bluuebunny/crossref_metadata_2025 huggingface dataset:
KiwiSaver fund performance and asset allocation policy
Authors: Dieu Dang Huong
Published: April 2019

Purpose

This paper aims to examine the performance and benchmark asset allocation policy of 70 KiwiSaver funds catergorised as growth, balanced or conservative over the period October 2007-June 2016. The study focuses on the sources for returns variability across time and returns variation among funds.

Design/methodology/approach

Each fund is benchmarked against a portfolio of eight indices representing eight invested asset classes. Three measures were used to examine the after-fee benchmark-adjusted performance of each fund: excess return, cumulative abnormal return and holding period returns difference. Tracking error and active share were used to capture manager’s benchmark deviation.

Findings

On average, funds underperform their respective benchmarks, with the mean quarterly excess return (after management fees) of −0.15 per cent (growth), −0.63 per cent (balanced) and −0.83 per cent (conservative). Benchmark returns variability, on average, explains 43-78 per cent of fund’s across-time returns variability, and this is primarily driven by fund’s exposures to global capital markets. Differences in benchmark policies, on average, account for 18.8-39.3 per cent of among-fund returns variation, while differences in fees and security selection may explain the rest. About 61 per cent of balanced and 47 per cent of Growth funds’ managers make selection bets against their benchmarks. There is no consistent evidence that more actively managed funds deliver higher after-fee risk-adjusted performance. Superior performance is often due to randomness.

Originality/value

This study makes use of a unique data set gathered directly from KiwiSaver managers and captures the long-term strategic asset allocation target which underlines the investment management process in reality. The study represents the first attempt to examine the impact of benchmark asset allocation policy on KiwiSaver fund’s returns variability across time and returns variation among funds.
“Getting freaky with the founders”
Authors: Hensley Matthew A.
Published: April 2019

Purpose

The purpose of this paper is to share with social science educators a coherent framework for implementing Hamilton: An American Musical into their classrooms, while also supporting the wider objective of leveraging music to foster disciplinary literacy skills and culturally relevant practices. The framework is a construct that draws on author’s previous teaching experience and its purpose is to inform and support teachers’ practice.

Design/methodology/approach

The author first highlights literature focused on the effectiveness of using music in the social science classroom as a response to author’s own teaching experience using Hamilton: An American Musical, then hones in on the impact of hip-hop music specifically. Finally, the author unites Pellegrino’s (2013) models (close reading, inquiry, student discovery and creative development) to songs from Miranda’s Hamilton to provide pedagogical strategies and examples that are ready to be implemented in the Secondary US History Classroom.

Findings

Lin Manuel Miranda’s portrayal of Hamilton and his historical compatriots as ethnically diverse, combustible and provocative figures bring to life experiences that are unexpectedly and uniquely American, connecting with current generations, while remaining anchored in history (Mason, 2017). The success and relatability of Miranda’s Hamilton and this time-warped story of the founding fathers has led social studies teachers to explore ways to use the music, dialogue and messages in their classrooms.

Originality/value

While many lesson examples related to Lin Manuel Miranda’s Hamilton have proliferated online, there remains a lack of pedagogical coherence to help teachers extend this work as part of a larger framework of practice designed to support teaching and learning through music. The author strives to provide social science educators a strategic, adaptable and ready-to-use framework for implementing Miranda’s Hamilton: An American Musical into their classrooms.
Comparison of bioethanol and beta‐galactosidase production by Kluyveromyces and Saccharomyces strains grown in cheese whey
Authors: Alves Érika de Pádua , Morioka Luiz Rodrigo Ito , Suguimoto Hélio Hiroshi
Published: April 2019

The production of ethanol and beta‐galactosidase by Kluyveromyces marxianus and Saccharomyces fragilis strains grown in cheese whey was evaluated. The conditions for fermentation in 50 g/L (3.3% lactose) and 150 g/L (8.8% lactose) cheese whey were 100 rpm for 24 h at 30, 35 and 40 °C. Saccharomyces fragilis IZ 275 in 8.8% lactose at 40 °C resulted in 3.90% ethanol. Kluyveromyces marxianus CCT 3172 showed higher beta‐galactosidase, 1.10 U/mg, at 30 °C. Therefore, the choice of cultivation conditions and the most suitable species is important for obtaining high yields of the products of interest.
Improving the uptake of post‐mortem after pregnancy loss
Authors: Marsh Michael
Published: April 2019

Editor‐in‐Chief, Dr Michael Marsh, discusses the latest thinking in women's health and highlights articles from this issue in an audio podcast available at: https://soundcloud.com/bjog/may-editorial-2019
c‐Ski accelerates renal cancer progression by attenuating transforming growth factor β signaling
Authors: Taguchi Luna , Miyakuni Kosuke , Morishita Yasuyuki , Morikawa Teppei , Fukayama Masashi , Miyazono Kohei , Ehata Shogo
Published: April 2019

