bluuebunny/crossref_metadata_2025 huggingface dataset:
Pluralising Political Forests: Unpacking “the State” by Tracing Virunga's Charcoal Chain
Authors: Marijnen Esther , Verweijen Judith
Published: December 2018

Peering through the lens of illegal charcoal production in the forested areas of Virunga National Park in eastern Democratic Republic of the Congo, this paper makes a case for disaggregating the notion of “the state” to better capture “the political” in contemporary political forests. It argues that to identify the fluctuating importance of different dimensions of “stateness”, it is crucial to acknowledge the polymorphous socio‐spatial relations that produce political forests. Thus, we draw on the notions of territory, place, scale and network (TPSN) to examine how “stateness” in Virunga has transformed under the particularisation, transnationalisation, and regionalisation of authority. This approach allows us to show how these processes do not only stem from neoliberalisation, but are also driven by, inter alia, regional warfare and non‐state militarisation. The resulting complexity of the regulatory landscape turns Virunga into a space marked by a plurality of partly overlapping and partly conflicting political forests.
How do we evaluate the role of focal/grid photocoagulation in the treatment of diabetic macular edema?
Authors: Blindbæk Søren L. , Peto Tunde , Grauslund Jakob
Published: December 2018

Vascular endothelial growth factor inhibitors (anti‐VEGF) have consistently demonstrated efficacy and safety and changed both the aim and perspectives of diabetic macular edema (DME) treatment. Hence, the present and future role of focal/grid laser photocoagulation in DME treatment has been subjected to some debate. However, extensive insight into technical advances in novel laser systems, treatment protocols of anti‐VEGF trials and the functional impact of modern focal/grid photocoagulation is needed to evaluate the present and future role of photocoagulation in DME treatment. Across a wide range of clinical trials laser therapy was required as adjunctive/rescue treatment in approximately 20–50% of patients receiving anti‐VEGF monotherapy for centre involving DME. Further, a lower retreatment rate and a more stable reduction in retinal thickness have been demonstrated in more studies. However, lacking information on the laser systems used, their technical specifications and protocols of application often complicates direct comparison of results in anti‐VEGF trials. Hence, this paper aimed to provide an overview of the currently available data relevant to the potential role of focal/grid laser photocoagulation in DME treatment including a thorough overview of the current most commonly used laser systems. Results with subthreshold diode micropulse laser photocoagulation are intriguing and may offer a valuable option as adjunctive therapy to anti‐VEGF treatment. However, more well‐designed studies on combination therapy are warranted to determine the full potential of modern retinal photocoagulation systems. In conclusion, current data suggest that focal/grid laser therapy should still be an option for consideration as adjunctive therapy in many patients.
Incidence of pseudophakic cystoid macular edema in eyes with and without pupil expansion device
Authors: Taipale Claudia , Holmström Emil J. , Ilveskoski Lotta , Tuuminen Raimo
Published: December 2018

Purpose

Novel pupil expansion devices are widely recognized for their intraoperative feasibility in safe small pupil cataract surgeries. To assess whether the use of pupil expansion devices affects recovery from cataract surgery.

Methods

A post hoc analysis of five consecutive prospective randomized clinical trials. 536 eyes of 536 patients undergoing routine cataract surgery were analysed according to the use of pupil expansion device. Thirty‐four eyes were operated with pupil expansion device and 502 eyes without. Clinical outcome parameters were recorded at 28 days and 3 months.

Results

Patient age and gender distribution, and baseline clinical outcome parameters were comparable between study groups. Pseudoexfoliation syndrome, glaucoma and medication for benign prostatic hyperplasia were more frequently present; phacoemulsification energy was higher and operation time longer in eyes with pupil expansion device. At 28 days, aqueous flare increased by 12.0 ± 25.1 pu/mseconds and mean central subfield macular thickness by 16.2 ± 24.4 μm in eyes with pupil expansion device, when compared to 4.6 ± 14.8 pu/mseconds (p = 0.015) and 7.0 ± 33.9 μm (p = 0.064) in eyes without the device. At 3‐month follow‐up, clinically significant pseudophakic cystoid macular edema (PCME) was reported in 12% of eyes with pupil expansion device and in 2% of eyes without (p = 0.006). After adjusting for the presence of confounding factors, hazard for clinically significant PCME was greater in eyes with pupil expansion device than in those without (HR 5.41, 95% CI 1.35–21.71, p = 0.017).

Conclusions

The use of pupil expansion device may predispose eyes to increased risk of clinically significant PCME. Effective anti‐inflammatory treatment and follow‐up are warranted in eyes with pupil expansion device.
Accurate prediction of anti‐phagocytic activity of Vibrio vulnificus by measurement of bacterial adherence to hydrocarbonsPrediction of Anti‐Phagocytic Activity
Authors: Kado Takehiro , Kashimoto Takashige , Yamazaki Kohei , Matsuda Kaho , Ueno Shunji
Published: December 2018

