bluuebunny/crossref_metadata_2025 huggingface dataset:
High success rate in salvage of catheter-related bloodstream infections due to Staphylococcus aureus, on behalf of project group of Italian society of nephrology
Authors: Mandolfo Salvatore , Anesi Adriano , Maggio Milena , Rognoni Vanina , Galli Franco , Forneris Giacomo
Published: September 2019

Background:

Catheter-related bloodstream infections caused by Staphylococcus aureus represent one of the most fearful infections in chronic haemodialysis patients with tunnelled central venous catheters. Current guidelines suggest prompt catheter removal in patients with positive blood cultures for S. aureus. This manoeuvre requires inserting a new catheter into the same vein or another one and is not without its risks.

Methods:

A protocol based on early, prompt diagnosis and treatment has been utilized in our renal unit since 2012 in an attempt to salvage infected tunnelled central venous catheters. We prospectively observed 247 tunnelled central venous catheters in 173 haemodialysis patients involving 167,511 catheter days.

Results:

We identified 113 catheter-related bloodstream infections (0.67 episodes per 1000 days/tunnelled central venous catheter). Forty were caused by S. aureus, including 19 by methicillin-resistant S. aureus (79% saved) and 21 by methicillin-sensitive S. aureus (90% saved), of which 34 (85%) were treated successfully. Eight recurrences occurred and six (75%) were successfully treated. A greater than 12 h time to blood culture positivity for S. aureus was a good prognostic index for successful therapy and tunnelled central venous catheter rescue.

Conclusion:

Our data lead us to believe that it is possible to successfully treat catheter-related bloodstream infection caused by S. aureus and to avoid removing the tunnelled central venous catheter in many more cases than what has been reported in the literature. On the third day, it is mandatory to decide whether to replace the tunnelled central venous catheter or to carry on with antibiotic therapy. Apyrexia and amelioration of laboratory parameters suggest continuing systemic and antibiotic lock therapy for no less than 4 weeks, otherwise, tunnelled central venous catheter removal is recommended.
Alcohol and Drug Abuse Resource Utilization in the ICU
Authors: Cervellione Kelly L , Shah Aashir , Patel Mahendra C , Curiel Duran Laura , Ullah Tofura , Thurm Craig
Published: September 2019

Alcohol and drug abuse continue to be major causes of morbidity and mortality and have significant social and economic ramifications. Studies have shown that for every $1 spent on substance use disorder treatment, $4 are saved on healthcare costs. Characterizing the healthcare resource utilization of these patients may shed light on the burden of disease and opportunities for intervention. A retrospective chart review of all patients admitted to the ICU between July 1, 2017 and December 31, 2017 was completed. Variables regarding demographic and clinical characteristics as well as healthcare resource utilization were collected. Of 737 admissions to the ICU, 158 (21%) were due to acute or chronic complications of alcohol or drug abuse. Even though alcohol and drug users were significantly younger (average age 50 years) than the general ICU cohort (average age 66 years), resource utilization was similar between these patients. The median length of stay in the ICU was similar. The number of patients transferred to in-patient rehab was low (8%), and all of those were due to comorbid psychiatric illness. The total hospital charges for the alcohol and drug abuse cohort was over 7 million dollars for the 6 months observed. A significant number of patients had at least one ER visit (49%) during the previous year, and most of these had numerous visits. ICU resource utilization by patients with acute and chronic sequelae of drug or alcohol abuse disorders continues to be high. These patients utilize resources at rates similar to an older group with other disease processes. Patients are unlikely to receive intervention for their disorder unless they have a comorbid psychiatric illness. Patients admitted to the ICU with alcohol or drug-related illness were frequently seen in the ER or were admitted to the hospital in the year prior to ICU admission, providing opportunities for intervention.
Effectiveness of Therapy on Post-Extubation Dysphagia: Clinical and Electromyographic Findings
Authors: El Gharib Aretuza Zaupa Gasparim , Berretin-Felix Giédre , Rossoni Diogo Francisco , Seiji Yamada Sergio
Published: September 2019

Introduction:

Patients who require prolonged endotracheal intubation (>48 hours) are at risk of dysphagia. Speech-language pathologists should perform swallowing exercises after extubation due to the high probability of developing aspiration pneumonia. There are no studies describing the use of swallowing techniques employed in post-extubation therapy aided by surface electromyography.

Objectives:

To evaluate the effects of swallowing function therapy in extubated patients after prolonged orotracheal intubation by means of clinical and electromyographic evaluation.

Methods:

A total of 15 patients were enrolled in this study (average age 48.6 ± 16.5 years). The study was carried out in three phases: (1) Clinical and electromyographic evaluation using the Dysphagia Risk Assessment Protocol following dysphagia scores criteria, and the measurement of the suprahyoid muscles amplitude (μV) expressed by root mean square (RMS), respectively; (2) swallowing rehabilitation program; and (3) reevaluation of patients after therapy. The Wilcoxon paired test assuming a significance level of 5% was used for statistical analysis.

Results:

By means of the swallowing scale, it was verified that patients suffered from severe oropharyngeal dysphagia at the first evaluation (80%), but the rehabilitation therapy reduced clinical signs, persistent only in one patient (6.7%) post-therapy, thus, improving swallowing. Significant differences, pre- and post-therapy, for suprahyoid muscles during maximal voluntary isometric contractions of right ( P = .0067) and left ( P = .0215), saliva swallowing by right ( P = .0413) and left ( P = .0151), and liquid swallowing by right ( P = .0479) and left ( P = .0215) sides, were found, as shown by electromyography.

