bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of pulmonary rehabilitation on smoking and health outcomes in COPD patients
Authors: Sahin Hulya , Naz Ilknur
Published: April 2021

Objectives

Although several positive effects of pulmonary rehabilitation (PR) are known in COPD patients, the results of PR in smoker COPD patients are unclear. We aimed to compare the effect of PR on smoking behaviour and health outcomes between COPD patients who are smoker and ex‐smoker.

Methods

In our study; 62 COPD patients (31 of them active smoker and 31 of them were ex‐smoker) who completed in an 8‐week outpatient PR programme were included. Pulmonary function test, blood gas analysis, mMRC Dyspnoea Scale, 6‐minute walk test, St. George's Respiratory Questionnaire, SF‐36 Quality of Life Questionnaire and Hospital Anxiety Depression Scale were performed. Smoking behaviour and nicotine dependence of the study group was evaluated.

Results

At baseline assessment; TLCO was found to be lower in the currently smoking group (p = 0.042) and significantly increased after PR (p = 0.012). FEV1, PaO2, arterial saturation, 6‐min walk distance and quality of life improved in both groups (p < 0.05). Anxiety score decreased in both groups; depression score decreased only in the ex‐smoker group. When comparing changes between groups; mMRC score was observed to be decreased more in the smoker group (p = 0.01). At the end of the programme, nicotine dependence score and the daily number of cigarettes were significantly decreased in the smoker group (p < 0.001), also 2 patients completely quit smoking.

Conclusion

Smoker COPD patients benefited from the PR programme at least as much as the patients who do not smoke. Furthermore, nicotine dependence and amount of cigarette decreased in smoker patients. Therefore, COPD patients who smoke should be referred to the PR programmes.
Evaluation of a multimodal analgesic regimen on outcomes following laparoscopic living donor nephrectomy
Authors: Marti Kristen , Rochon Caroline , O’Sullivan David M. , Ye Xiaoyi , Ebcioglu Zeynep , Kainkaryam Pranjali P. , Kuzaro Hillary , Morgan Glyn , Serrano Oscar K. , Singh Joseph , Tremaglio Joseph , Kutzler Heather L.
Published: April 2021

Postoperative pain is a significant source of morbidity in patients undergoing living donor nephrectomy (LDN) and a deterrent for candidates. We implemented a standardized multimodal analgesic regimen, which consists of pharmacist‐led pre‐procedure pain management education, a combination transversus abdominis plane and rectus sheath block performed by the regional anesthesia team, scheduled acetaminophen and gabapentin, and as‐needed opioids. This single‐center retrospective study evaluated outcomes between patients undergoing LDN who received a multimodal analgesic regimen and a historical cohort. The multimodal cohort had a significantly shorter length of stay (LOS) (days, mean ± SD: 1.8 ± 0.7 vs. 2.6 ± 0.8; p < .001) and a greater proportion who were discharged on postoperative day (POD) 1 (38.6% vs. 1.5%; p < .001). The total morphine milligram equivalents (MME) that patients received during hospitalization were significantly less in the multimodal cohort on POD 0‐2. The outpatient MME prescribed through POD 60 was also significantly less in the multimodal cohort (median [IQR]; 180 [150‐188] vs. 225 [150‐300]; p < .001). The mean patient‐reported pain score (PRPS) was significantly lower in the multimodal cohort on POD 0‐2. The maximum PRPS was significantly lower on POD 0 (mean ± SD: 7 ± 2 vs. 8 ± 1, respectively; p = .02). This study suggests that our multimodal regimen significantly reduces LOS, PRPS, and opioid requirements and has the potential to improve the donation experience.
Marijuana use among adult liver transplant candidates and recipients
Authors: Likhitsup Alisa , Saeed Naba , Winder Gerald Scott , Hassan Ammar , Sonnenday Christopher J , Fontana Robert J
Published: April 2021

Background

Data regarding marijuana (MJ) use among liver transplant (LT) candidates are limited. We set out to determine the incidence and pre­ and post­LT outcomes of adult LT candidates with a self‐reported history of MJ use.

Methods

Baseline clinical characteristics, waitlist, and post‐LT outcomes of adult LT candidates from January 2010 to March 2017 were compared.

Results

Among 2690 LT candidates, 630(23%) and 298(11%) reported a history of MJ use and use within the past 12 months, respectively. Although the proportion of MJ users increased over time(β = .76, p = .03), the proportion listed and transplanted did not change. Listing for LT increased with male (OR 1.24, 95% CI 11.01–1.52), MELD score (OR 1.08, 95% CI 1.01–1.15), HCC (OR 1.83, 95% CI 1.39–2.41) but decreased among MJ users (OR 0.67, 95% CI 0.50–0.91, p = .01). The median time to listing was longer among MJ users compared to non‐users (115 vs. 87 days, p < .0005). Post­LT survival was similar in 83 MJ users and 306 non‐users.

