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This article reports on an evaluated workshop using a speed networking method to promote inter-professional work-integrated learning (WIL) in a tertiary classroom setting. The article includes specific reference to speech-language therapy, nursing and social work, three of the seven disciplines that engaged with the exercise. Social constructivist learning theory is discussed with reference to development of work readiness for interprofessional teamwork among final year speech-language therapy students. The practical considerations used in facilitating the workshop are explained, with findings derived from a thematic analysis of the evaluation feedback provided. The key outcomes from the learning exercise identified an increased understanding of diverse professional identities amongst students whilst challenging pre-existing disciplinary stereotypes. Finally, the pedagogical implications of facilitating this WIL initiative are discussed.

We present a patient at risk of misdiagnosis with multiple myeloma due to pseudohypercalcemia. Examinations showed monoclonal protein, 50% monoclonal plasma cells in bone marrow, and hypercalcemia but no osteolytic bone lesions. Follow-up tests revealed pseudohypercalcemia, with elevated total calcium, but normal ionized calcium: a discrepancy due to calcium binding to monoclonal paraprotein (confirmed by laboratory experiments). Accordingly, the patient was diagnosed with smouldering myeloma. After 900 days, the presence of bone lesions prompted the start of treatment for myeloma. Consequently, monoclonal paraprotein levels declined and pseudohypercalcemia dissolved. Hence, ionized calcium should be measured in monoclonal gammopathies to avoid misdiagnosis.

Background: Young people with mental illness should be offered evidence-based treatments. In 2018, we developed a national evidence portal in Norway providing mental health professionals and others with living evidence summaries. This immense work has been an important contribution to mental health care in Norway but is also a rich data source for exploring the characteristics and evidence gaps of the existing research internationally. At the time of this study, eight overviews of systematic reviews (OoOs) had been published. These addressed treatments for attention deficit / hyperactivity disorder (ADHD), anxiety, depression, bipolar disorder, psychosis, obsessive compulsive disorder (OCD), self-harm and trauma/ post-traumatic stress disorder. The objective of this study was to do a secondary analysis of this evidence to describe the state-of-the art in this field, and to map: treatments evaluated for each patient group and the longest time of follow-up treatment comparisons evaluated for more than one patient group Methods: We performed a mapping review of the eight OoOs. Data extraction was performed by one author and double-checked by another. All data was entered into Excel. Findings were visualized in descriptive tables and using Sunburst-diagrams. We used statistical thresholds to determine the size of effect and report the associated certainty. Results: We identified 200 treatment comparisons including a wide variety of interventions. Some mental illnesses are treated mostly with pharmacological or combination therapies and others solely with psychological or psychosocial treatments or with more diversity. The evidence supporting most treatments is of low to very low certainty. Ten percent of the comparisons included follow-up assessments beyond 12 months. Cognitive behavioural therapy, dialectic behavioural therapy, physical activity and mindfulness interventions were effective across populations. Conclusions: The evidence supporting treatment of mental illness in young people has important limitations. Future research efforts should address these evidence gaps.

Objective: Radiofrequency ablation (RFA) is increasingly considered the prime option for treating symptomatic, benign, non-functioning thyroid nodules (NFTN). However, little is known about the degree of operator experience required to achieve optimal results. This study describes the RFA learning curve of a single-center team. Methods: A retrospective cohort study of the first 103 patients receivin g RFA treatment for a single, symptomatic, and benign NFTN, with a follow-up of at least 1 year. The primary outcome measure was technique efficacy, defined as the per centage of patients with a 6-month nodal volume reduction ratio (VRR) >50% after si ngle-session RFA. Optimal treatment efficacy was defined as a 6-month VRR >50% achie ved in at least 75% of patients. Secondary outcomes were complications of RFA and indications of secondary interventions. Results: Median nodal volume at baseline was 12.0 mL (range 2.0–58.0 mL ). A 6-month VRR >50% was achieved in 45% of the first 20 patients, 75% of th e next 20, and 79% of the following 63 patients. Complications included minor bleeding (N = 4), transient hyperthyroidism (N = 4), and transient loss of voice (N = 1). Poor volume reduction or nodular regrowth led to diagnostic lobectomy in 11 patients and a second RFA in 5. Lobectomy revealed a follicular carcinoma (T2N0M0) in 2 patient s. In 1 patient, nodule regrowth was caused by an intranodular solitary B-cell lymphoma. Conclusion: About 40 procedures are required to achieve a 6-month VRR >50% in the majority of patients. Appropriate follow-up with re-evaluation is recommended for all patients with a VRR

Many current immunoassays require multiple washing, incubation and optimization steps. Here the authors present Ratiometric Plug-and-Play Immunodiagnostics (RAPPID), a generic assay platform that uses ratiometric bioluminescent detection to allow sandwich immunoassays to be performed directly in solution.

