Hemoadsorption: Research Agenda and Potential Future Applications

In the randomized Balloon Angioplasty and Anticoagulation Study (BAAS), the addition of oral anticoagulants to aspirin significantly reduced early and late events after coronary angioplasty. However, bleeding episodes were increased. The present report studied the intensity and the duration of anticoagulation as predictors of thrombotic and bleeding events. A total of 530 patients, 34% of whom received a stent, were treated with aspirin plus coumarins. Half of the patients were randomized to angiographic follow-up. The target international normalized ratio (INR) was 2.1 to 4.8 during angioplasty and 6-month follow-up. Thrombotic events were death, myocardial infarction, target lesion revascularization, and thrombotic stroke. Bleeding complications were hemorrhagic stroke, major extracranial bleeding, and false aneurysm. "Optimal" anticoagulation was defined as an INR in the target range for at least 70% of the follow-up time. There were 17 early thrombotic events (3.2%), 7 early bleeding episodes (1.3%), and 10 false aneurysms (1.9%). The incidence rate for both early thrombotic and bleeding events was lowest in patients in the target range. A total of 61 late thrombotic events occurred (11.6%). Optimal anticoagulation was an independent predictor of late thrombotic events (relative risk, 0.33; 95% CI, 0.19 to 0.57) and was associated with a 0.21 mm (95% CI, 0.17 to 0.42) larger vessel lumen at 6 months. Late bleeding episodes (1.4%) were lowest in patients in the target range. Coumarins started before coronary angioplasty with a target INR of 2.1 to 4.8 led to the lowest procedural event rate, without an increase in bleeding episodes. During follow-up, optimal anticoagulation was associated with a decrease in the incidence of late events by 67% and a significant improvement in 6-month angiographic outcome.

A Physiological Marriage Made in Heaven: Treating and Measuring the Brain Through Stimulation.

The aim of this study was to investigate the current use of musculoskeletal US (MSUS) and the most relevant areas of interest for this imaging modality in paediatric rheumatology. A questionnaire was developed by the paediatric subgroup of the OMERACT US task force and e-mailed to the members of the main international paediatric rheumatology networks and societies. Responses were entered in an electronic database. Results were analysed quantitatively or summarized qualitatively in the case of open questions. The overall response rate was 36% (262/719). The use of MSUS varied among members of the various networks/societies. MSUS was considered of high relevance for improvement of diagnostic skills, for the guidance of joint injections and for the assessment of specific joints, namely the hip, ankle, midfoot and wrist. It was considered useful for early detection of synovitis and in determining disease activity and disease remission. Although at present MSUS is not widely used by paediatric rheumatologists, there is considerable interest in this imaging technology among members of the international networks. The results of this survey suggest that the next objective in the research agenda should be the standardization of the assessment of joints in healthy children. This will then help differentiate pathological (i.e. synovitic) joints from normal joints. The initial target joints should be the hip, ankle, midfoot and wrist. MSUS training focused on the assessment of paediatric patients might be very important in implementing the use of this technique in clinical practice and research.

Quality of anticoagulation control among patients with atrial fibrillation: An experience of a tertiary care center in Saudi Arabia

An invited report on national occupational health research priorities, agenda and strategy of Japan was delivered in the NORA (National Occupational Research Agenda) Symposium 2001, USA. The third NORA Symposium was held by the US National Institute for Occupational Safety and Health (NIOSH) in Washington DC on June 27, 2001. The national conference in Japan entitled "Conference on Occupational Health Research Strategies in the 21st Century" was organized by the Japanese Ministry of Labour (Currently, Ministry of Health, Labour and Welfare) in the years 1998-2001, and the national occupational health research agenda and strategy for the next decade in Japan was identified. A total of 50 Conference members, i.e., representatives from various fields of occupational health in Japan, ranked 58 comprehensive research topics, yielding short-term (5-year) and long-term (6-10 year) priority research topics. Overall (10-year) priority research topics were calculated by combining the short-term and long-term priority scores. Together with the ranking by 145 extramural occupational health specialists, it was identified that work stress (i.e., one of the 58 research topics) was the first overall priority research topic for the next 10 years in Japan. Three other topics, i.e., elderly workers, women workers and maternity protection, and mental health and quality of work and life, were the second group of priority topics; and hazard and risk assessment and biological effect index were the third priority group. Based on the scores for the short-term and long-term priority research topics, all 58 research topics were classified into three key research areas with 18 key research issues (National Occupational Health Research Agenda, NOHRA). Finally, eight implementation measures of national strategy for the Japanese Government to promote occupational health research were introduced.

