bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of physician migration on mortality in low and middle-income countries: an economic modelling study
Authors: Saluja Saurabh , Rudolfson Niclas , Massenburg Benjamin Ballard , Meara John G , Shrime Mark G 
Published: January 2020

BackgroundThe WHO estimates a global shortage of 2.8 million physicians, with severe deficiencies especially in low and middle-income countries (LMIC). The unequitable distribution of physicians worldwide is further exacerbated by the migration of physicians from LMICs to high-income countries (HIC). This large-scale migration has numerous economic consequences which include increased mortality associated with inadequate physician supply in LMICs.MethodsWe estimate the economic cost for LMICs due to excess mortality associated with physician migration. To do so, we use the concept of a value of statistical life and marginal mortality benefit provided by physicians. Uncertainty of our estimates is evaluated with Monte Carlo analysis.ResultsWe estimate that LMICs lose US$15.86 billion (95% CI $3.4 to $38.2) annually due to physician migration to HICs. The greatest total costs are incurred by India, Nigeria, Pakistan and South Africa. When these costs are considered as a per cent of gross national income, the cost is greatest in the WHO African region and in low-income countries.ConclusionThe movement of physicians from lower to higher income settings has substantial economic consequences. These are not simply the result of the movement of human capital, but also due to excess mortality associated with loss of physicians. Valuing these costs can inform international and domestic policy discussions that are meant to address this issue.
Occupational exposure to silica and risk of heart disease: a systematic review with meta-analysis
Authors: Liu Kai , Mu Min , Fang Kehong , Qian Yuanyuan , Xue Song , Hu Weijiang , Ye Meng 
Published: January 2020

ObjectiveTo search for evidence of the relationship between occupational silica exposure and heart disease.DesignA systematic review and meta-analysis.BackgroundGrowing evidence suggests a relationship between occupational silica exposure and heart disease; however, the link between them is less clear.Data sourcesPubMed, ScienceDirect, Springer and EMBASE were searched for articles published between 1 January 1995 and 20 June 2019. Articles that investigated the effects of occupational silica exposure on the risk of heart disease were considered.Study selectionWe included cohort studies, including prospective, retrospective and retroprospective studies.Data extraction and synthesisWe extracted data using a piloted data collection form and conducted random-effects meta-analysis and exposure-response analysis. The meta-relative risk (meta-RR), a measure of the average ratio of heart disease rates in those with and without silica exposure, was used as an inverse variance-weighted average of relative risks from the individual studies. The Newcastle-Ottawa Quality Assessment Scale for cohort studies was used for study quality assessment.Outcome measureWe calculated the risk of heart diseases such as pulmonary heart disease, ischaemic heart disease and others.ResultsTwenty cohort studies were included. The results suggest a significant increase in the risk of overall heart disease (meta-RR=1.08, 95% CI 1.03 to 1.13). Stronger evidence of association with pulmonary heart disease was found in the risk estimate of both categories of heart disease (meta-RR=1.24, 95% CI 1.08 to 1.43) and in the exposure-response analysis (meta-RR=1.39, 95% CI 1.19 to 1.62). Our subgroup analyses also revealed that the statistical heterogeneity among studies could be attributed mainly to the diversity in reference group, occupation and study quality score.ConclusionsSilica-exposed workers are at an increased risk for overall heart disease, especially pulmonary heart disease. Further research is needed to better clarify the relationship between occupational silica exposure and ischaemic heart disease.PROSPERO registration numberCRD42019124673.
Use of tabletop exercises for healthcare education: a scoping review protocol
Authors: Frégeau Amélie , Cournoyer Alexis , Maheu-Cadotte Marc-André , Iseppon Massimiliano , Soucy Nathalie , St-Cyr Bourque Julie , Cossette Sylvie , Castonguay Véronique , Fleet Richard 
Published: January 2020

