bluuebunny/crossref_metadata_2025 huggingface dataset:
Modified rotating-angle softened truss model for composite box-girder with corrugated steel webs under pure torsion
Authors: Zhu Yingbo , Wan Shui , Shen Kongjian , Su Qiang , Li Xiayuan
Published: February 2020

Replacement of traditional concrete webs with corrugated steel webs will lead to a significant decrease in torsional stiffness of composite box-girder with corrugated steel webs, which needs special attention in the design of wide and curved composite box-girder with corrugated steel webs. To improve the accuracy of prediction on the entire torsional performance of composite box-girder with corrugated steel webs, a modified rotating-angle softened truss model for torsion is developed in this study. Modified rotating-angle softened truss model for torsion mainly takes into account the new three-stage average stress coefficients, the new two-stage shear strain relationship between corrugated steel web and slabs, and the torsional deformation coordination of whole cross section. To testify the accuracy of modified rotating-angle softened truss model for torsion and to better understand the performance of composite box-girder with corrugated steel webs under pure torsion, two scaled specimens are tested in this article. The torque–twist curves and shear strains calculated by modified rotating-angle softened truss model for torsion reach a good agreement with experimental results, which indicates that modified rotating-angle softened truss model for torsion can successfully predict the entire torsional performance of composite box-girder with corrugated steel webs. In addition, compared with test data obtained from previous literature, the proposed modified rotating-angle softened truss model for torsion is more capable of predicting full torsional response of composite box-girder with corrugated steel webs than other rotating-angle models, especially at cracking stage and ultimate stage.
Health Professionals’ Experiences of Providing Trauma-Informed Care in Acute Psychiatric Inpatient Settings: A Scoping Review
Authors: O’Dwyer Carol , Tarzia Laura , Fernbacher Sabin , Hegarty Kelsey
Published: February 2020

Background:

Trauma-informed care is increasingly recognized as the ideal model of care for acute psychiatric inpatient units; however, it continues to be a challenge to implement. The aims of this review are (1) to synthesize the research exploring health professionals’ experiences of providing trauma-informed care in acute psychiatric inpatient settings and (2) to examine these experiences through a gender lens, particularly relating to gender-based violence. This research will provide additional insights to facilitate implementation of trauma-informed care in acute psychiatric inpatient care.

Method:

A comprehensive scoping review methodology was adopted. English-language, peer-reviewed articles published between January 1998 and March 2018 were identified from seven databases. Inclusion criteria included a qualitative or mixed-method study design.

Results:

Eight full-text articles were found. This review highlights the importance for health professionals to have a reflective environment and a multilayered level of collaboration to adopt trauma-informed care. However, negative attitudes toward female consumers and inconsistent implementation strategies continue to hold back implementation of trauma-informed care in acute psychiatric inpatient units. Overall, limited consideration for gendered issues and gender-based violence in the implementation of trauma-informed care in acute psychiatric inpatient settings was found.

Conclusion and Implications:

There is a lack of research on health professionals’ experiences of providing trauma-informed care in acute psychiatric inpatient units, with even less research considerating gender-based violence. We argue that more research is needed to gain a better understanding of the experience of health professionals from acute psychiatric inpatient settings to inform future implementation of trauma-informed care.
Thermal-wet model of knitted double jersey based on backpropagation algorithm of neural network
Authors: Li Xintong , Cong Honglian , Gao Zhe , Dong Zhijia
Published: February 2020

In this article, thermal resistance test and water vapor resistance test were experimented to obtain data of heat and humidity performance. Canonical correlation analysis was used on determining influence of basic fabric parameters on heat and humidity performance. Thermal resistance model and water vapor resistance model were established with a three-layered feedforward-type neural network. For the generalization of the network and the difficulty of determining the optimal network structure, trainbr was chosen as training algorithm to find the relationship between input factors and output data. After training and verification, the number of hidden layer neurons in the thermal resistance model was 12, and the error reached 10−3. In the water vapor resistance model, the number of hidden layer neurons was 10, and the error reached 10−3.
A Farewell to Art: Aesthetics as a Topic in Psychology and Neuroscience
Authors: Skov Martin , Nadal Marcos
Published: February 2020

Empirical aesthetics and neuroaesthetics study two main issues: the valuation of sensory objects and art experience. These two issues are often treated as if they were intrinsically interrelated: Research on art experience focuses on how art elicits aesthetic pleasure, and research on valuation focuses on special categories of objects or emotional processes that determine the aesthetic experience. This entanglement hampers progress in empirical aesthetics and neuroaesthetics and limits their relevance to other domains of psychology and neuroscience. Substantial progress in these fields is possible only if research on aesthetics is disentangled from research on art. We define aesthetics as the study of how and why sensory stimuli acquire hedonic value. Under this definition, aesthetics becomes a fundamental topic for psychology and neuroscience because it links hedonics (the study of what hedonic valuation is in itself) and neuroeconomics (the study of how hedonic values are integrated into decision making and behavioral control). We also propose that this definition of aesthetics leads to concrete empirical questions, such as how perceptual information comes to engage value signals in the reward circuit or why different psychological and neurobiological factors elicit different appreciation events for identical sensory objects.
Embodied Capital and Risk-Related Traits, Attitudes, Behaviors, and Outcomes: An Exploratory Examination of Attractiveness, Cognitive Ability, and Physical Ability
Authors: Refaie Nabhan , Mishra Sandeep
Published: February 2020

