bluuebunny/crossref_metadata_2025 huggingface dataset:
Accessing the Oregon Frontier: The Impact of Expanding Authority for Buprenorphine to Nurse Practitioners
Authors: Klein T. , Hartung D. , Geddes J.
Published: August 2020

Access to providers of treatment for opioid use disorder is a critical challenge to confronting the opioid epidemic. In 2017, the Comprehensive Addiction and Recovery Act (CARA) expanded buprenorphine prescribing privileges to nurse practitioners (NP). This research examined the effect of this regulatory change on buprenorphine prescribing in the state of Oregon.

We performed an interrupted time‐series (ITS) analysis to examine the effect of CARA implementation (February 2017) on buprenorphine prescribing for medications to treat opioid disorders (MOUD) from January 1, 2016 to December 31, 2018. Specifically, we characterized changes in the trend and patterns of buprenorphine prescribing overall, by prescriber type (NPs vs MD/DO), and geographic designation. Our ITS regression models estimated prepolicy trends, immediate changes after CARA implementation, and changes in trend following implementation.

We used Oregon Prescription Drug Monitoring Program data linked to a provider and dispensing characteristic files. Our study sample post‐CARA included 179 NPs with a total of 440 525 buprenorphine prescriptions statewide written by all prescribers.

Prior to CARA implementation, the trend in total buprenorphine dispensing was increasing by 149 prescriptions per month (P < .001). Following implementation, the trend in buprenorphine dispensing increased significantly by 75 prescriptions per month (P = .015). This increase was entirely driven by new NP prescribing of buprenorphine as the trend in MD/DO prescribing was unchanged (P = .65). By December 2018, 15% of buprenorphine prescriptions were prescribed by NPs. The proportion of buprenorphine prescribed by NPs increased in both urban (0.4% per month; P < .001) and rural areas (0.6% per month; P < .001). The increase was particularly large in counties classified as frontier (six or fewer people per square mile) where the proportion of buprenorphine prescribed by NPs increased from 1.2% to 23%.

Buprenorphine dispensing rates in Oregon increased significantly following CARA implementation. The impact of adding NPs as authorized prescribers has enhanced access to buprenorphine prescriptions in rural and sparsely populated areas of the state where such patients were previously underserved.

Expanding buprenorphine prescribing authority to NPs is a promising approach to improve access to MOUD, particularly in frontier counties where certified treatment centers do not exist. However, only 179 of the state’s 4946 licensed NPs prescribed buprenorphine demonstrating the need to for efforts to facilitate certification for these providers.

WSU College of Nursing.
Low‐value Prostate Cancer Screening: Decision Fatigue in Outpatient Providers’ PSA Testing Practices
Authors: Hunt T.C. , Ambrose J.P. , Haaland B. , Hanson H.A. , O'Neil B.B.
Published: August 2020

Research Objective

Low‐value prostate‐specific antigen (PSA) testing is responsible for substantial waste and potential harm to patients, yet it accounts for nearly half of prostate cancer (PCa) screening. Decision fatigue, the progressive decline in consistency and quality of choices with repetitive decision making, has been observed in breast and colorectal cancer care. Our aim was to determine whether low‐value PSA testing patterns by outpatient providers are consistent with decision fatigue.

Study Design

Outpatient encounters across various specialties were stratified by clinical guidelines as whether a PSA test order would be appropriate or low value. The primary endpoint was whether a PSA test was ordered. Logistic generalized estimating equations were used to analyze PSA test likelihood by appropriateness, with spline functions representing trends by hour. Models were adjusted for patient‐, provider‐, and appointment‐level factors and stratified by specialty.

Population Studied

Men without PCa at a large academic health system from July 2011 to June 2018 were identified. In total, 1,761,815 outpatient visits were completed by this cohort of men during the specified time period.

Principal Findings

Of these 1,761,815 outpatient encounters, a PSA test was ordered during 3.7% when it would be considered appropriate and 1.8% when it was low value. The overall likelihood of an encounter resulting in any PSA test was greatest at 8:00am, tapering off by 12:00pm (OR = 0.66; 0.58–0.75) and persisting at this nadir through 4:00pm (OR = 0.65; 0.56–0.77). Testing patterns differed between specialties, with nonurologists exhibiting a proportionately greater decline in the likelihood of ordering an appropriate test as the day progressed. Urologists showed a different pattern, with appropriate decisions relatively preserved throughout the day even as inappropriate testing declined in the middle of the day.

Conclusions

In a framework where PSA testing decisions are considered complex and the default position is to not test, PSA testing among nonurologists is consistent with decision fatigue. That is, testing is most likely early in the day when complex decisions are easiest. The pattern of PSA testing among urologists is different and may not be explained by decision fatigue. This may be due to differences in the default position for testing or greater PSA testing expertise, which lightens the cognitive load of decision making.

Implications for Policy or Practice

Future efforts to improve value and reduce waste in PSA testing might employ clinical decision support, which has been shown to be an effective intervention in the setting of decision fatigue. Interventions should ideally be tailored to each specialty’s unique needs.

