bluuebunny/crossref_metadata_2025 huggingface dataset:
Bidirectional longitudinal associations of fatness with physical fitness in adolescents with Down syndrome. The UP&DOWN Longitudinal study
Authors: Izquierdo‐Gomez Rocío , Esteban‐Cornejo Irene , Cabanas‐Sánchez Veronica , Villagra Ariel , Veiga Óscar L. , Martinez‐Gómez David ,   the UP, DOWN study group
Published: August 2020

Background

The aim of this study was to examine the bidirectional longitudinal associations of several markers of fatness and physical fitness in adolescents with Down syndrome.

Methods

This study comprised a total of 111 adolescents (41 females), aged from 11 to 20 years with complete data at the baseline. We had a drop‐out of <10% from the baseline to the 2‐year follow‐up. The ALPHA health‐related fitness test battery for youth was used.

Results

Our results show that all fatness variables at the baseline were associated with a 2‐year change in cardiorespiratory fitness (βranging from −0.32 to −0.38; allp < .05), but not with muscular and motor fitness (p > .05). However, no associations were found between physical fitness components as predictors and fatness indicators (p > .05).

Conclusions

Results suggest that reducing fatness during adolescence might represent a modifiable factor to improve cardiorespiratory fitness at the 2‐year follow‐up, but notvice versasince associations were not bidirectional.
Effective inhibition of Th17/Th22 pathway in 2D and 3D human models of psoriasis by Celastrol enriched plant cell culture extract
Authors: Nguyen T. , Lestienne F. , Cousy A. , Mengeaud V. , Castex‐Rizzi N.
Published: August 2020

Background

Psoriasis is an immune‐mediated inflammatory disease in which the Th17 pathway is mainly involved. Systemic interventions with biologics that specifically block the Th17 pathway are effective to treat severe psoriasis. However, for efficient topical treatment, small molecules are more suitable than antibodies to penetrate and target epidermal keratinocytes, the key players in psoriasis. Celastrol, a well‐described triterpene, is present in low amounts in Tripterygium wilfordii roots. By using plant cell culture (PCC), we were able to boost Celastrol production in bioreactors. Here, we evaluated immune modulator effect of Celastrol enriched extract (CEE) in Th17/Th22 psoriasis induced in 2D and 3D human models in vitro in view of its dermatological usage.

Methods

Human CD4+ T cells (hCD4), Normal Human Epidermal Keratinocytes (NHEK), micro‐epidermis and reconstructed human epidermis (RHE) were preincubated with CEE and reference controls. Then, hCD4 were stimulated by anti‐[CD3/CD28] while others were stimulated by Th17/22 cytokines cocktails. Psoriasis biomarkers were assessed by ELISA (hCD4 and RHE), by RT‐qPCR (NHEK) or by ICH/ELISA (micro‐epidermis).

Results

In 2D stimulated models (hCD4 and NHEK), CEE dose dependently inhibited, respectively, the expression of Th17 cytokines and psoriasis induced biomarkers. In 3D models (RHE and micro‐epidermis), IL‐8 expression was significantly reduced (RHE) and native phenotype was restored by CEE (micro‐epidermis).

Conclusion

These results clearly showed that Th17/Th22 cytokines, main inflammatory parameters, and psoriasis associated key biomarkers were inhibited by CEE in both 2D and 3D human in vitro models. Therefore, skin homeostasis could be restored by these modulator effects. Moreover, this high added value CEE was obtained by an ecofriendly bioprocess in contrast to traditional roots extracts. This is the first time that a well‐defined CEE immune modulator has been proposed for psoriasis adjuvant care to reduce inflammation.
Antidepressants and Fracture Risk: Is There a Real Connection?
Authors: Sundaresh Vishnu , Singh Balwinder
Published: August 2020

See the Reply by Tamblyn et al
Under‐reporting of the energy intake in patients with type 2 diabetes
Authors: do Nascimento A. G. , Grassi T. , Reischak de Oliveira A. , Steemburgo T.
Published: August 2020

Background

In patients with type 2 diabetes mellitus (DM), an accurate assessment of food intake is essential for clinical nutritional management. Tools such as the food frequency questionnaire (FFQ) and 24‐h food record (24HR) identify dietary habits in support of dietary planning. However, it is possible that these tools have reporting errors with respect to assessing food intake, particularly energy intake (EI).

Methods

A cross‐sectional study was conducted in patients with type 2 DM. EI was assessed by the FFQ and 24HR tools. Resting energy expenditure (REE) was measured by indirect calorimetry. Data were analysed using a kappa test, t‐test and Spearman's correlation coefficients. Under‐reporting was assessed using the EI/REE ratio. Patients with values <1.18 and <1.10 for FFQ and 24HR, respectively, were considered as under‐reporting.

Results

We evaluated 55 patients [mean (SD) 62.7 (5.3) years old, duration of diabetes 11.2 (7.3) years, 52.7% female]. The mean (SD) EI assessed by FFQ was 1797.7 (641.3) and as assessed by 24HR was 1624 (484.8) kcal day–1. The mean (SD) REE was 1641.3 (322.3) kcal day–1. The mean (SD) ratios FFQ/REE and 24HR/REE were 1.11 (0.38) and 1.01 (0.30), respectively. The tools showed a moderate agreement for under‐reporting of EI (kappa = 0.404; P = 0.003). Moderate and positive correlations between REE were observed with FFQ (r = 0.321; P = 0.017) and 24HR (r = 0.364; P = 0.006). According to the tools, the under‐reporting was observed in approximately 65% of patients.

