bluuebunny/crossref_metadata_2025 huggingface dataset:
Territory, islandness, and the secessionist imaginary: Why do very small communities favour autonomy over integration?
Authors: Corbett Jack
Published: January 2020

Small communities should have the most to gain from integration, but the average size of the state is shrinking as island nationalism creates new, and very small, states out of former colonies, and federalised or autonomous territories. “Islandness,” as a proxy for territory, is employed as a resource to justify secession, but mainstream studies subordinate this factor in accounts that privilege ethnic, religious, linguistic, or economic drivers of identity. This article adds to a small body of work that foregrounds territory. Drawing on an in‐depth case study of Barbuda's (population 1,600) attempt to secede from Antigua demonstrates how nationalists employ different meanings of territory—legal, cultural, and political—to make the case for secession in the absence of factors commonly theorised to drive identify formation. Barbudan secessionism therefore problematises mainstream theory. It concludes by arguing that paying greater attention to how territory acts as a resource in the nationalist imaginary allows us to re‐examine long‐standing studies and cases in new and penetrating light.
Human Factors Analysis for Maritime Accidents Based on a Dynamic Fuzzy Bayesian Network
Authors: Qiao Weiliang , Liu Yu , Ma Xiaoxue , Liu Yang
Published: January 2020

Human factors are widely regarded to be highly contributing factors to maritime accident prevention system failures. The conventional methods for human factor assessment, especially quantitative techniques, such as fault trees and bow‐ties, are static and cannot deal with models with uncertainty, which limits their application to human factors risk analysis. To alleviate these drawbacks, in the present study, a new human factor analysis framework called multidimensional analysis model of accident causes (MAMAC) is introduced. MAMAC combines the human factors analysis and classification system and business process management. In addition, intuitionistic fuzzy set theory and Bayesian Network are integrated into MAMAC to form a comprehensive dynamic human factors analysis model characterized by flexibility and uncertainty handling. The proposed model is tested on maritime accident scenarios from a sand carrier accident database in China to investigate the human factors involved, and the top 10 most highly contributing primary events associated with the human factors leading to sand carrier accidents are identified. According to the results of this study, direct human factors, classified as unsafe acts, are not a focus for maritime investigators and scholars. Meanwhile, unsafe preconditions and unsafe supervision are listed as the top two considerations for human factors analysis, especially for supervision failures of shipping companies and ship owners. Moreover, potential safety countermeasures for the most highly contributing human factors are proposed in this article. Finally, an application of the proposed model verifies its advantages in calculating the failure probability of accidents induced by human factors.
The evolving role of organizational theory within economic sociology
Authors: Nedzhvetskaya Nataliya , Fligstein Neil
Published: January 2020

Organizational theory was one of the roots of the “new” economic sociology. In recent years, a set of complementary research programs have come to the fore that augment our understanding of the social structuring of markets. These include an interest in the role of conventions and commensuration, market devices, the performativity of economics, and the role of morality in the construction of markets. These other interests have come to enrich our conception of the ways in which “the social” structures market activities. While this has decentered some of the emphasis on organizations, there are still active research programs pushing forward new ideas that are focused on organizations, institutions, and networks in economic sociology. We discuss some of the recent work on organizational logics, inter‐ and intra‐organizational networks, and social movements and organization. We note there has also been some hybridity as scholars borrow from each other's toolkits in order to deepen our knowledge of the way the economy works. Organizational theory remains a main theoretical mainstay of economic sociology, but it has now been joined by additional perspectives.
Characterization of the novel HLA‐DPA1 allele, HLA‐DPA1*01:27
Authors: Ingrassia Francesco , Pecoraro Alice , Blando Maria , Bruno Floriana , Cappuzzo Valentina
Published: January 2020

HLA‐DPA1*01:27 differs from DPA1*01:03:01:01 by a single non‐synonymous nucleotide change in codon 15 (ACG > ATG).
The isotropic organization of DEM structure and extraction of valley lines using hexagonal grid
Authors: Wang Lu , Ai Tinghua , Shen Yilang , Li Jingzhong
Published: January 2020

The automatic extraction of valley lines (VLs) from digital elevation models (DEMs) has had a long history in the GIS and hydrology fields. The quality of the extracted results relies on the geometrical shape, spatial tessellation, and placement of the grids in the DEM structure. The traditional DEM structure consists of square grids with an eight‐neighborhood relationship, where there is an inconsistent distance measurement between orthogonal neighborhoods and diagonal neighborhoods. The directional difference results in the extracted VLs by the D8 algorithm not guaranteeing isotropy characteristics. Alternatively, hexagonal grids have been proved to be advantageous over square grids due to their consistent connectivity, isotropy of local neighborhoods, higher symmetry, increased compactness, and more. Considering the merits above, this study develops an approach to VL extraction from DEMs based on hexagonal grids. First, the pre‐process phase contains the depression filling, flow direction calculation, and flow accumulation calculation based on the six‐neighborhood relationship. Then, the flow arcs are connected, followed by estimating the flow direction. Finally, the connected paths are organized into a tree structure. To explore the effectiveness of hexagonal grids, comparative experiments are implemented against traditional DEMs with square grids using three sample regions. By analyzing the results between these two grid structures via visual and quantitative comparison, we conclude that the hexagonal grid structure has an outstanding ability in maintaining the location accuracy and bending characteristics of extracted valley networks. That is to say, the DEM‐derived VLs based on hexagonal grids have better spatial agreement with mapped river systems and lower shape diversion under the same resolution representation. Therefore, the DEMs with hexagonal grids can extract finer valley networks with the same data volume relative to traditional DEM.
Activation of endogenous protein phosphatase 1 enhances the calcium sensitivity of the ryanodine receptor type 2 in murine ventricular cardiomyocytes
Authors: Potenza Duilio Michele , Janicek Radoslav , Fernandez‐Tenorio Miguel , Niggli Ernst
Published: January 2020

