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Considering the preferences in Shared Decision Making (SDM) of patients with Digestive Cancer (DC) is crucial to ensure the quality of care. To date, there is limited information on preferences in SDM of patients with DC. The objectives of this study were to describe digestive cancer patients’ preference for involvement in therapeutic decision-making and to identify variables associated with these preferences. An observational prospective study in a French university cancer center has been conducted. Patients completed two questionnaires to qualify and quantify their preference for involvement in therapeutic decision-making: the Control Preference Scale (CPS) and the Autonomy Preference Index (API), which is composed of the Decision Making (DM) score and the Information Seeking (IS) score. Associations between these scores and socio-demographic data, disease-related data, coping strategies (Brief-COPE), physical (QLQ-C30) and psychological (HADS) quality of life were tested. One-hundred fifteen patients returned the questionnaires. The majority of patients reported a passive (49.1%) or a collaborative (43.0%) CPS status. The mean DM score was 39.4 Variables associated with decision-making preferences were occupational status and time since diagnosis. The identification of variables associated with patients' preferences for involvement in decision-making can help make clinicians aware of patients' needs and wishes. However, it can only be determined by interviewing the patient individually.

Abstract Density functional theory is used to study the effect of asymmetric in-plane strain on various BiInO3 phases. Structural relaxation is carried out to simulate the growth of coherently strained epitaxial films on (001) oriented orthorhombic perovskite substrates. The results are in particular analyzed with respect to commercially available substrates in order to assess the stabilization of new and fundamentally interesting BiInO3 phases. We find that a pyroxene-like Pcca phase is energetically more favorable than the bulk-like Pna21 structure on standard cubic substrate materials, such as SrTiO3. However, the presence of imaginary phonon modes suggests that this phase is dynamically instable. The bulk-like structure instead is stable over a wide range of lattice in-plane strain, but coherent growth requires substrates with unusually large lattice parameters. We suggest the use of lanthanate substrates in order to produce high-quality thin films of the bulk phase. Graphical abstract

This paper presents an experimental and finite element (FE) investigation into the local-overall buckling interaction behaviour of axially loaded cold-formed steel (CFS) channel section columns. Current design guidelines from the American Iron and Steel Institute (AISI) and the Australian and New Zealand Standards (AS/NZS) recommend the use of a non-dimensional strength curve for determining the axial capacity of such CFS channel section columns. This study has reviewed the accuracy of the current AISI (2016), AS/NZS (2018) and Eurocode (EN 1993-1-3) design guidelines for determining the axial capacity of CFS channel sections under local-overall buckling interaction failure. A total of 40 tests were conducted on CFS channel sections covering stub, short, intermediate, and slender columns with varying thicknesses. A nonlinear FE model was then developed and validated against the test results. The validated FE model was used to conduct a parametric study comprising 70 FE models to review the accuracy of the current design guidelines in accordance with AISI (2016), AS/NZS (2018) and Eurocode (EN 1993-1-3). It was found that the AISI (2016) and AS/NZS (2018) are conservative by 10 to 15% on average when determining the axial capacity of pin-ended CFS channel section columns undergoing local-overall buckling interaction. Eurocode (EN 1993-1-3) design rules were found to lead to considerably more conservative predictions of column axial load capacity for CFS channels.This paper has therefore proposed modifications to the current design rules of AISI (2016) and AS/NZS (2018). The accuracy of proposed design rules was verified using the FE analysis and test results of CFS channel section columns undergoing local-overall buckling interaction.

