bluuebunny/crossref_metadata_2025 huggingface dataset:
Overdiagnosis and treatment of COPD in nonagenarians
Authors: Tole Mateo , Ascoli Christian J. , Joo Min , Rubinstein Israel
Published: January 2022

Background

The prevalence of COPD is increasing with age. However, the effects of age-dependent decline in lung function on diagnosis and treatment of COPD in nonagenarians are uncertain.

Objectives

To determine performance of spirometry, prescription of COPD medications, and COPD-related acute care visits and hospitalizations in patients 90 years and older with physician-diagnosed COPD.

Methods

Health records of 166 consecutive patients 90 years and older with physician-diagnosed COPD at a university-affiliated medical center in Chicago were reviewed. Pertinent demographic, clinical, and physiological data were extracted.

Results

Patients were predominantly ex-smoker (96%), African American (52%) males (96%). Sixty patients (36%) had no spirometry testing on record. Of the remaining 106 patients, 11 (10%) had baseline FEV1/FVC≥0.70, 24 (23%) had post-bronchodilator FEV1/FVC ≥0.70, 28 (26%) had FEV1/FVC <0.70 and ≥LLN, and 43 (41%) had FEV1/FVC <0.70 and <LLN. Thus, only 71 of 166 patients 90 years and older (43%) fulfilled the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations. Nonetheless, COPD medications, predominantly short-acting β2 agonists and long-acting muscarinic antagonists, were prescribed to 95 of the 166 patients (57%). No significant differences in prevalence of co-morbidities and prescribed COPD medications, including systemic corticosteroids and anti-infectives prescribed during unscheduled healthcare visits and hospitalizations, were found between the four groups.

Conclusions

These data suggest that a large proportion of nonagenarians at our medical center are overdiagnosed with and treated for COPD. A larger, multi-center, prospective study is warranted to support or refute these retrospective observations.
Rapid prototyping of metabolites detection by bacterial biosensors in human fecal samples
Authors: Zuñiga Ana , Boivineau Lucile , Mayonove Pauline , Conejero Ismael , Pageaux Georges-Philippe , Altwegg Romain , Bonnet Jerome
Published: January 2022

Gut metabolites are pivotal mediators of host-microbiome interactions and provide an important window on human physiology and disease. However, current methods to monitor gut metabolites rely on heavy and expensive technologies such as liquid chromatography-mass spectrometry (LCMS). In that context, robust, fast, field-deployable, and cost-effective strategies for monitoring fecal metabolites would support large-scale functional studies and routine monitoring of metabolites biomarkers associated with pathological conditions. Living cells are an attractive option to engineer biosensors due to their ability to detect and process many environmental signals and their self-replicating nature. Here we optimized a protocol for feces processing and gut metabolites detection using bacterial biosensors (bactosensors), enabling rapid evaluation of their operational capacity in these samples. We show that a simple filtration step is enough to remove host microbes and reproducibly obtain a physiological-derived media retaining important characteristics of human feces, such as matrix effects and endogenous metabolites. We measured how fecal samples affect the performance of biosensors for benzoate, lactate, anhydrotetracycline, and bile acids, and found that bactosensors are highly sensitive to fecal matrices. Sensitivity to the matrix is biosensor-dependent but also varies between individuals, highlighting the need for case-by-case optimization for bactosensors operation in feces. Finally, by detecting endogenous bile acids, we demonstrate that bactosensor can be used for metabolites monitoring in feces. This work lays the foundation for the optimization and use of bacterial biosensors for fecal metabolites monitoring. In the future, our method could also allow rapid pre-prototyping of engineered bacteria designed to operate in the gut, with applications to in situ diagnostics and therapeutics.
Structure and Protein-Protein Interactions of Ice Nucleation Proteins Drive Their Activity
Authors: Hartmann Susan , Ling Meilee , Dreyer Lasse S.A. , Zipori Assaf , Finster Kai , Grawe Sarah , Jensen Lasse Z. , Borck Stella , Reicher Naama , Drace Taner , Niedermeier Dennis , Jones Nykola C. , Hoffmann Søren V. , Wex Heike , Rudich Yinon , Boesen Thomas , Šantl-Temkiv Tina
Published: January 2022

ABSTRACT

Microbially-produced ice nucleating proteins (INpro) are unique molecular structures with the highest known catalytic efficiency for ice formation. Their critical role in rain formation and frost damage of crops together with their diverse commercial applications warrant an in-depth under-standing of their inherent ice nucleation mechanism. We used the machine-learning based software Al-phaFold to develop the first ab initio structural model of a bacterial INpro which is a novel beta-helix structure consisting of repeated stacks of two beta strands connected by two sharp turns. Using the synchrotron radiation circular dichroism, we validated the β-strand content of the model. Combining functional studies of purified recombinant INpro, electron microscopy and modeling, we further demonstrate that the formation of dimers and higher-order oligomers is key to INpro activity. This work presents a major advance in understanding the molecular foundation for bacterial ice-nucleation activity and the basis for investigating the mechanistic role of INpro-induced ice formation in the atmosphere, and for commercial design and production of ice-nucleating particles for industrial applications.
Metal cofactor stabilization by a partner protein is a widespread strategy employed for amidase activation
Authors: Page Julia E. , Skiba Meredith A. , Do Truc , Kruse Andrew C. , Walker Suzanne
Published: January 2022

