bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychosocial Aspects of Participation in Competitive Sports Among Older Athletes: A Scoping Review
Authors: Cannella Valentina , Villar Feliciano , Serrat Rodrigo , Tulle Emmanuelle
Published: June 2021

Background and Objectives

In the last decade, sport has been considered a tool in active aging to maintain physical fitness, improve mental well-being, and form social relationships among older people. However, a thorough psychosocial understanding of the phenomenon of older athletes competing in sports events is lacking. Most research has focused on competitive sports participation in the young population. This study analyzes the general state of knowledge of competitive sports participation among athletes aged 50 years and older from a psychosocial perspective.

Research Design and Methods

We followed the 5-step process outlined by Arksey and O’Malley. After the search in 4 electronic databases, 69 peer-reviewed articles met the inclusion criteria.

Results

The findings indicate that psychosocial research into older people’s participation in competitive sports has grown moderately in the last decade. While intrapersonal and interpersonal aspects have dominated the academic psychosocial discourse on older athletes’ competitive sports participation, aspects related to the environment/community and policy have largely been overlooked.

Discussion and Implications

We identified several critical gaps in the literature, classified into conceptual (e.g., lesser attention to personality, emotional, and cognitive aspects), methodological (e.g., longitudinal studies almost absent), and diverse aspects (e.g., focus on a wide indiscriminate age range; few comparisons between types of sports; underrepresentation of some nation or world regions as well as few cross-national comparative studies). These research gaps hint at opportunities that future research on older people’s participation in competitive sports should address.
Resituating Henrician Ireland: imperium, prophecy and Reformation between the Atlantic and Eurasian worlds, 1514–47
Authors: Leduc James
Published: June 2021

An intellectual-cultural history of sovereignty in Henrician Ireland, this article mines government writings and printed pamphlets to argue for Ireland’s integration within the dynastic strife, spiritual controversies and imperial ambitions that bridged the ‘New World’, the North Atlantic and the Mediterranean in the early Reformation. Its conclusions are twofold: that the Henrician Reformation galvanized the political theologies of interfaith representation in Ireland, and that the island felt the weight of European Atlantic colonialism earlier than has hitherto been appreciated. The article suggests the need to reconsider Henrician Ireland in its entanglements with the political-theological Reformation worlds of inter-imperial rivalry.
MiR-133a-3p inhibits the malignant progression of oesophageal cancer by targeting CDCA8
Authors: Wang Xin , Zhu Lihuan , Lin Xing , Huang Yangyun , Lin Zhaoxian
Published: June 2021

The study aims to explore the interaction between miR-133a-3p and cell division cycle associated 8 (CDCA8) in oesophageal cancer (EC) and their effect on malignant behaviour of EC cells. Differential miRNAs and mRNAs were obtained from The Cancer Genome Atlas (TCGA) database. Quantitative real-time PCR (qRT-PCR) was used to detect the expression levels of miR-133a-3p and CDCA8 mRNA in EC cells. Western blot was used to detect the expression of CDCA8 protein. CCK-8, flow cytometry and Transwell assays were conducted to detect cell proliferation, cell cycle and apoptosis, as well as migration and invasion, respectively. The targeting relationship between miR-133a-3p and CDCA8 was verified by dual-luciferase reporter gene assay. In EC, miR-133a-3p expression was evidently low and CDCA8 expression was prominently high. MiR-133a-3p downregulated CDCA8 expression. A range of cell function experiments revealed that CDCA8 promoted the proliferation, migration and invasion of EC cells, reduced cell cycle arrest in G0/G1 phase and inhibited cell apoptosis, while miR-133a-3p could reverse the above effects by regulating CDCA8. MiR-133a-3p is a crucial tumour suppressor miRNA in EC, playing a tumour suppressor role by targeting CDCA8.
Adjudication at the Service of Diplomacy: The Enrica Lexie Case
Authors: Tanzi Attila M
Published: June 2021

The article addresses the Enrica Lexie case as an example of integration between adjudicative and diplomatic means of dispute settlement. It illustrates the case focusing on the Tribunal’s assessment of the scope of its jurisdiction and of the applicable law. The article is organised in four parts, next to the introduction. First, it places the case in the context of the relationship between adjudication and diplomacy in the settlement of international disputes. Second, it illustrates the case as a dispute over the interpretation and application of UNCLOS. Third, it addresses the relevance of the immunity of the marines for the purposes of the jurisdiction of the Tribunal and the applicable law. Finally, it concludes with few general policy remarks on the beneficial impact of the Award for the disputing and third Parties, as to the balancing of the interests of flag-States and costal-States in interpreting and applying freedom of navigation.
Radiopharmaceutical preparations: what are the legislative differences across Europe?
Authors: Giustiniani Matteo , Musazzi Umberto M , Minghetti Paola , Paolino Donatella
Published: June 2021

Objectives

Radiopharmaceuticals, since the discovery of the first medical application of radioactive isotope, have been essential therapeutics for the diagnosis and treatment of numerous diseases. Since the Directive 2001/83/EC entered in force, European regulatory authorities have established a harmonised framework to set quality requirements for the industrial production of radiopharmaceuticals. However, little is known about the harmonisation of extemporaneous preparation of radiopharmaceutical preparations (EPRPs) among European countries. In this context, this study aims to provide an overview of the national regulatory framework on the production of EPRPs of five European countries (i.e. UK, Spain, France, Germany and Italy).