Conclusions

The majority of patients with type 2 DM under‐reported their calorie intake, as assessed by FFQ and 24HR. REE showed a positive correlation with both tools.
The pre‐mRNA splicing factor RDM16 regulates root stem cell maintenance in Arabidopsis
Authors: Lv Bingsheng , Hu Kongqin , Tian Te , Wei Kaijing , Zhang Feng , Jia Yuebin , Tian Huiyu , Ding Zhaojun
Published: August 2020

Pre‐mRNA (messenger RNA) splicing participates in the regulation of numerous biological processes in plants. For example, alternative splicing shapes transcriptomic responses to abiotic and biotic stress, and controls developmental programs. However, no study has revealed a role for splicing in maintaining the root stem cell niche. Here, a screen for defects in root growth in Arabidopsis thaliana identified an ethyl methane sulfonate mutant defective in pre‐mRNA splicing (rdm16‐4). The rdm16‐4 mutant displays a short‐root phenotype resulting from fewer cells in the root apical meristem. The PLETHORA1 (PLT1) and PLT2 transcription factor genes are important for root development and were alternatively spliced in rdm16‐4 mutants, resulting in a disordered root stem cell niche and retarded root growth. The root cap of rdm16‐4 contained reduced levels of cytokinins, which promote differentiation in the developing root. This reduction was associated with the alternative splicing of genes encoding cytokinin signaling factors, such as ARABIDOPSIS HISTIDINE PHOSPHOTRANSFER PROTEIN5 and ARABIDOPSIS RESPONSE REGULATORS (ARR1, ARR2, and ARR11). Furthermore, expression of the full‐length coding sequence of ARR1 or exogenous cytokinin application partially rescued the short‐root phenotype of rdm16‐4. This reveals that the RDM16‐mediated alternative splicing of cytokinin signaling components contributes to root growth.
Psychological impact of COVID‐19 outbreak on frontline nurses: A cross‐sectional survey study
Authors: Nie Anliu , Su Xiangfen , Zhang Shuzeng , Guan Wenjie , Li Jianfeng
Published: August 2020

Aims and objectives

This study aimed to portray the prevalence and associated factors of psychological distress among frontline nurses during COVID‐19 outbreak.

Background

The COVID‐19 outbreak has posed great threat to public health worldwide. Nurses fighting against the epidemic on the frontline might be under great physical and psychological distress. This psychological distress was predominantly described as sleep disturbance, symptoms of anxiety and depression, post‐traumatic stress, inability to make decisions and even somatic symptoms.

Design

Cross‐sectional study.

Methods

Frontline nurses from designated hospitals for COVID‐19 patients were invited to complete an online survey by convenience sampling, and the survey included six main sections: the General Health Questionnaire, the Perceived Social Support Scale, the Simplified Coping Style Scale, the Impact of Event Scale‐Revised, socio‐demographic, occupation and work history. Multiple logistic analysis was used to identify the potential risk factors of psychological distress. The study methods were compliant with the STROBE checklist.

Results

Of the 263 frontline nurses, 66 (25.1%) were identified as psychological distress. Multiple logistic analysis revealed that working in emergency department, concern for family, being treated differently, negative coping style and COVID‐19‐related stress symptom were positive related to psychological distress. Perceived more social support and effective precautionary measures were negatively associated with psychological distress.

Conclusions

The study demonstrated that COVID‐19 had a significant psychological impact on frontline nurses. Early detection of psychological distress and supportive intervention should be taken according to the associated factors to prevent more serious psychological impact on frontline nurses.

Relevance to clinical practice

This study highlighted that the frontline nurses were suffering from varying degrees of psychological distress, which needed early screening and supportive intervention for preventing more serious psychological impact on frontline nurses. Beside, more specific measurement should be combined with the GHQ‐12 to assess the varying degrees of psychological distress in frontline nurses.
Staging Poe: A Narrative Approach to Atmosphere in a First–Year Design Studio
Authors: Gülmez Nilay Ünsal , Yağan Durnev Atılgan , Güney Efsun Ekenyazıcı , Şahin Murat
Published: August 2020