Vibrio vulnificus can cause necrotizing soft tissue infection via exposure through an open wound, and the incubation period in cases of wound infection is only about 16 h. These facts strongly suggest that mechanisms to evade innate immune cell phagocytosis are essential for its pathogenicity. Hydrophobic interaction is one of the binding mechanisms between bacteria and phagocytes. Several factors that maintain cell surface hydrophobicity (CSH) can contribute to anti‐phagocytic activity. In this study, we tried to identify V. vulnificus genes involved in maintaining the CSH, in order to elucidate mechanisms of anti‐phagocytic activity. We obtained 143 mutants that had lost their ability to proliferate in the host, using signature‐tagged transposon basis mutagenesis (STM). The CSH of these mutants was measured by the bacterial adherence to hydrocarbons (BATH) assay. The CSH of only four mutants differed significantly from that of wild type (WT). Of these four mutants, degS mutant (degS::Tn) showed lesser anti‐phagocytic activity than WT in the opsonophagocytosis assay, even though degS::Tn showed opaque‐type colonies. Furthermore, survival times of mice subcutaneously inoculated with degS::Tn were prolonged. These facts indicated that the BATH assay is a more suitable method of analyzing the anti‐phagocytic activity of V. vulnificus than the comparison of colony morphology.
Ecology and fluvial dynamics of an Early Holocene medium‐sized European lowland river valley (Upper Scheldt, northern Belgium)
Authors: Storme Annelies , Bastiaens Jan , Crombé Philippe , Debruyne Sofie , Louwye Stephen , Deforce Koen
Published: December 2018

The fluvial environment of Early Holocene small‐ to middle‐sized lowland rivers in northwest Europe is mostly unstudied due to a lack of preserved and accessible deposits. A rescue excavation in the Scheldt valley in northern Belgium offered the opportunity to study a Boreal alluvial succession in detail. The results of palaeoecological and sedimentological analyses (diatoms, pollen, botanical macro‐remains, molluscs, grain size) characterize the biotic and physical environment in the middle reach of this medium‐sized river system. Although the Early Holocene in the Scheldt Basin has often been portrayed as a period of fluvial stability with marshy conditions and diffuse discharge, this study showed evidence of point bar formation by a small, low‐energy meandering river between ~9.5 and ~8.8 cal. ka BP. The point bar was at least temporarily vegetated and shows a shift from herbaceous riparian vegetation to an open willow‐dominated alluvial forest. This evidence points to a more open vegetation and a more energetic environment than traditionally described for rivers of this size and age. A link to the 9.3 ka BP cooling event is suggested and possible reasons for the scarcity of records of this type of deposits are discussed.
Taste Transitivity for Collaborative Filtering: A Stochastic Network Dynamics Approach
Authors: Xu Minghong , Bhattacharyya Siddhartha
Published: December 2018

We develop a stochastic actor‐based network model for online movie reviews and analyze social network dynamics to study the user‐movie taste networks constructed from real movie review datasets. Examining such taste networks provides useful insights into factors underlying the performance of collaborative filtering‐based recommenders. Our results show that similar taste transitivity effect does exist that support collaborative filtering methods to recommend movies based on user taste similarity. We also investigate the role of movie popularity, genre, user gender, age, and geographic location in the taste network evolution. The findings provide insights to improve current movie recommendation systems. The two‐ mode network analyses approach taken in this article will also be broadly useful in obtaining better understanding of factors that drive user appreciations for varied products.
Baseline characteristics in the VERIFY study: a randomized trial assessing the durability of glycaemic control with early vildagliptin‐metformin combination in newly diagnosed Type 2 diabetes
Authors: Matthews D. R. , Paldánius P. M. , Proot P. , Foley J. E. , Stumvoll M. , Del Prato S.
Published: December 2018

Aim

To assess the long‐term clinical benefits of early combination treatment with vildagliptin‐metformin vs. standard‐of‐care, metformin monotherapy in the ongoing VERIFY study.

Methods

We randomized 2001 participants with multi‐ethnic background, aged 18–70 years, having HbA1c levels 48–58 mmol/mol (6.5–7.5%) and BMI 22–40 kg/m2. Baseline data included HbA1c, fasting plasma glucose and homeostasis model β‐cell and insulin sensitivity. Standardized meal‐tests, insulin secretion rate relative to glucose, and oral glucose insulin sensitivity were assessed in a subpopulation.

Results

Out of 4524 screened, data were collected from the 2001 eligible participants (53% women) across Europe (52.4%), Latin America (26.8%), Asia (17.2%), South Africa (3.1%) and Australia (0.5%). The median (interquartile range) disease duration was 3.4 (0.9, 10.2) months; mean (±SD) age 54.3±9.4 years; weight 85.5±17.5 kg and BMI 31.1±4.7 kg/m2. Baseline HbA1c was 52±3 mmol/mol (6.9±0.3%), fasting plasma glucose 7.5±1.5 mmol/l and the median (interquartile range) of fasting insulin was 109 (75–160) mU/l. Homeostasis model β‐cell and insulin sensitivity values were 84% (60, 116) and 46% (31, 68), respectively. In those undertaking meal‐tests, insulin secretion rate relative to glucose was 28±12 pmol/min/m2/mmol/l and oral glucose insulin sensitivity was 353±57 ml/min/m2.

Conclusions

Our current, multi‐ethnic, newly diagnosed VERIFY population reflects a characteristic presence of early insulin resistance in participants with increased demand for insulin associated with obesity. The VERIFY study will provide unique evidence in characterizing therapeutic intervention in a diverse population with hyperglycaemia, focusing on durability of early glycaemic control.
Medical health care utilization cost of patients presenting with psychogenic nonepileptic seizures
Authors: Seneviratne Udaya , Low Zhi Mei , Low Zhi Xuen , Hehir Angela , Paramaswaran Sahira , Foong Monica , Ma Henry , Phan Thanh G.
Published: December 2018

Objective

To investigate the health care utilization cost of patients presenting with psychogenic nonepileptic seizures (PNES) to a tertiary hospital in Australia.

