bluuebunny/crossref_metadata_2025 huggingface dataset:
Tobacco control environment: cross-sectional survey of policy implementation, social unacceptability, knowledge of tobacco health harms and relationship to quit ratio in 17 low-income, middle-income and high-income countries
Authors: Chow Clara K , Corsi Daniel J , Gilmore Anna B , Kruger Annamarie , Igumbor Ehimario , Chifamba Jephat , Yang Wang , Wei Li , Iqbal Romaina , Mony Prem , Gupta Rajeev , Vijayakumar Krishnapillai , Mohan V , Kumar Rajesh , Rahman Omar , Yusoff Khalid , Ismail Noorhassim , Zatonska Katarzyna , Altuntas Yuksel , Rosengren Annika , Bahonar Ahmad , Yusufali AfzalHussein , Dagenais Gilles , Lear Scott , Diaz Rafael , Avezum Alvaro , Lopez-Jaramillo Patricio , Lanas Fernando , Rangarajan Sumathy , Teo Koon , McKee Martin , Yusuf Salim
Published: April 2017

Objectives

This study examines in a cross-sectional study ‘the tobacco control environment’ including tobacco policy implementation and its association with quit ratio.

Setting

545 communities from 17 high-income, upper-middle, low-middle and low-income countries (HIC, UMIC, LMIC, LIC) involved in the Environmental Profile of a Community's Health (EPOCH) study from 2009 to 2014.

Participants

Community audits and surveys of adults (35–70 years, n=12 953).

Primary and secondary outcome measures

Summary scores of tobacco policy implementation (cost and availability of cigarettes, tobacco advertising, antismoking signage), social unacceptability and knowledge were associated with quit ratios (former vs ever smokers) using multilevel logistic regression models.

Results

Average tobacco control policy score was greater in communities from HIC. Overall 56.1% (306/545) of communities had >2 outlets selling cigarettes and in 28.6% (154/539) there was access to cheap cigarettes (<5cents/cigarette) (3.2% (3/93) in HIC, 0% UMIC, 52.6% (90/171) LMIC and 40.4% (61/151) in LIC). Effective bans (no tobacco advertisements) were in 63.0% (341/541) of communities (81.7% HIC, 52.8% UMIC, 65.1% LMIC and 57.6% LIC). In 70.4% (379/538) of communities, >80% of participants disapproved youth smoking (95.7% HIC, 57.6% UMIC, 76.3% LMIC and 58.9% LIC). The average knowledge score was >80% in 48.4% of communities (94.6% HIC, 53.6% UMIC, 31.8% LMIC and 35.1% LIC). Summary scores of policy implementation, social unacceptability and knowledge were positively and significantly associated with quit ratio and the associations varied by gender, for example, communities in the highest quintile of the combined scores had 5.0 times the quit ratio in men (Odds ratio (OR) 5·0, 95% CI 3.4 to 7.4) and 4.1 times the quit ratio in women (OR 4.1, 95% CI 2.4 to 7.1).

Conclusions

This study suggests that more focus is needed on ensuring the tobacco control policy is actually implemented, particularly in LMICs. The gender-related differences in associations of policy, social unacceptability and knowledge suggest that different strategies to promoting quitting may need to be implemented in men compared to women.
Methods to decrease variability in histological scoring in placentas from a cohort of preterm infants
Authors: Straughen Jennifer K , Misra Dawn P , Ernst Linda M , Charles Adrian K , VanHorn Samantha , Ghosh Samiran , Buhimschi Irina , Buhimschi Catalin , Divine George , Salafia Carolyn M
Published: April 2017

Objective

Reliable semiquantitative assessment of histological placental acute inflammation is problematic, even among experts. Tissue samples in histology slides often show variability in the extent and location of neutrophil infiltrates. We sought to determine whether the variability in pathologists' scoring of neutrophil infiltrates in the placenta could be reduced by the use of ‘regions of interest’ (ROIs) that break the sample into smaller components.

Design

ROIs were identified within stained H&E slides from a cohort of 56 women. ROIs were scored using a semiquantitative scale (0–4) for the average number of neutrophils by at least two independent raters.

Setting

Preterm singleton births at Yale New Haven Hospital.

Participants

This study used stained H&E placental slides from a cohort of 56 women with singleton pregnancies who had a clinically indicated amniocentesis within 24 hours of delivery.

Primary and secondary outcome measures

Interrater agreement was assessed with the intraclass correlation coefficient (ICC) and log-linear regression. Predictive validity was assessed using amniotic fluid protein profile scores (neutrophil defensin-2, neutrophil defensin-1, calgranulin C and calgranulin A).

Results

Excellent agreement by the ICC was found for the average neutrophil scores within a region of interest. Log-linear analyses suggest that even where there is disagreement, responses are positively associated along the diagonal. There was also strong evidence of predictive validity comparing pathologists' scores with amniotic fluid protein profile scores.

