bluuebunny/crossref_metadata_2025 huggingface dataset:
Lactating Women’s Knowledge and Attitudes About Donor Human Milk in China
Authors: Tian Ce , Li Yamin , Soowon Lee , Xu Ying , Zhu Qin , Zhao Hong
Published: July 2020

Background

Donor milk is the preferred substitute to mother’s own milk, which can protect high-risk infants from many complications. Several milk banks have been established in China. However, the small number of donors and insufficient milk donated have become the primary obstacles for these milk banks.

Research aims

To explore the level of, and the factors influencing, knowledge and attitude about donor milk among currently lactating women across mainland China and to provide a reference for the development of Chinese milk banks.

Methods

A brief, self-reporting, prospective, cross-sectional, online survey was conducted in 2018 using The Knowledge and Attitude Questionnaire of Human Donor Milk for Hospitalized Women. Lactating women aged >18 years and willing to consent to study participation were recruited throughout China.

Results

All completed questionnaires ( N = 489) were included. 40.1% ( n = 196) of the participants had heard of donor milk or milk banks, and 76.7% ( n = 375) were willing to donate their milk. In the multiple linear regression analysis, educational level, cohabitation status, parity, history of delivering preterm or low-birth-weight infants, education provided by health professionals, and infants’ gestational age, weight, and feeding patterns were associated with the participants’ knowledge about donor milk ( F = 12.387, p < .001). The parity, delivery mode, mothers’ milk production, history of delivering preterm or low-birth-weight infants, education provided by health professionals, and infants’ age were associated with their attitude ( F = 9.420, p < .001).

Conclusion

The participants’ attitudes about donor milk were positive. However, there were gaps in their knowledge about donor milk.
Influences over Italian nurses’ job satisfaction and willingness to recommend their workplace
Authors: Vainieri Milena , Seghieri Chiara , Barchielli Chiara
Published: July 2020

Background

Nurses’ perception towards job satisfaction and willingness to recommend their workplace are relevant to a number of areas including the quality of nursing care delivery. Hence, an increasing number of scholars seek to understand the factors that influence these two concepts. Yet, inclusiveness and openness to innovation are under-investigated.

Purpose

The paper focuses on the relative importance that factors like propensity towards innovation, working conditions and inclusion have on nurses’ job satisfaction and their willingness to recommend their workplace.

Methods

A large sample of nurses was extracted from the organizational climate survey carried out in all healthcare authorities of nine Italian Regions through the years 2016–2018. Descriptive and multilevel regressions were carried out to investigate the factors that influence nurses’ job satisfaction and their willingness to recommend the hospital in which they work in, analysing both overall and in specific age classes.

Results

When recommending a workplace, nurses tend to recommend units showing higher propensity to innovate (OR 2.83), while the most important factor related to job satisfaction is the encouragement after a failure (OR 2.23). Inclusiveness is a key factor for both job satisfaction and willingness to recommend, whilst innovation prone organizations appear to be the most attractive for nurses. The levers mix is slightly different among the age classes. Findings identify the levers to be used in order to attract nurse workforce and increase nurses’ job satisfaction. These levers are partially different for young and senior nurses.
Aging Predicts Decline in Explicit and Implicit Memory: A Life-Span Study
Authors: Ward Emma V. , Berry Christopher J. , Shanks David R. , Moller Petter L. , Czsiser Enida
Published: July 2020

Explicit memory declines with age, but age effects on implicit memory are debated. This issue is important because if implicit memory is age invariant, it may support effective interventions in individuals experiencing memory decline. In this study, we overcame several methodological issues in past research to clarify age effects on implicit memory (priming) and their relationship to explicit memory (recognition, source memory). We (a) recruited a large life-span sample of participants ( N = 1,072) during a residency at the Science Museum in London, (b) employed an implicit task that was unaffected by explicit contamination, and (c) systematically manipulated attention and depth of processing to assess their contribution to age effects. Participants witnessed a succession of overlapping colored objects, attending to one color stream and ignoring the other, and identified masked objects at test before judging whether they were previously attended, unattended, or new. Age significantly predicted decline in both explicit and implicit memory for attended items.
How Does Public Debt Affect the Indian Macroeconomy? A Structural VAR Approach
Authors: Mohanty Ranjan Kumar , Panda Sidheswar
Published: July 2020

The study investigates the macroeconomic effects of public debt in India during 1980–2017 using a structural vector autoregression framework. The objective is to examine the impact of public debt on the interest rate, investment, inflation and economic growth in India. The results of the impulse response functions show that public debt has an adverse impact on economic growth but a positive impact on the long-term interest rate in the short run and a mixed effect (both negative and positive) on investment and inflation. We also find that domestic debt has a more adverse impact on the economy than external debt. The estimated variance decomposition analysis finds that much of the variation in selected macro variables are explained by public debt and growth in India. This study suggests that public debt especially domestic debt should be controlled and channelled productively to have a favourable impact on the economy.

JEL Classification: H63, O40, C40
Cultivating Cultural Competence: How Are Hospice Staff Being Educated to Engage Racially and Ethnically Diverse Patients?
Authors: Boucher Nathan A. , Johnson Kimberly S.
Published: July 2020

Background:

Compared to Whites, racial/ethnic minorities are less likely to enroll in hospice and if they enroll, more likely to experience poor quality care. Building cultural competence (CC) among hospice staff is a strategy that may reduce disparities.