Conclusions:

Swallowing exercises carried out by extubated patients after prolonged orotracheal intubation increased neuromuscular recruitment of suprahyoid muscles involved with swallowing and reduced dysphagia levels.
Trends in statin utilization among adults with severe peripheral artery disease including critical limb ischemia in an integrated healthcare delivery system
Authors: Reynolds Kristi , Mues Katherine E , Harrison Teresa N , Qian Lei , Chen Songyue , Hsu Jin-Wen Y , Philip Kiran J , Monda Keri L , Reading Stephanie R , Brar Somjot S
Published: September 2019

Evidence suggests that statin therapy in patients with peripheral artery disease (PAD) is beneficial yet use remains suboptimal. We examined trends in statin use, intensity, and discontinuation among adults aged ⩾ 40 years with incident severe PAD and a subset with critical limb ischemia (CLI) between 2002 and 2015 within an integrated healthcare delivery system. Discontinuation of statin therapy was defined as the first 90-day gap in treatment within 1 year following PAD diagnosis. We identified 11,059 patients with incident severe PAD: 31.1% ( n = 3442) with CLI and 68.9% ( n = 7617) without CLI. Mean (SD) age was 68.6 (11.3) years, 60.5% were male, 54.2% white, 23.2% Hispanic, and 16.2% black. Statin use in the year before diagnosis increased from 50.4% in 2002 to 66.0% in 2015 (CLI: 43.7% to 68.0%; without CLI: 53.1% to 64.2%, respectively). The proportion of patients on high-intensity statins increased from 7.3% in 2002 to 41.9% in 2015 (CLI: 7.2% to 39.4%; without CLI: 7.4% to 44.2%, respectively). Of the 40.5% ( n = 4481) who were not on a statin in the year before diagnosis, 13.5% ( n = 607) newly initiated therapy within 1 month (CLI: 10.1% ( n = 150); without CLI: 15.3% ( n = 457)). Following diagnosis, 12.5% ( n = 660) discontinued statin therapy within 1 year (CLI: 15.5% ( n = 202); without CLI: 11.5% ( n = 458)). Although use of statins increased from 2002 to 2015, a substantial proportion of the overall PAD and CLI subpopulation remained untreated with statins, representing a significant treatment gap in a population at high risk for cardiovascular events and adverse limb outcomes.
29 recommendations to combat social inequalities in health. The Norwegian Council on Social Inequalities in Health
Authors: Arntzen Annett , Bøe Tormod , Dahl Espen , Drange Nina , Eikemo Terje A , Elstad Jon Ivar , Fosse Elisabeth , Krokstad Steinar , Syse Astri , Sletten Mira Aaboen , Strand Bjorn Heine
Published: September 2019

All political parties in Norway agree that social inequalities in health comprise a public health problem and should be reduced. Against this background, the Council on Social Inequalities in Health has taken action to provide specific advice to reduce social health differences.

Our recommendations focus on the entire social gradient rather than just poverty and the socially disadvantaged. By proposing action on the social determinants of health such as affordable child-care, education, living environments and income structures, we aim to facilitate a possible re-orientation of policy away from redistribution to universalism.

The striking challenges of the causes of health differences are complex, and the 29 recommendations to combat social inequality of health demand cross sectorial actions. The recommendations are listed thematically and have not been prioritized. Some are fundamental and require pronounced changes across sectors, whereas others are minor and sector-specific.
Rigid-flexible coupling modelling and dynamic performance analysis of novel flexible road wheel
Authors: Deng Yaoji , Zhao Youqun , Xu Han , Lin Fen , Wang Qiuwei
Published: September 2019

A novel flexible road wheel with hub-hinge-ring combined structure is introduced to improve the buffer damping performance and lightweight level of tracked vehicles. To balance computational efficiency and precision, an advanced rigid-flexible coupled model of the flexible road wheel is established using a hybrid modelling method combining finite element method and multi-body dynamics. The reliability and accuracy of the established rigid-flexible coupled model are verified by wheel static loading experiment. The modal flexible body of the elastic outer ring is developed by modified Craig-Bampton method and the simulated results are in good agreement with the experimental data. Based on the verified rigid-flexible coupled model, the dynamic characteristics of the flexible road wheel under typical operation conditions were investigated. The simulation results show that when the motion state changes, the elastic outer ring will produce a hysteretic angle with respect to the hub, delaying the transmission of torque. The system parameters have a greater effect on the vertical vibration of the flexible road wheel. The higher the vehicle speed, the more vibration will be caused, and the increase in the load and number of hinge groups will reduce the vibration. The research results provide reference for structure optimization of flexible road wheel and lay a foundation for flexible multi-body dynamic simulation of tracked vehicles with flexible road wheels.
Being an insider and outsider: whiteness as a key dimension of difference
Authors: Britton Joanne
Published: September 2019

