bluuebunny/crossref_metadata_2025_split huggingface dataset:
‘It’s the value that we bring’: performance pay and top income earners’ perceptions of inequality
Authors: Hecht Katharina 
Published: October 2021

Abstract
Though the literature on perceptions of inequality and studies of ‘elites’ have identified the importance of meritocratic beliefs in legitimating inequality, little is known about the role of pay setting processes in sustaining ideals of meritocracy. Drawing on 30 in-depth interviews with UK-based top income earners working mainly in finance, I analyse how top income earners perceive economic inequality. My study highlights the crucial role of performance pay for perceptions that top incomes are meritocratically deserved. Participants expressed the view that performance pay, an increasingly prevalent pay-setting practice, ensures that top incomes reflect a share of economic ‘value created’ for shareholders, clients or investors. Focusing on narrow, economic criteria of evaluation perceived as objective, the majority of respondents (‘performance pay meritocrats’) justified any income difference as deserved if it reflects economic contribution. Meanwhile, a minority of respondents (‘social reflexivists’) applied broader evaluative criteria including distributive justice and social contributions.
Cognitive behavioral therapy for insomnia has sustained effects on insomnia, fatigue, and function among people with chronic heart failure and insomnia: the HeartSleep Study
Authors: Redeker Nancy S , Yaggi Henry Klar , Jacoby Daniel , Hollenbeak Christopher S , Breazeale Stephen , Conley Samantha , Hwang Youri , Iennaco Joanne , Linsky Sarah , Nwanaji-Enwerem Uzoji , O’Connell Meghan , Jeon Sangchoon 
Published: October 2021

AbstractStudy ObjectivesInsomnia is common among adults with chronic heart failure (HF) and associated with daytime symptoms and decrements in function. The purpose of this randomized controlled trial (RCT) was to evaluate the sustained effects over one year of CBT-I (Healthy Sleep: HS) compared with HF self-management education (Healthy Hearts; attention control: HH) on insomnia severity, sleep characteristics, symptoms, and function among people with stable HF. The primary outcomes were insomnia severity, actigraph-recorded sleep efficiency, and fatigue.MethodsWe randomized adults with stable HF with preserved or reduced ejection fraction who had at least mild insomnia (Insomnia severity index &gt;7) in groups to HS or HH (4 sessions/8 weeks). We obtained wrist actigraphy and measured insomnia severity, self-reported sleep characteristics, symptoms (fatigue, excessive daytime sleepiness, anxiety, depression), and six-minute walk distance at baseline, within one month of treatment, and at 6 and 12 months. We used general linear mixed models (GLMM) and generalized estimating equations (GEE) to evaluate the effects.ResultsThe sample included 175 participants (M age = 63 ± 12.9 years; 43% women; 18% Black; 68% New York Heart Association Class II or II; 33%; LVEF &lt; 45%) randomized to HS (n = 91) or HH (n = 84). HS had sustained effects on insomnia severity, sleep quality, self-reported sleep latency and efficiency, fatigue, excessive daytime sleepiness, and six-minute walk distance at 12 months.ConclusionsCBT-I produced sustained improvements in insomnia, fatigue, daytime sleepiness, and objectively measured physical function among adults with chronic HF, compared with a robust HF self-management program that included sleep hygiene education.Clinical Trial InformationInsomnia Self-Management in Heart Failure; https://clinicaltrials.gov/ct2/show/NCT02660385; NCT02660385.
Evaluation of microencapsulated organic acids and botanicals on growth performance of nursery and growing-finishing pigs
Authors: Hutchens Wade M , Tokach Mike D , Woodworth Jason C , DeRouchey Joel M , Goodband Robert D , Gebhardt Jordan T , Calderon Hilda I , Keppy Kaylee , Maynard Philip , Grilli Ester 
Published: October 2021

