bluuebunny/crossref_metadata_2025 huggingface dataset:
Playful urban intervention as creative placemaking strategy in Jakarta
Authors: Prawata Albertus Galih
Published: March 2020

This paper will discuss the interventions made by designers, artists and architects towards the urban and public spaces in Jakarta. Their urban interventions are intended to encourage creative activities, and playful experience amongst the citizens. The discussion will be based on the playful urban intervention activities during the Jakarta Architecture Triennale hosted by Indonesian Institute of Architects, Jakarta chapter. The interventions have the importance to be the urban fabrics that can create vibrant atmosphere to support the city, and they can be part of the creative sustainable city concept.
The differences of workload, fatigue, emotional intelligence and driving behavior based on age, experience, time on task per trip among Indonesian inter-city bus drivers
Authors: Zuraida Rida , Abbas Bahtiar S.
Published: March 2020

One of the factors affecting road accidents is driving behavior. The driving behavior influences by demographic aspects, fatigue, work condition, and others. To correct a behavior tendency, it is important to enhance the understanding of the influence of the demographic aspect to some factors related to the behavior tendency. This study was intended to measure the effect of age, driving experience, and time on task per trip to the workload (WL), fatigue (F), recovery needs (KP), and emotional intelligent (EI) as factors that influence driving behavior (DD). A set of questions as a research instrument was composed based on various literature. The instrument distributed to inter-city bus drivers from several bus companies. A total of 201 responds to questionnaires were obtained, but only 167 data processed further. The reliability of this instrument is quite good as indicated by the alpha Cronbach of 0.733 and the significant internal consistency result. The Kruskal Wallis test result showed that there were no differences among the above variables based on age groups (<35 y, 35-45 y, and> 45y). However, emotional intelligence differed between driving experience groups (<5 y, 5-10 y,> 10 y) and between time on task per trip (<3 hr, 3-5 hr,> 5 hr). The fatigue level also expressed differently of times on task per trip. Based on the result, it suggested to include emotional intelligence assessment in a corrected tendency behavior. The result also emphasized on time on task as a primary factor in fatigue mitigation to minimize risk accident.
Experimental Renovascular Disease Induces Endothelial Cell Mitochondrial Damage and Impairs Endothelium-Dependent Relaxation of Renal Artery Segments
Authors: Nargesi Arash Aghajani , Zhu Xiang-Yang , Saadiq Ishran M , Jordan Kyra L , Lerman Amir , Lerman Lilach O , Eirin Alfonso
Published: March 2020

BACKGROUND

Mitochondria modulate endothelial cell (EC) function, but may be damaged during renal disease. We hypothesized that the ischemic and metabolic constituents of swine renovascular disease (RVD) induce mitochondrial damage and impair the function of renal artery ECs.

METHODS

Pigs were studied after 16 weeks of metabolic syndrome (MetS), renal artery stenosis (RAS), or MetS + RAS, and Lean pigs served as control (n = 6 each). Mitochondrial morphology, homeostasis, and function were measured in isolated primary stenotic-kidney artery ECs. EC functions were assessed in vitro, whereas vasoreactivity of renal artery segments was characterized in organ baths.

RESULTS

Lean + RAS and MetS + RAS ECs showed increased mitochondrial area and decreased matrix density. Mitochondrial biogenesis was impaired in MetS and MetS + RAS compared with their respective controls. Mitochondrial membrane potential similarly decreased in MetS, Lean + RAS, and MetS + RAS groups, whereas production of reactive oxygen species increased in MetS vs. Lean, but further increased in both RAS groups. EC tube formation was impaired in MetS, RAS, and MetS + RAS vs. Lean, but EC proliferation and endothelial-dependent relaxation of renal artery segments were blunted in MetS vs. Lean, but further attenuated in Lean + RAS and MetS + RAS.

CONCLUSIONS

MetS and RAS damage mitochondria in pig renal artery ECs, which may impair EC function. Coexisting MetS and RAS did not aggravate EC mitochondrial damage in the short time of our in vivo studies, suggesting that mitochondrial injury is associated with impaired renal artery EC function.
News in Astronomy & Geophysics – April 2020
Authors: Bowler Sue
Published: March 2020

A digest of some of the big stories from the past two months
Alan S Rodger (1951–2020)
Authors: Dudeney John , Horne Richard , Lockwood Mike
Published: March 2020

John Dudeney, Richard Horne and Mike Lockwood remember a committed and generous scientist with an infectious love of life.
A mega-challenge
Authors: Massey Robert
Published: March 2020

Robert Massey shares the action that the RAS is taking – with the help of Fellows in the newly formed Policy Group – to mitigate the effects of satellite megaconstellations on astronomical observation.
Bondi on spherically symmetric accretion
Authors: Armitage Philip J
Published: March 2020

Philip J Armitage discusses the influence of Hermann Bondi's 1952 Monthly Notices paper on the treatment of a deceptively simple astrophysical process as it continues to inform our understanding of stars and black holes.
Nik Szymanek: Astrophotographer
Authors: Johnson Paul
Published: March 2020