Objective:

To describe the state of CC training across hospices.

Design:

National survey of hospices’ practices to promote CC.

Results:

A total of 197 hospices participated; most were not-for-profit (80%) with an average daily census less than 100 (47%); 73% offered staff cultural competence training (CCT). There were no differences in characteristics of hospices who offered CCT and those that did not. Of hospices offering CCT, 61% held it annually. Most trainings were 1 hour (60%); content was delivered via web (58%) and/or lecture (58%). While over 90% of staff (i.e., nurses, social workers, chaplains) completed CCT, a smaller proportion of medical directors (64%), senior leaders (71%) and board members (26%) did so. Most common topics were: cross-cultural communication, death/illness beliefs, spirituality’s role, and healthcare disparities. The majority focused on African-Americans (83%), Hispanics (76%), and Asians (62%)—the most common U.S. minority groups. Almost 30% reported no effectiveness assessment of CCT, while 51% reported a quiz at the end of training. Most hospices offered some CCT.

Conclusions:

CCT has been shown to improve healthcare providers’ knowledge and skills in caring for diverse patients and it is associated with increased patient satisfaction. Future research should evaluate effectiveness of CCT in improving the ability of hospices to deliver high quality end-of-life care to diverse groups of older adults.
Impact of Clinical Process Improvement Training in an Integrated Delivery System
Authors: Cummings Brian M. , Carballo Victoria , Kalibatas Orinta , Barysauskas Constance M. , Rao Sandhya , Jacobson Joseph O. , Sequist Thomas D.
Published: July 2020

Multiple integrated health systems use frontline staff training in quality and process improvement, although the optimal method to determine training success remains unknown. The authors assessed the Partners Clinical Process Improvement Leadership Program’s short-term impact by evaluating data in project presentations during 14 courses between 2010 and 2016. Long-term impact was assessed via a graduate survey. Among 262 interprofessional teams, 180 (69%) achieved short-term improvement, including 78 (30%) achieving and 102 (39%) demonstrating improvement toward their project goal. Projects implementing ≥2 interventions were more likely to succeed. Of 231 graduates surveyed, 79% reported the ability to lead and 67% reported actual work on additional quality improvement projects. Ninety-seven percent of alumni reported a positive career impact. Hospital leadership support of clinical process improvement training meets short-term improvement needs and promotes long-term capacity for learning health systems.
A Strategic Framework for Task Automation in Professional Services
Authors: Sampson Scott E.
Published: July 2020

Professional service jobs exist at the high end of the skill ladder; thus, some have assumed that highly trained professional workers are relatively immune to being replaced by automation. However, this assumption is a bit dubious because automation does not occur at the job level but rather at the task level, and some tasks within a professional job might be highly susceptible to automation disruption. This research builds on prior research by (1) empirically testing a model for automation of professional services and (2) developing a professional task-automation framework that shows how individual tasks within a given job can be enhanced or disrupted by automation in very different ways. Some tasks are augmented by automation and remain in the purview of professionally trained workers. Other tasks are deskilled by automation, allowing the tasks to be transferred to lower cost workers (who are aided by automation). Other tasks are moved directly to customers through self-service technologies, reducing or eliminating the need to interact with professionals or other workers. Finally, some professional tasks are centralized, which leverages professional workers’ distinctive expertise. Our framework shows precipitating conditions for each task-automation strategy and outlines logic for reconfiguring tasks within professional service systems.
Electronic Dance Music: From Spectacular Subculture to Culture Industry
Authors: Conner Christopher T. , Katz Nathan
Published: July 2020

This article is an attempt to show the dialectical nature of Guy Debord’s (1967/1994, The Society of the Spectacle, Aldgate Press) concept of the spectacle, showing how its employment as a resistance technique by electronic dance music (EDM) subculturalists would also help shape it into a corporately organized culture industry (Horkheimer & Adorno, 1944/1969). In doing so, we show the overlap between the French Internationalist approach and that of the Frankfurt School, and how the combination of these two concepts provides for a more nuanced conceptualization in which the agency of social actors ultimately resulted in the shaping of the subculture into a culture industry. In other words, we attempt to address the critique that the approaches endorsed by both schools are overly deterministic in their approach. We attempt to overcome this limitation by showing how promoters’ decisions to compromise with law enforcement agencies resulted in changes drastically altering the music subculture.
Social functions of gossip in adolescent girl’s talk
Authors: Guendouzi Jackie
Published: July 2020

Research has shown that gossip plays an important role in establishing and supporting group values and behaviors. However, gossip also plays a role in the development and social construction of identity. In particular, gossip is a discursive resource that enables participants to create what Kyratzis refers to as practice communities: discursive contexts where speakers can explore the acceptability of social behaviors and values with their peers. This study analyzed excerpts of gossip taken from conversations involving 16-year-old high school girls to examine the role gossip plays in negotiating adulthood.
Additively manufactured titanium alloys and effect of hydroxyapatite coating for biomedical applications: A review
Authors: Anene Franklin , Aiza Jaafar , Zainol Ismail , Hanim Azmah , Suraya Mohd Tahir
Published: July 2020

