LLukas22/scidocs huggingface dataset:
Reversal of atrial electrical remodeling following cardioversion of long-standing atrial fibrillation in man.

BACKGROUND
In animal studies, atrial fibrillation has been shown to shorten the atrial refractory period and impair its rate adaptation. However, little is known about the effects of chronic atrial fibrillation on atrial electrophysiology and its recovery course in humans.


METHODS AND RESULTS
Nineteen patients, mean age 64 +/- 14 years, with chronic atrial fibrillation of more than six months duration were included in this study. All of them were successfully converted to sinus rhythm with an external defibrillator. Atrial effective refractory periods at right atrial appendage and distal coronary sinus were determined with five pacing cycle lengths (300, 400, 500, 600 and 700 ms) at 30 min after cardioversion and once a day for four days. The atrial conduction properties, including P wave duration of surface ECG, and right and left atrial conduction times, were also measured at the same time interval. Twenty age-matched patients without a history of atrial tachyarrhythmia were evaluated as controls. In comparison with controls, chronic atrial fibrillation significantly shortened the atrial effective refractory period, impaired its rate adaptation response, especially at distal coronary sinus, and depressed the conduction properties of atria. The atrial conduction properties did not change during the four-day follow-up period; however, the atrial effective refractory period was gradually prolonged and its rate adaptation response improved after restoration of sinus rhythm.


CONCLUSIONS
In humans, chronic atrial fibrillation significantly shortened the atrial effective refractory period, and impaired its rate adaptation response. Restoration and maintenance of sinus rhythm could reverse these electrophysiological changes.
Plate bending approximation: Thin (Kirchhoff) plates and C1 continuity requirements

The subject of bending of plates and indeed its extension to shells was one of the first to which the finite element method was applied in the early 1960s. At that time the various difficulties that were to be encountered were not fully appreciated and for this reason the topic remains one in which research is active to the present day. Although the subject is of direct interest only to applied mechanicians and structural engineers there is much that has more general applicability, and many of the procedures which we shall introduce can be directly translated to other fields of application. Plates and shells are but a particular form of a three-dimensional solid, the treatment of which presents no theoretical difficulties, at least in the case of elasticity. However, the thickness of such structures (denoted throughout this and later chapters as t) is very small when compared with other dimensions, and complete three-dimensional numerical treatment is not only costly but in addition often leads to serious numerical ill-conditioning problems. To ease the solution, even long before numerical approaches became possible, several classical assumptions regarding the behaviour of such structures were introduced. Clearly, such assumptions result in a series of approximations. Thus numerical treatment will, in general, concern itself with the approximation to an already approximate theory (or mathematical model), the validity of which is restricted. On occasion we shall point out the shortcomings of the original assumptions, and indeed modify these as necessary or convenient. This can be done simply because now we are granted more freedom than that which existed in the 'pre-computer' era. The thin plate theory is based on the assumptions formalized by Kirchhoff in 1850,' and indeed his name is often associated with this theory, though an early version was presented by Sophie Germain in 18 1 1 .'-A relaxation of the assumptions was made by Reissner in 1945' and in a slightly different manner by Mindlin6 in 1951. These modified theories extend the field of application of the theory to ririck p1rrte.v and we shall associate this name with the Reissner-Mindlin postulates. It turns out that the thick plate theory is simpler to implement in the finite element method. though in the early days of analytical treatment it presented more difficulties. As it is more convenient to introduce first the thick plate theory and by imposition of
Sexual well being in parkinsonian patients after deep brain stimulation of the subthalamic nucleus.

OBJECTIVES
To evaluate changes in sexual well being in a group of patients with Parkinson's disease following deep brain stimulation (DBS) of the subthalamic nucleus (STN).


