bluuebunny/crossref_metadata_2025 huggingface dataset:
Economic and Clinical Burden Associated With Intensification of Glaucoma Topical Therapy: A US Claims-based Analysis
Authors: Patel Anik R. , Schwartz Gail F. , Campbell Joanna H. , Chen Chi-Chang , McGuiness Catherine B. , Multani Jasjit K. , Shih Vanessa , Smith Oluwatosin U.
Published: November 2020

Precis:

Incremental addition of intraocular pressure–lowering topical drops is associated with shorter-lasting benefit and higher health-related costs with each additional agent, suggesting a need for new treatment options to improve disease control and reduce treatment burden.

Purpose:

The purpose of this study was to evaluate treatment intensification as a driver of clinical and economic burden in patients receiving topical glaucoma medications for open-angle glaucoma/ocular hypertension.

Methods:

This retrospective analysis of administrative claims data (January 2011 to July 2017) from the IQVIA PharMetrics Plus database included diagnosed patients who initiated or intensified treatment with 1 to 4 topical glaucoma medications of a different drug class between January 2012 and July 2015 (index date being the first such event during this period). Patients with prior open-angle glaucoma surgery or an equal or greater number of topical glaucoma medication classes during the preindex period were excluded. Treatment intensification rates and eye-related outpatient costs were assessed over 24 months postindex.

Results:

Of 48,402 patients (mean age: 61.4 y), 22,874 (47.3%), 16,214 (33.5%), 7137 (14.7%), and 2177 (4.5%) received a first, second, third, or fourth medication class, respectively, as their first observed initial or intensified regimen. Among cohorts receiving 1, 2, 3, or 4 medication classes, 7.8%, 12.2%, 17.2%, and 22.6% of patients and 12.6%, 18.5%, 25.9%, and 33.7% of patients had subsequent treatment augmentation (class addition or glaucoma procedure, laser or surgical) within 12 and 24 months postindex, respectively. Eye-related outpatient costs over 24 months increased with each additional topical glaucoma medication class at index [mean (SD): $1610 ($3460), $2418 ($4863), $2872 ($5110), and $3751 ($6608) in the 1, 2, 3, or 4 class cohorts, respectively].

Conclusion:

Multiple-drop therapies yielded shorter-lasting benefits with each additional agent and were associated with the increased clinical and economic burden.
Long-term Results of the PRESERFLO MicroShunt in Patients With Primary Open-angle Glaucoma From a Single-center Nonrandomized Study
Authors: Batlle Juan F. , Corona Adalgisa , Albuquerque Rachel
Published: November 2020

Precis:

The MicroShunt was implanted in 23 patients with primary open-angle glaucoma (POAG) in a feasibility study. Reductions in intraocular pressure (IOP) and medications were sustained for up to 5 years with no long-term sight-threatening adverse events (AEs).

Purpose:

The purpose of this study was to assess the long-term effectiveness and safety of the PRESERFLO MicroShunt (8.5 mm long, 70 µm lumen surgical device, formerly known as the InnFocus MicroShunt) in POAG.

Patients and Methods:

In a feasibility study (NCT00772330), patients with POAG inadequately controlled on maximum tolerated therapy with IOP ≥18 to ≤40 mm Hg underwent MicroShunt implantation with adjunctive mitomycin C (0.4 mg/mL), alone or in combination with cataract surgery. Years 1 to 3 findings have previously been reported. Endpoints of this extension study included IOP reduction and success at years 4 and 5 (primary), incidence of AEs, medication use, and reoperations.

Results:

Mean IOP was reduced from 23.8±5.3 mm Hg at baseline to 12.8±5.6 mm Hg (year 4; n=21) and 12.4±6.5 mm Hg (year 5; n=21). Overall success (with/without medication use) was 87.0% (year 4) and 82.6% (year 5). The mean number of medications reduced from 2.4±1.0 at baseline to 0.8±1.3 (year 5). Common (≥5% of patients) AEs included corneal edema (n=4), transient hypotony (n=4), bleb-related complications (n=3), and device touching the iris (n=3). There were 4 reports of serious AEs and 2 reoperations.

Conclusions:

In this extension study, sustained reductions in mean IOP and medications were observed up to 5 years post-MicroShunt implantation. There were no reports of long-term sight-threatening AEs and a low rate of postoperative interventions.
State Scope of Practice Laws: An Analysis of Physician Assistant Programs and Graduates
Authors: Valentin Virginia L. , Najmabadi Shahpar , Jones Jeffery , Everett Christine M.
Published: November 2020

Purpose

The purpose of this study was to understand the association between physician assistant (PA) state scope of practice (SOP) laws and (1) PA program growth and (2) PA graduate demographics.

Methods

Scope of practice laws were categorized as ideal, average, and restrictive. Descriptive statistics by year and SOP categories were determined for the number of states, population density, PA programs, and PA graduate number, gender, race, and mean age. The Mann-Whitney U test was used to analyze demographic data by SOP categories. Adjusted risk ratios were generated for the number of PA programs and SOP categories.

Results

The number of PA programs is not associated with ideal SOP states. As of 2017, only 10 states have restrictive SOP laws. A minority of PA students now graduate from states with restrictive SOP laws.

