bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spectro-Spatial Wave Features in Nonlinear Metamaterials: Theoretical and Computational Studies
Authors: Bukhari Mohammad , Farzaneh Joubaneh Eshagh , Barry Oumar 
Published: September 2020

Abstract
Considerable attention has been given to nonlinear metamaterials because they offer some interesting phenomena such as solitons, frequency shifts, and tunable bandgaps. However, only little is known about the spectro-spatial properties of a wave propagating in nonlinear periodic chains, particularly, a cell with multiple nonlinear resonators. This problem is investigated here. Our study examines both hardening and softening nonlinearities in the chains and in the local resonators. Explicit expressions for the nonlinear dispersion relations are derived by the method of multiple scales. We validate our analytical results using numerical simulations. The numerical simulation is based on spectro-spatial analysis using signal processing techniques such as spatial-spectrogram and wave filtering. The spectro-spatial analysis provides detailed information about the interactions of dispersive and nonlinear phenomena of waveform in both short- and long-wavelength domains. Furthermore, we validate and demonstrate the theoretically obtained bandgaps, wave distortion, and birth of solitary waves through a computational study using finite element software, ansys. The findings, in both theoretical and computational analyses, suggest that nonlinear resonators can have more effect on the waveform than the nonlinear chains. This observation is valid in both short and long wavelength limits.
Completion of paediatric training: trends across 2011–2017 cohorts
Authors: Redman Melody Grace , Carzedda Davide , Jay Nicola , Clark Simon J , Rogers Marie 
Published: September 2020

Objective
To determine trends in the demographics and destinations of doctors who have recently completed paediatric training in the UK.

Design
A survey was sent to all new paediatric certificate holders 1 year on from completing specialty training every year from 2011 to 2017.

Setting
Retrospective survey.

Outcome measures
Demographics, career destinations, time to complete training, working patterns, subspecialty registration, numbers of job applications, and use of the period of grace are reported.

Results
1262 people who gained their paediatric certificate in the UK between 2011 and 2017 completed the survey (60.6% response rate). 58.5% (n=738) of respondents were female, and 32.4% (n=224) of women work less than full time, compared with 4.6% (n=23) of men. 85.9% (n=1056) of respondents were in a UK consultant post. 7.6% (n=94) were working overseas. 65.1% (n=722) remained in the region they trained in. 64.8% (n=1348) were registered for general paediatrics, whereas 35.2% (n=733) had subspecialised.
Respondents who held a non-UK medical degree (47.5%, n=501) made more job applications on average (mean=2.2; 95% CI 2.0 to 2.5) than those with a UK degree (52.5%, n=554) (mean=1.1; 95% CI 1.0 to 1.2) (p<0.001). Average training time increased from 9.8 years (95% CI 9.4 to 10.2) to 11.3 years (95% CI 11.1 to 11.6) (p<0.001). Respondents’ use of their grace period reduced from 42.7% (n=47) to 20.6% (n=29) (p<0.001).

Conclusions
The data reflect the diverse paediatric workforce and doctors’ working patterns following the completion of paediatric training in the UK. The trends demonstrated are vital to consider for evidence-based workforce planning.
Sodium glucose cotransporter 2 inhibitors and risk of major adverse cardiovascular events: multi-database retrospective cohort study
Authors: Filion Kristian B , Lix Lisa M , Yu Oriana HY , Dell’Aniello Sophie , Douros Antonios , Shah Baiju R , St-Jean Audray , Fisher Anat , Tremblay Eric , Bugden Shawn C , Alessi-Severini Silvia , Ronksley Paul E , Hu Nianping , Dormuth Colin R , Ernst Pierre , Suissa Samy 
Published: September 2020

Abstract

Objective
To compare the risk of cardiovascular events between sodium glucose cotransporter 2 (SGLT2) inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors among people with type 2 diabetes in a real world context of clinical practice.

Design
Multi-database retrospective cohort study using a prevalent new user design with subsequent meta-analysis.

Setting
Canadian Network for Observational Drug Effect Studies (CNODES), with administrative healthcare databases from seven Canadian provinces and the United Kingdom, 2013-18.

