bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physician Perspectives on Deprescribing Cardiovascular Medications for Older Adults
Authors: Goyal Parag , Anderson Timothy S. , Bernacki Gwen M. , Marcum Zachary A. , Orkaby Ariela R. , Kim Dae , Zullo Andrew , Krishnaswami Ashok , Weissman Arlene , Steinman Michael A. , Rich Michael W. 
Published: September 2019

BACKGROUND/OBJECTIVESGuideline‐based management of cardiovascular disease often involves prescribing multiple medications, which contributes to polypharmacy and risk for adverse drug events in older adults. Deprescribing is a potential strategy to mitigate these risks. We sought to characterize and compare clinician perspectives regarding deprescribing cardiovascular medications across three specialties.DESIGNNational cross‐sectional survey.SETTINGAmbulatory.PARTICIPANTSRandom sample of geriatricians, general internists, and cardiologists from the American College of Physicians.MEASUREMENTSElectronic survey assessing clinical practice of deprescribing cardiovascular medications, reasons and barriers to deprescribing, and choice of medications to deprescribe in hypothetical clinical cases.RESULTSIn each specialty, 750 physicians were surveyed, with a response rate of 26% for geriatricians, 26% for general internists, and 12% for cardiologists. Over 80% of respondents within each specialty reported that they had recently considered deprescribing a cardiovascular medication. Adverse drug reactions were the most common reason for deprescribing for all specialties. Geriatricians also commonly reported deprescribing in the setting of limited life expectancy. Barriers to deprescribing were shared across specialties and included concerns about interfering with other physicians' treatment plans and patient reluctance. In hypothetical cases, over 90% of physicians in each specialty chose to deprescribe when patients experienced adverse drug reactions. Geriatricians were most likely and cardiologists were least likely to consider deprescribing cardiovascular medications in cases of limited life expectancy (all P < .001), such as recurrent metastatic cancer (84% of geriatricians, 68% of general internists, and 45% of cardiologists), Alzheimer dementia (92% of geriatricians, 81% of general internists, and 59% of cardiologists), or significant functional impairment (83% of geriatricians, 68% of general internists, and 45% of cardiologists).CONCLUSIONSWhile barriers to deprescribing cardiovascular medications are shared across specialties, reasons for deprescribing, especially in the setting of limited life expectancy, varied. Implementing deprescribing will require improved processes for both physician‐physician and physician‐patient communication. J Am Geriatr Soc 68:78–86, 2019
Cognitive Performance Among Older Persons in Japan and the United States
Authors: Saito Yasuhiko , Kim Jung Ki , Davarian Shieva , Hagedorn Aaron , Crimmins Eileen M. 
Published: September 2019

OBJECTIVETo compare cognitive performance among Japanese and American persons, aged 68 years and older, using two nationally representative studies and to examine whether differences can be explained by differences in the distribution of risk factors or in their association with cognitive performance.DESIGNNationally representative studies with harmonized collection of data on cognitive functioning.SETTINGNihon University Japanese Longitudinal Study of Aging and the US Health and Retirement Study.PARTICIPANTSA total of 1953 Japanese adults and 2959 US adults, aged 68 years or older.MEASUREMENTSEpisodic memory and arithmetic working memory are measured using immediate and delayed word recall and serial 7s.RESULTSAmericans have higher scores on episodic memory than Japanese people (0.72 points on a 20‐point scale); however, when education is controlled, American and Japanese people did not differ. Level of working memory was higher in Japan (0.36 on a 5‐point scale) than in the United States, and the effect of education on working memory was stronger among Americans than Japanese people. There are no differences over the age of 85 years.CONCLUSIONEven with large differences in educational attainment and a strong effect of education on cognitive functioning, the overall differences in cognitive functioning between the United States and Japan are modest. Differences in health appear to have little effect on national differences in cognition. J Am Geriatr Soc 68:354–361, 2020
Nurses’ Role in Implementing and Sustaining Acute Telemedicine: A Mixed‐Methods, Pre‐Post Design Using an Extended Technology Acceptance Model
Authors: Bagot Kathleen , Moloczij Natasha , Arthurson Lauren , Hair Casey , Hancock Shaun , Bladin Christopher F. , Cadilhac Dominique A. 
Published: September 2019

