bluuebunny/crossref_metadata_2025 huggingface dataset:
Job burnout and turnover intention among Chinese primary healthcare staff: the mediating effect of satisfaction
Authors: Ran Li , Chen Xuyu , Peng Shuzhen , Zheng Feng , Tan Xiaodong , Duan Ruihua
Published: October 2020

Objectives

Although China has done a lot in strengthening the primary healthcare system, the high turnover intention is still a social problem to be reckoned with. The objective of this study is to explore the mediating effect of satisfaction between job burnout and turnover intention.

Design

Cross-sectional study.

Methods

A cross-sectional study was conducted to make sense of the job burnout, satisfaction and turnover intention among primary healthcare workers in central China. Structural equation modelling (SEM) was performed to study the mediating effect of satisfaction between job burnout and turnover intention with maximum likelihood estimation. The mediation effect test was carried out by using the bootstrap method.

Results

SEM showed that job burnout was positively related to the turnover intention with the standard path coefficient of 0.845 (C.R.=34.055, p<0.001). The partial mediating effect of satisfaction was 0.047, making up 5.32% of the total effect. The goodness-of-fit was acceptable (Goodness of Fit Index=0.947, Comparative Fit Index=0.975, root mean square error of approximation=0.067, Non-Normed Fit Index=0.971, Incremental Fit Index=0.975). Age, education level, monthly income, hire form and night shift were also found significantly correlated with turnover intention, and no difference was found between physicians and nurses.

Conclusions

The turnover intention is significantly affected by job burnout, satisfaction and demographical characteristics including age, education level, monthly income, hire form and night shift. Satisfaction can be regarded as a mediator between job burnout and turnover intention. Relative measures can be taken to promote enthusiasm and satisfaction thus decreasing the turnover rate.
The Seattle Flu Study: a multiarm community-based prospective study protocol for assessing influenza prevalence, transmission and genomic epidemiology
Authors: Chu Helen Y , Boeckh Michael , Englund Janet A , Famulare Michael , Lutz Barry , Nickerson Deborah A , Rieder Mark , Starita Lea M , Adler Amanda , Brandstetter Elisabeth , Frazer Chris D , Han Peter D , Gulati Reena K , Hadfield James , Jackson Michael , Kiavand Anahita , Kimball Louise E , Lacombe Kirsten , Newman Kira , Sibley Thomas R , Logue Jennifer K , Lyon Victoria Rachel , Wolf Caitlin R , Zigman Suchsland Monica , Shendure Jay , Bedford Trevor
Published: October 2020

Introduction

Influenza epidemics and pandemics cause significant morbidity and mortality. An effective response to a potential pandemic requires the infrastructure to rapidly detect, characterise, and potentially contain new and emerging influenza strains at both an individual and population level. The objective of this study is to use data gathered simultaneously from community and hospital sites to develop a model of how influenza enters and spreads in a population.

Methods and analysis

Starting in the 2018–2019 season, we have been enrolling individuals with acute respiratory illness from community sites throughout the Seattle metropolitan area, including clinics, childcare facilities, Seattle-Tacoma International Airport, workplaces, college campuses and homeless shelters. At these sites, we collect clinical data and mid-nasal swabs from individuals with at least two acute respiratory symptoms. Additionally, we collect residual nasal swabs and data from individuals who seek care for respiratory symptoms at four regional hospitals. Samples are tested using a multiplex molecular assay, and influenza whole genome sequencing is performed for samples with influenza detected. Geospatial mapping and computational modelling platforms are in development to characterise the regional spread of influenza and other respiratory pathogens.

Ethics and dissemination

The study was approved by the University of Washington’s Institutional Review Board (STUDY00006181). Results will be disseminated through talks at conferences, peer-reviewed publications and on the study website (www.seattleflu.org).
Spatiotemporal variations of asthma admission rates and their relationship with environmental factors in Guangxi, China
Authors: Ma Rui , Liang Lizhong , Kong Yunfeng , Chen Mingyang , Zhai Shiyan , Song Hongquan , Hou Yane , Zhang Guangli
Published: October 2020

Objective

The study aimed to determine if and how environmental factors correlated with asthma admission rates in geographically different parts of Guangxi province in China.

Setting

Guangxi, China.

Participants

This study was done among 7804 asthma patients.

Primary and secondary outcome measures

Spearman correlation coefficient was used to estimate correlation between environmental factors and asthma hospitalisation rates in multiple regions. Generalised additive model (GAM) with Poisson regression was used to estimate effects of environmental factors on asthma hospitalisation rates in 14 regions of Guangxi.

Results

The strongest effect of carbon monoxide (CO) was found on lag1 in Hechi, and every 10 µg/m3 increase of CO caused an increase of 25.6% in asthma hospitalisation rate (RR 1.26, 95% CI 1.02 to 1.55). According to the correlation analysis, asthma hospitalisations were related to the daily temperature, daily range of temperature, CO, nitrogen dioxide (NO2) and particulate matter (PM2.5) in multiple regions. According to the result of GAM, the adjusted R2 was high in Beihai and Nanning, with values of 0.29 and 0.21, which means that environmental factors are powerful in explaining changes of asthma hospitalisation rates in Beihai and Nanning.

