bluuebunny/crossref_metadata_2025 huggingface dataset:
Religion and the Republic
Authors: Harris Steven M.
Published: July 2021

This chapter attempts to enter into the ongoing debate over Calvinism’s place in the politics of the American Revolution by considering, in the persons of Phillis Wheatley and Lemuel Haynes, the black Calvinist tradition as generative of a distinctive theo-political imagination. Taking as its focus the thematics of providence and liberty, this chapter argues that black Calvinists in the Revolutionary period possessed a more sober, self-critical outlook on divine providence and a more comprehensive, consistent spirit of liberty than many of their Anglo counterparts. Wheatley and Haynes evidenced a critical patriotism and commended an aspirational vision of nation building that had as its hope the full humanity and equality of all people. Their cautionary theo-politics anticipated future national tensions, the implications of which continue to be felt today.
Introduction
Authors: Gordon Bruce , Trueman Carl R.
Published: July 2021

A handbook to Calvin and Calvinism must address the complexities of assessing the influence of one sixteenth-century figure on a religious tradition still very much alive from Brazil to China. Calvinism is a slippery term that suggests that an extremely diverse and often contradictory tradition can be traced to one man. In many respects this is unsustainable, yet patterns emerge. Arguably, the term ‘Reformed’ is more appropriate to reflect the protean character of a branch of Christianity that emerged out of Switzerland during the Reformation to become a global faith. The contributions to this volume bring fresh perspectives to Calvin’s thought and influence and explore the broad spectrum in which they have been manifested over four hundred years in doctrine, institutions, literature, art, politics, and popular culture. Just like its eponymous founder, Calvinism has continually reinvented itself, acquiring new forms and adapting to changing circumstances and cultures.
Experiments in IPE Research
Authors: Spilker Gabriele
Published: July 2021

Over the last decade, experiments have developed from a marginally employed to an increasingly standard method in the study of International Political Economy (IPE). After a short discussion of causal inference and the potential outcomes framework, this chapter outlines different kinds of experiments used to study questions concerning trade, migration, foreign aid, or investment. The chapter thereby not only strives to provide an overview of the state-of-the-art in experimental IPE research but also to outline the different roles or functions experimental studies can fulfill to further our knowledge on IPE. The chapter concludes by critically discussing both advantages and disadvantages of the experimental turn in IPE.
Foreign Aid and Quality of Government
Authors: Dietrich Simone , Winters Matthew S.
Published: July 2021

This chapter reviews empirical literature on foreign aid and QoG. The chapter begins with a description of how scholarship on foreign aid and QoG developed in conjunction with prominent debates in the development community. The chapter discusses three major debates: whether or not QoG moderates foreign aid effectiveness, whether or not donors give aid selectively based on QoG, and whether or not foreign aid undermines or can help build QoG. With regard to aid effectiveness, the most recent literature suggests that aid can be effective even under conditions of poor QoG. With regard to selectivity, the existing literature shows an increasing selectivity for overall aid flows since the end of the Cold War and provides evidence of selectivity in terms of type of aid. The evidence that aid undermines QoG is not as strong as has been claimed by some of the initial studies in this literature. The chapter concludes by suggesting ways forward for all three literatures.
Bringing Politics Back In
Authors: Persson Anna
Published: July 2021

Why are some states able to provide public goods and promote broad-based development whereas other states do not have the capacity to do any of these things? In search for an answer to this question, the past few decades have witnessed a radical increase in studies emphasizing a presumed negative role of ethnic fractionalization. Having been referred to as “one of the most powerful hypotheses in political economy,” the negative impact of ethnic fractionalization is now even so widely accepted that it has become a “standard” control in regressions explaining variation in political, social, and economic development. This chapter introduces, revisits, and confronts this so-called “diversity debit hypothesis,” focusing on the role of the Quality of Government. In particular, the chapter emphasizes the need to endogenize the relationship between ethnic fractionalization and public goods provision in a way that brings the state up front of the analysis as a social force in its own right, with the power to shape notions of “us” and “them” and, thus, development outcomes.
Governance Beyond the State
Authors: Carlitz Ruth , Lust Ellen
Published: July 2021

The past two decades have seen a “good governance” agenda gain prominence among both scholars and practitioners. When the state performs well, a number of positive consequences are expected to follow as a result. However, state institutions are not the sole determinants of development outcomes. This chapter takes an expanded view of governance, highlighting the role of nonstate, or social, institutions. Such an expanded view can help account for the variation we observe across and within countries in the quality of service delivery. Specifically, we show how social institutions can affect the targeting of public goods and services, the information that citizens have about the quality of service delivery, and their willingness and ability to make demands for improved services. We conclude by reflecting on the research agenda that emerges if we take social institutions more seriously, and the policy implications that may result.
Pockets of Effectiveness and Islands of Integrity
Authors: McDonnell Erin Metz , Vilaça Luiz
Published: July 2021