The relative state model posits two nonindependent pathways to risk. The need-based pathway suggests people take risks when nonrisky options are unlikely to meet their needs. The ability-based pathway suggests people take risks when they possess resources or abilities making them more capable of successfully “pulling off” risk-taking. Growing laboratory and field evidence supports need-based risk-taking. However, little is known about ability-based risk-taking. We examined whether three indicators of embodied capital (attractiveness, cognitive ability, and physical dexterity) were associated with risk-related personality traits, risk-attitudes, behavioral risk-taking, and outcomes associated with risk-taking. Among 328 community members recruited to maximize variance on risk-propensity, we demonstrate that embodied capital indices predict various instantiations of risk-propensity consistent with the relative state model.
An interesting case of melanoma with divergent differentiation aberrantly expressing calretinin stain
Authors: Tan Chien Sheng , Ong Suyin
Published: February 2020

Metaplastic melanoma or melanoma with divergent differentiation is a rare variant of melanoma with a wide spectrum of mesodermal and ectodermal differentiation. This is a case of metaplastic melanoma with aberrant expression for calretinin stain in the chondroid component and malignant cells adjacent to it. The finding of calretinin positivity in melanoma could be useful in diagnosing metastatic metaplastic melanoma. The awareness of the possibility of aberrant calretinin positivity in metaplastic melanoma with chondroid differentiation is critical to avoid a potential pitfall in misdiagnosing metaplastic melanoma as sarcoma or mesothelioma.
Population pharmacokinetics of riociguat and its metabolite in patients with chronic thromboembolic pulmonary hypertension from routine clinical practice
Authors: Michaličková Danica , Jansa Pavel , Bursová Miroslava , Hložek Tomáš , Čabala Radomír , Hartinger Jan Miroslav , Ambrož David , Aschermann Michael , Lindner Jaroslav , Linhart Aleš , Slanař Ondřej , Krekels Elke H.J.
Published: February 2020

Pharmacokinetic data for riociguat in patients with chronic thromboembolic pulmonary hypertension (CTEPH) have previously been reported from randomized clinical trials, which may not fully reflect the population encountered in routine practice. The aim of the current study was to characterize the pharmacokinetic of riociguat and its metabolite M1 in the patients from routine clinical practice. A population pharmacokinetic model was developed in NONMEM 7.3, based on riociguat and its metabolite plasma concentrations from 49 patients with CTEPH. One sample with riociguat and M1 concentrations was available from each patient obtained at different time points after last dose. Age, bodyweight, sex, smoking status, concomitant medications, kidney and liver function markers were tested as potential covariates of pharmacokinetic of riociguat and its metabolite. Riociguat and M1 disposition was best described with one‐compartment models. Apparent volume of distribution (Vd/F) for riociguat and M1 were assumed to be the same. Total bilirubin and creatinine clearance were the most predictive covariates for apparent riociguat metabolic clearance to M1 (CLf,M1/F) and for apparent riociguat clearance through remaining pathways (CLe,r/F), respectively. CLf,M1/F, CLe,r/F, Vd/F of riociguat and M1, and clearance of M1 (CLe,M1/F) for a typical individual with 70 mL/min creatinine clearance and 0.69 mg/dL total bilirubin were 0.665 L/h (relative standard error = 17%)), 0.66 (18%) L/h, 3.63 (15%) L and 1.47 (19%) L/h, respectively. Upon visual identification of six outlying individuals, an absorption lag‐time of 2.95 (6%) h was estimated for these patients. In conclusion, the only clinical characteristics related to riociguat exposure in patients with CTEPH from routine clinical practice are total bilirubin and creatinine clearance. This confirms the findings of the previous population pharmacokinetic studies based on data from randomized clinical trials.
No Honour in Honour Killing: Comparative Analysis of Indian Traditional Social Structure vis-à-vis Gender Violence
Authors: Kaushal Kaushambi
Published: February 2020