This paper explores how to begin interior architecture education and provides a fertile ground on which students can tackle design departures. Narratives are studied as a vehicle and an opportunity for self–expression and discovery for first–year students to explore and produce atmospheres. The project Staging Poe draws its narrative inspirations from Edgar Allan Poe's poems. It proposes to approach atmosphere through a narrative method, by translating words into materiality. Narratives of literary works are proposed to novice students as starting points while stepping into the not–yet–familiar ways of the design process. Staging Poe further envisions a first–year design studio rooted in ongoing contemporary debates on the theory and practice of atmosphere and materiality in tandem with technology. The objective is to inspire a new generation of interior architecture students. This paper begins by discussing the theory of atmospheres and the potential role of narratives in exploring atmosphere within the Basic Design studio. Next, we examine Poe's The Philosophy of Composition as a guide to translating narrative into atmosphere before discussing the design of the Staging Poe project and the two consecutive phases of its methodology. Student progress is reviewed through an analysis of weekly reports and followed by an examination of the students’ overall performance in the course. The findings of the analysis demonstrate how the structure of the studio advances student design thinking and performance in relation to their understanding of atmosphere and its material and quasimaterial agents. The study concludes that there is room for the exploration of alternative and field–specific methods in the education of interior architecture discipline.
Ultimate Legality: Reading the Community of Law
Authors: Fitzpatrick Peter , Mulqueen Tara , Paliwala Abdul , Tataryn Anastasia
Published: August 2020

This article is a contribution to the occasional series dealing with a major book that has influenced the author. Previous contributors include Stewart Macaulay, John Griffith, William Twining, Carol Harlow, Geoffrey Bindman, Harry Arthurs, André‐Jean Arnaud, Alan Hunt, Michael Adler, Lawrence O. Gostin, John P. Heinz, Roger Brownsword, Roger Cotterrell, Nicola Lacey, Carol J. Greenhouse, and David Garland.

An initial twist: several acute observers would consider the way I read to be the most influential effect of reading on me – a way of reading that extends beyond the specificity of the text yet, in so doing, connects integrally with it. Salvation of specificity is at hand, however. That way of reading is intimately reflective of Derridean deconstruction and a hugely influential reading becomes his ‘Force of Law’. A problem ensues. Other influential reading came before my love of Derrida – influential reading to do with law and society (of course), with decolonization and imperialism, with engaged anthropology, and with critical legal studies. A retrospective revelation then follows. Derridean deconstruction is found to haunt and inform these other readings. They can be read in a way that inherently anticipates deconstruction. Some culminating coherence is offered by the inescapable insistence of community and the mutually intrinsic fusion of community and law.
Optimal growth when consumption takes time
Authors: Ha‐Huy Thai , Le Van Cuong , Nguyen Thi‐Do‐Hanh
Published: August 2020

This article analyzes a one‐sector growth model where the consumption takes time. When the consumption takes time, the consumption set is compact and we meet satiety. However, we prove that dynamic constraints are binding. This result is crucial to prove that, under well‐known assumptions in macroeconomic dynamic programming, the optimal path is monotonic and always converges to a unique nontrivial steady state as in the case where consumption is timeless.
Post‐ACA Trends in the US Primary Care Physician Shortage with Index of Relative Rurality
Authors: Gemelas Jordan C.
Published: August 2020

Purpose

Index of Relative Rurality (IRR) captures multiple indicators of health care access but is underrepresented in the primary care literature. This research investigates trends in primary care physician supply in US counties with respect to IRR and time since the Affordable Care Act (ACA) was passed.

Methods

In this ecologic study, annual ratio of primary care physicians per 100,000 population in US counties was computed for 2010‐2017 (3,138 counties over 8 years, N = 25,104). IRR assigned in 2010 placed counties on a rural‐urban continuum without the use of a threshold. Primary outcomes were associations of IRR and year with physician ratio and annual change in physician ratio. Multivariable regression models were used to detect associations. The a priori hypothesis was that neither rurality nor year was associated with physician ratio or annual growth.

Results

IRR and year were independently inversely associated with the ratio of primary care physicians per 100,000 and annual growth in physician ratio. A post‐hoc analysis of highly rural US states revealed positive median growth rates in some areas.

Conclusions

Despite significant policies in the ACA designed to address the maldistribution of the US primary care physician workforce, more funding and further innovative reforms are urgently necessary to avert a rural workforce crisis in the coming decades. IRR may be a useful continuous, threshold‐free metric of rurality in future health services research.
Self‐reported sleep quality is more closely associated with mental and physical health than chronotype and sleep duration in young adults: A multi‐instrument analysis
Authors: Muzni Khyla , Groeger John A. , Dijk Derk‐Jan , Lazar Alpar S.
Published: August 2020

Sleep and circadian rhythms are considered to be important determinants of mental and physical health. Epidemiological studies have established the contribution of self‐reported sleep duration, sleep quality and chronotype to health outcomes. Mental health and sleep problems are more common in women and men are more likely to be evening types. Few studies have compared the relative strength of these contributions and few studies have assessed these contributions separately in men and women. Furthermore, sleep and circadian characteristics are typically assessed with a limited number of instruments and a narrow range of variables is considered, leaving the understanding of the relative contribution of different predictors somewhat fractionary. We compared sleep quality, sleep duration and chronotype as predictors for self‐reported mental and physical health and psychological characteristics in 410 men and 261 women aged 18 to 30. To ascertain that results were not dependent on the use of specific instruments we used a multitude of validated instruments including the Morningness‐Eveningness‐Questionnaire, Munich‐ChronoType‐Questionnaire, Pittsburgh‐Sleep‐Quality‐Index, British‐Sleep‐Survey, Karolinska‐Sleep‐Diary, Insomnia‐Severity‐Index, SF‐36‐Health Survey, General‐Health‐Questionnaire, Dutch‐Eating‐Behaviour‐Questionnaire, Big‐Five‐Inventory, Behaviour‐Inhibition‐System‐Behaviour‐Activation‐System, and the Positive‐Affect‐Negative‐Affect‐Schedule. Relative contributions of predictors were quantified as local effect sizes derived from multiple regression models. Across all questionnaires, sleep quality was the strongest independent predictor of health and in particular mental health and more so in women than in men. The effect of sleep duration and social jetlag was inconspicuous. A greater insight into the independent contributions of sleep quality and chronotype may aid the understanding of sleep‐health interactions in women and men.
CARDIAC chronotropic effects of sleep‐disordered breathing in patients with heart failure
Authors: Pinna Gian Domenico , La Rovere Maria Teresa , Robbi Elena , Tavazzi Luigi , Maestri Roberto
Published: August 2020