Although transforming growth factor beta (TGF‐β) is known to be involved in the pathogenesis and progression of many cancers, its role in renal cancer has not been fully investigated. In the present study, we examined the role of TGF‐β in clear cell renal carcinoma (ccRCC) progression in vitro and in vivo. First, expression levels of TGF‐β signaling pathway components were examined. Microarray and immunohistochemical analyses showed that the expression of c‐Ski, a transcriptional corepressor of Smad‐dependent TGF‐β and bone morphogenetic protein (BMP) signaling, was higher in ccRCC tissues than in normal renal tissues. Next, a functional analysis of c‐Ski effects was carried out. Bioluminescence imaging of renal orthotopic tumor models demonstrated that overexpression of c‐Ski in human ccRCC cells promoted in vivo tumor formation. Enhancement of tumor formation was also reproduced by the introduction of a dominant‐negative mutant TGF‐β type II receptor into ccRCC cells. In contrast, introduction of the BMP signaling inhibitor Noggin failed to accelerate tumor formation, suggesting that the tumor‐promoting effect of c‐Ski depends on the inhibition of TGF‐β signaling rather than of BMP signaling. Finally, the molecular mechanism of the tumor‐suppressive role of TGF‐β was assessed. Although TGF‐β signaling did not affect tumor angiogenesis, apoptosis of ccRCC cells was induced by TGF‐β. Taken together, these findings suggest that c‐Ski suppresses TGF‐β signaling in ccRCC cells, which, in turn, attenuates the tumor‐suppressive effect of TGF‐β.
Anthracycline‐induced cardiotoxicity in diffuse large B‐cell lymphoma: NT‐proBNP and cardiovascular score for risk stratification
Authors: Ferraro Mariana Paola , Gimeno‐Vazquez Eva , Subirana Isaac , Gómez Miquel , Díaz Javier , Sánchez‐González Blanca , García‐Pallarols Francesc , Martínez Laia , Ble Mireia , Molina Lluis , Belarte Laia Carla , Abella Eugenia , Elosua Roberto , Comín‐Colet Josep , Salar Antonio
Published: April 2019

Objective

To evaluate the role of N‐terminal pro‐brain‐type natriuretic peptide (NT‐proBNP) and a cardiovascular (CV) risk score named FRESCO for predicting anthracycline‐induced cardiotoxicity (AIC) in diffuse large B‐cell lymphoma (DLBCL).

Methods

A total of 130 consecutive DLBCL patients treated in first‐line with anthracycline‐containing immunochemotherapy. Competitive risk between NT‐proBNP, FRESCO, and time to AIC was considered.

Results

Cumulative incidence of AIC was 12.2% and 17.5% at 1 and 5 years, respectively. Median time to development cardiotoxicity was 6.4 months, with half of the cases showing heart failure and the other half silent AIC. Both NT‐proBNP levels and FRESCO score were independently associated with higher risk of AIC (P = 0.001 and P = 0.03, respectively). Patients with NT‐proBNP ≥600 pg/mL or those with FRESCO ≥4.5% had 3.97 or 2.54 times higher risk of AIC than those with lower values (P = 0.001 and P = 0.048, respectively). According to the previous cutoffs, three groups of patients with a significantly different risk of AIC could be identified (P < 0.0001).

Conclusions

Doxorubicin‐containing chemotherapy is associated with increased risk of silent and overt AIC. Baseline NT‐proBNP levels and FRESCO CV risk score are accurate predictors of AIC and can identify groups of patients at different risk, in which personalized cardiologic evaluation should be offered.
Characterization of circadian human facial surface lipid composition
Authors: Jia Yan , Zhou Mingyue , Huang Hong , Gan Yao , Yang Manli , Ding Ruiheng
Published: April 2019

Background

The circadian rhythm is an endogenous clock that governs a wide range of physiological functions. In the skin, rhythmic changes in skin barrier function have been investigated at the physiological level; however, few studies at the molecular level have been reported. Additionally, there is no study on lipidomic profile variations of skin surface lipid (SSL), which could potentially explain the rhythmic changes in skin status.

Objectives

The SSL profile of healthy young women was analysed to assess SSL variations and to assess the skin status during the circadian cycle.

Methods

Ultra performance liquid chromatography/quadrupole time‐of‐flight mass spectrometry and multivariate data analysis were performed to assess SSL variations.

Results

The lipidomic profile showed significant differences with the circadian rhythm. Multivariate data analysis indicated that glycerolipids were the lipids majorly affected by the circadian rhythm. Additionally, in the SSL profile, both the average chain length and the content of free fatty acids (FFAs) were higher at 20:00 than at 08:00.

Conclusions

The SSL profile significantly varied with respect to the circadian rhythm. The rhythm‐altered triacylglycerol level, FFA chain length and FFA content resulted in rhythmic changes in skin barrier function, including transepidermal water loss alteration and pH variation.
Latitude‐independent, continent‐wide consistency in climate–richness relationships in Asian ferns and lycophytes
Authors: Khine Phyo Kay , Kluge Jürgen , Kessler Michael , Miehe Georg , Karger Dirk N.
Published: April 2019

Aim

To assess richness patterns of ferns and lycophytes in relation to climatic factors in Eastern Asia, analysing eight elevational gradients, situated along a latitudinal gradient.

Location

East and Southeast Asia (4° S to 43.3° N).

Methods

Ferns and lycophytes were recorded in 480 plots of 400 m2along eight elevational gradients. We related macroclimatic factors to local fern species richness using generalized linear models. We tested the predictive power of macroclimatic variables by a leave‐one‐(gradient‐) out cross‐validation (LOOCV) and tested the predictive power of each model using Spearman's rank correlation, and predicted the respective models spatially. Model residuals were related to two available local (plot scale) factors, terrain inclination and terrain heterogeneity using simple linear regression.