Construction and remodeling of the bacterial peptidoglycan (PG) cell wall must be carefully coordinated with cell growth and division. Central to cell wall construction are hydrolases that cleave bonds in peptidoglycan. These enzymes also represent potential new antibiotic targets. One such hydrolase, the amidase LytH inStaphylococcus aureus, acts to remove stem peptides from PG, controlling where substrates are available for insertion of new PG strands and consequently regulating cell size. When it is absent, cells grow excessively large and have division defects. For activity, LytH requires a protein partner, ActH, that consists of an intracellular domain, a large rhomboid protease domain, and three extracellular tetratricopeptide repeats (TPRs). Here we demonstrate that the amidase-activating function of ActH is entirely contained in its extracellular TPRs. We show that ActH binding stabilizes metals in the LytH active site, and that LytH metal binding in turn is needed for stable complexation with ActH. We further present a structure of a complex of the extracellular domains of LytH and ActH. Our findings suggest that metal cofactor stabilization is a general strategy used by amidase activators and that ActH houses multiple functions within a single protein.

SIGNIFICANCE STATEMENT

The Gram-positive pathogenStaphylococcus aureusis a leading cause of antibiotic resistance-associated death in the United States. Many antibiotics used to treatS. aureus, including the beta-lactams, target biogenesis of the essential peptidoglycan (PG) cell wall. Some hydrolases play important roles in cell wall construction and are potential antibiotic targets. The amidase LytH, which requires a protein partner, ActH, for activity, is one such hydrolase. Here, we uncover how the extracellular domain of ActH binds to LytH to stabilize metals in the active site for catalysis. This work advances our understanding of how hydrolase activity is controlled to contribute productively to cell wall synthesis.
Nanoformulated Remdesivir with Extremely Low Content of Poly(2-oxazoline) - Based Stabilizer for Aerosol Treatment of COVID-19
Authors: Ramsey Jacob D. , Stewart Ian E. , Madden Emily A. , Lim Chaemin , Hwang Duhyeong , Heise Mark T. , Hickey Anthony J. , Kabanov Alexander V.
Published: January 2022

The rise of the novel virus SARS-CoV2 which causes the disease known as COVID-19 has led to a global pandemic claiming millions of lives. With no clinically approved treatment for COVID-19, physicians initially struggled to treat the disease and there is still need for improved anti-viral therapies in this area. We conceived early in the pandemic that an inhalable formulation of the drug Remdesivir which directly targets the virus at the initial site of infection could improve therapeutic outcomes in COVID-19. We developed a set of requirements that would be conducive to rapid drug approval: 1) try to use GRAS or GRAS similar reagents 2) minimize excipient concentration and 3) achieve a working concentration of 5 mg/mL Remdesivir to achieve a deliverable dose which is 5-10% of the IV dose. In this work, we discovered that Poly(2-oxazoline) block copolymers can stabilize drug nanocrystal suspensions and provide suitable formulation characteristics for aerosol delivery while maintaining anti-viral efficacy. We believe POx block copolymers can be used as a semi-ubiquitous stabilizer for the rapid development of nanocrystal formulations for new and existing diseases.
GLH/VASA helicases promote germ granule formation to ensure the fidelity of piRNA-mediated transcriptome surveillance
Authors: Chen Wenjun , Brown Jordan S , He Tao , Wu Wei-Sheng , Tu Shikui , Weng Zhiping , Zhang Donglei , Lee Heng-Chi
Published: January 2022

The ability to distinguish non-self from self is the key characteristic for any defense system. piRNAs function as guardians of the genome by silencing non- self nucleic acids and transposable elements in animals. Many piRNA factors are enriched in perinuclear germ granules, but whether their localization is required for piRNA biogenesis or function is not known. Here we show that GLH/VASA helicase mutants exhibit defects in forming perinuclear condensates containing PIWI and other small RNA cofactors. These mutant animals produce largely normal levels of piRNA but are defective in triggering piRNA silencing. Strikingly, while many piRNA targets are activated in GLH mutants, we observed that hundreds of endogenous genes are aberrantly silenced by piRNAs. This defect in self versus non-self recognition was also observed in other mutants where perinuclear P granules are disrupted. Together, our results argue that perinuclear germ granules function critically to promote the fidelity of piRNA- based transcriptome surveillance in C. elegans and preserve self versus non-self distinction.
What influences Vietnamese Airbnb travelers’ positive electronic word-of-mouth intentions? An extension of the Mehrabian – Russell model
Authors: Do Thuc Thi Mai Doan , Pinto Patrícia , Silva Joao Albino , Pereira Luis Nobre
Published: January 2022

Purpose

This study aims to investigate the relationship between environmental stimuli of Airbnb experience, customers’ perceived enjoyment and positive electronic word-of-mouth (eWOM) intentions through an extension of the Mehrabian–Russell model.

