bluuebunny/crossref_metadata_2025 huggingface dataset:
Hospital‐based health systems 20 years later: A taxonomy for policy research and analysis
Authors: Shortell Stephen M. , Gottlieb Daniel J. , Martinez Camblor Pablo , O’Malley A. James
Published: January 2021

Objective

Building on the original taxonomy of hospital‐based health systems from 20 years ago, we develop a new taxonomy to inform emerging public policy and practice developments.

Data Sources

The 2016 American Hospital Association's (AHA) Annual Survey; the 2016 IQVIA Healthcare Organizations and Systems (HCOS) database; and the 2017‐2018 National Survey of Healthcare Organizations and Systems (NSHOS).

Study Design

Cluster analysis of the 2016 AHA Annual Survey data to derive measures of differentiation, centralization, and integration to create categories or types of hospital‐based health systems.

Data Collection

Principal components factor analysis with varimax rotation generating the factors used in the cluster algorithms.

Principal Findings

Among the four cluster types, 54% (N = 202) of systems are decentralized (−0.35) and relatively less differentiated (−0.37); 23% of systems (N = 85) are highly differentiated (1.28) but relatively decentralized (−0.29); 15% (N = 57) are highly centralized (2.04) and highly differentiated (0.65); and approximately 9 percent (N = 33) are least differentiated (−1.35) and most decentralized (−0.64). Despite differences in calculation, the Highly Centralized, Highly Differentiated System Cluster and the Undifferentiated, Decentralized System Cluster were similar to those identified 20 years ago. The other two system clusters contained similarities as well as differences from those 20 years ago. Overall, 82 percent of the systems remain relatively decentralized suggesting they operate largely as holding companies allowing autonomy to individual hospitals operating within the system.

Conclusions

The new taxonomy of hospital‐based health systems bears similarities as well as differences from 20 years ago. Important applications of the taxonomy for addressing current challenges facing the healthcare system, such as the transition to value‐based payment models, continued consolidation, and the growing importance of the social determinants of health, are highlighted.
Prehospital Resuscitation Decision Making: A model of ambulance personnel experiences, preparation and support
Authors: Anderson Natalie E , Slark Julia , Gott Merryn
Published: January 2021

Objective

This paper presents the first Naturalistic Decision Making model of prehospital resuscitation decision‐making, which has clear implications for education, practice and support.

Methods

A mixed‐methods exploratory sequential research design consisting of interviews with ambulance personnel (study 1), focus groups with ambulance educators, managers and peer supporters (study 2), and an online survey of graduating paramedic students (study 3). This paper reports the model developed from integrated findings, across all three studies. All research was undertaken in New Zealand and underpinned by a critical realist worldview.

Results

The Prehospital Resuscitation Decision Making model identifies key processes, challenges and facilitators before, during and after ambulance personnel attend a cardiac arrest event. It is the only descriptive model of resuscitation decision making which acknowledges the decision‐maker, non‐prognostic factors and the importance of adequate preparation and support.

Conclusions

This research project is the first to comprehensively explore and model ambulance personnel perspectives on decisions to start, continue or stop resuscitation. The decision‐making process is complex and difficult to simply formularise. Education and supports must assist ambulance personnel in navigating this complexity. Where resuscitation is withheld or terminated, ambulance personnel need to feel confident that they can effectively provide after‐death care.
Sanction risk perceptions, coherence, and deterrence*
Authors: Barnum Timothy C. , Nagin Daniel S. , Pogarsky Greg
Published: January 2021

Research from environmental criminology, policing, and related literatures consistently finds that objective conditions related to risk of apprehension affect crime. The mechanism underlying this relationship is not explicitly tested; instead, perceptual deterrence is assumed. In this analysis we explicitly investigate that mechanism. This test is not straightforward, however, as some research shows that risk perceptions are susceptible to various cognitive biases and framing effects. Thus, we advance a framework of sanction risk perception that combines individual and contextual determinants. Specifically, we investigate whether contextual factors materially influence risk perceptions and in turn intentions to offend after accounting for the influence of individual‐specific determinants. Our data come from an experimental survey on speeding (N = 1,919). Respondents viewed videos from the driver's perspective of a sedan speeding on a highway and provided estimates of sanction risk, safety perceptions, and behavioral intentions. Although sanction risk and safety perceptions for speeding varied widely across respondents, they remained grounded in the objective conditions of the experimental videos. In turn, citizen perceptions of apprehension risk were comparable with risk estimates elicited from state troopers after viewing the same videos. The results suggest deterrence and safety considerations are important contributing factors that help shape intentions to transgress.
Effects of ultraviolet radiation onCulex quinquefasciatusimmature stages
Authors: Munawar Kashif , Alahmed Azzam M. , Khalil Sayed M.S.
Published: January 2021

