bluuebunny/crossref_metadata_2025 huggingface dataset:
Labour and the Wage
Authors: Adams Zoe
Published: April 2020

The book uses a Marxian inspired social ontological framework, and a genealogic method to explore the relationship between labour law, the market, and capitalist social relations. It advances a constitutive conception of the law–market and law–society ‘relationship’ that stresses law’s contradictory roles in the emergence and reproduction of capitalist social relations—and, relatedly, in the emergence, and reproduction, of the (capitalist) market, and explores this role in depth through a genealogical analysis of the social category of the wage. Tracing the evolution of the wage through legal discourse and the shifting repertoire of legal concepts (the ‘wage’, the ‘salary’, ‘remuneration’) through which it has been denoted over time, the book sheds new light on the problems of low pay and under-inclusive employment status, and on the role of the legal system in perpetuating, and potentially constituting, these problems. Spanning from the Norman conquest to the present day, and exploring issues as diverse as the decasualization of the docks; sweated labour; the truck system; tax credits, tips, and minimum wages, the book provides one of the most in-depth and comprehensive analyses of the wage to date, while, at the same time, offering a number of practical suggestions for labour law reform.
Criminal Investigation in Rural Areas: How Police Detectives Manage Remoteness and Resource Scarcity
Authors: Rantatalo Oscar , Lindberg Ola , Hällgren Markus
Published: April 2020

This article addresses how rural environments characterized by remoteness impact the work of police detectives in their casework. It reports on an ethnographic study of two investigative departments (working on volume crime and domestic crime) located in Northern Sweden. Interviews (N = 27) and participant observations (N = 56) were conducted in order to examine how investigators approached and managed rural conditions in their daily work. Findings indicate that police investigations in rural areas are characterized by constraints, such as resource shortages, extended set-up times (due to travelling), and challenges in multitasking. The findings identify two main practices for investigating crime in such settings: ‘rural investigation’ that entails a decentralized approach in which investigators are embedded locally; and ‘investigating the rural’ that entails a distanced, centralized approach. This article discusses trade-offs and predicted outcomes in crime investigation and highlights how the urban/rural binary divide encompasses a paradoxical tension that investigators must manage continuously.
Efficacy and safety of Sandoz biosimilar rituximab for active rheumatoid arthritis: 52-week results from the randomized controlled ASSIST-RA trial
Authors: Smolen Josef S , Cohen Stanley B , Tony Hans-Peter , Scheinberg Morton , Kivitz Alan , Balanescu Andra , Gomez-Reino Juan , Cen Liyi , Poetzl Johann , Shisha Tamas , Kollins Dmitrij
Published: April 2020

Objectives

This report provides data for the extent of B cell depletion and recovery, efficacy, safety and immunogenicity of Sandoz rituximab (SDZ-RTX; GP2013; Rixathon®) compared with reference rituximab (Ref-RTX) up to week 52 of the ASSIST-RA study.

Methods

Patients were randomized to SDZ-RTX or Ref-RTX in combination with methotrexate according to the RTX label. The primary endpoint was analysed at week 24. Responders (28-joint DAS [DAS28] decrease from baseline >1.2) at week 24 with residual disease activity (DAS28 ≥2.6) were eligible for a second treatment course between week 24 and 52. Endpoints after week 24 included change from baseline in peripheral B cells, DAS28, ACR 20% response rate (ACR20), Clinical and Simplified Disease Activity Indexes (CDAI, SDAI) and HAQ disability index (HAQ-DI). Safety and immunogenicity were assessed by the incidence of adverse events and antidrug antibodies.

Results

Primary and secondary endpoints up to week 24 were met. Overall, 260/312 randomized patients completed treatment up to week 52. SDZ-RTX resulted in B cell concentrations over time similar to Ref-RTX. The efficacy of SDZ-RTX was similar to Ref-RTX up to week 52, as measured by DAS28, ACR20/50/70, CDAI, SDAI and HAQ-DI. Safety of SDZ-RTX was similar to Ref-RTX regarding frequency, type and severity of adverse events, which were consistent with the known Ref-RTX safety profile. The incidence of antidrug antibodies was low and transient similarly across treatment groups.

Conclusion

SDZ-RTX demonstrated similar B cell concentrations over time, efficacy, safety and immunogenicity to Ref-RTX over 52 weeks of the ASSIST-RA study.
Refining myositis associated with primary Sjögren’s syndrome: data from the prospective cohort ASSESS
Authors: Felten Renaud , Giannini Margherita , Nespola Benoit , Lannes Beatrice , Levy Dan , Seror Raphaele , Vittecoq Olivier , Hachulla Eric , Perdriger Aleth , Dieude Philippe , Dubost Jean-Jacques , Fauchais Anne-Laure , Le Guern Veronique , Larroche Claire , Dernis Emmanuelle , Guellec Dewi , Cornec Divi , Sibilia Jean , Mariette Xavier , Gottenberg Jacques-Eric , Meyer Alain
Published: April 2020

Objectives

To refine the prevalence, characteristics and response to treatment of myositis in primary SS (pSS).

Methods

The multicentre prospective Assessment of Systemic Signs and Evolution in Sjögren’s Syndrome (ASSESS) cohort of 395 pSS patients with ≥60 months’ follow-up was screened by the 2017 EULAR/ACR criteria for myositis. Extra-muscular complications, disease activity and patient-reported scores were analysed.

