Must one take the bitter with the sweet? Sensory processing sensitivity and factors associated with resilience among artistically inclined individuals.

Sensory processing sensitivity (SPS), linked with a penchant for the arts and creativity, exerts its bivalent influences, contingent on context, on individuals' health-related outcomes. But little is known about how it interacts with creative self-concept (CSC). Focusing on the role of SPS, this study identified risk and protective factors of resilience among artistically inclined individuals from middle to later life during the coronavirus 2019 (COVID-19) restriction period and examined the interaction effect between SPS and CSC on depression. Two stages of analyses were pursued. Stage 1 identified factors associated with resilience by using regression and profile analyses on data from 224 anonymized respondents from middle to third age (Mage = 54.08, SD = 10.08, range = 40-84) with diverse disciplinary backgrounds in visual arts. Stage 2 examined the influence of SPS on the relationship between CSC and depression. SPS, lack of peer support of shared interests in the arts, and depression emerged as risk factors associated with lower levels of resilience. The profiles of SPS components among the relatively high and low resilience groups were found to be divergent. The effects of CSC on depression were contingent upon SPS, controlling for neuroticism. The findings call for future research to examine the differential correlational patterns among the SPS components and neuroticism across different populations. The risk/protective factors and patterns found in this study provide directions for research in SPS and applied work to support artistically inclined individuals from middle to later life.

Optimal surgeon and hospital volume thresholds to reduce mortality and length of stay for CABG.

OBJECTIVE: We used nationwide population-based data to identify optimal hospital and surgeon volume thresholds and to discover the effects of these volume thresholds on operative mortality and length of stay (LOS) for coronary artery bypass surgery (CABG). DESIGN: Retrospective cohort study. SETTING: General acute care hospitals throughout Taiwan. PARTICIPANTS: A total of 12,892 CABG patients admitted between 2011 and 2015 were extracted from Taiwan National Health Insurance claims data. MAIN OUTCOME MEASURES: Operative mortality and LOS. Restricted cubic splines were applied to discover the optimal hospital and surgeon volume thresholds needed to reduce operative mortality. Generalized estimating equation regression modeling, Cox proportional-hazards modeling and instrumental variables analysis were employed to examine the effects of hospital and surgeon volume thresholds on the operative mortality and LOS. RESULTS: The volume thresholds for hospitals and surgeons were 55 cases and 5 cases per year, respectively. Patients who underwent CABG from hospitals that did not reach the volume threshold had higher operative mortality than those who received CABG from hospitals that did reach the volume threshold. Patients who underwent CABG with surgeons who did not reach the volume threshold had higher operative mortality and LOS than those who underwent CABG with surgeons who did reach the volume threshold. CONCLUSIONS: This is the first study to identify the optimal hospital and surgeon volume thresholds for reducing operative mortality and LOS. This supports policies regionalizing CABG at high-volume hospitals. Identifying volume thresholds could help patients, providers, and policymakers provide optimal care.

Association of antidiabetic therapies with lower extremity amputation, mortality and healthcare cost from a nationwide retrospective cohort study in Taiwan.

We compared risks of clinical outcomes, mortality and healthcare costs among new users of different classes of anti-diabetic medications. This is a population-based, retrospective, new-user design cohort study using the Taiwan National Health Insurance Database between May 2, 2015 and September 30, 2017. An individual was assigned to a medication group based on the first anti-diabetic prescription on or after May 1, 2016: SGLT-2 inhibitors, DPP-4 inhibitors, GLP-1 agonists or older agents (metformin, etc.). Clinical outcomes included lower extremity amputation, peripheral vascular disease, critical limb ischemia, osteomyelitis, and ulcer. We built three Cox proportional hazards models for clinical outcomes and mortality, and three regression models with a log-link function and gamma distribution for healthcare costs, all with propensity-score weighting and covariates. We identified 1,222,436 eligible individuals. After adjustment, new users of SGLT-2 inhibitors were associated with 73% lower mortality compared to those of DPP-4 inhibitors or users of older agents, while 36% lower total costs against those of GLP-1 agonists. However, there was no statistically significant difference in the risk of lower extremity amputation across medication groups. Our study suggested that SGLT-2 inhibitors is associated with lower mortality compared to DPP 4 inhibitors and lower costs compared to GLP-1 agonists.