Methods

Five different national regulatory frameworks were compared based on the results of a literature search on electronic databases (i.e. PubMed, Google scholar).

Key findings

Unlike industrially produced radiopharmaceuticals, the results highlighted that the regulatory framework on EPRPs is still not fully harmonised at the European level and many provisions are regulated by local national laws. Similarities and differences exist among the European countries, both regarding quality standards and educational courses the operators involved in the preparation of EPRPs have to attend.

Conclusions

The regulatory framework on the EPRPs is still not harmonised at the European level affecting the access to therapies of European citizens who are not equally guaranteed when an extemporaneous radiopharmaceutical has to be prepared to meet their needs.
Rewilding crops for climate resilience: economic analysis and de novo domestication strategies
Authors: Razzaq Ali , Wani Shabir Hussain , Saleem Fozia , Yu Min , Zhou Meixue , Shabala Sergey
Published: June 2021

To match predicted population growth, annual food production should be doubled by 2050. This is not achievable by current agronomical and breeding practices, due to the impact of climate changes and associated abiotic stresses on agricultural production systems. Here, we analyze the impact of global climate trends on crop productivity and show that the overall loss in crop production from climate-driven abiotic stresses may exceed US$170 billion year–1 and represents a major threat to global food security. We also show that abiotic stress tolerance had been present in wild progenitors of modern crops but was lost during their domestication. We argue for a major shift in our paradigm of crop breeding, focusing on climate resilience, and call for a broader use of wild relatives as a major tool in this process. We argue that, while molecular tools are currently in place to harness the potential of climate-resilient genes present in wild relatives, the complex polygenic nature of tolerance traits remains a major bottleneck in this process. Future research efforts should be focused not only on finding appropriate wild relatives but also on development of efficient cell-based high-throughput phenotyping platforms allowing assessment of the in planta operation of key genes.
Design and Assessment of a Mobile Health Care Solution for the Military Pediatrician: The DHA Pediatrics App
Authors: Reeves Patrick T , Royall Matthew , Spencer Steven , Rogers Philip L , Durning Steven J , Samuel Anita , O’Meara Kevin , Gorman Gregory
Published: June 2021

Introduction

Mobile health technology design and use by patients and clinicians have rapidly evolved in the past 20 years. Nevertheless, the technology has remained in silos of practices, patients, and individual institutions. Uptake across integrated health systems has lagged.

Materials and Methods

In 2015, the authors designed a mobile health application (App) aimed at augmenting the capabilities of clinicians who care for children within the Military Health System (MHS). This App incorporated a curated, system-based collection of Clinical Practice Guidelines, access to emergency resuscitation cards, call buttons for local market subspecialty and inpatient teams, links to residency academic calendars, and other web-based resources. Over the next 5 years, three Plan-Do-Study-Act cycles facilitated multiple enhancements for the App which eventually transitioned from the Android/iOS stores to a web browser. The “People At the Centre of Mobile Application Development” tool which has validity evidence captured user experience. The team assessed the App’s global effectiveness using Google Analytics. A speed test measured time saved and accuracy of task completion for clinicians using the App compared to non-users. Finally, MHS medical librarians critiqued the App using a questionnaire with validity evidence. The Walter Reed National Military Medical Center Institutional Review Board reviewed the study and deemed it exempt.

Results

Clinician respondents (n = 68 complete responses across six MTFs, 51% graduate medical trainees representing a 7.4% response rate of active duty pediatrician forces) perceived the App to have appropriate qualities of efficiency, effectiveness, learnability, memorability, errors, satisfaction, and cognitive properties following App use in clinical practice. Google Analytics demonstrated more than 1,000 unique users on the App from May 1, 2020 to January 20, 2021. There were 746 instances (26% of all sessions) when a user navigated between more than one military treatment facility. App users were faster and more accurate at task completion during a digital scavenger hunt. Medical librarians measured the App to have acceptable usefulness, accuracy, authority, objectivity, timeliness, functionality, design, security, and value.

Conclusions

The App appears to be an effective tool to extend a clinician’s capabilities and inter-professional communication between world-wide users and six MHS markets. This App was designed—and used—for a large health care network across a wide geographic footprint. Next steps are establishing an enduring chain of App champions for continued updates and sharing the App’s code with other military medical disciplines and interested civilian centers.
The Efficacy of Bamlanivimab in Reducing Emergency Department Visits and Hospitalizations in a Real-world Setting
Authors: Corwin Douglas S , Ender Peter T , Sahu Nitasa , Durgham Ryan A , McGorry Dennis M , Rahman Awan , Stoltzfus Jill , Jahre Jeffrey A
Published: June 2021

Bamlanivimab, a monoclonal antibody targeting the spike protein of severe acute respiratory syndrome coronavirus 2, is available for ambulatory treatment of coronavirus disease 2019 (COVID-19). This real-world study confirms the efficacy of bamlanivimab in reducing hospital admissions and emergency department visits among high-risk outpatients with mild to moderate COVID-19 illness and reveals a trend toward improved mortality.
Delayed admissions and efficacy of steroid use in patients with critical and severe COVID-19: an apprehensive approach
Authors: Akhtar Hashaam , Khalid Sundas , Rahman Fazal-ur- , Ali Sabahat , Afridi Maham , Khader Yousef S , Hassan Faheem , Akhtar Nasim , Khan Muhammad Mujeeb , Ikram Aamer
Published: June 2021

Background

Inadvertent delays in access to appropriate therapeutic interventions in high-risk group coronavirus disease 2019 (COVID-19) patients contribute to mortality in patients with severe/critical disease presentation.