Key points

Increased protein phosphatase 1 (PP‐1) activity has been found in end stage human heart failure.

Although PP‐1 has been extensively studied, a detailed understanding of its role in the excitation–contraction coupling mechanism, in normal and diseased hearts, remains elusive.

The present study investigates the functional effect of the PP‐1 activity on local Ca2+ release events in ventricular cardiomyocytes, by using an activating peptide (PDP3) for the stimulation of the endogenous PP‐1 protein.

We report that acute de‐phosphorylation may increase the sensitivity of RyR2 channels to Ca2+ in situ, and that the RyR2‐serine2808 phosphorylation site may mediate such a process.

Our approach unmasks the functional importance of PP‐1 in the regulation of RyR2 activity, suggesting a potential role in the generation of a pathophysiological sarcoplasmic reticulum Ca2+ leak in the diseased heart.

Changes in cardiac ryanodine receptor (RyR2) phosphorylation are considered to be important regulatory and disease related post‐translational protein modifications. The extent of RyR2 phosphorylation is mainly determined by the balance of the activities of protein kinases and phosphatases, respectively. Increased protein phosphatase‐1 (PP‐1) activity has been observed in heart failure, although the regulatory role of this enzyme on intracellular Ca2+ handling remains poorly understood. To determine the physiological and pathophysiological significance of increased PP‐1 activity, we investigated how the PP‐1 catalytic subunit (PP‐1c) alters Ca2+ sparks in permeabilized cardiomyocytes and we also applied a PP‐1‐disrupting peptide (PDP3) to specifically activate endogenous PP‐1, including the one anchored on the RyR2 macromolecular complex. We compared wild‐type and transgenic mice in which the usually highly phosphorylated site RyR2‐S2808 has been ablated to investigate its involvement in RyR2 modulation (S2808A+/+). In wild‐type myocytes, PP‐1 increased Ca2+ spark frequency by two‐fold, followed by depletion of the sarcoplasmic reticulum Ca2+ store. Similarly, PDP3 transiently increased spark frequency and decreased sarcoplasmic reticulum Ca2+ load. RyR2 Ca2+ sensitivity, which was assessed by Ca2+ spark recovery analysis, was increased in the presence of PDP3 compared to a negative control peptide. S2808A+/+ cardiomyocytes did not respond to both PP‐1c and PDP3 treatment. Our results suggest an increased Ca2+ sensitivity of RyR2 upon de‐phosphorylation by PP‐1. Furthermore, we have confirmed the S2808 site as a target for PP‐1 and as a potential link between RyR2s modulation and the cellular response.
The
Vibrio cholerae
MARTX toxin silences the inflammatory response to cytoskeletal damage before inducing actin cytoskeleton collapse
Authors: Woida Patrick J. , Satchell Karla J. F.
Published: January 2020

The multifunctional MARTX toxin of
Vibrio cholerae
damages host cells and suppresses the innate response to that damage.
Genome Sequence of a Klebsiella pneumoniae NDM-1 Producer Isolated in Quebec City
Authors: Déraspe Maxime , Longtin Jean , Roy Paul H.
Published: January 2020

We report here the complete genome sequence of
Klebsiella pneumoniae
CCRI-22199, isolated from a patient from India treated in Quebec City, Canada. Genes encoding beta-lactamases NDM-1 and CTX-M-15 were identified on two distinct plasmids. While the chromosome is similar to that of strain BAA-2146, CCRI-22199 provides a further example of rearrangements in plasmids.
Metagenomic Sequences of Three Drinking Water and Two Shower Hose Biofilm Samples Treated with or without Copper-Silver Ionization
Authors: Stüken Anke , Haverkamp Thomas H. A.
Published: January 2020

We announce five shotgun metagenomics data sets from two Norwegian premise plumbing systems. The samples were shotgun sequenced on two lanes of an Illumina HiSeq 3000 instrument (THRUplex chemistry, 151 bp, paired-end reads), providing an extensive resource for sequence analyses of tap water and biofilm microbial communities.
Draft Genome Sequences of Five Potentially Probiotic Enterococcus faecium Strains Isolated from an Artisanal Tunisian Meat (Dried Ossban)
Authors: Zommiti Mohamed , Ferchichi Mounir , Sebei Khaled , Feuilloley Marc G. J. , Connil Nathalie , Boukerb Amine M.
Published: January 2020