India is always proud of its democracy, secularism between and after so many years of Independence. However, ethos of marriage remains the same. Marriages tend to be a holy sacrament solemnized by families. In some of the cases, young innocent women are subjected to horrific and horrendous waves of massacring for choosing the life partner according to their wish and choice. Moreover, this choice makes the women vulnerable to the alleged supreme caste, religious group and old guards of the society. A killing in the name of honour inculcates torture and rejection of equalitarianism, which is a corner stone of the Indian Constitution. Furthermore, it manifests how the value of feudalism and patriarchy is rooted in our social system in some corner. The qualitative- and quantitative-based comparative analyses of the study would depict various perspectives of violence, its vulnerability and peril nature towards some of Indian Women. In this backdrop, it is difficult to state the precise number of Honour Killings because many cases go unreported. In some of the cases, the perpetrators go unpunished and the concept of the honour becomes justified in the eyes of societies. It is estimated by the United Nations Population Funds that 5,000 women and girls are killed by their own family members. According to the recent report of National Crime Record Bureau, 356 cases of Honour Killing were reported along with 65 cases of culpable homicide in India. There are laws in Indian Penal Code for the Honour Killings; but it is just an antidote to such dishonourable practices. Law should be amended and made stringent towards it. It is manifested that a wide range of moderation is needed in order to effectively battle against patriarchal crimes and women’s sovereignty in India. It is not out of the context to mention here that ‘The Freedom of Belief doesn’t mean Freedom to Kill. Everyone has right to live there life with dignity, grace and equality. A woman deserves respect with dignity. There is No Honour in Honour Killings’.
Urbanisation and Economic Growth: The Arguments and Evidence for Africa and Asia
Authors: Turok Ivan , McGranahan Gordon
Published: February 2020

The relationship between urbanisation and development is a vital policy concern, especially in Africa and Asia. This article reviews the arguments and evidence for whether rapid urban population growth can help to raise living standards. The main finding is that the development effects of urbanisation and the magnitude of agglomeration economies are very variable. There is no simple linear relationship between urbanisation and economic growth, or between city size and productivity. The potential of urbanisation to promote growth is likely to depend on how conducive the infrastructure and institutional settings are. Removing barriers to rural–urban mobility may enable economic growth but the benefits will be much larger with supportive policies, markets and infrastructure investments. Cities should use realistic population projections as the basis for investing in public infrastructure and implementing supportive land policies. Governments should seek out ways of enabling forms of urbanisation that contribute to growth, poverty reduction and environmental sustainability, rather than encouraging (or discouraging) urbanisation per se.
Disruptive Innovation in Aerospace and Defense in Indian MSME
Authors: Rao Shuktij Singh , Banik Arindam , Khanna Ashutosh , Philip Deepu
Published: February 2020

Various movements in the Indian aerospace and defense industry indicate that the forces of disruptive innovation have been set in motion by the Government of India with signals of change in the industry, thereby nudging it toward disruption. This case studies one such company from the micro, small and medium enterprise (MSME) sector in pursuit of disruptive innovation in the Indian aerospace and defense industry. This case introduces and explains in detail the factors of disruptive innovation in aerospace and defense industry. It gives an inside view of Indian MSME’s environmental and internal situations in the Indian aerospace and defense industry and the problems faced by an entrepreneur who is looking for using technology to create disruption in industry.
The SAFER geodatabase for the Kathmandu Valley: Geotechnical and geological variability
Authors: Gilder Charlotte EL , Pokhrel Rama Mohan , Vardanega Paul J , De Luca Flavia , De Risi Raffaele , Werner Maximilian J , Asimaki Domniki , Maskey Prem Nath , Sextos Anastasios
Published: February 2020

The Kathmandu Valley is within a seismically active region with only few recorded strong-motion data. Geophysical information in the Valley is also sparse. In addition, the absence of an open database which compiles in situ geophysical tests, borehole records, and geotechnical laboratory data is affecting the advancement of knowledge in the region. This article presents SAFER/GEO-591 database, named after the Engineering and Physical Science Research Council (EPSRC)-funded project Seismic Safety and Resilience of Schools in Nepal (SAFER). SAFER/GEO-591 contains data from groundwater wells and boreholes originally commissioned for research and commercial purposes. This work describes (1) the quality assessment and harmonization process conducted on the dataset, (2) the variation of shear-wave velocity ( VS) measurements and geotechnical parameters with depth and elevation in the Valley, (3) the current understanding of the Valley sediment/bedrock topography, and finally (4) new geological cross sections. A companion article presents an updated VS30 map across the Valley based on the contributions of this article. The database can be downloaded from the University of Bristol repository via DOI: https://doi.org/10.5523/bris.3gjcvx51lnpuv269xsa1yrb0rw
Rituximab leads to early elimination of circulating CD20+ T and B lymphocytes in patients with iTTP despite ongoing TPEx
Authors: Carden Marcus A. , Gaddh Manila , Hoskote Abhinav , Brown Michael , Merrill Virginia , Stowell Sean R. , Chandrakasan Shanmuganathan , Antun Ana , Kudchadkar Ragini , Kotanchiyev Sarah , Jaye David L. , Bodó Imre
Published: February 2020

Key Points

How TPEx impacts rituximab effectiveness in iTTP patients is not fully understood. In iTTP patients on therapeutic plasma exchange, rituximab eliminates circulating CD20+ B and T cells in 24 hours for at least 1 week.
Probable usual interstitial pneumonia pattern on chest CT: is it sufficient for a diagnosis of idiopathic pulmonary fibrosis?
Authors: Fukihara Jun , Kondoh Yasuhiro , Brown Kevin K. , Kimura Tomoki , Kataoka Kensuke , Matsuda Toshiaki , Yamano Yasuhiko , Suzuki Atsushi , Furukawa Taiki , Sumikawa Hiromitsu , Takahashi Osamu , Johkoh Takeshi , Tanaka Tomonori , Fukuoka Junya , Hashimoto Naozumi , Hasegawa Yoshinori
Published: February 2020

Recent studies have suggested that in patients with an idiopathic interstitial pneumonia (IIP), a probable usual interstitial pneumonia (UIP) pattern on chest computed tomography (CT) is sufficient to diagnose idiopathic pulmonary fibrosis (IPF) without histopathology.