Design/methodology/approach

A quantitative methodology was adopted using a web-based survey. Data were collected from a sample of 162 Vietnamese Airbnb consumers who had stayed at the platform accommodations. A two-stage procedure with the partial least squares approach to structural equation modeling was conducted to evaluate the measurement model and structural model.

Findings

The results confirmed the significant positive effect of home benefits and social interaction on Airbnb customers’ perceived enjoyment, which subsequently inspires them to develop intentions to spread positive comments toward this platform. Moreover, these relationships remain unchanged among the different groups of customers, except Airbnb travelers with business purposes.

Practical implications

The findings will provide Airbnb stakeholders in emerging markets with insights into identifying the important environmental factors that are more likely to stimulate consumers’ enjoyment and encourage them to spread positive WOM on social network outlets.

Originality/value

This research provides a deeper comprehension of Airbnb users’ emotional states and positive eWOM intentions by exploring the possible antecedents. Moreover, to the best of the authors’ knowledge, this is the first study to propose the moderating role of gender, purpose of the trip and type of accommodation in the hypothesized relationships. The contradictory findings of this study also highlight the cultural difference in Airbnb customers’ perception and behavioral intentions.
Integrated project delivery in the Nigerian construction sector: an unexplored approach from the stakeholders’ perspective
Authors: Ebekozien Andrew , Aigbavboa Clinton Ohis , Aigbedion Marvelous , Ogbaini Iliye Faith , Aginah Ibeabuchi Lawrence
Published: January 2022

Purpose

Over the past years, high waste and inefficiencies in the construction industry may have contributed to many projects failing to meet clients’ expectations. Among the new project delivery mechanisms to tackle this problem is integrated project delivery (IPD). IPD has been proved as a mechanism that increases stakeholders’ collaboration at the early stage and delivers the highest value-for-money projects. In Nigeria, research regarding practitioners in the application of IPD in construction delivery is scarce. Thus, this study aims to investigate the level of awareness, issues hindering the implementation of IPD and proffer solutions to promote the use of IPD in project delivery.

Design/methodology/approach

Qualitative research was adopted. Twenty virtual interviews via Zoom and Whatsapp Videos were used to collect data from the selected participants and analysed via a thematic method. This is because of the unexplored dimension of the issues.

Findings

Results show that practitioners are aware of IPD but lax in the application. The emerged issues hindering the adoption and implementation of IPD were grouped into technological, legal, financial and cultural in Nigeria’s context.

Research limitations/implications

This study is restricted to the relevance and hindrances facing the usage of IPD in the Nigerian built environment. The study proffers solutions to promote the use of IPD in the built environment via a qualitative approach.

Practical implications

This paper will contribute towards stirring Nigeria’s stakeholders to create an enabling environment within the industry via IPD friendly policies and promote the use of IPD on construction projects.

Originality/value

This paper is one of the few papers that attempted to uncover issues that hinder the use of IPD on construction projects in Nigeria via a qualitative approach.
Exploring users' adoption intentions in the evolution of artificial intelligence mobile banking applications: the intelligent and anthropomorphic perspectives
Authors: Lee Jung-Chieh , Chen Xueqing
Published: January 2022

Purpose

The development of mobile technology has changed the traditional financial industry and banking sector. While traditional banks have adopted artificial intelligence (AI) techniques to deepen the development of mobile banking applications (apps), the current literature lacks research on the use of AI-based constructs to explore users' mobile banking app adoption intentions. To fill this gap, based on stimulus-organism-response (SOR) theory, two AI feature constructs as stimuli are considered, namely, perceived intelligence and anthropomorphism. This study then develops a research model to investigate how intelligence and anthropomorphism affect task-technology fit (TTF), perceived cost, perceived risk and trust (organism), which in turn influence users' AI mobile banking app adoption (response).

Design/methodology/approach

This study used a convenience nonprobability sampling approach; a total of 451 responses were collected to examine the model. The partial least squares technique was utilized for data analysis.

Findings

The results show that intelligence and anthropomorphism increase users' willingness to adopt mobile banking apps through TTF and trust. However, higher levels of anthropomorphism enhance users' perceived cost. In addition, both intelligence and anthropomorphism have insignificant effects on perceived risk. The results provide theoretical contributions for AI-based mobile banking app adoption and offer practical guidance for bank planning to use AI to retain users.

Originality/value

Based on SOR theory, this study reveals that as features, AI-enabled intelligence and anthropomorphism help us further understand users' perceptions regarding cost, risk, TTF and trust in the context of AI-enabled app adoption intentions.
Indian women consumers’ wine choice: a study based on conjoint analysis
Authors: Payini Valsaraj , Mallya Jyothi , Piramanayagam Senthilkumaran
Published: January 2022

Purpose

Wine consumption among women in India is gradually increasing on the back of several factors such as increased urbanization, higher disposable income, rising affluence of the people, exposure to new cultures and a gradually changing perception about wine being a healthy beverage. Eventually, this offers tremendous opportunities for wine marketers to design appropriate strategies to target Indian women consumers. However, along with this growth, there is growing need to identify the attributes that the women desire in the wines of their choice. Toward this, the current study aims to identify the wine attributes that influence the purchasing behavior of Indian women consumers.