AbstractA total of 1,215 pigs (L337 × 1050, PIC, Hendersonville, TN) were used to determine the effect of microencapsulated organic acids and botanicals (MOB; AviPlus; Vetagro, Inc. Chicago, IL), on growth performance from weaning to market. Pigs were weaned at approximately 21 d of age and placed in pens based on initial body weight (BW) with 27 pigs per pen in a randomized complete block design. During the 42-d nursery period, pigs were allotted to one of two treatments in an unbalanced treatment structure with 15 pens (replications) fed the control diet and 30 pens (replications) fed diets containing 0.30% MOB from days 0 to 21 and 0.10% from days 21 to 42. On day 42, pigs were transported as intact pens from the nursery to the finishing facility. During the finishing period, three treatments were applied which included: 1) pigs on the control diet in nursery remained on control diets; 2) 50% of pigs provided MOB in nursery were then fed 0.05% MOB throughout finishing, and 3) 50% of pigs provided MOB in nursery were then fed the control diet throughout finishing. All pens of pigs on treatments 2 and 3 were allotted based on ending nursery BW to the finishing treatment. There were 15 replications per treatment in the finishing period. From days 0 to 21, pigs fed diets with MOB had a tendency for increased (P &lt; 0.058) gain:feed (G:F) when compared to pigs fed the control diet; however, there was no evidence of difference (P &gt; 0.05) for average daily gain (ADG), average daily feed intake (ADFI), or day 21 BW. From days 21 to 42, there was no evidence of difference (P &gt; 0.05) for ADG, ADFI, or G:F. For the overall nursery period (days 0 to 42), pigs fed diets with MOB had increased (P &lt; 0.05) G:F (660 vs. 670 g/kg) when compared with pigs fed the control diet, but there was no evidence of difference (P &gt; 0.05) for day 42 BW, ADG, or ADFI between treatments. From d 42 to 106, there was no evidence of difference (P &gt; 0.05) for ADG, ADFI, and G:F. For the overall finishing period (days 42 to 156) and overall experimental period (days 0 to 156), there was no evidence of difference (P &gt; 0.05) for BW, ADG, ADFI, or G:F. For mortality and removals, there was no evidence of difference (P &gt; 0.05) observed during the nursery, finishing, or overall. In summary, providing MOB during the nursery phase increased G:F in the early and overall nursery phase, but there was no effect on overall wean-to-finish performance.
Distinguishing early patterns of physical activity goal attainment and weight loss in online behavioral obesity treatment using latent class analysis
Authors: Stansbury Melissa L , Harvey Jean R , Krukowski Rebecca A , Pellegrini Christine A , Wang Xuewen , West Delia S 
Published: October 2021

Abstract
Physical activity (PA) goal adherence is consistently associated with greater weight loss during behavioral obesity treatment, and early weight loss response predicts future weight loss success. However, it remains unclear which behaviors during the initial weeks of treatment distinguish responders from nonresponders and might be effective targets for improving treatment outcomes. To characterize subgroups with distinct patterns of PA goal adherence during the initial 2 months of an online, group-based weight control program and determine associations between these patterns and 6-month weight loss. Participants received an online behavioral obesity intervention with PA goals and daily self-monitoring. Weekly adherence to step goals and moderate-to-vigorous PA (MVPA) minute goals based on self-monitoring records were examined using latent class analysis. Body weight was objectively measured at 0, 2, and 6 months. Participants (N = 212; 91.5% female, 31.6% race/ethnic minority, mean body mass index: 35.8 ± 5.9 kg/m2) clustered into three subgroups based on early goal attainment: “Both PA Goals,” “MVPA Goals Only,” and “Neither PA Goal.” The “Both PA Goals” class had significantly greater 6-month weight loss (estimated mean weight loss [95% CI]: −9.4% [7.4 to 11.5]) compared to the “MVPA Goals Only” (−4.8% [3.4 to 6.1]) and “Neither PA Goal” classes (−2.5% [1.4 to 3.6]). Individuals meeting both PA goals early in treatment achieve greater weight losses than those meeting MVPA but not step goals, pointing to the need to explore factors associated with nonadherence to each of the PA goals to better understand these potential targets for treatment refinement and adaptive interventions.
Key points of investigation and analysis on traffic accidents involving intelligent vehicles
Authors: Yuan Quan , Peng Yong , Xu Xiaodong , Wang Xinghua 
Published: October 2021

