bluuebunny/crossref_metadata_2025 huggingface dataset:
Early Movers Advantage? Evidence from Short Selling during After‐Hours on Earnings Announcement Days
Authors: Jain Archana , Jain Chinmay , Jiang Christine X.
Published: April 2019

We examine short sellers’ after‐hours trading (AHT) following quarterly earnings announcements released outside of the normal trading hours. Our innovation is to use the actual short trades immediately after the announcements. We find that on these earnings announcement days, there is significant shorting activity in AHT relative to shorting activity both during AHT on nonannouncements days and during regular trading sessions around announcements. Short sellers who trade after‐hours on announcement days earn an excess return of 0.82% and 1.40% during before‐market‐open (BMO) and after‐market‐close (AMC)sessions, respectively. The magnitude of these returns increases to 1.48 (3.92%) for BMO (AMC) earnings announcements with negative surprise. We find that the reactive short selling during AHT has information in predicting future returns. Short sellers’ trades have no predictive power if they wait for the market to open to trade during regular hours. In addition, we find that the weighted price contribution during AHT increases with an increase in after‐hours short selling. Overall, our results suggest that short sellers in AHT are informed. Our findings remain robust using alternative holding periods and after controlling for macroeconomic news announcements during BMO sessions.
The Endogeneity of Trading Volume in Stock and Bond Returns: An Instrumental Variable Approach
Authors: Yamani Ehab , Rakowski David
Published: April 2019

This paper investigates the joint determination of trading volume and returns. Our approach follows from the argument that trading activity depends on security returns, thus resulting in a reverse causality from returns to trading activity. Using exogenous instruments for security trading activity, we estimate a system of two‐stage simultaneous equations to better model the return‐volume relationship. Our results confirm that returns and trading volume are determined simultaneously in both stock and corporate bond markets and that conclusions about the direction and significance of causality between volume and returns can be reversed once one corrects for the endogeneity of volume.
Historical geography, climbing and mountaineering: route setting for an inclusive future
Authors: Hunt Rachel
Published: April 2019

This article seeks to review work broadly defined as the historical geographies of mountaineering and climbing. As such, it outlines the links between mountaineering, colonialism, and vertical ascent as well as the historical geographies of rock climbing which speak to the culture, practices, and technologies of climbing. In outlining past work, particular attention is paid to the hidden and gendered histories of climbing and mountaineering. This moves discussion beyond common place tales of white privilege and Western philosophies of conquer through ascendancy to tackle the broader ways by which mountaineering and climbing have been explored by academic geography. A holistic appreciation of work on this topic, it is argued, can not only help the geographical discipline to deal with its colonial past but also show how the historical geographies of mountaineering and climbing fit within efforts to decolonise the discipline, include wider voices, and utilise archives unknown.
Ensiling in 2050: Some challenges and opportunities
Authors: Wilkinson John Michael , Muck Richard E.
Published: April 2019

Challenges to ensiling are coming from a wide spectrum. Faster harvest rates are making it more difficult to achieve target silage densities. Larger harvest equipment is increasing soil compaction and rural road issues. Older silos are too small and are overfilled, creating safety issues, or temporary piles are placed on bare ground permitting soil contamination. Mycotoxins and other pathogens in silages are still a problem. Global warming may affect the forage crops grown and crop characteristics as well as rates of silage fermentation and aerobic deterioration. Silage as an input to bio‐refineries has an unclear future. Silage analysis is challenged by sampling and knowing what components truly predict nutritional value. The future holds many opportunities for both ensiling and silage research. Robotic harvesting will release more labour for silo packing, and there are opportunities to develop tools to estimate silage density during filling. Total mixed ration silages should allow more by‐products in rations. The development of novel silage additives to improve silage hygiene or increase nutrient availability appears promising. Predicting the onset of aerobic deterioration with quick tests for lactate‐assimilating yeasts or silage temperatures seems possible. Metabolomics and metabonomics, in addition to the microbiome tools in development, put us at the cusp of being able to see which microorganisms are active in the silo and rumen and what compounds of significance they are producing. This could lead to many advances in silage quality including reduced microbial toxins, better hygiene and improved utilization by livestock.
A Large Undisturbed Column Method to Study Flow and Transport in Macropores and Fractured Media
Authors: Jørgensen Peter R. , Mosthaf Klaus , Rolle Massimo
Published: April 2019

Intact soil columns can bridge the gap between field studies and idealized laboratory investigations of flow and transport in macropores and fractured media. However, the value of intact column studies is often hampered by shortcomings such as lack of column intactness, small column size, and column rim flow, which can cause serious artifacts and hamper system understanding. The flexible‐wall pressurized large undisturbed column (LUC) method overcomes these limitations and is a valuable approach to analyze fluid flow and solute transport in macroporous and fractured geological formations. The method investigates subsurface processes in complex media, mimicking in situ conditions and facilitating the control of system boundary conditions including effective stress. In recent years, considerable experience has been gained through different applications of the LUC approach. Modeling tools have also been developed for a detailed interpretation of flow and transport processes in LUC systems. This paper describes the steps of the LUC method from column excavation in the field to experimental setup in the laboratory. The description encompasses the key features of the sampling of LUCs in field excavations, the laboratory setup, the procedure for hydraulic and transport experiments, as well as practical challenges and potential issues during operation of an LUC system. Application examples with a fully three‐dimensional numerical model of LUC tracer experiments are also presented to illustrate the quantitative interpretation of transport processes in macroporous clayey tills.
Beauvoir on Women's Complicity in Their Own Unfreedom
Authors: Knowles Charlotte
Published: April 2019

