Letter: immune checkpoint inhibitor‐induced colitis—shouldn’t we be checking more often? Authors’ reply

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151368/1/apt15448_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151368/2/apt15448.pd

A Bibliometric Review of Digital Nudging within Digital Food Choice Environments

People increasingly make choices about their food intake in digital environments (e.g., online food delivery, online grocery shopping, online school canteens). Given the critical role of diet quality as a key driver for non-communicable disease, it is vital to understand how to design such systems to facilitate healthy food choice through digital nudging. To better understand the impact of digital technologies on food choice, we need to understand the knowledge structure of previous literature. A systematic review of literature identified 83 relevant publications which have been included in this study. Bibliometric analyses were used to map out the knowledge structure, historical roots, and evolution. Reference year spectroscopy, co-word analysis and co-citation analysis were used. Findings show digital nudging is a rapid growing field with strong historical roots in psychology. Additionally, current literature is utilizing psychological theories during the development of digital technologies aimed at nudging consumers towards healthier food options

Diverse Ceramic Technologies in Neolithic Southern Vietnam: The Case of Rach Nui

The initial appearance of fine, incised, and impressed ceramics dating to the Neolithic period (4200–3000 B.P.) in southern Vietnam was associated with the emergence and spread of sedentary settlements, cereal agriculture, and new forms of material culture. However, differences existed in contemporary ceramic technologies between sites. This article presents a preliminary characterization of the pottery found at Rach Nui, a habitation site with an economy focused on vegeculture and foraging that was located at the confluence of the Vam Co Dong, Dong Nai, and Vam Co Tay rivers. The rim forms and decorations at Rach Nui are presented alongside a characterization of the tempers and clays from a small sample of sherds using scanning electron microscopy and energy dispersive X-ray spectrometry (SEM-EDX). The Rach Nui ceramics are compared to previous studies of pottery from An Son, located upstream on the Vam Co Dong River. The results of the characterization and comparison indicate that Rach Nui potters focused on local production of a limited range of vessels compared to primarily agricultural settlements like An Son. This research on Rach Nui pottery demonstrates that by ca. 3500 B.P., the inhabitants of the various Neolithic settlements of southern Vietnam, and perhaps more broadly across Mainland Southeast Asia, had established their own social and cultural traditions that were reflected in locally specific ceramic technologies

Patients’ Willingness to Share Limited Endoscopic Resources: A Brief Report on the Results of a Large Regional Survey

Background: In some health care systems, patients face long wait times for screening colonoscopy. We sought to assess whether patients at low risk for colorectal cancer (CRC) would be willing to delay their own colonoscopy so higher-risk peers could undergo colonoscopy sooner. Methods: We surveyed 1054 Veterans regarding their attitudes toward repeat colonoscopy and risk-based prioritization. We used multivariable regression to identify patient factors associated with willingness to delay screening for a higher-risk peer. Results: Despite a physician recommendation to stop screening, 29% of respondents reported being "not at all likely" to stop. However, 94% reported that they would be willing to delay their own colonoscopy for a higher-risk peer. Greater trust in physician and greater health literacy were positively associated with willingness to wait, while greater perceived threat of CRC and Black or Latino race/ethnicity were negatively associated with willingness to wait. Conclusion: Despite high enthusiasm for repeat screening, patients were willing to delay their own colonoscopy for higher-risk peers. Appealing to altruism could be effective when utilizing scarce resources

A standardized, evidence-based protocol to assess clinical actionability of genetic disorders associated with genomic variation

Genome and exome sequencing can identify variants unrelated to the primary goal of sequencing. Detecting pathogenic variants associated with an increased risk of a medical disorder enables clinical interventions to improve future health outcomes in patients and their at-risk relatives. The Clinical Genome Resource, or ClinGen, aims to assess clinical actionability of genes and associated disorders as part of a larger effort to build a central resource of information regarding the clinical relevance of genomic variation for use in precision medicine and research

Effect of a Perioperative, Cardiac Output-Guided Hemodynamic Therapy Algorithm on Outcomes Following Major Gastrointestinal Surgery A Randomized Clinical Trial and Systematic Review

Importance: small trials suggest that postoperative outcomes may be improved by the use of cardiac output monitoring to guide administration of intravenous fluid and inotropic drugs as part of a hemodynamic therapy algorithm.Objective: to evaluate the clinical effectiveness of a perioperative, cardiac output–guided hemodynamic therapy algorithm.Design, setting, and participants: OPTIMISE was a pragmatic, multicenter, randomized, observer-blinded trial of 734 high-risk patients aged 50 years or older undergoing major gastrointestinal surgery at 17 acute care hospitals in the United Kingdom. An updated systematic review and meta-analysis were also conducted including randomized trials published from 1966 to February 2014.Interventions: patients were randomly assigned to a cardiac output–guided hemodynamic therapy algorithm for intravenous fluid and inotrope (dopexamine) infusion during and 6 hours following surgery (n=368) or to usual care (n=366).Main outcomes and measures: the primary outcome was a composite of predefined 30-day moderate or major complications and mortality. Secondary outcomes were morbidity on day 7; infection, critical care–free days, and all-cause mortality at 30 days; all-cause mortality at 180 days; and length of hospital stay.Results: baseline patient characteristics, clinical care, and volumes of intravenous fluid were similar between groups. Care was nonadherent to the allocated treatment for less than 10% of patients in each group. The primary outcome occurred in 36.6% of intervention and 43.4% of usual care participants (relative risk [RR], 0.84 [95% CI, 0.71-1.01]; absolute risk reduction, 6.8% [95% CI, ?0.3% to 13.9%]; P?=?.07). There was no significant difference between groups for any secondary outcomes. Five intervention patients (1.4%) experienced cardiovascular serious adverse events within 24 hours compared with none in the usual care group. Findings of the meta-analysis of 38 trials, including data from this study, suggest that the intervention is associated with fewer complications (intervention, 488/1548 [31.5%] vs control, 614/1476 [41.6%]; RR, 0.77 [95% CI, 0.71-0.83]) and a nonsignificant reduction in hospital, 28-day, or 30-day mortality (intervention, 159/3215 deaths [4.9%] vs control, 206/3160 deaths [6.5%]; RR, 0.82 [95% CI, 0.67-1.01]) and mortality at longest follow-up (intervention, 267/3215 deaths [8.3%] vs control, 327/3160 deaths [10.3%]; RR, 0.86 [95% CI, 0.74-1.00]).Conclusions and relevance: in a randomized trial of high-risk patients undergoing major gastrointestinal surgery, use of a cardiac output–guided hemodynamic therapy algorithm compared with usual care did not reduce a composite outcome of complications and 30-day mortality. However, inclusion of these data in an updated meta-analysis indicates that the intervention was associated with a reduction in complication rate