This article demonstrates the significance of engaging with whiteness as a key dimension of difference shaping research in multi-faceted ways. I critically reflect on a research project that included interviews with Muslim men in Rotherham, a northern English town that had experienced a child sexual exploitation crisis involving Pakistani Muslim men. It raised significant methodological and epistemological issues regarding my position in the research, as a white female researcher, and my relationships with local Pakistani Muslim men and women. I highlight the fluidity of my insider–outsider position through exploring political and ethical dilemmas involved in carrying out the research and structural and experiential aspects of researcher subjectivity. I show how being white both facilitated and obstructed the research as I steered my way through a highly sensitive set of circumstances and how engaging with whiteness is key in democratising research and shedding light on unequal power relations in knowledge production.
Bringing the outside in: The feasibility of virtual reality with people with dementia in an inpatient psychiatric care setting
Authors: Rose Vienna , Stewart Inga , Jenkins Keith G , Tabbaa Luma , Ang Chee Siang , Matsangidou Maria
Published: September 2019

Background and objectives

Emerging research supports virtual reality use with people with dementia in the community, but is limited to this area, warranting further investigation in different care settings. The feasibility of virtual reality within an inpatient psychiatric care setting was therefore explored. Research design and methods: Eight people with dementia and 16 caregivers were recruited in January and February 2018 from a UK hospital specialising in progressive neurological conditions. A mixed methods design measured affect and behaviour using the Observed Emotion Rating Scale, Overt Aggression Scale-Modified for Neurorehabilitation and St Andrew’s Sexual Behaviour Assessment. Thematic analysis was conducted following semi-structured interviews. Caregivers who worked at the hospital supported people with dementia throughout the process and were interviewed for their views on Head Mounted Display-Virtual Reality (HMD-VR) use with people with dementia.

Results

HMD-VR was tried and accepted by people with dementia. Participants viewed HMD-VR positively as a ‘change in environment’ and would use it again. People with dementia experienced more pleasure during and after HMD-VR compared to before exposure, as well as increased alertness after. Three core themes emerged: ‘Virtual Reality Experiences’, ‘Impact of Virtual Reality’ and ‘Experiences within the Virtual Environment’. Caregivers discussed preconceptions about virtual reality use and how these changed. Discussion and implications: This is the first study to explore the feasibility of HMD-VR with people with mild to moderately severe dementia in hospital and found that overall HMD-VR is viable. Findings evidence the clinical feasibility of HMD-VR implementation in this environment and inform future research.
Corporate harm and embedded labour exploitation in agri-food supply networks
Authors: Davies Jon
Published: September 2019

Harm facilitated by corporations has received increased attention in recent years. However, corporate crime and harm remain under-researched themes in relation to labour exploitation, in both theoretical and empirical terms. The purpose of this article is to argue that, in the context of agricultural and food supply networks, harmful labour practices result from structural problems associated with the demand for products. Although individual employers and businesses have a role in facilitating these harmful practices, these practices also emerge from otherwise legitimate agri-food supply network dynamics, such as subcontracted labour, which results in fragmented responsibility. Therefore, labour practices have significant implications for the nature, organization and control of corporate harms, whereby harmful consequences become normalized, accepted and embedded in agri-food supply network practices. Criminological analyses of food production and contemporary markets more widely can begin to address the systemic challenges of harmful labour practices, in both domestic and global supply networks.
Interviewer Effects on Cooperation during Initial and Refusal Conversion Fieldwork Phases in Telephone Panel Surveys
Authors: Lipps Oliver
Published: September 2019

Specific interviewer characteristics, interviewer continuity, or matching interviewer and household characteristics may increase cooperation, especially for difficult-to-convince households. In face-to-face surveys, unobserved heterogeneity often makes a proper analysis of interviewer effects impossible. Although surveys conducted in telephone centers usually assign households to interviewers at random, there is less research on interviewer effects on cooperation, probably because telephone surveys produce smaller effects. Using data from a large telephone panel survey, I find interviewer effects only for households that refused to participate in a previous wave. Interviewer continuity or matching interviewers and households on sociodemographic variables has weak effects for any type of household. Interviewer experience has positive effects for previously refusing households only. Telephone survey organizations therefore only need to worry about using specially trained interviewers for refusal conversion calls, while specific assignments of interviewers to households are not necessary.
A Gap Analysis Assessing the Perceptions of Primary Care Physicians in the Management of Kidney Recipients After Transplantation
Authors: Famure Olusegun , Caballero Myra N. , Li Anna , Tang Rosalind , Chen Pei Xuan , Ashwin Monika , Adcock Leslie , Schiff Jeffrey , Kim S. Joseph
Published: September 2019

Objectives:

To examine the practice patterns and perceptions of primary care physicians in the management of chronic diseases in kidney recipients, assess care provided to recipients, and identify barriers to the optimal delivery of primary care to recipients.

Methods:

A self-administered questionnaire on the primary care of kidney recipients was developed and implemented. The survey investigated physician comfort and practice patterns in providing preventive and chronic care to recipients, patient self-management support, and physician perceptions on communication with transplant centers and barriers to ideal care.

