bluuebunny/crossref_metadata_2025 huggingface dataset:
Sustainable tourism development and competitiveness: The systematic literature review
Authors: Streimikiene Dalia , Svagzdiene Biruta , Jasinskas Edmundas , Simanavicius Arturas
Published: September 2020

Tourism is one of most perspective and dynamic businesses in the world. It is of great significance to plan and develop tourism purposefully and sustainably though the search for compromises between environmental, economic and social aims of society. The sustainable tourism development management has to retain high satisfaction degree of tourists' needs, assure significant experience for consumers, increasing their consciousness under issues of sustainability, and propagating practices of sustainable tourism among them. The significance of sustainable tourism sector development ambition is analysed in this paper through the lens of strengthening its competitiveness. The paper analyses scientific literature and seeks to discover the main forms and factors for the strengthening of the tourism competitiveness by implementing economic, social and environmental targets of tourism destination territories development. The broad systematic literature review provided for some interesting findings: The business participants are interested in the implementation of new technologies in tourism services having positive impact on environment and local communities; however, a lot of challenges exist how to change environment, increase of consumers' motivations for sustainable tourism services and to change their behaviour towards more sustainable one. The current Covid 19 outbreak and high risks of future pandemics have risen new challenges for sustainable tourism development. In this paper the main sustainable tourist development challenges are addressed and new insights for the strengthening of competitiveness of sustainable tourism destination are provided. The future research guidelines are set based on analysis performed.

Highlights

The systematic review of literature on sustainable tourism

The trade‐off between sustainability and competitiveness

The main challenges of sustainable tourist development

New insights for the strengthening of competitiveness of sustainable tourism

The future research guidelines are set based on analysis performed
Analysis of type I and II error rates of Bayesian and frequentist parametric and nonparametric two-sample hypothesis tests under preliminary assessment of normality
Authors: Kelter Riko
Published: September 2020

Testing for differences between two groups is among the most frequently carried out statistical methods in empirical research. The traditional frequentist approach is to make use of null hypothesis significance tests which usepvalues to reject a null hypothesis. Recently, a lot of research has emerged which proposes Bayesian versions of the most common parametric and nonparametric frequentist two-sample tests. These proposals include Student’s two-sample t-test and its nonparametric counterpart, the Mann–Whitney U test. In this paper, the underlying assumptions, models and their implications for practical research of recently proposed Bayesian two-sample tests are explored and contrasted with the frequentist solutions. An extensive simulation study is provided, the results of which demonstrate that the proposed Bayesian tests achieve better type I error control at slightly increased type II error rates. These results are important, because balancing the type I and II errors is a crucial goal in a variety of research, and shifting towards the Bayesian two-sample tests while simultaneously increasing the sample size yields smaller type I error rates. What is more, the results highlight that the differences in type II error rates between frequentist and Bayesian two-sample tests depend on the magnitude of the underlying effect.
Ugandan Medical Student Career Choices Relate to Foreign Funding Priorities
Authors: Kakembo Nasser , Situma Martin , Williamson Hannah , Kisa Phyllis , Kamya Moses , Ozgediz Doruk , Sekabira John , Fitzgerald Tamara N.
Published: September 2020

Introduction

The surgical workforce in sub‐Saharan Africa is insufficient to meet population needs. Therefore, medical students should be encouraged to pursue surgical careers and “brain drain” must be minimized. It is unknown to what extent foreign aid priorities influence medical student career choices in Uganda.

Methods

Medical students in Uganda completed an online survey examining their career choices and attitudes regarding career opportunities and funding priorities. Data were analyzed using descriptive statistics, and responses among men and women were compared using Fisher's exact tests.

Results

Ninety‐eight students participated. Students were most influenced by inspiring role models, employment opportunities and specialty fit with personal skills. Filling an underserved specialty was near the bottom of the influence scale. Women placed higher importance on advice from mentors (p = 0.049) and specialties with lower stress burden (p = 0.027). Men placed importance on opportunities in non‐governmental organizations (p = 0.033) and academia (p = 0.050). Students expressed that the most supported specialties were infectious disease (n = 65, 66%), obstetrics (n = 15, 15%) and pediatrics (n = 7, 7%). Most students (n = 91, 93%) were planning a career in infectious disease. Fifty‐three students (70%) indicated plans to leave Africa for residency. Female students were more likely to have a plan to leave (p = 0.027).

Conclusion

Medical students in Uganda acknowledge the career opportunities for physicians in specialties prioritized by the Sustainable Development Goals. In order to avoid “brain drain” and encourage students to pursue careers in surgery, career opportunities including surgical residencies must be prioritized and supported in sub‐Saharan Africa.
Visual Preference for Biological Motion in Children and Adults with Autism Spectrum Disorder: An Eye-Tracking Study
Authors: Kaliukhovich Dzmitry A. , Manyakov Nikolay V. , Bangerter Abigail , Ness Seth , Skalkin Andrew , Boice Matthew , Goodwin Matthew S. , Dawson Geraldine , Hendren Robert , Leventhal Bennett , Shic Frederick , Pandina Gahan
Published: September 2020