Objectives

The aim of this study was to determine the effect of timely admission to the hospital on mortality of patients with severe/critical COVID-19. Another secondary aspect of this study was to observe the efficacy of time-dependent use of corticosteroids on mortality of critical/severe COVID-19 patients.

Methods

Clinical data of 659 patients with severe/critical COVID-19, admitted to four major tertiary care hospitals from the Islamabad-Rawalpindi region of Pakistan was retrospectively collected from a period February–August 2020. Multivariate logistic regression analysis was carried out to determine the predictors of mortality in severe/critical COVID-19 patients.

Results

Out of a total of 659 patients, 469 (71.2%) patients died. Age > 60 years, presence of hypertension, heart disease and kidney disease along with late admission (>5 days) were significant predictors of mortality in patients with severe/critical COVID-19.

Conclusions

The study highlights the importance of well-timed provision of appropriate medical interventions control COVID-19-associated mortality.
Regulation and Characterization of Mutants of fixABCX in Rhizobium leguminosarum
Authors: Webb Isabel U. C. , Xu Jiabao , Sánchez-Cañizares Carmen , Karunakaran Ramakrishnan , Ramachandran Vinoy K. , Rutten Paul J. , East Alison K. , Huang Wei E. , Watmough Nicholas J. , Poole Philip S.
Published: June 2021

Symbiosis between Rhizobium leguminosarum and Pisum sativum requires tight control of redox balance in order to maintain respiration under the microaerobic conditions required for nitrogenase while still producing the eight electrons and sixteen molecules of ATP needed for nitrogen fixation. FixABCX, a cluster of electron transfer flavoproteins essential for nitrogen fixation, is encoded on the Sym plasmid (pRL10), immediately upstream of nifA, which encodes the general transcriptional regulator of nitrogen fixation. There is a symbiotically regulated NifA-dependent promoter upstream of fixA (PnifA1), as well as an additional basal constitutive promoter driving background expression of nifA (PnifA2). These were confirmed by 5′-end mapping of transcription start sites using differential RNA-seq. Complementation of polar fixAB and fixX mutants (Fix− strains) confirmed expression of nifA from PnifA1 in symbiosis. Electron microscopy combined with single-cell Raman microspectroscopy characterization of fixAB mutants revealed previously unknown heterogeneity in bacteroid morphology within a single nodule. Two morphotypes of mutant fixAB bacteroids were observed. One was larger than wild-type bacteroids and contained high levels of polyhydroxy-3-butyrate, a complex energy/reductant storage product. A second bacteroid phenotype was morphologically and compositionally different and resembled wild-type infection thread cells. From these two characteristic fixAB mutant bacteroid morphotypes, inferences can be drawn on the metabolism of wild-type nitrogen-fixing bacteroids.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Care Delivery in Cancer Patients With Asymptomatic COVID-19 Infection in a Tertiary, Safety-Net Hospital in Houston, Texas
Authors: Chen Nan , Jotwani Aparna , Li Ang
Published: June 2021

Objectives:

Current coronavirus disease 2019 (COVID-19) guidelines recommend delaying clinical care for all affected cancer patients, including incidentally diagnosed asymptomatic infections. This retrospective study conducted in a safety-net hospital in Houston examines the care delivery of asymptomatic COVID-19 cancer patients and how their diagnosis affected their care.

Methods:

A retrospective chart review was conducted on cancer patients with a documented positive SARS-CoV-2 laboratory result in the Harris Health System in Houston, Texas. Patient demographics, treatment delays, and patient outcomes were analyzed.

Results:

Thirteen percent (n=24) of all patients with cancer and COVID-19 diagnosis (n=181) were asymptomatic and 96% had a solid organ malignancy. Among asymptomatic patients, 44% (n=11) of them experienced a median treatment delay of 33 days and 21% (n=5) transitioned to hospice. No patients had progression of disease at first evaluation after recovering from COVID-19 diagnosis. Asymptomatic patients were more likely to have a worse ECOG performance status, metastatic disease, and charity insurance as compared with symptomatic patients.

Conclusions:

This study supports the safety of our current isolation guidelines for all COVID-19 asymptomatic cancer patients. While treatment delays occurred, they did not appear to significantly impact overall care. Differences in care delivery and health care usage patterns between symptomatic and asymptomatic patients demonstrate the need for continued studies in vulnerable populations.
Outcomes of Immune Checkpoint Inhibitor–related Diarrhea or Colitis in Cancer Patients With Superimposed Gastrointestinal Infections
Authors: Ma Weijie , Gong Zimu , Abu-Sbeih Hamzah , Peng Yuanzun , Peng Frederick , Zou Fangwen , Charabaty Aline , Okhuysen Pablo C. , McQuade Jennifer L. , Altan Mehmet , Zhang Hao Chi , Thomas Anusha S. , Wang Yinghong
Published: June 2021

Background and Objective:

Immune-mediated diarrhea and colitis (IMDC) is a common adverse event in cancer patients receiving immune checkpoint inhibitors (ICIs). Gastrointestinal (GI) infections can co-occur with IMDC, and its impact on the course and outcome of IMDC remains unclear.