Methods

This is a retrospective analysis of adult patients with PNES based on video‐electroencephalographic confirmation over a 5‐year period. We used an itemized list to collect detailed health care utilization data. The items included emergency room visits, hospital ward admissions, intensive care unit (ICU) admissions, outpatient neurology clinic visits, medical interventions, Code Blue and Medical Emergency Team calls for seizures, medications, and investigations. We calculated the cost of each individual item separately for each individual presentation. To investigate the proportional contribution of each covariate toward the total health care utilization cost, an analysis of the relative importance in the linear regression was performed.

Results

There were 39 patients, of whom seven (18%) were admitted to the ICU with suspected status epilepticus. The median total health care utilization cost per person until the diagnosis of PNES was established as 26 468 Australian dollars (AUD; 19 207 US dollars [USD]). In the item breakdown, the highest median cost was incurred by investigations (13 119 AUD = 9520 USD), followed by hospital ward management (8890 AUD = 6451 USD), ICU stay (3764 AUD = 2731 USD), outpatient neurology clinics (2200 AUD = 1596 USD), and emergency room visits (570 AUD = 413 USD). Nonepileptic psychogenic status (23%) and the duration of PNES disorder (10%) were the most significant variables contributing to the variance (R2) of the model.

Significance

A considerable burden of health care utilization cost is caused by PNES. The presence of nonepileptic psychogenic status and a longer duration of the condition predict a higher cost.
Path planning of humanoids based on artificial potential field method in unknown environments
Authors: Kumar Priyadarshi Biplab , Rawat Himanshu , Parhi Dayal R.
Published: December 2018

In this paper, an artificial potential field based navigational controller has been developed for motion planning of humanoid robots. Here, NAO robots are used as the humanoid platform using the underlying principles of potential field based method. The movement of the robot is considered to be under a negative gradient scheme by the combined effect of attractive and repulsive forces generated due to target and obstacles, respectively. The working of the controller is tested in a V‐REP simulation platform, and the simulation results are validated through a real‐time experimental set‐up developed under laboratory conditions. Here, the navigation of both single and multiple humanoids has been attempted. For avoiding intercollision among multiple humanoids during their navigation in a common platform, a Petri‐Net control scheme has been proposed. The results obtained from both the simulation and experimental platforms are compared against each other with a good agreement between them having minimal percentage of deviations. Finally, the proposed controller is also evaluated against another existing navigational model, and a significant performance improvement has been observed.
Structural integrity assessment of nuclear containment through fracture characterization
Authors: Trivedi Neha , Singh Ram Kumar , Singh Tarvinder
Published: December 2018

The paper deals with the study of structural response of partially cracked nuclear containment model structure in over pressurized condition with the simulated experiments conducted under severe accidents analysis program for Indian nuclear containment structures. In this research, the fracture characterization of concrete containment structure is also investigated through the over pressure experiments on the BARC Containment (BARCOM) test model structure, which represents 1:4 scale of the prototype 540 MWe Tarapur pre‐stressed nuclear containment structure. In addition to the surface‐type electrical resistance, strain gauges conventionally and commonly deployed for containment proof‐test and ultimate load capacity evaluation of containment models, embedded vibratory wire strain gauges (VWSGs), the digital image correlation (DIC) technique, and soap bubble tests are employed in this study. For fracture characterization, an optical crack profile (OCP) technique is developed through DIC full‐field experiment conducted at the identified critical locations with conventional strain gauges to evaluate the fracture energy and the characteristics of the fracture process zone of concrete containment model structure subjected to the over‐pressure condition for its performance assessment in the case of the beyond design basis accidents. The combination of conventional sensors and full‐field DIC deployed for the first time on the largest scale containment model along with the associated analysis is shown to be effective in fracture characterization and improved structural integrity assessment of the containment model.
Cost‐effectiveness of professional oral health care in Australian residential aged care facilities
Authors: Münzenmayer Melisa A. , Mariño Rodrigo , Hsueh Arthur
Published: December 2018

Objective

To conduct a model‐based cost‐effectiveness analysis, from a health care system perspective, of using oral health professionals to provide oral hygiene services at residential aged care facilities (RACFs) in Victoria, Australia, compared to current practice (CP).

Background

Increasingly dentate cohorts of older adults are entering RACFs, making urgent the need of further development and provision of oral health programmes in ageing dentitions.

Materials and Methods

The model was based on 47 624 RACFs’ places in Victoria over one year. The main outcome measured was “cost per pneumonia case averted.” Four different scenarios of oral hygiene provision were compared to CP. Costs included were RACF staff training, professional salaries, programme coordinator office expenses, dental equipment and hospitalisation costs. Effectiveness assumptions for each scenario were based on systematic reviews and randomised control trials.

Results

All four scenarios were dominant strategies. The magnitude of negative incremental cost‐effectiveness ratio was not informative; therefore, incremental costs and incremental effectiveness were used to present results. “Professional oral health care (POHC) provision once every two weeks and current provision of oral health care the other days” was the most cost‐saving alternative (AU $896 per resident saved). The most effective alternative was “POHC provision once a week and non‐POHC provision by trained Nurse aids twice per day the other days” (6779 pneumonia cases averted). One‐way sensitivity analyses confirmed the robustness of results.