Results:

A total of 210 physicians completed the survey (response rate of 22%). Among the respondents, 73% indicated they were currently providing care to kidney recipients. The majority of physicians specified that they rarely (57%) or never (20%) communicate with transplant centers. Most physicians felt comfortable providing care to recipients for non-transplant-related issues (92.5%), vaccinations (85%), and periodic health examinations (94%). The majority (75.3%) of physicians felt uncomfortable managing the immunosuppressive medications of recipients. Physicians’ most commonly stated barriers to delivering optimal care to recipients were insufficient guidelines provided by the transplant center (68.9%) and lack of knowledge in managing recipients (58.8%). Suggested resources by physicians to improve their comfort level in managing recipients included guidelines and continuing medical educational activities related to transplantation.

Conclusions:

Our results suggest that there are barriers to delivering optimal primary care to kidney recipients. The approach to providing resources needed to bridge the knowledge gap for physicians in the management of recipients requires further exploration.
Advocacy, Research, and Anesthesia Practice Models: Key Studies of Safety and Cost-Effectiveness
Authors: Hoyem Ruby L. , Quraishi Jihan A. , Jordan Lorraine , Wiltse Nicely Kelly L.
Published: September 2019

The practice of anesthesia includes multiple competing practice models, including services delivered by anesthesiologists, independent practice by certified registered nurse anesthetists (CRNAs), and team-based approaches incorporating anesthesiologist supervision or direction of CRNAs. Despite data demonstrating very low risk of death and complications associated with anesthesia, debate among professional societies and policymakers persists over the superiority or equivalence among these models. The American Society of Anesthesiologists uses published findings as evidence for claims that anesthesia is safer when anesthesiologists lead in providing care. The American Association of Nurse Anesthetists cites its own research on safety and cost-efficiency outcomes to defend against these claims. We review and critique studies of the safety outcomes and cost-effectiveness of anesthesia delivery that have been cited in the Federal Trade Commission comment letters related to competition in health care, where each profession has laid out their case for how they ought to be recognized in the market for anesthesia services. The Federal Trade Commission has a role in protecting consumers from anticompetitive conduct that has the potential to impact quality and cost in health care. Thus, it is important to evaluate the evidence used to make claims about these topics. We argue that while research in this area is imperfect, the strong safety record of anesthesia in general and CRNAs in particular suggest that politics and professional interests are the main drivers of supervision policy in anesthesia delivery.
Glucagon-like peptide-1 receptor pathway inhibits extracellular matrix production by mesangial cells through store-operated Ca2+channel
Authors: Huang Linjing , Ma Rong , Lin Tingting , Chaudhari Sarika , Shotorbani Parisa Y , Yang Liyong , Wu Peiwen
Published: September 2019

Glomerular mesangial cell is the major source of mesangial matrix. Our previous study demonstrated that store-operated Ca2+channel signaling suppressed extracellular matrix protein production by mesangial cells. Recent studies demonstrated that glucagon-like peptide-1 receptor (GLP-1R) pathway had renoprotective effects. However, the underlying mechanism(s) remains unclear. The present study was aimed to determine if activation of GLP-1R decreased extracellular matrix protein production by mesangial cells through upregulation of store-operated Ca2+function. Experiments were conducted in cultured human mesangial cells. Liraglutide and exendin 9–39 were used to activate and inhibit GLP-1R, respectively. Store-operated Ca2+function was estimated by evaluating the SOC-mediated Ca2+entry (SOCE). We found that liraglutide treatment reduced high glucose-stimulated production of fibronectin and collagen IV. The inhibitory effects of liraglutide were not observed in the presence of exendin 9–39. Exendin-4, another GLP-1R agonist also blunted high glucose-stimulated fibronectin and collagen IV production. Treatment of human mesangial cells with liraglutide for 24 h significantly attenuated the high glucose-induced reduction of Orai1 protein. Consistently, Ca2+imaging experiments showed that the inhibition of high glucose on SOCE was significantly attenuated by liraglutide. However, in the presence of exendin 9–39, liraglutide failed to reverse the high glucose effect. Furthermore, liraglutide effects on fibronectin and collagen IV protein abundance were significantly attenuated by GSK-7975A, a selective blocker of store-operated Ca2+. Taken together, our findings suggest that GLP-1R signaling inhibited high glucose-induced extracellular matrix protein production in mesangial cells by restoring store-operated Ca2+function.

Impact statement

Diabetic kidney disease continues to be a major challenge to health care system in the world. There are no known therapies currently available that can cure the disease. The present study provided compelling evidence that activation of GLP-1R inhibited extracellular matrix protein production by glomerular mesangial cells. We further showed that the beneficial effect of GLP-1R was attributed to upregulation of store-operated Ca2+channel function. Therefore, we identified a novel mechanism contributing to the renal protective effects of GLP-1R pathway. Activation of GLP-1R pathway and/or store-operated Ca2+channel signaling in MCs could be an option for patients with diabetic kidney disease.
Ludosity, Radical Contextualism, and a New Games History: Pleasure, Truth, and Deception in the Mid-20th-Century London Arcade
Authors: Litherland Benjamin
Published: September 2019

This article offers a social history of funfairs and arcades in mid-20th-century urban England. Critiquing existing histories of games for often neglecting players and the specific locales in which games are played, it draws on both new cinema history and cultural studies’ conception of “radical contextualism” to outline what the article describes as a game’s ludosity. Ludosity, the article proposes, is the condition or quality of game partcipation as shaped by a range of agents, institutions, and contexts. Utilizing mass observation records, it offers a detailed analysis of the ways in which social interactions influenced ludic experiences of pinball tables and crane machines and posits that games history needs to center players in order to fully conceptualize games in history.
Elektra prosthesis versus resection-suspension arthroplasty for thumb carpometacarpal osteoarthritis: a long-term cohort study
Authors: Froschauer Stefan M. , Holzbauer Matthias , Hager Dietmar , Schnelzer Richard , Kwasny Oskar , Duscher Dominik
Published: September 2019

