bluuebunny/crossref_metadata_2025_split huggingface dataset:
Theoretical analysis of policies to improve the recruitment and retention of rural physicians
Authors: Danish Alya , Champagne François , Blais Régis 
Published: October 2020

AbstractThe lack of success in resolving the shortage of rural physicians in Organisation for Economic Cooperation and Development countries has been attributed to the weakness of implemented policies. This research examines the theoretical plausibility of policies to improve the recruitment and retention of rural physicians, first, by modelling the policies; and then, by describing how they might achieve their intended outcome based on a theoretical analysis. A theory‐driven method relying on published research and expert analysis is used. A conceptual model is created to represent the policies and their underlying assumptions. Then, the functional mechanism of the policies is defined. This research demonstrates that financial, educational and tailored interventions might improve rural physician recruitment and retention, but that regulatory interventions are unlikely to do this. The majority of the policies implemented in Organisation for Economic Cooperation and Development countries are therefore theoretically plausible.
Thirty‐day outcomes after gynecologic oncology surgery: A single‐center experience of enhanced recovery after surgery pathways
Authors: Bernard Laurence , McGinnis Justin M. , Su Jane , Alyafi Mohammad , Palmer Delia , Potts Leonard , Nancekivell Kelly‐Lynn , Thomas Heidi , Kokus Heather , Eiriksson Lua R. , Elit Lorraine M. , Jimenez Waldo G. F. , Reade Clare J. , Helpman Limor 
Published: October 2020

AbstractIntroductionThe purpose of the study is to evaluate the impact of an enhanced recovery after surgery (ERAS) program implemented in a Gynecologic Oncology population undergoing a laparotomy at a Canadian tertiary care center.Material and methodsProspectively collected data, using the American College of Surgeons’ National Surgical Quality Improvement Program dataset (ACS NSQIP), was used to compare 30‐day postoperative outcomes of gynecologic oncology patients undergoing a laparotomy before and after the 2018 implementation of an ERAS program in a Canadian regional cancer center. Patient demographics, surgical variables and postoperative outcomes of 187 patients undergoing surgery in 2019 were compared with those of 441 patients undergoing surgery between January 2016 and December 2017. Student’s t, Mann‐Whitney U and Chi‐square tests, as well as multivariate linear and logistic regressions were used to evaluate baseline characteristics and 30‐day postoperative complications.ResultsLength of stay was significantly shortened in the study population after introducing the ERAS protocol, from a mean of 4.7 (SD = 3.8) days to a mean of 3.8 (SD = 3.2) days (P = .0001). The overall complication rate decreased from 24.3% to 16% (P = .02). Significant decreases in the rates of postoperative infections (adjusted odds ratio [OR] 0.56, 95% confidence interval [CI] 0.31‐0.99) and cardiovascular complications (adjusted OR 0.27, 95% CI 0.09‐0.79) were noted, without a significant increase in readmission rate (adjusted OR 0.50, 95% CI 0.21‐1.07).ConclusionsIntroducing an ERAS program for gynecologic oncology patients undergoing laparotomy was effective in shortening length of stay and the overall complication rate without a significant increase in readmission. Advocacy for broader implementation of ERAS among gynecologic oncology services and ongoing discussion on challenges and opportunities in the implementation process are warranted to improve patient outcomes and experiences.
Right ventricular outflow tract reconstruction with Medtronic Freestyle valve in the Ross procedure: A systematic review with meta‐analysis
Authors: Van den Eynde Jef , Sá Michel Pompeu B. O. , Callahan Connor P. , Dimagli Arnaldo , Vervoort Dominique , Kampaktsis Polydoros N. , Zhigalov Konstantin , Ruhparwar Arjang , Weymann Alexander 
Published: October 2020

