bluuebunny/crossref_metadata_2025 huggingface dataset:
Developing the culture of ethics in population health intervention research in Canada
Authors: Hamelin Anne-Marie , Caux Chantal , Désy Michel , Guichard Anne , Ouédraogo Samiratou , Tremblay Marie-Claude , Vissandjée Bilkis , Godard Béatrice
Published: May 2020

Population health intervention research (PHIR) is a particular field of health research that aims to generate knowledge that contributes to the sustainable improvement of population health by enabling the implementation of cross-sectoral solutions adapted to social realities. Despite the ethical issues that necessarily raise its social agenda, the ethics of PHIR is still not very formalized. Unresolved ethical challenges may limit its focus on health equity. This contribution aims to highlight some of these issues and calls on researchers to develop a culture of ethics in PHIR. Three complementary ways are proposed: to build an ethical concept specific to this field, to promote a shared space for critical reflection on PHIR ethics, and to develop the ethical competence in PHIR for which a preliminary framework is proposed.
Educator Perceptions of English Language Learners
Authors: Szymanski Antonia (Toni) , Lynch Michelle
Published: May 2020

This article explores educator perceptions of gifted and talented (GT) English language learning (ELL) students. Nine educators from two schools within a school district with high population of ELL students were interviewed in this qualitative study. Discussion focused on understanding teachers’ ideas regarding ELL gifted students. Three main themes emerged from interviews: educator perceptions, identification, and professional development. Implications from the study include the need for specific professional development to restructure thinking regarding ELL students and to inform educators on the myriad of ways giftedness may manifest itself.
On the uses and abuses of Gramsci’s hegemony
Authors: Saccarelli Emanuele
Published: May 2020

As formulated in classical Marxism, hegemony referred to the unique position of the working class as the only independent revolutionary force under capitalism, as well as its political and ideological relations leading other social groups. Today hegemony typically refers instead to a constellation of arguments that regard a revolutionary orientation as hopeless and deny the unique political position of the working class. I examine the theoretical and political significance of this change by reflecting on Gramsci’s elaboration of hegemony and its dubious appropriation by post-Marxism, broadly understood.
Developmental anomalies of the lateral portion of the cervical neural arch: Multimodal imaging and clinical implications
Authors: Hsu Charlie Chia-Tsong , Meehan Louise , Fomin Igor , Watkins Trevor William , Ashburner Graham , Stewart Nikolas , Kreltszheim Michael , Kumar Mahendrah Jaya , Krings Timo
Published: May 2020

Objective

This study aimed to describe the imaging spectrum of developmental anomalies of the lateral portion of the cervical neural arch.

Method

This was a five-year retrospective review of consecutive computed tomography (CT) scans of the cervical spine for structural anomalies of the cervical vertebral pedicle and facets. CT, radiographs and, when available, magnetic resonance imaging studies were independently reviewed. Anomalies were grouped into the following three categories: the absence of a pedicle, clefts in the vertebral arch or isolated dysmorphism of the facet. Clinical data on demographics and neurological outcomes were documented.

Results

Among 9134 consecutive patients undergoing a CT scan of the cervical spine, 18 (0.2%) patients were found to have developmental anomalies of the pedicle and facets. Findings included 7/18 (39%) with congenital absence of a pedicle, 8/18 (44%) with clefts in the vertebral arch and 3/18 (17%) with isolated dysmorphism of the articular facets. No acute neurological deficits or spinal cord injuries were reported. Associated chronic symptoms included neck pain 10/18 (56%), radiculopathy 7/18 (39%) and myelopathy 1/18 (6%).

Conclusion

Developmental anomalies of the pedicle and facet may mimic traumatic spinal pathologies. Recognising a diverse spectrum of imaging findings is vital to prevent misdiagnosis and unnecessary intervention.
Prospective, case-controlled study evaluating serum concentration of sirtuin-1 and mannose-binding lectin in patients with and without periodontal and coronary artery disease
Authors: Caribé Pérola Michelle Vasconcelos , Villar Cristina Cunha , Romito Guiseppe Alexandre , Takada Júlio Yoshio , Pacanaro Ana Paula , Strunz Célia Maria Cassaro , César Luiz Antonio Machado , Mansur Antonio de Padua
Published: May 2020

Background:

Atherosclerosis and periodontal disease (PD) are inflammatory diseases that have been shown in studies to have a direct association. Mannose-binding lectin (MBL) is an immune system protein that binds to periodontal pathogens favoring phagocytosis. Conversely, increased serum sirtuin-1 (SIRT1) concentration reduces the inflammatory process.

Methods:

This was a prospective, case-controlled study that analyzed serum concentration of biomarkers in patients with or without coronary artery disease (CAD) and PD. A total of 78 patients were evaluated: 20 healthy individuals, 18 patients with CAD, 20 patients with PD, and 20 patients with both PD and CAD. Clinical and laboratory characteristics were analyzed before and after nonsurgical treatment of PD and also at two equivalent times in patients without PD. Serum MBL and SIRT1 concentration were analyzed by enzyme-linked immunosorbent assay.