Primary Funding Source

National Institutes of Health.
ESRD QIP Payment Reductions Are Associated with Mortality, Utilization, and Cost
Authors: Young E. , Ding Z. , Kapke A. , Houseal D. , Pearson J. , Turenne M.
Published: August 2020

Research Objective

CMS launched the ESRD Quality Incentive Program (QIP) in 2010. The ESRD QIP adjusts Medicare payments to dialysis facilities based on their performance on a set of quality measures. The measures are revised in most years. We assessed whether the magnitude of ESRD QIP payment reductions was associated with several important patient outcomes that are not an intrinsic part of the QIP measure set.

Study Design

We compared mortality, utilization of health care services, and Medicare payments per patient‐year during 2015‐2017 for dialysis facilities in each ESRD QIP payment reduction category (0%, 0.5%, 1.0%, 1.5%, and 2.0%) corresponding to their QIP performance for the same year. The data sources include Medicare claims and enrollment files. Results were expressed as unadjusted averages and as modeled measures of association that adjusted for important patient factors (age, sex, race, ethnicity, diabetes, duration of ESRD, and dual eligibility).

Population Studied

The patient cohort consisted of Medicare fee‐for‐service beneficiaries receiving chronic dialysis for ESRD on the first day of each year. Patients were attributed to the first facility that provided treatment during the year.

Principal Findings

Most patients were treated in facilities that did not receive an ESRD QIP payment reduction (Table). There was a stepwise increase in mortality, hospitalization, hospital days, and Medicare payments per year in facilities with successively larger payment reductions. The increase in Medicare payments was largely for inpatient services. All findings were statistically significant in adjusted regression models (shown in the Table for mortality and total payment).

Conclusions

Mortality, utilization, and Medicare payments were substantially higher for patients treated in facilities whose contemporaneous performance on ESRD QIP measures resulted in a payment reduction. Moreover, these outcome measures increased stepwise with the magnitude of facility payment reductions. The findings are consistent with the hypothesis that the ESRD QIP measures and scoring system capture meaningful determinants of health care quality and value.

Implications for Policy or Practice

The findings support the validity of ESRD QIP. The findings offer an approach to ongoing monitoring and validation of QIP measures.

Primary Funding Source

The study was funded by the Centers for Medicare and Medicaid Services.
On Abolition Ecologies and Making “Freedom as a Place”
Authors: Heynen Nik , Ybarra Megan
Published: August 2020

This introduction calls for political ecology to systematically engage with the ways that white supremacy shapes human relationships with land through entangled processes of settler colonialism, empire and racial capitalism. To develop the analytic of abolition ecology, we begin with the articulation of W.E.B. Du Bois’ abolition democracy together with Ruth Wilson Gilmore’s spatially attuned analytic of abolition geography. Rather than define communities by the violence they suffer, abolition ecologies call for attention to radical place‐making and the land, air and water based environments within which places are made. To that end, we suggest that an abolition ecology demands attention to the ways that coalitional land‐based politics dismantle oppressive institutions and to the promise of abolition, which Gilmore describes as making “freedom as a place”.
Effects of learning physics using Augmented Reality on students’ self‐efficacy and conceptions of learning
Authors: Cai Su , Liu Changhao , Wang Tao , Liu Enrui , Liang Jyh‐Chong
Published: August 2020

The Augmented Reality (AR)‐based learning environment not only provides educators with novel ways to present learning materials but also give learners the opportunity to spontaneously interact with the material. Previous studies have shown that AR has many advantages in education; however, few focuses on the mechanisms behind promoting inquiry motivation, such as the effect of AR on learners’ self‐efficacy and conceptions of learning. This study developed an AR‐based wave‐particle duality learning application, “AROSE,” to explore the effect of AR technology on students’ self‐efficacy and conceptions of learning physics. A quasi‐experimental study method was used, and 98 high school students aged between 16 and 18 were randomly assigned to experimental and control group. After a 4‐week intervention, it was found that integrating AR technology into physics classrooms can (1) significantly enhance students’ physics learning self‐efficacy, as indicated by understanding of concepts, higher‐level cognitive skills, practice and communication; (2) guide students to be more inclined to higher‐level conceptions of learning physics rather than lower ones; and (3) stimulates students’ motivation to learn more deeply.
CE‐DIFF: An Approach to Identifying and Coping with Irregular Ratings in Collaborative Decision Making
Authors: Yu Li , Zhang Dongsong , Fu Zhe
Published: August 2020

A key to collaborative decision making is to aggregate individual evaluations into a group decision. One of its fundamental challenges lies in the difficulty in identifying and dealing with irregular or unfair ratings and reducing their impact on group decisions. Little research has attempted to identify irregular ratings in a collaborative assessment task, let alone develop effective approaches to reduce their negative impact on the final group judgment. In this article, based on the synergy theory, we propose a novel consensus‐based collaborative evaluation (CE) method called Collaborative Evaluation based on rating DIFFerence (CE‐DIFF) for identifying irregular ratings and mitigating their impact on collaborative decisions. CE‐DIFF determines and assigns different weights automatically to individual evaluators or ratings based on the level of consistency of one's ratings with the group assessment outcome through continuous iterations. We conducted two empirical experiments to evaluate the proposed method. The results show that CE‐DIFF has higher accuracy in dealing with irregular ratings than existing CE methods, such as arithmetic mean and trimmed mean. In addition, the effectiveness of CE‐DIFF is independent of group size. This study provides a new and more effective method for collaborative assessment, as well as novel theoretical insights and practical implications on how to improve collaborative assessment.
Compliance of atrial fibrillation treatment with the ABC pathway in patients with concomitant diabetes mellitus in the Middle East based on the Gulf SAFE registry
Authors: Domek Magdalena , Gumprecht Jakub , Li Yan‐Guang , Proietti Marco , Rashed Wafa , Al Qudaimi Ahmed , Gumprecht Janusz , Zubaid Mohammad , Lip Gregory Y. H.
Published: August 2020

