bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of weekend admission and changes in treating team on patient flow and outcomes in adults admitted to hospital with community‐acquired pneumonia
Authors: Milevski Stefan V. , Lloyd Melanie , Janus Edward , Maguire Graeme , Karunajeewa Harin 
Published: March 2021

AbstractBackgroundThe effect of workflow factors, such as timing of admission and changes in treating team, on patient outcomes remains inconclusive.AimsTo investigate the impact of weekend admission and changes in treating team on four pre‐defined outcomes in patients admitted to hospital with community‐acquired pneumonia (CAP).MethodsWe performed an observational cohort study by utilising prospective longitudinal data collected during the IMPROVE‐GAP trial, a stepped‐wedge randomised study investigating an evidence‐based bundle of care in the management of CAP. We assessed the effect of two exposure variables, day of admission and change of treating team, on four pre‐specified outcomes: (i) length of stay; (ii) time to clinical stability; (iii) readmission within 30 days; and (iv) mortality at 30 days. Our analysis was restricted to patients with a primary diagnosis of CAP and employed multivariable Cox regression and logistic regression to adjust for potential measured confounders.ResultsOf 753 participants, 224 (29.7%) were admitted on the weekend and 71 (9.4%) changed treating team during admission. Weekend admissions had significantly longer hospital stays than weekday admissions (hazard ratio (95% confidence interval; P‐value) 0.82 (0.70–0.98; 0.03)) and took longer to reach clinical stability (0.80 (0.68–0.95; 0.01)). Change of treating team doubled the odds of readmission at 30 days (odds ratio 1.95 (1.08–3.58; 0.03)).ConclusionsThese results suggest workflow factors can negatively impact both health service and patient outcomes. Systems interventions aimed at improving out of hours service and reducing changes in treating team should be considered.
Invasive versus conservative management in patients aged ≥85 years presenting with non‐ST‐elevation myocardial infarction
Authors: Kunniardy Phelia , Koshy Anoop N. , Meehan Georgie , Murphy Alexandra C. , Ramchand Jay , Clark David J. , Farouque Omar , Yudi Matias B. 
Published: March 2021

AbstractBackgroundGuidelines recommend early coronary angiography (CA) in patients with non‐ST‐elevation myocardial infarction (NSTEMI) irrespective of age. However, elderly patients are less likely to be treated according to these guidelines due to their perceived high risk and medical comorbidities. Whether an invasive strategy is associated with improved survival in patients aged ≥85 years remains uncertain due to their exclusion from randomised trials.AimsPatients were stratified based on whether they underwent invasive management with CA with a view to revascularisation versus conservative management. The primary outcome was long‐term mortality.MethodsConsecutive patients aged ≥85 years presenting to a tertiary centre with NSTEMI between 2008 and 2018 were included in this retrospective cohort study.ResultsOf 7591 patients with NSTEMI, 1052 patients aged ≥85 years were included. Ninety‐nine (9.4%) patients underwent CA. Those undergoing CA were more likely to be younger, male, live independently, without mobility or cognitive issues (all P < 0.01). Overall, 495 (47%) patients died during a mean follow up of 1.3 ± 1 year. On Cox regression, after adjusting for age, pre‐morbid functional status, cognition and cardiovascular risk factors, invasive management was the strongest predictor for survival (hazard ratio 0.47; 95% confidence interval 0.26–0.85; P = 0.01). Invasive management was associated with a trend to increased risk of in‐hospital bleeding (6.1% vs 2.6%; P = 0.054) with no significant difference in stroke (2.0% vs 3.8%; P = 0.37).ConclusionIn patients aged ≥85 years who presented with NSTEMI, invasive management was associated with improved survival without significant differences in bleeding or stroke. A randomised controlled study assessing the efficacy and safety of invasive management in very elderly patients with NSTEMI is warranted.
Mega‐evolutions in medical education: Helpful or harmful to higher cognitive skill development?
Authors: Chumley Heidi 
Published: March 2021

