Socioeconomic Inequalities in Type 2 Diabetes: Mediation Through Status Anxiety?

Objectives: While status anxiety has received attention as a potential mechanism generating health inequalities, empirical evidence is still limited. Studies have been ecological and have largely focused on mental and not physical health outcomes. Methods: We conducted individual-level analyses to assess status anxiety (feelings of inferiority resulting from social comparisons) and resources (financial difficulties) as mediators of the relationship between socioeconomic status (SES) (education/occupation/employment status) and type 2 diabetes (T2D). We used cross-sectional data of 21,150 participants (aged 18-70 years) from the Amsterdam-based HELIUS study. We estimated associations using logistic regression models and estimated mediated proportions using natural effect modelling. Results: Odds of status anxiety were higher among participants with a low SES [e.g., OR = 2.66 (95% CI: 2.06-3.45) for elementary versus academic occupation]. Odds of T2D were 1.49 (95% CI: 1.12-1.97) times higher among participants experiencing status anxiety. Proportion of the SES-T2D relationship mediated was 3.2% (95% CI: 1.5%-7.0%) through status anxiety and 10.9% (95% CI: 6.6%-18.0%) through financial difficulties. Conclusion: Status anxiety and financial difficulties played small but consistent mediating roles. These individual-level analyses underline status anxiety's importance and imply that status anxiety requires attention in efforts to reduce health inequalities.

[Deployment of the nurse practitioner and physician assistant in The Netherlands]. / De inzet van de verpleegkundig specialist en physician assistant.

The Physician Assistant and the Nurse Practitioner have been successfully implemented in the Dutch health care system. The professionals provide good quality care, contribute to reducing the workload of physicians, and in most cases are cost-effective. The changing labor market, the increased demand for care and the way health care is organized will further increase demand. Within the labor market, we see several developments affecting the demand for PAs and USs; the need for physicians to have more work-life balance and the shortage of residents not in training ('anioses'). The increased and changing demand for care also requires additional staff, in this case PAs and VSs. In addition, it appears to be quite possible to have care performed by a PA or VS supported by the use of technology and guidelines.

Advanced Practice Providers as Leaders of a Rapid Response Team: A Prospective Cohort Study.

In view of the shortage of medical staff, the quality and continuity of care may be improved by employing advanced practice providers (APPs). This study aims to assess the quality of these APPs in critical care. In a large teaching hospital, rapid response team (RRT) interventions led by APPs were assessed by independent observers and intensivists and compared to those led by medical residents MRs. In addition to mortality, the MAELOR tool (assessment of RRT intervention), time from RRT call until arrival at the scene and time until completion of clinical investigations were assessed. Process outcomes were assessed with the crisis management skills checklist, the Ottawa global rating scale and the Mayo high-performance teamwork scale. The intensivists assessed performance with the handoff CEX recipient scale. Mortality, MAELOR tool, time until arrival and clinical investigation in both groups were the same. Process outcomes and performance observer scores were also equal. The CEX recipient scores, however, showed differences between MRs and APPs that increased with experience. Experienced APPs had significantly better situational awareness, better organization, better evaluations and better judgment than MRs with equal experience (p < 0.05). This study shows that APPs perform well in leading an RRT and may provide added quality over a resident. RRTs should seriously consider the deployment of APPs instead of junior clinicians.

Advanced practice providers versus medical residents as leaders of rapid response teams: A 12-month retrospective analysis.

PURPOSE: In a time of worldwide physician shortages, the advanced practice providers (APPs) might be a good alternative for physicians as the leaders of a rapid response team. This retrospective analysis aimed to establish whether the performance of APP-led rapid response teams is comparable to the performance of rapid response teams led by a medical resident of the ICU. MATERIAL AND METHODS: In a retrospective single-center cohort study, the electronic medical record of a tertiary hospital was queried during a 12-months period to identify patients who had been visited by our rapid response team. Patient- and process-related outcomes of interventions of rapid response teams led by an APP were compared with those of teams led by a medical resident using various parameters, including the MAELOR tool, which measures the performance of a rapid response team. RESULTS: In total, 179 responses of the APP-led teams were analyzed, versus 275 responses of the teams led by a resident. Per APP, twice as many calls were handled than per resident. Interventions of teams led by APPs, and residents did not differ in number of admissions (p = 0.87), mortality (p = 0.8), early warning scores (p = 0.2) or MAELOR tool triggering (p = 0.19). Both groups scored equally on time to admission (p = 0.67) or time until any performed intervention. CONCLUSION: This retrospective analysis showed that the quality of APP-led rapid response teams was similar to the quality of teams led by a resident. These findings need to be confirmed by prospective studies with balanced outcome parameters.