The administrative quality of states is typically measured at the level of national governments, tacitly presuming organizational strength is evenly distributed throughout the organizations comprising central state administration. However, those organizations vary substantially in providing impartial, effective, and honest administration. This chapter examines variation in the quality of government within central state administrations, a newly consolidating subfield identified with “pockets of effectiveness” or “islands of integrity.” This scholarship analyzes how some state agencies manage to offer high-quality administration in challenging institutional contexts where many peer organizations are weak, ineffectual, or corrupt. The chapter discusses methodological challenges and traces the history of first- and second-wave scholarship in this subfield. Then through meta-analysis, it identifies four major theoretical themes in prior scholarship: technical competence and incentives, external networks, autonomy, and organizational culture. The chapter concludes with promising avenues for future research, identifying ways scholars and practitioners interested in quality of government broadly can benefit from the findings of this subfield.
Quality of Government and Welfare State Support
Authors: Kumlin Staffan
Published: July 2021

Abstract: Research on citizens’ support for government redistribution, social protection, and public services (shorthand: welfare state support) has been late to examine quality of government explanations. Slowly but surely in the 2000s, however, scholars have compensated a previous neglect. This literature provides examples of how research on welfare state attitudes is expanding beyond the much-studied rich Western welfare states. In terms of substantive questions, scholars increasingly seek to answer questions such as: Are citizens’ assessments of various “quality of government” aspects positive or negative across space and time? Are assessments multi- or unidimensional? What aspects of quality of government do citizens assess? Are evaluations rooted in relevant information and objective facts? Finally, how do quality of government factors affect normative support for the welfare state and its constituent policies and aspects?
State Capacity, Quality of Government, Sequencing, and Development Outcomes
Authors: D'Arcy Michelle , Nistotskaya Marina
Published: July 2021

This chapter provides a review of the state capacity and institutional sequencing literatures. It begins with a discussion on the conceptualization of the notion of state capacity, examining the pros and cons of the existing conceptual approaches with regard to measurement and inference. It also surveys the existing empirical indicators, highlighting recent progress in this area, particularly relating to measures of informational capacity and territorial reach. The chapter proceeds with a review of the scholarly debate about institutional sequencing, considering the theoretical arguments and empirical evidence of both the “state first” and “democracy first” literatures. This is followed by an assessment of the existing evidence of the effects of state capacity on economic development and public goods provision. The final section summarizes the state of the art, reflecting on challenges and outlining possible avenues for future research.
“Quality of Government”
Authors: Kirby Nikolas , Wolff Jonathan
Published: July 2021

Until recently, with some notable exceptions, contemporary political philosophy has had little to say about topics of “governance.” Unlike earlier thinkers, contemporary theorists have largely ignored topics such as bureaucracy, institutions, corruption, public integrity, and public service. Accordingly, Rothstein and Jan Teorell’s idea of “Quality of Government” (“QoG”), combined with the work of other political scientists and public administration theorists, invites a welcome and long overdue return to topics of governance for political philosophy. This chapter first aims to clarify the precise question to which “QoG” is intended to be answer, that is, the question of “good governance” and distinguish it from more traditional philosophical concerns with justice and legitimacy. We review the limited philosophical landscape, and then critique of the QoG as a theory of good governance. Finally, we tentatively outline an alternative account, and consider directions for future research.
A Rhetorical Genre(?)
Authors: Polemis Ioannis
Published: July 2021

The chapter is a case study of Byzantine learned rhetoric in action, and some of the complications that one faces when one applies the concept of “genre” to Byzantine rhetoric. The test case is the invective, in Greek ψόγος, from the perspective of Byzantine rhetorical education and practice. After a series of general observations on rhetorical definitions of the “invective,” as well as on the fact that the invective resembles more a rhetorical “mode,” which is present in a variety of “genres,” than a “genre” per se, the chapter reviews a few representative related texts from the middle and late Byzantine period.
School Law Enforcement Officer Perceptions of Developmentally Oriented Training
Authors: Scheuermann Brenda , Billingsley Glenna , Dede-Bamfo Ohenewaa , Martinez-Prather Kathy , White Shawna R
Published: July 2021

School-based policing, one of the fastest-growing areas of law enforcement, requires unique skills and presents unique challenges. Specialized training for school resource officers (SROs) is encouraged by the US Departments of Education and Justice (2016) and states are increasingly making available or requiring SROs to complete training designed to better prepare them for school settings. In 2016, Texas mandated a comprehensive, 16-h training programme for SROs from moderate and large school districts. In this paper, we describe a survey conducted to assess perceptions of the first class of SROs to complete that training. We describe SROs’ perceptions of the quality and content of the training, need for the training, and the self-reported impact of training on officers’ daily job activities. Based on the largely positive responses and comments from over 400 SROs, we provide recommendations for policy makers considering similar specialized training for SROs.
The Relationship Between Sleep Quality, Sleep-Related Biomarkers, and Motor Skill Acquisition in People With Multiple Sclerosis: A Pilot Study
Authors: Al-Sharman Alham , Al-khazaaleh Heba Mefleh , Khalil Hanan , Aburub Ala’S , El-Salem Khalid
Published: July 2021

Objective

Neurorehabilitation that involves learning new motor skills is one of the promising clinical methods for motor recovery in people with multiple sclerosis (PwMS); therefore, factors that influence the acquisition of motor skills in PwMS need to be investigated. Sleep disturbances are common in PwMS; however, no study has investigated the effect of sleep and sleep-related biomarkers on skill acquisition in PwMS. This study aimed to examine the effect of sleep and sleep-related biomarkers on motor acquisition in PwMS.