The present study compares 34 patients with thumb carpometacarpal osteoarthritis (37 thumbs) treated with the Elektra® prosthesis, with 18 patients (18 thumbs) treated with resection-suspension arthroplasty, with an overall mean follow-up period of 13.3 years. Evaluation with disability of arm and shoulder scores, pain via visual analogue scale and range of motion (radial and palmar abduction, and opposition) indicated no significant difference. However, the cohort with a surviving prosthesis showed significantly better subjective grip strength ( p  =  0.04). Complications occurred in 23 of the 37 thumbs in the prosthesis group compared with two in the resection-suspension arthroplasty patients. Seventeen prostheses required revision. At revision operations, we observed local signs of metallosis in 15 of 17 cases. The patients receiving resection-suspension arthroplasty were more satisfied with their treatment ( p  =  0.003). Therefore, we cannot recommend the implantation of Elektra® prosthesis and we speculate that the key problem of aseptic cup loosening is a result of the metal-on-metal bearing.

Level of evidence: III
On the relevance of Carl Schmitt’s concept of Großraum in contemporary international politics
Authors: Orsi Roberto
Published: September 2019

Since the end of the Cold War, a number of authors have affirmed the relevance of Carl Schmitt’s concept of Großraum for contemporary international politics. This article reviews those claims and argues that Großraum has little to offer in analytical terms to enhance our understanding of the international political situation in this early twenty-first century. Those authors who wish to revive Großraum for the sake of their theoretical work overlook vitally important components of this concept. Furthermore, their claims fail to meet the criteria of Reinhart Koselleck’s structural iterability.
Evaluation of a Bioengineered Honey and Its Synthetic Equivalent as Novel Staphylococcus aureus Biofilm-Targeted Topical Therapies in Chronic Rhinosinusitis
Authors: Papadopoulou Dionyssia , Dabrowska Alicja , Harries Philip G. , Webb Jeremy S. , Allan Raymond N. , Salib Rami J.
Published: September 2019

Background

Chronic rhinosinusitis (CRS) is a common condition which affects the quality of life of millions of patients worldwide and has a significant impact on health-care resources. While Staphylococcus aureus bacterial biofilms play an important role in this disease, antimicrobial therapy is rarely effective and may promote antibiotic resistance. Thus, development of novel biofilm-targeting and antibiotic-sparing therapies is highly desirable and urgently required.

Objective

This in vitro study evaluated the antimicrobial activity of a novel synthetic honey-equivalent product which was designed to have the same reactive oxygen release profile as the engineered honey SurgihoneyRO™.

Methods

Treatment efficacy was investigated by assessment of planktonic growth, biofilm viability, thickness, and biomass using 12 CRS-related S. aureus mucosal bacterial strains.

Results

Both SurgihoneyRO™ and the synthetic honey-equivalent product inhibited growth of planktonic methicillin-resistant and methicillin-sensitive S. aureus strains, with the synthetic honey-equivalent product exhibiting a lower minimum inhibitory concentration. Treatment of established S. aureus biofilms reduced biofilm viability with 24-hour treatment resulting in a 2-log reduction in viability of biofilms formed by methicillin-resistant strains and a 1-log reduction in biofilms formed by methicillin-sensitive strains.

Conclusions

This preliminary study shows that the synthetic honey-equivalent product provides marked antimicrobial activity against S. aureus biofilms, with the potential for development in the clinical setting as an adjunctive biofilm-targeted therapy in CRS. The ultimate aim of such a product would be to reduce the need for antibiotics, steroids, and invasive surgical procedures in CRS patients as well as improving clinical outcomes following endoscopic sinus surgery.
The impact of systolic and diastolic blood pressure variability on mortality is age dependent: Data from the Dublin Outcome Study
Authors: Bilo Grzegorz , Dolan Eamon , O'Brien Eoin , Facchetti Rita , Soranna Davide , Zambon Antonella , Mancia Giuseppe , Parati Gianfranco
Published: September 2019

Background

Twenty-four-hour blood pressure variability (BPV) is independently related to cardiovascular outcomes, but limited and conflicting evidence is available on the relative prognostic importance of systolic and diastolic BPV. The aim of this study was to verify the hypothesis that the association of systolic and diastolic blood pressure variability over 24 h with cardiovascular mortality in untreated subjects is affected by age.

Design and methods

The study included 9154 untreated individuals assessed for hypertension between 1982 and 2002 in the frame of the Dublin Outcome Study, in which 24 h ambulatory blood pressure monitoring was obtained (age 54.1 ± 14.3 years, 47% males). The association of short-term systolic and diastolic blood pressure variability with cardiovascular and all-cause mortality in the entire sample and separately in younger and older age subgroups was assessed over a median follow-up period of 6.3 years.