International audience; As flood events are expected to become more frequent due to climate change, investigating how overland flow exports terrestrial nutrients, carbon and living organisms into aquatic systems is essential for understanding both soil and stream ecosystem status. Here we assessed how dissolved organic carbon (DOC), total suspended sediments (TSS), and stream bacterial diversity responded to stream discharge and overland flow during stormflow in a tropical catchment. A higher humification index and a decreasing ratio of allochthonous to autochthonous DOC indicated that DOC from soils was exported to stream during the flood. The delta C-13 and delta N-15 of particulate matter was indicative of a source in the cultivated areas of the upper catchment and of subsurface soils (stream banks and gullies) in the downstream section. Bacterial richness of particle-attached (PA) and the free-living (FL) fractions increased with the flood progression in the upstream section. Moreover, the community structure of the PA fraction in the stream was more similar to that of overland flow than was the FL fraction. This suggests that the soil PA bacterial community was washed-out with overland flow during the flood recession. The relative contribution of sources and the composition of TSS, rather than hydrological regime, significantly drove the composition of bacterial community. In conclusion, our results emphasize that overland flow during a flood event strongly influences the structure of stream bacterial communities further underlining the biological connectivity between terrestrial runoff and stream flow.

We investigated the incidence of tuberculosis (TB) in patients with newly diagnosed oral cancer and analyzed the risk factors for TB development and mortality in oral cancer patients. We used Taiwan’s National Health Insurance Database to determine the incidence of TB and to analyze the risk factors for TB in patients newly diagnosed with oral cancer. From 2000 to 2011, we identified 40,327 oral cancer patients and the same number of subjects from the general population matched for sex, age, and comorbidities at a 1:1 ratio. Compared with the matched cohort, oral cancer patients exhibited a higher risk for TB (adjusted hazard ratio (aHR) 2.36, 95% confidence interval (CI) 2.06–2.71). Age ≥ 50 (aHR 1.90, 95% CI 1.57–2.29), being male (aHR 1.98, 95% CI 1.36–2.89), having diabetes mellitus (aHR 1.31, 95% CI 1.05–1.64), alcohol use disorder (aHR 1.42, 95% CI 1.06–1.89), human immunodeficiency virus (HIV) (aHR 8.24, 95% CI 2.05–33.14), chemotherapy (aHR 1.41, 95% CI 1.15–1.72), and radiotherapy for oral cancer (aHR 1.92, 95% CI 1.57–2.36) were identified as independent risk factors for TB in oral cancer patients. Hyperlipidemia was an independent protective factor for TB in oral cancer patients. Old age, male sex, diabetes mellitus, alcohol use disorder, and HIV were independent risk factors for TB in patients with oral cancer. High-risk oral cancer patients should be regularly screened for TB, especially those in endemic areas.

Our aim was to determine the effect of soil characteristics and root traits on soil aggregate stability at an inter- and intra-site scale in a range of agro-ecosystems. We also evaluated the effect of soil depth and the type of land use on aggregate stability. Soil aggregate stability, soil physicochemical properties and fine root traits were measured along land use gradients (from monocultures to agroforestry systems and forests), at two soil depths at four sites (Mediterranean and tropical climates) with contrasting soils (Andosol, Ferralsol, Leptosol and Fluvisol). Aggregate stability was much lower in deep than in surface soil layers, likely linked to lower soil organic carbon (SOC) and lower root mass density (RMD). Locally, and consistently in all sites, land use intensification degrades soil aggregate stability, mainly in surface soil layers. Soil organic carbon, cation exchange capacity and root traits: water-soluble compounds, lignin and medium root length proportion were the most important drivers of aggregate stability at the inter-site level, whereas SOC, root mass and root length densities (RMD, RLD) were the main drivers at the intra-site level. Overall, the data suggest different controls on soil aggregate stability globally (soil) and locally (roots). Conversion from forests to agricultural land will likely lead to greater C losses through a loss of aggregate stability and increased soil erosion.