Patients and Methods:

We retrospectively reviewed cancer patients who received ICIs and developed IMDC between January 2015 and September 2019. GI multiplex panel is used to assess GI infection. The study group included patients with positive infection except those who are only positive for Clostridioides difficile or cytomegalovirus. The control group is IMDC patients with negative infection using frequency matching. Patients’ disease course and outcome were compared between groups.

Results:

A total of 72 patients with IMDC were included: 22 in the study group and 50 as control. Escherichia coli of different pathotypes was observed in 17 patients. Five patients had viral infections, for example, adenovirus, norovirus, and sapovirus. Patients with GI infections more frequently had grade 3 or 4 colitis (43% vs. 18%, P=0.041). Overall, GI infections were not associated with different risks of IMDC recurrence or overall survival. Antibiotics treatment did not affect the requirement for infliximab or vedolizumab but relate to a higher risk of IMDC recurrence (50.0% vs. 0.0%, P=0.015).

Conclusions:

In our study, concomitant GI infections are associated with more severe symptoms in IMDC patients. Antimicrobial treatment did not circumvent the need for immunosuppressive therapy for IMDC or improve the clinical outcome. Concomitant GI infection was not associated with a higher risk of IMDC recurrence or poor overall survival.
Established Trauma Triage Score Predicts Risk of Falling After Femoral Neck Fracture Arthroplasty Surgery
Authors: Konda Sanjit R. , Perskin Cody R. , Parola Rown , Littlefield Connor P. , Egol Kenneth A.
Published: June 2021

Introduction:

The purpose of this study is to determine whether the Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA) patients is able to predict fall, fracture, periprosthetic fracture, or dislocation risk after femoral neck fracture arthroplasty surgery.

Methods:

Four hundred one patients who underwent hip arthroplasty surgery after a femoral neck fracture at one urban academic medical center were stratified into groups based on their risk scores assigned at femoral neck fracture presentation. The cohort was reviewed for the occurrence of postdischarge falls, secondary fractures, and prosthetic dislocations that resulted in a presentation to the emergency department (ED) after discharge from their hip fracture surgery. The incidence and timing of these complications after discharge were compared between the low-risk and high-risk groups.

Results:

The low-risk group included 201 patients, and the high-risk group included 200 patients. The high-risk group had significantly more postdischarge falls resulting in ED presentation (49 vs. 32, p = .035) that occurred significantly sooner (12.6 vs. 18.3 months, p = .034) after discharge.

Conclusions:

The STTGMA model was able to successfully stratify patients who are at a higher risk of sustaining a fall after an arthroplasty procedure for a femoral neck fracture.
Expansion of telehealth in primary care during the COVID-19 pandemic: benefits and barriers
Authors: Dhaliwal Jaspreet K. , Hall Tara D. , LaRue Julie L. , Maynard Susan E. , Pierre Peterson E. , Bransby Kristen A.
Published: June 2021

The novel coronavirus disease 2019 (COVID-19) pandemic remarkably accelerated the adoption of telemedicine in outpatient settings. Out of necessity, virtual care became a preferred and default modality of extending primary care services to health care consumers. Although telemedicine is not a new concept and had been used in many organizations and health systems, the COVID-19 pandemic scaled up its use in a variety of health care settings. Telehealth's use in primary care was particularly important because of the need to maintain continuity of care for successful coordination of chronic disease management. This article examines the benefits of telehealth, including continuity of care, convenience of access to care, screening and triaging, and social distancing and disease prevention. The utilization of telehealth and financial implications are discussed, including reimbursement and cost-effectiveness. Barriers and challenges are addressed, including methods for successful implementation of nurse practitioner (NP) in primary care practices as a response to the COVID-19 pandemic. The leadership role of the NP in telehealth is discussed and implementation guidance is provided.
Frequency and Correlates of Mycoplasma genitalium Antimicrobial Resistance Mutations and Their Association With Treatment Outcomes: Findings From a National Sentinel Surveillance Pilot in England
Authors: Fifer Helen , Merrick Rachel , Pitt Rachel , Yung Mandy , Allen Hester , Day Michaela , Sinka Katy , Woodford Neil , Mohammed Hamish , Brown Colin S. , Hughes Gwenda , Cole Michelle ,   on behalf of the MARS Collaborators Group
Published: June 2021

Background

Mycoplasma genitalium infection is a public health concern due to extensive antimicrobial resistance. Using data from a pilot of M. genitalium antimicrobial resistance surveillance, we determined the prevalence and risk factors for resistance among specimens from sexual health clinic attendees and assessed treatment outcomes.

Methods

Seventeen sexual health clinics in England sent consecutive M. genitalium–positive specimens to the national reference laboratory from January to March 2019. Regions of the 23S rRNA, parC, and gyrA genes associated with macrolide and fluoroquinolone resistance, respectively, were amplified and sequenced where appropriate. Fisher exact tests, and univariate and multivariable logistic regression models were used to determine associations between demographic, clinical, and behavioral factors and resistance-associated mutations.

