bluuebunny/crossref_metadata_2025 huggingface dataset:
The Development of Adolescent Chronic Pain following Traumatic Brain Injury and Surgery: The Role of Diet and Early Life Stress
Authors: Salberg Sabrina , Sgro Marissa , Brady Rhys D. , Noel Melanie , Mychasiuk Richelle
Published: July 2020

Pain is evolutionarily necessary for survival in that it reduces tissue damage by signaling the body to respond to a harmful stimulus. However, in many circumstances, acute pain becomes chronic, and this is often dysfunctional. Adolescent chronic pain is a growing epidemic with an unknown etiology and limited effective treatment options. Given that the relationship between acute pain and chronic pain is not straightforward, there is a need to better understand the factors that contribute to the chronification of pain. Since early life factors are critical to a variety of outcomes in the developmental and adolescent periods, they pose promise as potential mechanisms that may underlie the transition from acute to chronic pain. This review examines two early life factors: poor diet and adverse childhood experiences (ACEs); they may increase susceptibility to the development of chronic pain following surgical procedures or traumatic brain injury (TBI). Beyond their high prevalence, surgical procedures and TBI are ideal models to prospectively understand mechanisms underlying the transition from acute to chronic pain. Common themes that emerged from the examination of poor diet and ACEs as mechanisms underlying this transition included: prolonged inflammation and microglia activation leading to sensitization of the pain system, and stress-induced alterations to hypothalamic-pituitary-adrenal axis function, where cortisol is likely playing a role in the development of chronic pain. These areas provide promising targets for interventions, the development of diagnostic biomarkers, and suggest that biological treatment strategies should focus on regulating the neuroinflammatory and stress responses in an effort to modulate and prevent the development of chronic pain.
Balloon Versus Self-Expandable Valve for the Treatment of Bicuspid Aortic Valve Stenosis
Authors: Mangieri Antonio , Tchetchè Didier , Kim Won-Keun , Pagnesi Matteo , Sinning Jean-Malte , Landes Uri , Kornowski Ran , De Backer Ole , Nickenig Georg , Ielasi Alfonso , De Biase Chiara , Søndergaard Lars , De Marco Federico , Montorfano Matteo , Chiarito Mauro , Regazzoli Damiano , Stefanini Giulio , Presbitero Patrizia , Toggweiler Stefan , Tamburino Corrado , Immè Sebastiano , Tarantini Giuseppe , Sievert Horst , Schäfer Ulrich , Kempfert Jörg , Wöehrle Jochen , Gallo Francesco , Laricchia Alessandra , Latib Azeem , Giannini Francesco , Colombo Antonio
Published: July 2020

Background:

Large data comparing the performance of new-generation self-expandable versus balloon-expandable transcatheter heart valves in bicuspid aortic stenosis are lacking. We aim to compare the safety and performance of balloon-expandable and self-expandable transcatheter heart valves in the treatment of bicuspid aortic stenosis.

Methods:

The BEAT (balloon versus self-expandable valve for the treatment of bicuspid aortic valve stenosis) registry included 353 consecutive patients who underwent transcatheter aortic valve implantation using new-generation Evolut R/PRO or Sapien 3 valves in bicuspid aortic valve.

Results:

A total of 353 patients (n=242 [68.6%] treated with Sapien 3 and n=111 [68.6%] treated with Evolut R (n=70)/PRO [n=41]) were included. Mean age was 77.8±8.3 years and mean Society of Thoracic Surgeons Predicted Risk of Mortality was 4.4±3.3%. Valve Academic Research Consortium-2 device success was similar between Sapien 3 and Evolut R/PRO (85.6% versus 87.2%;
P
=0.68). In the Sapien 3 group, 4 patients experienced annular rupture whereas this complication did not occur in the Evolut R/PRO group. After propensity score matching, Valve Academic Research Consortium-2 device success was similar between both groups (Sapien 3=85.7% versus Evolut R/Pro=84.4%;
P
=0.821). Both in the overall and in the matched population, no differences in the rate of permanent pacemaker implant were observed. At 1-year follow-up, the rate of overall death and cardiovascular death were similar between the 2 groups. In the unmatched population, the 1-year echocardiographic follow-up demonstrated similar rate of moderate-to-severe paravalvular aortic regurgitation (Evolut R/PRO 10.5% versus Sapien 3 4.2%,
P
=0.077); however, after propensity matching, the rate of moderate-to-severe paravalvular leak became significantly higher among patients treated with self-expandable valves (9.3% versus 0%;
P
=0.043).

Conclusions:

Our study confirms the feasibility of both Sapien 3 and Evolut R/PRO implantation in bicuspid aortic valve anatomy; a higher rate of moderate-severe paravalvular aortic regurgitation was observed in the Evolut R/PRO group at 1-year follow-up in the matched cohort, although patients treated with balloon-expandable valve had a higher rate of annular rupture.
Postimplant Phosphodiesterase Type 5 Inhibitors Use Is Associated With Lower Rates of Thrombotic Events After Left Ventricular Assist Device Implantation
Authors: Xanthopoulos Andrew , Tryposkiadis Konstantinos , Triposkiadis Filippos , Fukamachi Kiyotaka , Soltesz Edward G. , Young James B. , Wolski Kathy , Blackstone Eugene H. , Starling Randall C.
Published: July 2020

Background

Left ventricular assist device (
LVAD
) thrombosis is clinically devastating and impacts the cost effectiveness of
LVAD
therapy for advanced heart failure. Anticoagulation and antiplatelet therapies represent the standard of care to mitigate
LVAD
thrombosis. Phosphodiesterase type 5 inhibitors (
PDE
‐5is) exhibit hemodynamic, antiplatelet, and antithrombotic effects. Using a national registry, we examined the relationship of
PDE
‐5i use on thrombotic events in patients with continuous‐flow
LVAD
s.