AbstractMedicine is practiced in environments of volatility, uncertainty, complexity, ambiguity, and disruption (VUCAD). Medical educators are tasked with providing an education that prepares graduates to successfully practice medicine in those types of environments. While medical education is continually evolving to incorporate new content and educational approaches, there are two mega‐evolutions that have permeated medical education: increased curricular structure and content integration. Structure and integration are assumed to be positive changes; however, they may alter the development of higher cognitive skills such as information management, planning, breadth of approach, strategy, and initiative. As new graduates will practice in VUCAD environments, it seems prudent to consider the effects of medical education’s mega‐evolutions on the development of higher cognitive skills critical to those types of environments. This paper explores the potential consequences of the increased curricular structure and content integration in medical education for learners who will practice in VUCAD environments and proposes a research agenda to better understand the relationship between curricular structure and integration and higher cognitive skill development.
Limits of authenticity: How organizational politics bound the positive effects of authentic leadership on follower satisfaction and performance
Authors: Munyon Timothy P. , Houghton Jeffery D. , Simarasl Nastaran , Dawley David D. , Howe Michael 
Published: March 2021

AbstractThe authentic leadership paradigm has been widely advocated as an effective leadership approach for organizations interested in promoting positive and ethical leader—member relations. Despite accumulating evidence concerning the positive follower effects of authentic leadership, research examining potential boundary conditions remains limited. The political influence theoretical perspective promises to shed new light on the effects of authentic leadership by proposing that authentic leadership may be less effective in political contexts, bounding its positive operation on followers. Specifically, we anticipate that organizational politics will erode the motivational power of authentic leaders on followers, reducing their ability to engender positive performance contributions in followers. We also predict that organizational politics will weaken the positive relationship between authentic leadership and job satisfaction by reducing the ability of employees to realize their goals at work. To explore these theoretical assertions, we incorporated a two‐study functional replication (n1 = 265; n2 = 175) to ascertain how authentic leadership and organizational politics impact follower job satisfaction, organizational citizenship behavior (OCB), and task performance. We find that organizational politics consistently weaken the positive effects of authentic leadership on follower OCB across two studies. Furthermore, in Study 2, our findings suggest that organizational politics attenuate the positive impact of authentic leadership on follower job satisfaction and task performance. We discuss theoretical and practical implications.
Impact of age on the outcome of cryoballoon ablation as the primary approach in the interventional treatment of atrial fibrillation: Insights from a large all‐comer study
Authors: Hartl Stefan , Dorwarth Uwe , Pongratz Janis , Aurich Florian , Brück Benedikt , Tesche Christian , Ebersberger Ullrich , Wankerl Michael , Hoffmann Ellen , Straube Florian 
Published: March 2021

AbstractIntroductionThe objective was to analyze the impact of patient age on clinical characteristics, procedural results, safety, and outcome of cryoballoon ablation (CBA) as the primary approach in the interventional treatment of symptomatic atrial fibrillation (AF).Methods and ResultsThe single‐center prospective observational study investigated consecutive patients who underwent initial left atrial ablation for symptomatic paroxysmal (PAF) or persistent AF (persAF). Age groups (A–F) of less than 40, 40–49, 50–59, 60–69, 70–79 and more than or equal to 80 years were evaluated. Follow‐up (FU) included ECG, Holter monitoring and assessment of AF‐symptoms. From 2012 to 2016, a total of 786 patients (64 ± 11 years, range 21–85) underwent CBA. With advancing age, more cardiovascular comorbidities and larger LA diameter were observed, more females were included (each p < .001). PAF (57%) and persAF (43%, p = .320) were equally distributed over all age groups. Age was neither related to procedural parameters, nor to the complication rate (3.9%, p = .233). Median FU was 38 months. Two non‐procedure related noncardiac deaths occurred late during FU. Freedom from arrhythmia was independent of age at 18 months (p = .210) but decreased for patients more than or equal to 70 years at 24 months (p = .02). At 36 months, freedom from arrhythmia was 66%–74% (groups A–D), 54% (E) and 49% (F), respectively (p = .002). LA diameter and persAF were independent predictors, whereas age was a dependent predictor of recurrence.ConclusionCBA as the primary approach in the initial ablation procedure is safe and highly effective in the young, middle aged, and elderly population. LA diameter and persAF, but not ageing, were independent predictors for arrhythmia recurrence.
Sexually antagonistic evolution of mitochondrial and nuclear linkage
Authors: Radzvilavicius Arunas , Layh Sean , Hall Matthew D. , Dowling Damian K. , Johnston Iain G. 
Published: March 2021

