bluuebunny/crossref_metadata_2025 huggingface dataset:
Patients undergoing surgery for oligometastatic oesophageal cancer survive for more than 2 years: bootstrapping systematic review data
Authors: Schizas Dimitrios , Mylonas Konstantinos S , Kapsampelis Panagiotis , Bagias George , Katsaros Ioannis , Frountzas Maximos , Hemmati Pouya , Liakakos Theodoros
Published: June 2020

OBJECTIVES

Oesophageal cancer oligometastasis is a state of limited systemic disease characterized by ˂5 metastases. Without surgery average survival is 4–12 months. We sought to estimate patient prognosis following the surgical resection of oligometastatic disease from oesophageal cancer.

METHODS

Eligible studies were identified through systematic search of PubMed and the Cochrane Library (end-of-search date: 20 November 2019). We estimated cumulative 1-, 3- and 5-year, as well as overall survival using bootstrap methodology with 1 000 000 repetitions per outcome.

RESULTS

We investigated six studies involving 420 patients who underwent metastasectomy for oligometastasis from oesophageal cancer. Adenocarcinoma [77.3%; 95% confidence interval (CI) 62.8–87.3] was the most prevalent histological type followed by squamous cell carcinoma (22.7%; 95% CI 12.7–37.2). Metastatic lesions were typically synchronous (91.5%; 95% CI 87.5–94.1). Overall, 73.5% (95% CI 67.5–78.6) of the patients underwent resection of the primary and metastatic tumours synchronously. Neoadjuvant chemoradiotherapy was utilized in the majority of the patients (66.7%; 95% CI 49.5–80.3) followed by neoadjuvant chemotherapy (33.3%; 95% CI 19.6–50.5). The mean overall survival was 24.5 months (95% CI 14.4–34.6). One-year survival was 88.3% (95% CI 85.6–90.8). Three-year survival and 5-year survival were 36.3% (95% CI 15.3–7.3) and 23.8% (95% CI 12.0–35.7), respectively.

CONCLUSIONS

Patients undergoing surgical resection of oesophageal oligometastasis survive for more than 24 months. Therefore, loco-regional control of oligometastatic disease appears to improve survival by at least 100%.
Brand-Name Antidepressants Outperform Their Generic Counterparts in Preventing Hospitalization for Depression: The Real-World Evidence from Taiwan
Authors: Hsu Chih-Wei , Lee Sheng-Yu , Yang Yao-Hsu , Wang Liang-Jen
Published: June 2020

Background

Generic antidepressants are approved on the market based on evidence of bioequivalence to their brand-name versions. We aimed to assess whether generic antidepressants exert equal effectiveness as their brand-name counterparts for treating patients with depressive disorders.

Methods

In a nationwide, population-based cohort in Taiwan from 1997 through 2013, patients with a diagnosis of a depressive disorder aged between 18 and 65 years who were new users of antidepressant drugs were classified into either the brand-name group or the generic group. All patients were followed up until medication discontinuation or the end of the study period. We assessed the risk for hospitalization as a primary outcome and augmentation therapy, daily dose, medication discontinuation, or switching to another antidepressant as secondary outcomes.

Results

A total of 277 651 brand-name users (35.8% male; mean age: 41.2 years) and 270 583 generic users (35.8% male; mean age: 41.0 years) were divided into 10 different antidepressant groups (fluoxetine, sertraline, paroxetine, escitalopram, citalopram, venlafaxine, mirtazapine, moclobemide, imipramine, and bupropion). We found that patients treated with the generic form of sertraline, paroxetine, escitalopram, venlafaxine, mirtazapine, and bupropion demonstrated significantly higher risks of psychiatric hospitalization (adjusted hazard ratios ranged from 1.20–2.34), compared to their brand-name counterparts. The differences between brand-name antidepressants and their generic counterparts in secondary outcomes varied across different drugs.

Conclusions

Compared to most generic antidepressants, brand-name drugs exhibited more protective effects on psychiatric hospitalization for depressive patients. These findings could serve as an important reference for clinicians when encountering patients with depressive disorder.
Planarity in Higher-Dimensional Contact Manifolds
Authors: Acu Bahar , Moreno Agustin
Published: June 2020

We obtain several results for (iterated) planar contact manifolds in higher dimensions. (1) Iterated planar contact manifolds are not weakly symplectically co-fillable. This generalizes a 3D result of Etnyre [ 14] to a higher-dimensional setting, where the notion of weak fillability is that due to Massot-Niederkrüger-Wendl [ 38]. (2) They do not arise as nonseparating weak contact-type hypersurfaces in closed symplectic manifolds. This generalizes a result by Albers-Bramham-Wendl [ 4]. (3) They satisfy the Weinstein conjecture, that is, every contact form admits a closed Reeb orbit. This is proved by an alternative approach as that of [ 2] and is a higher-dimensional generalization of a result of Abbas-Cieliebak-Hofer [ 1]. The results follow as applications from a suitable symplectic handle attachment, which bears some independent interest.
Global Rigidity of 2D Linearly Constrained Frameworks
Authors: Guler Hakan , Jackson Bill , Nixon Anthony
Published: June 2020