Abstract
Intellectualization is regarded as the future mainstream development trend of the automobile industry. The automation level of intelligent vehicles is relatively low so far, and the road traffic system will be in a mixed state of non-autonomous vehicles and vehicles with different levels of automation for a long time. Therefore, the road traffic system will be more complex with more diverse accidents. This paper analysed the characteristics and causal factors of intelligent vehicle accidents. Based on the problems existing in investigation, analysis and liability identification of intelligent vehicle accident, the study proposed a preliminary accident investigation framework and method, summarized the key points of accident analysis from the perspectives of technical defects, information security and passive safety, and specified the liability subjects for intelligent vehicle accidents and their corresponding legal liability. The results from this study contributed to the development of intelligent vehicle accident investigation and disposal, and provided the reference for the improvement of vehicle safety and accident prevention.
Developing Telemedicine Curriculum Competencies for Graduate Medical Education: Outcomes of a Modified Delphi Process
Authors: Hart Alexander , Romney Douglas , Sarin Ritu , Mechanic Oren , Hertelendy Attila J. , Larson Deanna , Rhone Kelly , Sidel Kristi , Voskanyan Amalia , Ciottone Gregory R. 
Published: October 2021

Purpose
Telemedical applications have only recently begun to coalesce into the field of telemedicine due to varying definitions of telemedicine and issues around reimbursement. This process has been accelerated by the COVID-19 pandemic and the ensuing expansion of telemedicine delivery. This article demonstrates the development of a set of proposed competencies for a telemedicine curriculum in graduate medical education.

Method
A modified Delphi process was used to create a panel of competencies. This included a systematic review of the telemedicine literature through November 2019 to create an initial set of competencies, which were analyzed and edited by a focus group of experts in January 2020. Initial competencies were distributed in a series of 3 rounds of surveys to a group of 23 experts for comments and rating from April to August 2020. Competencies that obtained a score of 4.0 or greater on a 5-point Likert scale in at least 2 rounds were recommended.

Results
Fifty-five competencies were developed based on the systematic review. A further 32 were added by the expert group for a total of 87. After 3 rounds of surveys, 34 competencies reached the recommendation threshold. These were 10 systems-based practice competencies, 7 professionalism, 6 patient care, 4 practice-based learning and improvement, 4 interpersonal and communication skills, and 3 medical knowledge competencies.

Conclusions
Half (17/34) of the competencies approved by the focus group and surveyed expert panel pertained to either systems-based practice or professionalism. Both categories exhibit more variation between telemedicine and in-person practice than other categories. The authors offer a set of proposed educational competencies that can be used in the development of curricula for a wide range of providers and are based on the best evidence and expert opinion available.
A Novel Online Curriculum and Coaching Strategy to Expand the Addiction Medicine Workforce: The Michigan Collaborative Addiction Resources and Education System
Authors: Poland Cara , Bennett Lia , Strutz Kelly L. , Plantegenest Geraud , Greenwald Mark K. 
Published: October 2021

Problem
There is a shortage of addiction medicine (AM) physicians and a 9-year period (2017–2025) in which to build the workforce via a practice pathway enabling physicians to combine experiential hours with passing a board exam to become board-certified AM physicians. Afterward, AM specialists will need to complete the traditional fellowship pathway, requiring additional training.

Approach
The Michigan Collaborative Addiction Resources and Education System (MI CARES) was developed from February to June 2019 to support physicians in obtaining AM certification via the practice pathway. This program was originally planned for Michigan physicians but was quickly expanded nationally. This novel, asynchronous, self-directed online curriculum follows the knowledge blueprint for the board exam, including continuing medical education credits. The program also provides 1:1 coaching support to educate physicians on how to properly document their experiential hours on the application for the AM board exam. The first module, which describes the practice pathway, was released in January 2020, and 7 substance-specific content modules were released monthly from February to August 2020.