Results

Before enrolment and during the 5-year follow-up, myositis was suspected in 38 pSS patients and confirmed in 4 [1.0% (95% CI: 0.40, 2.6)]. Patients with suspected but not confirmed myositis had higher patient-reported scores and more frequent articular and peripheral nervous involvement than others. By contrast, disease duration in patients with confirmed myositis was 3-fold longer than without myositis. Two of the four myositis patients fulfilled criteria for sporadic IBM. Despite receiving three or more lines of treatment, they showed no muscle improvement, which further supported the sporadic IBM diagnosis. The two other patients did not feature characteristics of a myositis subtype, which suggested ‘pure’ pSS myositis. Steroids plus MTX was then efficient in achieving remission.

Conclusions

Myositis, frequently suspected, occurs in 1% of pSS patients. Especially when there is resistance to treatment, sporadic IBM should be considered and might be regarded as a late complication of this disease.
IMPACT OF THE THREE GORGES WATER CONSERVANCY PROJECT ON RADIOACTIVITY CONCENTRATION LEVELS IN SURROUNDING WATERS
Authors: Yang Qiang , Shao Yang , Du Hengyan , Lin Xuefeng , Wang Lei , Luo Ziyi , Ge Liangquan , Wang Erqi
Published: April 2020

Large-scale water conservancy projects bear much economic and social significance. However, there is a lack of systematic research on how such projects affect radioactivity levels in regional water bodies. For the first time, the present paper uses data for nearly 10 y at different impoundment levels during construction of the dam to analyze changes in water radioactivity concentration levels in China’s Three Gorges region, in order to provide a valuable reference for evaluating the impact of large-scale water conservancy projects on radioactivity concentration levels. Results show that gross α, gross β, U, Th, 226Ra, 40K, 90Sr and 137Cs levels in the water bodies of the Three Gorges region fall within normal limits and annual effective dose for the adults, children and infants are below the WHO recommended reference level of 0.1 mSv per y. The period where the sample was collected and spatial distribution are the main reasons why some radionuclides are not normally distributed. Different water levels during different periods result in large variations in the levels of certain radionuclides, indicating that water levels can have a strong influence on radionuclide levels in reservoir regions. Hence, when evaluating the impact of large-scale water conservancy projects on radioactivity levels, analysis should be carried out on samples collected during different periods in order to make accurate assessments.
EVALUATION OF AMBIENT DOSE EQUIVALENT SURROUNDING TRANSMISSION FULL-BODY SCANNERS
Authors: Elias Caio Caraciolo Rodrigues , D’Oliveira Cardoso Domingos , de Medeiros Marcos Paulo Cavaliere , de Oliveira Cláudio Luiz , Gavazza Sérgio , Correa Samanda Cristine Arruda , Souza Edmilson Monteiro
Published: April 2020

This study analyses the ambient dose equivalent around transmission full-body scanners used in Brazilian prisons and airports. In order to achieve this goal, three transmission full-body scanners of the same model assembled by a Brazilian manufacturer were evaluated. Ambient dose equivalent rates were measured at several positions around these screening devices with the help of an ionisation chamber made by Ludlum, model 9DP. These systems consist of an X-ray generator with three distinct modes of operation, each with a unique value for maximum energy (100, 150 and 160 keV) and current (0.4, 0.5 and 0.9 mA). Results show the integrated dose per scan at each of the measurement positions considered, presenting values for ambient dose equivalent with and without an individual being scanned, in order to take into account the scattering due to the presence of a human body.
Overexpression of the 3-hydroxy-3-methylglutaryl-CoA synthase gene LcHMGS effectively increases the yield of monoterpenes and sesquiterpenes
Authors: Wu Liwen , Zhao Yunxiao , Zhang Qiyan , Chen Yicun , Gao Ming , Wang Yangdong
Published: April 2020

Monoterpenes are important components of plant essential oils and have long been used as raw materials for spices and food flavorings. A number of studies have been performed to increase the content of monoterpenes in plants, but no obvious effect was observed. Exchange was observed between the methylerythritol phosphate (MEP) and mevalonic acid (MVA) metabolic pathways, which produce monoterpenes and sesquiterpenes, respectively. However, the specific details of the communication have not been elucidated. In the present study, we investigated the effects of overexpressing Litsea cubeba (Lour.) Persoon 3-hydroxy-3-methylglutaryl-coenzyme A synthase (LcHMGS) on the production of monoterpenes and sesquiterpenes. In addition, we also explored the flow of metabolic flux between the MEP and MVA pathways. We cloned LcHMGS and analyzed its expression pattern in various tissues. The overexpression of LcHMGS significantly increased the species and content of monoterpenes and sesquiterpenes. In addition, LcHMGS overexpression in plants induced such phenotypes as excessive growth, enlarged vegetative organs and early flowering by elevating the GA3 content. Our results demonstrate a metabolic engineering strategy to improve the yield of monoterpenes and sesquiterpenes and simultaneously increase the biomass of plants.
Cytokinins are involved in drought tolerance ofPinus radiataplants originating from embryonal masses induced at high temperatures
Authors: Castander-Olarieta Ander , Moncaleán Paloma , Pereira Catia , Pěnčík Aleš , Petřík Ivan , Pavlović Iva , Novák Ondřej , Strnad Miroslav , Goicoa Tomas , Ugarte Maria D , Montalbán Itziar A
Published: April 2020