A linearly constrained framework in $\mathbb{R}^d$ is a point configuration together with a system of constraints that fixes the distances between some pairs of points and additionally restricts some of the points to lie in given affine subspaces. It is globally rigid if the configuration is uniquely defined by the constraint system. We show that a generic linearly constrained framework in $\mathbb{R}^2$ is globally rigid if and only if it is redundantly rigid and “balanced”. For unbalanced generic frameworks, we determine the precise number of solutions to the constraint system whenever the rigidity matroid of the framework is connected. We obtain a stress matrix sufficient condition and a Hendrickson type necessary condition for a generic linearly constrained framework to be globally rigid in $\mathbb{R}^d$.
A Novel Solid Artificial Diet for Zeugodacus cucurbitae (Diptera: Tephritidae) Larvae With Fitness Parameters Assessed by Two-Sex Life Table
Authors: Liu Xiangrui , Lin Xianwu , Li Jing , Li Fen , Cao Fengqin , Yan Rihui
Published: June 2020

The melon fly, Zeugodacus cucurbitae (Coquillett), is a serious pest of many fruits and vegetables throughout the world. Here we have developed an easy and quick-to-prepare solid medium with multiple benefits including reductions in post-rearing waste, storage space, and labor for rearing Z. cucurbitae larvae. The development time from egg to pupa was 19.11 d when larvae were reared on the artificial diet, slightly longer than 17.73 d on pumpkin and 17.13 d on cucumber. Zeugodacus cucurbitae achieved higher values of pupal weight, length, and width on the artificial diet than two natural diet controls. The rates of pupation and adult emergence of Z. cucurbitae grown on the solid medium were comparable with those on pumpkin and cucumber. Furthermore, determined by age-specific two-sex life table method, the age-specific survival rate of Z. cucurbitae was higher on the artificial diet than cucumber but lower than pumpkin. The reproductive ability and population dynamics of Z. cucurbitae were not significantly affected on the solid medium compared with those on the two natural diets. The results suggest that our solid artificial diet is excellent for rearing Z. cucurbitae larvae in laboratory and may be used for its mass rearing, therefore facilitating its research and control.
Transfusion Requirements and Blood Bank Support in Heart and Lung Transplantation
Authors: Yoo Dong-Won , Lee Hyun-Ji , Oh Seung-Hwan , Kim In Suk , Kim Hyung-Hoi , Je Hyung Gon , Kim Dohyung , Cho Woo Hyun , Kim Jeong Su , Lee Soo Yong , Yeo Hye Ju
Published: June 2020

Objective

Transplantations may require massive transfusion of blood products. Therefore, blood banks need to predict, prepare, and supply the required amount of blood products.

Methods

We measured the volume of transfused blood components as red blood cells, fresh frozen plasma, platelets, and cryoprecipitate in 54 and 89 patients who received heart and lung transplantation, respectively, in our hospital between January 2012 and December 2019.

Results

Platelets were the most frequently transfused blood component. Transfusion volumes during heart and lung transplantation surgeries differed: red blood cells, 7.83 units vs 14.84 units; fresh frozen plasma, 2.67 units vs 12.29 units; platelets, 13.13 units vs 23.63 units; and cryoprecipitate, 1.74 units vs 2.57 units; respectively. The average transfusion volume of transplants was different each year.

Conclusion

Periodic evaluation of transfusion requirements will facilitate the efficient management of blood products at the time of transplantation and help blood banks predict changes in blood requirements.
A mechanism of spark motion in inner acceleration region to investigate subpulse drifting in pulsars
Authors: Basu Rahul , Mitra Dipanjan , Melikidze George I
Published: June 2020

Coherent radio emission in pulsars is excited due to instabilities in a relativistically streaming non-stationary plasma flow, which is generated from sparking discharges in the inner acceleration region (IAR) near the stellar surface. A number of detailed works have shown the IAR to be a partially screened gap (PSG) dominated by non-dipolar magnetic fields with continuous outflow of ions from the surface. The phenomenon of subpulse drifting is expected to originate due to variable $\boldsymbol {E}\times \boldsymbol {B}$ drift of the sparks in PSG, where the sparks lag behind corotation velocity of the pulsar. Detailed observations show a wide variety of subpulse drifting behaviour where subpulses in different components of the profile have different phase trajectories. But the drifting periodicity is seen to be constant, within measurement errors, across all components of the profile. Using the concept of sparks lagging behind corotation speed in PSG as well as the different orientations of the surface non-dipolar magnetic fields, we have simulated the expected single pulse behaviour in a representative sample of pulsars. Our results show that the different types of drifting phase behaviour can be reproduced using these simple assumptions of spark dynamics in a non-dipolar IAR.
Model-Based Inference of Punctuated Molecular Evolution
Authors: Manceau Marc , Marin Julie , Morlon Hélène , Lambert Amaury
Published: June 2020