Results

More than two-thirds (173 of 249 [69%]) of M. genitalium specimens had mutations associated with macrolide resistance, whereas predicted fluoroquinolone (21 of 251 [8%]) and dual-drug (12 of 237 [5%]) resistance were less prevalent. No specimens had both gyrA and parC resistance-associated mutations. Macrolide resistance was more common in specimens from men who have sex with men compared with heterosexual men (adjusted odds ratio, 2.64; 95% confidence interval, 1.09–6.38; P = 0.03). There was an association between both macrolide and fluoroquinolone resistance and having a previous sexually transmitted infection (P = 0.06).

Only 19% of individuals returned for a test of cure. Of those infected with a macrolide-resistant genotype who were given azithromycin, 57 of 78 (73%) were known or assumed to be clinically cured; however, 43 of these 57 (75%) also received doxycycline. Of the 21 with a macrolide-resistant genotype who failed treatment, 18 of 21 (86%) also received doxycycline.

Conclusions

Although macrolide resistance was widespread, particularly among specimens from men who have sex with men and those with a previous sexually transmitted infection diagnosis in the past year, resistance-associated mutations in M. genitalium did not seem to be unequivocally predictive of treatment failure.
PAX7 Is a Sensitive Marker of Skeletal Muscle Differentiation in Rhabdomyosarcoma and Tumors With Rhabdomyosarcomatous Differentiation in the Female Genital Tract
Authors: Weiel Julianna J. , Kokh Dina , Charville Gregory W. , Longacre Teri A.
Published: June 2021

In the female genital tract, rhabdomyosarcoma may occur in “pure” form or as a heterologous constituent of a biphasic neoplasm such as carcinosarcoma or adenosarcoma. Discriminating rhabdomyosarcoma from its histologic mimics relies on confirmation of skeletal muscle differentiation by morphology or immunohistochemistry (IHC), which can be challenging to interpret in some cases owing to limited expression. PAX7, a transcription factor expressed in mammalian muscle progenitor cells, has been reported in up to 86% of soft tissue rhabdomyosarcomas by IHC. To determine whether PAX7 IHC could augment current approaches to identify rhabdomyosarcoma in gynecologic malignancies, we assessed PAX7, myogenin, and MyoD1 IHC on whole tissue sections from 100 gynecologic tumors: 50 with rhabdomyosarcomatous differentiation and 50 with features mimicking rhabdomyosarcoma. PAX7 expression was present in 96% (48/50) of gynecologic tumors with rhabdomyosarcomatous differentiation and was absent in all rhabdomyosarcoma mimics; it was more diffusely expressed than myogenin in 16 cases and was positive in a greater percentage of tumor cells in 28 cases. PAX7 and myogenin were typically coexpressed, and no rhabdomyosarcoma exhibited complete absence of both markers; however, 2 myogenin-negative tumors were PAX7-postive. Morphologically, PAX7 localized to the nuclei of primitive-appearing cells, whereas myogenin was observed in maturing rhabdomyoblasts including strap cells. Our findings highlight the utility of PAX7 as a complementary diagnostic marker of rhabdomyosarcomatous differentiation in gynecologic tumors. PAX7 should be used in combination with other markers of skeletal muscle differentiation, namely myogenin, and may be particularly helpful in cases where myogenin and/or MyoD1 expression is limited.
Hospital effects drive variation in access to inpatient rehabilitation after trauma
Authors: Lussiez Alisha , Montgomery John R. , Sangji Naveen F. , Fan Zhaohui , Oliphant Bryant W. , Hemmila Mark R. , Dimick Justin B. , Scott John W.
Published: June 2021

BACKGROUND

Postacute care rehabilitation is critically important to recover after trauma, but many patients do not have access. A better understanding of the drivers behind inpatient rehabilitation facility (IRF) use has the potential for major cost-savings as well as higher-quality and more equitable patient care. We sought to quantify the variation in hospital rates of trauma patient discharge to inpatient rehabilitation and understand which factors (patient vs. injury vs. hospital level) contribute the most.

METHODS

We performed a retrospective cohort study of 668,305 adult trauma patients admitted to 900 levels I to IV trauma centers between 2011 and 2015 using the National Trauma Data Bank. Participants were included if they met the following criteria: age >18 years, Injury Severity Score of ≥9, identifiable injury type, and who had one of the Centers for Medicare & Medicaid Services preferred diagnoses for inpatient rehabilitation under the “60% rule.”

RESULTS

The overall risk- and reliability-adjusted hospital rates of discharge to IRF averaged 18.8% in the nonelderly adult cohort (18–64 years old) and 23.4% in the older adult cohort (65 years or older). Despite controlling for all patient-, injury-, and hospital-level factors, hospital discharge of patients to IRF varied substantially between hospital quintiles and ranged from 9% to 30% in the nonelderly adult cohort and from 7% to 46% in the older adult cohort. Proportions of total variance ranged from 2.4% (patient insurance) to 12.1% (injury-level factors) in the nonelderly adult cohort and from 0.3% (patient-level factors) to 26.0% (unmeasured hospital-level factors) in the older adult cohort.

CONCLUSION

Among a cohort of injured patients with diagnoses that are associated with significant rehabilitation needs, the hospital at which a patient receives their care may drive a patient’s likelihood of recovering at an IRF just as much, if not more, than their clinical attributes.

