bluuebunny/crossref_metadata_2025 huggingface dataset:
Which patients receive surgery in for-profit and non-profit hospitals in a universal health system? An explorative register-based study in Norway
Authors: Holom Geir Hiller , Alexandersen Nina , Goldhaber-Fiebert Jeremy D , Hagen Terje P
Published: June 2018

Objectives

To compare the socioeconomic status (SES) and case-mix among day surgical patients treated at private for-profit hospitals (PFPs) and non-profit hospitals (NPs) in Norway, and to explore whether the use of PFPs in a universal health system has compromised the principle of equal access regardless of SES.

Design

A retrospective, exploratory study comparing hospital types using the Norwegian Patient Register linked with socioeconomic data from Statistics Norway by using Norwegian citizens’ personal identification numbers.

Setting

The Norwegian healthcare system.

Population

All publicly financed patients in five Norwegian metropolitan areas having day surgery for meniscus (34 100 patients), carpal tunnel syndrome (15 010), benign breast hypertrophy (6297) or hallux valgus (2135) from 2009 to 2014.

Primary outcome measure

Having surgery at a PFP or NP.

Results

Across four unique procedures, the adjusted odds ratios (aORs) for using PFPs were generally lower for the lowest educational level (0.77–0.87) and the lowest income level (0.68–0.89), though aORs were not always significant. Likewise, comorbidity and previous hospitalisation had lower aORs (0.62–0.95; 0.44–0.97, respectively) for having surgery at PFPs across procedures, though again aORs were not always significant. No clear patterns emerged with respect to age, gender or higher levels of income and education.

Conclusions

The evidence from our study of four procedures suggests that equal access to PFPs compared with NPs for those patients at the lowest education and income levels may be compromised, though further investigations are needed to generalise these findings across more procedures and probe causal mechanisms and appropriate policy remedies. The finding that comorbidity and previous hospitalisation had lower odds of treatment at PFPs indicates that NPs play an essential role for more complex patients, but raises questions about patient preference and cream skimming.
Ultrasound-guided versus landmark approach for peripheral intravenous access by critical care nurses: a randomised controlled study
Authors: Bridey Céline , Thilly Nathalie , Lefevre Thomas , Maire-Richard Adeline , Morel Maxime , Levy Bruno , Girerd Nicolas , Kimmoun Antoine
Published: June 2018

Objective

Establishing a peripheral intravenous catheter (PIVC) after a long intensive care unit (ICU) stay can be a challenge for nurses, as these patients may present vascular access issues. The aim of this study was to compare an ultrasound-guided method (UGM) versus the landmark method (LM) for the placement of a PIVC in ICU patients who no longer require a central intravenous catheter (CIVC).

Design

Randomised, controlled, prospective, open-label, single-centre study.

Setting

Tertiary teaching hospital.

Participants

114 awake patients hospitalised in ICU fulfilling the following criteria: (1) with a central venous catheter that was no longer required, (2) needing a PIVC to replace the central venous catheter and (3) with no apparent or palpable veins on upper limbs after tourniquet placement.

Intervention

Placement of a PIVC using an UGM.

Primary outcome

Number of attempts for the establishment of a PIVC in the upper limbs.

Results

57 patients were respectively included in both the UGM group and LM group. Stasis oedema in the upper limbs was the main cause of poor venous access identified in 80% of patients. Both the number of attempts (2 (1–4), p=0.911) and catheter lifespan ((3 (1–3) days and 3 (2–3) days, p=0.719) were similar between the two groups. Catheters in the UGM group tended to be larger (p=0.059) and be associated with increased extravasation (p=0.094).

Conclusion

In ICU patients who no longer require a CIVC, use of an UGM for the establishment of a PIVC is not associated with a reduction in the number of attempts compared with LM.

Trial registration number

NCT02285712; Results.
Who attends out-of-hours general practice appointments? Analysis of a patient cohort accessing new out-of-hours units
Authors: Kelly Shona, J. , Piercy Hilary , Ibbotson Rachel , Fowler Davis Sally V.
Published: June 2018

Objectives

This report describes the patients who used additional out-of-hours (OOH) appointments offered through a UK scheme intended to increase patient access to primary care by extending OOH provision.

Design

Cohort study and survey data.

Setting

OOH appointments offered in four units in one region in England (October 2015 to November 2016).

Methods

Unidentifiable data on all patients were abstracted from a bespoke appointment system and the responses to a patient opinion questionnaire about this service. Descriptive analysis of the appointment data was conducted. Multivariate analysis of the opinion survey data examined the characteristics of the patients who would have gone to the emergency department (ED) had the OOH appointments not been available.

Results

There were 24 448 appointments for 19 701 different patients resulting in 29 629 service outcomes. Women dominated the uptake and patients from the poorest fifth of the population used nearly 40% of appointments. The patient survey found OOH appointments were extremely popular—93% selecting ‘extremely likely’ or ‘likely’ to recommend the service. Multivariate analysis of patient opinion survey data on whether ED would have been an alternative to the OOH service found that men, young children, people of Asian heritage and the most deprived were more likely to have gone to ED without this service.