We retrospectively compared the prognosis and time to first acute exacerbation (AE) in IIP patients with a UIP and a probable UIP pattern on initial chest CT.

One hundred and sixty IIP patients with a UIP pattern and 242 with a probable UIP pattern were identified. Probable UIP pattern was independently associated with longer survival time (adjusted hazard ratio 0.713, 95% CI 0.536–0.950; p=0.021) and time to first AE (adjusted hazard ratio 0.580, 95% CI 0.389–0.866; p=0.008). In subjects with a probable UIP pattern who underwent surgical lung biopsy, the probability of a histopathological UIP pattern was 83%. After multidisciplinary discussion and the inclusion of longitudinal behaviour, a diagnosis of IPF was made in 66% of cases. In IPF patients, survival time and time to first AE were not associated with CT pattern. Among subjects with a probable UIP pattern, compared to non-IPF patients, survival time and time to first AE were shorter in IPF patients.

In conclusion, IIP patients with a probable UIP pattern on initial chest CT had a better prognosis and longer time to first AE than those with a UIP pattern. However, when baseline data and longitudinal behaviour provided a final diagnosis of IPF, CT pattern was not associated with these outcomes. This suggests diagnostic heterogeneity among patients with a probable UIP pattern.
Antifouling and antibacterial activities of bioactive extracts from different organs of the sea cucumber Holothuria leucospilota
Authors: Darya Mehrnoosh , Sajjadi Mir Masoud , Yousefzadi Morteza , Sourinejad Iman , Zarei Maaroof
Published: February 2020

In this study, antifouling and antibacterial properties of polar, semi polar and non-polar bioactive compounds derived from the sea cucumber Holothuria leucospilota were investigated. A series comprising n-hexane, ethyl acetate and methanol extracts from four different organs of sea cucumber (body wall, gonad, digestive tract and respiratory tree) were investigated for their antibacterial and antifouling activity against two species of microalgae, larvae of barnacle Amphibalanus amphitrite and a non-target organism: larvae of Artemia salina. Results showed that the highest antibacterial activity was found in the ethyl acetate extract of body wall against Staphylococcus aureus with minimum inhibitory concentration (MIC) of 0.250 mg/mL. The MIC of ethyl acetate extract of body wall ranged between 0.062 and 0.250 mg/mL against two microalgal strains. All extracts showed moderate to low toxicity against larvae of barnacles. The most pronounced anti-barnacle activity was found in the ethyl acetate extract of body wall with median lethal concentration (LC50) value of 0.049 mg/mL. Among the twelve extracts, the ethyl acetate extracts of body wall showed the maximum antibacterial and antifouling activities. The bioactive compounds of the ethyl acetate extract of the sea cucumber body wall were determined using gas chromatography coupled with mass spectrometry. Fatty acids and terpenes were the major compounds, which may be responsible for antibacterial and antifouling activity of the ethyl acetate extract of body wall of the sea cucumber H. leucospilota.
Applying the information–motivation–behavioral model to explore the influencing factors of self-management behavior among osteoporosis patients
Authors: Tsamlag Lhakpa , Wang Huwen , Shen Qiuming , Shi Yue , Zhang Shuxian , Chang Ruijie , Liu Xiyu , Shen Tian , Cai Yong
Published: February 2020

Background

The prevalence of osteoporosis (OP) is rapidly increasing. Healthy behaviors are crucial for the management of OP. Application of the information–motivation–behavioral skills (IMB) model has been verified in various chronic diseases, but this model has not been investigated for behavioral interventions among people with OP. This study aimed to examine factors influencing OP self-management behavior and their interaction paths based on the IMB model.

Methods

We conducted a cross-sectional study using a convenience sampling method in 20 community health service centers in Shanghai, China. Predictive relationships between IMB model variables and self-management behaviors were evaluated using an anonymous questionnaire. Structural equation modeling was used to test the IMB model.

Results

In total, 571 participants completed the questionnaire, of which 461 (80.7%) were female. Participants’ mean age was 68.8 ± 10.1 years. Only 101 (17.7%) participants were classified as having better OP self-management behaviors. The model demonstrated the data had an acceptable fit. Paths from information to self-efficacy (β = 0.156, P < 0.001) and self-management behaviors (β = 0.236, P < 0.001), from health beliefs to self-efficacy (β = 0.266, P < 0.001), from medical system support to self-efficacy (β = 0.326, P < 0.001) and self-management behaviors (β = 0.230, P < 0.001), and from self-efficacy to self-management behaviors (β = 0.376, P < 0.001) were all significant and in the predicted direction.