Participants with autism spectrum disorder (ASD) (n = 121, mean [SD] age: 14.6 [8.0] years) and typically developing (TD) controls (n = 40, 16.4 [13.3] years) were presented with a series of videos representing biological motion on one side of a computer monitor screen and non-biological motion on the other, while their eye movements were recorded. As predicted, participants with ASD spent less overall time looking at presented stimuli than TD participants (P < 10–3) and showed less preference for biological motion (P < 10–5). Participants with ASD also had greater average latencies than TD participants of the first fixation on both biological (P < 0.01) and non-biological motion (P < 0.02). Findings suggest that individuals with ASD differ from TD individuals on multiple properties of eye movements and biological motion preference.
Development of tannic acid-enriched materials modified by poly(ethylene glycol) for potential applications as wound dressing
Authors: Kaczmarek Beata , Mazur Olha , Miłek Oliwia , Michalska-Sionkowska Marta , Osyczka Anna M. , Kleszczyński Konrad
Published: September 2020

The interests in the biomedical impact of tannic acid (TA) targeting production of various types of biomaterials, such as digital microfluids, chemical sensors, wound dressings, or bioimplants constantly increase. Despite the significant disadvantage of materials obtained from natural-based compounds and their low stability and fragility, therefore, there is an imperative need to improve materials properties by addition of stabilizing formulas. In this study, we performed assessments of thin films over TA proposed as a cross-linker to be used in combination with polymeric matrix based on chitosan (CTS), i.e. CTS/TA at 80:20 or CTS/TA at 50:50 and poly(ethylene glycol) (PEG) at the concentration of 10% or 20%. We evaluated their mechanical parameters as well as the cytotoxicity assay for human bone marrow mesenchymal stem cells, human melanotic melanoma (MNT-1), and human osteosarcoma (Saos-2). The results revealed significant differences in dose-dependent of PEG regarding the maximum tensile strength (σmax) or impact on the metabolic activity of tissue culture plastic. We observed that PEG improved mechanical parameters prominently, decreased the hemolysis rate, and did not affect cell viability negatively. Enclosed data, confirmed also by our previous reports, will undoubtedly pave the path for the future application of tannic acid-based biomaterials to treat wound healing.
The Critical Point and the Supercritical State of Alkali Feldspars: Implications for the Behavior of the Crust During Impacts
Authors: Kobsch Anaïs , Caracas Razvan
Published: September 2020

The position of the vapor‐liquid dome and of the critical point determine the evolution of the outermost parts of the protolunar disk during cooling and condensation after the Giant Impact. The parts of the disk in supercritical or liquid state evolve as a single thermodynamic phase; when the thermal trajectory of the disk reaches the liquid‐vapor dome, gas and melt separate leading to heterogeneous convection and phase separation due to friction. Different layers of the proto‐Earth behaved differently during the Giant Impact depending on their constituent materials and initial thermodynamic conditions. Here we use first‐principles molecular dynamics to determine the position of the critical point for NaAlSi3O8 and KAlSi3O8 feldspars, major minerals of the Earth and Moon crusts. The variations of the pressure calculated at various volumes along isotherms yield the position of the critical points: 0.5–0.8 g cm−3 and 5500–6000 K range for the Na‐feldspar, 0.5–0.9 g cm−3 and 5000–5500 K range for the K‐feldspar. The simulations suggest that the vaporization is incongruent, with a degassing of O2 starting at 4000 K and gas component made mostly of free Na and K cations, O2, SiO and SiO2 species for densities below 1.5 g cm−3. The Hugoniot equations of state imply that low‐velocity impactors (<8.3 km s−1) would at most melt a cold feldspathic crust, whereas large impacts in molten crust would see temperatures raise up to 30000 K.
Evaluation of the MC4R gene across eMERGE network identifies many unreported obesity-associated variants
Authors: Namjou Bahram , Stanaway Ian B. , Lingren Todd , Mentch Frank D. , Benoit Barbara , Dikilitas Ozan , Niu Xinnan , Shang Ning , Shoemaker Ashley H. , Carey David J. , Mirshahi Tooraj , Singh Rajbir , Nestor Jordan G. , Hakonarson Hakon , Denny Joshua C. , Crosslin David R. , Jarvik Gail P. , Kullo Iftikhar J. , Williams Marc S. ,   The eMERGE Network, Harley John B.
Published: September 2020

Background/Objectives

Melanocortin-4 receptor (MC4R) plays an essential role in food intake and energy homeostasis. More than 170 MC4R variants have been described over the past two decades, with conflicting reports regarding the prevalence and phenotypic effects of these variants in diverse cohorts. To determine the frequency of MC4R variants in large cohort of different ancestries, we evaluated the MC4R coding region for 20,537 eMERGE participants with sequencing data plus additional 77,454 independent individuals with genome-wide genotyping data at this locus.

Subjects/Methods

The sequencing data were obtained from the eMERGE phase III study, in which multisample variant call format calls have been generated, curated, and annotated. In addition to penetrance estimation using body mass index (BMI) as a binary outcome, GWAS and PheWAS were performed using median BMI in linear regression analyses. All results were adjusted for principal components, age, sex, and sites of genotyping.

