bluuebunny/crossref_metadata_2025_split huggingface dataset:
Angiotensinogen and Megalin Interactions Contribute to Atherosclerosis—Brief Report
Authors: Ye Feiming , Wang Ya , Wu Congqing , Howatt Deborah A. , Wu Chia-Hua , Balakrishnan Anju , Mullick Adam E. , Graham Mark J. , Danser A.H. Jan , Wang Jian’an , Daugherty Alan , Lu Hong S. 
Published: December 2018

Objective—
AGT (Angiotensinogen) is the unique precursor of the renin-angiotensin system that is sequentially cleaved by renin and ACE (angiotensin-converting enzyme) to produce Ang II (angiotensin II). In this study, we determined how these renin-angiotensin components interact with megalin in kidney to promote atherosclerosis.

Approach and Results—

AGT, renin, ACE, and megalin were present in the renal proximal convoluted tubules of wild-type mice. Hepatocyte-specific AGT deficiency abolished AGT protein accumulation in proximal tubules and diminished Ang II concentrations in kidney, while renin was increased. Megalin was most abundant in kidney and exclusively present on the apical side of proximal tubules. Inhibition of megalin by antisense oligonucleotides (ASOs) led to ablation of AGT and renin proteins in proximal tubules, while leading to striking increases of urine AGT and renin concentrations, and 70% reduction of renal Ang II concentrations. However, plasma Ang II concentrations were unaffected. To determine whether AGT and megalin interaction contributes to atherosclerosis, we used both male and female low-density lipoprotein receptor
−/−
mice fed a saturated fat-enriched diet and administered vehicles (PBS or control ASO) or megalin ASO. Inhibition of megalin did not affect plasma cholesterol concentrations, but profoundly reduced atherosclerotic lesion size in both male and female mice.

Conclusions—
These results reveal a regulatory role of megalin in the intrarenal renin-angiotensin homeostasis and atherogenesis, positing renal Ang II to be an important contributor to atherosclerosis that is mediated through AGT and megalin interactions.
Seven Tenets of Creative Research
Authors: Dichter Ernest 
Published: December 2018

Research in its real sense means continuous searching. To be scientific, it has to submit to the same criteria whether applied in the marketing field or the atomic field. These standards involve the formulation of hypotheses and their validation. In this provocative article, Dr. Dichter develops seven such tenets, which he sees as prerequisites for a sensitive and creative diagnosis of “why” questions in any field.
Early prediction of falls after stroke: a 12-month follow-up of 490 patients in The Fall Study of Gothenburg (FallsGOT)
Authors: Samuelsson Carina M , Hansson Per-Olof , Persson Carina U 
Published: December 2018

Objective: To identify the incidence of falls and factors present shortly after stroke, which are associated with the occurrence of falls over the first 12 months after stroke onset, following discharge from inpatient rehabilitation. Design: Prospective follow-up study. Setting: Stroke unit and outpatient department. Subjects: A total of 490 individuals with acute stroke. Methods: Postural control was assessed using the Swedish modified version of the Postural Assessment Scale for Stroke Patients. Data on self-reported falls were collected using a standardized questionnaire at three months after discharge and six and 12 months after stroke onset. Associations between characteristics during the acute phase after a stroke and falls after six and 12 months were investigated using univariable and multivariable regression analyses. Main measures: The endpoint was a self-reported fall. Results: Within three months after discharge, 38 of 165 respondents (23%) had experienced at least one fall. Within six and 12 months after stroke onset, respectively, 108 of 376 (29%) and 140 of 348 (40%) of the respondents had experienced at least one fall. Poor postural control (odds ratio 3.92, 95% confidence interval 2.07–7.45, P < 0.0001) and using a walking aid (odds ratio 2.84, 95% confidence interval 1.71–4.72, P < 0.0001) were predictors of falls after discharge within 12 months after stroke onset. The same variables were independent predictors of falls within six months. Conclusion: Poor postural control and using a walking aid in the acute phase after a stroke are associated with falls after discharge from a stroke unit within 12 months after stroke onset.
Short stems in total hip replacement: evidence on primary stability according to the stem type
Authors: Drosos Georgios I , Touzopoulos Panagiotis 
Published: December 2018