Results:

A negative correlation was observed between changes in serum concentration of MBL and SIRT1 ( r = −0.30; p = 0.006). Comparison between pre- and post-treatment of PD showed a reduction in MBL levels (886.27 ± 906.72 versus 689.94 ± 808.36; p = 0.002) and an increase in SIRT1 values (0.80 ± 1.01 versus 1.49 ± 1.55; p = 0.005) in patients with PD and without CAD. The same result was observed in patients with PD and CAD for MBL and SIRT1, respectively, of 1312.43 ± 898.21 versus 1032.90 ± 602.52 ( p = 0.010) and 1.32 ± 1.0 versus 1.82 ± 1.75 ( p = 0.044).

Conclusion:

PD treatment reduced MBL serum concentration and increased SIRT1 serum concentration in patients with and without CAD.
Health care providers’ perceptions of factors that influence the provision of acute stroke care in urban and rural settings: A qualitative study
Authors: Dwyer Mitchell , Peterson Gregory M. , Gall Seana , Francis Karen , Ford Karen M.
Published: May 2020

Objectives:

Individuals living in rural areas have comparatively less access to acute stroke care than their urban counterparts. Understanding the local barriers and facilitators to the use of current best practice for acute stroke may inform efforts to reduce this disparity.

Methods:

A qualitative study featuring semi-structured interviews and focus groups was conducted in the Australian state of Tasmania. Clinical staff from a range of disciplines involved in acute stroke care were recruited from three of the state’s four major public hospitals (one urban and two rural). A semi-structured interview guide based on the findings of an earlier quantitative study was used to elicit discussion about the barriers and facilitators associated with providing acute stroke care. An inductive process of thematic analysis was then used to identify themes and subthemes across the data set.

Results:

Two focus groups and five individual interviews were conducted. Four major themes were identified from analysis of the data: systemic issues, clinician factors, additional support and patient-related factors. Acute stroke care within the study’s urban hospital was structured and comprehensive, aided by the hospital’s acute stroke unit and specialist nursing support. In contrast, care provided in the study’s rural hospitals was somewhat less comprehensive, and often constrained by an absence of infrastructure or poor access to existing resources.

Conclusion:

The identified factors help to characterise acute stroke care within urban and rural hospitals and will assist quality improvement efforts in Tasmania’s hospitals.
Using a cognitive orthosis to support older adults during meal preparation: Clinicians’ perspective on COOK technology
Authors: Yaddaden Amel , Couture Mélanie , Gagnon-Roy Mireille , Belchior Patricia , Lussier Maxime , Bottari Carolina , Giroux Sylvain , Pigot Hélène , Bier Nathalie
Published: May 2020

Introduction

Occupational therapists promote safety and autonomy of older adults with cognitive impairments. A technology, named COOK, offers support on a touch screen installed next to the stove to support task performance while correcting risky behaviors. We aimed to document (1) the functional profiles according the diagnosis (2) the types of interventions used to increase autonomy in the kitchen (3) the facilitators and obstacles to the implementation of COOK with this clientele.

Methods

Four focus groups were conducted with occupational therapists ( n = 24) and were transcribed and analyzed using thematic analysis, including coding and matrix building.

Results

Occupational therapists identified different (1) functional profiles and (2) interventions for both diagnoses. The use of COOK (3) could be more beneficial in mild cognitive impairment, as many barriers occur for the use in Alzheimer’s disease. Some parameters, such as digital control of the stove and complex information management, need to be simplified.

Discussion

According to occupational therapists, this technology is particularly applicable to people with mild cognitive impairment, because this population has better learning abilities.

Conclusion

This study documented the specific needs of older adults with cognitive impairments as well as interventions used by occupational therapists. The perspectives of caregivers should be captured in future research.
Mindfully Scrolling: Rethinking Facebook After Time Deactivated
Authors: Baym Nancy K. , Wagman Kelly B. , Persaud Christopher J.
Published: May 2020

Many people express concern that Facebook’s users are overly connected. This article examines responses to survey questions asked after a large random sample of American Facebook users had been paid to deactivate Facebook. We find a recurring discourse of mind including, for example, references to mindfulness. Using iterative qualitative coding, we ask what meanings and practices are invoked in this discourse. Furthermore, we critically assess the potential of what respondents describe to address the problems of overconnection. We find explicit awareness of the automaticity of use, the value and content of Facebook, and how it makes users feel. We find that users came to practice disconnection at many nested levels of vernacular affordances. Ultimately, we argue that Facebook has become a landscape trap, altering daily life such that individual practices, such as mindful scrolling, cannot overcome the overconnection problems it may create. Mindfulness in this discourse may be power, but it is power to avoid elements of Facebook, not power to transform it.
Left Ventricular Aneurysm in a Child After Recovering From Dilated Cardiomyopathy
Authors: Lizano-Santamaria Ramiro , Cohen Mitchell , Atkins Melany , Collazo Lucas
Published: May 2020