Long-term labor market returns to upper secondary school track choice: Leveraging idiosyncratic variation in peers' choices.

Vocational education and training (VET) is theorized to play a dual role for inequality of labor market outcomes: the role of a safety net and the role of socioeconomic diversion. In this paper, we test these hypotheses by examining the long-term labor market returns to track choice in upper secondary education in Denmark using an instrumental variable approach that relies on random variation in school peers' educational decisions. We report two main findings. First, VET diverts students on the margin to the academic track away from higher-status but not higher-paying occupations. Second, VET protects students on the margin to leaving school from risks of non-employment and unskilled work, also leading to higher earnings. These results suggest that in countries with a highly compressed wage structure, a strong VET system benefits students unlikely to continue to college, while causing few adverse consequences for students on the margin to choosing academic education.

How teachers form educational expectations for students: A comparative factorial survey experiment in three institutional contexts.

While schools are thought to use meritocratic criteria when evaluating students, research indicates that teachers hold lower expectations for students from disadvantaged backgrounds. However, it is unclear what the unique impact is of specific student traits on teacher expectations, as different traits are often correlated to one another in real life. Moreover, research has neglected the role of the institutional context, yet tracking procedures, financial barriers to education, and institutionalized cultural beliefs may influence how teachers form expectations. We conducted a factorial survey experiment in three contexts that vary with respect to these institutional characteristics (The United States, New York City; Norway, Oslo; the Netherlands, Amsterdam). We asked elementary school teachers to express expectations for hypothetical students whose characteristics were experimentally manipulated. Teachers in the different contexts used the same student traits when forming expectations, yet varied in the importance they attached to these traits. In Amsterdam - where teachers track students on the basis of their performance and tracking bears significant consequences for educational careers - we found a large impact of student performance. In Oslo - where institutions show an explicit commitment to equality of educational opportunity - teachers based their expectations less on student effort, and seemed to make more inferences about student performance by a student's socio-economic background. New York teachers seemed to make few inferences about student performance based on their socio-economic background.

Multi-Camera Vessel-Speed Enforcement by Enhancing Detection and Re-Identification Techniques.

This paper presents a camera-based vessel-speed enforcement system based on two cameras. The proposed system detects and tracks vessels per camera view and employs a re-identification (re-ID) function for linking vessels between the two cameras based on multiple bounding-box images per vessel. Newly detected vessels in one camera (query) are compared to the gallery set of all vessels detected by the other camera. To train and evaluate the proposed detection and re-ID system, a new Vessel-reID dataset is introduced. This extensive dataset has captured a total of 2474 different vessels covered in multiple images, resulting in a total of 136,888 vessel bounding-box images. Multiple CNN detector architectures are evaluated in-depth. The SSD512 detector performs best with respect to its speed (85.0% Recall@95Precision at 20.1 frames per second). For the re-ID of vessels, a large portion of the total trajectory can be covered by the successful detections of the SSD model. The re-ID experiments start with a baseline single-image evaluation obtaining a score of 55.9% Rank-1 (49.7% mAP) for the existing TriNet network, while the available MGN model obtains 68.9% Rank-1 (62.6% mAP). The performance significantly increases with 5.6% Rank-1 (5.7% mAP) for MGN by applying matching with multiple images from a single vessel. When emphasizing more fine details by selecting only the largest bounding-box images, another 2.0% Rank-1 (1.4% mAP) is added. Application-specific optimizations such as travel-time selection and applying a cross-camera matching constraint further enhance the results, leading to a final 88.9% Rank-1 and 83.5% mAP performance.

Procedures Performed by Advanced Practice Providers Compared With Medical Residents in the ICU: A Prospective Observational Study.