METHODS
31 consecutive patients with Parkinson's disease (21 men and 10 women), bilaterally implanted for DBS of STN, were evaluated one month before and 9-12 months after surgery. Sexual functioning was assessed using a reduced form of the Gollombok Rust inventory of sexual satisfaction (GRISS). Depression (Beck depression inventory) and anxiety (STAI-X1/X2) were also evaluated. Relations between sexual functioning and modifications in the severity of disease (Hoehn and Yahr stage), reduction in levodopa equivalent daily dosage (LEDD), age, and duration of disease were analysed.


RESULTS
While no modifications were found in female patients, male patients reported slightly but significantly more satisfaction with their sexual life after DBS of STN. When only male patients under 60 years old were considered, a greater improvement in sexual functioning was found, though still small. Modifications in depressive symptoms and anxiety, as well as duration of the disease, reduction in LEDD, and improvement in the severity of disease, showed no relation with changes in sexual functioning after DBS of STN.


CONCLUSIONS
DBS of STN appears to affect sexual functioning in a small but positive way. Male patients with Parkinson's disease, especially when under 60, appeared more satisfied with their sexual well being over a short term follow up period.
DESIGN OF DUAL-FEED DUAL-POLARIZED MICROSTRIP ANTENNA WITH HIGH ISOLATION AND LOW CROSS POLARIZATION

Abstract—A broadband dual-feed dual-polarized microstrip antenna with low cross polarization and high isolation is presented. The dualorthogonal linearly polarized mode is excited by two different feed mechanisms from a single circular radiating patch. One of the two modes is excited by a pair of L-shaped probes with a 180◦ phase differences, and the other is excited by an H-shaped aperture. The proposed design has a very simple antenna structure with a wide input impedance bandwidth (23.25% for Port 1 and 35% for Port 2) and also its two input port isolation is found to be as low as −40 dB. Measured results of the fabricated antenna prototypes are also carried out to verify the simulation analysis.
Geomorphology of anomalously high glaciated mountains at the northwestern end of Tibet: Muztag Ata and Kongur Shan

Article history: Muztag Ata and Kongur Sh Accepted 15 November 2007 Available online 10 May 2008
Nationwide Survey of Work Environment, Work-Life Balance and Burnout among Psychiatrists in Japan

BACKGROUND
Psychiatry has been consistently shown to be a profession characterised by 'high-burnout'; however, no nationwide surveys on this topic have been conducted in Japan.


AIMS
The objective of this study was to estimate the prevalence of burnout and to ascertain the relationship between work environment satisfaction, work-life balance satisfaction and burnout among psychiatrists working in medical schools in Japan.


METHOD
We mailed anonymous questionnaires to all 80 psychiatry departments in medical schools throughout Japan. Work-life satisfaction, work-environment satisfaction and social support assessments, as well as the Maslach Burnout Inventory (MBI), were used.


RESULTS
Sixty psychiatric departments (75.0%) responded, and 704 psychiatrists provided answers to the assessments and MBI. Half of the respondents (n = 311, 46.0%) experienced difficulty with their work-life balance. Based on the responses to the MBI, 21.0% of the respondents had a high level of emotional exhaustion, 12.0% had a high level of depersonalisation, and 72.0% had a low level of personal accomplishment. Receiving little support, experiencing difficulty with work-life balance, and having less work-environment satisfaction were significantly associated with higher emotional exhaustion. A higher number of nights worked per month was significantly associated with higher depersonalisation.


CONCLUSIONS
A low level of personal accomplishment was quite prevalent among Japanese psychiatrists compared with the results of previous studies. Poor work-life balance was related to burnout, and social support was noted to mitigate the impact of burnout.
Modeling and Analysis of a Flywheel Energy Storage System with a Power Converter Interface