Corporate interests have the potential to influence public debate and policymaking by influencing the research agenda, namely the initial step in conducting research, in which the purpose of the study is defined and the questions are framed. We conducted a scoping review to identify and synthesize studies that explored the influence of industry sponsorship on research agendas across different fields. We searched MEDLINE, Scopus, and Embase (from inception to September 2017) for all original research and systematic reviews addressing corporate influence on the research agenda. We hand searched the reference lists of included studies and contacted experts in the field to identify additional studies. We included empirical articles and systematic reviews that explored industry sponsorship of research and its influence on research agendas in any field. There were no restrictions on study design, language, or outcomes measured. We excluded editorials, letters, and commentaries as well as articles that exclusively focused on the influence of industry sponsorship on other phases of research such as methods, results, and conclusions or if industry sponsorship was not reported separately from other funding sources. At least 2 authors independently screened and then extracted any quantitative or qualitative data from each study. We grouped studies thematically for descriptive analysis by design and outcome reported. We developed the themes inductively until all studies were accounted for. Two investigators independently rated the level of evidence of the included studies using the Oxford Centre for Evidence-Based Medicine ratings. We included 36 articles. Nineteen cross-sectional studies quantitatively analyzed patterns in research topics by sponsorship and showed that industry tends to prioritize lines of inquiry that focus on products, processes, or activities that can be commercialized. Seven studies analyzed internal industry documents and provided insight on the strategies the industry used to reshape entire fields of research through the prioritization of topics that supported its policy and legal positions. Ten studies used surveys and interviews to explore the researchers' experiences and perceptions of the influence of industry funding on research agendas, showing that they were generally aware of the risk that sponsorship could influence the choice of research priorities. Corporate interests can drive research agendas away from questions that are the most relevant for public health. Strategies to counteract corporate influence on the research agenda are needed, including heightened disclosure of funding sources and conflicts of interest in published articles to allow an assessment of commercial biases. We also recommend policy actions beyond disclosure such as increasing funding for independent research and strict guidelines to regulate the interaction of research institutes with commercial entities. Public Health Implications. The influence on the research agenda has given the industry the potential to affect policymaking by influencing the type of evidence that is available and the kinds of public health solutions considered. The results of our scoping review support the need to develop strategies to counteract corporate influence on the research agenda.

This chapter presents an overview of childhood alcohol use, including global patterns, trends, and systems surrounding the child, based on current theoretical understanding of child development. Key areas are discussed regarding patterns and trends, including age of initiation, and current use related to children’s age and sex. Data and findings from large international surveys are presented and limitations are herein mentioned. In short, varying trends on current alcohol use are seen globally, and large European and North American regional surveys point toward slowly declining trends, although for certain regions, such as the Balkans, the opposite is seen. Also, disparities are observed within the varying regions, exemplified as past-30-days alcohol use among 12–15-year-olds spanning from 5–60% in African countries. Alcohol use is discussed in relation to both genetic and mental health-related factors, as well as environmental factors, such as parents and peers. The chapter finally discusses cultural influence and the potential for modulating child environment and cultural influence through policy, such as regulating advertisement, product placement, and access.KeywordsChildhoodAlcoholSubstanceDrinkingUseAbuseDependenceParentUpbringingEnvironmentTrendsPrevalenceSocial influenceMental healthPolicy

Hispanic drug abuse in an evolving cultural context: An agenda for research

Information and communication technologies (ICTs) are increasingly influencing human beings and are changing our attitudes towards these technologies. The purpose of this article is to understand the factors influencing the use of ICTs in agricultural extension through a descriptive research method. The populations were 320 individuals of agricultural Extension Workers (EWs) of Isfahan province that 200 people selected as a research sample. The reliability of self-completion questionnaire according to pilot test and calculating Cronbach’s alpha for four part of the instrument was 82.6-87.8. The results revealed that the EWs have a positive attitude toward using ICT. They mostly viewed it as a useful tool for extension, which can potentially save money and time and extension. On the ranking of principal areas of applying ICTs by EWs “typing letters/report”, “prepare and protect file on process basic agricultural and rural information”, had most usage. The main result of the study revealed that the EWs approximately use ICT quite a bit. Also, the EWs with high school diploma degree used ICT less than the EWs with MSc degree and the EWs with 5 years and less experience had higher ICT application than the EWs with 15-16 year experience.