Population
209 867 new users of a SGLT2 inhibitor matched to 209 867 users of a DPP-4 inhibitor on time conditional propensity score and followed for a mean of 0.9 years.

Main outcome measures
The primary outcome was major adverse cardiovascular events (MACE, a composite of myocardial infarction, ischaemic stroke, or cardiovascular death). Secondary outcomes were the individual components of MACE, heart failure, and all cause mortality. Cox proportional hazards models were used to estimate site specific adjusted hazards ratios and 95% confidence intervals, comparing use of SGLT2 inhibitors with use of DPP-4 inhibitors in an as treated approach. Site specific results were pooled using random effects meta-analysis.

Results

Compared with DPP-4 inhibitors, SGLT2 inhibitors were associated with decreased risks of MACE (incidence rate per 1000 person years: 11.4
v
16.5; hazard ratio 0.76, 95% confidence interval 0.69 to 0.84), myocardial infarction (5.1
v
6.4; 0.82, 0.70 to 0.96), cardiovascular death (3.9
v
7.7; 0.60, 0.54 to 0.67), heart failure (3.1
v
7.7; 0.43, 0.37 to 0.51), and all cause mortality (8.7
v
17.3; 0.60, 0.54 to 0.67). SGLT2 inhibitors had more modest benefits for ischaemic stroke (2.6
v
3.5; 0.85, 0.72 to 1.01). Similar benefits for MACE were observed with canagliflozin (0.79, 0.66 to 0.94), dapagliflozin (0.73, 0.63 to 0.85), and empagliflozin (0.77, 0.68 to 0.87).

Conclusions
In this large observational study conducted in a real world clinical practice context, the short term use of SGLT2 inhibitors was associated with a decreased risk of cardiovascular events compared with the use of DPP-4 inhibitors.

Trial registration

ClinicalTrials.gov
NCT03939624
.
Pregnant women’s retention and associated health facility characteristics in the prevention of mother-to-child HIV transmission in Indonesia: cross-sectional study
Authors: Lumbantoruan Christina , Kelaher Margaret , Kermode Michelle , Budihastuti Endang 
Published: September 2020

ObjectivesDespite the national effort to integrate the Prevention of Mother-to-Child Transmission (PMTCT) programme into antenatal care clinics in Indonesia, the rate of mother-to-child HIV transmission remains high. This national study was conducted to describe PMTCT programme performance and to identify health facility characteristics associated with this performance in order to inform programme planning and policy development.DesignA retrospective cross-sectional study in December 2017.SettingAll health facilities providing PMTCT programmes in Indonesia.ParticipantsAll health facilities registering at least one woman in antenatal care in 2017.InterventionPMTCT data extraction from the national reporting system on HIV/AIDS and government reports.OutcomesWomen retention in the PMTCT programme for at least 3 months and associated health facility characteristics.ResultsA total of 373 health facilities registering 6502 HIV-positive women in antenatal care were included in the analysis. One-third of women (2099) never started antiretroviral treatment. Of the 4403 women who started, 2610 (57%) were retained; 462 (10%) were not retained; and the retention status of 1252 (28%) women referred out of the health facilities was unknown. Compared with primary health centres, hospitals were more likely to retain women (OR=2.88, 95% CI 2.19 to 3.79). The odds of retention were higher in hospital types A and B (OR=3.89, 95% CI 3.19 to 4.76), located within concentrated HIV epidemic areas (OR=2.09, 95% CI 1.83 to 2.38) and a high-priority area for the HIV programme (OR=1.83, 95% CI 1.60 to 2.09). We observed no differential retention between women who initiated PMTCT under different options (B+/non-B+).ConclusionsWe observed low retention of HIV-positive pregnant women in the PMTCT programme in Indonesia in 2017. Additional efforts are needed to improve women’s retention in the PMTCT programme. Retention could be increased through the delivery of PMTCT programmes by replicating strategies implemented at hospital types A and B located in concentrated HIV epidemic areas where an HIV programme is a high priority.
Retrospective analysis of medical malpractice claims in tertiary hospitals of China: the view from patient safety
Authors: Li Heng , Dong Shengjie , Liao Ziyi , Yao Yao , Yuan Suwei , Cui Yujie , Li Guohong 
Published: September 2020