Vegetative propagation through somatic embryogenesis is an effective method to produce elite varieties and can be applied as a tool to study the response of plants to different stresses. Several studies show that environmental changes during embryogenesis could determine future plant development. Moreover, we previously reported that physical and chemical conditions during somatic embryogenesis can determine the protein, hormone and metabolite profiles, as well as the micromorphological and ultrastructural organization of embryonal masses and somatic embryos. In this sense, phytohormones are key players throughout the somatic embryogenesis process as well as during numerous stress–adaptation responses. In this work, we first applied different high-temperature regimes (30 °C, 4 weeks; 40 °C, 4 days; 50 °C, 5 min) during induction of Pinus radiata D. Don somatic embryogenesis, together with control temperature (23 °C). Then, the somatic plants regenerated from initiated embryogenic cell lines and cultivated in greenhouse conditions were subjected to drought stress and control treatments to evaluate survival, growth and several physiological traits (relative water content, water potential, photosynthesis, stomatal conductance and transpiration). Based on those preliminary results, even more extreme high-temperature regimes were applied during induction (40 °C, 4 h; 50 °C, 30 min; 60 °C, 5 min) and the corresponding cytokinin profiles of initiated embryonal masses from different lines were analysed. The results showed that the temperature regime during induction had delayed negative effects on drought resilience of somatic plants as indicated by survival, photosynthetic activity and water- use efficiency. However, high temperatures for extended periods of time enhanced subsequent plant growth in well-watered conditions. High-temperature regime treatments induced significant differences in the profile of total cytokinin bases, N6-isopentenyladenine, cis-zeatin riboside and trans-zeatin riboside. We concluded that phytohormones could be potential regulators of stress-response processes during initial steps of somatic embryogenesis and that they may have delayed implications in further developmental processes, determining the performance of the generated plants.
Does root respiration in Australian rainforest tree seedlings acclimate to experimental warming?
Authors: Noh Nam Jin , Crous Kristine Y , Li Jinquan , Choury Zineb , Barton Craig V M , Arndt Stefan K , Reich Peter B , Tjoelker Mark G , Pendall Elise
Published: April 2020

Plant respiration can acclimate to changing environmental conditions and vary between species as well as biome types, although belowground respiration responses to ongoing climate warming are not well understood. Understanding the thermal acclimation capacity of root respiration (Rroot) in relation to increasing temperatures is therefore critical in elucidating a key uncertainty in plant function in response to warming. However, the degree of temperature acclimation of Rroot in rainforest trees and how root chemical and morphological traits are related to acclimation is unknown. Here we investigated the extent to which respiration of fine roots (≤2 mm) of four tropical and four warm-temperate rainforest tree seedlings differed in response to warmer growth temperatures (control and +6 °C), including temperature sensitivity (Q10) and the degree of acclimation of Rroot. Regardless of biome type, we found no consistent pattern in the short-term temperature responses of Rroot to elevated growth temperature: a significant reduction in the temperature response of Rroot to +6 °C treatment was only observed for a tropical species, Cryptocarya mackinnoniana, whereas the other seven species had either some stimulation or no alteration. Across species, Rroot was positively correlated with root tissue nitrogen concentration (mg g−1), while Q10 was positively correlated with root tissue density (g cm−3). Warming increased root tissue density by 20.8% but did not alter root nitrogen across species. We conclude that thermal acclimation capacity of Rroot to warming is species-specific and suggest that root tissue density is a useful predictor of Rroot and its thermal responses in rainforest tree seedlings.
Molecular and physiological mechanisms underlying magnesium-deficiency-induced enlargement, cracking and lignification of Citrus sinensis leaf veins
Authors: Ye Xin , Chen Xu-Feng , Cai Li-Ya , Lai Ning-Wei , Deng Chong-Ling , Guo Jiu-Xin , Yang Lin-Tong , Chen Li-Song
Published: April 2020

Little is known about the physiological and molecular mechanisms underlying magnesium (Mg)-deficiency-induced enlargement, cracking and lignification of midribs and main lateral veins of Citrus leaves. Citrus sinensis (L.) Osbeck seedlings were irrigated with nutrient solution at a concentration of 0 (Mg-deficiency) or 2 (Mg-sufficiency) mM Mg(NO3)2 for 16 weeks. Enlargement, cracking and lignification of veins occurred only in lower leaves, but not in upper leaves. Total soluble sugars (glucose + fructose + sucrose), starch and cellulose concentrations were less in Mg-deficiency veins of lower leaves (MDVLL) than those in Mg-sufficiency veins of lower leaves (MSVLL), but lignin concentration was higher in MDVLL than that in MSVLL. However, all four parameters were similar between Mg-deficiency veins of upper leaves (MDVUL) and Mg-sufficiency veins of upper leaves (MSVUL). Using label-free, liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis, we identified 1229 and 492 differentially abundant proteins (DAPs) in MDVLL vs MSVLL and MDVUL vs MSVUL, respectively. Magnesium-deficiency-induced alterations of Mg, nonstructural carbohydrates, cell wall components, and protein profiles were greater in veins of lower leaves than those in veins of upper leaves. The increased concentration of lignin in MDVLL vs MSVLL might be caused by the following factors: (i) repression of cellulose and starch accumulation promoted lignin biosynthesis; (ii) abundances of proteins involved in phenylpropanoid biosynthesis pathway, hormone biosynthesis and glutathione metabolism were increased; and (iii) the abundances of the other DAPs [viz., copper/zinc-superoxide dismutase, ascorbate oxidase (AO) and ABC transporters] involved in lignin biosynthesis were elevated. Also, the abundances of several proteins involved in cell wall metabolism (viz., expansins, Rho GTPase-activating protein gacA, AO, monocopper oxidase-like protein and xyloglucan endotransglucosylase/hydrolase) were increased in MDVLL vs MSVLL, which might be responsible for the enlargement and cracking of leaf veins.
Evaluating Cucurbit Rootstocks to Prevent Disease Caused by Pythium aphanidermatum and P. myriotylum on Watermelon
Authors: Toporek Sean M. , Keinath Anthony P.
Published: April 2020