Conclusion

The proportion of MJ users among LT candidates is increasing. MJ users have a greater burden of psychosocial issues which may contribute to longer evaluations and lower rate of LT listing. Post‐LT survival was not impacted by self‐reported MJ use history.
Three cobblers worth the mastermind? The potential of ensemble in crowdsourced classification problems
Authors: Yan Wangcheng , Letizia Paolo , Zhou Wenjun
Published: April 2021

Classification problems, where the objective is to identify the class labels of given data points, are most often the subject of open contests, in which solvers compete for awards offered by solution seekers. Extant literature in open contests has studied both the winner‐takes‐all and top‐K award schemes, in which the award is granted to the best one and the best K solutions, respectively. However, in comparing these two schemes, researchers have never considered that under a top‐K award scheme, seekers may often benefit from aggregating the solutions as an ensemble, which could achieve a performance that is superior to any individual solution. The practice of ensemble is very common especially in classification and other data science problems, and in this work, we are the first to model it with the scope of deriving the optimal award scheme in open contests. Our results formally show that, given the option of ensemble, a top‐K award scheme may have the advantage to grant a higher profit to the seeker than the winner‐takes‐all award scheme. Further, the optimal number of awards is positively affected by contest parameters including the solvers' expertise, the number of solvers, and the return on effort, whereas it is negatively affected by the technical uncertainty when such uncertainty is sufficiently large. These findings are consistent with the increasing adoption of the top‐K award scheme in contests held on Kaggle and other similar platforms.
Towards a New 1933? The Fascist Labor of the Extreme and Radical right
Authors: Salomonsen Jone
Published: April 2021

Ten years ago, right‐wing extremist Anders Behring Breivik conducted a carefully planned terrorist attack on Norway (July 22, 2011). During the trial, he claimed to have defended Norwegian culture, people, and religion from the seemingly destructive powers of multiculturalism, feminism, and Islamic migration. Yet, which “religion” did Breivik defend? What were his larger political goals of waging “war”? With Hannah Arendt, I will show how Breivik, his American admirer Greg Johnson, and their allies have no political project and not one religion but primarily articulate (with words and/or with violent acts) a yearning to return to racialized, kin‐based, patriarchal camps that ideally are to be organized according to “the aristocratic principle of nature,” as theorized by Adolf Hitler in Mein Kampf.
Duration of type 2 diabetes does not appear to moderate hypoglycaemia rate with insulin degludec versus insulin glargine U100
Authors: Alexopoulos Anastasia‐Stefania , Andersen Andreas , Donatsky Anders Meller , Gowda Amoolya , Buse John B.
Published: April 2021

In the DEVOTE and SWITCH 2 trials, insulin degludec 100 units/mL (degludec) was superior to insulin glargine 100 units/mL (glargine U100) with respect to the rates of severe (DEVOTE; across trial) and overall symptomatic (SWITCH 2; during the maintenance period of the trial) hypoglycaemia in individuals with type 2 diabetes. In this post hoc analysis, data from 7635 individuals from DEVOTE and 720 individuals from SWITCH 2 were analysed by subgroups of diabetes duration at baseline (<10, ≥10–<15, ≥15–<20 and ≥20 years) using prespecified models from both trials. There was a trend towards lower rates of hypoglycaemia with degludec versus glargine U100 across all diabetes duration subgroups in both trials, with the difference being statistically significant in some subgroups in DEVOTE and SWITCH 2. Overall, however, no significant interaction was observed between diabetes duration and treatment (DEVOTE interaction, P = .496; SWITCH 2 interaction, P = .144). Therefore, in this post hoc analysis of DEVOTE and SWITCH 2, diabetes duration did not appear to affect the reduction in rates of hypoglycaemia observed with degludec compared with glargine U100.
Batman or Joker? A mixed‐method approach to understanding children’s perceptions of dentists
Authors: Buldur Burak
Published: April 2021

It is important to understand children's perceptions of dentists in order to improve child–dentist communication. The aim of this mixed‐methods study was to develop and validate a conceptual model of individual determinants of children's perceptions of dentists. A total of 1014 children completed an oral health behaviour form, a metaphor form, the Children's Fear Survey Schedule‐Dental Subscale, the Dental Trust Scale, and the Early Childhood Oral Health Impact Scale. A conceptual model, which included five endogenous and two exogenous variables, was developed and validated. Qualitative (metaphor analysis) and quantitative (path analysis) analyses were conducted. The metaphors that were used to describe dentists were classified into seven conceptual categories: chaotic and unlovable; scary; artistic; protective and alleviative; restorative; scientific; and educative. Better oral health behaviours, greater trust in dentists, and lower dental anxiety were associated with positive perceptions of dentists. Oral health behaviours, trust in dentists, and dental anxiety had the strongest direct effects on perceptions of dentists, but age had the strongest indirect effect. The developed model should help dentists to understand pathways between children's individual determinants and perceptions of dentists. Coupled with behaviour management, this understanding can be an important part of improving dental visit behaviours and fostering positive post‐visit attitudes among children.
Hypothesis on the pathophysiology of small intestinal strangulation by a pedunculated lipoma
Authors: Gandini M. , Freeman D. E. , Giusto G.
Published: April 2021