Methods and Results

We obtained data from 13 772 patients with continuous flow
LVAD
s participating in a national registry. Patients implanted with primary
LVADs
from 2012 to 2017 were included in the analysis. The primary end point was a composite of
LVAD
thrombosis and ischemic stroke. Patients were analyzed according to any use of
PDE
‐5i after LVAD implantation (
PDE
‐5i group) versus no use after
LVAD
implantation (no
PDE
‐5i group). The primary end point was significantly lower in the
PDE
‐5i group compared with the no
PDE
‐5i group (hazard ratio [HR], 0.84; 95%
CI,
0.77–0.91;
P
<0.001) at 48 months. The components of the primary end point (
LVAD
thrombosis: HR, 0.82; 95%
CI
, 0.74–0.90;
P
<0.001; and ischemic stroke: HR, 0.85; 95%
CI,
0.75–0.97;
P
=0.019), as well as the secondary end point all‐cause mortality (HR, 0.86; 95%
CI
, 0.79–0.93;
P
<0.001) were lower in the
PDE
‐5i group versus the no
PDE
‐5i at 48 months post
LVAD
. The favorable results observed with postimplant
PDE
‐5i use were consistent with both axial and centrifugal flow devices.

Conclusions

The postimplant use of
PDE
‐5i was associated with fewer thrombotic events and improved survival in
LVAD
patients. A randomized clinical trial is warranted to confirm these findings.
Burden of Stroke in Europe
Authors: Wafa Hatem A. , Wolfe Charles D.A. , Emmett Eva , Roth Gregory A. , Johnson Catherine O. , Wang Yanzhong
Published: July 2020

Background and purpose:

Prediction of stroke impact provides essential information for healthcare planning and priority setting. We aim to estimate 30-year projections of stroke epidemiology in the European Union using multiple modeling approaches.

Methods:

Data on stroke incidence, prevalence, deaths, and disability-adjusted life years in the European Union between 1990 and 2017 were obtained from the global burden of disease study. Their trends over time were modeled using 3 modeling strategies: linear, Poisson, and exponential regressions―adjusted for the gross domestic product per capita, which reflects the impact of economic development on health status. We used the Akaike information criterion for model selection. The 30-year projections up to 2047 were estimated using the best fitting models, with inputs on population projections from the United Nations and gross domestic product per capita prospects from the World Bank. The technique was applied separately by age-sex-country groups for each stroke measure.

Results:

In 2017, there were 1.12 million incident strokes in the European Union, 9.53 million stroke survivors, 0.46 million deaths, and 7.06 million disability-adjusted life years lost because of stroke. By 2047, we estimated an additional 40 000 incident strokes (+3%) and 2.58 million prevalent cases (+27%). Conversely, 80 000 fewer deaths (–17%) and 2.31 million fewer disability-adjusted life years lost (–33%) are projected. The largest increase in the age-adjusted incidence and prevalence rates are expected in Lithuania (average annual percentage change, 0.48% and 0.7% respectively), and the greatest reductions in Portugal (–1.57% and –1.3%). Average annual percentage change in mortality rates will range from −2.86% (Estonia) to −0.08% (Lithuania), and disability-adjusted life years’ from −2.77% (Estonia) to −0.23% (Romania).

Conclusions:

The number of people living with stroke is estimated to increase by 27% between 2017 and 2047 in the European Union, mainly because of population ageing and improved survival rates. Variations are expected to persist between countries showing opportunities for improvements in prevention and case management particularly in Eastern Europe.
Infarct Volume Before Hemicraniectomy in Large Middle Cerebral Artery Infarcts Poorly Predicts Catastrophic Outcome
Authors: Casolla Barbara , Kuchcinski Gregory , Kyheng Maéva , Hanafi Riyad , Lejeune Jean-Paul , Leys Didier , Cordonnier Charlotte , Hénon Hilde
Published: July 2020

Background and Purpose:

Infarct volumes predict malignant infarcts in patients undergoing decompressive hemicraniectomy (DH) for large middle cerebral artery territory infarcts. The aim of the study was to determine the optimal magnetic resonance imaging infarct volume threshold that predicts a catastrophic outcome at 1 year (modified Rankin Scale score of 5 or death).

Methods:

We included consecutive patients who underwent DH for large middle cerebral artery infarcts. We analyzed infarct volumes before DH with semi-automated methods on b1000 diffusion-weighted imaging sequences and apparent diffusion coefficient maps. We studied infarct volume thresholds for prediction of catastrophic outcomes, and analyzed sensitivity, specificity, and the area under the curve, a value ≥0.70 indicating an acceptable prediction.