To assess the frequency and safety of procedures performed by advanced practice providers and medical residents in a mixed-bed ICU. DESIGN: A prospective observational study where consecutive invasive procedures were studied over a period of 1 year and 8 months. The interventions were registered anonymously in an online database. Endpoints were success rate at first attempt, number of attempts, complications, level of supervision, and teamwork. SETTING: A 33-bedded mixed ICU. SUBJECTS: Advanced practice providers and medical residents. INTERVENTIONS: Registration of the performance of tracheal intubation, central venous and arterial access, tube thoracostomies, interhospital transportation, and electrical cardioversion. MEASUREMENT AND MAIN RESULTS: A full-time advanced practice provider performed an average of 168 procedures and a medical resident an average of 68. The advanced practice provider inserted significant more radial, brachial, and femoral artery catheters (66% vs 74%, p = 0.17; 15% vs 12%, p = 0.14; 18% vs 14%, p = 0.14, respectively). The median number of attempts needed to successfully insert an arterial catheter was lower, and the success rate at first attempt was higher in the group treated by advanced practice providers (1.30 [interquartile range, 1-1.82] vs 1.53 [interquartile range, 1-2.27], p < 0.0001; and 71% vs 54%, p < 0.0001). The advanced practice providers inserted more central venous catheters (247 vs 177) with a lower median number of attempts (1.20 [interquartile range, 1-1.71] vs 1.33 [interquartile range, 1-1.86]) and a higher success rate at first attempt (81% vs 70%; p < 0.005). The number of intubations by advanced practice providers was 143 and by medical residents was 115 with more supervision by the advanced practice provider (10% vs 0%; p = 0.01). Team performance, as reported by nursing staff, was higher during advanced practice provider procedures compared with medical resident procedures (median, 4.85 [interquartile range, 4.85-5] vs 4.73 [interquartile range, 4.22-5]). Other procedures were also more often performed by advanced practice providers. The complication rate in the advanced practice provider-treated patient group was lower than that in the medical resident group. CONCLUSIONS: Advanced practice providers in critical care performed procedures safe and effectively when compared with medical residents. Advanced practice providers appear to be a valuable addition to the professional staff in critical care when it comes to invasive procedures.

Are universities left-wing bastions? The political orientation of professors, professionals, and managers in Europe.

Universities are accused of being left-wing bastions, unwelcoming to conservative and right-wing professors. However, we know little about the political orientation of professors in comparison to other professionals, which would be the right comparison group if we want to know whether universities are potentially hostile environments to conservatives. Examining culturally and economically oriented political orientations in Europe, it is demonstrated that professors are more liberal and left-leaning than other professionals. However, there is no greater homogeneity of political orientations among the professoriate relative to other specific professions, suggesting that there is a diversity of opinions which is similar to what professionals would find in other occupations. One exception concerns attitudes towards immigration, on which professors have more liberal orientations and comparatively low residual variance around that more liberal mean. Importantly, the difference between professors and other professionals is not so clear within graduates from the social sciences, but emerges more clearly among graduates with a medical, STEM, economics or law degree. An important political cleavage exists between professionals and managers, a group of similar social standing.

Selectivity of Migration and the Educational Disadvantages of Second-Generation Immigrants in Ten Host Societies.

Selectivity of migration varies significantly between ethnic/origin country groups, and between the destination countries which these groups have migrated to. Yet, little comparative research has measured empirically how selective different migrant groups are in multiple destination countries, nor has research studied whether the selectivity of migration is related to the magnitude of ethnic inequalities among the children of migrants in Western societies. We present an empirical measure of educational selectivity of migrants from many different origin countries having migrated to ten different destination countries. We examine whether selective migration of a particular ethnic group in a particular destination country is related to the gap between their children's and native children's educational outcomes. We find that the disadvantage in educational outcomes between the second generation and their peers from majority populations is smaller for ethnic groups that are more positively selected in terms of educational attainment. We also find some evidence that the effect of selective migration is moderated by the integration policies or tracking arrangements in the educational system in the destination country.

Utility of the cold pressor test to predict future cardiovascular events.

INTRODUCTION: The cold pressor test (CPT) is a common and extensively validated test, which induces systemic stress involving immersion of an individual's hand in ice water (normally temperature between 0 and 5 degrees Celsius) for a period of time. CPT has been used in various fields, like examining effects of stress on memory, decision-making, pain and cardiovascular health. Areas covered: In terms of cardiovascular health, current research is mainly interested in predicting the occurrence of cardiovascular (CV) events. The objective of this review is to give an overview of the history and methodology of the CPT, and clinical utility in possibly predicting CV events in CAD and other atherosclerotic diseases. Secondly, we will discuss possible future applications of the CPT in clinical care. Expert opinion: An important issue to address is the fact that the physiology of the CPT is not fully understood at this moment. As pointed out multiple mechanisms might be responsible for contributing to either coronary vasodilatation or coronary vasoconstriction. Regarding the physiological mechanism of the CPT and its effect on the measurements of the carotid artery reactivity even less is known.

Impact of the Advanced Practice Provider in Adult Critical Care: A Systematic Review and Meta-Analysis.