Thirty years of chasing the ultimate astroimage have led the amateur astronomer to professional collaborations and worldwide exposure for his stunning photographs. Interview by Paul Johnson.
Pottery workers, ‘the Ladies’, and ‘the Middling Class of people’: production and marketing of ‘Etruscan and Grecian vases’ at Wedgwood c.1760–1820*
Authors: Petsalis-Diomidis Alexia
Published: March 2020

Collections of Greek vases, and their reproductions in the form of luxury publications and vessels displayed atop bookshelves in libraries, were the domain of male elites in eighteenth- and nineteenth-century Britain. Less well explored is the consumption of creative reproductions of Greek vases by elite and ‘middling’ women, and the participation of women across the social spectrum in the production of ceramics inspired by Greek vases. This article uses the Wedgwood archive to tell such stories. The subjects range from aristocratic designers through paintresses to women doing the hard labour of wedging. It argues for the importance of recognizing these engagements with Greek vases as part of the history of the reception of Greek vases in Britain. It explores the way that gender and class constrained the kind of contact women had with these materials, and it puts forward an interpretation of these engagements as independent embodied knowledge of Greek vases.
Interpretable factor models of single-cell RNA-seq via variational autoencoders
Authors: Svensson Valentine , Gayoso Adam , Yosef Nir , Pachter Lior
Published: March 2020

Motivation

Single-cell RNA-seq makes possible the investigation of variability in gene expression among cells, and dependence of variation on cell type. Statistical inference methods for such analyses must be scalable, and ideally interpretable.

Results

We present an approach based on a modification of a recently published highly scalable variational autoencoder framework that provides interpretability without sacrificing much accuracy. We demonstrate that our approach enables identification of gene programs in massive datasets. Our strategy, namely the learning of factor models with the auto-encoding variational Bayes framework, is not domain specific and may be useful for other applications.

Availability and implementation

The factor model is available in the scVI package hosted at https://github.com/YosefLab/scVI/.

Contact

v@nxn.se

Supplementary information

Supplementary data are available at Bioinformatics online.
TCRBuilder: multi-state T-cell receptor structure prediction
Authors: Wong Wing Ki , Marks Claire , Leem Jinwoo , Lewis Alan P , Shi Jiye , Deane Charlotte M
Published: March 2020

Motivation

T-cell receptors (TCRs) are immune proteins that primarily target peptide antigens presented by the major histocompatibility complex. They tend to have lower specificity and affinity than their antibody counterparts, and their binding sites have been shown to adopt multiple conformations, which is potentially an important factor for their polyspecificity. None of the current TCR-modelling tools predict this variability which limits our ability to accurately predict TCR binding.

Results

We present TCRBuilder, a multi-state TCR structure prediction tool. Given a paired αβTCR sequence, TCRBuilder returns a model or an ensemble of models covering the potential conformations of the binding site. This enables the analysis of structurally driven polyspecificity in TCRs, which is not possible with existing tools.

Availability and implementation

http://opig.stats.ox.ac.uk/resources.

Contact

deane@stats.ox.ac.uk

Supplementary information

Supplementary data are available at Bioinformatics online.
Bootstrapping M-estimators in generalized autoregressive conditional heteroscedastic models
Authors: Mukherjee K
Published: March 2020

We consider the weighted bootstrap approximation to the distribution of a class of M-estimators for the parameters of the generalized autoregressive conditional heteroscedastic model. We prove that the bootstrap distribution, given the data, is a consistent estimate in probability of the distribution of the M-estimator, which is asymptotically normal. We propose an algorithm for the computation of M-estimates which at the same time is useful for computing bootstrap replicates from the given data. Our simulation study indicates superior coverage rates for various weighted bootstrap schemes compared with the rates based on the normal approximation and existing bootstrap methods for the generalized autoregressive conditional heteroscedastic model, such as percentile $t$-subsampling schemes. Since some familiar bootstrap schemes are special cases of the weighted bootstrap, this paper thus provides a unified theory and algorithm for bootstrapping in generalized autoregressive conditional heteroscedastic models.
Utilization of Direct Oral Anticoagulants in People Living with Human Immunodeficiency Virus: Observational Data from the District of Columbia Cohort
Authors: George Jomy M , Kuriakose Safia S , Monroe Anne , Hou Qingjiang , Byrne Morgan , Pau Alice K , Masur Henry , Hadigan Colleen , Castel Amanda D , Horberg Michael A ,   District of Columbia (D.C.) Cohort Executive Committee, Binkley Jeffery , Taylor Rob , Rayeed Nabil , Akridge Cheryl , Purinton Stacey , Hou Qingjiang , Naughton Jeff , Parfitt David , D’Angelo Lawrence , Rahkmanina Natella , Kharfen Michael , Serlin Michael , Kumar Princy , Parenti David , Castel Amanda , Greenberg Alan , Monroe Anne , Happ Lindsey Powers , Jaurretche Maria , Wilbourn Brittany , Peterson James , Levy Matthew , Byrne Morgan , Ma Yan , Wilcox Ronald , Rana Sohail , Horberg Michael , Fernandez Ricardo , Kuriakose Safia , Hebou Annick , Dieffenbach Carl , George Jomy , Hadigan Colleen , Masur Henry , Pau Alice , Bordon Jose , Teferi Gebeyehu , Benator Debra , Ruiz Maria Elena , Goldstein Deborah
Published: March 2020

Background

Direct oral anticoagulants (DOACs) have become first-line treatment for venous thrombotic events. DOAC prescribing trends among people living with human immunodeficiency virus (PWH) are not well described. The coadministration of DOACs with the antiretroviral (ARV) pharmacokinetic boosters ritonavir (RTV) or cobicistat (COBI) may be complicated by pharmacokinetic interactions.