Conclusions

The users of the OOH service were substantially different from in-hours service users with a large proportion of children under age 5, and the poor, which support the idea that there may be unmet need as the poor have the least flexible working conditions. These results demonstrate the need for equality impact assessment in planning service improvements associated with policy implementation. It suggests that OOH need to take account of patients expectations about convenience of appointments and how patients use services for urgent care needs.
Work-related injuries resulting in death in Chile: a cross-sectional study on 2014 and 2015 registries
Authors: Bachelet Vivienne C
Published: June 2018

Objective

To characterise work-related fatal events that occurred in Chile in 2014 and 2015 in workers covered by the Occupational Accidents and Professional Disease No 16.744 Act.

Design

Cross-sectional on registries of the Chilean Worker’s Health and Safety National Information System, specifically focusing on the Fatal Work Accidents Registry of the Social Security Superintendence.

Study population

Secondary data analysis on all 815 cases of occupational injury-related deaths registered in 2014 and 2015 in Chile and that were accredited by the Social Security Superintendence up to March 2016.

Outcome measures

Variables relating to employer, workers and the events were analysed.

Results

The overall mortality rate for all injuries, both at work and during commuting, per 100 000 workers affiliated to the occupational social security system, was 7.2 for 2014 and 7.3 for 2015. For 2014, the highest mortality rates occurred in the transport and communications sectors (20.15) and the mining sector (18.17), while for 2015 the highest rates were found in the fishing industry (11.3) and in mining (12.1). Seventy-two per cent of cases occurred in small and medium-sized enterprises. Half of the companies that had work-related fatal injuries did not have a risk prevention department. Twenty-two per cent (121) of the companies had previous labour law infractions. The four activities most affected by workers’ deaths in the two study years were freight land transport, engineering works under construction, minor works under construction and construction of complete buildings or parts of buildings. Half of all fatal injuries occurred in workers who had been employed for less than a year in their company.

Conclusions

This descriptive study provides valuable insight into the current national registry on occupational deaths in Chile. While containing valuable information, the registry was not designed for epidemiological surveillance. Further efforts are needed to achieve a proper epidemiological integration of surveillance data.
Effectiveness of amoxicillin alone in the treatment of uncomplicated acute otitis media: a systematic review protocol
Authors: Choffor-Nchinda Emmanuel , Atanga Leonel Christophe , Nansseu Jobert Richie , Djomou François
Published: June 2018

Introduction

Amoxicillin is the first-line antibiotic recommended by most scientific societies for the treatment of uncomplicated acute otitis media (AOM) in children and adults. In low-income and middle-income countries however, absence of setting-specific recommendations and antibiotic resistance, promoted by higher population density and over-the-counter antibiotic availability, could hamper the effectiveness of amoxicillin. We aim to provide updated information to enable evidence-based decisions for first-line therapy of uncomplicated AOM in our setting.

Methods and analysis

We will conduct a systematic review of all randomised controlled trials on the clinical effectiveness of amoxicillin for the treatment of uncomplicated AOM in children above 6 months and adults. The search will include studies published from the generation of the included databases to 31 December 2017. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and study quality will be assessed by the Risk of Bias Assessment Tool from the Cochrane Handbook for randomised trials. A meta-analysis will be conducted for homogeneous studies, eventually, using the fixed-effect model. Subgroup analysis will include age groups, amoxicillin dosage, treatment duration, effectiveness criteria, time of trial realisation, study quality and region of the world involved.

Ethics and dissemination

Formal ethical approval is not required, as primary data will not be collected. The results will be disseminated through a peer-reviewed publication and presented at scientific meetings.

PROSPERO registration number

CRD42017080029.
Ultrasound-guided tendon fenestration versus open-release surgery for the treatment of chronic lateral epicondylosis of the elbow: protocol for a prospective, randomised, single blinded study
Authors: Lungu Eugen , Grondin Philippe , Tétreault Patrice , Desmeules François , Cloutier Guy , Choinière Manon , Bureau Nathalie J
Published: June 2018

Introduction

Chronic lateral epicondylosis (CLE) of the elbow is a prevalent condition among middle-aged people with no consensus on optimal care management but for which surgery is generally accepted as a second intention treatment. Among conservative treatment options, ultrasound (US)-guided fenestration has shown encouraging results that should be explored before surgery is considered. The primary objective of this study is to compare the efficacy of US-guided fenestration with open-release surgery in patients with failure to improve following a minimum 6 months of conservative treatment.

Methods and analysis

This study protocol entails a two-arm, single-blinded, randomised, controlled design. Sixty-four eligible patients with clinically confirmed CLE will be assigned to either US-guided fenestration or open-release surgery. Fisher’s exact test will be used to compare the proportion of patients reporting a change of 11/100 points or more in thePatient Rated Tennis Elbow Evaluationscore at 6 months, according to an intention-to-treat analysis. Secondary analyses will compare the two treatment groups in terms of pain and disability, functional limitations at work, pain-free grip strength, medication burden, patients’ global impression of change and level of satisfaction at 6 weeks, 3, 6 and 12 months, using mixed linear models for repeated measures or Fisher’s exact test, as appropriate. Finally, recursive partitioning analyses will investigate US and elastography parameters as predictors of treatment success at 6 and 12 months. This data will contribute to evidence-based treatment guidelines for CLE and explore the value of imaging biomarkers to improve risk stratification plans and assist clinicians.