Results

Local fern species richness declined linearly towards higher latitudes, and simultaneously elevational richness peaks shifted towards lowlands with increasing distance from the equator, transitioning from unimodal to linear patterns. Temperature was the macroclimatic factor with the highest predictive power for fern species richness. In combination with other variables, especially cloud cover, macroclimatic factors could explain up to about 60% of species richness distributions.

Main conclusions

Macroclimatic factors, such as temperature and cloud cover, are able to predict a substantial proportion of the variation in local fern species richness in East and Southeast Asia. Using predictive models based onLOOCVsubstantially increases the accuracy of species richness predictions as compared to simply searching for correlates along all gradients.
Public health nurses' perceptions of interprofessional collaboration related to adolescents' mental health problems in secondary schools: A phenomenographic study
Authors: Granrud Marie Dahlen , Anderzèn‐Carlsson Agneta , Bisholt Birgitta , Steffenak Anne Kjersti Myhrene
Published: April 2019

Aims and objectives

To describe the variation in public health nurses' perceptions of interprofessional collaboration related to adolescents' mental health problems in secondary schools in Norway.

Background

Mental health problems among adolescents account for a large portion of the global burden of disease and affect 10%–20% of adolescents worldwide. Public health nurses in school health services play an important role in disease prevention and promotion of physical and mental health. In order to serve adolescents with regard to mental health problems, public health nurses are dependent on collaboration with other professionals in schools.

Design

Qualitative interviews were conducted with 18 public health nurses working in the school health services.

Method

A phenomenographic approach was used for interviewing and for analysing the qualitative interviews. This study is presented in line with COREQ's checklist.

Result

The analysis resulted in three descriptive categories based on eight identified conceptions. The categories are as follows: “The formal structure has an impact on interprofessional collaboration”; “The public health nurse is an important, but not always self‐evident, partner in interprofessional collaboration”; and “The primary players are the teachers in collaboration.”

Conclusion

The public health nurses describe that they had limited impact on collaboration and were dependent on both the school principal and the teachers for achieving good collaboration. Teachers have the power to decide whether to collaborate with the public health nurse, and public health nurses regard teachers as the most important collaborative partners. The public health nurses need to make themselves and their competence visible.

Relevance to clinical practice

The findings demonstrated that public health nurses are important collaborators, but are not always included in interprofessional collaboration. This knowledge is essential to strengthen public health nurses' roles and presence in schools, which could most certainly benefit adolescents with mental health problems in secondary school.
The fertility fitness paradox of anabolic‐androgenic steroid abuse in men
Authors: Mossman J. A. , Pacey A. A.
Published: April 2019

Click here to view the Original article by Dr. H. Horwitz et al.
Folate of pregnant women after a nationwide folic acid supplementation in China
Authors: Zhang Xuejuan , Liu Jufen , Jin Yongsheng , Yang Shuang , Song Zhijiao , Jin Lei , Wang Linlin , Ren Aiguo
Published: April 2019

Folate insufficiency during the periconceptional period increases the risk of neural tube defects (NTDs) in offspring, and folic acid supplementation substantially reduces the risk. Widespread large‐scale folic acid supplementation (0.4‐mg folic acid tablet) has been adopted as a main strategy to prevent NTDs in China since 2009. We examined folate concentrations in plasma and red blood cells (RBCs) of pregnant women and the factors associated with blood folate concentrations in a population with a high prevalence of NTDs in northern China. A cross‐sectional survey was conducted in 2014, and 1,107 pregnant women were recruited from 11 county or city maternal and child health centres across Shanxi province. Microbiological assays were used to determine folate concentrations. Factors associated with blood folate insufficiency were identified. The median (25th and 75th percentiles) folate concentrations were 28.4 (17.6, 45.2) nmol L−1 and 1,001.2 (658.7, 1,402.5) nmol L−1 in plasma and RBCs, respectively. According to the proposed RBC (906 nmol L−1) concentrations for optimal NTD prevention, 42.4% participants had RBC folate insufficiency. Rural women had a higher proportion of folate insufficiency than urban women. Folic acid supplementation was the only factor associated with RBC folate insufficiency. A large proportion of women had RBC folate concentrations that are not optimal for the prevention of NTDs despite free access to folic acid supplements. Actions that aim to improve folic acid supplementation compliance are needed to reach the full potential of the nationwide folic acid supplementation programme in terms of NTD prevention.
Effectiveness and safety of sofosbuvir‐based therapy against chronic hepatitis C infection after successful kidney transplantation
Authors: Musialik Joanna , Kolonko Aureliusz , Kwiecień Katarzyna , Owczarek Aleksander J. , Więcek Andrzej
Published: April 2019

Background

Direct‐acting antivirals (DAAs), including sofosbuvir (SOF), are recommended for treatment of chronic hepatitis C virus (HCV) infection. However, few studies have investigated the effectiveness and safety of new DAAs in kidney transplant recipients (KTRs).

Objectives

To assess the effectiveness and safety of SOF‐based therapy in stable KTRs.

Patients and methods

Forty KTRs were treated with SOF‐based regimens. Rapid, end‐therapeutic, and sustained virologic responses were assessed, as was liver stiffness by elastometry. Safety was monitored by measuring the estimated glomerular filtration rate (eGFR), blood hemoglobin (Hb) concentration, proteinuria, and blood trough levels of calcineurin inhibitors (CNIs). Other side effects were also recorded.