LEVEL OF EVIDENCE

Care management, level IV.
Contemporary utility of diagnostic peritoneal aspiration in trauma
Authors: Schellenberg Morgan , Owattanapanich Natthida , Emigh Brent , Karavites Lindsey , Clark Damon H. , Lam Lydia , Inaba Kenji
Published: June 2021

BACKGROUND

Focused Assessment with Sonography for Trauma (FAST) has supplanted diagnostic peritoneal lavage (DPL) as the preferred bedside evaluation for traumatic hemoperitoneum. Diagnostic peritoneal aspiration (DPA) is a simpler, faster modification of DPL with an unclear role in contemporary practice. This study delineated modern roles for DPA and defined its diagnostic yield.

METHODS

All trauma patients presenting to our Level I center who underwent DPA were included (May 2015 to May 2020). Demographics, comorbidities, clinical/injury data, and outcomes were collected. The diagnostic yield and accuracy of DPA were calculated against the criterion standard of hemoperitoneum at exploratory laparotomy or computed tomography scan.

RESULTS

In total, 41 patients underwent DPA, typically after blunt trauma (n = 37, 90%). Patients were almost exclusively hypotensive (n = 20, 49%) or in arrest (n = 18, 44%). Most patients had an equivocal or negative FAST and hypotension or return of spontaneous circulation after resuscitative thoracotomy (n = 32, 78%); or had a positive FAST and known cirrhosis (n = 4, 10%). In two (5%) patients, one obese, the catheter failed to access the peritoneal cavity. Diagnostic peritoneal aspiration sensitivity, specificity, positive predictive value, and negative predictive value were 80%, 100%, 100%, and 90%, with an accuracy of 93%. One (2%) complication, a small bowel injury, occurred.

CONCLUSION

Despite near ubiquitous FAST availability, DPA remains important in diagnosing or excluding hemoperitoneum with exceedingly low rates of failure and complications. Diagnostic peritoneal aspiration is most conclusive when positive, without false positives in this study. Diagnostic peritoneal aspiration was most used among blunt hypotensive or postarrest patients who had an equivocal or negative FAST, in whom the preliminary diagnosis of hemoperitoneum is a critically important decision making branch point.

LEVEL OF EVIDENCE

Diagnostic, level III.
Combat-related ocular injuries in the Israel Defense Forces during the years 2013 to 2019
Authors: Shakarchy-Kaminsky Nitzan , Megreli Jacob , Kaminsky Dan , Tsur Avishai M. , Nadler Roy , Radomislensky Irina , Gelikas Shaul , Glassberg Elon , Benov Avi , Furer Ariel
Published: June 2021

BACKGROUND

Ocular injuries account for up to 13% of battle injuries, despite the implementation of advanced protective eyewear (PE). The aim of this study was to describe the extent of ocular injuries over the last years among Israel Defense Forces soldiers and to examine the change in PE policy introduced in 2013 and the effect of a high-intensity conflict on ocular injury characteristics.

METHODS

This retrospective registry-based analysis derived data from the Israel Defense Forces Trauma Registry and included soldiers who sustained combat-related ocular injuries between the years 2013 and 2019. Demographic data and injury characteristics of casualties, as well as information regarding the use of PE, were collected and analyzed.

RESULTS

A total of 2,312 military casualties were available for this study; the incidence of combat-related ocular injuries was 8.9% (n = 113). Ocular injuries occurred among male soldiers (98.2%) with a mean ± SD age of 22.7 ± 4.6 years; mechanism of injury was penetrating in 59.3% of the casualties and blunt in 22.1% of the casualties, ocular injury was isolated in 51.3% of the casualties, and others sustained concomitant injuries including head (32.7%), upper extremity injury (17.7%), lower extremity (15.9%), torso (8.0%), neck (6.2%), and other (5.9%) injuries. Ocular injuries rate was similar among casualties who used PE (11.2%) and those who did not use PE (13.0%) while injured (p = 0.596). Rate of open globe injuries was 9.1% in casualties who used PE and 39.5% (p = 0.002) in casualties who did not.

CONCLUSION

Eye protection may significantly reduce ocular injuries severity. Education of the combatants on the use of PE and guidance of medical teams on proper assessment, initial treatment, and rapid evacuation of casualties are needed to improve visual outcomes of the casualties further.

LEVEL OF EVIDENCE

Epidemiological study, level IV.
HLA-DR Mismatch and Black Race Are Associated With Recurrent Autoimmune Hepatitis After Liver Transplantation
Authors: McCabe Marshall , Rush Natalia , Lammert Craig , Patidar Kavish R. , Nephew Lauren , Saxena Romil , Ekser Burcin , Salven James , Kubal Chandrashekhar , Ghabril Marwan
Published: June 2021

Background.

The predictors of recurrent autoimmune hepatitis (R-AIH) after liver transplantation (LT) are heterogeneous with limited data to guide immunosuppression, with little data on impact of race.

Aims.

To describe the incidence, predictors, and outcomes of R-AIH.

Methods.

We studied patients undergoing LT for AIH during 2000–2017 at our center. Liver biopsies were performed for clinical indications. R-AIH was defined using clinical and histologic criteria.

Results.