Here, we report the first draft genome sequences of five bacteriocinogenic and potentially probiotic
Enterococcus faecium
strains (MZF1 to MZF5), which were isolated from homemade Tunisian meat (dried ossban). The estimated median genome sizes were about 2,582,641 ± 109,039 bp, with a median G+C content of 40% ± 0.4%.
Annotated Genome Sequence of
Aspergillus tanneri
NIH1004
Authors: Mounaud Stephanie , Venepally Pratap , Singh Indresh , Losada Liliana , Seyedmousavi Seyedmojtaba , Kwon-Chung Kyung J. , Nierman William C.
Published: January 2020

The annotated genome of
Aspergillus tanneri
, a recently discovered drug-resistant pathogen, was determined by employing the Oxford Nanopore MinION platform and the Funannotate pipeline. The genome size and the number of protein-coding genes are notably larger than those of the most common etiological agent of aspergillosis,
Aspergillus fumigatus
.
Complete Genome Sequence of Klebsiella pneumoniae Strain TK421, a Conjugative Hypervirulent Isolate
Authors: Kochan Travis J. , Ozer Egon A. , Pincus Nathan B. , Fitzpatrick Margaret A. , Hauser Alan R.
Published: January 2020

Klebsiella pneumoniae
is a Gram-negative bacterium that is a major cause of nosocomial infections worldwide. Here, we present the complete genome sequence of TK421, a clinical bacteremia isolate containing a hypervirulence plasmid carrying
tra
-associated conjugation machinery genes. Emergence of conjugative hypervirulence plasmids could portend rapid dissemination of hypervirulence among multidrug-resistant
K. pneumoniae
strains.
Genome Sequence of Lignin-Degrading Arthrobacter sp. Strain RT-1, Isolated from Termite Gut and Rumen Fluid
Authors: Couger Matthew B. , Graham Caroline , Fathepure Babu Z.
Published: January 2020

Here, we report the genome sequence of
Arthrobacter
sp. strain RT-1, isolated from a cocktail of termite gut and rumen fluid. Strain RT-1 degrades a variety of lignin monomers and dimers as the growth substrates. The genome annotation predicted the genes necessary for the catabolism of lignin-derived aromatic compounds.
Draft Genome Sequences of Bacterial Strains Capable of Degrading Ulvan from the Green Alga Ulva ohnoi
Authors: Mondal Ratna , Satoh Miho , Ohnishi Kouhei
Published: January 2020

We present here the draft genome sequences of four marine bacterial strains which can use ulvan as their sole carbon source. We used ulvan extracted from the green alga
Ulva ohnoi
. Each bacterium contains a polysaccharide-utilizing locus, which is necessary for the complete degradation of ulvan.
Cretaceous-Paleocene transition along a rocky carbonate shore: Implications for the Cretaceous-Paleocene boundary event in shallow platform environments and correlation to the deep sea
Authors: Sanders* Diethard , Keller Gerta , Schlagintweit Felix , Studeny† Martin
Published: January 2020

The Cretaceous-Paleocene (K/P) boundary intervals are rarely preserved in successions of shallow-water limestones. Here, we describe a shallow rocky shore on the active orogenic wedge of the eastern Alps (Austria) fringed by a carbonate platform that was largely cannibalized by erosion. We compared this succession with similar nearshore environments globally, as well as the deep sea, to gain a better understanding of the environmental response to the K/P boundary transition. In the eastern Alps, Cretaceous and Paleocene lithofacies across the K/P boundary transition are separated by a hardground that formed during subaerial exposure and that terminates Upper Maastrichtian limestone with planktic foraminiferal assemblages deposited at neritic depth during zone CF3 (ca. 66.500 Ma). Above the hardground, there are beachrocks with early Danian zone P1a(1) assemblages, which indicate the hardground spans about ~600 k.y. of nondeposition and/or erosion. During the early Danian, the marine transgressive fringe fluctuated between “shoreface to emersion” environments, depositing limestones rich in bryozoans, rhynchonellids, coralline algae, and rare planktic foraminifera along with abraded, bored, and/or encrusted clasts eroded from older rocks. Repeated short subaerial exposure is marked by vadose diagenesis and hardgrounds, including an ~1.5 m.y. interval between magnetochrons C29n to C28n and planktic foraminiferal zones P1b to P1c(2).

Comparison with platform carbonate sequences from Croatia, Oman, Madagascar, Belize, and Guatemala, as well as nearshore siliciclastic environments of southern Tunisia, Texas, and Argentina, across the K/P boundary transition revealed surprisingly similar deposition and erosion patterns, with the latter correlative with sea-level falls and repeated subaerial exposure forming hardgrounds. Comparison with deep-sea depositional patterns revealed coeval but shorter intervals of erosion. This pattern shows a uniform response to the K/P boundary transition linked to climate and sea-level changes, whether in shallow nearshore or deep-sea environments, with climate change tied to Deccan volcanism in magnetochrons C29r-C29n.
Understanding thermogenic degassing in large igneous provinces: Inferences from the geological and statistical characteristics of breccia pipes in the western parts of the Karoo Basin
Authors: Svensen Henrik H. , Hammer Øyvind , Chevallier Luc , Jerram Dougal A. , Silkoset Petter , Polteau Stephane , Planke Sverre
Published: January 2020