It is still not known whether the oscillation in heart rate (HR) induced by sleep‐disordered breathing (SDB) in patients with heart failure entails significant chronotropic effects. We hypothesised that since cyclical changes in ventilation and arterial blood gases during SDB affect HR through multiple and complexly interacting mechanisms characterised by large inter‐subject variability, chronotropic effects may change from patient to patient. A total of 42 patients with moderate‐to‐severe chronic heart failure with systolic dysfunction underwent an in‐hospital sleep study. Chronotropic effects of SDB were quantified by comparing the distribution of instantaneous HR during SDB with that during periods without SDB (noSDB) within the same night in each patient. Based on distribution changes from noSDB to SDB, 12, nine, 11, and 10 patients showed a significant tachycardic, bradycardic, tachycardic and bradycardic, and neither significant tachycardic nor significant bradycardic effect, respectively. Tachycardic and bradycardic effects were primarily due to an increase in the rate rather than in the magnitude of cyclical HR elevations and reductions, and were more prevalent and severe in patients with dominant obstructive and central events, respectively. The apnea–hypopnea index did not differ between groups. Conversely, the time spent with an oxygen saturation of <90% was greater in the tachycardic and tachycardic‐bradycardic groups compared to the bradycardic group. These findings indicate that HR distribution changes induced by SDB can vary from patient to patient revealing four distinct and well‐characterised chronotropic effects. These effects are related to the degree of hypoxic burden brought about by SDB and are affected by the type of sleep apnea (central/obstructive).
Application of continuous quality improvement to medical education
Authors: Wong Brian M. , Headrick Linda A.
Published: August 2020

Context

The explicit, intentional and systematic application of continuous quality improvement (QI) in medical education practice and research can improve medical education and help it achieve its goals. Quality improvement and medical education share a foundation centred on learning—experiencing, reflecting, thinking and acting in continuous cycles that spiral to sustained advancement. This suggests that a QI mindset can be brought to bear on various aspects of medical education research and practice.

Discussion

To explore this possibility, we turn to W. Edwards Deming's System of Profound Knowledge, widely regarded as one of the foundational frameworks in quality improvement, where he argues strongly that there are four highly interrelated elements that are required for improvement: Appreciation of a System, Theory of Knowledge, Knowledge about Variation and Knowledge of Psychology. In this article, we define and explore each of the four domains and their application in medical education, highlighting both opportunities and challenges.

Conclusion

Medical educators who utilise QI in their educational practices can help create learning environments that imprint positively on learners and contribute to better outcomes in their clinical learning environments. We provide recommendations for how educators' informed use of QI can improve medical education and help it achieve its ultimate goal of improved health and health care.
The regulation of ethylene biosynthesis: a complex multilevel control circuitry
Authors: Pattyn Jolien , Vaughan‐Hirsch John , Van de Poel Bram
Published: August 2020

The gaseous plant hormone ethylene is produced by a fairly simple two‐step biosynthesis route. Despite this pathway’s simplicity, recent molecular and genetic studies have revealed that the regulation of ethylene biosynthesis is far more complex and occurs at different layers. Ethylene production is intimately linked with the homeostasis of its general precursor S‐adenosyl‐l‐methionine (SAM), which experiences transcriptional and posttranslational control of its synthesising enzymes (SAM synthetase), as well as the metabolic flux through the adjacent Yang cycle. Ethylene biosynthesis continues from SAM by two dedicated enzymes: 1‐aminocyclopropane‐1‐carboxylic (ACC) synthase (ACS) and ACC oxidase (ACO). Although the transcriptional dynamics of ACS and ACO have been well documented, the first transcription factors that control ACS and ACO expression have only recently been discovered. Both ACS and ACO display a type‐specific posttranslational regulation that controls protein stability and activity. The nonproteinogenic amino acid ACC also shows a tight level of control through conjugation and translocation. Different players in ACC conjugation and transport have been identified over the years, however their molecular regulation and biological significance is unclear, yet relevant, as ACC can also signal independently of ethylene. In this review, we bring together historical reports and the latest findings on the complex regulation of the ethylene biosynthesis pathway in plants.
Microbiome variations in preschool children with halitosis
Authors: Zhang Yu , Zhu Ce , Feng Xiping , Chen Xi
Published: August 2020

Objective

To assess the bacterial characteristics associated with intra‐oral halitosis among Chinese preschool children.