Background: As the prevalence of total hip replacement is increasing in younger patients, less invasive implants (short stems) are becoming more favourable. However, despite the advantages of these stems, clinical results with a follow-up of more than 10 years are limited to a very few stem designs. There has been an increase in publications recently – mechanical and clinical studies – concerning the primary stability of short stems. Primary stem stability is an important factor as it reflects final stem stabilisation and is related to the clinical results of the prosthesis. Method: We conducted a systematic review of the literature to retrieve evidence concerning primary implant stability in short stems – as expressed by implant micromotion and stem subsidence – according to our previously proposed short-stem classification. Results: Mechanical in vitro studies on stem micromotion are very few and limited to type 2 “partial collum” short stems. The results are comparable to those of stems with a known long-term excellent clinical course. Clinical results concerning stem migration patterns are also limited to some of the commercially available short stems. Although comparative studies are very few, the results for most of the short stems are similar to those of standard stems. Conclusion: There are promising results concerning biomechanical studies of the initial micromotion of short stems, as well as clinical results of stem migration patterns. Long-term clinical studies are needed in order to confirm these findings. The existing literature concerns very few of the many commercially available implants.
Misinterpretation of online surgical outcomes: The British Association of Urological Surgeons Surgical Outcomes Audit
Authors: Sathianathen Niranjan J , Albersheim-Carter Jacob , Labine Lucas , Watson Brett , Konety Badrinath R , Weight Christopher J 
Published: December 2018

Objective: The purpose of this study was to evaluate whether the information presented in the British Association of Urological Surgeons Surgical Outcomes Audit is comprehended by the general population. Methods: An in-person electronic survey was administered at the local state fair in 2016. Participants were presented with an representative output from the British Association of Urological Surgeons Surgical Outcomes Audit and were asked to estimate the complication rate and make a hypothetical healthcare decision. The primary output depicted a complication rate of 6.7% which was above the 99th percentile. The degree of misinterpretation and the risk of making an inappropriate healthcare decision was evaluated. Results: Of the 350 completed responses, only 142 (40.6%) correctly estimated the surgeons’ complication rate. Individuals who were not college educated (odds ratio 3.02, 95% confidence interval 1.88–4.95) were more likely to misinterpret the information. Only 7.6% recognized that the surgeon’s complication rate was above the 99th percentile. Despite the high complication rate, 16.6% decided to continue with the surgery as planned and not ask the surgeon about their rates, seek a second opinion or change surgeons. Misinterpreters had a higher risk of making an inappropriate hypothetical decision (odds ratio 2.75, 95% confidence interval 1.42–5.62). Conclusion: The general population have difficulty in interpreting the data presented by The British Association of Urological Surgeons Surgical Outcomes Audit and are thus vulnerable to making poor healthcare decisions or decisions which are inconsistent with their goals of care. Level of evidence: IIb
Prone versus modified supine percutaneous nephrolithotomy: which is more cost effective in an Australian tertiary teaching hospital?
Authors: Chu Isabel E-Hui , Ranasinghe Weranja , Jones Madeleine Nina , McCahy Philip 
Published: December 2018