AbstractPurposeTechnology‐based systems like telemedicine are frequently being implemented into healthcare settings, impacting clinician practices. Little is known about factors influencing acute telemedicine uptake, if factors differ across time, or between nurses and non‐nurses.DesignA mixed‐methods, pre‐post design with implementation of a new acute stroke telemedicine service.MethodsA survey based on an extended Technology Acceptance Model (TAM) was administered to clinicians involved in acute stroke care at 16 regional hospitals (2014–2017). Open‐ended questions postimplementation (at 6 months) included strengths of the program and areas to improve. Subsequently, a secondary analysis of nurses’ semistructured interviews at the first telemedicine site (2010–2011) was completed to provide greater explanatory detail.FindingsSurveys were completed by nurses (preimplementation n = 77, postimplementation n = 92) and non‐nurses (pre n = 90, post n = 44). Preimplementation, perceived usefulness was the only significant predictor of intending to use telemedicine for nurses, while perceived ease of use and social influence were significant for non‐nurses. Postimplementation, perceived usefulness was significant for both groups, as was facilitating conditions for nurses. Specific examples aligned to TAM categories from our detailed interviews (n = 11 nurses) included perceived usefulness (improved clinical support and patient care), perceived ease of use (technical, clinical aspects), facilitating conditions (setting, education, confidence), and social influence (working relationships).ConclusionsImportant factors for acute stroke telemedicine varied between nurses and non‐nurses, and changed after implementation. The benefits of telemedicine should be emphasized to nurses. Preimplementation, more non‐nurses wanted systems to be easy. Support in clinical, technical, and relationship aspects of telemedicine consultations is required.Clinical RelevanceNurses are influential in implementing acute telemedicine, which is complex, with clinical and technical aspects entwined. Evidence‐based implementation strategies must be tailored over time, and between nurses and non‐nurses, to ensure initial uptake and ongoing use.
Reduced matrix metalloproteinase and collagen transcription mediated by the TGF‐β/Smad pathway in passaged normal human dermal fibroblasts
Authors: Kim Young Il , Kim Kyung Sook , Ahn Hye‐Jin , Kang In‐Hye , Shin Min Kyung 
Published: September 2019

AbstractBackgroundTransforming growth factor‐β (TGF‐β) is a major regulator of extracellular matrix (ECM) events, particularly collagen production.AimWe explored whether the expression of matrix metalloproteinases (MMPs) and collagen are transcriptionally regulated by the TGF‐β and Smad signaling pathways, and the roles played by NF‐κB and mitogen‐activated protein kinase (MAPK) signaling in normal, aged, human dermal fibroblasts.MethodsWe quantified mRNA and protein expression using real‐time PCR and immunoblotting of proteins from cells in passage 5‐15.ResultsThe levels of mRNAs encoding TGF‐β1, TGF‐β3, and TGF‐β receptor type I (TGFβ RI) decreased with increasing passage number. The levels of mRNAs encoding TGF‐β2, TGFβ RII, and TGFβ RIII increased to passage 10 but decreased by passage 15. The levels of mRNAs encoding Smad‐2, ‐3, ‐4, and ‐7 decreased with increasing passage number. The level of mRNA encoding MMP‐1 increased with increasing passage number, and the levels of mRNAs encoding MMP‐2, TIMP‐1, and TIMP‐2 increased to passage 10 but decreased by passage 15. The levels of mRNAs encoding collagen types I and II decreased with increasing passage number. At the protein level, NF‐κB, IκBα, p38, ERK, Akt, and JNK became increasingly phosphorylated at higher passage numbers.ConclusionOur results suggest that reductions in the expression levels of MMPs and collagen types I and III in aging human dermal fibroblasts reflect reduced expression of TGF‐β/Smad and TGF‐β receptors, thus compromising the TGF‐β receptor‐binding capacity of fibroblasts; the NF‐κB and Akt‐JNK/MAPK signaling pathways may play active roles in this process.
Biology of the vernix caseosa: A review
Authors: Nishijima Koji , Yoneda Makoto , Hirai Takayoshi , Takakuwa Koichi , Enomoto Takayuki 
Published: September 2019