InThe Second Sex, Simone de Beauvoir argues that women are often complicit in reinforcing their own unfreedom. But why women become complicit remains an open question. The aim of this article is to offer a systematic analysis of complicity by focusing on the Heideggerian strands of Beauvoir's account. I begin by evaluating Susan James's interpretation of complicity qua republican freedom, which emphasizes the dependent situation of women as the primary cause of their complicity. I argue that James's analysis is compelling as far as it goes, but that it implies complicity is the inevitable outcome of women's current existence and fails to adequately account for Beauvoir's claim that women actively embrace their own unfreedom. I then draw out the Heideggerian strands of Beauvoir's analysis, demonstrating how this enables us to systematize Beauvoir's account of women's oppressive situation with her claims regarding the active role women can play in reinforcing their own unfreedom. I argue that this approach preserves the strengths of the republican interpretation, but provides a better account of cases where complicity may not be inevitable and yet some women still act to reinforce rather than resist their own unfreedom.
Patent Litigation Strategy and Its Effects on the Firm
Authors: Yang Deli
Published: April 2019

Patent litigation has attracted scholarly attention to reconcile multiple views for new research. Accordingly, this paper addresses patent litigation strategy and its effect on the firm. Based on 106 papers and articles, six books, the author's logic and practice impressions, it first defines patent litigation strategy and differentiates similar concepts. Second, based on the process, the author fine‐tunes patent litigation strategy into three tactics: threat, filing and verdict. Then, she categorizes and examines the impact of patent litigation on market value, monetary gain/loss and strategic collaboration. The findings show that the effect on the market value is more complex and ambiguous than anticipated, and sometimes contradictory. The analysis shows the consistency of monetary effect in practice, that firms tend to have higher monetary gains from private settlement than from legal awards. It also demonstrates that existing studies lag behind reality in investigating the detailed role of patent litigation on strategic collaboration from partnership (e.g. licensing and strategic alliance) to takeover (i.e. merger and acquisition). Finally, the author reflects on the findings, and maps out critical paths toward new research. This process also reveals that stakeholders, industrial settings and country environments moderate the studied relationship. This paper contributes to knowledge and practice: appreciates the interdisciplinary endeavors to draw the findings; categorizes patent litigation and its effect; and critiques prior studies on the relationship to integrate knowledge for future research.
Service user's actual involvement in mental health research practices: A scoping review
Authors: Sangill Carina , Buus Niels , Hybholt Lisbeth , Berring Lene Lauge
Published: April 2019

Service user involvement in mental health research is on the international political agenda, for example mirrored by an emphasis on user involvement in funding of research. The idea is that service users contribute with their lived experiences of mental distress to the research process and thereby heighten the quality and relevance of the research. The purpose of this scoping review was to identify and evaluate empirical research of how mental health service users actually partake in collaborative research processes and to summarize this research in dialogue with mental health user‐researchers. The review included 32 studies. Main findings indicated that actual involvement of service user‐researchers in research processes encompassed a complex set of precarious negotiation practices, where academics and service user‐researchers were positioned and positioned themselves in alternative ways. The review accounts for how mental health service users were involved in collaborative research processes. The extracted themes concerned: (i) Expectations of research processes, (ii) Contribution to research processes, and (iii) Training and learning from research processes. The study reveals that collaborative research in mental health requires changes to traditional research practices to create and support genuine collaborative partnerships and thereby avoid tokenism and power inequalities.
Improving nursing knowledge and care for neonates with respiratory distress in Jordan
Authors: Ali R.A. , Obeisat S.M. , Tarawneh L.H.
Published: April 2019

Aim

This study evaluates the effectiveness of an educational intervention in the area of nursing knowledge and practice relating to neonatal respiratory distress syndrome.

Background

In Jordan, respiratory distress is the leading cause of death among neonates. Recent studies have revealed a knowledge deficit relating to respiratory distress among nurses in neonatal intensive care units, hence the need for advanced training and specialization in this area.

Methods

A quasi‐experimental, repeated‐measures, one‐group pre‐test–post‐test design was used to assess the effectiveness of the educational intervention. A convenience sample of 48 nurses was recruited from three hospitals in northern Jordan. A self‐reporting questionnaire was used to assess the respondents’ knowledge of respiratory distress and an observational checklist to assess their practice. The study intervention consisted of 12 two‐hour lecture‐based interactive teaching sessions lasting 4 weeks. A follow‐up assessment was conducted 1 month after the post‐test.