Association of intrinsic and extrinsic motivating factors with physician burnout and job satisfaction: a nationwide cross-sectional survey in Taiwan.

OBJECTIVE: The aim of this study was to systematically and simultaneously examine the association of intrinsic and extrinsic motivating factors with physician burnout and job dissatisfaction. DESIGN: A nationally representative survey was fielded from September to November 2017. SETTING: Hospitals and clinics throughout Taiwan. PARTICIPANTS: A total of 6674 physicians. MAIN EXPOSURE MEASURE: The main exposure measures were intrinsic motivators (sense of calling, personally rewarding hours per day and meaningful, long-term relationships with patients) and extrinsic motivators (income, work hours, autonomy, and pay-for-performance (P4P) and bundled payment initiatives). MAIN OUTCOME MEASURES: The main outcome measures were physician burnout and job dissatisfaction. RESULTS: A total of 1152 physicians returned the surveys. More sense of calling and personally rewarding hours per day were associated with less physician burnout (OR 0.16, 95% CI 0.10 to 0.26 and OR 0.25, 95% CI 0.13 to 0.47, respectively) and job dissatisfaction (OR 0.35, 95% CI 0.21 to 0.57 and OR 0.46, 95% CI 0.26 to 0.83, respectively). Longer work hours were associated with more physician burnout (OR 2.67, 95% CI 1.54 to 4.63) and job dissatisfaction (OR 1.71, 95% CI 1.05 to 2.79). Not receiving P4P bonuses from their organisations was associated with more physician burnout (OR 1.56, 95% CI 1.02 to 2.38). Not sharing the losses from caring for patients included in the bundled payment system was associated with less physician burnout (OR 0.59, 95% CI 0.36 to 0.97). CONCLUSIONS: Fostering a healthcare work environment that supports intrinsic motivation and improves work hours may reduce physician burnout and job dissatisfaction. Rewarding physicians fairly and equitably may prevent them from feeling burned out. Value-based care delivery and payment model innovations, such as bundled payments, may encourage healthcare professionals to coordinate care through the standardisation of care to decrease burnout.

Inquiline predator increases nutrient-cycling efficiency of Nepenthes rafflesiana pitchers.

The modified-leaf pitchers of Nepenthes rafflesiana pitcher plants are aquatic, allochthonous ecosystems that are inhabited by specialist inquilines and sustained by the input of invertebrate prey. Detritivorous inquilines are known to increase the nutrient-cycling efficiency (NCE) of pitchers but it is unclear whether predatory inquilines that prey on these detritivores decrease the NCE of pitchers by reducing detritivore populations or increase the NCE of pitchers by processing nutrients that may otherwise be locked up in detritivore biomass. Nepenthosyrphus is a small and poorly studied genus of hoverflies and the larvae of one such species is a facultatively detritivorous predator that inhabits the pitchers of N. rafflesiana. We fitted a consumer-resource model to experimental data collected from this system. Simulations showed that systems containing the predator at equilibrium almost always had higher NCEs than those containing only prey (detritivore) species. We showed using a combination of simulated predator/prey exclusions that the processing of the resource through multiple pathways and trophic levels in this system is more efficient than that accomplished through fewer pathways and trophic levels. Our results thus support the vertical diversity hypothesis, which predicts that greater diversity across trophic levels results in greater ecosystem functioning.

Should we pay attention to surgeon or hospital volume in total knee arthroplasty? Evidence from a nationwide population-based study.

BACKGROUND: Although prior research into the relationship between volume and outcome indicates that this relationship is not linear and that an optimal volume should be specified, consensus is lacking regarding the ideal value of this optimal volume. The purposes of this study were to use a visual method to identify surgeon- and hospital-volume thresholds and to examine the relationships of surgeon and hospital volume thresholds to 30-day readmission. METHODS: A retrospective nationwide population-based study design was adopted. Patients who received total knee replacement surgery between 2007 and 2008 in any hospital in Taiwan were included. After adjusting for patient, physician, and hospital characteristics, a restricted cubic spline regression model was used to identify optimal surgeon- and hospital-volume thresholds. Further, a patient-level mixed effect model was conducted to test the respective relationships between these thresholds and 30-day readmission. RESULTS: A total of 30,828 patients who had received their surgeries from 1,468 surgeons in 437 hospitals were included in this study. Thresholds of 50 cases a year for surgeons and 75 cases a year for hospitals were identified using a restricted cubic spline regression model. However, only the surgeon volume threshold was associated with 30-day readmission using a patient-level mixed effect model after adjusting for patient-, surgeon- and hospital-level covariates. CONCLUSIONS: According to the results of the restricted cubic spline models, the optimal volume thresholds for surgeons and hospitals are 50 cases and 75 cases a year, respectively. However, only the surgeon volume threshold is associated with 30-day readmission.