Methods

Forty participants with MS and 40 controls were recruited in this study. To assess motor acquisition, each participant was asked to perform a novel game through a virtual reality (VR) system 5 times (blocks). The main outcome measures for each block were the required time to complete the VR game and the recorded errors. The difference in scores between Block 5 and Block 1 for both outcomes were considered to represent motor skill acquisition. Sleep was assessed by self-report using the Pittsburgh Sleep Quality Index (PSQI) and objectively using sleep monitor technology. Serotonin level was assessed using means of enzyme-linked immunosorbent assay using plasma samples.

Results

There were significant positive correlations in both groups between motor skill acquisition and PSQI score. In PwMS, significant negative correlation between motor skill acquisition and sleep efficiency and significant positive correlation between motor skill acquisition and sleep latency were also observed. Interestingly, a significant negative correlation was observed between motor skill acquisition and the plasma serotonin level in both groups. Most of these correlations remained significant after controlling for disease severity, fatigue, baseline performance, and cognitive status.

Conclusion

Sleep quality may influence motor skill acquisition in PwMS. Circulatory serotonin level might explain this relationship.

Impact

Physical therapists are encouraged to be aware of sleep quality and sleep assessment. Sleep management strategies should be considered when treating PwMS.
The influence of particle size of Enogen Feed corn and conventional yellow dent corn on nursery and finishing pig performance, carcass characteristics and stomach morphology
Authors: Williams Hadley R , Tokach Mike D , Woodworth Jason C , DeRouchey Joel M , Goodband Robert D , Gebhardt Jordan T , Paulk Chad B
Published: July 2021

Enogen Feed corn is a variety developed by Syngenta Seeds (Downers Grove, IL) that has been genetically modified to contain an α-amylase enzyme trait (SYT-EFC). Originally, Enogen feed corn was developed for the ethanol industry due to its reduction in viscosity of the corn mash, thus eliminating the need to add a liquid form of the α-amylase enzyme. However, there is a potential application for Enogen Feed corn to be used in livestock diets due to the increase in α-amylase enzyme potential to increase starch digestibility. A more common method of increasing starch digestibility in corn is to finely grind it to reduce particle size. This increases the surface area and allows for greater interaction with digestive enzymes. We hypothesized that pigs fed Enogen feed corn potentially could achieve similar gain:feed ratio (G:F) at larger particle sizes than conventional corn because of the differences in starch digestibility. In experiment 1, a total of 360 pigs (DNA 200 × 400, Columbus, NE; initially 6.6 ± 0.1 kg BW) were used with five pigs per pen and 12 pens per treatment. Treatments were arranged in a 2 × 3 factorial with main effects of corn source (Enogen Feed corn or conventional yellow dent corn) and ground corn particle size (300, 600, or 900 µm). Overall, there was a corn source × particle size interaction (linear, P = 0.027) for G:F. There was no effect due to particle size when pigs were fed conventional yellow dent corn, but in pigs fed Enogen Feed corn, G:F increased with decreasing particle size. Neither corn source nor particle size affected (P > 0.05) overall average daily gain (ADG) or average daily feed intake (ADFI). In experiment 2, a total of 323 pigs (241 × 600; DNA, Columbus, NE; initially 50.0 ± 1.3 kg) were used with nine pigs per pen and six pens per treatment. Treatments were identical as experiement 1. Overall, corn source had no effect on finishing pig ADG, ADFI or G:F. For corn particle size, ADG and G:F increased (linear, P < 0.014) and ADFI decreased (P = 0.043) as particle size decreased. For stomach morphology, there was a tendency for a corn source × particle size interaction (P = 0.055) for keratinization score with keratinization increasing linearly (P = 0.001) as particle size of the corn decreased for yellow dent corn with no change in keratinization score as particle size decreased for Enogen Feed corn. In summary, reducing corn particle size improved G:F with no major differences observed between corn sources for overall pig performance.
Anaphylaxis viewed by experts: unmet needs
Authors: Sala-Cunill Anna , Cardona Victoria
Published: July 2021

Purpose of review

The purpose of the review is to identify unmet needs in the management of anaphylaxis, covering aspects such as epidemiology, diagnosis, treatment and prevention.

Recent findings

Redefinition of clinical diagnostic criteria may allow a better identification of anaphylaxis. International diagnostic coding system improvement will be major step for future policies and epidemiological studies. Digital health can aid in managing anaphylaxis.

Anaphylaxis is a medical emergency; current data show that frequently identification of the reaction, acute and long-term management, are not optimal. Therefore, there is a need to implement strategies to improve the situation. This review has identified unmet needs in anaphylaxis regarding aspects such as epidemiology, severity scoring, definition and diagnostic criteria, anaphylaxis in infants and toddlers, cofactors, biomarkers, long-term management, undertreatment and availability of epinephrine autoinjectors. Strategies focused on education, legislation, digital health and research are proposed.
Intersegmental Kinematics of the Upper Cervical Spine
Authors: Lorente Ana I. , Hidalgo-García César , Rodríguez-Sanz Jacobo , Maza-Frechín Mario , López-de-Celis Carlos , Pérez-Bellmunt Albert
Published: July 2021

Study Design.

Biomechanical study using cadaveric cervical spines.

Objective.

To evaluate joint mobility and stiffness at the craniovertebral junction.

Summary of Background Data.

Data on the intersegmental kinematics of the craniovertebral joints are available in the literature with a widespread range of values. The effect that alar ligament injuries have on intersegmental kinematics remains unclear and requires further biomechanical investigation.