Ultraviolet radiation has negative effects on different living organisms. The effects of ultraviolet radiation have been widely studied on some insects, such as stored‐product pests. However, few studies have examined the effects of ultraviolet radiation on mosquitoes. In this study, we report the effect of ultraviolet radiation type C, or ultraviolet C, on the immature stages ofCulex quinquefasciatus. Our results suggest that early larval instars were more susceptible to ultraviolet C than late instars, and longer ultraviolet C exposure times were more lethal to larvae regardless of age. Ultraviolet C caused 100% mortality in pupae after 11 minutes of exposure. No egg hatching was observed after 15 minutes of exposure. Mortality in immature stages occurred over time, especially during larval molting and adult emergence.
Prebiotic frozen dessert processed with water‐soluble extract of rice byproduct: Vegan and nonvegan consumers perception using preferred attribute elicitation methodology and acceptance
Authors: da Silva Jiuliane Martins , Barão Carlos Eduardo , Esmerino Erick Almeida , Cruz Adriano Gomes , Pimentel Tatiana Colombo
Published: January 2021

The objective of this study was to assess the perceptions (using the preferred attribute elicitation [PAE] methodology) and acceptance of frozen dessert processed with water‐soluble extract of rice byproduct and added with prebiotic components (long‐chain inulin, medium‐chain inulin, oligofructose, or polydextrose, 5 g/100 g) by vegan or nonvegan consumers. Most of the elicited attributes (9 out of 13 attributes, yellow color, brightness, creamy appearance, passion fruit aroma, sweet taste, passion fruit flavor, acid taste, sour taste, and creamy texture) were considered important for the characterization and/or acceptance of the frozen dessert formulations by both groups (vegan and nonvegan), but the order of importance was different between the groups. The sensory profile (Rv = 0.48, P = 0.03 in MFA) of the frozen dessert formulations was similar between vegan and nonvegan groups, and polydextrose contributed to increase firmness/consistency of the frozen dessert, while long‐chain inulin contributed to the increase in the creaminess of the products. Finally, oligofructose and polydextrose could reduce the sour taste of the products. The consumers gave scores from 6 to 8 in a 9‐point hedonic scale for the products, suggesting suitable acceptance. However, vegan consumers gave lower scores for the same products. In conclusion, PAE methodology can be used to compare the perception of different consumer groups, and vegan and nonvegan consumers have a similar perception about prebiotic frozen dessert processed with water‐soluble extract of rice byproduct. Furthermore, the frozen dessert developed had suitable consumer acceptance, although vegan gave lower scores than nonvegan consumers.

Practical Application

This is the first study involving the development of prebiotic frozen dessert from water‐soluble extract of rice byproduct and application of PAE to assess the sensory perception of vegan and nonvegan consumers. The results are important for the industry as they indicate that the PAE methodology can be used to characterize food products, compare the perception of different consumer groups, and elicit attributes that are important for the products, suggesting that universal marketing strategies could be used and that the developed frozen dessert could serve both vegan consumers and those on conventional diets.
Advances in our understanding and distribution of the Cronobacter genus in China
Authors: Ling Na , Jiang Yujun , Zeng Haiyan , Ding Yu , Forsythe Stephen
Published: January 2021

This review considers how research in China has progressed our understanding and subsequent improved control of Cronobacter. This emergent bacterial pathogen is associated with neonatal infections through the ingestion of contaminated prepared feed. The review includes large‐scale surveys of various sources of the organism, including infant formula production facilities. The analysis of over 20,000 samples is presented. Over 10,000 being from powdered infant formula and other infant foods as well as environmental sampling of production facilities, the remaining being from food, food ingredients, and human carriage. A major advance in China was adopting DNA‐sequence‐based methods (that is, multilocus sequence typing, clustered regularly interspaced short palindromic repeats‐cas array profiling, and single‐nucleotide polymorphism analysis) for the identification and genotyping of the organism. These methods have considerably advanced our understanding of the taxonomy, ecology, and virulence of this organism. In turn, this has improved source tracking of the organism both in infant formula production facilities and epidemiological investigations. Furthermore, whole‐genome sequencing has revealed a range of virulence and persistence mechanisms as well as plasmid‐borne multidrug resistance traits. China now has reliable and robust methods for accurate microbial source tracking of Cronobacter for use both in the food production environment and epidemiological analysis.
Investigation on the correlation between changes in water and texture properties during the processing of surimi from golden pompano (Trachinotus ovatus)
Authors: Liu Yang , Sun Qinxiu , Pan Yanmo , Wei Shuai , Xia Qiuyu , Liu Shucheng , Ji Hongwu , Deng Chujin , Hao Jiming
Published: January 2021

Water and texture properties are important indicators for evaluating surimi and surimi seafood quality. The present study assessed the impact of surimi processing on the water and texture properties and analyzed their correlations. The results showed that the moisture content exhibited significant positive correlations with T22 and A22 (P < 0.05). However, water‐holding capacity (WHC) revealed significant negative correlation with T21 and A22 (P < 0.05). Moreover, correlations between water and texture properties were observed. Moisture content and A22 displayed significant negative correlation with hardness (P < 0.05). WHC exhibited significant positive correlations with cohesiveness, springiness, and chewiness (P < 0.05), whereas T21 exhibited significant negative correlation with those properties (P < 0.05). Springiness is an important indicator for texture properties of surimi gel. T21 and WHC exhibited significant correlations with springiness (P < 0.05). We used two equations to assess the relationship between springiness and T21 (y = 9.64 × x2 − 33.79 × x + 29.62, R2 = 0.995, P < 0.05) and between springiness and WHC (y = 0.57 + 9.05/{1+e[−29.29 × (x − 83.90)]}0.01, R2 = 0.999, P < 0.05), respectively. Verification experiments proved that these two regression equations could be used to predict the change law among feature indicators during the processing of surimi seafood. The present study finds an easy‐to‐control method to monitor the quality of surimi production and processing for all the stages, and provides ideas for quality design of surimi products.