The current hypothesis proposed for strangulation of small intestine by a pedunculated lipoma in horses involves movement of the lipoma around the small intestine until it loops through its own pedicle. This mechanism is difficult to demonstrate during surgical correction. The objective was to examine an alternative explanation for strangulation by pedunculated lipomas that is logical and consistent with intraoperative findings by the analysis of the anatomical features of 11 cases of lipoma strangulation in horses. In the proposed hypothesis, the stalk of the lipoma is tensed by the weight of the lipoma alone or by external forces on it from adjacent intestine. This produces a slit‐like aperture formed by the stalk and the contiguous mesentery. One or more loops of intestine pass across the lateral edge of the stalk before turning into this aperture, either because of lack of space in the abdominal cavity or through the effects of peristalsis. The weight of the intestine itself causes the loop to ‘fall’ into the aperture and become entrapped. This creates a half‐hitch knot in which the loop of intestine uses the lipoma pedicle as a ‘post’ around which it becomes strangulated. It was concluded that the proposed hypothesis differs from the existing one by requiring intestinal movement to create the strangulation, which is more plausible than the current proposal that the strangulation is caused by movement of the lipoma itself. It is also more consistent with surgical findings.
Spatiotemporal variability in the occurrence of juvenile Japanese jack mackerel Trachurus japonicus along coastal areas of the Kuroshio Current
Authors: Ishikawa Kazuo , Watanabe Chikako , Kameda Takahiko , Tokeshi Tsutomu , Horie Hikari , Hashida Daisuke , Ookawa Toshiyuki , Takeda Takashi , Kuno Masahiro , Suzuki Yuki , Takamura Shozo , Fukumoto Ryousuke , Itoh Sachihiko
Published: April 2021

To understand the population structure of the Japanese jack mackerel Trachurus japonicus in coastal areas adjacent to the Kuroshio Current (referred to as the “CAK”), we analyzed size composition and commercial landing data of juvenile fish in these areas for the period 2005–2015. Trachurus japonicus does not undergo population‐scale spawning migration, and thus, the connectivity between the spawning and juvenile/adult habitat areas is important. Therefore, our primary aim was to assess the origin of juveniles landed in a number of subareas, including those spawned in local spawning grounds in January–May in the western part of the CAK (w‐CAK), those spawned in May–July in the eastern part (e‐CAK), and those spawned in February–March in the remote spawning ground in the southern East China Sea (s‐ECS). Fishing periods starting in spring (spring onset) were commonly observed in the CAK, which involved relatively small size classes (50–100 mm fork length [FL]). Back estimates based on the growth rate of T. japonicus suggested that the contributions from the s‐ECS probably dominated most of the spring onsets in April–June because the smallest size class (50–70 mm FL) occurred almost exclusively in April–May. In autumn, onset signals were associated with the landing of juveniles from the local spawning ground in an eastern subarea of the e‐CAK. Despite the asymmetric transport and migration flows between the habitat areas of T. japonicus, its population levels may be sustained because the local and remote spawning grounds are used in different seasons.
Rapid evolution generates synergism between multiple stressors: Linking theory and an evolution experiment
Authors: Orr James A. , Luijckx Pepijn , Arnoldi Jean‐François , Jackson Andrew L. , Piggott Jeremy J.
Published: April 2021

Global change encompasses many co‐occurring anthropogenic stressors. Understanding the interactions between these multiple stressors, whether they be additive, antagonistic or synergistic, is critical for ecosystem managers when prioritizing which stressors to mitigate in the face of global change. While such interactions between stressors appear prevalent, it remains unclear if and how these interactions change over time, as the majority of multiple‐stressor studies rarely span multiple generations of study organisms. Although meta‐analyses have reported some intriguing temporal trends in stressor interactions, for example that synergism may take time to emerge, the mechanistic basis for such observations is unknown. In this study, by analysing data from an evolution experiment with the rotifer Brachionus calyciflorus (~35 generations and 31,320 observations), we show that adaptation to multiple stressors shifts stressor interactions towards synergism. We show that trade‐offs, where populations cannot optimally perform multiple tasks (i.e. adapting to multiple stressors), generate this bias towards synergism. We also show that removal of stressors from evolved populations does not necessarily increase fitness and that there is variation in the evolutionary trajectories of populations that experienced the same stressor regimes. Our results highlight outstanding questions at the interface between evolution and global change biology, and illustrate the importance of considering rapid adaptation when managing or restoring ecosystems subjected to multiple stressors under global change.
Contrast‐enhanced nano‐CT reveals soft dental tissues and cellular layers
Authors: Hildebrand T. , Nogueira L. , Sunde P. T. , Ørstavik D. , Glasmacher B. , Haugen H. J.
Published: April 2021

Aim

To introduce a methodology designed to simultaneously visualize dental ultrastructures, including cellular and soft tissue components, by utilizing phosphotungstic acid (PTA) as a contrast‐enhancement agent.

Methodology

Sound third molars were collected from healthy human adults and fixed in 4% buffered paraformaldehyde. To evaluate the impact of PTA in concentrations of 0.3%, 0.7% and 1% on dental soft and hard tissues for CT imaging, cementum and dentine‐pulp sections were cut, dehydrated and stained with immersion periods of 12, 24 h, 2 days or 5 days. The samples were scanned in a high‐resolution nano‐CT device using pixel sizes down to 0.5 µm to examine both the cementum and pulpal regions.

