bluuebunny/crossref_metadata_2025_split huggingface dataset:
Are franchisees more prone to employment standards violations than other businesses? Evidence from Ontario, Canada
Authors: Easton Mark D , Noack Andrea M , Vosko Leah F 
Published: October 2020

Using an administrative dataset from the Ontario Ministry of Labour, we investigate three hypotheses about employment standards violations among franchised businesses: (1) franchisees have a higher probability of violating employment standards than other businesses, (2) franchisees have a higher probability of monetary/wage-related ES violations than other businesses, and (3) franchisees have a lower probability of repaying monetary/wage-related violations than other businesses. The results of our statistical models suggest that overall, franchisees are indeed more likely to violate ES, have a higher probability of monetary/wage-related violations, and are less likely to repay such violations. However, the results vary substantially by industry. While franchisees had only marginally higher probabilities of an ES violation in two of the seven industry-groups examined, five of the seven industries showed substantially higher probabilities of a monetary violation. The results also show that franchisees in three industry groups (retail, accommodation and food services, and education, public administration, healthcare and social services) are particularly prone to monetary violations.JEL codes: J83, J88, J89
Toward Defining Healthcare Simulation Escape Rooms
Authors: Anderson Mindi , Lioce Lori , M. Robertson Jamie , O. Lopreiato Joseph , A. Díaz Desiree 
Published: October 2020

Background. Escape rooms have been adapted from a range of educational purposes across disciplines, including healthcare simulation. The use of this technique has become increasingly popular among industry and faculty members. We sought to clarify the characteristics of healthcare simulation escape rooms in order to work toward a shared mental model and definition. Methods. A scoping review of the literature with an environmental scan of websites and other public information was performed to identify concepts which describe educational and healthcare simulation escape rooms to differentiate between and determine key features and scope of this clinical education tool to provide an interprofessional definition. Twenty-three references were used. Results. Healthcare simulation escape rooms share many of the characteristics of those being used for education and may be utilized for teaching a variety of skills. These may be conducted either within a simulation scenario, within the simulation/simulated environment, and/or with associated equipment. It is essential that the development and implementation of these escape rooms follow design standards of best practice for healthcare simulation for optimal learning. Only one definition of simulation escape rooms was found. Discussion. While similar to escape rooms utilized in other forms of education, there are principal differences between those escape rooms and ones used in healthcare simulation. Key features include utilization of core healthcare simulation principles, including providing a safe and realistic learning environment. Conclusion. Escape rooms may be used to engage learners in a simulation experience. It is important to differentiate between true simulation escape rooms and escape rooms that do not reflect healthcare simulation-based learning experiences. An expanded definition is provided, as reflected by the literature review, to provide a clearer understanding of the term as applied to healthcare simulation and enhance repeatable studies to advance the science of healthcare simulation.
Bone Growth Capacity of Human Umbilical Cord Mesenchymal Stem Cells and BMP-2 Seeded Into Hydroxyapatite/Chitosan/Gelatin Scaffold in Alveolar Cleft Defects: An Experimental Study in Goat
Authors: Bangun Kristaninta , Sukasah Chaula L. , Dilogo Ismail H. , Indrani Decky J. , Siregar Nurjati Chairani , Pandelaki Jacub , Iskandriati Diah , Kekalih Aria , Halim Jessica 
Published: October 2020