Conclusions

Agreement among observers of semiquantitative neutrophil scoring through the use of digitised ROIs was demonstrated to be feasible with high reliability and validity.
How is rehabilitation with and without an integrated self-management approach perceived by UK community-dwelling stroke survivors? A qualitative process evaluation to explore implementation and contextual variations
Authors: Jones Fiona , McKevitt Christopher , Riazi Afsane , Liston Matthew
Published: April 2017

Objective

Self-management programmes could support long-term needs after stroke and using methods integrated into rehabilitation is one option. To explore theoretical assumptions and possible mechanisms of implementation a process evaluation was delivered alongside a cluster trial which has demonstrated feasibility of an integrated self-management programme (Bridges SMP) in community-dwelling stroke survivors. This paper aims to show the extent to which experiences from stroke survivors receiving rehabilitation in control (usual care) and intervention (integrated self-management) sites reflected the differences in rehabilitation received and whether their understandings aligned with the self-management approach employed.

Design

Semistructured qualitative interviews carried out as part of a process evaluation analysed thematically.

Setting

Study was based in South London; all interviews were carried out in participants' home setting.

Participants

22 stroke participants recruited; 12 from integrated self-management sites and 10 from usual care sites.

Results

All participants revealed shared appreciation of knowledge and support from therapists but subtle differences emerged between sites in respect to perceptions about responsibility, control and how previous experiences were used. Accounts depicted a variance regarding who had structured and planned their rehabilitation, with greater flexibility about content and involvement perceived by participants from the integrated self-management sites. They also provided accounts and experiences which aligned with principles of the intervention, such as self-discovery and problem-solving.

Conclusions

The findings reflect our theoretical assumptions and possible mechanisms of implementation that rehabilitation with a focus on supporting self-management is reflected in accounts and understandings of stroke survivors. Taken together with our previous research this justifies evaluating the effectiveness of Bridges SMP in a larger sample to further contribute to an understanding of the functioning of the intervention, implementation, contextual factors and mechanisms of impact.

Trial registration number

ISRCTN42534180; Post-results.
Atraumatic versus traumatic lumbar puncture needles: a systematic review and meta-analysis protocol
Authors: Nath Siddharth , Badhiwala Jetan H , Alhazzani Waleed , Nassiri Farshad , Belley-Cote Emilie , Koziarz Alex , Shoamanesh Ashkan , Banfield Laura , Oczkowski Wieslaw , Sharma Mike , Sahlas Demetrios , Reddy Kesava , Farrokhyar Forough , Singh Sheila , Sharma Sunjay , Zytaruk Nicole , Selim Magdy , Almenawer Saleh A
Published: April 2017

Introduction

Lumbar puncture is one of the oldest and most commonly performed procedures in medicine, used to diagnose and treat disease. Headache following lumbar puncture remains a frequent complication, causing significant patient discomfort and often requiring narcotic analgesia or invasive therapy. Needle tip design has been proposed to affect the incidence of headache postlumbar puncture, with pencil-point ‘atraumatic’ needles thought to reduce its incidence in comparison to bevelled ‘traumatic’ needles. Despite this, the use of atraumatic needles and knowledge of their existence remains significantly limited among clinicians. This study will systematically review the evidence on atraumatic lumbar puncture needles and compare them with traumatic needles across a variety of clinical outcomes.

Methods and analyses

We will include published randomised controlled trials (RCTs), observational studies and abstracts, with no publication type or language restrictions. Search strategies will be designed to peruse the MEDLINE, EMBASE, Web of Science, ClinicalTrials.gov, CINAHL, WHO Clinical Trials Database and Cochrane Library databases. We will also implement strategies to search the grey literature. 3 reviewers will thoroughly and independently examine the search results, complete data abstraction and conduct quality assessment. Included RCTs will be assessed using the Cochrane risk of bias assessment tool and eligible observational studies will be examined using the Newcastle-Ottawa Scale. We will examine the outcomes of: headache and its type, intensity, duration and treatment; backache; success rate; hearing disturbance and nerve root irritation. The primary outcome will be the incidence of postdural puncture headache. We will calculate pooled estimates, relative risks for dichotomous outcomes and weighted mean differences for continuous outcomes, with corresponding 95% CIs. Statistical heterogeneity will be measured using Cochran's Q test and quantified using the I2statistic. We will also conduct prespecified subgroup and sensitivity analyses to examine if covariates exist and to explore potential heterogeneity.

Ethics and dissemination

Research ethics board approval is not required for this study as it draws from published data and raises no concerns related to patient privacy. This review will provide a comprehensive assessment of the evidence on atraumatic needles for lumbar puncture and is directed to a wide audience. Results from the review will be disseminated extensively through conferences and submitted to a peer-reviewed journal for publication.

Trial registration number

CRD42016047546.
Tobacco and alcohol use among drug users receiving methadone maintenance treatment: a cross-sectional study in a rural prefecture of Yunnan Province, Southwest China
Authors: Duan Song , Jin Ziyi , Liu Xing , Yang Yuecheng , Ye Runhua , Tang Renhai , Gao Meiyang , Ding Yingying , He Na
Published: April 2017

Objective

To estimate the prevalence of ever, current and heavy tobacco and alcohol use and their correlates among patients undergoing methadone maintenance treatment (MMT).

Design

Cross-sectional study.

Setting

The study was conducted in all of the 5 MMT clinics in Dehong Prefecture, China.

Participants

2121 (81.6%) eligible MMT participants were included in the study population.

Analysis

Ordinal logistic regression was used to estimate the ORs and their 95% CIs.