Conclusion

This study validated the utility of the IMB model for OP self-management behaviors in this population. Middle-aged and older adult patients with OP have poor self-management behaviors. Enhanced knowledge about OP and is important for improving self-management behaviors.
Psychometric properties of a nationwide survey for adults with and without diabetes: the “disease knowledge and information needs – diabetes mellitus (2017)” survey
Authors: Stühmann Lena M. , Paprott Rebecca , Heidemann Christin , Ziese Thomas , Hansen Sylvia , Zahn Daniela , Scheidt-Nave Christa , Gellert Paul
Published: February 2020

Background

In order to close existing information gaps on diabetes-related health perceptions, diabetes knowledge, and information-seeking behaviors among adults in Germany, a representative population-based survey targeting the German-speaking population 18 years and older with and without diabetes was conducted. The aim of the present work was to analyze the psychometric properties of the multi-item scales, applied in the survey in order to provide guidance for decisions on the use of these measurements for future research.

Methods

Based on data from participants who completed the final survey (N = 1479 with known diabetes; N = 2327 without known diabetes) reliability and unidimensionality of multi-item scales were tested using Cronbach’s Alpha and confirmatory factor analysis (CFA).

Results

Psychometric properties and model fit varied across scales. Cronbach’s alpha values ranged from very good to unacceptable. Model fit indices suggested evidence of a single underlying factor in some but not all scales. Adequate reliability and at least mediocre model fit were found for diabetes distress and patient-provider-relationship in people with diabetes and for perceived level of information in individuals without diabetes. Scales revealing inacceptable reliability values or not suggesting unidimensionality were e.g. diabetes-related stigmatization in both individuals with and without diabetes, self-efficacy in individuals with diabetes, and perceived personal control in those without diabetes.

Conclusion

Based on results of the current study, some of the scales applied in the survey can be recommended for present and future analyses of the survey data and for future surveys (e.g. diabetes distress, patient-provider-relationship in people with diabetes). Other scales should be interpreted and used with caution (e.g. depressive symptoms in people with diabetes) while others should be reformulated, interpreted only as single items, or need further investigation (e.g. diabetes-related stigmatization in people with and without diabetes). Findings provide researchers the opportunity to evaluate diabetes-specific scales in population-based studies of adults with and without diabetes.
A systematic review of hand-hygiene and environmental-disinfection interventions in settings with children
Authors: Staniford Leanne J. , Schmidtke Kelly A.
Published: February 2020

Background

Helping adults and children develop better hygiene habits is an important public health focus. As infection causing bacteria can live on one’s body and in the surrounding environment, more effective interventions should simultaneously encourage personal-hygiene (e.g. hand-hygiene) and environmental-disinfecting (e.g. cleaning surfaces). To inform the development of a future multi-faceted intervention to improve public health, a systematic literature review was conducted on behavior change interventions designed to increase hand-hygiene and environmental-disinfecting in settings likely to include children.

Methods

The search was conducted over two comprehensive data-bases, Ebsco Medline and Web of Science, to locate intervention studies that aimed to increase hand-hygiene or environmental-disinfecting behavior in settings likely to include children. Located article titles and abstracts were independently assessed, and the full-texts of agreed articles were collaboratively assessed for inclusion. Of the 2893 titles assessed, 29 met the eligibility criteria. The extracted data describe the Behavior Change Techniques (version 1) that the interventions employed and the interventions’ effectiveness. The techniques were then linked to their associated theoretical domains and to their capability-opportunity-motivation (i.e., COM-B model) components, as described in the Behavior Change Wheel. Due to the heterogeneity of the studies’ methods and measures, a meta-analysis was not conducted.

Results

A total of 29 studies met the inclusion criteria. The majority of interventions were designed to increase hand-hygiene alone (N = 27), and the remaining two interventions were designed to increase both hand-hygiene and environmental-disinfecting. The most used techniques involved shaping knowledge (N = 22) and antecedents (N = 21). Interventions that included techniques targeting four or more theoretical domains and all the capability-opportunity-motivation components were descriptively more effective.

Conclusions

In alignment with previous findings, the current review encourages future interventions to target multiple theoretical domains, across all capability-opportunity-motivation components. The discussion urges interventionists to consider the appropriateness of interventions in their development, feasibility/pilot, evaluation, and implementation stages.

Registration

Prospero ID - CRD42019133735.
Pulmonary alveolar proteinosis in Korea: analysis of prevalence and incidence via a nationwide population-based study
Authors: Yoon Hee-young , Kim Ji Hyeon , Kim Ye-Jee , Song Jin Woo
Published: February 2020

Background

Pulmonary alveolar proteinosis (PAP) is a very rare lung disease and its prevalence and incidence remain unclear. The prevalence and incidence of PAP were investigated by using nationwide claims data from the Korean Health Insurance Review and Assessment service.