Results:

Of 173 patients (109 men, 63%; median age 53 years), 42 (24.3%) had catastrophic outcomes. Magnetic resonance imaging b1000 diffusion-weighted imaging and apparent diffusion coefficient infarct volumes were associated to the occurrence of 1-year catastrophic outcome (adjusted odds ratio, 9.17 [95% CI, 2.00–42.04] and odds ratio, 4.18 [95% CI, 1.33–13.19], respectively, per 1 log increase). The optimal volume cutoff of were 211 mL on b1000 diffusion-weighted imaging and 181 mL on apparent diffusion coefficient maps. The 2 methods showed similar sensitivities and specificities and overlapping area under the curve of 0.64 (95% CI, 0.54–0.74).

Conclusions:

In patients with large middle cerebral artery infarcts, optimal magnetic resonance imaging infarct volume thresholds showed poor accuracy and low specificity to predict 1-year catastrophic outcome, with different b1000 diffusion-weighted imaging and apparent diffusion coefficient thresholds. In the setting of DH, optimal infarct volumes alone should not be used to deny DH, irrespectively of the method used.
Two Types of Resumptive Pronouns in Swahili
Authors: Scott Tessa
Published: July 2020

In this article, I demonstrate that Swahili distinguishes two types of resumptive pronouns: (a) lower Ā-movement copies and (b) base-generated bound pronouns. These two types of resumptive pronouns are morphologically distinct: the presence of (local) person features reflects a base-generated derivation, and the absence of person features reflects Ā-movement. Crucial evidence comes from local person pronominal clefts derived from islands (bound pronoun context) and parasitic gaps (movement copy context). Inspired by Van Urk 2018, I analyze this pattern using Landau’s (2006) theory of chain reduction in which only movement copies create chains and are then subject to an algorithm that deletes person features.
Revision of the Australian bee fly genus Meomyia Evenhuis, 1983, with description of three new species (Bombyliidae, Bombyliinae, Bombyliini)
Authors: LI XUANKUN , YEATES DAVID K.
Published: July 2020

The endemic Australian bee fly genus Meomyia Evenhuis is revised, including six described species and three newly described: Meomyia hortorum sp. nov., Meomyia kochae sp. nov., Meomyia melanocincta sp. nov. Bombylius tetratrichus Walker is excluded from Meomyia and placed in Dissodesma Bowden & Li. Meomyia is characterised by the slender and elongate antennal flagellum, and the black abdominal band and dense black tuft on apex of abdomen. A key to species of Meomyia is provided. Species are found in southern Australia.
Description a new species of Nemacerota Hampson, [1893] (Lepidoptera: Thyatiridae) from the Xizang Autonomous Region, China
Authors: DA WA , RONKAY LÁSZLÓ , HAN HUILIN
Published: July 2020

A new species of Nemacerota Hampson, [1893], N. paizhenensis sp. n., is described from the Xizang Autonomous Region (= Tibet), China. The male adult and the genitalia of the new species are illustrated and compared with its most similar species: N. inouei László, Ronkay, Ronkay & Witt, 2007 and N. pectinata (Houlbert, 1921); an identification key and distribution map for all Chinese Nemacerota species are provided.
Multiple Complications in Emergency Surgery
Authors: Hatchimonji Justin S. , Swendiman Robert A. , Kaufman Elinore J. , Scantling Dane , Passman Jesse E. , Yang Wei , Kit Delgado M. , Holena Daniel N.
Published: July 2020

Background

While the use of the failure-to-rescue (FTR) metric, or death after complication, has expanded beyond elective surgery to emergency general surgery (EGS), little is known about the trajectories patients take from index complication to death.

Methods

We conducted a retrospective cohort study of EGS operations using the National Surgical Quality Improvement Project (NSQIP) dataset, 2011-2017. 16 major complications were categorized as infectious, respiratory, thrombotic, cardiac, renal, neurologic, or technical. We tabulated common combinations of complications. We then use logistic regression analyses to test the hypotheses that (1) increase in the number and frequency of complications would yield higher FTR rates and (2) secondary complications that span a greater number of organ systems or mechanisms carry a greater associated FTR risk.

Results

Of 329 183 EGS patients, 69 832 (21.2%) experienced at least 1 complication. Of the 11 195 patients who died following complication (16.0%), 8205 (63.4%) suffered more than 1 complication. Multivariable regression analyses revealed an association between the number of complications and mortality risk (odds ratio [OR] 2.37 for 2 complications vs 1, P < .001). There was a similar increase in mortality with increased complication accrual rate (OR 3.29 for 0.2-0.4 complications/day vs <0.2, P < .001). Increasing the number of types of complication were similarly associated with mortality risk.

Discussion

While past FTR analyses have focused primarily on index complication, a broader consideration of ensuing trajectory may enable identification of high-risk cohorts. Efforts to reduce mortality in EGS should focus on attention to those who suffer a complication to prevent a cascade of downstream complications culminating in death.
Factors Associated with Refractory Nasal Congestion Following Adenoidectomy
Authors: Patel Aneesh , Brook Christopher D. , Levi Jessica R.
Published: July 2020

Objective:

The objective of this study was to better characterize factors associated with refractory rhinitis in pediatric patients who underwent adenoidectomy compared to those who had symptom resolution.