Methods.

Ten occipito-atlanto-axial (C0-C1-C2) human specimens were articulated to flexion, extension, bilateral lateral bending, and bilateral axial rotation. The moment–rotation response was continuously tracked through the entire range of motion before and after unilateral alar ligament transection of the right side.

Results.

The intersegmental (C0-C1/C1-C2) moment–rotation response was continuously quantified in full flexion (7.2 ± 6.6°/12.1 ± 5.8°), extension (11.1 ± 6.4°/3.0 ± 2.8°), lateral bending to the right (3.1 ± 2.2°/1.6 ± 1.2°) and left sides (3.3 ± 1.6°/2.1 ± 1.5°), and axial rotation to the right (1.2 ± 3.5°/32.3 ± 9.3°) and left sides (2.7 ± 2.6°/25.3 ± 8.3°). Unilateral alar ligament transection increased the range of motion of C0-C2 in the three planes of movement; however, intersegmental motion alterations were not always observed.

Conclusion.

Increases in the range of extension and lateral bending at C0-C1, which had not been reported previously, were observed. Further, the range of rotation on the right and left sides increased, in conjunction with the increased ranges at C0-C1 and C1-C2.

Level of Evidence: N/A
Methylprednisolone and 60 Days in Hospital Survival in Coronavirus Disease 2019 Pneumonia
Authors: Go Ronaldo C. , Shah Roshan , Nyirenda Themba , Oe Yukiko , Sarfraz Khurram , Panthappattu Justin J. , Philip Lesley , Bheeman Chandni , Shah Neel , Shah Sapan , Dar Sophia , Hung Sung , Rahman Waqas , Im Hyun , Marafelias Michael , Omidvari Karan , Pradhan Anuja , Sadikot Sean , Rose Keith M. , Sperber Steven J. , Josephs Joshua
Published: July 2021

OBJECTIVES:

To determine methylprednisolone’s dose, duration, and administration from onset of symptoms and association with 60 days in hospital survival of coronavirus disease 2019 pneumonia.

DESIGN:

Cohort study.

SETTING:

Thirteen hospitals in New Jersey, United States during March to June 2020.

PATIENTS:

Seven-hundred fifty-nine hospitalized coronavirus disease 2019 patients.

INTERVENTIONS:

We performed a propensity matched cohort study between patients who received methylprednisolone and no methylprednisolone. Patients in the methylprednisolone group were further differentiated into dose (high dose and low dose), duration, and administration from onset of symptoms.

MEASUREMENTS AND MAIN RESULTS:

In the propensity matched sample, 99 out of 380 (26%) in no methylprednisolone, 69 out of 215 (31.9%) in low-dose methylprednisolone, and 74 out of 164 (55.2%) high-dose methylprednisolone expired. Overall median survival for no methylprednisolone (25.0 d), low-dose methylprednisolone (39.0 d), high-dose methylprednisolone (20.0 d), less than or equal to 7 days duration (19.0 d), 7–14 days duration (30.0 d), greater than 14 days duration (44.0 d), onset of symptoms less than or equal to 7 days (20.0 d), and onset of symptoms 7–14 days (27.0 d) were statistically significant (log-rank p ≤ 0.001). Multivariate Cox regression showed nursing home residents, coronary artery disease, and invasive mechanical ventilation were independently associated with mortality. Methylprednisolone was associated with reduced mortality compared with no methylprednisolone (hazard ratio, 0.40; 95% CI, 0.27–0.59; p < 0.001) but no added benefit with high dose. Low-dose methylprednisolone for 7–14 days was associated with reduced mortality compared with less than or equal to 7 days (hazard ratio, 0.45; 95% CI, 0.22–0.91; p = 0.0273), and no additional benefit if greater than 14 days (hazard ratio, 1.27; 95% CI, 0.60–2.69; p = 0.5434). Combination therapy with tocilizumab was associated with reduced mortality over monotherapy (p < 0.0116).

CONCLUSIONS:

Low-dose methylprednisolone was associated with reduced mortality if given greater than 7 days from onset of symptoms, and no additional benefit greater than 14 days. High dose was associated with higher mortality.
Automated Assessment of Brain CT After Cardiac Arrest—An Observational Derivation/Validation Cohort Study
Authors: Kenda Martin , Scheel Michael , Kemmling André , Aalberts Noelle , Guettler Christopher , Streitberger Kaspar J. , Storm Christian , Ploner Christoph J. , Leithner Christoph
Published: July 2021

OBJECTIVES:

Prognostication of outcome is an essential step in defining therapeutic goals after cardiac arrest. Gray-white-matter ratio obtained from brain CT can predict poor outcome. However, manual placement of regions of interest is a potential source of error and interrater variability. Our objective was to assess the performance of poor outcome prediction by automated quantification of changes in brain CTs after cardiac arrest.

DESIGN:

Observational, derivation/validation cohort study design. Outcome was determined using the Cerebral Performance Category upon hospital discharge. Poor outcome was defined as death or unresponsive wakefulness syndrome/coma. CTs were automatically decomposed using coregistration with a brain atlas.

SETTING:

ICUs at a large, academic hospital with circulatory arrest center.