Objective: To evaluate bone regeneration in alveolar defects treated with human umbilical cord–derived mesenchymal stem cells (hUCMSCs), hydroxyapatite/chitosan/gelatin (HA/CS/Gel) scaffold, and bone morphogenic protein-2 (BMP-2) in Capra hircus models. Design: Randomized posttest-only control group design. Setting: Animal Hospital at Bogor Agricultural Institute. Participants: Healthy and equally treated 24 female Capra hircus/goats. Intervention: Animals were randomly assigned to 3 experimental group design (iliac crest alveolar bone graft/ICABG [control], HA/Cs/Gel+BMP-2 [ Novosys], and HA/Cs/Gel+BMP-2+UCMSCs). Graft materials were implanted in surgically made alveolar defects. Main Outcome Measures: Postoperative functional score and operating time were assessed. New bone growth, bone density, inflammatory cells recruitment, and neoangiogenesis were evaluated based on radiological and histological approach at 2 time points, week 4 and 12. Statistical analysis was done between treatment groups. Results: Operating time was 34% faster and functional score 94.5% more superior in HA/Cs/Gel+BMP-2+hUCMSC group. Bone growth capacity in HA/Cs/Gel+BMP-2+UCMSCs mimicked ICABG, but ICABG showed possibility of bone loss between week 4 and 12. The HA/Cs/Gel+BMP-2+UCMSCs showed early bone repopulation and unseen inflammatory cells and angiogenesis on week 12. Discussion and Conclusion: The HA/Cs/Gel+BMP-2+hUCMSCs were superior in enhancing new bone growth without donor site morbidity compared to ICABG. The presence of hUCMSCs in tissue-engineered alveolar bone graft (ABG), supported with paracrine activity of the resident stem cells, initiated earlier new bone repopulation, and completed faster bone regeneration. The HA/Cs/Gel scaffold seeded with UCMSCs+BMP-2 is a safe substitute of ICABG to close alveolar bone defects suitable for patients with cleft lip, alveolus, and palate.
Msx1 Heterozygosity in Mice Enhances Susceptibility to Phenytoin-Induced Hypoxic Stress Causing Cleft Palate
Authors: Park Jinsil , Nakatomi Mitsushiro , Sasaguri Masaaki , Habu Manabu , Takahashi Osamu , Yoshiga Daigo , Matsuyama Kae , Kataoka Shinji , Toyono Takashi , Seta Yuji , Peters Heiko , Tominaga Kazuhiro 
Published: October 2020

Objective: Cleft palate is among the most frequent congenital defects in humans. While gene–environment multifactorial threshold models have been proposed to explain this cleft palate formation, only a few experimental models have verified this theory. This study aimed to clarify whether gene–environment interaction can cause cleft palate through a combination of specific genetic and environmental factors. Methods: Msx1 heterozygosity in mice ( Msx1+/−) was selected as a genetic factor since human MSX1 gene mutations may cause nonsyndromic cleft palate. As an environmental factor, hypoxic stress was induced in pregnant mice by administration of the antiepileptic drug phenytoin, a known arrhythmia inducer, during palatal development from embryonic day (E) 11 to E14. Embryos were dissected at E13 for histological analysis or at E17 for recording of the palatal state. Results: Phenytoin administration downregulated cell proliferation in palatal processes in both wild-type and Msx1+/− embryos. Bone morphogenetic protein 4 ( Bmp4) expression was slightly downregulated in the anterior palatal process of Msx1+/− embryos. Although Msx1+/− embryos do not show cleft palate under normal conditions, phenytoin administration induced a significantly higher incidence of cleft palate in Msx1+/− embryos compared to wild-type littermates. Conclusion: Our data suggest that cleft palate may occur because of the additive effects of Bmp4 downregulation as a result of Msx1 heterozygosity and decreased cell proliferation upon hypoxic stress. Human carriers of MSX1 mutations may have to take more precautions during pregnancy to avoid exposure to environmental risks.
Personality and Cognitive–Emotional Variables in Spanish Children and Adolescents With and Without Cleft Lip and/or Palate
Authors: Guillén Ana Ruiz , Olmo María José González , Puente Cecilia Peñacoba , Maroto Martín Romero 
Published: October 2020

