bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatric dermatology eConsults: Reduced wait times and dermatology office visits
Authors: Seiger Kira , Hawryluk Elena B. , Kroshinsky Daniela , Kvedar Joseph C. , Das Shinjita 
Published: June 2020

AbstractBackground/ObjectivesStore‐and‐forward teledermatology provides pediatricians with specialist guidance in managing skin disease. This study evaluates wait times and face‐to‐face (FTF) dermatology visit avoidance associated with a pediatric dermatology eConsult program at an urban academic medical center.MethodsIn this retrospective cohort study, electronic medical records were reviewed for patients under age 18 for whom a dermatology eConsult was completed between November 1, 2014, and December 31, 2017. Wait times for eConsult completion and initial FTF dermatology appointments were calculated and compared to average wait times for new patient dermatology office appointments from 2016 to 2017. Recommendations for FTF dermatology visits were assessed, along with FTF visit attendance and potential cost savings.ResultsOne hundred eighty pediatric patients with 188 unrelated skin conditions (“cases”) were referred to the program. Of 188 cases, FTF dermatology visits were recommended for 60 (31.9%). Actual FTF dermatology visit avoidance was 53.7% of total cases (n = 101 for whom FTF visit was not recommended and no dermatology visit occurred within 90 days after eConsult submission). The program generated potential savings of $24 059 ($9840 out‐of‐pocket) in 2016 dollars. Average turnaround for eConsult completion was 1.8 calendar days (median: 1 calendar day, target: 2 business days). Average wait time to initial FTF dermatology evaluation was 37.3 calendar days (versus 54.1 days for pediatric patients referred directly to dermatology clinic between 2016 and 2017).ConclusionPediatric dermatology eConsults reduce wait times for specialist care, triage cases for in‐office evaluation, reduce need for FTF dermatology visits, and offer potential cost savings for payers and patients.
Pulmonary hypertension in Saudi Arabia: First data from the SAUDIPH registry with a focus on pulmonary arterial hypertension
Authors: Aldalaan Abdullah M. , Saleemi Sarfraz A. , Weheba Ihab , Abdelsayed Abeer , Aleid Maha M. , Alzubi Fatima , Zaytoun Hamdeia , Alharbi Nadeen 
Published: June 2020

ABSTRACTBackground and objectiveThis study presents the first results of ‘SAUDIPH’ registry, aiming to assess patient characteristics, treatment approach and clinical and survival outcomes in patients with PAH.MethodsThe registry enrolled patients with Group 1 and Group 4 PH under clinical management in a specialized tertiary care centre from 2004 to 2018. Changes from baseline to last follow‐up visit were assessed.ResultsA total of 222 patients were enrolled, and Group 1 PH was the most frequent aetiology (57.7%). Mean age at diagnosis was 32 years. mPAP was 55.0 mm Hg and was higher for Group 1 PH (59.0 mm Hg, P < 0.001). At the last visit, most patients were on specific therapy (83.7%) and 30% shifted from FC III/IV to FC I/II. NT‐proBNP improved by 29.2% in the overall population. The 1‐, 3‐ and 5‐year cumulative probabilities of survival were 95.6% (95% CI: 91.5–99.9%), 89.2% (95% CI: 82.1–96.9%) and 74.6% (95% CI: 59.4–93.7%), respectively. CHD‐PAH demonstrated the best survival among Group 1 PAH with 1‐, 3‐ and 5‐year cumulative probability of 100%, 100%, and 75.0% (95% CI: 42.6–100), respectively.ConclusionPAH was the most frequent aetiology and patients were younger at diagnosis compared to other cohorts. Most patients showed improvement in FC and NT‐proBNP. The estimated 1‐year survival was better than previous studies, possibly reflecting wider use of combination therapy and the high prevalence of CHD‐PAH.
Structural change and global trade flows: Does an emerging giant matter?
Authors: Dennis Benjamin N. , İşcan Talan B. 
Published: June 2020