Introduction

Atrial fibrillation (AF) and diabetes mellitus (DM) constitute a heavy burden on healthcare expenditure due to their negative impact on clinical outcomes in the Middle East. The Atrial fibrillation Better Care (ABC) pathway provides a simple strategy of integrated approach of AF management: A—Avoid stroke; B—Better symptom control; C—Cardiovascular comorbidity risk management.

Aims

Evaluation of the AF treatment compliance to ABC pathway in DM patients in the Middle East. Assessment of the impact of ABC pathway adherence on all‐cause mortality and the composite outcome of stroke/systemic embolism, all‐cause death and cardiovascular hospitalisations.

Methods

From 2043 patients in the Gulf SAFE registry, 603 patients (mean age 63; 48% male) with DM were included in an analysis of ABC pathway compliance: A—appropriate use of anticoagulation according to CHA2DS2‐VASc score; B—AF symptoms management according to the European Heart Rhythm Association (EHRA) scale; C—Optimised cardiovascular comorbidities management.

Results

86 (14.3%) patients were treated in compliance with the ABC pathway. During 1‐year follow‐up, 207 composite outcome events and 87 deaths occurred. Mortality was significantly lower in the ABC group vs non‐ABC (5.8% vs 15.9%, P = .0014, respectively). On multivariate analysis, ABC compliance was associated with a lower risk of all‐cause death and the composite outcome after 6 months (OR 0.18; 95% CI: 0.42‐0.75 and OR 0.54; 95% Cl: 0.30‐1.00, respectively) and at 1 year (OR 0.30; 95% Cl: 0.11‐0.76 and OR 0.57; 95% Cl: 0.33‐0.97, respectively) vs the non‐ABC group.

Conclusions

Compliance with the ABC pathway care was independently associated with the reduced risk of all‐cause death and the composite outcome in DM patients with AF, highlighting the importance of an integrated approach to AF management.
The trend is an analyst's friend: Analyst recommendations and market technicals
Authors: Flugum Ryan
Published: August 2020

In this paper, I assess the empirical relation between analyst recommendation decisions and market technicals. Research shows market technicals have predictive content that leads to abnormal returns. Recent survey evidence, however, shows analysts' rank technical signals as having relatively little usefulness in forming their recommendations, leading them to underweight the information content of technical signals. I find lagged positive stock price trends are associated with a greater likelihood of consensus recommendation upgrade. Furthermore, I show market technicals enhance the investment value of consensus recommendations. Overall, I demonstrate that market technicals are an important complement to analyst recommendations.
Private Equity and the COVID‐19 Economic Downturn: Opportunity for Expansion?
Authors: Haarmeyer David
Published: August 2020

The coronavirus‐related global economic downturn poses a significant risk to PE portfolio companies, but also represents a significant opportunity to purchase quality companies at a discount. Because the industry is today much larger, as well as more diversified and experienced, than at the time of the 2008 downturn, it is better positioned not only to weather the severe economic storm, but emerge with an even larger and stronger asset base.

Compared with PE at the time of the global financial crisis, today's $3.9 trillion private equity industry has considerably more dry powder, with more heavily capitalized strategies, including private credit and “secondaries,” more permanent capital, and stronger operational capabilities. In contrast with the pre‐crisis hyper‐competitive market environment in which purchase multiples were at record highs and returns faced significant downward pressure, the fear and uncertainty that characterize current market conditions have put PE in a position to grow its asset base at bargain prices. The advantages of scale, diversification, adaptability, and access to longer‐term capital are all expected to help today's larger alternative asset groups, which have in recent years achieved greater diversification in terms of strategy as well as geography and investors.
Characteristics of Long‐Term Care Residents That Predict Adverse Events after Hospitalization
Authors: Kapoor Alok , Field Terry , Handler Steven , Fisher Kimberly , Saphirak Cassandra , Crawford Sybil , Fouayzi Hassan , Johnson Florence , Spenard Ann , Zhang Ning , Gurwitz Jerry H.
Published: August 2020

BACKGROUND/OBJECTIVES

Adverse events (AEs) occur frequently in long‐term care (LTC) residents transitioning from the hospital back to an LTC facility. Measuring the association between resident characteristics and AEs can inform AE risk reduction strategies.

DESIGN

Prospective cohort analysis.

SETTING

A total of 32 nursing homes from six New England states.

PARTICIPANTS

A total of 555 LTC residents contributing 762 transitions from the hospital back to LTC.