Methods

Data were extracted for adults who visited any secondary or tertiary medical institute between 2010 and 2016 with the PAP-related Korean Classification of Disease, 7th edition code J84.0 and the Rare Intractable Disease exempted calculation code V222. To robust case definition, a narrow case definition was made when all following factors were met: 1) more than two PAP-coded visits within 1 year of the first claim, and 2) more than one claim for both chest computed tomography and diagnostic procedures (bronchoscopy or surgical lung biopsy) within 90 days before or after the first claim.

Results

A total of 182 patients (narrow, n = 82) with PAP-related codes were identified from 2010 to 2016 and 89 new patients (narrow, n = 66) visited medical institutes between 2012 and 2015. The prevalence of PAP was 4.44 (narrow: 2.27) per 106 population, with a peak age of 60–69 years. The incidence of PAP was 0.56 (narrow: 0.41) per 106 population at risk, with a peak age of 50–59 years. Among incident cases, the male-to-female ratio was 1.52 and about two-thirds had comorbidities, dyslipidaemia being the most common.

Conclusions

The prevalence and incidence of PAP in Korea are low, similar to those in other countries; however, Korean patients with PAP are characterized by older diagnostic age and a lower male-to-female ratio.
Development, implementation and evaluation of a management specialization course in oncology using blended learning
Authors: Fernandes Raphaella Amanda Maria Leite , de Oliveira Lima Jurema Telles , da Silva Bruno Hipólito , Sales Mozart Júlio Tabosa , de Orange Flávia Augusta
Published: February 2020

Background

Identifying effective methods for safeguarding the efficient functioning of the healthcare system contributes significantly towards establishing a successful healthcare organization. Consequently, quality management programs are currently being implemented in healthcare as a vital strategy for patient care. Quality management encompasses protocols and guidelines in decision-making and in the evaluation of processes and treatment flowcharts, data analysis and health indicators, and addresses improvement in the interaction between different health professionals. Qualifying health professionals to perform quality management has represented a barrier to implementing a well-structured management system. Indeed, the pathway to qualifying health managers is often poorly outlined, with clear gaps in the definition of their competencies, training and career plans. Therefore, studies and education-related actions aimed at qualifying health professionals in management are vital if health services of excellence are to be established. The present study aimed to plan, develop, implement and evaluate a management specialization course in oncology using blended learning.

Methods

Following approval by the institution’s internal review board, the study was conducted at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP). The Analysis, Design, Development, Implementation and Evaluation (ADDIE) model was used to plan, develop, implement and evaluate the course. Data were collected as the course participants who had concluded all the modules evaluated the program.

Results

A management course in oncology, consisting of ten sequential modules, was developed and implemented between March 2018 and February 2019. The course consisted of monthly face-to-face encounters, each with 12 h of activities, and distance education using a virtual learning environment. Each module was presented by a specialist on the subject in question. After the end-of-course conclusion work had already been handed in and evaluated by the tutors, the participants completed a form to assess the course using Kirkpatrick’s training evaluation model.

Conclusions

A management course in oncology was developed using the ADDIE model. A high degree of satisfaction was found among the participants regarding improvements in their management skills and their professional behavior. The expectation is that this initiative will ultimately improve healthcare and reduce costs, as well as encourage further innovative educational actions for health professionals.
Reducing hospital admissions in older care home residents: a 4-year evaluation of the care home innovation Programme (CHIP)
Authors: Giebel Clarissa , Harvey Debbie , Akpan Asangaedem , Chamberlain Peter
Published: February 2020

Background

Older care home residents frequently attend emergency departments with a high conversion to admissions. For this purpose, a novel Care Home Innovation Programme (CHIP) was introduced with the aim of reducing potentially avoidable hospital admissions by 30%. The aim of this study is to evaluate the implementation of this innovative service in practice.

Methods

A total of 32 care homes with 1314 beds in South Sefton, Merseyside were invited to sign up to CHIP which was launched in April 2015 and continued in its entirety until June 2018. As part of the CHIP, care home matrons were introduced, new protocols were developed to address common presentations, a 24-h 7–day a week televideo system installed across all homes, and a quarterly training collaborative brought care homes together to learn and share good practices together. Data on emergency calls and calls resulting in conveyances were recorded over a four-year period, and analysed using frequency analysis.

Results

In comparison to the 12 months prior to launch, over a four-year period, implementation of the CHIP resulted in a 15% reduction of emergency calls, and in a 19% reduction of conveyances to hospital.

Conclusions

The South Sefton CHIP demonstrated itself an effective programme in reducing conveyances and consequently, hospital admissions of care home residents. This model will be superseded by the enhanced health in care homes being promoted by the NHS Long Term Care Plan.
Physician workforce in the United States of America: forecasting nationwide shortages
Authors: Zhang Xiaoming , Lin Daniel , Pforsich Hugh , Lin Vernon W.
Published: February 2020

Background

Physicians play a critical role in healthcare delivery. With an aging US population, population growth, and a greater insured population following the Affordable Care Act (ACA), healthcare demand is growing at an unprecedented pace. This study is to examine current and future physician job surplus/shortage trends across the United States of America from 2017 to 2030.