Objectives: To analyze personality (Big Five Model) and cognitive–emotional variables in children and adolescents with a cleft lip/palate (s) in comparison to an equivalent peer sample without an orofacial cleft. Design: Cross-sectional study with data collected using self-reported questionnaires over 2 years. Setting: Data were collected during visits to health center dental clinics. Patients: Children and adolescents (aged 8-18 years) with nonsyndromic CL/P (n = 60) and without a cleft (n = 60). Method: Patients completed questionnaires with assistance as needed from a member of the research team. Main Outcome Measures: Children’s Perceived Self-Efficacy, Cognitive Emotion Regulation Questionnaire (child version), Big Five Questionnaire for Children, and Alexithymia Questionnaire for Children. Results: When accounting for age, children with CL/P had normative self-efficacy and cognitive–emotional regulation strategies, with the protective factor of significantly lower rumination than peers. Children with CL/P were significantly lower on the Big Five personality areas of conscientiousness, openness to experience, extraversion, and agreeableness along with significantly higher neuroticism. They were similarly significantly higher than peers for alexithymia. Conclusion: Children with CL/P showed strengths in self-efficacy typical of peers and less use of some maladaptive coping strategies; however, they also had higher levels of alexithymia and risk factors associated with the Big Five Model of personality. Strategies may be clinically useful that maximize areas of strength to support children with CL/P in expressing their emotions to reduce alexithymia, coping with of negative affect, and building assertiveness.
Tyrosine kinase inhibitors in the treatment of metastatic renal cell cancer patients with early cytokine intolerance: TURCOS, a Turkish national, prospective observational study
Authors: Benekli Mustafa , Gumus Mahmut , Ozkan Metin , Dane Faysal , Elkiran Emin T. , Cicin Irfan , Sevinc Alper , Aliustaoglu Mehmet , Isikdogan Abdurrahman , Meydan Nezih , Oksuzoglu Berna , Ozyilkan Ozgur , Artac Mehmet , Ozdemir Feyyaz , Kilickap Sadettin 
Published: October 2020

Objective Cytokines have been the mainstay of treatment in metastatic renal cell cancer (mRCC) for decades before the introduction of tyrosine kinase inhibitors (TKIs), which dramatically changed the therapeutic landscape in these patients. This observational study was designed to evaluate use of TKIs in the treatment of cytokine-intolerant mRCC patients. Methods A total of 151 cytokine-intolerant mRCC patients who were treated with TKIs (sunitinib, pazopanib and sorafenib) were enrolled in this prospective, non-interventional, multi-center observational study at 16 oncology centers across Turkey. Mean (SD) age was 61.3 (11.1) years and 74.8% were males. Data on duration of TKI treatment was the primary outcome measure. Additionally, overall response rate (ORR), progression free survival (PFS), overall survival (OS) and safety data were recorded. Results Median duration of treatment was 8.2 months at a median follow up of 17.9 months. ORR and disease control rate were 12.5% and 70.8%, respectively. Median PFS and OS were 7.5 months (95%CI: 6.4–10.4) and 27.3 months (95%CI: 17.6–27.3) with no significant difference among three TKI agents in terms of treatment duration, ORR, PFS and OS. The most common adverse events excluding progression-which was the protocol requirement were diarrhea (13.6%), asthenia (13.6%) and hand-foot syndrome (12.6%). Dose modifications were required in 30.5% of the patients and 15% discontinued TKIs because of toxicity. Conclusions Our findings confirm the efficacy and safety profile of TKIs in the first-line treatment of mRCC patients intolerant to cytokine treatment. There was no significant difference among three TKI agents in terms of treatment duration, ORR, PFS and OS. Trial registration: TURCOS ClinicalTrials.gov Identifier: NCT01585974. Registered April 25, 2012.
Multidirectional pattern of hair growth with carflizomib use for multiple myeloma
Authors: Tuler Shahaf , Kaur Jaspreet , Delaware Suzette , Dasanu Constantin A 
Published: October 2020

Introduction Extensive use of novel therapies for multiple myeloma has been accompanied by intriguing toxic side effects affecting various organs and organ systems. Although skin effects with some of these medications have been well-documented, hair changes are fairly rare. Case report We report herein a unique case of a patient with myeloma who developed multidirectional pattern of scalp hair growth starting at 14 months into treatment with cafilzomib. This pattern of hair growth had not previously been described in the literature. Management and outcome: The patient had a near-complete response to caflizomib, and continues on this maintenance treatment regimen to the present day. There has not been any change in the unusual hair appearance and texture. Discussion A score of 5 on the Naranjo nomogram makes the causality relationship between carfilzomib use and the multidirectional hair growth probable. The mechanism by which carfilzomib causes this hair change remains to be elucidated.
Prevalence of Venous Thromboembolism in Kumasi: A Postmortem-Based Study in a Tertiary Hospital in Ghana
Authors: Ossei Paul Poku Sampene , Owusu Isaac Kofi , Owusu-Asubonteng Gerald , Ankobea-Kokroe Frank , Ayibor William Gilbert , Niako Nicholas 
Published: October 2020