Results

The effectiveness of DAAs was 100% at all time points. The therapy did not significantly influence eGFR or proteinuria, but significantly decreased mean blood Hb levels (13.5 ± 2.0 vs 11.6 ± 1.9, respectively, P < 0.001), which required a dose reduction or cessation of ribavirin (RBV) in 50% of patients. A profound, significant decrease in initial CNI concentrations was also observed during treatment in the majority of patients within the first month of therapy.

Conclusions

In this cohort of KTRs, the new SOF‐based therapies were characterized by 100% effectiveness and good safety profiles. However, in patients co‐treated with RBV, close blood Hb monitoring and early RBV dose reduction are necessary. In the majority of KTRs, antiviral therapy leads to a substantial and early decrease in CNIs levels, thus frequent measurement of CNI levels is necessary during SOF‐based therapy.
Cambios estructurales y prácticas de movilización política en Argentina. Dos ciclos políticos en perspectiva histórica (1989-2002 y 2003-2015)
Authors: Trujillo Lucia , Retamozo Martín
Published: April 2019

Este artículo analiza dos ciclos de movilización ocurridos en la Argentina. El primero ocurrido entre 1989 y 2002 en el que se registran repertorios de acción clásicos e innovaciones y nuevos actores como respuestas a la situación socio-económica. El segundo entre 2003 y 2015, en un contexto de retorno de lo nacional, popular estadocéntrico en el que se evidencia una revitalización de los sindicatos, cambios en las demandas sociales y la forma de movilización. La mirada propuesta incluye la relación entre cambios estructurales y las respuestas de movilización política en ambos ciclos y pone en evidencia las mediaciones que operan entre la estructura y la acción para explicar la dinámica de la contienda.
The Kinematics of Containment for N-Dimensional Ellipsoids
Authors: Ruan Sipu , Ding Jianzhong , Ma Qianli , Chirikjian Gregory S.
Published: April 2019

Knowing the set of allowable motions of a convex body moving inside a slightly larger one is useful in applications such as automated assembly mechanisms, robot motion planning, etc. The theory behind this is called the “kinematics of containment (KC).” In this article, we show that when the convex bodies are ellipsoids, lower bounds of the KC volume can be constructed using simple convex constraint equations. In particular, we study a subset of the allowable motions for an n-dimensional ellipsoid being fully contained in another. The problem is addressed in both algebraic and geometric ways, and two lower bounds of the allowable motions are proposed. Containment checking processes for a specific configuration of the moving ellipsoid and the calculations of the volume of the proposed lower bounds in the configuration space (C-space) are introduced. Examples for the proposed lower bounds in the 2D and 3D Euclidean space are implemented, and the corresponding volumes in C-space are compared with different shapes of the ellipsoids. Practical applications using the proposed theories in motion planning problems and parts-handling mechanisms are then discussed.
Orchestrated biomechanical, structural, and biochemical stimuli for engineering anisotropic meniscus
Authors: Zhang Zheng-Zheng , Chen You-Rong , Wang Shao-Jie , Zhao Feng , Wang Xiao-Gang , Yang Fei , Shi Jin-Jun , Ge Zi-Gang , Ding Wen-Yu , Yang Yu-Chen , Zou Tong-Qiang , Zhang Ji-Ying , Yu Jia-Kuo , Jiang Dong
Published: April 2019

Anisotropic meniscus engineered using biomechanical, biochemical, and structural cues demonstrates long-term knee chondroprotection in rabbits.
Recurrent abducens nerve palsy and hypophosphatasia syndrome
Authors: Khade Neha , Carrivick Simon , Orr Carolyn , Prentice David
Published: April 2019

A 47-year-old woman presented with six episodes of horizontal binocular double vision over a 2-year period. CT imaging was significant for extensive dural calcification in the spine and calcification of the skull base, likely involving Dorello’s canal. Biochemical testing revealed a persistently low alkaline phosphatase level. Recurrent nerve palsy may possibly be induced by mechanical compression of the sixth cranial nerve in Dorello’s canal from calcification due to hypophosphatasia syndrome.
Effective but uncommon treatment of a spontaneous otogenic epidural pneumocephalus
Authors: Hofmann Veit-Maria , Pudszuhn Annett , Niehues Stefan Markus
Published: April 2019

We describe an uncommon treatment for epidural pneumocephalus and an effective but uncommon treatment option. Complete and permanent relief was achieved in a young patient using a tympanostomy tube to eliminate excessive positive air pressure in the mastoid bone that was the cause of spontaneous pneumocephalus. The patient showed no recurrence and absence of clinical symptoms at outpatient follow-up. Post-traumatic, infectious or spontaneous pneumocephalus may require an active, usually surgical approach. Treatment with a tympanostomy tube can be an alternative in suitable patients.
Acalculous acute cholecystitis during the course of an enteroviral infection
Authors: Simões Ana Sofia , Marinhas Andreia , Coelho Paulo , Ferreira Sandra
Published: April 2019