Results

Dental cementum and periodontium as well as odontoblasts and predentine were made visible through PTA staining in high‐resolution three‐dimensional nano‐CT scans. Different segments of the tooth required different staining protocols. The thickness of the cementum could be computed over the length of the tooth once it was made visible by the PTA‐enhanced contrast, and the attached soft tissue components of the interior of the tooth could be shown on the dentine‐pulp interface in greater detail. Three‐dimensional illustrations allowed a histology‐like visualization of the sections in all orientations with a single scan and easy sample preparation. The segmentation of the sigmoidal dentinal tubules and the surrounding dentine allowed a three‐dimensional investigation and quantitative of the dentine composition, such as the tubular lumen or the ratio of the tubular lumen area to the dentinal surface.

Conclusion

The staining protocol made it possible to visualize hard tissues along with cellular layers and soft tissues in teeth using a laboratory‐based nano‐CT technique. The protocol depended on both tissue type and size. This methodology offers enhanced possibilities for the concomitant visualization of soft and hard dental tissues.
Design, metallurgical features, mechanical performance and canal preparation of six reciprocating instruments
Authors: Martins J. N. R. , Silva E. J. N. L. , Marques D. , Belladonna F. , Simões‐Carvalho M. , Vieira V. T. L. , Antunes H. S. , Braz Fernandes F. M. B. , Versiani M. A.
Published: April 2021

Aim

To compare six reciprocating instruments regarding their geometric design, metallurgical characteristics, mechanical behaviour and ability to prepare root canals.

Methodology

A total of 246 new 25‐mm NiTi instruments (41 per group) from six reciprocating systems (Reciproc, Reciproc Blue, One Files, One Files Blue, Reverso Silver, and WaveOne Gold) were evaluated throughout a multimethod approach regarding their design using stereomicroscopy (number of blades and helix angle) and scanning electron microscopy (blades symmetry, cross section and surface finishing), nickel‐titanium composition, phase transformation temperatures, mechanical performance (cyclic fatigue, torsional and bending resistance) and unprepared canal surface area on anatomically matched mandibular molars assessed by micro‐CT. One‐way ANOVA and post hoc Tukey’s or Mood's median tests were selected depending on sample distribution with significance level set at 5%.

Results

The instruments had similarities regarding their metal composition and unprepared canal area, whilst differences in phase transformation temperatures and geometric design (number of blades, surface finishing and tip geometry) were observed. Overall, no difference was observed regarding the maximum torque values (P > 0.05), whilst One Files (72 s) and One Files Blue (414 s) had the shortest and longest times to fracture, respectively (P < 0.05). Similar angles of rotation were observed in Reciproc (310°), One Files (285°) and Reverso Silver (318°) instruments (P > 0.05), which were significantly lower than Reciproc Blue (492°), One Files Blue (456°) and WaveOne Gold (492°; P < 0.05). Maximum bending load demonstrated that Reciproc Blue (201.3 gf) was significantly more flexible that the other instruments (P < 0.05).

Conclusion

Although there were similarities in metal composition and percentage of unprepared canal surface, the instruments had differences in the overall geometric design, phase transformation temperatures and in the four mechanical resistance parameters (time to fracture, maximum torque, angle of rotation and maximum bending load).
Mucosal Kaposi's sarcoma in HIV‐negative patients: a large case series from a single, tertiary referral center in Italy
Authors: Brambilla Lucia , Maronese Carlo Alberto , Bortoluzzi Paolo , Barberi Francesco , Tourlaki Athanasia
Published: April 2021

Background

Mucosal involvement in HIV‐negative Kaposi's sarcoma (KS) is uncommon but has potentially serious repercussions on patient care. Evidence regarding its epidemiology and optimal management is limited. Invasive endoscopic staging at diagnosis and periodically during follow‐up is currently recommended by major guidelines.

Materials and methods

We reviewed the clinical records of 1,308 HIV‐negative KS patients followed at our dedicated KS outpatient service. Demographics, clinical characteristics, and treatment outcomes for cases with biopsy proven mucosal lesions were collected.

Results

Mucosal involvement was documented in 53 patients (4.1% of our cohort), being present at diagnosis in 28 (52.8%) and occurring at a later time in the remaining 25 (47.2%) patients, with a mean latency of 8 years (±7.7). Oral cavity (43.4%) and glans penis (39.6%) were the most frequently involved anatomical sites. Of those with available treatment response data, complete response (CR) of mucosal KS was appreciated in 41 cases (93.2%), while partial response (PR) and stable disease (SD) were documented in one (2.3%) and two cases (4.5%), respectively. Same‐site recurrences were noticed in seven patients (17.1%).

Conclusion

Mucosal involvement in HIV‐negative KS is rare, and its recurrence, if properly treated, appears to be infrequent. Thus, routine invasive monitoring in this setting may be unnecessary. We propose a tailored approach based on the clinical manifestations of each patient, limiting the indication of invasive procedures to the first evaluation and in case of significant clinical worsening or to monitor known mucosal localizations.
Digital light processing stereolithography of hydroxyapatite scaffolds with bone‐like architecture, permeability, and mechanical properties
Authors: Baino Francesco , Magnaterra Giulia , Fiume Elisa , Schiavi Alessandro , Tofan Luciana‐Patricia , Schwentenwein Martin , Verné Enrica
Published: April 2021