Results

Targeted sequencing data of MC4R revealed 125 coding variants in 1839 eMERGE participants including 30 unreported coding variants that were predicted to be functionally damaging. Highly penetrant unreported variants included (L325I, E308K, D298N, S270F, F261L, T248A, D111V, and Y80F) in which seven participants had obesity class III defined as BMI ≥ 40 kg/m2. In GWAS analysis, in addition to known risk haplotype upstream of MC4R (best variant rs6567160 (P = 5.36 × 10−25, Beta = 0.37), a novel rare haplotype was detected which was protective against obesity and encompassed the V103I variant with known gain-of-function properties (P = 6.23 × 10−08, Beta = −0.62). PheWAS analyses extended this protective effect of V103I to type 2 diabetes, diabetic nephropathy, and chronic renal failure independent of BMI.

Conclusions

MC4R screening in a large eMERGE cohort confirmed many previous findings, extend the MC4R pleotropic effects, and discovered additional MC4R rare alleles that probably contribute to obesity.
Sacrificial layer-assisted nanoscale transfer printing
Authors: Liu Junshan , Pang Bo , Xue Riye , Li Rui , Song Jinlong , Zhao Xiaojun , Wang Dazhi , Hu Xiaoguang , Lu Yao , Wang Liding
Published: September 2020

Transfer printing is an emerging assembly technique for flexible and stretchable electronics. Although a variety of transfer printing methods have been developed, transferring patterns with nanometer resolution remains challenging. We report a sacrificial layer-assisted nanoscale transfer printing method. A sacrificial layer is deposited on a donor substrate, and ink is prepared on and transferred with the sacrificial layer. Introducing the sacrificial layer into the transfer printing process eliminates the effect of the contact area on the energy release rate (ERR) and ensures that the ERR for the stamp/ink-sacrificial layer interface is greater than that for the sacrificial layer/donor interface even at a slow peel speed (5 mm s−1). Hence, large-area nanoscale patterns can be successfully transferred with a yield of 100%, such as Au nanoline arrays (100 nm thick, 4 mm long and 47 nm wide) fabricated by photolithography techniques and PZT nanowires (10 mm long and 63 nm wide) fabricated by electrohydrodynamic jet printing, using only a blank stamp and without the assistance of any interfacial chemistries. Moreover, the presence of the sacrificial layer also enables the ink to move close to the mechanical neutral plane of the multilayer peel-off sheet, remarkably decreasing the bending stress and obviating cracks or fractures in the ink during transfer printing.
An active self-cleaning surface system for photovoltaic modules using anisotropic ratchet conveyors and mechanical vibration
Authors: Sun Di , Böhringer Karl F.
Published: September 2020

The purpose of this work is to develop an active self-cleaning system that removes contaminants from a solar module surface by means of an automatic, water-saving, and labor-free process. The output efficiency of a solar module can be degraded over time by dust accumulation on top of the cover glass, which is often referred to as “soiling”. This paper focuses on creating an active self-cleaning surface system using a combination of microsized features and mechanical vibration. The features, which are termed anisotropic ratchet conveyors (ARCs), consist of hydrophilic curved rungs on a hydrophobic background. Two different ARC systems have been designed and fabricated with self-assembled monolayer (SAM) silane and fluoropolymer thin film (Cytop). Fabrication processes were established to fabricate these two systems, including patterning Cytop without degrading the original Cytop hydrophobicity. Water droplet transport characteristics, including anisotropic driving force, droplet resonance mode, cleaning mechanisms, and system power consumption, were studied with the help of a high-speed camera and custom-made test benches. The droplet can be transported on the ARC surface at a speed of 27 mm/s and can clean a variety of dust particles, either water-soluble or insoluble. Optical transmission was measured to show that Cytop can improve transmittance by 2.5~3.5% across the entire visible wavelength range. Real-time demonstrations of droplet transport and surface cleaning were performed, in which the solar modules achieved a 23 percentage-point gain after cleaning.
Microfracture versus Enhanced Microfracture Techniques in Knee Cartilage Restoration: A Systematic Review and Meta-Analysis
Authors: Wen Hong-Jie , Yuan Li-Bo , Tan Hong-Bo , Xu Yong-Qing
Published: September 2020

This study aimed to compare the efficacy and safety of the microfracture (MFx) and microfracture augmented (MFx + ) techniques for the treatment of cartilage defects of the knee. The PubMed and EMBASE databases were searched from 1 January, 1950 to 1 May, 2019. RevMan5.3 was used to perform statistical analysis. Relative risk was calculated for binary variables, and weighted mean difference and standardized mean difference (SMD) were measured for continuous variables. The 95% confidence interval (CI) of each variable was assessed. Thirteen trials with 635 patients were included. There was a significant difference in the Lysholm's score (SMD = 0.26, 95% CI: 0.01–0.50, p = 0.04) and magnetic resonance observation of cartilage repair tissue score (SMD = 14.01, 95% CI: 8.01–20.02, p < 0.01) between the MFx and MFx+ groups. There was no significant difference in the Western Ontario and McMaster Universities Osteoarthritis Index score (SMD =  − 12.40, 95% CI: −27.50 to 32.71, p = 0.11), International Knee Documentation Committee score (SMD = 8.67, 95% CI: −0.92 to 18.27, p = 0.08), visual analog scale score (SMD =  − 0.20, 95% CI: −2.45 to 0.96, p = 0.57), Tegner's score (SMD = 0.26, 95% CI: −0.67 to 1.18, p = 0.59), modified Cincinnati's score (SMD =  − 4.58, 95% CI: −14.31 to 5.14, p = 0.36) and modified International Cartilage Repair Society pain score (SMD = 0.09, 95% CI: −0.37 to 0.55, p = 0.70) between the groups. Results of the pooled analyses of the MFx+ and MFx groups suggested that the MFx+ technique is slightly superior to the MFx technique for the treatment of articular cartilage defects of the knee. Further research is required and future studies should include assessments of the outcomes at long-term follow-ups. Trial registration number is PROSPERO CRD42019135803.
Cutoff criteria for overall model fit indexes in generalized structured component analysis
Authors: Cho Gyeongcheol , Hwang Heungsun , Sarstedt Marko , Ringle Christian M.
Published: September 2020

