bluuebunny/crossref_metadata_2025 huggingface dataset:
Fear of the Disability Con: Perceptions of Fraud and Special Rights Discourse
Authors: Dorfman Doron
Published: November 2019

This article presents a new framework for analyzing the development and implementation of disability law: the prism of the fear of “the disability con”—popular perceptions of fraud and fakery. We all encounter disability rights and accommodations in everyday life. However, people with disabilities pay a price for the legal recognition of their rights. People who park in disabled parking spots, use service dogs, move to the front of lines, receive Social Security benefits, or request academic accommodations are often viewed as faking disabilities and abusing the law. This disability con stereotype thus serves as an important invisible barrier preventing Americans with disabilities from fully taking part in society, as it not only undermines the public legitimacy of rights but also restricts the design and implementation of the legal regime illustrating those. Nevertheless, this moral panic around disability con in American society and its manifestations has yet to be studied in a systematic-empirical way, nor has it been addressed in sociolegal scholarship. Using a mixed-methods approach composed of an original nationally representative survey along with in-depth interviews, this article fills this gap. The data suggest that the stereotype of disability con applies to multiple disability rights across venues and contexts; that nearly 60% of Americans with disabilities feel that others question their disability; that the stereotype of disability con extends to visible disabilities and to less apparent ones; and that, counterintuitively, the people most suspicious are nondisabled individuals with a personal connection to a disabled person and disabled people who experience suspicion themselves. Based on the richer understanding of the sociolegal phenomenon, this article suggests strategies to increase trust and reduce suspicion of the disability con.
Examining the Paradox of Crime Reporting: Are Disadvantaged Victims More Likely to Report to the Police?
Authors: Zaykowski Heather , Allain Erin Cournoyer , Campagna Lena M.
Published: November 2019

This study uses an intersectional approach to examine the “paradox” that disadvantaged victims often mobilize the police, despite their distrust and lack of confidence in the law. Data from the National Crime Victimization Survey (1994–2016) were analyzed using logistic regression to model the predicted probabilities of police notification by victims of crime. Economic disadvantage, as measured by family poverty and lack of a high school education, increased the probability that females reported their victimization to the police, but decreased the likelihood that males did so. Economically disadvantaged black females had the highest probability of reporting, while economically disadvantaged black and Hispanic males had the lowest. Examining the intersectional differences across social groups shows that reporting behavior is not just a function of one attribute but rather is a function of multiple identities and structural inequalities.
Bat ecology and conservation in semi‐arid and arid landscapes: a global systematic review
Authors: Lisón Fulgencio , Jiménez‐Franco María V. , Altamirano Adison , Haz Ángeles , Calvo José F. , Jones Gareth
Published: November 2019

Semi‐arid and arid landscapes (dry‐lands) cover 41% of the Earth’s land surface over five continents. These areas are home to 55% of mammal species. Bats have the second highest species richness among mammals, and, although many species are adapted to arid conditions, they are particularly sensitive in these habitats and require conservation priority.

Information on bats in arid and semi‐arid landscapes is scattered, patchy and focused on small‐scale studies; therefore, we undertook a systematic review using the PRISMA protocol to identify the current knowledge status, detect knowledge gaps and propose future research priorities.

We analysed 346 published articles and evaluated 40 topics within five topic categories (taxa studied, methodologies used, biology, ecology and conservation). The most commonly studied topic categories were ecology and biology. However, we found a gap in the topic category conservation (including topics such as conservation status and roost conservation). Our network analysis of topics within the categories showed that most ecology papers were focused on distribution, species richness and habitat use.

When we analysed keywords, we found that phylogeny, taxonomy and distribution demonstrated relatively high presence. Moreover, comparison of the percentage of studies conducted in dry‐lands and the percentage of land surface area covered by dry‐lands in the continents revealed that dry‐lands in Africa and Australia were especially under‐represented. Our review shows that knowledge of bats in semi‐arid and arid landscapes is biased towards new records of the distribution of species, as well as covering systematic/taxonomic and morphological aspects of bat biology.

We suggest that research on conservation measures and guidelines to protect the bat species found in semi‐arid and arid landscapes should be prioritised, together with the sharing of knowledge with local practitioners and the development of citizen science programmes.
An analysis of mating biases in trees
Authors: Ismail Sascha A. , Kokko Hanna
Published: November 2019