Pythium species cause root and stem rot in watermelon (Citrullus lanatus), but cucurbit rootstocks used to graft watermelon have not been evaluated for resistance. P. aphanidermatum and P. myriotylum were inoculated onto 15 nongrafted watermelon, citron (Citrullus amarus), bottle gourd (Lagenaria siceraria), and interspecific hybrid squash (Cucurbita maxima × C. moschata) cultivars in a growth chamber. Watermelon was more susceptible than bottle gourd and interspecific hybrid squash at 20 and 30°C. Twenty-one cultivars were inoculated in a field with an equal blend of both Pythium species. Interspecific hybrid squash was less susceptible than bottle gourd and watermelon in 2018 and 2019. Seedless watermelon cultivar Tri-X 313 was grafted to one citron, one bottle gourd, and three interspecific hybrid squash rootstocks. Plants were inoculated in the field as described. Grafting to interspecific hybrid squash rootstocks reduced disease incidence compared with nongrafted controls in 2018 and 2019. Mefenoxam and propamocarb applied at transplanting did not affect disease compared with non-fungicide-treated plots. Grafting to interspecific hybrid squash Camelforce significantly increased total and marketable fruit numbers and total weight in 2019 compared with the nongrafted control. In summary, interspecific hybrid squash was consistently resistant to Pythium, demonstrating resistance and utility in watermelon grafting.
Using Kolb’s Experiential Learning to Educate Nursing Students About Providing Culturally and Linguistically Appropriate Care
Authors: Krol Maria , Adimando Andrea
Published: April 2020

Over the past decade, the Agency for Healthcare Research and Quality and The Joint Commission have identified that communication problems are a root cause of most serious adverse events and that patients with limited English proficiency are more likely than others to suffer physical harm when such errors occur. It is essential to educate nursing students on the challenges of patients with limited English proficiency and empower them with tools, such as the National Culturally and Linguistically Appropriate Services standards, to minimize this phenomenon in their future nursing practice. We describe an educational intervention designed to accomplish this using Kolb’s experiential learning theory as a foundation for implementation.
Assessing Trainees and Making Entrustment Decisions: On the Nature and Use of Entrustment-Supervision Scales
Authors: ten Cate Olle , Schwartz Alan , Chen H. Carrie
Published: April 2020

Clinical teachers are continuously entrusting trainees with care responsibilities in health care settings. Entrustable professional activities employ entrustment decision making as an approach to assessment in the workplace.

Various scales have been created to measure “entrustment,” all basically expressing the level or type of supervision a trainee requires for safe and high-quality care. However, some of these scales are only weakly related to the purpose of making decisions about the autonomy trainees will be granted. The authors aim to increase understanding about the nature, purpose, and practice of supervision scales aimed at entrustment.

After arguing for entrustment as a component of workplace-based assessment, the distinction between ad hoc entrustment decisions (daily decisions in health care settings) and summative entrustment decisions (with a certifying nature) is clarified. Next, the noncontinuous nature of entrustment-supervision (ES) scales, as opposed to most workplace-based assessment scales, is explained. ES scales have ordinal, rather than interval, properties and focus on discrete decisions. Finally, some scales are retrospective (“how much supervision was provided?”), and others are prospective (“how much supervision will be needed in the near future?”). Although retrospective scales reflect observed behavior, prospective scales truly focus on entrustment and ask for more holistic judgment, as they include a broader evaluation and a risk estimation to enable a decision about increase of autonomy.

The analysis concludes with a discussion about entrustment for unsupervised practice and supervision of others, as well as the program, context, and specialty specificity of scales.
The Health Care Chief Wellness Officer: What the Role Is and Is Not
Authors: Ripp Jonathan , Shanafelt Tait
Published: April 2020

Occupational distress among clinicians and its impact on quality of care is a major threat to the health care delivery system. To address threats to clinician well-being, many institutions have introduced a new senior leadership position—the health care chief wellness officer (CWO). This role is distinct from CWOs or other wellness leadership positions that have historically existed outside of medicine. The health care CWO role was established to reduce widespread occupational distress in clinicians by improving the work environment rather than by promoting health behaviors to reduce health insurance costs. A complex array of system-level drivers has contributed to clinician distress. Developing and overseeing the execution of a strategy to address these challenges and working in partnership with other operational leaders to improve well-being require a correctly placed senior leader with the appropriate authority and resources, such as a CWO.