AbstractThe vernix caseosa is a complex membranous structure comprising 80% water, 10% protein, and 10% lipids including barrier lipids such as ceramides, free fatty acids, phospholipids and cholesterol, synthesized partly by fetal sebaceous glands during the last trimester of pregnancy in an antero‐posterior and dorsoventral manner. Because of its lipid content, vernix is hydrophobic and protects the skin from excessive water exposure during the development of the stratum corneum. The vernix caseosa has various functions during fetal transition from an intrauterine to an extrauterine environment, including lubrication of the birth canal during parturition, barrier function to prevent water loss, temperature regulation, for innate immunity and for intestinal development. This review discusses the evidence supporting the prenatal and postnatal functions of vernix caseosa, along with its structure, composition, and physical and biological characteristics. Understanding the biology of the vernix may facilitate improved care of preterm infants immediately post‐partum.
Social identity management strategies of women in STEM fields
Authors: Ryan Ann Marie , King Danielle D. , Elizondo Fabian , Wadlington Patrick 
Published: September 2019

Recruiting and retaining women in science, technology, engineering, and mathematics (STEM) occupations is seen as challenging, and researchers have begun to consider how women manage their identity in these contexts in response to potential questions of fit. Within identity management theoretical work, there has been little attention to occupational influences. Based on role congruity theory, we investigate occupational characteristics as influences on women's gender identity management, along with individual differences and organizational support influences. Results suggest that engaging in identity management behaviours is unrelated to the gender stereotypicality or gender composition of the field, but that support, fit (i.e., congruence between the interests of the individual and occupation), and personality affect engagement in these behaviours. Implications for enhancing the experiences of women in STEM fields as well as for social identity‐related research more broadly are discussed.Practitioner points

Individuals may differ in how they choose to address stigmatization at work, based on their personality and fit with the position.

Perceived organizational support is associated with willingness to engage in stigmatization confronting strategies.

Efforts to understand and affect identity management strategy use should consider individual characteristics (i.e., interests and personality).
Heterogeneous impacts of China's economic and development zone program
Authors: Howell Anthony 
Published: September 2019

AbstractThis paper examines the impact of economic and development zones (EDZs) on the productivity of incumbent firms in China. To deal with the selection issue, I first take into account potentially different selection mechanisms across two popular types of EDZs—economic and technological development zones (ETDZs) and high‐tech development zones (HTDZs)—by relying on multiple treatment propensity scores matching techniques. Next, I apply the difference‐in‐differences estimator to the matched sample and conduct an event study analysis. The results show that the respective effects of ETDZs and HTDZs on firm productivity are positive, but subject to a nonlinear trend over time. The size of the productivity gains depends critically on the type of EDZ, however. A new HTDZ (ETDZ) leads to an average productivity gain of up to 30.2% (18.4%) for incumbent firms in the 5 years after the zone was created. These findings suggest that the size of productivity spillovers for spatially targeted firms differ quite significantly depending on the strategic development and policy goals of the EDZ: HTDZs that focus on promoting indigenous‐based factors of learning lead to higher productivity spillovers compared with ETDZs that focus on promoting extra‐local linkages.
Parental Mental Health Associated With Child Overweight and Obesity, Examined Within Rural and Urban Settings, Stratified by Income
Authors: Foster Byron A. , Weinstein Kelsey , Mojica Cynthia M. , Davis Melinda M. 
Published: September 2019