Design/methodology/approach

In-depth interviews of 27 women wine consumers, aged between 25 to 46 years, were conducted to identify the topmost essential wine attributes. Later, a conjoint analysis using 1000minds, an Internet-based software implementing Potentially All Pairwise RanKings of all Possible Alternatives (PAPRIKA), was used to collect data from the participants. The total number of responses received was 271.

Findings

The type of wine, taste, price, familiarity and country of origin emerged as the five most crucial wine attributes in wine choice after the in-depth interview. Conjoint analysis results revealed that sweet red wine priced between Rs 600 to Rs 1,200 is the most preferred wine by Indian women consumers.

Research limitations/implications

The study provides valuable and actionable insights for both domestic and international wine marketers and manufacturers in the identification of wine attributes that predominantly influence women consumers’ choice of wine in India.

Originality/value

The study contributes to wine consumers' literature by identifying wine attributes favored by women consumers in India. Our findings will be of great use to wine marketers who can leverage the insights to design appropriate marketing and advertising strategies, develop new products and make more informed branding and pricing decisions.
Making (remote) sense of lianas
Authors: van der Heijden Geertje M. F. , Proctor Ashley D. C. , Calders Kim , Chandler Chris J. , Field Richard , Foody Giles M. , Krishna Moorthy Sruthi M. , Schnitzer Stefan A. , Waite Catherine E. , Boyd Doreen S.
Published: January 2022

Lianas (woody vines) are abundant and diverse, particularly in tropical ecosystems. Lianas use trees for structural support to reach the forest canopy, often putting leaves above their host tree. Thus they are major parts of many forest canopies. Yet, relatively little is known about distributions of lianas in tropical forest canopies, because studying those canopies is challenging. This knowledge gap is urgent to address because lianas compete strongly with trees, reduce forest carbon uptake and are thought to be increasing, at least in the Neotropics.

Lianas can be difficult to study using traditional field methods. Their pliable stems often twist and loop through the understorey, making it difficult to assess their structure and biomass, and the sizes and locations of their crowns. Furthermore, liana stems are commonly omitted from standard field surveys. Remote sensing of lianas can help overcome some of these obstacles and can provide critical insights into liana ecology, but to date there has been no systematic assessment of that contribution.

We review progress in studying liana ecology using ground‐based, airborne and space‐borne remote sensing in four key areas: (i) spatial and temporal distributions, (ii) structure and biomass, (iii) responses to environmental conditions and (iv) diversity. This demonstrates the great potential of remote sensing for rapid advances in our knowledge and understanding of liana ecology. We then look ahead, to the possibilities offered by new and future advances. We specifically consider the data requirements, the role of technological advances and the types of methods and experimental designs that should be prioritised.

Synthesis. The particular characteristics of the liana growth form make lianas difficult to study by ground‐based field methods. However, remote sensing is well suited to collecting data on lianas. Our review shows that remote sensing is an emerging tool for the study of lianas, and will continue to improve with recent developments in sensor and platform technology. It is surprising, therefore, how little liana ecology research has utilised remote sensing to date—this should rapidly change if urgent knowledge gaps are to be addressed. In short, liana ecology needs remote sensing.
Relations of extraction, relations of redistribution: Empire, nation, and the construction of the British welfare state
Authors: Bhambra Gurminder K.
Published: January 2022

The consolidation of the British welfare state in the mid‐twentieth century did not only coincide with the systematic dismantling of the British Empire but was significantly shaped by the empire that preceded it. The story that tends to be told about the welfare state, however, situates it firmly within the national context. Such understandings go on to shape contemporary political debates centered on questions of entitlement and concerns over legitimacy. In this article, I reassess the standard accounts of taxation and welfare that are claimed to be central to the construction of the nation to demonstrate how taking the empire into account offers the possibility of a different political response to the challenges we are faced with today.
New institutional leadership goes viral EU crisis reforms and the coming about of the covid recovery fund
Authors: SMEETS SANDRINO , BEACH DEREK
Published: January 2022

This article reconstructs the coming about of the 750 billion EU Covid Recovery Fund. We provide an embedded process‐tracing analysis of the dynamics from mid‐March 2020, when the idea of ‘Corona‐bonds’ was parachuted onto the Heads’ Agenda, up until the ‘historic’ deal on the Multiannual Financial Framework and Recovery Fund of 21 July. Where most media accounts and scholarly assessments focus on the high‐level deal making between political leaders, we trace the proceedings inside the EU's institutional machinery, which produced the solutions and laid out the groundwork for a deal. The reconstruction assesses the role and influence of the EU institutions – the European Commission in particular – in producing this major step. We show that the process was characterized by a handicapped European Council, which hampered the ability of member states to oversee and control developments. The conclusions discuss the implications of our findings for our understanding of (institutional) leadership and policy making during crisis.
Smurf participates in Helicoverpa armigera diapause by regulating the transforming growth factor‐β signaling pathway
Authors: Li Haiyin , Lu Qin , Li Yan , Yan Yufang , Yin Zhiyong , Guo Jianjun , Xu Weihua
Published: January 2022