IntroductionThere is a growing interest in developing interprofessional education (IPE) in the community of healthcare educators. Tabletop exercises (TTX) have been proposed as a mean to cultivate collaborative practice. A TTX simulates an emergent situation in an informal environment. Healthcare professionals need to take charge of this situation as a team through a discussion-based approach. As TTX are gaining in popularity, performing a review about their uses could guide educators and researchers. The aim of this scoping review is to map the uses of TTX in healthcare.Methods and analysisA search of the literature will be conducted using medical subject heading terms and keywords in PubMed, Medline, EBM Reviews (Evidence-Based Medicine Reviews), CINAHL (Cumulative Index of Nursing and Allied Health Literature), Embase and ERIC (Education Resources Information Center), along with a search of the grey literature. The search will be performed after the publication of this protocol (estimated to be January 1st 2020) and will be repeated 1 month prior to the submission for publication of the final review (estimated to be June 1st 2020). Studies reporting on TTX in healthcare and published in English or French will be included. Two reviewers will screen the articles and extract the data. The quality of the included articles will be assessed by two reviewers. To better map their uses, the varying TTX activities will be classified as performed in the context of disaster health or not, for IPE or not and using a board game or not. Moreover, following the same mapping objective, outcomes of TTX will be reported according to the Kirkpatrick model of outcomes of educational programs.Ethics and disseminationNo institutional review board approval is required for this review. Results will be submitted for publication in a peer-reviewed journal. The findings of this review will inform future efforts to TTX into the training of healthcare professionals.
Protocol for studying racial/ethnic disparities in depression care using joint information from participant surveys and administrative claims databases: an observational cohort study
Authors: Donneyong Macarius , Reynolds Charles , Mischoulon David , Chang Grace , Luttmann-Gibson Heike , Bubes Vadim , Guilds McKenna , Manson Joann , Okereke Olivia 
Published: January 2020

IntroductionCurrent evidence indicates that older racial/ethnic minorities encounter disparities in depression care. Because late-life depression is common and confers major adverse health consequences, it is imperative to reduce disparities in depression care. Thus, the primary objectives of this protocol are to: (1) quantify racial/ethnic disparities in depression treatment and (2) identify and quantify the magnitude of these disparities accountable for by a multifactorial combination of patient, provider and healthcare system factors.Methods and analysisData will be derived from the Vitamin D and Omega-3 Trial-Depression Endpoint Prevention (VITAL-DEP) study, a late-life depression prevention ancillary study to the VITAL trial. A total of 25 871 men and women, aged 50+ and 55+ years, respectively, were randomised in a 2×2 factorial randomised trial of heart disease and cancer prevention to receive vitamin D and/or fish oil for 5 years starting from 2011. Most participants were aged 65+ years old at randomisation. Medicare claims data for over 19 000 VITAL/VITAL-DEP participants were linked to conduct our study.The major study outcomes are depression treatment (antidepressant use and/or receipt of psychotherapy services) and adherence to medication treatment (antidepressant adherence and acceptability). The National Academy of Medicine framework for studying racial disparities was leveraged to select patient-level, provider-level and healthcare system-level variables and to address their potential roles in depression care disparities. Blinder-Oaxaca regression decomposition methods will be implemented to quantify and identify correlates of racial/ethnic disparities in depression treatment and adherence.Ethics and disseminationThis study received Institutional Review Board (IRB) approval from the Partners Healthcare (PHS) IRB, protocol# 2010P001881. We plan to disseminate our results through publication of manuscripts patient engagement activities, such as study newsletters regularly sent out to VITAL participants, and presentations at scientific meetings.Trial registration numberNCT01696435.
Multiprofessional in situ simulation is an effective method of identifying latent patient safety threats on the gastroenterology ward
Authors: Uttley Elizabeth , Suggitt Deborah , Baxter David , Jafar Wisam 
Published: January 2020

