardisation is achieved by defining time boundaries for each step in the process. The cancer reform program is a collaborative effort initiated and incentivized by the central government while multi-professional groups develop the time-bound standardized care pathways, which the regional authorities are responsible for implementing. The broad stakeholder engagement and time-bound guidelines are interesting approaches to study for other countries that need to streamline care processes.

Psychometric evaluation of a standardized set of alcohol cue photographs to assess craving

INTRODUCTION

Research using alcohol-related visual stimuli has been limited due to a lack of published studies examining the psychometric properties of alcohol cues. The primary aim of the current study was to examine the factor structure, validity, and reliability of craving ratings following exposure to alcohol cues (including beer, wine, hard liquor, and mixed drinks) in an alcohol cue-reactivity paradigm.

METHODS

U.S. adults ages 21-69 [N = 195; Mage = 32.19, SD = 10.63; 74.4% male; 56.4% Asian/Pacific Islander, 34.9% White (non-Hispanic), 4.6% Other, 2.0% Hispanic/Latino, 1.5% Native American/Alaskan Native, and 0.5% African-American] completed questionnaires and provided craving, arousal, and valence ratings following alcohol, positive, negative and neutral cues in a web-based study.

RESULTS

The alcohol craving ratings following alcohol cues formed one internally consistent factor. Convergent and incremental validity was supported as alcohol cue craving ratings were positively correlated with general craving, past-year hazardous alcohol use, and behavioral activation facets, even while controlling for neutral cue craving ratings and other related variables. Alcohol craving was significantly higher following alcohol cues compared to neutral cues and unrelated to behavioral inhibition, supporting discriminant validity.

CONCLUSIONS

These findings provide support that the alcohol cues we developed are reliable and valid stimuli for the use in alcohol cue reactivity paradigms. Future research assessing alcohol cue reactivity using this validated photographic cue set may facilitate a greater understanding of the affective processes associated with alcohol use and allow for more targeted behavioral change interventions for alcohol-related problems.

[Laparoscopic promontofixation: defining early morbidity using a standardized method]

OBJECTIVE

Adverse event reporting for laparoscopic promontofixation is highly variable and non-standardized in the literature. The aim of this study was to better characterize early postoperative complications of laparoscopic promontofixation for genital prolapse using a standardized reporting methodology.

PATIENTS AND METHODS

A retrospective study was conducted on 174 women with genital prolapse undergoing laparoscopic promontofixation from January 2008 to January 2013. Complications arising during the first month after surgery were reviewed according to the Clavien and Dindo classification.

RESULTS

At least one postoperative adverse event was reported in 57 out of 174 (33 %) women, grade 1 in 22 patients (13 %), grade 2 in 31 patients (18 %) and grade 3 in 4 patients (2 %). No patient experienced a grade 4 or 5 complication. Fifty-three out of 57 (93 %) complications were grade 1 or 2. The most frequently reported adverse event (n=24; 14 %) was constipation (grade 2).

DISCUSSION AND CONCLUSION

Laparoscopic promontofixation is a safe procedure with almost exclusively benign (grade 1 or 2) early complications. The hypothesis of induction or increasing constipation by this type of genital prolapse surgery should be further evaluated.

Optimization of an "in situ" subtidal rocky-shore sampling strategy for monitoring purposes

This study compared 2 standardized protocols to monitor subtidal rocky shores. We tested 2 sampling methods (temporal unit and quadrat) to assess the efficiency of extracting biota parameters (diversity, abundance, and biomass) of macroalgae, Mollusca, and Porifera with respect to time-cost and the number of sampling units. Species richness and occurrence of rocky subtidal habitats were better described by visual censuses than by quadrats. The same estimated richness was provided by the 2 methods. The association of a visual census and a quadrat was the most efficient way for responding to the requirements. A minimum of 5 sampling units per discrete area is recommended for accurately describing habitats. Then, we tested the sensitivity of the proposed protocol on the Bizeux Islet to study the variations of community structures according to depth and station. Based on the results, recommendations for monitoring purposes have been proposed according to European directives.