Conclusion

There is heterogeneity in PA SOP laws throughout the United States but only a minority of PA graduates now come from restrictive SOP states. This study provides foundational information prior to the implementation of optimal team practice.
Blood pressure-lowering efficacy of a 6-week multi-modal isometric exercise intervention
Authors: Baddeley-White Daniel S. , Wood Cayla N. , McGowan Cheri L.M. , Howden Reuben , Gaillard Ebony C. , Gordon Benjamin D.H. , Goss-Sampson Mark A. , Swaine Ian L.
Published: November 2020

Isometric exercise training (IET) is an effective method for reducing resting blood pressure (BP). To date, no research studies have been conducted using multiple exercises within an IET intervention. Previous research has suggested that varied exercise programmes may have a positive effect on adherence. Therefore, this randomized controlled study aimed to investigate the BP-lowering efficacy of a multi-modal IET (MIET) intervention in healthy young adults. Twenty healthy participants were randomized to an MIET [n = 10; four women; SBP 117.9 ± 6.9 mmHg; DBP 66.3 ± 5.1 mmHg] or control (CON) group (n = 10; five women; SBP, 123.3 ± 10.4 mmHg; DBP, 77.3 ± 6.7 mmHg). The MIET group completed three sessions per week of 4, 2-min isometric contractions, with a 1-min rest between each contraction, for 6 weeks. Resting BP and heart rate (HR) were measured at baseline and post-intervention. Pre-to-post intervention within-group reductions in resting BP were observed (SBP: 5.3 ± 6.1 mmHg, DBP: 3.4 ± 3.7 mmHg, MAP: 4.0 ± 3.9 mmHg, HR: 4.8 ±6 .6 bpm), although clinically relevant (≥2 mmHg), these changes were not statistically significant. Significant (p < 0.05) between-group differences were found between the intervention and control groups, indicating that the MIET intervention has a greater BP-lowering effect compared to control. The clinically relevant post-training reductions in resting BP suggest that MIET may be a promising additional IET method for hypertension prevention. These findings; however, must be interpreted with caution due to the small sample size and the non-clinical cohort.
Characterizing the relationship between the chemical structures of drugs and their activities on primary cultures of pediatric solid tumors
Authors: Simeon Saw , Ghislat Ghita , Ballester Pedro J.
Published: November 2020

Better drugs are required to manage pediatric cancers. A high-throughput screen of drugs in primary cultures derived from orthotopic patient-derived xenografts (O-PDX) of pediatric solid tumours has been recently published. Here we analyzed these data sets to find out whether it is possible to leverage them for identifying new drug leads in a phenotypic manner. We found that drugs bearing a higher number of heterocyclic rings, two carbon-hetero bonds and halogens are associated to submicromolar potency in alveolar rhabdomyosarcoma and osteosarcoma O-PDXs. Furthermore, Murcko scaffolds 1-cyclopentyl-octahydro-1H-indene and tetradecahydroanthracene can be utilized as starting scaffolds to selectively optimize potency against osteosarcoma since drugs bearing this scaffold displayed superior O-PDX culture potency. Lastly, we have generated QSAR (Quantitative Structure–Activity Relationship) models able to predict the potency of drugs on each O-PDX tumor. To permit their use to guide drug repositioning on these 30 O-PDX cell cultures, we are providing a user-friendly web server implementing these QSAR models athttps://rnewbie.shinyapps.io/Shobek-master
An integrated multi-omic analysis of iPSC-derived motor neurons from C9ORF72 ALS patients
Authors:   The NeuroLINCS Consortium, Ornelas Loren , Gomez Emilda , Panther Lindsay , Frank Aaron , Lei Susan , Mandefro Berhan , Banuelos Maria G , Shelley Brandon , Kaye Julia A , Lima Leandro , Wyman Stacia , Lim Ryan G , Wu Jie , Stocksdale Jennifer , Casale Malcolm , Dardov Victoria , Matlock Andrea , Venkatraman Vidya , Holewenski Ronald , Milani Pamela , Adam Miriam , Wassie Brook T , Cheng Andrew , Coyne Alyssa N , Daigle J. Gavin , Li Johnathan , Yang Stephanie , Cox Veerle , Wilhelm Mark , Lloyd Thomas E , Hayes Lindsey , Pham Jacqueline , Escalante-Chong Renan , Lenail Alex , Sachs Karen , Patel-Murray Natasha Leanna , Ramamoorthy Divya , Thompson Terri G ,   NYGC ALS Consortium, Finkbeiner Steven , Fraenkel Ernest , Rothstein Jeffrey D , Sareen Druv , Van Eyk Jennifer E , Svendsen Clive N , Thompson Leslie M.
Published: November 2020