This work deals with the additive manufacturing and characterization of hydroxyapatite scaffolds mimicking the trabecular architecture of cancellous bone. A novel approach was proposed relying on stereolithographic technology, which builds foam‐like ceramic scaffolds by using three‐dimensional (3D) micro‐tomographic reconstructions of polymeric sponges as virtual templates for the manufacturing process. The layer‐by‐layer fabrication process involves the selective polymerization of a photocurable resin in which hydroxyapatite particles are homogeneously dispersed. Irradiation is performed by a dynamic mask that projects blue light onto the slurry. After sintering, highly‐porous hydroxyapatite scaffolds (total porosity ~0.80, pore size 100‐800 µm) replicating the 3D open‐cell architecture of the polymeric template as well as spongy bone were obtained. Intrinsic permeability of scaffolds was determined by measuring laminar airflow alternating pressure wave drops and was found to be within 0.75‐1.74 × 10−9 m2, which is comparable to the range of human cancellous bone. Compressive tests were also carried out in order to determine the strength (~1.60 MPa), elastic modulus (~513 MPa) and Weibull modulus (m = 2.2) of the scaffolds. Overall, the fabrication strategy used to print hydroxyapatite scaffolds (tomographic imaging combined with digital mirror device [DMD]‐based stereolithography) shows great promise for the development of porous bioceramics with bone‐like architecture and mass transport properties.
Moral Status, Luck, and Modal Capacities: Debating Shelly Kagan
Authors: Lloyd Harry R.
Published: April 2021

Shelly Kagan has recently defended the view that it is morally worse for a human being to suffer some harm than it is for a lower animal (such as a dog or a cow) to suffer a harm that is equally severe (ceteris paribus). In this article, I argue that this view receives rather less support from our intuitions than one might at first suppose. According to Kagan, moreover, an individual’s moral status depends partly upon her ‘modal capacities.’ In this article, I argue that the most natural strategy for justifying Kagan’s theory faces some important challenges. More generally, I argue that philosophers who wish to defend the view that human beings have a higher moral status than that of the lower animals face a dilemma. Either their theory of moral status will imply (unacceptably) that some severely cognitively impaired human beings have a significantly lower moral status than that of typical human beings, or these philosophers will be forced to ground moral status in a set of properties so far removed from a subject’s actual capacities that it will become difficult to see why these kinds of properties should have such moral importance.
Novel COL4A1‐VEGFD gene fusion in myofibroma
Authors: Dachy Guillaume , Fraitag Sylvie , Boulouadnine Boutaina , Cordi Sabine , Demoulin Jean‐Baptiste
Published: April 2021

Myofibroma is a benign pericytic tumour affecting young children. The presence of multicentric myofibromas defines infantile myofibromatosis (IMF), which is a life‐threatening condition when associated with visceral involvement. The disease pathophysiology remains poorly characterized. In this study, we performed deep RNA sequencing on eight myofibroma samples, including two from patients with IMF. We identified five different in‐frame gene fusions in six patients, including three previously described fusion transcripts, SRF‐CITED1, SRF‐ICA1L and MTCH2‐FNBP4, and a fusion of unknown significance, FN1‐TIMP1. We found a novel COL4A1‐VEGFD gene fusion in two cases, one of which also carried a PDGFRB mutation. We observed a robust expression of VEGFD by immunofluorescence on the corresponding tumour sections. Finally, we showed that the COL4A1‐VEGFD chimeric protein was processed to mature VEGFD growth factor by proteases, such as the FURIN proprotein convertase. In conclusion, our results unravel a new recurrent gene fusion that leads to VEGFD production under the control of the COL4A1 gene promoter in myofibroma. This fusion is highly reminiscent of the COL1A1‐PDGFB oncogene associated with dermatofibrosarcoma protuberans. This work has implications for the diagnosis and, possibly, the treatment of a subset of myofibromas.
Are patients really getting what they want? The routine implementation of decision aids for patients with hip or knee osteoarthritis in the high value healthcare collaborative and alignment between patient treatment choice and receipt
Authors: Hurley Vanessa B.
Published: April 2021

Rationale, Aims and Objectives

Alignment between patients' treatment choices and treatments received is acknowledged as an important outcome of shared decision‐making (SDM), yet recent research suggests that patients' choices do not always align with their actual treatment trajectories. This paper explores the alignment of patient‐expressed treatment choices (for surgery or medical management) after exposure to decision aids and treatments received among patients with hip or knee osteoarthritis within High Value Healthcare Collaborative (HVHC) systems as the collaborative integrated decision aids intended to support SDM into routine clinical practice.

Method

This retrospective cohort study examines data from adult (≥18 years) patients with hip or knee osteoarthritis who received decision aids as part of orthopaedic consultations within HVHC systems between 2012 and 2015. Multivariable logistic regression explored the association between patient‐level characteristics with the odds of treatment choice‐receipt alignment.

Results

The majority of patients with knee osteoarthritis (68.3%) and hip osteoarthritis (71.9%) received treatments aligned with their choices following exposure to decision aids, but analyses reveal important differences in the odds of such alignment across patient characteristics. In adjusted models, African American patients with knee osteoarthritis had 50% lower odds of receiving treatment aligned with their choices compared with Caucasian patients (OR = 0.52, P < .05). Medicare‐ or Medicaid‐insured knee patients had 49% and 59% lower odds (respectively) of receiving choice‐aligned treatments relative to privately insured patients. Patients with knee (OR = 0.40, P < .01) or hip (OR = 0.75, P < .05) osteoarthritis at earlier decision‐making stages had lower odds of receiving treatments congruent with their choices.