ObjectiveIn situ simulation (ISS) is an effective training method for multiprofessional teams dealing with emergencies in high pressured environments. A regular ISS programme was organised for the multiprofessional gastroenterology team with a primary objective of identifying, classifying and addressing latent patient safety threats and secondary objectives of improving team confidence and individual role recognition.Method22 unannounced ISS sessions (averaging approximately one session every 6 weeks and four participants per session) were conducted between February 2017 and August 2019 involving multiprofessional team members. The sessions centred around the following four common gastrointestinal emergency scenarios: massive upper gastrointestinal haemorrhage; biliary sepsis (cholangitis) and shock; postendoscopic retrograde cholangiopancreatography complications including perforation and cardiac arrest. Following the simulation, the faculty, which included nurses and doctors, facilitated a structured debrief session and action plan to identify and address latent errors.Results96 participants from nursing, medical, physician associate and pharmacy backgrounds took part in the simulation programme. Analysis of collected latent safety threats identified the following four themes: education and training; equipment; medication and team working. Analysis of anonymously completed questionnaires identified that 95% of participants had a perceived better understanding of their role and 86% felt more confident in assessing an unwell patient. 96% of participants felt comfortable during the debrief.ConclusionISS provides a unique opportunity to train the multiprofessional gastroenterology team in their own high-pressured environment, helping identify and address latent patient safety threats and improve perceived participant confidence and role recognition.
Exploring healthcare professionals’ knowledge, attitudes and experiences of shared decision making in rheumatology
Authors: Mathijssen Elke G E , van den Bemt Bart J F , Wielsma Sabien , van den Hoogen Frank H J , Vriezekolk Johanna E 
Published: January 2020

ObjectivesTo explore physicians’ and nurses’ knowledge, attitudes and experiences of shared decision making (SDM) in rheumatology, to identify barriers and facilitators to SDM, and to examine whether physicians’ and nurses’ perspectives of SDM differ.MethodsA cross-sectional, exploratory, online survey was used. Besides demographic characteristics, healthcare professionals’ knowledge, attitudes and experiences of SDM in rheumatology were assessed. Barriers and facilitators to SDM were identified from healthcare professionals’ answers. Descriptive statistics were computed and differences between physicians’ and nurses’ perspectives of SDM were examined with a t-test or Fisher’s exact test, as appropriate.ResultsBetween April and June 2019, 77 physicians and 70 nurses completed the survey. Although most healthcare professionals lacked a full conceptual understanding of SDM, almost all physicians (92%) and all nurses had a (very) positive attitude toward SDM, which was most frequently motivated by the belief that SDM improves patients’ treatment adherence. The majority (>50%) of healthcare professionals experienced problems with the application of SDM in clinical practice, mostly related to time constraints. Other important barriers were the incompatibility of SDM with clinical practice guidelines and beliefs that patients do not prefer to be involved in decision making or are not able to take an active role. Modest differences between physicians’ and nurses’ perspectives of SDM were found.ConclusionsThere is a clear need for education and training that equips and empowers healthcare professionals to apply SDM. Furthermore, the commitment of time, resources and financial support for national, regional and organisational initiatives is needed to make SDM in rheumatology a practical reality.
Heterogeneities in intrinsic excitability and frequency-dependent response properties of granule cells across the blades of the rat dentate gyrus
Authors: Mishra Poonam , Narayanan Rishikesh 
Published: January 2020