Conclusion

Asthma hospitalisation rate was significantly and more strongly associated with CO than with NO2, SO2 or PM2.5 in Guangxi. The risk factors of asthma exacerbations were not consistent in different regions, indicating that targeted measures should differ between regions.
Study protocol for a randomised controlled trial investigating two different refeeding formulations to improve safety and efficacy of hospital management of adolescent and young adults admitted with anorexia nervosa
Authors: Parker Elizabeth , Flood Victoria , Halaki Mark , Wearne Christine , Anderson Gail , Gomes Linette , Clarke Simon , Wilson Frances , Russell Janice , Frig Elizabeth , Kohn Michael
Published: October 2020

Introduction

Providing effective nutritional rehabilitation to patients hospitalised with anorexia nervosa (AN) is challenging, partly due to conservative recommendations that advocate feeding patients at low energy intakes. An ‘underfeeding syndrome’ can develop when patients are not provided with adequate nutrition during treatment, whereby malnourished patients fail to restore weight in a timely matter, and even lose weight. Of particular concern, the reintroduction of carbohydrate in a starved patient can increase the risk of developing electrolyte, metabolic and organ dysfunction. The proposed trial assesses the efficacy and safety of a lower carbohydrate enteral formula (28% carbohydrate) against a standard enteral formula (54% carbohydrate), in adolescent and young adult patients (aged 15–25 years), hospitalised with AN.

Methods and analysis

The study employs a double-blind randomised controlled trial design. At admission to hospital, malnourished adolescent and young adults with AN will be randomly allocated to commence feeding on a standard enteral feeding formula (1.5 kcal/mL, 54% carbohydrate) or a lower carbohydrate isocaloric enteral feeding formula (1.5 kcal/mL, 28% carbohydrate). Assessments of nutritional intake, weight and biochemistry (phosphate, magnesium, potassium) will be conducted at baseline and during the first 3 weeks of hospital admission. The primary outcome measure will be incidence of hypophosphatemia. Secondary outcomes include weight gain, oedema, other electrolyte distortion, length of hospital admission, admission to the Intensive Care Unit (ICU) and number of days to reach medical stability, using defined parameters.

Ethics and dissemination

The protocol was approved by the Western Sydney Local Health District Human Research Ethics Committee and institutional research governance approvals were granted. Written informed consent will be sought prior to study enrolment. Study findings will be widely disseminated through peer-reviewed publications and conference presentations.

Trial registration number

Australian New Zealand Clinical Trials Registry (ACTRN12617000342314); Pre-results.
Protocol of a multicentre, prospective cohort study that evaluates cost-effectiveness of two perioperative care strategies for potential obstructive sleep apnoea in morbidly obese patients undergoing bariatric surgery
Authors: van Veldhuisen Sophie L. , Kuppens Kim , de Raaff Christel A. L. , Wiezer Marinus J. , de Castro Steve M. M. , van Veen Ruben N. , Swank Dingeman J. , Demirkiran Ahmet , Boerma Evert-Jan G. , Greve Jan-Willem M. , van Dielen Francois M. H. , Frederix Geert W. J. , Hazebroek Eric J.
Published: October 2020

Introduction

Despite the high prevalence of obstructive sleep apnoea (OSA) in obese patients undergoing bariatric surgery, OSA is undiagnosed in the majority of patients and thus untreated. While untreated OSA is associated with an increased risk of preoperative and postoperative complications, no evidence-based guidelines on perioperative care for these patients are available. The aim of the POPCORN study (Post-Operative Pulse oximetry without OSA sCreening vs perioperative continuous positive airway pressure (CPAP) treatment following OSA scReeNing by polygraphy (PG)) is to evaluate which perioperative strategy is the most cost-effective for obese patients undergoing bariatric surgery without a history of OSA.

Methods and analysis

In this multicentre observational cohort study, data from 1380 patients who will undergo bariatric surgery will be collected. Patients will receive either postoperative care with pulse oximetry monitoring and supplemental oxygen during the first postoperative night, or care that includes preoperative PG and CPAP treatment in case of moderate or severe OSA. Local protocols for perioperative care in each participating hospital will determine into which cohort a patient is placed. The primary outcome is cost-effectiveness, which will be calculated by comparing all healthcare costs with the quality-adjusted life-years (QALYs, calculated using EQ-5D questionnaires). Secondary outcomes are mortality, complications within 30 days after surgery, readmissions, reoperations, length of stay, weight loss, generic quality of life (QOL), OSA-specific QOL, OSA symptoms and CPAP adherence. Patients will receive questionnaires before surgery and 1, 3, 6 and 12 months after surgery to report QALYs and other patient-reported outcomes.

Ethics and dissemination

Approval from the Medical Research Ethics Committees United was granted in accordance with the Dutch law for Medical Research Involving Human Subjects Act (WMO) (reference number W17.050). Results will be submitted for publication in peer-reviewed journals and presented at (inter)national conferences.

Trial registration number

NTR6991.
Acupuncture for chronic cancer-related pain: a systematic review and network meta-analysis protocol
Authors: Yang Jiao , Xu Guixing , Yin Zihan , Cheng Ying , Sun Sheng Ming , Zheng Qianhua , Chen Jiao , Liang Fan-rong , Zhao Ling
Published: October 2020

Introduction

Chronic cancer-related pain is one of the most common excruciating symptom that can be caused by the cancer (by the primary tumour or by metastases) or by its treatment (surgery, chemotherapy and radiotherapy). Although multiple clinical trials and systematic reviews have suggested that acupuncture could be effective in treating chronic cancer-related pain, the comparative efficacy and safety of these acupuncture methods remains unclear. We, therefore, performed this study to evaluate and rank the efficacy and safety of different acupuncture methods for chronic cancer-related pain.