Generalized structured component analysis (GSCA) is a technically well-established approach to component-based structural equation modeling that allows for specifying and examining the relationships between observed variables and components thereof. GSCA provides overall fit indexes for model evaluation, including the goodness-of-fit index (GFI) and the standardized root mean square residual (SRMR). While these indexes have a solid standing in factor-based structural equation modeling, nothing is known about their performance in GSCA. Addressing this limitation, we present a simulation study’s results, which confirm that both GFI and SRMR indexes distinguish effectively between correct and misspecified models. Based on our findings, we propose rules-of-thumb cutoff criteria for each index in different sample sizes, which researchers could use to assess model fit in practice.
Hidden language ‘battles’ in the diaspora
Authors: Sabaté-Dalmau Maria
Published: September 2020

Following a critical sociolinguistics approach to language maintenance in the diaspora, this paper investigates interplaying linguistic identities and ideologies towards home and host languages among four case-study Pakistanis living in Catalonia, a Catalan/Spanish-speaking European society. By drawing on fieldnotes, interviews, naturally-occurring conversations and visual materials gathered in a Barcelona call shop, it shows how informants invest in Spanish as the ‘integration’ language, despite being categorised as ‘deficient’ users of it. They present themselves as ‘native’ speakers of Urdu, which indexes modern ‘Muslimness’ and ‘Pakistaniness’, while Punjabi users, associated with the ‘yokels’, are silenced. English is ambivalently taken-up as an intra-group sign of educational status and political power and as an anti-Muslim ‘coloniser’ language. Overall, these stratifying sociolinguistic behaviours reveal how Pakistanis’ home/host multilingual resources get re-ideologised through linguistic hierarchisations which foster the maintenance of majority languages only, dismissing minority language speakers, in unchartered transnational contexts where these are already ‘delanguaged’.
Hot Bathtub, Cold Consequences—Misleading Wounds After Scald Injuries: A Retrospective Analysis
Authors: Bingoel Alperen S , Krezdorn Nicco , Jokuszies Andreas , Dastagir Khaled , Vogt Peter Maria , Mett Tobias R
Published: September 2020

Scalds in the elderly are frequently associated with the use of a bathtub and a disturbed consciousness. Therefore, the total burn surface area is often high. The initial clinical presentation displays a stark erythema of the skin, which frequently does not represent the true depth. The aim of this study was to characterize and assess medical features and outcome of scalds sustained in the bathtub. We conducted a retrospective study at a burn intensive care unit (BICU) between 2011 and 2018. Medical features as well as the treatment in these patients were statistically analyzed. We identified 16 patients and divided them into two groups regarding survival and lethality. The mean total burn surface area was 37.50 ± 19.47%. In 81.25% of the patients, we found a previous history of neurological or psychiatric disorders. Dementia and alcohol abuse were the most common triggers for the trauma. The statistical analysis showed a significant difference for the ABSI-score and the presence of multi organ failure (P-value .0462, respectively, .0004). Erythematous skin areas tended to progress into full thickness burns. We, therefore, coined the term “lobster redness” for these regions. Scalds sustained in the bathtub are devastating injuries. Initial assessment can be misleading and might delay early necrectomy. The wounds request even more attention, if the injuries occurred due to unconsciousness because of the longer exposure to heat. Early necrectomy should be considered. A biopsy with histological workup can be useful. Furthermore, we recommend special safety precautions for neurologically and psychiatrically affected patients.
APPLICABILITY OF VENTILATION SYSTEMS FOR REDUCING THE INDOOR RADON CONCENTRATION
Authors: Jiránek Martin , Kačmaříková Veronika
Published: September 2020

An analysis is presented of the ability of balanced mechanical ventilation systems to reduce the radon concentration in residential buildings efficiently. The analysis takes into account the following parameters: radon supply rate into the building, ventilation intensity, required indoor radon concentration and energy consumption. It is shown that the applicability of ventilation systems is limited mainly by energy consumption. Ventilation systems can be considered energetically acceptable if the ventilation intensity does not exceed 0.6 h−1, i.e. radon supply rate should not exceed 60 Bq/m3h for a required indoor radon concentration of 100 Bq/m3. Energy consumption can be significantly reduced by operating the ventilation system in a cyclic mode. Simulating the behavior of ventilation systems in time has been found as a useful tool for their design. In order to express by one parameter energy consumption and radon reduction, a completely new quantity—the ‘radon-related energy need’ has been proposed.
Constraints, Normative Ideal, and Actions to Foster Change in the Practice of Nursing
Authors: Martin Patrick , Bouchard Louise
Published: September 2020