Health care CWOs must focus primarily on improving their organizations’ work environment and culture, not on developing individual-level interventions, such as personal resilience, mindfulness, and self-care offerings. The goal of this work is to address what is wrong with the practice environment, not to make individuals better able to tolerate a broken system. Metrics to evaluate organizational progress as well as the efficacy of the health care CWO and his or her team are discussed in this Perspective. Occupational distress in clinicians is widespread and has implications for quality of care. Vanguard organizations have begun to put into place the leaders, infrastructure, and improvement teams necessary to address this issue. The health care CWO plays a critical role in the effectiveness of these efforts.
Use of Resident-Sensitive Quality Measure Data in Entrustment Decision Making: A Qualitative Study of Clinical Competency Committee Members at One Pediatric Residency
Authors: Schumacher Daniel J. , Martini Abigail , Sobolewski Brad , Carraccio Carol , Holmboe Eric , Busari Jamiu , Poynter Sue , van der Vleuten Cees , Lingard Lorelei
Published: April 2020

Purpose

Resident-sensitive quality measures (RSQMs) are quality measures that are likely performed by an individual resident and are important to care quality for a given illness of interest. This study sought to explore how individual clinical competency committee (CCC) members interpret, use, and prioritize RSQMs alongside traditional assessment data when making a summative entrustment decision.

Method

In this constructivist grounded theory study, 19 members of the pediatric residency CCC at Cincinnati Children’s Hospital Medical Center were purposively and theoretically sampled between February and July 2019. Participants were provided a deidentified resident assessment portfolio with traditional assessment data (milestone and/or entrustable professional activity ratings as well as narrative comments from 5 rotations) and RSQM performance data for 3 acute, common diagnoses in the pediatric emergency department (asthma, bronchiolitis, and closed head injury) from the emergency medicine rotation. Data collection consisted of 2 phases: (1) observation and think out loud while participants reviewed the portfolio and (2) semistructured interviews to probe participants’ reviews. Analysis moved from close readings to coding and theme development, followed by the creation of a model illustrating theme interaction. Data collection and analysis were iterative.

Results

Five dimensions for how participants interpret, use, and prioritize RSQMs were identified: (1) ability to orient to RSQMs: confusing to self-explanatory, (2) propensity to use RSQMs: reluctant to enthusiastic, (3) RSQM interpretation: requires contextualization to self-evident, (4) RSQMs for assessment decisions: not sticky to sticky, and (5) expectations for residents: potentially unfair to fair to use RSQMs. The interactions among these dimensions generated 3 RSQM data user profiles: eager incorporation, willing incorporation, and disinclined incorporation.

Conclusions

Participants used RSQMs to varying extents in their review of resident data and found such data helpful to varying degrees, supporting the inclusion of RSQMs as resident assessment data for CCC review.
Point-of-care ultrasound in pediatric anesthesia: perioperative considerations
Authors: Adler Adam C. , Matisoff Andrew J. , DiNardo James A. , Miller-Hance Wanda C.
Published: April 2020

Purpose of review

To review the perioperative applications of point-of-care ultrasound (POCUS).

Recent findings

The role of point-of-care ultrasonography for perioperative care is expanding with respect to perioperative application. The imaging approach can complement the physical exam and provide additional information for decision-making in pediatric perioperative medicine. This review will focus on applications in the following organ systems: airway, cardiac, pulmonary and gastric. Specifically, POCUS of the airway has been used to optimize endotracheal tube depth, aid in tube size selection and predict difficulty with laryngoscopy and intubation. Lung POCUS has been used to assess for causes hypoxemia as well as to optimize ventilatory mechanics. Cardiac POCUS has been used for assessment of hemodynamics, valvular and ventricular function. Gastric ultrasound has emerged as an evaluative mechanism of gastric content in the setting of fasting as well as to confirm placement of gastric tubes. The applications of POCUS in the perioperative setting continue to evolve as a reliable diagnostic tool that can assist in timely diagnosis, improve procedural safety and has the potential to improve patient outcomes.

The utility of perioperative POCUS has been well demonstrated, specifically for examination of the airway, stomach and cardiopulmonary system. It is advisable for the novice sonographer to perform POCUS within the guidelines set by the American Society of Echocardiography regarding basic POCUS. As with all diagnostic modalities, understanding the limitations of ultrasound and POCUS as well as continuous self-assessment is crucial.
Perioperative β-blocker use: what is new in 2020?
Authors: Wang Xiaoxiao , Fernandez Robles Claudia , Kertai Miklos D.
Published: April 2020

Purpose of review

Although the indications for β-blockers in the management of patients with congestive heart failure and myocardial infarction are well established, the use of β-blockers in the perioperative setting remains controversial.

Recent findings

Since 2008 PeriOperative ISchemic Evaluation Trial, there have been numerous studies suggesting that perioperative β-blockers are associated with adverse events such as hypotension, bradycardia, increased mortality, and stroke.

In this article, we review the most recent evidence to suggest an approach to perioperative β-blocker use tailored to patient and surgical risk factors. We also review recent studies on off-label uses for perioperative β-blockers.
Industry Payments to Orthopedic Spine Surgeons Reported by the Open Payments Database
Authors: Pathak Neil , Mercier Michael R. , Galivanche Anoop R. , Mets Elbert J. , Bovonratwet Patawut , Bagi Paul S. , Varthi Arya G. , Grauer Jonathan N.
Published: April 2020

Study Design:

This was a retrospective study of publicly available data.