Methods and analysis

Seven databases will be searched, including Cochrane Library, MEDLINE, Embase, Chinese National Knowledge Infrastructure (CNKI), Wanfang Database, the Chongqing VIP Chinese Science and Technology Periodical Database and Chinese Biomedical Literature Database (CBM) from their inception to March 2020. The primary outcome is the change of pain intensity. Bayesian network meta-analysis will be conducted using software R3.5.1. Finally, we will use the Grading of Recommendations Assessment, Development and Evaluation System (GRADE) to assess the quality of evidence.

Ethics and dissemination

Ethical approval is not required for literature-based studies. The results will be disseminated through peer-reviewed publication.

PROSPERO registration number

CRD42020165747
Strengthening integration of chronic care in Africa: protocol for the qualitative process evaluation of integrated HIV, diabetes and hypertension care in a cluster randomised controlled trial in Tanzania and Uganda
Authors: Van Hout Marie-Claire , Bachmann Max , Lazarus Jeffrey V , Shayo Elizabeth Henry , Bukenya Dominic , Picchio Camila A , Nyirenda Moffat , Mfinanga Sayoki Godfrey , Birungi Josephine , Okebe Joseph , Jaffar Shabbar
Published: October 2020

Introduction

In sub-Saharan Africa, the burden of non-communicable diseases (NCDs), particularly diabetes mellitus (DM) and hypertension, has increased rapidly in recent years, although HIV infection remains a leading cause of death among young-middle-aged adults. Health service coverage for NCDs remains very low in contrast to HIV, despite the increasing prevalence of comorbidity of NCDs with HIV. There is an urgent need to expand healthcare capacity to provide integrated services to address these chronic conditions.

Methods and analysis

This protocol describes procedures for a qualitative process evaluation of INTE-AFRICA, a cluster randomised trial comparing integrated health service provision for HIV infection, DM and hypertension, to the current stand-alone vertical care. Interviews, focus group discussions and observations of consultations and other care processes in two clinics (in Tanzania, Uganda) will be used to explore the experiences of stakeholders. These stakeholders will include health service users, policy-makers, healthcare providers, community leaders and members, researchers, non-governmental and international organisations. The exploration will be carried out during the implementation of the project, alongside an understanding of the impact of broader structural and contextual factors.

Ethics and dissemination

Ethical approval was granted by the Liverpool School of Tropical Medicine (UK), the National Institute of Medical Research (Tanzania) and TASO Research Ethics Committee (Uganda) in 2020. The evaluation will provide the opportunity to document the implementation of integration over several timepoints (6, 12 and 18 months) and refine integrated service provision prior to scale up. This synergistic approach to evaluate, understand and respond will support service integration and inform monitoring, policy and practice development efforts to involve and educate communities in Tanzania and Uganda. It will create a model of care and a platform of good practices and lessons learnt for other countries implementing integrated and decentralised community health services.

Trial registration number

ISRCTN43896688; Pre-results.
Evaluation of cytokines as a biomarker to distinguish active tuberculosis from latent tuberculosis infection: a diagnostic meta-analysis
Authors: Qiu Beibei , Liu Qiao , Li Zhongqi , Song Huan , Xu Dian , Ji Ye , Jiang Yan , Tian Dan , Wang Jianming
Published: October 2020

Objectives

With a marginally effective vaccine and no significant breakthroughs in new treatments, a sensitive and specific method to distinguish active tuberculosis from latent tuberculosis infection (LTBI) would allow for early diagnosis and limit the spread of the pathogen. The analysis of multiple cytokine profiles provides the possibility to differentiate the two diseases.

Design

Systematic review and meta-analysis.

Data sources

PubMed, Cochrane Library, Clinical Key and EMBASE databases were searched on 31 December 2019.

Eligibility criteria

We included case–control studies, cohort studies and randomised controlled trials considering IFN-γ, TNF-α, IP-10, IL-2, IL-10, IL-12 and VEGF as biomarkers to distinguish active tuberculosis and LTBI.

Data extraction and synthesis

Two students independently extracted data and assessed the risk of bias. Diagnostic OR, sensitivity, specificity, positive and negative likelihood ratios and area under the curve (AUC) together with 95% CI were used to estimate the diagnostic value.

Results

Of 1315 records identified, 14 studies were considered eligible. IL-2 had the highest sensitivity (0.84, 95% CI: 0.72 to 0.92), while VEGF had the highest specificity (0.87, 95% CI: 0.73 to 0.94). The highest AUC was observed for VEGF (0.85, 95% CI: 0.81 to 0.88), followed by IFN-γ (0.84, 95% CI: 0.80 to 0.87) and IL-2 (0.84, 95% CI: 0.81 to 0.87).

Conclusion

Cytokines, such as IL-2, IFN-γ and VEGF, can be utilised as promising biomarkers to distinguish active tuberculosis from LTBI.