Left ventricular aneurysms are extremely rare in children. A child developed an aneurysm a year after recovering from idiopathic dilated cardiomyopathy. The initial management was conservative. After several years and due to aneurysm enlargement and other complications, the patient underwent successful aneurysm surgical repair with left ventricular aneurysmorrhaphy. We describe our experience treating this child during the course of this disease.
The Mediating Effect of Organizational Stress on Organizational Culture and Time Management: A Comparative Study With Two Universities
Authors: Yaşar Hikmet , Sağsan Mustafa
Published: May 2020

This research was designed to investigate whether organizational stress had an intermediary role in the effect of Hofstede cultural dimensions on time management. Near East University from Cyprus, which represents the individual culture, and Hakkari University from Turkey representing the collectivist culture were selected for the research analyses. In all, 638 administrative and academic members from both universities were interviewed face-to-face on a voluntary basis, and data were collected by the simple random sampling method. The research findings suggest that time should be managed after identifying the type of culture—individualistic or collectivist—to decrease the level of stress experienced by university staff. In other words, Hofstede’s cultural dimension has an impact on time management, and organizational stress has a partial mediation effect on this dimension. Although the variables in the study have been studied in the literature together with many different factors, Hofstede is significant in terms of determining the role of organizational stress in the effect of cultural dimensions on time management. The effectiveness of Hofstede’s cultural dimensions through organizational stress in time management allows business and project plans to be carried out in a way that manages individual, team or departmental performances taking into account the organizational stress elements. It is considered that this study will particularly be effective in medicine, project management, and independent auditing.
Targeting Turkish-to-English Interlingual Interference Through Context-Heavy Data-Driven Learning
Authors: Lay Keith John , Yavuz Mehmet Ali
Published: May 2020

This study investigates the effect of grammar-focused hands-on in-class data-driven learning (DDL) with a heavily contextualized corpus on the frequency of written errors attributable to common interlingual interference issues in low–intermediate Turkish learners ( n = 30) of English. Items representing the most common Turkish-to-English interlingual errors were selected through a two-step process involving the analysis of past studies and a subsequent ranking survey of teachers ( n = 10) of Turkish learners of English. Participants’ grammar development in terms of types of written errors was measured over a ten-week period through written tasks in a pre/posttest design, producing 19,328 words for analysis. The results, although variable by item, suggest that targeted DDL with the TED Corpus Search Engine (TCSE) helps reduce written errors in Turkish learners of English to a significant degree with a moderate effect size. Consequently, the investigation of DDL with the TCSE for the targeting of interlingual interference in other first-language contexts is recommended.
Financial Literacy: An Intra-Household Case Study from West Bengal, India
Authors: Banerjee Tanmoyee , Roy Malabika
Published: May 2020

The study is an exercise to identify the presence of intra-household gender disparities in financial literacy levels between male and female decision-makers of the family (identified as male and female household heads) using data from a primary survey conducted in 24 Parganas (North), West Bengal, India. The survey shows the existence of significant intra-household gender gap in financial literacy. We also found that the female household heads with low financial literacy use mass media less intensively. Further, the study identifies that financial literacy is low for respondents in families with low levels of income and asset. Financial literacy improves with the use of mass media and education level. Interestingly, the higher the age of respondents the less are they financially literate.

JEL Classifications: D19, J16, G190
Saffronizing the periphery: Explaining the rise of the Bharatiya Janata Party in contemporary Assam
Authors: Saikia Smitana
Published: May 2020

The remotely located and relatively marginalized states of northeast India have historically been a Congress bastion, despite posing continued challenges to the nation-building project through many insurgency movements. The success of the grand old party depended on creating ‘umbrella coalitions’ with diverse ethnic groups to sustain power. However, since General elections 2014, the Bharatiya Janata Party (BJP) has successfully challenged the dominance of Congress, particularly in the state of Assam. In this context, this paper seeks to discuss recent shifts in electoral dynamics in Assam and its implication for a region hitherto considered peripheral. The paper situates the BJP’s emergence as the new locus of power in the long-term processes of party politics in Assam and discusses the resultant shifts in social alignments, cleavages and political issues in the multi-ethnic landscape of the state. It also explores the role of the RSS in negotiating its larger ideological interests with local political realities of the state and its ability to appropriate local cultural symbols. The paper concludes that the unprecedented rise of the BJP, which is a result of the changing political opportunity structures in Assam, will nevertheless be tested severely due to the state’s multi-ethnic character and complex, localized social fault lines.
Shutting Eyes to Merit! The Curse of Cronyism in Pakistani Small and Medium Scale Business
Authors: Bilal Ahmad Raza , Fatima Tehreem , Imran Muhammad Kashif
Published: May 2020