Ethics and dissemination

The study has been approved by the Research Ethics Board of our institution on 23 March 2016 (REB 15.327). In case of important protocol modifications, a new version of the protocol with appropriate amendments will be submitted to the REB for approval. Study results will be published in peer-reviewed journals and presented at local, national and international conferences.

Trial registration number

NCT02710682.
Beyond the limbic system: disruption and functional compensation of large-scale brain networks in patients with anti-LGI1 encephalitis
Authors: Heine Josephine , Prüss Harald , Kopp Ute A , Wegner Florian , Then Bergh Florian , Münte Thomas , Wandinger Klaus-Peter , Paul Friedemann , Bartsch Thorsten , Finke Carsten
Published: June 2018

Objective

Hippocampal inflammation in anti-LGI1 encephalitis causes memory deficits, seizures and behavioural abnormalities. Recent findings suggest that extralimbic brain areas are additionally affected and that patients also suffer from non-limbic cognitive symptoms. Moreover, up to 60% of patients show no structural MRI abnormalities in the acute disease stage. We therefore investigated whether functional connectivity analyses can identify brain network changes underlying disease-related symptoms.

Methods

We studied 27 patients and a matched healthy control group using structural and functional MRI. Intrinsic functional networks were analysed using Independent Component Analysis and Dual Regression. Cognitive testing covered working memory, episodic memory, attention and executive function.

Results

Our analysis revealed functional connectivity alterations in several large-scale networks, including the default mode network (DMN) which showed an aberrant structure-function relationship with the damaged hippocampus. In addition, connectivity in the sensorimotor, salience and higher visual networks was impaired independent of hippocampal damage. Increased connectivity in ventral and dorsal DMN regions significantly correlated with better memory performance. In contrast, stronger connectivity of the insula with the salience network and DMN was linked to impaired memory function.

Conclusions

Anti-LGI1 encephalitis is associated with a characteristic pattern of widespread functional network alterations. Increased DMN connectivity seems to represent a compensatory mechanism for memory impairment induced by hippocampal damage. Network analyses may provide a key to the understanding of clinical symptoms in autoimmune encephalitis and reveal changes of brain function beyond apparent structural damage.
The 7th French Airborne Forward Surgical Team experience of surgical support to the population of a low-income country: a prospective study on 341 patients with short-term follow-up
Authors: Goudard Yvain , Butin C , Carfantan C , Pauleau G , Soucanye de Landevoisin E , Goin G , Clement D , Bordes J , Balandraud P
Published: June 2018

Background

The 7th Airborne Forward Surgical Team (FST) has deployed to Chad in 2015 and 2016, in support of French military forces. Humanitarian surgical care is known to represent a significant part of the surgical activity in such missions, but to date limited data have been published on the subject.

Methods

All surgical patients from a civilian host population treated by the FST during these missions have been prospectively included. Indications, operative outcomes and postoperative outcomes were evaluated.

Results

During this period, the FST operated on 358 patients. Humanitarian surgical care represented 95% of the activity. Most patients (92.7%) were operated for elective surgery. Emergencies and infectious diseases represented, respectively, 7.3% and 9.1% of cases. The mean length of stay (LOS) was three days (2–4), and the median follow-up was 30 days (22–34). Mortality rate was 0.6% and morbidity was 5.6%. Parietal surgery had no significant complication and had shorter LOS (p<0.001). Emergent surgeries were more complicated (p<0.01) and required more reoperations (p<0.05). Surgical infectious cases had longer LOS (p<0.01).

Conclusions

Humanitarian surgical care can be provided without compromising the primary mission of the medical forces. Close surveillance and follow-up allowed favourable outcomes with low morbidity and mortality rates. Humanitarian care is responsible for a considerable portion of the workload in such deployed surgical teams. Accounting for humanitarian care is essential in the planning and training for such future medical operations.
Clinical and virological features of acute hepatitis A during an ongoing outbreak among men who have sex with men in the North of France
Authors: Boucher Anne , Meybeck Agnes , Alidjinou Kazali , Huleux Thomas , Viget Nathalie , Baclet Veronique , Valette Michel , Alcaraz Isabelle , Sauser Eveline , Bocket Laurence , Faiza Ajana
Published: June 2018

Objectives

Since February 2017, an increase of acute hepatitis A (AHA) cases has been notified in North of France. We aimed to report clinical and virological features of 49 cases treated in three hospitals in Lille European Metropolis (LEM).

Methods

All adult patients treated for AHA in 3 LEM hospitals between 20 February and 5 July 2017 were included. Demographic characteristics, exposure risk factors to hepatitis A virus (HAV), AHA manifestations and concomitant sexually transmitted infections (STI) were retrospectively recorded.