Neurodegenerative diseases present a challenge for systems biology, due to the lack of reliable animal models and the difficulties in obtaining samples from patients at early stages of disease, when interventions might be most effective. Studying induced pluripotent stem cell (iPSC)-derived neurons could overcome these challenges and dramatically accelerate and broaden therapeutic strategies. Here we undertook a network-based multi-omic characterization of iPSC-derived motor neurons from ALS patients carrying genetically dominant hexanucleotide expansions inC9orf72to gain a deeper understanding of the relationship between DNA, RNA, epigenetics and protein in the same pool of tissue. ALS motor neurons showed the expectedC9orf72-related alterations to specific nucleoporins and production of dipeptide repeats. RNA-seq, ATAC-seq and data-independent acquisition mass-spectrometry (DIA-MS) proteomics were then performed on the same motor neuron cultures. Using integrative computational methods that combined all of the omics, we discovered a number of novel dysregulated pathways including biological adhesion and extracellular matrix organization and disruption in other expected pathways such as RNA splicing and nuclear transport. We tested the relevance of these pathwaysin vivoin aC9orf72Drosophila model, analyzing the data to determine which pathways were causing disease phenotypes and which were compensatory. We also confirmed that some pathways are altered in late-stage neurodegeneration by analyzing human postmortem C9 cervical spine data. To validate that these key pathways were integral to the C9 signature, we prepared a separate set ofC9orf72and control motor neuron cultures using a different differentiation protocol and applied the same methods. As expected, there were major overall differences between the differentiation protocols, especially at the level of in individual omics data. However, a number of the core dysregulated pathways remained significant using the integrated multiomic analysis. This new method of analyzing patient specific neural cultures allows the generation of disease-related hypotheses with a small number of patient lines which can be tested in larger cohorts of patients.
Intestinal ferritinophagy is regulated by HIF-2α and is essential for systemic iron homeostasis
Authors: Das Nupur K , Sankar Amanda , Schwartz Andrew J , Solanki Sumeet , Ma Xiaoya , Parimi Sanjana , Santana-Codina Naiara , Mancias Joseph D. , Shah Yatrik M
Published: November 2020

Iron is critical for many processes including oxygen transport and erythropoiesis. Transcriptomic analysis demonstrates that HIF-2α regulates over 90% of all transcripts induced following iron deficiency in the intestine. However, beyond divalent metal transporter 1 (DMT1), ferroportin 1 (Fpn1) and duodenal cytochrome b (Dcytb), no other genes/pathways have been critically assessed with respects to their importance in intestinal iron absorption. Ferritinophagy is associated with cargo specific autophagic breakdown of ferritin and subsequent release of iron. We show here that nuclear receptor co-activator 4 (NCOA4)-mediated intestinal ferritinophagy is integrated to systemic iron demand via HIF-2α. Duodenal NCOA4 expression is regulated by HIF-2α during high systemic iron demands. Moreover, overexpression of intestinal HIF-2α is sufficient to activate NCOA4 and promote lysosomal degradation of ferritin. Promoter analysis revealed NCOA4 as a direct HIF-2α target. To demonstrate the importance of intestinal HIF-2α/ferritinophagy axis in systemic iron homeostasis, whole body and intestine-specific NCOA4-null mouse lines were assessed. These analyses demonstrate an iron sequestration in the enterocytes, and significantly high tissue ferritin levels in the dietary iron deficiency and acute hemolytic anemia models. Together, our data suggests efficient ferritinophagy is critical for intestinal iron absorption and systemic iron homeostasis.
Understanding influences on consumers’ dietary stress in healthy food buying
Authors: Hansen Torben , Thomsen Thyra Uth
Published: November 2020

Purpose

This study aims to investigate relationships among body mass index (BMI), socioeconomic variables, dietary self-efficacy and consumer dietary stress in healthy food buying and explore whether different levels of personal values influence these relationships.

Design/methodology/approach

The study is based on an online representative cross-sectional study with 380 food consumers. Structural equation modeling served to estimate direct, mediating and moderating effects between the studied constructs and variables.

Findings

Examples of moderating and moderated mediating effects include a negative impact of BMI on dietary stress for consumers with low levels of enjoyment value but no significant effect for consumers with high levels of enjoyment. BMI also had a greater negative impact on dietary self-efficacy when the level of respect/achievement was high (vs low), and respect/achievement positively moderated the mediating effect of BMI on dietary stress through dietary self-efficacy.

Research limitations/implications

This study focuses on analyzing healthy food buying in a particular cultural setting and may suffer from a lack of generalizability to other cultures. The results suggest that research should take into account personal values when investigating stress.

Practical implications

Food managers and health authorities can improve their ability to reduce dietary stress when addressing consumers by understanding the role of personal values in healthy food choice and the impact on mental well-being.

Originality/value

This study offers a novel, more fine-grained conceptual model of how consumers develop dietary stress when buying healthy food.
Leadership practices of school principal through a distributed leadership lens: a case study of a secondary school in urban Pakistan
Authors: Nawab Ali , Asad Muhammad Mujtaba
Published: November 2020

Purpose

Unless the expertise of multiple teachers is availed, it is very unlikely for an individual leader to bring improvement especially at classroom level. This realization had led to the emergence of distributed leadership which is about engaging multiple individuals in leadership roles. The purpose of this study is to explore the role of school leadership in distributing leadership to teachers in a private secondary school in an urban context of Pakistan.

Design/methodology/approach

Using qualitative approach and case study method, the research collects data from school leaders and teachers involved in leadership roles through interviews.

Findings

It was found that leadership facilitates distributed leadership through formulating a vision to develop teachers, enhancing the capacity of individuals involved in leadership roles, establishing a culture of trust, and creating opportunities for interaction and collaboration among teachers.

Practical implications

School leadership should distribute leadership to teachers in order to utilize the potential of multiple individuals which will ultimately lead to school improvement through initiatives from within. Educational reformers should incorporate the concept of distributed leadership in the professional development programmes designed for school leaders and teachers.