Organizational cronyism is profoundly ingrained in South Asian small and medium scale business and is responsible for eliciting a variety of negative individual- and organizational-level outcomes. It is a practice where management grants favour to certain employees based on personal relationships forming an “in-group” and discriminates “out-group” employees without regard to merit. This study attempts to improve understanding of the way organizational cronyism impacts the success of small and medium scale business in Pakistan through reduced employee task performance and the moderating role of egoistic climate plays in strengthening the organizational cronyism and task performance association. In addition, this study aimed to examine the complex in-group and out-group dynamics created by organizational cronyism and its subsequent outcomes. We employed an explanatory sequential mixed-method design and data were collected across two studies, i.e., a quantitative survey ( n = 321, 4 waves) and a qualitative inquiry ( n = 23) from employees working in small and medium scale enterprises of Pakistan. The results of the survey proved the direct and moderation hypotheses, while mediation hypotheses were partially substantiated. Semi-structured interviews affirmed the presence of in-groups and out-groups based on organizational cronyism in SMEs and revealed that organizational cronyism results in negative task performance regardless of the group membership and declines SMEs’ success. The overall results suggest that small and medium scale businesses in Pakistan should maintain fair and transparent business practices in order to avoid cronyism and thrive successfully.
Cost Analysis in Shoulder Surgery: A Systematic Review
Authors: Tischer Thomas , Lenz Robert , Breinlinger-O’Reilly Jochen , Lutter Christoph
Published: May 2020

Background:

Cost analysis studies in medicine were uncommon in the past, but with the rising importance of financial considerations, it has become increasingly important to use available resources most efficiently.

Purpose:

To analyze the current state of cost-effectiveness analyses in shoulder surgery.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

A systematic review of the current literature was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. All full economic analyses published since January 1, 2010 and including the terms “cost analysis” and “shoulder” were checked for usability. The methodological quality of the studies was assessed using the Oxford Centre for Evidence-Based Medicine levels of evidence and established health economic criteria (Quality of Health Economic Studies [QHES] instrument).

Results:

A total of 34 studies fulfilled the inclusion criteria. Compared with older studies, recent studies were of better quality: one level 1 study and eight level 2 studies were included. The mean QHES score was 87 of 100. The thematic focus of most studies (n = 13) was rotator cuff tears, with the main findings as follows: (1) magnetic resonance imaging is a cost-effective imaging strategy, (2) primary (arthroscopic) rotator cuff repair (RCR) with conversion to reverse total shoulder arthroplasty in case of failure is the most cost-effective strategy, (3) the platelet-rich plasma augmentation of RCR seems not to be cost-effective, and (4) the cost-effectiveness of double-row RCR remains unclear. Other studies included shoulder instability (n = 3), glenohumeral osteoarthritis (n = 3), proximal humeral fractures (n = 4), subacromial impingement (n = 4), and other shoulder conditions (n = 7).

Conclusion:

Compared with prior studies, the quality of recently available studies has improved significantly. Current studies could help decision makers to appropriately and adequately allocate resources. The optimal use of financial resources will be of increasing importance to improve medical care for patients. However, further studies are still necessary.
Corrupt governance: Self-defeating anti-corruption rhetoric and initiatives in Russia
Authors: Pavlova Elena
Published: May 2020

Resilience theory has been used to describe the “bounce back” effect—a system’s ability to recover to its normal state after a shock. While this usually applies to systems whose survival is seen in a positive light (such as democracy), this article emphasizes the other, darker side of this phenomenon. I demonstrate how anti-corruption discourse can support certain practices that actually contribute to the resilience of corruption. By comparing the anti-corruption discourses of the Russian government and its political opposition, this article shows the interdependence and mutual reinforcement of two practices: (I) the pervasive resolution of everyday problems by corrupt methods and (II) focusing on the corruption of particular actors as the main obstacle to the development of the country and society. The effect of this interdependence is ambivalent, as both practices challenge corruption and contribute to its resilience. In effect, this becomes a mode of government and I link the concept of resilience with the literature on governmentality to better illuminate the endurance of corruption in Russia despite sincere (and even well-intended) anti-corruption campaigns. This model of rethinking the resilience of corrupt practices with the special focus on anti-corruption rhetoric can be applied to other countries where corruption serves as a pivot of the social and economic system, as it does in Russia.
Competing myths of Czech identity
Authors: Chlup Radek
Published: May 2020

The article analyses the current antagonism between the Czech pro-Western liberal democratic discourse and the discourse of national sovereignty from the perspective of long-term conceptions of Czech national identity and the mythical narratives through which they have been expressed. I identify two basic mythical perspectives that have been crucial for the Czechs since the 19th century: the ‘particularist’ and the ‘universalist’. The latter originally only existed as a complement of the former, and it was not until 1968 that it was clearly expressed on its own (in its pro-Western version) in opposition to the particularist myth, eventually becoming the dominant narrative of the 1990s with their ethos of returning to the West. Once the post-revolutionary enthusiasm evaporated, however, the subsequent disillusion again came to be expressed through the particularist myth. While at present the universalist myth might seem as superior to the particularist one, from the perspective of theories of nationalism, both have their bright and dark sides, and it is only due to their present-day opposition that the particularist myth has taken the illiberal turn. A critical reflection of the limitations of both myths might allow us to soften their antagonism.
Utility of medicines information leaflets in hypertensive care in a setting with low health literacy: A cross-sectional study
Authors: Kudzinesta Mtungwazi , Mubita Mwangana , Kalemeera Francis , Godman Brian , Hango Ester , Kibuule Dan
Published: May 2020

Introduction:

Higher levels of health literacy improve utilization of health information, medication adherence and outcomes. Few studies evaluate the utility of medicines information in hypertensive care in settings with low health literacy.