ObjectivesThe study analysed medical malpractice claims to assess patient safety in hospitals. The information derived from malpractice claims reflects potential risks and could help lead to reducing medical errors and improving patient safety.Design, settingWe analysed 4380 medical malpractice claims from 351 grade-A tertiary hospitals in China for 2008–2017. We examined the characteristics of medical errors and patient safety, including the types of medical errors, proportionate liabilities and payments for medical malpractice in different clinical specialties.Main outcome measuresWe assessed claim characteristics, payment amounts and liability.ResultsOur data analysis demonstrated that 72.5% of the claims involved medical errors, with average payments of US$31 430. The hospital’s errors in medical malpractice resulted in 41.4% average liability in patient injury payments. Most medical malpractice cases occurred in Shanghai (817 claims, 18.7%) and Beijing (468 claims, 10.7%). The highest risks for medical error and malpractice claims were related to orthopaedics (11.3% of all claims, 72.8% with medical errors) and obstetrics and gynaecology (10.0% of all claims, 76.0% with medical errors). The highest rates related to proportionate liabilities were observed in otolaryngology (51.9%) and endocrinology (47.7%). Respiratory medicine had the highest proportion of claims in death rates (77.3%). Medical technology errors accounted for 91.8% of the claims and medical ethics errors for 5.8%. The highest average payment was found in cardiovascular surgery (US$41 733) and the lowest in stomatology (US$8822).ConclusionsA previous study found that grade-A tertiary hospitals in China have similar medical error rates to general Chinese hospitals. 36Different specialties had different risk characteristics regarding medical errors, payments and proportionate liabilities. Orthopaedics had the highest number of malpractices claims and higher proportionate liability but lower death rates.
Work-related stressors among hospital physicians: a qualitative interview study in the Tokyo metropolitan area
Authors: Ihara Yuko , Son Daisuke , Nochi Masahiro , Takizawa Ryu 
Published: September 2020

ObjectivesWe explored Japanese physicians’ work-related stressors and identified those unique to this population, as well as clarified the influence of cultural and medical system diversity on these stressors to determine the content of future stress-reducing interventions for hospital physicians in Japan.DesignWe conducted a semistructured, face-to-face interview-based qualitative study between August and October 2017. The collected data were analysed using the grounded theory approach.SettingHospitals around the Tokyo metropolitan area, Japan.ParticipantsSixteen hospital physicians (mean age (SD)=33.9 (4.2) years; 11 men, 5 women). Seven worked in internal medicine and nine in surgery.ResultsWe found unique stressors related to the Japanese medical system and culture, such as continuous all-day work after night shifts, and a hierarchical organisational system calledIkyoku. The results also indicated that Japanese physicians shared several stressors with Western physicians, such as sleep deprivation, high pressure and the limits of medicine.ConclusionsOur study clarifies some sources of work-related stressors among hospital physicians in Japan. While the key components of Western interventions might be useful in a Japanese context, the original evidence obtained from this study highlights the necessity of initiating interventions addressing the unique stressors of Japanese physicians. To reduce physicians’ stress and enhance their well-being, psychological interventions for hospital physicians must be introduced in Japan.
Postoperative mortality in New Zealand following general anaesthetic: demographic patterns and temporal trends
Authors: Gurney Jason K , McLeod Melissa , Stanley James , Campbell Doug , Boyle Luke , Dennett Elizabeth , Jackson Sarah , Koea Jonathan , Ongley Dick , Sarfati Diana 
Published: September 2020