Metallic implants are extensively used to treat a spectrum of orthopaedic related disorders. Among the metals, titanium and its alloys are considered most excellent and indispensable material for the production of orthopaedic implants regarding their sterling mechanical properties and exceptional biocompatibility. Recently, rapid progress in developing non-toxic titanium-based alloys with modulus similar to that of human bone has inspired researchers globally. Thus, many studies have focused on titanium alloys, their heat treatment processes and several processing technologies. Additive manufacturing has been designed to enhance their mechanical properties tailored towards biomedical applications. Inarguably, the need to further improve on the implant’s biocompatibility with bodily environment for optimum service life is of great importance. Hence, hydroxyapatite coating provides an improvement as demonstrated by in vitro as well as in vivo studies. The present article critically reviews, based on recent scientific literatures, the progress made thus far in the development of titanium-based alloys, additive manufacturing processes and their heat and surface treatments tailored towards biomedical applications.
Building strong teacher–child relationships in today’s kindergarten classroom: Focusing on opportunities versus obstacles
Authors: White Kelley M
Published: July 2020

Research documents that young children in high-quality teacher–child relationships experience better school adjustment and are more engaged in learning. Yet, many American kindergarten (age 5) teachers report spending less time on relationship building and children’s social and emotional development given pressure to have students reading and writing fluently by the end of the school year. In an attempt to better understand the dilemma facing today’s American kindergarten teachers, the principal investigator chose to re-enter the field while on sabbatical from her position as professor at a 4-year university. Through the use of qualitative methods and participant observation, she collected data in a variety of ways. Results revealed attempts to intentionally plan for relationship building and integrate relationship building into the academic curriculum. The teacher also built relationships with students by capitalizing on small moments and following the lead of the children. The study has a variety of implications for practitioners and for future research.
Designing a laser-cut panel for light collection for daylighting using a generalised mathematical model
Authors: Singh S , Bisht DS , Garg H
Published: July 2020

The current daylighting requirements require a system that can maintain a uniform light output throughout the day while enabling deep and controlled penetration of sunlight. If such a system is simple to manufacture, inexpensive and incorporates no moving parts and maintenance, it can easily fulfil all the daylighting needs. This paper focuses on the development of such a system using laser-cut panels. Mathematical models for determining the dimensions of a laser-cut panel and its efficiency were developed. A laser-cut panel collector was designed based on these models and simulated. The results showed enhanced light output at light pipe end by up to 47 times and 32 times as compared to a flat plate collector in the month of June and December, respectively and up to nine times for a dome collector for the designed range of sun altitudes. For this range, the ratio of pipe output to input was up to 4.5 times higher than the other collectors. The light at diffuser side was more distributed for the laser-cut panel collector. The current design, however, did not provide appropriate reduction in illuminance at peak hours in June. This approach can easily be used for light collection without involving any complex mechanisms.
Improved Transmucosal Delivery of Glimepiride via Unidirectional Release Buccal Film Loaded With Vitamin E TPGS-Based Nanocarrier
Authors: Basahih Tahani S. , Alamoudi Abdullah A. , El-Say Khalid M. , Alhakamy Nabil A. , Ahmed Osama A. A.
Published: July 2020

Glimepiride (GMD) is a hypoglycemic agent that has variation in bioavailability for its unexpected absorption. Glimepiride was formulated in a buccal film loaded with a nanobased formulation to enhance its absorption via buccal mucosa. Nanostructured lipid carriers (NLCs) and d-α-tocopherol polyethylene glycol 1000 succinate-based micelles enhance GMD solubility and improve its permeation through the buccal mucosa. The formulation variables were optimized using a Box-Behnken design. These factors, such as the percent of micelles relative to NLC ( X 1), the percent of Carbopol ( X 2), and the percent of permeation enhancer ( X 3), were investigated for their effect on the initial release ( Y 1) and the cumulative release after 6 hours ( Y 2). The optimum levels for X 1, X 2, and X 3 were 100%, 0.05%, and 1.8%, respectively. The optimized formulation revealed that the permeation of GMD from the film was in favor of micelles. This optimized film was then coated with ethyl cellulose to direct the release only through the buccal mucosa. The optimized unidirectional GMD transmucosal film showed a release of 93.9% of GMD content at 6 hours compared to 60.41% of GMD release from the raw GMD film. This finding confirmed the suitability of transmucosal delivery of GMD via the buccal mucosa.
Evolution of interactive elements in socio-political talk shows in post-Soviet Russia
Authors: Gulenko Petr , Dolgova Yulia
Published: July 2020

The article studies the place and degree of interactivity of interactive elements in socio-political talk shows on Russian television during the period of the presidency and premiership of Vladimir Putin (2000–2017), and comprises unique material that allows us to analyse the interactive elements of talk shows in identified stages over time. The criteria for defining the level of interactivity of the given elements are distinguished. The material analysed proves that only a few programmes on Russian television demonstrated a high level of interactivity and their audience could influence the results of the studio discussions, for only a very short period.
Predictors of mortality in inflammatory bowel disease patients treated for pneumonia
Authors: Ukashi Offir , Barash Yifatch , Segel Michael J. , Ungar Bella , Soffer Shelly , Ben-Horin Shomron , Klang Eyal , Kopylov Uri
Published: July 2020

Background:

Community-acquired pneumonia is among the most common infections affecting ulcerative colitis and Crohn’s disease patients. Data regarding epidemiology and outcomes of pneumonia in inflammatory bowel disease patients is lacking. We aimed to identify predictors of adverse outcomes among inflammatory bowel disease patients treated for pneumonia.