In standard models of molecular evolution, DNA sequences evolve through asynchronous substitutions according to Poisson processes with a constant rate (called the molecular clock) or a rate that can vary (relaxed clock). However, DNA sequences can also undergo episodes of fast divergence that will appear as synchronous substitutions affecting several sites simultaneously at the macroevolutionary timescale. Here, we develop a model, which we call the Relaxed Clock with Spikes model, combining basal, clock-like molecular substitutions with episodes of fast divergence called spikes arising at speciation events. Given a multiple sequence alignment and its time-calibrated species phylogeny, our model is able to detect speciation events (including hidden ones) cooccurring with spike events and to estimate the probability and amplitude of these spikes on the phylogeny. We identify the conditions under which spikes can be distinguished from the natural variance of the clock-like component of molecular substitutions and from variations of the clock. We apply the method to genes underlying snake venom proteins and identify several spikes at gene-specific locations in the phylogeny. This work should pave the way for analyses relying on whole genomes to inform on modes of species diversification.
3′-Terminal 2′-O-methylation of lung cancer miR-21-5p enhances its stability and association with Argonaute 2
Authors: Liang Hongwei , Jiao Zichen , Rong Weiwei , Qu Shuang , Liao Zhicong , Sun Xinlei , Wei Yao , Zhao Quan , Wang Jun , Liu Yuan , Chen Xi , Wang Tao , Zhang Chen-Yu , Zen Ke
Published: June 2020

Methylation of miRNAs at the 2′-hydroxyl group on the ribose at 3′-end (2′-O-methylation, 2′Ome) is critical for miRNA function in plants and Drosophila. Whether this methylation phenomenon exists for mammalian miRNA remains unknown. Through LC–MS/MS analysis, we discover that majority of miR-21-5p isolated from human non-small cell lung cancer (NSCLC) tissue possesses 3′-terminal 2′Ome. Predominant 3′-terminal 2′Ome of miR-21-5p in cancer tissue is confirmed by qRT-PCR and northern blot after oxidation/β-elimination procedure. Cancerous and the paired non-cancerous lung tissue miRNAs display different pattern of 3′-terminal 2′Ome. We further identify HENMT1 as the methyltransferase responsible for 3′-terminal 2′Ome of mammalian miRNAs. Compared to non-methylated miR-21-5p, methylated miR-21-5p is more resistant to digestion by 3′→5′ exoribonuclease polyribonucleotide nucleotidyltransferase 1 (PNPT1) and has higher affinity to Argonaute-2, which may contribute to its higher stability and stronger inhibition on programmed cell death protein 4 (PDCD4) translation, respectively. Our findings reveal HENMT1-mediated 3′-terminal 2′Ome of mammalian miRNAs and highlight its role in enhancing miRNA’s stability and function.
The Party Abroad: A New Modus Operandi for Political Parties
Authors: Rashkova Ekaterina R
Published: June 2020

In an era where millions of people live elsewhere than their country of birth and many hold multiple nationalities, the questions of who and how represents these people becomes imperative. The traditional manner of representation is through political parties, yet the form in which parties have historically existed is within state bounds. Throughout time, we have witnessed the transition from cadre to cartel parties and through them the changing role of the political party. This article argues that with the vast expansion of the movement of people around the world, which has been influenced by the enlargement of the European Union, by globalisation, migration and most recently by the refugee crisis, political parties are reshaping their structures both domestically and internationally, and we are witnessing the development of a ‘new modus operandi’ of political parties—the party abroad. The party abroad is viewed as a natural evolvement of the functions of domestic political parties in their response to a changing civil society and changing competitive space. The article provides a theory of the party abroad, it discusses how it relates to previous models of political parties and offers a framework based on which we can study it.
Globalisation and the Movement of People: What It Means for Party Politics? An Introduction
Authors: Rashkova Ekaterina R , Van Der Staak Sam
Published: June 2020

Living in a globalised world, with its inherent easier movement of people between nations, imposes new challenges for representative democracy and for party politics specifically. Political parties have traditionally operated at a domestic level, yet, with the large number of people moving around the globe, this is now changing. This special section, deriving from a workshop on the topic, is one of the first attempts to systematically address this issue. It offers a theoretical framework and five empirical studies on the party abroad. The collection provides evidence of varied levels of existence of the party abroad in different contexts. It illustrates that the party abroad as a new modus operandi for parties that exist in all corners of the world; yet, it is most distinctly developed where the electoral stimuli and the type and size of the diaspora group give strategic incentive to political parties to do so.
Can the personalized medicine approach contribute in controlling tuberculosis in general and India in particular?
Authors: Khan Nikhat , Das Aparup
Published: June 2020

Poor drug compliance and drug-resistant Mycobacterium tuberculosis are the two principal obstacles in controlling tuberculosis (TB) in endemic regions including India, which has contributed the most to global TB burden. We argue here that a personalized medicine approach, to start with the N-acetyl transferase-2–isoniazid (NAT2–INH) model, could be a step forward in dealing with both these limitations in controlling TB in India.
The Wellbeing of UK Police: A Study of Recorded Absences from Work of UK Police Employees Due to Psychological Illness and Stress Using Freedom of Information Act Data
Authors: Cartwright Ashley , Roach Jason
Published: June 2020

