bluuebunny/crossref_metadata_2025_split huggingface dataset:
“If the Big Fish are Doing It Then Why Not Me Down Here?”: Informal Fee Payments and Reproductive Health Care Provider Motivation in Kenya
Authors: Tumlinson Katherine , Gichane Margaret W. , Curtis Siân L. 
Published: February 2020

AbstractInformal fees are payments made by patients to their health care provider that are over and above the official cost of services. Payments may be motivated by a combination of factors such as low supervision, weak sanctions, and inadequate provider salaries. The practice of soliciting informal fees from patients may result in restricted access to medical care and reduced care‐seeking behavior among vulnerable populations. The objective of this study is to examine nuanced health care provider perspectives on informal fee payments solicited from reproductive health patients in Kenya. We conducted in‐depth semistructured interviews in 2015–2016 among a sample of 20 public and private‐sector Kenyan health care workers. Interviews were coded and analyzed using an iterative thematic approach. More than half of participants reported that solicitation of informal fees is common practice in health care facilities. Providers reported low public‐sector wages were a primary driver of informal fee solicitation coupled with collusion among senior staff. Additionally, patients may be unaware that they are being asked to pay more than the official cost of services. Strategies for reducing this behavior include more adequate and timely remuneration within the public sector, educating patient populations of free or low‐cost services, and evidence‐based methods to increase provider motivation.
Journal Bearing Surface Topography Design Based on Transient Lubrication Analysis
Authors: Gu Thomas , Jane Wang Q. , Gangopadhyay Arup , Liu Zhiqiang 
Published: February 2020

Abstract
A transient mixed lubrication model is used to study the performance of a journal bearing subjected to impulse loading, considering mass conservation and the effects of asperities on flow and contact, to explore a novel journal bearing surface design methodology. The bearing surface features include an outlet pocket and axial lip for topographical design consideration. A data-driven approach for a steadily loaded bearing was first presented to illustrate the behavior of an indented pocket design at low and high loads, and Pareto optimization and sensitivity analysis methods were employed to analyze the data and provide insight to the design. The results show that the pocket location was the most influential parameter for the optimal bearing surface design for energy-efficient lubrication performance. For transient operation, a comprehensive parametric study was conducted, and the results reveal that, when compared to the results of the unmodified bearing, the bearing designed with the optimal outlet pocket can run at 9% lower mean friction while maintaining the baseline film thickness. The bearing with the lip feature shows a 20% minimum film thickness increase and 3% mean friction reduction. The design with outlet pocket and lip features combined can lead to 20% film thickness increase and 10% mean friction reduction.
Maximizing the Lubricant Film Thickness Between a Rigid Microtextured and a Smooth Deformable Surface in Relative Motion, Using a Soft Elasto-Hydrodynamic Lubrication Model
Authors: Allen Quentin , Raeymaekers Bart 
Published: February 2020

Abstract
We design a pattern of microtexture features to increase hydrodynamic pressure and lubricant film thickness in a hard-on-soft bearing. We use a soft elastohydrodynamic lubrication model to evaluate the effect of microtexture design parameters and bearing operating conditions on the resulting lubricant film thickness and find that the maximum lubricant film thickness occurs with a texture density between 10% and 40% and texture aspect ratio between 1% and 14%, depending on the bearing load and operating conditions. We show that these results are similar to those of hydrodynamic textured bearing problems because the lubricant film thickness is almost independent of the stiffness of the bearing surfaces in full-film lubrication.
Revealing the Linear and Nonlinear Dynamic Behaviors of Metabeams With a Dynamic Homogenization Model
Authors: Lou Jia , He Liwen , Du Jianke , Wu Huaping 
Published: February 2020