Originality/value

The study is first of its nature which reports on distributed leadership from a private sector school of Pakistan based on original data.
The sorcerer’s apprentice
Authors: Hirsch Peter Buell
Published: November 2020

Purpose

The purpose of this paper is to illuminate the challenges of ad hoc teams in the corporate setting.

Design/methodology/approach

Review of the literature about teams, agile methodologies, scrums, etc. was carried out.

Findings

While ad hoc teams can create value, their proliferation has had unintended consequences.

Research limitations/implications

The literature review is, by its nature, selective not comprehensive.

Practical implications

Based on the recommendations cited, corporations will be able to make better decisions about when to initiate special teams.

Social implications

By doing so, companies will eliminate the frustrations employees feel in certain types of teams and improve their quality of life.

Originality/value

Although the subject of ad hoc teams has been extensively covered, this viewpoint takes a fresh look at the overall consequences of their proliferation.
The impact of semantic fluency on consumers' aesthetic evaluation in graphic designs with text
Authors: Deng Xun , Wang Liangyan
Published: November 2020

Purpose

The purpose of this study is to examine the influence of semantic fluency on consumers' aesthetic evaluation in graphic designs with text and the mediating effect of visual complexity in this relationship.

Design/methodology/approach

The hypotheses are examined in three experiments. Experiments 1 and 2 both verify that Chinese consumers rated the designs with low (vs high) semantic fluency words as more beautiful, and Experiment 3 further confirmed this effect in non-Chinese speakers.

Findings

Confirmed by Chinese and non-Chinese consumers, high fluency text leads to lower perceived visual complexity and less aesthetic perception of the entire design.

Research limitations/implications

Findings enrich the theory of beauty standards and put forward challenges to the positive relationship between processing fluency and aesthetic pleasure. Findings are limited to the decorative function of text, and lack discussions on how designers should balance when the informational function of text is equally important.

Originality/value

This study is the first to discuss how designs with text influence consumers' aesthetic perception and provides meaningful guidelines of transnational marketing for fashion designers and enterprises.
An outline for an integrated language-sensitive approach to global work and mobility: cross-fertilising expatriate and international business and management research
Authors: Vulchanov Ivan Olav
Published: November 2020

Purpose

The purpose of this conceptual literature review is to investigate how language factors have been studied in the expatriate literature, and how cross-fertilisation with the broader language-sensitive international business and management field may facilitate integrated research of language in global work.

Design/methodology/approach

This paper is based on a thematic review of expatriate research and international business and management literature. The findings are structured through Reiche et al.'s (2019) three-dimensional conceptualisation of global work, after which two frameworks are developed to conceptualise how language connects the three dimensions – actors, structures and processes.

Findings

The literature review demonstrates that language-related topics are yet to gain status in the expatriate tradition, and the majority of studies, which do consider linguistic factors appear largely dissociated from the growing community of language research in the broader international management and international business fields. However, once consolidated, the literature reveals that language is present in all dimensions of global work. A processual view of corporate language management highlights the central role of human resource management (HRM), while a dynamic multi-level perspective indicates that language may form bidirectional relationships between the three dimensions of global work.

Originality/value

Due to the segmentation between language-sensitive research in the expatriate and international business/management traditions, few studies have considered the HRM implications of global mobility and the multifaceted nature of language at work. This conceptual literature review brings both perspectives together for a more contextualised and holistic view of language in international workforces.
The role of client knowledge absorptive capacity for innovation in KIBS
Authors: Chichkanov Nikolay
Published: November 2020

Purpose

This paper aims to study the relationship between the knowledge exchanged during client interactions and innovation in knowledge-intensive business services (KIBS) enterprises. It adapts the concept of absorptive capacity, i.e. the ability of the firm to successfully deal with external knowledge, to the case of client knowledge being absorbed with the support of information and communication technologies and explores whether its three main dimensions (acquisition, assimilation and application of client knowledge) are significant enablers of KIBS’ innovation propensity.

Design/methodology/approach

An empirical analysis is based on a dataset of 417 Russian KIBS companies collected in 2019 following the recommendations suggested in the new edition of Oslo Manual. To examine the relationship between the three-client knowledge absorptive capacity dimensions and implementation of different types of innovation by KIBS, the study applies linear ordinary least squares and logistic regression methods.

Findings

The results show that acquisition of client knowledge through the wide number of digital channels, assimilation of such knowledge boosted by its codification through a digital customer relationship management (CRM) system and application of client knowledge across different functional areas are positively associated with both product and business process innovations in KIBS.

Originality/value

The paper proposes that KIBS should develop and sustain the strong internal capacity to absorb knowledge through routine day-to-day client interactions as a part of their knowledge management systems. The results also indicate that application of digital communication tools and CRM systems are beneficial for KIBS and increases their propensity to innovate.
The global trends of automated container terminal: a systematic literature review
Authors: Kon W.K. , Abdul Rahman Noorul Shaiful Fitri , Md Hanafiah Rudiah , Abdul Hamid Saharuddin
Published: November 2020

Purpose

Since the first automated container terminal (ACT) was introduced at Europe Container Terminals Delta Terminal in Port Rotterdam back in the year 1992, a lot of research had been done to improve the management of ACT. However, up until recently, the number of literature available still appeared scarce. Hence, this paper aims to review the collection of literature about ACT to generate an exhaustive summary to answer the formulated review question in this study.