AbstractPurposeRural areas experience greater childhood obesity compared with urban areas. Differences in reported physical activity and dietary intake do not fully explain the disparity. The purpose of this study was to examine the association between parental mental health and childhood obesity within urban and rural areas.MethodsWe used data from the National Survey of Children's Health, 2016, subset to children age 10‐17 with available weight data. We stratified the sample by rural and urban settings and examined whether maternal or paternal mental health was associated with child overweight or obesity, accounting for income stratum (low‐income: ≤200% federal poverty line; high‐income: >200% federal poverty line). We used multivariable analyses to test if associations remained after including covariates of food security, physical activity, and screen time.FindingsFor the 14,733 children 10‐17 years of age in our sample, family income but not rurality was associated with overweight or obesity. Among high‐income families, positive mental health of either the mother or the father was associated with lower odds of overweight or obesity. In multivariable models, the association between positive maternal mental health and lower odds of child overweight/obesity persisted after adjustment for family food security, child physical activity, and child screen time. For paternal mental health, the association was not significant after adjusting for these covariates.ConclusionsAfter stratification by income, there were no differences in childhood overweight/obesity by rurality. Both maternal and paternal mental health are associated with children's weight, though only the maternal association remains after adjusting for covariates.
Debunking the myth that the majority of medical errors are attributed to communication
Authors: Clapper Timothy C , Ching Kevin 
Published: September 2019

AbstractContextMany articles, book chapters and presentations begin with a declaration that the majority of medical errors are attributed to communication. However, this statement may not be supported by the research reported in the literature.ObjectivesThe purpose of this systematic review is to identify where errors are reported in the research literature.MethodsA systematised review was conducted of research articles over the last 20 years (1998‐2018) indexed in PubMed/MEDLINE and the Cumulative Index to Nursing and Allied Health (CINAHL) using term combinations: medical errors, research and communication. Inclusion was based on reported generalised primary research of medical error and the reported causes.ResultsThis systematised review resulted in 2881 research articles, which produced 42 that met the inclusion criteria. Although there was some overlap, three categories of errors were dominant in this research: errors of commission (20 articles; 47.6%), errors of omission (six articles; 14.2%) and errors through communication (four articles; 9.5%). There were 12 (28.5%) articles in which all three categories together significantly contributed to error. Of these 12 articles, errors of commission or omission were dominant in nine articles (21.4%) and errors of communication were prevalent in only three articles (7%).ConclusionsThe assertion that the majority of medical errors can be attributed to miscommunication is not supported by this systematic review. Overwhelmingly, most reported errors are attributed to errors of omission or commission. Intentionally or unintentionally providing misinformation may mislead patient safety initiatives, and research and funding agency priorities.
Medical student views of and responses to expectations of professionalism
Authors: Stubbing Evangeline A , Helmich Esther , Cleland Jennifer 
Published: September 2019

ContextTo earn society's trust, medical students must develop professional values and behaviours via a transformative process, from lay person to doctor. Yet students are expected to epitomise the values and behaviours of a doctor from the outset of medical school, leading them to feel ‘judged all the time’ (in terms of their professionalism). Our aim, therefore, is to extend knowledge exploring the expectations communicated to and perceived by medical students and to provide a conceptually framed understanding of students’ associated emotional tensions.MethodsWe used a qualitative exploratory case study methodology within a constructivist paradigm to explore the messages communicated about professionalism and students’ perceived expectations of professionalism in one medical school. Data were collected in the form of: (i) regulatory and medical school documents, and (ii) focus groups with 23 participants in their first 2 years at medical school. We used thematic analysis for data interpretation and two theoretical lenses, Amalberti et al.'s framework of system migration for health care and Sinclair's adaptation of Goffman's dramaturgical theory, to critically analyse the results.ResultsWe found messages and perceived expectations of knowledge and competence, and the need to ensure trust. We also identified that the expectations of patients, doctors, society, family and friends are just as, if not more, influential than policy and regulatory expectations for early years’ medical students. Moreover, we found tensions, with students feeling that the expectations of them from others were unrealistic for their level of training. With this came a sense of pressure to meet expectations that participants responded to by acting as if already competent.ConclusionsOur findings suggest that external forces (expectations) drive early years’ students to act as if competent. Although this is part of student identity formation it could also have implications for patient safety and therefore necessitates recognition and support from educators.
Emotional challenges of medical students generate feelings of uncertainty
Authors: Weurlander Maria , Lönn Annalena , Seeberger Astrid , Hult Håkan , Thornberg Robert , Wernerson Annika 
Published: September 2019