PROSPERO registration number

CRD42020170725.
PARTNER: a service delivery model to implement optimal primary care management of people with knee osteoarthritis: description of development
Authors: Egerton Thorlene , Hinman Rana S , Hunter David J , Bowden Jocelyn L , Nicolson Philippa J A , Atkins Lou , Pirotta Marie , Bennell Kim L
Published: October 2020

Objective

Implementation strategies, such as new models of service delivery, are needed to address evidence practice gaps. This paper describes the process of developing and operationalising a new model of service delivery to implement recommended care for people with knee osteoarthritis (OA) in a primary care setting.

Methods

Three development stages occurred concurrently and iteratively. Each stage considered the healthcare context and was informed by stakeholder input. Stage 1 involved the design of a new model of service delivery (PARTNER). Stage 2 developed a behavioural change intervention targeting general practitioners (GPs) using the behavioural change wheel framework. In stage 3, the ‘Care Support Team’ component of the service delivery model was operationalised.

Results

The focus of PARTNER is to provide patients with education, exercise and/or weight loss advice, and facilitate effective self-management through behavioural change support. Stage 1 model design: based on clinical practice guidelines, known evidence practice gaps in current care, chronic disease management frameworks, input from stakeholders and the opportunities and constraints afforded by the Australian primary care context, we developed the PARTNER service-delivery model. The key components are: (1) an effective GP consultation and (2) follow-up and ongoing care provided remotely (telephone/email/online resources) by a ‘Care Support Team’. Stage 2 GP behavioural change intervention: a multimodal behavioural change intervention was developed comprising a self-audit/feedback activity, online professional development and desktop software to provide decision support, patient information resources and a referral mechanism to the ‘Care Support Team’. Stage 3 operationalising the ‘care support team’—staff recruited and trained in evidence-based knee OA management and behavioural change methodology.

Conclusion

The PARTNER model is the result of a comprehensive implementation strategy development process using evidence, behavioural change theory and intervention development guidelines. Technologies for scalable delivery were harnessed and new primary evidence was generated as part of the process.

Trial registration number ACTRN12617001595303 (UTN U1111-1197-4809)
Incidence of sudden cardiac death in the young: a systematic review
Authors: Couper Keith , Putt Oliver , Field Richard , Poole Kurtis , Bradlow William , Clarke Aileen , Perkins Gavin D , Royle Pamela , Yeung Joyce , Taylor-Phillips Sian
Published: October 2020

Objective

To summarise studies describing incidence of sudden cardiac death in a general population of young individuals to inform screening policy.

Design

Systematic review.

Data sources

Database searches of MEDLINE, EMBASE and the Cochrane library (all inception to current) on 29 April 2019 (updated 16 November 2019), and forward/backward citation tracking of eligible studies.

Study eligibility criteria

All studies that reported incidence of sudden cardiac death in young individuals (12–39 years) in a general population, with no restriction on language or date. Planned subgroups were incidence by age, sex, race and athletic status (including military personnel).

Data extraction

Two reviewers independently assessed study eligibility, extracted study data and assessed risk of bias using the Joanna Briggs Institute critical appraisal checklist for prevalence studies.

Analysis

Reported incidence of sudden cardiac death in the young per 100 000 person-years.

Results

38 studies that reported incidence across five continents. We identified substantial heterogeneity in population, sudden cardiac death definition, and case ascertainment methods, precluding meta-analysis. Median reported follow-up years was 6.97 million (IQR 2.34 million–23.70 million) and number of sudden cardiac death cases was 64 (IQR 40–251). In the general population, the median of reported incidence was 1.7 sudden cardiac death per 100 000 person-years (IQR 1.3–2.6, range 0.75–11.9). Most studies (n=14, 54%) reported an incidence between one and two cases per 100 000 person-years. Incidence was higher in males and older individuals.

Conclusions

This systematic review identified variability in the reported incidence of sudden cardiac death in the young across studies. Most studies reported an incidence between one and two cases per 100 000 person-years.

PROSPERO registration number

CRD42019120563.
Does acupressure help reduce nausea and vomiting in palliative care patients? A double blind randomised controlled trial
Authors: Perkins Paul , Parkinson Anne , Parker Rebecca , Blaken Alison , Akyea Ralph K
Published: October 2020

Introduction

Nausea and vomiting are common symptoms for patients with advanced cancer. While there is evidence for acupuncture point stimulation for treatment of these symptoms for patients having anticancer treatment, there is little for when they are not related to such treatment.

Objective

To determine whether acupressure at the pericardium 6 site can help in the treatment of nausea and vomiting suffered by palliative care patients with advanced cancer.

Materials and methods

Double blind randomised controlled trial—active versus placebo acupressure wristbands. In-patients with advanced cancer in two specialist palliative care units who fitted either or both of the following criteria were approached: Nausea that was at least moderate; Vomiting daily on average for the prior 3 days.

Results

57 patients were randomised to have either active or placebo acupressure wristbands. There was no difference in any of the outcome measures between the two groups: change from baseline number of vomits; Visual Analogue Scale for ‘did acupressure wristbands help you to feel better?’; total number of as needed doses of antiemetic medication; need for escalation of antiemetics.