Results

The overall prevalence of ever, current and heavy smoking was 98.6%, 97.8% and 66.3%, respectively; while that of ever, current and hazardous alcohol drinking was 86.6%, 58.6% and 16.6%, respectively. Among HIV-infected participants, the proportions of those experiencing harmful effects of tobacco and alcohol on AIDS were 53.6% and 72.5%, respectively, and 16.9% and 49.3% had ever tried to quit after diagnosis with HIV. After adjusting for potential confounders, heavier smokers and more hazardous drinkers were more likely to be men, older and less educated. Ethnic minorities were less likely to heavily smoke, but more likely to engage in hazardous drinking. In addition, hazardous drinking was negatively associated with longer years of MMT and HIV infection. Moreover, heavier smoking (OR≥2=2.08, 95% CI 1.16 to 3.73) and more hazardous drinking (OR≥2=2.46, 95% CI 1.53 to 3.97) were positively associated with having multiple sexual partners, and both were positively associated with each other.

Conclusions

The prevalence of tobacco and alcohol consumption was extraordinarily high among MMT participants in China, suggesting the urgent need of enhancing MMT patients' awareness of the harmful effects of tobacco and alcohol consumption and implementing comprehensive education and effective intervention programmes.
What are the physical and psychological health effects of suicide bereavement on family members? Protocol for an observational and interview mixed-methods study in Ireland
Authors: Spillane Ailbhe , Larkin Celine , Corcoran Paul , Matvienko-Sikar Karen , Arensman Ella
Published: April 2017

Introduction

Research indicates that experiencing the suicide of a relative can have a significant impact on family members' emotional health. However, research incorporating the impact of suicide bereavement on family members' physical health is sparse. This paper details the protocol for a mixed-methods study of suicide-bereaved family members. The study will primarily examine the physical and mental health needs of those bereaved by suicide. A secondary objective of the study is to describe the support service needs of family members bereaved by suicide.

Methods and analysis

A mixed-methods approach, using semistructured interviews and self-report questionnaires, will be used. Interviews will be conducted with a group of 15–20 relatives who experienced suicide bereavement. This protocol will follow the COREQ checklist criteria for the reporting of qualitative research interviews. Thematic analysis will be used to examine experiences and impact of bereavement on psychological and physical health. Self-report quantitative data on well-being will be analysed using descriptive statistics.

Ethics and dissemination

Ethical approval to conduct this study has been granted from the Clinical Research Ethics Committee of the Cork Teaching Hospitals. Pseudonyms will be given to participants to protect anonymity. It will be explained to participants that participation in the study is voluntary and they have to right to withdraw at any time. The findings of this research will be disseminated to regional, national and international audiences through publication in peer-reviewed international journals and presentations at scientific conferences. This research also forms part of a PhD thesis.
Adult children's socioeconomic resources and mothers' survival after a breast cancer diagnosis: a Swedish population-based cohort study
Authors: Brooke Hannah L , Ringbäck Weitoft Gunilla , Talbäck Mats , Feychting Maria , Ljung Rickard
Published: April 2017

Objectives

Socioeconomic inequalities in survival after breast cancer persist worldwide. We aim to determine whether adult offspring's socioeconomic resources contribute to inequalities in mothers' survival after breast cancer.

Methods

14 231 women, aged 65–79 years, with a child aged ≥30 years and a first primary diagnosis of breast cancer in the National Cancer Register between 2001 and 2010 were followed until death, 10 years after diagnosis, or end of study (December 2015). Relative survival proportions and excess mortality within 10 years of diagnosis by strata of offspring's education level and disposable income were estimated using flexible parametric models accounting for measures of mothers' socioeconomic position and expected mortality in the general population.

Results

4292 women died during 102 236 person-years of follow-up. Crude 10-year relative survival proportions for mothers of children with >14, 12–14 and <12 years of education were 0.89 (0.87 to 0.91), 0.87 (0.85 to 0.89) and 0.79 (0.76 to 0.81), respectively. Compared with mothers of children with >14 years of education, mothers of children with <12 or 12–14 years of education had substantially higher excess mortality (excess HR 1.69 (1.38 to 2.07) and 1.22 (1.00 to 1.48), respectively). Higher mortality did not differ between tertiles of offspring's disposable income.

Conclusions

Adult offspring's education level may contribute to inequalities in mothers' survival after breast cancer. Clinicians should be aware of the educational context beyond the individual and women with less educated offsprings may require extra support. This should be considered in future research, policy frameworks and interventions aimed at reducing survival inequalities.
Chasing the Golden Hour – Lessons learned from improving initial neutropenic sepsis management.
Authors: Forde Caroline , Scullin Paula
Published: April 2017