Abstract
Metastructures can be designed to exhibit extraordinary properties and thus are widely applicable in various fields, such as vibration suppression, wave control, and energy harvesting. In the present work, a dynamic homogenization model is strictly derived for a metabeam (a beam with periodic resonators) by using the asymptotic homogenization method. The homogenization model is validated via comparing the vibration frequencies and associated vibration modes of the metabeam predicted by the present model with exact ones, and it is then used to analyze the linear (or nonlinear) vibration responses of the metabeam subject to a harmonic excitation with a small- (or large-) amplitude. Furthermore, the effect of periodic resonators on the vibration suppression performance of the metabeam is discussed. It is demonstrated that such kind of dynamic homogenization model is of great convenience to predict the vibration responses of metastructures besides the widely studied dispersion relation. Thus, it is expected to be useful for the vibration suppression and control of engineering structures.
Deep Reinforcement Learning for Procedural Content Generation of 3D Virtual Environments
Authors: López Christian E. , Cunningham James , Ashour Omar , Tucker Conrad S. 
Published: February 2020

AbstractThis work presents a deep reinforcement learning (DRL) approach for procedural content generation (PCG) to automatically generate three-dimensional (3D) virtual environments that users can interact with. The primary objective of PCG methods is to algorithmically generate new content in order to improve user experience. Researchers have started exploring the use of machine learning (ML) methods to generate content. However, these approaches frequently implement supervised ML algorithms that require initial datasets to train their generative models. In contrast, RL algorithms do not require training data to be collected a priori since they take advantage of simulation to train their models. Considering the advantages of RL algorithms, this work presents a method that generates new 3D virtual environments by training an RL agent using a 3D simulation platform. This work extends the authors’ previous work and presents the results of a case study that supports the capability of the proposed method to generate new 3D virtual environments. The ability to automatically generate new content has the potential to maintain users’ engagement in a wide variety of applications such as virtual reality applications for education and training, and engineering conceptual design.
Acute Ketone Supplementation and Exercise Performance: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Valenzuela Pedro L. , Morales Javier S. , Castillo-García Adrián , Lucia Alejandro 
Published: February 2020

Purpose: To determine the acute effects of ketone supplementation on exercise performance (primary outcome) and physiological and perceptual responses to exercise (secondary outcomes). Methods: A systematic search was conducted in PubMed, Web of Science, and SPORTDiscus (since inception to July 21, 2019) to find randomized controlled trials assessing the effects of acute ketone supplementation compared with a drink containing no ketones (ie, control intervention). The standardized mean difference (Hedges g) between interventions and 95% confidence interval (CI) were computed using a random-effects model. Results: Thirteen studies met all inclusion criteria. No significant differences were observed between interventions for overall exercise performance (Hedges g = −0.05; 95% CI, −0.30 to 0.20; P = .68). Subanalyses revealed no differences between interventions when analyzing endurance time-trial performance (g = −0.04; 95% CI, −0.35 to 0.28; P = .82) or when assessing the separate effects of supplements containing ketone esters (g = −0.07; 95% CI, −0.38 to 0.24; P = .66) or salts (g = −0.02; 95% CI, −0.45 to 0.41; P = .93). All studies reported increases in plasma ketone concentration after acute ketone supplementation, but no consistent effects were reported on the metabolic (plasma lactate and glucose levels), respiratory (respiratory exchange ratio, oxygen uptake, and ventilatory rate), cardiovascular (heart rate), or perceptual responses to exercise (rating of perceived exertion). Conclusions: The present findings suggest that ketone supplementation exerts no clear influence on exercise performance (from sprints to events lasting up to ∼50 min) or metabolic, respiratory, cardiovascular, or perceptual responses to exercise. More research is needed to elucidate if this strategy could provide ergogenic effects on other exercise types (eg, ultraendurance exercise).
Modifiable Physical Factors Associated With Physical Functioning for Patients Receiving Dialysis: A Systematic Review
Authors: Tarca Brett D. , Wycherley Thomas P. , Bennett Paul , Meade Anthony , Ferrar Katia E. 
Published: February 2020