Methods:

This was a retrospective cohort study that included adult patients admitted to Sheba Medical Center for pneumonia between 2012 and 2018. Data was collected from an electronic repository of all emergency department admissions and included tabular demographic and clinical variables and free-text physician records. Pneumonia cases were extracted using the International Classification of Diseases (ICD-10) coding.

Results:

Of 16,732 admissions with pneumonia, 97 were inflammatory bowel disease patients (45 Crohn’s disease; 52 ulcerative colitis). We found a similar rate of 30-day mortality among inflammatory bowel disease and non-inflammatory bowel disease patients (12.1% versus 11.3%, p = 0.824) and between Crohn’s disease and ulcerative colitis patients (11.1% versus 11.5%, p = 0.947). There was an increased hospitalization rate among inflammatory bowel disease patients (92.8% versus 85.6%, p = 0.045), but similar hospitalization duration (4 versus 4 days, p = 0.384). Crohn’s disease patients had a shorter hospitalization duration compared with ulcerative colitis patients (3 versus 5.5 days, p = 0.029). Bronchiectasis (adjusted odds ratio 60.95, 95% confidence interval 2.72–1364.39, p = 0.01) and opioids use (adjusted odds ratio 13.21, 95% confidence interval 1.29–135.18, p = 0.03) were associated with an increased 30-day mortality rate in inflammatory bowel disease patients.

Conclusion:

This is the first study to identify predictors of mortality in inflammatory bowel disease patients with pneumonia. The rate of mortality and hospitalization duration of stay were similar among inflammatory bowel disease and non-inflammatory bowel disease patients. Use of opioids and presence of bronchiectasis were associated with a higher risk of mortality in inflammatory bowel disease patients with pneumonia.
A cross-sectional investigation of prevalence of occupational burnout in Saudi aviation industry
Authors: Ekore John O , Allui Alawiya , Al Shareef Sarah , Zawawi Rafed
Published: July 2020

Achievement of excellence in the aviation industry largely depends on a highly effective workforce. In the management of organizational behavior, the well-being of employees is essential in the workforce and organization’s outcomes. Despite the roles of occupational burnout in well-being and productivity, not much exist in the global literature that includes the Saudi aviation industry. Our study was designed as a survey to examine the prevalence of occupational burnout in the aviation industry. It involved a sample size of 1051 from different work groups in the industry. Questionnaires that required information on socio-demographics and contained the Maslach and Jackson’s burnout inventory that was adapted for the study were utilized for data collection. A prevalence of 41.7% of occupational burnout was found and it existed by age and work group differences in the sample. The findings are indicative of burnout as a near epidemic that has significant potential to negatively influence employees’ productivity in the industry. Enlarging the scope and inclusion of some other dispositional variables that could enhance impact analysis of occupational burnout may be considered in future researches. Nevertheless, the study has provided empirical basis to raise awareness of occupational burnout for management, scholars and practitioners. It is expected to guide interventions that promote employees’ well-being, and also help to expand the global literature on aviation industry data.
Progress on Terpenoids With Biological Activities Produced by Plant Endophytic Fungi in China Between 2017 and 2019
Authors: Zhao Yu , Cui Jing , Liu Mengyujie , Zhao Lei
Published: July 2020

Plant endophytic fungi are an important part of plant microecosystems and a natural resource for human survival and development. Various bioactive natural products produced by plant endophytic fungi show promising prospects in biopharmacy, agricultural production, and industrial fermentation. Terpenoids, the most numerous and structurally diverse natural products from endophytic fungi, possess a broad range of biological activities and huge potential for drug development. It is critically significant for ecological and economic benefits to develop their activities. This paper utilized literature analysis to summarize 200 terpenoids with biological activities that are derived from plant endophytic fungi in China between 2017 and 2019. Among them, sesquiterpenoids were the most important kind of terpenoids, and Trichoderma and Aspergillus species were main terpenoid-producing plant endophytic fungi. Furthermore, these terpenoids displayed multifarious biological activities, including antimicrobial, antipathogenic, and anti-inflammatory activities, as well as cytotoxicity, antitumor agents, and enzyme inhibition.
The Flip Tilt Illusion: Visible in Peripheral Vision as Predicted by the Central-Peripheral Dichotomy
Authors: Zhaoping Li
Published: July 2020