Neutropenic sepsis remains a time critical and potentially fatal complication of systemic anti-cancer therapy. A target ‘door to needle’ time of one hour for first dose empirical intravenous antibiotics continues to be promoted nationally. A baseline audit (June 2011) highlighted shortfalls in care in the Belfast Trust, with only 15% of patients receiving antibiotics within sixty minutes. A multi-professional group within the Trust was established to try and initiate the improvements in neutropenic sepsis recognition and initial management that were urgently required. A number of strategies have been developed over the last five years. Firstly an integrated care pathway was introduced, which is currently used by nursing and medical staff for patients presenting with suspected neutropenic sepsis, through acute cancer centre assessment areas and emergency departments, as well as inpatients developing neutropenic sepsis. An initial reaudit June 2012 demonstrated improvement (62% meeting 1hour target), but a subsequent audit, January 2013, was disappointing (only 50% meeting 1hour target). In response, a new compact, user-friendly care pathway was introduced. A range of other measures have also been subsequently introduced. Patients' care is continually monitored through simple ward based documentation, completed after initial treatment of each neutropenic sepsis episode. A patient group direction facilitates nurse led prescribing and administration of first dose antibiotics. Regular multidisciplinary education sessions and improved access to regional guidelines have also been prioritised. From November 2013, consistently greater than 80% of patients have met the one hour target. Recent data continues to be encouraging; in July 2016 100% of patients received first doses within sixty minutes, in October 95% of patients. Significant sustained improvements in meeting the sixty minute target have been demonstrated. The combination of measures ensures neutropenic sepsis is considered and basic clinical care delivered quickly and safely, through a co-ordinated standardised approach, to avoid complications.
Improving Bisphosphonate Infusion Monitoring at Haematology Medical Day Unit
Authors: Ong Michal Wen Sheue , Jones Lydia
Published: April 2017

This project was started after an incident of bisphosphonate-induced hypocalcaemia in September 2015. As part of management of lytic bone lesions in patients with multiple myeloma were given either Zoledronic Acid or Pamidronate Disodium at our Haematology Day Unit. According to the British National Formulary (BNF), it is necessary to correct disturbances of calcium metabolism (e.g. vitamin D deficiency, hypocalcaemia) and consider dental check-ups before starting bisphosphonate infusion due to the risk of osteonecrosis of the jaw. There was no formal checklist in place for all patients prior to starting bisphosphonate infusion. The aim of this quality improvement project was (1) to avoid preventable bisphosphonate induced adverse effects, (2) to improve safety of bisphosphonate prescribing and administration and (3) to increase patient's awareness of needing regular dental checks. Interventions were modified over multiple Plan-Do-Study-Act (PDSA) improvement cycles to improve bisphosphonate infusion monitoring and patient safety.There was an overall improvement in ensuring safety checks were done prior to administration of bisphosphonate infusion compared to baseline measurements. At baseline, 36% (n=9) of patients had a dental check within the last 6 months; after PDSA cycle 3, there was an improvement of up to 69% (n=11). All patients had renal function and bone profile checked prior to infusion from throughout the study. It was all recorded in the blood results section of the checklist with no missing data. We found that 32% (n=8) of patients had never had 25-OHD at baseline. After PDSA cycle 3, all patients had 25-OHD checked at some point.
Validating the Manchester Acute Coronary Syndromes (MACS) and Troponin-only Manchester Acute Coronary Syndromes (T-MACS) rules for the prediction of acute myocardial infarction in patients presenting to the emergency department with chest pain
Authors: Greenslade Jaimi H , Nayer Robert , Parsonage William , Doig Shaela , Young Joanna , Pickering John W , Than Martin , Hammett Christopher , Cullen Louise
Published: April 2017

Background

The Manchester Acute Coronary Syndromes (MACS) rule and the Troponin-only MACS (T-MACS) rule risk stratify patients with suspected acute coronary syndrome (ACS). This observational study sought to validate and compare the MACS and T-MACS rules for assessment of acute myocardial infarction (AMI).

Methods

Prospectively collected data from twoEDs in Australia and New Zealand were analysed. Patients were assigned a probability of ACS based on the MACS and T-MACS rules, incorporating high-sensitivity troponin T, heart-type fatty acid-binding protein, ECG results and clinical symptoms. Patients were then deemed very low risk, low risk, intermediate or high risk if their MACS probability was less than 2%, between 2% and 5%, between 5% and 95% and greater than 95%, respectively. The primary endpoint was 30-day diagnosis of AMI. The secondary endpoint was 30-day major adverse cardiac event (MACE) including AMI, revascularisation or coronary stenosis (>70%). Sensitivity, specificity and predictive values were calculated to assess the accuracy of the MACS and T-MACS rules.

Results

Of the 1244 patients, 114 (9.2%) were diagnosed with AMI and 163 (13.1%) with MACE. The MACS and T-MACS rules categorised 133 (10.7%) and 246 (19.8%) patients, respectively, as very low risk and potentially suitable for early discharge from the ED. There was one false negative case for both rules making sensitivity 99.1% (95.2%–100%).

Conclusions

MACS and T-MACS accurately risk stratify very low risk patients. The T-MACS rule would allow for more patients to be discharged early. The potential for missed MACE events means that further outpatient testing for coronary artery disease may be required for patients identified as very low risk.
There is still a role for cytology in the ‘liquid biopsy’ era. A lesson from a TKI-treated patient showing adenocarcinoma to squamous cell carcinoma transition during disease progression
Authors: Clery Eduardo , Pisapia Pasquale , Feliciano Salvatore , Vigliar Elena , Marano Antonio , De Luca Caterina , Malapelle Umberto , Troncone Giancarlo , Bellevicine Claudio
Published: April 2017