Outcomes
As of October 31, 2020, 231 physicians from 13 American Board of Medical Specialties in 37 U.S. states were enrolled in MI CARES. The longer a module was available, the more participants visited the module. Three early program adopters were approved to sit for the 2019 board exam, and 51 participants passed the board exam in 2020. Of these 51, 5 had previously been denied approval before participating in MI CARES.

Next Steps
It will be important to replicate preliminary evidence of feasibility for this novel model for expanding the workforce in a newly approved and underrepresented specialty to see if it holds promise for replication as other subspecialties are identified. The curriculum is being expanded to include modules on additional topics and adapted for graduate and undergraduate medical education students.
Institutional Accountability for Students With Disabilities: A Call for Liaison Committee on Medical Education Action
Authors: Meeks Lisa M. , Stergiopoulos Erene , Petersen Kristina H. 
Published: October 2021

Medical educators and leaders have called for greater diversity among the physician workforce, including those with disabilities. However, many students with disabilities are precluded from entering and completing medical training due to historically restrictive technical standards and poor internal practices to protect student privacy. This limits the possibilities for growing this part of the workforce and making progress toward the ultimate goal of having a physician workforce that better represents the patients it serves. To achieve diversity among the physician workforce, medical education must create environments that allow students with disabilities to apply to, flourish in, and feel well supported in medical school.
Recent additions to Accreditation Council for Graduate Medical Education requirements have helped to catalyze work in the area of disability inclusion by incorporating disability-focused mandates into graduate medical education accreditation standards. However, similar mandates for undergraduate medical education have not yet materialized. In this article, the authors call for the Liaison Committee on Medical Education (LCME) to elevate disability as a valued part of medical school diversity in its accreditation standards and to include protections for disabled students. The authors propose that the LCME can take 5 actions to promote institutional accountability toward students with disabilities: (1) define disability as diversity, (2) mandate disability support, (3) protect from conflicts of interest, (4) protect privacy, and (5) verify schools’ technical standards comply with the Americans with Disabilities Act. By adopting these recommendations, the LCME would send the powerful message that students with disabilities bring welcome expertise and value to the medical community.
Frailty and cardiac surgery: to operate or not?
Authors: Emmert Daniel A. , Arcario Mark J. , Maranhao Bruno , Reidy Andrea B. 
Published: October 2021

Purpose of review
With an aging cardiac surgery population, prefrail and frail patients are becoming more common. Anesthesiologists will be faced with the decision of how best to provide care to frail patients. Identification, management, and outcomes in frail patients will be discussed in this review.

Recent findings
Frailty is associated with a variety of poor outcomes, such as increased hospital length of stay, medical resource utilization, readmission rates, and mortality. Prehabilitation may play a greater role in the management of frail cardiac surgery patients.

Summary
As frailty will likely only increase amongst cardiac surgery patients, it is important to develop multicenter trials to study management and treatment options. Until those studies are performed, the care of frail cardiac surgery patients may be best provided by high-volume surgical centers with expertise in the management of frail patients.
Spinal Anesthesia with Targeted Sedation based on Bispectral Index Values Compared with General Anesthesia with Masked Bispectral Index Values to Reduce Delirium: The SHARP Randomized Controlled Trial
Authors: Brown Charles H. , Edwards Charles , Lin Charles , Jones Emily Ledford , Yanek Lisa R. , Esmaili Melody , Gorashi Yara , Skelton Richard , Kaganov Daniel , Curto Ryan , Lessing Noah L. , Cha Stephanie , Colantuoni Elizabeth , Neufeld Karin , Sieber Frederick , Dean Clayton L. , Hogue Charles W. 
Published: October 2021

Background
Reducing depth of anesthesia and anesthetic exposure may help prevent delirium, but trials have been conflicting. Most studies were conducted under general anesthesia or in cognitively impaired patients. It is unclear whether reducing depth of anesthesia beyond levels consistent with general anesthesia reduces delirium in cognitively intact patients. The authors’ objective was to determine whether a bundled approach to reduce anesthetic agent exposure as determined by Bispectral Index (BIS) values (spinal anesthesia with targeted sedation based on BIS values) compared with general anesthesia (masked BIS) reduces delirium.