ObjectivesIn this manuscript, we describe broad trends in postoperative mortality in New Zealand (a country with universal healthcare) for acute and elective/waiting list procedures conducted between 2005 and 2017.Design, participants and settingWe use high-quality national-level hospitalisation data to compare the risk of postoperative mortality between demographic subgroups after adjusting for key patient-level confounders and mediators. We also present temporal trends and consider how rates in postoperative death following acute and elective/waiting list procedures have changed over this time period.Results and conclusionA total of 1 836 683 unique patients accounted for 3 117 374 admissions in which a procedure was performed under general anaesthetic over the study period. We observed an overall 30-day mortality rate of 0.5 per 100 procedures and a 90-day mortality rate of 0.9 per 100. For acute procedures, we observed a 30-day mortality rate of 1.6 per 100, compared with 0.2 per 100 for elective/waiting list procedures. In terms of procedure specialty, respiratory and cardiovascular procedures had the highest rate of 30-day mortality (age-standardised rate, acute procedures: 3–6 per 100; elective/waiting list: 0.7-1 per 100). As in other contexts, we observed that the likelihood of postoperative death was not proportionally distributed within our population: older patients, Māori patients, those living in areas with higher deprivation and those with comorbidity were at increased risk of postoperative death, even after adjusting for all available factors that might explain differences between these groups. Increasing procedure risk (measured using the Johns Hopkins Surgical Risk Classification System) was also associated with an increased risk of postoperative death. Encouragingly, it appears that risk of postoperative mortality has declined over the past decade, possibly reflecting improvements in perioperative quality of care; however, this decline did not occur equally across procedure specialties.
Consequences of early life exposure to the 1983–1985 Ethiopian Great Famine on cognitive function in adults: a historical cohort study
Authors: Arage Getachew , Belachew Tefera , Abera Mubarek , Abdulhay Fedilu , Abdulahi Misra , Hassen Abate Kalkidan 
Published: September 2020

ObjectivesTo investigate the association between early life famine exposure and cognitive function in adults.DesignHistorical cohort studySettingNorth Wollo Zone, Northeast Ethiopia.ParticipantsWe recruited 1047 adult men and women aged 30–38 years who had history of early life exposure to Ethiopian great famine. Based on self-reported age and birth date, participants were categorised into famine exposed in early life (prenatal/postnatal) and non-exposed groups.Outcome measuresThe primary outcome measure of this study was cognitive function in adults after early life exposure to famine. Cognitive function was measured using Montreal Cognitive Assessment—basic. Associations between exposure and outcome variables were examined by linear regression analysis models.ResultsAdjusted for covariates, early life exposure to famine showed 1.29 (β=−1.29; 95% CI −2.16 to -0.52) points lower cognitive function score compared with non-exposed. Based on subanalysis for timing of famine exposure, postnatal exposure to famine resulted in 2.26 (β=−2.26; 95% CI −3.12 to -1.36) points lower cognitive function score compared with non-exposed groups. Prenatal famine exposure had 1.26 (β=−1.26; 95% CI −2.35 to 0.94) points lower cognitive function score although not statistically significant.ConclusionsFamine exposure in early life was associated with cognitive functions in adults. While the overall findings highlight the importance of optimal nutrition in early life for brain growth and development, the association observed between postnatal famine exposure and adult cognitive function may indicate the relative importance of learning and experience during early childhood for optimal brain development after birth. Further studies are needed to elucidate the potential mechanism behind this association.
Self-reported secondhand smoke exposure following the adoption of a national smoke-free policy in Poland: analysis of serial, cross-sectional, representative surveys, 2009–2019
Authors: Jankowski Mateusz , Rees Vaughan , Zgliczyński Wojciech Stefan , Kaleta Dorota , Gujski Mariusz , Pinkas Jarosław 
Published: September 2020