Non-small cell lung carcinoma harbouring epidermal growth factor receptor (EGFR) mutation, usually progress after an initial response to tyrosine-kinase inhibitors (TKI). Liquid biopsy enables with a simple blood draw the accurate detection ofEGFRp.T790M mutation, the most common resistance mechanism, avoiding the more invasive tissue re-biopsy. However, in a subset of cases, resistance mechanisms are more complex featuring both genetic and morphological changes. Here we report the case of a 67 years-old woman, affected by anEGFRmutated lung adenocarcinoma and treated by TKI. At disease progression, the patient developed a morphological transition to squamous cell carcinoma in association to the arising of aPIK3CAp.E542K mutant subclone. This case illustrates that, even in the “liquid biopsy” era, cytology can have still a role by providing an overall assessment of both morphology and genetic TKI resistance mechanisms.
Nasopharyngeal Microbiome in Premature Infants and Stability during Rhinovirus Infection
Authors: Perez Geovanny F , Pérez-Losada Marcos , Isaza Natalia , Rose Mary C , Colberg-Poley Anamaris M , Nino Gustavo
Published: April 2017

Rationale

The nasopharyngeal (NP) microbiota of newborns and infants plays a key role in modulating airway inflammation and respiratory symptoms during viral infections. Premature (PM) birth modifies the early NP environment and is a major risk factor for severe viral respiratory infections. However, it is currently unknown if the NP microbiota of PM infants is altered relative to full-term (FT) individuals.

Objectives

To characterize the NP microbiota differences in preterm and FT infants during rhinovirus (RV) infection.

Methods

We determined the NP microbiota of infants 6 months to ≤2 years of age born FT (n=6) or severely PM<32 weeks gestation (n=7). We compared microbiota composition in healthy NP samples and performed a longitudinal analysis during naturally occurring RV infections to contrast the microbiota dynamics in PM versus FT infants.

Results

We observed significant differences in the NP bacterial community of PM versus FT. NP from PM infants had higher within-group dissimilarity (heterogeneity) relative to FT infants. Bacterial composition of NP samples from PM infants showed increased Proteobacteria and decreased in Firmicutes. There were also differences in the major taxonomic groups identified, including Streptococcus, Moraxella, and Haemophilus. Longitudinal data showed that these prematurity-related microbiota features persisted during RV infection.

Conclusions

PM is associated with NP microbiota changes beyond the neonatal stage. PM infants have an NP microbiota with high heterogeneity relative to FT infants. These prematurity-related microbiota features persisted during RV infection, suggesting that the NP microbiota of PM may play an important role in modulating airway inflammatory and immune responses in this vulnerable group.
Surface complement C3 fragments and cellular binding of microparticles in patients with SLE
Authors: Winberg Line Kjær , Nielsen Claus Henrik , Jacobsen Søren
Published: April 2017

Objectives

To examine microparticles (MPs) from patients with SLE and healthy controls (HCs) by determining the cellular origin of the MPs, quantifying attached fragments of complement component 3 (C3) and assessing the ability of MPs to bind to circulating phagocytes and erythrocytes. These features may be relevant for clearance of MPs in SLE pathogenesis.

Methods

Attached C3 fragments (C3b, iC3b, C3d), membrane integrity and cell surface markers of MPs from 18 patients with SLE and 11 HCs were measured by adding specific antibodies, 7-aminoactinomycin D (7AAD) and annexin V. MPs from all subjects were labelled with carboxyfluorescein diacetate succinimidyl ester and allowed to bind to autologous phagocytes and erythrocytes in the presence of autologous serum, and the binding to individual cell populations was assessed by flow cytometry.

Results

The proportion of MPs bearing C3 fragments was higher in patients with SLE than in HCs (p=0.026), but the amount of opsonising C3b/iC3b molecules was lower (p=0.004). The C3b/iC3b level correlated with the concentration of circulating C3 (rs=0.53, p=0.036). Phagocytes and erythrocytes from patients and HCs bound autologous MPs, and granulocytes from patients bound 13% more MPs than those from HCs (p=0.043). The presence of erythrocytes inhibited the MP binding to granulocytes by approximately 50%.

Conclusions

Our demonstration of altered composition of C3 fragments on MPs from patients with SLE, including decreased numbers of opsonising C3 fragments, and competitive binding of MPs to circulating phagocytes and erythrocytes corroborates the hypothesis of defective clearance of apoptotic material in SLE, and indicates that differences in both MP opsonisation and binding of MPs to cells are important in the pathogenesis of SLE.
Gender and international clinician educators
Authors: Stadler Dora J , Archuleta Sophia , Ibrahim Halah , Shah Nina G , Al-Mohammed Ahmed Ali , Cofrancesco Joseph
Published: April 2017

Objectives

To describe gender differences of international clinician educators (CEs) and leaders, and CEs’ perceptions by gender of preparation, roles, rewards and factors affecting job satisfaction and retention in emerging international competency-based residency programmes.

Methods

Cross-sectional surveys of CEs and leadership were conductedJune 2013–June 2014 at institutions that had adopted competency-based graduate medical education and were accredited by the Accreditation Council for Graduate Medical Education-International.

Results

274 (76.3%) of 359 eligible participants responded; 69 (25.2%) were female. Two (18%) of 11 chief executive officers and 1 (9%) of 11 chief medical officers were women. Female CEs were younger, more likely to be single and childless. They were less likely to hold academic appointments, despite no gender differences in length of time at current institution or in current position. A greater proportion of female CEs felt they were ‘never’ rewarded by academic promotion. Satisfaction rates were similar between the genders. Single female CEs were five times as likely to report being ‘extremely likely’ to stay in the country. Female CEs with children <21 were less likely to report high likelihood of staying in academia. Marital status and children were not associated with outcomes for male CEs.