Optimal Hospital and Surgeon Volume Thresholds to Improve 30-Day Readmission Rates, Costs, and Length of Stay for Total Hip Replacement.

BACKGROUND: Little is known about whether there are optimal hospital and surgeon volume thresholds to reduce readmission, costs, and length of stay (LOS) for total hip replacement (THR). Nationwide population-based data were applied to identify the optimal hospital and surgeon volume thresholds and to discover the effects of these volume thresholds on 30-day unplanned readmission, costs and LOS for THR. METHODS: A total of 6367 patients identified through Taiwan's National Health Insurance Research Database received THR in 2012. Restricted cubic splines were used to identify the optimal hospital and surgeon volume needed to decrease the risk of 30-day unplanned readmission. Multilevel regression modeling and propensity score weighting were used to examine the impact of hospital and surgeon volume thresholds on 30-day unplanned readmission, costs, and LOS, after adjusting for patient, surgeon, and hospital characteristics. RESULTS: The volume thresholds for hospitals and surgeons were 65 cases and 15 cases a year, respectively. The overall mean LOS was 7.3 ± 4.3 days. Patients who received THR from surgeons who did not reach the volume threshold had higher 30-day unplanned readmission rates, costs, and LOS than those who received THR from surgeons who reached the volume threshold. CONCLUSION: This is the first study to identify the surgeon volume threshold that can reduce 30-day unplanned readmission rates, costs, and LOS for THR. However, the results from Taiwan may not be applicable to other parts of the world. Identifying the threshold could help patients, providers, and policymakers to make decisions regarding optimal delivery of THR.

Do Hospital and Physician Volume Thresholds for the Volume-Outcome Relationship in Heart Failure Exist?

BACKGROUND: Although volume-outcome relationships have been explored for various procedures and interventions, limited information is available concerning the effect of hospital and physician volume on heart failure mortality. Most importantly, little is known about whether there are optimal hospital and physician volume thresholds to reduce heart failure mortality. OBJECTIVES: We used nationwide population-based data to identify the optimal hospital and physician volume thresholds to achieve optimum mortality and to examine the relative and combined effects of the volume thresholds on heart failure mortality. METHODS: We analyzed all 20,178 heart failure patients admitted in 2012 through Taiwan's National Health Insurance Research Database. Restricted cubic splines and multilevel logistic regression were used to identify whether there are optimal hospital and physician volume thresholds and to assess the relative and combined relationships of the volume thresholds to 30-day mortality, adjusted for patient, physician, and hospital characteristics. RESULTS: Hospital and physician volume thresholds of 40 cases and 15 cases a year, respectively, were identified, under which there was an increased risk of 30-day mortality. Patients treated by physicians with previous annual volumes <15 cases had higher 30-day mortality compared with those with previous annual volumes ≥15 cases, and the relationship was stronger in hospitals with previous annual volumes <40 cases. CONCLUSIONS: This is the first study to identify both the hospital and physician volume thresholds that lead to decreases in heart failure mortality. Identifying the hospital and physician volume thresholds could be applied to quality improvement and physician training.

Are PCI Service Volumes Associated with 30-Day Mortality? A Population-Based Study from Taiwan.

The volume-outcome relationship has been discussed for over 30 years; however, the findings are inconsistent. This might be due to the heterogeneity of service volume definitions and categorization methods. This study takes percutaneous coronary intervention (PCI) as an example to examine whether the service volume was associated with PCI 30-day mortality, given different service volume definitions and categorization methods. A population-based, cross-sectional multilevel study was conducted. Two definitions of physician and hospital volume were used: (1) the cumulative PCI volume in a previous year before each PCI; (2) the cumulative PCI volume within the study period. The volume was further treated in three ways: (1) a categorical variable based on the American Heart Association's recommendation; (2) a semi-data-driven categorical variable based on k-means clustering algorithm; and (3) a data-driven categorical variable based on the Generalized Additive Model. The results showed that, after adjusting the patient-, physician-, and hospital-level covariates, physician volume was associated inversely with PCI 30-day mortality, but hospital volume was not, no matter which definitions and categorization methods of service volume were applied. Physician volume is negatively associated with PCI 30-day mortality, but the results might vary because of definition and categorization method.