Methods

A longitudinal cohort study was conducted using the D.C. Cohort Database in Washington, D.C., from January 2011 to March 2017, to describe oral anticoagulant prescribing among PWH ≥ 18 years old and the prevalence of DOAC use with RTV or COBI. Data collection included demographic and clinical characteristics, ARV and anticoagulant prescriptions, and International Classification of Diseases Ninth and Tenth Edition diagnosis codes.

Results

Among 8315 PWH, there were 236 anticoagulant prescriptions (96 DOAC, 140 warfarin) for 206 persons. PWH prescribed anticoagulants were predominantly Black (82%) and male (82%), with a mean age at anticoagulant initiation of 56 years. DOAC use increased from 3% of total anticoagulant prescribing in 2011 to 43% in 2016, accounting for 64% of all newly recorded anticoagulant prescriptions by 2016. There were 19 bleeding events recorded among 16 individuals. Despite the Food and Drug Administration label recommendation to avoid rivaroxaban with boosted ARVs, 41% remained on boosted ARVs after rivaroxaban initiation.

Conclusions

DOAC use increased substantially in PWH by 2016. Although rivaroxaban is not recommended with RTV or COBI, concomitant use was recorded in 41% of rivaroxaban recipients in this cohort. As DOAC usage increases, clinicians need to be aware of potential DOAC/ARV interactions in order to select the most appropriate oral anticoagulant and monitoring plan for PWH.
Effects of Chinese Privet on Bees and Their Vertical Distribution in Riparian Forests
Authors: Ulyshen Michael D , Horn Scott , Hanula James L
Published: March 2020

Chinese privet (Ligustrum sinense Lour.), is known to negatively affect biodiversity near the ground in invaded forests by forming thick layers of non-native vegetation in the midstory. Whether these effects extend above the shrub layer into the canopy remains unclear. We sought to test this question by using flight-intercept traps (clear plastic panels attached to a white bucket) to sample bees at three heights (0.5, 5, and 15 m) in plots in which L. sinense had or had not been experimentally eliminated. Privet removal (i.e., restoration) resulted in significantly higher bee abundance, richness, and diversity than in invaded sites, but this effect was only observed at 0.5 m. In restored plots, bee diversity was generally higher at 5 and 15 m than near the forest floor, but there were no differences between traps at 5 and 15 m. Our findings show that bees will benefit from the removal of invasive shrubs near the forest floor but not in the canopy. Why bee diversity is higher in the canopy than near the ground in temperate deciduous forests remains unknown.

Study Implications

Chinese privet is recognized as one of the most problematic plants invading southeastern US forests where it has strong negative effects on native plant and insect diversity near the forest floor. This study tested the impacts of privet removal on the diversity of bees at three heights to determine whether the effects of removing privet extend into the canopies of temperate deciduous forests. The findings indicate that management activities aimed at eliminating Chinese privet will greatly increase bee activity near the forest floor but will not immediately impact bee numbers in the canopy.
On the Baum–Connes Conjecture for Groups Acting on CAT(0)-Cubical Spaces
Authors: Brodzki Jacek , Guentner Erik , Higson Nigel , Nishikawa Shintaro
Published: March 2020

We give a new proof of the Baum–Connes conjecture with coefficients for any second countable, locally compact topological group that acts properly and cocompactly on a finite-dimensional CAT(0)-cubical space with bounded geometry. The proof uses the Julg–Valette complex of a CAT(0)-cubical space introduced by the 1st three authors and the direct splitting method in Kasparov theory developed by the last author.
Determination of Some Common Heavy Metals and Radionuclides in Some Medicinal Herbs Using ICP-MS/MS
Authors: Thabit Tamer M A M , Elgeddawy Dalia I H , Shokr Shokr Abdelsalam
Published: March 2020

Medicinal herbs are the ancient, traditional way of treating many diseases and are now considered the first natural source of pharmaceutical active ingredients. Therefore, it is very important to focus on the hygiene of these plants so as to make sure they are safe for consumption. This work aimed to monitor the common heavy and radioactive elements in some commonly used herbs: anise, chamomile, clover, cumin, coriander, fennel, roselle, rosemary, sage, and thyme. A total of 12 elements were measured including 2 radionuclides, Al, As, Cd, Hg, Co, Cr, Ni, Pb, Sr, Th, U, and V. Heavy metals are ecologically and biologically important, and may be involved in some health disorder symptoms within the human body. Samples were digested with a microwave digester and measurements were completed with ICP-MS/MS in Helium mode to increase sensitivity, lower the background, and avoid interferences. Method validation and verification were performed through the spiking process at 2.0 µg/kg level, and then RSD, LOD, and LOQ were calculated. Recoveries ranged from 93–103% for all elements and RSD% from 2.8–9.6%. Hg and Th were not detected in all samples, while U was detected in some sample of anise, rosemary, sage, and thyme, and ranged from 0.018–0.048 mg/kg. As was detected in anise, fennel, roselle, and rosemary, and ranged from 0.0.031–5.88 mg/kg. Al, Cd, Co, Cr, Ni, Pb, Sr, and V were detected in most samples of all herbs, and ranged from 3.88–17.80, 0.122–0.654, 0.019–0.851, 0.344–2.91, 1.872–5.82, 0.120–12.56, 0.128–0.844, and 0.083–0.912 mg/kg, respectively.
Finding a Flexible Hot-Deck Imputation Method for Multinomial Data
Authors: Andridge Rebecca , Bechtel Laura , Thompson Katherine Jenny
Published: March 2020