Consider a gray field comprising pairs of vertically aligned dots; in each pair, one dot is white the other black. When viewed in a peripheral visual field, these pairs appear horizontally aligned. By the Central-Peripheral Dichotomy, this flip tilt illusion arises because top-down feedback from higher to lower visual cortical areas is too weak or absent in the periphery to veto confounded feedforward signals from the primary visual cortex (V1). The white and black dots in each pair activate, respectively, on and off subfields of V1 neural receptive fields. However, the sub-fields’ orientations, and the preferred orientations, of the most activated neurons are orthogonal to the dot alignment. Hence, V1 reports the flip tilt to higher visual areas. Top-down feedback vetoes such misleading reports, but only in the central visual field.
Patient participation in nursing documentation: A qualitative descriptive study
Authors: Kollerup Mette Geil , Vinther Kirsten Korsgaard , Jørgensen Lone
Published: July 2020

A divergence exists between registered nurses’ (RNs’) intention to document together with the patient and their actual documentation practice; a practice that also diverges from official intentions of patient participation. This study aimed to explore and describe RNs’ reflected experiences on patient participation in nursing documentation. A descriptive qualitative study was conducted based on three focus groups with 14 registered nurses from an acute medical ward. Content analysis and conversational analysis were performed. The reporting adhered to the COREQ checklist. The findings showed that nurses made little mention of patient participation in nursing documentation due to challenges in meeting both the patients’ expected needs and nurses’ needs. However, patient participation was important for time accurate and summative nursing documentation. This study adds to a critical debate on patient participation and contributes to a practice-based understanding of the challenges that registered nurses experience concerning patient participation in nursing documentation.
Assessment of lateral hindfoot impingement with weightbearing multiplanar imaging in a flatfoot
Authors: Yoshida Yasuhisa , Matsubara Hidenori , Kawashima Hiroki , Aikawa Takao , Ugaji Shuhei , Hamada Tomo , Tsuchiya Hiroyuki
Published: July 2020

Background

Estimation of the lateral hindfoot impingement in the standing position in conventional radiography can be difficult due to superimposition of different bones. Patients with flat feet frequently suffer from pain around the lateral malleolus and sinus tarsi caused by osseous impingement in the lateral hindfoot. Weightbearing multiplanar images (tomosynthesis) yield tomographic images and can be taken while full weightbearing.

Purpose

To assess the availability of tomosynthesis to determine hindfoot lateral impingement.

Material and Methods

A total of 14 feet (in 13 patients) with acquired flatfoot deformity and lateral hindfoot pain were included (mean age 64 years; age range 55–80 years). All patients underwent tomosynthesis, radiography, and computed tomography (CT) (non-weightbearing). Talofibular, calcaneofibular, and talocalcaneal impingement were determined. To compare the number of impingements or to determine the area between each image, statistical evaluations were analyzed using the Mann–Whitney U-test ( P < 0.05).

Results

On tomosynthesis, we clearly found talofibular impingement in three feet, calcaneofibular impingement in seven feet, and talocalcaneal impingement in 11 feet. Therefore, we could identify most impingements as “positive” compared to those on normal radiographs and CT images. The number of impingements in the calcaneofibular and talocalcaneal regions was significantly higher using tomosynthesis than when using CT ( P < 0.05).

Conclusion

Tomosynthesis imaging makes it easier to obtain CT-like images in a short period of time, in a free position, including while standing, and provides useful information to assess lateral pain in patients with flatfoot deformity.
Situational factors associated with concussion in cricket identified from video analysis
Authors: Saw Anna E , Howard David J , Kountouris Alex , McIntosh Andrew S , Orchard John W , Saw Richard , Hill Thomas
Published: July 2020

Video analysis of situational factors associated with head impacts and concussion has been completed in several sports, however has yet to be completed in cricket. This study aimed to identify situational factors associated with concussion in elite Australian male and female cricket. Match video of head impacts were coded for player position, impacting object, source of ball, location of impact, and where the ball went after impact. Head impacts were then categorised as either concussion or no concussion based on clinical diagnosis. Data for 197 head impacts included 35 (18%) which were diagnosed as concussion. Head impacts typically occurred to an on-strike batter facing a pace bowler (84%). If the ball stopped or rebounded towards the source, 21% were diagnosed as concussion (13% if the ball deflected away from the source). If impact was to an unprotected head, 38% were diagnosed as concussion (16% if impact was to a helmet). If impact was to the back of the helmet or head, 40% were diagnosed as concussion (11–21% for other areas of the head or helmet). The combination of situational factors most consistent with concussion were impact from ball that hit the back of helmet or head and stopped or rebounded towards the source (PPV 80%, p = 0.002). Consideration of the situational factors of a head impact may improve the speed and accuracy of clinical decision making on whether to remove a player from the field for further assessment, particularly if clinical signs are unclear. Video may be used as a tool to support this process. Improved impact attenuation of cricket helmets, particularly at the back, may reduce the risk of concussion.
Guidelines on Writing Multiple Choice Questions: A Well-Received and Effective Faculty Development Intervention
Authors: Przymuszała Piotr , Piotrowska Katarzyna , Lipski Dawid , Marciniak Ryszard , Cerbin-Koczorowska Magdalena
Published: July 2020