A shipboard power system is a stiff, isolated power system. Power is generated locally, and distributed over short distances making the system vulnerable to transients. Power quality problems such as voltage sags, which arise due to a fault or a pulsed load, can cause interruptions of critical loads. This can be of a serious concern for the survivability of a combat ship. A series voltage injection type flywheel energy storage system is used to mitigate voltage sags. The basic circuit consists of an energy storage system, power electronic interface and a series connected transformer. In this case the energy storage system consists of a flywheel coupled to an induction machine. The power electronic interface consists of two voltage sourced converters (VSC) connected through a common DC link. The flywheel stores energy in the form of kinetic energy and the induction machine is used for energy conversion. Bi-directional power flow is maintained by regulating the DC bus voltage. Indirect field oriented control with space vector PWM is used to control the induction machine. Sinusoidal PWM is used for controlling the power system side VSC. This paper presents the modeling, simulation and analysis of a flywheel energy storage system and with a power converter interface using EMTDC..
Illicit drug exposure in patients evaluated for alleged child abuse and neglect.

BACKGROUND
Substantiation of drug exposure in cases with alleged maltreatment is important to provide proper treatment and services to these children and their families. A study performed at University of Iowa Hospitals and Clinics showed that 30% of pediatric patients with burn injuries, which were due to child maltreatment, were also exposed to illicit drugs.


OBJECTIVE
The children presenting to the University of Iowa Hospitals and Clinics with alleged maltreatment have been tested for illicit substances since 2004. The objective of this study was to analyze the presence of illicit drug exposure in the pediatric subpopulation admitted to pediatric inpatient and outpatient units for an evaluation for abuse/neglect.


DESIGN AND METHODS
The study design is a retrospective chart review. Using hospital databases, every pediatric chart with a child abuse/neglect allegation was retrieved. The association between risk factors and clinical presentation and illicit drug test result was assessed. Excel and SAS were used for statistical analysis. Institutional review board approval was obtained to conduct this study.


RESULTS
Six hundred sixty-five charts met study inclusion criteria for child abuse/neglect allegation. Of those, 232 cases were tested for illicit drugs between 2004 and 2008 per the testing protocol. Thirty-four cases (14.7%) tested positive on a drug test. Positive test rates based on clinical presentation were 28.6% (18/63) in neglect cases, 16.1% (5/31) in cases with soft tissue injuries, 14.3% (4/28) in burn injuries, 10.0% (2/20) in cases with sexual abuse, 7.1% (2/28) in cases with fractures, and 4.8% (3/62) in abusive head trauma cases. There were long-term abuse findings in 129 children (55.6%). Logistic regression analysis revealed that positive drug testing was most significantly associated with clinical symptoms suggesting physical abuse or neglect versus sexual abuse (odds ratio [OR] = 6.70; 95% confidence interval [CI], 1.26-35.49; P = 0.026), no or public health insurance versus those with private insurance (OR = 4.49; 95% CI, 1.47-13.66; P = 0.008), history of parental drug abuse versus those without parental history of drug abuse (OR = 3.42; 95% CI, 1.38-8.46; P = 0.008), and history of domestic violence versus those without a history of domestic violence (OR = 2.81; 95% CI, 1.08-7.30; P = 0.034).


CONCLUSIONS
The results of this study showed that an illicit drug screening protocol used in the assessment of children evaluated for child abuse identified almost 15% of the population of allegedly abused and neglected children who were tested according to a protocol being exposed to illicit drugs. Thus, routine drug testing of at least children assessed for neglect and nonaccidental burn and soft tissue injuries, children with a history of either parental drug use or domestic violence is recommended.
Arteriosclerotic changes as background factors in patients with peripheral vestibular disorders.

Symptoms such as vertigo and unsteady gait occur in various diseases and are among the relatively common chief complaints. Even at present, the mechanisms underlying these disorders are unclear. We considered the possibility of peripheral vestibular disorders correlating with lifestyle-related illnesses. Under these circumstances, we assessed correlations of lifestyle-related illness as background factors for peripheral vestibular disorders and associated arteriosclerotic changes. Using carotid ultrasonography, we assessed maximum intima-media thickness (max IMT) and maximum common carotid artery IMT and evaluated biochemical examinations in 85 patients with peripheral vertigo. The patients were divided into two groups: those with benign paroxysmal positional vertigo (BPPV) and those with peripheral vestibular disorders. The frequency of abnormal IMT was significantly higher in those in the BPPV group. Calculating for average age, max IMT was significantly higher in the BPPV group. The correlation coefficient between age and max IMT was 0.343 (p < .001). All other correlation coefficients also reached statistical significance. Our results indicate that cervical ultrasonography is useful for noninvasive examination of arteriosclerotic changes in patients with peripheral vestibular disorders. Our results also indicated that peripheral vestibular disorder patients show progression of arteriosclerotic changes.
The manufacturing TQM and service quality literatures: synergistic or conflicting paradigms?