Conclusion

The four scenarios were highly cost‐effective compared to CP. These results could be a strong basis to implement new oral health programmes in Australian RACFs.
The effect of SPS parameters on the production of yttria transparent ceramic
Authors: Amirzadeh‐Fotovat Vahid , Hatefi Yousef
Published: December 2018

In this work, the spark plasma sintering (SPS) of commercial yttria nanopowder is investigated. The SPS parameters such as sintering temperature, applied pressure, and dwell time are varied. Densification without grain growth occurring at occurred up to a sintering temperature of 1400°C and grain growth without further densification taking place at the higher temperature. The optimum sample was obtained at a temperature of 1400°C with a pressure of 70 MPa and dwelling time of 15 minutes. The highest relative density of 99.8% and the average grain size of 1.26 μm were obtained at 1400°C. The yttria ceramic annealed at 1200°C had the in‐line transmission of 5%‐70% and 70%‐82% in the visible and infrared wavelength region, respectively. The measurements of hardness and fracture toughness characteristics of the transparent yttria ceramic showed 9.2 GPa and 2.24 MPa.m1/2, respectively.
Eight issues in studying organizational constructs: Tackling a complex problem
Authors: Ree Malcolm James , Carretta Thomas R.
Published: December 2018

Much of the industrial/organizational psychology research literature involves abstractions called constructs. Frequently, new constructs are proposed and measures are developed, revised, and evaluated in studies for modeling or predicting organizational criteria. There are many hazards in these studies that lead to incorrect conclusions and decisions. This is especially applicable to the introduction and use of new constructs. We discuss several methodological issues that affect the interpretation of results from theoretical and applied studies and provide examples where construct confusion occurred due to failure to use best practices. A paradigm is proposed to increase the efficacy of studies regardless of which model of constructs has been chosen. Consideration is given to sample characteristics, range restriction, reliability of scores, criterion development, identifying latent sources of variance, content validity, comparing regression equations, and defining the nomological network.
L'effet d'un programme d'inclusion sur l'absentéisme des travailleurs handicapés: les enseignements d'une quasi‐expérience
Authors: FOLGUERA‐I‐BELLMUNT Conxita , FERNÁNDEZ‐I‐MARÍN Xavier , BATISTA‐FOGUET Joan Manuel
Published: December 2018

Les auteurs examinent l'effet d'un programme visant à favoriser l'inclusion des personnes handicapées dans l'emploi sur l'absentéisme pour maladie et accident parmi les bénéficiaires. Après une évaluation qualitative des spécificités du programme, ils procèdent à une quasi‐expérience, en utilisant deux groupes témoins (non équivalent et sans traitement) et des séries chronologiques interrompues (2005–2012). L'analyse repose sur un modèle binomial négatif hiérarchique non imbriqué, avec une variable dépendante retardée. La comparaison entre les trois groupes (personnes handicapées, bénéficiaires ou non, et personnes valides) montre que les absences pour maladie sont sensiblement réduites chez les bénéficiaires. Pour les accidents, le recul est plus faiblement attesté.
Polymorphonuclear myeloid‐derived suppressor cells attenuate allergic airway inflammation by negatively regulating group 2 innate lymphoid cells
Authors: Cao Yingjiao , He Yumei , Wang Xiangyang , Liu Yongdong , Shi Kun , Zheng Zheng , Su Xue , Lei Aihua , He Juan , Zhou Jie
Published: December 2018

Hyperactivation of the type 2 immune response is the major mechanism of allergic asthma, in which both group 2 innate lymphoid cells (ILC2s) and type 2 helper T (Th2) cells participate. Myeloid‐derived suppressor cells (MDSCs) alleviate asthma by suppressing Th2 cells. However, the potential effects of MDSCs on the biological functions of ILC2s remain largely unknown. Here, we examined the roles of MDSCs (MDSCs) in the modulation of ILC2 function. Our results showed that polymorphonuclear (PMN)‐MDSCs, but not monocytic (M‐) MDSCs, effectively suppressed the cytokine production of ILC2s both in vitro and in vivo, thereby alleviating airway inflammation. Further analyses showed that cyclo‐oxygenase‐1 may mediate the suppressive effects of PMN‐MDSCs on ILC2 responses. Our findings demonstrated that PMN‐MDSCs may serve as a potent therapeutic target for the treatment of ILC2‐driven allergic asthma.
Improving the use of discretion in monetary policy
Authors: Mishkin Frederic S.
Published: December 2018

This paper argues that the rules versus discretion debate has been miscast because a central bank does not have to choose only between adopting a policy rule versus pure discretion, both of which have serious shortcomings. Rather, it can choose a constrained discretionary regime that has rule‐like attributes. To make monetary policy discretion more rule‐like, it can be improved by (1) adopting a nominal anchor such as an inflation target, a monetary‐policy strategy that has proved to be very successful in recent years, and (2) communication of a monetary‐policy reaction process, especially through data‐based forward guidance, in which the monetary‐policy authorities describe how the future policy path will change as economic circumstances change.
Synthesis of mesoporous strontium titanate by molten salt assisted template‐free method
Authors: Yu He , Zhao Yicheng , Yan Shicheng , Zhou Peng
Published: December 2018