The purpose of this study was to explore the lived experiences of politically engaged hospital staff nurses, the way in which they would like to practice, as well as the ideas and actions they have undertaken to foster change in their nursing practice. A qualitative design was used to collect data from a purposive sample of 39 nurses. Results indicate a deprofessionalization of nursing and a drift toward authoritarianism. There are, nonetheless, nurses who employ acts of resistance with the aim of establishing new power relations. It appears that those actions must focus on the radical renewal of democracy in hospitals.
Preoperative angulation as a predictor for operations of Wassel type IV polydactyly
Authors: Luangjarmekorn Pobe , Virojanawat Natthawat , Pongpacharaamphon Podsawee , Kitidumrongsook Pravit
Published: September 2020

The aim of this study was to find the degree of preoperative metacarpophalangeal (MCP) joint angulation that determines the need for corrective osteotomy and to compare the result for Wassel type IV thumb polydactyly operated by soft tissue reconstruction alone or with corrective osteotomy. The surgical options for correction of the angular deformity of the MCP joint in Wassel type IV thumb polydactyly were retrospectively reviewed. The preoperative angular deformity of the MCP joint and the last postoperative residual deformity at MCP joint were measured from the radiograph of thumb posteroanterior view. The cut-off point of the preoperative MCP angulation that provided less residual deformity in patients who were treated by soft tissue procedures alone was identified from receiver operating characteristic curve. A total of 45 patients with 46 thumb polydactyly (Wassel type IV) were studied. Mean pre and postoperative MCP angulation were 24.01 (range 0–68°) and 14.65 (range 0–39°), respectively. Thirty-four thumbs from 33 patients (73.91%) were operated on by soft tissue procedures alone and 12 thumbs (26.09%) needed corrective osteotomy. The best cut-off point of preoperative MCP angulation that showed less significant residual deformity when treated by soft tissue procedure alone was 30° (96.43% sensitivity and 100% specificity). In MCP angulation ≤30°, soft tissue reconstruction alone was an effective method for correction of angular deformity with predictable outcome of no significant residual deformity (0/27 thumbs). In MCP angulation >30°, corrective osteotomy is recommended over soft tissue procedure alone due to achieve proper thumb position and adequate soft tissue balance. There is also a statistical decrease in significant residual deformity [from 85.71% (6/7 cases, treated by soft tissue procedure alone) to 30% (3/10 cases, treated by corrective osteotomy), P < 0.05]. This study proposes the use of preoperative MCP joint angular deformity as a guide to the type of surgical intervention in Wassel type IV thumb polydactyly.
Irradiated Skeletal Muscle Cells Mimicking Those of Atypical Fibroxanthoma on Mohs Frozen Sections
Authors: Xiong Michael Y. , Kolker Steven , Bennett Richard G.
Published: September 2020

Radiation can induce changes to skeletal muscle cells that may mimic and thus be confused with cells of atypical fibroxanthoma (AFX), pleomorphic dermal sarcoma, spindle cell squamous cell carcinoma, and other spindle soft-tissue tumors. An 80-year-old White man presented for Mohs micrographic surgery of an AFX on the left lateral neck. The medical history was notable for a tongue squamous cell carcinoma 9 years before that had been treated with wide local excision, left neck dissection, and radiation to the oral cavity and left neck. Frozen sections from the first stage of Mohs did not show typical AFX, but did reveal patchy clusters of atypical spindled and epithelioid cells, some with multiple nuclei. Because of the unusual appearance of these cells, Mohs micrographic surgery was halted, and the frozen tissue block was sent for permanent pathology examination. The cells on permanent sections stained positive for desmin, revealing them to be of skeletal muscle origin (in this case damaged platysma muscle because of late postradiation changes). It is thus important for the Mohs surgeon and the consultant dermatopathologist to be aware of the unusual histologic appearance of irradiated skeletal muscle to avoid confusion with other spindle cell tumors.
Evaluation of dual time-point fluorodeoxyglucose PET/computed tomography imaging in gastric cancer
Authors: Tasdemir Bekir , Güzel Yunus , Komek Halil , Can Canan
Published: September 2020

Background

We aimed to evaluate the efficiency of dual time-point fluorodeoxyglucose (FDG) PET/computed tomography (CT) imaging in detecting primary and metastatic lesions in gastric cancer.

Methods

Between May 2019 and January 2020, 52 patients with gastric carcinoma were prospectively involved in our study. And dual time-point FDG PET/CT imaging performed to the patients. Of detected primary and metastatic lesions, the ones that are better visualized or only appear in delayed imaging were visually identified. Also, maximum standardized uptake value (SUVmax) of the primary and metastatic lesions and the intact liver tissue were measured in early and delayed imaging. Acquired SUVmax values and SUVmax ratios were compared statistically.

Results

In delayed images, lesions were better visualized in 32 patients (61.5%) and extra lesions were detected in 4 patients (7.7%). SUVmax of primary tumor, SUVmax of liver metastases, SUVmax of lymph node metastases, primary tumor SUVmax/liver SUVmax ratio and lymph node metastasis SUVmax/liver SUVmax ratio were significantly higher in delayed images (P < 0.001, P = 0.022, P < 0.001, P < 0.001, P < 0.001, respectively). However, SUVmax of liver parenchyma was significantly lower in delayed images (P < 0.001).