Fluid release structures resulting from the interaction of igneous intrusions with sedimentary basins form an important part of the evolution of large igneous provinces. Hydrothermal breccia pipes formed in the Karoo Basin in South Africa during emplacement of igneous sills in the Karoo large igneous province represent one of the best-exposed expressions of such venting structures. Earlier work has shown that degassing of thermogenic CO2 and CH4 through the breccia pipes may have contributed to the Early Jurassic environmental changes. Here, we present the first detailed analysis of the distribution of breccia pipes in the western parts of the Karoo Basin. We mapped 431 pipes in a 650 km2 area using outcrop data. The pipes are rooted in contact aureoles around four sills emplaced in organic-rich Ecca Group shale, and thermal modeling of sill cooling and contact metamorphism gives a maximum temperature of 675 °C near the sill contacts, sufficient to convert a significant fraction of the organic carbon to gas. Model estimates indicate that metamorphism in the 650 km2 area generated 75–88 Gt of CO2, depending on actual sill thicknesses and emplacement levels. When further up-scaled, an area of 7400–8700 km2 (i.e., less than 2% of the area in the Karoo Basin intruded by sills) would be required to generate 1000 Gt of CO2. In order to characterize the degassing pipes, their geographical positions and diameters were analyzed using several point-pattern methods. The results showed that the pipes (1) have diameters in the 11–177 m range (average 44 m), (2) are spaced with an average nearest-neighbor distance of 452 m, and (3) are overall randomly spaced but with weak overdispersion at very small scales (<50 m) and weak clusters at larger scales (400–3000 m). In contrast to studies of volcanic pipe spacing, this study on breccia pipes does not indicate that the pipe spacing is controlled by any large-scale geophysical parameters such as crustal or basin thicknesses. Conclusions point to the pipes being formed following sill emplacement and pressure increase in the low-permeability organic-rich shale, followed by rapid carbon degassing, emphasizing their important role in the Early Jurassic climate change and oceanic anoxic event.
Antibiotic prescribing without documented indication in ambulatory care clinics: national cross sectional study
Authors: Ray Michael J , Tallman Gregory B , Bearden David T , Elman Miriam R , McGregor Jessina C
Published: January 2020

Objectives

To identify the frequency with which antibiotics are prescribed in the
absence of a documented indication in the ambulatory care setting, to
quantify the potential effect on assessments of appropriateness of
antibiotics, and to understand patient, provider, and visit level
characteristics associated with antibiotic prescribing without a documented
indication.

Design

Cross sectional study.

Setting

2015 National Ambulatory Medical Care Survey.

Participants

28 332 sample visits representing 990.9 million ambulatory care visits
nationwide.

Main outcome measures

Overall antibiotic prescribing and whether each antibiotic prescription was
accompanied by appropriate, inappropriate, or no documented indication as
identified through ICD-9-CM (international classification of diseases, 9th
revision, clinical modification) codes. Survey weighted multivariable
logistic regression was used to evaluate potential risk factors for receipt
of an antibiotic prescription without a documented indication.

Results

Antibiotics were prescribed during 13.2% (95% confidence interval 11.6% to
13.7%) of the estimated 990.8 million ambulatory care visits in 2015.
According to the criteria, 57% (52% to 62%) of the 130.5 million
prescriptions were for appropriate indications, 25% (21% to 29%) were
inappropriate, and 18% (15% to 22%) had no documented indication. This
corresponds to an estimated 24 million prescriptions without a documented
indication. Being an adult male, spending more time with the provider, and
seeing a non-primary care specialist were significantly positively
associated with antibiotic prescribing without an indication. Sulfonamides
and urinary anti-infective agents were the antibiotic classes most likely to
be prescribed without documentation.

Conclusions

This nationally representative study of ambulatory visits identified a large
number of prescriptions for antibiotics without a documented indication.
Antibiotic prescribing in the absence of a documented indication may
severely bias national estimates of appropriate antibiotic use in this
setting. This study identified a wide range of factors associated with
antibiotic prescribing without a documented indication, which may be useful
in directing initiatives aimed at supporting better documentation.
Impact of Feed the Future initiative on nutrition in children aged less than 5 years in sub-Saharan Africa: difference-in-differences analysis
Authors: Ryckman Theresa , Robinson Margaret , Pedersen Courtney , Bhattacharya Jay , Bendavid Eran
Published: January 2020

Objective

To evaluate the impact of the US government’s Feed the Future initiative on
nutrition outcomes in children younger than 5 years in sub-Saharan
Africa.

Design

Difference-in-differences quasi-experimental approach.

Setting

Households in 33 low and lower middle income countries in sub-Saharan
Africa.

Population

883 309 children aged less than 5 years with weight, height, and age recorded
in 118 surveys conducted in 33 countries between 2000 and 2017: 388 052
children were from Feed the Future countries and 495 257 were from non-Feed
the Future countries.

Main outcome measures

A difference-in-differences approach was used to compare outcomes among
children in intervention countries after implementation of the initiative
with children before its introduction and children in non-intervention
countries, controlling for relevant covariates, time invariant national
differences, and time trends. The primary outcome was stunting (height for
age >2 standard deviations below a reference median), a key indicator of
undernutrition in children. Secondary outcomes were wasting (low weight for
height) and underweight (low weight for age).