Results

The baseline assessment revealed that more than half of the nurses scored low on knowledge and the majority scored low on practice. One‐way repeated ANOVA showed that post‐test and follow‐up test scores on nursing knowledge and practice were significantly higher than the baseline scores.

Conclusion

The study findings show the efficacy of educational interventions in enhancing nursing knowledge and practice relating to the care of neonates with respiratory distress.

Implications for nursing and health policy

For neonatal nurses, periodic teaching and training interventions are essential to ensuring the quality nursing care required to reduce morbidity and mortality rates among neonates. Health policymakers should support nurses in pursuing educational opportunities aimed at enhancing their knowledge of advanced neonate care.
A longitudinal study on implicit rationing of nursing care among Lebanese patients – Study protocol
Authors: Dhaini Suzanne R. , Ausserhofer Dietmar , El Bajjani Martine , Dumit Nuhad , Abu‐Saad Huijer Huda , Simon Michael
Published: April 2019

Aim

To gain an in‐depth understanding of the variations and trends of implicit rationing of nursing care, of its associated factors and of its relation to with nurse and patient outcomes.

Background

Maintaining and improving the quality of nursing care and patient safety have been the focus of health services researchers over the last decade. Cross‐sectional studies have showed the magnitude of implicit rationing of nursing care and its associations with negative patient and nurse outcomes.

Design

Observational longitudinal study.

Method

Two‐year funded study (between 2018–2020), including a sample of 317 Registered Nurses working on 19 units in two large Lebanese urban hospitals. The study included a cross‐sectional baseline survey followed by multiple follow‐up assessments over 90 days. The repeated measurements on each of the units include repeated surveys on nurses' rationing of care, hospital administration reported nurse‐sensitive indicators, nurse staffing levels, and patient mortality data.

Discussion

The study results will describe variations and trends of implicit rationing of nursing care in hospital units over time and whether and which elements of the nurses' work environment are associated with these variations. Data will inform on the impact of implicit rationing of care on patient and nurse outcomes. These data are needed to advance future planning and interventional research to efficiently reduce rationing of nursing care and improve the quality of care.

Impact

Generating new knowledge (variations and trends) on the association between rationing of care and other element of nurses' work environment and nurse and patient outcomes.
Exploring the optimal allostatic load scoring method in women of reproductive age
Authors: Li Yang , Rosemberg Marie‐Anne S. , Dalton Vanessa K. , Lee Shawna J. , Seng Julia S.
Published: April 2019

Aims

The aim of this study was to determine the optimal allostatic load scoring method.

Design

This is a secondary analysis of data on women of reproductive age from the 2001–2006 National Health and Nutrition Examination Survey.

Methods

We created allostatic load summary scores using five scoring methods including the count‐based, Z‐Score, logistic regression, factor analysis and grade of membership methods. Then, we examined the predictive performance of each allostatic load summary measure in relation to three outcomes: general health status, diabetes and hypertension.

Results

We found that the allostatic load summary measure by the logistic regression method had the highest predictive validity with respect to the three outcomes. The logistic regression method performed significantly better than the count‐based and grade of membership methods for predicting diabetes as well as performed significantly better for predicting hypertension than all of the other methods. But the five scoring methods performed similarly for predicting poor health status.

Conclusion

We recommended the logistic regression method when the outcome information is available, otherwise the frequently used simpler count‐based method may be a good alternative.

Impact

The study compared different scoring methods and made recommendations for the optimal scoring approach. We found that allostatic load summary measure by the logistic regression method had the strongest predictive validity with respect to general health status, diabetes and hypertension. The study may provide empirical evidence for future research to use the recommended scoring approach to score allostatic load. The allostatic load index may serve as an ‘early warning’ indicator for health risk.
Life‐history innovation to climate change: can single‐brooded migrant birds become multiple breeders?
Authors: Both Christiaan , Ubels Richard , Ravussin Pierre‐Alain
Published: April 2019

When climatic conditions change and become outside the range experienced in the past, species may show life‐history innovations allowing them to adapt in new ways. We report such an innovation for pied flycatchers Ficedula hypoleuca. Decades of breeding biological studies on pied flycatchers have rarely reported multiple breeding in this long‐distance migrant. In two populations, we found 12 recent incidents of females with second broods, all produced by extremely early laying females in warm springs. As such early first broods are a recent phenomenon, because laying dates have gradually advanced over time, this innovation now allows individual females to enhance their reproductive success considerably. If laying dates continue advancing, potentially more females may become multiple breeders and selection for early (and multiple) breeding phenotypes increases, which may accelerate adaptation to climatic change.
Classical response of antidromic atriofascicular tachycardia to premature atrial extrastimulus delivered during septal refractoriness
Authors: Mohanan Nair Krishna Kumar , Namboodiri Narayanan , Abhilash Sreevilasam Pushpangadhan , Prabhu Mukund , Das Debashish , Valaparambil Ajitkumar
Published: April 2019