Among 75 patients undergoing LT for AIH (mean age 45 ± 16, 65% female individuals, 19% Black), 71 (95%) received antithymocyte globulin induction with tacrolimus-based immunosuppression. R-AIH developed in 20 (27%) patients at a median interval of 313 d (interquartile range, 155–1205). R-AIH was associated with level 2 HLA-DR mismatch (hazard ratio, 3.6; (95% confidence interval, 1.3-9.9; P = 0.01) and Black race (hazard ratio, 4.5; 95% confidence interval, 1.8-11.8; P = 0.002)] in the multivariable analysis. R-AIH developed in 62% of patients with level 2 HLA-DR mismatch on single-agent immunosuppression but in <20% of patients with no or 1 HLA-DR mismatch regardless of maintenance immunosuppression. R-AIH developed in 8 (57%) of 14 Black patients (71% on single-agent and 43% on dual-agent maintenance immunosuppression). Patient and graft survival were not impacted by R-AIH over a median follow-up of 8.3 y (interquartile range, 3–12).

Conclusions.

High-level HLA-DR mismatch and Black recipient race are associated with an increased risk of R-AIH. Immunosuppression did not predict R-AIH, but higher rates of disease recurrence with single-agent maintenance immunosuppression with these risk factors were observed and may guide maintenance immunosuppression in LT for AIH.
Investigation and analysis of blood-borne occupational exposure of medical staff in a hospital in Hubei Province
Authors: Yang Yan , Yang Junzheng
Published: June 2021

Objectives

By collecting and sorting out the data of 220 blood-borne occupational exposure medical staff’ in a hospital in Hubei Province, investigated the present situations and problems of the blood-borne occupational exposure, and the causes were analyzed and the improvement measures for personal safety of the medical staff were also made, which may provide guidance and reference significance for the medical staff.

Methods

a retrospective survey was conducted to analyze occupational exposure populations by influence factors (gender, age, occupation, occurrence places, occurrence links, and exposure of pathogens types.

Results

There were 220 medical staff of blood-borne occupational exposure in the hospital in Hubei Province from 2015 to 2017 to be investigated, and the blood-borne occupational exposure populations were mainly concentrated on nurses (65%) and doctors (31.82%) (both of populations accounted for 96.82% in total occupational exposure medical staff), and the age of blood-borne occupational exposure populations were mainly 20~29 years old (61.82%), followed by 30~39 years old (26.82%), 40~49 years old (8.64%), and >50 years old (2.73%). The main occurrence places for blood-borne occupational exposure were wards (46.36%) and treatment room/disposal rooms(26.36%); the main occurrence links of blood-borne occupational exposure were mainly injured during needle extraction (29.09%), stab and cut during treatment (23.64%), disposal of waste (17.27%) and accidental injury during operation (16.82%). The main pathogen types of blood-borne occupational exposure were hepatitis B (HBV) and syphilis, accounting for 36.36% and 10.45%, respectively.

Conclusions

The population of blood-borne occupational exposure in this hospital mainly concentrated in nurses aged 20-29 years old, followed by doctors, mainly happened at wards and treatment rooms/disposal rooms; the high-risk links were mainly injured during needle extraction and stab and cut during treatment, and the main pathogen types were HBV and syphilis. Those evidences showed that to strengthen the awareness of prevention and operation standard training for the related medical staff (mainly nurses and doctors aged 20-29 years old) and to supervise the relevant departments to do a good job of supervision, it can greatly reduce the incidence and risk of blood-borne occupational exposure in this hospital.
Crystal structure and optical properties of a two-sited EuIIIcompound: an EuIIIion coordinated by two [EuIII(DOTA)]−complexes (DOTA is 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetate)
Authors: Thomsen Maria Storm , Madsen Anders Ø. , Sørensen Thomas Just
Published: June 2021

The structure and solid-state luminescence properties of an EuIIIcompound with two different lanthanide sites, [Eu(μ-O)5(OH)(H2O)2][Eu(DOTA)(H2O)]2(DOTA is 1,4,7,10-tetrazacyclododecane-1,4,7,10-tetraacetate, C16H24N4O8), were determined. The compound crystallizes in a laminar structure in the triclinic space groupP-1, where the two sites are a free europium(III) ion and an [Eu(DOTA)(H2O)]−complex. The crystal structure was determined using complex data treatment due to nonmerohedral twinning. Experimental data sets were recorded with large redundancy and separated according to scattering domains in order to obtain a reliable structure. In the first site, the [Eu(DOTA)(H2O)]−complex was found to adopt a capped twisted square-antiprismatic (cTSAP) conformation, where a capping water molecule increased the coordination number of the europium(III) site to nine (CN = 9). In the second site, the europium(III) ion was found to be coordinated by two water molecules, one hydroxide group and five oxide groups from neighbouring [Eu(DOTA)(H2O)]−complexes. The coordination geometry of this site was found to be a compressed square antiprism (SAP) and the coordination number of the europium(III) ion was found to be eight (CN = 8). A large increase in the rate constant of luminescence was observed for EuIIIin [Eu(DOTA)(H2O)]−in solid-state luminescence spectroscopy measurements compared to in solution, which led to investigations of single crystals in deuterated media to exclude additional effects of quenching. We conclude that the most probable cause of the decrease in the observed luminescence lifetimes is the high asymmetry of the coordination environment of [Eu(DOTA)(D2O)]−in the [Eu(μ-O)5(OD)(D2O)2][Eu(DOTA)(D2O)]2crystals.
Toward enhanced excellence in Brazilian investment firms: the role of investors' personality assessment tools
Authors: Frantz Adriana , Olivo Rodolfo Leandro de Faria , Sales George André Willrich , Silva Fabiana
Published: June 2021

Purpose

This research aims to investigate how personality, identified through the psychological type, can contribute to a more robust process of identifying the investor's profile. The traditional process of investor profile analysis of Brazilian financial institutions is performed through a form in which basic information is required to define the profile. By adding psychological and behavioral aspects obtained through the Myers–Briggs type indicator (MBTI) typology, institutions participating in the financial and capital markets could enrich the understanding of their clients.