Methods

An epidemiological study was conducted among 273 preschool children (aged 3‐4 years) in Shanghai, China, followed by the collection of 16 samples from the tongue coating of caries‐free healthy and halitosis participants. The characterization of associated microbial communities was performed using 16S rRNA gene sequencing on the MiSeq.

Results

Halitosis was observed in 13.2% of the preschool children. No significant difference in terms of microbial diversity (p > .05) was detected in the control and halitosis groups. The dominant bacterial genera observed in both groups included Prevotella, Veillonella, Streptococcus, Neisseria, Actinomyces, Haemophilus, and Leptotrichia. The relative proportions of thirteen species (including Leptotrichia sp. HMT_417, Prevotella Pallens, and Alloprevotella rava) were significantly higher in the halitosis group compared with the control group, whereas the distribution of seventeen species from genera Streptococcus, Gemella, and Kingella showed a higher abundance in the control group. Further investigation of interactions among species demonstrated obvious differences in two groups, indicating that various microorganisms interact to produce halitosis in preschool children.

Conclusions

Overall, halitosis is associated with multi‐microbial mutual interactions. The oral flora microorganisms may exert potentiating or inhibiting effects on each other.
Comparison of regional analgesia techniques for pleurodesis pain in pediatric patients
Authors: Xie James , Mooney David P. , Cravero Joseph
Published: August 2020

Background

Mechanical pleurodesis can prevent recurrence of spontaneous pneumothorax but is associated with significant postoperative pain. Adequate pain control is not only beneficial for patient comfort but also critical for mobilization and pulmonary recovery. Thoracic epidural catheters and paravertebral blocks have been used to alleviate pain after thoracoscopic surgery. However, no studies have evaluated the safety and efficacy of paravertebral block vs epidural analgesia vs no block in children undergoing pleurodesis.

Methods

In this retrospective case series review, data were extracted from a single institution's integrated patient outcome database on children who underwent thoracoscopic pleurodesis from 2013 to 2018. Demographics, operative indication, procedure performed, and perioperative pain management were assessed by chart review. Patients whose operation was converted to thoracotomy, who had an underlying diagnosis of chronic pain, or who underwent pleurodesis for other indications were excluded. The primary outcomes were postoperative pain scores and opioid consumption. Secondary outcomes included psot anesthesia care unit length of stay, hospital length of stay, functional outcomes during recovery, and any adverse events.

Results

66 patients met inclusion criteria: 23 received thoracic epidurals, 34 received paravertebral blocks, and 9 received no epidural/paravertebral block. Patient characteristics did not significantly differ among groups. Although mean pain scores were statistically significantly lower in the epidural group on post‐op day 1, all three groups' pain scores were in the 1 to 3 out of 10 range during the entire postoperative period. Thus, this statistical significance had little clinical significance as all groups had good pain control. The epidural group had significantly lower opioid consumption on post‐op days 0 ‐ 2 compared to paravertebral block. No adverse events related to epidural or paravertebral block were noted.

Discussion

We present the an analysis of epidural vs paravertebral block (with comparison to no regional analgesia) following pleurodesis in children. Pain is well managed, regardless of the method; however, additional systemic opioid consumption was decreased in the epidural analgesia cohort. Prospective trials and comparisons with other analgesic techniques for pediatric thoracic surgeries are needed.

Conclusions

Thoracic epidural analgesia offers a reduction in opioid use in the first two post‐op days after pleurodesis but did not produce a clinically significant reduction in pain scores in comparison with paravertebral block or no block.
The standard form of CD44 as a marker for invasion of encapsulated papillary carcinoma of the breast
Authors: Kato Hiroyuki , Naiki‐Ito Aya , Yamada Takehiro , Suzuki Shugo , Yamashita Yoriko , Inaguma Shingo , Kondo Naoto , Wanifuchi‐Endo Yumi , Toyama Tatsuya , Takahashi Satoru
Published: August 2020

Encapsulated papillary carcinoma (EPC), a rare variant of papillary carcinoma of the breast, is regarded as a transition form between carcinoma in situ and invasive carcinoma. Here, we tried to identify differences in immunohistochemical phenotype between 10 EPCs with invasive properties (EPC with invasion) and 17 non‐invasive EPCs (EPC). We immunohistochemically assessed the expression of hormone receptors, matrix metalloproteinase (MMP) 2 and MMP9, vascular endothelial growth factor (VEGF), CD31, and D2‐40, markers of tumor‐associated macrophages (CD163, CD206), Ki‐67 and stem cell markers (CD44 and CD24). The frequency of MMP9‐positive cases and the number of tumor‐associated macrophages infiltrating into the fibrous capsule were significantly higher in EPC with invasion than in EPC. The expression of the standard form of CD44 (CD44s) was significantly stronger in EPC with invasion than in EPC (P = 0.0036) and was correlated with MMP2 expression and M2‐like macrophage infiltration. A multivariate logistic model analysis showed that CD44s expression in tumor cell and infiltration of CD163 positive macrophage in EPC capsule showed an independent odds ratio for invasion of EPC. Thus, CD44s may be a potential marker predicting invasive potential of EPC and could play an important role in progression to the invasive phase of EPC.
Examining the Impacts of Clinical Practice Variation on Operational Performance
Authors: Youn Seokjun , Heim Gregory R. , Kumar Subodha , Sriskandarajah Chelliah
Published: August 2020