Detailed breakdowns on totals are often collected in surveys, such as a breakdown of total product sales by product type. These multinomial data are often sparsely reported with wide variability in proportions across units. In addition, there are often true zeros that differ across units even within industry; for example, one establishment sells jeans but not shoes, and another sells shoes but not socks. It is quite common to have large fractions of missing data for these detailed items, even when totals are relatively completely observed. Hot-deck imputation, which fills in missing data with observed data values, is an attractive approach. The entire set of proportions can be simultaneously imputed to preserve multinomial distributions, and zero values can be imputed. However, it is not clear what variant of the hot deck is best. We describe a large set of “flavors” of the hot deck and compare them through simulation and by application to data from the 2012 Economic Census. We consider different ways to create the donor pool: choosing one nearest neighbor (NN), choosing from five NNs, or using all units as the donor pool. We also consider different ways to impute from the donor: directly impute the donor’s vector of proportions or randomly draw from a multinomial distribution using this vector of proportions. We consider scenarios where a strong predictor of these multinomial distributions exists as well as when covariate information is weak.
Prerenal acute kidney injury—still a relevant term in modern clinical practice?
Authors: Bonavia Anthony , Vece Gregory , Karamchandani Kunal
Published: March 2020

The traditional taxonomy of acute kidney injury (AKI) has remained pervasive in clinical nephrology. While the terms ‘prerenal’, ‘intrarenal’ and ‘postrenal’ highlight the diverse pathophysiology underlying AKI, they also imply discrete disease pathways and de-emphasize the nature of AKI as an evolving clinical syndrome with multiple, often simultaneous and overlapping, causes. In a similar vein, prerenal AKI comprises a diverse spectrum of kidney disorders, albeit one that is often managed by using a standardized clinical algorithm. We contend that the term ‘prerenal’ is too vague to adequately convey our current understanding of hypoperfusion-related AKI and that it should thus be avoided in the clinical setting. Practice patterns among nephrologists indicate that AKI-related terminology plays a significant role in the approaches that clinicians take to patients that have this complex disease. Thus, it appears that precise terminology does impact the treatment that patients receive. We will outline differences in the diagnosis and management of clinical conditions lying on the so-called prerenal disease spectrum to advocate caution when administering intravenous fluids to these clinically decompensated patients. An understanding of the underlying pathophysiology may, thus, avert clinical missteps such as fluid and vasopressor mismanagement in tenuous or critically ill patients.
A Broken Antibiotic Market: Review of Strategies to Incentivize Drug Development
Authors: Bhavnani Sujata M , Krause Kevin M , Ambrose Paul G
Published: March 2020

The threat posed by infections arising from antimicrobial-resistant bacteria is a global concern. Despite this trend, the future development of new antimicrobial agents is currently very uncertain. The lack of commercial success for newly launched antimicrobial agents provides little incentive to invest in the development of new agents. To address this crisis, a number of push and pull incentives have been constructed to support antimicrobial drug development. Push incentives, which are designed to lower the cost of developing new antimicrobial agents, include grants, contracts, public-private partnerships, tax credits, and clinical trial networks. Pull incentives, which are designed to facilitate higher financial returns for a newly launched antimicrobial agent, include those that decrease the time for a regulatory review, extend patent exclusivity, or provide premium pricing. Such incentives may also include direct, advanced, or milestone payments or they may be insurance-based whereby healthcare systems pay for the right to access an antimicrobial agent rather than the number of units administered. Another strategy involves the re-evaluation of interpretive criteria for in vitro susceptibility testing (susceptibility breakpoints) of old antimicrobial agents using the same standards applied to those of new agents, which will allow for an accurate determination of antimicrobial resistance. Although each of the above-described strategies will be important to ensure that antimicrobial agents are developed in the decades to come, the update of susceptibility breakpoints for old agents is a strategy that could be implemented quickly and one that could be the most effective for incentivizing drug developers and financiers to reconsider the development of antimicrobial agents.
L’assurance médicaments au Canada : le point de vue de la pédiatrie
Authors: McLaughlin Tom , Jong Geert ‘t , Gilpin Andrea , Hepburn Charlotte Moore
Published: March 2020