MEASUREMENTS

We measured the association between all AEs and preventable AEs developing in the 45 days following discharge back to LTC and demographic variables, hospital length of stay (LOS), Charlson Comorbidity Index (CCI) (0–1, 2–3, 4–5 and ≥6), dependency in activities of daily living (ADLs) using the Minimum Data Set Long Form Scale (in quintiles 0–12, 13–15, 16, 17–18, and ≥19), and number of regularly scheduled medications (0–9, 10–13, 14–17, and ≥18). To understand the independent association of each resident characteristic with AEs and preventable AEs, we constructed multiple Cox proportional hazards models.

RESULTS

There were 283 discharges with one or more AEs and 212 with preventable AEs. Characteristics independently associated with higher risk of an AE included hospital LOS 9 or more days (hazard ratio [HR] = 1.49; 95% confidence interval [CI] = 1.02–2.17); CCI of 4 to 5 (HR = 1.74; 95% CI = 1.13–2.67) or 6 or higher (HR = 1.58; 95% CI = 1.01–2.46); 18 or more regularly scheduled medications (HR = 1.53; 95% CI = 1.07–2.18); and 19 and above on ADL dependency (HR = 1.78; 95% CI = 1.21–2.62). Results from models with preventable AEs were similar to those with all AEs.

CONCLUSION

Increased LOS, higher comorbidity burden, greater dependency in ADLs, and polypharmacy were the resident characteristics most strongly associated with risk of AEs and preventable AEs. We recommend heightened vigilance in the care of LTC residents with these characteristics transitioning back to LTC. We also recommend research to assess strategies to reduce the risk of AEs.
Feasibility, acceptability and cost efficiency of using webinars to deliver first‐line patient education for people with Irritable Bowel Syndrome as part of a dietetic‐led gastroenterology service in primary care
Authors: Williams M. , Barclay Y. , Harper L. , Marchant C. , Seamark L. , Hickson M.
Published: August 2020

Background

Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder. International research suggests dietary intervention as a first‐line approach, although dietetic services are struggling to cope with demand. Digital technology may offer a solution to deliver appropriate patient education. The present study aimed to assess the feasibility, acceptability and cost efficiency of using webinars to deliver first‐line IBS advice to patients as part of a dietetic‐led gastroenterology service in primary care.

Methods

Patients were directed to an IBS First Line Advice webinar on a specialist NHS website. Data were collected from patients pre‐ and post‐webinar use using an online survey.

Results

In total, 1171 attendees completed the pre‐webinar survey and 443 completed the post‐webinar survey. Attendees ranged from under 17 years to over 75 years. Of the attendees, 95% found the webinar easy to access and 91% were satisfied with the content of the webinar. Those with excellent or good knowledge rose from 25% pre‐webinar to 67% post‐webinar, and confidence in managing their condition improved for 74% of attendees. Using the webinars led to a 44% reduction in referrals for one‐to‐one appointments with a specialist dietitian in the first year of use. The value of the clinical time saved is estimated at £3593 per annum. The one‐off cost of creating the webinar was £3597.

Conclusions

The use of webinars is a feasible, acceptable and cost‐efficient way of delivering first‐line patient education to people suffering with Irritable Bowel Syndrome as part of a dietetic‐led gastroenterology service in primary care.
Trust in the nurse: Findings from a survey of hospitalised children
Authors: Sheehan Rosemarie , Fealy Gerard
Published: August 2020

Aims and objectives

To measure hospitalised children's trust in the nurse.

Background

Trust is central to the therapeutic relationship between the nurse and the patient. There can be no trusting relationship between the nurse and child if the parents have no trust or block the relationship (Bricher [Journal of Clinical Nursing, 8: 452, 1999]).

Design

This study was a cross‐sectional, correlational descriptive design using a self‐complete questionnaire to measure children's trust in nurses, to examine the relationship between children's trust and their parents, and the correlations between trust and medication adherence, fear and interactions with the nurse.

Methods

A modified version of the Children's Trust in General Nurses Scale designed by Rotenberg et al. (Journal for Specialists in Pediatric Nursing, 20: 298, 2015) was used. This Scale is a short self‐report questionnaire designed to elicit information on children's beliefs in, and attitudes to, trust in nurses. The Strengthening the Reporting of Observational Studies in Epidemiology statement for observational studies was applied (von Elm [British Medical Journal, 335: 806, 2007]).

Results

The results indicated high levels of trust beliefs in the nurse. The children's and parents’ trust beliefs were found to be correlated. Gender did not influence trust beliefs. Younger children had higher levels of trust than older children, particularly in relation to the perceived honesty of the nurse. Trust beliefs in the nurse lessened with previous exposure to the hospital setting. One‐fifth of children reported fear of the nurse. Positive interaction with the nurse was shown to be positively related to adherence to care.