Design/methodology/approach

Preferred reporting items for systematic reviews and meta-analyses to narrow down the search parameters of literature retrieved so that only relevant articles were only selected. The systematic literature reviews were applied to analyse the content of the articles retrieved to determine its journal ranking, research findings and timeline of publications.

Findings

The adoption of ACT technology by container terminal operators could increase the terminal efficiency in productivity, cost reduction and environmental sustainability. Owing to global environmental awareness, the research trend of container terminal field and container terminal operator in the terminal design is much more environmentally friendly oriented.

Research limitations/implications

The limited numbers of experts in the management of ACT are causing challenges in data collections.

Practical implications

The analysis of the global ACT trend could help academicians and industrial investors to review the revolution timeline of maritime technology in port and shipping that is happening rapidly.

Originality/value

The analysis of timeline and collective literature leads to the propose of the conceptual framework to determine the relationship between increased productivity, cost reduction and environmentally sustainable.
Investigation of color and anticorrosive properties of pigments in the Fe-Al-Mg-O-H system by the simplex lattice method
Authors: Frolova Liliya , Butyrina Tatyana
Published: November 2020

Purpose

The purpose of this paper is to study the patterns of formation of anti-corrosion properties, the development of compositions for pigments by using the method of co-precipitation and subsequent heat treatment.

Design/methodology/approach

To obtain co-precipitated hydroxides, aqueous solutions of salts were used. The conditions of synthesis varied according to the following parameters: the nature of the starting salts of metals; and the ratio of metal cations. The anticorrosive activity of the pigments was evaluated by the potentiodynamic method, by comparing the anodic and cathodic polarization curves, and calculated potentials and corrosion currents on the basis of regions of Tafel on curves. Polarization curves were obtained by using Potentiostat/Galvanostat/ZRA Gamry, which connected to the PC, and by using the program Gamry Framework. The measurement results were processed by using the method of simplex-lattice planning. X-ray diffractograms of pigments were recorded on a DRON – 2.0 diffractometer (monochromatic copper radiation with a nickel filter).

Findings

The paper deals with the results of research the dependence of colour characteristics and anticorrosion properties of synthesized compositions on their nature and composition. The presence of aluminium cations leads to the formation of solid solutions of ferrum and aluminium oxyhydroxides.

Originality/value

The main technological properties of pigments are determined by the anionic and cationic composition. Colour characteristics are determined by the cation-chromophore. The anti-corrosive properties of non-calcined pigments are determined to a greater extent by the presence of the formed hydroxyl ions and the composition of the compounds. The greatest protective effect is observed when using double compounds of metals, the dissociation constants of which differ significantly. The protective effect is mainly determined by the slowdown of the anode process. Anions containing aluminium atoms accelerate the corrosion processes.
Weathering in Detroit: Place, Race, Ethnicity, and Poverty as Conceptually Fluctuating Social Constructs Shaping Variation in Allostatic Load
Authors: GERONIMUS ARLINE T. , PEARSON JAY A. , LINNENBRINGER ERIN , EISENBERG ALEXA K. , STOKES CARMEN , HUGHES LANDON D. , SCHULZ AMY J.
Published: November 2020

Policy Points

Despite 30 years of attention to eliminating population health inequity, it remains entrenched, calling for new approaches.

Targeted universalism, wellness‐based local development, and Jedi Public Health approaches that are community informed, evidence based, and focused on improving everyday settings and diverse lived experiences are important policy directions.

State and federal revenue transfers are necessary to mitigate the harms of austerity and assure greater equity in fiscal and population health in places like Detroit, Michigan.

Context

US population health inequity remains entrenched, despite mandates to eliminate it. To promote a public health approach of consequence in this domain, stakeholders call for moving from risk‐factor epidemiology toward consideration of dynamic local variations in the physiological impacts of structured lived experience.

Methods

Using a community‐based, participatory research approach, we collected and analyzed a unique data set of 239 black, white, and Mexican adults from a stratified, multistage probability sample of three Detroit, Michigan, neighborhoods. We drew venous blood, collected saliva, took anthropometric measurements, and assayed specimens to measure allostatic load (AL), an indicator of stress‐mediated biological dysregulation, linking participants’ AL scores and survey responses. In a series of nested Poisson models, we regressed AL on socioeconomic, psychosocial, neighborhood, and behavioral stressors to test the hypothesis that race/ethnicity and poverty‐to‐income ratio (PIR) are conceptually fluctuating variables whose impacts on AL are sensitive to structured lived experience.

Findings

White and Mexican Detroit participants with PIR < 1 have higher AL than counterparts nationally; black participants in Detroit and nationwide had comparable AL. Within Detroit, disparities by PIR were higher in whites than blacks, with no significant difference by PIR in Mexicans. The size of estimated effects of having PIR < 1 for whites is 58 percentage points greater than that of Mexicans and twice that of blacks.