Assortative mating is a deviation from random mating based on phenotypic similarity. As it is much better studied in animals than in plants, we investigate for trees whether kinship of realized mating pairs deviates from what is expected from the set of potential mates and use this information to infer mating biases that may result from kin recognition and/or assortative mating. Our analysis covers 20 species of trees for which microsatellite data is available for adult populations (potential mates) as well as seed arrays. We test whether mean relatedness of observed mating pairs deviates from null expectations that only take pollen dispersal distances into account (estimated from the same data set). This allows the identification of elevated as well as reduced kinship among realized mating pairs, indicative of positive and negative assortative mating, respectively. The test is also able to distinguish elevated biparental inbreeding that occurs solely as a result of related pairs growing closer to each other from further assortativeness. Assortative mating in trees appears potentially common but not ubiquitous: nine data sets show mating bias with elevated inbreeding, nine do not deviate significantly from the null expectation, and two show mating bias with reduced inbreeding. While our data sets lack direct information on phenology, our investigation of the phenological literature for each species identifies flowering phenology as a potential driver of positive assortative mating (leading to elevated inbreeding) in trees. Since active kin recognition provides an alternative hypothesis for these patterns, we encourage further investigations on the processes and traits that influence mating patterns in trees.
Genomic footprints of a biological invasion: Introduction from Asia and dispersal in Europe of the topmouth gudgeon (Pseudorasbora parva)
Authors: Baltazar‐Soares Miguel , Blanchet Simon , Cote Julien , Tarkan Ali S. , Záhorská Eva , Gozlan Rodolphe E. , Eizaguirre Christophe
Published: November 2019

Facilitated by the intensification of global trading, the introduction and dispersal of species to areas in which they are historically non‐native is nowadays common. From an evolutionary standpoint, invasions are paradoxical: not only non‐native environments could be different from native ones for which introduced individuals would be ill‐adapted, but also small founding population size should be associated with reduced adaptive potential. As such, biological invasions are considered valuable real‐time evolutionary experiments. Here, we investigated the population structure and adaptive potential of the highly invasive topmouth gudgeon (Pseudorasbora parva) across Europe and East Asia. We RAD‐sequenced 301 specimens from sixteen populations and three distinct within‐catchment invaded regions as well as two locations in the native range. With 13,785 single nucleotide polymorphisms, we provide conclusive evidence for a genome‐wide signature of two distinct invasion events, in Slovakia and Turkey, each originating from a specific area in the native range. A third invaded area, in France, appears to be the result of dispersal within the invasive range. Few loci showed signs of selection, the vast majority of which being identified in the Slovakian region. Functional annotation suggests that faster early stage development, resistance to pollution and immunocompetence contribute to the invasion success of the local habitats. By showing that populations in the invasive range have different evolutionary histories, our study reinforces the idea that populations, rather than species, are the units to consider in invasion biology.
Immunoreactivities for hepcidin, ferroportin, and hephaestin in astrocytes and choroid plexus epithelium of human brains
Authors: Yanase Ken , Uemura Naoya , Chiba Yoichi , Murakami Ryuta , Fujihara Ryuji , Matsumoto Koichi , Shirakami Gotaro , Araki Nobukazu , Ueno Masaki
Published: November 2019

Iron plays essential roles in the central nervous system. However, how the iron level is regulated in brain cells including glia and neurons remains to be fully clarified. In this study, the localizations of hepcidin, ferroportin, and hephaestin, which are known to be involved in iron efflux, were immunohistochemically examined in autopsied human brains. Immunoreactivities for hepcidin and ferroportin were observed in granular structures within the cytoplasm of reactive astrocytes and epithelial cells of the choroid plexus. Granular structures showing immunoreactivities for hepcidin and ferroportin were also stained with antibodies for early endosome antigen 1 (EEA1). In addition, immunoreactivity for hephaestin was observed in the cytoplasm of epithelial cells of the choroid plexus as well as reactive astrocytes. Immunoreactivity for hephaestin in the cytoplasm of reactive astrocytes was occasionally colocalized with immunoreactivity for EEA1, while that of hephaestin was frequently observed in the cytoplasm showing no immunoreactivity for EEA1. These findings suggest that immunoreactivities for hepcidin and ferroportin are localized in close proximity to granular structures showing immunoreactivity for EEA1 in the cytoplasm of human brain astrocytes. They also suggest that immunoreactivity of hephaestin is localized in the cytoplasm of the choroid plexus epithelium as well as reactive astrocytes of human brains.
Conceptual model for intensive care nurse work well‐being: A qualitative secondary analysis
Authors: Jarden Rebecca J. , Sandham Margaret , Siegert Richard J. , Koziol‐McLain Jane
Published: November 2019

Background

There had been little focus on the well‐being of intensive care nurses until a recent programme of research found work well‐being to be best described as a collection of elements, a multifaceted construct. Strengtheners of intensive care nurses' work well‐being were found to extend across individual, relational, and organizational resources. Actions such as simplifying their lives, giving and receiving team support, and accessing employee assistance programmes were just a few of the intensive care nurses' identified strengtheners.

Aims and objectives

To synthesize intensive care nurse perceptions of work well‐being characteristics and strengtheners to identify opportunities for job crafting and redesign.

Design

This was a qualitative secondary analysis.

Methods

Intensive care nurse work well‐being characteristics and strengtheners were explored using applied thematic analysis and pre‐design, open card‐sort technique.

Results

Five facets were identified in the analysis: (a) healthy, (b) authentic, (c) meaningful, (d) connected, and (e) innovative. These five facets were described from a theoretical perspective and illustrated as a conceptual model for intensive care nurse job crafting and redesign.