Aim:

To determine the level of health literacy and utility of medicines information leaflets (MILs) among hypertensive patients in public health care in Namibia.

Methods:

A hospital-based survey among hypertensive patients receiving care at a referral hospital in Namibia from the 8 June 2018 to 29 June 2018. Patient’s health literacy and utility of MIL were assessed using three literacy tools and a survey questionnaire. Quantitative data were analysed using descriptive statistics and qualitative thematic content analysis for factors associate with the utility of the MIL.

Results:

Of the 139 patients, 63% were female and the mean age was 45.7 (range: 19.0–84.0) years. Over 85.6% had of low literacy skills (Rapid Estimate of Literacy in Medicine (REALM) score <44, that is, unable to read simple health materials), 38.8% had positive Single Item Literacy Screener (SILS) scores (⩾2, require help to read medicines information) and 66.9% had inadequate skills for comprehension, appraisal and decision-making with regard to health information (Health Literacy Skills Instrument-Short Form (HLSI-SF) score <70%). The level of access to and utility of MIL were low, 32.4% and 34.6%, respectively. The main factors associated with poor utility of the MIL were low patient health literacy, lack of guidelines on the use of MIL and MIL written in non-native languages.

Conclusion:

Low rates of health literacy and utility of MIL were observed among hypertensive patients in Namibia. The integration of health literacy programmes, and MIL guidelines are needed to promote utility of medicine information and improve medication adherence.
Urban Climate Politics in Emerging Economies: A Multi-Level Governance Perspective
Authors: Stehle Fee , Hickmann Thomas , Lederer Markus , Höhne Chris
Published: May 2020

Several scholars have pointed to the increasing salience of cities in the global endeavour to reduce dangerous climate change to 1.5°C. However, we still lack systematic comparative analyses on how urban climate initiatives evolve in different political-administrative systems of countries in the global South and what role transnational city networks play in that context. This question is specifically important with regard to the role of cities in contributing to reaching the targets of the Paris Agreement. Against this backdrop, this article explores the vertical and horizontal integration of cities’ climate actions in the multi-level climate governance landscapes in Brazil, India, Indonesia and South Africa. We contend that while transnational city networks provide significant support to cities in some cases, their tools and practices can only reach their full potential where they encounter committed local administrations and when they are not constrained by domestic political-administrative and economic factors.
How does road marking in horizontal curves influence driving behaviour?
Authors: Havránek Pavel , Zůvala Robert , Špaňhel Jakub , Herout Adam , Valentová Veronika , Ambros Jiří
Published: May 2020

Purpose

Given the inconsistent application of various road markings on Czech rural roads, there is a question “How does road marking in horizontal curves influence driving behaviour?” The study objective was to assess how centreline and edgelines influence driving behaviour.

Methods

To focus on the critical conditions, six curves on secondary rural roads, with radii below 200 m, were selected and monitored before and after application of road marking. The studied indicators were average speed and lateral position, which were collected using trajectories detected in calibrated video recordings.

Results

The results indicated that speeds decreased in both edgeline and centreline applications; regarding lateral positions, the edgelines were associated with shifting the driving trajectories towards the centre of the road, and the centrelines were associated with shifting the driving trajectories towards the road edges.

Conclusions

The indicated trends are likely to be influenced also by other factors, such as specific curve radii values, superelevation, speed profile, or parameters of road surroundings. Following study should thus focus on collecting data in a larger sample of sites and building a cross-sectional model, statistically linking the mentioned characteristics with safety.
Identifying branch-specific positive selection throughout the regulatory genome using an appropriate proxy neutral
Authors: Berrio Alejandro , Haygood Ralph , Wray Gregory A.
Published: May 2020

Background

Adaptive changes in cis-regulatory elements are an essential component of evolution by natural selection. Identifying adaptive and functional noncoding DNA elements throughout the genome is therefore crucial for understanding the relationship between phenotype and genotype.

Results

We used ENCODE annotations to identify appropriate proxy neutral sequences and demonstrate that the conservativeness of the test can be modulated during the filtration of reference alignments. We applied the method to noncoding Human Accelerated Elements as well as open chromatin elements previously identified in 125 human tissues and cell lines to demonstrate its utility. Then, we evaluated the impact of query region length, proxy neutral sequence length, and branch count on test sensitivity and specificity. We found that the length of the query alignment can vary between 150 bp and 1 kb without affecting the estimation of selection, while for the reference alignment, we found that a length of 3 kb is adequate for proper testing. We also simulated sequence alignments under different classes of evolution and validated our ability to distinguish positive selection from relaxation of constraint and neutral evolution. Finally, we re-confirmed that a quarter of all non-coding Human Accelerated Elements are evolving by positive selection.