Objective:

The objective of this study was to characterize and assess trends in Open Payments Database (OPD) industry payments reported to orthopedic spine surgeons from 2014 to 2017.

Summary of Background Data:

There have been a lack of studies characterizing OPD industry payments to orthopedic spine surgeons over the 4 full years of data available.

Materials and Methods:

General industry payments made to orthopedic spine surgeons from 2014 to 2017 were characterized by year with analysis of: number of compensated surgeons, median payment per surgeon, top strata of compensated surgeons, and subtype (ie, food/beverage). Research and Ownership Payments were characterized by median payment per surgeon. Mann-Whitney U tests were used to compare payments.

Results:

For General Payments, the number of compensated orthopedic spine surgeons increased from 1539 in 2014 to 1673 in 2017. Later year median General Payments per surgeon were compared with the 2014 median ($1051): 2015 ($1070: P=0.375), 2016 ($1263: P=0.012), and 2017 ($978: P=0.561). In 2014, the top 10% of compensated orthopedic spine surgeons received 89% of the total General compensation to orthopedic spine surgeons, top 5% received 79%, and the top 1% received 55%. The median General Payment for these 3 top strata remained similar over the 4 years evaluated (P>0.05). For subtype analyses, the median aggregate General Payment for “education” increased (P=0.002) across the years. Finally, it was determined that the median payment per surgeon for Research and Ownership Payment categories remained stable across the time period (P>0.05).

Conclusions:

Many expected industry payments to surgeons to decrease under public scrutiny of the OPD, but the present study showed no net change in median payment (General, Research, and Ownership) over the years studied. In the age of greater transparency, these findings shed insight into the orthopedic spine surgeon-industry relationship.

Level of Evidence:

Level III.
Liposomal Bupivacaine Is Both Safe and Effective in Controlling Postoperative Pain After Spinal Surgery in Children
Authors: Chughtai Morad , Sultan Assem A. , Hudson Brittany , Goodwin Ryan C. , Seif John , Khlopas Anton , Bena James , Jin Yuxuan , Gurd David P. , Kuivila Thomas E. , Ballock Robert Tracy
Published: April 2020

Study Design:

Retrospective comparative cohort study.

Objective:

To evaluate: (1) pain relief efficacy; (2) opioid consumption; (3) length of stay (LOS); (4) discharge disposition (DD); and (5) safety and adverse effects of liposomal bupivacaine (LB) in pediatric patients who underwent spinal deformity correction.

Summary of Background Data:

LB is a long-acting, locally injectable anesthetic. Previous orthopedic studies investigating its use have been limited to adult patients. The use of LB as part of postoperative pain management in pediatric patients undergoing spine deformity correction surgery is yet to be evaluated.

Materials and Methods:

A total of 195 patients that received LB as part of their postoperative pain management regimen were compared with 128 patients who received standard pain management without LB. Pain intensity, opioid consumption, LOS, and DD were recorded. Potential LB-related complications were reported as frequencies and statistically compared for superiority. Noninferiority tests were performed using the Farrington-Manning score test. Multivariate tests based on generalized estimating equations were performed to determine the common and average treatment effects. Odds ratios (OR) with 95% confidence intervals (CI) were calculated.

Results:

The LB cohort demonstrated lower pain scores [postoperative day 1 (POD 1)—median=2, interquartile range (IQR)=(0–5) vs. 5 (2.5–7); POD 2—3 (0–5) vs. 4 (3–6); P<0.001], lower overall opioid consumption (78.2 vs. 129 morphine milligram equivalents; P=0.0001) and consistently from POD 0 to 3 (mean differences; 7.47, 9.04, 17.2, and 17.3 morphine milligram equivalents, respectively; P<0.01), shorter LOS (median=3 d, IQR=3–4 vs. 4 d, IQR=4–6; P<0.001), and similar to-home DD (98% vs. 97%). Complications were similar among the cohorts in superiority and 10% noninferiority analyses. Patients in the LB cohort had lower odds for complications (odds ratio=0.77; 95% CI, 0.64–0.93; P=0.009 and 0.67; 95% CI, 0.50–0.90; P=0.008).

Conclusions:

This study demonstrated the safety and efficacy of LB when added to the current multimodal postoperative pain management regimens after pediatric spinal surgery.

Level of Evidence:

Level III.
Demographic and Perioperative Factors Associated With Patient-reported Outcomes Measurement Information System (PROMIS) Survey Completion
Authors: Parrish James M. , Jenkins Nathaniel W. , Patel Dil V. , Karmarkar Sailee S. , Yoo Joon S. , Lamoutte Eric H. , Singh Kern
Published: April 2020

Study Design:

This was a retrospective study.

Objective:

To evaluate independent demographic and perioperative factors associated with lower Patient-reported Outcome Measurement Information System Physical Function (PROMIS PF) survey completion rates after spine surgery.

Summary of Background Data:

There has not been a study evaluating factors related to PROMIS PF survey completion following spine surgery.

Methods:

Patients undergoing spine procedures were retrospectively reviewed. The number of PROMIS PF surveys that were completed at each time period and the number of surveys that were completed in succession starting with the first survey were tabulated and reported using descriptive statistics. Independent preoperative and perioperative factors associated with full survey completion up to the 12-month period were identified using χ2 analysis and Poisson regression with robust error variance. A final multivariate model was created using a backward, stepwise multivariate regression.