Methods:

The authors conducted a case series of patients younger than 18 years old who underwent adenoidectomy at Boston Medical Center from October 2012 to December 2018. Patients who underwent tonsillectomy and adenoidectomy or who underwent adenoidectomy for indications other than rhinitis were excluded. Patients who had refractory rhinitis symptoms postoperatively were compared to those who had resolution of their symptoms using Chi-square analysis and t-tests.

Results:

One hundred three patients who had refractory symptoms following adenoidectomy were compared to 139 patients who had resolution of symptoms. Patients who had refractory symptoms had significantly higher proportion of use (89.3%, P = .0011) and higher mean number of preoperative (1.50, P = .0226) and postoperative (1.10, P < .0001) medications, including nasal saline, intranasal steroids, antihistamines, and/or antibiotics. They were more likely to receive postoperative allergy evaluations (50%, P = .0068) and repeat surgery (30.1%, P < .0001), and had a higher proportion of reported history of allergies (24.3%, P = .0089).

Conclusion:

Use and number of preoperative medications, reported history of allergies, and postoperative allergy evaluation were significantly higher in patients with refractory chronic rhinitis following adenoidectomy. This study identified differences in patients who developed refractory symptoms that may help clinical decision making for surgical management.
COVID-19 Epidemic: Clinical Characteristics of Patients in Pediatric Isolation Ward
Authors: Zhu Jian , Wu Yabin
Published: July 2020

In order to accurately admit children with COVID-19 to an isolation ward, our study retrospectively analyzed the clinical characteristics of children in isolation wards during the COVID-19 epidemic. It was found that 55 cases (83.3%) had fever and 48 cases (72.7%) coughed in the isolated area, 31 cases (47%) had a history of exposure, 26 cases (39.4%) had a decrease in lymphocytes (LYM), more than half had an increase in lactate dehydrogenase and creatine kinase isoenzyme, 14 cases (21.2%) had positive SARS-CoV-2 nucleic acid, 58 cases (87.9%) had abnormal chest computed tomography (CT), and 11 cases (16.7%) had sinus arrhythmia. Therefore, for some suspected children with COVID-19, we can make a comprehensive judgment through clinical symptoms, epidemiological history, LYM number, myocardial enzyme spectrum, chest CT, and electrocardiogram; put these children in an isolation ward for treatment; and then transfer them to a general ward for treatment after excluding COVID-19.
Absence of Pilot Monitoring Affects Scanning Behavior of Pilot Flying: Implications for the Design of Single-Pilot Cockpits
Authors: Faulhaber Anja K. , Friedrich Maik , Kapol Tatjana
Published: July 2020

Objective

This study examines whether the pilot flying’s (PF) scanning behavior is affected by the absence of the pilot monitoring (PM) and aims at deriving implications for the design of single-pilot cockpits for commercial aviation.

Background

Due to technological progress, a crew reduction from two-crew to single-pilot operations (SPO) might be feasible. This requires a redesign of the cockpit to support the pilot adequately, especially during high workload phases such as approach and landing. In these phases, the continuous scanning of flight parameters is of particular importance.

Method

Experienced pilots flew various approach and landing scenarios with or without the support of the PM in a fixed-base Airbus A320 simulator. A within-subject design was used and eye-tracking data were collected to analyze scanning behavior.

Results

The results confirm that the absence of the PM affects the PF’s scanning behavior. Participants spent significantly more time scanning secondary instruments at the expense of primary instruments when flying alone. Moreover, the frequency of transitions between the cockpit instruments and the external view increased while mean dwell durations on the external view decreased.

Conclusion

The findings suggest that the PM supports the PF to achieve efficient scanning behavior. Information should be presented differently in commercial SPO to compensate for the PM’s absence and to avoid visual overload.

Application

This research will help inform the design of commercial SPO flight decks providing adequate support for the pilot particularly in terms of efficient scanning behavior.
Role of Self-control and Money Attitude in Personal Financial Planning
Authors: Mahapatra Mousumi Singha , Mishra Ram Kumar
Published: July 2020

Having a suitable financial plan to take care of present and future financial needs as well as to balance day to day expenditure and savings is considered indispensable given the increased complexity and attention that the investment space taken in the recent times. Appreciating that there is a definitive role of intrinsic elements which can bring about a discipline to engage in the process or personal financial planning, the present study has the objective of understanding the role of self-control and money attitude in impacting personal financial planning. Considering a national sample of salaried individuals, the study has measured and collected data on self-control, money attitude and personal financial planning. Apart from conducting exploratory factor analysis, confirmatory factor analysis establishes a measurement model with satisfactory fit indices. Further, structural equation model exemplifies the positive a strong influence of self-control and money attitude on personal financial planning in presence of demographic factors viz. gender, age, education, income, job and marital status as control variables. The implications for investors, finance professional and academicians are discussed.
Contextualizing Russia and South Asia Relations through Putin’s Look East Policy
Authors: Bakare Najimdeen
Published: July 2020