PurposeThis study conducts a systematic literature review of e-tail product returns research. E-tail product returns are essentially acquisition of products that have been sold through purely online or brick-and-click channels and then returned by consumer to business.Design/methodology/approachUsing a systematic literature review protocol, we identified 75 peer-reviewed articles on e-tail product returns, conducted bibliometric analysis and content analysis of the articles and summarised our findings.FindingsThe findings reveal that the subject of e-tail returns is a new research area; academics have started to investigate several aspects of e-tail returns through different research methodologies and theoretical foundations. Further research is required in leading e-commerce countries and on key areas such as omni-channel returns management, customer satisfaction and service, the impact of resources such as people skills, the benefits of technology and IT systems in managing e-tail returns.Practical implicationsThe study offers a summative account of current e-tail knowledge areas, which can serve as a reference guide for e-tailers to develop strategies for more efficient and competitive product returns.Originality/valueThis study contributes theoretically by developing clusters of key themes or knowledge areas about e-tail returns. It also provides a conceptual framework for e-tail returns management, which can be used as a springboard for further empirical research.

Purpose – To close the inaugural volume of Strategic Outsourcing, an International Journal (SOIJ), this paper's objective is to suggest a research agenda for outsourcing related studies, aiming to identify a limited number of key and most urgent research areas in need of scientifically valid research. Design/methodology/approach – The authors draw on their personal experience and knowledge as well as the content of the first volume of SOIJ, to identify key seminal studies in the field, observe gaps in current knowledge, and provide suggestions for future research. Findings – The major outcome of the paper is our suggestion for the top‐10 most urgent outsourcing research areas. Also interesting are the other three top‐10s we propose: the top‐10 theories underpinning current outsourcing research; the top‐10 research areas investigated by past research on outsourcing; and the top‐10 research questions that have emerged this year. Research limitations/implications – Considering the methodology we chose for this article, we are aware, and indeed so should you be, that this research is biased and subjective by our own admission. Hence its categorisation as a viewpoint. Nonetheless, considering the large amount of information we have used and the very narrow focus we have kept in identifying only the most urgent gaps, we believe the article has relevant implications in terms of clarifying a short‐term roadmap for research in the field. Practical implications – From a practical perspective, as with all research agendas, the longer‐term implications are much more important and visible than the shorter‐term ones. The extremely fast pace at which outsourcing practice develops, coupled with the slower pace at which theoretical formulation and education move, are leaving outsourcing practitioners short of the proper "tools of trade". A clear and focused research agenda can help generate knowledge supporting a drastic reduction in the confusion surrounding this practice and hence increase practitioners' ability to develop the proper skills, learn from and apply validated theories and, in turn, more successfully manage their outsourced operations or contracts. Originality/value – That outsourcing related research is going to increase over the next few years, is undisputed. The key question is how we can maximise current and future efforts to shorten the development time. Being part of the editorial team of SOIJ puts us in the privileged position to have visibility over most current research being undertaken in the field of outsourcing. Complementing this with our own experience as researchers and practitioners in the field, we can provide relevant suggestions to those researchers who share an interest in developing this field into a fully‐fledged scientific discipline.

Cassava is an important subsistence crop grown only in the tropics, and represents a major source of calories for many people in developing countries. Improvements in the areas of resistance to insects and viral diseases, enhanced nutritional qualities, reduced cyanogenic content and modified starch characteristics are urgently needed. Traditional breeding is hampered by the nature of the crop, which has a high degree of heterozygosity, irregular flowering, and poor seed set. Biotechnology has the potential to enhance crop improvement efforts, and genetic engineering techniques for cassava have thus been developed over the past decade. Selectable and scorable markers are critical to efficient transformation technology, and must be evaluated for biosafety, as well as efficiency and cost-effectiveness. In order to facilitate research planning and regulatory submission, the literature on biosafety aspects of the selectable and scorable markers currently used in cassava biotechnology is surveyed. The source, mode of action and current use of each marker gene is described. The potential for toxicity, allergenicity, pleiotropic effects, horizontal gene transfer, and the impact of these on food or feed safety and environmental safety is evaluated. Based on extensive information, the selectable marker genes nptII, hpt, bar/pat, and manA, and the scorable marker gene uidA, all have little risk in terms of biosafety. These appear to represent the safest options for use in cassava biotechnology available at this time.