Do you see what I see?: An exploration of inter-ethnic ideal body size comparisons among college women.

The present study explored African American (n=16) and European American (n=19) college women's ideal body size perceptions for their own and the other ethnic group along with reasons behind their selections. Respondents completed an ethnically-neutral figure rating scale and then participated in ethnically-homogenous focus groups. European Americans mostly preferred a curvy-thin or athletic ideal body while most African American students resisted notions of a singular ideal body. European Americans suggested that African Americans' larger ideal body sizes were based on greater body acceptance and the preferences of African American men. African Americans used extreme terms when discussing their perceptions of European Americans' thin idealization, celebrity role models, and weight management behaviors. African Americans' perceptions of European Americans' body dissatisfaction were also attributed to the frequent fat talk they engaged in. Implications for promoting the psychosocial well-being of ethnically-diverse emerging adult females attending college are discussed.

Comparative nephrotoxicity of aristolochic acid and tetrandrine in vitro and in vivo.

Aristolochic acid (AA) and tetrandrine (TET) are the major bioactive components in Chinese herbs used for weight loss. The nephropathy caused by the 2 Chinese herbs has not been simultaneously investigated. The aim of this study was to examine the potential nephrotoxicity of AA and TET using Madin-Darby canine kidney (MDCK) cells and mice. The results showed that TET was more potent than AA in inhibiting MDCK cell growth via inducing apoptosis, as determined by annexin-V staining, 4', 6'-diamino-2-phenylindole (DAPI) staining, DNA fragmentation, and caspase 3 activity. Mice treated with AA (10 mg/kg) by intraperitoneal administration for 3 months showed nephrotoxicity, elevated blood urea nitrogen, and increased renal tubular injuries. In contrast, mice treated with 50 mg/kg of TET in the same time period had moderate hydropic degeneration of the distal tubules in the kidneys. These results suggest that TET is more cytotoxic than AA in MDCK cells but shows less nephrotoxic than AA in mice.

CyclinD1 protein expressed in pterygia is associated with ß-catenin protein localization.

BACKGROUND: The Wnt (Wg/Wnt) signaling cascade plays an important role in tumorigenesis. Our previous report indicated that aberrant localization of ß-catenin proteins was a feature of pterygia. Therefore, this study aimed to analyze the association of ß-catenin protein and expression of a downstream gene, cyclin D1, in pterygial tissues. METHODS: Using immunohistochemistry, ß-catenin and cyclin D1 protein expression was studied, in 150 pterygial specimens and 30 normal conjunctivas. RESULTS: Seventy-three (48.7%) and 60 (40.0%) pterygial specimens tested positive for ß-catenin and cyclin D1 protein expression, respectively. Cyclin D1protein expression was significantly higher in ß-catenin-nuclear/cytoplasmic positive groups than in ß-catenin membrane positive and negative groups (p < 0.0001). In addition, cyclin D1 expression was significantly higher in the fleshy group than in the atrophic and intermediate groups (p = 0.006). CONCLUSIONS: Our study demonstrated that ß-catenin expressed in nuclei/cytoplasm increases cyclinD1 protein expression, which invokes pterygial cell proliferation.

The effects of cognitive defusion and thought distraction on emotional discomfort and believability of negative self-referential thoughts.

Previous research has shown that rapid vocal repetition of a one-word version of negative self-referential thought reduces the stimulus functions (e.g., emotional discomfort and believability) associated with that thought. The present study compares the effects of that defusion strategy with thought distraction and distraction-based experimental control tasks on a negative self-referential thought. Non-clinical undergraduates were randomly assigned to one of three protocols. The cognitive defusion condition reduced the emotional discomfort and believability of negative self-referential thoughts significantly greater than comparison conditions. Favorable results were also found for the defusion technique with participants with elevated depressive symptoms.