AbstractIn this paper, we develop a novel trade‐accounting framework that is based on a multi‐country, multi‐industry model of trade. The framework links observed changes in wages, sectoral employment shares, total labor force, and bilateral trade costs to changes in bilateral trade values at the sector level. In our application, we quantify the changes in trade patterns from 1995 to 2010 among 15 advanced and emerging market economies attributable to structural change in China, focusing on three manifestations of trade creation and destruction: China’s replacement of manufactured final goods exports to advanced economies at the expense of other economies; an expansion of China’s imports of manufactured final goods and commodities; and an expansion of China’s imports of parts and components that are then processed and exported as manufactured final goods to the advanced economies. Our main findings are: (a) scale effects have more than compensated for the loss of competitiveness due to higher wages in China; (b) China’s wage growth has been an economically more significant determinant of trade creation and destruction than its reallocation of labor across sectors, and (c) structural change in China has shifted other countries toward more commodity‐intensive production.
Andean style 1.50–1.35 Ga arc dynamics in the Southeastern Laurentian margin: The rifting and reassembly of Quebecia
Authors: Groulier Pierre‐Arthur , Indares Aphrodite , Dunning Gregory , Moukhsil Abdelali 
Published: June 2020

AbstractQuebecia is a unique Geon 15 to 13 composite arc belt in the central Grenville Province that preserves record of rifting and subsequent re‐amalgamation of part of the Laurentian margin. Key lithological components include: (a) c. 1.5 Ga metasedimentary sequences indicative of earlier rifting of the Laurentian margin; (b) remnants of 1.50–1.45 Ga peri‐Laurentian island arcs to the south built on rifted crustal slivers; (c) 1.45–1.42 Ga mafic dyke swarms to the northwest, linked to an asthenospheric window or back‐arc opening; (d) a major 1.43–1.37 Ga felsic plutonic belt marking the time of accretion to Laurentia; and (e) 1.38–1.35 Ga AMCG complexes suggesting slab‐breakoff and mafic underplating of the lower crust during arc accretion. Differences between Quebecia and continental arcs of the same age on both sides attest to lateral variations in subduction dynamics under Laurentia comparable to the modern‐day Andean system.
Evaluation of hematologic, biochemical, and blood gas variables in stored canine packed red blood cells, and the impact of storage time on blood recipients
Authors: Rodrigues Renata R. , Kayano Caroline Y. , dos Santos Vinícius P. , Moroz Ludmila R. , Fantoni Denise T. , Ambrósio Aline M. 
Published: June 2020

AbstractBackgroundCanine packed red blood cells (pRBCs) can be stored under refrigeration for several days; however, cellular metabolism remains active inside the units, thus producing substances that affect their quality.ObjectivesWe aimed to evaluate hematologic, biochemical, and blood gas variable alterations that occur in canine pRBCs during storage, and their effects on recipient clinicopathologic parameters.MethodsThe study was conducted in two phases. In phase I, 15 pRBC units containing CPDA‐1 were stored for 28 days; samples were collected weekly from the units of days 0 to 28 to measure the packed cell volume (PCV), pH, partial pressure carbon dioxide (PCO2), partial pressure oxygen (PO2), concentrations of lactate and potassium, and the percent hemolysis. In phase II, another 22 canine pRBC units stored for different time periods (maximum of 21 days) were transfused, and the recipients were evaluated before and after transfusion for changes in clinical parameters (heart rate, respiratory rate, systolic arterial pressure, and rectal temperature) and hematologic variables (PCV, lactate and potassium concentrations, pH, PCO2, the ratio of arterial oxygen partial pressure to fractional inspired oxygen [PO2/FiO2] ratio, oxygen saturation [SaO2], base excess, and bicarbonate [HCO3]).ResultsIn the pRBC units, the PCV increased from 70% to 78.33%, the lactate concentration increased 627%, the potassium concentration increased 183%, the percent hemolysis reached 0.69%, and the pH decreased 9% after 28 days. However, the dogs who received transfusions were not negatively affected. There was a significant increase in PCVs, and a significant decrease in heart rates.ConclusionCanine pRBCs undergo hematologic, blood gas, and biochemical alterations during storage; however, the transfusion of pRBCs stored for up to 21 days increased PCVs without causing harm to the dogs.
Influence of Pump Rotation Speed on Hydrodynamic Performance and Stator Blade Surface Pressure Pulsation in Torque Converter
Authors: Liu Boshen , Tan Lu , Li Jin 
Published: June 2020