Practical Application

The quality of surimi seafood is affected by the process used for surimi production. Early detection of the material quality can efficiently prevent resource wastage. The feature indicators and their correlations help in easy‐to‐control of all surimi processing stages. Low‐field nuclear magnetic resonance (LF‐NMR) is a fast, nondestructive method for monitoring food real‐time, but the instrument is expensive; whereas water‐holding capacity and texture profile analysis (TPA) are traditional methods but time‐consuming and material‐consuming. Surimi enterprises or researchers choose the right methods based on their needs.
Effects of slightly acidic electrolyzed water pretreatment combined with biopreservatives on the shelf life of refrigerated obscure pufferfish (Takifugu obscurus)
Authors: Feng Haojie , Lan Weiqing , Sun Xiaohong , Xie Jing
Published: January 2021

This study assessed the effects of ε‐polylysine hydrochloride (ε‐PLH) and rosemary extract (RE) combined with slightly acidic electrolyzed water (SAEW) on the shelf life of obscure pufferfish (Takifugu obscurus) during refrigerated storage at (4 ± 1 °C). The samples were first dipped in SAEW and then treated with sterilized water (CK) and other solutions (0.2% RE [RE], 0.3% ε‐PLH [PLH], and 0.2% RE + 0.3% ε‐PLH [RE+PLH], respectively). Afterwards, microbiological, physicochemical, water migration, and sensory attributes were periodically assessed. The results showed that compared with CK and RE groups, ε‐PLH treatment could effectively inhibit microbial growth and delay the increase in total volatile base nitrogen (TVB‐N). In addition, microbial indexes, TVB‐N, thiobarbituric acid, and metmyoglobin value in the samples treated with RE+ε‐PLH were lower than those with ε‐PLH or RE alone during storage. Meanwhile, samples treated with RE+ε‐PLH exhibited the best sensory properties and no effect on color parameters. Based on the results of microbiological analysis, the shelf life of obscure pufferfish treated with RE+ε‐PLH was 14 days during refrigerated storage at (4 ± 1 °C).

Practical Application

In our study, the combined application of ε‐PLH, RE, and SAEW was effective to extend the shelf life of obscure pufferfish. Based on the results of total viable counts, the RE+PLH group had a shelf life of approximately 14 days. Accordingly, bio‐preservatives combined with SAEW technology have a broad application potential in the storage of obscure pufferfish.
Prevalence and clinical features of bile acid diarrhea in patients with chronic diarrhea
Authors: Costa Stefania , Gattoni Serena , Nicolardi Maria Luisa , Costetti Martina , Maimaris Stiliano , Schiepatti Annalisa , Biagi Federico
Published: January 2021

Objective

Bile acid diarrhea is a form of chronic diarrhea caused by excessive bile reaching the colon. Conditions involving the terminal ileum and cholecystectomy are predisposing factors but an idiopathic form of bile acid diarrhea has also been described. In this study we aimed to evaluate the prevalence of bile acid diarrhea in patients consecutively evaluated for chronic diarrhea in an Outpatient Gastroenterology Clinic.

Methods

Medical records of all patients admitted for chronic diarrhea (>4 weeks) between June 2018 and April 2019 were retrospectively reviewed. Bile acid diarrhea was suspected in patients with ileal disease, cholecystectomy or post‐prandial diarrhea. Patients’ age at diagnosis, sex, presenting symptoms, results of main test and examinations, final diagnoses and date of last follow‐up visit were also collected. Exclusion of chronic diarrhea of other causes and a 6‐month clinical improvement with cholestyramine treatment confirmed the diagnosis of bile acid diarrhea.

Results

In total, 139 patients aged 46 ± 20 years (76 women and 63 men) were included. Diarrhea due to an organic cause was diagnosed in 16 patients. A clinical response to cholestyramine persisting for more than 6 months led to a diagnosis of bile acid diarrhea in 39 (aged 52 ± 19 years) out of the remaining 123 patients with functional forms of diarrhea. Therefore, the prevalence of bile acid diarrhea was 28.1% (95% confidence interval 19.9%‐38.4%) in patients with chronic diarrhea.

Conclusions

Bile acid diarrhea is a very common, yet under‐recognized cause of chronic functional diarrhea. A therapeutic trial of cholestyramine is a valid diagnostic strategy.
Metabolic energy conservation for fermentative product formation
Authors: Folch Pauline L. , Bisschops Markus M.M. , Weusthuis Ruud A.
Published: January 2021