Results:

A total of 713 patients were included. Variables positively associated with PROMIS survey completion were aged above 60 years and Patient Health Questionnaire (PHQ)-9≥10. African Americans and Hispanics were negatively associated with survey completion. Postoperative day 0 narcotic use ≥50 oral morphine equivalents was positively associated with survey completion, while outpatient surgical setting and high preoperative radicular arm/leg pain were negatively associated with survey completion. In the final multivariate model, depression was the only variable that was positively associated, while both outpatient surgical setting and high preoperative radicular arm/leg pain were negatively associated with survey completion.

Conclusion:

This study identified demographic and perioperative variables associated with PROMIS survey completion and response rates. Patients who underwent surgery in the outpatient setting and those with high preoperative radicular limb pain were less likely to complete surveys. Interestingly, patients with clinical signs of depression were more likely to fill out surveys. Understanding variables associated with survey completion may provide the clinician with insight into which demographic groups are the most at-risk for not responding to surveys.
Partnering With Family Members to Detect Delirium in Critically Ill Patients*
Authors: Fiest Kirsten M. , Krewulak Karla D. , Ely E. Wesley , Davidson Judy E. , Ismail Zahinoor , Sept Bonnie G. , Stelfox Henry T.
Published: April 2020

Objectives:

To evaluate the diagnostic accuracy of family-administered tools to detect delirium in critically ill patients.

Design:

Diagnostic accuracy study.

Setting:

Large, tertiary care academic hospital in a single-payer health system.

Patients:

Consecutive, eligible patients with at least one family member present (dyads) and a Richmond Agitation-Sedation Scale greater than or equal to –3, no primary direct brain injury, the ability to provide informed consent (both patient and family member), the ability to communicate with research staff, and anticipated to remain admitted in the ICU for at least a further 24 hours to complete all assessments at least once.

Interventions:

None.

Measurements and Main Results:

Family-administered delirium assessments (Family Confusion Assessment Method and Sour Seven) were completed once daily. A board-certified neuropsychiatrist and team of ICU research nurses conducted the reference standard assessments of delirium (based on Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition, criteria) once daily for a maximum of 5 days. The mean age of the 147 included patients was 56.1 years (sd, 16.2 yr), 61% of whom were male. Family members (n = 147) were most commonly spouses (n = 71, 48.3%) of patients. The area under the receiver operating characteristic curve on the Family Confusion Assessment Method was 65.0% (95% CI, 60.0–70.0%), 71.0% (95% CI, 66.0–76.0%) for possible delirium (cutpoint of 4) on the Sour Seven and 67.0% (95% CI, 62.0–72.0%) for delirium (cutpoint of 9) on the Sour Seven. These area under the receiver operating characteristic curves were lower than the Intensive Care Delirium Screening Checklist (standard of care) and Confusion Assessment Method for ICU. Combining the Family Confusion Assessment Method or Sour Seven with the Intensive Care Delirium Screening Checklist or Confusion Assessment Method for ICU resulted in area under the receiver operating characteristic curves that were not significantly better, or worse for some combinations, than the Intensive Care Delirium Screening Checklist or Confusion Assessment Method for ICU alone. Adding the Family Confusion Assessment Method and Sour Seven to the Intensive Care Delirium Screening Checklist and Confusion Assessment Method for ICU improved sensitivity at the expense of specificity.

Conclusions:

Family-administered delirium detection is feasible and has fair, but lower diagnostic accuracy than clinical assessments using the Intensive Care Delirium Screening Checklist and Confusion Assessment Method for ICU. Family proxy assessments are essential for determining baseline cognitive function. Engaging and empowering families of critically ill patients warrant further study.
Filling the gaps of patient information and comprehension
Authors: Ector Geneviève I.C.G. , Hermens Rosella P.M.G. , Blijlevens Nicole M.A.
Published: April 2020

Purpose of review

This review describes the gaps in cancer patient information and comprehension and provides examples of interventions aimed at filling the gaps.

Recent findings

Despite the technologically advanced era, unmet information needs remain a challenge in current cancer care, even though the beneficial effects of adequate information provision are well described.It starts with the basics of patient–physician communication and information exchange. Barriers are described both patient and physician-specific. For patients to comprehend and recall information correctly, information provision should be tailored to the specific patient in content, as well as in readability level. Tailored content based on bidirectional and iterative information exchange (i.e., patients reported outcomes, followed by specific/personalized feedback) is of focus in the current development of interventions aimed at meeting the gaps. However, the effects of such interventions are not overwhelming and the explanation could be multifactorial.

Unmet informational needs are still a gap in current cancer care. The effect of eHealth interventions is not yet well established. Key is to educate patients and (future) healthcare professionals in eHealth. Future research should focus on identifying what kind of interventions are able to fill the gaps.
Intracellular signaling modules linking DNA damage to secretome changes in senescent melanoma cells
Authors: Chavanet Alexandra , Hill Kathryn R. , Jiménez-Andrade Yanek , Choo Min-Kyung , White Kristin , Park Jin Mo
Published: April 2020