Conclusions

Structurally rooted unobserved heterogeneity bias threatens the validity of independent main effects interpretations of associations between race/ethnicity, socioeconomic characteristics, or place and health. One‐size‐fits‐all analytic or policy models developed from the perspective of the dominant social group insufficiently address the experiences of diverse populations in specific settings and historical moments; nor do they recognize culturally mediated protective resources residents may have developed against material and psychosocial hardship.
A Semi‐quantitative method for the detection of fentanyl using surface‐enhanced Raman scattering (SERS) with a handheld Raman instrument
Authors: Smith Matthew , Logan Mike , Bazley Mikaela , Blanchfield Joanne , Stokes Robert , Blanco Ana , McGee Rachel
Published: November 2020

A handheld, spatially offset Raman spectroscopy (SORS) system was successfully used to obtain Surface‐enhanced Raman Scattering (SERS) spectra of fentanyl under simulated field conditions. A series of aqueous fentanyl solutions were prepared with commercially available gold nanoparticle solution, at concentrations ranging from 0.003 to 1697 μM. These SERS spectra were then used to generate two concentration calibration models (via a plot of peak area (1026 cm−1) versus concentration, and quantitative spectral decomposition using partial least squares (PLS1)). For both models, the relationship followed Langmuir adsorption and became non‐linear at concentrations above ~0.2 μM, with a limit of detection (LOD) of approximately 3 nM. The same technique was successfully used to measure fentanyl in the presence of two common “cutting agents,” heroin and glucose, at 1% and 2% fentanyl proportions (w/w). Fentanyl detection was successfully achieved, but mixture interference from the cutting agents prevented a calibration model being generated. Four fentanyl analogues were also investigated—butyrylfentanyl, furanylfentanyl, acetylfentanyl, and ocfentanyl. A concentration calibration model for each species was successfully generated, but differentiation from fentanyl proved more challenging, although several potential diagnostic peaks were identified. These results identified a pathway forward in using handheld equipment for the reliable detection of ultra‐low concentrations of fentanyl and fentanyl analogues via SERS, even when mixed with diluents. However, quantitative detection is negatively impacted in the presence of heroin and glucose. This also provides a starting point for a SERS‐based spectral library of fentanyl analogues, in combination with a range of different diluents.
Assessment of the availability and utility of the paramedic record in the emergency department
Authors: O'Connor Katherine , Golding Michael
Published: November 2020

Objective

Clinical handover between pre‐hospital ambulance service and the ED is important for patient safety and quality care. This study assessed the availability and utility of the paramedic record to ED clinicians in their patient assessment.

Methods

The document transfer in 110 handovers between ambulance service and a tertiary metropolitan hospital ED was observed. Timestamps were recorded when the electronic paramedic record was printed, when it was placed in the hospital's paper‐based patient medical record, when ED patient assessment occurred and it was noted if there was a verbal handover from paramedic to ED clinician. ED clinicians were surveyed about the availability and usefulness of the paramedic record.

Results

The paramedic record was printed prior to the patient being seen in only 49% of encounters and was available in the medical record at the time of initial clinical assessment in 32% of encounters. When available it was reviewed in over 90% of encounters. 87% of these reviews were reported as ‘significantly’ or ‘somewhat useful’. The paramedic record could not be located at all in 21% of encounters. In 98% of encounters the treating ED clinician would have preferred the paramedic record to have been electronic. The ED system data was corrupt in 4% of encounters.

Conclusions

The information in the paramedic record was found to be useful to ED clinicians when it was available. Increasing the availability of the paramedic record for ED clinical assessment may be an opportunity to improve patient safety and flow.
Assessment and management of urinary tract infections in aged care facilities
Authors: Khatri Dipti , Burrows Judith
Published: November 2020

Objectives

To compare assessment and management of urinary tract infections (UTI) for residents in aged care facilities (ACF) with evidence‐based infection criteria and recommended therapy.

Methods

A retrospective clinical audit was conducted for all short‐course antibiotics (SCA) prescribed to treat presumed UTIs (p‐UTIs). Surveillance, microbiological and dispensing data determined whether p‐UTIs met the revised McGeer criteria for infection and the extent to which SCAs complied with guideline recommendations.

Results

Ten out of 74 (14%) p‐UTIs were confirmed infections, that is met both the clinical and microbiological criteria for infection. Thirty‐four out of 74 (46%) p‐UTIs were classified as asymptomatic bacteriuria. The dose and frequency of the prescribed SCA were concordant with guideline recommendations for 87% and 85% of the courses, respectively; however, only 42% of the SCAs followed the recommended duration of therapy.

Conclusion

Overdiagnosis of UTIs and consequent overprescribing of antibiotics, specifically extended duration, are consistent with similar studies.
ADIPS position paper on pre‐existing diabetes and pregnancy
Authors: Rudland Victoria L. , Price Sarah A. L. , Callaway Leonie
Published: November 2020

This is an executive summary of the Australasian Diabetes in Pregnancy Society (ADIPS) 2020 guideline for pre‐existing diabetes and pregnancy. The summary focuses on the main clinical practice points for the management of women with type 1 diabetes and type 2 diabetes in relation to pregnancy, including preconception, antepartum, intrapartum and postpartum care. The full guideline is available at https://doi.org/10.1111/ajo.13265.
The predicted clinical workload associated with early post‐term surveillance and inductions of labour in south Asian women in a non‐tertiary hospital setting
Authors: Green Brittany , Howat Paul , Hui Lisa
Published: November 2020

Background

Stillbirth increases steeply after 42 weeks gestation; hence, induction of labour (IOL) is recommended after 41 weeks. Recent Victorian data demonstrate that term stillbirth risk rises at an earlier gestation in south Asian mothers (SAM).