Gallbladder diseases are uncommon in children. Acalculous acute cholecystitis, although rare, is the most frequent form of acute cholecystitis in childhood. In acalculous acute cholecystitis, clinical presentation and laboratory findings are unspecific, making the diagnosis challenging. Abdominal ultrasonography is the first-line exam. Most cases of paediatric acalculous acute cholecystitis have been described in critically ill patients, but can occur in previously healthy children, without underlying diseases or severe conditions. The authors present a clinical report of a child with acalculous acute cholecystitis and enteroviral infection. Diagnosis, treatment, clinical course and prognosis are described. Pathophysiology, aetiology, diagnosis and treatment of acalculous acute cholecystitis are also discussed.
Posaconazole in the treatment of refractoryPurpureocillium lilacinum(formerPaecilomyces lilacinus) keratitis: the salvation when nothing works
Authors: Almeida Oliveira Mariana , Carmo Analia , Rosa Andreia , Murta Joaquim
Published: April 2019

We report a case of a 41-year-old woman, wearer of contact lenses who was presented to the emergency room with a 2-month history of pain and red eye. She presented with a severe keratitis refractory to quinolones, fortified antibiotics and clotrimazole. Due to the risk of perforation, a tectonic penetrating keratoplasty (PK) was performed. Clinical signs of keratitis recurrence were observed and cultures were positive forPurpureocillium lilacinum (formerPaecilomyces lilacinus). The patient did not improve on topical amphotericin B and intracameral voriconazole. Worsening of clinical condition required a new PK. Oral posaconazole was initiated postoperatively and suspended at the fourth postoperative month. The cornea remains clear until the last follow-up visit, 12 months after the second graft. To our knowledge, this is the second case report that documents the effectiveness of oral posaconazole in a refractoryP. lilacinuskeratitis, resistant to other second-generation triazoles and conventional antifungals.
How to use relevant data for maximal benefit with minimal risk: digital health data governance to protect vulnerable populations in low-income and middle-income countries
Authors: Tiffin Nicki , George Asha , LeFevre Amnesty Elizabeth
Published: April 2019

Globally, the volume of private and personal digital data has massively increased, accompanied by rapid expansion in the generation and use of digital health data. These technological advances promise increased opportunity for data-driven and evidence-based health programme design, management and assessment; but also increased risk to individuals of data misuse or data breach of their sensitive personal data, especially given how easily digital data can be accessed, copied and transferred on electronic platforms if the appropriate controls are not implemented. This is particularly pertinent in low-income and middle-income countries (LMICs), where vulnerable populations are more likely to be at a disadvantage in negotiating digital privacy and confidentiality given the intersectional nature of the digital divide. The potential benefits of strengthening health systems and improving health outcomes through the digital health environment thus come with a concomitant need to implement strong data governance structures and ensure the ethical use and reuse of individuals’ data collected through digital health programmes. We present a framework for data governance to reduce the risks of health data breach or misuse in digital health programmes in LMICS. We define and describe four key domains for data governance and appropriate data stewardship, covering ethical oversight and informed consent processes, data protection through data access controls, sustainability of ethical data use and application of relevant legislation. We discuss key components of each domain with a focus on their relevance to vulnerable populations in LMICs and examples of data governance issues arising within the LMIC context.
Differentiating the cognitive development of early-term births in infants and toddlers: a cross-sectional study in China
Authors: Hua Jing , Sun Jie , Cao Zhijuan , Dai Xiaotian , Lin Senran , Guo Jialin , Gu Guixiong , Du Wenchong
Published: April 2019

Objectives

This study aimed to explore the cognitive development of low-risk children during early childhood for early-term births at 37 and 38 weeks of gestation compared with full term births at 39–41 weeks of gestation.

Setting and participants

We conducted a cross-sectional study in Shanghai, one of the largest cities in China. A total of 1444 children from singleton pregnancies born at term gestation were included in the study.

Measures

The cognitive outcomes of the subjects were measured using the cognitive subtest of Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) across three cities in China. We analysed the association between gestational age and cognitive development during infancy and toddler stages using multivariate linear modelling.

Results

The cognitive development scores for infants born at 37 gestational weeks were significantly lower than those born at 39–41 gestational weeks (β=−2.257, 95% CI −4.280 to −0.235; p<0.05) after adjusting for children’s and maternal characteristics, as well as socio-economic factors. However, there were no significant differences in cognitive ability between infants born at 38 gestational weeks compared with their full-term counterparts (p>0.05). Moreover, these effects were not found in toddlers (between 17 and 48 months of age) after adjusting for the possible confounders (p>0.05).

Conclusions

Infants born at 37 weeks of gestation exhibited weaker cognitive ability compared with those born at 39–41 weeks of gestation. Our findings provide evidences for the close monitoring of potential developmental problems in early-term children, especially those born at 37 gestational weeks.
Extent and determinants of catastrophic health expenditure for tuberculosis care in Chongqing municipality, China: a cross-sectional study
Authors: Duan Weixia , Zhang Wen , Wu Chengguo , Wang Qingya , Yu Ya , Lin Hui , Liu Ying , Hu Daiyu
Published: April 2019

Objective

To investigate the extent and associations of patient/diagnostic delay and other potential factors with catastrophic health expenditure (CHE) for tuberculosis (TB) care in Chongqing municipality, China.

Design

A cross-sectional study.

Setting

Four counties of Chongqing municipality, China.

Participants

A total of 1199 patients with active pulmonary TB beyond 16 years and without mental disorders were consecutively recruited in the four counties’ designated TB medical institutions.