Policing is undoubtedly a dangerous occupation whereby officers are routinely exposed to dangerous and potentially traumatic events, such as attending road traffic collisions, informing people of the death of a loved one, and ensuring public safety at football matches. Frontline policing is of course not the only place whereby constant exposure to dangerous and distressing incidents can increase the risk of police employees developing emotional and psychological complaints that have serious effects on their ‘wellbeing’, with previous research identifying specific policing areas such as homicide investigation as likely to have negative effects on those doing the investigating. Although to date, research has focused on the wellbeing effects of ‘routine policing’, criminal investigation, and specific events, as yet little is known about the effect on UK police employees wellbeing of ‘doing the job’ in terms of the number of days recorded as absent due to psychological illness, trauma, and stress. This study seeks to redress this gap by analysing sickness absence data recorded for 20 UK Police services for the past 10 years, obtained under the Freedom of Information (FOI) Act. The data set represents some 57% of UK police personnel, and findings suggest that police employee absence due to psychological ill health, trauma, and stress had nearly doubled in the past 10 years to an absence rate of 8.82%. Furthermore, this study found that 39% of those who take a first leave of absence due to mental ill health go on to take further absences from work.
Greater risk of severe COVID-19 in Black, Asian and Minority Ethnic populations is not explained by cardiometabolic, socioeconomic or behavioural factors, or by 25(OH)-vitamin D status: study of 1326 cases from the UK Biobank
Authors: Raisi-Estabragh Zahra , McCracken Celeste , Bethell Mae S , Cooper Jackie , Cooper Cyrus , Caulfield Mark J , Munroe Patricia B , Harvey Nicholas C , Petersen Steffen E
Published: June 2020

Background

We examined whether the greater severity of coronavirus disease 2019 (COVID-19) amongst men and Black, Asian and Minority Ethnic (BAME) individuals is explained by cardiometabolic, socio-economic or behavioural factors.

Methods

We studied 4510 UK Biobank participants tested for COVID-19 (positive, n = 1326). Multivariate logistic regression models including age, sex and ethnicity were used to test whether addition of (1) cardiometabolic factors [diabetes, hypertension, high cholesterol, prior myocardial infarction, smoking and body mass index (BMI)]; (2) 25(OH)-vitamin D; (3) poor diet; (4) Townsend deprivation score; (5) housing (home type, overcrowding) or (6) behavioural factors (sociability, risk taking) attenuated sex/ethnicity associations with COVID-19 status.

Results

There was over-representation of men and BAME ethnicities in the COVID-19 positive group. BAME individuals had, on average, poorer cardiometabolic profile, lower 25(OH)-vitamin D, greater material deprivation, and were more likely to live in larger households and in flats/apartments. Male sex, BAME ethnicity, higher BMI, higher Townsend deprivation score and household overcrowding were independently associated with significantly greater odds of COVID-19. The pattern of association was consistent for men and women; cardiometabolic, socio-demographic and behavioural factors did not attenuate sex/ethnicity associations.

Conclusions

In this study, sex and ethnicity differential pattern of COVID-19 was not adequately explained by variations in cardiometabolic factors, 25(OH)-vitamin D levels or socio-economic factors. Factors which underlie ethnic differences in COVID-19 may not be easily captured, and so investigation of alternative biological and genetic susceptibilities as well as more comprehensive assessment of the complex economic, social and behavioural differences should be prioritised.
Evaluating Firm-Level Expected-Return Proxies: Implications for Estimating Treatment Effects
Authors: Lee Charles M C , So Eric C , Wang Charles C Y
Published: June 2020

We introduce a parsimonious framework for choosing among alternative expected-return proxies (ERPs) when estimating treatment effects. By comparing ERPs’ measurement error variances in the cross-section and in the time series, we provide new evidence on the relative performance of firm-level ERPs nominated by recent studies. Generally, “implied-costs-of-capital” metrics perform best in the time series, whereas “characteristic-based” proxies perform best in the cross-section. Factor-based ERPs, even the latest renditions, perform poorly. We revisit four prior studies that use ex ante ERPs and illustrate how this framework can potentially alter either the sign or the magnitude of prior inferences.
Initial analgesic prescriptions for osteoarthritis in the United Kingdom, 2000–2016
Authors: Zeng Chao , Zhang Weiya , Doherty Michael , Persson Monica S M , Mallen Christian , Swain Subhashisa , Li Xiaoxiao , Wei Jie , Lei Guanghua , Zhang Yuqing
Published: June 2020

Objectives

To examine trends in the initial prescription of commonly-prescribed analgesics and patient- as well as practice-level factors related to their selection in incident OA.

Methods

Patients consulting with incident clinical OA between 2000–2016 were identified within The Health Improvement Network in the United Kingdom (UK) general practice. Excluded were patients who had history of cancer or were prescribed the analgesics of interest within 6 months before diagnosis of OA. Initial analgesic prescription included oral non-selective NSAID, oral selective cyclooxygenase-2 inhibitor, topical NSAID, paracetamol, topical salicylate or oral/transdermal opioid within 1 month after OA diagnosis.

Results

∼44% of patients with incident OA (n = 125 696) were prescribed one of these analgesics. Incidence of oral NSAID prescriptions decreased whereas other analgesic prescriptions, including oral opioid prescriptions, increased (all P-for-trend < 0.001). Patients with a history of gastrointestinal disease were more likely to receive topical NSAIDs, paracetamol or oral/transdermal opioids. Only 38% of patients with history of gastrointestinal disease and 21% of patients without it had co-prescription of gastroprotective agent with oral NSAIDs. Oral/transdermal opioid prescription was higher among the elderly (≥65 years), women, obesity, current smoker, and patients with gastrointestinal, cardiovascular or chronic kidney disease. Prescription of oral opioids increased with social deprivation (P-for-trend < 0.05) and was highest in Scotland, whereas transdermal opioid prescription was highest in Northern Ireland (all P-for-homogeneity-test < 0.05).