Results

Across all years and countries, 38.3% of children in the study sample were
stunted, 8.9% showed wasting, and 21.3% were underweight. In the first six
years of Feed the Future’s implementation, children in 12 countries with the
initiative exhibited a 3.9 percentage point (95% confidence interval 2.4 to
5.5) greater decline in stunting, a 1.1 percentage point (0.1 to 2.1)
greater decline in wasting, and a 2.8 percentage point (1.6 to 4.0) greater
decline in underweight levels compared with children in 21 countries without
the initiative and compared with trends in undernutrition before Feed the
Future was launched. These decreases translate to around two million fewer
stunted and underweight children aged less than 5 years and around a half
million fewer children with wasting. For context, about 22 million children
were stunted, 11 million children were underweight, and four million
children were wasted in the Feed the Future countries at baseline.

Conclusions

Feed the Future’s activities were closely linked to notable improvements in
stunting and underweight levels and moderate improvements in wasting in
children younger than 5 years. These findings highlight the effectiveness of
this large, country tailored initiative focused on agriculture and food
security and have important implications for the future of this and other
nutrition interventions worldwide.
“Asset exchange”—interactions between patient groups and pharmaceutical industry: Australian qualitative study
Authors: Parker Lisa , Fabbri Alice , Grundy Quinn , Mintzes Barbara , Bero Lisa
Published: January 2020

Objective

To understand and report on the nature of patient group interactions with the
pharmaceutical industry from the perspective of patient group
representatives by exploring the range of attitudes towards pharmaceutical
industry sponsorship and how, why, and when interactions occur.

Design

Empirical qualitative interview study informed by ethics theory.

Setting

Australian patient groups.

Participants

27 participants from 23 Australian patient groups that represented diverse
levels of financial engagement with the pharmaceutical industry. Groups were
focused on general health consumer issues or disease specific topics, and
had regional or national jurisdictions.

Analysis

Analytic techniques were informed by grounded theory. Interview transcripts
were coded into data driven categories. Findings were organised into new
conceptual categories to describe and explain the data, and were supported
by quotes.

Results

A range of attitudes towards pharmaceutical industry sponsorship were
identified that are presented as four different types of relationship
between patient groups and the pharmaceutical industry. The dominant
relationship type was of a successful business partnership, and participants
described close working relationships with industry personnel. These
participants acknowledged a potential for adverse industry influence, but
expressed confidence in existing strategies for avoiding industry influence.
Other participants described unsatisfactory or undeveloped relationships,
and some participants (all from general health consumer groups) presented
their groups’ missions as incompatible with the pharmaceutical industry
because of fundamentally opposing interests. Participants reported that
interactions between their patient group and pharmaceutical companies were
more common when companies had new drugs of potential interest to group
members. Patient groups that accepted industry funding engaged in exchanges
of “assets” with companies. Groups received money, information, and advice
in exchange for providing companies with marketing, relationship building
opportunities with key opinion leaders, coordinated lobbying with companies
about drug access and subsidy, assisting companies with clinical trial
recruitment, and enhancing company credibility.

Conclusions

An understanding of the range of views patient groups have about
pharmaceutical company sponsorship will be useful for groups that seek to
identify and manage any ethical concerns about these relationships. Patient
groups that receive pharmaceutical industry money should anticipate they
might be asked for specific assets in return. Selective industry funding of
groups where active product marketing opportunities exist might skew the
patient group sector’s activity towards pharmaceutical industry interests
and allow industry to exert proxy influence over advocacy and subsequent
health policy.
Planned earlier delivery for late pre-eclampsia may be better for mothers
Authors: Cook Rob , Lyon-Maris Johnny , Davidson Peter
Published: January 2020

The study

Chappell LC, Brocklehurst P, Green ME, et al. Planned early delivery or expectant management for late preterm pre-eclampsia (PHOENIX): a randomised controlled trial. Lancet 2019;394:1181-90.

This project was funded by the NIHR Health Technology Assessment Programme (project number 12/25/03).

To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000838/mothers-benefit-from-a-planned-earlier-delivery-for-late-pre-eclampsia
Post-discharge acute care and outcomes following readmission reduction initiatives: national retrospective cohort study of Medicare beneficiaries in the United States
Authors: Khera Rohan , Wang Yongfei , Bernheim Susannah M , Lin Zhenqiu , Krumholz Harlan M
Published: January 2020

Objectives

To determine whether patients discharged after hospital admissions for conditions covered by national readmission programs who received care in emergency departments or observation units but were not readmitted within 30 days had an increased risk of death and to evaluate temporal trends in post-discharge acute care utilization in inpatient units, emergency departments, and observation units for these patients.

Design

Retrospective cohort study.

Setting

Medicare claims data for 2008-16 in the United States.

Participants

Patients aged 65 or older admitted to hospital with heart failure, acute myocardial infarction, or pneumonia—conditions included in the US Hospital Readmissions Reduction Program.

Main outcome measures

Post-discharge 30 day mortality according to patients’ 30 day acute care utilization; acute care utilization in inpatient and observation units and the emergency department during the 30 day and 31-90 day post-discharge period.