Conclusions

There is a visually and statistically significant increase in the number and detectability of lesions seen in delayed images and dual time-point FDG PET/CT imaging seems useful in detecting primary and metastatic lesions in gastric cancer.
Managing Dyspnea in Individuals With Idiopathic Pulmonary Fibrosis
Authors: Fenwick Kathryn E. , Swan Beth Ann
Published: September 2020

Idiopathic pulmonary fibrosis is an unrelenting form of interstitial lung disease associated with a high symptom burden and reported low health-related quality of life. Clinicians have access to limited pharmacologic interventions to help slow the disease progression. Nonpharmacologic interventions are vital in managing dyspnea for these individuals, which is one of the most frequently reported factors that negatively impacts health-related quality of life. Common methods of symptom control include integration of pulmonary rehabilitation, supplemental oxygen, and interdisciplinary support, such as support groups, palliative care, and case conferences, into routine medical care. This literature review describes a multidisciplinary approach for managing dyspnea to improve health-related quality of life for those with idiopathic pulmonary fibrosis. Findings demonstrate that structured pulmonary rehabilitation programs, fast-track case conferences, and supplemental oxygen therapy are most effective. Further research is needed to demonstrate a clinically significant benefit of palliative care visits in the long term for these individuals.
Walking on Eggshells
Authors: SmithBattle Lee
Published: September 2020

Teen mothers are stigmatized for violating age norms for parenting and for being members of devalued racial or socioeconomic groups. Stereotypes of young mothers perpetuate stigma by teen pregnancy prevention campaigns, television shows, sex education programs, professionals, and the general public. How teen mothers became a stigmatized group; updates on research about their experience of stigma; and resources for reducing stigma are presented. Because stigma is pervasive and has damaging effects, nurses are urged to reduce stigma and discrimination by assuring that health settings are safe and welcoming, and that pregnant and parenting teens are treated with respect and dignity. Doing so is consistent with our professional commitment to promote social justice and mitigate the social inequities that contribute to health disparities for all parents, irrespective of age, gender, ethnicity, immigration status, or income.
A Comparison of US Clinical Laboratory Chlamydia and Gonorrhea Testing Practices Before and After the 2014 Centers for Disease Control and Prevention Testing Recommendations
Authors: Davis Alissa , Gaynor Anne
Published: September 2020

Background

Adherence to recommended laboratory testing practices is crucial for sexually transmitted infection prevention and control. The objective of this article is to compare Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) testing practices of US clinical laboratories in 2013 before the updated 2014 Centers for Disease Control and Prevention recommendations and in 2015 after the updated recommendations.

Methods

A total of 236 clinical laboratories participated in surveys about their 2013 and 2015 CT and NG testing practices, including questions on specimen types collected and assays used.

Results

There was an increase of 5 laboratories offering CT nucleic acid amplification testing (NAAT) from 2013 to 2015 and an increase of 5 laboratories offering NG NAAT. There was a net increase of 3 laboratories accepting urine for CT and NG NAAT, the preferred specimen type for male individuals. There was not a net increase in the total number of laboratories accepting vaginal swabs for CT NAAT (n = 89 in 2013 and 2015), the preferred specimen type for female individuals, but there was an increase of 3 laboratories accepting vaginal swabs for NG NAAT. The number of laboratories performing NG susceptibility testing decreased from 100 in 2013 to 89 in 2015 (χ2 = 1.07, P > 0.10).

Conclusions

There were no major changes in testing practices in the 2-year period from 2013 to 2015. However, there were some small shifts, including increases in the use of NAATs, acceptance of Centers for Disease Control and Prevention–preferred specimen types for CT/NG, and changes in usage of assays by manufacturer.
High-Risk Opioid Prescribing Trends: Prescription Drug Monitoring Program Data From 2010 to 2018
Authors: Ball Sarah J. , Simpson Kit , Zhang Jingwen , Marsden Justin , Heidari Khosrow , Moran William P. , Mauldin Patrick D. , McCauley Jenna L.
Published: September 2020

Objective:

Deaths due to opioids have continued to increase in South Carolina, with 816 opioid-involved overdose deaths reported in 2018, a 9% increase from the prior year. The objective of the current study is to examine longitudinal trends (quarter [Q] 1 2010 through Q4 2018) of opioid prescribing volume and high-risk opioid prescribing behaviors in South Carolina using comprehensive dispensing data available in the South Carolina Prescription Drug Monitoring Program (SC PDMP).

Design:

Retrospective analyses of SC PDMP data were performed using general linear models to assess quarterly time trends and change in rate of each outcome Q1 2010 through Q4 2018.

Participants:

Opioid analgesic prescription fills from SC state residents between Q1 2010 and Q4 2018.

Main Outcome Measures:

High-risk prescribing behaviors included (1) opioid prescribing rate; (2) percentage of patients receiving opioids dispensed 90 or more average morphine milligram equivalents daily; (3) percentage of opioid prescribed days with overlapping opioid and benzodiazepine prescriptions; (4) rate per 100 000 residents of multiple provider episodes; and (5) percentage of patients prescribed extended release opioids who were opioid naive.