Background: There is a dearth of publications on the prevalence of venous thromboembolism in Ghana. Knowledge of the prevalence of venous thromboembolism, which is often undetected clinically, will help save lives as appropriate interventions can be made as well as provide a general clue to clinicians on detecting venous thromboembolism and pulmonary embolism. Methods: The study employs a retrospective design with data extracted from the Autopsy Daybook of the Pathology unit, Komfo Anokye Teaching Hospital, 2009 to 2016. Data on patients’ demographics were retrieved to establish diagnoses and age and gender distribution. Analysis was made of pulmonary embolism and deep vein thrombosis as a cause of death recorded on death certificates using the criteria of the International Classification of Diseases, version 10. Results: A total of 150 cases of deep vein thrombosis and/or pulmonary embolism were available for the study period and the results showed an average age of 45.3 years with a standard deviation of 19.96. The ages ranged between 3 years and 96 years with the age group 31 to 40 years being the modal age group. Males recorded the highest number of cases with 92 (59.35%) compared to females with 63 (40.65%). Respiratory disorders, of which pneumonia is the most prevalent, are the leading clinical condition that is often misdiagnosed in place of pulmonary thromboembolism. Conclusion: VTE is a major health problem especially among the elderly, but unfortunately the clinical diagnosis is usually missed by clinicians hence the need to maintain a high suspicion index.
Lateralized Rhythmic Delta Activity in Patients With Infectious or Autoimmune Insular Lesions
Authors: Husari Khalil S. , Ritzl Eva K. 
Published: October 2020

Introduction Lateralized rhythmic delta activity (LRDA) is a rare pattern on the ictal-interictal continuum (IIC) encountered in critically ill patients. Its association with acute seizures is yet to be fully explored. Insular involvement is a common finding in patients with infectious and autoimmune encephalitis. The association between acute insular lesions and the ictal-interictal continuum, particularly LRDA, has not been explored before. Methods A case series of 4 patients with either herpetic or autoimmune encephalitis and prominent insular cortex involvement who had LRDA when monitored on continuous EEG is being presented. Results Two patients had herpetic encephalitis and 2 patients had autoimmune encephalitis. All patients had either clinical or electrographic seizures with 1 patient progressing into new-onset refractory status epilepticus. Conclusion LRDA can be seen in patients with insular cortex acute inflammation. In this group of patients, LRDA may be associated with a higher risk of acute seizures. The presence of this otherwise not clearly epileptiform pattern should raise the clinical suspicion for the development of acute seizures. Patients with LRDA and ipsilateral insular lesions should be carefully monitored for the development of recurrent electrographic or electroclinical seizures and status epilepticus.
Nonoperative Management of Olecranon Fractures in Elderly Patients: A Systematic Review
Authors: Alvara Christina A. , Biedron Griffin , Dunn John C. 
Published: October 2020

Background: Despite increased utilization of conservative measures for displaced olecranon fractures in elderly patients, in whom operative fixation may be complicated by coexisting comorbidities and declining bone quality, the noninferiority of nonoperative management has yet to be proven. The purpose of this study was to review nonoperative management of displaced olecranon fractures in the elderly patient population. Methods: A literature search of the PubMed database was performed using the term olecranon fracture. Papers included those with results for patients aged 65 years and older published between 1990 and 2018 in the English language. Data were pooled to analyze outcomes and complications of nonoperative management of olecranon fractures in the elderly patient population. Results: Four eligible studies combined for a total of 69 patients with 70 fractures with an average age of 83.8 years (71-95 years), female predominance of 88%, and a mean follow-up of 12.4 months who underwent nonoperative management of displaced olecranon fractures. While only 25% of fractures went on to radiographic union, the mean Disabilities of the Arm, Shoulder, and Hand score was 16.9 (0-59.6), the mean arc of motion was 138°, and 92% of patients achieved excellent results. One-quarter (26%) of the patients experienced complications: radial head subluxation (1), skin sore (1), degenerative arthropathy (1), pain on movement (2), click in movement of the elbow (5), and local pain (8). Conclusion: Displaced olecranon fractures in patients aged older than 70 years may be effectively managed with nonoperative measures to produce high satisfaction and functional range of motion.
Radiographic Predictors of Delayed Carpal Tunnel Syndrome After Distal Radius Fracture in the Elderly
Authors: Kim Kevin H. , Duell Bryan , Munnangi Swapna , Long Mitchell , Morrison Elizabeth 
Published: October 2020