This study explores whether and how lower variations in clinical practice relate to hospital operational performance. This relation is critical to the overall search for pathways that will allow the healthcare industry to bend the cost curve, implying significant implications for practice and regulators. We define practice variation as all variation not resulting from patient mix and construct a novel measure using inpatient discharge data for each patient cohort having an identical medical condition. Hospitals in our dataset show a broad practice variation spectrum. Using statistical process control (SPC) as a theoretical lens, we hypothesize the negative impacts of practice variation on operational performance. We also consider intervening impacts of hospital quality evaluations on the relationship. Analyzing data of six years from hospitals in NY and FL states using a dynamic panel system Generalized Method of Moments estimator, we find that higher practice variation relates to longer average patient length‐of‐stay and higher total cost per capita. This phenomenon is even stronger when a hospital provides services with higher quality in patient experience because such a hospital tends to provide more responsive care to patients, which is often resource‐intensive. By delving into granular dimensions of practice variation based on detailed charge data, we find that higher care‐delivery practice variation (i.e., the provision of healthcare) is directly associated with poor operational performance. We also find that pursuing higher quality measures may be harmful to some hospital operational performance measures as they have combined effects with the test‐ordering practice variation (i.e., detecting disease and monitoring its status). Taken together, these findings imply that careful attention to the two dimensions of practice variation and the nuanced joint relationship with quality measures may address the trade‐off between high quality and low cost, and provide room for improvement in practice, ultimately reducing waste in the healthcare industry. Our measure of practice variation also contributes since it enables researchers and managers to rigorously measure and visualize the status of hospitals’ practice variation linked to hospital operational performance.
Tears of joy, aesthetic chills and heartwarming feelings: Physiological correlates of Kama Muta
Authors: Zickfeld Janis H. , Arriaga Patrícia , Santos Sara Vilar , Schubert Thomas W. , Seibt Beate
Published: August 2020

Situations involving increased closeness or exceptional kindness are often labeled as moving or touching and individuals often report bodily symptoms, including tears, goosebumps, and warmth in the body. Recently, the kama muta framework has been proposed as a cross‐cultural conceptualization of these experiences. Prior research on kama muta has mostly relied on subjective reports. Thus, our main goal of the present project was to examine the pattern of physiological responses to kama muta inducing videos and compare it to the patterns for the similar, though distinct emotions of sadness and awe. One hundred forty‐four Portuguese and Norwegian participants were individually exposed to all three emotion conditions. Several psychophysiological indexes of the autonomic nervous system were collected continuously during exposure, including cardiovascular, respiratory, and electrodermal activity, facial EMG, skin temperature, as well as piloerection and lachrymation using cameras. Overall, the results partly replicated previous findings on being moved experiences and self‐report studies. Strong self‐reported experiences of kama muta were associated with increased phasic skin conductance, skin temperature, piloerection, and zygomaticus activity, while they were associated with reduced heart rate, respiration rate, and tonic skin conductance. The physiological profile of kama muta was successfully distinguished from sadness and awe, partly corroborating self‐report evidence. We obtained no clear evidence of a kama muta association with the occurrence of lachrymation or heart rate variability. Our findings provide a systematic overview of psychophysiological response to experiences of kama muta, and help to inform future research on this emotion and positive emotions in general.
Resilience of cold water aquaculture: a review of likely scenarios as climate changes in the Gulf of Maine
Authors: Bricknell Ian R. , Birkel Sean D. , Brawley Susan H. , Van Kirk Tyler , Hamlin Heather J. , Capistrant‐Fossa Kyle , Huguenard Kimberly , Van Walsum G. Peter , Liu Zhilong L. , Zhu Longhuan H. , Grebe Gretchen , Taccardi Emma , Miller Molly , Preziosi Brian M. , Duffy Kevin , Byron Carrie J. , Quigley Charlotte T.C. , Bowden Timothy J. , Brady Damian , Beal Brian F. , Sappati Praveen K. , Johnson Teresa R. , Moeykens Shane
Published: August 2020

Climate change is one of the biggest challenges facing development and continuation of sustainable aquaculture in temperate regions. We primarily consider the ecological and physical resilience of aquaculture in the Gulf of Maine (GoM), where a thriving industry includes marine algae, extensive and intensive shellfish aquaculture, and a well‐established Atlantic salmon industry, as well as the infrastructure required to support these economically important ventures. The historical record of sea surface temperature in the GoM, estimated from gridded, interpolated in situ measurements, shows considerable interannual and decade‐scale variability superimposed on an overall warming trend. Climate model projections of sea surface temperature indicate that the surface waters in the GoM could warm 0.5–3.5°C beyond recent values by the year 2100. This suggests that, while variability will continue, anomalous warmth of marine heatwaves that have been observed in the past decade could become the norm in the GoM ca. 2050, but with the most significant impacts to existing aquaculture along the southernmost region of the coast. We consider adaptations leading to aquacultural resilience despite the effects of warming, larger numbers of harmful nonindigenous species (including pathogens and parasites), acidification, sea‐level rise, and more frequent storms and storm surges. Some new species will be needed, but immediate attention to adapt existing species (e.g. preserve/define wild biodiversity, breed for temperature tolerance and incorporate greater husbandry) and aquaculture infrastructure can be successful. We predict that these measures and continued collaboration between industry, stakeholders, government and researchers will lead to sustaining a vibrant working waterfront in the GoM.
Is Being an only Child Harmful to Psychological Health?: Evidence from an Instrumental Variable Analysis of China's one-child Policy
Authors: Zeng Shuxi , Li Fan , Ding Peng
Published: August 2020