Results

3 772 924 hospital admissions for heart failure, 1 570 113 for acute myocardial infarction, and 3 131 162 for pneumonia occurred. The overall post-discharge 30 day mortality was 8.7% for heart failure, 7.3% for acute myocardial infarction, and 8.4% for pneumonia. Risk adjusted mortality increased annually by 0.05% (95% confidence interval 0.02% to 0.08%) for heart failure, decreased by 0.06% (−0.09% to −0.04%) for acute myocardial infarction, and did not significantly change for pneumonia. Specifically, mortality increased for patients with heart failure who did not utilize any post-discharge acute care, increasing at a rate of 0.08% (0.05% to 0.12%) per year, exceeding the overall absolute annual increase in post-discharge mortality in heart failure, without an increase in mortality in observation units or the emergency department. Concurrent with a reduction in 30 day readmission rates, stays for observation and visits to the emergency department increased across all three conditions during and beyond the 30 day post-discharge period. Overall 30 day post-acute care utilization did not change significantly.

Conclusions

The only condition with increasing mortality through the study period was heart failure; the increase preceded the policy and was not present among patients who received emergency department or observation unit care without admission to hospital. During this period, the overall acute care utilization in the 30 days after discharge significantly decreased for heart failure and pneumonia, but not for acute myocardial infarction.
Therapeutic efficacy and safety of initial triple combination of metformin, sitagliptin, and lobeglitazone in drug-naïve patients with type 2 diabetes: initial triple study
Authors: Lim Soo , Ku Eu Jeong , Lee Seo Young , Lee Ji Hyun , Lee Jie-Eun , Kim Kyoung Min , Davies Melanie J
Published: January 2020

Objective

To compare the efficacy and safety of an initial triple therapy using metformin, a dipeptidyl peptidase-4 (DPP4) inhibitor, and thiazolidinedione with a stepwise approach using sulfonylurea and metformin in new-onset, drug-naïve patients with type 2 diabetes.

Research design and methods

Among drug-naïve patients with 9.0%–12.0% glycated hemoglobin (HbA1c) but no hyperglycemic symptoms, 100 subjects who started triple medications (metformin 1000 mg/day, sitagliptin 100 mg/day, and lobeglitazone 0.5 mg/day) were selected as an initial triple therapy group. Age and body mass index-matched subjects (n=100) who started glimepiride (≥2 mg/day with uptitration) and metformin (≥1000 mg/day with uptitration) were selected as a conventional therapy group. We investigated changes in HbA1c level, dynamic indexes for insulin sensitivity and β-cell function, and hypoglycemia.

Results

After 12 months of treatment, HbA1c levels decreased significantly in both groups: from 10.7%±1.0% to 6.7%±1.3% in the triple group, and from 10.5%±1.0% to 7.3%±1.2% in the conventional therapy group. At 12 months, achievement of the HbA1c target (<7.0%) was higher in the triple group than in the conventional group (70% vs 52%, p<0.01). Dynamic indexes related to β-cell function and insulin sensitivity improved, and albuminuria reduced significantly only in the triple group. Hypoglycemia was more common in the conventional group.

Conclusions

Initial triple combination therapy with the DPP4 inhibitor, metformin, and thiazolidinedione showed a higher achievement of the target HbA1c goal with a lower risk of hypoglycemia, better restoration of β-cell function, and multiple metabolic benefits, implying durable glycemic control. This strategy may be useful for patients presenting with type 2 diabetes and high HbA1c levels.
Prevalence and sex-specific patterns of metabolic syndrome in rural Uganda
Authors: Ben-Yacov Limor , Ainembabazi Pearl , Stark Aliza Hannah , Kizito Samuel , Bahendeka Silver
Published: January 2020

Background and aims

In sub-Saharan Africa, infectious diseases are still the leading causes of mortality; however, this may soon be surpassed by non-communicable illnesses, namely hypertension, diabetes and cardiovascular disease. This study determined the prevalence and patterns of metabolic syndrome and cardio-risk factors in men and women in rural Uganda.

Methods

A household-based, cross-sectional survey was carried out following the WHO STEP-wise approach to surveillance. It included demographic and lifestyle questionnaires, anthropometric measurements and biochemical analyses. Of the 200 randomly recruited participants, 183 successfully completed two steps of the study and 161 provided blood samples.

Results

Data were collected from 183 adults, aged 18–69 years; 62% were female. Based on the National Cholesterol Education Program-Adult Treatment Panel-III criteria, the prevalence of metabolic syndrome was 19.1% (95% CI 14.0 to 22.5). Elevated fasting plasma glucose was observed in 14.2% (95% CI 9.1 to 19.3) of participants, hypertriglyceridaemia in 16.9% (95% CI 12.1 to 23.1); hypertension in 36.1% (95% CI 29.0 to 43.0) and 52.5% (95% CI 45.2 to 59.6) had low HDL (high-density lipoprotein) cholesterol. Abdominal obesity was found in 24.6% (95% CI 18.8 to 31.4) of participants. Sex disparities were significant for several risk factors. Females had significantly higher prevalence of abdominal obesity (38.6% vs 1.5% in males, p=0.001) and twice the rates of low HDL (65.8% vs 30.4%, p=0.001). Men tended to have higher but not significant rates of hypertension (42.0% vs 32.5%) and smoked significantly more than women (49.3% vs 21.1%, p<0.001). Alcohol consumption was also higher in men (55.1% vs 18.4%, p<0.001) and quantities consumed were approximately three times greater than in females (p<0.001).