Relevance to clinical practice

Children's level of trust in the nurse can be measured. A trusting child is likely to be less fearful and experience clinical procedures as less threatening and is more likely to adhere to treatment. Children's nurses should recognise that trust can change with age and with multiple hospital admissions.
There is no ‘African American Physiology’: the fallacy of racial essentialism
Authors: Tsai J. , Cerdeña J. P. , Khazanchi R. , Lindo E. , Marcelin J. R. , Rajagopalan A. , Sandoval R. S. , Westby A. , Gravlee C. C.
Published: August 2020

Click here to view the Letter to the Editor by Gower et al.
On collective self‐healing and traces: How can swarm intelligence help us think differently about team adaptation?
Authors: Cristancho Sayra M.
Published: August 2020

Background

Health care teams are increasingly forced to navigate complex challenges to achieve their collective aim of delivering high‐quality, safe patient care. The teamwork literature has struggled to develop strategies that promote effective adaptive behaviours among health care teams. In part, this challenge stems from the fact that truly collective adaptive behaviour requires members of the teams to abandon the human urge to act self‐sufficiently. Nature contains striking examples of collective behaviour as seen in social insects, fish and bird colonies. This collective behaviour is known as Swarm Intelligence (SI). SI remains poorly described in the health care team literature and its potential benefits hidden.

Objective

In this cross‐cutting edge paper, I explore the principles of SI as they pertain to systemic or collective adaptation in human teams. In particular, I consider the principles of trace‐based communication and collective self‐healing and what they might offer to team adaptation researchers in medical education.

Results

From a SI perspective, a solution to a problem emerges as a result of the collective action of the members of the swarm, not the individual action. This collective action is achieved via four principles: direct and indirect communication, awareness, self‐determination and collective self‐healing. Among those principles, trace‐based communication and collective self‐healing have been purposefully used by other industries to foster team adaptation. Trace‐based communication relies on leaving ‘traces’ in the environment to drive the behaviour of others. Collective self‐healing is the ability of the swarm to cope with failure and adapt to changes by permitting swarm members to be interchangeable.

Conclusions

While allowing teams to rely on indirect communication and to be interchangeable might create discomfort to our ways of thinking, teams outside health care are demonstrating their value to advance human teamwork. SI offers a helpful analogy and a constructive language for thinking about team adaptation.
Functional characterization of PETIOLULE‐LIKE PULVINUS (PLP) gene in abscission zone development in Medicago truncatula and its application to genetic improvement of alfalfa
Authors: Du Juan , Lu Shaoyun , Chai Maofeng , Zhou Chuanen , Sun Liang , Tang Yuhong , Nakashima Jin , Kolape Jaydeep , Wen Zhaozhu , Behzadirad Marjan , Zhong Tianxiu , Sun Juan , Zhang Yunwei , Wang Zeng‐Yu
Published: August 2020

Alfalfa (Medicago sativa L.) is one of the most important forage crops throughout the world. Maximizing leaf retention during the haymaking process is critical for achieving superior hay quality and maintaining biomass yield. Leaf abscission process affects leaf retention. Previous studies have largely focused on the molecular mechanisms of floral organ, pedicel and seed abscission but scarcely touched on leaf and petiole abscission. This study focuses on leaf and petiole abscission in the model legume Medicago truncatula and its closely related commercial species alfalfa. By analysing the petiolule‐like pulvinus (plp) mutant in M. truncatula at phenotypic level (breakstrength and shaking assays), microscopic level (scanning electron microscopy and cross‐sectional analyses) and molecular level (expression level and expression pattern analyses), we discovered that the loss of function of PLP leads to an absence of abscission zone (AZ) formation and PLP plays an important role in leaflet and petiole AZ differentiation. Microarray analysis indicated that PLP affects abscission process through modulating genes involved in hormonal homeostasis, cell wall remodelling and degradation. Detailed analyses led us to propose a functional model of PLP in regulating leaflet and petiole abscission. Furthermore, we cloned the PLP gene (MsPLP) from alfalfa and produced RNAi transgenic alfalfa plants to down‐regulate the endogenous MsPLP. Down‐regulation of MsPLP results in altered pulvinus structure with increased leaflet breakstrength, thus offering a new approach to decrease leaf loss during alfalfa haymaking process.
Fungicide resistance in Cercospora species causing cercospora leaf blight and purple seed stain of soybean in Argentina
Authors: Sautua Francisco J. , Doyle Vinson P. , Price Paul P. , Porfiri Alejandro , Fernandez Paula , Scandiani Maria M. , Carmona Marcelo A.
Published: August 2020

Cercospora species cause cercospora leaf blight (CLB) and purple seed stain (PSS) on soybean. Because there are few resistant soybean varieties available, CLB/PSS management relies heavily upon fungicide applications. Sensitivity of 62 Argentinian Cercospora isolates to demethylation inhibitor (DMI), methyl benzimidazole carbamate (MBC), quinone outside inhibitor (QoI), succinate dehydrogenase inhibitor (SDHI) fungicides, and mancozeb was determined in this study. All isolates were sensitive to difenoconazole, epoxiconazole, prothioconazole, tebuconazole, and cyproconazole (EC50 values ranged from 0.006 to 2.4 µg/ml). In contrast, 51% of the tested isolates were sensitive (EC50 values ranged from 0.003 to 0.2 µg/ml), and 49% were highly resistant (EC50 > 100 µg/ml) to carbendazim. Interestingly, all isolates were completely resistant to azoxystrobin, trifloxystrobin, and pyraclostrobin, and insensitive to boscalid, fluxapyroxad, and pydiflumetofen (EC50 > 100 µg/ml). The G143A mutation was detected in 82% (53) of the QoI‐resistant isolates and the E198A mutation in 97% (31) of the carbendazim‐resistant isolates. No apparent resistance mutations were detected in the succinate dehydrogenase genes (subunits sdhB, sdhC, and sdhD). Mancozeb completely inhibited mycelial growth of the isolates evaluated at a concentration of 100 µg/ml. All Argentinian Cercospora isolates were sensitive to the DMI fungicides tested, but we report for the first time resistance to QoI and MBC fungicides. Mechanism(s) other than fungicide target‐site modification may be responsible for resistance of Cercospora to QoI and MBC fungicides. Moreover, based on our results and on the recent introduction of SDHI fungicides on soybean in Argentina, Cercospora species causing CLB/PSS are insensitive (naturally resistant) to SDHI fungicides. Insensitivity must be confirmed under field conditions.
Health insurers' operations in the face of health care reform: An analysis of the Supplemental Health Care Exhibit
Authors: Lei Yu , Browne Mark J.
Published: August 2020

