bluuebunny/crossref_metadata_2025 huggingface dataset:
CEO Awards and Financial Misconduct
Authors: Li Jiangyan , Shi Wei , Connelly Brian L. , Yi Xiwei , Qin Xin
Published: May 2020

We propose that CEOs are more likely to engage in financial misconduct after the media names them as being among the best business leaders. We theorize this occurs because winning such an award is a meaningful event that increases the CEO’s self-worth but also increases the CEO’s sense of psychological entitlement, including the freedom to break rules. We test our ideas by examining scenarios where award-winning CEOs feel especially entitled and therefore are most likely to commit misconduct. Using a sample of award-winning CEOs from Chinese publicly listed firms, we find that award-winning CEOs are more likely to commit financial misconduct in the post-award period than in the pre-award period. In addition, the effect of winning a CEO award on financial misconduct is stronger when CEOs are underpaid or from industries in which awards are rare and therefore more special. We also validate aspects of our theory that are difficult to observe. First, we use bivariate probit models with partial observability to confirm that our results hold when accounting for unobserved misconduct. Second, we use survey data that capture the psychological entitlement of a subsample of CEOs to confirm the mediating effect of psychological entitlement on the relationship between winning an award and committing financial misconduct.
The 2018 World Cup in Russia and Its Regimes of Visibility: The Cases of Nizhny Novgorod and Kazan
Authors: Makarychev Andrey , Yatsyk Alexandra
Published: May 2020

The article addresses visualizations of the 2018 FIFA World Cup in Russian and international digital media. Drawing on the scholarship on discoursive hegemony, the authors intoduce a concept of hegemonic regime of visibility as a general frame for understanding the dominant ways of visualizing mega-events which comprise elements of attractiveness and enjoyment, on one hand, and surveillance, control, and security, on the other. Based on the cases of Nizhny Novgorod and Kazan, the authors argue, first, that the 2018 World Cup’s hegemonic regime of visibility, co-administered by FIFA and Russian government, implied a hierarchy of performative roles prescribed to the host cities as major promoters of the event. Second, local authorities in Russia used this regime for self-(re)branding to advertise the cities/regions as parts of the global world and authentically specific spaces with unique folkloric and ethnic traditions. Third, the FIFA hegemonic regime of visibility was challenged by alternative incursions that destabilized and infused new meanings in the dominant visual order.
A Model of Discipline: The Rule(s) of Midnight Football and the Production of Order in Subjects and Society
Authors: Ekholm David , Dahlstedt Magnus
Published: May 2020

This article explores the rationalities of social change of a sports-based intervention, midnight football, carried out on two sites in the suburban landscape of Sweden. Based on interviews with coaches and managers and on-site observations, we examine how rationalities and technologies of social change are promoted, how technologies of social change are assumed to operate within the intervention, and how the intervention objectives are formed in relation to the technologies promoted. The analysis is guided by a Foucauldian perspective on disciplinary and pastoral power. It displays how various conceptualizations of risk underpin the intervention, and, in particular, technologies of spatial and temporal diversion. Youth are (dis)located to perceived sites of order and rule, as midnight football is portrayed as a regulated arena in opposition to outside sites of disorder. To form and visualize the rules of law, coaches, ascribed the position of role-models and law-makers, have a particularly important role to play, embodying law, rule, and conduct. In addition, disciplinary power operates through normalizing sanctions, stressing the corrective influence of coaches and readjustment of youth conduct. The technologies promoted are underpinned by goals to form a certain order of subjects, where ideals of conduct can be transferred and proliferated to the world outside, forming order and security in society. Those deemed at-risk and in need of social change, are addressed by means of discipline and control. Conclusively, the technologies promoted appear more as a symptom of existing patterns of inequalities and segregation than as a solution to the challenges confronted.
The Trach Trail: A Systems‐Based Pathway to Improve Quality of Tracheostomy Care and Interdisciplinary Collaboration
Authors: Cherney Rebecca L. , Pandian Vinciya , Ninan Ashly , Eastman Debra , Barnes Brian , King Elizabeth , Miller Brianne , Judkins Samantha , Smith Alfred E. , Smith Nan M. , Hanley Julie , Creutz Eileen , Carlson Megan , Schneider Kevin J. , Shever Leah L. , Casper Keith A. , Davidson Patricia M. , Brenner Michael J.
Published: May 2020

Objective

To implement a standardized tracheostomy pathway that reduces length of stay through tracheostomy education, coordinated care protocols, and tracking patient outcomes.

Methods

The project design involved retrospective analysis of a baseline state, followed by a multimodal intervention (Trach Trail) and prospective comparison against synchronous controls. Patients undergoing tracheostomy from 2015 to 2016 (n = 60) were analyzed for demographics and outcomes. Trach Trail, a standardized care pathway, was developed with the Iowa Model of Evidence‐Based Practice. Trach Trail implementation entailed monthly tracheostomy champion training at 8‐hour duration and staff nurse didactics, written materials, and experiential learning. Trach Trail enrollment occurred from 2018 to 2019. Data on demographics, length of stay, and care outcomes were collected from patients in the Trach Trail group (n = 21) and a synchronous tracheostomy control group (n = 117).

Results

Fifty‐five nurses completed Trach Trail training, providing care for 21 patients placed on the Trach Trail and for synchronous control patients with tracheostomy who received routine tracheostomy care. Patients on the Trach Trail and controls had similar demographic characteristics, diagnoses, and indications for tracheostomy. In the Trach Trail group, intensive care unit length of stay was significantly reduced as compared with the control group, decreasing from a mean 21 days to 10 (P <. 05). The incidence of adverse events was unchanged.