Le système d’assurance médicaments du Canada est l’un des plus coûteux au monde, mais des millions de Canadiens peinent pourtant à accéder aux médicaments dont ils ont besoin. C’est pourquoi les gouvernements fédéral, provinciaux et territoriaux envisagent des propositions de polices d’assurance médicaments publiques pour tous les Canadiens. Les polices d’assurance médicaments permettent de prioriser les enfants et les adolescents, dont les besoins pharmacologiques particuliers ont longtemps été négligés. La prise de médicaments sur ordonnance est courante au sein de cette population, puisqu’environ la moitié des enfants et des adolescents canadiens ont besoin d’au moins une ordonnance au cours d’une année donnée. La prise de médicaments demeure toutefois concentrée au sein des populations atteintes de maladies complexes, chroniques ou graves. Les enfants et les adolescents recourent largement aux préparations magistrales et aux médicaments dans un emploi non conforme à l’étiquette, ce qui a une incidence sur l’innocuité, l’efficacité, la palatabilité et les coûts. Les organes décisionnels en matière de remboursement n’accordent pas toute l’importance qu’ils devraient aux avantages uniques des médicaments pédiatriques, ce qui inclut les formulations adaptées à la pédiatrie, une meilleure qualité de vie pour les enfants et les familles et les économies à l’extérieur du système de santé. Quel que soit le modèle d’assurance médicaments finalement adopté, il est essentiel d’offrir une couverture d’assurance médicaments sur ordonnance complète, universelle et transférable pour tous les enfants et les adolescents. C’est pourquoi les experts des médicaments pédiatriques doivent créer un formulaire national de médicaments pédiatriques fondé sur des données probantes. Santé Canada doit également améliorer les processus pour que les formulations et médicaments commerciaux adaptés à la pédiatrie deviennent plus disponibles et accessibles. À cette fin, le gouvernement fédéral doit également soutenir la recherche-développement des médicaments pédiatriques.
Morphine post-conditioning-induced up-regulation of lncRNA TINCR protects cardiomyocytes from ischemia–reperfusion injury via inhibiting degradation and ubiquitination of FGF1
Authors: Wang M , Liu S , Wang H , Tang R , Chen Z
Published: March 2020

Background

Our previous study has demonstrated that morphine post-conditioning (MpostC) protects cardiomyocytes from ischemia/reperfusion (I/R) injury partly through activating protein kinase-epsilon (PKCε) signaling pathway and subsequently inhibiting mitochondrial permeability transition pore (mPTP) opening.

Aim

In this study, we aim to investigate the relationship between long non-coding RNA TINCR and PKCε in cardiomyocytes under MpostC-treated I/R injury.

Design

The myocardial I/R rat model was established by the ligation of lower anterior descending coronary artery for 45 min followed by the reperfusion for 1 h, and MpostC was performed before the reperfusion.

Method

H/R and MpostC were performed in the rat cardiomyocyte cell line (H9C2), and the Cytochrome-c release in cytosol and mPTP opening were determined. Cell viability was detected by using Cell Counting Kit-8, and cell apoptosis was determined by using flow cytometry or TUNEL assay.

Results

The results indicated that MpostC restored the expression of TINCR in I/R rat myocardial tissues. In cardiomyocytes, the therapeutic effect of MpostC, including reduced mPTP opening, reduced Cytochrome-c expression, increased cell viability and reduced cell apoptosis, was dramatically negated by interfering TINCR. The expression of fibroblast growth factor 1 (FGF1), a protein that activates PKCε signaling pathway, was positively correlated with TINCR. The RNA immunoprecipitation and RNA pull-down assay further confirmed the binding between FGF1 and TINCR. Furthermore, TINCR was demonstrated to inhibit the degradation and ubiquitination of FGF1 in cardiomyocytes using the cycloheximide experiment and the ubiquitination assay. The TINCR/FGF1/PKCε axis was revealed to mediate the protective effect of MpostC against hypoxia/reoxygenation injury both in vitro and in vivo.

Conclusion

In conclusion, our findings demonstrated that MpostC-induced up-regulation of TINCR protects cardiomyocytes from I/R injury via inhibiting degradation and ubiquitination of FGF1, and subsequently activating PKCε signaling pathway, which provides a novel insight in the mechanism of TINCR and PKCε during MpostC treatment of I/R injury.
Milk yield and composition from ewes fed diets containing narasin and their lambs’ performance
Authors: Sardinha Lairana A , Marques Rodrigo S , Miszura Alexandre A , Barroso José Paulo R , Oliveira Gabriela B , Martins André S , Limede Arnaldo C , Ferraz Jr Marcos Vinicius C , Ferreira Evandro M , Pires Alexandre V , Eastridge Maurice L , Polizel Daniel M
Published: March 2020