Conclusions

In the international academic medicine programmes studied, there were fewer female CEs in the pipeline and they perceived a gender gap in appointment and advancement. Stakeholders at international programmes need to develop contextualised strategies to expand entry and decrease attrition of women into CE tracks, and promote gender equity.
Contribution of PPARγ in modulation of acrolein-induced inflammatory signaling in gp91phoxknock-out mice
Authors: Yousefipour Zivar , Chug Neha , Marek Katarzyna , Nesbary Alicia , Mathew Joseph , Ranganna Kasturi , Newaz Mohammad A.
Published: April 2017

Oxidative stress and inflammation are major contributors to acrolein toxicity. Peroxisome proliferator activated receptor gamma (PPARγ) has antioxidant and anti-inflammatory effects. We investigated the contribution of PPARγ ligand GW1929 to the attenuation of oxidative stress in acrolein-induced insult. Male gp91phoxknock-out (KO) mice were treated with acrolein (0.5 mg·(kg body mass)–1by intraperitoneal injection for 7 days) with or without GW1929 (GW; 0.5 mg·(kg body mass)–1·day–1, orally, for 10 days). The livers were processed for further analyses. Acrolein significantly increased 8-isoprostane and reduced PPARγ activity (P < 0.05) in the wild type (WT) and KO mice. GW1929 reduced 8-isoprostane (by 32% and 40% in WT and KO mice, respectively) and increased PPARγ activity (by 81% and 92% in WT and KO, respectively). Chemokine activity was increased (by 63%) in acrolein-treated WT mice, and was reduced by GW1929 (by 65%). KO mice exhibited higher xanthine oxidase (XO). Acrolein increased XO and COX in WT mice and XO in KO mice. GW1929 significantly reduced COX in WT and KO mice and reduced XO in KO mice. Acrolein significantly reduced the total antioxidant status in WT and KO mice (P < 0.05), which was improved by GW1929 (by 75% and 74%). The levels of NF-κB were higher in acrolein-treated WT mice. GW1929 reduced NF-κB levels (by 51%) in KO mice. Acrolein increased CD36 in KO mice (by 43%), which was blunted with GW1929. Data confirms that the generation of free radicals by acrolein is mainly through NAD(P)H, but other oxygenates play a role too. GW1929 may alleviate the toxicity of acrolein by attenuating NF-κB, COX, and CD36.
Holding capacity of dynamically installed anchors in normally consolidated clay under inclined loading
Authors: Fu Yong , Zhang Xiying , Li Yuping , Gu Hai , Sun Jie , Liu Yong , Lee Fook Hou
Published: April 2017

This paper describes a design framework for inclined tensile loading capacity (holding capacity) of dynamically installed anchors in soft clay. Centrifuge model test and numerical results indicate that, while ultimate inclined holding capacity increases with a loading angle smaller than 45° (to the vertical at anchor padeye), anchor failure is controlled predominantly by the ultimate vertical holding capacity, which can be predicted using the American Petroleum Institute method put forth in 2007 with interface friction ratio of 0.25–0.34 and 0.60–0.82 for short- and long-term conditions, respectively. For a loading angle larger than about 65°, anchor failure is controlled largely by the ultimate horizontal holding capacity. It is proposed herein that the ultimate lateral holding capacity can be estimated by generalizing Broms’ method put forth in 1964 for lateral anchor capacity to variable cross section; thereby allowing anchor geometry to be considered in a rational manner. Good agreement can be obtained between the estimated ultimate horizontal holding capacity and that computed using the finite element method by using a lateral resistance of 10.5su, where suis the undrained shear strength. For a loading angle between 45° and 65°, there is significant interaction between vertical and horizontal failure modes. This allows a normalized horizontal–vertical interaction curve to be defined by fitting data from this and previous studies.
Differential colonization by bioprospected rhizobial bacteria associated with common bean in different cropping systems
Authors: de Oliveira-Francesquini Josiele Polzin , Hungria Mariangela , Savi Daiani Cristina , Glienke Chirlei , Aluizio Rodrigo , Kava Vanessa , Galli-Terasawa Lygia Vitoria
Published: April 2017

In this study, we evaluated the diversity of rhizobia isolated from root nodules on common bean (Phaseolus vulgaris) derived from Andean and Mesoamerican centers and grown under field and greenhouse conditions. Genetic characterization of isolates was performed by sequencing analyses of the 16S rRNA gene and 2 housekeeping genes, recA and glnII, and by the amplification of nifH. Symbiotic efficiency was evaluated by examining nodulation, plant biomass production, and plant nitrogen (N) accumulation. The influence of the environment was observed in nodulation capacity, where Rhizobium miluonense was dominant under greenhouse conditions and the Rhizobium acidisoli group prevailed under field conditions. However, strain LGMB41 fit into a separate group from the type strain of R. acidisoli in terms of multilocus phylogeny, implying that it could belong to a new species. Rhizobium miluonense LGMB73 showed the best symbiotic efficiency performance, i.e., with the highest shoot-N content (77.7 mg/plant), superior to the commercial standard strain (56.9 mg/plant). Biodiversity- and bioprospecting-associated studies are important to better understand ecosystems and to develop more effective strategies to improve plant growth using a N-fixation process.
Propagation of acoustic waves in 2D periodic and quasiperiodic phononic crystals
Authors: Aly Arafa H. , Nagaty Ahmed , Khalifa Z.
Published: April 2017