Since donning the mantle of authority, President Putin has taken actions which have uninhibitedly been geared at reasserting Russia’s hegemony around the world. Putin’s Look East policy stems from his schematic geopolitics, a plan which was formally announced in 2010. Through the prism of Putin’s Look East policy, the paper contextually analyses Russia–South Asia relations, with reference to India and Pakistan. By cross-examining Russia’s official foreign policy documents, the paper establishes why South Asia is paramount to Russia’s economic and geostrategic reassertion. Every new policy has its challenges, and the same holds true for the Look East policy vis-à-vis South Asia. Premised on the unfolding geopolitics in the region, the paper surmises that striking a balance between New Delhi and Islamabad will be problematic for Moscow, just as it has always been for Washington.
Rebel Justice during Armed Conflict
Authors: Loyle Cyanne E.
Published: July 2020

Research on rebel behavior focuses on the violent conduct of these groups. Work on rebel governance, however, has documented the myriad ways in which rebel groups seek to gain legitimacy, project strength, and govern civilian populations beyond direct violence. These efforts stress the importance of governance institutions for securing cooperation and compliance from the civilian population, a central concern for rebel groups. Judicial processes are one avenue through which this cooperation and compliance can be secured. These efforts encompass a range of processes including ad hoc trials, truth commissions and commissions of inquiry, offers of amnesty, and reparations programs. Using new data on the rebel use of judicial processes from 1946 to 2011, I examine the argument that rebel judicial processes can best be understood as a mobilization strategy by the group, offering concessions to a supportive civilian population or coercion when support is weak.
The revival and refashioning of gender pay equity in New Zealand
Authors: Parker Jane , Donnelly Noelle
Published: July 2020

While the foundations for redressing gender pay inequality in New Zealand were established half a century ago, significant numbers of women still endure the sharp end of gender-based pay differentials. Following a landmark test case in the aged care sector which focused on the (re)interpretation of the Equal Pay Act 1972, gender pay equality is once again under intense scrutiny. On the 125th anniversary of women’s suffrage, the New Zealand government signalled the introduction of legislative amendments to address this enduring challenge. Although widely contested, the intent of the Equal Pay Amendment Bill is to lower the threshold for raising pay equity claims, while establishing a bargaining process for resolving them. Alongside this, the government has introduced an ambitious workplace action plan to eliminate public service gender pay gaps. Informed by gender equity policy approaches, this article examines New Zealand’s (gendered) regulatory history relating to equal pay, yielding insights into how labour law and policy have both addressed and evaded the objective of equal remuneration for work of equal value, concluding with a discussion of recent initiatives. This qualitative analysis illustrates how institutional contexts for wage-setting and value-laden equality strategies impact women’s experience of work in New Zealand.
Preservice Teachers’ Professional Noticing When Viewing Standard and 360 Video
Authors: Kosko Karl W. , Ferdig Richard E. , Zolfaghari Maryam
Published: July 2020

Use of video as a representation of practice in teacher education is commonplace. The current study explored the use of a new format (360 video) in the context of preservice teachers’ professional noticing. Findings suggest that preservice teachers viewing 360 videos attended to more student actions than their peers viewing standard video. In addition, using a virtual reality headset to view the 360 videos led to different patterns in where preservice teachers looked in the recorded classroom, and to increased specificity of mathematics content from the scenario. Thus, findings and results support the use of 360 video in teacher education to facilitate teacher noticing. However, future research is needed to further explore this novel technology.
School-Based Social-Emotional Learning and Ethnic-Racial Identity Among African American and Latino Adolescents
Authors: Rivas-Drake Deborah , Lozada Fantasy T. , Pinetta Bernardette J. , Jagers Robert J.
Published: July 2020

This study sheds light on the interrelations of universal, school-based social-emotional learning strategies and ethnic-racial identity over time. We assessed exposure to social-emotional learning practices and ethnic-racial identity exploration and resolution among 367 middle school students (70% African American, 30% Latinx; 51% girls) across 3 years. The results of a latent growth model with social-emotional learning practices as a time-varying covariate suggest that practices that afford youth opportunities for autonomy, prosocial behavioral routines, and collaboration in the context of homerooms (advisories) and classrooms were consistently associated with greater ethnic-racial identity exploration and resolution across the middle school years. Theoretical and practical implications for the potential of school-based social-emotional learning to support the development of cultural assets such as ethnic-racial identity are discussed.
Same Game, Different Names: Cream-Skimming in the Post-ACA Individual Health Insurance Market
Authors: Sacks Daniel W. , Drake Coleman , Abraham Jean M. , Simon Kosali
Published: July 2020

One of the Affordable Care Act’s (ACA) signature reforms was creating centralized Health Insurance Marketplaces to offer comprehensive coverage in the form of comprehensive insurance complying with the ACA’s coverage standards. Yet, even after the ACA’s implementation, millions of people were covered through noncompliant plans, primarily in the form of continued enrollment in “grandmothered” and “grandfathered” plans that predated ACA’s full implementation and were allowed under federal and state regulations. Newly proposed and enacted federal legislation may grow the noncompliant segment in future years, and the employment losses of 2020 may grow reliance on individual market coverage further. These factors make it important to understand how the noncompliant segment affects the compliant segment, including the Marketplaces. We show, first, that the noncompliant segment of the individual insurance market substantially outperformed the compliant segment, charging lower premiums but with vastly lower costs, suggesting that insurers have a strong incentive to enter the noncompliant segment. We show, next, that state’s decisions to allow grandmothered plans is associated with stronger financial performance of the noncompliant market, but weaker performance of the compliant segment, as noncompliant plans attract lower-cost enrollees. This finding indicates important linkages between the noncompliant and compliant segments and highlights the role state policy can play in the individual insurance market. Taken together, our results point to substantial cream-skimming, with noncompliant plans enrolling the healthiest enrollees, resulting in higher average claims cost in the compliant segment.
The Low-Carbon Imperative: Destination Management under Urgent Climate Change
Authors: Gössling Stefan , Higham James
Published: July 2020