Sugar-sweetened beverage (SSB) consumption in early childhood is a public health concern. Adequate hydration in early childhood is also important. We developed a national research agenda to improve beverage consumption patterns among 0-5-year-olds. This article focuses on the process used to develop this research agenda. A mixed methods, multi-step process was used to develop the research agenda, including: (i) a scientific advisory committee; (ii) systematic reviews on strategies to reduce SSB consumption and increase water access and consumption; (iii) two stakeholder surveys to first identify and then rank strategies to reduce SSB consumption and increase water access and consumption; (iv) key informant interviews to better understand determinants of beverage consumption and strategies to improve beverage consumption patterns among high-risk groups; (v) an in-person convening with experts; and (vi) developing the final research agenda. This process included research and stakeholders from across the United States. A total of 276 participants completed survey 1 and 182 participants completed survey 2. Key informant interviews were conducted with 12 stakeholders. Thirty experts attended the convening, representing academia, government, and non-profit sectors. Thirteen key issue areas and 59 research questions were developed. Priority topics were beverage consumption recommendations, fruit-flavoured drink consumption, interventions tailored to high-risk groups, and family engagement in childcare. This research agenda lays the groundwork for research efforts to improve beverage patterns of young children. The methods used can be a template to develop research agendas for other public health issues.

The U.S. Department of Veterans Affairs (VA) is undergoing an enterprise-wide transition from a homegrown electronic health record (EHR) system to a commercial off-the-shelf product. Because of the far-reaching effects of the EHR transformation through all aspects of the healthcare system, VA Health Services Research and Development identified a need to develop a research agenda that aligned with health system priorities so that work may inform evidence-based improvements in implementation processes and outcomes. The purpose of this paper is to report on the development of a research agenda designed to optimize the EHR transition processes and implementation outcomes in a large, national integrated delivery system. We used a sequential mixed-methods approach (portfolio assessment, literature review) combined with multi-level stakeholder engagement approach that included research, informatics, and healthcare operations experts in EHR transitions in and outside the VA. Data from each stage were integrated iteratively to identify and prioritize key research areas within and across all stakeholder groups. VA informatics researchers, regional VA health system leaders, national VA program office leaders, and external informatics experts with EHR transition experience. Through three rounds of stakeholder engagement, priority research topics were identified that focused on operations, user experience, patient safety, clinical outcomes, value realization, and informatics innovations. The resulting EHR-focused research agenda was designed to guide development and conduct of rigorous research evidence aimed at providing actionable results to address the needs of operations partners, clinicians, clinical staff, patients, and other stakeholders. Continued investment in research and evaluation from both research and operations divisions of VA will be critical to executing the research agenda, ensuring its salience and value to the health system and its end users, and ultimately realizing the promise of this EHR transition.

Oral anticoagulants are prescribed to millions of Americans, and consequently are among the medications most likely to contribute to emergency department visits and hospitalizations. Although guidelines and consensus statements promote systematic approaches to therapy, anticoagulation (AC) management is often suboptimal. Electronic health records (EHRs) have the potential to improve safety and quality but have not yet incorporated specialized features necessary to optimize therapy. To generate a comprehensive, consensus-based list of EHR features clinically necessary to deliver optimized AC management, provide a "language bridge" to accelerate incorporation of features into EHR systems, and suggest mechanisms for the objective evaluation of available EHRs. A multidisciplinary panel of AC specialists utilized the framework of a previously published consensus statement to map outpatient AC management and developed a comprehensive array of sequential computer logic steps using a restricted language scheme. Logic steps were then translated into narrative descriptions of potential EHR features, which were refined through multiple group evaluations. A finalized list of proposed features was ranked according to perceived clinical necessity by physician, pharmacist, and nurse panelists in a blinded manner using a 5-point Likert scale. Features receiving no more than 1 dissenting opinion were included in a finalized list of clinically necessary features. The task force generated 78 recommended EHR features across 20 key discrete areas and 425 individual logic steps. All recommended features received Strongly Agree or Agree rankings regarding their perceived clinical necessity, and no feature received more than a single Disagree response. The incorporation of key AC-related features into existing EHRs or specialized AC management systems has the potential to systematize the delivery of optimal AC care by health care professionals at the point of care. Optimized AC management has the potential to reduce adverse drug events associated with anticoagulant therapy in the outpatient setting.