A 23‐year‐old gentleman presented with a history of palpitations. The 12‐lead electrocardiogram showed no manifest ventricular pre‐excitation. Echocardiogram was within normal limits. A retrograde study showed concentric activation of the atrium with decremental conduction. Atrial pacing from right atrial free wall showed progressive pre‐excitation. No anterograde nodal duality was documented.
Device infections in implantable cardioverter defibrillators versus permanent pacemakers: A systematic review and meta‐analysis
Authors: Rattanawong Pattara , Kewcharoen Jakrin , Mekraksakit Poemlarp , Mekritthikrai Raktham , Prasitlumkum Narut , Vutthikraivit Wasawat , Putthapiban Prapaipan , Dworkin Jonathan
Published: April 2019

Introduction

Recent studies suggest that implantable cardioverter defibrillators (ICDs) are associated with increased risk of cardiac implantable electronic device (CIED) infections when compared with permanent pacemakers (PPMs). However, there were controversies among studies. In this study we performed a systematic review and meta‐analysis to explore the risk of device infection in ICD versus PPM.

Methods

We searched the databases of MEDLINE and EMBASE from inception to January 2019. Data from each study were combined using the random‐effects, generic inverse variance method of Der Simonian and Laird to calculate odds ratios (OR) and 95% confidence intervals (CI).

Results

Twenty‐seven studies involving 202 323 CIEDs (36 782 ICDs and 165 541 PPMs) were included. Infections occurred from 9 days to 6 years postoperatively. When compared with PPM, ICD had a significantly higher risk of device infection in overall analysis (OR = 1.62, 95% CI: 1.29‐2.04). The risk was seen in subgroups such as single chamber or dual chamber device (OR = 1.57, 95% CI: 1.18‐2.09), de novo implantation (OR = 1.62, 95% CI: 1.29‐2.69), revision implantation (OR = 1.63, 95% CI: 1.24‐2.13), and cardiac resynchronization therapy (CRT) (OR = 1.75, 95% CI: 1.18‐2.60). CRT‐defibrillator increased risk of infection over CRT‐pacemaker in revision implantation (OR = 1.81, 95% CI: 1.20‐2.74) but not in de novo implantation (OR = 1.07, 95% CI: 0.23‐4.88). The increased risk of infection among defibrillator was higher in CRT compared to non‐CRT but not significant (P = 0.654).

Conclusions

Our meta‐analysis demonstrates a statistically significant increased risk of device infection in CIED patients who received ICD when compared to PPM.
Effect of cryoballoon and radiofrequency ablation for pulmonary vein isolation on left atrial function in patients with nonvalvular paroxysmal atrial fibrillation: A prospective randomized study (Cryo‐LAEF study)
Authors: Giannopoulos Georgios , Kossyvakis Charalampos , Vrachatis Dimitrios , Aggeli Constadina , Tsitsinakis Georgios , Letsas Konstantinos , Tsiachris Dimitrios , Tsoukala Styliani , Efremidis Michalis , Katritsis Dimosthenis , Deftereos Spyridon
Published: April 2019

Background

Isolation of the pulmonary veins (PVI) has become a mainstay in atrial fibrillation (AFib) therapy. Lesions in left atrial tissue lead to scar formation and this may affect left atrial function.

Methods

Patients with paroxysmal AFib were randomly assigned in a 1:2 allocation scheme to radiofrequency (RF) ablation or cryoballoon. Real‐time three‐dimensional echocardiography was performed (under sinus rhythm in all cases) before ablation and at 1 and 3 months to evaluate the left atrial functional indices. The primary outcome measure was change in left atrial ejection fraction (LAEF) at 1 month.

Results

120 patients were randomized (80 to cryoballoon, 40 to RF). The absolute change in LAEF at 1 month was 4.0 (Q1‐Q3, −0.1to 7.6)% in the cryoballoon group and −0.8 (Q1‐Q3, −1.9 to 0.9)% in the RF group (P < 0.001 for the comparison between groups). At 3 months, the corresponding changes were 6.7 (Q1‐Q3, 3.4‐11.2)% and 0.7 (Q1‐Q3, −0.7 to 3.5)%, respectively (P < 0.001). Overall, the rate of patients with lower LAEF at 3 months compared to baseline was 2.5% in the cryoballoon group and 32.5% in the RF group (P < 0.001). AFib recurrence rate at 6 months was higher in patients with decreased LAEF (odds ratio, 6.2; 95% confidence interval, 2.0‐19.5; P = 0.002).

Conclusion

The Cryo‐LAEF study prospectively compared the effects of RF and cryoballoon ablation on left atrial function. Both at 1 and 3 months postablation, LAEF was either improved or stable in both ablation groups.
Outcomes and costs of remote patient monitoring among patients with implanted cardiac defibrillators: An economic model based on the PREDICT RM database
Authors: Hummel James P. , Leipold Robert J. , Amorosi Stacey L. , Bao Haikun , Deger Kristen A. , Jones Paul W. , Kansal Anuraag R. , Ott Lesli S. , Stern Sean , Stein Kenneth , Curtis Jeptha P. , Akar Joseph G.
Published: April 2019

Background

Remote monitoring of implantable cardioverter‐defibrillators has been associated with reduced rates of all‐cause rehospitalizations and mortality among device recipients, but long‐term economic benefits have not been studied.