Microbial production of bulk chemicals and biofuels from carbohydrates competes with low‐cost fossil‐based production. To limit production costs, high titres, productivities and especially high yields are required. This necessitates metabolic networks involved in product formation to be redox‐neutral and conserve metabolic energy to sustain growth and maintenance. Here, we review the mechanisms available to conserve energy and to prevent unnecessary energy expenditure. First, an overview of ATP production in existing sugar‐based fermentation processes is presented. Substrate‐level phosphorylation (SLP) and the involved kinase reactions are described. Based on the thermodynamics of these reactions, we explore whether other kinase‐catalysed reactions can be applied for SLP. Generation of ion‐motive force is another means to conserve metabolic energy. We provide examples how its generation is supported by carbon‐carbon double bond reduction, decarboxylation and electron transfer between redox cofactors. In a wider perspective, the relationship between redox potential and energy conservation is discussed. We describe how the energy input required for coenzyme A (CoA) and CO2 binding can be reduced by applying CoA‐transferases and transcarboxylases. The transport of sugars and fermentation products may require metabolic energy input, but alternative transport systems can be used to minimize this. Finally, we show that energy contained in glycosidic bonds and the phosphate‐phosphate bond of pyrophosphate can be conserved. This review can be used as a reference to design energetically efficient microbial cell factories and enhance product yield.
A large genome with chromosome‐scale assembly sheds light on the evolutionary success of a true toad (Bufo gargarizans)
Authors: Lu Bin , Jiang Jianping , Wu Hua , Chen Xiaohong , Song Xiaowei , Liao Wenbo , Fu Jinzhong
Published: January 2021

We present a high‐quality genome assembly for the Asiatic toad (Bufo gargarizans) and explore the evolution of several large gene families in amphibians. With a large genome assembly size of 4.55 Gb, the chromosome‐scale assembly includes 747 scaffolds with an N50 of 539.8 Mb and 1.79% gaps. Long terminal repeats (LTRs) constitute a high proportion of the genome and their expansion is a key contributor to the inflated genome size in this species. This is very different from other small amphibian genomes, but similar to that of the enormous axolotl genome. The genome retains a large number of duplicated genes, with tandem (TD) and proximal duplications (PD) the predominant mode of duplication. A total of 122 gene families have undergone significant expansion and were mainly enriched in sensory perception of smell and bitter taste. The CYP2C subfamily, which plays an important role in metabolic detoxification, specifically expanded via TD and PD in the Asiatic toad and the cane toad (true toads). Most of Na+/K+‐ATPase genes experienced accelerated evolution along Bufonid lineages and two amino acid sites involving toad‐toxin resistance were found to experience positive selection. We also revealed a dynamic evolution of olfactory and vomeronasal receptor gene families which was likely driven by the water‐to‐land transition. The high‐quality genome of the Asiatic toad will provide a solid foundation to understand the genetic basis of its many biological processes.
Mapping forest leaf area density from multiview terrestrial lidar
Authors: Béland Martin , Kobayashi Hideki
Published: January 2021

Terrestrial lidar data are known to be useful for estimating the three‐dimensional (3D) distribution of leaf area in forests. This type of product holds great potential for modelling canopy reflectance and light interception to study the links between structure and function. However, little is currently known about its potential and limits in dense forests. Higher leaf area density implies that more laser pulses emitted by the ground‐based instrument are intercepted in lower canopy levels, and the implications of such occlusion effects on radiative transfer simulations are unknown. Occlusion effects can be minimized by increasing the number of locations lidar data is acquired from; how many locations are required for a forest with a given structure? This paper aims to address these knowledge gaps.

We acquired terrestrial lidar data using a very high density of scanning positions (5 m between positions) over four dense forest 60 m × 60 m plots along a structural gradient. Occlusion effects were quantified, and the 3D distribution of leaf area density was mapped using voxels (cubic volumes) for four different scan densities (one original and three downsampled). The voxel arrays were then input into a radiative transfer model to simulate bidirectional reflectance factors and vertical fraction of absorbed radiation.

We found that the summation of leaf area estimates for all voxels within the plot provided leaf area index (LAI) values close to LAI values estimated using traditional methods at each site. Occluded areas occurred mostly at the top of bottom heavy canopies. Radiative transfer simulations suggest that modelling small scale (<1 m) bidirectional reflectance factors (BRF) and light interception requires the highest scan position density used (5 m between scan positions), particularly at bottom heavy sites, and that 10 m between scan positions can be used for plot scale BRF simulations in forests with foliage density and vertical profiles similar to those tested here.

This work establishes some initial guidelines for establishing terrestrial lidar survey protocols for mapping leaf area density in forests. The leaf area density voxel arrays derived are among the most accurate plot‐level 3D characterizations of foliage arrangement produced to date.
Nursing diagnoses of the self‐perception domain in women in the puerperium
Authors: Farias Danielly Gama Lima Malheiros , Mota Maria Eduarda Wanderley , Carneiro Marília Cabral Pinheiro , de Almeida Bárbara Guedes , Pessoa Natália Ramos Costa , Frazão Cecília Maria Farias de Queiroz
Published: January 2021

Purpose

During puerperium, women experience changes that may be responsible for disorders in the phenomenon of self‐perception. Thus, the present study aims to analyze the nursing diagnoses of the self‐perception domain of NANDA International Taxonomy II in puerperal women.

Methods

Descriptive, cross‐sectional, and quantitative study. The sample consisted of 153 women on puerperium followed in a University Hospital in a Brazilian capital. Data were collected through interviews with the application of an instrument. Data analysis was performed using descriptive and inferential statistics. The study was approved by the Research Ethics Committee (CAAE: 02849818.0. 0000.5208).

Findings

The most prevalent Nursing Diagnosis of the self‐concept class was Readiness for enhanced self‐concept, which presented statistically significant associations with two defining characteristics. The risk for situational low self‐esteem was the most prevalent Nursing Diagnosis in the Self‐esteem class and presented associations to two risk factors. The Nursing Diagnosis Disrupted body image, present in the Body Image class, showed associations with 11 significant defining characteristics.