Results:

A total of 33 027 461 opioid prescriptions were filled by SC state residents within the time period of Q1 2010 through Q4 2018. A 41% decrease in the quarterly prescribing rate of opioids occurred from Q1 2010 to Q4 2018. The decrease in overall opioid prescribing was mirrored by significant decreases in all 4 high-risk prescribing behaviors.

Conclusion:

PDMPs may represent the most complete data regarding the dispensing of opioid prescriptions and as such be valuable tools to inform and monitor the supply of licit opioids. Our results indicate that public health policy, legislative action, and multiple clinical interventions aimed at reducing high rates of opioid prescribing across the health care ecosystem appear to be succeeding in the state of South Carolina.
The Cost of Providing the Foundational Public Health Services in Ohio
Authors: Singh Simone R. , Leider Jonathon P. , Orcena Jason E.
Published: September 2020

Objectives:

To examine levels of expenditure and needed investment in public health at the local level in the state of Ohio pre–COVID-19.

Design:

Using detailed financial reporting from fiscal year (FY) 2018 from Ohio's local health departments (LHDs), we characterize spending by Foundational Public Health Services (FPHS). We also constructed estimates of the gap in public health spending in the state using self-reported gaps in service provision and a microsimulation approach. Data were collected between January and June 2019 and analyzed between June and September 2019.

Participants:

Eighty-four of the 113 LHDs in the state of Ohio covering a population of almost 9 million Ohioans.

Results:

In FY2018, Ohio LHDs spent an average of $37 per capita on protecting and promoting the public's health. Approximately one-third of this investment supported the Foundational Areas (communicable disease control; chronic disease and injury prevention; environmental public health; maternal, child, and family health; and access to and linkages with health care). Another third supported the Foundational Capabilities, that is, the crosscutting skills and capacities needed to support all LHD activities. The remaining third supported programs and activities that are responsive to local needs and vary from community to community. To fully meet identified LHD needs in the state pre–COVID-19, Ohio would require an additional annual investment of $20 per capita on top of the current $37 spent per capita, or approximately $240 million for the state.

Conclusions:

A better understanding of the cost and value of public health services can educate policy makers so that they can make informed trade-offs when balancing health care, public health, and social services investments. The current environment of COVID-19 may dramatically increase need, making understanding and growing public health investment critical.
Revealing the Unequal Burden of COVID-19 by Income, Race/Ethnicity, and Household Crowding: US County Versus Zip Code Analyses
Authors: Chen Jarvis T. , Krieger Nancy
Published: September 2020

Objective:

To overcome the absence of national, state, and local public health data on the unequal economic and social burden of COVID-19 in the United States.

Design:

We analyze US county COVID-19 deaths and confirmed COVID-19 cases and positive COVID-19 tests in Illinois and New York City zip codes by area percent poverty, percent crowding, percent population of color, and the Index of Concentration at the Extremes.

Setting:

US counties and zip codes in Illinois and New York City, as of May 5, 2020.

Main Outcome Measures:

Rates, rate differences, and rate ratios of COVID-19 mortality, confirmed cases, and positive tests by category of county and zip code–level area-based socioeconomic measures.

Results:

As of May 5, 2020, the COVID-19 death rate per 100 000 person-years equaled the following: 143.2 (95% confidence interval [CI]: 140.9, 145.5) vs 83.3 (95% CI: 78.3, 88.4) in high versus low poverty counties (≥20% vs <5% of persons below poverty); 124.4 (95% CI: 122.7, 126.0) versus 48.2 (95% CI: 47.2, 49.2) in counties in the top versus bottom quintile for household crowding; and 127.7 (95% CI: 126.0, 129.4) versus 25.9 (95% CI: 25.1, 26.6) for counties in the top versus bottom quintile for the percentage of persons who are people of color. Socioeconomic gradients in Illinois confirmed cases and New York City positive tests by zip code–level area-based socioeconomic measures were also observed.

Conclusions:

Stark social inequities exist in the United States for COVID-19 outcomes. We recommend that public health departments use these straightforward cost-effective methods to report on social inequities in COVID-19 outcomes to provide an evidence base for policy and resource allocation.
Acute Postoperative Complications in Prepectoral versus Subpectoral Reconstruction following Nipple-Sparing Mastectomy
Authors: Avila Azalia , Bartholomew Alex J. , Sosin Michael , Deldar Romina , Griffith Kayla F. , Willey Shawna C. , Song David H. , Fan Kenneth L. , Tousimis Eleni A.
Published: September 2020

Background:

Nipple-sparing mastectomy is associated with improved aesthetics and oncologic safety. Recently, there has been a resurgence in prepectoral reconstruction. Because of limited data comparing complication rates on patients undergoing prepectoral breast reconstruction, this study compared 30-day postoperative complications by plane of prosthetic placement.

Methods:

A retrospective review was conducted on all consecutive patients undergoing nipple-sparing mastectomy with implant-based reconstruction with either prepectoral or subpectoral placement from 2014 to 2018. The primary outcome was a composite, acute 30-day postoperative complication, including nipple-areola complex necrosis, mastectomy flap necrosis, wound dehiscence, infection, hematoma, and seroma. Secondary outcomes included nipple loss and rates of unintended reoperations. Univariate and mixed effects multivariate logistic regression were used to compare outcomes.