To stay within the safe boundaries of global warming, the world now has 30 years to decarbonize its economy. This represents a very significant challenge for tourism as a growth system. Much attention has been paid to different tourism subsectors such as aviation, accommodation, and activities to reduce emissions, mostly on the basis of (future) technology. However, the Paris Agreement demands immediate action and significant year-on-year progress on a zero-carbon trajectory. This article discusses destination management under the new low-carbon imperative. It analyses challenges, including economic viability and resilience, that have also gained importance in light of the COVID-19 pandemic, and explores opportunities for better profitability on the basis of a leakage/spending value dichotomy proposition. The final section highlights the foremost role that destination managers must play in building prosperous and resilient low-carbon tourism destination systems and discusses the key insights for destination managers.
Making Things Possible
Authors: Abend Gabriel
Published: July 2020

I argue that what-makes-it-possible questions are a distinct and important kind of sociological research question. What is social phenomenon P made possible or enabled by? Results won’t be about P’s causes and causal relationships, but about its enablers and enabling relationships. I examine the character of what-makes-it-possible questions and claims, how they can be empirically investigated, and what they’re good for. If I’m right, they provide a unique perspective on social phenomena, they show how the social world doesn’t come ready-made, and they open up new avenues for research.
Associations of day of week and time of day of ICU admission with hospital mortality in Malawi
Authors: Prin Meghan , Ji Ruoyu , Kadyaudzu Clement , Li Guohua , Charles Anthony
Published: July 2020

This prospective cohort study evaluated the associations of day and time of admission to the Intensive Care Unit (ICU) with hospital mortality at a referral hospital in Malawi, a low-income country in sub-Saharan Africa. Patients admitted to the ICU during the day (08:00–16:00) were compared to those admitted at night (16:01–07:59); patients admitted on weekdays (Monday–Friday) were compared to admissions on weekends/holidays. The primary outcome was hospital mortality. Most patients were admitted during daytime (56%) and on weekdays (72%). There was no difference in mortality between night and day admissions (58% vs. 56%, P = 0.8828; hazard ratio [HR] = 1.09, 95% confidence interval [CI = 0.82–1.44, P = 0.5614) or weekend/holiday versus weekday admissions (56% vs. 57%, P = 0.9011; HR = 0.87, 95% CI = 0.62–1.21, P = 0.4133). No interaction between time and day was found. These results may be affected by high overall hospital mortality.
Accounting for standard errors of measurement when modeling change
Authors: Grimm Kevin J. , Fine Kimberly , Stegmann Gabriela
Published: July 2020

Modeling within-person change over time and between-person differences in change over time is a primary goal in prevention science. When modeling change in an observed score over time with multilevel or structural equation modeling approaches, each observed score counts toward the estimation of model parameters equally. However, observed scores can differ in terms of their precision—both within and across participants. We propose an approach to weight observed scores by their level of precision, which is estimated as the inverse of their standard error of measurement in the context of item response modeling. Thus, scores with lower standard errors of measurement have greater weight, and scores with higher standard errors of measurement are down weighted. We discuss the weighting approaches and illustrate how to apply this approach with commonly available software. We then compare this approach to modeling change without weighting based on standard errors of measurement.
Brief Workplace Interventions Addressing Burnout, Compassion Fatigue, and Teamwork: A Pilot Study
Authors: Copeland Darcy
Published: July 2020

Burnout and compassion fatigue are problematic for nurses, patients, and organizations. Identifying brief interventions nurses can engage in while at work to address compassion fatigue, burnout, and teamwork, as burnout and teamwork are inversely related, is important for all stakeholders. This quasi-experimental pilot study sought to examine the feasibility, acceptability, and effectiveness of five-minute interventions on nurses’ burnout, compassion fatigue, and perceptions of teamwork. Nurses were randomized into five groups: meditation, journaling, gratitude, outside, and control. Participants engaged in the interventions, the majority of shifts worked, and many expressed a desire to continue after the six-week intervention period. Cohen’s d effect sizes were greatest for burnout, range 0.495–0.757, and situation monitoring, range 0.252–1.1. The journaling group had the highest burnout (−11.88%), compassion satisfaction (7.54%), situation monitoring (−21.21%), and communication (−26.47%) Delta scores. Feasibility, acceptability, and effectiveness of these brief workplace interventions were preliminarily established to inform a larger study.
When we say “perceived support,” what do we mean? Contexts and components of support among people with serious medical conditions
Authors: Rivers Alannah Shelby , Sanford Keith
Published: July 2020