Diapause, an important strategy used by insects to avoid adverse environments, is regulated by various cell signaling pathways. The results of our previous studies demonstrated that the transforming growth factor‐β (TGF‐β) signaling pathway regulated pupal diapause in Helicoverpa armigera, which was accompanied by downregulation of proteins in TGF‐β signaling. However, to date the mechanism underlying this phenomenon remains unknown. Here, we cloned the E3 ubiquitin ligases gene Smurf. In vitro experiments showed that Smurf directly bound to TGF‐β receptor type I (TGFβRI) and Smad2. Overexpressing Smurf promoted ubiquitination of TGFβRI and Smad2, thereby downregulating their protein levels. Conversely, silencing of the Smurf gene suppressed ubiquitination of TGFβRI and Smad2 thereby increasing their protein levels. Results from in vivo co‐immunoprecipitation assays revealed that the binding of Smurf to TGFβRI or Smad2 was stronger in diapause pupae than in nondiapause pupae. Injection of Smurf inhibitor A01 into diapause pupae markedly upregulated expression of TGFβRI and Smad2 proteins, leading to resumption of development in diapause pupae. Taken together, these findings suggested that ubiquitin ligase E3 Smurf participated in H. armigera diapause by regulating TGF‐β signaling, and thus could be playing a crucial role in insect diapause.
Prehospital airway management for out‐of‐hospital cardiac arrest: A nationwide multicenter study from the KoCARC registry
Authors: Chang Hansol , Jeong Daun , Park Jong Eun , Kim Taerim , Lee Gun Tak , Yoon Hee , Hwang Sung Yeon , Cha Won Chul , Shin Tae Gun , Sim Min Seob , Jo Ik Joon , Lee Seung‐Hwa , Shin Sang Do , Choi Jin‐Ho
Published: January 2022

Aim

This study investigated whether prehospital advanced airway management (AAM) is associated with improved survival of out‐of‐hospital cardiac arrest (OHCA) compared with conventional bag–valve–mask (BVM) ventilation.

Methods

We investigated the neurologically favorable survival of adult patients with OHCA who underwent BVM or AAM using the Korean Cardiac Arrest Research Consortium (KoCARC), a multicenter OHCA registry of Korea. The differences in clinical characteristics were adjusted by matching or weighting the clinical propensity for use of AAM or by least absolute shrinkage and selection operator (LASSO). The primary outcome was 30‐day survival with neurologically favorable status defined by cerebral performance category 1 or 2.

Results

Of the 9,616 patients enrolled (median age = 71 years; 65% male), there were 6,243 AAM and 3,354 BVM patients. In unadjusted analysis, the 30‐day neurologically favorable survival was lower in the AAM group compared with the BVM group (5.5% vs. 10.0%; hazard ratio [HR] = 1.21, 95% confidence interval [CI] = 1.16 to 1.27; all p < 0.001). In propensity score matching–adjusted analysis, these differences were not found (9.6% vs. 10.0%; HR = 0.98, 95% CI = 0.93 to 1.03, p > 0.05). Inverse probability of treatment weighting‐ and LASSO‐adjusted analyses replicated these results.

Conclusions

In this nationwide real‐world data analysis of OHCA, the 30‐day neurologically favorable survival did not differ between prehospital AAM and BVM after adjustment for clinical characteristics.
Fentanyl versus placebo with ketamine and rocuronium for patients undergoing rapid sequence intubation in the emergency department: The FAKT study—A randomized clinical trial
Authors: Ferguson Ian , Buttfield Alexander , Burns Brian , Reid Cliff , Shepherd Shamus , Milligan James , Harris Ian A. , Aneman Anders ,   the Australasian College for Emergency Medicine Clinical Trials Network
Published: January 2022

Objective

The objective was to determine whether the use of fentanyl with ketamine for emergency department (ED) rapid sequence intubation (RSI) results in fewer patients with systolic blood pressure (SBP) measurements outside the pre‐specified target range of 100–150 mm Hg following the induction of anesthesia.

Methods

This study was conducted in the ED of five Australian hospitals. A total of 290 participants were randomized to receive either fentanyl or 0.9% saline (placebo) in combination with ketamine and rocuronium, according to a weight‐based dosing schedule. The primary outcome was the proportion of patients in each group with at least one SBP measurement outside the prespecified range of 100–150 mm Hg (with adjustment for baseline abnormality). Secondary outcomes included first‐pass intubation success, hypotension, hypertension and hypoxia, mortality, and ventilator‐free days 30 days following enrollment.

Results

A total of 142 in the fentanyl group and 148 in the placebo group commenced the protocol. A total of 66% of patients receiving fentanyl and 65% of patients receiving placebo met the primary outcome (difference = 1%, 95% CI = −10 to 12). Hypotension (SBP ≤ 99 mm Hg) was more common with fentanyl (29% vs. 16%; difference = 13%, 95% CI = 3% to 23%), while hypertension (≥150 mm Hg) occurred more with placebo (69% vs. 55%; difference = 14%, 95% CI = 3 to 24). First‐pass success rate, 30 day mortality, and ventilator‐free days were similar.