AbstractAcross eukaryotes, genes encoding bioenergetic machinery are located in both mitochondrial and nuclear DNA, and incompatibilities between the two genomes can be devastating. Mitochondria are often inherited maternally, and theory predicts sex‐specific fitness effects of mitochondrial mutational diversity. Yet how evolution acts on linkage patterns between mitochondrial and nuclear genomes is poorly understood. Using novel mito‐nuclear population‐genetic models, we show that the interplay between nuclear and mitochondrial genes maintains mitochondrial haplotype diversity within populations, and selects both for sex‐independent segregation of mitochondrion‐interacting genes and for paternal leakage. These effects of genetic linkage evolution can eliminate male‐harming fitness effects of mtDNA mutational diversity. With maternal mitochondrial inheritance, females maintain a tight mitochondrial–nuclear match, but males accumulate mismatch mutations because of the weak statistical associations between the two genomic components. Sex‐independent segregation of mitochondria‐interacting loci improves the mito‐nuclear match. In a sexually antagonistic evolutionary process, male nuclear alleles evolve to increase the rate of recombination, whereas females evolve to suppress it. Paternal leakage of mitochondria can evolve as an alternative mechanism to improve the mito‐nuclear linkage. Our modelling framework provides an evolutionary explanation for the observed paucity of mitochondrion‐interacting genes on mammalian sex chromosomes and for paternal leakage in protists, plants, fungi and some animals.
COVID‐19 and gynecological cancers: Asia and Oceania Federation of Obstetrics and Gynecology oncology committee opinion
Authors: Tse Ka Yu , Domingo Efren J. , Konar Hiralal , Kumarasamy Suresh , Pariyar Jitendra , Tjokroprawiro Brahmana A. , Ushijima Kimio , Inthasorn Perapong , Tan Ai Ling , Wilailak Sarikapan ,   The Oncology Committee, Asia and Oceania Federation of Obstetrics and Gynecology
Published: March 2021

AbstractSince the outbreak of COVID‐19, there have already been over 26 million people being infected and it is expected that the pandemic will not end in near future. Not only the daily activities and lifestyles of individuals have been affected, the medical practice has also been modified to cope with this emergency catastrophe. In particular, the cancer services have faced an unprecedented challenge. While the services may have been cut by the national authorities or hospitals due to shortage of manpower and resources, the medical need of cancer patients has increased. Cancer patients who are receiving active treatment may develop various kinds of complications especially immunosuppression from chemotherapy, and they and their carers will need additional protection against COVID‐19. Besides, there is also evidence that cancer patients are more prone to deteriorate from COVID‐19 if they contract the viral infection. Therefore, it is crucial to establish guidelines so that healthcare providers can triage their resources to take care of the most needed patients, reduce less important hospitalization and visit, and to avoid potential complications from treatment. The Asia and Oceania Federation of Obstetrics and Gynecology (AOFOG) hereby issued this opinion statement on the management of gynecological cancer patients during the COVID‐19.
Diagnostic performance of MRI using extracellular contrast agents versus gadoxetic acid for hepatocellular carcinoma: A systematic review and meta‐analysis
Authors: Feng Zhichao , Zhao Huafei , Guan Shiwei , Wang Wei , Rong Pengfei 
Published: March 2021