Author(s): E. Boksem [sup.1] , J. M. Schotman [sup.1] , F. B. M. Joosten [sup.2] , M. M. G. J. van Borren [sup.3] , H. de Boer [sup.1] Author Affiliations: [...], Background Recently, a new model has been proposed to assess hydration in patients by measurement of total body electrical resistance (TBER), with results expressed in ohm rather than in liter body water. According to this approach, hydration is considered to be normal if TBER is within the normal range. As TBER is inversely related to the size of the limb muscle compartment, this relationship can be used to calculate the patient-specific TBER normal value (TBER.sub.norm). The present study investigates whether the prediction of TBER.sub.norm can be improved by the use of ultrasound (US) instead of anthropometrically derived parameters of limb muscularity. Methods In total, 129 healthy subjects (60 men and 69 women) ranging in age from 18 to 75 yr, and in BMI from 17.4 to 52.0 kg/m.sup.2 were included in the study. Arm muscle cross-sectional area assessed by anthropometry (AMA.sub.caliper) was compared with mean muscle thickness (MMT) of arm and leg assessed by B-mode US. Results MMT correlated stronger with TBER than AMA, and reduced the standard error of the estimate (SEE) by 15% in men and by 26% in women. Muscularity was overestimated by AMA.sub.caliper due to a systematic error directly proportional to subcutaneous fat layer thickness. The gender independent relation between MMT and TBER.sub.norm is described by the equation: TBER.sub.norm = 705-75.4*MMT (R.sup.2 = 0.85, SEE = 22.3 [OMEGA]/m, P < 0.001). Conclusions US-based measurement of limb muscularity provides a more precise prediction of TBER.sub.norm, in particular in obese subjects, and is recommended as the method of choice.

Background: A starting point for evaluating the effectiveness of treatments should be to identify evidence gaps. Furthermore, such evaluations should consider the perspectives of patients, clinicians and carers to ensure relevance and potentially influence future research initiatives. Methods: Our approach, inspired by the James Lind Alliance methods, involved three steps. First, we performed a document analysis by identifying interventions and outcomes in two recently published overviews of systematic reviews, which summarised the effects of interventions for anxiety and depression in children and adolescents. Second, we surveyed children and adolescents with personal experiences of depression or anxiety as well as clinicians, and asked them to suggest treatments and outcomes associated with uncertainty. Finally, we facilitated a consensus process where clinicians and youth mental health patient representatives were invited to prioritise research uncertainties in separate consensus processes. Results: The survey included 674 respondents who reported a total of 1267 uncertainties. Independent coding by four investigators revealed 134 suggestions for treatments of anxiety, 90 suggestions for treatments of depression, 84 for outcomes of interventions for anxiety and 71 suggestions for outcomes of interventions for depression. Two separate priority setting workshops with eight clinicians and ten youth resulted in four independent top ten priority lists. Conclusion: Top ten lists of treatments and outcome domains of anxiety and depression in children and adolescents was identified by youth and clinicians. The results may influence the research agenda, and ultimately benefit patients.

Author(s): J. M. Schotman [sup.1] , M. M. G. J. van Borren [sup.2] , J. F. M. Wetzels [sup.3] , H. J. Kloke [sup.3] , L. J. M. Reichert [sup.1] [...], Background Fluid balance management in hospitalized patients is hampered by the limited sensitivity of currently available tools. The aim of this study was to assess the sensitivity of total body electrical resistance (TBER) measurements for the detection of extracellular volume (ECV) expansion. Methods TBER and plasma resistivity ([rho].sub.plasma) were measured during a 4-h infusion of NaCl 0.9% at a rate of 500 mL/h in 23 patients undergoing a diagnostic saline infusion test for primary hyperaldosteronism. Extracellular fluid gain (EFG) was defined as infusion volume minus urinary volume. Results Infusion of 2.0 L NaCl 0.9% was associated with a mean diuresis of 1.1 [plus or minus] 0.5 L, an EFG of 0.9 [plus or minus] 0.5 L, a decrease in [rho].sub.plasma of 1.1 [plus or minus] 0.7 [OMEGA]·cm or 1.7 [plus or minus] 1.0% (P < 0.001), and a decline in TBER of 23.2 [plus or minus] 10.9 [OMEGA] or 4.6 [plus or minus] 2.2% (P < 0.001). At group level, infusion of 80 mL saline was sufficient to induce a statistically significant decline in mean TBER. At personal level, the decline in TBER was significant on 76% of occasions after an EFG of 0.5-0.75 L, and on all occasions after an EFG of 1.0 L or greater. Conclusion Raw TBER data are very informative for the detection of ECV expansion induced by the infusion of NaCl 0.9%, with a sensitivity at a personal level that is relevant for clinical practice.