The changes promoted by feed additives in ruminal fermentation, especially increasing the availability of propionate, can improve the energy balance of an animal, which is of great importance in the lactation period. This trial aimed to evaluate the inclusion of narasin in the diet of lactating ewes on milk yield, composition, dry matter intake (DMI), and plasma metabolites of the ewes and growth rate of lambs. Thirty-two lactating ewes (59.0 ± 2.42 kg) were assigned to a randomized complete block design. The experimental diets contained 500 g/kg of dry matter (DM) of coast cross (Cynodon dactylon (L.) Pers) hay and 500 g/kg DM of concentrate, and the treatments were: N0—no narasin inclusion; N13—inclusion of 13 mg of narasin/kg DM. Once a week, from week 2 to 10 of lactation, ewes were separated from their lambs, injected with oxytocin, and milked mechanically to empty the udder. After 3 h, the milk production was recorded, using the same procedure, and sampled to evaluate the composition. The blood samples were taken weekly, 4 h after feeding. The average daily gain (ADG) and starter DMI of the lambs were evaluated weekly from week 2 to 12 of age. The inclusion of narasin did not affect (P = 0.93) DMI of ewes; however, it increased milk production (P < 0.01) and feed efficiency (P = 0.02; FE). Ewes fed N13 had a greater milk fat (P < 0.01), protein (P < 0.01), lactose (P = 0.04), and total solids production (P < 0.01). Narasin inclusion in ewe’s diet increased plasma glucose concentration (P = 0.05) at weeks 8, 9 and 10; however, there was no effect on plasma urea concentration (P = 0.96). The lambs of N0 ewes had a greater starter DMI (P < 0.01) at weeks 7, 8, 9, and 10; however, the ADG and body weight at weaning and after weaning were similar between treatments (P > 0.05). The results showed that the inclusion of 13 mg of narasin/kg DM improved the milk production and FE of the ewes without altering the composition of the milk. The lower initial consumption of concentrate by N13 lambs before weaning was caused by the higher production of milk. The results obtained in the present study demonstrate the possible productive gain with the inclusion of narasin in diets for lactating ewes.
ADN to BSN Transitioning: An Early Decision Model
Authors: Jones Melinda Mitchell , Chapman Karla , Lacy Darlene , Cannon Sharon , Schnetter Vicki
Published: March 2020

Incentivizing nursing students in associate degree programs (ADN) and facilitating transition into RN-to-BSN studies has been a goal of the nursing profession. One partnership has established an “early decision” model for students who want to declare their intent to seek a BSN while earning the ADN. This article discusses how the model creates a relationship between the college, the university, and the student to support the student’s transition to the university and academic success.
Standardization in the MSPE: Key Tensions for Learners, Schools, and Residency Programs
Authors: Hauer Karen E. , Giang Daniel , Kapp Meghan E. , Sterling Robert
Published: March 2020

The Medical Student Performance Evaluation (MSPE), which summarizes a medical student’s academic and professional undergraduate medical education performance and provides salient information during the residency selection process, faces persistent criticisms regarding heterogeneity and obscurity. Specifically, MSPEs do not always provide the same type or amount of information about students, especially from diverse schools, and important information is not always easy to find or interpret. To address these concerns, a key guiding principle from the Recommendations for Revising the MSPE Task Force of the Association of American Medical Colleges (AAMC) was to achieve “a level of standardization and transparency that facilitates the residency selection process.” Benefits of standardizing the MSPE format include clarification of performance benchmarks or metrics, consistency across schools to enhance readability, and improved quality. In medical education, standardization may be an important mechanism to ensure accountability of the system for all learners, including those with varied backgrounds and socioeconomic resources. In this article, members of the aforementioned AAMC MSPE task force explore 5 tensions inherent in the pursuit of standardizing the MSPE: (1) presenting each student’s individual characteristics and strengths in a way that is relevant, while also working with a standard format and providing standard content; (2) showcasing school-specific curricular strengths while also demonstrating standard evidence of readiness for internship; (3) defining and achieving the right amount of standardization so that the MSPE provides useful information, adds value to the residency selection process, and is efficient to read and understand; (4) balancing reporting with advocacy; and (5) maintaining standardization over time, especially given the tendency for the MSPE format and content to drift. Ongoing efforts to promote collaboration and trust across the undergraduate to graduate medical education continuum offer promise to reconcile these tensions and promote successful educational outcomes.
Opioid Stewardship Program and Postoperative Adverse Events
Authors: Barreveld Antje M. , McCarthy Robert J. , Elkassabany Nabil , Mariano Edward R. , Sites Brian , Ghosh Roshni , Buvanendran Asokumar
Published: March 2020

Background

A 6-month opioid use educational program consisting of webinars on pain assessment, postoperative and multimodal pain opioid management, safer opioid use, and preventing addiction coupled with on-site coaching and monthly assessments reports was implemented in 31 hospitals. The authors hypothesized the intervention would measurably reduce and/or prevent opioid-related harm among adult hospitalized patients compared to 33 nonintervention hospitals.

Methods

Outcomes were extracted from medical records for 12 months before and after the intervention start date. Opioid adverse events, evaluated by opioid overdose, wrong substance given or taken in error, naloxone administration, and acute postoperative respiratory failure causing prolonged ventilation were the primary outcomes. Opioid use in adult patients undergoing elective hip or knee arthroplasty or colorectal procedures was also assessed. Differences-in-differences were compared between intervention and nonintervention hospitals.

Results

Before the intervention, the incidence ± SD of opioid overdose, wrong substance given, or substance taken in error was 1 ± 0.5 per 10,000 discharges, and naloxone use was 117 ± 13 per 10,000 patients receiving opioids. The incidence of respiratory failure was 42 ± 10 per 10,000 surgical discharges. A difference-in-differences of –0.2 (99% CI, –1.1 to 0.6, P = 0.499) per 10,000 in opioid overdose, wrong substance given, or substance taken in error and –13.6 (99% CI, –29.0 to 0.0, P = 0.028) per 10,000 in respiratory failure was observed postintervention in the intervention hospitals; however, naloxone administration increased by 15.2 (99% CI, 3.8 to 30.0, P = 0.011) per 10,000. Average total daily opioid use, as well as the fraction of patients receiving daily opioid greater than 90 mg morphine equivalents was not different between the intervention and nonintervention hospitals.