Conclusion

The initial prescription pattern of analgesics for OA has changed over time in the UK. Co-prescription of gastroprotective agents with oral NSAIDs remains suboptimal, even among those with prior gastrointestinal disease.
Phylogenomics of Monitor Lizards and the Role of Competition in Dictating Body Size Disparity
Authors: Brennan Ian G , Lemmon Alan R , Lemmon Emily Moriarty , Portik Daniel M , Weijola Valter , Welton Luke , Donnellan Stephen C , Keogh J Scott
Published: June 2020

Organismal interactions drive the accumulation of diversity by influencing species ranges, morphology, and behavior. Interactions vary from agonistic to cooperative and should result in predictable patterns in trait and range evolution. However, despite a conceptual understanding of these processes, they have been difficult to model, particularly on macroevolutionary timescales and across broad geographic spaces. Here, we investigate the influence of biotic interactions on trait evolution and community assembly in monitor lizards (Varanus). Monitors are an iconic radiation with a cosmopolitan distribution and the greatest size disparity of any living terrestrial vertebrate genus. Between the colossal Komodo dragon Varanus komodoensis and the smallest Australian dwarf goannas, Varanus length and mass vary by multiple orders of magnitude. To test the hypothesis that size variation in this genus was driven by character displacement, we extended existing phylogenetic comparative methods which consider lineage interactions to account for dynamic biogeographic history and apply these methods to Australian monitors and marsupial predators. Incorporating both exon-capture molecular and morphological data sets we use a combined evidence approach to estimate the relationships among living and extinct varaniform lizards. Our results suggest that communities of Australian Varanus show high functional diversity as a result of continent-wide interspecific competition among monitors but not with faunivorous marsupials. We demonstrate that patterns of trait evolution resulting from character displacement on continental scales are recoverable from comparative data and highlight that these macroevolutionary patterns may develop in parallel across widely distributed sympatric groups.[Character displacement; comparative methods; phylogenetics; trait evolution; Varanus.]
Lessons learned from an under-reported mumps epidemic among Rohingya refugees in Cox's Bazar District, Bangladesh
Authors: Mair Luke , Relan Pryanka , Hamilton David Oliver , Al-Noman Abdullah , O'Dempsey Timothy
Published: June 2020

Background

In 2018, a large mumps epidemic coincided with an outbreak of diphtheria in refugee camps established in Bangladesh for the Rohingya people. These refugees did not receive a mumps-containing vaccine.

Methods

Cases of mumps were reported to the WHO's Early Warning, Alert and Response System (EWARS) during the Rohingya refugee crisis. The authors present amalgamated epidemiological data of a major, previously under-reported, mumps epidemic.

Results

In total, 19 215 mumps cases across a total of 218 facilities were reported to EWARS during 2018. The attack rate was 2.1% of the whole population. Of these cases, 7687 (40%) were in children aged <5 y. Mumps was more commonly seen among males than females.

Conclusion

Detailed reporting of outbreaks of all vaccine-preventable diseases is essential to ensure appropriate vaccination decisions can be made in future humanitarian crises.
An open-circuit fault-diagnosis method for inverters based on phase current
Authors: Cheng Shu , Zhao Jundong , Chen Chunyang , Li Kaidi , Wu Xun , Yu Tianjian , Yu Yongsheng
Published: June 2020

The inverter is an indispensable part of a power electronics system. Its safety and stability are important indicators for evaluating the reliability of the system. Inverter faults are usually caused by operating faults in the switch elements. This paper therefore proposes a non-intrusive fault-diagnosis method for open-circuit faults in inverter semiconductor power switches. This method requires only a current signal. It is simple and economical. Faults can be diagnosed quickly using the proposed algorithm. First, the phase current waveforms before and after the open-circuit fault are analysed based on the mathematical model. Then, based on the analysis of the phase currents, the fault features are extracted and the fault is located using the proposed integration algorithm. Finally, the effectiveness and reliability of the proposed fault-diagnosis method are verified using a hardware-in-the-loop experiment.
From Theory to Practice: The Application of Cognitive Load Theory to the Practice of Medicine
Authors: Szulewski Adam , Howes Daniel , van Merriënboer Jeroen J.G. , Sweller John
Published: June 2020

Cognitive load theory has become a leading model in educational psychology and has started to gain traction in the medical education community over the last decade. The theory is rooted in our current understanding of human cognitive architecture in which an individual’s limited working memory and unlimited long-term memory interact during the process of learning. Though initially described as primarily a theory of learning, parallels between cognitive load theory and broader aspects of medical education as well as clinical practice are now becoming clear. These parallels are particularly relevant and evident in complex clinical environments, like resuscitation medicine. The authors have built on these connections to develop a recontextualized version of cognitive load theory that applies to complex professional domains and in which the connections between the theory and clinical practice are made explicit, with resuscitation medicine as a case study. Implications of the new model for medical education are also presented along with suggested applications.
Exercise Addiction Prevalence and Correlates in the Absence of Eating Disorder Symptomology: A Systematic Review and Meta-analysis
Authors: Trott Mike , Jackson Sarah E. , Firth Joseph , Fisher Abigail , Johnstone James , Mistry Amit , Stubbs Brendon , Smith Lee
Published: June 2020

Background:

Exercise addiction (EA) can be debilitating and can be a symptom of an eating disorder. To date, the prevalence rates of EA without indicated eating disorders in the general population and associated correlates remain unreported.