Discussion

Introduction of the Trach Trail was associated with a reduction in length of stay in the intensive care unit. Realizing broader patient‐centered improvement likely requires engaging respiratory therapists, speech language pathologists, and social workers to maximize patient/caregiver engagement.

Implications for Practice

Standardized tracheostomy care with interdisciplinary collaboration may reduce length of stay and improve patient outcomes.
An Analysis of 1‐Year Charges for Head and Neck Cancer: Targets for Value‐Based Interventions
Authors: Pang John , Crawford Kayva , Faraji Farhoud , Ramsey Celia , Kemp Aaron , Califano Joseph A.
Published: May 2020

Objective

To identify the dominant clinical factors associated with increased 1‐year charges in treating head and neck cancer.

Study Design

Retrospective review.

Setting

Single academic institution.

Subjects and Methods

We retrospectively reviewed 1‐year charges for 196 consecutive patients with head and neck cancer (HNC) who were treated exclusively at our institution. We analyzed charges by department as well as factors associated with increased charges per multivariable regression.

Results

The mean age was 59.6 years (SD, 14.9). Most of the population was male (64%), white (70%), and commercially insured (46%). The most common primary sites were the oropharynx (25%; 76%, HPV positive), skin (19%), and thyroid (17%). Eighty‐three percent of total charges were due to standard‐of‐care treatment for HNC: surgery ($16 million), radiation therapy ($22 million), or chemotherapy ($11 million). The median total charge per patient was $212,484 (interquartile range, $78,630‐$475,823). Multivariable regression demonstrated that the following were associated with increased charges: nasopharynx subsite ($250,929 [95% CI, $93,290‐$408,569]; effect size in US dollars, P =. 002), advanced stage (American Joint Committee on Cancer, seventh edition; $80,331 [$22,726‐$137,936], P =. 007), therapeutic surgery ($281,893 [$117,371‐$446,415], P =. 001), chemotherapy ($183,331 [$125,497‐$241,165], P <. 001), radiation ($203,397 [$143,454‐$263,341], P <. 001), surgical complication requiring return to the operating room ($147,247 [$37,240‐$257,254], P =. 009), emergency department visits ($89,050 [$23,811‐$154,289], P =. 008), and admissions ($140,894 [$82,895‐$198,893], P <. 001; constant, –$233,927 [–$410,790 to –$57,064]). The top quartile accrued 55% of the total charges.

Conclusion

Radiation, followed by surgery and chemotherapy, were the most expensive components of HNC care. In this analysis, we identified the dominant clinical factors associated with increased charges.
Surgical Field Visualization during Functional Endoscopic Sinus Surgery: Comparison of Propofol‐ vs Desflurane‐Based Anesthesia
Authors: Gollapudy Suneeta , Gashkoff Drake A. , Poetker David M. , Loehrl Todd A. , Riess Matthias L.
Published: May 2020

Objective

To assess if the type of general anesthetic affects bleeding and field visualization during endoscopic sinus surgery.

Study Design

Prospective, randomized, controlled trial.

Setting

Academic teaching hospital and Veterans Affairs hospital in the United States.

Subjects and Methods

Seventy patients were randomized to 1 of 3 anesthetic regimens: (1) the volatile anesthetic desflurane (n = 22), (2) intravenous anesthesia with propofol (n = 25), or (3) a combination of propofol and desflurane (n = 23). Intravenous remifentanil was titrated to decrease the mean arterial pressure to 60 to 70 mm Hg but not ≥30% from baseline. Surgical bleeding scores were recorded along with bleeding rates and hemodynamic parameters, including cardiac output and systemic vascular resistance through pulse contour analysis from a radial arterial line. Statistics: multiple comparison tests and regression analyses; α =. 05.

Results

There were no differences in bleeding rate (median, 0.58, 0.85, 0.57 mL min–1), bleeding score (2.1, 2.0, 2.0), surgery duration (79, 81, 86 minutes), extubation time (9, 7, 8 minutes), recovery room time (65, 61, 61 minutes), or any hemodynamic parameters among groups 1 through 3, respectively. Group 1 required lower remifentanil infusions than group 2 (0.11 vs 0.26 µg kg–1 min–1; P =. 01). The bleeding score correlated positively with height (P =. 014) and the Lund‐MacKay score (P =. 013). Bilateral vs unilateral surgery led to longer surgery duration (P =. 001) and recovery room time (P =. 004).

Conclusion

When remifentanil is used for controlled hypotension, propofol has no advantage over desflurane to improve surgical field visualization during functional endoscopic sinus surgery.
Impact of Smoking on Survival Outcomes in HPV‐Related Oropharyngeal Carcinoma: A Meta‐analysis
Authors: Ference Ryan , Liao David , Gao Qi , Mehta Vikas
Published: May 2020

Objective

Characterize the survival impact of smoking on HPV‐related (human papillomavirus) oropharyngeal squamous cell carcinoma.

Data Sources

Articles from 2000 to 2019 in the PubMed, Embase, and Cochrane Library databases were systematically reviewed for content and inclusion/exclusion criteria.

Review Methods

Two reviewers independently analyzed the databases for eligibility and quality of the articles. Demographic data, smoking history, and survival outcomes were recorded. Hazard ratios and 95% CIs were collectively analyzed through a random effects meta‐analysis model.