AbstractBackground & AimsMagnetic resonance imaging (MRI) is the first‐line tool for the noninvasive diagnosis of hepatocellular carcinoma (HCC) in patients with chronic liver diseases. We performed a meta‐analysis to compare the performance of MRI using extracellular contrast agents (ECA‐MRI) with that using gadoxetic acid (EOB‐MRI) for diagnosing HCC.MethodsWe searched multiple databases for studies comparing the diagnostic performance of ECA‐MRI with that of EOB‐MRI in patients with suspected HCC until 31 May 2020. The bivariate random‐effects model was used to pool the performance and further subgroup analysis was performed.ResultsEight studies were included evaluating a total of 1002 patients. ECA‐MRI revealed significantly higher per‐lesion sensitivity in the diagnosis of HCC than EOB‐MRI did (0.76 vs 0.63, P = .002). For modified EOB‐MRI (mEOB‐MRI) using extended washout to the transitional phase (TP) or hepatobiliary phase (HBP), the sensitivity increased compared with that of EOB‐MRI using restrictive washout in the portal venous phase (PVP) (0.74 vs 0.63, P = .07). No significant difference among the specificities of ECA‐MRI, EOB‐MRI, and mEOB‐MRI (0.96, 0.98, and 0.93, respectively) was found. The sensitivity for lesions < 20 mm was significantly lower than that for lesions ≥ 20mm (0.66 vs 0.87, P = .01) only for ECA‐MRI, which achieved higher sensitivity in Asian patients or with a 3.0 T scanner.ConclusionsECA‐MRI outperforms EOB‐MRI in per‐lesion sensitivity for diagnosing HCC, whereas mEOB‐MRI shows a trend towards improved sensitivity compared with EOB‐MRI with slightly decreased specificity.Registration: Prospero CRD42020189680.
Epistemic Analyticity Reconsidered
Authors: Teixeira Célia 
Published: March 2021

AbstractIt is nowadays standard to distinguish between epistemic and metaphysical analyticity. Metaphysical analyticity has been widely rejected, while epistemic analyticity has been widely endorsed. I argue that we also have good reason to reject epistemic analyticity. I do so by considering all the plausible ways of characterizing epistemic analyticity and of drawing the epistemic analytic–synthetic distinction. I argue that on all of them, the distinction fails to carve at the semantic joints. I conclude that that there is good reason to think that there is no semantic distinction to be drawn between analytic and synthetic sentences.
The spectrum of pediatric scarring alopecia: A retrospective review of 27 patients seen at Mayo Clinic
Authors: Imhof Reese L. , Cantwell Hafsa M. , Proffer Sydney L. , Tolkachjov Stanislav N. , Torgerson Rochelle R. , Tollefson Megha M. 
Published: March 2021

AbstractBackground/ObjectiveThere are few studies examining pediatric scarring alopecia. The objective of this study is to characterize the clinicopathologic findings, comorbidities, and treatment outcomes of pediatric patients with scarring alopecia.MethodsRetrospective review of patients under age 18 diagnosed with scarring alopecia at Mayo Clinic from 01/01/1992 through 02/05/2019.Results27 patients met inclusion criteria with a mean age of 11.2 years and a racial breakdown of 85.2% (23) White, 11.1% (3) Black, and 3.7% (1) Multiracial. Clinical scarring was noted in most (23, 85.2%). Biopsy confirmed the diagnosis in most (24, 88.9%). The most common diagnoses were folliculitis decalvans (6, 22.2%), lichen planopilaris (6, 22.2%), aplasia cutis congenita (4, 14.8%), tinea capitis (4, 14.8%), and morphea (3, 11.1%). Comorbid depression (6, 22.2%) and anxiety (6, 22.2%) were prevalent. Of the patients who received follow‐up, most who pursued treatment achieved stabilization (55.5%) or slowing of progression (27.8%), with 44.4% of those treated experiencing regrowth. Mean time to stabilization in the treated population was 19.6 months. Two patients did not pursue treatment, but received follow‐up and these untreated patients did not experience hair regrowth.ConclusionsMost patients presented with clinically evident primary scarring alopecia. Biopsy may confirm the diagnosis. Active treatment should be pursued, and successful treatment often requires combination therapies. Time to stabilization often takes years. Screening for depression and anxiety should be pursued.
Slurs, neutral counterparts, and what you could have said
Authors: Falbo Arianna 
Published: March 2021

AbstractRecent pragmatic accounts of slurs argue that the offensiveness of slurs is generated by a speaker's free choice to use a slur opposed to a more appropriate and semantically equivalent neutral counterpart. I argue that the theoretical role of neutral counterparts on such views is overstated. I consider two recent pragmatic analyses, Bolinger (Noûs, 51, 2017, 439) and Nunberg (New work on speech acts, Oxford University Press, 2018), which rely heavily upon the optionality of slurs, namely, that a speaker exercises a deliberate lexical choice to use a slur when they could have easily used a neutral counterpart instead. Against such views, I argue that across a range of different offensive uses of slurs, a speaker's choice to use a slur opposed to a neutral counterpart plays little to no role in accounting for why the slur generates offence. Such cases cast serious doubt upon the explanatory depth of these pragmatic analyses, and raise more general concerns for views which draw upon the relationship between a slur and its neutral counterpart. The main upshot is this: theorists should exercise caution in assuming that neutral counterparts play any fundamental or systemic role in explaining why slurs are offensive.
Increased insulin resistance is associated with vascular cognitive impairment in Chinese patients with cerebral small vessel disease
Authors: Guo Xiaoming , Zhu Yuting , Li Xinling , Lu Zhenhui , Cao Zhiyong , Yi Xiaoyi , Zhu Xiangyang 
Published: March 2021