There has been a lively public debate for some time now about the possession and presentation of cultural artifacts from the former colonies in European museum collections. Many call for the decolonization of these collections, with decolonization being understood in different ways. For some, it is about challenging and altering the presentation and approach of these objects, as these would still testify to a colonial outlook. Others interpret decolonization as calling for the return of these items. The coloniality of collections of natural or organics objects, in botanical gardens and natural history museums, in former colonies and in Europe, has so far not received the same amount of attention in public and academic debates. How deeply natural history collections, assembled since the early days of modernity, are steeped into political, cultural, epistemological and symbolic coloniality has been side-lined for a long time in Western academia. Even if scholars have been aware of the colonial roots of natural history for long, we only recently see the emergence of a body of critical reflection on the importance and consequences of these roots for identities, power relations and knowledge production. Only reluctantly have natural history museums, botanical gardens and other institutions with natural history collections started to join the critical conversation about their colonial legacies. With this special issue (‘dossier’) on The Coloniality of Natural History Collections, we aim to bring the critical conversation further. The prehistory of this issue dates back to the workshop ‘The colonial legacy of Dutch natural history collections’ in December 2018, organized by Caroline Drieënhuizen (History, Open University (OU) Netherlands) and Fenneke Sysling (History, Utrecht University/Leiden University) and hosted by Artis Amsterdam Royal Zoo. In this workshop, participants demonstrated how this kind of objects should not by regarded as apolitical and objective artefacts, but as objects deeply entangled with colonialism and resulting worldviews and identities.

Background: A starting point for evaluating the effectiveness of treatments should be to identify evidence gaps. Furthermore, such evaluations should consider the perspectives of patients, clinicians and carers to ensure relevance and potentially influence future research initiatives. Methods: Our approach, inspired by the James Lind Alliance methods, involved three steps. First, we performed a document analysis by identifying interventions and outcomes in two recently published overviews of systematic reviews, which summarised the effects of interventions for anxiety and depression in children and adolescents. Second, we surveyed children and adolescents with personal experiences of depression or anxiety as well as clinicians, and asked them to suggest treatments and outcomes associated with uncertainty. Finally, we facilitated a consensus process where clinicians and youth mental health patient representatives were invited to prioritise research uncertainties in separate consensus processes. Results: The survey included 674 respondents who reported a total of 1267 uncertainties. Independent coding by four investigators revealed 134 suggestions for treatments of anxiety, 90 suggestions for treatments of depression, 84 for outcomes of interventions for anxiety and 71 suggestions for outcomes of interventions for depression. Two separate priority setting workshops with eight clinicians and ten youth resulted in four independent top ten priority lists. Conclusion: Top ten lists of treatments and outcome domains of anxiety and depression in children and adolescents was identified by youth and clinicians. The results may influence the research agenda, and ultimately benefit patients.

We present a patient at risk of misdiagnosis with multiple myeloma due to pseudohypercalcemia. Examinations showed monoclonal protein, 50% monoclonal plasma cells in bone marrow, and hypercalcemia but no osteolytic bone lesions. Follow‐up tests revealed pseudohypercalcemia, with elevated total calcium, but normal ionized calcium: a discrepancy due to calcium binding to monoclonal paraprotein (confirmed by laboratory experiments). Accordingly, the patient was diagnosed with smouldering myeloma. After 900 days, the presence of bone lesions prompted the start of treatment for myeloma. Consequently, monoclonal paraprotein levels declined and pseudohypercalcemia dissolved. Hence, ionized calcium should be measured in monoclonal gammopathies to avoid misdiagnosis. [ABSTRACT FROM AUTHOR]