Results

Fifteen articles were included in the meta‐analysis for overall survival, disease‐specific survival, disease‐free survival, progression‐free survival, and locoregional recurrence outcomes. The overall survival hazard ratio was 2.4 for ever having smoked (95% CI, 1.4‐4.0; P =. 0006, I2 =. 384) and 3.2 for current smoking (95% CI, 2.2‐4.6; P <. 0001, I2 = 0). The hazard ratio for disease‐specific survival in current smokers was 6.3 (95% CI, 1.3‐29.3; P =. 0194, I2 = 0). Ever smoking had a larger impact on overall survival and disease‐specific survival than the 10–pack year smoking threshold.

Conclusion

Smoking negatively affects survival in patients with HPV‐related oropharyngeal carcinoma across all outcomes. Current smoking during treatment is associated with the greatest reduction in survival, possibly secondary to diminished radiation therapy efficacy.
Airborne Aerosol Generation During Endonasal Procedures in the Era of COVID‐19: Risks and Recommendations
Authors: Workman Alan D. , Jafari Aria , Welling D. Bradley , Varvares Mark A. , Gray Stacey T. , Holbrook Eric H. , Scangas George A. , Xiao Roy , Carter Bob S. , Curry William T. , Bleier Benjamin S.
Published: May 2020

Objective

In the era of SARS‐CoV‐2, the risk of infectious airborne aerosol generation during otolaryngologic procedures has been an area of increasing concern. The objective of this investigation was to quantify airborne aerosol production under clinical and surgical conditions and examine efficacy of mask mitigation strategies.

Study Design

Prospective quantification of airborne aerosol generation during surgical and clinical simulation.

Setting

Cadaver laboratory and clinical examination room.

Subjects and Methods

Airborne aerosol quantification with an optical particle sizer was performed in real time during cadaveric simulated endoscopic surgical conditions, including hand instrumentation, microdebrider use, high‐speed drilling, and cautery. Aerosol sampling was additionally performed in simulated clinical and diagnostic settings. All clinical and surgical procedures were evaluated for propensity for significant airborne aerosol generation.

Results

Hand instrumentation and microdebridement did not produce detectable airborne aerosols in the range of 1 to 10 μm. Suction drilling at 12,000 rpm, high‐speed drilling (4‐mm diamond or cutting burs) at 70,000 rpm, and transnasal cautery generated significant airborne aerosols (P <. 001). In clinical simulations, nasal endoscopy (P <. 05), speech (P <. 01), and sneezing (P <. 01) generated 1‐ to 10‐μm airborne aerosols. Significant aerosol escape was seen even with utilization of a standard surgical mask (P <. 05). Intact and VENT‐modified (valved endoscopy of the nose and throat) N95 respirator use prevented significant airborne aerosol spread.

Conclusion

Transnasal drill and cautery use is associated with significant airborne particulate matter production in the range of 1 to 10 μm under surgical conditions. During simulated clinical activity, airborne aerosol generation was seen during nasal endoscopy, speech, and sneezing. Intact or VENT‐modified N95 respirators mitigated airborne aerosol transmission, while standard surgical masks did not.
A Synthetic Graft With Multilayered Co-Electrospinning Nanoscaffolds for Bridging Massive Rotator Cuff Tear in a Rat Model
Authors: Cong Shuang , Sun Yaying , Lin Jinrong , Liu Shaohua , Chen Jiwu
Published: May 2020

Background:

Graft bridging is used in massive rotator cuff tear (MRCT); however, the integration of graft-tendon and graft-bone is still a challenge.

Hypothesis:

A co-electrospinning nanoscaffold of polycaprolactone (PCL) with an “enthesis-mimicking” (EM) structure could bridge MRCT, facilitate tendon regeneration, and improve graft-bone healing.

Study Design:

Controlled laboratory study.

Methods:

First, we analyzed the cytocompatibility of the electrospinning nanoscaffolds, including aligned PCL (aPCL), nonaligned PCL (nPCL), aPCL–collagen I, nPCL–collagen II, and nPCL-nanohydroxyapatite (nHA). Second, for the EM condition, nPCL–collagen II and nPCL-nHA were electrospun layer by layer at one end of the aPCL–collagen I; for the control condition, the nPCL was electrospun on the aPCL. In 40 mature male rats, resection of both the supraspinatus and infraspinatus tendons was performed to create MRCT, and the animals were divided randomly into EM and control groups. In both groups, one end of the layered structure was fixed on the footprint of the rotator cuff, whereas the other end of the layered structure was sutured with the tendon stump. The animals were euthanized for harvesting of tissues for histologic and biomechanical analysis at 4 weeks or 8 weeks postoperatively.

Results:

All scaffolds showed good cytocompatibility in vitro. The graft-tendon tissue in the EM group had more regularly arranged cells, denser tissue, a significantly higher tendon maturing score, and more birefringence compared with the control group at 8 weeks after operation. Newly formed fibrocartilage could be observed at the graft-bone interface in both groups by 8 weeks, but the EM group had a higher graft-bone healing score and significantly more newly formed fibrocartilage than the control group. An enthesis-like structure with transitional layers was observed in the EM group at 8 weeks. Biomechanically, the values for maximum failure load and stiffness of the tendon-graft-bone complex were significantly higher in the EM group than in the control group at 8 weeks.

Conclusion:

The co-electrospinning nanoscaffold of aPCL–collagen I could be used as a bridging graft to improve early graft-tendon healing for MRCT in a rat model and enhance early enthesis reconstruction in combination with a multilayered structure of nPCL–collagen II and nPCL-nHA.