Methods:

Two authors searched major databases from inception to 31/12/2018 to identify studies investigating the prevalence of EA in any population without indicated eating disorders. We conducted a random effects meta-analysis to report (i) prevalence rates of EA using the exercise addiction inventory and exercise dependence scale and compare sub-populations, (ii) compare methods of EA measurement and explore heterogeneity, and (iii) report on correlates.

Results:

A total of 13 studies including 3635 people were included. The prevalence of EA among general exercisers was 8.1% (95% CI 1.5%–34.2%), amateur competitive athletes was 5.0% (95% CI 1.3%–17.3%), and university students was 5.5% (95% CI 1.4–19.1%%). Overall prevalence rates varied depending on the EA measurement tool. EA subjects were more likely to have lower levels of overall wellbeing (only in amateur competitive athletes), higher anxiety levels, and have greater frontal brain activity.

Conclusions:

EA is prevalent in the absence of indicated eating disorders across populations but varies depending on measurement tool. Further research is needed to explore EA without indicated eating disorders in different populations using homogenous measurement tools, further determine psychological correlates, and examine which measures of EA without indicated eating disorders predict poor health outcomes.
The Effect of Atropine on Trigeminocardiac Reflex-induced Hemodynamic Changes During Therapeutic Compression of the Trigeminal Ganglion
Authors: Wang Chang-Ming , Guan Zhan-Ying , Zhao Ping , Huang Hai-Tao , Zhang Jing , Li Yan-Feng , Ma Yi
Published: June 2020

Background:

Percutaneous compression of the trigeminal ganglion (PCTG) can induce significant hemodynamic perturbations secondary to the trigeminocardiac reflex (TCR). The aim of this study was to investigate the effect of atropine pretreatment on hemodynamic responses during PCTG for trigeminal neuralgia.

Materials and Methods:

A total of 120 patients who received PCTG were randomly assigned to control and atropine groups that were pretreated with saline (n=60) and atropine 0.004 mg/kg intravenously (n=60), respectively. Heart rate (HR) and mean arterial pressure (MAP) were measured at 9 timepoints from before induction of anesthesia until the end of the PCTG procedure; the incidence of TCR was also observed.

Results:

HR was higher in the atropine compared with control group from the time of skin puncture with the PCTG needle until after the procedure was completed (P<0.05). MAP was also higher in the atropine compared with control group, but only at entry of the needle into the foramen ovale until 1 minute after trigeminal ganglion compression (P<0.05). HR was reduced in both groups during entry of the needle into the foramen ovale and during ganglion compression, but less so in the atropine compared with the control group (P<0.05). MAP increased during PCTG compared with baseline in both groups, but with a larger increase in the atropine group (P<0.05). Two and 52 cases in the control group, and 6 and 1 cases in the atropine group, exhibited a TCR during entry of the needle into the foramen ovale and at ganglion compression, respectively (P<0.05).

Conclusion:

Pretreatment with atropine was effective in most patients at minimizing abrupt reduction in HR during PCTG.
Ellipsoidal process of the femoral head in Legg–Calvé–Perthes disease. Part I
Authors: Abril Juan Carlos , Montero Margarita , Egea-Gámez Rosa M. , Ismael Maryem Fama
Published: June 2020

Legg–Calvé–Perthes disease (LCPD) often produces a residual deformity, typically consistent with coxa magna, coxa plana, and ellipsoidal shape. Depending on the degree of asphericity and flatness, this morphology was classified by Stulberg in stages III and IV. Thus far, few studies have investigated physeal injury as an etiological cause or evaluated its progressive profile throughout Waldenström’s reossification stage and the remodelling stage. In this study, we analysed the ellipsoidal process of the femoral head. This was a retrospective control case study involving 83 unoperated hips with LCPD and Stulberg stages III and IV outcome. The data were compared with those obtained for 49 healthy contralateral hips (control). The Ellipsoidal Index, the presence of a double epiphyseal reossification nucleus, physeal narrowing, intraphyseal angle, epiphyseal height, diameter of the head, and Reimer’s Index were determined. Measurements were performed at four-time points: the year the reossification stage was initiated, the final growth stage, and two equally spaced time points in between. The Ellipsoidal Index gradually increased throughout the course of the disease from 1.6 in the initial reossification stage to 2.0 at the end of growth. In the control cases, this value was consistently 1.4. More ellipsoidal deformity was observed in Stulberg stage IV versus Stulberg stage III patients (P < 0.05). Moreover, there was a direct link between a high Ellipsoidal Index and the appearance of a double reossification nucleus, a physeal narrowing in the area underlying the anterosuperior nucleus, intraphyseal angle. Reimer’s Index showed a gradual extrusion from baseline to the end of growth (26.1 versus 31.8, respectively; P < 0.05). The ellipsoidal process of the femoral head occurs gradually throughout the reossification and remodelling stages. This was linked to the appearance of a double epiphyseal nucleus, gradual extrusion, an angulated physis appearance, an asymmetrical narrowing of the physis and a high Ellipsoidal Index, which may be indicative of poor prognosis. Levels of Evidence for Primary Research Question: Level III, case-control study.
Results of an Early Access Treatment Protocol of Daratumumab Monotherapy in Spanish Patients With Relapsed or Refractory Multiple Myeloma
Authors: Alegre Adrián , de la Rubia Javier , Sureda Balari Anna , Encinas Rodríguez Cristina , Suárez Alexia , Blanchard María Jesús , Bargay Lleonart Joan , Rodríguez‐Otero Paula , Insunza Andrés , Palomera Luis , Peñarrubia María Jesús , Ríos‐Tamayo Rafael , Casado Montero Luis Felipe , González Marta Sonia , Potamianou Anna , Couturier Catherine , Pei Huiling , Hevia Henar , Milionis Iordanis , Gaudig Maren , Mateos María‐Victoria
Published: June 2020