Introduction: Percutaneous nephrolithotomy is currently one of the main treatment options for large renal stones, but the effect of positioning on comparative costing has been scarcely documented. We aimed to compare the cost effectiveness of modified supine with traditional prone percutaneous nephrolithotomy procedures in the context of Victoria, Australia. Materials and methods: A prospective group of 236 renal units (224 patients) was included in the two-site study, with 76 performed in the prone position and 160 performed in the modified supine position. Costing was calculated using a ‘bottom-up’, all-inclusive framework that generates per-hour costs for theatre, recovery unit and ward costs from base costs and maintenance costs. Percutaneous nephrolithotomy-specific equipment was added to calculate comparative costs of modified supine versus prone procedures. Chi squared and T tests were used for statistical analysis. Results: There was a significant difference in the overall costing between the modified supine and prone groups. The modified supine group had a lower total cost (AUD$6424.29) compared to the prone group (AUD$7494.79) ( P=0.007), lower operative costs (AUD$4250.93 vs. AUD$5084.29, P=0.002) and lower ward costs (AUD$533.55 vs. AUD$1130.20, P<0.001). There was no significant difference in recovery times in the modified supine and prone groups, although the modified supine group appeared to have shorter recovery times (AUD$690.69 vs. AUD$586.05, P=0.209). Conclusions: Modified supine percutaneous nephrolithotomy has significantly lower total costs, operative costs and ward costs compared to prone percutaneous nephrolithotomy. Larger randomised trials are needed to assess these findings further. Level of evidence: Not applicable for this multicentre audit.
Resident Involvement in Shoulder Arthroscopy Is Not Associated With Short-term Risk to Patients
Authors: Basques Bryce A. , Saltzman Bryan M. , Mayer Erik N. , Bach Bernard R. , Romeo Anthony A. , Verma Nikhil N. , Cole Brian J. , Weber Alexander E. 
Published: December 2018

Background: Shoulder arthroscopy is a commonly performed, critical component of orthopaedic residency training. However, it is unclear whether there are additional risks to patients in cases associated with resident involvement. Purpose: To compare shoulder arthroscopy cases with and without resident involvement via a large, prospectively maintained national surgical registry to characterize perioperative risks. Study Design: Cohort study; Level of evidence, 3. Methods: The prospectively maintained American College of Surgeons National Surgical Quality Improvement Program registry was queried to identify patients who underwent 1 of 12 shoulder arthroscopy procedures from 2005 through 2012. Multivariate Poisson regression with robust error variance was used to compare the rates of postoperative adverse events and readmission within 30 days between cases with and without resident involvement. Multivariate linear regression was used to compare operative time between cohorts. Results: A total of 15,774 patients with shoulder arthroscopy were included in the study, and 12.3% of these had a resident involved with the case. The overall rate of adverse events was 1.09%. On multivariate analysis, resident involvement was not associated with increased rates of any aggregate or individual adverse event. There was also no association between resident involvement and risk of readmission within 30 days. Resident involvement was not associated with any difference in operative time ( P = .219). Conclusion: Resident involvement in shoulder arthroscopy was not associated with increased risk of adverse events, increased operative time, or readmission within 30 days. The results of this study suggest that resident involvement in shoulder arthroscopy cases is a safe method for trainees to learn these procedures.
Against the stream: drugs policy needs to be turned on its head
Authors: Meacher Baroness Molly 
Published: December 2018

SummaryHumans have always used mind-altering drugs. However, in 1961 the United Nations approved the Single Convention, under which the production, sale or possession of a number of drugs, including heroin, cocaine, ecstasy and cannabis, became illegal. The prohibitionist regime was then introduced by most countries around the world and has substantially remained in place ever since. Some countries, particularly those in Latin America, have never criminalised the use of cannabis. A small number of countries have introduced more liberal policies. This article examines the evidence of the consequences of policy liberalisation and argues that there is now a clear case for every country to examine its drug policies and to introduce evidence-based policies with a public health focus.Declaration of interestNone.
Burnout among pediatric residents and junior consultants working at a tertiary care hospital
Authors: Bari Attia , Kamran Rizwana , Haroon Farah , Bano Iqbal 
Published: December 2018