Conclusion

This work elucidates the odds of treatment choice‐aligned care for patients within health care systems attempting to routinely integrate decision aids to support SDM into clinical practice and underscores the gaps in achieving this alignment among African American patients, those with public insurance and those at early decision‐making stages.
Vibrio parahaemolyticus CadC regulates acid tolerance response to enhance bacterial motility and cytotoxicity
Authors: Gu Dan , Wang Kangru , Lu Tianyu , Li Lingzhi , Jiao Xinan
Published: April 2021

Pathogens adapted to sub‐lethal acidic conditions could increase the virulence and survival ability under lethal conditions. In the aquaculture industry, feed acidifiers have been used to increase the growth of aquatic animals. However, there is limited study on the effects of acidic condition on the virulence and survival of pathogens in aquaculture. In this study, we investigated the survival ability of Vibrio parahaemolyticus at lethal acidic pH (4.0) after adapted the bacteria to sub‐lethal acidic pH (5.5) for 1 hr. Our results indicated that the adapted strain increased the survival ability at lethal acidic pH invoked by an inorganic (HCl) or organic (citric) acid. RNA‐sequencing (RNA‐seq) results revealed that 321 genes were differentially expressed at the sub‐lethal acidic pH including cadC, cadBA and groES/groEL relating to acid tolerance response (ATR), as well as genes relating to outer membrane, heat‐shock proteins, phosphotransferase system and flagella system. Quantitative real‐time polymerase chain reaction (qRT‐PCR) confirmed that cadC and cadBA were upregulated under sub‐lethal acidic conditions. The CadC protein could directly regulate the expression of cadBA to modulate the ATR in V. parahaemolyticus. RNA‐seq data also indicated that 113 genes in the CadC‐dependent way and 208 genes in the CadC‐independent way were differentially expressed, which were related to the regulation of ATR. Finally, the motility and cytotoxicity of the sub‐lethal acidic adapted wild type (WT) were significantly increased compared with the unadapted strain. Our results demonstrated that the dietary acidifiers may increase the virulence and survival of V. parahaemolyticus in aquaculture.
Physical vulnerability assessment to flash floods using an indicator‐based methodology based on building properties and flow parameters
Authors: Leal Miguel , Reis Eusébio , Pereira Susana , Santos Pedro Pinto
Published: April 2021

This study focuses on the physical vulnerability of buildings to flash floods using an indicator‐based methodology. A physical vulnerability index (PhVI) that combines intrinsic vulnerability (IV) of buildings and flash flood intensity (FFI) is proposed. IV evaluates the propensity to suffer damage, resulting from indicators related to building properties. FFI estimates the potential to cause damage, resulting from indicators related to flow parameters. PhVI was applied to a critical section of a small drainage basin in Portugal where flash floods are frequent. Evaluating IV and the intensity of natural hazards is essential in physical vulnerability assessments. This study addresses two problems found in the literature: the lack of flash flood‐dedicated physical vulnerability assessments and the difficulties in assembling building properties and the intensity of natural hazards in a vulnerability index defined from indicator‐based methodologies. PhVI is a useful tool where damage records are rare or non‐existent, allowing the prioritisation of resources and application of local protection measures. This index can be adapted to other study areas and natural hazards, although more research is needed to improve the knowledge on the indicators and weights of IV and FFI.
Neuropsychological and behavioural profiles of students with intellectual development disorder on parents and teachers' perceptions
Authors: Furlin V. , Bara T. S. , Felden É. P. G. , de Farias A. C. , Cordeiro M. L.
Published: April 2021

Background

Children with intellectual development disorder (IDD) have high rates of comorbid neuropsychological and behavioural problems. However, there are not many studies on this population in middle‐income and low‐income countries. Therefore, we aimed to investigate the prevalence of neuropsychological and behavioural problems in students with and without IDD and to assess the correlation between the responses from informants (parents and teachers) and the clinical diagnoses in Brazil.

Methods

After clinical diagnosis, 78 male and female students (7–15 years old) were divided into two groups: children with IDD (n = 39) and children without IDD (n = 39). The Child Behaviour Checklist (CBCL) and Teacher's Report Form (TRF) scales were used to track neuropsychological and behavioural problems. Calculations of prevalence ratios were performed using Poisson regression with Wald tests. The CBCL and TRF results were compared between groups with Mann–Whitney U‐tests and receiver operating characteristic (ROC) analyses. The agreement between scales was assessed using the Spearman correlation test.

Results

Neuropsychological and behavioural problems were significantly more prevalent in students with IDD. The average amount of CBCL problems was significantly higher than that of TRF in the dimensions of thought, attention, somatic, attention deficit/hyperactivity, opposition defiant and total problems. Low‐to‐moderate correlations between CBCL and TRF dimensions in the IDD group were observed. ROC analyses revealed that the dimensions of internalising problems and total scores reflecting CBCL and TRF problems were the most important factors for identifying neuropsychological and behavioural problems in the IDD group.