PATIENTS:

We identified 433 cardiac arrest patients from a large previously established database with brain CTs within 10 days after cardiac arrest.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Five hundred sixteen brain CTs were evaluated (derivation cohort n = 309, validation cohort n = 207). Patients with poor outcome had significantly lower radiodensities in gray matter regions. Automated GWR_si (putamen/posterior limb of internal capsule) was performed with an area under the curve of 0.86 (95%-CI: 0.80-0.93) for CTs taken later than 24 hours after cardiac arrest (similar performance in the validation cohort). Poor outcome (Cerebral Performance Category 4–5) was predicted with a specificity of 100% (95% CI, 87–100%, derivation; 88–100%, validation) at a threshold of less than 1.10 and a sensitivity of 49% (95% CI, 36–58%, derivation) and 38% (95% CI, 27–50%, validation) for CTs later than 24 hours after cardiac arrest. Sensitivity and area under the curve were lower for CTs performed within 24 hours after cardiac arrest.

CONCLUSIONS:

Automated gray-white-matter ratio from brain CT is a promising tool for prediction of poor neurologic outcome after cardiac arrest with high specificity and low-to-moderate sensitivity. Prediction by gray-white-matter ratio at the basal ganglia level performed best. Sensitivity increased considerably for CTs performed later than 24 hours after cardiac arrest.
Mortality and years of life lost of colorectal cancer in China, 2005–2020: findings from the national mortality surveillance system
Authors: Wang Wei , Yin Peng , Liu Yun-Ning , Liu Jiang-Mei , Wang Li-Jun , Qi Jin-Lei , You Jin-Ling , Lin Lin , Meng Shi-Di , Wang Fei-Xue , Zhou Mai-Geng
Published: July 2021

Background:

Colorectal cancer (CRC) is the fourth cause of cancer death in China. We aimed to provide national and subnational estimates and changes of CRC premature mortality burden during 2005–2020.

Methods:

Data from multi-source on the basis of the national surveillance mortality system were used to estimate mortality and years of life lost (YLL) of CRC in the Chinese population during 2005–2020. Estimates were generated and compared for 31 provincial-level administrative divisions in China.

Results:

Estimated CRC deaths increased from 111.41 thousand in 2005 to 178.02 thousand in 2020; age-standardized mortality rate decreased from 10.01 per 100,000 in 2005 to 9.68 per 100,000 in 2020. Substantial reduction in CRC premature mortality burden, as measured by age-standardized YLL rate, was observed with a reduction of 10.20% nationwide. Marked differences were observed in the geographical patterns of provincial units, and they appeared to be obvious in areas with higher economic development. Population aging was the dominant driver which contributed to the increase in CRC deaths, followed by population growth and age-specific mortality change.

Conclusions:

Substantial discrepancies were observed in the premature mortality burden of CRC across China. Targeted considerations were needed to promote a healthy lifestyle, expand cost-effective CRC early screening and diagnosis, and improve medical treatment to reduce CRC mortality among high-risk populations and regions with inadequate healthcare resources.
Sodium–glucose cotransporter-2 Inhibitors in Heart Failure: An Updated Systematic Review and Meta-analysis of 13 Randomized Clinical Trials Including 14,618 Patients With Heart Failure
Authors: Shrestha Dhan Bahadur , Budhathoki Pravash , Sedhai Yub Raj , Karki Parag , Gurung Suja , Raut Sumit , Damonte Juan Ignacio , Del Buono Marco Giuseppe , Mojadidi Mohammad Khalid , Elgendy Islam Y. , Patel Toralben , Patel Nimesh K.
Published: July 2021

Sodium–glucose cotransporter-2 (SGLT-2) inhibitors showed benefit in patients with heart failure. In this updated meta-analysis, we evaluate the therapeutic efficacy and safety of SGLT-2 inhibitors in patients with heart failure. Different electronic databases were searched to find relevant articles. RevMan 5.4 was used for pooling data using a random/fixed-effects model, complemented by several sensitivity and subgroup analyses. A total of 13 randomized clinical trials including 14,618 patients with heart failure were included in analysis among 6797 studies screened. The overall mortality rate was 12.45% in the SGLT-2 group and 14.67% in the placebo group with 18% lower odds of overall mortality [odds ratio (OR), 0.82; confidence interval (CI), 0.75–0.91] in the SGLT-2 group. Odds of cardiovascular mortality was 18% lower (OR, 0.82; CI, 0.74–0.92) in the SGLT-2 group. The odds of hospitalization for heart failure (HHF) was 38% lower during the study period (OR, 0.62; CI, 0.56–0.68) in the SGLT-2 group. In addition, a benefit was seen for composite outcome HHF or mortality and considering subgrouping based on diabetes status, gender, and age groups. Although genital infection was significantly higher in the SGLT-2 group, the occurrence of severe adverse events, hypoglycemia, urinary tract infection, bone fracture, volume depletion, and other renal events did not differ between the 2 groups. Thus, SGLT-2 inhibitors improved cardiovascular outcomes among patients with heart failure with no significant difference in adverse events. Clinical benefit was comparable in diabetic and nondiabetic individuals, males and females, people in younger and older age groups with underlying heart failure, and HF with reduced ejection fraction.
Five years of cardio-ankle vascular index (CAVI) and CAVI0: how close are we to a pressure-independent index of arterial stiffness?
Authors: Giudici Alessandro , Khir Ashraf W. , Reesink Koen D. , Delhaas Tammo , Spronck Bart
Published: July 2021