Results

Forty-nine cases of AHA were diagnosed among which 34 (69%) were hospitalised. Severe AHA occurred in 7 (14%) patients. The median age of cases was 36 years. All cases except 1 were men and 32 (65%) were identified as men having sex with men (MSM). Eleven (23%) patients were HIV-infected, 5 were under HIV pre-exposure prophylaxis (PrEP), 6 had a history of HIV postexposure prophylaxis and 19 had a history of at least one STI. Only three patients had received HAV vaccine. Proportion of patients tested for syphilis, chlamydial and gonococcal infections was 75% (18/24) in those seen by sexual health specialists and 21% (6/29) in those seen by other specialists. At least one concomitant STI was diagnosed in 13 out of 24 tested patients (54%). RT-PCR sequencing was available for 38 cases and confirmed co-circulation of 3 different strains of subgenotype IA (VRD 521 2016: n=24, RIVM-HAV16-090: n=13, V16-25801: n=1), already identified in several European countries.

Conclusions

We are facing an outbreak of AHA among MSM in the North of France with a high rate of hospitalisation. Analysis of cases highlighted missed opportunities of vaccination and lack of concomitant STI screening. Awareness among healthcare providers and MSM should be increased and HAV vaccination promoted.
Role of habit in treatment adherence among adults with cystic fibrosis
Authors: Hoo Zhe Hui , Gardner Benjamin , Arden Madelynne A , Waterhouse Simon , Walters Stephen J , Campbell Michael J , Hind Daniel , Maguire Chin , Dewar Jane , Wildman Martin J
Published: June 2018

Among adults with cystic fibrosis (CF), medication adherence is low and reasons for low adherence are poorly understood. Our previous exploratory study showed that stronger ‘habit’ (ie, automatically experiencing an urge to use a nebuliser) was associated with higher nebuliser adherence. We performed a secondary analysis of pilot trial data (n=61) to replicate the earlier study and determine whether habit–adherence association exists in other cohorts of adults with CF. In this study, high adherers also reported stronger habit compared with low adherers. Habit may be a promising target for self-management interventions.

Trial registration number

ACtiF pilot, ISRCTN13076797.
Theoretical studies of the electronic structure and magnetic properties of aluminum-rich intermetallic alloy Al13Fe4
Authors: Ullah Israr , Mehmood Shahid , Ali Zahid , Rehman Gul , Khan Imad , Ahmad Iftikhar
Published: June 2018

In this paper, structural, electronic and magnetic properties of the aluminum-rich intermetallic alloy Al[Formula: see text]Fe4are investigated using full potential linearized augmented plane waves (FPLAPW) approach in the frame work of density functional theory (DFT). The calculated structural parameters are consistent with the experimentally reported data. In this alloy, Fe atoms possess different coordination numbers with Al atoms, i.e., Fe(1) and Fe(2) have the same coordination number 5, whereas Fe(3), Fe(4) and Fe(5) have 4, 7 and 9 coordination numbers, respectively. The compound is found metallic and ferromagnetic in nature. Post-DFT (BoltzTraP code) calculations confirm the ferromagnetic and anisotropic behavior. The Fe(5) atom plays a central role in the electronic and magnetic properties of the alloy due to the large coordination with Al atom as compared to the rest Fe atoms.
Immunity War: A Novel Therapy for Lymphoma Using T-cell Bispecific Antibodies
Authors: Prakash Ajay , Diefenbach Catherine S.
Published: June 2018

The activity of T-cell–mediated immunotherapies in B-cell lymphoma has been limited to date. The novel bispecific antibody CD20-TCB has a 2:1 antibody design to maximize T-cell engagement and demonstrates activity in preclinical models. This may represent a novel therapeutic approach for patients with relapsed/refractory non-Hodgkin lymphoma (NHL). Clin Cancer Res; 24(19); 4631–2. ©2018 AACR.

See related article by Bacac et al., p. 4785
Increased Risk of Spontaneous Bacterial Peritonitis in Cirrhotic Patients Using Proton Pump Inhibitors
Authors: Elzouki Abdel-Naser , Neffati Nadia , Rasoul Fatma A. , Abdallah Ali , Othman Muftah , Waness Abdelkarim 
Published: June 2018

Background: The association between bacterial infections and proton pump inhibitors (PPIs) has recently been studied with debatable results. Aim: The aim of this study was to investigate the relationship between PPIs and the development of spontaneous bacterial peritonitis (SBP) or other bacterial infections in cirrhotic patients. Materials and Methods: Consecutive cirrhotic patients hospitalized from 2007 through 2012 to Hamad General Hospital–, Doha, Qatar, were enrolled and classified as PPI users or non-users according to PPI consumption in the 90 days prior to hospitalization. Cirrhosis was clinically diagnosed by a combination of physical, biochemical, radiological, and endoscopic findings, or by liver biopsy. Results: A total of 333 patients were included in this study, of whom 171 (51.4%) used PPIs and 162 (48.6%) did not use PPIs. PPI users were significantly older in age (p = 0.001). There was no statistical difference between the 2 groups in sex distribution and etiology of cirrhosis (p > 0.05 for both parameters). PPI users had a significantly higher incidence of overall bacterial infection (38%) than non-PPI users (13.6%), p = 0.0001. Statistical significance is observed specifically for SBP and chest infection (p = 0.0006 and p = 0.01, respectively). In multivariate analysis, older age (> 60 years; OR = 1.246, 95% CI 1.021–08.486; p = 0.02), and PPI use (OR = 2.149, 95% CI 1.124–06.188; p = 0.01) were independent predicting factors for SBP and overall bacterial infection. Conclusion: The present study shows that PPI use, as well as older age (> 60 years), was an independent predicting factor for the development of overall infection and SBP in hospitalized cirrhotic patients. Unless it is indicated, PPI therapy should be avoided in this group of patients, particularly in those older than 60 years of age.
Liver Resection for Colorectal Hepatic Metastases after Systemic Chemotherapy and Selective Internal Radiation Therapy with Yttrium-90 Microspheres: A Systematic Review
Authors: Baltatzis Minas , Siriwardena Ajith K.
Published: June 2018