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Impacts of Primary Care Physician System on Healthcare Utilization and Antibiotic Prescription: Difference-in-Differences and Causal Mediation Analyses
Authors: Okubo Yusuke , Michihata Nobuaki , Uda Kazuhiro , Kinoshita Noriko , Horikoshi Yuho , Miyairi Isao
Published: June 2020

Background:

The overutilization of healthcare and overuse/misuse of antibiotics in Japan are responsible for the increase in healthcare expenditure and the development of antimicrobial resistance. The Japanese government started paying incentives to medical facilities for primary care physician registrations, but the impact of this new policy is still unclear.

Methods:

We conducted a retrospective cohort study for all pediatric outpatients from April 2015 to December 2016 in Japan, targeting 1.4 million children under 2 years of age. We investigated the effects of primary care physician registration on physician visits, total antibiotic use and admission rates using difference-in-differences (DID) and causal mediation analyses.

Results:

DID analyses showed that primary care registration policy contributed to increases in total physician visits, total and broad-spectrum antibiotic use and radiologic study utilization, but reduced out-of-hour visits and did not affect hospitalization rates. Similar results were obtained when we adjusted for and matched on potential confounders. Causal mediation analyses found that the greatest pathway was controlled by direct effects of 53.2 DOTs per 1000 person-months (95% CI: 29.1–77.2), indicating that the effect of new health policy that did not mediate increased outpatient visits mostly contributed to the excess use of antibiotics.

Conclusions:

The health policy further increased antibiotic use. On April 2018, a new health policy of paying incentives for not prescribing antibiotics to children with respiratory infection or gastroenteritis was initiated. Further studies are needed whether this new health policy can mitigate the overutilization of healthcare and antibiotic use.
Validation of the Bacterial Meningitis Score in adults consulting at an emergency department: a retrospective multicentric study
Authors: Delannoy Quentin , Pean-de-Ponfilly Gauthier , Mesnil Celine , Severin Constance , Robert Jerome , Plaisance Patrick , Freund Yonathan , Hausfater Pierre , Cambau Emmanuelle , Jacquier Hervé , Chauvin Anthony
Published: June 2020

Objective

The Bacterial Meningitis Score (BMS) is recommended by pediatric academic societies to rule out the diagnosis of bacterial meningitis. The aim of this study was to evaluate the performance of the BMS to identify adults at no risk for bacterial meningitis.

Methods

We conducted a multicentric retrospective study including adults who consulted the emergency department (ED) for meningitis [cerebrospinal fluid (CSF) white blood cells ≥5/mm3 with a ratio of white blood cells/red blood cells <1:900) during a 4-year period. The BMS variables were: CSF positive Gram stain, CSF absolute neutrophil count ≥1000 cells/μL, CSF protein ≥80 mg/dL, peripheral blood absolute neutrophil count ≥10 000 cells/μL, and seizures. Bacterial meningitis was defined for patients who had a lumbar puncture with CSF pleocytosis and positive bacterial analysis of CSF. The primary endpoint was the sensitivity of the BMS to rule out bacterial meningitis in adults. The secondary outcome was to assess the rate of patients for whom antibiotics could have been avoided using the BMS and the diagnostic performance of procalcitonin in patients with a BMS ≥1.

Results

Of 930 patients with meningitis, 626 were included in the analysis, and 27 (4.3%) were diagnosed with bacterial meningitis. A total of 384/626 (61.3%) patients had a BMS = 0, and none presented bacterial meningitis. BMS sensitivity was 100% [95% confidence interval (CI), 87.2–100%], and its negative predictive values were 100% (95% CI, 98.8–100%).