Conclusions

A 6-month opioid educational intervention did not reduce opioid adverse events or alter opioid use in hospitalized patients. The authors’ findings suggest that despite opioid and multimodal analgesia awareness, limited-duration educational interventions do not substantially change the hospital use of opioid analgesics.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Defining the Minimal Clinically Important Difference and Patient-acceptable Symptom State Score for Disability Assessment in Surgical Patients
Authors: Shulman Mark A. , Kasza Jessica , Myles Paul S.
Published: March 2020

Background

The World Health Organization Disability Assessment Schedule 2.0 has been used to measure postoperative disability in several clinical trials and cohort studies. It is uncertain what the minimal clinically important difference or patient-acceptable symptom state scores are for this scale in patients recovering from surgery.

Methods

The authors analyzed prospectively collected data from three studies that measured disability 3 and 6 months after surgery. Three distribution-based methods (0.3 multiplied by SD, standard error of the measurement, and 5% range) and two anchor-based methods (anchored to two patient-rated health status questions and separately to unplanned hospital readmission) were averaged to estimate the minimal clinically important difference for the World Health Organization Disability Assessment Schedule 2.0 score converted to a percentage scale. Scores consistent with a patient-acceptable symptom state and clinically significant disability were determined by an anchored 75th centile method.

Results

Data from 4,361 patients were analyzed. The average minimal clinically important difference estimate for the World Health Organization Disability Assessment Schedule 2.0 was 5%, with similar estimates in patients with or without preoperative disability. The patient-acceptable symptom state score was 16%, and the score consistent with at least moderate clinically significant disability was 35%. Using these estimates, between baseline and 6 months after surgery, 21% of patients had a significant increase in disability, and 73% achieved a patient-acceptable symptom state.

Conclusions

A change in World Health Organization Disability Assessment Schedule 2.0 score of 5% or more after surgery is consistent with a clinically important change in disability. Patients with a score less than 16% after surgery have an acceptable symptom state and can be considered as disability-free, whereas patients with a score of 35% or more can be considered as having at least moderate clinically significant disability.

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Association of Surgical Hospitalization with Brain Amyloid Deposition
Authors: Walker Keenan A. , Gottesman Rebecca F. , Coresh Josef , Sharrett A. Richey , Knopman David S. , Mosley Thomas H. , Alonso Alvaro , Zhou Yun , Wong Dean F. , Brown Charles H.
Published: March 2020

Background

As more older adults undergo surgery, it is critical to understand the long-term effects of surgery on brain health, particularly in relation to the development of Alzheimer’s disease. This study examined the association of surgical hospitalization with subsequent brain β-amyloid deposition in nondemented older adults.

Methods

The Atherosclerosis Risk in Communities–Positron Emission Tomography (ARIC–PET) study is a prospective cohort study of 346 participants without dementia who underwent florbetapir PET imaging. Active surveillance of local hospitals and annual participant contact were used to gather hospitalization and surgical information (International Classification of Disease, Ninth Revision, Clinical Modification codes) over the preceding 24-yr period. Brain amyloid measured using florbetapir PET imaging was the primary outcome. Elevated amyloid was defined as a standardized uptake value ratio of more than 1.2.

Results

Of the 313 participants included in this analysis (age at PET: 76.0 [SD 5.4]; 56% female), 72% had a prior hospitalization, and 50% had a prior surgical hospitalization. Elevated amyloid occurred in 87 of 156 (56%) participants with previous surgical hospitalization, compared with 45 of 87 (52%) participants who had no previous hospitalization. Participants with previous surgical hospitalizations did not show an increased odds of elevated brain amyloid (odds ratio, 1.32; 95% CI, 0.72 to 2.40; P = 0.370) after adjusting for confounders (primary analysis). Results were similar using the reference group of all participants without previous surgery (hospitalized and nonhospitalized; odds ratio, 1.58; 95% CI, 0.96 to 2.58; P = 0.070). In a prespecified secondary analysis, participants with previous surgical hospitalization did demonstrate increased odds of elevated amyloid when compared with participants hospitalized without surgery (odds ratio, 2.10; 95% CI, 1.09 to 4.05; P = 0.026). However, these results were attenuated and nonsignificant when alternative thresholds for amyloid-positive status were used.

Conclusions

The results do not support an association between surgical hospitalization and elevated brain amyloid.

