bluuebunny/crossref_metadata_2025_split huggingface dataset:
Longitudinal Spending on Endovascular and Open Abdominal Aortic Aneurysm Repair
Authors: Trooboff Spencer W. , Wanken Zachary J. , Gladders Barbara , Columbo Jesse A. , Lurie Jon D. , Goodney Philip P. 
Published: May 2020

Background:
Endovascular repair (EVR) has replaced open surgery as the procedure of choice for patients requiring elective abdominal aortic aneurysm (AAA) repair. Long-term outcomes of the 2 approaches are similar, making the relative cost of caring for these patients over time an important consideration.

Methods and Results:

We linked Medicare claims to Vascular Quality Initiative registry data for patients undergoing elective EVR or open AAA repair from 2004 to 2015. The primary outcome was Medicare’s cumulative disease-related spending, adjusted to 2015 dollars. Disease-related spending included the index operation and associated hospitalization, surveillance imaging, reinterventions (AAA-related and abdominal wall procedures), and all-cause admissions within 90 days. We compared the incidence of disease-related events and cumulative spending at 90 days and annually through 7 years of follow-up. The analytic cohort comprised 6804 EVR patients (median follow-up: 1.85 years; interquartile range: 0.82–3.22 years) and 1889 open repair patients (median follow-up: 2.62 years; interquartile range: 1.13–4.80 years). Spending on index surgery was significantly lower for EVR (median [interquartile range]: $25 924 [$22 280–$32 556] EVR versus $31 442 [$24 669–$40 419] open;
P
<0.001), driven by a lower rate of in-hospital complications (6.6% EVR versus 38.0% open;
P
<0.001). EVR patients underwent more surveillance imaging (1.8 studies per person-year EVR versus 0.7 studies per person-year open;
P
<0.001) and AAA-related reinterventions (4.0 per 100 person-years EVR versus 2.1 per 100 person-years open;
P
=0.041). Open repair patients had higher rates of 90-day readmission (12.9% EVR versus 17.8% open;
P
<0.001) and abdominal wall procedures (0.6 per 100 person-years EVR versus 1.5 per 100 person-years open;
P
<0.001). Overall, EVR patients incurred more disease-related spending in follow-up ($7355 EVR versus $2706 open through 5 years). There was no cumulative difference in disease-related spending between surgical groups by 5 years of follow-up (−$33 EVR [95% CI: −$1543 to $1476]).

Conclusions:
We observed no cumulative difference in disease-related spending on EVR and open repair patients 5 years after surgery. Generalized recommendations about which approach to offer elective AAA patients should not be based on relative cost.
Prevalence of Ipsilateral Nonstenotic Carotid Plaques on Computed Tomography Angiography in Embolic Stroke of Undetermined Source
Authors: Ospel Johanna M. , Singh Nishita , Marko Martha , Almekhlafi Mohammed , Dowlatshahi Dar , Puig Josep , Demchuk Andrew , Coutts Shelagh B. , Hill Michael D. , Menon Bijoy K. , Goyal Mayank 
Published: May 2020

Background and Purpose—
Embolic stroke of undetermined source (ESUS) constitutes a large proportion of acute ischemic stroke. It is crucial to identify possible stroke etiologies in this patient subgroup to individually tailor secondary stroke prevention strategies. This study aimed to assess the prevalence of carotid plaques causing <50% stenosis in ESUS patients on computed tomography angiography and the association of these plaques with ipsilateral strokes.

Methods—
Patients from INTERRSeCT—a multicenter prospective study of patients with acute ischemic stroke—were included in this study if their stroke etiology was not large artery atherosclerosis (>50% stenosis), and neck computed tomography angiography was obtained. Degree of stenosis (<30% versus 30%–50%), maximum plaque thickness, degree of plaque calcification (<50% versus ≥50%), plaque irregularity, ulceration, hypodensity, carotid web, and focal vessel outpouching were assessed for both carotid arteries on computed tomography angiography. Prevalence of carotid plaques with <50% stenosis (nonstenotic plaques), ipsilateral and contralateral to the stroke, in ESUS patients was determined and compared with non-ESUS patients. Features of these plaques with versus without ipsilateral stroke in ESUS patients were compared. Uni- and multivariable logistic regression was performed to determine associations between nonstenotic carotid plaque, plaque characteristics, and ipsilateral stroke in ESUS patients.