In this study, we have investigated theoretically the propagation of longitudinal sonic waves in 2D periodic and aperiodic (quasiperiodic) phononic crystals. Fibonacci sequence has been used to generate the aperiodic structure. The effect of transformation from 2D periodic to aperiodic structure has been elucidated by calculating the transmission coefficient. The consequences of inserting a circular solid cylinder inside a host water matrix have been repeated at the same calculating conditions. Changing filling fraction has been used to tune the stop band width.
Comment on “the ground-state structures of Au10−, Au8Ni and Au9Ni clusters”
Authors: Zheng Ben-Xia , Die Dong , Li Qian-Qian , Dai Ming-Liang , Li Zhi-Qin , Yang Ji-Xian
Published: April 2017

The lowest energy structures of Au[Formula: see text] and Au[Formula: see text]Ni ([Formula: see text] = 2–9) clusters have been researched using the CALYPSO structure searching method in conjunction with the density functional theory. It is found that the most stable structures of Au[Formula: see text], Au8Ni and Au9Ni clusters reported by Tang et al. [C. M. Tang, X. X. Chen and X. D. Yang, Int. J. Mod. Phys. B 28, 1450138 (2014)] are low-lying isomers. The correct ground states and vibrational spectra are given in this paper.
Effects of lithofacies and environment on
in situ
and laboratory Schmidt hammer tests: a case study of carbonate rocks
Authors: Arman Hasan , Abdelghany Osman , Hashem Waheed , Aldahan Ala
Published: April 2017

The Schmidt hammer (SH) test, which is quick, inexpensive, non-destructive and simple to use, has been widely applied to determine hardness and to assess the unconfined compressive strength of rocks. Lithofacies (composition and texture) and environmental conditions (mainly climate) influence the mechanical properties of rock masses as shown by the investigation presented here. To evaluate these effects, a range of carbonate rocks from Al-Ain arid region in the United Arab Emirates were used for extensive
in situ
and laboratory SH tests. The results expose a wide range of Schmidt hardness rebound (SHR
cor
) values for both the
in situ
and the laboratory tests, but show comparable correlation coefficients between the
in situ
and laboratory natural surface data. This indicates that field SH measurements can be a simple and reliable tool to obtain data on rock mechanical properties; however, caution should be taken in generalization even in a small locality or a region. Although our data are within the wide range of SH values in the published literature, it is apparent that they represent unique values for the rock type investigated and the environment and thereby provide better constraints for engineers in planning for the safety aspects of constructions.
Geotechnical profiling of deep-ocean sediments at the AFEN submarine slide complex
Authors: Madhusudhan B. N. , Clare M. A. , Clayton C. R. I. , Hunt J. E.
Published: April 2017

The Atlantic Frontier Environmental Network (AFEN) submarine slide complex is located 95 km NW of the Shetland Islands, at a water depth of
c.
1000 m. It is thought to have occurred some 2800 years ago. The slide complex is
c.
4 km wide and 13 km in length, and lies on a shallow slope, between 0.7 and 2.5°. Previous sampling and laboratory testing of the very soft sediment has been limited, and did not penetrate the basal failure surface, nor the underlying sediments. This paper presents the first intensive geotechnical profiling of deep-sea sediments from the AFEN slide complex, carried out on core obtained during the July 2014 expedition of the R.V.
Pelagia
. Importantly, this core sampled through, and below, the failure surface of the AFEN slide, and was subjected to unusually closely spaced geotechnical testing using a range of index and classification testing techniques. These are shown to have great value, when taken together with standard sedimentological logging, in establishing ground profiles. From these data new mechanisms of triggering the long runout slope failure at AFEN are postulated, and explain how submarine slides here and elsewhere can have occurred on very shallow slopes, of the order of 1 – 2°.
Objective Assessment of Surgical Technical Skill and Competency in the Operating Room
Authors: Vedula S. Swaroop , Ishii Masaru , Hager Gregory D.
Published: April 2017

Training skillful and competent surgeons is critical to ensure high quality of care and to minimize disparities in access to effective care. Traditional models to train surgeons are being challenged by rapid advances in technology, an intensified patient-safety culture, and a need for value-driven health systems. Simultaneously, technological developments are enabling capture and analysis of large amounts of complex surgical data. These developments are motivating a “surgical data science” approach to objective computer-aided technical skill evaluation (OCASE-T) for scalable, accurate assessment; individualized feedback; and automated coaching. We define the problem space for OCASE-T and summarize 45 publications representing recent research in this domain. We find that most studies on OCASE-T are simulation based; very few are in the operating room. The algorithms and validation methodologies used for OCASE-T are highly varied; there is no uniform consensus. Future research should emphasize competency assessment in the operating room, validation against patient outcomes, and effectiveness for surgical training.
Design and Scaling Up of Microchemical Systems: A Review
Authors: Zhang Jisong , Wang Kai , Teixeira Andrew R. , Jensen Klavs F. , Luo Guangsheng
Published: April 2017