Methods and Results

An economic model was developed using the PREDICT RM database comparing outcomes with and without remote monitoring. The database included patients ages 65 to 89 who received a Boston Scientific device from 2006 to 2010. Parametric survival equations were derived for rehospitalization and mortality to predict outcomes over a maximum time horizon of 25 years. The analysis assessed rehospitalization, mortality, and the cost‐effectiveness (expressed as the incremental cost per quality‐adjusted life year) of remote monitoring versus no remote monitoring. Remote monitoring was associated with reduced mortality; average life expectancy and average quality‐adjusted life years increased by 0.77 years and 0.64, respectively (6.85 life years and 5.65 quality‐adjusted life years). When expressed per patient‐year, remote monitoring patients had fewer subsequent rehospitalizations (by 0.08 per patient‐year) and lower hospitalization costs (by $554 per patient year). With longer life expectancies, remote monitoring patients experienced an average of 0.64 additional subsequent rehospitalizations with increased average lifetime hospitalization costs of $2784. Total costs of outpatient and physician claims were higher with remote monitoring ($47 515 vs $42 792), but average per patient‐year costs were lower ($6232 vs $6244). The base‐case incremental cost‐effectiveness ratio was $10 752 per quality‐adjusted life year, making remote monitoring high‐value care.

Conclusion

Remote monitoring is a cost‐effective approach for the lifetime management of patients with implantable cardioverter‐defibrillators.
Cryoballoon ablation for persistent atrial fibrillation in patients without left atrial fibrosis
Authors: Gramlich Michael , Maleck Carole , Marquardt Jonathan , Duckheim Martin , Stimpfle Fabian , Heinzmann David , Scheckenbach Christian , Gawaz Meinrad , Schreieck Jürgen , Seizer Peter
Published: April 2019

Introduction

The role of cryoballoon (CB) pulmonary vein isolation (PVI) for patients with persistent atrial fibrillation (AF) is controversial, since long‐term success can be poor. We performed left atrial voltage mapping before CB PVI and determined AF‐free survival depending on the extent of low‐voltage areas (LVAs).

Methods and Results

We consecutively enrolled 60 patients with persistent AF (average age, 60.6 ± 12.9 years; CHA2DS
2 VASc score, 2.3 ± 1.6; and left atrial size 46.0 ± 5.2 mm) who were planned for CB PVI. Before ablation, we performed left atrial voltage mapping (Abbott EnSite Precision or Velocity). LVAs were defined if local bipolar signal amplitudes were less than 0.5 mV during sinus rhythm. Thirty‐seven patients did not show significant LVAs (<10%), while 12 patients had LVAs between 10% and 30% and 11 patients showed substantial LVAs greater than 30% of the left atrial area. CB PVI could be successfully performed in all patients. A 7‐day holter monitoring was obtained 3, 6, and 12 months after ablation. After a 12‐month follow‐up time, 83.8% of patients without LVAs (<10%) were free of atrial fibrillation, while 50.0% of patients with 10% to 30% LVAs and 9.1% of patients with LVAs more than 30% had stable sinus rhythm. The degree of atrial fibrosis correlated with the risk of AF recurrence.

Conclusion

In patients with persistent AF undergoing CB PVI, the extent of left atrial LVAs predicts an AF‐free survival. CB PVI seems to be a highly effective treatment for patients with persistent AF without atrial fibrosis.
Etiology of tricuspid valve disease is a predictor of bradyarrhythmia after tricuspid valve surgery
Authors: Herrmann Florian E. M. , Graf Helen , Wellmann Petra , Sadoni Sebastian , Hagl Christian , Juchem Gerd
Published: April 2019

Aims

The tricuspid valve is situated in close proximity to cardiac conduction tissue and damage to this tissue can affect postoperative rhythm. The aim of this study was to quantify the incidence of pacemaker requirement after tricuspid valve surgery and investigate predictors.

Methods

Data were collected via our operative data collection system and patient files. All patients who underwent surgical procedures of the tricuspid valve from 2004 until 2017 and lacked a pacemaker preoperatively were included in the study.

Results

In our cohort of 505 patients 54 required a pacemaker in the first 50 days after surgery. We calculated a 17.5% (95% confidence interval [CI], 13.5‐21.3) risk of pacemaker implantation at 4 years postoperatively. Multivariate analysis identified preoperative active endocarditis (odds ratio 3.17; CI, 1.32‐7.65; P = 0.010) and “inadequate pacemaker dependent rhythm” (defined as any intrinsic heart rate below 45 per minute requiring pacing) upon admission to the intensive care unit after surgery (odds ratio 5.924; CI, 2.82‐12.44; P = 0.001) as predictors for pacemaker requirement in the first 50 days after surgery. Twenty‐six pacemakers (48%) were implanted for atrioventricular block, 16 (30%) for sinus node dysfunction and 12 (22%) for atrial fibrillation. Kaplan‐Meier analysis showed no difference in survival between the pacemaker and no pacemaker group.