Clinical Relevance:

We constructed a graft to bridge MRCT, enhance graft-tendon healing and graft-bone healing, and reconstruct the enthesis structure.
Lexical Patterns in Adolescents’ Online Writing: The Impact of Age, Gender, and Education
Authors: Hilte Lisa , Daelemans Walter , Vandekerckhove Reinhild
Published: May 2020

This article examines the impact of the sociodemographic profile (including age, gender, and educational track) of Flemish adolescents (aged 13–20) on lexical aspects of their informal online discourse. The focus on lexical and more “traditional,” print-based aspects of literacy is meant to complement previous research on sociolinguistic variation with respect to the use of prototypical features of social media writing. Drawing on a corpus of 434,537 social media posts written by 1,384 teenagers, a variety of lexical features and related parameters is examined, including lexical richness, top favorite words, and word length. The analyses reveal a strong common ground among the adolescents with respect to some features but divergent writing practices by different groups of teenagers with regard to other parameters. Furthermore, this study analyzes both standardized versions of social media messages and the original utterances (including nonstandard markers of online writing). Strikingly, different results emerge with respect to adolescents’ exploitation of more traditional versus digital literacy skills in relation to their sociodemographic profile, especially with respect to sentiment expression (verbal versus typographic/pictorial). The study suggests that the inclusion of nonverbal communicative strategies, for instance in language teaching, might be a pedagogical asset, since these strategies are eagerly adopted by teenagers who show proof of less developed traditional writing skills.
Amniotic Fluid Stem Cells Improve Rat Bladder Dysfunction After Pelvic Nerve Transection
Authors: Liang Ching-Chung , Shaw Sheng-Wen Steven , Chou Hung-Hsueh , Huang Yung-Hsin , Lee Tsong-Hai
Published: May 2020

The effects of human amniotic fluid stem cells (hAFSCs) transplantation on bladder dysfunction after pelvic nerve transection (PNT) remain to be clarified. Five groups of female Sprague-Dawley rats were studied including sham operation, unilateral PNT alone or plus hAFSCs transplantation, and bilateral PNT alone or plus hAFSCs transplantation. hAFSCs were injected at the site of PNT. Cystometries, neurofilament density within bladder nerves, and the expressions of bladder protein gene-product 9.5 (PGP9.5), growth-associated protein 43 (GAP-43), nerve growth factor (NGF), p75 (NGF receptor), CXCL12, CCL7, and enkephalin were studied. Compared to sham-operation group, bladder weight increased and neurofilament density decreased at 10 and 28 days after unilateral and bilateral PNT, but all improved after hAFSCs transplantation. Unilateral PNT could increase bladder capacity, residual volume, and number of nonvoiding contractions but decrease peak voiding pressure and leak point pressure. Bilateral PNT caused overflow incontinence and increased the number of nonvoiding contractions. These cystometric parameters improved after hAFSCs transplantation. After PNT, bladder PGP9.5 mRNA and immunoreactivities decreased at 10 and 28 days, GAP-43 mRNA and immunoreactivities increased at 10 days and decreased at 28 days, both NGF and p75 mRNAs and immunoreactivities increased at 10 and/or 28 days, and enkephalin immunoreactivities decreased at 10 and 28 days, but these were all improved after hAFSCs transplantation. Our results showed that bladder dysfunction induced by PNT could be improved by hAFSCs transplantation, and PGP9.5, GAP-43, and neurotrophins could be involved in the mechanisms of nerve regeneration after hAFSCs transplantation.
Data Mining Identifies Six Proteins that Can Act as Prognostic Markers for Head and Neck Squamous Cell Carcinoma
Authors: Wu Zeng-hong , Yun-Tang  , Cheng Qing
Published: May 2020

Head and neck squamous cell carcinoma (HNSCC) is a malignant tumor of the upper aerodigestive tract affecting the oral cavity, lips, paranasal sinuses, larynx, and nasopharynx. Proteogenomics combines proteomics and genomics and employs mass spectrometry and high-throughput sequencing technologies to identify novel peptides. The aim of this study was to identify potential protein biomarkers for clinical treatment of HNSCC. To achieve this, we utilized two sets of data, one on proteins from The Cancer Proteome Atlas (TCPA) and the other on gene expression from The Cancer Genome Atlas (TCGA) database, to evaluate dysfunctional proteogenomics microenvironment. Univariate Cox regression analysis was performed to examine the relationship between protein signatures and prognosis. A total of 19 proteins were significantly associated with overall survival (OS) of patients, of which E2F transcription factor 1 (E2F1; HR = 4.557, 95% CI = 1.810 to 11.469) and enhancer of zeste homolog 2 (EZH2; HR = 0.430, 95% CI = 0.187 to 0.984) were the most differentially expressed between patients with longer and shorter OS, respectively. Furthermore, multivariate Cox regression analysis on six proteins (ERALPHA, HER3, BRAF, P27, RAPTOR, and E2F1) was performed to build the prognostic model. The receiver operating characteristic curves were used to determine whether the expression pattern of survival-related proteins could provide an early prediction of the occurrence of HNSCC. Herein, we found an AUC of 0.720. Based on an online database, we identified novel protein markers for the prognosis of HNSCC. The findings of the present study may provide new insights into the development of new and reliable tools for precise cancer intervention.
Effect of modified microcrystalline cellulose on poly(3-hydroxybutyrate) molecular dynamics by proton relaxometry
Authors: Ribeiro Filipe Antonio dos Santos Viegas , Cavalcante Maxwell de Paula , Tavares Maria Inês Bruno , Melo Amanda Ramos Aragão
Published: May 2020