Methods

Using projected changes in population size and age, the authors developed demand and supply models to forecast the physician shortage (difference between demand and supply) in each of the 50 states. Letter grades were then assigned based on projected physician shortage ratios (physician shortage per 100 000 people) to evaluate physician shortages and describe the changing physician workforce in each state.

Results

On the basis of current trends, the number of states receiving a grade of “D” or “F” for their physician shortage ratio will increase from 4 in 2017 to 23 by 2030, with a total national deficit of 139 160 physician jobs. By 2030, the West is forecasted to have the greatest physician shortage ratio (69 physician jobs per 100 000 people), while the Northeast will have a surplus of 50 jobs per 100 000 people.

Conclusion

There will be physician workforce shortages throughout the country in 2030. Outcomes of this study provide a foundation to discuss effective and efficient ways to curb the worsening shortage over the coming decades and meet current and future population demands. Increased efforts to understand shortage dynamics are warranted.
Angiotensin I and angiotensin II concentrations and their ratio in catecholamine-resistant vasodilatory shock
Authors: Bellomo Rinaldo , Wunderink Richard G. , Szerlip Harold , English Shane W. , Busse Laurence W. , Deane Adam M. , Khanna Ashish K. , McCurdy Michael T. , Ostermann Marlies , Young Paul J. , Handisides Damian R. , Chawla Lakhmir S. , Tidmarsh George F. , Albertson Timothy E.
Published: February 2020

Background

In patients with vasodilatory shock, plasma concentrations of angiotensin I (ANG I) and II (ANG II) and their ratio may reflect differences in the response to severe vasodilation, provide novel insights into its biology, and predict clinical outcomes. The objective of these protocol prespecified and subsequent post hoc analyses was to assess the epidemiology and outcome associations of plasma ANG I and ANG II levels and their ratio in patients with catecholamine-resistant vasodilatory shock (CRVS) enrolled in the Angiotensin II for the Treatment of High-Output Shock (ATHOS-3) study.

Methods

We measured ANG I and ANG II levels at baseline, calculated their ratio, and compared these results to values from healthy volunteers (controls). We dichotomized patients according to the median ANG I/II ratio (1.63) and compared demographics, clinical characteristics, and clinical outcomes. We constructed a Cox proportional hazards model to test the independent association of ANG I, ANG II, and their ratio with clinical outcomes.

Results

Median baseline ANG I level (253 pg/mL [interquartile range (IQR) 72.30–676.00 pg/mL] vs 42 pg/mL [IQR 30.46–87.34 pg/mL] in controls; P <  0.0001) and median ANG I/II ratio (1.63 [IQR 0.98–5.25] vs 0.4 [IQR 0.28–0.64] in controls; P <  0.0001) were elevated, whereas median ANG II levels were similar (84 pg/mL [IQR 23.85–299.50 pg/mL] vs 97 pg/mL [IQR 35.27–181.01 pg/mL] in controls; P = 0.9895). At baseline, patients with a ratio above the median (≥1.63) had higher ANG I levels (P <  0.0001), lower ANG II levels (P <  0.0001), higher albumin concentrations (P = 0.007), and greater incidence of recent (within 1 week) exposure to angiotensin-converting enzyme inhibitors (P <  0.00001), and they received a higher norepinephrine-equivalent dose (P = 0.003). In the placebo group, a baseline ANG I/II ratio <1.63 was associated with improved survival (hazard ratio 0.56; 95% confidence interval 0.36–0.88; P = 0.01) on unadjusted analyses.

Conclusions

Patients with CRVS have elevated ANG I levels and ANG I/II ratios compared with healthy controls. In such patients, a high ANG I/II ratio is associated with greater norepinephrine requirements and is an independent predictor of mortality, thus providing a biological rationale for interventions aimed at its correction.

Trial registration

ClinicalTrials.gov identifier NCT02338843. Registered 14 January 2015.
Gyriform restricted diffusion in adults: looking beyond thrombo-occlusions
Authors: Pai Vivek , Sitoh Yih Yian , Purohit Bela
Published: February 2020