Conclusions

In contrast to a previously published feasibility study, active acupressure wristbands were no better than placebo for specialist palliative care in-patients with advanced cancer and nausea and vomiting.
Infective endocarditis at a tertiary care hospital in South Korea
Authors: Kim Jung Ho , Lee Hi Jae , Ku Nam Su , Lee Seung Hyun , Lee Sak , Choi Jun Yong , Yeom Joon-Sup
Published: October 2020

Objective

The treatment of infective endocarditis (IE) has become more complex with the current myriad healthcare-associated factors and the regional differences in causative organisms. We aimed to investigate the overall trends, microbiological features, and outcomes of IE in South Korea.

Methods

A 12-year retrospective cohort study was performed. Poisson regression was used to estimate the time trends of IE incidence and mortality rate. Risk factors for in-hospital mortality were identified with multivariable logistic regression, and model comparison was performed to evaluate the predictive performance of notable risk factors. Kaplan-Meier survival analysis and Cox regression were performed to assess long-term prognosis.

Results

We included 419 patients with IE, the incidence of which showed an increasing trend (relative risk 1.06, p=0.005), whereas mortality demonstrated a decreasing trend (incidence rate ratio 0.93, p=0.020). The in-hospital mortality rate was 14.6%. On multivariable logistic regression analysis, aortic valve endocarditis (OR 3.18, p=0.001), IE caused byStaphylococcus aureus(OR 2.32, p=0.026), neurological complications (OR 1.98, p=0.031), high Sequential Organ Failure Assessment score (OR 1.22, p=0.023) and high Charlson Comorbidity Index (OR 1.11, p=0.019) were predictors of in-hospital mortality. Surgical intervention for IE was a protective factor against in-hospital mortality (OR 0.25, p<0.001) and was associated with improved long-term prognosis compared with medical treatment only (p<0.001).

Conclusions

The incidence of IE is increasing in South Korea. Although the mortality rate has slightly decreased, it remains high. Surgery has a protective effect with respect to both in-hospital mortality and long-term prognosis in patients with IE.
Impact of age on the toxicity of immune checkpoint inhibition
Authors: Samani Amit , Zhang Shuai , Spiers Laura , Suwaidan Ali Abdulnabi , Merrick Sophie , Tippu Zayd , Payne Miranda , Faust Guy , Papa Sophie , Fields Paul , Van Hemelrijck Mieke , Josephs Debra H
Published: October 2020

Indications for immune checkpoint inhibitor therapy are increasing. As the population ages, many patients receiving such drugs will be older adults. Such patients are under-represented in clinical trials, and therefore the safety of immune checkpoint inhibitors in this population has not been adequately assessed. A retrospective multicenter analysis of toxicities was performed in patients with advanced or metastatic solid cancers receiving anti-programmed cell death protein 1 (anti-PD-1) and/or anti-CTLA4 antibodies across three age cohorts (<65 years, 65–74 years and ≥75 years) using univariable and multivariable analyzes. Eligible patients (n=448) were divided into age cohorts: <65 years (n=185), 65–74 years (n=154) and ≥75 years (n=109). Fewer patients in the oldest cohort (7.3%) received an anti-CTLA4 antibody containing regimen compared with the younger cohorts (21.1% and 17.5%). There was no significant difference overall in all grade or ≥G3 toxicities between age cohorts. Significantly fewer patients in the older (65–74 years and ≥75 years) age cohorts discontinued treatment because of toxicity (10.1% and 7.4%) compared with in the <65 years cohort (20.5%; p=0.006). Using logistic regression, only treatment type (ipilimumab containing) was significantly associated with all grade toxicity. However, there was a significantly lower incidence of all-grade endocrine toxicity in the oldest cohort (11.0%) compared with the youngest cohort (22.7%, p=0.02; OR 0.43, 95% CI 0.21 to 0.87), while all-grade dermatological toxicity showed the reverse trend (28.4% vs 18.9%; OR 1.85, 95% CI 1.04 to 3.30). Results were corroborated in the sensitivity analysis using only data from patients who received PD-1 inhibitor monotherapy. This multicenter, real-world cohort demonstrates that immune checkpoint inhibitor therapy is safe and well tolerated regardless of age, with no appreciable increase in adverse events in older adult patients.
Integrating philosophy, policy and practice to create a just and fair health service
Authors: Fritz Zoe , Cox Caitríona L
Published: October 2020

To practise ‘fairly and justly’ a clinician must balance the needs of both the many and the few: the individual patient in front of them, and the many unseen patients in the waiting room, and in the county. They must consider the immediate clinical needs of those in the present, and how their actions will impact on future patients. The good medical practice guidance ‘Make the care of your patient your first concern’ provides no guidance on how doctors should act when they care for multiple patients with conflicting needs. Moreover, conflicting needs extend far past simply those between different patients. At an organisational level, financial obligations must be balanced with clinical ones; the system must support those who work within it in a variety of roles; and, finally, in order for a healthcare service to be sustainable, the demands of current and future generations must be balanced.

The central problem, we propose, is that there is no shared philosophical framework on which the provision of care or the development of health policy is based, nor is there a practical, fair and transparent process to ensure that the service is equipped to deal justly with new challenges as they emerge. Many philosophers have grappled with constructing a set of principles which would lead to a ‘good’ society which is just to different users; prominent among them is Rawls.

Four important principles can be derived using a Rawlsian approach: equity of access, distributive justice, sustainability and openness. However, Rawls’ approach is sometimes considered too abstract to be applied readily to policymaking; it does not provide clear guidance for how individuals working within existing institutions can enact the principles of justice. We therefore combine the principles derived from Rawls with Scanlonian contractualism: by demanding that decisions are made in a way which cannot be ‘reasonably rejected’ by different stakeholders (including ‘trustees’ for those who cannot represent themselves), we ensure that conflicting needs are considered robustly.