Results

Diastolic BPV was directly and independently related to cardiovascular mortality (adjusted hazard ratio (adjHR) for daytime standard deviation 1.16 (95% confidence interval 1.08–1.26)) with no significant differences among age groups. Conversely, systolic BPV was independently associated with cardiovascular mortality only in younger (<50 years) subjects (adjHR for daytime standard deviation 1.72 (95% confidence interval 1.33–2.23)), superseding the predictive value of diastolic BPV in this group.

Conclusions

Diastolic short-term BPV independently predicts cardiovascular mortality in hypertensive subjects at all ages, while systolic BPV seems a particularly strong predictor in young adults. If confirmed, these findings might improve the understanding of the prognostic value of BPV, with new perspectives for its possible clinical application.
The mobile instant messaging interview (MIMI): Using WhatsApp to enhance self-reporting and explore media usage in situ
Authors: Kaufmann Katja , Peil Corinna
Published: September 2019

How do people use media technologies in everyday life and how do they make sense of them? This is one of the core questions in media and communication studies, gaining even more in relevance in light of the rapidly changing, convergent media environment. Yet, rich and context-sensitive data about media and technology use are difficult to generate when media consumption is increasingly pervasive, ubiquitous, and often goes on in passing. At the same time, the full potential of smartphones in qualitative research has not yet been realized. The mobile instant messaging interview (MIMI) introduced and assessed in this paper is intended to fill this gap by exploiting some of the unique communication and multimedia features offered by mobile instant messaging apps. Drawing on diary techniques and on the tried and tested mobile experience sampling method (MESM), the MIMI uses WhatsApp for an in situ exploration of distinct settings and situations of social action (e.g., media usage). To substantiate the approach, the results of a pilot study conducted with young smartphone users are presented, discussing the advantages and drawbacks of mobile instant messaging interviews in detail, from the researcher’s as well as the participant’s point of view.
Gender, letters, relatives, and God: mediating actors in mammographic screening among Pakistani women in Norway
Authors: Bhargava Sameer , Hofvind Solveig , Moen Kåre
Published: September 2019

Background

Pakistani immigrant women in Norway have lower attendance rates in the national breast cancer screening program (BreastScreen Norway) compared to non-immigrants and immigrants from most other countries.

Purpose

To identify and explore human and non-human actors that play a role for Pakistani immigrant women’s attendance in the program.

Material and Methods

Qualitative interviews with 16 Norwegian-Pakistani women in 2017 and 2018. Inspired by Latour, we explored how human and non-human actors act and interact when Pakistani immigrant women consider attendance in BreastScreen Norway.

Results

Among the actors found to play a significant role in the relationship between Pakistani immigrant women and the screening program were trust in the healthcare system and breast cancer screening, the gender of the screening radiographer, the written information received from the screening program, family life, daughters, general practitioners, non-governmental organizations, religious beliefs, private service providers, monetary expenses, accessibility, worries, and digital tools.

Conclusion

Many human and non-human actors work to shape and influence Pakistani immigrant women’s screening attendance, or lack thereof, for instance by creating thoughts, promoting opportunities, raising doubts and generating worries, thus variously encouraging, enabling, facilitating, discouraging or preventing attendance in organized breast cancer screening.
How Individual Coping, Mental Health, and Parental Behavior Are Related to Identity Development in Emerging Adults in Seven Countries
Authors: Seiffge-Krenke Inge , Weitkamp Katharina
Published: September 2019

So far, there is a dearth of research comparing identity processes across cultures and its contributing factors. In this study, the association of individual and family factors with identity processes was analyzed in 2,113 emerging adults ( M = 22.0 years; 66% female) from France, Germany, Greece, Peru, Pakistan, Poland, and Turkey. Exploration and commitment levels were highest in non-Western countries like Peru, Turkey, and Pakistan, whereas emerging adults in France scored lowest in exploration and commitment and reported highest levels in identity distress, internalizing/externalizing symptoms, and identity diffusion. Identity distress, coping with identity distress, parental behavior, and mental health were regressed on identity processes (exploration breadth/depth, commitment, and ruminative exploration). Distinctive patterns emerged; high identity distress, high identity diffusion, and high maternal anxious rearing in all countries were related to ruminative exploration. Findings were interpreted with a focus on universal and distinctive pathways in different countries in changing times.
A Prospective Injury Surveillance Study on Ski Touring
Authors: Mueller Taina , Ruedl Gerhard , Ernstbrunner Matthaeus , Plachel Fabian , Fröhlich Stefan , Hoffelner Thomas , Resch Herbert , Ernstbrunner Lukas
Published: September 2019

Background:

Ski touring is an outdoor sport with growing popularity in alpine countries. Information about injuries in ski touring is limited.

Purpose:

To determine injury rates, mechanisms, causes, and risk factors in ski touring.

Study Design:

Descriptive epidemiology study.

Methods:

Between November 2015 and May 2016, a total of 191 participants from the Alps region were prospectively tracked via personalized online questionnaires. Injury rates were calculated per 1000 hours of sports exposure. Risk factors were assessed per multivariate logistic regression analysis.