Conclusion

Here, we introduce a method we called adaptiPhy, which adds significant improvements to our earlier method that tests for branch-specific directional selection in noncoding sequences. The motivation for these improvements is to provide a more sensitive and better targeted characterization of directional selection and neutral evolution across the genome.
A prognostic nomogram for event-free survival in patients with atrial fibrillation before cardiac resynchronization therapy
Authors: Cai Minsi , Hua Wei , Zhang Nixiao , Yang Shengwen , Hu Yiran , Gu Min , Niu Hongxia , Zhang Shu
Published: May 2020

Background

Atrial fibrillation (AF), one of the most common comorbidities of heart failure (HF), is associated with worse long-term prognosis in HF patients receiving cardiac resynchronization therapy (CRT). However, there is still no convenient tool to identify CRT candidates with AF who are at high risk of mortality and hospitalization due to HF.

Methods

We included 152 consecutive patients with AF for CRT in our hospital from January 2009 to July 2019. Multiple imputation was used for missing values. With imputed datasets, a multivariate Cox regression model was performed for variable selection using the backward stepwise method to predict all-cause mortality and HF readmissions. A nomogram and nomogram-based scoring system were constructed from the selected predictors. Then, internal validation and calibration were achieved by the bootstrap method, deriving the corrected concordance index and calibration curves. Sensitivity analysis was also performed to validate our selected predictors.

Results

Five predictors were incorporated in the nomogram, including N-terminal pro brain natriuretic protein (NT-proBNP) > 1745 pg/mL, history of syncope, previous pulmonary hypertension, moderate or severe tricuspid regurgitation, thyroid-stimulating hormone (TSH) > 4 mIU/L. The concordance index (0.70, 95% CI 0.62–0.77), corrected concordance index (0.67, 95% CI 0.59–0.74) and calibration curve showed optimal discrimination and calibration of the established nomogram. A significant difference in overall event-free survival was recognized by the nomogram-derived scores for patients with high risk (> 50 points), intermediate risk (21–50 points) and low risk (0–20 points) before CRT.

Conclusion

Our internally validated nomogram may be an applicable tool for the early risk stratification of CRT candidates with AF.
Efficacy and safety of inhaled budesonide on prevention of acute mountain sickness during emergent ascent: a meta-analysis of randomized controlled trials
Authors: Nepal Gaurav , Yadav Jayant Kumar , Rehrig Jessica Holly , Bhandari Niroj , Baniya Santosh , Ghimire Rakesh , Mahotra Narayan
Published: May 2020

Background

Acute Mountain Sickness (AMS) is a pathophysiologic process that occurs in non-acclimated susceptible individuals rapidly ascending to high-altitude. Barometric pressure falls at high altitude and it translates to a decreased partial pressure of alveolar oxygen (PAO2) and arterial oxygen (PaO2). A gradual staged ascent with sufficient acclimatization can prevent AMS but emergent circumstances requiring exposure to rapid atmospheric pressure changes – such as for climbers, disaster or rescue team procedures, and military operations – establishes a need for effective prophylactic medications. This systematic review and meta-analysis aim to analyze the incidence of AMS during emergent ascent of non-acclimatized individuals receiving inhaled budesonide compared to placebo.

Methods

This current meta-analysis was conducted according to the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We searched PubMed, Google Scholar and Embase for relevant studies. The efficacy of budesonide in reducing incidence of AMS was evaluated by calculating the pooled ORs and 95% CIs. The efficacy of budesonide in maintaining hemoglobin-oxygen saturation was evaluated by calculating standard mean difference (SMD) and 95% confidence intervals.

Results

We found that at high altitude, inhaled budesonide was effective in reducing the incidence of mild AMS [OR: 0.37; 95% CI, 0.14 to 0.9, p = 0.042] but was ineffective in reducing the incidence of severe AMS [OR: 0.46; 95% CI, 0.14 to 1.41, p = 0.17]. Inhaled budesonide was also effective in maintaining SpO2 (SMD: 0.47; 95% CI, 0.09 to 0.84, p = 0.014) at high altitude. However, it was not effective in maintaining or improving pulmonary function at high altitude. Systematic-review found no adverse effects of budesoide in the dose used for prophylaxis of AMS.

Conclusions

Our systematic review showed that prophylactic inhaled budesonide is effective in preventing mild AMS during emergency ascent but not effective in preventing severe AMS. Though statistically significant, authors recommend caution in interpretation of data and questions for further well designed randomized studies to evaluate the role of budesonide in prophylaxis of AMS during an emergent ascent.
Improving assent in health research: a rapid systematic review
Authors: Soll Dominik , Guraiib Maria Magdalena , Rollins Nigel Campbell , Reis Andreas Alois
Published: May 2020

Background

Enrolment in a research study requires the participant’s informed consent. In the case of minors, informed consent of the respective legal guardian is obtained in conjunction with informed assent of the underage p

articipant. Since comprehension of the information provided may be limited, effective interventions to improve understanding should be identified. Thus, it is the objective of this study to review quantitative studies that tested interventions to improve the understanding of information provided during assent processes in health research. The studied population consisted of minors that participated or were willing to participate in research. The primary outcome was the level of comprehension after intervention.