Mesoporous SrTiO3 was synthesized via the NaOH/KOH molten salt method. The detailed formation mechanism for the mesoporous SrTiO3 should be obtained to adjust the microstructure, which is an import factor affecting the photocatalytic activity. The detailed mechanism is explored by studying the intermediate phase. It is found that the NaOH/KOH molten salt method for mesoporous SrTiO3 synthesis, using four kinds of TiO2 with different morphologies as precursors, follows the precursor dissolution‐precipitation growth mechanism. The mesoporous SrTiO3 structure originates from the reservation of space for NaOH/KOH. The crystallinity, number of pores, and size of particles are affected by the cleaning temperature, which can thus influence the photocatalytic activity.
Laser ablation behaviors of vacuum plasma sprayed ZrC‐based coatings
Authors: Liu Tao , Niu Yaran , Pan Xiaohui , Shi Minhao , Zheng Xuebin , Yu Jianding , Ding Chuanxian
Published: December 2018

ZrC, ZrC‐30 vol% SiC, and ZrC‐30 vol% TiC coatings were fabricated by vacuum plasma spray and the laser ablation behaviors were evaluated by a CO2 laser beam under two heat fluxes (15.9 and 25.5 MW/m2). The phase compositions and microstructures of the coatings after ablation were investigated and the effect of SiC and TiC additives was analyzed. The results showed that the ZrC–SiC coating displayed better ablation resistance compared with the ZrC and ZrC–TiC coatings under 15.9 MW/m2 heat flux. While the ZrC–TiC coating exhibited the improved ablation resistance under 25.5 MW/m2 heat flux. The continuous and integral ZrO2–SiO2 scale provided protective effect for the ZrC–SiC coating. A liquid ZrO2–TiO2 layer which owned self‐healing ability was formed for the ZrC–TiC coating in both heat fluxes. However, the state of the formed liquid, like amount, viscosity, evaporation, and decomposition, was influenced by the environment and was vital for the ablation resistance. This work might give a clue for designing ultrahigh‐temperature ceramics as potential laser ablation–resistant coating materials.
A risk score model for predicting intraprocedural cardiac injury during implantable cardioverter defibrillator implantation: Insights from the National Cardiovascular Data Registry
Authors: Padala Santosh K. , Gunda Sampath , Li Shelby , Sharma Parikshit S. , Koneru Jayanthi N. , Varosy Paul D. , Ellenbogen Kenneth A.
Published: December 2018

Background

Individual risk factors of intraprocedural cardiac injury (cardiac perforation and tamponade) during implantable cardioverter defibrillator (ICD) placement have been documented. However, the prognostic impact of their coexistence has not been explored.

Objective

To develop a risk score model to identify patients at risk for intraprocedural cardiac injury.

Methods

We identified 438 679 patients from National Cardiovascular Data Registry (NCDR)‐ICD who underwent de novo ICD implantation between 2010 and 2015, split randomly into a derivation cohort (n = 220 000) and a validation cohort (n = 218 679). The generalized estimating equations (GEEs) analysis with quasilikelihood under the independence model criterion goodness‐of‐fit statistics were used to identify the predictors of intraprocedural cardiac injury and a risk scoring model was developed. Model discrimination was assessed by receiver‐operator characteristic curve and C‐statistic.

Results

The risk of intraprocedural cardiac injury in the overall cohort was 0.13%. GEE analysis yielded seven variables (points in parentheses) that were strongly associated with intraprocedural cardiac injury: age, greater than 75 years (1), female gender (1), body mass index, less than 18.5 kg/m
2 (1), hypertension (1), chronic lung disease (1), left bundle branch block (1), and continued warfarin use (1). Only prior history of coronary artery bypass grafting (CABG) (−1) was associated with reduced risk. A risk scoring system was developed that had good discrimination with a C‐statistic of 0.72. The risk of intraprocedural cardiac injury increased with the increase in risk score from low risk (0.03%) to high risk (1.37%).

Conclusion

A practical risk score model can stratify patients into high‐ and low‐risk groups for cardiac perforation or tamponade before undergoing ICD implantation.
Relations between baseline burden, maximum duration, and relative reduction of atrial fibrillation: Insights from continuous monitoring in rhythm control
Authors: Lin Po‐Lin , Huang Chun‐Che , Wu Yih‐Jer , Su Min‐I , Chiou Wei‐Ru , Liu Lawrence Yu‐Min , Liao Feng‐Ching , Lai Edward , Chen Chun‐Yen , Kuo Jen‐Yuan , Lee Ying‐Hsiang
Published: December 2018

Introduction

Cardiac implantable electronic devices (CIEDs) can measure atrial fibrillation (AF) early; however, the timing for administering antiarrhythmic drugs (AADs) to suppress AF remains unclear. This study aimed to investigate the association between baseline values and changes after AAD in terms of relative reduction of AF burden (RRAB) and maximum AF duration (RRMD).

Methods

This multicenter retrospective study screened all patients with nonpermanent AF who had dual‐chamber pacemakers and only enrolled those receiving a naive AAD between September 2009 and December 2014. AF burden and maximum duration were calculated using CIED at 0 and 3 to 6 months after starting rhythm control. All the enrolled patients were divided into four groups according to baseline AF burden. RRAB and RRMD were monitored using CIEDs.

Results

Overall, 145 eligible subjects received a naive AAD for nonpermanent AF. The mean RRAB in the four groups (AF burden <1%, 1%‐4%, 4%‐18%, and ≥18%) were −65.3%, −46.4%, −34.7%, and −27.9% (P = 0.005), respectively. Mean RRMD were −26.8%, −12.4%, 4.2%, and 6.0%, respectively (
P = 0.006). Multivariate analysis revealed that the lowest baseline AF burden (<1%) was significantly associated with greater RRAB, which was not observed in the RRMD model.