Conclusion

Among patients with a diagnosis of meningitis in ED, a BMS of 0 may safely rule out bacterial meningitis.
Addressing Population Health
Authors: O'Connor Mary , Tingo Elizabeth
Published: June 2020

Since the 1970s, the state of Maryland has operated on a different payment system for Medicare than that in the rest of the country. Known as the Maryland Waiver, recent terms have focused on reducing cost and waste while increasing value and scope toward population health. This article describes a partnership between 2 community hospitals in Maryland to meet the goals of the waiver. The partnership addressed the triple aim: improving access and population health; improving the experience of care; and decreasing per capita hospital costs for the patients both organizations serve. The goals of the partnership were to develop and implement cross-organizational, multidisciplinary tools and processes to reduce potentially avoidable utilization; integrate behavioral health into primary care settings; and improve all hospital patient outcomes and satisfaction for the target population. The success of the interventions implemented has exceeded the metrics in the proposal.
The Effect of Virtual Nursing and Missed Nursing Care
Authors: Schuelke Sue , Aurit Sarah , Connot Nancy , Denney Shannon
Published: June 2020

This article describes the impact of a Virtually Integrated Care team on missed nursing care as defined by the MISSCARE survey. This multisite project reported that the most common missed cares and reasons for missed cares were consistent with other reported results in earlier literature. However, when evaluating missed cares that were directly impacted by the virtual nurses' roles and responsibilities, 1 of the 2 sites demonstrated a decrease in missed nursing care during the project. The virtual nurses with in the team were constantly monitoring care, and even though the second site did not demonstrate a similar finding, the authors felt it was due to the virtual nurses bringing a heightened awareness of missed cares to the team.
First-Line Nurse Managers' Challenges at the Crossroads of Norwegian Health Care Reforms
Authors: Solbakken Rita , Bondas Terese , Kasén Anne
Published: June 2020

Norwegian municipal health care has large public service offerings, funded by tax revenues; however, the current Norwegian welfare model is not perceived as sustainable and future-oriented. First-line nurse managers in Norwegian municipal health care are challenged by changes due to major political and government-initiated reforms requiring expanded utilization of home nursing. The aim of this theoretical study was to describe challenges the first-line nurse managers in a Nordic welfare country have encountered on the basis of government-initiated reforms and to describe strategies to maintain their responsibilities in nursing care. First-line nurse managers' competence, clinical presence, and support from superiors were identified as prerequisites to maintain sight of the patients in leadership when reforms are implemented. The strategies first-line nurse managers in Norwegian municipal health care use to implement multiple reforms, regulations, and new acts require solid competencies in nursing, leadership, and administration. Competence in nursing enables focus on the patient while leading the staff. Supports from superiors and formal leadership networks are described as prerequisites for managing the challenges posed by change and to persist in leadership positions.
Diversifying Nursing Leadership Through Commitment, Connection, and Collaboration
Authors: Persaud Sabita
Published: June 2020

By 2043, it is projected that more than half of the nation's population will belong to a minority ethnic group. Health care organizations are challenged to create teams that mirror the communities they serve. Diversity in health care leadership can improve community relations, enhance quality of care, and reduce disparities in care. While the profession of nursing has made positive strides toward increased diversity, this is not reflected in nursing leadership. This article discusses how organizations can support the leadership development of underrepresented minority nurses through connection, collaboration, and commitment. Also highlighted are strategies that underrepresented minority nurses can employ, as they pursue leadership roles.
Building Community Well-being by Leveraging the Economic Impact of Health Systems
Authors: Weston Marla J. , Pham Bich Ha , Zuckerman David
Published: June 2020

Local communities face systematically deepening disparities in economic, health, and well-being outcomes. Nurses are increasingly leading initiatives to positively impact the social determinants of health in local communities. This article describes how to use the enormous economic impact of hospitals and health systems as anchor institutions embedded in local communities. By leveraging the everyday business practices of hospitals and health systems, such as hiring, purchasing, and investing, nurses can help to transform the economic and consequent health well-being of socioeconomically disadvantaged individuals and neighborhoods. Hiring, purchasing, and investing in nearby neighborhoods build community wealth through both gainful employment and subsequent recirculation of money locally. Improving the economic viability of the local community positively impacts concomitant social determinants of health. Nurses, with their experience and expertise in collaboration and communication with diverse stakeholder and with their high ranking as the most trusted profession, are natural leaders to build community networks and partnerships that promote community transformation for well-being.
Transitional Care Home Visits Among Underserved Patients With Heart Failure
Authors: Arnold Erica R. , White-Williams Connie , Miltner Rebecca S. , Hites Lisle , Su Wei , Shirey Maria R.
Published: June 2020

Heart failure (HF), a global public health problem affecting 26 million people worldwide, significantly impacts quality of life. The prevalence of depression associated with HF is 3 times higher than that of the general population. Evidence, though, supports the use of transitional care as a method to enhance functional status and improve rates of depression in patients with HF. This article discusses the findings of a quality improvement project that evaluated health outcomes in underserved patients with HF who participated in a transitional care home visitation program. The visitation program exemplifies the role of leadership in facilitating transitions across the health care continuum. The 2-year retrospective review included 79 participants with HF. Comparisons of outcomes were made over 6 months. Although not statistically significant, clinically significant differences in health outcomes were observed in participants who received a home visit >14 days compared with ≤14 days after hospital discharge. A home visitation program for underserved patients with HF offers opportunities to enhance care across the continuum. Ongoing evaluation of the existing home visitation program is indicated over time with the goal of offering leaders data to enhance patient and family-centered transitional care coordination.