Hybrid films of poly(3-hydroxybutyrate) (PHB) and modified cellulose by solution casting method were prepared, aiming to study the influence of modified cellulose (0.25%, 0.5% and 0.75% w/w) on the structural organization and thermal properties of PHB matrix. The modified cellulose showed good dispersion in polymer matrix, due to the high compatibility between phases explained by similarity of polymer and filler structures. The composites were studied by wide-angle X-ray diffractometry, differential scanning calorimetry, thermogravimetric analysis, and time-domain nuclear magnetic resonance (NMR) spectroscopy. The conjugation of results coming from those techniques allowed to determine the cellulose concentration that had the highest influence on crystalline planes and degree of crystallinity of PHB, that is, the influence in the composite structure. The molecular dynamics obtained by NMR showed a reciprocal influence between polymer matrix and cellulose particles, enhancing the interactions present in the agglomerated particles.
Nigerian Governance Challenge: Exploring the Role of Natural Resource Rents
Authors: Fagbemi Fisayo , Omowumi Adeoye Grace
Published: May 2020

Nigeria is a glaring example of a country where weak public institutions are pervasive in spite of its huge natural resource wealth. The presence of natural resource abundance has exacerbated the overwhelming development challenge in the economy. While the upshot of most empirical findings of the resource impact covers how the growth path is determined through the channel of institutions, the question as to why resource rents often fail to stimulate improved governance is more critical than ever. Hence, the study examines the effect of natural resource rents on the quality of governance in Nigeria for the period 1984–2017, using ARDL bounds test approach, Dynamic Least Squares (DOLS), and Granger Causality test based on Vector Error Correction Model (VECM). Results reveal that natural resource rents have an insignificant effect on governance indicators in the long-run as well in the short-run, suggesting that natural resource windfalls have a shallow effect on the development of good governance. However, further evidence indicates that pervasive institutional gaps in Nigeria could be stimulated or caused by the overdependence on natural resource rents and entrenched mismanagement tendencies. Thus, the study suggests that maintaining strong political commitment, curtailing overdependence on natural resources, and ensuring sound management of natural resource wealth are central for improved governance.
Getting Ahead in a Just-Gettin’-By World: Gender Differences in Intake Characteristics and Poorer Outcomes Observed for Men
Authors: Wahler Elizabeth A. , Cummings Cristy E.
Published: May 2020

Getting Ahead in a Just-Gettin’-By World (“GA”), a capacity-building, anti-poverty, group-based intervention, is widely used in the United States and internationally. This U.S. nationwide study examines gender differences in intake characteristics and outcomes ( N = 328). Specific focus was on men ( n = 108), because they are often the minority in GA groups and may have different poverty-related risk factors and help-seeking behaviors. At intake, men were more likely to have criminal convictions and substance abuse problems. Outcome comparisons indicated that men had lesser increases in mental health and well-being, social support, hope, and goal-directed behavior and planning throughout participation in GA than did women. Findings suggest that modifications might need to be made to GA to better meet the needs of men.
Variations in Patient Satisfaction Scores Between HCAHPS and a Novel Orthopedic Practice–Specific Survey
Authors: Chang Michael , Russo Glenn S. , Canseco Jose A. , Nicholson Kristen , Sharma Rishi , Koomson Jacqueline , Vaccaro Alexander R.
Published: May 2020

Performance on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey can affect up to 33% of a physician’s reimbursement from the Centers for Medicare & Medicaid Services. At this pseudo-private orthopedic practice, the authors characterized how physicians often achieve drastically different scores between HCAHPS and an Internal Patient Satisfaction Questionnaire (IPSQ). Eighteen physicians were ranked separately according to percentage of top-box scores on HCAHPS and IPSQ. There was an inverse relationship between physician rank for the 2 surveys according to Spearman correlation coefficient (ρ = −0.36, P = .15). Qualitative subanalysis indicated that although “physician interaction” was the most common reason for negative comments on HCAHPS, “ancillary staff” and “workflow” concerns were common on IPSQ. The outpatient setting remains a critical component in achieving high-quality orthopedic care. Consequently, HCAHPS alone may not be a sufficient indicator of patient satisfaction for orthopedic and other subspecialty practices.
Interaction Between Low-Dose Aspirin and Nonsteroidal Anti-Inflammatory Drugs Can Compromise Aspirin’s Efficacy in Preventing Venous Thrombosis Following Total Joint Arthroplasty
Authors: Krauss Eugene , Cronin MaryAnne , Dengler Nancy , Segal Ayal
Published: May 2020