Abstract
An experimental investigation was performed to characterize the influence of pump rotation speed on the hydrodynamic performance and the associated unsteady pressure on the stator blade pressure-surface in a torque converter. High-resolution miniature transducers were used to obtain the signature of the pressure pulsation at specific surface locations. Results show that the increase of the pump rotation speed can enhance the torque capacity of the stator, leading to a higher torque ratio in the low speed ratio range and an improvement of the highest transmission efficiency. The efficiency increase rate starts to reduce at approximately SR = 0.4, corresponding to where the stator capacity reaches the maximum and exhibits a uniform distribution of the pressure pulsation intensity. The spectral decomposition of the pulsating pressure reveals the existence of two dominating frequencies, which corresponds to the upstream pump turbine interaction and the downstream pump blade passing. Higher pump speeds enhance the pump turbine interaction and results in a more regular pressure pulsation, improving the hydrodynamic performance of the torque converter.
Mechanobiology of Cartilage Impact Via Real-Time Metabolic Imaging
Authors: Walsh Shannon K. , Shelley Joshua C. , Henak Corinne R. 
Published: June 2020

AbstractCartilage loading is important in both structural and biological contexts, with overloading known to cause osteoarthritis (OA). Cellular metabolism, which can be evaluated through the relative measures of glycolysis and oxidative phosphorylation, is important in disease processes across tissues. Details of structural damage coupled with cellular metabolism in cartilage have not been evaluated. Therefore, the aim of this study was to characterize the time- and location-dependent metabolic response to traumatic impact loading in articular cartilage. Cartilage samples from porcine femoral condyles underwent a single traumatic injury that created cracks in most samples. Before and up to 30 min after loading, samples underwent optical metabolic imaging. Optical metabolic imaging measures the fluorescent intensity of byproducts of the two metabolic pathways, flavin adenine dinucleotide for oxidative phosphorylation and nicotinamide adenine dinucleotide ± phosphate for glycolysis, as well as the redox ratio between them. Images were taken at varied distances from the center of the impact. Shortly after impact, fluorescence intensity in both channels decreased, while redox ratio was unchanged. The most dramatic metabolic response was measured closest to the impact center, with suppressed fluorescence in both channels relative to baseline. Redox ratio varied nonlinearly as a function of distance from the impact. Finally, both lower and higher magnitude loading reduced flavin adenine dinucleotide fluorescence, whereas reduced nicotinamide adenine dinucleotide ± phosphate fluorescence was associated only with low strain loads and high contact pressure loads, respectively. In conclusion, this study performed novel analysis of metabolic activity following induction of cartilage damage and demonstrated time-, distance-, and load-dependent response to traumatic impact loading.
Improved Discrete Random Walk Stochastic Model for Simulating Particle Dispersion and Deposition in Inhomogeneous Turbulent Flows
Authors: Mofakham Amir A. , Ahmadi Goodarz 
Published: June 2020

Abstract
The performance of different versions of the discrete random walk models in turbulent flows with nonuniform normal root-mean-square (RMS) velocity fluctuations and turbulence time scales were carefully investigated. The OpenFOAM v2−f low Reynolds number turbulence model was used for evaluating the fully developed streamwise velocity and the wall-normal RMS velocity fluctuations profiles in a turbulent channel flow. The results were then used in an in-house matlab particle tracking code, including the drag and Brownian forces, and the trajectories of randomly injected point-particles with diameters ranging from 10 nm to 30 μm were evaluated under the one-way coupling assumption. The distributions and deposition velocities of fluid-tracer and finite-size particles were evaluated using the conventional-discrete random walk (DRW) model, the modified-DRW model including the velocity gradient drift correction, and the new improved-DRW model including the velocity and time gradient drift terms. It was shown that the conventional-DRW model leads to superfluous migration of fluid-point particles toward the wall and erroneous particle deposition rate. The concentration profiles of tracer particles obtained by using the modified-DRW model still are not uniform. However, it was shown that the new improved-DRW model with the velocity and time scale drift corrections leads to uniform distributions for fluid-point particles and reasonable concentration profiles for finite-size heavy particles. In addition, good agreement was found between the estimated deposition velocities of different size particles by the new improved-DRW model with the available data.
Design Optimization of the Impeller and Volute of a Centrifugal Pump to Improve the Hydraulic Performance and Flow Stability
Authors: Shim Hyeon-Seok , Kim Kwang-Yong 
Published: June 2020