Dynamic magnetic resonance imaging (MRI) allows real-time characterization of upper airway collapse in sleeping subjects with obstructive sleep apnea (OSA). The aim of our study was to use sleep MRI to compare differences in upper airway collapse sites between BMI-matched subjects with mild OSA and severe OSA. This is a prospective, nested case–control study using dynamic sleep MRI to compare 15 severe OSA subjects (AHI >40) and 15 mild OSA (AHI

The purpose of this study was to evaluate the association between obstructive sleep apnea (OSA) and ophthalmologic diseases, specifically glaucoma, nonarteritic anterior ischemic optic neuropathy (NAION), retinal vein occlusion (RVO), central serous chorioretinopathy (CSR), and floppy eyelid syndrome (FES), by performing a systematic review and meta-analysis of published studies. PubMed, Embase, and Scopus databases were searched for observational studies on OSA and its association with select ophthalmologic diseases. Data was pooled for random-effects modeling. The association between OSA and ophthalmologic diseases was summarized using an estimated pooled odds ratio with a 95 % confidence interval. Relative to non-OSA subjects, OSA subjects have increased odds of diagnosis with glaucoma (pooled odds ratio (OR) = 1.242; P

Autotomy and regrowth of a body part occurs in many animal species. It is costly to regrow the limb and there are often additional long-term costs in, for example, limb strength, foraging efficiency and even mating success. In the fiddler crab Uca mjoebergi, 7 % of males have autotomized and regrown their large claw at some point in their lives. Previous work has shown that there is a great disadvantage to having a regenerated claw. While these males are able to attract mate-searching females to visit them, none of the 84 males observed to have mated in previously collected data had regenerated claws. Since females’ final mate choice is based on burrow structure, it was assumed that males with regenerated claws had poorer burrows. Here we show that, by finding only three cases of a female mating with a regenerated claw male, that there is, in fact, no mating disadvantage to having a regenerated claw. We also show that the burrows of males with regenerated claws are no different than those of orginal-clawed males. This is a very clear reminder that sample size matters, especially when dealing with rare events.

Female mating preferences can vary temporally, with females choosing different males at different times; and spatially, with females in different populations preferring different males. This level of complexity is now well established, but we know of no evidence for a mosaic of female preferences within a single population. Here we show that, in the banana fiddler crab, Uca mjoebergi, female preferences vary both temporally and spatially. Females living in the high inter-tidal zone changed their mating preference for male size over the duration of the 9-day mating period every semi-lunar cycle: early mating females selected larger males with cooler burrows, slowing embryonic development; those mating later, selected smaller males with warmer burrows, accelerating development. Females living lower in the inter-tidal zone, however, did not show this temporal variation: they select the same sized males throughout the mating period. It is only in the high inter-tidal zone, at the start of the fortnightly mating period, that large size confers a mating advantage to males.

Scientific Reports 6: Article number: 26475; published online: 25 May 2016; updated: 19 August 2016. In this Article, the authors ran an XRD experiment on the oxidised samples indicating that the alumina layers formed at temperatures as high as 1300 °C were mostly amorphous and an alumina signal wasnot detected, as shown in Figure 7b.

International audience; Pentameric ligand-gated ion channels mediate signal transduction through conformational transitions between closed-pore and open-pore states. To stabilize a closed conformation of GLIC, a bacterial proton-gated homolog from Gloeobacter violaceus whose open structure is known, we separately generated either four cross-links or two single mutations. We found all six mutants to be in the same 'locally closed' conformation using X-ray crystallography, sharing most of the features of the open form but showing a locally closed pore as a result of a concerted bending of all of its M2 helices. The mutants adopt several variant conformations of the M2-M3 loop, and in all cases an interacting lipid that is observed in the open form disappears. A single cross-linked mutant is functional, according to electrophysiology, and the locally closed structure of this mutant indicates that it has an increased flexibility. Further cross-linking, accessibility and molecular dynamics data suggest that the locally closed form is a functionally relevant conformation that occurs during allosteric gating transitions.

Multiple questionnaires completed over the semester by 514 students enrolled in a first year psychology course reveal that no single pattern of reliance on print, online, or in-person resources guarantees a high mark. Analyses of the reported and measured frequency of use of various resources correlated against students’, performance on both individual assessments and their final marks suggests that students employ a range of strategies in their use of class resources. They tend to rely on their textbooks, Web-based lecture notes, and online quizzes, but their final marks are more strongly determined by their university entrance scores than by their resource use strategy, their sex, or whether or not English is their first language. The data suggest that students adapt their learning strategies to the resources available, with an apparent emphasis on learning what will be assessed rather than exploring for understanding. Importantly, the results argue that investment in development of educational technologies – and students’, use of educational technologies – must be informed by empirical data concerning its impact on the efficiency and quality of learning.