Aims

To determine the impact on a non‐tertiary hospital in Melbourne, Australia, if post‐dates IOL were recommended one week earlier at 40 + 3 for SAM; and to calculate the proportion of infants with birthweight < 3rd centile that were undelivered by 40 weeks in SAM and non‐SAM, as these cases may represent undetected fetal growth restriction.

Materials and Methods

Singleton births ≥ 37 weeks during 2017–18 were extracted from the hospital Birthing Outcomes System. Obstetric and neonatal outcomes for pregnancies that birthed after spontaneous onset of labour or IOL were analysed according to gestation and country of birth.

Results

There were 5408 births included, and 24.9% were born to SAM (n = 1345). SAM women had a higher rate of IOL ≥ 37 weeks compared with non‐SAM women (42.5% vs 35.0%, P < 0.001). If all SAM accepted an offer of IOL at 40 + 3, there would be an additional 80 term inductions over two years. There was no significant difference in babies < 3rd centile undelivered by 40 weeks in SAM compared with non‐SAM (29.6% vs 37.7%, P = 0.42).

Conclusions

Earlier IOL for post‐term SAM would only modestly increase the demand on birthing services, due to pre‐existing high rates of IOL. Our current practices appear to capture the majority at highest risk of stillbirth in our SAM population.
Ethnic disparities for thyroid surgery
Authors: Wu Johnny , Ebrahim AK
Published: November 2020

Background

Significant health disparities exist between Māori and non‐Māori patients in New Zealand. Māori patients treated medically for their thyroid disease are less likely to be euthyroid. The prevalence of thyroid disease and characteristics of Māori presenting for thyroid surgery has not been well studied. We aim to assess the differences in ethnic representation for thyroid surgery.

Methods

A retrospective analysis of cases performed between 2009 and 2019 at the Otolaryngology/Head and Neck Department in Waikato District Health Board (DHB) was completed. All patients who received a thyroid operation were included and divided into Māori and non‐Māori groups. Clinical and operation notes were reviewed and the duration of presenting symptoms, weight, volume and diagnosis of the thyroid gland were assessed.

Results

A total of 93 patients were included in our study, of whom 71 patients were female and 22 male with 37 being Māori and 56 non‐Māori. Māori patients had significantly higher rates of retrosternal extension, compressive symptoms, post‐operative complications, delayed presentation and larger thyroid goitres when compared to non‐Māori (P < 0.05).

Conclusion

Our study confirms that there is a significant ethnic disparity for Māori patients requiring thyroid surgery. This highlights an additional poor health outcome for Māori compared to non‐Māori patients.
Trends and geographic variations in self‐reported diabetes incidence: A prospective open cohort study of Chinese men and women, 1997–2015
Authors: Yu Xuexin , Xia Fan , Zhang Wei
Published: November 2020

Aim

This study aims to evaluate the trends and geographic variations of incident diabetes as well as the corresponding sex differences in China.

Methods

The open cohort study derived data of 16,610 individuals from the China Health and Nutrition Survey 1997–2015. Direct standardisation was employed to calculate the age‐standardised diabetes incidence. Mixed effects logistic regression models with interaction terms were performed to examine variations in incident diabetes. Socio‐demographic (age, sex, marital status, racial compositions and educational attainment) and lifestyle attributes (smoking history, BMI and waist circumference) were sequentially included as covariates.

Results

Overall age‐standardised diabetes incidence increased from 2.94 per 1000 person‐years (95% CI, 2.44–3.44) in 1997–2004 to 5.54 (95% CI, 4.94–6.14) in 2009–2015. Models with interaction terms suggest that the increase among men was higher than that among women (wave 2006–2009 × Female: OR = 0.45, 95% CI 0.28–0.72). Age‐standardised incidence of diabetes varied across regions, ranging from 5.67 (95% CI, 4.95–6.40) in Eastern China to 2.69 (95% CI 2.19–3.19) in Western China. Subsequent modelling analyses suggest that the geographic variations could be mostly explained by the variations in the BMI and waist circumference across regions.

Conclusions

Results suggest that the incidence of self‐reported diabetes approximately doubled during the study period. The increase among men was steeper than that among women. Public interventions reducing the population's obesity level hold promise to alleviate geographic variations and flatten the growth curve.
Randomized trial of a patient empowerment and cognitive training program for older people with diabetes mellitus and cognitive impairment
Authors: Wong Chit‐wai , O Wai‐Tsun William , Wong Kin‐Wai Shirley , Ma Ronald , Hui Elsie , Kwok Chi‐yui Timothy
Published: November 2020

Aim

To evaluate the effectiveness of a combined patient empowerment program (PEP) and cognitive training (CT) program on improving glycemic control among older subjects with diabetes and cognitive impairment.

Methods

A prospective single blinded, randomized controlled study was carried out in 139 older patients with diabetes aged ≥65 years with memory complaints and recent glycosylated hemoglobin level of 7–9%. They were randomly assigned to either undergo once‐weekly PEP combined with CT for 10 weeks (intervention group, N = 73) or receive no intervention (control group, N = 66). All participants were followed up at months 4 and 12 to examine the immediate and long‐term effects on glycemic control, cognition, mood and compliance to drug and diabetes self‐management.