Conclusions

The analysis of the Nursing Diagnosis of the Self‐Perception domain can assist in planning interventions directed to the specific needs of women in the puerperium.

Implications for nursing practice

This study may contribute to the development of specific interventions to the reality of the puerperal, encouraging the nursing professional to implement the Nursing Process in the clinical practice. It may also contribute to the refinement of the NANDA‐II taxonomy and the advancement of nursing research, in addition to providing safe clinical practice grounded in scientific knowledge for planning educational actions in puerperal women in order to minimize the negative perceptions experienced by them.
The swedish covid‐19 intensive care cohort: Risk factors of ICU admission and ICU mortality
Authors: Ahlström Björn , Frithiof Robert , Hultström Michael , Larsson Ing‐Marie , Strandberg Gunnar , Lipcsey Miklos
Published: January 2021

Background

Several studies have recently addressed factors associated with severe Coronavirus disease 2019 (COVID‐19); however, some medications and comorbidities have yet to be evaluated in a large matched cohort. We therefore explored the role of relevant comorbidities and medications in relation to the risk of intensive care unit (ICU) admission and mortality.

Methods

All ICU COVID‐19 patients in Sweden until 27 May 2020 were matched to population controls on age and gender to assess the risk of ICU admission. Cases were identified, comorbidities and medications were retrieved from high‐quality registries. Three conditional logistic regression models were used for risk of ICU admission and three Cox proportional hazards models for risk of ICU mortality, one with comorbidities, one with medications and finally with both models combined, respectively.

Results

We included 1981 patients and 7924 controls. Hypertension, type 2 diabetes mellitus, chronic renal failure, asthma, obesity, being a solid organ transplant recipient and immunosuppressant medications were independent risk factors of ICU admission and oral anticoagulants were protective. Stroke, asthma, chronic obstructive pulmonary disease and treatment with renin‐angiotensin‐aldosterone inhibitors (RAASi) were independent risk factors of ICU mortality in the pre‐specified primary analyses; treatment with statins was protective. However, after adjusting for the use of continuous renal replacement therapy, RAASi were no longer an independent risk factor.

Conclusion

In our cohort oral anticoagulants were protective of ICU admission and statins was protective of ICU death. Several comorbidities and ongoing RAASi treatment were independent risk factors of ICU admission and ICU mortality.
Age‐related changes in hippocampal‐dependent synaptic plasticity and memory mediated by p75 neurotrophin receptor
Authors: Wong Lik‐Wei , Chong Yee Song , Lin Wei , Kisiswa Lilian , Sim Eunice , Ibáñez Carlos F. , Sajikumar Sreedharan
Published: January 2021

The plasticity mechanisms in the nervous system that are important for learning and memory are greatly impacted during aging. Notably, hippocampal‐dependent long‐term plasticity and its associative plasticity, such as synaptic tagging and capture (STC), show considerable age‐related decline. The p75 neurotrophin receptor (p75NTR) is a negative regulator of structural and functional plasticity in the brain and thus represents a potential candidate to mediate age‐related alterations. However, the mechanisms by which p75NTRaffects synaptic plasticity of aged neuronal networks and ultimately contribute to deficits in cognitive function have not been well characterized. Here, we report that mutant mice lacking the p75NTRwere resistant to age‐associated changes in long‐term plasticity, associative plasticity, and associative memory. Our study shows that p75NTRis responsible for age‐dependent disruption of hippocampal homeostatic plasticity by modulating several signaling pathways, including BDNF, MAPK, Arc, and RhoA‐ROCK2‐LIMK1‐cofilin. p75NTRmay thus represent an important therapeutic target for limiting the age‐related memory and cognitive function deficits.
CEO decision horizon and corporate R&D investments: an explanation based on managerial myopia and risk aversion
Authors: Li Yaoqin , Xu Xixiong , Zhu Yushu , Haq Mamiza
Published: January 2021

Combining the views of managerial myopia and risk aversion, we argue that a short decision horizon could divert corporate investments away from R&D investments. We devise an industry‐adjusted measurement combining CEO’s expected tenure and age as a proxy for CEO decision horizon and find a positive relationship between the horizon and corporate R&D investments. The relationship is stronger among firms with lower industry‐level income volatility and lower firm‐level performance pressure. The results also show that CEO age is more important than CEO tenure in affecting the decision horizon. Further analyses indicate that risk aversion determines the studied relationship.
“The Lady from North Carolina: The Perils and Limitations of External Expertise”
Authors: Phillips Aprille J. , Hamann Edmund T.
Published: January 2021

This paper examines a state department of education’s (SDE) decision to contract a consultant to “turnaround” schools, per a logic of outsourcing for external expertise. Our ethnographically informed case study explores whose knowledge had the most worth in diagnosing areas for improvement and identifies this case as part of a trend to rent competencies, under a neoliberal guise of efficiency, but at the expense of system capacity or learning.
A genome‐wide association study for the number of teats in European rabbits (Oryctolagus cuniculus) identifies several candidate genes affecting this trait
Authors: Bovo S. , Schiavo G. , Utzeri V. J. , Ribani A. , Schiavitto M. , Buttazzoni L. , Negrini R. , Fontanesi L.
Published: January 2021