We demonstrate how embedding this framework would ensure just policies and fair practice. We illustrate this by using examples of how it would help prevent injustice among different socioeconomic groups, prevent intergenerational injustice and prevent injustice in a crisis, for example, as we respond to new challenges such as COVID-19.

Attempts to help individual doctors practise fairly and justly throughout their professional lives are best focused at an institutional or systemic level. We propose a practical framework: combining Scanlonian contractualism with a Rawlsian approach. Adopting this framework would equip the workforce and population to contribute to fair policymaking, and would ultimately result in a healthcare system whose practice and policies—at their core—were just.
Is casual employment in Australia bad for workers’ health?
Authors: Hahn Markus H , McVicar Duncan , Wooden Mark
Published: October 2020

Objectives

This paper assessed the impact of working in casual employment, compared with permanent employment, on eight health attributes that make up the 36-Item Short Form (SF-36) Health Survey, separately by sex. The mental health impacts of casual jobs with irregular hours over which the worker reports limited control were also investigated.

Methods

Longitudinal data from the Household, Income and Labour Dynamics in Australia Survey, over the period 2001–2018, were used to investigate the relationship between the eight SF-36 subscales and workers’ employment contract type. Individual, household and job characteristic confounders were included in dynamic panel data regression models with correlated random effects.

Results

For both men and women, health outcomes for casual workers were no worse than for permanent workers for any of the eight SF-36 health attributes. For some health attributes, scores for casual workers were higher (ie, better) than for permanent workers (role physical: men: β=1.15, 95% CI 0.09 to 2.20, women: β=1.79, 95% CI 0.79 to 2.80; bodily pain: women: β=0.90, 95% CI 0.25 to 1.54; vitality: women: β=0.65, 95% CI 0.13 to 1.18; social functioning: men: β=1.00, 95% CI 0.28 to 1.73); role emotional: men: β=1.81, 95% CI 0.73 to 2.89, women: β=1.24, 95% CI 0.24 to 2.24). Among women (but not men), mental health and role emotional scores were lower for irregular casual workers than for regular permanent workers but not statistically significantly so.

Conclusions

This study found no evidence that casual employment in Australia is detrimental to self-assessed worker health.
Health-related quality of life and lived experiences in males and females with thoracic aortic disease and their partners
Authors: Thijssen Carlijn G E , Dekker Silvy , Bons Lidia Rianne , Gökalp Arjen L , Kauling Robert M , van den Bosch Annemien E , Cuypers Judith Anne Adriane Ellen , Utens Elisabeth M W J , van Kimmenade Roland R L , Takkenberg Johanna J M , Roos Leontien M H , Goossens Eva , Roos-Hesselink Jolien W
Published: October 2020

Objective

Thoracic aortic disease (TAD) may have substantial impact on health-related quality of life (HRQOL). We described HRQOL in patients with TAD, cardiovascular screening participants and their partners; identified factors associated with HRQOL; and explored lived experiences and feelings of anxiety or depression using a mixed methods design.

Methods

For this cross-sectional study, all consecutive patients visiting the TAD outpatient clinic (2017–2019) at our centre were asked to complete three questionnaires: the Short Form 36 (SF-36), the Hospital Anxiety and Depression Scale (HADS) and the Rotterdam Disease Specific Questionnaire (RDSQ). A subsample was invited for in-depth interviews.

Results

In total, 261 participants were included: 147 patients with TAD (thoracic aortic diameter ≥40 mm; 54 females, 36.7%), 114 screening participants (cardiovascular family screening; 71 females, 62.3%) and 66 partners. Compared with the general population, patients with TAD showed markedly lower HRQOL, whereas screening participants’ HRQOL was less impaired. Female and younger participants scored significantly lower on the SF-36 and HADS compared with male and older participants. Smaller aortic diameter was associated with better RDSQ score, and previous aortic surgery was associated with higher HADS depression scores. Furthermore, partners scored significantly lower on 2/8 SF-36 subdomains when compared with the general population. From 11 interviewees, determinants of psychological distress included coping strategies, impact on social and professional life, disease-related knowledge, state of aortic diameters and physical symptoms.

Conclusions

Healthcare professionals must be aware of HRQOL impairments in patients with TAD, particularly in younger females. Moreover, attention for partners is needed. Coping strategies and communication within the family were found to be important factors influencing psychological distress, and might be valuable leads for counselling and HRQOL improvement in this population.
Estimating the overconsolidation ratio in uniform cohesive soil with cone penetrometer tests considering soil structure and index properties
Authors: Saye Steven R. , Kumm Bryan P. , Lutenegger Alan J.
Published: October 2020