OBJECTIVES: To evaluate the effects on quality and efficiency of implementation of the advanced practice provider in critical care. DATA SOURCES: PubMed, Embase, The Cochrane Library, and CINAHL were used to extract articles regarding advanced practice providers in critical care. STUDY SELECTION: Articles were selected when reporting a comparison between advanced practice providers and physician resident/fellows regarding the outcome measures of mortality, length of stay, or specific tasks. Descriptive studies without comparison were excluded. The methodological quality of the included studies was rated using the Newcastle-Ottawa scale. The agreement between the reviewers was assessed with Cohen's kappa. A meta-analysis was constructed on mortality and length of stay. DATA EXTRACTION AND SYNTHESIS: One-hundred fifty-six studies were assessed by full text. Thirty comparative cohort studies were selected and analyzed. These compared advanced practice providers with physician resident/fellows. All studies comprised adult intensive care. Most of the included studies showed a moderate to good quality. Over time, the study designs advanced from retrospective designs to include prospective and comparative designs. DATA SYNTHESIS: Four random effects meta-analyses on length of stay and mortality were constructed from the available studies. These meta-analyses showed no significant difference between performance of advanced practice providers on the ICU and physician residents/fellows on the ICU, suggesting the quality of care of both groups was equal. Mean difference for length of stay on the ICU was 0.34 (95% CI, -0.31 to 1.00; I = 99%) and for in hospital length of stay 0.02 (95% CI, -0.85 to 0.89; I = 91%); whereas the odds ratio for ICU mortality was 0.98 (95% CI, 0.81-1.19; I = 37.3%) and for hospital mortality 0.92 (95% CI, 0.79-1.07; I = 28%). CONCLUSIONS: This review and meta-analysis shows no differences between acute care given by advanced practice providers compared with physician resident/fellows measured as length of stay or mortality. However, advanced practice providers might add value to care in several other ways, but this needs further study.

Ozonesonde Quality Assurance: The JOSIE-SHADOZ (2017) Experience.

The ozonesonde is a small balloon-borne instrument that is attached to a standard radiosonde to measure profiles of ozone from the surface to 35 km with ~100-m vertical resolution. Ozonesonde data constitute a mainstay of satellite calibration and are used for climatologies and analysis of trends, especially in the lower stratosphere where satellites are most uncertain. The electrochemical-concentration cell (ECC) ozonesonde has been deployed at ~100 stations worldwide since the 1960s, with changes over time in manufacture and procedures, including details of the cell chemical solution and data processing. As a consequence, there are biases among different stations and discontinuities in profile time-series from individual site records. For 22 years the Jülich [Germany] Ozone Sonde Intercomparison Experiment (JOSIE) has periodically tested ozonesondes in a simulation chamber designated the World Calibration Centre for Ozonesondes (WCCOS) by WMO. In October-November 2017 a JOSIE campaign evaluated the sondes and procedures used in SHADOZ (Southern Hemisphere Additional Ozonesondes), a 14-station sonde network operating in the tropics and subtropics. A distinctive feature of the 2017 JOSIE was that the tests were conducted by operators from eight SHADOZ stations. Experimental protocols for the SHADOZ sonde configurations, which represent most of those in use today, are described, along with preliminary results. SHADOZ stations that follow WMO-recommended protocols record total ozone within 3% of the JOSIE reference instrument. These results and prior JOSIEs demonstrate that regular testing is essential to maintain best practices in ozonesonde operations and to ensure high-quality data for the satellite and ozone assessment communities.

Comparing peri-operative complications of paediatric and adult anaesthesia: A retrospective cohort study of 81 267 cases.

BACKGROUND: Comparisons of peri-operative complications associated with paediatric (≤16 years) and adult anaesthesia are poorly available, especially in which cardiac surgery, organ transplantation and neurosurgery are involved. OBJECTIVE: The aim of this study was to evaluate the nature and incidence of peri-operative complications that might be due to anaesthesia and to identify independent risk factors for complications in children and adults, including those undergoing cardiac surgery, organ transplantation and neurosurgery. DESIGN: Retrospective cohort study. SETTING: The study was performed at the University Medical Centre Groningen in the 4 years between 1 January 2010 and the 31 December 2013. MAIN OUTCOME MEASURES: Complications and their severity were graded according to the standard complication score (20 items) of the Dutch Society of Anaesthesia. Univariate and multivariate regression analysis was used to identify independent risk factors for the reported complications. RESULTS: A total of 81 267 anaesthetic cases were included. In the paediatric cohort, there were 410 (2.9%) complications and 1675 (2.5%) in the adults. In both cohorts age, American Society of Anaesthesiologists classification and emergency treatment were independent risk factors for complications. With respect to age, infants less than 1 year were at the highest risk, whereas in the adult cohort, increased age was related to a greater number of complications. The incidences of the specific complications were different between both cohorts. Upper airway obstruction was more frequently observed in paediatric patients (26%), whereas in the adults, complications with the highest incidence concerned conversion of regional-to-general anaesthesia (25%) and hypotension (17%). CONCLUSION: Risk factors for all peri-operative complications were similar for paediatric and adult anaesthesia. However, the incidence of specific complications differed between both age categories.