AbstractCryopreserved pulmonary homografts (PH) are the current gold standard for right ventricular outflow tract (RVOT) reconstruction in the Ross procedure. Unfortunately, their use is limited by a relatively scarce availability and high cost. Porcine stentless xenografts (SX) such as the Medtronic Freestyle SX are increasingly being used, although it is unclear whether the hemodynamic performance and the long‐term durability are satisfactory. The present systematic review followed the Preferred Reporting Items for Systematic reviews and Meta‐Analysis statement. The pooled treatment effects were calculated using a weighted DerSimonian‐Laird random‐effects model. We also evaluated the effect of time after RVOT reconstruction on valve gradients using meta‐regression. Six studies with a total of 156 patients met the inclusion criteria. The pooled estimates for the pooled follow‐up of 37 months were: 1.3% operative mortality, 94.8% overall survival, 7.5% structural valve deterioration, 5.2% reintervention, 73.3% asymptomatic, and 1.5% moderate or severe pulmonary insufficiency. Peak valve gradients were significantly correlated with time after RVOT, increasing during follow‐up. Three studies compared PH with SX, one concluded that the SX is an acceptable alternative for RVOT reconstruction, whereas two concluded that this valvular substitute had inferior performance. The Freestyle SX can be considered as an alternative to PH, although it might be associated with more reinterventions, higher peak valve pressure gradients, and pulmonary valve dysfunction.
Outcomes of left ventricular unloading with a transseptal cannula during extracorporeal membrane oxygenation in adults
Authors: Kim Ah‐Ram , Park Hanbit , Lee Sang‐Eun , Ahn Jung‐Min , Park Duk‐Woo , Lee Seung‐Whan , Kim Jae‐Joong , Park Seung‐Jung , Hong Jung Ae , Kang Pil‐Je , Jung Sung‐Ho , Kim Min‐Seok 
Published: October 2020

AbstractWe evaluated the benefit of left ventricular (LV) unloading using a percutaneous transseptal left atrial (LA) drain catheter via femoral vein incorporated into the ECMO venous circuit. This single‐center retrospective observational study analyzed clinical outcomes of the LA venting group (N = 62) who underwent percutaneous transseptal LA drain placement comparing with the conventionally treated control group (N = 62) with an arterial pulse pressure below 10 mm Hg for at least 24 hours from December 2012 to August 2018. The ECMO weaning rate (61.3% vs. 38.7%, P = .012) and cardiac transplantation rate (29.0% vs. 11.3%, P = .014) were higher in the LA venting group than in the control group. Inhospital mortality was not significantly different (56.5% vs. 69.4%, P = .191). Pulmonary congestion mostly improved after LA decompression (61.3%, P = .003). A serum lactate level at 24 hours after LA venting of more than 2.2 mmol/L was associated with poor outcomes. LA venting via transseptal cannula reduced pulmonary venous congestion and achieved higher rates of successful ECMO weaning and cardiac transplantation. Placement of a transseptal venous drain cannula should be considered in patients with uncontrolled pulmonary edema secondary to severe LV loading undergoing VA‐ECMO.
Febrile children in the Emergency Department: Frequency and predictors of poor outcome
Authors: Long Elliot , Solan Tom , Stephens David J. , Schlapbach Luregn J. , Williams Amanda , Tse Wai Chung , Babl Franz E. 
Published: October 2020

AbstractAimTo evaluate the frequency and predictors of poor outcome in febrile children presenting to the Emergency Department.MethodsRetrospective observational study from the Emergency Department of The Royal Children's Hospital, Melbourne, Australia. All children with presenting complaint of fever or triage temperature >38°C over a 6‐month period were included. Poor outcome was defined as: new organ dysfunction or the requirement for organ support therapy (inotrope infusion, mechanical ventilation, renal replacement therapy and extra‐corporeal life support). Predictors evaluated were as follows: initial vital signs, blood tests and clinical scores. Odds ratio, sensitivity, specificity and area under the receiver‐operating characteristics curve were calculated for each predictor variable.ResultsBetween Jan‐June 2019, 6217 children met inclusion criteria. Twenty‐seven (0.4%) developed new organ dysfunction, 10 (0.2%) required organ support therapy (inotrope infusion in 5, mechanical ventilation in 6, renal replacement therapy in 1, extra‐corporeal life support in 1). Odds of new organ dysfunction, requirement for inotropic support and mechanical ventilation were higher with abnormal initial vital signs, blood tests and clinical scores, though overall test characteristics were poor due to infrequency.ConclusionPoor outcomes were uncommon among febrile children presenting to the Emergency Department. Vital signs, blood tests and clinical scores were poor predictors.
Population pharmacokinetic and optimization of polymyxin B dosing in adult patients with various renal functions
Authors: Yu Xu‐Ben , Jiao Zheng , Zhang Chun‐Hong , Dai Ying , Zhou Zi‐Ye , Han Lu , Wen Xin , Sheng Chang‐Cheng , Lin Guan‐Yang , Pan Jing‐Ye 
Published: October 2020