Pulse wave velocity, a common metric of arterial stiffness, is an established predictor for cardiovascular events and mortality. However, its intrinsic pressure-dependency complicates the discrimination of acute and chronic impacts of increased blood pressure on arterial stiffness. Cardio-ankle vascular index (CAVI) represented a significant step towards the development of a pressure-independent arterial stiffness metric. However, some potential limitations of CAVI might render this arterial stiffness metric less pressure-independent than originally thought. For this reason, we later introduced CAVI0. Nevertheless, advantages of one approach over the other are left debated. This review aims to shed light on the pressure (in)dependency of both CAVI and CAVI0. By critically reviewing results from studies reporting both CAVI and CAVI0 and using simple analytical methods, we show that CAVI0 may enhance the pressure-independent assessment of arterial stiffness, especially in the presence of large inter-individual differences in blood pressure.
Individual changes of central blood pressure in response to upright posture: different hemodynamic phenotypes
Authors: Suojanen Lauri J. , Koskela Jenni K. , Wilenius Matias , Choudhary Manoj Kumar , Hautaniemi Elina J. , Viik Jari , Mustonen Jukka T. , Pörsti Ilkka H.
Published: July 2021

Objectives:

Most studies about upright regulation of blood pressure have focused on orthostatic hypotension despite the diverse hemodynamic changes induced by orthostatic challenge. We investigated the effect of passive head-up tilt on aortic blood pressure.

Methods:

Noninvasive peripheral and central hemodynamics in 613 volunteers without cardiovascular morbidities or medications were examined using pulse wave analysis, whole-body impedance cardiography and heart rate variability analysis.

Results:

In all participants, mean aortic SBP decreased by −4 (−5 to −3) mmHg [mean (95% confidence intervals)] and DBP increased by 6 (5--6) mmHg in response to upright posture. When divided into tertiles according to the supine-to-upright change in aortic SBP, two tertiles presented with a decrease [−15 (−14 to −16) and −4 (−3 to −4) mmHg, respectively] whereas one tertile presented with an increase [+7 (7-- 8) mmHg] in aortic SBP. There were no major differences in demographic characteristics between the tertiles. In regression analysis, the strongest explanatory factors for upright changes in aortic SBP were the supine values of, and upright changes in systemic vascular resistance and cardiac output, and supine aortic SBP.

Conclusion:

In participants without cardiovascular disease, the changes in central SBP during orthostatic challenge are not uniform. One-third presented with higher upright than supine aortic SBP with underlying differences in the regulation of systemic vascular resistance and cardiac output. These findings emphasize that resting blood pressure measurements give only limited information about the blood pressure status.
IMAGE ANALYSIS OF OPTICAL COHERENCE TOMOGRAPHY SCANS TO EXPLORE ESTABLISHED AND NOVEL CHOROIDAL FEATURES IN PATIENTS WITH CENTRAL SEROUS CHORIORETINOPATHY
Authors: Aslam Tariq M. , Chhabra Ramandeep , Agrawal Rupesh , Beg Amaad , Kasbia Shakti , Boonarpha Nattapon , Ali Zaria , Hoyle David C.
Published: July 2021

Purpose:

To explore the characteristics of choroidal tissue in patients with and without central serous chorioretinopathy (CSC) using an automated system of image analysis to determine known and novel metrics.

Methods:

This was a retrospective case–control analysis of optical coherence tomography scans of patients seen at Manchester Royal Eye Hospital, UK, comparing patients with active CSC to an age-matched and gender-matched group with no CSC using a purpose-built automated system of image analysis. The expert system segments and measures established and novel features of choroid using a combination of thresholding, noise removal, and morphological techniques.

Results:

A total of 72 patients were included in this study, with 40 included in the group with CSC and 32 patient controls with no CSC. There were significant increases from normal to CSC of median choroidal vascularity index, 54.7(median absolute deviation = 9.8) to 61.2(4.3), and all choroidal thickness indices including maximum depth, from 249.0(90.1)µm to 372.3(80.3)µm. For novel measures, there was a significant increase in tissue entropy from 6.68(0.28) to 6.95(0.17) and area of the largest five vessels from 6.28(3.04) mm2to 9.10(3.49) mm2. The ratio of vessel lumen to stromal tissue intensity was conversely significantly reduced from 0.674(0.11) in normal patients to 0.59(0.06) in CSC.

Conclusion:

The automated system of choroidal analysis expands on the utility of known measures and introduces novel metrics. These findings contribute pathophysiological insights and metrics for further assessment and research on conditions affecting choroidal tissue.
Diplopia After Migraine Surgery
Authors: Celik Buyuktepe Tuna , Bingöl Kiziltunç Pinar , Atilla Huban
Published: July 2021

A 46-year-old man with refractory migraine headache was treated with decompressive migraine surgery of the supraorbital and supratrochlear nerves. Postoperatively, he reported diplopia that got better on left head tilt. After ophthalmological examination, a diagnosis of right superior oblique palsy was made. The aim is to report the first case of superior oblique muscle or trochlea damage that may have occurred because of inadvertent entry through the orbital septum into the right superior orbit.
Work-Related Behavior and Experience Patterns Among Ambulance Service Personnel of Different Organizational Structures in Urban and Rural Regions
Authors: Thielmann Beatrice , Böckelmann Irina , Schumann Heiko
Published: July 2021

Objective:

The aim of this study was to identify work-related experience and behavior patterns among rescue workers in different urban and rural organizational structures.