Methods

A systematic search was conducted in eleven databases including regional databases: PubMed, Web of Science, ERIC, PsycINFO, CINAHL, POPLINE, AIM, LILACS, WPRIM, IMSEAR, and IMEMR and included references from inception of the database until July 2018 except PubMed which spanned the period from May 2013 to July 2018. Search terms focused on Informed Consent/Assent, Minors, and Comprehension. To complement the search, reference lists of retrieved publications were additionally searched. We included all quantitative studies that were conducted in minors, tested an intervention, covered assent processes in health research, and assessed comprehension. One reviewer screened titles, abstracts, and full-texts to determine eligibility and collected data on study design, population, intervention, methods, outcome, and for critical appraisal. Interventions comprised enhanced paper forms, interspersed questions, multimedia format, and others.

Results

Out of 7089 studies initially identified, 19 studies comprising 2805 participants and conducted in seven countries were included in the review. Fourteen studies (74 %) tested an intervention against control and ten (53 %) were randomized controlled trials. Heterogeneous methodology as well as incomplete outcome and statistical reporting impaired the reliability of the collected data. Positive effects were suggested for use of enhanced paper forms, interspersed questions, use of pie charts, and organizational factors.

Conclusions

Improving assent in health research is an under-researched area with little reliable evidence. While some interventions are proposed to improve understanding in assent processes, further investigation is necessary to be able to give evidence-based recommendations.

Trial registration

PROSPERO ID: 106808.
Current methods for development of rapid reviews about diagnostic tests: an international survey
Authors: Arevalo-Rodriguez Ingrid , Steingart Karen R. , Tricco Andrea C. , Nussbaumer-Streit Barbara , Kaunelis David , Alonso-Coello Pablo , Baxter Susan , Bossuyt Patrick M. , Emparanza José Ignacio , Zamora Javier
Published: May 2020

Background

Rapid reviews (RRs) have emerged as an efficient alternative to time-consuming systematic reviews—they can help meet the demand for accelerated evidence synthesis to inform decision-making in healthcare. The synthesis of diagnostic evidence has important methodological challenges. Here, we performed an international survey to identify the current practice of producing RRs for diagnostic tests.

Methods

We developed and administered an online survey inviting institutions that perform RRs of diagnostic tests from all over the world.

Results

All participants (N = 25) reported the implementation of one or more methods to define the scope of the RR; however, only one strategy (defining a structured question) was used by ≥90% of participants. All participants used at least one methodological shortcut including the use of a previous review as a starting point (92%) and the use of limits on the search (96%). Parallelization and automation of review tasks were not extensively used (48 and 20%, respectively).

Conclusion

Our survey indicates a greater use of shortcuts and limits for conducting diagnostic test RRs versus the results of a recent scoping review analyzing published RRs. Several shortcuts are used without knowing how their implementation affects the results of the evidence synthesis in the setting of diagnostic test reviews. Thus, a structured evaluation of the challenges and implications of the adoption of these RR methods is warranted.
Probiotics use for antibiotic-associated diarrhea: a pragmatic participatory evaluation in nursing homes
Authors: van Wietmarschen Herman A. , Busch Martine , van Oostveen Annemiek , Pot Gerda , Jong Miek C.
Published: May 2020

Background

Antibiotic-associated diarrhea (AAD) occurs in 2–25% of nursing home residents, which may lead to dehydration, malnutrition, severe complications and hospitalizations. Research shows that probiotics can be effective and safe in reducing AAD. However, probiotics are not routinely used in Dutch nursing homes. The objectives of this evaluation were to develop a procedure for the implementation of probiotics to prevent AAD in nursing homes, to evaluate effects on AAD occurrence, and to evaluate the implementation process of probiotics in daily care.

Methods

A pragmatic participatory evaluation (PPE) design was chosen, as it seemed a suitable approach for implementation of probiotics, as well as for evaluation of its effectiveness in daily nursing home practice. Probiotics administration was implemented in three nursing homes of the Rivas Zorggroep for residents with somatic and/or psychogeriatric conditions. Ninety-three residents provided data on 167 episodes of antibiotics use, of which 84 episodes that included supplementation with probiotics and 83 episodes with no probiotics supplementation. A multispecies probiotics was administered twice daily upon start of antibiotic treatment, up to 1 week after completing the antibiotics course. The occurrence of AAD was monitored and a process evaluation was conducted to assess facilitators and barriers of probiotics implementation.

Results

The number of episodes with AAD when using probiotics was significantly lower than when no probiotics was used (20% vs 36%; p = 0,022, Chi-square). No significant differences in the occurrence of AAD were found between the residents taking amoxicillin/clavulanic acid or ciprofloxacin. Reported facilitators for implementation were perceived benefits of probiotics and prescription by medical staff. Reported challenges were probiotics intake by residents and individual decision-making as to which resident would benefit from it.