Conclusions

Students with IDD require early identification of behavioural and emotional symptoms to avoid the underdiagnoses of various mental health problems, especially those with internalising characteristics. The CBCL and TRF may assist in the early screening of these comorbidities.
Antecedents and Outcomes of Nurses’ Subjective Career Success: A Path Analysis
Authors: Sönmez Betül , Gül Duygu , İspir Demir Öznur , Emiralioğlu Ramazan , Erkmen Tuna , Yıldırım Aytolan
Published: April 2021

Purpose

This study aimed to test the hypothesis model showing the relationship between nurses’ individual and working characteristics, nursing work environment, subjective career success, job satisfaction, intent to leave, and professional commitment.

Design and Methods

A cross‐sectional and correlational design was utilized for the study. The study sample consisted of 604 nurses working in four hospitals in Istanbul, Turkey. Data were collected using the Nurse Information Form, Subjective Career Success Inventory, Practice Work Environment Scale of the Nursing Work Index, Job Satisfaction Global Item, Intent to Leave Subscale, and Professional Commitment Scale. Data were analyzed using descriptive and correlation analysis, and the hypothesis model was tested using structural equation modeling.

Findings

The hypothesis model that was established to test the antecedents and outcomes of subjective career success in nurses was acceptable and had a good fit. Having a master’s degree, work schedule with rotating shifts (negative), good individual income, participation in hospital affairs, staffing and resource adequacy, and nurse–physician relations were significantly associated with the subjective career success of nurses. Subjective career success had a positive effect on job satisfaction and professional commitment and a negative significant effect on intent to leave in nurses.

Conclusions

This study revealed that human capital, objective career success, and some characteristics of the nursing work environment were significantly associated with nurses’ subjective career success, and that increased subjective career success produced positive professional and organizational outcomes.

Clinical Relevance

The results of this study, which revealed the antecedents and outcomes of nurses’ career success, should be taken into consideration by managers who wish to retain a qualified nursing workforce.
Incidence and risk factors of urinary tract infections in hospitalised patients with spinal cord injury
Authors: Kim Yielin , Cho Mi Hwa , Do Kyungmin , Kang Hye Jin , Mok Jin Ju , Kim Mi Kyoung , Kim Gwang Suk
Published: April 2021

Aims and objectives

To investigate the incidence of urinary tract infection and analyse its risk factors among hospitalised patients with spinal cord injury.

Background

While the incidence of urinary tract infection varies widely according to the healthcare setting and patients’ clinical characteristics, formal reports are limited in quantity. There has been no consensus regarding the risk factors for urinary tract infection.

Design

A retrospective descriptive study.

Methods

Electronic medical records of 964 subjects between 2010–2017 were reviewed. Urinary tract infection status was examined to identify newly occurred cases. Data included demographic and clinical characteristics, hydration status and length of hospitalisation. The reporting of the study followed the EQUATOR Network's STROBE checklist.

Results

Of the sample, 31.7% had urinary tract infection (95% confidence interval: 1.288 to 1.347, p < .001). Sex, completeness of injury, type of bladder emptying, detrusor function and urethral pressure were significant factors affecting urinary tract infection. Patients who were male and those with injury classifications A, B and C had higher risk of urinary tract infection. Patients with urinary or suprapubic indwelling catheters, as well as those with areflexic detrusor combined with normotonic urethral pressure or overactive detrusor combined with normotonic urethral pressure, showed higher risk. Length of hospitalisation in patients with urinary tract infection was greater than that in uninfected patients, which implies the importance of prevention of urinary tract infection.

Conclusions

Nurses should carefully assess risk factors to prevent urinary tract infection in patients with spinal cord injury in the acute and sub‐acute stages of the disease trajectory and provide individualised nursing care.

Relevance to clinical practice

This study contributes evidence for up‐to‐date clinical nursing practice for the comprehensive management of urinary tract infection. This can lead to improvements in nursing care quality and patient outcomes, including length of hospitalisation.
Theorising survivorship after intensive care: A systematic review of patient and family experiences
Authors: Kean Susanne , Donaghy Eddie , Bancroft Angus , Clegg Gareth , Rodgers Sheila
Published: April 2021

Aims and Objective

This systematic literature review explores and maps what we know about survivorship to understand how survivorship can be theoretically defined.

Background

Survivorship of critical illness has been identified as a challenge for the 21st Century. Whilst the use of the term ‘survivorship’ is now common in critical care, it has been borrowed from the cancer literature where the discourse on what survivorship means in a cancer context is ongoing and remains largely descriptive. In the absence of a theoretical understanding, the term ‘survivorship’ is often used in critical illness in a generic way, limiting our understanding of what survivorship is. The current COVID‐19 pandemic adds to an urgency of understanding what intensive care unit (ICU) survivorship might mean, given the emerging long‐term consequences of this patient cohort. We set out to explore how survivorship after critical illness is being conceptualised and what the implications might be for clinical practice and research.

Design

Integrated systematic literature review. The review protocol was registered with PROSPERO International Prospective Register of Systematic Reviews. PRISMA guidelines were followed and a PRISMA checklist for reporting systematic reviews completed.

Results

The three main themes around which the reviewed studies were organised are: (a) healthcare system; (b) ICU survivors’ families; and (c) ICU survivor's identity. These three themes feed into an overarching core theme of ‘ICU Survivorship Experiences’. These themes map our current knowledge of what happens when a patient survives a critical illness and where we are in understanding ICU survivorship.