Conclusions

The proposed conceptual model contributes new knowledge to be explored in meaningful discussions about intensive care nurse work well‐being and empirically investigated in terms of construct validity and theory development. Furthermore, the model provides practical opportunities to explore individual and collaborative ways to enhance intensive care nurse work well‐being across a range of levels.

Relevance to clinical practice

Opportunities for job crafting and redesign were identified and presented in a conceptual model of intensive care nurse work well‐being. This model provides individual nurses, intensive care teams, health care organizations, and workers' well‐being programme and policy developers practical opportunities to explore individual and collaborative ways to enhance intensive care nurse work well‐being.
Digital Divides among Asylum‐Related Migrants: Comparing Internet Use and Smartphone Ownership
Authors: Merisalo Maria , Jauhiainen Jussi S.
Published: November 2019

This paper studies asylum‐related migrants’ Internet use and smartphone ownership. In total, 2,454 asylum‐related migrants originating from Africa, Asia, and the Middle East (37 countries) answered the surveys in the European Union migration hotspots (Lesvos in Greece and Lampedusa in Italy) and in transit/host countries (Iran, Jordan, and Turkey). Internet use was studied at three phases: before the actual journey in the country of origin, during the journey before entering the hotspot or transit/host location, and at the hotspot or transit/host location where smartphone ownership was also studied. During their journeys (from the country of origin to hotspot or transit/host location), the differences in Internet use regarding education and urban/rural backgrounds diminished and vanished in regards to gender. In the transit/host or hotspot location, many respondents started to use the Internet even if they had not used it before in their country of origin.
Sepsis outcomes in solid organ transplant recipients
Authors: Gotur Deepa B. , Masud Faisal N. , Ezeana Chika F. , Nisar Tariq , Paranilam Jaya , Chen Shenyi , Puppala Mamta , Wong Stephen T. C. , Zimmerman Janice L.
Published: November 2019

Background

We present data on a cohort of patients diagnosed with sepsis over a 10‐year period comparing outcomes in solid organ transplant (SOT) and non–solid organ transplant (non–SOT) recipients.

Methods

This is a retrospective single‐center study of patients with diagnosis of sepsis from 1/1/06 to 6/30/16. Cases and controls were matched by year of sepsis diagnosis with propensity score matching. Conditional logistic regression and repeated measurement models were performed for binary outcomes. Trends over time for in‐hospital mortality were determined using the Cochran‐Armitage test. A gamma‐distributed model was performed on the continuous variables.

Results

Overall, there were 18 632 admission encounters with a discharge diagnosis of sepsis in 14 780 unique patients. Of those admissions, 1689 were SOT recipients. After 1:1 matching by year, there were three thousand three hundred and forty patients (1670 cases; 1670 controls) diagnosed with sepsis. There was a decreasing trend for in‐hospital mortality for sepsis over time in SOT patients and non–SOT patients (P < .05) due to early sepsis recognition and improved standard of care. Despite higher comorbidities in the SOT group, conditional logistic regression showed that in‐hospital mortality for sepsis in SOT patients was similar compared with non–SOT patients (odds ratio [OR] =1.14 [95% confidence interval {CI}, 0.95‐1.37], P = .161). However, heart and lung SOT subgroups had higher odds of dying compared with the non–SOT group (OR = 1.83 [95% CI, 1.30‐2.57], P < .001 and OR = 1.77 [95% CI, 1.34‐2.34], P < .001). On average, SOT patients had 2 days longer hospital length of stay compared with non–SOT admissions (17.00 ± 19.54 vs 15.23 ± 17.07, P < .05). Additionally, SOT patients had higher odds of hospital readmission within 30 days (OR = 1.25 [95% CI, 1.06‐1.51], P = .020), and higher odds for DIC compared with non–SOT patients (OR = 1.76 [95% CI, 1.10‐2.86], P = .021).

Conclusion

Sepsis in solid organ transplants and non–solid organ transplant patients have similar mortality; however, the subset of heart and lung transplant recipients with sepsis has a higher rate of mortality compared with the non–solid organ transplant recipients. SOT with sepsis as a group has a higher hospital readmission rate compared with non–transplant sepsis patients.
Metapragmatic comments and orthographic performances of a New York accent on YouTube
Authors: Cutler Cecelia
Published: November 2019

This paper adopts a metapragmatic approach (Urban, 2006) to analyze responses to YouTube videos on ‘how to talk like a New Yorker’ in a corpus of YouTube comments (N = 2,649). The analysis illustrates how linguistic features associated with this way of talking are experienced and negotiated by locals and non‐locals in their metapragmatic comments and performances of the accent and how they come to be socially recognized as indexical of a certain set of speaker attributes (Agha, 2005; Bolander, 2016). Analyzing user‐generated reactions to linguistic variation complements traditional variationist work by illustrating how people experience sociolinguistic difference (Leone‐Pizzighella & Rymes, 2017; Rymes, 2014). It also shows how digital sharing and commenting practices expose shifts in language ideologies that mirror the changing status of American English within the Inner Circle.
Sounds associated with foraging and prey capture in individual fish-eating killer whales, Orcinus orca
Authors: Holt Marla M. , Hanson M. Bradley , Emmons Candice K. , Haas David K. , Giles Deborah A. , Hogan Jeffrey T.
Published: November 2019