ObjectivesHealth care students face many situations during their education that might be emotionally challenging. Students are confronted with illness, suffering, death, patient treatment dilemmas, and witnessing unprofessional behaviour on the part of health care professionals. Few studies have focused on what these experiences lead to in relation to the process of becoming a professional. The purpose of the study was to explore medical students’ main concerns relating to emotionally challenging situations during their medical education.MethodsA constructivist grounded theory approach was used to explore and analyse medical students’ experiences. Data were gathered by means of focus group interviews, including two interviews in the middle and two interviews at the end of the students’ undergraduate programme. A total of 14 medical students participated.ResultsStudents’ main concerns relating to emotionally challenging situations were feelings of uncertainty. These feelings of uncertainty concerned: (i) insufficient knowledge and skills; (ii) the struggle to manage emotions in patient encounters; (iii) perceived negative culture and values amongst health care professionals and in the health care system, and (iv) lacking a self‐evident position on the health care team. The first two aspects relate to uncertainties concerning their own capabilities and the other two aspects relate to uncertainties regarding the detached medical culture and the unclear expectations of them as students in the health care team.ConclusionsIn the process of becoming a physician, students develop their professional identity in constant negotiation with their own perceptions, values and norms and what they experience in the local clinical context in which they participate during workplace education. The two dimensions that students have to resolve during this process concern the questions: Do I have what it takes? Do I want to belong to this medical culture? Until these struggles are resolved, students are likely to experience worry about their future professional role.
PR Prolongation predicts inadequate resynchronization with biventricular pacing in left bundle branch block
Authors: Atwater Brett D. , Emerek Kasper , Sørensen Peter L. , Hansen Steen M. , Loring Zak , Graff Claus , Polcwiartek Christoffer , Kisslo Joseph , Søgaard Peter , Friedman Daniel J. 
Published: September 2019

AbstractBackgroundPR interval prolongation is associated with poor outcome after cardiac resynchronization therapy (CRT) among patients with left bundle branch block (LBBB) but the mechanisms are unknown. We investigated clinical outcomes, electrocardiogram (ECG), and echocardiogram changes after CRT by PR interval.MethodsThis is a retrospective study of CRT recipients with a baseline ejection fraction ≤35% and ECG showing sinus rhythm and LBBB. Patients were stratified by baseline PR interval quartile and the primary combined endpoint was time to heart transplantation, left ventricular assist device (LVAD) implantation, or death. ECG, echocardiogram, and clinical variables were compared to identify mechanisms for observed differences in outcomes.ResultsOf 291 eligible patients, the mean age was 65 years, 60% were male, and 19% had prior atrial fibrillation. Patients with PR prolongation (quartile 4, PR > 200 ms) more frequently had a history of atrial fibrillation, coronary artery bypass graft surgery, prior implantable cardioverter defibrillator implantation, and use of amiodarone than patients in PR quartiles 1‐3. A PR > 200ms was associated with an adjusted hazard ratio of 1.7 (95% CI: 1.1‐2.5) for the primary endpoint. Patients with PR > 200 ms had less reduction in QRS duration and QRS area after CRT while having more increase in QT and QTc intervals than patients with PR ≤ 200 ms. No major differences were observed in echocardiography by baseline PR interval quartiles.ConclusionsPR prolongation predicts shorter survival free of heart transplantation or LVAD implantation in patients with LBBB. This may be due to inadequate ventricular resynchronization.