Abstract
Multi-objective design optimization was applied to the impeller and volute of a centrifugal pump using surrogate-based optimization techniques and three-dimensional Reynolds-averaged Navier–Stokes (RANS) analysis. The objective functions used to improve the hydraulic performance and operating stability of the pump were the hydraulic efficiency at the design condition and the flow rate at which the maximum volute pressure recovery coefficient occurs. Three design variables were selected based on the results of a sensitivity analysis: the blade outlet angle, the constants in determining the impeller outlet width, and the cross-sectional area of the volute. Using response surface approximation (RSA), surrogate models were constructed for the objective functions based on numerical results at experimental points obtained by Latin hypercube sampling (LHS). The representative Pareto-optimal solutions obtained by the multi-objective genetic algorithm (MOGA) show enhanced objective function values compared to the baseline design. The results of unsteady calculation show that the flow instability of the centrifugal pump was successfully suppressed by the optimization.
An analysis of International Health Regulations Emergency Committees and Public Health Emergency of International Concern Designations
Authors: Mullen Lucia , Potter Christina , Gostin Lawrence O , Cicero Anita , Nuzzo Jennifer B 
Published: June 2020

IntroductionNine events have been assessed for potential declaration of a Public Health Emergency of International Concern (PHEIC). A PHEIC is defined as an extraordinary event that constitutes a public health risk to other states through international spread and requires a coordinated international response. The WHO Director-General convenes Emergency Committees (ECs) to provide their advice on whether an event constitutes a PHEIC. The EC rationales have been criticised for being non-transparent and contradictory to the International Health Regulations (IHR). This first comprehensive analysis of EC rationale provides recommendations to increase clarity of EC decisions which will strengthen the IHR and WHO’s legitimacy in future outbreaks.Methods66 EC statements were reviewed from nine public health outbreaks of influenza A, Middle East respiratory syndrome coronavirus, polio, Ebola virus disease, Zika, yellow fever and coronavirus disease-2019. Statements were analysed to determine which of the three IHR criteria were noted as contributing towards the EC’s justification on whether to declare a PHEIC and what language was used to explain the decision.ResultsInterpretation of the criteria were often vague and applied inconsistently. ECs often failed to describe and justify which criteria had been satisfied.DiscussionGuidelines must be developed for the standardised interpretation of IHR core criteria. The ECs must clearly identify and justify which criteria have contributed to their rationale for or against PHEIC declaration.ConclusionStriving for more consistency and transparency in EC justifications would benefit future deliberations and provide more understanding and support for the process.
Protocol for a realist review of General Practitioners’ Role in Advancing Practice in Care Homes (GRAPE study)
Authors: Gordon Adam L , Devi Reena , Williams Christopher , Goodman Claire , Sartain Kathleen , Chadborn Neil H 
Published: June 2020