Foraging behavior in odontocetes is fundamentally tied to the use of sound. Resident-type killer whales use echolocation to locate and capture elusive salmonid prey. In this investigation, acoustic recording tags were suction cup-attached to endangered Southern Resident killer whales to describe their acoustic behavior during different phases of foraging that, along with detections of prey handling sounds (e.g., crunches) and observed predation events, allow confirmation of prey capture. Echolocation click trains were categorized based on the inter-click interval (ICI) according to hypothesized foraging function. Whales produced slow click trains (ICI >100 ms) at shallowest depths but over the largest change of depth, fast click trains (10 ms < ICI ≤100 ms) at intermediate depths, and buzz trains (ICI ≤10 ms) at deepest depths over the smallest depth change. These results align with hypotheses regarding biosonar use to search, pursue and capture prey. Males exhibited a higher probability of producing slow click trains, buzzes and prey handling sounds, indicating higher levels of prey searching and capture to support the energy requirement of their larger body size. These findings identify relevant acoustic indicators of subsurface foraging behaviors of killer whales, enabling investigations of human impacts on sound use and foraging.
Interdependency of Respiratory Metabolism and Phenazine-Associated Physiology in Pseudomonas aeruginosa PA14
Authors: Jo Jeanyoung , Price-Whelan Alexa , Cornell William Cole , Dietrich Lars E. P.
Published: November 2019

The clinically relevant pathogen
Pseudomonas aeruginosa
uses diverse organic compounds as electron donors and possesses multiple enzymes that transfer electrons from central metabolism to O
2
. These pathways support a balanced intracellular redox state and produce cellular energy.
P. aeruginosa
also reduces secondary metabolites called phenazines to promote redox homeostasis and virulence. In this study, we examined the reciprocal relationship between these primary and secondary routes of electron flow. We found that phenazines affect respiratory function and that the complement of phenazines produced is strongly affected by growth in assemblages called biofilms. These results provide a more nuanced understanding of
P. aeruginosa
redox metabolism and may inform strategies for treating persistent infections caused by this bacterium.
Using an Activity Based on Constructivism To Help Students Develop a More Integrated Understanding of Cell Signaling Pathways
Authors: MacDonald Laura , Segarra Verónica A. , Solem Amanda
Published: November 2019

In subjects like cell biology, genetics, and immunology, a solid understanding of signal transduction is key to mastering new content.  Often times students’ approach to learning signal transduction pathways relies heavily on memorization.  In this paper, we describe a modular method to introduce students to signal transduction.  In this method, students are first presented with the discreet building blocks or molecules that comprise signaling pathways (such as the vocabulary terms signal molecule, receptor, effector and target) and asked to integrate the knowledge by building (“do it yourself” or DIY) their own signaling pathway.  Students are then given the opportunity to learn about each other’s pathways to identify ways in which they overlap and diverge.  Ultimately, students are given the task to search the literature to identify a real-world example that mimics or is very similar to the pathway they came up with and note similarities and differences.  We find this is a way to foster students integrating signal transduction knowledge.
Career Choice among First-Generation, Minority STEM College Students
Authors: Dewsbury Bryan M. , Taylor Cynthia , Reid Amy , Viamonte Connie
Published: November 2019

We qualitatively investigated ways in which undergraduates unpacked their perceptions of STEM careers after attending a seminar series that introduced them to diverse scientists. Using Social Cognitive Career Theory (SCCT) as a guiding framework, we explored how culturally-specific realities impacted students’ career choices. Our findings suggest that familial ties and cultural expectations played key roles in determining how students navigated career choice. Our results have implications for how institutions navigate career pursuit discussions with students.
Lithosphere thickness controls continental basalt compositions: An illustration using Cenozoic basalts from eastern China
Authors: Guo Pengyuan , Niu Yaoling , Sun Pu , Gong Hongmei , Wang Xiaohong
Published: November 2019