Background Delayed-onset carpal tunnel syndrome (DCTS) can develop weeks and months after distal radius fracture (DRFx). A better understanding of the risk factors of DCTS can guide surgeon’s decision making regarding the management of DRFx and also provides another discussion point to be had with elderly patients when discussing outcomes of nonoperative management. Methods We reviewed 216 nonoperatively managed DRFx between June 2015 and January 2019 at a single level 1 trauma center and senior author’s office. We identified 26 patients who developed DCTS at a minimum of 6 weeks after DRFx, which constituted our case group. The remaining 190 patients served as the control group (non–carpal tunnel syndrome [CTS]). Differences between case and control group were evaluated through univariate and multivariate analyses. Results The prevalence of DCTS among nonoperatively managed DRFx was 12%. In univariate analysis, volar tilt (VT) and teardrop angle (TDA) were significant independent predictors of development of DCTS. Multivariate logistic regression analysis determined that the odds of developing CTS increased by 12% and 24% for each degree of decrease in VT and TDA, respectively. No other significant risk factors were identified. Conclusions Decreasing VT and TDA are the most significant risk factors associated with DCTS in nonoperatively managed DRFx. These are simple and reliable radiographic measurements that provide significant prognostic value. These parameters can be used to guide surgeon decision making regarding management of DRFx in the elderly while aiding patient expectations and outcomes following nonoperative management of DRFx.
Psychological impact of caring for critically ill patients during the Covid-19 pandemic and recommendations for staff support
Authors: Bates Andrew , Ottaway Julia , Moyses Helen , Perrrow Marcie , Rushbrook Sophie , Cusack Rebecca 
Published: October 2020

Background Reports of significant psychological stress among frontline healthcare workers are emerging from the Covid-19 outbreak in China. Concerningly, these match findings from previous infective outbreaks, which resulted in long-term psychological pathology. Methods During the Covid-19 pandemic, a multi-disciplinary cohort of Intensive Care staff completed an online survey of psychological well-being and rated the perceived usefulness of supportive interventions. Results Sixty per cent of invited staff responded. Seventy-seven per cent reported normal/high level of resilience. Thirty-two staff (35%) reported anxiety of a level at which formal psychological assessment is recommended. Sixteen (14%) staff members reported symptomology suggestive of post-traumatic stress disorder (PTSD). Multiple regression analysis revealed a significant relationship between job-related well-being, anxiety (p = 0.003) and PTSD (p = 0.005). Nurses were seven times more likely than doctors to score higher anxiety (OR = 6.8; p = 0.01). Preferred supportive interventions were adequate personal protective equipment, rest facilities and regular breaks. In the subgroup with high anxiety, psychological support was perceived as significantly more useful, with significant reductions reported for rest facilities and PPE. Discussion We report concerning levels of anxiety and post-traumatic stress symptomology among intensive care staff during the Covid-19 crisis, significantly impacting job-related well-being. Nurses are disproportionately affected. Overall, physiologically protective supportive interventions were preferred by staff; however, staff with established anxiety desire professional psychological help. Our findings match reports from SARS 2003 and China 2019. To mitigate long-term psychological consequences of caring for patients during a pandemic, easily deliverable protective strategies should be instigated, supported by formal and longer-term psychological support. Particular attention should be paid to developing strategies which support nursing staff.