IntroductionOlder people who live in care homes have a high level of need with complex health conditions. In addition to providing medical care to residents, general practitioners (GPs) play a role as gatekeeper for access to services, as well as leadership within healthcare provision. This review will describe how GPs were involved in initiatives to change arrangements of healthcare services in order to improve quality and experience of care.Methods and analysisFollowing RAMESES quality and publication guidelines standards, we will proceed with realist review to develop theories of how GPs work with care home staff to bring about improvements. We identify when improvement in outcomes does not occur and why this may be the case. The first stage will include interviews with GPs to ask their views on improvement in care homes. These interviews will enable development of initial theories and give direction for the literature searches. In the second stage, we will use iterative literature searches to add depth and context to the early theories; databases will include Medline, Embase, CINAHL, PsycINFO and ASSIA. In stage 3, evidence that is judged as rigorous and relevant will be used to test the initial theories, and through the process, refine the theory statements. In the final stage, we will synthesise findings and provide recommendations for practice and policy-making.During the review, we will invite a context expert group to reflect on our findings. This group will have expertise in current trends in primary care and the care home sector both in UK and internationally.Ethics and disseminationThe study was approved by University of Nottingham Faculty of Medicine and Health Sciences Research Ethics Committee: 354-1907. Findings will be shared through stakeholder networks, published in National Institute for Health Research journal and submitted for peer-reviewed journal publication.
The ethics of state-sponsored and clinical promotion of long-acting reversible contraception
Authors: Wale Jeffrey , Rowlands Sam 
Published: June 2020

ObjectivesTo review ethical aspects of the promotion and provision of long-acting reversible contraception (LARC). Specifically, to examine (1) the tension between informational exchange and the active promotion of LARC methods to new and existing contraceptive users by healthcare professionals; and (2) the distinct ethical issues arising from the promotion of LARC methods by state-sponsored actors and healthcare professionals.MethodsNarrative review and ethical analysis.FindingsThere is an ethical difference between raising awareness/informational provision and actively promoting or prioritising specific contraceptive methods. It matters whether the policy choice is made, or the promotional activity about contraception is undertaken, by individual healthcare professionals at a local level or by more remote state-sponsored actors, because the relationship between the promoter and the (potential) contraceptive user is of a different kind. Imposing a dual responsibility upon healthcare professionals for raising awareness/informational exchange and the active promotion of LARC creates an unnecessary tension and barrier for the delivery of patient-centred care.ConclusionsThis review highlights the need for ethical reflection on the central role of the promoting agent and the distinction between facilitating informational awareness and active promotion of LARC. LARC methods should not be prioritised in isolation and without regard to the wider implications of public promotion. A balanced narrative and information-sharing programme that respects the individual interests of each contraceptive user is called for, especially in direct professional/service user relationships. No assumption should be made that user decision-making will necessarily be determined and influenced solely by the relative effectiveness of the contraceptive method.
Integrating and maintaining automated external defibrillators and emergency planning in community sport settings: a qualitative case study
Authors: Fortington Lauren V , Bekker Sheree , Finch Caroline F 
Published: June 2020

IntroductionA voluntary State Government-led programme in Victoria, Australia ‘Defibrillators for Sporting Clubs and Facilities Program’ ran from 2015 to 2019, broadly aimed at increasing access to automated external defibrillators (AEDs), together with a greater number of community members trained for management of medical emergencies. This study aimed to understand whether participating sport clubs/facilities had successfully integrated an AED and medical planning with other club/facility safety practices, 12 months after delivery of the programme.MethodsThis was a qualitative case study of 14 sport clubs/facilities in Victoria, Australia in 2017, underpinned by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. We conducted observational audits of facilities (to locate AED placement, signage and other relevant location-specific factors) and semi-structured, face-to-face interviews with representatives of the clubs/facilities. Interview questions were designed to determine if and how the related, mandated emergency management programme was adapted for the long term (embedding), whether this aligned to ongoing organisational mission (active engagement), and whether or not it was still ongoing 6 months postinitial implementation (sustainability). Data were evaluated using qualitative descriptive methodology. For reporting, descriptive summaries of the audit were combined with interview data to contextualise and visualise the sport club/facility setting and key results.ResultsKey issues identified were accessibility and visibility of the AED, with inadequate signage and challenges identifying an efficient location for access and storage. Most interviewees reported the AED and training were received with no further actions taken towards safety planning or integration with club/facility practice. Several challenges regarding remaining up to date with training and ensuring required routine checks of the AED take place were also raised.ConclusionsThis study identified several challenges for community sport clubs/facilities in the implementation of an AED and medical planning programme, including where to store the AED, how to make its presence known to the community and how to integrate changes alongside other club/facility practices.