Cellular senescence is a major barricade on the path of cancer development, yet proteins secreted from senescent cells exert complex and often discordant effects on subsequent cancer evolution. Somatic genome alternations driving the formation of nevi and melanoma are efficient inducers of cellular senescence. Melanocyte and melanoma cell senescence is likely to come into play as a key factor affecting the course of tumorigenesis and responsiveness to therapy; little mechanistic information has been generated, however, that substantiates this idea and facilitates its clinical translation. Here, we established and characterized a model of melanoma cell senescence in which pharmacologically induced DNA damage triggered divergent ATM kinase- and STING-dependent intracellular signaling cascades and resulted in cell cycle arrest, cytomorphologic remodeling, and drastic secretome changes. Targeted proteome profiling revealed that senescent melanoma cells in this model secreted a panoply of proteins shaping the tumor immune microenvironment. CRISPR-mediated genetic ablation of the p38α and IKKβ signaling modules downstream of the ATM kinase severed the link between DNA damage and this secretory phenotype without restoring proliferative capacity. A similar genetic dissection showed that loss of STING signaling prevented type I interferon induction in DNA-damaged melanoma cells but otherwise left the senescence-associated processes in our model intact. Actionable proteins secreted from senescent melanoma cells or involved in senescence-associated intracellular signaling hold potential as markers for melanoma characterization and targets for melanoma treatment.
Enhanced recovery after surgery in minimally invasive gynecologic surgery surgical patients: one size fits all?
Authors: Helou Christine M. , Chaves Katherine F. , Limperg Tobias B. , Anderson Ted L.
Published: April 2020

Purpose of review

Enhanced recovery after surgery (ERAS) programs aim to expedite functional recovery and improve surgical outcomes without increasing complications or cost. First championed by colorectal surgeons, ERAS protocols are now widely utilized among surgical subspecialties. The present review focuses on use of ERAS pathways in minimally invasive gynecologic surgery (MIGS) and risk factors for suboptimal outcomes in this population.

Recent findings

Studies across multiple fields has shown benefit to adoption of ERAS protocols. However, lack of protocol standardization among institutions, implementation of interventions as a bundle, varied compliance, and lack of study randomization collectively obscure generalizability of findings from such studies. Emerging data in fact suggest benefits may not translate equally across all populations, cautioning against indiscriminate application of protocols to all surgeries or patients. Thus applicability of ERAS protocols to the MIGS population merits close examination.

ERAS protocols improve postoperative outcomes, satisfaction, and cost of care for most patients undergoing gynecologic surgery. However, modifications to typical ERAS protocols may be beneficial to certain subsets of patients including patients with chronic pelvic pain, opiate dependence, or psychiatric disorders. Identification of risk factors for admission or increased hospital stay may help guide protocol modifications for at-risk groups within the MIGS population.
A Mediterranean Lifestyle Is Associated With Lower Hypertension Prevalence and Better Aerobic Capacity Among New England Firefighter Recruits
Authors: Lan Fan-Yun , Fernandez-Montero Alejandro , Yiannakou Ioanna , Marinos-Iatrides Orestes , Ankeny Jacob T. , Kiser Jeffrey , Christophi Costas A. , Christiani David C. , Sotos-Prieto Mercedes , Kales Stefanos N.
Published: April 2020

Objective:

Examine the association between healthy Mediterranean lifestyle practices and cardiovascular disease (CVD) risk factors among New England firefighter recruits.

Methods:

A MEDI-Lifestyle score was used to measure adherence to a Mediterranean lifestyle (not smoking, increased physical activity, high adherence to Mediterranean diet, non-obese body mass index, decreased screen time, adequate nightly sleep, and napping) among the recruits. MEDI-Lifestyle scores were cross-sectionally analyzed with blood pressure, aerobic capacity, and other CVD risk factors.

Results:

Among 92 recruits, high adherence to MEDI-Lifestyle was significantly associated with a decreased risk of prevalent hypertension (odds ratio [OR] = 0.14 [0.03–0.71]) and a greater probability of high aerobic capacity (OR = 5.80 [1.05–32.05]) as compared with low adherence in age- and sex-adjusted analyses.

Conclusions:

Increased adherence to MEDI-Lifestyle is associated with a better CVD risk profile in firefighter recruits.
Student Self-Assessments and Peer Assessments of Video Recordings of Physical Examination Practicums in a Physical Diagnosis Course
Authors: Sadowski Catherine K. , Dickerson Lisa , Taylor Leslie F.
Published: April 2020

Purpose

Self-assessments and peer assessments of video recordings of performance have been used in a variety of educational and professional training programs; however, there is no literature on the application of such performance assessments in physician assistant (PA) education. The purpose of this pilot study was to both explore the feasibility of adding video recordings of existing practicum examinations to a physical diagnosis course and evaluate students' self-assessments and peer assessments of the activity.

Methods

Fifty first-semester students who were enrolled in a 7-semester PA program participated. Three 15-minute practicums were recorded on students' personal smartphones and uploaded to a private YouTube channel. Students completed self- and peer-review questionnaires after each practicum, as well as a separate reflective questionnaire at the end of the course to garner their feedback of the video-recorded practicums on their physical examination (PE) performance.

Results

Students assessed their peers' performances more favorably than their own. Students reported increased awareness of their own verbal and nonverbal communication strengths and weaknesses with the use of video-recorded practicums, as well as increased motivation to practice. The majority of students found these sessions to have improved their performance and decreased their anxiety with performing a complete PE at the end of the course.

Conclusions

The use of periodic video recordings of PE practicums with both self-assessments and peer assessments increased the students' level of practice of these important skills, enhanced students' awareness of nontechnical aspects of patient examination, was well received by the majority of students, and may be implemented with minimal expense.