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Delivery at 39 Weeks of Gestation
Authors: Ayala Nina K. , Lewkowitz Adam K. , Rouse Dwight J.
Published: March 2020

It has long been observed that neonates born between 39 and 40 gestational weeks have the best perinatal outcomes. What has not been known, until recently, is whether these ideal perinatal outcomes would be achieved in neonates whose delivery was brought on intentionally in this window by labor induction. Recent randomized trials and large observational cohorts have answered this question: labor induction, as compared with expectant management, lowers the rate of cesarean delivery (without increasing other adverse maternal outcomes) and improves perinatal outcomes. For those women still pregnant, delivery at 39 weeks of gestation would simultaneously lower the number of cesarean deliveries and reduce the number of stillbirths and neonatal deaths in the United States.
The Nature of Suffering, Health Care “Providers,” and the Opioid Crisis
Authors: Wall L. Lewis
Published: March 2020

Over the past 40 years, American medicine has become corporatized. Medical care has become permeated by a business philosophy whose primary concern is increasing shareholder value rather than providing optimal care for patients. Patient–physician relationships have eroded as the health care system has turned its attention toward electronic medical records (rather than face-to-face interactions with patients), toward quantifiable (“billable”) metrics, and toward calculating the relative value units delivered by various health care “providers.” An emphasis on clinical efficiency has diminished the depth of patient–physician contacts and has tended to promote quick, superficial interactions. Patients in pain are often overmedicated rather than listened to and understood. Suffering (which is at bottom a problem about the meaning of illness) has lost its place as a major medical concern. It is often easier to write a prescription for a powerful narcotic than to probe the details of a patient's life. This unfortunate tendency to seek quick, pill-based solutions to pain has been reinforced by the pharmaceutical industry, which has promoted this simple but profitable approach through the aggressive marketing of oxycodone and related medications. Both patients and physicians have lost out in the process. We need to reconstruct a health care system that gives pain its due but places that pain in the larger context of a patient's suffering. This can only be done by restoring clinicians to their preeminent place in medicine. We must strive to be healers, not simply providers.
Social Determinants of Pregnancy-Related Mortality and Morbidity in the United States
Authors: Wang Eileen , Glazer Kimberly B. , Howell Elizabeth A. , Janevic Teresa M.
Published: March 2020

OBJECTIVE:

To synthesize the literature on associations between social determinants of health and pregnancy-related mortality and morbidity in the United States and to highlight opportunities for intervention and future research.

DATA SOURCES:

We performed a systematic search using Ovid MEDLINE, CINAHL, Popline, Scopus, and ClinicalTrials.gov (1990–2018) using MeSH terms related to maternal mortality, morbidity, and social determinants of health, and limited to the United States.

METHODS OF STUDY SELECTION:

Selection criteria included studies examining associations between social determinants and adverse maternal outcomes including pregnancy-related death, severe maternal morbidity, and emergency hospitalizations or readmissions. Using Covidence, three authors screened abstracts and two screened full articles for inclusion.

TABULATION, INTEGRATION, AND RESULTS:

Two authors extracted data from each article and the data were analyzed using a descriptive approach. A total of 83 studies met inclusion criteria and were analyzed. Seventy-eight of 83 studies examined socioeconomic position or individual factors as predictors, demonstrating evidence of associations between minority race and ethnicity (58/67 studies with positive findings), public or no insurance coverage (21/30), and lower education levels (8/12), and increased incidence of maternal death and severe maternal morbidity. Only 2 of 83 studies investigated associations between these outcomes and socioeconomic, political, and cultural context (eg, public policy), and 20 of 83 studies investigated material and physical circumstances (eg, neighborhood environment, segregation), limiting the diversity of social determinants of health studied as well as evaluation of such evidence.

CONCLUSION:

Empirical studies provide evidence for the role of race and ethnicity, insurance, and education in pregnancy-related mortality and severe maternal morbidity risk, although many other important social determinants, including mechanisms of effect, remain to be studied in greater depth.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42018102415.
Figure-of-eight brace versus sling: a retrospective cohort study of effect on shortening for displaced midshaft pediatric clavicular fractures
Authors: Sugalski Christopher , Mundy Andrew , Buchan Daniel , Everhart Joshua S. , Samora Walter P.
Published: March 2020

Background:

We sought to determine if there is a difference in clavicle shortening when utilizing figure-of-eight braces versus simple sling treatments for completely displaced midshaft fractures in the pediatric population.

Methods:

A pediatric level I trauma center patient database was queried for diagnosis of clavicular fracture between January 2009 and December 2014 for patients between the ages of 10 to 18 yr. Radiographs were reviewed and 100% displaced midshaft fractures identified. Initial injury and follow-up radiographs were measured for longitudinal shortening. Change in shortening was calculated as the difference in the initial injury and the follow-up measurements.

Results:

Records of 1153 patients with clavicular fractures were reviewed, and 126 were identified with 100% displaced midshaft fractures, adequate radiographic imaging, and nonoperative treatment. Ninety-seven patients (77%) were treated with a figure-of-eight brace. Twenty-nine patients (23%) were treated with a sling. Change in shortening was −0.4 mm and −1.9 mm for the figure-of-eight brace and sling, respectively (P=0.14), indicating further shortening in both treatment groups. No significant differences were observed between treatment groups with respect to age, side injured, length of radiographic follow-up, initial shortening, or change in shortening.

Conclusions:

There is no significant difference in change in shortening for 100% displaced midshaft pediatric clavicular fractures when comparing treatment with a figure-of-eight brace versus treatment with a sling. There is a trend toward improved alignment (2.6 mm lengthening) for more significantly displaced fractures (>10 mm); however, the clinical significance of the finding is indeterminate.

Level of Evidence:

Level III.