In the European rabbit (Oryctolagus cuniculus), a polytocous livestock species, the number of teats indirectly impacts the doe reproduction efficiency and, in turn, the sustainable production of rabbit meat. In this study, we carried out a genome‐wide association study (GWAS) for the total number of teats in 247 Italian White does included in the Italian White rabbit breed selection program, by applying a selective genotyping approach. Does had either 8 (n = 121) or 10 teats (n = 126). All rabbits were genotyped with the Affymetrix Axiom OrcunSNP Array. Genomic data from the two extreme groups of rabbits were also analysed with the single‐marker fixation index statistic and combined with the GWAS results. The GWAS identified 50 significant SNPs and the fixation index analysis identified a total of 20 SNPs that trespassed the 99.98th percentile threshold, 19 of which confirmed the GWAS results. The most significant SNP (P = 4.31 × 10−11) was located on OCU1, close to the NUDT2 gene, a breast carcinoma cells proliferation promoter. Another significant SNP identified as candidate gene NR6A1, which is well known to play an important role in affecting the correlated number of vertebrae in pigs. Other significant markers were close to candidate genes involved in determining body length in mice. Markers associated with increased number of teats could be included in selection programmes to speed up the improvement for this trait in rabbit lines that need to increase maternal performances.
Local anaesthetic adjuncts for peripheral regional anaesthesia: a narrative review
Authors: Desai N. , Kirkham K. R. , Albrecht E.
Published: January 2021

Moderate‐to‐severe postoperative pain persists for longer than the duration of single‐shot peripheral nerve blocks and hence continues to be a problem even with the routine use of regional anaesthesia techniques. The administration of local anaesthetic adjuncts, defined as the concomitant intravenous or perineural injection of one or more pharmacological agents, is an attractive and technically simple strategy to potentially extend the benefits of peripheral nerve blockade beyond the conventional maximum of 8–14 hours. Historical local anaesthetic adjuncts include perineural adrenaline that has been demonstrated to increase the mean duration of analgesia by as little as just over 1 hour. Of the novel local anaesthetic adjuncts, dexmedetomidine and dexamethasone have best demonstrated the capacity to considerably improve the duration of blocks. Perineural dexmedetomidine and dexamethasone increase the mean duration of analgesia by up to 6 hour and 8 hour, respectively, when combined with long‐acting local anaesthetics. The evidence for the safety of these local anaesthetic adjuncts continues to accumulate, although the findings of a neurotoxic effect with perineural dexmedetomidine during in‐vitro studies are conflicting. Neither perineural dexmedetomidine nor dexamethasone fulfils all the criteria of the ideal local anaesthetic adjunct. Dexmedetomidine is limited by side‐effects such as bradycardia, hypotension and sedation, and dexamethasone slightly increases glycaemia. In view of the concerns related to localised nerve and muscle injury and the lack of consistent evidence for the superiority of the perineural vs. systemic route of administration, we recommend the off‐label use of systemic dexamethasone as a local anaesthetic adjunct in a dose of 0.1–0.2 mg.kg−1 for all patients undergoing surgery associated with significant postoperative pain.
The role of peripheral nerve stimulation in the era of ultrasound‐guided regional anaesthesia
Authors: Gadsden J. C.
Published: January 2021

With the widespread use of ultrasound for localising nerves during peripheral nerve blockade, the value of electrical nerve stimulation of evoked motor responses has been questioned. Studies continue to show that, compared with nerve stimulation, ultrasound guidance alone leads to: significantly improved block success; decreased need for rescue analgesia; decreased procedural pain; and lower rates of vascular puncture. Nerve stimulation combined with ultrasound does also not appear to improve block success rates, apart from those blocks where the nerves are challenging to view, such as the obturator nerve. The role of nerve stimulation has changed in the last 15 years from a technique to locate nerves to that of an adjunct to ultrasound. Nerve stimulation can serve as a monitor against needle‐nerve contact and may be useful in avoiding nerves that are in the needle trajectory during specific ultrasound guided techniques. Nerve stimulation is also a useful adjunct in teaching novices ultrasound‐guided regional anaesthesia, especially when the position and or appearance of nerves may be variable. In this review, the changing role of nerve stimulation in contemporary regional anaesthetic practice is presented and discussed.
Incidence of accidental awareness during general anaesthesia in obstetrics: a multicentre, prospective cohort study
Authors: Odor P. M. , Bampoe S. , Lucas D. N. , Moonesinghe S. R. , Andrade J. , Pandit J. J. ,   Pan‐London Peri‐operative Audit and Research Network (PLAN), for the DREAMY Investigators Group
Published: January 2021