The Patient Protection and Affordable Care Act (ACA) introduced significant changes to the health insurance marketplace in the United States. The act also imposed reporting requirements on insurers. The law has required insurers since 2010 to file yearly the Supplemental Health Care Exhibit (SHCE). The SHCE provides unique information on how health insurers operate. We analyze data in the SCHE to understand how insurers have complied with one of the major new regulations affecting health insurers' operations arising from the ACA—the Medical Loss Ratio (MLR) Provision. This requires that insurers spend a minimum percentage of their premium revenue on medical claims, quality improvement expenses, and deductible fraud and abuse detection and recovery expenses. Our analysis of the 2010–2017 SHCE indicates that insurers' underwriting performance worsened in the early years of the ACA as they worked to increase MLRs to become ACA‐compliant. Analysis of the SHCE further reveals that insurers' profits from managing uninsured plans grew as the profitability of underwriting insured plans decreased. Future research on health insurer operations is warranted. The currently underutilized and data‐rich SHCE provides unique information that makes future research possible.
Expanding the conceptualisation of the Art of Caring
Authors: Suárez‐Baquero Daniel F.M. , Champion Jane D.
Published: August 2020

Objective

To analyze the concept Art of Caring and expand its conceptualization in the Nursing discipline.

Methods

A conceptual analysis in Spanish and English was developed based on the steps proposed by Walker and Avant.

Findings

Five principal historical stages of development of the concept were identified. Attributes, antecedents, consequences, and cases are provided. An analogy is proposed to illustrate this concept through the representation of a four‐dimensional figure (tesseract).

Conclusions

Art of Caring embeds the core disciplinary nursing knowledge. Exploring this concept leads to a broad perspective of Nursing and the act of caring, with the potential of uniting the discipline globally.

Implications for nursing practice

With the increasing use of Nursing knowledge in different languages, the global understanding of its foundations is key for advancement of the discipline. This concept analysis provides tools to help nurses to understand and be understood regardless of linguistic differences.
Evolution of Anand Parameters With Elevated Temperature Aging for SnAgCu Lead-free Alloys
Authors: Lall Pradeep , Yadav Vikas , Suhling Jeff , Locker David
Published: August 2020

Electronic components in downhole oil drilling and gas industry applications, automotive, and avionics may be exposed to high temperatures (>150 °C) and high strain rates (1–100 per sec) during storage, operation, and handling, which can contribute to the failures of electronic devices. Temperatures in these applications can exceed 200 °C, which is close to melting point for SnAgCu (SAC) alloys. Prior studies at low strain rates have shown property evolution even under moderate exposure to high temperature. In this paper, the evolution of Anand parameters for unaged and aged SAC (SAC105 and SAC-Q) lead-free solder alloys at high strain rates has been investigated induced under sustained periods of thermal aging. The thermal aged lead-free SAC solder alloys specimen has been tested at high strain rates (10–75 per sec) at elevated temperatures of (25 °C–200 °C). The SAC lead-free solder samples were subjected to isothermal aging at 50 °C up to 1-year before testing. To describe the material constitutive behavior, the Anand Viscoplastic model has been used. The effect of thermal aging on Anand parameters also has been investigated. In order to verify the accuracy of the model, the computed Anand parameters have been used to simulate the uni-axial tensile test. The material constitutive behavior has been implemented in a finite element framework to simulate the drop events using the Anand constitutive model and determine the plastic work per shock event. The plastic work per shock event is a measure of the damage progression in the solder interconnects. The constitutive model has been used to simulate the shock event of a ball-grid array package on printed circuit board assembly.
Design of experiments approach to luminescent CaMoO4 by atomic layer deposition
Authors: Kvalvik Julie Nitsche , Hansen Per-Anders , Nilsen Ola
Published: August 2020