Conclusion

Surgery of the tricuspid valve has a high burden of postoperative pacemaker requirement. Preoperative active endocarditis and the initial postoperative rhythm are predictors. Understanding this allows for better decision‐making regarding further medical/device therapy.
Safety of Ramadan fasting in young patients with type 1 diabetes: A systematic review and meta‐analysis
Authors: Loh Huai Heng , Lim Lee‐Ling , Loh Huai Seng , Yee Anne
Published: April 2019

Aims/Introduction

Although patients with type 1 diabetes are medically exempt, many insist on fasting during Ramadan. Multiple daily insulin injections (MDI), premixed insulin and continuous subcutaneous insulin infusion (CSII) are commonly used. To date, little is known about the safety of Ramadan fasting in these patients.

Materials and Methods

We pooled data from 17 observational studies involving 1,699 patients treated with either CSII or non‐CSII (including premixed and MDI) regimen. The study outcomes were the frequencies of hypoglycemia, hyperglycemia and/or ketosis. Given the lack of patient‐level data, separate analyses for premixed and MDI regimen were not carried out.

Results

The CSII‐treated group (n = 203) was older (22.9 ± 6.9 vs 17.8 ± 4.0 years), and had longer diabetes duration (116.7 ± 66.5 vs 74.8 ± 59.2 months) and lower glycated hemoglobin (7.8 ± 1.1% vs 9.1 ± 2.0%) at baseline than the non‐CSII‐treated group (n = 1,496). The non‐CSII‐treated group had less non‐severe hypoglycemia than the CSII‐treated group (22%, 95% CI 13–34 vs 35%, 95% CI 17–55). Of the non‐CSII‐treated group, 7.1% (95% CI 5.8–8.5) developed severe hypoglycemia, but none from the CSII‐treated group did. The non‐CSII‐treated group was more likely to develop hyperglycemia (12%, 95% CI 3–25 vs 8.8%, 95% CI 0–31) and ketosis (2.5%, 95% CI 1.0–4.6 vs 1.6%, 95% CI 0.1–4.7), and discontinue fasting (55%, 95% CI 34–76 vs 31%, 95% CI 9–60) than the CSII‐treated group.

Conclusions

The CSII regimen had lower rates of severe hypoglycemia and hyperglycemia/ketosis, but a higher rate of non‐severe hyperglycemia than premixed/MDI regimens. These suggest that appropriate patient selection with regular, supervised fine‐tuning of the basal insulin rate with intensive glucose monitoring might mitigate the residual hypoglycemia risk during Ramadan.
A Team Disclosure of Error Educational Activity: Objective Outcomes
Authors: Krumwiede Kim Hoggatt , Wagner James M. , Kirk Lynne M. , Duval Tara M. , Dalton Thomas O. , Daniel Kathryn M. , Huffman Allison S. , Adams‐Huet Beverley , Rubin Craig D.
Published: April 2019

Medical errors can involve multiple team members. Few curricula are being developed to provide instruction on disclosing medical errors that include simulation training with interprofessional team disclosure. To explore more objective evidence for the value of an educational activity on team disclosure of errors, faculty developed and assessed the effectiveness of a multimodal educational activity for learning team‐based disclosure of a medical error.

This study employed a methodological triangulation research design. Participants (N = 458) included students enrolled in academic programs at three separate institutions. The activity allowed students to practice team communication while: (1) discussing a medical error within the team; (2) planning for the disclosure of the error; and (3) conducting the disclosure. Faculty assessed individual student's change in knowledge and, using a rubric, rated the performance of the student teams during a simulation with a standardized family member (SFM).

Students had a high level of preexisting knowledge and demonstrated the greatest knowledge gains in questions regarding the approach to disclosure (P < .001) and timing of an apology (P < .001). Both SFMs and individual students rated the team error disclosure behavior highly (rho = 0.54; P < .001). Most participants (more than 80%) felt the activity was worth their time and that they were more comfortable with disclosing a medical error as a result of having completed the activity.

This activity for interprofessional simulation of team‐based disclosure of a medical error was effective for teaching students about and how to perform this type of important disclosure.
Deterioration of nutritional status of patients with locally advanced cervical cancer during treatment with concomitant chemoradiotherapy
Authors: Sánchez M. , Castro‐Eguiluz D. , Luvián‐Morales J. , Jiménez‐Lima R. , Aguilar‐Ponce J. L. , Isla‐Ortiz D. , Cetina L.
Published: April 2019

Background

In Mexico, 80% women with cervical cancer are diagnosed at locally advanced stages and are treated with concomitant chemoradiotherapy. The treatment modality and catabolic state confer a nutritional risk. The present study aimed to thoroughly evaluate the nutritional status and change in body composition of locally advanced cervical cancer (LACC) patients throughout treatment.

Methods

An observational prospective study, carried out at the Mexican National Cancer Institute, included 55 LACC patients. Nutritional status was evaluated before, during and after treatment, using anthropometric, dietary and biochemical measurements. Body composition was analysed using computed tomography images obtained at the time of diagnosis and approximately 4 months after treatment completion. Clinical outcomes were associated with changes in body composition.