The past two decades have witnessed a rapid development of microreactors. A substantial number of reactions have been tested in microchemical systems, revealing the advantages of controlled residence time, enhanced transport efficiency, high product yield, and inherent safety. This review defines the microchemical system and describes its components and applications as well as the basic structures of micromixers. We focus on mixing, flow dynamics, and mass and heat transfer in microreactors along with three strategies for scaling up microreactors: parallel numbering-up, consecutive numbering-up, and scale-out. We also propose a possible methodology to design microchemical systems. Finally, we provide a summary and future prospects.
Engineering Microneedle Patches for Vaccination and Drug Delivery to Skin
Authors: Prausnitz Mark R.
Published: April 2017

Microneedle patches (MNPs) contain arrays of solid needles measuring hundreds of microns in length that deliver drugs and vaccines into skin in a painless, easy-to-use manner. Optimal MNP design balances multiple interdependent parameters that determine mechanical strength, skin-insertion reliability, drug delivery efficiency, painlessness, manufacturability, and other features of MNPs that affect their performance. MNPs can be made by adapting various microfabrication technologies for delivery of small-molecule drugs, biologics, and vaccines targeted to the skin, which can have pharmacokinetic and immunologic advantages. A small number of human clinical trials, as well as a large and growing market for MNP products for cosmetics, indicate that MNPs can be used safely, efficaciously, and with strong patient acceptance. More advanced clinical trials and commercial-scale manufacturing will facilitate development of MNPs to realize their potential to dramatically increase patient access to otherwise-injectable drugs and to improve drug performance via skin delivery.
Child Maltreatment and Risk for Psychopathology in Childhood and Adulthood
Authors: Jaffee Sara R.
Published: April 2017

Although rates of child maltreatment are declining, more than 600,000 children in the United States are substantiated victims of abuse or neglect. The focus of this review is on the relationship between maltreatment and mental health problems in childhood and adulthood. Children and adults who are exposed to abuse or neglect in childhood are at risk for a range of poor mental health outcomes, including internalizing and externalizing psychopathology, posttraumatic stress disorder, psychotic symptoms, and personality disorders. I review three potential mechanisms by which maltreatment may increase risk for various forms of psychopathology, (a) hypervigilance to threat, (b) deficits in emotion recognition and understanding, and (c) low responsivity to reward. I also review genetic and psychosocial factors that moderate the relationship between maltreatment and risk for psychopathology. Finally, I discuss methodological limitations of the literature on maltreatment, with an emphasis on the challenges associated with establishing a causal role for maltreatment (and moderators or mediators of maltreatment) in the development of mental health problems and the reliance of many studies on retrospective self-reports.
Memory Reconsolidation Interference as an Emerging Treatment for Emotional Disorders: Strengths, Limitations, Challenges, and Opportunities
Authors: Beckers Tom , Kindt Merel
Published: April 2017

Experimental research on emotional memory reconsolidation interference, or the induction of amnesia for previously established emotional memory, has a long tradition, but the potential of that research for the development of novel interventions to treat psychological disorders has been recognized only recently. Here we provide an overview of basic research and clinical studies on emotional memory reconsolidation interference. We point out specific advantages of interventions based on memory reconsolidation interference over traditional treatment for emotional disorders. We also explain how findings from basic research suggest limitations and challenges to clinical translation that may help to understand why clinical trials have met with mixed success so far and how their success can be increased. In closing, we preview new intervention approaches beyond the induction of amnesia that the phenomenon of memory reconsolidation may afford for alleviating the burden imposed by emotional memories and comment on theoretical controversies regarding the nature of memory reconsolidation.
Andreev Reflection in Superfluid 3He: A Probe for Quantum Turbulence
Authors: Bradley D.I. , Guénault A.M. , Haley R.P. , Pickett G.R. , Tsepelin V.
Published: April 2017

Andreev reflection, familiar in superconducting systems, shows a much more extensive set of behaviors in the p-wave condensate of superfluid 3He. We discuss the basic ideas of Andreev reflection in the superfluid and its various manifestations. The fact that the process displays almost perfect retroreflection allows us to exploit the remarkable properties of the phenomenon for characterizing the pure quantum turbulence that can exist in these condensates. Finally, we discuss Andreev-reflection “optics” as a means of visualizing this turbulence in real time through the vortex video camera.
X-Ray Tomography for Lithium Ion Battery Research: A Practical Guide
Authors: Pietsch Patrick , Wood Vanessa
Published: April 2017

X-ray tomography has emerged as a powerful technique for studying lithium ion batteries, allowing nondestructive and often quantitative imaging of these complex systems, which contain solid components with length scales spanning orders of magnitude and which are in-filled with liquid electrolyte. Over the past decade, X-ray tomography has allowed interrogation of structure and material composition, providing quantitative or qualitative insight into battery operation and degradation. In this review, we first provide an overview of X-ray tomography and explore what types of experiments can yield insight into open questions in the lithium ion battery research field. In the second half of the review, we discuss the aspects a researcher must consider, and we summarize challenges and approaches to sample preparation, experimental setup, and data analysis. Finally, we describe both outstanding challenges and promise in using X-ray tomography for lithium ion battery research.