Perceived social support is important for numerous health outcomes in people with serious medical conditions; however, previous studies have targeted different assessment contexts (including single people or partnered people reporting on either general or relationship-specific support) and different components of perceived support (including positive and negative interactions and support availability). The present study investigated potential functional differences across these contexts and components. A sample of 340 people with serious medical conditions were recruited via market research panels to complete online questionnaires. The sample included three assessment context groups and participants completed scales assessing three components of perceived support along with criterion variables regarding treatment adherence, affect, coping, and aspects of general psychological functioning. Results suggested a high degree of functional invariance across the different assessment contexts, but important distinctions between the different components of perceived support. Following theoretical expectations, each component explained unique variance in different sets of criterion variables. Results suggest that it is meaningful for researchers to generalize across assessment contexts, but important to distinguish between components of perceived support.
Does cannabis complement or substitute alcohol consumption? A systematic review of human and animal studies
Authors: Risso Constanza , Boniface Sadie , Subbaraman Meenakshi Sabina , Englund Amir
Published: July 2020

Background:

Whether alcohol and cannabis complement or substitute each other has been studied for over two decades. In the changing cannabis policy landscape, debates are moving rapidly and spill-over effects on other substances are of interest.

Aims:

update and extend a previous systematic review, by: (a) identifying new human behavioural studies reporting on substitution and/or complementarity of alcohol and cannabis, and (b) additionally including animal studies.

Methods:

We replicated the search strategy of an earlier systematic review, supplemented with a new search for animal studies. Search results were crossed checked against the earlier review and reference lists were hand searched. Findings were synthesised using a narrative synthesis.

Results:

Sixty-five articles were included (64 in humans, one in animals). We synthesised findings into categories: patterns of use, substitution practices, economic relationship, substance use disorders, policy evaluation, others and animal studies. Overall, 30 studies found evidence for substitution, 17 for complementarity, 14 did not find evidence for either, and four found evidence for both.

Conclusions:

Overall, the evidence regarding complementarity and substitution of cannabis and alcohol is mixed. We identified stronger support for substitution than complementarity, though evidence indicates different effects in different populations and to some extent across different study designs. The quality of studies varied and few were designed specifically to address this question. Dedicated high-quality research is warranted.
Does diffusion-weighted magnetic resonance imaging have a place in the differential diagnosis of brucella sacroiliitis and seronegative spondyloarthropathy?
Authors: Karayol Sunay Sibel , Karayol Kudret Cem
Published: July 2020

Background

The aim of this study is to investigate the role of diffusion-weighted imaging (DWI) in the differential diagnosis of sacroiliitis.

Purpose

To compare the sacroiliac magnetic resonance imaging (MRI) examinations of patients with suspected active sacroiliitis with patients with acute SpA MR findings and the DWI examinations of patients with acute brucella sacroiliitis, and thereby determine whether DWI can contribute to the differential diagnosis.

Material and Methods

A total of 84 patients were included in the study and were separated into three groups: group 1 (13 women, 6 men) comprised cases with brucella positive for sacroiliitis; group 2 (17 women, 19 men) comprised cases negative for brucella but with sacroiliitis; and group 3 (16 women, 13 men) comprised cases negative for brucella and sacroiliitis.

Results

The mean bone marrow apparent diffusion coefficient (ADC) values independently of edema were determined as 0.71 × 10−3 in sacroiliitis and brucella-positive patients, as 0.53 × 10−3 in brucella-negative and sacroiliitis-positive patients, and as 0.43 × 10−3 in the control group of brucella-negative sacroiliitis-negative patients. In the ADC measurements taken from areas of evident edema in patients with sacroiliitis, the mean values were 0.13 × 10−3 in the brucella-positive group and 0.12 × 10−3 in the brucella-negative group.

Conclusion

By adding DWI, which is a rapid MR sequence, to sacroiliac joint MR examination, normal bone marrow and bone marrow with sacroiliitis can be objectively differentiated with ADC measurements in addition to visual evaluation.
Predictability of ANB, Beta, and YEN Angles as Anteroposterior Dysplasia Indicators in Gulbarga Population
Authors: Katti Chandrika G. , Mohan Archana , A Abhi
Published: July 2020

In orthodontics, various methods of assessing sagittal jaw base relationship are formulated. Earlier, skeletal pattern was analyzed only clinically; however, after the introduction of cephalometrics by Broadbent and Hofrath in 1931, ANB and Beta angles are being used to describe skeletal discrepancies between the maxilla and mandible. YEN angle has also been used as a sagittal dysplasia indicator after its introduction in 2009. The aim of our study is to assess the predictability of ANB, Beta, and YEN angles as anteroposterior dysplasia indicators in skeletal class II malocclusion in Gulbarga population. This study is an attempt to check the variation as well as correlation existing between these 3 parameters, so that a more presumable and least variable parameter can be obtained. Total of 70 lateral cephalograms of skeletal class II patients were selected based on Down’s facial angle and tracing was carried out manually to measure ANB, Beta, and YEN angles. Statistical analysis was carried out to assess the coefficient of variation and the Pearson coefficient. Our study concluded that YEN angle is highly predictable and a homogenously distributed angular parameter used to assess sagittal discrepancy in class II patients compared to ANB and Beta angles.
The Effect of Facilitative Versus Inhibitory Word Training Corpora on Word Reading Accuracy Growth in Children With Dyslexia
Authors: Steacy Laura M. , Petscher Yaacov , Elliott James D. , Smith Kathryn , Rigobon Valeria M. , Abes Daniel R. , Edwards Ashley A. , Himelhoch Alexandra C. , Rueckl Jay G. , Compton Donald L.
Published: July 2020