Results—

Four hundred forty-six patients were included in the study (median age, 73 years; 218 men), 138 of which were ESUS patients (median age, 70 years; 61 men). Nonstenotic carotid plaques (with <50% stenosis) were present in 54 of 138 (39.1%) ESUS patients. Twelve (8.7%) patients had bilateral carotid plaques. Forty (60.6%) of these plaques were ipsilateral and 26 (39.4%) contralateral to the side of the stroke (
P
=0.004). Nonstenotic carotid plaques were significantly associated with ipsilateral strokes (adjusted odds ratio, 1.83 [95% CI, 1.05–3.18]).

Conclusions—
In patients with ESUS, nonstenotic carotid plaques were significantly more common on the side of the ischemic stroke, suggesting that these plaques could be a potential stroke etiology in patients in whom the ischemic stroke is classified currently as ESUS.
Magnetic Resonance Elastography of Human Hippocampal Subfields: CA3-Dentate Gyrus Viscoelasticity Predicts Relational Memory Accuracy
Authors: Daugherty Ana M. , Schwarb Hillary D. , McGarry Matthew D. J. , Johnson Curtis L. , Cohen Neal J. 
Published: May 2020

Abstract
The hippocampus is necessary for binding and reconstituting information in relational memory. These essential memory functions are supported by the distinct cytoarchitecture of the hippocampal subfields. Magnetic resonance elastography is an emerging tool that provides sensitive estimates of microstructure vis-à-vis tissue mechanical properties. Here, we report the first in vivo study of human hippocampal subfield viscoelastic stiffness and damping ratio. Stiffness describes resistance of a viscoelastic tissue to a stress and is thought to reflect the relative composition of tissue at the microscale; damping ratio describes relative viscous-to-elastic behavior and is thought to generally reflect microstructural organization. Measures from the subiculum (combined with presubiculum and parasubiculum), cornu ammonis (CA) 1–2, and CA3-dentate gyrus (CA3-DG) were collected in a sample of healthy, cognitively normal men (n = 20, age = 18–33 years). In line with known cytoarchitecture, the subiculum demonstrated the lowest damping ratio, followed by CA3-DG and then combined CA1–CA2. Moreover, damping ratio of the CA3-DG—potentially reflective of number of cells and their connections—predicted relational memory accuracy and alone replicated most of the variance in performance that was explained by the whole hippocampus. Stiffness did not differentiate the hippocampal subfields and was unrelated to task performance in this sample. Viscoelasticity measured with magnetic resonance elastography appears to be sensitive to microstructural properties relevant to specific memory function, even in healthy younger adults, and is a promising tool for future studies of hippocampal structure in aging and related diseases.
Opining Beauty Itself in Republic V
Authors: Reshotko Naomi 
Published: May 2020

Abstract
In consoling the lover of sights and sounds at Republic 475e4-479d5, Socrates describes a tripartite distinction among knowledge, doxa, and ignorance. Socrates claims that knowledge is ‘over’ (epi) what-is, doxa is over what is and is-not, and ignorance is over nothing at all. I argue that Plato shows that doxa and ignorance are also related to what-is. While knowledge, doxa, and ignorance interact with different first-degree objects, these three capacities have a common second-degree object: what-is. The fact that Socrates claims that doxa is inferior to knowledge, and ignorance is inferior to doxa, shows that these three capacities have a shared aspiration that doxa and ignorance each fail to fulfill in their own way. Following Plato’s analogy to the senses at 477c1-d1, I use an analogy to the senses to demonstrate Plato’s understanding of the relationship between doxa and what is.
<p><strong>A new species of <em>Blakea</em> (Melastomataceae: Blakeeae) with pendulous flowers from Costa Rica</strong></p>
Authors: MICHELANGELI FABIÁN A. , SANTAMARÍA-AGUILAR DANIEL 
Published: May 2020

We describe Blakea ricardoi (Melastomataceae: Blakeeae), a species known only from the Parque Internacional La Amistad in Costa Rica side. It can be distinguished by the long peduncles up to 6.5 cm long, pendant flowers with green petals and indumentum of roughened trichomes. A key to other species of Blakea with pendulous flowers and connivent petals is provided.
Queensland smoking care in adult acute mental health inpatient units: Supporting practice change
Authors: Plever Sally , McCarthy Irene , Anzolin Melissa , Emmerson Brett , Allan John , Hay Karen 
Published: May 2020