The paper evaluates the effects of being an only child in a family on psychological health, leveraging data on the one-child policy in China. We use an instrumental variable approach to address the potential unmeasured confounding between the fertility decision and psychological health, where the instrumental variable is an index of the intensity of the implementation of the policy. We establish an analytical link between the local instrumental variable approach and principal stratification to accommodate the continuous instrumental variable. Within the principal stratification framework, we postulate a Bayesian hierarchical model to infer various causal estimands of policy interest while adjusting for the clustering data structure. We apply the method to the data from the China Family Panel Studies and find small but statistically significant negative effects of being an only child on self-reported psychological health for some subpopulations. Our analysis reveals treatment effect heterogeneity with respect to both observed and unobserved characteristics. In particular, urban males suffer the most from being only children, and the negative effect has larger magnitude if the families were more resistant to the one-child policy. We also conduct a sensitivity analysis to assess the key instrumental variable assumption.
Self‐rated health over a two‐year period after breast cancer surgery: prospective ratings and retrospective rating by means of a health‐line
Authors: Jakobsson Sofie , Alexanderson Kristina , Wennman‐Larsen Agneta , Taft Charles , Ringsberg Karin C
Published: August 2020

Background

There are difficulties in clinical assessment of patients' health, and there is a need for evaluating instruments that measures self‐rated health over time and that are based on the patient's own experiences of their health situation.

Aim

To describe the trajectory of self‐rated health given in a retrospective health‐line and its correspondence with the ratings of health given at six different time points during 2 years following a first breast cancer surgery.

Designs and methods

An explorative prospective cohort study presented according to the STROBE guideline. At six time points, 459 women (26–63 years) completed assessments of self‐rated health during 2 years following a first breast cancer surgery. Subsequently, the women retrospectively rated health month by month over the two years by means of a health‐line. The women were included consecutively in 2007–2009, last data collection was performed in 2012. Statistical analyses were used to compare the health‐line with previous ratings.

Results

Most women (74–88%) rated their health as good, very good or excellent at all six time points. Health‐line ratings were somewhat lower than the ratings made at the actual time‐point; however, the illustrated trajectories back in time followed the same patterns as the women had reported during the two years. The lowest ratings of self‐rated health were reported at four months after surgery. The retrospective illustrations varied greatly, and poorer health was reported by women undergoing chemotherapy, with lower education and who reported more life events.

Conclusions

Even if the retrospective ratings by the health‐line were somewhat lower than the ratings at the actual time‐point, the health‐line captures the health trajectory. The individual graphic illustration by means of a health‐line may serve as a basis for assessment and support patient health narratives. The findings indicate that life event, lower education and chemotherapy influence concurrent and retrospective self‐assessment of health.
Gentrification in the “City of Good Neighbors”: Race, Class, and Neighborhoods in Buffalo
Authors: Coley J , Adelman Robert M.
Published: August 2020

Many neighborhoods in U.S. cities that were once predominantly black and poor have become largely white and middle class. The process of gentrification has fundamentally changed neighborhoods—and metropolises—throughout the United States. Using in‐depth, in‐person interview data from black and white young adults in two Buffalo, New York, neighborhoods, we seek to more fully develop the economic, social, and cultural explanations that draw new residents to such neighborhoods. The racial and neighborhood comparisons also allow us to make sense of gentrifiers’ residential and housing choices. Several themes are developed from the data including neighborhood popularity, cost, and diversity. The data also reveal two types of gentrifiers: mindful and perfunctory. Mindful gentrifiers include residents who think about their socioeconomic footprint and issues such as displacement; perfunctory gentrifiers are more generally concerned with the amenities of a neighborhood. As city planners, social scientists, and others seek to improve the outcomes associated with gentrification, debates will benefit from detailed insights about young adults’ residential decisions.
Pragmatic Prosumption: Searching for Food Prosumers in the Netherlands
Authors: Veen Esther J. , Dagevos Hans , Jansma Jan Eelco
Published: August 2020

This paper explores the concept of prosumption in the world of food. Prosumption is a combination of production and consumption: food prosumers are people who actively produce food for self‐consumption. Besides reflecting on sociological conceptualisations of prosumption, this exploratory study uses an online survey (N = 835) and semi‐structured interviews (N = 12) to examine prosumption empirically. Respondents, living in Almere, the Netherlands, have mostly personal and pragmatic reasons, such as the enjoyment of gardening and the pleasure of producing food, to engage in some form of prosumption. Respondents are hardly motivated by profound concerns about sustainability or a wish to create a ‘radical’ alternative food system. We argue, therefore, that a more pragmatic approach to the concept of prosumption in the field of food is more appropriate than sociological interpretations linking prosumption to such grand themes as power, capitalism and activism.
The cosmopolitics of flow and healing in north‐central Timor‐Leste
Authors: Palmer Lisa
Published: August 2020