Atomic layer deposition (ALD) is evolving beyond binary compounds to complex oxides and doped structures, taking advantage of the nanometer precision ALD provides. In practice, the development of complex ALD-processes usually means performing many ALD-runs, as success at first attempt is unlikely. One factor at a time methods, where only one factor is altered and the rest are kept constant, are most often chosen due to their intuitive communication of control. However, they do have several drawbacks, being slow, neglecting secondary effects, and are usually not randomized—meaning that errors that arise over time can easily be overlooked. We here dig into our statistical toolbox and show how design of experiments (DoE) can be used to efficiently develop an ALD-process to deposit crystalline, luminescent CaMoO4—a proposed material for optoelectronic applications, like light emitting diodes or as a host for solar down-converters. Using DoE enables screening for a wider range of deposition temperatures, pulsed composition, and annealing parameters, by only performing nine ALD-runs in our case. We moreover look into how these parameters affect crystallinity, composition, and the photoluminescence properties and use DoE to show which factors have the greatest effects on these properties. The work also lays out the basic theory of the DoE-field and how to implement DoE in developing ALD-processes, in general, to ease the usage of DoE for the ALD-community.
Metabolic Cost of Paddling on Different Commercially Available Kayak Ergometers
Authors: Oliveira Borges Thiago , Bullock Nicola , Aitken David , Cox Gregory R. , Coutts Aaron J.
Published: August 2020

Purpose: To compare the metabolic cost of paddling on different commercially available kayak ergometers using a standardized kayak incremental exercise protocol. Methods: Six male sprint kayak athletes undertook an incremental exercise protocol on 3 different kayak ergometers utilizing a randomized counterbalanced pair-matched design. Results: Mean maximal aerobic power on the WEBA ergometer (265 [14] W) was significantly higher than on the Dansprint (238 [9] W) and KayakPro® (247 [21] W, P < .01, effect size [ES] = 0.80). At the fifth stage, absolute oxygen consumption on the WEBA (3.82 [0.25] L·min−1) was significantly lower (P < 0.05, ES = 0.20) than KayakPro and Dansprint (4.10 [0.28] and 4.08 [0.27] L·min−1, respectively). Blood lactate concentration response at the sixth stage was significantly lower for the WEBA (3.5 [0.8] mmol·L−1), compared with KayakPro and Dansprint (5.4 [1.2] and 5.6 [1.5] mmol·L−1, P = .012, ES = 0.20). Stroke rate was significantly higher, without any effect of pacing during the submaximal stages for the Dansprint, compared with the WEBA (P < .001, ES = 0.28) and KayakPro (P < .001, ES = 0.38). A pacing effect was present at the maximal stage for all ergometers. Conclusions: This study demonstrated that paddling on different kayak ergometers when controlling power output elicits different metabolic and work outputs. It is recommended that scientists and coaches avoid testing on different ergometers and regularly calibrate these devices. Moreover, when an ergometer has been calibrated against a first principle device, it is necessary to consider calibration of various drag settings, due to their impact on stroke rate. Further research should explore the relationship between drag settings and stroke rate.
Acute Effects of Single- Versus Double-Leg Postactivation Potentiation on Postural Balance of Older Women: An Age-Matched Controlled Study
Authors: Fernandes Ilha G. , Souza Matheus A. , Oliveira Matheus L. , Miarka Bianca , Barbosa Michelle A. , Queiroz Andreia C. , Barbosa Alexandre C.
Published: August 2020

Aims:To compare the postactivation potentiation effects of isometric contraction until failure in double- and single-leg tasks on older women’s balance.Methods:The one-legged balance test was performed before and immediately after a rise-to-toes task until the task failure. Older women were divided into two groups: a group performed the task with double leg (n = 43) and the other group with single-leg support (n = 55).Results:The single-leg group showed slower velocity of sway post rise-to-toes task (pre = 4.02 ± 1; post = 3.78 ± 1.15 m/s;p = .04) without differences for the center of pressure path length (pre = 79 ± 21; post = 75 ± 23 cm;p = .08). In the double-leg group, faster velocity of sway (pre = 4 ± 1.22; post = 4.25 ± 1.13;p = .03) and increased center of pressure path length (pre = 80 ± 24; post = 85 ± 23 cm;p = .03) were observed after the task.Conclusions:The single-leg group showed improved balance outcomes due to postactivation potentiation, while the double-leg group showed worsened balance consistent with muscle fatigue.
The Effects of Attentional Focus Instructions Specific to Body Movements on Movement Quality and Performance
Authors: Yamada Masahiro , Raisbeck Louisa D.
Published: August 2020

Contexts: Directing an individual’s attention to the effect of the movements (external focus) has been shown to improve performance than directing attention to body movements (internal focus). However, the effect of attentional focus instructions specific to movement quality has not been investigated thoroughly. Objective: To compare the effects of internal and external focus instructions specific to body movements. Design: Mixed design, 2 (sex) × 2 (instructions). Settings: Laboratory setting. Participants: A total of 40 participants (males, n = 20; mean [SD]; age = 22.0 [2.19] y; height = 179.33 [5.90] cm; mass = 77.7 [13.04] kg; females, n = 20; age = 22.0 [3.87] y; height = 164.84 [5.80] cm; mass = 71.48 [20.66] kg) were recruited. Intervention: Participants completed 2 consecutive jumps (ie, a forward jump from a height and then a maximal vertical jump) with internal focus and external focus instructions. External focus was elicited by placing pieces of tape on the participants’ legs. Main Outcome measures: Landing quality was measured by the Landing Error Scoring System to assess movement quality, and the vertical jump height was measured by Vertec. Results: The performance results showed that the external focus condition resulted in superior vertical jump height compared with the internal focus condition (P < .05). Although landing quality did not show significant differences between 2 conditions, the effect size (η2 = .09) indicated that landing quality was better when participants adopted an external, rather than an internal focus of attention (P = .07). Conclusions: The body-oriented instructions can be provided externally by adding artificial external cues and directing attention to them. Importantly, the findings were evident in a qualitative assessment that can be adopted by practitioners. The results suggest that practitioners should adopt an external focus cue for performance and also consider using an external focus for movement quality.
Distinct Mycoplasma pneumoniae Interactions with Sulfated and Sialylated Receptors
Authors: Williams Caitlin R. , Chen Li , Sheppard Edward S. , Chopra Pradeep , Locklin Jason , Boons Geert-Jan , Krause Duncan C.
Published: August 2020