Total joint arthroplasty is a rapid recovery procedure with patients optimized quickly in preparation for discharge. Two significant postoperative goals are effective pain management and prevention of postoperative venous thromboembolism (VTE). Low-risk patients receive aspirin 81 mg twice daily for VTE prophylaxis; this dosing regimen has been reduced over the past few years from 325 mg to 162 mg to 81 mg twice daily. Unless contraindications exist, all patients receive multimodal pain management that includes the use of celecoxib or meloxicam. Upon reduction of the aspirin dose to 81 mg twice daily, we rapidly identified 2 patients who developed a pulmonary embolus when celecoxib or meloxicam was administered concurrently with aspirin. The interaction between nonsteroidal anti-inflammatory drugs (NSAIDs) and low-dose aspirin varies among the different NSAIDs. It is also highly dependent on numerous factors, including time of administration, dose of aspirin, and both pharmacodynamics and dose of the NSAID. Real-world outcomes of concomitant administration of NSAIDs with low-dose aspirin led to increased incidence of VTE, possibly due to competitive inhibition of aspirin at platelet receptor sites. This interaction was mitigated by altering the administration times of both agents.
Analysis of Effectiveness, Safety, and Bleeding Related to Rivaroxaban in Elderly Patients
Authors: Hou Huimin , Li Ang , Zhang Liping , Qin Xiujiao , Jiang Yanfang , Zhao Huiying
Published: May 2020

This study explored the efficacy and safety of rivaroxaban in elderly patients, at different doses and age of patients, and analyzed risk factors of bleeding. A retrospective analysis was conducted of 299 patients aged 60 years or older who were admitted to the First Hospital of Jilin University between January 2016 and August 2018. It was found that the rate of bleeding events (but not embolism) significantly increased as the dose of oral rivaroxaban increased ( P < .001), and with age, especially in patients aged ≥80 years ( P = .001, both). The multivariate logistic regression analysis indicated that age (odds ratio [OR]: 2.963, 95% CI: 1.627-5.396) and the daily dose of rivaroxaban (OR: 2.325, 95% CI: 1.483-3.645) were independent risk factors for bleeding. The study determined that rivaroxaban anticoagulant therapy is effective in the elderly patients, but the risk of bleeding increases with age, and is a concern especially in the most old patients. The recommended daily dose of rivaroxaban is effective, but a lower dose is safer for the elderly patients.
“Intertwangerlings”: A Multiple (Auto) Ethnography of Journeys, Gentle Collisions-Hard Boundaries, Statues, and Tilt and Turn Gate/Bridges at the 13th International Congress of Qualitative Research
Authors: Hodkinson Alan , Houston Ella , Denzin Norman , Adams Heather , Kirkpatrick Davina , Kandemir Asli , Maslen Joseph , Mendus Alys , Rhodes Paul , Stronach Ian
Published: May 2020

The article introduces the concept of the “intertwangle,” a concept grounded within the gentle collisions of delegates at the 13th International Congress for Qualitative Inquiry at the University of Illinois and the simultaneous retelling of multiple autoethnographies of such encounters. Through such encounters and “retellings,” perhaps a different way of thinking about autoethnography is developed. The article presents a story of a journey to and through the 13th Congress. A journey of no answers and no certainty—this journey is not a collaborative sharing of data but more of the gentle collisions and the recounting of different stories located within shared experiences. It is a simple journey bounded by way-markers of uncertainty, at times self-deprecation, loss, and death. It is a journey of new beginnings, of no ends—of uncertainty rather than certainty, revealing rather than obscuring and expanding rather than reducing.
Developing an Effective Campus Sexual Assault Prevention Task Force: Lessons Learned From Multiple Midwestern Universities
Authors: Mabachi Natabhona M. , Quiason Marcy , Doan Alesha E. , Carlson Juliana
Published: May 2020

Background/Aim. Developing a comprehensive prevention strategy requires a coordinated effort among campus stakeholders. Creating a campus sexual assault prevention task force consisting of key stakeholders is a way to ensure coordinated and sustainable prevention efforts. Understanding how to convene and maintain an effective campus prevention task force is important. However, there is little literature offering such guidance. In this article, we present the facilitators, barriers, and lessons learned from creating a campus sexual assault prevention task force in seven Midwestern postsecondary institutions. Method. Our data come from interviews with 25 key stakeholders, representing seven Midwestern postsecondary institutions. Questions focused on the perceived strengths and capacity to form a campus prevention task force, barriers, current campus knowledge, and attitudes toward sexual assault, current institutional support for prevention efforts, and current prevention programing. Results. Main barriers to developing a task force included (a) limited capacity, (b) lack of knowledge, (c) limited student engagement, and (d) bureaucratic structure. Facilitators included (a) strong interpersonal relationships, (b) a positive campus culture, and (c) preexisting programing.
Bleb reconstruction using donor scleral patch graft for late bleb leak and hypotony
Authors: O’Rourke Michael , Moran Sarah , Collins Niamh , Doyle Aoife
Published: May 2020

Purpose

Bleb dysfunction may occur as a late complication following glaucoma filtration surgery. Over-filtering, thinning and cystic blebs can lead to hypotony, leak and corneal dellen. We report our surgical management and outcomes of this specific entity using donor scleral patch grafts.

Methods

This is a 10-year non-comparative, retrospective interventional case series. Bleb reconstruction involved excision of encysted conjunctiva and sclera to identify the original fistula. A functioning donor scleral patch graft was sited over this with fixed and releasable sutures and the conjunctiva advanced. Intraocular pressure, visual acuity and post-operative issues were assessed.

Results

A total of 18 eyes of 17 patients with mean age 65 years (standard deviation 13.5) were included. Trabeculectomy was the primary procedure in 72% ( n = 13) and deep sclerectomy in 28% ( n = 5). Bleb leak accounted for 61% ( n = 11), hypotony 33% ( n = 6) and corneal dellen 6% ( n = 1). Mean pre-operative intraocular pressure was 7 mm Hg (standard deviation 4.6) which increased to 18.5 mm Hg (standard deviation 12) at day 1 ( p < 0.001), 11.8 mm Hg (standard deviation 4.6) at 3 months ( p < 0.05), 12.1 mm Hg (standard deviation 4.2) at 1 year ( p < 0.01) which was maintained at 12.1 mm Hg (standard deviation 5.3) at last follow-up ( p < 0.001). Post-operative interventions included bleb needling, re-suturing, suture removal, further glaucoma management, bleb leak and cataract surgery. Visual acuity also improved post-operatively and was maintained.