Methods
Important eligibility criteria for this parallel-arm randomized trial were patients 65 yr or greater undergoing lumbar spine fusion. The intervention group received spinal anesthesia with targeted sedation to BIS greater than 60 to 70. The control group received general anesthesia (masked BIS). The primary outcome was delirium using the Confusion Assessment Method daily through postoperative day 3, with blinded assessment.

Results
The median age of 217 patients in the analysis was 72 (interquartile range, 69 to 77). The median BIS value in the spinal anesthesia with targeted sedation based on BIS values group was 62 (interquartile range, 53 to 70) and in the general anesthesia with masked BIS values group was 45 (interquartile range, 41 to 50; P < 0.001). Incident delirium was not different in the spinal anesthesia with targeted sedation based on BIS values group (25.2% [28 of 111] vs. the general anesthesia with masked BIS values group (18.9% [20 of 106]; P = 0.259; relative risk, 1.22 [95% CI, 0.85 to 1.76]). In prespecified subgroup analyses, the effect of anesthetic strategy differed according to the Mini-Mental State Examination, but not the Charlson Comorbidity Index or age. Two strokes occurred among patients receiving spinal anesthesia and one death among patients receiving general anesthesia.

Conclusions
Spinal anesthesia with targeted sedation based on BIS values compared with general anesthesia with masked BIS values did not reduce delirium after lumbar fusion.

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Threshold-based Monitoring of Compound Muscle Action Potentials for Percutaneous Pedicle Screw Placement in the Lumbosacral Spine
Authors: Tani Yoichi , Saito Takanori , Taniguchi Shinichiro , Ishihara Masayuki , Paku Masaaki , Adachi Takashi , Ando Muneharu , Kohara Nobuo , Kimura Jun 
Published: October 2021

Study Design.
A prospective analysis.

Objective.
To test if threshold-based monitoring of compound muscle action potentials (CMAPs) by stimulating the screw loaded to uninsulated extender sleeve provides a valid safety warning for percutaneous pedicle screw (PPS) placements in the lumbosacral spine.

Summary of Background Data.
Utility of the CMAP monitoring to PPS procedures remains controversial.

Methods.
A series of 202 patients underwent a total of 1664 lumbosacral PPS placements under CMAP monitoring without fluoroscopic guidance. The monitoring consisted of stimulating the PPS assembled to uninsulated extender sleeve and recording CMAPs from the vastus medialis, biceps femoris, tibialis anterior, and medial gastrocnemius. Automated steps of a threshold hunting algorithm using 0.2-ms duration pulses of increasing intensities delivered at 2/s allowed quick determination of a minimum stimulation current to evoke >100-μV amplitude CMAPs.

Results.
At L2 through S1 spines, postoperative CT scans identified 51 medial or inferior pedicle wall breaches of 1536 screws (3.3%) without neurologic complications. The receiver operating characteristic curve analysis determined the critical cutoff threshold value of 27 mA (74% sensitivity and 95% specificity) for predicting 35 breaches of 627 screws (5.6%) at L2 and L3, and of 17 mA (100% sensitivity and 98% specificity) for 16 of 909 (1.8%) at L4 through S1. While advancing the screw, three breaches (5.9%) showed a particularly low threshold of ≤6-mA, allowing the surgeon to immediately redirect the screw and retest the new trajectory as safe.

Conclusion.
Screw stimulation with threshold hunting algorithm has a distinct advantage over the time-consuming insulated pilot hole stimulation, allowing an uninterrupted flow of the surgery. The present findings have documented practical usefulness and reliability of CMAP monitoring using direct stimulation of the PPS assembled to uninsulated extender sleeve.