Abstract Background Health researchers often use survey studies to examine associations between risk factors at one time point and health outcomes later in life. Previous studies have shown that missing not at random (MNAR) may produce biased estimates in such studies. Medical researchers typically do not employ statistical methods for treating MNAR. Hence, there is a need to increase knowledge about how to prevent occurrence of such bias in the first place. Methods Monte Carlo simulations were used to examine the degree to which selective non-response leads to biased estimates of associations between risk factors and health outcomes when persons with the highest levels of health problems are under-represented or totally missing from the sample. This was examined under different response rates and different degrees of dependency between non-response and study variables. Results Response rate per se had little effect on bias. When extreme values on the health outcome were completely missing, rather than under-represented, results were heavily biased even at a 70% response rate. In most situations, 50–100% of this bias could be prevented by including some persons with extreme scores on the health outcome in the sample, even when these persons were under-represented. When some extreme scores were present, estimates of associations were unbiased in several situations, only mildly biased in other situations, and became biased only when non-response was related to both risk factor and health outcome to substantial degrees. Conclusions The potential for preventing bias by including some extreme scorers in the sample is high (50–100% in many scenarios). Estimates may then be relatively unbiased in many situations, also at low response rates. Hence, researchers should prioritize to spend their resources on recruiting and retaining at least some individuals with extreme levels of health problems, rather than to obtain very high response rates from people who typically respond to survey studies. This may contribute to preventing bias due to selective non-response in longitudinal studies of risk factors and health outcomes.

Abstract Background The long-term natural history of microscopic colitis (MC) (collagenous colitis (CC), lymphocytic colitis (LC)), traditionally considered relapsing but non-progressive diseases, is poorly defined. Whether persistent histologic inflammation in such diseases is associated with an increased risk of colorectal neoplasia (CRN) or extracolonic cancers has not been robustly established. Methods This retrospective cohort included diagnosed with MC at a referral center. Rates of CRN and extracolonic cancer were compared to patients undergoing screening colonoscopy (n = 306) and to the United States population using data from the Surveillance, Epidemiology, and End-Results (SEER) program. Standardized incidence ratios (SIR) and 95% confidence intervals were calculated and multivariable regression models used to identify the effect of MC diagnosis and severity on cancer risk. Results Our study included 221 patients with microscopic colitis (112 CC, 109 LC) among whom 77% were women. Compared to the colonoscopy control population, MC was associated with similar odds of tubular adenoma (Odds ratio (OR) 1.07, 95% CI 0.69–1.66) or villous adenoma (OR 1.26, 95% CI 0.17–9.42). Compared to patients with a single episode of MC, those with 2 or more episodes had similar risk of colon cancer (OR 0.83, 95% CI 0.20–3.39) or tubular adenoma (OR 1.49 95% CI 0.83–2.67). We also identified no statistical increase in the rates of cancer in the MC population compared to US-SEER data. Conclusion Microscopic colitis was not associated with increased risk of CRN and extracolonic cancers when compared to controls undergoing colonoscopy or the US SEER population.

Emerging data highlight the critical role for the innate immune system in the progression of nonalcoholic fatty liver disease (NAFLD). Connexin 32 (Cx32), the primary liver gap junction protein, is capable of modulating hepatic innate immune responses and has been studied in dietary animal models of steatohepatitis. In this work, we sought to determine the association of hepatic Cx32 with the stages of human NAFLD in a histologically characterized cohort of 362 patients with NAFLD. We also studied the hepatic expression of the genes and proteins known to interact with Cx32 (known as the connexome) in patients with NAFLD. Last, we used three independent dietary mouse models of nonalcoholic steatohepatitis to investigate the role of Cx32 in the development of steatohepatitis and fibrosis. In a univariate analysis, we found that Cx32 hepatic expression associates with each component of the NAFLD activity score and fibrosis severity. Multivariate analysis revealed that Cx32 expression most closely associated with the NAFLD activity score and fibrosis compared to known risk factors for the disease. Furthermore, by analyzing the connexome, we identified novel genes related to Cx32 that associate with NAFLD progression. Finally, we demonstrated that Cx32 deficiency protects against liver injury, inflammation, and fibrosis in three murine models of nonalcoholic steatohepatitis by limiting initial diet‐induced hepatoxicity and subsequent increases in intestinal permeability. Conclusion: Hepatic expression of Cx32 strongly associates with steatohepatitis and fibrosis in patients with NAFLD. We also identify novel genes associated with NAFLD and suggest that Cx32 plays a role in promoting NAFLD development. (Hepatology Communications 2018;2:786‐797)