Conclusion

Reconstruction of the filtering bleb architecture with donor sclera results in improved intraocular pressure while maintaining visual acuity. Post-operative care is required to support the restored bleb function. Our findings support the use of scleral patch graft as an effective and safe method for the long-term management of hypotony and bleb leak as a late complication of glaucoma filtration surgery.
Systematic Review on Exercise Training as a Neuroplasticity-Inducing Behavior in Multiple Sclerosis
Authors: Sandroff Brian M. , Jones C. Danielle , Baird Jessica F. , Motl Robert W.
Published: May 2020

Background. Exercise training is associated with functional improvements in persons with multiple sclerosis (MS), perhaps based on neuroplasticity. However, inferences regarding neuroplasticity require observations of exercise-related changes in the central nervous system that explain functional adaptations. This systematic review critically evaluated studies on exercise training, neuroimaging outcomes, and functional outcomes in MS based on consistency with a well-established conceptual model for characterizing exercise training as a possible neuroplasticity-inducing behavior in this population. Methods. We performed targeted and comprehensive searches of multiple databases for papers involving exercise training interventions on functional and neuroimaging outcomes in persons with MS. Acceptable study designs included randomized controlled trials, single-group pre/post designs, and quasi-experimental designs. Four independent reviewers extracted relevant data from each eligible paper on characteristics of participants, exercise interventions, neuroimaging outcomes, functional outcomes, pattern of study results, and potential risks of bias. Results. The literature search returned only 10 papers (involving 8 original interventions) that met eligibility criteria wherein inferences regarding neuroplasticity could be drawn, based on inclusion of neuroimaging and functional endpoints. Within those 10 papers, there is mixed evidence for exercise training as a neuroplasticity-inducing behavior in persons with MS. Conclusions. Such a paucity of evidence supporting exercise-induced neuroplasticity in MS is likely a product of a very small number of papers that do not sufficiently examine hypothesized mechanisms of action. Future research might consider examining specific neural changes that might result from exercise prescriptions that are specifically designed to induce certain functional changes among persons with MS.
Pandemic leadership: Lessons from New Zealand’s approach to COVID-19
Authors: Wilson Suze
Published: May 2020

This case study analyses the leadership approach and practices of the New Zealand government, led by Prime Minister Jacinda Ardern, in the response thus far to the COVID-19 pandemic. It reports on how a shared sense of purpose has been established, that of minimizing harm to lives and livelihoods, for which the government has sought – and secured – New Zealanders’ commitment. Key leadership practices comprise the government’s willingness to themselves be led by expertise, its efforts to mobilise the population, and to enable coping, all of which serve to build the trust in leadership needed for transformative, collective action such as the pandemic demands. At the time of writing, New Zealand appears well on track to achieve its ambitious goal of achieving rapid and complete control over the COVID-19 outbreak – not just ‘flattening the curve’ as other countries are struggling to do – at least in part due to these leadership contributions. A framework of good practices for pandemic leadership is offered drawn from this case study, in the hope transferable lessons can be taken to aid others in the continuing struggle to limit the harm COVID-19 poses to lives and livelihoods throughout the world.
A review of radiation-induced lymphopenia in patients with esophageal cancer: an immunological perspective for radiotherapy
Authors: Wang Xin , Wang Peiliang , Zhao Zongxing , Mao Qingfeng , Yu Jinming , Li Minghuan
Published: May 2020

Radiotherapy is a frequently utilized therapeutic modality in the treatment of esophageal cancer (EC). Even though extensive studies are carried out in radiotherapy for EC, the design of the clinical target volume and the radiation dose is not satisfactorily uniform. Radiotherapy acts as a double-edged sword on the immune system; it has both an immunostimulatory effect and an immunosuppressive effect. Radiation-induced lymphopenia and its potential association with tumor control and survival outcomes remain to be understood. The advent of immunotherapy has renewed the focus on preserving a pool of functioning lymphocytes in the circulation. In this review, we summarize the potential impact mechanisms of radiotherapy on peripheral blood lymphocytes and the prognostic role of radiation-induced lymphopenia in patients with EC. We also propose the concept of organs-at-risk of lymphopenia and discuss potential strategies to mitigate its effects on patients with EC. From an immunological perspective, we put forward the hypothesis that optimizing radiation modalities, radiation target volume schemes, and radiation doses could help to reduce radiation-induced lymphopenia risks and maximize the immunomodulatory role of radiotherapy. An optimized radiotherapy plan may further enhance the feasibility and effectiveness of combining immunotherapy with radiotherapy for EC.
Assessing Comorbidity of Diarrhea and Acute Respiratory Infections in Children Under 5 Years: Evidence From Kenya’s Demographic Health Survey 2014
Authors: Mulatya Diana Mutuku , Mutuku Faith Wayua
Published: May 2020