Outcome measures

The incidence and intensity of CHE for TB care were described. The association between patients’ ‘sociodemographic and clinical characteristics such as patient delay, diagnostic delay, forms of TB, health insurance status and hospitalisation and CHE were analysed using univariate and multivariate logistic regression.

Results

The incidence of CHE was 52.8% and out-of-pocket (OOP) payments were 93% of the total costs for TB care. Compared with patients without delay, the incidence and intensity of CHE were higher in patients who had patient delay or diagnostic delay. Patients who experienced patient delay or diagnostic delay, who was a male, elderly (≥60 years), an inhabitant, a peasant, divorced/widow, the New Cooperative Medical Scheme membership had greater risks of incurring CHE for TB care. Having a higher educational level appeared to be a protective factor. However, hospitalisation was not associated with CHE after controlling for other variables.

Conclusion

The incidence and intensity of CHE for TB care are high, which provides baseline data about catastrophic costs that TB-related households faced in Chongqing of China. Variety of determinants of CHE implicate that it is essential to take effective measures to promote early seeking care and early diagnosis, improve the actual reimbursement rates of health insurance, especially for outpatients, and need more fine-tuned interventions such as precise poverty alleviation to reduce catastrophic costs of the vulnerable population.
Typhoon track change–based emergency shelter location–allocation model: a case study of Wenchang in Hainan province, China
Authors: Qin Lianjie , Xu Wei , Zhao Xiujuan , Ma Yunjia
Published: April 2019

Background

Determining the locations of disaster emergency shelters and the allocation of impacted residents are key components in shelter planning and emergency management. Various models have been developed to solve this location–allocation problem, but gaps remain regarding the processes of hazards. This study attempts to develop a model based on the change of typhoon track that addresses the location–allocation problem for typhoon emergency shelters.

Purpose

To consider the changes in candidate shelters and number of evacuees due to the change in impact area with the progression of a typhoon.

Methods

The proposed model is composed of several static processes and solved by a modified particle swarm optimisation algorithm with a restart strategy.

Results

The model is illustrated with the case of the evacuation process for Wenchang in Hainan province during Typhoon Rammasun in 2014 and Typhoon Mirinae in 2016. For the case of Typhoon Rammasun in 2014, the residents from east to west need to evacuate in three phases. For the case of Typhoon Mirinae in 2016, residents in the northern communities need not to evacuate to candidate shelters because they are not affected by the typhoon.

Conclusion

The proposed model has advantages compared with non-typhoon track change–based model in saving time spent in shelters for residents and saving public resources for the local governments. With the proposed model, a manager could efficiently evacuate residents by considering the typhoon conditions.
Recent trends in child and youth emergency department visits because of pedestrian motor vehicle collisions by socioeconomic status in Ontario, Canada
Authors: Rothman Linda , Macarthur Colin , Wilton Andrew , Howard Andrew William , Macpherson Alison K
Published: April 2019

Background

Children in lower-income households have higher injury rates. Trends in emergency department (ED) visits by children 0–19 years because of pedestrian motor vehicle collisions (PMVCs) in Ontario, Canada (2008–2015) by socioeconomic status were examined.

Methods

PMVC ED data were obtained from the Institute for Clinical Evaluative Sciences for children age 0–19 years over the period 2008–2015. Age-adjusted rates were calculated using Ontario census data. Household income quintiles were determined from the Registered Persons Database. Poisson regression was used to model ED visit rates by year, age and income quintile.

Results

The frequency of child PMVC ED visits in Ontario decreased from 1562 in 2008 to 1281 in 2015. Age-adjusted rates were unchanged over time (IRR 1.00, 95% CI 0.99 to 1.00); however, rate disparities by income status persisted with an IRR of 0.52 (0.50 to 0.55) comparing the highest with the lowest income level.

Conclusions

Exposure to traffic may play a role in rate disparities by income status in child PMVC; however, less safe traffic environments in lower income areas may also be strong contributors. These findings highlight the potential impact of roadway safety modifications in lower income areas to mitigate disparities in injury rates by socioeconomic status.
Antiepileptic drugs as prophylaxis for de novo brain tumour-related epilepsy after craniotomy: a systematic review and meta-analysis of harm and benefits
Authors: Mirian Christian , Møller Pedersen Maria , Sabers Anne , Mathiesen Tiit
Published: April 2019

Objectives

To investigate potential harm and benefits of antiepileptic drugs (AED) given prophylactically to prevent de novo brain tumour-related epilepsy after craniotomy.

Methods

Randomised controlled trials (RCT) and retrospective studies published before 27 November 2018 were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were applied. Eligible patients were diagnosed with a brain tumour, were seizure naïve and underwent craniotomy. The random effects model was used for quantitative synthesis. The analysis was adjusted for the confounding effect of including patients with a history of seizure prior to study inclusion.

Results

A total of 454 patients received prophylactic AED whereas 333 were allocated to placebo or no treatment. Two RCTs and four retrospective studies were identified. The OR was 1.09 (95% CI 0.7 to 1.8, p=0.7, I2=5.6%, χ2p=0.5), indicating study consistency and no significant differences. An additional two RCTs and one retrospective study combined craniotomy and diagnostic biopsy, and were subgroup analysed—which supported no difference in odds for epilepsy.