AimsCurrent FDA‐approved label recommends that the dosage of polymyxin B should be adjusted according to renal function. However, the correlation between polymyxin B pharmacokinetics (PK) and creatinine clearance (CrCL) is poor. This study aimed to develop a population PK model of polymyxin B in adult patients with various renal functions and to identify a dosing strategy.MethodsA retrospective PK study was performed in 32 adult patients with various renal function. Nonlinear mixed effects modelling was applied to build a population PK model of polymyxin B followed by Monte Carlo simulations which designed polymyxin B dosing regimens across various renal function.ResultsPolymyxin B PK analyses included 112 polymyxin B concentrations at steady state from 32 adult patients, in which 71.9% of them were critically ill. In the final PK model, CrCL was the significant covariate on CL (typical value 1.59 L/h; between‐subject variability 13%). The mean (SD) individual empirical Bayesian estimate of CL was 1.75 (0.43) L/h. In addition, a new dosing strategy combining the PK/pharmacodynamic (PD) targets and Monte Carlo simulation indicated that the reduction of polymyxin B dose in patients with renal insufficiency improved the probability of achieving optimal exposure. For severe infections caused by organisms with minimum inhibitory concentration (MIC) ≥ 2 mg/L, a high daily dose of polymyxin B might be possible for bacterial eradication, but the risk of nephrotoxicity is increased.ConclusionsRenal function plays a significant role in polymyxin B PK, and the dose of polymyxin B should be adjusted according to CrCL in patients with renal insufficiency.
Genetic variability in 13q33 and 9q34 is linked to aggressiveness patterns and a higher risk of progression of non‐muscle‐invasive bladder cancer at the time of diagnosis
Authors: Lenfant Louis , Cancel‐Tassin Geraldine , Gazut Stéphane , Compérat Eva , Rouprêt Morgan , Cussenot Olivier 
Published: October 2020

ObjectiveTo identify single nucleotide polymorphisms (SNPs) associated with patterns of aggressiveness of non‐muscle‐invasive bladder cancer (NMIBC).Patients and MethodsFrom January 2011 to December 2018, 476 patients with NMIBC were prospectively included. The first step aimed to identify SNPs associated with aggressiveness patterns (e.g. ≥pT1or high‐grade/Grade 3 or presence of carcinoma in situ) by analysing the data of a genome‐wide association study (GWAS) on 165 patients with BC. The second step aimed to validate the SNPs previously identified, by genotyping the germline DNA of 311 patients with NMIBC.ResultsOverall, the median (interquartile range) age was 66 (58–75) years and the rate of patients with aggressive NMIBC was comparable between both groups (46% vs 46%, P = 1). GWAS data analysis identified four SNPs associated with an aggressive NMIBC (rs12615669, rs4976845, rs2989734, and rs2802288). In the validation cohort, the genotype CC of rs12615669, as well as age >70 years at the time of diagnosis were associated with aggressive NMIBC (P = 0.008 and P < 0.001, respectively). Genotyping of the entire cohort showed an association between aggressive NMIBC and the T allele of rs12615669 (P = 0.0007), the A allele of rs4976845 (P = 0.012), and the A allele of rs2989734 (P = 0.007). A significant association was also found for the entire cohort between the risk of progression and the A allele of rs4976845 (P = 0.04).ConclusionThis two‐phase study identified three SNPs (rs12615669, rs4976845, and rs2989734) associated with aggressive NMIBC and one SNP (rs4976845) associated with a higher risk of progression.
Autophagy involvement in oncogenesis
Authors: Torii Satoru , Honda Shinya , Murohashi Michiko , Yamaguchi Hirofumi , Shimizu Shigeomi 
Published: October 2020

AbstractVarious clinical and experimental findings have revealed the causal relationship between autophagy failure and oncogenesis, and several mechanisms have been suggested to explain this relationship. We recently proposed two additional mechanisms: centrosome number dysregulation and the failure of autophagic cell death. Here, we detail the mechanical relationship between autophagy failure and oncogenesis.
Motivational interviewing for preventing early childhood caries: A systematic review and meta‐analysis
Authors: Colvara Beatriz Carriconde , Faustino‐Silva Daniel Demétrio , Meyer Elisabeth , Hugo Fernando Neves , Celeste Roger Keller , Hilgert Juliana Balbinot 
Published: October 2020