Multiple choice questions (MCQs) are commonly used for assessing students, but medical teachers may lack training in writing them. MCQs often have imperfections called item-writing flaws (IWFs) that can affect students’ results and impede objective evaluation of their knowledge. This study aimed to evaluate a guideline-based faculty development intervention on writing MCQs at Levels 1 and 2 of the Kirkpatrick Model. MCQs written by teachers prior and after the intervention were analyzed with the Shapiro–Wilk test, Student’s t-test, and Wilcoxon signed-rank test as appropriate. In addition, the phenomenological approach was chosen to describe experiences of 10 teachers in semi-structured in-depth interviews. Results showed satisfaction of teachers with the document. They found it helpful in writing MCQs and noticed the requirement for another guidelines. They appreciated it for its briefness and clarity. The statistical analysis of the quality of MCQs before and after the intervention showed that the document contributed to a statistically significant reduction of IWFs. To conclude, our results showed that a guideline document on writing MCQs may serve as a well-received and effective faculty development intervention. The document may be used as a flexible, time-saving, and just-in-time learning method, fitting needs of medical teachers.
Association between childhood maltreatment and the prevalence and complexity of multimorbidity: A cross-sectional analysis of 157,357 UK Biobank participants
Authors: Hanlon Peter , McCallum Marianne , Jani Bhautesh Dinesh , McQueenie Ross , Lee Duncan , Mair Frances S
Published: July 2020

Background:

Child maltreatment is associated with long-term conditions (LTCs) in adulthood. Its relationship to multimorbidity (≥2 LTCs) is less clear. We explore the relationship between child maltreatment, multimorbidity and factors complicating management.

Methods:

Cross-sectional analysis of 157,357 UK Biobank participants. Experience of four maltreatment types (physical/sexual/emotional/neglect) was identified. We explored the relationship between type, number and frequency of maltreatment and LTC count (0, 1, 2, 3, ≥4) using multinomial logistic regression. Binary logistic regression assessed the relationship between maltreatment and self-rated health, loneliness, social isolation, frailty and widespread pain in those with multimorbidity, adjusting for sociodemographics and lifestyle factors.

Results:

52,675 participants (33%) experienced ≥1 type of maltreatment; 983 (0.6%) experienced all four. Type, frequency and number of types of maltreatment were associated with higher LTC count. People experiencing four types of maltreatment were 5 times as likely to have a LTC count of ≥4 as those experiencing none (odds ratio (OR): 5.16; 99% confidence interval (CI): 3.77-7.07). Greater number of types of maltreatment was associated with higher prevalence of combined physical/mental health LTCs (OR: 2.99; 99% CI: 2.54–3.51 for four types of maltreatment). Compared to people who reported no maltreatment, people experiencing all four types of maltreatment were more likely to have poor self-rated health (OR: 3.56; 99% CI: 2.58–4.90), loneliness (OR: 3.16; 99% CI: 2.17–4.60), social isolation (OR: 1.45; 99% CI: 1.03–2.05), widespread pain (OR: 3.19; 99% CI: 1.87–5.44) and frailty (OR: 3.21; 99% CI: 2.04–5.05).

Conclusion:

Peoplewith a history of maltreatment have higher LTC counts and potentially more complicated management needs reinforcing calls for early intervention.
Vitamin D level in the rotator cuff muscle and serum correlates with postoperative muscle performance at 1 year after rotator cuff repair
Authors: Rhee Sung-Min , Jeong Hyeon Jang , Oh Joo Han
Published: July 2020

Objectives:

Previously, we reported that tissue vitamin D (tVD) in the rotator cuff muscle had strong correlation with pre-operative serum vitamin D (sVD). Furthermore, tVD reflected more on the preoperative muscle power. This study was a follow-up study to evaluate correlations of tVD, vitamin D receptor (VDR), and postoperative sVD with rotator cuff muscle performance, fatty degeneration, healing failure, and functional outcomes at 1 year after rotator cuff repair (RCR).

Methods:

Between March and October in 2017, 36 patients who underwent RCR were prospectively enrolled and 26 patients were followed at 1 year postoperatively and analyzed. tVD was assessed using liquid chromatography, and the VDR was measured by western blotting. sVD was checked preoperatively, 6 months, and 1 year post-operatively. At 1 year after surgery, isokinetic muscle performance test (IMPT), ASES score and Constant score were evaluated, and MRI was used to analyze fatty degeneration and the healing failure.

Results:

The mean level of sVD at 1 year post-operatively was 20.5 ± 9.2 ng/ml. Only six patients had normal level of sVD (> 20 ng/ml, 23.1%), while 19 patients had insufficiency (10 - 20 ng/ml, 73.0%), and one patient had defi-ciency (< 10 ng/ml, 3.8%). Lower sVD at pre-operatively had lower sVD at 6 months and 1 year post-operatively (all p < 0.05). Higher pre-operative and 1 year post-operative sVD had less deficiency of IMPT in abduction (pre-operative, post-operative; CC; Abduction, -0.324, -0.395, p = 0.047, 0.041, respectively) How-ever, no correlation was found in deficiency of IMPT in ER, IR (pre-operative, post-operative; CC; ER, IR; 0.025, -0.042; p = 0.926, 0.874, respectively; post-operative; CC; ER, IR; -0.250, -0.157; p = 0.333, 0.548, re-spectively). Although, there was no correlation was found between torque of muscle power at 1 year post-operatively with pre- and post-operative sVD (all p > 0.05), higher tVD had higher torque of abduction (CC: 0.440, p = 0.043), and showed tendency of higher torque of external rotation (ER) (CC: 0.335, p = 0.077). There was no correlation of tVD and sVD with functional outcomes, fatty degeneration and re-tear rate (all p > 0.05). VDR showed no correlation with any variables (all p > 0.05).