General anaesthesia for obstetric surgery has distinct characteristics that may contribute towards a higher risk of accidental awareness during general anaesthesia. The primary aim of this study was to investigate the incidence, experience and psychological implications of unintended conscious awareness during general anaesthesia in obstetric patients. From May 2017 to August 2018, 3115 consenting patients receiving general anaesthesia for obstetric surgery in 72 hospitals in England were recruited to the study. Patients received three repetitions of standardised questioning over 30 days, with responses indicating memories during general anaesthesia that were verified using interviews and record interrogation. A total of 12 patients had certain/probable or possible awareness, an incidence of 1 in 256 (95%CI 149–500) for all obstetric surgery. The incidence was 1 in 212 (95%CI 122–417) for caesarean section surgery. Distressing experiences were reported by seven (58.3%) patients, paralysis by five (41.7%) and paralysis with pain by two (16.7%). Accidental awareness occurred during induction and emergence in nine (75%) of the patients who reported awareness. Factors associated with accidental awareness during general anaesthesia were: high BMI (25–30 kg.m‐2); low BMI (<18.5 kg.m‐2); out‐of‐hours surgery; and use of ketamine or thiopental for induction. Standardised psychological impact scores at 30 days were significantly higher in awareness patients (median (IQR [range]) 15 (2.7–52.0 [2–56]) than in patients without awareness 3 (1–9 [0–64]), p = 0.010. Four patients had a provisional diagnosis of post‐traumatic stress disorder. We conclude that direct postoperative questioning reveals high rates of accidental awareness during general anaesthesia for obstetric surgery, which has implications for anaesthetic practice, consent and follow‐up.
The Anaesthesia Case Report (ACRE) checklist: a tool to promote high‐quality reporting of cases in peri‐operative practice
Authors: Shelton C. L. , Klein A. A. , Bailey C. R. , El‐Boghdadly K.
Published: January 2021

Case reports have fulfilled an important role in the development of anaesthesia and continue to be highly relevant to modern practice. Despite this, they are sometimes criticised for being insufficiently rigorous to meaningfully inform clinical practice or research design. Reporting checklists are a useful tool to improve rigour in research and, although case report checklists have previously been developed, no existing checklist focuses on the peri‐operative setting. In order to address the need for a case reports checklist that better accommodates peri‐operative care, we used an established tool as the basis for developing the 12‐item Anaesthesia Case Report checklist. This was refined using an iterative approach through feedback from journal editors with experience of handling case reports, patient and public involvement, and trialling its use on Anaesthesia Reports submissions. The Anaesthesia Case Report checklist differs from existing checklists by aligning with peri‐operative practice; it places less emphasis on making diagnoses and focuses on the way in which clinical challenges, for example, related to the patient’s comorbidities or operative interventions, are addressed. Adopting a standardised approach to the content of case reports presents clear benefits to authors, editors and peer reviewers through streamlining the processes involved in writing and publication. The Anaesthesia Case Report checklist provides a pragmatic framework for comprehensive and transparent reporting. We hope it will facilitate the authorship of high‐quality case reports with the potential to further improve the quality and safety of peri‐operative care.
Comparative assessment of different versions of axial and centrifugal LVADs: A review
Authors: Kannojiya Vikas , Das Arup Kumar , Das Prasanta Kumar
Published: January 2021

Continuous‐flow left ventricular assist devices (LVADs) have gained tremendous acceptance for the treatment of end‐stage heart failure patients. Among different versions, axial flow and centrifugal flow LVADs have shown remarkable potential for clinical implants. It is also very crucial to know which device serves its purpose better to treat heart failure patients. A thorough comparison of axial and centrifugal LVADs, which may guide doctors in deciding before the implant, still lacks in the literature. In this work, an assessment of axial and centrifugal LVADs has been made to suggest a better device by comparing their engineering, clinical, and technological development of design aspects. Hydrodynamic and hemodynamic aspects for both types of pumps are discussed along with their biocompatibility, bearing types, and sizes. It has been observed numerically that centrifugal LVADs perform better over axial LVADs in every engineering aspect like higher hydraulic efficiency, better characteristics curve, lesser power intake, and also lesser blood damage. However, the clinical outcomes suggest that centrifugal LVADs experience higher events of infections, renal, and respiratory dysfunction. In contrast, axial LVADs encountered higher bleeding and cardiac arrhythmia. Moreover, recent technological developments suggested that magnetic type bearings along with biocompatible coating improve the life of LVADs.
Clinical outcomes of combined pars plana vitrectomy and scleral fixation of the intraocular lens with a suspension bridge method in eyes with aphakia or insufficient capsular support
Authors: Choi Hun Jin , Kwon Oh Woong , Byeon Suk Ho , Song Ji Hun
Published: January 2021

Purpose

To describe a modified technique of scleral fixation for intraocular lens (IOL) implantation and report the clinical outcomes of combined pars plana vitrectomy and scleral IOL fixation using the suspension bridge method.

Methods

This retrospective case series included 57 eyes (56 patients) of aphakia or phakic and pseudophakic eyes with insufficient capsular support that underwent IOL implantation or dislocated IOL repositioning with scleral fixation using the ‘suspension bridge’ method by a single surgeon between 1 July 2010 and 1 March 2019. Preoperative status, changes in visual acuity, refractive outcomes as spherical equivalent and related complications were assessed with a minimum follow‐up of 3 months.

Results

The mean follow‐up period was 25.5 ± 25.4 months. Preoperative visual acuity (logarithm of the minimum angle of resolution) was 1.32 ± 0.68 (20/400 Snellen), and it significantly improved to 0.80 ± 0.53 (20/125), 0.59 ± 0.56 (20/80) and 0.24 ± 0.37 (20/35) at 1 week, 1 month and 3 months, respectively (p < 0.001). Postoperative complications included corneal wound dehiscence (n = 1), vitreous incarceration (n = 1), optic‐iris capture (n = 6) and cystoid macular oedema (n = 1). The above‐mentioned complications were successfully corrected with simple procedures. However, one case of IOL dislocation required reoperation.