Background: Kenya is one among the 15 countries that account for three-quarters of the global mortality burden due to diarrhea and respiratory tract infections (RTIs). Comorbidity of diarrhea and acute respiratory infection (ARI) can either be simultaneous (both occurring at the same time) or sequential (where the occurrence of one leads to the occurrence of the other. This study aimed to determine the shared risks that influence comorbidity of diarrhea and RTIs among Kenya’s children younger than 5 years. Methods: The study entailed an analysis of secondary data from the Kenya Demographic Health Survey (DHS) 2014 using STATA Corp 2010. Descriptive analysis of independent variables and logistic regression model was used to analyze risk factors associated with comorbidity from diarrhea and ARI in children <5 years. Results: A total of 18 702 children <5 years were in the study out of whom 411 had comorbidity from diarrhea and ARI in the 2 weeks prior to the survey. Comorbidity peaked at 6 to 11 months (4.6%). Child’s age between 6 and 11 months (adjusted odds ratio [aOR] = 3.48, 95% CI = 2.02-5.99) and caregivers with incomplete primary education (aOR = 1.66, 95% CI = 1.11-2.50) were associated with higher odds of comorbidity from diarrhea and ARI. The main determinants associated with lower odds of combined morbidity from diarrhea and ARI were high wealth quintile (aOR = 0.58, 95% CI = 0.39-0.85) and older aged caregivers (aOR = 0.47, 95% CI = 0.23-0.95). However, we found no association between nutritional status of a child, sex, residence, exclusive breastfeeding between 0 and 6 months, and combined morbidity from diarrhea and ARI. Conclusion: Programs aimed at reducing comorbidity should target children between 6 and 11 months and deliberate emphasis should be placed on addressing barriers to wealth and caregivers’ education.
Personal Perception of Health in Urban Women of Low Socioeconomic Status: A Qualitative Study
Authors: Rathbun Kimberly Paige , Loerzel Victoria , Edwards Joellen
Published: May 2020

Introduction: Women of low socioeconomic status experience health disparities that contribute to poor outcomes. Objectives: The purpose of this study was to explore self-perception of health and health promoting behaviors in women who were patients in a federally qualified health center. Methods: A qualitative descriptive design was used to interview 19 women. The researchers conducted content analysis and used descriptive statistics to present participant demographics. Results: Women viewed health primarily as physical and themselves as healthy, in-between healthy and unhealthy, or unhealthy. Healthy women made more active attempts to improve their health, while not healthy women reported twice as many barriers to health maintenance and felt defined by their illnesses. Conclusion: Findings support that a women’s self-perception of health is aligned with self-management health behaviors and health outcomes.
Smart City Architecture Development Methodology (SCADM): A Meta-Analysis Using SOA-EA and SoS Approach
Authors: Prasetyo Yuli Adam , Lubis Muharman
Published: May 2020

Architecture and methodology development for smart city are still being carried out together in clarifying the scope of smart city. This is because the application of Enterprise Architecture (EA) still does not accommodate its characteristics as a form of System of System. This study discusses the EA research overview on smart city design and the gaps in EA implementation for smart city architecture development. This research is intended to create a smart city architecture development methodology as a System of System for reference architecture with the collaboration of several systems. The system is an element of smart city designed and developed by the leaders of each coordinated system. In the end, this methodology can form the basis for building and coordinating the development of a collaborative smart city by several actors.
Risk Factors for Osteochondral Lesions and Osteophytes in Chronic Lateral Ankle Instability: A Case Series of 1169 Patients
Authors: Wang Ding-yu , Jiao Chen , Ao Ying-fang , Yu Jia-kuo , Guo Qin-wei , Xie Xing , Chen Lin-xin , Zhao Feng , Pi Yan-bin , Li Nan , Hu Yue-lin , Jiang Dong
Published: May 2020

Background:

Osteochondral lesions (OCLs) and bony impingement are common secondary lesions of chronic lateral ankle instability (CLAI), but the risk factors that predict OCLs and bony impingement are unknown.

Purpose:

To analyze the risk factors for the development of OCLs and osteophytes in patients with CLAI.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

Patients diagnosed with CLAI at our institution from June 2007 to May 2018 were enrolled. The assessed potential risk factors were age, sex, postinjury duration, body mass index, injury side, and ligament injury type (isolated anterior talofibular ligament [ATFL] injury, isolated calcaneofibular ligament [CFL] injury, or concomitant ATFL and CFL injuries). Univariate and multivariate logistic regression analyses were performed to evaluate the association between these factors and the presence of OCLs and osteophytes.

Results:

A total of 1169 patients with CLAI were included; 436 patients (37%) had OCLs and 334 (31%) had osteophytes. The presence of OCLs was significantly associated with the presence of osteophytes ( P < .001). Male sex and older age were significantly associated with the presence of OCLs in the medial and lateral talus. A postinjury duration of 5 years or longer was significantly associated with the presence of OCLs in the medial talus (odds ratio [OR], 1.532; 95% CI, 1.023-2.293; P = .038) but not in the lateral talus. ATFL and CFL injuries were both significantly associated with the presence of lateral OCLs. Risk factors for the presence of osteophytes were male sex, older age, postinjury duration 5 years or longer, and CFL injury. Patients with concomitant ATFL and CFL injuries were significantly more likely to have osteophytes than were patients with single-ligament injuries ( P = .018).

Conclusion:

Risk factors for OCLs and osteophytes were postinjury duration of 5 years or longer, older age, and male sex. ATFL injury was associated with the presence of lateral OCLs, whereas CFL injury was associated with the presence of lateral OCLs and osteophytes. Patients with these risk factors should be closely monitored and treated to reduce the incidence of ankle arthritis.