Background: Selective internal radiation therapy (SIRT) using yttrium-90 resin microspheres has been used together with systemic chemotherapy to treat patients with unresectable liver metastases. This study undertook the first systematic pooled assessment of the case profile, treatment and outcome in patients with initially inoperable colorectal hepatic metastases undergoing resection after systemic chemotherapy and SIRT. Methods: A systematic review of the literature was performed using Medline and Embase for publications between January 1998 and August 2017. Keywords and MESH headings “SIRT”, “Yttrium-99 radio embolization” and “liver metastases” were used. Reports on patients undergoing liver resection after SIRT for colorectal liver metastases were included. Case reports, reviews and papers without original data were excluded. The study protocol was registered with PROSPERO, (registration number: CRD42017072374). Results: The study population comprised of 120 patients undergoing liver resection after chemotherapy and SIRT. The conversion rate to hepatectomy in previously unresectable patients was 13.6% (109 of 802). All studies report a single application of SIRT. The interval from SIRT to surgery ranged from 39 days to 9 months. Overall, there were 4 (3.3%) deaths after hepatectomy in patients treated by chemotherapy and SIRT. Conclusions: This large pooled report of patients undergoing hepatectomy for colorectal liver metastases after chemotherapy and SIRT shows that 13.6% of patients with initially inoperable disease undergo resection with low procedure-related mortality.
Therapeutic Strategies Following Major, Clinically Relevant Nonmajor, and Nuisance Bleeding in Atrial Fibrillation: Findings From ORBIT‐AF
Authors: O'Brien Emily C. , Holmes DaJuanicia N. , Thomas Laine , Fonarow Gregg C. , Kowey Peter R. , Ansell Jack E. , Mahaffey Kenneth W. , Gersh Bernard J. , Peterson Eric D. , Piccini Jonathan P. , Hylek Elaine M.
Published: June 2018

Background

Oral anticoagulation (
OAC
) reduces stroke risk in atrial fibrillation, but bleeding is a frequent side effect. The decision to discontinue or modify medication regimens in response to a bleeding event may differ according to bleeding site and severity.

Methods and Results

We used data from a large, national outpatient registry,
ORBIT
‐
AF
(Outcomes Registry for Better Informed Treatment of Atrial Fibrillation; 2010–2011), to evaluate event characteristics and OAC management following the first bleeding event occurring during follow‐up. Bleeding events were classified into 3 categories: (1) International Society of Thrombosis and Hemostasis major bleeding, (2) clinically relevant nonmajor bleeding requiring medical attention, and (3) nuisance bleeding not requiring medical attention (eg, bruising, hemorrhoidal bleeding). Of 9743 patients enrolled in
ORBIT
‐
AF
with follow‐up data, 510 (3.23/100 subject‐years) experienced a major bleed, 615 (3.90/100 subject‐years), experienced a clinically relevant nonmajor bleed, and 1558 (9.87/100 subject‐years) experienced a nuisance bleed, among first bleeds over 2 years. Nearly one third of patients (31.6%) discontinued
OAC
therapy following a major bleeding event, 12.7% following a clinically relevant nonmajor bleed, and 4.5% following a nuisance bleed. Compared with those who experienced a clinically relevant nonmajor or nuisance bleed, patients who experienced a major bleed were more likely to be black and female and to have a history of heart failure and stroke. Those who discontinued were more likely to have central nervous system or gastrointestinal bleeding than those who persisted on
OAC
therapy.

Conclusions

Overall, 1 in 3 patients who experienced a major bleed was no longer anticoagulated after the event. Those who discontinued
OAC
were more likely to have central nervous system or gastrointestinal bleeding than those who persisted on
OAC
.
Methodologic Differences Across Studies of Patients With Atrial Fibrillation Lead to Varying Estimates of Stroke Risk
Authors: Quinn Gene R. , Severdija Olivia N. , Chang Yuchiao , Dallalzadeh Liane O. , Singer Daniel E.
Published: June 2018

Background

Guidelines for anticoagulation in atrial fibrillation (
AF
) assume that stroke risk scheme point scores correspond to fixed stroke rates. However, reported stroke rates vary widely across
AF
cohort studies, including studies from the same country. Reasons for this variation are unclear. This study compares methodologies used to assemble and analyze large
AF
cohorts worldwide and assesses potential bias in estimating stroke rates.