Results

At the time of diagnosis, no patients were clinically malnourished, although 33.3% presented sarcopenia and most were overweight; by the end of treatment, 69% became clinically malnourished and 58% were sarcopenic. Average weight loss was 7.4 kg (P = 0.001). Adequacy of energy intake was reduced to 54%, obtained predominantly from carbohydrates. By the week 9, 62.8% patients became anemic and 34.5% had low albumin levels. Body composition analysis revealed that patients lost both, muscle and adipose tissues, although 27% patients were muscle depleted by the end of treatment. Patients who lost ≥10% skeletal muscle presented a higher tumour recurrence (hazard ratio = 2.957, P = 0.006) and a tendency towards diminished overall survival (hazard ratio = 2.572, not significant).

Conclusions

The nutritional status of cervical cancer patients deteriorates during treatment with concomitant chemoradiotherapy and, most importantly, muscle loss impacts the clinical outcome of patients.
Genetic mapping of folate QTLs using a segregated population in maize
Authors: Guo Wenzhu , Lian Tong , Wang Baobao , Guan Jiantao , Yuan Dong , Wang Huan , Safiul Azam Fardous Mohammad , Wan Xing , Wang Weixuan , Liang Qiuju , Wang Haiyang , Tu Jinxing , Zhang Chunyi , Jiang Ling
Published: April 2019

As essential B vitamin for humans, folates accumulation in edible parts of crops, such as maize kernels, is of great importance for human health. But its breeding is always limited by the prohibitive cost of folate profiling. The molecular breeding is a more executable and efficient way for folate fortification, but is limited by the molecular knowledge of folate regulation. Here we report the genetic mapping of folate quantitative trait loci (QTLs) using a segregated population crossed by two maize lines, one high in folate (GEMS31) and the other low in folate (DAN3130). Two folate QTLs on chromosome 5 were obtained by the combination of F2 whole‐exome sequencing and F3 kernel‐folate profiling. These two QTLs had been confirmed by bulk segregant analysis using F6 pooled DNA and F7 kernel‐folate profiling, and were overlapped with QTLs identified by another segregated population. These two QTLs contributed 41.6% of phenotypic variation of 5‐formyltetrahydrofolate, the most abundant storage form among folate derivatives in dry maize grains, in the GEMS31×DAN3130 population. Their fine mapping and functional analysis will reveal details of folate metabolism, and provide a basis for marker‐assisted breeding aimed at the enrichment of folates in maize kernels.
Patients and home carers' experience and perceptions of different modalities of enteral feeding
Authors: Ang Shin Yuh , Lim Mei Ling , Ng Xin Ping , Lam Madeleine , Chan Mei Mei , Lopez Violeta , Lim Siew Hoon
Published: April 2019

Aims and objectives

To explore patients and carers' experience and perceptions of different modalities of long‐term enteral feeding.

Background

With an ageing population in Singapore, there is a concomitant increase in number of patients with dysphagia and hence increase in prevalence of enteral feeding. It is essential to understand experiences of patients and home carers with long‐term home enteral feeding and perceptions of different modalities to better provide support.

Design

A qualitative descriptive approach fulfilling the COREQ checklist criteria (See File S1). Nine patients who were receiving long‐term enteral feeding and nine carers were recruited over the period of August to December 2017. One‐to‐one interviews were conducted and audio‐recorded. An inductive content analysis approach, with open coding, creation of categories and abstraction of data, was adopted.

Results

Three themes were generated: (a) factors influencing choice of mode of enteral feeding; respondents narrated factors such as need to “conceal” illness, need to be independent and previous bad experience with alternative modality (b) identified informational, emotional and physical needs. Respondents reported the need for support in terms of information on the different modalities, and training on how to self‐care or provide care and (c) individual perception and attitude towards life with enteral feeding. Most respondents portrayed a positive outlook to life, despite that they could no longer participate in communal eating.

Conclusion and Relevance to clinical practice

Understanding patients and carers' experience and perceptions will inform the development of strategies to empower future patients and carers in choice of modality for enteral feeding. Patients with percutaneous endoscopic gastrostomy (PEG) found it easier to integrate enteral tube feeding into daily lives. Carers played a pivotal role in choice of modality, as well as in care of patients on enteral feeding.
Relationship between patient’s health literacy and adherence to coronary heart disease secondary prevention measures
Authors: Lu Minmin , Ma Jianying , Lin Ying , Zhang Xian , Shen Yunzhi , Xia Haiou
Published: April 2019

Aims and Objectives

To examine the relationship between health literacy (HL) and adherence to secondary coronary heart disease (CHD) prevention behaviours in patients in China.

Background

Adherence of patients to secondary CHD prevention behaviours is important in order to slow or reverse disease progression. The relationship between HL and adherence is varied across populations and warrants further research in order to inform nurses caring for such patients how to direct their teaching.

Design

A descriptive cross‐sectional design.