Recent studies demonstrate that lithosphere thickness variation exerts the primary control on global seafloor basalt compositions. If the mechanism of such control, i.e., the lid effect, is indeed at work, lithosphere thickness variation must also influence basaltic compositions in continental settings. To test this hypothesis, we chose to study Cenozoic basalts in eastern continental China over a distance of ∼260 km along a southeast-to-northwest traverse with a steep topographic gradient (∼500 to ∼1500 m above sea level) mirrored with a steep lithospheric thickness gradient (∼80 to ∼120 km). The basalts erupted on the thinned lithosphere to the east are characterized by lower pressure (e.g., higher Si72, lower Mg72, Fe72, and [Sm/Yb]N; subscript “72” refers to corresponding oxides corrected for fractionation effect to Mg# = 72; N—primitive mantle normalized) and higher extent (e.g., low Ti72, P72, K72, Rb, Ba, Th, and ratios of more- to less-incompatible elements such as [La/Sm]N, Ba/Zr, and Zr/Yb) of melting than basalts erupted on the thickened lithosphere to the west. Importantly, these geochemical parameters all show significant correlations with both lithosphere thickness and topographic elevation. These first-order observations are a straightforward manifestation of the lid effect. Lithospheric contamination and mantle-source compositional variation can indeed contribute to the compositional variability of these continental basalts, but these latter effects are averaged out and are overshadowed by the lid effect. This finding emphasizes the importance of evaluating the lid effect before interpreting the petrogenesis of continental basalts and mantle dynamics. Our results also indicate that the continental surface elevation is isostatically balanced above a mantle depth that is deeper than the lithosphere-asthenosphere boundary.
Conjunctival stromal tumour (COST): anterior-segment OCT findings
Authors: Das Joyeeta , Basak Samar K , Das Nibedita
Published: November 2019

Conjunctival stromal tumour (COST) is a recently described rare conjunctival tumour of mesenchymal origin with only four publications describing a handful of cases thus far. In this report, we describe the anterior-segment optical coherence tomography (AS-OCT) characteristics in a case of COST for the first time, in addition to the clinical and histopathological characteristics. The AS-OCT showed an elevated, dome-shaped hyporeflective homogenous lesion in the conjunctival stroma lined by hyperreflective outer layer with mild posterior shadowing, consistent with histological description of a paucicellular tumour with large myxoid collagenous material inside. Immunohistochemistry showed positive CD34 and vimentin but negative S100 and smooth muscle actin, thereby differentiating it from conjunctival myxoma.
Rare infection in patient with rheumatoid arthritis treated with adalimumab
Authors: Kapur Navina , Ghai Ritu , Block Joel A , Khandelwal Sonali
Published: November 2019

Mycobacterium haemophilumis a rare pathogen, predominately present in the immunocompromised population. It is especially studied in HIV and haematological malignancy patients. Given its unique living conditions, it is often difficult to establish its diagnosis, but it is often suspected by its classic association with ulcerating skin findings. Our case is unique in that our patient is immunocompromised by his rheumatoid arthritis treatment, and presented without any skin lesions, but was found to have this rare pathogen causing a constellation of unusual symptoms.
Clinical effects from household insecticide: pyrethroid or organophosphate toxicity?
Authors: Basrai Zahir , Koh Cynthia , Celedon Manuel , Warren Jonathan
Published: November 2019

A 54-year-old man with a history of schizophrenia presented to the emergency room for weakness with associated lacrimosis, drooling, nausea, emesis, diarrhoea, diplopia and burning sensation on his skin that began 6 hours after spraying five cans of Raid on his carpet. He was noted to have miotic pupils and hyperactive bowel sounds. Given the clinical presentation, the patient was diagnosed with organophosphate (OP) toxicity. After being admitted, he developed symptoms associated with his OP toxicity and was successfully treated with atropine and pralidoxime. Most Raid products contain pyrethroids; however, both OPs and pyrethroids are available in commercial pesticides and patients may misidentify ingestions. There are limited data reporting the toxicity of pyrethroid overdose in humans and to guide its subsequent treatment. It is crucial to keep a low threshold for diagnosing and treating patients with acute onset of symptoms suspicious for an OP or pyrethroid toxidrome.
Possible pitfalls in the workup of ectopic ACTH secretion illustrated by four rare cases
Authors: Boers Jorianne , Oldenburg-Ligtenberg P Christine , Stades Aline ME , van Treijen Mark JC
Published: November 2019

In this case report, we highlight four different cases of ectopic adrenocorticotropic hormone (ACTH) secretion with different pitfalls in the diagnostic workup. Ectopic ACTH secretion (EAS) is an uncommon cause of Cushing’s syndrome that accompanies a variety of tumours. It is associated with significant morbidity and mortality. This underlines the importance of early and adequate diagnosis. We will review the causes of EAS and their presentation to increase awareness of this rare and progressive disease.
Rare cause of spontaneous haemothorax: mediastinal and distant lymph node metastases from uveal melanoma
Authors: Reznitsky Frances , Klausen Siri , Donia Marco , Scheie David
Published: November 2019

We report a rare case of isolated mediastinal and inferior mediastinal lymph node metastases from choroidal melanoma. The patient was treated for primary choroidal melanoma with local tumour resection and radioactive plaque brachytherapy. Eleven years later, he was diagnosed with metastatic disease. Molecular analysis of the metastatic tumour demonstrated a GNAQ Q209P mutation. There was no evidence of malignant blue naevus or primary melanoma of the central nervous system on physical examination or imaging. The rare modality of clinical presentation highlights the unpredictable nature of metastatic uveal melanoma.
Chronic pancreatitis in children: treat like an adult?
Authors: Pereira Miguel Paiva , Santos Filipa , Neto Ana Serrão , Canena Jorge
Published: November 2019