Mycoplasma pneumoniae
is a cell wall-less bacterial pathogen of the conducting airways, causing bronchitis and atypical or “walking” pneumonia in humans.
M. pneumoniae
recognizes sialylated and sulfated oligosaccharide receptors to colonize the respiratory tract, but the contribution of the latter is particularly unclear. We used chamber slides coated with sulfatide (3-
O
-sulfogalactosylceramide) to provide a baseline for
M. pneumoniae
binding and gliding motility.
HIV-1 Lethality and Loss of Env Protein Expression Induced by Single Synonymous Substitutions in the Virus Genome Intronic-Splicing Silencer
Authors: Jordan-Paiz Ana , Nevot Maria , Lamkiewicz Kevin , Lataretu Marie , Franco Sandra , Marz Manja , Martinez Miguel Angel
Published: August 2020

Synonymous substitutions can influence virus phenotype, replication capacity, and virulence. In this study, we explored how synonymous codon mutations impacted HIV-1 Env protein expression and virus replication capacity. We changed a single codon, AGG to CGU, which was located in the gp41 coding region (
env
nucleotide residues 2125 to 2127) and was included in the HIV-1 intronic splicing silencer. This change completely abolished virus replication and Env expression. We also found that changing codon usage in the gp120 region by including an increased number of CpG dinucleotides did not significantly affect Env expression or virus viability. Our findings showed that synonymous recoding was useful for altering viral phenotype and exploring virus biology.
Acute perimyocarditis with cardiac tamponade in COVID-19 infection without respiratory disease
Authors: Dalen Havard , Holte Espen , Guldal Anna Ulstein , Hegvik Johan-Arnt , Stensaeth Knut Haakon , Braaten Anders Tjellaug , Mjølstad Ole Christian , Rossvoll Ole , Wiseth Rune
Published: August 2020

The COVID-19 pandemic with its severe respiratory disease has caused overflow to hospitals and intensive care units. Elevated troponins and natriuretic peptides are related to cardiac injury and poor prognosis. We present a young woman with COVID-19 infection with haemodynamic instability caused by acute perimyocarditis and cardiac tamponade. Troponin T was modestly elevated. Focused cardiac ultrasound made the diagnosis. Echocardiography revealed transient thickening of the myocardial walls. After pericardial drainage and supportive care, she improved significantly within 1 week without targeted therapy. The case illustrates the importance of cardiac diagnostic imaging in patients with COVID-19 and elevated cardiac biomarkers.
Pretreatment with transcutaneous electrical acupoint stimulation to prevent postoperative ileus in patients undergoing laparoscopic colon surgery: study protocol for a randomised controlled trial
Authors: Wang Jian , Li Dongli , Tang Wei , Guo Jun , Chen Wenting , Yong Yue , Song Wei , Yu Guijie , Feng Rui , Yuan Lan , Fu Guoqiang , Song Jiangang , Fan Lihua
Published: August 2020

Introduction

Postoperative ileus (POI), a common complication after surgery, severely affects postoperative recovery. It is unclear whether pretreatment with transcutaneous electrical acupoint stimulation (TEAS) can improve recovery from POI. This trial will evaluate the effects of pretreatment with TEAS on POI.

Methods and analysis

This will be a prospective, randomised controlled trial. American Society of Anesthesiologists (ASA) physical status classification I–III level patients, aged 18–75 years and scheduled for laparoscopic colon surgery, will be included in the study. It is planned that 146 subjects will be randomised to the TEAS and sham TEAS (STEAS) groups. The groups will undergo two sessions of TEAS/STEAS daily for 3 days before surgery, with a final TEAS/STEAS treatment 30 min before anaesthesia. The primary endpoint of the study will be time to first defaecation. Secondary endpoints will include time to first flatus, time to tolerance of oral diet, GI-2 (composite outcome of time to first defaecation and time to tolerance of oral diet), time to independent walking, length of hospital stay, postoperative pain Visual Analogue Scale score on the first 3 days after surgery, analgesic requirements, complications and plasma concentrations of interferon-β (IFN-β), IFN-γ, interleukin-6 (IL-6) and IL-1β. Multiple linear regression will be used to identify independent predictors of outcome measures.

Ethics and dissemination

This study has been approved by the Chinese Registered Clinical Trial Ethics Review Committee (No. ChiECRCT-20170084). The results of the trial will be published in an international peer-reviewed journal.

Trial registration number

This study has been registered with the Chinese Clinical Trial Registry (No. ChiCTR-INR-17013184).

Trial status

The study was in the recruitment phase at the time of manuscript submission.