Objective: To determine the burnout among postgraduate residents’ and junior consultants in a tertiary care hospital.
Methods: This cross-sectional study was conducted among the postgraduate residents (PGR) and junior consultants (JC) working at The Children’s Hospital Lahore in 2018. Participants were asked to complete Copenhagen Burnout Inventory questionnaire about burnout on 5 point Likert scale. ‘100 (always), 75 (often), 50 (sometimes), 25 (seldom) and 0 (never/almost never or according to intensity ranging from ‘a very low degree’ to ‘to a very high degree’. Data was analyzed using SPSS version 22. Three questions were added related to hospital factors but scored separately. Students t-test and chi square test were used to compare the burnout.
Results: A total of 227 participants including 177 PGR and 50 JC completed the questionnaire with a response rate of 84% and 86% respectively. There was a female predominance, 140 participants (61.7%) were female. Majority was from pediatric medicine 173 (76.2%). The mean personal and work related-burnout was high among PGRs as compared to JCs (18.68±5.01 vs 16.62±4.57) (p=0.008) and (21.14±5.57 vs. 18.56±5.52) (p=0.004) respectively. Similarly, there was significantly more burnout among pediatric medicine study participants as compared to surgery and diagnostic in all domains (personal BO; p=0.030, work-related BO; p=0.021, patient related BO; 0.033 and hospital related BO; 0.001). No difference was noted based on gender and year of training.
Conclusion: Tertiary care hospital postgraduate residents and junior consultants face moderate burnout. Postgraduate residents had significantly more burnout as compared to junior consultants and majority were from pediatric medicine.
How to cite this:Bari A, Kamran R, Haroon F, Bano I. Burnout among pediatric residents and junior consultants working at a tertiary care hospital. Pak J Med Sci. 2019;35(1):45-49. doi: https://doi.org/10.12669/pjms.35.1.43
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Accompaniment of Teaching and Research Activities of Younger Schoolchildren in the Conditions of Tourist and Local Lore Travel
Authors: Ильяшенко И. , Il'yashenko I. 
Published: December 2018

The article reveals the content and principles of pedagogical support of teaching and research activities of younger schoolchildren in the course of tourist and local history travel. The specificity of designing an individual educational route for an elementary schoolchild is analyzed. The contribution of educational and research activities of tourist and local lore orientation to the achievement of the necessary learning results at the
subject, meta-subject and personal levels is considered.
Methodology of Studying the Problem of Underperformance of Children of Preschool and Primary School Age in Germany
Authors: Писарева Л. , Pisareva L. 
Published: December 2018

Based on the study of K. Bart’s “Early Diagnostics of Underperformance in Schooling at Preschool and Primary School Age” involving similar works by other German specialists of different profiles, the article analyzes the reasons for academic failure, repetition, learning difficulties and adaptation of children to school in Germany. Special attention is paid to the methodology of studying this phenomenon and approaches to its elimination. The urgency of the problem of failure of schoolchildren is accentuated not only in relation to the educational system in Germany, but also in other countries, including Russia. The comments of experts in the field of international comparative studies of student performance
are given.
Investigating defense interpretation depth using lag
sequential analysis
Authors: Petraglia Jonathan , Bhatia Maneet , De Roten Yves , Despland Jean-Nicolas , Drapeau Martin 
Published: December 2018

Aim of the studyThis study investigated the association between therapist interventions and patient defensive functioning in low-alliance and high-alliance sessions over the course of short-term dynamic psychotherapy (STDP) (n= 22).Subject or material and methodsLag sequential analysis was used to determine if there were predictable sequences of therapist interventions and patient defenses in low-alliance and high alliance sessions and whether these two sequences differ.ResultsThe results of this study suggest that sequences between alliance session groups are different. Specifically, defense interpretation depth unfolds in a predictable fashion during a low-alliance session while supportive strategies appear more predictable during high-alliance sessions.DiscussionThe statistical trends obtained in this study are discussed in light of prior research studies in this area. Specifically, differences between low and high alliance sessions are discussed.ConclusionsDefense interpretation depth is a clinical construct that warrants further study in psychotherapy research.
Comparison of the effectiveness of the transactional
analysis training and emotion regulation
on the improvement of love trauma syndrome:
Dealing with the problems caused by the separation
and love break up
Authors: rajabi soran , Nikpoor Neda 
Published: December 2018