Conclusions and Relevance

There was no difference in the primary outcome between groups, although lower blood pressures were more common with fentanyl. Clinicians should consider baseline hemodynamics and postinduction targets when deciding whether to use fentanyl as a coinduction agent with ketamine.
General practitioner obstetricians’ models of care in rural Western Australia
Authors: Wazir Maryam , Roxburgh Carly , Moore Sarah
Published: January 2022

Background

In Australia, a significant proportion of women live rurally and deliver their babies in services supported by general practitioner obstetricians (GPOs). While GPOs are known to be an important backbone in the provision of maternity care in Australia, little attention has been paid to their models of care.

Aims

To describe the models of maternity care provided by GPOs across Western Australia.

Materials and Methods

This was a multi‐phase mixed‐methods cross‐sectional exploratory study. We invited rural GPOs in Western Australia to complete an online survey about their models of care and a sub‐group of GPOs agreed to an interview to further explore their responses.

Results

Thirty‐five GPOs completed the survey and 12 completed an interview. We found that GPOs work in a variety of models, dependent on local community needs, resources and geography. Key attributes of GPO models are continuity of care, safety, generalism, accessibility and affordability. GPO care involves continuity of care beyond the time limits of pregnancy.

Conclusions

GPOs’ models of care make up an essential part of rural maternity services and have evolved to meet the needs of the communities they serve. This work informs rural generalist trainees of career pathways and policymakers about rural service provision.
Evaluation of the geriatrician in the practice model of care for dementia assessment and management in rural Australia
Authors: Christley Jeremy , Cuenca Jose , Davis Kimberley J. , Evry Narelle , Hartwell Tabitha , Shepherd Karen
Published: January 2022

Objectives

To evaluate an integrated care program expanding the physician in the practice model into geriatrics, focussing on dementia assessment and management.

Design

Observational descriptive study.

Setting

The rural section of a local health district in New South Wales, Australia.

Participants

Patients attending eight general practices, in addition to practice nurses and general practitioners.

Interventions

Self‐report questionnaires completed by patients, specialist general practitioners and practice nurses. Responses to open‐ended questions were analysed using content analysis. Routinely collected health data of patients who took part in the program were compared with data of patients from the same institution who did not take part in the program.

Main outcome measures

A number of planned reviews, actual reviews and emergency department presentations for participating patients, self‐efficacy amongst general practitioners and practice nurses, and patient satisfaction and comfort levels.

Results

The GIP program was well received by most patients, GPs and practice nurses. Almost 90% of patients found it easier to see the specialist at their general practice. They were less likely to have planned reviews, actual reviews and emergency department presentations than patients who did not take part in the program. GPs and practice nurses expressed increased confidence in and knowledge of dementia assessment and management.

Conclusions

Dementia assessment and management programs based on the physician in the practice model may be well received in similar rural settings. Larger prospective studies are needed to further examine the relationship between programs and patients’ health outcomes.
Clinician and consumer perceptions of head and neck cancer services in rural areas: Implications for speech pathology service delivery
Authors: Foley Jasmine , Nund Rebecca L. , Ward Elizabeth C. , Burns Clare L. , Wishart Laurelie R. , Graham Nicky , Patterson Corey , Ashley Amy , Fink Julie , Tiavaasue Emily , Comben Wendy
Published: January 2022

Objective

Individuals with head and neck cancer residing in rural areas face numerous challenges accessing post‐acute rehabilitation services, including speech pathology services. In order to inform future service enhancements, the key issues impacting access to, and the provision of, speech pathology head and neck cancer services in rural areas was explored through the perspectives of patients, carers, speech pathology clinicians and service managers.

Setting

A rural health referral network in Queensland consisting of tertiary, regional and remote hospitals.

Participants

Twenty‐eight participants, including 12 speech pathology staff/managers and 16 consumers (people with head and neck cancer/carers).

Design

Qualitative methodology using semi‐structured interviews was analysed using content analysis.

Results

Two themes were identified from the consumer group including (a) navigating health services for head and neck cancer management and (b) burden of accessing head and neck cancer care. Speech pathology staff/managers interviews raised 3 themes: (a) transfer of care and access to local services, (b) workforce and workload and (c) travelling impacts the service our patients can receive. An integrative theme across both groups highlighted the perceived disparity in health care access that existed for people with head and neck cancer in rural areas.