Introduction Although most of the exponents of TQM explicitly claim that TQM is transferable to services, the precepts and practices have been derived from the experience of consultants and practitioners in manufacturing. Both the US and Japanese " gurus " focus and address their work primarily to manufacturers, with application of TQM in services only given secondary attention. As Albrecht (Albrecht and Bradford, 1990) puts it, these contributors " were born in a manufacturing era, and they have a predominantly manufacturing mindset at their foundation ". Yet, despite its manufacturing origins, both academics and practitioners have, over the past 15 years, been concerned to apply and transfer TQM principles and practices to services. However, the inadequacy of the literature in guiding service managers and transferring the TQM principles, management tools and techniques to service environments has become a familiar theme (see for example, Many of the tools and techniques are quantitative and have limited application in service environments where the deliverables are often intangible, heterogeneous and their consumption and delivery simultaneous. In part no doubt to address this deficiency, the service quality literature has evolved over the past 15 years mainly in the fields of service marketing and operations management. Although influenced by TQM thinking in manufacturing, it has been developed separately, by a different set of contributors. Indeed according to Dale (1992), " there appears to be little close collaboration with the group of academics investigating service quality and marketing aspects of TQM and those researching TQM in the context of manufacturing industry ". In this paper, an attempt is made to compare, contrast and assimilate the manufacturing and service perspectives on TQM. A model of TQM derived from the manufacturing literature is examined, developed and enhanced in the light of the service management literature; and the contribution of the service quality literature to the development of many of the TQM principles and practices which originated from manufacturing is evaluated. This results in a
Source apportionment of ambient non-methane hydrocarbons in Hong Kong : Application of a principal component analysis / absolute principal component scores ( PCA / APCS ) receptor model

Receptor-oriented source apportionment models are often used to identify sources of ambient air pollutants and to estimate source contributions to air pollutant concentrations. In this study, a PCA/APCS model was applied to the data on non-methane hydrocarbons (NMHCs) measured from January to December 2001 at two sampling sites: Tsuen Wan (TW) and Central & Western (CW) Toxic Air Pollutants Monitoring Stations in Hong Kong. This multivariate method enables the identification of major air pollution sources along with the quantitative apportionment of each source to pollutant species. The PCA analysis identified four major pollution sources at TW site and five major sources at CW site. The extracted pollution sources included vehicular internal engine combustion with unburned fuel emissions, use of solvent particularly paints, liquefied petroleum gas (LPG) or natural gas leakage, and industrial, commercial and domestic sources such as solvents, decoration, fuel combustion, chemical factories and power plants. The results of APCS receptor model indicated that 39% and 48% of the total NMHCs mass concentrations measured at CW and TW were originated from vehicle emissions, respectively. 32% and 36.4% of the total NMHCs were emitted from the use of solvent and 11% and 19.4% were apportioned to the LPG or natural gas leakage, respectively. 5.2% and 9% of the total NMHCs mass concentrations were attributed to other industrial, commercial and domestic sources, respectively. It was also found that vehicle emissions and LPG or natural gas leakage were the main sources of C3–C5 alkanes and C3–C5 alkenes while aromatics were predominantly released from paints. Comparison of source contributions to ambient NMHCs at the two sites indicated that the contribution of LPG or natural gas at CW site was almost twice that at TW site. High correlation coefficients (R > 0.8) between the measured and predicted values suggested that the PCA/APCS model was applicable for estimation of sources of NMHCs in ambient air. # 2004 Elsevier Ltd. All rights reserved.
Ultrasound in management of rheumatoid arthritis: ARCTIC randomised controlled strategy trial

OBJECTIVE
 To determine whether a treatment strategy based on structured ultrasound assessment would lead to improved outcomes in rheumatoid arthritis, compared with a conventional strategy.