Methods:

The subjects included 276 paramedics from Germany (average age 39.3 ± 8.04 years) in three groups (professional fire department, aid organization in urban or rural regions). Work-related behavior and experience patterns (AVEM) were examined. Influences of age, gender, professional qualifications, frequency of operation, and organization were analyzed.

Results:

AVEM risk patterns were detectable in 44.3% of professional fire department personnel and in 20% of both aid organization groups. There were differences in the various AVEM dimensions. Age had a strong influence on the AVEM dimension work-related ambition.

Conclusions:

There is a need for workplace health promotion and prevention measures, which are especially useful for employees in professional fire departments. Aid organizations in urban and rural regions should also attend to these measures.
Blood pressure and heart rate monitoring in children and adolescent with Still’s vibratory murmur
Authors: Dursun Hasan , Türkmenoğlu Yelda , Aygun Tuğçe Sibel , Kacar Alper , Umman Nazli , Irdem Ahmet
Published: July 2021

Background

Innocent heart murmur is common in healthy infants, children and adolescents. Although most cases are not pathologic, a murmur may be the manifestation of cardiovascular disease. It may also cause or be an indicator of blood pressure (BP) and heart rate (HR) changes.

Objective

This study aimed to document changes in BP and HR in children with Still’s vibratory murmur (SVM).

Methods

This study included 226 children with SVM, and the control group included 138 healthy children that were age-, height- and weight-balanced. Patient files and our hospital registry system were retrospectively investigated for laboratory findings and electrocardiography and echocardiography results. In addition, we prospectively performed 24-h ambulatory BP monitoring in both groups.

Results

There were no statistically significant differences in 24-h, daytime and nighttime systolic BP, 24-h and nighttime diastolic BP and nighttime HR between the patient and control groups (P = ns). However, daytime diastolic BP, mean HR and daytime HR were significantly higher in patient group (P = 0.009, 0.039 and 0007, respectively).

Conclusions

We believe that in the presence of a higher HR and a higher aortic diastolic BP, which may induce hemodynamic changes in the left ventricle, flow turbulence through the aortic valve may increase, increasing the probability of hearing a murmur. ambulatory BP monitoring could be useful to obtain a better picture of these parameters during the 24-h period.
Waist circumference was associated with 2-year blood pressure change in community dwelling adults independently of BMI
Authors: Tebar William R. , Ritti-Dias Raphael M. , Silva Kelly Samara da , Mielke Gregore Iven , Canhin Daniel S. , Scarabottolo Catarina C. , Mota Jorge , Christofaro Diego G.D.
Published: July 2021

Objective

The present study aimed to analyze the association of 2-year changes in BMI and waist circumference with changes in blood pressure (BP) in a randomized sample of community-dwelling adults.

Methods

A sample of 331 middle-aged and older adults (mean age of 59.6 ± 17.3 years) was randomly selected. Measurements of SBP and DBP, BMI, and waist circumference were collected at baseline and after 2-year follow-up. Chronological age, sex, socioeconomic status, ethnicity, and self-reported medical diagnosis and use of medication for hypertension, diabetes, and high low-density lipoprotein-cholesterol were covariates. Multiple linear regression models were adopted for statistical analysis.

Results

SBP was positively associated with BMI (β = 0.48,P = 0.013) and waist circumference (β = 0.21,P = 0.005) at baseline and only with waist circumference at follow-up (β = 0.20,P = 0.007). DBP was positively associated with BMI (β = 0.31,P = 0.009) and waist circumference (β = 0.12,P = 0.006) values at baseline and at follow-up (BMIβ = 0.42,P = 0.001; waist circumferenceβ = 0.18,P = 0.001). Only the 2-year changes in waist circumference were associated to changes in SBP (β = 0.33,P = 0.013), regardless of confounding factors and BMI.

Conclusion

It is suggested that waist circumference is the main factor for control over the time in strategies focused on BP management in adult population.
Mobility speed predicts new-onset hypertension: a longitudinal study
Authors: Chen Yaoxin , Liu Yuewen , Han PeiPei , Zhang Hui , Mei Yan , Wang Yiwen , Wang Jiayou , Zhao Jinxuan , Sha Rui , Wang Wei , Guo Qi , Wang Hong
Published: July 2021

Objective

The aim of this study was to investigate whether declining mobility and muscle strength predict new-onset hypertension in suburban-dwelling elderly individuals.

Methods

This study was designed as a longitudinal prospective cohort study. It was comprised of 362 individuals (mean age = 67.8 ± 6.2; 157 men) without hypertension at baseline. At baseline, all participants completed health questionnaires and underwent measurements of mobility [the Timed Up and Go test (TUGT) and 4-m walking test] and muscle strength (grip strength). At 1-year follow-up, we determined the number of participants who had developed new-onset hypertension. We then evaluated the relationship between above metrics and the development of hypertension.