Conclusions

In rural areas, consumers face multiple barriers navigating the head and neck cancer treatment pathway, while health services encounter specific challenges ensuring access and equity in care. Despite the complexities, possible avenues for service change and service enhancement are proposed. Speech pathology services in rural areas need to proactively evaluate services and address existing disparities in order to enact positive change for people with head and neck cancer living outside metropolitan locations.
Online Isha Upa Yoga for student mental health and well‐being during COVID‐19: A randomized control trial
Authors: Chang Tracy F. H. , Ley Barbara L. , Ramburn Triya T. , Srinivasan Sangeetha , Hariri Sepideh , Purandare Pradeep , Subramaniam Balachundhar
Published: January 2022

College students experienced increased stress and anxiety during the COVID‐19 pandemic. This study evaluated the effect of brief online Isha Upa Yoga modules on undergraduates' mental health and well‐being. Randomized control trial (RCT) with waitlist control crossover (N = 679). The intervention group was instructed to learn and practice the modules daily for 12 weeks. At the end of the 4‐week RCT, the control group was instructed to learn and practice the modules for the remaining 8 weeks. Primary outcomes included stress and well‐being. Secondary outcomes included anxiety, depression, resilience, positive affect and negative affect. Linear mixed‐effects models were used for analyses. Isha Upa Yoga significantly reduced stress (Group [intervention, control] × Time [baseline, Week 4] interaction, p = .009, d = .27) and increased well‐being (Group × Time interaction p = .002, d = .32). By the study's end, the intervention and control groups experienced significant improvements in well‐being (p < .001, p < .001), stress (p < .001, p < .001), anxiety (p < .001, p < .001), depression (p < .001, p = .004), positive affect (p = .04, p < .001), and negative affect (p < .001, p < .001). Online Isha Upa Yoga shows promise for mitigating the pandemic's negative impact on undergraduates' mental health and improving their well‐being.
Non‐metastatic muscle‐invasive bladder cancer: the role of age in receiving treatment with curative intent
Authors: van Hoogstraten Lisa M.C. , Witjes J. Alfred , Meijer Richard P. , Ripping Theodora M. ,   BlaZIB study group, Kiemeney Lambertus A. , Aben Katja K.H.
Published: January 2022

Objectives

To evaluate which patient and tumour characteristics are associated with remaining untreated in patients with potentially curable, non‐metastatic muscle‐invasive bladder cancer (MIBC), and to compare survival of untreated vs treated patients with similar characteristics.

Patients and methods

For this cohort study, 15 047 patients diagnosed with cT2–T4aN0/xM0/x urothelial MIBC between 2005 and 2019 were identified in the Netherlands Cancer Registry. Factors associated with remaining untreated were identified using logistic regression analyses. Interhospital variation was assessed using multilevel analysis. Using a propensity score, the median overall survival (mOS) of untreated and treated patients was evaluated. Analyses were stratified by age (<75 vs ≥75 years).

Results

One‐third of patients aged ≥75 years remained untreated; increasing age, worse performance status, worse renal function, cT4a stage and previous radiotherapy in the abdomen/pelvic area increased the odds of remaining untreated. One in 10 patients aged <75 years remained untreated; significant associations were only found for performance status, renal function and cT4a stage. Interhospital variation for remaining untreated was largest for patients aged ≥75 years, ranging from 37% to 69% (case‐mix‐adjusted). Irrespective of age, mOS was significantly worse for untreated patients: 6.4 months (95% confidence interval [CI] 5.1–7.3) vs 16.0 months (95% CI 13.5–19.1) for treated patients.

Conclusion

On average, one in five patients with non‐metastatic MIBC remained untreated. Untreated patients were generally older and had a more unfavourable prognostic profile. Untreated patients had significantly worse overall survival, regardless of age. Age alone should therefore not affect treatment decision‐making. Considering the large interhospital variation, a proportion of untreated patients might be wrongfully denied life‐prolonging treatment.
Do zombie firms crowd out healthy firms and slow their growth? Evidence from China
Authors: Guo Xiaohan , Ye Jianliang , Su Wunhong , Luo Deming , Jin Xiangrong
Published: January 2022

Motivation

To prevent job losses, firms facing insolvency in China may be kept running by bank credit, even though they show few signs of returning to profit. These loss‐making firms are termed “zombies”.

Purpose

Does keeping zombie firms operating block access to credit for financially healthy firms, thereby slowing their growth, and consequently the number of jobs they might create? We analyse the effect of zombie firms within a postal zone—a sub‐division of the county—on the growth of employment in non‐zombie firms in the same zone.

Methods and approach

Zombie firms are identified as those that have been unprofitable for at least two successive years, and that have a high and rising ratio of liabilities to assets. Data come from China’s industrial enterprise database for 1998–2008 and 2011–2013, gathered from manufacturing, extractive industry, and utilities enterprises with annual sales of more than RMB 5 million (RMB 20 million for 2011 and beyond). It covers between 83,000 and 217,000 firms for the years examined. We use regression to examine the relationship between the presence of zombie firms and employment growth in healthy firms. We test the robustness of the analysis.

Findings

Between 1999 and 2013 the share of firms in the database classified as zombies fell from almost 10% to under 3%. Regression analysis shows that the presence of zombies in the same postal code does indeed slow the growth of employment in healthy firms. This effect is stronger for private firms, small firms, and those located in central China. Results are robust when considering start‐up firms, analysing relations at county level, and checking for endogeneity. We show that the most likely mechanism that slows the growth of healthy firms is being crowded out of credit markets by banks that allocate their limited credit to keep zombies operating.