AbstractBackgroundThe aim of this study was to investigate the association between insulin resistance (IR) and vascular cognitive impairment (VCI) in patients with cerebral small vessel disease (CSVD).MethodsA total of 275 CSVD patients were enrolled in this retrospective case–control study. The homeostatic model assessment of insulin resistance (HOMA‐IR) was used to measure the index of insulin resistance. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Spearman's correlation coefficient was used to evaluate the correlation between HOMA‐IR and MoCA score. The variance inflation factor (VIF) was used to detect collinearity between variables. Multivariate logistic regression analysis was employed to confirm whether HOMA‐IR is an independent risk factor for VCI in CVSD. Finally, receiver operating characteristic (ROC) curve analysis was conducted to assess the diagnostic value of HOMA‐IR in VCI.ResultsOf the 275 patients, 164 displayed VCI. VCI patients showed a significantly higher level of HOMA‐IR compared to non‐VCI patients (P < 0.001). HOMA‐IR was negatively correlated with the MoCA score (r = −0.593, P < 0.001). After adjusting for potential confounding variables, using HOMA‐IR quartile 1 (<1.11) as the reference, HOMA‐IR quartile 3 (1.71–2.50) and quartile 4 (≥2.50) were independently associated with the occurrence of VCI; for each one unit increase in the HOMA‐IR, the risk of VCI increased by 177.3% (odds ratio 2.773, 95% confidence interval: 1.050–7.324, P = 0.040) and 444.3% (odds ratio 5.443, 95% confidence interval: 2.109–14.050, P < 0.001), respectively. According to the ROC curve, the optimal cut‐off point of HOMA‐IR in predicting VCI was 1.55, and the area under the curve was 0.744, with a sensitivity of 71.3% and a specificity of 69.4%.ConclusionThis study demonstrated that increased IR is significantly associated with VCI in CSVD patients.
Different antidumping legislations within the WTO: What can we learn from China's varying market economy status?
Authors: Sandkamp Alexander , Yalcin Erdal 
Published: March 2021

AbstractThis paper examines how varying antidumping methodologies applied within the World Trade Organization differ in the extent to which they reduce targeted exports. We show that antidumping duties, on average, hit Chinese exporters harder than those of other targeted countries. This difference can be traced back in part to China's non‐market economy status, which affects the way antidumping duties are calculated. Furthermore, we show that the type of imposed duty matters, as ad‐valorem duties affect exports differently compared to specific duties or duties conditional on the export price. Overall, however, antidumping duties remain effective in reducing imports independent of market economy status.
Optimal Block Designs for Experiments on Networks
Authors: Koutra Vasiliki , Gilmour Steven G. , Parker Ben M. 
Published: March 2021

AbstractWe propose a method for constructing optimal block designs for experiments on networks. The response model for a given network interference structure extends the linear network effects model to incorporate blocks. The optimality criteria are chosen to reflect the experimental objectives and an exchange algorithm is used to search across the design space for obtaining an efficient design when an exhaustive search is not possible. Our interest lies in estimating the direct comparisons among treatments, in the presence of nuisance network effects that stem from the underlying network interference structure governing the experimental units, or in the network effects themselves. Comparisons of optimal designs under different models, including the standard treatment models, are examined by comparing the variance and bias of treatment effect estimators. We also suggest a way of defining blocks, while taking into account the interrelations of groups of experimental units within a network, using spectral clustering techniques to achieve optimal modularity. We expect connected units within closed-form communities to behave similarly to an external stimulus. We provide evidence that our approach can lead to efficiency gains over conventional designs such as randomised designs that ignore the network structure and we illustrate its usefulness for experiments on networks.