A basic empirical approach to estimate the preconsolidation stress and overconsolidation ratio, OCR, in uniform cohesive soils using cone penetration and piezocone tests uses a correlation factor, kc, that is equal to the preconsolidation stress divided by the net tip stress referenced to the soil plasticity index. An adaptation of the “stress history and normalized soil engineering properties” (SHANSEP) format extends this basic approach by organizing the data into normally consolidated and overconsolidated components. The SHANSEP-based approach is improved in this paper by applying an empirical method to identify structured and unstructured soil behavior and to develop a separate empirical correlation for each type of soil structure. Overconsolidated structured soils are shown to exhibit kc values less than the normally consolidated kc and the m exponent in the SHANSEP relationship is greater than 1. In unstructured overconsolidated soils, the kc value is greater than the normally consolidated kc value and the SHANSEP m exponent is less than 1. The proposed method to identify structured vs. unstructured behavior is an important improvement in the approach and helps illustrate why some mCPTu values are less than 1 and others are greater than 1. Site characterization efforts are significantly improved when structured soil behavior is identified and included in the assessment of OCR.
Lifshitz scaling effects on the holographic p-wave superconductors coupled to nonlinear electrodynamics
Authors: Mohammadi Mahya , Sheykhi Ahmad
Published: October 2020

We employ gauge/gravity duality to study the effects of Lifshitz scaling on the holographic p-wave superconductors in the presence of Born–Infeld nonlinear electrodynamics. By using the shooting method in the probe limit, we calculate the relation between critical temperature $$T_\mathrm{{c}}$$

T
c

and $$\rho ^{z/d}$$

ρ

z
/
d

numerically for different values of mass, nonlinear parameter b and Lifshitz critical exponent z in various dimensions. We observe that critical temperature decreases by increasing b, z or the mass parameter m which makes conductor/superconductor phase transition harder to form. In addition, we analyze the electrical conductivity and find the behavior of the real and the imaginary parts as a function of frequency, which depend on the model parameters. However, some universal behaviors are seen. For instance at low frequencies, the real part of conductivity shows a delta function behavior, while the imaginary part has a pole, which means that these two parts are connected to each other through the Kramers–Kronig relation. The behavior of the real part of the conductivity in the large frequency regime can be achieved by $$\mathrm{{Re}}[\sigma ]=\omega ^{D-4}$$

Re

[
σ
]

=

ω

D
-
4

. Furthermore, with increasing the Lifshitz scaling z, the energy gap and the minimum values of the real and imaginary parts become unclear.
All but one
Authors: Kuhlenkamp Jörn , Werner Sebastian , Borges Maria C. , Ernst Dominik
Published: October 2020

Serverless computing through Function-as-a-Service (FaaS) platforms is a popular new cloud computing model, offering high elasticity while being fully-managed. However, FaaS platforms do not quantify elasticity; thus, application developers are unaware of how elastic FaaS platforms are.

This paper is an extended version of [18]. The original paper proposes an experiment design and corresponding toolkit for observing elasticity and its associated trade-offs with latency, reliability, and execution costs. Results for evaluating four popular FaaS platforms by AWS, Google, IBM, and Microsoft indicate significant short-comings in terms of elasticity for all but AWS's service offer.

One year later, we reproduced all experiments and revisited our discussions. We report significant improvements by Google and IBM. Our results indicate that (currently) all but Microsoft's FaaS platform are elastic with differences in latency and execution costs.
The Functional Orlicz Brunn-Minkowski Inequality for q-Capacity
Authors: Wang Wei , Li Juan , He Rigao , Liu Lijuan
Published: October 2020

In this paper, we establish functional forms of the Orlicz Brunn-Minkowski inequality and the Orlicz-Minkowski inequality for the electrostatic q-capacity, which generalize previous results by Zou and Xiong. We also show that these two inequalities are equivalent.
Thresholds of Abnormality Perception in Facial Esthetics among Laypersons and Dental Professionals: Profile Esthetics
Authors: Alrbata Raed H. , Alfaqih Ayham Kh. , Almhaidat Mohammad R. , Al-Tarawneh Ahmad M.
Published: October 2020

Aim. To find thresholds at which laypersons and dental professionals from Jordanian population perceive abnormalities in sagittal positioning of upper and lower jaws as a major determinant to facial profile esthetics. Materials and Methods. Using photo editing software, a baseline profile image of a young male was manipulated on a 2 mm incremental basis to move each of the upper and lower jaws backward and forward relative to true vertical line (TVL) at which four variables of maxillary and mandibular retrusion and protrusion were researched. A total of 120 participants divided equally into four groups of laypersons, general dental practitioners (GDPs), orthodontists, and oral and maxillofacial surgeons (OMFSs) rated the images using an analog scale of 100 mm long. The image that showed the first statistical difference compared to the baseline was considered as a threshold of abnormality. Results. Laypersons, GDPs, and OMFSs perceived the abnormality in the maxillary retrusion at −5 mm to TVL, while orthodontists defined that at −3 mm. All dental professionals perceived the abnormality in the maxillary protrusion at +1 mm to TVL while the layperson group at +3 mm. A threshold of −7 mm mandibular retrusion to TVL was abnormally perceived by all groups. All dental professionals realized the abnormality in the mandibular protrusion at 0 mm to TVL while the laypersons at +2 mm. Conclusion. These thresholds regarding profile esthetics may contribute to the process of establishing proper orthodontic treatment planning that suits the highest facial esthetic standards.
Resina Draconis Reduces Acute Liver Injury and Promotes Liver Regeneration after 2/3 Partial Hepatectomy in Mice
Authors: He Zhi-yong , Lou Kai-han , Zhao Jia-hui , Zhang Ming , Zhang Lan-chun , Li Ju , Yu Hao-fei , Zhang Rong-ping , Wei-yan Hu
Published: October 2020