DESIGN
 Multicentre, open label, two arm, parallel group, randomised controlled strategy trial.


SETTING
 Ten rheumatology departments and one specialist centre in Norway, from September 2010 to September 2015.


PARTICIPANTS
 238 patients were recruited between September 2010 and April 2013, of which 230 (141 (61%) female) received the allocated intervention and were analysed for the primary outcome. The main inclusion criteria were age 18-75 years, fulfilment of the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis, disease modifying anti-rheumatic drug naivety with indication for disease modifying drug therapy, and time from first patient reported swollen joint less than two years. Patients with abnormal kidney or liver function or major comorbidities were excluded.


INTERVENTIONS
 122 patients were randomised to an ultrasound tight control strategy targeting clinical and imaging remission, and 116 patients were randomised to a conventional tight control strategy targeting clinical remission. Patients in both arms were treated according to the same disease modifying anti-rheumatic drug escalation strategy, with 13 visits over two years.


MAIN OUTCOME MEASURES
 The primary endpoint was the proportion of patients with a combination between 16 and 24 months of clinical remission, no swollen joints, and non-progression of radiographic joint damage. Secondary outcomes included measures of disease activity, radiographic progression, functioning, quality of life, and adverse events. All participants who attended at least one follow-up visit were included in the full analysis set.


RESULTS
 26 (22%) of the 118 analysed patients in the ultrasound tight control arm and 21 (19%) of the 112 analysed patients in the clinical tight control arm reached the primary endpoint (mean difference 3.3%, 95% confidence interval -7.1% to 13.7%). Secondary endpoints (disease activity, physical function, and joint damage) were similar between the two groups. Six (5%) patients in the ultrasound tight control arm and seven (6%) patients in the conventional arm had serious adverse events.


CONCLUSIONS
 The systematic use of ultrasound in the follow-up of patients with early rheumatoid arthritis treated according to current recommendations is not justified on the basis of the ARCTIC results. The findings highlight the need for randomised trials assessing the clinical application of medical technology.Trial registration Clinical trials NCT01205854.
A qualitative study of systemic influences on paramedic decision making: care transitions and patient safety.

OBJECTIVES
Paramedics routinely make critical decisions about the most appropriate care to deliver in a complex system characterized by significant variation in patient case-mix, care pathways and linked service providers. There has been little research carried out in the ambulance service to identify areas of risk associated with decisions about patient care. The aim of this study was to explore systemic influences on decision making by paramedics relating to care transitions to identify potential risk factors.


METHODS
An exploratory multi-method qualitative study was conducted in three English National Health Service (NHS) Ambulance Service Trusts, focusing on decision making by paramedic and specialist paramedic staff. Researchers observed 57 staff across 34 shifts. Ten staff completed digital diaries and three focus groups were conducted with 21 staff.


RESULTS
Nine types of decision were identified, ranging from emergency department conveyance and specialist emergency pathways to non-conveyance. Seven overarching systemic influences and risk factors potentially influencing decision making were identified: demand; performance priorities; access to care options; risk tolerance; training and development; communication and feedback and resources.


CONCLUSIONS
Use of multiple methods provided a consistent picture of key systemic influences and potential risk factors. The study highlighted the increased complexity of paramedic decisions and multi-level system influences that may exacerbate risk. The findings have implications at the level of individual NHS Ambulance Service Trusts (e.g. ensuring an appropriately skilled workforce to manage diverse patient needs and reduce emergency department conveyance) and at the wider prehospital emergency care system level (e.g. ensuring access to appropriate patient care options as alternatives to the emergency department).