Results:

A total of 3900 ski tours were performed, with 10,955 hours and 4,108,503 m in height ascension (uphill) recorded. The overall injury rate was 2.5 injuries per 1000 hours of ski touring. A total of 27 injury-events were reported, of which 18 (67%) were classified as mild, 7 (26%) as moderate, and 2 (7%) as severe. Hands (28%) and knees (16%) were the most commonly involved anatomic regions. Most injuries were limited to the soft tissue, such as bruises (31%) and abrasions (18%). Significantly more injuries happened during the descent (n = 17; 63%) than during the ascent (n = 6; 22%) (odds ratio, 5.96; P = .004), while poor weather conditions, icy surface, and inattentiveness were the most often reported reasons for injury. Sidecountry ski touring was identified as the only significant independent risk factor for injury ( P < .001).

Conclusion:

In this prospective injury surveillance study, the majority of ski touring injuries were mild and limited to the soft tissue. Ski touring injuries were more likely to happen during the descent of a tour, and sidecountry ski touring was the only significant independent risk factor for injury. Bad weather, icy surface, and inattentiveness were found to be the leading causes for an injury-event in this study.
Measurement of Perceived Physician Empathy in Orthopedic Patients
Authors: Keulen Mark Hendrik Franciscus , Teunis Teun , Kortlever Joost Teunis Pieter , Vagner Gregg Alan , Ring David , Reichel Lee Matthew
Published: September 2019

Background:

Empathy is a key component of a therapeutic relationship. Perceived empathy and compassion are associated with patient satisfaction, reduced symptoms, and adherence to treatment.

Objective:

To assess the advantages and disadvantages of the validated Jefferson Scale of Patient’s Perception of Physician Empathy (JSPPPE) and the Consultation and Relational Empathy (CARE) tools.

Methods:

Eighty-four patients completed the JSPPPE and the CARE measure. With Pearson’s correlation and exploratory factor analysis, we measured the underlying construct. Flooring and ceiling effects were measured. Multivariable models were created to assess factors associated with both measures.

Results:

The high interquestionnaire correlation (rho = 0.70) and factor loading (0.77) confirm that the JSPPPE and CARE measure the same construct. The CARE (55%) had a higher ceiling effect than JSPPPE (18%). Both JSPPPE (partial R2 = 0.53, 95% confidence interval [CI]: 0.38-0.64) and CARE (partial R2 = 0.60, 95% CI: 0.46-0.69) accounted for similar amounts of variation in satisfaction with the orthopedic surgeon.

Conclusion:

Perceived empathy accounts for a substantial amount of the variation in satisfaction. The JSPPPE measures the same construct as CARE with a lower ceiling effect. Because both questionnaires have considerable ceiling effects, a new questionnaire might help to study factors associated with a more empathetic experience.
Large Osteochondral Lesions of the Talus Treated With Autologous Bone Graft and Periosteum Transfer
Authors: Nikolopoulos Dimitrios , Sergides Neoptolemos , Safos George , Moustakas Konstantinos , Safos Petros , Moutsios-Rentzos Andreas
Published: September 2019

Background:

The treatment of large osteochondral lesions of the talus (OLTs) is challenging due to the poor intrinsic reparative capability of the damaged articular cartilage. Autologous transfer of bone and periosteum has been used successfully in the treatment of large defects in animals, and therefore it was believed that this technique might show similar results in humans. The purpose of this study was to assess the outcome of an innovative technique for autologous transplantation of cancellous tibial graft with periosteal transfer in large OLTs.

Methods:

Forty-one patients (22 females, 19 males), with a mean age of 34.9 years (range, 18-72 years), with a large OLT (>200 mm2) were treated with autologous bone graft and periosteum transfer. OLTs averaging 310 mm2 were identified on a preoperative computed tomography scan. The procedure consisted of malleolar osteotomy, curettage of sclerotic bone, autologous bone graft from the proximal tibia, and transfixion of periosteum over the graft. Outcome measures, including the pain visual analog scale (VAS), ankle range of motion (ROM), American Orthopaedic Foot & Ankle Society (AOFAS) score, and Foot & Ankle Disability Index (FADI), were compared between preoperative and 1 and 2 years following surgery.

Results:

There were significant improvements in VAS pain score from 7.7 before surgery to 1.1 at 1 year after surgery and 0.4 at 2 years or more after surgery. The AOFAS and FADI scores were also significantly improved from 40.3 and 53.3 preoperatively to 95 and 93.2 postoperatively at 1 year and 95 and 93.2 at 2 or more years postoperatively, respectively. Postoperative complications included 2 patients who required removal of medial malleolar osteotomy tension bands due to symptomatic hardware. There were no nonunions or malunions of the osteotomies and no donor site complications.

Conclusion:

Autologous bone graft and periosteum transfer was an effective treatment for large OLTs leading to significant decreases in pain and improvement in functional scores at more than 2 years after surgery.