Conclusions:

tVD and sVD showed positive correlation with rotator cuff muscle performance at 1 year after RCR. Regarding lower sVD at pre-operatively had lower sVD at 1 year post-operatively, and considering lower sVD had higher deficiency of muscle power, supplementation of vitamin D to these patients with low sVD would enhance rota-tor cuff muscle performance postoperatively.
Shoulder Instability, Performance and Return to Play in National Hockey League Athletes
Authors: McCormick Kyle , Tedesco Liana , Herndon Carl , Ahmad Christopher , Levine William , Popkin Charles , Swindell Hasani
Published: July 2020

Objectives:

Hockey players are at risk for various injury due to the aggressive nature of gameplay with the rate of shoulder injuries ranges from 8.6% to 21.9%. Although performance and return to play outcomes following shoulder instability events have been analyzed in other contact sports, there is a paucity of information on the effects amongst professional hockey players. Our study investigates the incidence of shoulder instability events in the National Hockey League (NHL) and the subsequent effect on return-to-play (RTP) and player performance. We hypothesized that NHL players sustaining a shoulder instability event returned to play at a high rate without significant changes in player performance after injury.

Methods:

A total of 67 confirmed in-season shoulder instability events were identified in the NHL between 2003 - 2017. Demographic characteristics and performance statistics one year prior to injury and one year following injury were collected and analyzed. Overall RTP was determined and differences in performance following injury were compared to experience-matched, era-matched, position-matched and age-matched controls. A separate analysis was performed comparing differences in performance as a function of operative and nonoperative treatment.

Results:

An average of 4.19 shoulder dislocations occurred per season in the NHL with an overall incidence rate of 0.020 instability events per 1000 game exposures (CI 0.017-0.027) with no significant differences between forwards and defensemen (p = 0.871). Overall, 33.8% of players suffered season ending injuries but 98.5% of all players were able to return to play with an average of 26.3±20.8 regular season games missed. Compared to controls, players suffering a shoulder instability event experienced an increase in both average time on ice and shooting percentage upon returning to gameplay (p = 0.002, p <0.001, respectively) yet there were no significant differences in seasons played, goals, assists and points per game; offensive, defensive and overall point shares compared to controls. In terms of treatment, 47.8% of all players were treated operatively with half of these players treated with surgery after suffering season-ending injuries. Compared to operative treatment, conservatively managed players experienced a significant decrease in points per game after injury (p = 0.034), however there were no significant differences in number of seasons played, goals per game, assists per game, offensive, defensive and overall point shares between treatment groups.

Conclusion:

Regardless of treatment, professional hockey players experience a high rate of return to play with acceptable performance outcomes following in-game shoulder instability events. Surgical management can be beneficial as an increase in points per game was seen in those treated operatively compared to players managed nonoperatively.
Superior Labral Anterior Posterior Repair and Biceps Tenodesis Surgery: Trends of the American Board of Orthopaedic Surgery Database
Authors: Frantz Travis , Gowd Anirudh , Erickson Brandon , Romeo Anthony , Cvetanovich Gregory
Published: July 2020

Objectives:

Recent evidence has specified indications for performing Superior Labrum Anterior and Posterior (SLAP) repair and biceps tenodesis (BT) for the treatment of bicipital-labral lesions in the shoulder. Trends in performance of these procedures are expected to reflect the growing body of research regarding this topic. The purpose of this study was to report practice trends for the surgical treatment of SLAP lesions, particularly in older patients, as the management of isolated SLAP lesions remains controversial.

Methods:

The American Board of Orthopaedic Surgery (ABOS) database was retrospectively queried between 2012-2017 by Current Procedural Terminology for SLAP repair (29807), open BT (23430), and arthroscopic BT (29828). The patient population was excluded if any concomitant open shoulder procedure was performed. Trends over time were evaluated with respect to case volume, patient age, surgeon subspecialty. Separate trends were evaluated with and without concomitant arthroscopic rotator cuff repair (RCR, CPT: 29827).

Results:

A total of 9,908 cases met inclusion/exclusion criteria: 4,632 performed with RCR and 5,276 performed without. Mean age of patients without RCR was 40.8 +/- 13.8, while those receiving RCR was 55.0 +/- 9.9 years . In patients without RCR, there was a significant decline in rate of SLAP repairs performed over this period (p < 0.001). No significant change was noted in mean age of patients receiving arthroscopic BT, open BT, SLAP repair, and BT + SLAP. A significantly greater proportion of patients receiving open and arthroscopic BT were over 35 years old, compared to those receiving SLAP repair (p < 0.001). Within the RCR cohort, there was also a significant decline in concomitant SLAP repairs performed (p < 0.001) over the study period. With respect to biceps tenodesis, in the RCR cohort, open was performed in 52.2% of cases while arthroscopic was performed in 47.8%, while in the cohort without RCR open was performed in 74.9% and arthroscopic was performed in 25.9%.