Design/methodology/approach

It presents a quantitative approach, with an exploratory-descriptive focus, with a survey carried out on a sample of 613 investors, in which nonparametric tests were performed to test hypotheses on the influence of personality on the behavioral aspects of these investors.

Findings

The results showed a relationship between the dimensions of the personality type and the investment profile, indicating that personality is a relevant factor in guiding investor behavior. In this context, evidence of the applicability of the principles of behavioral finance to investor behavior was found, to the detriment of traditional finance principles.

Practical implications

Findings help investors to plan and manage their finances more appropriate manner. Financial institutions can create more accurate and realistic investor profile analysis processes, adding psychological and behavioral aspects obtained through the MBTI typology. In this way, companies and financial advisors will be able to provide a better-quality service to their clients, recommending the most appropriate investment strategies.

Originality/value

The elements originality of this study are as follows: (1) methodology: there is a lack of research covering the application of personality assessment tools, particularly the MBTI, to improve investor's profile analysis; (2) geographical coverage: lack of research of the theme in Brazil and Latin America in general; (3) robustness of the database.
Managerial coaching: where are we now and where should we go in the future?
Authors: Carvalho Charles , Carvalho Fallan Kirby , Carvalho Sheldon
Published: June 2021

Purpose

In this paper, we provide a brief understanding of the field of managerial coaching, specifically, offering insights on what has been studied and ideas on where the field can move forward.

Design/methodology/approach

We review managerial coaching research, focusing in particular on its consequences and determinants. Based on the review, we uncover three areas that will help advance the development of managerial coaching research.

Findings

Our review indicates that both individual and contextual factors influence managerial coaching. Managerial coaching is beneficial not only for employees but also for managers who engage in coaching and the teams they manage. Despite the overwhelmingly positive view of managerial coaching, emerging research addresses the detrimental effects of coaching on managers who engage in coaching. We call on researchers to undertake more work on the factors that reduce managers’ inclination to coach, dark side outcomes of coaching, and role of individual and contextual factors in influencing the effects of coaching.

Originality/value

By reviewing extant managerial coaching research as well as suggesting fruitful avenues for researchers to explore, this paper serves as a useful guide for scholars interested in contributing to the emerging body of research on managerial coaching.
Fast and accurate computation of interactions between linear fiber segments
Authors: Pal Anirban
Published: June 2021

Purpose

Fiber networks represent a vast class of materials, which can be modeled by representing its microstructure using one-dimensional fiber embedded in three-dimensional space. Investigating the statics, dynamics and thermodynamics of such structures from computational first principles requires the efficient estimation of cohesive-repulsive energies and forces between interacting fiber segments. This study offers a fast, efficient and effective computational methodology to estimate such interactions which can be coupled with Hamiltonian mechanics to simulate the behavior of fibrous systems.

Design/methodology/approach

This method preserves the uniformly continuous distribution of particles on the line segments and utilizes adaptive numerical integration of relevant distance-distribution functions to estimate the effective interaction energy and forces.

Findings

This method is found to be cheaper to compute and more accurate than the corresponding discrete scheme. This scheme is also versatile in the sense that any pair-wise interaction model can be used.

Research limitations/implications

The scheme depends on the availability of a suitable pair-interaction potential, such as a Lennard-Jones potential or Morse potential. Additionally, it can only be used for systems which are purely fibrous in nature. For example, fiber composites with a non-fibrous matrix are not addressed.

Practical implications

Paper, woven and hair can be represented as purely fibrous at some relevant length scales and are thus excellent candidate systems for this scheme.

Originality/value

This paper presents a novel method which allows rapid and accurate implementation of an otherwise computationally expensive process.
The mediating role of financial performance in the relationship between green innovation and firm value: evidence from ASEAN countries
Authors: Asni Nur , Agustia Dian
Published: June 2021

Purpose

The purpose of this paper is to investigate the mediating role of financial performance (FP) in modelling the relationship between green innovation (GI) and firm value (FV), using ASEAN countries as sample with panel analysis.

Design/methodology/approach

A panel data was collected from 374 publicly traded companies in six ASEAN countries, and was analysed using feasible general least squares (FGLS) to control heteroscedasticity and serial correlation.

Findings

The findings suggest that financial performance, namely return on assets (ROA) and return on equity (ROE), has a significant value in mediating the relationship between GI and FV. This illustrates that investors in the ASEAN region's capital market are more interested in the economic motivation for companies implementing GI. Other findings also provide evidence that ROA and ROE have positive and significant effects on FV. This indicates that the profitability resulting from a firm's ability to continuously innovate has a positive impact on the creation of value by manufacturing companies in the ASEAN region.

Research limitations/implications

The number of observations is still relatively limited, from manufacturing companies listed on stock exchanges in the ASEAN countries. The total number of samples used in this study was 374 companies with 22.30% of the total population.

Originality/value

This study combines the different types of secondary data to provide panel evidence on the mediating effect of financial performance using ROA and ROE in the relationship between green innovation and firm value, using ASEAN countries as the sample.