The dentate gyrus (DG), the input gate to the hippocampus proper, is anatomically segregated into three different sectors, namely, the suprapyramidal blade, the crest region, and the infrapyramidal blade. Although there are well-established differences between these sectors in terms of neuronal morphology, connectivity patterns, and activity levels, differences in electrophysiological properties of granule cells within these sectors have remained unexplored. Here, employing somatic whole cell patch-clamp recordings from the rat DG, we demonstrate that granule cells in these sectors manifest considerable heterogeneities in their intrinsic excitability, temporal summation, action potential characteristics, and frequency-dependent response properties. Across sectors, these neurons showed positive temporal summation of their responses to inputs mimicking excitatory postsynaptic currents and showed little to no sag in their voltage responses to pulse currents. Consistently, the impedance amplitude profile manifested low-pass characteristics and the impedance phase profile lacked positive phase values at all measured frequencies and voltages and for all sectors. Granule cells in all sectors exhibited class I excitability, with broadly linear firing rate profiles, and granule cells in the crest region fired significantly fewer action potentials compared with those in the infrapyramidal blade. Finally, we found weak pairwise correlations across the 18 different measurements obtained individually from each of the three sectors, providing evidence that these measurements are indeed reporting distinct aspects of neuronal physiology. Together, our analyses show that granule cells act as integrators of afferent information and emphasize the need to account for the considerable physiological heterogeneities in assessing their roles in information encoding and processing. NEW & NOTEWORTHY We employed whole cell patch-clamp recordings from granule cells in the three subregions of the rat dentate gyrus to demonstrate considerable heterogeneities in their intrinsic excitability, temporal summation, action potential characteristics, and frequency-dependent response properties. Across sectors, granule cells did not express membrane potential resonance, and their impedance profiles lacked inductive phase leads at all measured frequencies. Our analyses also show that granule cells manifest class I excitability characteristics, categorizing them as integrators of afferent information.
Clinical Outcomes of Dynamic Computed Tomography Myocardial Perfusion Imaging Combined With Coronary Computed Tomography Angiography Versus Coronary Computed Tomography Angiography–Guided Strategy
Authors: Yu Mengmeng , Shen Chengxing , Dai Xu , Lu Zhigang , Wang Yining , Lu Bin , Zhang Jiayin 
Published: January 2020

Background:
Dynamic computed tomography (CT) myocardial perfusion imaging (MPI) provides quantitative myocardial blood flow for the precise assessment of myocardial ischemia. However, compared with coronary CT angiography (CCTA), whether this functional imaging modality can reduce invasive coronary angiography without revascularization remains unknown. We aimed to determine the clinical outcomes of a dynamic CT-MPI+CCTA-guided versus CCTA-guided strategy in patients with suspected coronary artery disease.

Methods:
Consecutive patients with intermediate pretest probability of coronary artery disease were prospectively enrolled and randomized to dynamic CT-MPI+CCTA-guided or CCTA-guided workup. The primary end point was the rate of invasive coronary angiography without revascularization within 3 months. The secondary end point was a composite of major adverse cardiac event at the 3-month, 6-month, and 1-year follow-up.

Results:

A total of 240 patients (mean age, 69.01±11.2 years; 173 men) were included. The total radiation dose and contrast media usage within 90 days were higher in the CT-MPI+CCTA group than in the CCTA group (10.3 versus 7.1 mSv,
P
=0.031; 134.5±40.6 versus 108.1±48.2 mL,
P
<0.0001). Compared with the CCTA-guided group, the CT-MPI+CCTA-guided group had significantly lower rates of invasive coronary angiography within 90 days (48.3% [58/120] versus 30.8% [37/120],
P
=0.006) and invasive coronary angiography without revascularization (50.0% [29/58] versus 10.8% [4/37],
P
<0.0001). There were no significant differences regarding the frequency of major adverse cardiac event between the 2 groups at the 3-month, 6-month, and 1-year follow-up.

Conclusions:
In patients with intermediate pretest probability of coronary artery disease, CT-MPI+CCTA-guided patient management may be preferred over the CCTA-guided strategy as an approach to reduce unnecessary invasive procedures.
On the Borders of Law, History and Politics: Estonian Statesman Jüri Jaakson’s Views and Life in Context
Authors: Erne Jaanika 
Published: January 2020

Focusing on the life and work of the Estonian politician and Statesman Jüri Jaakson (1870–1942), the article gives an overview of the changing historical and social context that has influenced the formation of Estonian law. Estonia’s historical diversity can be regarded as events of transformation and disruption that have resulted in vague concepts.
The article consists of three interrelated parts, taking into account that law and society are interconnected and that politics is constructed through language. The first part builds on Jüri Jaakson’s presentation at the first Estonian Lawyers’ Days in 1922, and shows how historical events have influenced political and legal conceptualisation. The second part shows how Jüri Jaakson’s own biography tragically reflects the changing Estonian historical context that he himself considered diverse and controversial. Finally, in the third part, some normative assertions have been made in an attempt to show that any legal term always relates to a certain social and political context.
Although the author’s aim has not been to frame a doctrine or provide instruction, but rather, with the help of Jüri Jaakson’s thoughts situated in the context of his time, to offer a moral measure for understanding the developments that could influence small states, it offers a measure for understanding why societies require (new) conceptualisation and re-conceptualisation. Conceptualisation is understood as constructing something new that we cannot identify in the past, while reconceptualisation is understood as change, also resulting from discontinuity and/or interruption. Because there are no unchangeable social categories or meanings, continuity can at best mean a situation where the research objects have remained more static over a concrete period.
Methodologically this article is an attempt to connect legal research with a conceptual historical approach.
Posttransplant Lymphoproliferative Disorders Presenting as an External Nasal Deformity: A Case Report
Authors: Yuan Jingjing , Yan Zhanfeng , Liu Jinfeng , Wang Ningyu 
Published: January 2020