Results

In the present study, 94 (26.0%) participants developed hypertension after 1 year. After adjusting for mixed factors, the TUGT scores [hazard ratio = 1.15; 95% confidence interval (CI), 1.10–1.31; P = 0.030] were positively associated with the development of hypertension, while the 4-m walking test scores (hazard ratio = 0.07; 95% CI, 0.01–0.47; P = 0.007) showed an inverse relationship with hypertension incidence. Grip strength (hazard ratio = 1.03; 95% CI, 0.99–1.06; P = 0.098) was not significantly associated with hypertension incidence.

Conclusion

Our results indicate that people with declining mobility are significantly more likely to develop hypertension. Hence, improving mobility could be protective against hypertension for elderly individuals.
Evaluation of arterial hypertension by ambulatory blood pressure monitoring in pediatric liver transplant recipients
Authors: Arikanoğlu Emrullah , Tabel Yilmaz , Selimoğlu Ayşe
Published: July 2021

Objective

Many cardiovascular complications, including hypertension, are seen in pediatric liver transplantation. The purpose of this study was to analyze the frequency of arterial hypertension of pediatric liver transplant recipients and also to determine the related risk factors.

Methods

Thirty-six pediatric liver transplant recipients aged 8–17 years were prospectively studied by manual and ambulatory blood pressure measurement (ABPM) technique.

Results

The mean age of patients was 12.42 ± 2.74 years and the mean ABPM measurement time after transplantation was 2 years (3 months–5.9 years). Only one (2.7%) patient was detected as hypertensive by casual measurement, but 17 (47.2%) patients were found to be hypertensive when measured through ABPM. Of children that were found to be hypertensive as a result of ABPM, 64.7% were observed to have a nondipper pattern. Considering the time passed after the transplantation, patients were found to be more hypertensive in the first 2 years posttransplant although it was not found statistically significant.

Conclusions

In this study, it has been shown that it is possible to diagnose hypertension at an earlier period of transplantation using ABPM in pediatric liver transplant patients. ABPM is needed to detect masked hypertension that may develop following liver transplantation.
The Cost of Guideline Adherence
Authors: Azab Mohamed M. , Kahl Ryan , Lin Emily , Kam Kelli , Balagoni Harika , Pham Jonathan , Oh Nathan , Piper Marc S. , Wright Andrew P.
Published: July 2021

Goal:

The goal of this study was to determine the financial impact of adopting the US Multi-Society Task Force (USMSTF) polypectomy guidelines on physician reimbursement and disposable equipment costs for gastroenterologists in the academic medical center and community practice settings.

Background:

In 2020, USMSTF guidelines on polypectomy were introduced with a strong recommendation for cold snare rather than cold forceps technique for removing diminutive and small polyps. Polypectomy with snare technique reimburses physicians at a higher rate compared with cold forceps and also requires different disposable equipment. The financial implications of adopting these guidelines is unknown.

Materials and Methods:

Patients that underwent screening colonoscopy where polypectomy was performed at an academic medical center (Loma Linda University Medical Center) and community practice medical center (Ascension Providence Hospital) between July 2018 and July 2019 were identified. The polypectomy technique performed during each procedure was determined (forceps alone, snare alone, forceps plus snare) along with the number and size of polyps as well as disposable equipment. Actual and projected provider reimbursement and disposable equipment costs were determined based on applying the new polypectomy guidelines.

Results:

A total of 1167 patients underwent colonoscopy with polypectomy. Adhering to new guidelines would increase estimated physician reimbursement by 5.6% and 12.5% at academic and community practice sites, respectively. The mean increase in physician reimbursement per procedure was significantly higher at community practice compared with the academic setting ($29.50 vs. $14.13, P<0.00001). The mean increase in disposable equipment cost per procedure was significantly higher at the community practice setting ($6.11 vs. $1.97, P<0.00001).

Conclusion:

Adopting new polypectomy guidelines will increase physician reimbursement and equipment costs when colonoscopy with polypectomy is performed.
The Manchester Triage System in a Pediatric Emergency Department of an Austrian University Hospital
Authors: Beck Nikolas , Michel Miriam , Binder Elisabeth , Kapelari Klaus , Maurer Michael , Lamina Claudia , Müller Thomas , Karall Daniela , Scholl-Bürgi Sabine
Published: July 2021

Objectives

The Manchester Triage System (MTS) has entered widespread international use in emergency departments (EDs). This retrospective study analyzes urgency of patient visits (PV) at the ED of the Clinic for Pediatrics at the Medical University of Innsbruck.

Methods

We collected demographic and outcome information, including PV urgency levels (UL) according to the MTS, for 3 years (2015–2018), separating PV during regular office hours (ROH; 8:00 am to 5:00 pm) from PV during afternoon and night hours (5:00 pm to 8:00 am), and PV on weekdays from PV on weekends and bank holidays (WE).

Results

A total of 56,088 PV were registered with a UL. Most (68.4%) PV were classified as nonurgent. During ROH, more PV per hour (PV/h) were recorded than during afternoon and night hours (3.0 PV/h vs 1.6 PV/h), with a higher proportion of less urgent cases during ROH. On WE, the amount of PV/h was higher than on weekdays (3.6 PV/h vs 2.8 PV/h), with a higher proportion of nonurgent cases (74.6% vs 68.6%). Likelihoods of inpatient admission and hospital stay lengths increased in step with UL.

Conclusions

The MTS proved useful for delineating UL distributions. The MTS analyses may be of value in managing EDs. Prompted by the results of our study, a general practice pediatric care unit was established to support the ED during WE.