Aim. To investigate the protective effects and possible mechanisms of action of resina draconis (RD) on acute liver injury and liver regeneration after 2/3 partial hepatectomy (PH) in mice. Methods. 2/3 PH was used to induce acute liver injury. Mice were divided into three groups: sham, vehicle + 2/3 PH, and RD + 2/3 PH. Resina draconis was administered intragastrically after 2/3 PH into the RD + 2/3 PH group, and the same volume of vehicle (1% sodium carboxymethyl cellulose) was injected into the vehicle + 2/3 PH group and sham group mice. The index of liver to body weight (ILBW) and proliferating cell nuclear antigen (PCNA) were assayed to evaluate liver regeneration. Blood and liver tissues were collected for serological and western blotting analysis. Results. Resina draconis protected against 2/3 PH‐induced acute severe liver injury and promoted liver regeneration as shown by significantly increased ILBW compared with that of controls. 2/3 PH increased serum AST and ALT levels, which were significantly decreased by RD treatment, while 2/3 PH decreased serum TP and ALB, which were increased by RD treatment. In the RD + 2/3 PH group, PCNA expression was significantly increased compared with the 2/3 PH group. Further, hepatocyte growth factor (HGF), TNFα, and EGFR levels were increased in the RD group at postoperative days 2 and 4 compared with the those in the 2/3 PH group. Conclusion. Our results suggest that RD ameliorates acute hepatic injury and promotes liver cell proliferation, liver weight restoration, and liver function after 2/3 PH, probably via HGF, TNFα, and EGFR signaling.
Synthesis and Antimicrobial Resistant Modulatory Activity of 2,4-Dinitrophenylhydrazone Derivatives as Agents against Some ESKAPE Human Pathogens
Authors: Ade Alberta , Amengor Cedric D. K. , Brobbey Abena , Ayensu Isaac , Harley Benjamin K. , Boakye Yaw Duah
Published: October 2020

A library of six novel phenylhydrazones were synthesized and evaluated for their in vitro antimicrobial and resistance modulating activity against a panel of Gram-positive, Gram-negative, and fungal species. The compounds were produced in good yields of 60–92% w/w and characterized using melting point, UV-visible spectroscopy, infrared, and nuclear magnetic resonance (1H, 13C, and DEPT-Q) techniques. Mass spectroscopy was used to confirm the identity of one of the most active compounds, 5 [SA5]. The phenylhydrazones showed activity against all the six selected microorganisms with minimum inhibitory concentration (MIC) values of the most active compounds, 1 [BP1] and 5 [SA5], at 138 µM (Klebsiella pneumoniae) and 165 µM (Streptococcus pneumoniae), respectively. Compound 1 [BP1] further demonstrated a high resistance modulatory activity at 1.078 µM against Streptococcus pneumoniae and Klebsiella pneumoniae.
Fortified S‐Allyl L‐Cysteine: Animal Safety, Effect on Retinal Ischemia, and Role of Wnt in the Underlying Therapeutic Mechanism
Authors: Chao Windsor Wen-Jin , Chen Yu-Kuang , Chao Howard Wen-Haur , Pan Wynn Hwai-Tzong , Chao Hsiao-Ming
Published: October 2020

Purpose. Retinal ischemia is a medical condition associated with numerous retinal vascular disorders, such as age‐related macular degeneration, glaucoma, and diabetic retinopathy. This in vitro cell and in vivo animal study investigated not only the protective effect of S‐allyl L‐cysteine (SAC, an active component of garlic) against retinal ischemia but also its associated protective mechanisms. Methods. Retinal ischemia was mimicked by raising the intraocular pressure to 120 mmHg for 1 hour in one eye. The effects of pre‐/postischemic administration of vehicle vs. SAC 0.18 mg vs. SAC 0.018 mg vs. SAC 0.0018 mg treatments on retina cells were evaluated through cellular viability (MTT assay), flash electroretinograms (ERGs), and fluorogold retrograde labelling (retinal ganglion cell (RGC) counting). Also, protein immunoblot was utilized to assess the role of Wnt, hypoxia inducible factor (HIF)‐1α, and vascular endothelium factor (VEGF) in the proposed anti‐ischemic mechanism. Lastly, the safety of drug consumption was investigated for changes in the animal’s body weight, ERG waves, and blood biochemical parameters (e.g., glucose levels). Results. The characteristic ischemic changes including significant reduction in ERG b‐wave ratio and RGC number were significantly counteracted by pre‐ and postischemic low dose of SAC. Additionally, ischemia‐induced overexpression of Wnt/HIF‐1α/VEGF protein was ameliorated significantly by preischemic low dose of SAC. In terms of the animal safety, no significant body weight and electrophysiological differences were observed among defined different concentrations of SAC without following ischemia. In low SAC dosage and vehicle groups, various blood biochemical parameters were normal; however, high and medium concentrations of SAC significantly lowered the levels of uric acid, Hb, and MCHC. Conclusion. This study shows that preischemic administration of low SAC dosage has been proved to be safe and most effective against rat retinal ischemia electrophysiologically and/or histopathologically. Moreover, counteracting the ischemia‐induced overexpression of Wnt/HIF‐1α/VEGF might presently explain SAC’s anti‐ischemic mechanism.