Introduction: Posttransplant lymphoproliferative disorder (PTLD) is a serious disease that usually occurs after solid organ transplant and stem cell transplant. Posttransplant lymphoproliferative disorder often involves the head and neck, but it is rare to present as a nasal deformity. Here, we describe a case of external nasal enlargement resulting from PTLD. Case report: A 40-year-old man presented with an enlarged external nose half a year ago. The nasal ala thickened, and the external nose was gradually enlarged, accompanied by bilateral nasal obstructions. A biopsy was taken under endoscopy procedure, and the result suggested a diagnosis of PTLD. Discussion: Posttransplant lymphoproliferative disorder usually appears in lymphoid tissues that form Waldeyer’s rings or cervical lymph nodes in the head and neck. The early involvement of other head and neck subpoints is considered rare. This case is the first report of PTLD presenting as an external nasal deformity. The symptoms and clinical manifestations of PTLD in otorhinolaryngology are usually diverse and nonspecific but are early symptoms in the clinical course of PTLD.
Urine metabolomics signatures in reversible cerebral vasoconstriction syndrome
Authors: Hsu Wei-Hsiang , Wang Shuu-Jiun , Chao Yen-Ming , Chen Chao-Jung , Wang Yen-Feng , Fuh Jong-Ling , Chen Shih-Pin , Lin Yun-Lian 
Published: January 2020

Background The pathophysiology of reversible cerebral vasoconstriction syndrome is unclear. An unbiased systems-based approach might help to illustrate the metabolite profiling and underlying pathophysiology. Methods Urine samples were collected from reversible cerebral vasoconstriction syndrome patients and matched controls recruited in Taipei Veterans General Hospital. 1H-Nuclear magnetic resonance was used to initially explore the metabolic profile, and liquid chromatography tandem mass spectrometry was then used to identify metabolic alterations in reversible cerebral vasoconstriction syndrome. Untargeted metabolite screening was randomly performed on 10 reversible cerebral vasoconstriction syndrome patients and 10 control subjects in the discovery phase. The selected untargeted metabolites were further validated on 47 reversible cerebral vasoconstriction syndrome patients during their ictal stage (with 40 of them having remission samples) and 47 controls in the replication phase. Results and conclusion Six metabolites-hippurate, citrate, 1,3,7-trimethyluric acid, ascorbic acid, D-glucurono-6,3-lactone, and D- threo-isocitric acid-with t-test derived p-value < 0.05 and VIP score >1, were identified as potential urine signatures that can well distinguish reversible cerebral vasoconstriction syndrome subjects at ictal stage from controls. Among them, citrate, hippurate, ascorbic acid, and D-glucurono-6,3-lactone were significantly lower, and 1,3,7-trimethyluric acid and D- threo-isocitric acid were higher in reversible cerebral vasoconstriction syndrome patients. Of these, four selected metabolites, citrate, D-glucurono-6,3-lactone, ascorbic acid, and 1,3,7-trimethyluric acid, returned to normal levels in remission. These metabolites are related to pathways associated with free radical scavenging, with the hub molecules being associated with endothelial dysfunction or sympathetic overactivity. Whether these metabolites and their implicated networks play a role in the pathogenesis of reversible cerebral vasoconstriction syndrome remains to be confirmed.