Results

The intervention did not significantly reduce glycosylated hemoglobin. The intervention group showed significant progressive improvement in memory over 1 year and executive function improved significantly at month 12. There was no significant change in diabetes self‐management activities with the intervention.

Conclusions

Combination of PEP and CT did not improve glycemic control or self‐care activities in older patients with diabetes and memory complaints but was effective in improving cognitive function in the longer term. Geriatr Gerontol Int 2020; 20: 1164–1170.
Fabrication of C/C‐SiC composites using high‐char‐yield resin
Authors: Yang Jinhua , Ai Yingjun , Lv Xiaoxu , Qi Zhe , Jiao Jian
Published: November 2020

Carbon fiber reinforced ceramic matrix composites (C/C‐SiC composites) were fabricated using a type of high‐char‐yield phenolic resin with the char yield of 81.17 wt.%. Firstly, the fabric prepreg was prepared by spreading the phenolic resin solution onto the two dimensional carbon fiber plain weave fabric and dried consequently. Afterward, the resin was cured and then the carbon fiber reinforced polymer (CFRP) was pyrolyzed to get amorphous carbon. Finally, C/C‐SiC composites were obtained through liquid silicon infiltration (LSI) process. SEM micrographs showed that the Si/SiC area was homogeneously dispersed in the matrix, and during the siliconization process, a layer of SiC was formed along the surface of carbon fibers or carbon matrix. The fiber volume of CFRP was about 40 vol.%, which was much lower than other studies. XRD result indicated that only β‐SiC type was formed. The result of X‐ray computed tomography clearly showed the structure changes before and after the melt infiltration process. Mechanical property test showed that the composites had fracture strength of 186 ± 23 MPa, and a flexural modulus of 106 ± 8 GPa.
Impact of a nurse‐led intervention on quality of life in patients with chronic non‐malignant pain: An open randomized controlled trial
Authors: Morales‐Fernández Ángeles , Jimenez‐Martín José Manuel , Morales‐Asencio José Miguel , Vergara‐Romero Manuel , Mora‐Bandera Ana María , Aranda‐Gallardo Marta , Canca‐Sanchez José Carlos
Published: November 2020

Aims

To determine the effect of a comprehensive nurse‐led programme for patients with chronic non‐malignant pain, on quality of life, level of pain, anxiety, and depression, as primary outcomes and patients' satisfaction as a secondary end point.

Design

An open‐label randomized controlled trial was carried out.

Methods

The experimental group received both a nurse‐led intervention on healthy lifestyles, education on self‐esteem, pain awareness, communication, and relaxation techniques. The control group received usual care. Quality of life, level of pain, anxiety, and depression were the main outcomes. Data were obtained at baseline, immediately after the intervention, and 6 and 9 months. The study was carried out from 2015–2017.

Results

The sample was composed of 279 patients. At 9 months, the effect size (non‐parametric effect size statistic A) favoured the intervention group for SF‐36 mental health score (A = 0.79; 95% CI: 0.73–0.85), anxiety (A = 0.58; 95% CI: 0.51–0.65), pain intensity (A = 0.57; 95% CI: 0.51–0.64), and depression (A = 0.58; 95% CI: 0.51–0.65). Smaller differences were found on physical scores between the intervention and the usual care group. Patients showed a high level of satisfaction with the introduced intervention.

Conclusion

A comprehensive nurse‐led programme for patients with chronic non‐malignant pain has a positive impact on their quality of life, level of pain, and mental health.

Impact

Studies have reported that the problem of chronic pain is not optimally controlled. A structured nurse‐led programme has been tested to facilitate healthy behaviours to help patients manage their chronic pain and to provide them with the necessary tools for their self‐care. This nurse‐led intervention improved their mental health and decreased their level of pain.
Morphological evolution of silica scales in the freshwater genus Synura (Stramenopiles)
Authors: Jadrná Iva , Siver Peter A. , Škaloud Pavel
Published: November 2020

A high degree of morphological variability is expressed between the ornately sculptured siliceous scales formed by species in the chrysophycean genus, Synura. In this study, we aimed to uncover the general principles and trends underlying the evolution of scale morphology in this genus. We assessed the relationships among thirty extant Synura species using a robust molecular analysis that included six genes, coupled with morphological characterization of the species‐specific scales. The analysis was further enriched with addition of morphological information from fossil specimens and by including the unique modern species, Synura punctulosa. We inferred the phylogenetic position of the morphologically unique S. punctulosa, to be an ancient Synura lineage related to S. splendida in the section Curtispinae. Some morphological traits, including development of a keel or a labyrinth ribbing pattern on the scale, appeared once in evolution, whereas other structures, such as a hexagonal meshwork pattern, originated independently several times over geologic time. We further uncovered numerous construction principles governing scale morphology and evolution, as follows: (i) scale roundness and pore diameter decreased during evolution; (ii) elongated scales became strengthened by a higher number of struts or ribs; (iii) as a consequence of scale biogenesis, scales with spines possessed smaller basal holes than scales with a keel and; and (iv) the keel area was proportional to scale area, indicating its potential value in strengthening the scale against breakage.