Conclusions

Lower baseline AF burden was associated with greater RRAB by AADs. Our finding suggests that rhythm control should be started in the early stage to achieve better responses to AADs.
Arrhythmogenecity and thrombogenicity of the residual left atrial appendage stump following surgical exclusion of the appendage in patients with atrial fibrillation
Authors: Mohanty Sanghamitra , Di Biase Luigi , Trivedi Chintan , Choudhury Fahim , Della Rocca Domenico G. , Romero Jorge , Gianni Carola , Sanchez Javier , Hranitzky Patrick , Gallinghouse G. Joseph , Al‐Ahmad Amin , Horton Rodney P. , Burkhardt David , Natale Andrea
Published: December 2018

Introduction

It is common to find residual stump after the amputation or clip exclusion of the left atrial appendage (LAA). We evaluated the arrhythmogenic and thrombogenic potential of LAA stumps in atrial fibrillation (AF) patients.

Methods

Consecutive patients undergoing catheter ablation for AF recurrence with LAA stump detected at baseline transesophageal echocardiogram (TEE) were included in the analysis. Nonpulmonary vein (non‐PV) triggers were ablated based on operator's discretion.

Results

A total of 213 patients with LAA stump were included in the analysis. Firing from the LAA stump was detected in 186 cases, of which 145 received stump isolation (group I) and the stump was not targeted for isolation in 41 (group II) patients. In 27 patients with no firing from the stump (group III) only non‐PV triggers from sites other than the LAA stump were targeted for ablation. At 16.7 ± 8.5 months of follow‐up, 126 (86.9%) patients from group I, eight (19.5%) from group II, and eight (33.3%) from group III remained arrhythmia‐free off antiarrhythmic drugs (AAD) (P < 0.001). Sixty out of 70 patients underwent redo procedure; electrical isolation of the stump and ablation of other non‐PV triggers was done in all 60 cases. At 1 year after the repeat procedure, 55 (91.7%) patients remained arrhythmia‐free off‐AAD. A total of four (1.88%) thromboembolic (TE) events reported, three of which were transient ischemic attacks and all three patients had “smoke” detected in the left atrium.

Conclusion

LAA stump is arrhythmogenic and electrical isolation improves clinical outcome. TE events are rare and mostly associated with left atrial smoke in this subset of AF population.
Slow atrioventricular nodal pathway affecting fast pathway conduction
Authors: Prystowsky Eric N.
Published: December 2018

A 15‐year‐old girl with a history of paroxysmal supraventricular tachycardia underwent an electrophysiology study (EPS) for diagnosis and ablation. Her baseline electrocardiogram and echocardiogram were normal. At EPS, she had dual atrioventricular nodal (AVN) conduction, but isoproterenol was needed to initiate the slow‐fast form of AVN reentry. Before ablation without any isoproterenol, she began to have a spontaneous block in the fast pathway with continuous conduction over the slow pathway. After ablation of the slow pathway, all complexes conducted over the fast pathway during a 25‐year follow‐up. Possible electrotonic interaction between the slow and fast pathways is proposed as the mechanism for this phenomenon.
Amiodarone is associated with adverse outcomes in patients with sustained ventricular arrhythmias upgraded to cardiac resynchronization therapy—defibrillators
Authors: Adelstein Evan C. , Althouse Andrew D. , Davis Lydia , Schwartzman David , Bazaz Raveen , Jain Sandeep , Wang Norman , Saba Samir
Published: December 2018

Introduction

Amiodarone reduces recurrent ventricular tachyarrhythmias (VTA) but may worsen cardiovascular outcomes in heart failure (HF) patients. Cardiac resynchronization therapy (CRT) may also be antiarrhythmic. When patients with prior sustained VTA are upgraded to CRT defibrillators (CRT‐D) from conventional implantable cardioverter‐defibrillators (ICDs), should concomitant amiodarone be continued or is CRT’s antiarrhythmic potential sufficient?

Methods and Results

We identified 67 patients from a prospective CRT registry with spontaneous sustained VTA, New York Heart Association (NYHA) II‐IV HF, and left bundle‐branch block (LBBB) who were upgraded to CRT defibrillators from conventional ICDs. We compared changes in QRS duration and left ventricular ejection fraction (LVEF) pre‐ and post‐CRT, time to death, transplant or ventricular assist device (VAD), and time to recurrent VTA therapies between 37 patients continuing amiodarone therapy and 30 amiodarone‐naïve patients. Amiodarone‐treated patients had worse renal function and a higher prevalence of prior VTA storm compared with amiodarone‐naïve patients. After CRT, amiodarone‐treated patients demonstrated less QRS narrowing (8 vs 20 ms; P = 0.021) and less LVEF improvement (−2.7 vs +5.2%; P = 0.006). Over 29 months, 31 (47%) patients died and 13 (20%) received transplant or VAD. Risk of death, transplant, or VAD was greater in amiodarone‐treated than ‐naïve patients (corrected hazard ratio [HR], 2.14; 95% confidence interval [CI], 1.12‐4.11; P = 0.022). Appropriate CRT‐D therapies occurred in 37 (55%) patients; amiodarone use was not associated time to first therapy (HR, 1.13; 95% CI, 0.59‐2.16; P = 0.72).