AbstractObjectivesThis systematic review with meta‐analysis was performed to assess whether motivational interviewing (MI) is effective in the prevention of early childhood caries (ECC) and to examine potential sources of heterogeneity.MethodsInterventions based on motivational interviewing were considered eligible. The main outcome was new caries lesions (some studies included white‐spot lesions in total count), and secondary outcomes included caregivers’ oral health knowledge, home‐care behaviours, plaque index, gingival index and fluoride varnish applications. Controls were any type of oral health education or negative controls without any specific intervention.ResultsFrom a total of 1498 studies identified in the databases search, 1078 were assessed for eligibility by reading titles and abstracts, after removal of duplicates. Full‐text screening was performed in 61 articles, with 18 reporting on 14 different studies included in the qualitative synthesis and 8 in the quantitative synthesis (four studies included new white‐spot lesions in total count). Subgroup analysis was performed by the control group dmft/dmfs and the test for subgroup differences suggests that there is a subgroup effect (P = .06), so population caries experience modifies the effect of MI‐based intervention. In populations with high caries experience, the MI‐based approach proved preventing an average of 3.15 (95% CI: −6.14, −0.17) dmfs in young children. In samples with low caries experience, differences were smaller, since the caries levels were already lower (−0.31; 95% CI: −0.63, 0.00).ConclusionMotivational interviewing has the potential to modify knowledge and behaviours and reduce ECC with a more significant impact on children with high caries experience.
The progression of salt‐wasting and the body weight change during the first 2 weeks of life in classical 21‐hydroxylase deficiency patients
Authors: Gau Maki , Konishi Kaoru , Takasawa Kei , Nakagawa Ryuichi , Tsuji‐Hosokawa Atsumi , Hashimoto Atsuko , Sutani Akito , Tajima Toshihiro , Hasegawa Tomonobu , Morio Tomohiro , Kashimada Kenichi 
Published: October 2020

AbstractBackgroundOne of the major purposes of newborn screening for 21‐hydroxylase deficiency (21OHD) is preventing life‐threatening adrenal crisis. However, the details of adrenal crisis in newborns are not precisely documented.AimWe aimed to clarify the clinical details of salt‐wasting in newborn 21OHD patients.MethodsBased on the follow‐up survey of the screening in Tokyo from 1989 to 2017, we retrospectively analysed the conditions of classical 21OHD neonates before the initiation of therapy.ResultsOne hundred classical 21OHD patients (55 male, 45 female) were analysed. The age at the first hospital visit was 0–20 days with sex difference (male: 9.0 ± 3.5 days; female: 6.2 ± 3.9 days). Thirty‐seven (37.4%) patients exhibited severe salt‐wasting (SSW), that is, Na < 130 mEq/L, K > 7 mEq/L or Na/K ratio < 20; except for one case, SSW developed in or after the second week of life. The serum concentrations of Na, K and Na/K were linearly correlated with age in days (R2 = .38, .25, and .34 respectively), suggesting that the risk of SSW increases linearly without a threshold. The age at which the regression lines reached Na < 130 mEq/L, K > 7 mEq/L and Na/K < 20 was approximately coincided, 11.1, 12.3 and 11.2 days, respectively. All SSW patients exhibited decreased body weight from birth in their second week of life.ConclusionOur data revealed that the risk of developing SSW increases during the second week of life without a threshold, and for preventing SSW, early intervention, ideally during first week of life, is desirable. An increased body weight in the second week of life indicates the absence of SSW.
Anisotropic Spectral Manifold Wavelet Descriptor
Authors: Li Qinsong , Hu Ling , Liu Shengjun , Yang Dangfu , Liu Xinru 
Published: October 2020

AbstractIn this paper, we present a powerful spectral shape descriptor for shape analysis, named Anisotropic Spectral Manifold Wavelet Descriptor (ASMWD). We proposed a novel manifold harmonic signal processing tool termed Anisotropic Spectral Manifold Wavelet Transform (ASMWT) first. ASMWT allows to comprehensively analyse signals from multiple wavelet diffusion directions on local manifold regions of the shape with a series of low‐pass and band‐pass frequency filters in each direction. Based on the ASMWT coefficients of a very simple signal, the ASMWD is efficiently constructed as a localizable and discriminative multi‐scale point descriptor. Since the wavelets used in our descriptor are direction‐sensitive and able to robustly reconstruct the signals with a finite number of scales, it makes our descriptor compact, efficient, and unambiguous under intrinsic symmetry. The extensive experiments demonstrate that our descriptor achieves significantly better performance than the state‐of‐the‐art descriptors and can greatly improve the performance of shape matching methods including both handcrafted and learning‐based methods.
Gillnet illumination as an effective measure to reduce sea turtle bycatch
Authors: Allman Phil , Agyekumhene Andrews , Stemle Leyna 
Published: October 2020