Methods and Results

From a previous systematic review of
AF
cohorts, we analyzed studies including at least 5000 patients. We assessed methods used to generate rates of ischemic stroke off anticoagulants, according to a structured inventory of database interrogation methods. Nine studies (497 578 total patients) met our criteria. Overall cohort stroke rates ranged from 0.45% to 7.03% per year. In bivariate study‐level analysis, multiple features were associated with higher stroke rates, including
AF
identified as inpatients versus outpatients (rate ratio 2.60, 95% confidence interval, 1.19, 5.68), and lack of clinical validation of outcome events (rate ratio 4.09, 95% confidence interval, 1.06, 15.70). European studies reported rates more than 4‐fold higher than North American studies.
International Classification of Diseases (ICD)
coding schemes for outcomes varied widely. Multiple high rate features coexisted in the same studies.

Conclusions

Among
AF
cohort studies, differences in the composition, method of assembly, determination of clinical features and outcomes, and analytic approach were strongly associated with reported stroke rates. Our study highlights the need for standardized and validated methodologies for
AF
cohort assembly and analysis to generate accurate stroke rates to better support anticoagulation guidelines for patients with
AF
.
Emotional Rescue
Authors: Moralee Jason
Published: June 2018

Individuals, city-states, and small-scale communities of worshippers memorialized instances when they were rescued from danger. They did so in a variety of ways, from staging fictional accounts of danger and deliverance to the public praise of local patriots and annual festivals in honor of gods and goddesses for their roles in saving the community. This article examines the significance of epigraphic narratives of endangerment and rescue from the third centuryBCto the third centuryAD. It argues that these inscriptions joined individuals into an emotional community of those whose lives had been touched by the gods. These epigraphic narratives point to the social significance of having a status as one rescued by the gods. Talking about one’s own weakness, vulnerability, and misfortune was a key way for individuals andpoleisto claim rights and privileges within communities, between them, and across time.
The Participation of Colombia in United Nations’ Multidimensional Peace Operations
Authors: Fernandez-Osorio Andres Eduardo
Published: June 2018

This article challenges conventional explanations why Colombia, a country emerging from an armed internal conflict but still with multiple challenges, should participate in United Nations’ multidimensional peace operations. While Colombian official rationale maintains that contribution to peacekeeping is a common stage for countries within a post-peace agreement scenario to gain worldwide recognition, to improve legitimacy, and to establish an alternative source of funding, international experience suggests that the occurrence of several other circumstances is necessary before making such a commitment. The results of a statistical analysis show how the level of implementation of the peace agreement, as well as disarmament, demobilization, reintegration, addressing minority rights, and solving issues with criminal groups are fundamental for deciding on participation in peace operations. Additionally, while international missions may be considered a way of enhancing diplomacy, cautious assessments should be made to determine the military capabilities needed to balance national interests and foreign policy without fostering a regional security dilemma.
Does thyrotoxic periodic paralysis have a genetic predisposition? A case report
Authors: Rasheed E , Seheult J , Gibney J , Boran G
Published: June 2018

Thyrotoxic periodic paralysis is a rare complication of hyperthyroidism where increased influx of potassium into skeletal muscle cells leads to profound hypokalaemia and paralysis. Most cases arise sporadically in Asians; however, it is being increasingly reported in Caucasians. It is regarded as a channelopathy where a genetic and/or acquired defect in the sodium-potassium (Na/K-ATPase) pump renders it more sensitive to excess thyroid hormone in susceptible individuals. Because the clinical presentation is similar to familial hypokalaemic periodic paralysis, genes implicated in this autosomal-dominant condition became candidates for thyrotoxic periodic paralysis, particularly if they were known to have thyroid hormone-responsive elements. These include the voltage-gated calcium (CACNA1S) and sodium (SCN4A) channel genes, KCNJ18 which encodes the inwardly rectifying potassium channel Kir2.6, and subunits of the Na/K-ATPase genes. Although no single pathogenetic mutation has been identified in thyrotoxic periodic paralysis, several single-nucleotide polymorphisms in these genes have been associated with it. We describe a 27-year-old Caucasian Irish male who presented with acute onset limb paralysis and severe hypokalaemia. He was diagnosed as having thyrotoxic periodic paralysis secondary to Graves’ disease based on clinical presentation, biochemical findings and rapid response to intravenous potassium. Genetic analysis identified heterozygous variants in three candidate genes: KCNJ18 (c.576G>C), SCN4A (c.2341G>A) and CACNA1S (c.1817G>A). Since these variants are not disease causing and occur at high prevalences of 50%, 2–3% and 1%, respectively, in the normal population, they do not explain the clinical phenotype in our patient suggesting that acquired environmental triggers or as-yet unidentified gene mutations remain as leading pathogenetic co-factors in thyrotoxic periodic paralysis.
Microaggressions and Ethnic Identity in the Career Development of Latina College Students
Authors: Bonifacio Luisa , Gushue George V. , Mejia-Smith Brenda X.
Published: June 2018