In north central Timor‐Leste, multi‐sensory ecological engagement is deeply entangled with conceptualisations of and approaches to people’s wellbeing. How people understand human health and wellbeing is closely related to how they understand nature or more particularly human/nature relations and distinctions across multiple timescales. Working through complex cosmopolitics and activated through cross‐temporal more‐than‐human ‘mutualities of being’, kinship networks are attuned torelational flowsbetween ‘bodies’ and things. Rather than concentrating on the disjunctions created by thedifferencesin the natures of beings or their ritual separation, this paper examines howrelational flowsbetween such ‘bodies’ and things open up cosmopolitical spaces for the creation and negotiation of intergenerational wellbeing.
How to … assess the quality of qualitative research
Authors: Stenfors Terese , Kajamaa Anu , Bennett Deirdre
Published: August 2020

As a clinician interested in qualitative research, you are likely to have pondered whether a particular study is trustworthy. How do you know whether qualitative research findings are valid and can be applied in your setting? The quality standards you would look for in quantitative research do not apply. Furthermore, qualitative research is conducted within a number of paradigms, or ways of understanding the nature of reality and knowledge, each associated with different ways of defining, understanding and reporting quality. This ‘How to …’ article aims to support health care practitioners, educators and researchers to recognise some of the essential characteristics or ‘markers’ of high‐quality qualitative research. We hope that this article will support those reflecting on the quality of their own research, those justifying research design to funders and those reviewing qualitative research for journals or for inclusion in reviews.
Pilot study: Application of artificial intelligence for detecting left atrial enlargement on canine thoracic radiographs
Authors: Li Shen , Wang Zigui , Visser Lance C. , Wisner Erik R. , Cheng Hao
Published: August 2020

Although deep learning has been explored extensively for computer‐aided medical imaging diagnosis in human medicine, very little has been done in veterinary medicine. The goal of this retrospective, pilot project was to apply the deep learning artificial intelligence technique using thoracic radiographs for detection of canine left atrial enlargement and compare results with those of veterinary radiologist interpretations. Seven hundred ninety‐two right lateral radiographs from canine patients with thoracic radiographs and contemporaneous echocardiograms were used to train, validate, and test a convolutional neural network algorithm. The accuracy, sensitivity, and specificity for determination of left atrial enlargement were then compared with those of board‐certified veterinary radiologists as recorded on radiology reports. The accuracy, sensitivity, and specificity were 82.71%, 68.42%, and 87.09%, respectively, using an accuracy driven variant of the convolutional neural network algorithm and 79.01%, 73.68%, and 80.64%, respectively, using a sensitivity driven variant. By comparison, accuracy, sensitivity, and specificity achieved by board‐certified veterinary radiologists was 82.71%, 68.42%, and 87.09%, respectively. Although overall accuracy of the accuracy driven convolutional neural network algorithm and veterinary radiologists was identical, concordance between the two approaches was 85.19%. This study documents proof‐of‐concept for application of deep learning techniques for computer‐aided diagnosis in veterinary medicine.
A systematic review evaluating the influence of incisional Negative Pressure Wound Therapy on scarring
Authors: Zwanenburg Pieter R. , Timmermans Floyd W. , Timmer Allard S. , Middelkoop Esther , Tol Berend T. , Lapid Oren , Obdeijn Miryam C. , Gans Sarah L. , Boermeester Marja A.
Published: August 2020

Pathological scars can result in functional impairment, disfigurement, a psychological burden, itch, and even chronic pain. We conducted a systematic review to investigate the influence of incisional Negative Pressure Wound Therapy (iNPWT) on scarring. PubMed, EMBASE and CINAHL were searched for preclinical and clinical comparative studies that investigated the influence of iNPWT on scarring‐related outcomes. Individual studies were assessed using the OHAT Risk of Bias Rating Tool for Human and Animal studies. The body of evidence was rated using OHAT methodology. Six preclinical studies and nine clinical studies (377 patients) were identified. Preclinical studies suggested that iNPWT reduced lateral tension on incisions, increased wound strength, and reduced scar width upon histological assessment. Two clinical studies reported improved patient‐reported scar satisfaction as measured with the PSAS (1 year after surgery), POSAS, and a VAS (both 42, 90, and 180 days after surgery). Five clinical studies reported improved observer‐reported scar satisfaction as measured with the VSS, SBSES, OSAS, MSS, VAS, and POSAS (7, 15, 30, 42, 90, 180, and 365 days after surgery). Three clinical studies did not detect significant differences at any point in time (POSAS, VAS, and NRS). Because of imprecision concerns, a moderate level of evidence was identified using OHAT methodology. Preclinical as well as clinical evidence indicates a beneficial influence of iNPWT on scarring. Moderate level evidence indicates that iNPWT decreases scar width and improves patient and observer‐reported scar satisfaction.