Gyriform restricted diffusion (GRD) refers to hyperintense signal involving the cerebral cortex on diffusion-weighted images (DWI) with corresponding hypointensity on apparent diffusion coefficient (ADC) images. These changes are commonly seen following a vascular occlusion, reflecting the limitation of water molecule movement across cell membranes (restricted diffusion) due to the failure of Na+/K+-ATPase pumps (cytotoxic oedema). However, GRD can occur in several other neurological conditions as well. A thorough understanding of these conditions and their anatomic predilection plays a critical role in identifying and differentiating them from vascular thrombo-occlusion, with impact towards appropriate clinical management. This review highlights the less commonly encountered, non-stroke causes of GRD in adults with case-based examples. A tabulated chart of the patterns of cortical and subcortical involvement associated with these aetiologies is provided for a quick, pattern-based reference for daily radiological reporting.
Quantitative 18F-FDG PET-CT scan characteristics correlate with tuberculosis treatment response
Authors: Malherbe Stephanus T. , Chen Ray Y. , Dupont Patrick , Kant Ilse , Kriel Magdalena , Loxton André G. , Smith Bronwyn , Beltran Caroline G. G. , van Zyl Susan , McAnda Shirely , Abrahams Charmaine , Maasdorp Elizna , Doruyter Alex , Via Laura E. , Barry Clifton E. , Alland David , Richards Stephanie Griffith- , Ellman Annare , Peppard Thomas , Belisle John , Tromp Gerard , Ronacher Katharina , Warwick James M. , Winter Jill , Walzl Gerhard
Published: February 2020

Background

There is a growing interest in the use of F-18 FDG PET-CT to monitor tuberculosis (TB) treatment response. Tuberculosis lung lesions are often complex and diffuse, with dynamic changes during treatment and persisting metabolic activity after apparent clinical cure. This poses a challenge in quantifying scan-based markers of burden of disease and disease activity. We used semi-automated, whole lung quantification of lung lesions to analyse serial FDG PET-CT scans from the Catalysis TB Treatment Response Cohort to identify characteristics that best correlated with clinical and microbiological outcomes.

Results

Quantified scan metrics were already associated with clinical outcomes at diagnosis and 1 month after treatment, with further improved accuracy to differentiate clinical outcomes after standard treatment duration (month 6). A high cavity volume showed the strongest association with a risk of treatment failure (AUC 0.81 to predict failure at diagnosis), while a suboptimal reduction of the total glycolytic activity in lung lesions during treatment had the strongest association with recurrent disease (AUC 0.8 to predict pooled unfavourable outcomes). During the first year after TB treatment lesion burden reduced; but for many patients, there were continued dynamic changes of individual lesions.

Conclusions

Quantification of FDG PET-CT images better characterised TB treatment outcomes than qualitative scan patterns and robustly measured the burden of disease. In future, validated metrics may be used to stratify patients and help evaluate the effectiveness of TB treatment modalities.
Neuropsychiatric symptoms in Parkinson's disease: aetiology, diagnosis and treatment
Authors: Jones Shoned , Torsney Kelli M. , Scourfield Lily , Berryman Katie , Henderson Emily J.
Published: February 2020

Historically, Parkinson's disease was viewed as a motor disorder and it is only in recent years that the spectrum of non-motor disorders associated with the condition has been fully recognised. There is a broad scope of neuropsychiatric manifestations, including depression, anxiety, apathy, psychosis and cognitive impairment. Patients are more predisposed to delirium, and Parkinson's disease treatments give rise to specific syndromes, including impulse control disorders, dopamine agonist withdrawal syndrome and dopamine dysregulation syndrome. This article gives a broad overview of the spectrum of these conditions, describes the association with severity of Parkinson's disease and the degree to which dopaminergic degeneration and/or treatment influence symptoms. We highlight useful assessment scales that inform diagnosis and current treatment strategies to ameliorate these troublesome symptoms, which frequently negatively affect quality of life.
Mental health in UK Biobank – development, implementation and results from an online questionnaire completed by 157 366 participants: a reanalysis
Authors: Davis Katrina A. S. , Coleman Jonathan R. I. , Adams Mark , Allen Naomi , Breen Gerome , Cullen Breda , Dickens Chris , Fox Elaine , Graham Nick , Holliday Jo , Howard Louise M. , John Ann , Lee William , McCabe Rose , McIntosh Andrew , Pearsall Robert , Smith Daniel J. , Sudlow Cathie , Ward Joey , Zammit Stan , Hotopf Matthew
Published: February 2020

Background

UK Biobank is a well-characterised cohort of over 500 000 participants including genetics, environmental data and imaging. An online mental health questionnaire was designed for UK Biobank participants to expand its potential.

Aims

Describe the development, implementation and results of this questionnaire.

Method

An expert working group designed the questionnaire, using established measures where possible, and consulting a patient group. Operational criteria were agreed for defining likely disorder and risk states, including lifetime depression, mania/hypomania, generalised anxiety disorder, unusual experiences and self-harm, and current post-traumatic stress and hazardous/harmful alcohol use.

Results

A total of 157 366 completed online questionnaires were available by August 2017. Participants were aged 45–82 (53% were ≥65 years) and 57% women. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status. Lifetime depression was a common finding, with 24% (37 434) of participants meeting criteria and current hazardous/harmful alcohol use criteria were met by 21% (32 602), whereas other criteria were met by less than 8% of the participants. There was extensive comorbidity among the syndromes. Mental disorders were associated with a high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation.

Conclusions

The UK Biobank questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed because of selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.