Conclusion

Successful implementation of probiotics demonstrated the prevention of AAD in nursing home residents.

Trial registration

ISRCTN 94786163, retrospectively registered on 3 February 2020.
Effectiveness of a community program for older adults with type 2 diabetes and multimorbidity: a pragmatic randomized controlled trial
Authors: Miklavcic John J. , Fraser Kimberly D. , Ploeg Jenny , Markle-Reid Maureen , Fisher Kathryn , Gafni Amiram , Griffith Lauren E. , Hirst Sandra , Sadowski Cheryl A. , Thabane Lehana , Triscott Jean A. C. , Upshur Ross
Published: May 2020

Background

Type II diabetes mellitus (T2DM) affects upwards of 25% of Canadian older adults and is associated with high comorbidity and burden. Studies show that lifestyle factors and self-management are associated with improved health outcomes, but many studies lack rigour or exclude older adults, particularly those with multimorbidity. More evidence is needed on the effectiveness of community-based self-management programs in older adults with T2DM and multimorbidity. The study purpose is to evaluate the effect of a community-based intervention versus usual care on physical functioning, mental health, depressive symptoms, anxiety, self-efficacy, self-management, and healthcare costs in older adults with T2DM and 2 or more comorbidities.

Methods

Community-living older adults with T2DM and two or more chronic conditions were recruited from three Primary Care Networks (PCNs) in Alberta, Canada. Participants were randomly allocated to the intervention or control group in this pragmatic randomized controlled trial comparing the intervention to usual care. The intervention involved up to three in-home visits, a monthly group wellness program, monthly case conferencing, and care coordination. The primary outcome was physical functioning. Secondary outcomes included mental functioning, anxiety, depressive symptoms, self-efficacy, self-management, and the cost of healthcare service use. Intention-to-treat analysis was performed using ANCOVA modeling.

Results

Of 132 enrolled participants (70-Intervention, 62-Control), 42% were 75 years or older, 55% were female, and over 75% had at least six chronic conditions (in addition to T2DM). No significant group differences were seen for the baseline to six-month change in physical functioning (mean difference: -0.74; 95% CI: − 3.22, 1.74; p-value: 0.56), mental functioning (mean difference: 1.24; 95% CI: − 1.12, 3.60; p-value: 0.30), or other secondary outcomes..

Conclusion

No significant group differences were seen for the primary outcome, physical functioning (PCS). Program implementation, baseline differences between study arms and chronic disease management services that are part of usual care may have contributed to the modest study results. Fruitful areas for future research include capturing clinical outcome measures and exploring the impact of varying the type and intensity of key intervention components such as exercise and diet.

Trial registration

NCT02158741 Date of registration: June 9, 2014.
Antibiotic prescribing among patients with severe infectious diseases in two private sector hospitals in Central India – a time series analysis over 10 years
Authors: Damlin Anna , Sharma Megha , Marrone Gaetano , Stålsby Lundborg Cecilia
Published: May 2020

Background

Antibiotic resistance is an emerging problem caused due to antibiotic use. In countries with high rates of infectious diseases, antibiotic resistance is a frequent cause of mortality. The aim was to analyse antibiotic prescribing practices between 2008 and 2017 in a teaching (TH) and a non-teaching (NTH) hospital, as typical hospitals of low- and middle-income countries, and to compare antibiotic prescribing for severe infectious indications for which empiric antibiotic treatment is recommended.

Methods

Data from adult patients registered at two Indian private-sector hospitals with one of the following indications: epiglottitis, pneumonia, peritonitis, pyelonephritis, cellulitis, erysipelas, septic arthritis, endocarditis, meningitis or sepsis; were included and analysed. Antibiotic prescription data was analyzed using the World Health Organization’s (WHO) Anatomical Therapeutic Chemical classification system and the Defined Daily Doses. Chi-square and linear regression were used to compare the data between groups. Time series analyses were conducted using linear regression.P-values < 0.05 were considered significant.

Results

In total, 3766 patients were included, 2504 inpatients in the NTH and 1262 in the TH, of which 92 and 89% patients, respectively, were prescribed antibiotics. Sixty-one percent of total prescriptions in the TH and 40% in the NTH comprised theaccesscategory of antibiotics (i.e. the first-choice of treatment according to the WHO). The WHO’s second-choice of treatment, thewatchcategory, comprised 29 and 40% of total prescriptions in the TH and NTH, respectively. Prescribing of fixed-dose combinations (FDCs) of antibiotics was significantly higher in the NTH (18%) than in the TH (8%,P < 0.05). Prescribing ofwatchantibiotics and FDCs increased significantly in both hospitals between 2008 and 2017 among patients with pneumonia, cellulitis and peritonitis (P < 0.05).

Conclusions

Prescribing ofwatchantibiotics and FDCs of antibiotics increased over time at both hospitals, indicating under prescribing ofaccessantibiotics and more prescribing of second-choice antibiotics. The results can be used to highlight the areas of improvement in similar settings. Implementing diagnostic routines and local prescribing guidelines could improve the prescribing practices.