Methods

A total of 598 patients with CHD were recruited during hospitalisation for a myocardial revascularization procedure at either of two tertiary hospitals in China. Data were collected by self‐report on demographics, HL and adherence to secondary CHD prevention behaviours (medication‐taking and heart‐healthy lifestyle) prior to this admission. HL was measured by the short version of European Health Literacy Survey Questionnaire (HLS‐EU‐Q16), while adherence was measured with the Medical Outcomes Study Specific Adherence Scale (MOS‐SAS). Descriptive, chi‐square test and regression analyses were conducted. The study was reported based on STROBE checklist.

Results

Overall, 74.5% of the patients had limited HL. Adherence rates to medication‐taking and heart‐healthy lifestyle were 84.7% and 53.2%, respectively. HL was not significantly associated with medication adherence, but in regression models patients with limited HL demonstrated significantly increased odds for nonadherence to heart‐healthy lifestyle (OR 1.69).

Conclusion

HL was not significantly associated with medication adherence but was related to heart‐healthy lifestyle adherence.

Relevance to clinical practice

Nurses should assess the health literacy of discharging patients with CHD and focus on patients with limited health literacy to improve heart‐healthy lifestyle behaviours, and not just taking medications.
Critical care nurses’ clinical reasoning about physiologic monitor alarm customisation: An interpretive descriptive study
Authors: Ruppel Halley , Funk Marjorie , Whittemore Robin , Wung Shu‐Fen , Bonafide Christopher P. , Powell Kennedy Holly
Published: April 2019

Aims and objectives

To explore clinical reasoning about alarm customisation among nurses in intensive care units.

Background

Critical care nurses are responsible for detecting and rapidly acting upon changes in patients’ clinical condition. Nurses use medical devices including bedside physiologic monitors to assist them in their practice. Customising alarm settings on these devices can help nurses better monitor their patients and reduce the number of clinically irrelevant alarms. As a result, customisation may also help address the problem of alarm fatigue. However, little is known about nurses' clinical reasoning with respect to customising physiologic monitor alarm settings.

Design

This article is an in‐depth report of the qualitative arm of a mixed methods study conducted using an interpretive descriptive methodological approach.

Methods

Twenty‐seven nurses were purposively sampled from three intensive care units in an academic medical centre. Semi‐structured interviews were conducted by telephone and were analysed using thematic analysis. Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guidelines were used.

Results

Four themes were identified from the interview data: unit alarm culture and context, nurse attributes, motivation to customise and customisation “know‐how.” A conceptual model demonstrating the relationship of these themes was developed to portray the factors that affect nurses’ customisation of alarms.

Conclusions

In addition to drawing on clinical data, nurses customised physiologic monitor alarms based on their level of clinical expertise and comfort. Nurses were influenced by the alarm culture on their clinical unit and colleagues’ and patients’ responses to alarms, as well as their own technical understanding of the physiologic monitors.

Relevance to clinical practice

The results of this study can be used to design strategies to support the application of clinical reasoning to alarm management, which may contribute to more appropriate alarm customisation practices and improvements in safety.
A cross‐validation study of the incident‐reporting attitude scale for staff in long‐term care facilities—A cross‐sectional study
Authors: Lin Shu‐Yuan , Yang Hui‐Ching , Chiang Hui‐Ying , Lee Shu‐Li
Published: April 2019

Aims and objectives

To test the construct and concurrent validity and reliability of the incident‐reporting attitude scale used for staff in long‐term care facilities (IRA‐LTC) by the two‐phase cross‐validation method.

Background

Lack of accurate measurement on incident‐reporting attitude might hinder improvements of safety practice in long‐term care facilities.

Design/Methods

A two‐phase cross‐sectional questionnaire survey was conducted in Taiwan. A fixed proportion of long‐term care facilities were randomly selected that included 20 and 15 long‐term care facilities at phases one and two separately. Nursing and administrative staffs in these facilities were recruited at the first phase (N = 207) for testing the validity and reliability of the newly developed scale and for cross‐validation of the scale at the second phase (N = 251). The scale of IRA‐LTC was a self‐developed structured questionnaire consisting of 31 items. The data were analysed usingspssfor Windows 20.0 and AMOS 24.0. Descriptive statistics, correlation analysis, Cronbach'sα, exploratory and confirmatory factory analysis were carried to examine the homogeneity of items, reliability, construct and concurrent validity. The STROBE checklist was adhered (See Appendix S1).

Results

The IRA‐LTC scale comprised two dimensions: “cognition and intention to report” and “barriers to report.” The two‐factor structure explained 60.20%–61.89% of the total variance at two phases. Validation of the initial factorial model gained at the first phase was satisfactorily supported at the second phase. Concurrent validity of the IRA‐LTC scale was satisfied.

Cronbach'sαfor the scale and subscales was 0.94–0.97.

Conclusions

This IRA‐LTC scale is valid and reliable and can be recommended to evaluate the incident‐reporting attitude among all kinds of staff in long‐term care facilities.

Relevance to clinical practice

Positive incident‐reporting attitude can lead to positive incident‐reporting behaviour. Using the IRA‐LTC scale for assessing staff's incident‐reporting attitude is recommended as the first step to enhance staff's safety performance in long‐term care facilities.