Conclusion

In patients with sustained VTA and LBBB upgraded from conventional ICDs to CRT defibrillators, concomitant amiodarone use is associated with less QRS narrowing, less LVEF improvement, greater risk of death, transplant, or VAD, and similar risk of recurrent VTA.
Ambient fine particulate matter (PM2.5) exposure is associated with idiopathic ventricular premature complexes burden: A cohort study with consecutive Holter recordings
Authors: Tsai Tsung‐Ying , Lo Li‐Wei , Liu Shin‐Huei , Cheng Wen‐Han , Chou Yu‐Hui , Lin Wei‐Lun , Shinya Yamada , Lin Yenn‐Jiang , Chang Shih‐Lin , Hu Yu‐Feng , Chung Fa‐Po , Liao Jo‐Nan , Chao Tze‐Fan , Tuan Ta‐Chuan , Chen Shih‐Ann
Published: December 2018

Background

Epidemiological evidence has shown an association between ambient fine particulate matter (PM2.5) exposure and cardiovascular mortality. Increased ventricular premature complex (VPC) burden can cause left ventricular dilatation and dysfunction. We aimed to investigate the relationship between acute PM2.5 exposure and VPC burden in patients without structural heart disease.

Methods

We reviewed 26 820 patients who underwent 24‐hour Holter electrocardiogram (ECG) recordings between 1 Jan 2013 and 1 Dec 2016. We enrolled patients with significant idiopathic (structurally normal heart) VPC burden defined as ≥30 VPCs/h (Lown grade 2) who had at least two Holter ECG recordings. The VPC burden between the studies on high and low PM2.5 exposure dates was compared in 24 and 12 hours time periods.

Result

Sixty‐seven patients (31 men, 56.49 ± 18.35 years) were enrolled. Patients were exposed to 25.63 ± 11.47 and 14.66 ± 7.51 μg/m
3 of PM2.5 during the high and low study dates, respectively. The overall VPC counts (10,490.69 ± 10,681.63/day) and burden (10.22% ± 10.17%) were significantly higher on the days with higher PM2.5 exposure compared with low PM2.5 exposure dates (8293.31 ± 9009.09;
P = 0.014% and 9.14% ± 12.73%,
P = 0.012, respectively). Compared with low PM2.5 exposure dates, the VPC burden on high exposure dates was significantly higher from 9
am to 9
pm (5.85% ± 6.41% vs 4.84% ± 6.97%;
P = 0.025) but not at nocturnal periods.

Conclusion

Our study demonstrated a significantly higher VPC burden on high PM2.5 exposure date. The burden was increased in the daytime but not at nighttime. This result suggests that daytime PM2.5 exposure may be associated with ventricular arrhythmia burden in the healthy population.
Improving patient access to hepatitis C antiviral medicines in Switzerland: Understanding the financial risks for community pharmacies
Authors: Berger Jérôme , Bourdin Aline , Pires Fatima , Backes Claudine , Perraudin Clémence , Bugnon Olivier
Published: December 2018

Rationale

As observed in other countries, some patients may experiment difficulties in obtaining their hepatitis C antiviral medicines (HCVm) in Swiss community pharmacies. There is a lack of data related to access to HCVm at the patient level and notably related to the potential financial risks for the community pharmacies.

Aims

(a) To evaluate the potential financial risks for community pharmacist associated with the delivery of HCVm in the Swiss healthcare system; (b) to explore the attitudes and experiences of community pharmacists related to these risks and their consequences for the patients.

Method

A three‐step approach was chosen as follows: (a) estimation of costs, incomes, and gross financial results directly related to 3‐month treatment with Harvoni based on the drug delivery process (data from 68 patients over 2 years); (b) sensitivity analyses; (c) exploration of local community pharmacists' attitudes and experiences related to the delivery of HCVm in the canton of Vaud (Western Switzerland).

Results

Two main risks were identified: (a) Incomes do not always cover costs; (b) reimbursement issues could lead to an increase in the requirement for working capital. According to the survey, 23% (14/60) of pharmacies refused to deliver HCVm to at least one patient, and these patients had to find a solution mostly on their own.

Conclusions

The scenario analysis clarifies the causes of the possible refusal to deliver HCVm. With the growing number of high‐priced medicines, the healthcare systems should have a clear strategy to encourage their delivery by community pharmacies by ensuring seamless and collaborative care for patients. The community pharmacists could be accountable to provide such services—if they get the education, training, and remuneration.
Evidence‐based medicine as science
Authors: Vere Joseph , Gibson Barry
Published: December 2018

Evidence‐based medicine has claimed to be science on a number of occasions, but it is not clear that this status is deserved. Within the philosophy of science, four main theories about the nature of science are historically recognized: inductivism, falsificationism, Kuhnian paradigms, and research programmes. If evidence‐based medicine is science, knowledge claims should be derived using a process that corresponds to one of these theories. This paper analyses whether this is the case. In the first section, different theories about the nature of science are introduced. In the second section, the claim that evidence‐based medicine is science is reinterpreted as the claim that knowledge claims derived from randomized controlled trails and meta‐analyses are science. In the third section, the knowledge claims valued within evidence‐based medicine are considered from the perspective of inductivism, falsificationism, Kuhnian paradigms, and research programmes. In the final section, possible counter arguments are considered. It is argued that the knowledge claims valued by evidence‐based medicine are not justified using inductivism, falsificationism, Kuhnian paradigms, or research programmes. If these are the main criteria for evaluating if something is science or not, evidence‐based medicine does not meet these criteria.
Lessons and Outcomes of Mobile Acute Care for Elders Consultation in a Veterans Affairs Medical Center
Authors: Schubert Cathy C. , Parks Rebecca , Coffing Jessica M. , Daggy Joanne , Slaven James E. , Weiner Michael
Published: December 2018

OBJECTIVE

Describe the implementation and effects of Mobile Acute Care for Elders (MACE) consultation at a Veterans Affairs Medical Center (VAMC).