Background: Patients receiving dialysis have reduced physical function, which is associated with unfavorable clinical outcomes and decreased quality of life. The authors aimed to identify and explore modifiable physical factors associated with physical function for patients receiving dialysis. Methods: Searches were performed in MEDLINE, Embase, Ovid Emcare, and The Cochrane Library in October 2018. Etiological studies involving dialysis populations that report association or predictive statistics between a modifiable physical factor and physical function were eligible for inclusion. Predictor variables were (1) modifiable via exercise and (2) considered an impairment in the International Classification of Functioning, Disability and Health. Results: Of 5384 titles screened, 23 studies were included. Thirteen studies focused on physical activity levels and muscle strength and the relationship with physical function while 2 studies investigated sedentary behavior. Twenty-one studies focused on hemodialysis populations. Studies related to physical activity levels displayed a moderately strong relationship with physical function, whereas muscle strength displayed a predominantly weak to moderate relationship. Conclusions: Physical activity levels, sedentary behavior levels, and muscle strength are related to physical function status for patients receiving dialysis. There is a need for robust longitudinal data to confirm the results of this investigation and for more focus on populations receiving peritoneal dialysis.
Permo–Triassic granitoids, Hainan Island, link to Paleotethyan not Paleopacific tectonics
Authors: He Huiying , Wang Yuejun , Cawood Peter A. , Qian Xin , Zhang Yuzhi , Zhao Guofeng 
Published: February 2020

Abstract
Hainan Island may have lain at the boundary between the Tethyan and Pacific domains since the late Paleozoic. Permo–Triassic granitoids outcropped on the island provide insight into Mesozoic tectonic evolution and potential dynamics. Based on analyses of zircon U-Pb geochronological and Hf-O isotopic data, along with whole-rock elemental and Sr-Nd isotopic data, the Permo–Triassic granitoids are divided into three groups: Late Permian (256–252 Ma) gneissic granitoids (Group 1), Early–Middle Triassic (247–244 Ma) massive granitoids (Group 2), and Middle-Late Triassic (242–225 Ma) massive granitoids (Group 3). Groups 1 and 2 exhibit similar elemental and Sr-Nd isotopic compositions with εNd(t) values ranging from –6.71 to –3.25. Group 1 is characterized by gneissic foliation and calc-alkaline I-type geochemical affinities with negative Nb-Ta and Ti anomalies; it has low εHf(t) (–4.2∼+0.2) and high δ18O values (9.35–10.46‰), possibly related to derivation of a metabasite source in a continental arc setting. The Group 2 samples are peraluminous massive granitoids with slightly high A/CNK ratios of 1.00–1.31, δ18O values (8.85–11.75‰), and high Sr/Y ratios but low εHf(t) (–8.7∼+1.6) values. They may have originated from the mixed source of greywacke and metabasite, indicating a compressive tectonic setting. The Group 3 high-K calc–alkaline granitoids have high zircon temperatures (842–867 °C) and show the geochemical signatures of A-type granites. They are featured by slightly low whole-rock εNd(t) and zircon εHf(t) values, suggestive of the derivation from a metabasite–greywacke source in an extensional setting. In combination with other geochronological and geochemical data from Hainan Island, it is proposed that the Permian–Triassic igneous magmatism in Hainan Island reflects a continuous amalgamation process from back-arc consumption (272–252 Ma) to orogenic assembly (251–243 Ma) and orogenic collapse (242–225 Ma) between the South China and Indochina Blocks. Such a temporal–spatial pattern for the Hainan granitoids is consistent with that along the Truong Son, Jinshajiang–Ailaoshan–Song Ma tectonic zone, suggesting dominant control of Paleotethyan domain instead of Paleopacific tectonics.
Activity and functional readiness, not age, are the critical factors for second anterior cruciate ligament injury — the Delaware-Oslo ACL cohort study
Authors: Grindem Hege , Engebretsen Lars , Axe Michael , Snyder-Mackler Lynn , Risberg May Arna 
Published: February 2020