Conclusion

We mapped in this systematic review the different pieces of the jigsaw that emerge following critical illness to understand and see the bigger picture of what happens after patients survive critical illness. It is evident that existing research has mapped these connections, but what we have not managed to do yet is defining what survivorship is theoretically. We offer a preliminary definition of survivorship as a process but are aware that this definition needs to be developed further with patients and families.
Illegitimate tasks in health care: Illegitimate task types and associations with occupational well‐being
Authors: Kilponen Kiia , Huhtala Mari , Kinnunen Ulla , Mauno Saija , Feldt Taru
Published: April 2021

Aims and objectives

The aims of the study were to identify content categories of unreasonable and unnecessary illegitimate tasks and to investigate how unreasonable and unnecessary tasks relate to occupational wellbeing.

Background

Illegitimate tasks are a common stressor among healthcare professionals, and they have been shown to have negative associations with occupational well‐being. Despite this evidence, research has not yet uncovered what kinds of tasks healthcare professionals consider illegitimate.

Design and method

The data gathered by means of an online survey consisted of 1024 municipal healthcare organisation employees. A theory‐driven qualitative content analysis was used to analyse freely reported illegitimate tasks. For occupational well‐being associations, a mixed‐methods approach was used (ANCOVA and linear regression analysis). The STROBE statement—checklist for cross‐sectional studies was used.

Results

Eight content categories were found for illegitimate tasks. For unreasonable tasks, these were (1) tasks outside one's occupational role (78% of all unreasonable tasks), (2) conflicting or unclear demands (9%), (3) tasks with insufficient resources (8%) and (4) tasks with difficult consequences (5%), and for unnecessary tasks, these were (1) impractical or outdated working habits (31% of all unnecessary tasks), (2) tasks related to dysfunctional technology (30%), (3) unnecessary procedures (27%) and (4) tasks related to bureaucratic demands (12%). Unreasonable and unnecessary tasks were associated with higher levels of burnout and lower work engagement and the meaningfulness of work.

Conclusions

Our findings support the theory that illegitimate tasks are an occupational stressor with negative effects on burnout, work engagement and meaningfulness of work.

Relevance to clinical practice

The study offers insights into the types of tasks health care employees see as illegitimate and highlights the importance of good job design in promoting occupational well‐being in health care.
Effect of self‐care intervention for controlling interdialytic weight gain among patients on haemodialysis: A systematic review and meta‐analysis
Authors: Cho Mi‐Kyoung , Kang Youngmi
Published: April 2021

Aims and objectives

This study aims to identify the combined effects of self‐care or self‐management nursing interventions on primary (interdialytic weight gain) and secondary (potassium, phosphorous, self‐care and self‐efficacy) outcomes in haemodialysis patients with chronic kidney disease.

Background

Prior systematic reviews and meta‐analyses revealed inconclusive evidence regarding the effects of self‐care or self‐management nursing interventions among the patients on haemodialysis. Also, insufficient or unclear descriptions of methods resulted in weak empirical evidence of such effects.

Design

Systematic review and meta‐analysis were used.

Methods

Four databases were searched to identify 36 articles published from 2000 to 2020. Keywords were selected according to the Population Intervention Comparison Outcome format using MeSH terms and text words. The meta‐analysis involved synthesis of effect size, tests of homogeneity and heterogeneity, and funnel plot, Egger's regression test, and Begg's test for assessing publication bias. This study was performed based on the Guidelines of Systematic Reporting of Examination presented in the PRISMA checklist (Appendix S1) and the Cochrane Handbook for Systematic Reviews of Interventions. The search protocol has been registered at the PROSPERO International Prospective Register of Systematic Reviews.

Results

The overall effect on interdialytic weight gain was −0.26, suggesting a small effect size, with the interdialytic weight gain after nursing interventions decreasing significantly. Among the type of nursing interventions, the overall effect on interdialytic weight gain of education programmes and fluid and sodium control programmes was −0.36 and 0.25, respectively, a small effect size, and was statistically significant.

Conclusions

Based on the results of this study, healthcare professionals may encourage the patients on haemodialysis to engage in self‐directed management of their symptoms, such as health contract, and promote health literacy through improving their self‐efficacy.

Relevance to clinical practice

This meta‐analysis could provide fundamental data to assist with the development of an evidence‐based practice guideline.
Integrative therapies in intensive care units: A scoping review
Authors: Mamba Welile M. , Filmalter Celia J. , Heyns Tanya
Published: April 2021

Aim

We reviewed literature describing the incorporation of integrative therapies in intensive care units. We aimed to elicit an overall picture of research and find existing knowledge gaps on this topic.

Design

We conducted a scoping review guided by Arksey and O'Malley's methodological framework and were guided by the PRISMA‐ScR Checklist.

Methods

Various databases were searched for relevant literature. English language articles published between 1999 and 2019 were retrieved. Data were extracted based on sample, sample size, methodology, findings and implications for practice.

Results

From 275 studies retrieved, 30 were included, based on the inclusion criteria. Three key themes related to integrative therapies in intensive care units emerged from the literature: 1) general information on integrative therapies; 2) interventions using integrative therapies; and 3) perceptions and attitudes of nurses on integrative therapies. Positive outcomes were observed in ICUs, and nurses showed positive attitudes towards using integrative therapies.