Conclusion

The modified technique of the suspension bridge method precludes the need for a scleral flap, with the advantage of easy adjustment of the IOL position. It is a simple and feasible technique with good surgical results and low complication rates.
Exposure sources, amounts and time course of gluten ingestion and excretion in patients with coeliac disease on a gluten‐free diet
Authors: Silvester Jocelyn A. , Comino Isabel , Rigaux Lisa N. , Segura Veronica , Green Kathy H. , Cebolla Angel , Weiten Dayna , Dominguez Remedios , Leffler Daniel A. , Leon Francisco , Bernstein Charles N. , Graff Lesley A. , Kelly Ciaran P. , Sousa Carolina , Duerksen Donald R.
Published: January 2021

Background

A major deficit in understanding and improving treatment in coeliac disease (CD) is the lack of empiric data on real world gluten exposure.

Aims

To estimate gluten exposure on a gluten‐free diet (GFD) using immunoassays for gluten immunogenic peptides (GIP) and to examine relationships among GIP detection, symptoms and suspected gluten exposures

Methods

Adults with biopsy‐confirmed CD on a GFD for 24 months were recruited from a population‐based inception cohort. Participants kept a diary and collected urine samples for 10 days and stools on days 4‐10. ‘Doggie bags’ containing ¼ portions of foods consumed were saved during the first 7 days. Gluten in food, stool and urine was quantified using A1/G12 ELISA.

Results

Eighteen participants with CD (12 female; age 21‐70 years) and three participants on a gluten‐containing diet enrolled and completed the study. Twelve out of 18 CD participants had a median 2.1 mg gluten per exposure (range 0.2 to >80 mg). Most exposures were asymptomatic and unsuspected. There was high intra‐individual variability in the interval between gluten ingestion and excretion. Participants were generally unable to identify the food.

Conclusions

Gluten exposure on a GFD is common, intermittent, and usually silent. Excretion kinetics are highly variable among individuals. The amount of gluten varied widely, but was typically in the milligram range, which was 10‐100 times less than consumed by those on an unrestricted diet. These findings suggest that a strict GFD is difficult to attain, and specific exposures are difficult to detect due to variable time course of excretion.
Implementing the formal language of the vegetation classification expert systems (ESy) in the statistical computing environment R
Authors: Bruelheide Helge , Tichý Lubomír , Chytrý Milan , Jansen Florian
Published: January 2021

Aims

The machine‐readable formal language of classification expert systems has become a standard for applying plot assignment rules in vegetation classification. Here we present an efficient algorithm implementing the vegetation classification expert system in the statistical programming language R.

Methods

The principal idea of the R implementation is to solve the assignments to vegetation types not sequentially plot by plot but to parse the assignment rules into (nested) components that each can be evaluated by simultaneous vector‐based processing of all plots in a database.

Results and conclusions

We demonstrate the algorithm taking the EUNIS classification expert system of European habitat types (EUNIS‐ESy) as an example. The R code version of the vegetation classification expert system is particularly useful in large vegetation‐plot databases because it solves all logical operations vector‐wise across all plots, allowing for efficient evaluation of membership expressions and formulas. Another advantage of the R implementation is that membership formulas are not only readable but can also be produced as a machine‐written result, for example as the output of classification algorithms run in R.
Domperidone and the risks of sudden cardiac death and ventricular arrhythmia: A systematic review and meta‐analysis of observational studies
Authors: Ou Linda B. , Moriello Carolina , Douros Antonios , Filion Kristian B.
Published: January 2021

Aims

Concerns exist regarding the cardiovascular safety of domperidone. However, many of the previous studies addressing this issue had important limitations. We aimed to examine domperidone and the risks of sudden cardiac death and ventricular arrhythmia through a systematic review and meta‐analysis of observational studies, including an in‐depth methodological assessment.

Methods

We systematically searched MEDLINE, PubMed, EMBASE, Scopus and CINAHL Plus to identify observational studies examining the association of domperidone and sudden cardiac death and/or ventricular arrhythmia. We assessed study quality in duplicate using the ROBINS‐I tool supplemented by an assessment of specific biases and the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach. Data were pooled across studies using DerSimonian and Laird random‐effects models.

Results

Six case–control studies, 1 case‐crossover study and 1 retrospective cohort study were included (n = 480 395). Based on ROBINS‐I, 3 studies had moderate risk of bias, 4 had serious risk, and 1 had critical risk. The overall GRADE rating is moderate. When data were pooled across nonoverlapping studies, domperidone was associated with an increased risk of composite endpoint of sudden cardiac death or ventricular arrhythmia compared to nonuse (adjusted odds ratio: 1.69; 95% confidence interval: 1.46, 1.95; I2: 0%; τ2: 0). This association persisted when restricted to higher‐quality studies (odds ratio: 1.60; 95% confidence interval: 1.30, 1.97; I2: 0%; τ2: 0).

Conclusion

Domperidone is associated with an increased risk of sudden cardiac death and ventricular arrhythmia compared to nonuse. Further investigation comparing domperidone to an active comparator and in younger populations are warranted.