Results:

A total of 228 patients and 405 breasts were included in the final cohort, with 202 in the subpectoral cohort and 203 in the prepectoral cohort. The overall complication rate was 7.65 percent, with no significant difference between subpectoral and prepectoral cohorts (9.41 percent versus 5.91 percent, respectively; p = 0.148). Prepectoral reconstruction was associated with significantly reduced ischemic complications, including nipple loss because of necrosis (2.97 percent versus 0.49 percent, respectively; p = 0.015) and mastectomy flap necrosis (5.45 percent versus 0 percent; p = 0.003). There were no significant differences in rates of infection, hematoma, seroma, or implant loss/exchange.

Conclusions:

Prepectoral reconstruction is associated with similar overall 30-day postoperative complications and reoperations compared to traditional subpectoral implants. However, prepectoral reconstruction was associated with significantly decreased ischemic complications, including mastectomy flap necrosis and nipple-areola complex loss because of necrosis.

Clinical Question/Level of Evidence:

Therapeutic, III.
Evaluating a Multimodal Clinical Anesthesia Course Integrated Into an Existing Veterinary Curriculum
Authors: Noyes Julie A. , Keegan Robert D. , Carbonneau Kira J. , Lepiz Mauricio L. , Rankin David C. , Matthew Susan M.
Published: September 2020

Introduction

This study evaluated a multimodal, simulation-based course in veterinary anesthesia integrated into an existing veterinary curriculum.

Methods

A simulation-based, multimodal training course in clinical anesthesia was evaluated using outcomes from multiple levels of the Kirkpatrick Model of Training Evaluation. Cognitive and affective outcomes were evaluated before and after instruction. Head-mounted cameras were used to record clinical performance during students' first live patient anesthesia experience in the curriculum.

Results

Pretest-posttest analysis of cognitive and affective outcomes for course participants revealed significant increases in knowledge and self-efficacy. Course participants received higher ratings on clinical task performance and professional skills (ie, communication and collaboration) compared with a matched control group when evaluated by blinded, external raters using a standardized rubric.

Conclusions

These findings indicate that implementing a multimodal anesthesia simulation-based course directly into the curriculum can enhance cognitive and affective outcomes and prepare students for subsequent anesthesia-related patient care experiences.
Technical Report and Surgical Outcomes of Needlescopic Totally Extraperitoneal Inguinal Hernia Repair: A Single-center, Retrospective Cohort Study
Authors: Kojima Shigehiro , Kikukawa Rina , Sakamoto Tsuguo
Published: September 2020

Background:

Technical difficulties in totally extraperitoneal inguinal hernia repair (TEP) may be strongly associated with poor operability in a limited operative field. Needlescopic instruments could be helpful in a limited space, and the aim of this study was to evaluate the clinical efficacy of needlescopic TEP.

Materials and Methods:

The study population constituted 150 consecutive patients undergoing needlescopic TEP, and we compared these patients with 151 consecutive patients who underwent conventional TEP regarding patients’ demographic features and operative outcomes. Inclusion criteria were: (1) being treated by an experienced surgeon and (2) replying to our questionnaire regarding postoperative outcomes.

Results:

The mean skin opening to closing times for unilateral and bilateral repairs were, respectively, 95.3±30.1 and 130.2±48.7 minutes for conventional TEP and 75.7±24.5 and 114.5±46.3 minutes for needlescopic TEP. The difference for unilateral repairs between the 2 surgical groups was significant (P=0.01). Conversion rates, postoperative hospital stays, and perioperative morbidity rates showed no significant differences between the 2 groups.

Conclusions:

Needlescopic TEP is a useful procedure that decreases operative duration with no significant differences in perioperative morbidity compared with conventional TEP.
Skeletal ageing in Virunga mountain gorillas
Authors: Ruff Christopher B. , Junno Juho-Antti , Eckardt Winnie , Gilardi Kirsten , Mudakikwa Antoine , McFarlin Shannon C.
Published: September 2020

Bone loss and heightened fracture risk are common conditions associated with ageing in modern human populations and have been attributed to both hormonal and other metabolic and behavioural changes. To what extent these age-related trends are specific to modern humans or generally characteristic of natural populations of other taxa is not clear. In this study, we use computed tomography to examine age changes in long bone and vertebral structural properties of 34 wild-adult Virunga mountain gorillas (Gorilla beringei beringei) whose skeletons were recovered from natural accumulations. Chronological ages were known or estimated from sample-specific dental wear formulae and ranged between 11 and 43 years. Gorillas show some of the same characteristics of skeletal ageing as modern humans, including endosteal and some periosteal expansion. However, unlike in humans, there is no decline in cortical or trabecular bone density, or in combined geometric-density measures of strength, nor do females show accelerated bone loss later in life. We attribute these differences to the lack of an extended post-reproductive period in gorillas, which provides protection against bone resorption. Increases in age-related fractures (osteoporosis) in modern humans may be a combined effect of an extended lifespan and lower activity levels earlier in life.

This article is part of the theme issue ‘Evolution of the primate ageing process'.