We modeled word reading growth in typically developing ( n = 118) and children with dyslexia ( n = 20), Grades 2–5, across multiple exposures to 30 words. We explored the facilitative versus inhibitory effects of exposures to differential mixes of words that support high- versus low-frequency vowel pronunciations. One training corpus contained a ratio of 80%–20% high- to low-frequency pronunciations (e.g., for ea; 80% ea pronounced as /i/ as in bead and 20% ea pronounced /ε/ as in dead), whereas the other consisted of a ratio of 20%–80%. We also modeled accuracy at the final exposure for a subset of 12 shared words across conditions using item-level crossed-random effects models with reading skill (i.e., typically developing vs. dyslexic), condition, word frequency, and vowel pronunciation (i.e., high- vs. low-frequency vowel pronunciation) as predictors in the model. We were particularly interested in the interaction between condition and vowel pronunciation across reading groups. Results suggest typically developing children were influenced by the interaction between condition and vowel pronunciation, suggesting both facilitation and inhibition, whereas children with dyslexia were influenced by condition and vowel pronunciation without an interaction. Results are interpreted within the overfitting model of dyslexia.
How Valid is the Question of Fear of a Partner in Identifying Intimate Partner Abuse? A Cross-Sectional Analysis of Four Studies
Authors: Signorelli Marcos , Taft Angela , Gartland Deirdre , Hooker Leesa , McKee Christine , MacMillan Harriet , Brown Stephanie , Hegarty Kelsey
Published: July 2020

Intimate partner abuse (IPA) affects women’s health, requiring accurate questions to identify the abuse. We investigated the accuracy of three questions about fear of an intimate partner in identifying exposure to IPA. We compared the sensitivity and specificity of these questions with the Composite Abuse Scale (CAS) using secondary data analysis of four existing studies. All studies recruited adult women from clinical settings, with sample sizes ranging from 1,257 to 5,871. We examined associations between demographic factors and fear through multivariate logistic regression, and analysis of the sensitivity and specificity of the questions about fear and IPA (CAS), generating a receiver operating curve (ROC). The prevalence of lifetime fear of a partner ranged from 9.5% to 26.7%; 14.0% of women reported fear in the past 12 months; and current fear ranged from 1.3% to 3.3%. Comparing the three questions, the question “afraid of a partner in the past 12 months” was considered the best question to identify IPA. This question had the greatest area under the ROC (0.80, 95% confidence interval (CI) = [0.78–0.81]) compared with “are you currently afraid” (range 0.57–0.61) or “have you ever been afraid” (range 0.66–0.77); and demonstrated better sensitivity (64.8%) and specificity (94.8%). Demographic factors associated with “fear of a partner in the past 12 months” included being divorced/separated (odds ratio [OR] = 8.49, 95% CI = [6.70–10.76]); having a low income (OR = 4.21, 95% CI = [3.46–5.13]); and having less than 12 years of education (OR = 2.48, 95% CI = [2.04–3.02]). The question “In the last 12 months did you ever feel frightened by what your partner says or does?” has potential to identify a majority of women experiencing IPA, supporting its utilization where more comprehensive measures are not possible.
Comparison of Narrow-Versus Broad-Spectrum Antibiotics in Elderly Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease
Authors: Joyner Kayla R. , Walkerly Autumn , Seidel Kelsey , Walsh Nicholas , Damshekan Neda , Perry Tyler , Soric Mate M.
Published: July 2020

Background

Little evidence is available regarding the choice of empiric antibiotic therapy in elderly patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). The primary objective of this study is to compare the outcomes of elderly patients receiving broad- versus narrow-spectrum antibiotics during hospitalization for AECOPD.

Design

A multicenter, retrospective, cohort analysis was performed. Inpatients 65 years and older with a primary discharge diagnosis of AECOPD who received ≥48 hours of antibiotic therapy were included in the study population. Patients were compared based on the spectrum of their antibiotic therapy. Narrow-spectrum antibiotics included: azithromycin, doxycycline, sulfamethoxazole/trimethoprim, or aminopenicillin. The primary outcome was a composite of mechanical ventilation 48 hours after admission, transfer to the intensive care unit 48 hours after admission, 30-day chronic obstructive pulmonary disease (COPD) readmission, and oxygen saturation less than 90% on room air or increased oxygen requirements from baseline 48 hours after admission.

Results

Two hundred fifty-three patients were included in this analysis; 127 patients were included in the narrow-spectrum group, and 126 patients were included in the broad-spectrum group. Patient demographics and comorbid conditions were similarly distributed in each group. The incidence of the primary composite outcome occurred in 50 (39.3%) and 60 (47.6%) of patients in the narrow- and broad-spectrum groups, respectively ( P = .19).

Conclusions and Relevance

No difference was found in the primary outcome in inpatients aged ≥65 years with AECOPD who received empiric broad-spectrum or narrow-spectrum antibiotics.