Counseling psychologists have noted the importance of examining the intersection of sociocultural identity and vocational psychology. In our study, we considered this intersection in a sample of 202 Latina college and graduate students from a perspective informed by social cognitive career theory. We examined how ethnic identity and experiences of self-reported microagressions were related to career decision self-efficacy and outcome expectations, including relationships to both positive and negative outcome expectations in our model. Findings indicated that higher endorsement of ethnic identity was positively related to career decision self-efficacy and to negative outcome expectations, whereas higher endorsement of experiences of microaggressions was related to lower career-decision self-efficacy, greater negative outcome expectations, and lower positive outcome expectations. Career decision self-efficacy was associated with lower negative outcome expectations and higher positive outcome expectations. Indirect relationships and two alternative models were also explored. We discuss implications for future research and career counseling with Latinas.
Experimental investigation on interply friction properties of thermoset prepreg systems
Authors: Pasco Corentin , Khan Muhammad , Gupta Jaipal , Kendall Kenneth
Published: June 2018

A comprehensive novel investigation into the characterisation of interply friction behaviour of thermoset prepregs for high-volume manufacturing was conducted. High interply slipping rate and normal pressure typically used for high-volume manufacturing present challenges when preforming carbon fibre reinforced plastics. The study involved multiple reinforcement architectures (woven and unidirectional with the same rapid-cure resin system) which were characterised using a bespoke interply friction test rig used to simulate processing conditions representative to press forming and double diaphragm forming. Under prescribed conditions, woven and unidirectional prepregs exhibit significantly different frictional behaviour. Results demonstrated the unidirectional material obeys a hydrodynamic lubrication mode. For the woven material, a rate-dependent friction behaviour was found at low normal pressure. At higher normal pressure however, the woven material exhibited a friction behaviour similar to that of a dry reinforcement and significant tow displacement was observed. Post-characterisation analysis of test-specimens showed significant resin migration towards the outer edges of the plies, leaving a relatively resin-starved contact interface. The findings generate new knowledge on interply friction properties of thermoset prepreg for high-volume manufacturing applications, yet reveal a lack of understanding of the influence of tow tensions as well as the pre-impregnation level for a range of processing conditions.
Impactful Learning Environments: A Humanistic Approach to Fostering Adolescents’ Postindustrial Social Skills
Authors: Leach Nicole
Published: June 2018

“Humanistic education” and “postindustrial skills” movements are concerned with promoting social development; thus, it is apropos to question if a humanistic learning environment is effective in fostering adolescent development of social skills. This qualitative study is a 3-year longitudinal, ethnographic case study examining the role of humanistic learning environments on fostering adolescent postindustrial social skills. The sample consisted of observations of 281 students and interviews from 17 parents, 5 teachers, and 37 students in a mastery-oriented public-charter school with an approximate 350 student population. Four humanistic learning environment characteristics (relationships, community, respect, and consciousness) were found to foster five developmental postindustrial social skills (socioemotional development, communication, collaboration, sociability, character, and social responsibility) using inductive data analysis.
Unemployment and Marital Quality in Great Recession America: An Exploratory Canonical Correlation Analysis
Authors: Bland Andrew M. , McQueen Kand S
Published: June 2018

To contribute to the literature on unemployment and marital quality in light of rapid social, economic, and political changes that characterized the past decade (2008-2018), this exploratory study assessed how unemployment during the Great Recession affected marital quality based on participants’ beliefs about marital roles (on a continuum from more traditional to more progressive) and on their levels of education, duration of marriage, and duration and frequency of unemployment. Nationwide, 129 participants completed an online questionnaire consisting of two scales of marital quality (Dyadic Adjustment Scale and Revised Kansas Marital Satisfaction Scale) plus demographic items. Although the canonical correlation analysis was not significant, a number of trends emerged that suggested possibilities worthy of discussion and that provide a foundation for further research. For example, the results suggested the possibility that humanistic theorizing on unemployment and marriage might not be confined to ideological beliefs about gender-based marital roles, and that marital quality in the face of unemployment may be more directly affected by education level. Moreover, repeated measures analyses of variance suggested that, although most participants experienced situational distress, faith in and commitment to the relationship seemed to sustain marriages despite the short-term obstacle of unemployment, which echoes humanistic psychologists’ focus on resilience in relationships.
The Impacts of Organizational Justice on Early Childhood Educators' Intention to Participate in Professional Associations: The Mediator Role of Deliberative Beliefs
Authors: Lin Chun-wen
Published: June 2018

Guided by the general incentives rational action model and deliberative participatory democracy framework, we investigated whether deliberative beliefs, including normative and personal aspects, mediate the relationship between distributive, procedural, and interactive organizational justice and intention to participate in professional associations. Self-report measures of organizational justice, deliberative belief, and intention of participation were obtained from 789 early childhood educators in Taiwan. Structural equation modeling was used to analyze the proposed model. According to the results of the study, there is a relationship between organizational justice and intention of professional association participation, and a fully significant mediation effect was found for deliberative beliefs between organizational justice and intention to participate. These findings are discussed with respect to improving professional association participation and applying deliberative pedagogy.
An open label, prospective, multicenter, non-interventional study of iodixanol 270 mg I/mL for use in individuals undergoing computed tomography angiography in real-world clinical practice
Authors: Du Xiangying , Lu Bin , Hu Daoyu , Song Bin , Li Kuncheng
Published: June 2018

Background

Concern about radiation exposure is leading to an increasing interest in low-concentration contrast medium administration.