Conclusion

Metabolic syndrome exists at worrying rates in the rural Ugandan population. Sex disparities are evident in risk factor prevalence, reflecting physiological variables and deeply entrenched cultural and lifestyle norms.
Development and evaluation of a patient decision aid for patients considering ongoing medical or surgical treatment options for ulcerative colitis using a mixed-methods approach: protocol for DISCUSS study
Authors: Baker Daniel Mark , Lee Matthew James , Folan Anne-Mairead , Blackwell Sue , Robinson Kerry , Wootton Rebecca , Sebastian Shaji , Brown Steven R , Jones Georgina Louise , Lobo Alan J
Published: January 2020

Introduction

Approximately 20%–30% of patients with ulcerative colitis (UC) require surgery, the majority of these being elective due to chronic symptoms refractory to medical treatment. The decision for surgery is difficult and dependent on patient preferences. Current resources for patients considering surgery have been found not to meet minimum international standards. The overall aim of the ‘DISCUSS’ study is to develop and evaluate a new patient decision aid (PtDA) for patients considering surgery for UC created in line with international minimum standards.

Methods and analysis

This is a prospective mixed-methods study of adults (18+ years) who are considering surgical intervention for UC across two regional centres in Yorkshire, UK. This study is in three stages. In stage 1 we will develop the PtDA and its content via systematic reviews and a patient questionnaire. In stage 2 we will assess the face validity of the PtDA using mixed-methods on key stakeholders using both semistructured interviews and questionnaires, following which the PtDA will be refined. In stage 3 we will assess the acceptability of using the PtDA in clinical practice. This will use a mixed-methods approach on clinicians and patients who are considering undergoing elective surgery. Questionnaires including the Preparation for Decision-Making Scale, a measure of anxiety and decisional conflict will be analysed at two timepoints using paired sample t-tests and CIs. Interviews with patients and clinicians will be analysed using thematic analysis.

Ethics and dissemination

Research ethics approval from North East–Tyne & Wear South Research Ethics Committee (Ref: 19/NE/0073) and Health Research Authority approval (Ref: 257044) have been granted. Results will be published in open access peer-reviewed journals, presented in conferences and distributed through the Crohn’s and Colitis UK charity. External endorsement will be sought from the International Patient Decision Aid Standards Collaboration inventory of PtDAs.

PROSPERO registration number

CRD42018115513, CRD42019126186, CRD42019125193.
Medical students’ experiences of the benefits and influences regarding a placement mentoring programme preparing them for future practice as junior doctors: a qualitative study
Authors: Ng Ka Ying Bonnie , Lynch Siobhan , Kelly Jacquie , Mba Obinna
Published: January 2020

Objective

To study medical students’ views and experiences of the benefits and influences regarding a mentoring programme aimed at preparing them for future practice as a doctor during their Obstetrics and Gynaecology (O&G) placement in a UK teaching hospital.

Design

A qualitative approach, employing focus groups and thematic analysis.

Setting

Single-centre UK Teaching hospital.

Participants

Thirteen undergraduate medical students at the University of Southampton who had completed their standard 8-week placement in O&G and had been assigned a mentor throughout.

Main outcome measures

Medical students’ experiences and perceptions of the benefits and influences of having a mentor throughout their O&G placement.

Results

From our data, four central themes were identified: integration, feedback, seniority and expectations. Students found mentorship useful for integration into the team, and an opportunity for constructive feedback on their clinical skills and professional skills for example, communication and team-working. Seniority and the level of contact of their mentor was the main reason for differing mentoring experiences: although senior mentors spent less time with their mentees, they were able to offer more careers advice. Students felt that the mentors and mentees were not always clear on the expectations of the mentoring programme.

Conclusions

Mentorship may be a useful addition to help prepare students for future clinical practice. Mentor training may improve consistency of experiences. This study demonstrates that a mentoring programme is deliverable and widely accepted by medical students in a clinical placement such as O&G, and may have wider benefits if introduced on a regional/national level.
Professional assessment of potential concussions in elite football tournaments
Authors: Tarzi Christopher , Aubrey Jason , Rotundo Mario , Armstrong Nicholas , Saha Ashirbani , Cusimano Michael D
Published: January 2020

Background

Potential concussive events (PCEs) are a major health concern in football. Though there are protocols set in place for assessments of PCEs, there has been no evidence of adherence in major football tournaments.

Methods

Our research goal is to determine if PCEs in elite football are professionally assessed according to the International Conference on Concussion in Sport (ICCS) consensus statement recommendations. Identification and analysis of PCEs in the 2018 World Cup (WC) were accomplished through standardised observation of video footage by trained observers. Results were contrasted with data from the 2014 WC and 2016 Euro Cup. Our primary outcomes include frequency and professional assessment of PCEs, signs of concussions and time stopped for assessments.