ObjectiveTo elucidate the relationships between age, return to level I sport (RTS) within the first postoperative year, passing RTS criteria and second anterior cruciate ligament (ACL) injury.MethodsIn a prospective cohort study, 213 athletes were followed for 2 years after ACL reconstruction to record second ACL injuries. Independent variables were age, passing RTS criteria and level I RTS within the first postoperative year (vs later or no RTS). We defined passing RTS criteria as ≥90 on the Knee Outcome Survey — Activities of Daily Living Scale, global rating scale of function and quadriceps strength/hop test symmetry.ResultsThe follow-up rate was >87% for all outcomes. In multivariable analysis, level I RTS within the first postoperative year and passing RTS criteria were highly associated with second ACL injury (level I RTS HR: 6.0 (95% CI: 1.6 to 22.6), pass RTS criteria HR: 0.08 (95% CI: 0.01 to 0.6)), while age was not (age HR: 0.96 (95% CI: 0.89 to 1.04)). Athletes <25 years had higher level I RTS rates in the first postoperative year (60.4%) than older athletes (28.0%). Of those who returned to level I sport in the first postoperative year, 38.1% of younger and 59.1% of older athletes passed RTS criteria.ConclusionHigh rates of second ACL injury in young athletes may be driven by a mismatch between RTS rates and functional readiness to RTS. Passing RTS criteria was independently associated with a lower second ACL rate. Allowing more time prior to RTS, and improving rehabilitation and RTS support, may reduce second ACL injury rates in young athletes with ACL reconstruction.
Hospital-wide ELectronic medical record evaluated computerised decision support system to improve outcomes of Patients with staphylococcal bloodstream infection (HELP): study protocol for a multicentre stepped-wedge cluster randomised trial
Authors: Hagel Stefan , Gantner Julia , Spreckelsen Cord , Fischer Claudia , Ammon Danny , Saleh Kutaiba , Phan-Vogtmann Lo An , Heidel Andrew , Müller Susanne , Helhorn Alexander , Kruse Henner , Thomas Eric , Rißner Florian , Haferkamp Silke , Vorwerk Jens , Deffge Saskia , Juzek-Küpper Marc Fabian , Lippmann Norman , Lübbert Christoph , Trawinski Henning , Wendt Sebastian , Wendt Thomas , Dürschmid Andreas , Konik Margarethe , Moritz Stefan , Tiller Daniel , Röhrig Rainer , Schulte-Coerne Jonas , Fortmann Jonas , Jonas Stephan , Witzke Oliver , Rath Peter-Michael , Pletz Mathias W , Scherag André 
Published: February 2020

IntroductionStaphylococci are the most commonly identified pathogens in bloodstream infections. Identification of Staphylococcus aureus in blood culture (SAB) requires a prompt and adequate clinical management. The detection of coagulase-negative staphylococci (CoNS), however, corresponds to contamination in about 75% of the cases. Nevertheless, antibiotic therapy is often initiated, which contributes to the risk of drug-related side effects. We developed a computerised clinical decision support system (HELP-CDSS) that assists physicians with an appropriate management of patients with Staphylococcus bacteraemia. The CDSS is evaluated using data of the Data Integration Centers (DIC) established at each clinic. DICs transform heterogeneous primary clinical data into an interoperable format, and the HELP-CDSS displays information according to current best evidence in bacteraemia treatment. The overall aim of the HELP-CDSS is a safe but more efficient allocation of infectious diseases specialists and an improved adherence to established guidelines in the treatment of SAB.Methods and analysisThe study is conducted at five German university hospitals and is designed as a stepped-wedge cluster randomised trial. Over the duration of 18 months, 135 wards will change from a control period to the intervention period in a randomised stepwise sequence. The coprimary outcomes are hospital mortality for all patients to establish safety, the 90-day disease reoccurrence-free survival for patients with SAB and the cumulative vancomycin use for patients with CoNS bacteraemia. We will use a closed, hierarchical testing procedure and generalised linear mixed modelling to test for non-inferiority of the CDSS regarding hospital mortality and 90-day disease reoccurrence-free survival and for superiority of the HELP-CDSS regarding cumulative vancomycin use.Ethics and disseminationThe study is approved by the ethics committee of Jena University Hospital and will start at each centre after local approval. Results will be published in a peer-reviewed journal and presented at scientific conferences.Trial registration numberDRKS00014320.
Total laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy (TJDBPS01): study protocol for a multicentre, randomised controlled clinical trial
Authors: Zhang Hang , Feng Yechen , Zhao Junfang , Chen Rufu , Chen Xuemin , Yin Xinmin , Cheng Wei , Li Dewei , Li Jingdong , Huang Xiaobing , Li Jing , Liu Jianhua , Liu Jun , Liu Yahui , Tan Zhijian , Zhao Wenxing , Huang Heguang , Li Deyu , Yu Yahong , Wang Min , Qin Renyi 
Published: February 2020