ObjectiveWe assessed changes in secondhand smoke (SHS) exposure in workplaces and public venues in Poland over a 9-year period following the adoption of a smoke-free policy in Poland in 2010.DesignSix waves of cross-sectional surveys were carried out between 2009 and 2019.ParticipantsA nationally representative sample of adult Polish residents (age 15 years and older) was surveyed.Survey respondents self-reported SHS exposure in the workplace and 12 different public venues. Data were analysed separately for samples consisting of (1) all respondents and (2) non-smokers only.SHS exposure was defined based on self-report, which may invoke error such as demand bias or recall bias and study protocol do not include participation of paediatric populations that are key limitations of this study.ResultsWithin a year of adopting the smoke-free policy in 2010, the proportion of non-smokers exposed to SHS in Polish workplaces decreased by more than half (from 19.2% in 2009 to 9.5% in 2011). Over 10 years, a substantial reduction in SHS exposure was observed in all public venues. The highest decrease in SHS exposure was observed in transport services (decreased from 45.7% to 11.7% among all respondents and from 44.2% to 11.7% among non-smokers) and in bars/pubs (SHS exposure decreased from 45.0% to 7.0% among all respondents and from 39.4% to 7.0% among non-smokers).ConclusionsThis study demonstrates the substantial success of a national smoke-free law. Nevertheless, smoke-free laws must continue to be refined in terms of their legal boundaries as well as implementation strategies to eliminate disparities in SHS exposure in certain types of venues.
Nationwide incidence of central retinal artery occlusion in Japan: an exploratory descriptive study using the National Database of Health Insurance Claims (2011–2015)
Authors: Kido Ai , Tamura Hiroshi , Ikeda Hanako Ohashi , Miyake Masahiro , Hiragi Shusuke , Tsujikawa Akitaka 
Published: September 2020

AimsThe latest evidence in the incidence of central retinal artery occlusion (CRAO) is needed to support the development of novel treatments as orphan drugs. However, up-to-date information on the incidence of CRAO in the ageing or aged population is limited. We aimed to investigate the nationwide epidemiological and clinical characteristics of CRAO in Japan, using nationwide health insurance claims data.MethodsWe analysed a total of 16 069 762 claims data in the sampling dataset of the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), which is the nationwide health insurance claims database of 127 million whole Japanese individuals. CRAO was identified using the International Classification of Diseases 10th edition diagnostic code H34.1. The crude incidence rates and age-standardised incidence rates of CRAO, according to the standard age-structure population of the WHO, were calculated.ResultsThe crude incidence rate of CRAO in Japan was 5.84 (95% CI, 5.71 to 5.97) per 100 000 person-years. With respect to the sex-related incidence, the rate was higher 1.40 times in men than in women (6.85 (95% CI, 6.65 to 7.06) vs 4.88 (95% CI, 4.71 to 5.05), p<0.001). The age-standardised incidence rate was 2.53 (95% CI, 2.29 to 2.76) per 100 000 person-years.ConclusionsThe crude incidence rate of CRAO was higher in Japan than in other countries, as reported previously, reflecting the Japanese population structure as a super-aged society. These findings can be helpful for the development of appropriate healthcare policies to address the increasing incidence of CRAO with the ageing population.
Antiarrhythmic and cardiac electrophysiological effects of SZV-270, a novel compound with combined Class I/B and Class III effects, in rabbits and dogs
Authors: Varga Richárd S. , Hornyik Tibor , Husti Zoltán , Kohajda Zsófia , Krajsovszky Gábor , Nagy Norbert , Jost Norbert , Virág László , Tálosi László , Mátyus Péter , Varró András , Baczkó István 
Published: September 2020

Cardiovascular diseases are the leading causes of mortality. Sudden cardiac death is most commonly caused by ventricular fibrillation (VF). Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major cause of stroke and heart failure. Pharmacological management of VF and AF remains suboptimal due to limited efficacy of antiarrhythmic drugs and their ventricular proarrhythmic adverse effects. In this study, the antiarrhythmic and cardiac cellular electrophysiological effects of SZV-270, a novel compound, were investigated in rabbit and canine models. SZV-270 significantly reduced the incidence of VF in rabbits subjected to coronary artery occlusion/reperfusion and reduced the incidence of burst-induced AF in a tachypaced conscious canine model of AF. SZV-270 prolonged the frequency-corrected QT interval, lengthened action potential duration and effective refractory period in ventricular and atrial preparations, blocked IKrin isolated cardiomyocytes (Class III effects), and reduced the maximum rate of depolarization (Vmax) at cycle lengths smaller than 1000 ms in ventricular preparations (Class I/B effect). Importantly, SZV-270 did not provoke Torsades de Pointes arrhythmia in an anesthetized rabbit proarrhythmia model characterized by impaired repolarization reserve. In conclusion, SZV-270 with its combined Class I/B and III effects can prevent reentry arrhythmias with reduced risk of provoking drug-induced Torsades de Pointes.