Purpose

To evaluate the image quality and safety profile after administration of iodixanol 270 mg I/mL at 100-kVp tube voltage with iterative reconstruction in subjects undergoing computed tomography angiography (CTA).

Material and Methods

Patients who completed CTA examination using iodixanol 270 mg I/mL and 100-kVp tube voltage along with iterative reconstruction for coronary, aortic, head and neck, renal, or pulmonary arteries were included. Image quality was qualitatively and quantitatively evaluated. Incidence of adverse events (AEs) and adverse drug reactions (ADRs) within seven days and radiation dose were also analyzed.

Results

A total of 4513 individuals in 42 centers in China were enrolled, among which 4367 were included in efficacy analysis. The mean image quality score was 4.8 ± 0.45 across all arteries (all above 4.6) and 99.7% of the individuals’ images were classified as evaluable. The CT attenuation, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) in the regions of interest (ROIs) were 431.79 ± 99.018, 18.29 ± 11.947, and 28.21 ± 19.535 HU, respectively. Of all the participants, 68 (1.5%) and 65 (1.4%) experienced AEs and ADRs, respectively. No serious AEs or AEs leading to discontinuation occurred. The average effective radiation dose was 3.13 ± 2.550 mSv.

Conclusion

Iodixanol 270 mg I/mL in combination with 100-kVp tube voltage and iterative reconstruction could be safely applied in CTA and yield high-quality and evaluable images with reduced radiation dose.
The Effect of Activity Restriction on Infant’s Birth Weight and Gestational Age at Birth: PRAMS Data Analysis
Authors: Omar Abeer
Published: June 2018

Background:

Activity restriction is extensively prescribed for pregnant women with major comorbidities despite the lack of evidence to support its effectiveness in preventing preterm birth or low birth weight.

Purpose:

To determine the moderation effect of home activity restriction for more than a week on infant’s birth weight and gestational age at birth for high-risk women with obstetrical and medical comorbidities.

Methods:

A secondary analysis of 2004–2008 New York Pregnancy Risk Assessment Monitoring System was conducted with 1426 high-risk women.

Results:

High-risk group included 41% of women treated with activity restriction and 59% of those not treated with activity restriction. Women with preterm premature rupture of membrane (PPROM) who were treated with activity restriction had a lower infant birth weight ( b = −202.85, p = ≤.001) and gestational age at birth ( b = −.91, p = ≤.001) than those without activity restriction. However, women with preterm labor and hypertensive disorders of pregnancy who were not treated with activity restriction had lower infant gestational age at birth ( b = −96, p = ≤.01) and ( b = −92, p = ≤.001), respectively, compared to those who were treated with activity restriction.

Conclusion:

Findings suggest a contrary effect of activity restriction on infants born to women with PPROM, which is a major reason for prescribing activity restriction. The current study results may trigger the need to conduct randomized control trials to determine the effect of severity of activity restriction on maternal and infant outcomes.
Preventing and Responding to Sexual Misconduct: Preliminary Efficacy of a Peer-Led Bystander Training Program for Preventing Sexual Misconduct and Reducing Heavy Drinking Among Collegiate Athletes
Authors: Morean Meghan E. , Darling Nancy , Smit Jessie , DeFeis Jolie , Wergeles Maya , Kurzer-Yashin Dana , Custer Kaitlyn
Published: June 2018

Sexual misconduct occurs with disproportionate frequency on college campuses, and alcohol is involved in most sexual assaults. Importantly, collegiate athletes are at risk for both heavy drinking and sexual misconduct. Thus, the current study evaluated the efficacy of a novel, 2.5-hr, peer-facilitated, interactive, group-based bystander intervention program for student athletes that integrated information on sexual misconduct and risky drinking (Preventing and Responding to Sexual Misconduct [PRSM]). In all, 205 athletes completed 25-min surveys immediately before and after the training, and 76 (of 94 invited) completed a 3-month follow-up. Participating in the workshop was associated with significant increases in acknowledgment that sexual misconduct is a problem on campus, knowledge of where to get help if sexual misconduct occurs, knowledge about the college’s procedures for addressing sexual misconduct, confidence that the college’s procedures for addressing sexual misconduct are fair, bystander confidence, and engagement in a range of bystander activities. A significant decrease in rape myths also was observed. Participating in the workshop also produced changes in alcohol-related beliefs and behaviors. After participating in PRSM, athletes reported increased expectations that drinking alcohol can produce negative effects including aggression and acute intoxication. Participating in the workshop also was associated with significant reductions in drinking frequency, the total number of drinks consumed per month, the maximum drinks consumed in 24 hours, the frequency of binge-drinking episodes, and the experience of alcohol-related problems. In sum, the PRSM program evidenced preliminary efficacy as a program designed to increase prosocial bystander behavior and decrease high-risk drinking among collegiate athletes; changes in beliefs and behaviors consistent with reducing risk for sexual misconduct and problem drinking were observed after workshop participation. Future research should evaluate whether the PRSM program is effective for use with other high-risk populations like fraternity members or more diverse institutions of higher education including large universities.