Conclusions

A prophylactic effect of AED could not be demonstrated (nor rejected statistically). Levetiracetam was associated with less adverse effects than phenytoin. The potential harm of AED was not balanced by the potential prophylactic benefit. This study suggests that prophylactic AED should not be administered to prevent brain tumour-related epilepsy after craniotomy.
‘Real-world’ comparison of first-line direct aspiration and stent retriever mechanical thrombectomy for the treatment of acute ischemic stroke in the anterior circulation: a multicenter international retrospective study
Authors: Martini Michael , Mocco J , Turk Aquilla , Siddiqui Adnan H , Fiorella David , Hanel Ricardo A , Woodward Keith , Rai Ansaar , Frei Don , Delgado Almandoz Josser E , Kelly Michael E , Peeling Lissa , Arthur Adam S , Baxter Blaise , English Joey , Linfante Italo , De Leacy Reade
Published: April 2019

Background

Thrombectomy for anterior large vessel occlusion less than 24 hours since last known well is now standard of care. Certain aspects of clinical trials may limit generalizability to ’real-world' practice.

Objective

To compare revascularization rates and outcomes for direct aspiration (ADAPT) and stent retriever thrombectomy following anterior acute ischemic stroke (AIS) in a real-life setting.

Methods

Data from the most recent 20 consecutive patients with AIS treated with mechanical thrombectomy between 2015 and 2016 were collected from 15 high-volume stroke centers across North America for a total of 300 cases. Patients with proximal anterior large vessel occlusions were dichotomized by primary treatment technique. Ordinal logistic regression assessed the effects of clinical variables on patient disability using 90-day modified Rankin Scale (mRS) scores.

Results

Adequate revascularization (Thrombolysis in Cerebral Infarction ≥2b) was ultimately achieved in 91.2% of first-line direct aspiration (ADAPT) cases with an average of 1.9±1.9 passes and in 87.5% of stent retriever cases with an average of 1.7±1.0 passes. Time from groin puncture to revascularization was shorter for ADAPT cases. The mean 90-day mRS score for both groups was 3.0±2.4. Number of passes using primary technique, and postintervention intracranial hemorrhage, were significant predictors of 90-day mRS scores after ADAPT, while age and preprocedure mRS score were predictive of outcomes following first-line stent retriever.

Conclusions

Our data show similar adequate revascularization rates and 90-day functional outcomes for first-line direct aspiration and stent retrievers for anterior large vessel occlusion in a real-world setting. These results support the findings of other prospective trials evaluating the two techniques.
A survey of burnout and professional satisfaction among United States neurointerventionalists
Authors: Fargen Kyle M , Arthur Adam S , Leslie-Mazwi Thabele , Garner Rebecca M , Aschenbrenner Carol A , Wolfe Stacey Q , Ansari Sameer A , Dabus Guilherme , Spiotta Alejandro , Mokin Maxim , Linfante Italo , Mocco J , Hirsch Joshua A
Published: April 2019

Background

The toll of burnout on healthcare is significant and associated with physician depression and medical errors.

Objective

To assess the prevalence and risk factors for burnout among neurointerventionalists.

Methods

A 39-question online survey containing questions about neurointerventional practice and the Maslach Burnout Inventory-Human Services Survey for medical personnel was distributed to members of major US neurointerventional physician societies.

Results

320 responses were received. Median (interquartile range) composite scores for emotional exhaustion were 25 (16–35), depersonalization 7 (4–12), and personal accomplishment 39 (35–44). 164/293 respondents (56%) met established criteria for burnout. There was no significant relationship between training background, practice setting, call frequency, or presence of a senior partner on burnout prevalence. Multiple logistic regression analysis showed that feeling underappreciated by hospital leadership (OR=3.71; p<0.001) and covering more than one hospital on call (OR=1.96; p=0.01) were strongly associated with burnout. Receiving additional compensation for a call was independently protective against burnout (OR= 0.70; p=0.005).

Conclusions

This survey of United States neurointerventional physicians demonstrated a self-reported burnout prevalence of 56%, which is similar to the national average among physicians across other specialties. Additional compensation for a call was a significant protective factor against burnout. In addition, feeling underappreciated by departmental or hospital leadership and covering more than one hospital while on call were associated with greater odds of burnout.
Flow diversion treatment of aneurysms of the complex region of the anterior communicating artery: which stent placement strategy should ‘I’ use? A single center experience
Authors: Pagiola Igor , Mihalea Cristian , Caroff Jildaz , Ikka Léon , Chalumeau Vanessa , Yasuda Thomas , Marenco de la Torre Joaquin , Iacobucci Marta , Ozanne Augustin , Gallas Sophie , Marques Marcio Chaves , Carrete Henrique , Frudit Michel Eli , Moret Jacques , Spelle Laurent
Published: April 2019

Background

Aneurysms of the anterior communicating artery (ACoA) are difficult to treat with coiling or clipping because of the anatomical variation in this region. Flow diversion represents a feasible treatment, but no consensus exists as to which stent deployment technique is more suitable.

Methods

All patients with ACoA aneurysms treated with flow diverters between April 2014 and November 2018 were retrospectively analyzed. Aneurysm characteristics, follow-up results, and clinical outcome data were recorded, and a new classification comparing the diameters of both A1 segments is proposed: H1=same diameters; H2=<50% difference in diameters; H3= ≥50% difference; and Y=no A1 segment.