Level of Evidence:

Level IV, retrospective case series.
Substance P and Hemokinin 1 in Nasal Lavage Fluid of Patients with Chronic Sinusitis and Nasal Polyposis
Authors: Lonergan Ashley , Theoharides Theoharis , Tsilioni Eirini , Rebeiz Elie
Published: September 2019

This pilot study was undertaken to isolate and quantify substance P (SP) and hemokinin 1 (HK‐1) in the nasal lavage fluid of patients with chronic rhinosinusitis with nasal polyps to better elucidate the pathophysiology underlying this inflammatory process, which remains poorly understood. Mucus samples were collected from this introductory cohort of 10 patients diagnosed with chronic rhinosinusitis with nasal polyps at Tufts Medical Center (Boston, Massachusetts). Relative levels of SP and HK‐1 were measured with enzyme‐linked immunosorbent assay methods. Both inflammatory neuropeptides were found in detectable and comparable amounts in patient samples and in concentrations up to 100‐fold those established in past literature. The presence of SP and HK‐1 necessitates further investigation into their role in nasal polyposis and the potentiation of the chronic inflammation inherent to chronic rhinosinusitis. Downregulating these peptides could therefore provide novel treatment targets to manage this disease process.
Suppression of HIF2 signalling attenuates the initiation of hypoxia-induced pulmonary hypertension
Authors: Hu Cheng-Jun , Poth Jens M. , Zhang Hui , Flockton Amanda , Laux Aya , Kumar Sushil , McKeon Brittany , Mouradian Gary , Li Min , Riddle Suzette , Pugliese Steven C. , Brown R. Dale , Wallace Eli M. , Graham Brian B. , Frid Maria G. , Stenmark Kurt R.
Published: September 2019

Most published studies addressing the role of hypoxia inducible factors (HIFs) in hypoxia-induced pulmonary hypertension development employ models that may not recapitulate the clinical setting, including the use of animals with pre-existing lung/vascular defects secondary to embryonic HIF ablation or activation. Furthermore, critical questions including how and when HIF signalling contributes to hypoxia-induced pulmonary hypertension remain unanswered.

Normal adult rodents in which global HIF1 or HIF2 was inhibited by inducible gene deletion or pharmacological inhibition (antisense oligonucleotides (ASO) and small molecule inhibitors) were exposed to short-term (4 days) or chronic (4–5 weeks) hypoxia. Haemodynamic studies were performed, the animals euthanised, and lungs and hearts obtained for pathological and transcriptomic analysis. Cell-type-specific HIF signals for pulmonary hypertension initiation were determined in normal pulmonary vascular cellsin vitroand in mice (using cell-type-specific HIF deletion).

GlobalHif1adeletion in mice did not prevent hypoxia-induced pulmonary hypertension at 5 weeks. Mice with globalHif2adeletion did not survive long-term hypoxia. PartialHif2adeletion orHif2-ASO (but notHif1-ASO) reduced vessel muscularisation, increases in pulmonary arterial pressures and right ventricular hypertrophy in mice exposed to 4–5 weeks of hypoxia. A small molecule HIF2 inhibitor (PT2567) significantly attenuated early events (monocyte recruitment and vascular cell proliferation) in rats exposed to 4 days of hypoxia, as well as vessel muscularisation, tenascin C accumulation and pulmonary hypertension development in rats exposed to 5 weeks of hypoxia.In vitro, HIF2 induced a distinct set of genes in normal human pulmonary vascular endothelial cells, mediating inflammation and proliferation of endothelial cells and smooth muscle cells. EndothelialHif2aknockout prevented hypoxia-induced pulmonary hypertension in mice.

Inhibition of HIF2 (but not HIF1) can provide a therapeutic approach to prevent the development of hypoxia-induced pulmonary hypertension. Future studies are needed to investigate the role of HIFs in pulmonary hypertension progression and reversal.
Exhaled volatile organic compounds as markers for medication use in asthma
Authors: Brinkman Paul , Ahmed Waqar M. , Gómez Cristina , Knobel Hugo H. , Weda Hans , Vink Teunis J. , Nijsen Tamara M. , Wheelock Craig E. , Dahlen Sven-Erik , Montuschi Paolo , Knowles Richard G. , Vijverberg Susanne J. , Maitland-van der Zee Anke H. , Sterk Peter J. , Fowler Stephen J.
Published: September 2019

Introduction

Asthma is a heterogeneous condition, characterised by chronic inflammation of the airways, typically managed with inhaled bronchodilators and corticosteroids. In the case of uncontrolled asthma, oral corticosteroids (OCSs) are often prescribed. Good adherence and inhalation technique are associated with improved outcomes; however, it is difficult to monitor appropriate drug intake and effectiveness in individual patients. Exhaled breath contains thousands of volatile organic compounds (VOCs) that reflect changes in the body's chemistry and may be useful for monitoring drug pharmacokinetics/pharmacodynamics. We aimed to investigate the association of exhaled VOCs in severe asthma patients from the U-BIOPRED cohort (by gas chromatography coupled with time-of-flight mass spectrometry) with urinary levels of salbutamol and OCSs (by liquid chromatography coupled with high-resolution mass spectrometry).

Methods

Samples were collected at baseline and after 12–18 months of follow-up. Statistical analysis was based on univariate and multivariate modelling, followed by area under the receiver operating characteristic curve (AUC) calculation. Results were verified through longitudinal replication and independent validation.

Results

Data were available for 78 patients (baseline n=48, replication n=30 and validation n=30). Baseline AUC values were 82.1% (95% CI 70.4–93.9%) for salbutamol and 78.8% (95% CI 65.8–91.8%) for OCS. These outcomes could be adequately replicated and validated. Additional regression analysis between qualified exhaled VOCs and urinary concentrations of salbutamol and prednisone showed statistically significant correlations (p<0.01).

Conclusion

We have linked exhaled VOCs to urinary detection of salbutamol and OCSs. This merits further development of breathomics into a point-of-care tool for therapeutic drug monitoring.