A 15-year-old boy with a medical background of obesity, familial hyperlipidemia and acute recurrent pancreatitis, presented to emergency department reporting a 3-day course of periumbilical abdominal pain and nausea. Pain was noticed on epigastric palpation. Laboratory evaluation revealed leucocytosis, neutrophilia and pancreatic enzymes elevation more than three times the upper limit of normal. An acute recurrence of pancreatitis was diagnosed, was admitted to the hospital, being discharged after 5 days. Four days after, he was readmitted because of symptoms recurrence. Elevation of transaminases, gamma-glutamyltransferase (GGT) and direct bilirubin were noticed. Pancreatic enzymes still elevated but lower than in the previous episode. An endoscopic ultrasound revealed a Wirsung with a cephalic stricture and diffuse structural abnormalities suggestive of chronic pancreatitis. The patients was submitted to endotherapy with several sessions of endoscopic retrograde cholangiopancreatography including stenting and pancreatoscopy with marked clinical and imaging improvement. A genetic variant was identified.
Motivating factors on performance of primary care workers in China: a systematic review and meta-analysis
Authors: Li Huiwen , Yuan Beibei , Wang Dan , Meng Qingyue
Published: November 2019

Objective

Although China has made remarkable progress in strengthening its primary healthcare system, lack of well-performed primary health workforce is still the bottleneck of deepening the reform. The objective of this review is to understand the current profile of Chinese primary care workers (PCWs) and their motivating factors of performance and propose targeted policy suggestions on improving their work performance.

Design

Systematic review.

Methods

A systematic search of PubMed and MEDLINE was conducted to identify articles published from January 1, 2000, to June 2, 2018. Quality assessment and data extraction for the studies closely relevant to performance of PCWs in China were conducted by two reviewers independently. A preliminary framework containing different levels of factors influencing PCWs’ motivation based on existence, growth and relatedness (ERG) theory guided the synthesis analysis. In addition, we used a random-eﬀects model to pool individual studies on job satisfaction and estimate the overall job satisfaction of PCWs.

Results

A total of 36 articles were included; 16 (23 882 participants) in the meta-analysis. Regarding the individual level of motivation, 3 overarching themes and 12 subthemes were developed. The subthemes of financial incentives, career advancement and work itself were frequently mentioned and have more influences on PCWs’ performance. Moreover, the healthcare system reform policies have inevitable and complex impacts on different levels of human needs, and then influences on the motivation and performance of PCWs. Meta-analysis showed that the overall job satisfaction score among PCWs was 3.30, just reaching a satisfied rating and varied in different regions.

Conclusions

This study suggests low work satisfaction among PCWs in China, with financial incentives and career advancement being two most important motivating factors. Eﬀorts to improve the work performance in PCWs should give priority to these motivating factors and systematically take into account the health policy’s impacts on performance of PCWs.
At the grassroots of home and community-based aged care: strategies for successful consumer engagement
Authors: Brett Lindsey , Siette Joyce , Nguyen Amy , Jorgensen Mikaela , Miao Melissa , Westbrook Johanna , Lee Winifred , Gow Edwina , Hourihan Fleur , Georgiou Andrew
Published: November 2019

Objectives

(1) To describe the processes used to plan and conduct a stakeholder forum in aged care as a means of informing future uptake of consumer participatory research. (2) To discuss how capturing and drawing on stakeholders’ experiences of aged care can generate new research ideas and inform the delivery of more person-centred aged care services.

Key principles of consumer engagement

A stakeholder forum was conducted as part of Ageing Well, a 2-year project evaluating the value and impact of social participation and quality of life tools as part of routine community aged care assessments at a large Australian provider. The forum was codesigned with community aged care clients and care coordinators and aimed to coproduce implementation strategies with a targeted representation of stakeholders. The stakeholder forum was developed using five key principles of consumer engagement activities: purposeful, inclusive, timely, transparent and respectful. The forum fostered an environment of mutual respect and collective inquiry to encourage contributions from all participants. This article outlines practical guidance on using a consumer engagement framework and the lessons learnt.

Discussion

The stakeholder forum facilitated an understanding of consumers’ needs and existing gaps in aged care services and the circumstances that can enable or hinder the delivery and implementation of these services. This collective information can guide future research and policy at institutional, regional and national committees that relate to aged care.

Trial registration number

ACTRN12617001212347
Observational cohort study to investigate the unmet need and time waiting for referral for specialist opinion in adult asthma in England (UNTWIST asthma)
Authors: Blakey John D , Gayle Alicia , Slater Mariel G , Jones Gareth H , Baldwin Michael
Published: November 2019

Objectives

This study aimed to estimate how many patients with asthma in England met the referral eligibility criteria using national asthma guidelines, identify what proportion were referred and determine the average waiting time to referral.

Design

This is an observational cohort study.

Setting/Data sources

Routinely collected healthcare data were provided by Clinical Practice Research Datalink records and Hospital Episode Statistics records from January 2007 to December 2015.

Participants

Patients with asthma aged 18–80 years participated in this study.