Results

We analyzed 30 procedures in 30 patients with ACoA aneurysms, including 16 ruptured aneurysms treated with coiling embolization and 4 previously unruptured aneurysms (two Medina and two Woven EndoBridge devices). Adequate aneurysm occlusion occurred in 86.9%; one patient (3.3%) experienced symptomatic ischemic stroke. The global thromboembolic complications for each group were 17.6% (H1), 25% (H2), and 60% (H3).

Conclusion

Flow diversion treatment in this region is safe, feasible, and effective. The most suitable anatomical configuration for flow diverter treatment seems to be the H1 configuration where the ‘I technique’ is suitable (from an A1 segment to the ipsilateral A2). There is a tendency that the H3 configuration is not a good indication for flow diverter treatment. However, further studies are needed to evaluate the feasibility of this anatomical classification and the reproducibility of our findings.
Are we reaping what we sow? Gender diversity in surgery: a survey of medical students
Authors: Cronin Ciara , Lucas Mairi , McCarthy Andrea , Boland Fiona , Varadarajan Raghu , Premnath N , Gillen Peter
Published: April 2019

Background

A survey of medical students from the Royal College of Surgeons in Ireland (RCSI) at Dublin, Perdana and Penang in Malaysia was undertaken in an attempt to explore attitudes towards a career in surgery and document potential differences between male and female students’ perceptions of a surgical career.

Method

A hyperlink to an online, anonymised questionnaire was distributed to medical students in 3rd, 4th and final year at three RCSI campuses. Basic descriptive statistics were used to describe the responses to individual questions and appropriate statistical tests used to compare male and female responses to questions.

Results

A total of 464 completed questionnaires were analysed. Almost 40% (n=185) were male and 60% (n=279) were female. Males were significantly more influenced by remuneration than females (p<0.001) towards a choice of surgical career. Females were significantly more influenced in their choice of surgical career by part-time work (p<0.001), parental leave (p<0.001), working hours (p<0.001) and length of residency (p=0.003). During surgical attachments, females were significantly more likely to admit feeling intimidated than males (p=0.002) and males more likely to report feeling confident (p<0.001). Ninety-six per cent of students felt they would be more likely to pursue a career in which they had identified a positive role model, with female medical students three times more likely to have identified a female role model than males.

Conclusion

According to our study, preference for a career in surgery declines with advancing years in medical school for both males and females. Medical students report high levels of feeling intimidated or ignored during their surgical placements, and enthusiasm for surgery reduces during medical school with exposure to this. These findings, along with the importance of role modelling, add further urgency to the need to address factors which make surgery less appealing to female medical graduates.
Overview of complications of acute and chronic myocardial infarctions: revisiting pathogenesis and cross-sectional imaging
Authors: Stephens Nicholas R , Restrepo Carlos S , Saboo Sachin S , Baxi Ameya J
Published: April 2019

Myocardial infarction (MI) remains one of the leading contributors to overall mortality and morbidity in the modern world, even with recent advances in medicine. Various complications can arise following an MI, particularly with delayed or inadequate treatment. Even though many of these complications are uncommon, they can have a significant impact on patient outcomes. Some of these complications can be diagnosed based on clinical, laboratory and echocardiographic evaluation. Other times, however, cardiac MR and multidetector CT are necessary in their diagnosis and proper evaluation. Accurate detection of these complications is an important aspect of optimising prompt and effective patient care, leading to better clinical outcomes. It is the goal of this article to review the role of cross-sectional imaging in patients with post-MI as well as the characteristic imaging findings and differential diagnosis of common and uncommon complications of MI.
Multi-Institutional Multidisciplinary Injury Mortality Investigation in the Civilian Pre-Hospital Environment (MIMIC): a methodology for reliably measuring prehospital time and distance to definitive care
Authors: Medrano Nicolas W , Villarreal Cynthia Lizette , Price Michelle A , MacKenzie Ellen , Nolte Kurt B , Phillips Monica J , Stewart Ronald M , Eastridge Brian J
Published: April 2019

The detailed study of prehospital injury death is critical to advancing trauma and emergency care, as circumstance and causality have significant implications for the development of mitigation strategies. Though there is no true ‘Golden Hour,’ the time from injury to care is a critical element in the analysis matrix, particularly in patients with severe injury. Currently, there is no standard method for the assessment of time to definitive care after injury among prehospital deaths. This article describes a methodology to estimate total prehospital time and distance for trauma patients transported via ground emergency medical services and helicopter emergency medical services using a geographic information system. Data generated using this method, along with medical examiner and field investigation reports, will be used to estimate the potential survivability of prehospital trauma deaths occurring in five US states and the District of Columbia as part of the Multi-Institutional Multidisciplinary Injury Mortality Investigation in the Civilian Pre-Hospital Environment study. One goal of this work is to develop standard metrics for the assessment of total prehospital time and distance, which can be used in the future for more complex spatial analyses to gain a deeper understanding of trauma center access. Results will be used to identify high priority areas for research and development in injury prevention, trauma system performance improvement, and public health.
Ways to pass the stress test
Authors: Crowe Carolyne
Published: April 2019

Stress is a reasonable response to tricky situations, unexpected scenarios and a busy life – and so probably an inevitable part of life in the veterinary profession. Here Carolyne Crowe offers some top tips on how best to deal with it.