Aim of the studyThis pilot study compare the effectiveness of the transactional analysis training and emotion regulation therapy on the reduction of love trauma syndrome (LTS).Subject or material and methodsThe present research was developed as pre-test and post-test. Randomly 44 participants were divided into three TA (N = 15; Mage = 23.01, SD = 3.02), ERT (N = 14; Mage = 22.78, SD = 3.33), and control groups (N = 15; Mage = 22.60, SD = 3.14).Resultsthe results of one-way analysis of covariance demonstrated that there is a significant difference in LTS between two treatment groups and control group (P<0.001).DiscussionHowever, no significant difference found between the treatments groups of TA and ERT. The present study indicated that both TA and ERT equally reduced the LTS.ConclusionsPreliminary findings suggest that indicated that both TA and ERT equally reduced the LTS.
Improving the approach to future care planning in care homes
Authors: Kinley Julie , Denton Lilette , Levy Jean 
Published: December 2018

Background: There is international and national interest in the availability and provision of quality end-of-life care. In the UK this includes the promotion of advance care planning (ACP). Aims: To support care home staff to apply national policy on ACP in practice. Methods: A proactive document, the PErsonalised Advisory CarE (PEACE) plan, was created. An audit was undertaken of its implementation in practice in one care home. Findings: All of the residents with a PEACE plan who died (n=8) did so in their preferred place of care; only 50% of residents (3 out of 6) without a PEACE plan died in their preferred place of care. No family members declined the opportunity to have a PEACE plan conversation. Conclusion: Future care planning, rather than ACP, is required in nursing care homes. Research investigating the outcomes and cost-effectiveness of undertaking these conversations is required to further guide national recommendations.
Upholding an ideal image of palliative work in the face of obstacles
Authors: Beck Ingela , Pålsson Christina , Tops Anita Bengtsson 
Published: December 2018

Objective: Homecare workers play a pivotal role in palliative care, but research on their experiences is limited. The aim of this study was to describe how homecare workers in Sweden experience their work in palliative homecare. Method: This qualitative study used open-ended interviews with a purposive sample of 15 homecare workers. The data was analysed by means of qualitative content analysis. Results: One main theme emerged from the analysis: upholding an ideal image of palliative work. This had four subthemes: doing good; doing their best work; feeling work satisfaction; and facing difficulties. Conclusion: Palliative care performed by homecare workers is demanding. Homecare workers need more practical support and would benefit from a care model that involves working with registered nurses, as a team, to provide humanistic care to dying patients and their relatives.
Exploring empathy levels among Canadian paramedic students
Authors: Kus Lucy , Gosling Cassidy , Wilson Taylor , Batt Alan M. 
Published: December 2018

Background: Empathy is an important factor in communication between healthcare provider and patient. Previous studies have shown that empathy benefits patient care in multiple ways. Empathy allows a space of decreased vulnerability and, as a result, builds trust in healthcare relationships. It fosters open communication that leads to improved patient care; improves patient satisfaction; and buffers healthcare provider burnout. This study aimed to determine the empathy levels demonstrated by paramedic students to patients with various medical conditions, and to compare these findings with those of previous studies. Methods: This study employed a cross-sectional design of a convenience sample of first and second year paramedic students in a community college programme in Ontario, Canada. The Medical Condition Regard Scale (MCRS) was used to measure empathy levels in these students across five medical conditions: physical disability, intellectual disability, suicide attempt, mental health emergency, and substance abuse. Results: A total of 43 students participated in the study; 27 males and 15 females (1 unknown). Males demonstrated a mean empathy score of 232.44 while females demonstrated a mean of 266.4. Across the five medical conditions, substance abuse had the lowest mean empathy score (42.88), followed by mental health emergency (49.58), suicide attempt (49.47), intellectual disability (50.42) and physical disability (53.0). Conclusion: Results from this study suggest that paramedic students demonstrated the lowest levels of empathy towards patients suffering from substance abuse issues, and the highest levels of empathy towards patients with a physical disability. Male paramedic students are less empathetic than their female peers, and second year paramedic students are less empathetic than their first year counterparts. These results provide an insight into paramedic student attitudes in Canada, and provide a foundation for further studies.