DESIGN

Retrospective cohort analysis.

INTERVENTION

Veterans aged 65 or older who were admitted to the medicine service between October 1, 2012, and September 30, 2014, were screened for geriatric syndromes via review of medical records within 48 hours of admission. If the screen was positive, the MACE team offered the admitting team a same‐day consultation involving comprehensive geriatric assessment and ongoing collaboration with the admitting team and supportive services to implement patient‐centric recommendations for geriatric syndromes.

RESULTS

Veterans seen by MACE (n = 421) were compared with those with positive screens but without consultation (n = 372). The two groups did not significantly differ in age, comorbidity, sex, or race. All outcomes (30‐day readmission, 30‐day mortality, readmission costs) were in the expected direction for patients receiving MACE but did not reach statistical significance. Patients receiving MACE had lower odds of 30‐day readmission (11.9% vs 14.8%; odds ratio [OR] = 0.82; 95% confidence interval [CI] = 0.54‐1.25; p = .360) and 30‐day mortality (5.5% vs 8.6%; OR = 0.64; CI = 0.36‐1.12; p = .115), and they had lower 30‐day readmission costs (MACE $15,502; CI = $12,242‐$19,631; comparison = $18,335; CI = $14,641‐$22,962; p = .316) than those who did not receive MACE after adjusting for age and Charlson Comorbidity Index.

CONCLUSION

Our MACE consultation model for older veterans with geriatric syndromes leverages the limited supply of clinicians with expertise in geriatrics. Although not statistically significant in this study of 793 subjects, MACE patients had lower odds of 30‐day readmission and mortality, and lower readmission costs. J Am Geriatr Soc 67:818–824, 2019.
The Heterogeneous Responses of Consumption between Poor and Rich to Government Spending Shocks
Authors: MA EUNSEONG
Published: December 2018

Government spending shocks have substantially different effects on consumers across the income distribution: consumption increases for the poor whereas it decreases for the rich in response to a rise in government expenditure. I shed light on this issue by incorporating a progressive tax scheme and productive public expenditure into a heterogeneous agent model economy with indivisible labor. The model economy is able to successfully match aggregate and disaggregate effects of government spending shocks on consumption. When the government increases its spending and accompanies it by a rise in tax progressivity, the poor are employed and increase their consumption since after‐tax wage rates increase while the rich decrease their consumption because of a fall in after‐tax wage rates.
Factors affecting prognosis in locoregional recurrence of oral squamous cell carcinoma
Authors: Borsetto Daniele , Higginson James A. , Aslam Adil , Al‐Qamachi Laith , Dhanda Jagtar , Marioni Gino , Franchella Sebastiano , Frigo Annachiara , Praveen Prav , Martin Tim , Parmar Sat , Nankivell Paul
Published: December 2018

Background

Recurrence of oral squamous cell carcinoma (rOSCC) after primary treatment is associated with poor survival outcomes. Salvage treatment with further surgery, radiotherapy and chemotherapy has high morbidity, making patient selection crucial. However, in the recurrence setting, reliable stratification data are scarce. Decision‐making in this context is consequently complex. We investigated factors influencing overall survival after rOSCC.

Methods

Retrospective cohort study of patients with rOSCC (n = 83) at the Queen Elizabeth Hospital Birmingham, UK between 2006 and 2016. Associations with overall survival were analysed using univariate and multivariate analyses to identify important clinical prognostic indicators.

Results

Overall survival at 1 year was 32.5% and at 5 years was 18.1% after a median follow‐up of 7.4 months. Multivariate analysis identified four independent predictors of overall survival following rOSCC: size of primary tumour (HR 2.077; 95% CI 1.034‐4.172), extent of recurrent disease (HR 3.286; 95% CI 1.545‐6.991), history of moderate alcohol consumption (HR 0.351; 95% CI 0.162‐0.763), and close or positive margins at primary resection (HR 1.955; 95% CI 1.063‐3.595).

Conclusions

We identified four key factors that help prognostication and risk stratification of rOSCC. Given the high morbidity associated with salvage treatment, we recommend that the multidisciplinary team (MDT) and the patient weigh these factors carefully when considering further treatment. Further investigation of the biology underlying these oncophenotypes may contribute to better patient stratification.
The Effect of Ad Skepticism and Celebrity Preference on Brand Attitude Change in Celebrity‐Endorsed Advertising
Authors: Kang Jungsuk
Published: December 2018

The use of a celebrity endorser who is well recognized and favorably evaluated by the target viewers is a common strategy used by advertisers to increase the persuasiveness of an advertisement. Yet, at the same time, being skeptical of the claim being made by the celebrity endorser is the typical response of the viewers to such persuasion attempts. The present research examines how these effects potentially counterbalance each other as viewers evaluate the advertised brand in a low‐involvement setting. The results show that the degree of ad skepticism and the relative allocation of attentional resources to celebrity and brand elements in advertisements determine how preference for a celebrity endorser is transferred to the advertised brand. The findings provide a more complete understanding of the psychological mechanisms by which celebrity preference influences brand attitude change than has previously been available. They indicate that ad skepticism may be the missing link in understanding the effectiveness of celebrity‐endorsed advertising.