AbstractThe growing demand for fish around the world is an immediate threat to marine megafauna that are unintentionally captured in commercial and artisanal fishery operations. Bycatch mitigation strategies, such as turtle excluder devices, circle hooks, and net illumination, have successfully reduced this risk in some fisheries. We explored the effectiveness of gillnet illumination to reduce sea turtle captures in 2 artisanal fisheries (Mankoadze and Winneba, Ghana) under normal fishing conditions. We first quantified sea turtle bycatch in Ghana's artisanal gillnet fishery from 15 boats for 12 months. We then quantified catch of targeted species and sea turtle bycatch from 20 boats for 15 months (7427 net sets). For 10 of these boats, we placed a Centro Economy green light (1 LED) at each 10‐m interval on the net. We also quantified target catch and sea turtle bycatch from 30 boats for 8 months (2250 net sets). In 15 of these boats, a Centro Deluxe green light (3 LEDs) was installed at 15‐m intervals. Boats with economy lights and those with deluxe lights both exhibited an 81% decrease in sea turtle captures (W = 1, p < 0.001, n = 20; W = 215, p < 0.001, n = 30, respectively) compared with control boats without lights. Illuminated nets resulted in fewer turtle catches for leatherback (Dermochelys coriacea), olive ridley (Lepidochelys olivacea), and green sea turtles (Chelonia mydas) (p < 0.05 for all species). Target catch (mass) (W = 53, p = 0.853 n = 20; W = 76, p = 0.449, n = 23) and value (W = 50, p = 1, n = 20; W = 69, p = 0.728, = 23) were not different across treatments. Our study affirms net illumination can reduce capture rates of 3 species of sea turtles, including the imperiled leatherback. Gear modification methods can successfully reduce bycatch if they are affordable and have broad applications for multiple species in different fisheries.
Increased arterial stiffness in males with abdominal aortic aneurysm
Authors: Åström Malm Ida , De Basso Rachel , Blomstrand Peter , Bjarnegård Niclas 
Published: October 2020

AbstractBackgroundAbdominal aortic aneurysm (AAA), a localized dilatation of the abdominal aorta, has a prevalence of about 1.5%–3% among 65‐ to 70‐year‐old males in Europe. AAA confers an increased risk of developing major cardiovascular events in addition to the risk of aneurysm rupture. The aim of this study was to evaluate whether the arterial wall distensibility is altered in subjects with AAA.MethodsTwo hundred and eighty‐four male subjects (182 with AAA and 102 controls) were enrolled in the study. Arterial wall distensibility was evaluated using non‐invasive applanation tonometry to measure regional pulse wave velocity between the carotid and femoral arteries and the carotid and radial arteries. In addition, blood pressure was measured, and the pulse pressure waveform was analysed.ResultsHigher aortic augmentation index (25.1% versus 20.6%; p < .001) and higher aortic pulse wave velocity (12.3 m/s versus 10.9 m/s; p < .001) were demonstrated in the AAA cohort. The slightly higher arm pulse wave velocity in the AAA group (9.4 m/s versus 9.1 m/s; p < .05) was abolished after adjusting for mean arterial blood pressure.ConclusionsMales with AAA have decreased aortic wall distensibility and enhanced reflection waves in central aorta during systole. These results imply that increased arterial wall stiffness may be a contributing factor to the overall higher cardiovascular risk seen in patients with AAA.
Resource supply governs the apparent temperature dependence of animal production in stream ecosystems
Authors: Junker James R. , Cross Wyatt F. , Benstead Jonathan P. , Huryn Alexander D. , Hood James M. , Nelson Daniel , Gíslason Gísli M. , Ólafsson Jón S. 
Published: October 2020

AbstractRising global temperatures are changing how energy and materials move through ecosystems, with potential consequences for the role of animals in these processes. We tested a central prediction of the metabolic scaling framework—the temperature independence of animal community production—using a series of geothermally heated streams and a comprehensive empirical analysis. We show that the apparent temperature sensitivity of animal production was consistent with theory for individuals (Epind = 0.64 vs. 0.65 eV), but strongly amplified relative to theoretical expectations for communities, both among (Epamong = 0.67 vs. 0 eV) and within (Epwithin = 1.52 vs. 0 eV) streams. After accounting for spatial and temporal variation in resources, we show that the apparent positive effect of temperature was driven by resource supply, providing strong empirical support for the temperatureindependenceof invertebrate production and the necessary inclusion of resources in metabolic scaling efforts.