Conclusion:

The ABOS database reveals significantly reduced rates of SLAP repairs being performed. Trends with age remain consistent over time, in that SLAP repairs were predominantly performed in younger patients. Arthroscopic biceps tenodesis was performed much more frequently with RCR than without.
One-Year MRI Outcomes of Osteochondral Allograft Transplantation of the Knee for Large Chondral Defects: Comparison of Elliptical, Stacked, and Single Allografts
Authors: Wang Dean , Ode Gabriella , Elbuluk Ameer , Burge Alissa , Jones Kristofer , Williams Riley , Coxe Francesca
Published: July 2020

Objectives:

Osteochondral allograft transplantation (OCA) is a proven cartilage restoration procedure for patients with large chondral defects. However, elongated condylar lesions pose a challenge for dowel OCA in restoring articular surface congruity. Recently, instrumentation to harvest a single, elliptical allograft has been developed for treating ovoid lesions without requiring an adjacent-plug (stacked or snowman) technique. The purpose of this study was to compare 1-year MRI outcomes of patients treated with elliptical, stacked, or single OCA using the Osteochondral Allograft MRI Scoring System (OCAMRISS) and percent osseous integration.

Methods:

A retrospective review on patients treated from 2000 to 2018 with OCA for condylar defects of the knee was conducted. Inclusion criteria included those followed prospectively with a MRI at ˜1 year after surgery. OCAMRISS and osseous integration scores (0-25%; 26-50%; 51-75%; 76%-100%) were graded by a musculoskeletal radiologist blinded to the outcomes. Comparisons of demographics and MRI scores were performed with the ANOVA.

Results:

A total of 57 knees (mean age, 35.8 years; 70% male) met the inclusion criteria and were treated with either elliptical (n=19), stacked (n=19), or single (n=19) OCA. Mean time to post-operative MRI was 10.7, 11.1, and 12.4 months, respectively (p=0.17). There were no significant differences in demographics or number of prior ipsilateral knee surgeries among groups. Defect characteristics were significantly different between groups, where single plugs treated a higher percentage of LFC defects (58%) compared to elliptical and stacked (26%, each) (p=0.02). Total chondral defect area was greatest in the stacked group (5.4 ± 1.3) compared to elliptical (4.6 ± 1.2) and single (4.6 ± 1.4) (p=0.12). Bone, cartilage, ancillary, and total OCAMRISS scores were not significantly different between groups. A trend towards a higher percentage of osseous integration (single>stacked>elliptical) was noted which correlated with less transplanted allograft bone, however, these differences were not significant (p=0.15).

Conclusion:

One-year OCAMRISS and osseous integration scores did not differ among patients treated with elliptical, stacked, or single OCA. Further investigation is needed to explore potential differences in clinical outcomes and long-term osseous integration between elliptical and stacked OCA for the treatment of elongated condylar defects of the knee. [Table: see text]
Increased Costs and Health Care Utilization Associated with Delay in Diagnosis of ACL Injuries
Authors: Cook Sara , Byrnes Thomas , Hagen Mia , Gee Albert , Kweon Christopher , Slattery Casey
Published: July 2020

Objectives:

Anterior cruciate ligament (ACL) injuries can be difficult to diagnose, especially among providers with limited musculoskeletal training. Early and accurate diagnosis of ACL injuries is important for initiating proper treatment and limiting inefficient or costly healthcare utilization. We hypothesized that a delayed diagnosis in patients sustaining ACL injuries would result in treatment that is more costly and utilizes more healthcare resource compared to patients diagnosed without delay.

Methods:

A large national private insurance database (Truven MarketScan) was utilized to identify all patients aged 10-63 years-old diagnosed with an ACL tear from 2011 through 2015. Patients with a possible delay in diagnosis were determined via a database search for the most commonly assigned alternative knee-related diagnosis codes found in patients who were later diagnosed with an ACL tear. Patients were stratified into three groups according to time from non-specific knee diagnosis code to ACL diagnosis: 1) no delay (0 days), short delay (1-30 days) and long delay (>30 days). Subsequent cost and healthcare utilization data including physical therapy, medication use, and number of clinic visits were collected for a period of one-year after initial presentation with an ACL tear or knee-related diagnosis.

Results:

A search from 2011 through 2015 identified 87,435 patients meeting inclusion criteria that were diagnosed with an ACL injury. There were 24.1% of patients diagnosed at initial presentation whereas 43.5% were diagnosed between one day and 30 days. There were 38.2% of patients that were treated without surgery and had the lowest total cost regardless of delay in diagnosis (Table 1). ACL reconstruction combined with other knee procedures had the highest total cost, particularly with a longer delay in diagnosis. Each day of delay in diagnosis was three times more costly in the non-surgical (additional $27.06 cost per day of delay) versus the surgical groups ($8.09 cost per day of delay).

Conclusions:

A timely diagnosis of ACL injuries is associated with a lower cost of treatment and less visits to healthcare providers. Non-operative injuries may benefit the most from a timely diagnosis given the high additional cost per day of diagnosis delay. In order to further decrease the burden on the healthcare system, future studies should assess methods than can decrease delays in diagnosis while measuring cost and utilization differences as well as outcomes after ACL tears.