Main outcome measures

Eligibility for referral by the British Thoracic Society/Scottish Intercollegiate Guidelines Network (BTS/SIGN) 2016 guidelines, determined after a 3-month pharmacological therapy exposure assessment, was classed by either ‘high-dose therapies’, ‘continuous or frequent use of oral steroids’ or ‘incident eligibility’ during follow-up (continuous oral corticosteroids for more than 3 months, or ≥800 µg/day inhaled corticosteroids/long-acting β2-agonist (or three controllers) and ≥2 asthma attacks/year).

Results

From the final cohort (n=23293), 19837 patients were eligible for specialist referral during follow-up based on the BTS/SIGN guideline recommendations. Among eligible patients without any previously recorded referral, 4% were referred during follow-up, with a median waiting time of 880 days (IQR=1428 days) between eligibility and referral.

Conclusions

A large number of patients with asthma were eligible for specialist referral, of which a small proportion were referred, and many experienced a long waiting time before referral. The results indicate a major unmet need in asthma referral, which is a potential source of preventable harm and are likely to have implications regarding how services are organised to address this unmet need.
Does obesity modify the epidemiological association between hyperuricemia and the prevalence of hypertension among Northern Chinese community-dwelling people? A Chinese population-based study
Authors: Tian Simiao , Liu Yazhuo , Xu Yang , Feng Ao
Published: November 2019

Objectives

Hyperuricemia and obesity both play a role in the development of hypertension. However, limited evidence is available for the combined effect of hyperuricemia and obesity on the prevalence of hypertension in the Chinese population. We aimed to assess the separate and combined effects of these two risk factors on the risk of hypertension.

Methods

We conducted a cross-sectional study in an area of Dalian city, Liaoning Province, China, from September 2015 to November 2016; 8700 adult residents were invited to participate in this study. Hyperuricemia was defined as serum uric acid ≥ 416 μmol/L in men and ≥ 357 μmol/L in women according to the guidelines. Individuals were categorised into four groups: the control group (body mass index (BMI) §amp;lt; 25 without hyperuricemia, the reference group), the obesity group (BMI ≥ 25 without hyperuricemia), the hyperuricemia group (BMI §amp;lt; 25 with hyperuricemia) and the obese-hyperuricemia group (BMI ≥ 25 with hyperuricemia). A multivariable logistic model was used to investigate individual and combined effects of hyperuricemia and obesity on the risk of hypertension.

Results

Of the 8331 individuals included, 44.3% were obese, 13.6% suffered from hyperuricemia, and 7.8% were both obese and hyperuricemic. The hypertension prevalence was the highest in the obese-hyperuricemia group (55.5% (95% CI 51.6% to 59.2%)), followed by that in the obesity (44.3% (42.6% to 46.1%)) and that in the hyperuricemia groups (33.5% (29.5% to 37.9%)). After adjusting for confounders, the obese-hyperuricemia group had a nearly threefold increased risk of hypertension compared with their healthy counterparts (OR 2.98 (2.48 to 3.57)). This pattern was also observed in the obesity group with a higher risk of hypertension (OR 2.18 (1.96 to 2.42)) compared with the control group, whereas the risk of hypertension was not elevated significantly in the hyperuricemia group (OR 1.14 (0.92 to 1.42)).

Conclusion

Our study provided the first evidence that obese Chinese individuals with hyperuricemia had a significantly increased risk of hypertension compared with their healthy counterparts. This combined effect on the risk of hypertension is much stronger than the individual effect of either factor.
Cohort profile: the MCC-Spain follow-up on colorectal, breast and prostate cancers: study design and initial results
Authors: Alonso-Molero Jessica , Molina Antonio J , Jiménez-Moleón Jose Juan , Pérez-Gómez Beatriz , Martin Vicente , Moreno Victor , Amiano Pilar , Ardanaz Eva , de Sanjose Silvia , Salcedo Inmaculada , Fernandez-Tardon Guillermo , Alguacil Juan , Salas Dolores , Marcos-Gragera Rafael , Chirlaque Maria Dolores , Aragonés Nuria , Castaño-Vinyals Gemma , Pollán Marina , Kogevinas Manolis , Llorca Javier
Published: November 2019

Purpose

Since 2016, the multicase-control study in Spain (MCC-Spain) has focused towards the identification of factors associated with cancer prognosis. Inception cohorts of patients with colorectal, breast and prostate cancers were assembled using the incident cases originally recruited.

Participants

2140 new cases of colorectal cancer, 1732 of breast cancer and 1112 of prostate cancer were initially recruited in 12 Spanish provinces; all cancers were incident and pathologically confirmed. Follow-up was obtained for 2097 (98%), 1685 (97%) and 1055 (94.9%) patients, respectively.