Findings

In the 64 games of the 2018 WC, 87 PCEs (1.36 per game) were identified. Thirty-one (35.6%) PCEs were professionally assessed, resulting in the removal of three (3.5%) players from the match. Six (6.9%) PCEs showed one sign of concussion, 60 (69.0%) showed two signs, 20 (23.0%) showed three signs and 1 (1.2%) showed four or more signs. The mean time stopped for assessment was 63.3 s. No significant change in the percentage of professional assessments (mean=33.4%, 95% CI 20.7% to 46.1%) were identified across tournaments (p=0.42).

Interpretation

These findings demonstrate a need for adherence to concussion protocols in order to improve the brain-health of athletes. Proper enforcement of the ICCS protocols during these tournaments and promoting player health and safety can influence the officiating, coaching and playing of football worldwide by promoting player safety.
Determinants, circumstances and consequences of injurious falls among older women living in the community
Authors: Phelan Elizabeth A , Rillamas-Sun Eileen , Johnson Lisa , LaMonte Michael J , Buchner David M , LaCroix Andrea Z , Anderson Garnet L
Published: January 2020

Objective

To identify the risk factors of women who fell with injury relative to women who did not fall or fell without injury and to describe the circumstances and consequences of injurious and non-injurious falls.

Methods

We analysed 5074 older women from the Objective Physical Activity and Cardiovascular Health Study who prospectively tracked their falls using a 13-month calendar. Women with a reported fall were phone interviewed about fall-related details, including injuries. Risk factors were identified from surveys and clinical home visits. Logistic regression models were used to calculate adjusted ORs and 95% CIs for injurious falls relative to not falling or falling without injury. Circumstances of injurious and non-injurious falls were compared.

Results

At least one fall was experienced by 1481 (29%) participants. Of these, 1043 were phone interviewed, of whom 430 (41%) reported at least one injurious fall. Relative to not falling, the risk factor most strongly associated with experiencing an injurious fall was having fallen ≥2 times (OR 4.0, CI 2.7 to 5.8) in the past year. Being black was protective for fall-related injury (OR 0.6, CI 0.4 to 0.9). No strong associations in risk factors were observed for injurious relative to non-injurious falls. Injurious falls were more likely to occur away from and outside of the home (p<0.05). Over half of those who injured self-managed their injury.

Conclusion

Falling repeatedly is a powerful risk factor for injurious falls. Those who have fallen more than once should be prioritised for interventions to mitigate the risk of an injurious fall.
Trajectories of material living standards, physical health and mental health under a universal pension
Authors: Allen Joanne , Alpass Fiona M
Published: January 2020

Objective

Aged pension schemes aim to support material and non-material well-being of older populations. The current work aimed to describe dominant trajectories of material living standards in the decades prior to and following eligibility for an aged pension, and describe associated trajectories of physical and mental health.

Methods

Longitudinal data on living standards and indices of health Short Form 12 were collected over 2–12 years follow-up from 4811 New Zealand adults aged 55–76. Growth mixture models were used to identify dominant trajectories of living standards with age. Latent growth curve models were used to describe trajectories of physical and mental health associated with each living standards trajectory class.

Results

A group characterised by good living standards with age (81.5%) displayed physical and mental health scores comparable to those of the general adult population. Smaller groups experienced hardship but increasing living standards (11.8%) and hardship and declining living standards (6.8%). While both groups in hardship experienced poor health in the decade prior pension eligibility, mental health improved among those with increasing living standards, while physical and mental health declined among those with declining living standards.

Conclusion

Under the current policy settings, a majority of older adults in New Zealand maintain a good level of living standards and health in later life. However, significant proportions experience material hardship and poor health in the decade prior to pension eligibility. Alleviation of material hardship may reduce health inequalities in later life.
Influenza Vaccination Reduces Dementia in Patients with Chronic Obstructive Pulmonary Disease: A Nationwide Cohort Study
Authors: Luo Ching-Shan , Chi Ching-Chi , Fang Yu-Ann , Liu Ju-Chi , Lee Kang-Yun
Published: January 2020

This study aimed to explore the protective potential of influenza vaccination against occurrence of dementia in patients with chronic obstructive pulmonary disease (COPD), who are expected to be more vulnerable to influenza infection. This nationwide retrospective cohort study enrolled patients with COPD (aged ≥60 years) from 1 January 2001 to 31 December 2012 by using the Taiwan National Health Insurance Research Database. By applying time-dependent Cox proportional hazard model, we used multivariate analysis to calculate the adjusted HR (aHR) with 95% CI of dementia in relation to influenza vaccination among patients with COPD. Besides, patients were partitioned into four groups according to the vaccination number (unvaccinated, 1, 2-3 and ≥4 total vaccinations) to investigate the dose-response effect of vaccinations on the dementia incidence. This cohort study included 19 848 patients with COPD, and 45% of them received influenza vaccination. The aHR of dementia was 0.68 (95% CI: 0.62 to 0.74, p<0.001) comparing vaccinated patients with unvaccinated ones. Furthermore, there was a trend of dementia risk reduction with the vaccination number. For patients who received 2-3 vaccinations, the aHR was 0.81 (95% CI: 0.73 to 0.90), and for those received 4 vaccinations, the aHR was 0.44 (95% CI: 0.40 to 0.50), with p for trend <0.001. In conclusion, annual influenza vaccination can reduce the risk of dementia in patient with COPD in a dose-dependent manner.