The ladies trial: laparoscopic peritoneal lavage or resection for purulent peritonitisA and Hartmann's procedure or resection with primary anastomosis for purulent or faecal peritonitisB in perforated diverticulitis (NTR2037)

Background: Recently, excellent results are reported on laparoscopic lavage in patients with purulent perforated diverticulitis as an alternative for sigmoidectomy and ostomy. The objective of this study is to determine whether LaparOscopic LAvage and drainage is a safe and effective treatment for patients with purulent peritonitis (LOLA-arm) and to determine the optimal resectional strategy in patients with a purulent or faecal peritonitis (DIVA-arm: perforated DIVerticulitis: sigmoidresection with or without Anastomosis). Methods/Design: In this multicentre randomised trial all patients with perforated diverticulitis are included. Upon laparoscopy, patients with purulent peritonitis are treated with laparoscopic lavage and drainage, Hartmann's procedure or sigmoidectomy with primary anastomosis in a ratio of 2:1:1 (LOLA-arm). Patients with faecal peritonitis will be randomised 1:1 between Hartmann's procedure and resection with primary anastomosis (DIVA-arm). The primary combined endpoint of the LOLA-arm is major morbidity and mortality. A sample size of 132:66:66 patients will be able to detect a difference in the primary endpoint from 25% in resectional groups compared to 10% in the laparoscopic lavage group (two sided alpha = 5%, power = 90%). Endpoint of the DIVA-arm is stoma free survival one year after initial surgery. In this arm 212 patients are needed to significantly demonstrate a difference of 30% (log rank test two sided alpha = 5% and powe

Deceptive Journalism: Characteristics of Untrustworthy News Items

Trustworthiness is key in journalism, yet some journalists intentionally deceive their audiences by fabricating sources or inventing news stories altogether. Earlier research suggests that deceitful news articles have characteristics that are different from trustworthy news articles. We aimed to confirm and expand on the existing literature by examining the case of Perdiep Ramesar, an esteemed Dutch journalist until it was discovered in 2014 that sources were non-existing in 126 of his articles for national newspaper Trouw (“Fidelity”). Using content analysis, we searched for systematic differences in source use and presentation comparing Ramesar’s deceptive news articles with two same-sized sets of reliable articles, (1) articles on similar topics from other journalists and (2) articles with verifiable sources from Ramesar himself. Results indicate that compared to real news sources, fictitious sources are more often secondary definers, who are presented in more stereotypical ways and through more and longer direct quotations. Furthermore, negations and self-references occur more often in deceptive news articles

Raising clickworthiness: Effects of foregrounding news values in online newspaper headlines

What attracts news readers in headlines? Many news websites test alternative headlines in order to assess which headline generates more clicks (A/B testing). In order to raise clickworthiness, headlines may emphasize news values including Negativity, Novelty and Eliteness. Headlines may also employ forward referencing (‘This is what you need to know’), or language intensity (‘Worst storm in decades’). Systematic analysis of A/B test data helps to identify characteristics of successful headlines. Using a data set provided by a Dutch national newspaper, headline characteristics are compared as to which incite more clicks, or, more specifically, click-through rates (CTR). The results indicate that besides language intensity and forward referencing, only the news value Negativity has a positive influence on CTR

Multipolar radiofrequency ablation for colorectal liver metastases close to major hepatic vessels

Background: Resection of colorectal liver metastases (CRLM) is often hindered by their location close to the major hepatic vessels. So far, radiofrequency ablation for perivascular tumours was thought to be ineffective and unsafe due to either the heat sink effect or vascular thrombosis. The aim of this study was to examine whether RFA using multipolar probes could be a safe and effective option for CRLM adjacent to major hepatic vessels. Methods: Patients were treated with multipolar RFA during an open procedure using 3 simultaneously placed electrodes. In 52 consecutive patients with CRLM, 144 tumours were ablated with RFA. In 16 out of 52 (31%) patients, metastases were abutting major hepatic vessels. We examined whether perivascular location was a risk factor for local tumour progression. The relation between perivascular location and time to local tumour progression and recurrence free survival was assessed using cox-regression analysis. Results: All patients were followed for at least 3 years after RFA unless they deceased before this time. Local tumour progression following RFA occurred in 17 out of 144 tumours (12%), of which 4 out of 21 were perivascular tumours. Tumour size was the only risk factor for local tumour progression in this study. Proximity to large vessels was neither a risk factor for local local tumour progression, nor for time to local tumour progression or recurrence free survival. Discussion: This study indicates that patients with CRLM abutting any of the large hepatic vessels can be safe and effectively treated with RFA when using a multipolar system

Acuerdo entre evaluadores en la puntuación visual de las convulsiones neonatales basadas en la votación mayoritaria en un sistema basado en la web: la base de datos Neoguard EEG

Objective To assess interrater agreement based on majority voting in visual scoring of neonatal seizures. Methods An online platform was designed based on a multicentre seizure EEG-database. Consensus decision based on ‘majority voting’ and interrater agreement was estimated using Fleiss’ Kappa. The influences of different factors on agreement were determined. Results 1919 Events extracted from 280 h EEG of 71 neonates were reviewed by 4 raters. Majority voting was applied to assign a seizure/non-seizure classification. 44% of events were classified with high, 36% with moderate, and 20% with poor agreement, resulting in a Kappa value of 0.39. 68% of events were labelled as seizures, and in 46%, all raters were convinced about electrographic seizures. The most common seizure duration was <30 s. Raters agreed best for seizures lasting 60–120 s. There was a significant difference in electrographic characteristics of seizures versus dubious events, with seizures having longer duration, higher power and amplitude. Conclusions There is a wide variability in identifying rhythmic ictal and non-ictal EEG events, and only the most robust ictal patterns are consistently agreed upon. Database composition and electrographic characteristics are important factors that influence interrater agreement. Significance The use of well-described databases and input of different experts will improve neonatal EEG interpretation and help to develop uniform seizure definitions, useful for evidence-based studies of seizure recognition and managemen