Findings to date

Information gathered at recruitment included sociodemographic factors, medical history, lifestyle and environmental exposures. Biological samples were obtained, and 80% of patients were genotyped using a commercial exome array. The follow-up was performed by (1) reviewing medical records; (2) interviewing the patients by phone on quality of life; and (3) verifying vital status and cause of death in the Spanish National Death Index. Ninety-seven per cent of recruited patients were successfully followed up in 2017 or 2018; patient-years of follow-up were 30 914. Most colorectal cancers (52%) were at clinical stage II or lower at recruitment; 819 patients died in the follow-up and the 5-year survival was better for women (74.4%) than men (70.0%). 71% of breast cancers were diagnosed at stages I or II; 206 women with breast cancer died in the follow-up and the 5-year survival was 90.7%. 49% of prostate cancers were diagnosed at stage II and 32% at stage III; 119 patients with prostate cancer died in the follow-up and the 5-year survival was 93.7%.

Future plans

MCC-Spain has built three prospective cohorts on highly frequent cancers across Spain, allowing to investigate socioeconomic, clinical, lifestyle, environmental and genetic variables as putative prognosis factors determining survival of patients of the three cancers and the inter-relationship of these factors.
Identifying and prioritising unanswered research questions for people with hyperacusis: James Lind Alliance Hyperacusis Priority Setting Partnership
Authors: Fackrell Kathryn , Stratmann Linda , Kennedy Veronica , MacDonald Carol , Hodgson Hilary , Wray Nic , Farrell Carolyn , Meadows Mike , Sheldrake Jacqueline , Byrom Peter , Baguley David M , Kentish Rosie , Chapman Sarah , Marriage Josephine , Phillips John , Pollard Tracey , Henshaw Helen , Gronlund Toto A , Hoare Derek J
Published: November 2019

Objective

To determine research priorities in hyperacusis that key stakeholders agree are the most important.

Design/setting

A priority setting partnership using two international surveys, and a UK prioritisation workshop, adhering to the six-staged methodology outlined by the James Lind Alliance.

Participants

People with lived experience of hyperacusis, parents/carers, family and friends, educational professionals and healthcare professionals who support and/or treat adults and children who experience hyperacusis, including but not limited to surgeons, audiologists, psychologists and hearing therapists.

Methods

The priority setting partnership was conducted from August 2017 to July 2018. An international identification survey asked respondents to submit any questions/uncertainties about hyperacusis. Uncertainties were categorised, refined and rephrased into representative indicative questions using thematic analysis techniques. These questions were verified as ‘unanswered’ through searches of current evidence. A second international survey asked respondents to vote for their top 10 priority questions. A shortlist of questions that represented votes from all stakeholder groups was prioritised into a top 10 at the final prioritisation workshop (UK).

Results

In the identification survey, 312 respondents submitted 2730 uncertainties. Of those uncertainties, 593 were removed as out of scope, and the remaining were refined into 85 indicative questions. None of the indicative questions had already been answered in research. The second survey collected votes from 327 respondents, which resulted in a shortlist of 28 representative questions for the final workshop. Consensus was reached on the top 10 priorities for future research, including identifying causes and underlying mechanisms, effective management and training for healthcare professionals.

Conclusions

These priorities were identified and shaped by people with lived experience, parents/carers and healthcare professionals, and as such are an essential resource for directing future research in hyperacusis. Researchers and funders should focus on addressing these priorities.
Multifaceted intervention to Reduce Antimicrobial Prescribing in Care Homes: a process evaluation of a UK-based non-randomised feasibility study
Authors: Potter Rachel , Campbell Anne , Ellard David R , Shaw Catherine , Gardner Evie , Agus Ashley , O’Reilly Dermot , Underwood Martin , Loeb Mark , Stafford Bob , Tunney Michael , Hughes Carmel
Published: November 2019

Objectives

To explore the facilitators and obstacles to the development and implementation of the Reduce Antimicrobial Prescribing in Care Homes intervention.

Design

We used a mixed-methods approach. We conducted focus groups with care home staff and relatives of residents, and interviews with general practitioners (GPs) and home managers, completed observational visits and collected demographic data, training attendance records and data on the use of a decision-making algorithm. We used normalisation process theory to inform topic guides and interpretation of the data.

Setting

Six care homes, three in Northern Ireland and three in the West Midlands, England.

Intervention

A decision-making algorithm for urinary tract, respiratory tract and skin and soft-tissue infections, plus small group interactive training for care home staff.

Results

We ran 21 training sessions across the six homes and trained 35/42 (83%) of nurses and 101/219 (46%) of all care staff. Care home staff reported using the decision-making algorithm 81 times. Postimplementation, staff reported being more knowledgeable about antimicrobial resistance but were unsure if the intervention would change how GPs prescribed antimicrobials. The pressures of everyday work in some homes meant that engagement was challenging at times. Staff felt that some of the symptoms included in decision-making algorithm, despite being evidence based, were not easy to detect in residents with dementia or urinary incontinence. Some staff did not use the decision-making algorithm, noting that their own knowledge of the resident was more important.

Conclusion

We delivered a training package to a substantial number of key staff in care homes. A decision-making algorithm for common infections in care homes empowered staff but was challenging to operationalise at times. A future study should consider the findings from the process evaluation to help ensure the successful implementation on a larger scale.