Background European health systems depend increasingly on the services of health professionals who obtained their primary medical qualification from other countries. There has been a significant increase recently in fully qualified specialist doctors arriving from the European Union to provide short term or longer-term solutions to health human resources needs in the UK National Health System. These doctors often take up senior consultant positions. As a result, the NHS has had to learn to deal with both expatriation and repatriation of EU doctors as a constant dynamic characteristic of its own ability to deliver services. We conducted a qualitative study to explore the acclimatisation experience of EU doctors with qualifications in anaesthesia arriving in the United Kingdom to take up clinical employment in the NHS. The question we ask is: how do specialty registered anaesthetists who trained in other European countries experience the process of acclimatisation to practice in the United Kingdom in a large hospital in London? Methods We did individual interviews with non-UK, EU-qualified doctors with Certification of Completion of specialty Training who were registered with the General Medical Council in the UK and could practice in the NHS as specialist anaesthetists. The doctors were all interviewed whilst working in a large NHS teaching hospital in London, UK. We analysed qualitative data from interview transcripts to identity themes and patterns regarding senior doctor’s acclimatisation to the British system. Results Acclimatisation conceived of as transfer of clinical expertise was problematic for doctors who felt they lacked the right kind of support. Doctors sought different opportunities to share wider perspectives on care deriving from their previous experience. Conclusions Hospital conceptions of acclimatisation as a highly individual process can offer an idealized view of clinical work and learning in the new system. Socio-cultural theories suggest we create regular learning opportunities for international staff to critically reflect on practice with local staff to acclimatise more effectively. Electronic supplementary material The online version of this article (doi:10.1186/s12909-015-0331-4) contains supplementary material, which is available to authorized users.

Previous research has generallyfailed to find a relation between the waystudents approach the task of studying andtheir exam grades. The present studyinvestigated why it is that a deep approach tostudying, which has been shown to result in ahigher quality of learning, does notconsistently result in higher exam grades. Theparticipants in the study were 49 third-yearpsychology students. They completedquestionnaires that assessed approaches tostudying, motivation, and intelligence. Theirfinal exam marks, along with indicators of thequality of their final exam responses and thequantity of information reproduced in the finalexam were used as indicators of academicperformance. The results showed that the deepstudy approach was linearly related to thequality of exam responses, but quadraticallyrelated to the quantity of informationreproduced. The use of the deep approach was nomore effective in facilitating high exam marksfor questions that emphasised understanding ofthe study material than for questions thatemphasised reproduction of it. Taken together,these findings suggest that students who usehigh levels of the deep approach fail toconsistently achieve higher exam grades becauseof deficiencies in the quantity of theirresponses, rather than because of theinsensitivity of exams to students'understanding of the study material.

Background. Exogenous surfactant treatment of hyaline membrane disease is known to modify the pattern of radiological changes on the chest radiograph. Objectives. To analyse and attempt to explain the radiological changes observed after exogenous surfactant treatment. Materials and methods. Thirty-nine premature infants with typical hyaline membrane disease. Results. Transient asymmetrical clearing with better aeration of the right lung in the absence of malposition of the tip of the endotracheal tube was observed in nine cases (23 %). This asymmetry was patchy in one case. It was due to a complication of mechanical ventilation in three cases [pneumothorax (n = 2) and pneumomediastinum (n = 1)]. In the other six cases, asymmetrical clearing could be related to the anatomical position of the right main bronchus, which facilitates distribution of surfactant to the right lung. However, the course of these premature infants was similar to that of infants with symmetrical chest radiological findings after treatment. Conclusions. Asymmetrical clearing of chest radiographs, sometimes patchy, after surfactant treatment requires exclusion of pneumothorax or infection but has no influence on clinical outcome.