IntroductionPancreatoduodenectomy (PD) is one of the most complex abdominal operations to perform, and it is usually conducted for tumours of the periampullary region and chronic pancreatitis. Minimally invasive surgery has been progressively being developed for pancreatic surgery, first with the advent of hybrid-laparoscopy and recently with total laparoscopic surgery. Issues including the safety and efficacy of total laparoscopic pancreaticoduodenectomy (TLPD) and open pancreaticoduodenectomy (OPD) are currently being debated. Studies comparing these two surgical techniques are emerging, and large randomised controlled trials (RCTs) are lacking but are clearly required.Methods and analysisTJDBPS01 is a multicentre, prospective, randomised controlled, parallel-group, superiority trial in 14 centres with pancreatic surgery experts who have performed ≥104 TLPDs and OPDs. A total of 656 patients who will undergo PD are randomly allocated to the TLPD group or OPD group in a 1:1 ratio. The trial hypothesis is that TLPD has superior or equivalent safety and advantages in postoperative recovery compared with OPD. The primary outcome is the postoperative length of stay.Ethics and disseminationThe Instituitional Review Board Approval of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology has approved this trial and will be routinely monitoring the trial at frequent intervals, as will an independent third-party organisation. Any results from this trial (publications, conference presentations) will be published in peer-reviewed journals and conference proceedings.Trial registration numberNCT03138213
Perspectives on simulation-based training from paediatric healthcare providers in Nigeria: a national survey
Authors: Umoren Rachel , Ezeaka Veronica Chinyere , Fajolu Ireti B , Ezenwa Beatrice N , Akintan Patricia , Chukwu Emeka , Spiekerman Chuck 
Published: February 2020

ObjectivesThe objective of this study was to explore the access to, and perceived utility of, various simulation modalities by in-service healthcare providers in a resource-scarce setting.SettingPaediatric training workshops at a national paediatric conference in Nigeria.ParticipantsAll 200 healthcare workers who attended the workshop sessions were eligible to participate. A total of 161 surveys were completed (response rate 81%).Primary and secondary outcome measuresA paper-based 25-item cross-sectional survey on simulation-based training (SBT) was administered to a convenience sample of healthcare workers from secondary and tertiary healthcare facilities.ResultsRespondents were mostly 31–40 years of age (79, 49%) and women (127, 79%). Consultant physicians (26, 16%) and nurses (56, 35%) were in both general (98, 61%) and subspecialty (56, 35%) practice. Most had 5–10 years of experience (62, 37%) in a tertiary care setting (72, 43%). Exposure to SBT varied by profession with physicians more likely to be exposed to manikin-based (29, 30% physicians vs 12, 19% nurses, p<0.001) or online training (7, 7% physician vs 3, 5% nurses, p<0.05). Despite perceived barriers to SBT, respondents thought that SBT should be expanded for continuing education (84, 88% physician vs 39, 63% nurses, p<0.001), teaching (73, 76% physicians vs 16, 26% nurses, p<0.001) and research (65, 68% physicians vs 14, 23% nurses, p<0.001). If facilities were available, nearly all respondents (92, 98% physicians; 52, 96% nurses) would recommend the use of online simulation for their centre.ConclusionsThe access of healthcare workers to SBT is limited in resource-scarce settings. While acknowledging the challenges, respondents identified many areas in which SBT may be useful, including skills acquisition, skills practice and communication training. Healthcare workers were open to the use of online SBT and expressed the need to expand SBT beyond the current scope for health professional training in Nigeria.