Policy implications

While it is tempting for government to pressure banks to keep zombie firms operating, thereby avoiding them shutting down with loss of jobs, the cost is high in slowing the growth of financially healthy firms.

Banks should offer credit based on expected returns and risk, rather than keeping insolvent firms going. Local and national government should take note that protecting zombie firms has medium‐ and long‐term costs in lost growth of employment.
Behavioural intervention in medication overuse headache: A concealed double‐blind randomized controlled trial
Authors: Pijpers Judith A. , Kies Dennis A. , van Zwet Erik W. , Rosendaal Frits R. , Terwindt Gisela M.
Published: January 2022

Background and purpose

Medication overuse headache is a prevalent disorder, with a strong biobehavioural component. Hence, behavioural interventions might effectuate reduction of the overused medication. We assessed in a double‐blind manner the efficacy of a behavioural intervention during medication withdrawal therapy.

Methods

In this concealed, double‐blind, randomized controlled trial in medication overuse headache, conducted at the Leiden University Medical Centre, we compared the effect of maximal versus minimal behavioural intervention by a headache nurse during withdrawal therapy. Maximal intervention consisted of an intensive contact schedule, comprising education, motivational interviewing, and value‐based activity planning during 12 weeks of withdrawal therapy. Minimal intervention consisted of a short contact only. Patients were unaware of the existence of these treatment arms, as the trial was concealed in another trial investigating botulinum toxin A. Endpoints were successful withdrawal and monthly days of acute medication use after the withdrawal period.

Results

We enrolled 179 patients (90 maximal, 89 minimal intervention). At Week 12, most patients achieved withdrawal in both groups (82/90 [93%] maximal intervention vs. 75/89 [86%] minimal intervention, odds ratio = 2.44, 95% confidence interval [CI] = 0.83–7.23, p = 0.107). At Week 24, patients in the maximal intervention group had fewer medication days (mean difference = −2.23, 95% CI = −3.76 to −0.70, p = 0.005). This difference receded over time. Change in monthly migraine days did not differ between groups (−6.75 vs. −6.22).

Conclusions

This trial suggests modest benefit of behavioural intervention by a headache nurse during withdrawal therapy for medication overuse headache, to reduce acute medication use during and shortly after intervention, but extension seems warranted for a prolonged effect
Emerging Ideas: The near invisibility of Native Americans and their families within the flagship journals of family science
Authors: Gavazzi Stephen M.
Published: January 2022

Objective

To assess the family science literature's focus on Native Americans and their families through articles published in the flagship journals of the National Council on Family Relations.

Background

Historically, Native Americans and their families have been underrepresented in the social sciences literature. Scholars have attributed this near invisibility to shifting census categories, underrepresentation in samples, and residence in more rural geographic areas. Combined with elements of systematic and structural racism and other forms of oppression, the continued representation of Native American populations as an “asterisk” in scholarship contributes to their ongoing marginalization as a people.

Method

A literature search of all published issues of the three flagship journals published by the National Council on Family Relations—Journal of Marriage and the Family, Family Relations, and Journal of Family Theory and Review—was conducted using the terms “Native American,” “American Indian,” and “Indigenous.” Articles identified using those search terms subsequently were placed into three categories: (a) articles that focused specifically on Native Americans, (b) articles that included Native Americans in a substantive but not exclusive manner, and (c) articles that mentioned Native Americans only as part of the demographics of a study or cited other literature in the reference section.

Results

Of more than 10,000 scholarly works published in the three flagship journals by the end of 2020, only 28 total articles (one third of 1%) included any mention of American Indians, Native Americans, or Indigenous Peoples. Of these identified publications, six articles were classified as scholarly works that focused specifically on Native Americans and their families, five articles that included substantive but not exclusive mention of Native American issues, and an additional 17 articles made some more minor mention of Native Americans in the body of the text or reference section.

Conclusion

Family science theorists, researchers, and practitioners must redouble their efforts to focus on the lives and experiences of Native Americans and their families. Similarly, the editors and editorial boards of NCFR's flagship journals should create publication opportunities that underscore the notion that Native Americans and their families do matter.

Implications

These findings have implications for family scholars who are committed generally to diversity and inclusion in their work, as well as anyone working with Native Americans and their families more specifically.
Resisting public monitoring in authoritarian regimes: Evidence from local environmental litigation in China
Authors: Zhu Xiao , Qiu Taotao , Liu Dongshu
Published: January 2022

Civic activism is increasingly popular for authoritarian regimes to ensure local compliance and improve local governance, but it also places pressure on local officials. How do local officials respond to such pressures? With a unique dataset of city‐level environmental investigations and public interest litigation in China, we conduct a generalized difference‐in‐difference analysis and find that public interest litigation, a new legal channel for social actors to monitor environmental governance, can significantly reduce information disclosure related to investigations. Furthermore, it changes the focus of investigations: the number of low‐profile investigations is increased, while the number of high‐profile cases is decreased. This finding reveals how local officials avoid public monitoring by reducing information disclosure but maintaining a certain level of enforcement, which implies that the effect of civic engagement on the accountability of local governments in authoritarian regimes is dynamic with the coevolution of strategies of local officials and civil societies.