Extracellular acidification induces ROS- and mPTP-mediated death in HEK293 cells.

The extracellular pH (pHe) is a key determinant of the cellular (micro)environment and needs to be maintained within strict boundaries to allow normal cell function. Here we used HEK293 cells to study the effects of pHe acidification (24h), induced by mitochondrial inhibitors (rotenone, antimycin A) and/or extracellular HCl addition. Lowering pHe from 7.2 to 5.8 reduced cell viability by 70% and was paralleled by a decrease in cytosolic pH (pHc), hyperpolarization of the mitochondrial membrane potential (Δψ), increased levels of hydroethidine-oxidizing ROS and stimulation of protein carbonylation. Co-treatment with the antioxidant α-tocopherol, the mitochondrial permeability transition pore (mPTP) desensitizer cyclosporin A and Necrostatin-1, a combined inhibitor of Receptor-interacting serine/threonine-protein kinase 1 (RIPK1) and Indoleamine 2,3-dioxygenase (IDO), prevented acidification-induced cell death. In contrast, the caspase inhibitor zVAD.fmk and the ferroptosis inhibitor Ferrostatin-1 were ineffective. We conclude that extracellular acidification induces necroptotic cell death in HEK293 cells and that the latter involves intracellular acidification, mitochondrial functional impairment, increased ROS levels, mPTP opening and protein carbonylation. These findings suggest that acidosis of the extracellular environment (as observed in mitochondrial disorders, ischemia, acute inflammation and cancer) can induce cell death via a ROS- and mPTP opening-mediated pathogenic mechanism.

First Reprocessing of Southern Hemisphere ADditional OZonesondes (SHADOZ) Profile Records: 3. Uncertainty in Ozone Profile and Total Column.

Reprocessed ozonesonde data from eight SHADOZ (Southern Hemisphere ADditional OZonesondes) sites have been used to derive the first analysis of uncertainty estimates for both profile and total column ozone (TCO). The ozone uncertainty is a composite of the uncertainties of the individual terms in the ozone partial pressure (PO3) equation, those being the ozone sensor current, background current, internal pump temperature, pump efficiency factors, conversion efficiency, and flow-rate. Overall, PO3 uncertainties (ΔPO3) are within 15% and peak around the tropopause (15±3km) where ozone is a minimum and ΔPO3 approaches the measured signal. The uncertainty in the background and sensor currents dominate the overall ΔPO3 in the troposphere including the tropopause region, while the uncertainties in the conversion efficiency and flow-rate dominate in the stratosphere. Seasonally, ΔPO3 is generally a maximum in the March-May, with the exception of SHADOZ sites in Asia, for which the highest ΔPO3 occurs in September-February. As a first approach, we calculate sonde TCO uncertainty (ΔTCO) by integrating the profile ΔPO3 and adding the ozone residual uncertainty, derived from the McPeters and Labow [2012] 1-σ ozone mixing ratios. Overall, ΔTCO are within ±15 DU, representing ~5-6% of the TCO. TOMS and OMI satellite overpasses are generally within the sonde ΔTCO. However, there is a discontinuity between TOMS v8.6 (1998-2004/09) and OMI (2004/10-2016) TCO on the order of 10DU that accounts for the significant 16DU overall difference observed between sonde and TOMS. By comparison, the sonde-OMI absolute difference for the eight stations is only ~4DU.

Radical distinction: Support for radical left and radical right parties in Europe.

Support for radical parties on both the left and right is on the rise, fueling intuition that both radicalisms have similar underpinnings. Indeed, existing studies show that radical left and right voters have overlapping positions and preferences. In this article, however, we focus on the differences in the voting bases of such parties. We show that radical left and right voters have sharply diverging ideological profiles. When it comes to the historical traditions of the 'left' and 'right', these voters differ radically from each other. Both groups express the traditions associated with their mainstream counterparts-particularly with respect to (non-)egalitarian, (non-)altruistic, and (anti-)cosmopolitan values. Such differences also explain why radical left voters tend to be more, not less, educated than mainstream or radical right voters.