Objective: To review a clinical practice improvement approach to statewide implementation of smoking care in adult acute mental health inpatient units across public mental health services in Queensland. Method: Queensland public mental health services, with adult acute inpatient units, joined a statewide collaborative to work together to increase the routine screening of smoking and delivery of a Smoking Cessation Clinical Pathway brief intervention to identified smokers. Results: Over a 2-year period, statewide improvements were demonstrated in the recording of smoking status (88–97%) and in the provision of a brief smoking cessation intervention to smokers (38–73%). In addition, all individual mental health services increased the delivery of a brief intervention to identified smokers and the recording of smoking status either improved or remained at high levels. Conclusion: Smoking remains an ongoing challenge for mental health services and one of the most important physical health issues for people living with a mental illness. The ability to implement statewide smoking care in public mental health services is an important step in shifting poor health outcomes. The clinical practice change approach adopted in Queensland has demonstrated encouraging outcomes in improving the delivery of smoking care that has been sustained over a 2-year period.
Low vision evaluation training in Nigeria: Time to improve human resource in developing countries
Authors: Adio Adedayo , Bekibele Charles , Lewerenz David , Lawrence Linda 
Published: May 2020

Routine low vision care is a rarity in Nigeria and in most developing countries. The reason for the widespread apathy and lack of human resource development in this area is myriad. The Center for Vision, The Lens Rehabilitation Center for the Blind located in Portharcourt, Nigeria sought to correct this by working to revive interest and thus improve human resource available through provision of quality hands on training with world renowned scholars and faculty . Records of all who registered for two separate Low vision training courses at TLEC re(Hab) Nigeria between 2018 and 2019 were audited. Number of courses taught, participating faculty, gender and age distribution of trainees, previous training accessed by trainees, pretest scores and post test scores were compared. Numbers actually practicing low vision after 3 months of conclusion of the training and outcome of feedback questionnaires were also evaluated using a simple calculator. Fifty eyecare workers (42 in one day training and 8 over 2 weeks) with mean age of 33.6years and gender ratio of 1:2.3 were trained in two batches. There were 26 faculty available to teach both online and physically. Previous exposure to training was absent in the one day group while the two week group had just one. The courses taught were mainly on low vision evaluation(50% in the one day , 44.29% in the 2 week course) with additional courses on early intervention, rehabilitation of the blind and evaluation in special kids with additional problems. The hands on sessions were significantly better in the two week training with a third of the periods available dedicated to stepwise approach in low vision evaluation. A comparison of pretest and post test scores showed there was an exponential improvement in understanding between the one day and the two week training of up to 50 % increase which reflected in the numbers able to refer appropriately and evaluate low vision patients in the country when the one day and 2 week groups were compared. There was a general consensus that the two week training was more preferred. Empowerment with relevant low vision charts and device equipment significantly improved the numbers still practicing 3 months after training ended when compared with those who were not given any by as much as 400%. In conclusion, low vision needs dedicated and well trained staff who compulsorily need to be empowered to function with provision of required equipment especially in developing countries where the majority of the need for low vision aids and assistive devices appear to be.
Non-specific effects of acupuncture and sham acupuncture in clinical trials from the patient’s perspective: a systematic review of qualitative evidence
Authors: Ho Robin ST , Wong Charlene HL , Wu Justin CY , Wong Samuel YS , Chung Vincent CH 
Published: May 2020

Background Previous clinical trials have demonstrated that both acupuncture and sham acupuncture exert significant, non-specific effects on treatment outcomes when compared to no-treatment controls. A recently developed framework (mechanisms in orthodox and complementary and alternative medicine—MOCAM) suggests that the non-specific effects of acupuncture originate from multiple domains (e.g. patient characteristics, acupuncturist skill/technique, the patient–acupuncturist relationship, and the acupuncture environment). However, it remains to be determined precisely how these domains influence the non-specific effects of treatment among patients receiving acupuncture and sham acupuncture in clinical trials. Therefore, we conducted a systematic review to synthesize existing qualitative evidence on how trial participants randomized to acupuncture and sham acupuncture groups experience non-specific effects, regardless of the types of medical condition investigated. Methods This systematic review included primary qualitative studies embedded in randomized controlled trials designed to investigate acupuncture or sham acupuncture interventions. Eligible studies published in English were derived from a search of five international databases. The methodological quality of included studies was evaluated using the Critical Appraisal Skills Programme (CASP) tool. Using a framework synthesis approach, the identified MOCAM framework was adapted based on the synthesis of the available qualitative evidence. Results A total of 20 studies of high methodological quality were included. Our proposed model indicated that the effects of acupuncture may be increased by maintaining a professional status, applying a holistic treatment approach, practicing empathy, and providing patients with an appropriate explanation of the theory behind acupuncture and sham acupuncture. From the patient’s perspective, the efficacy of treatment can be increased by following the lifestyle modification advice provided by acupuncturists, maintaining a positive attitude toward treatment efficacy, actively engaging with acupuncturists during consultation, and making behavioral changes based on experience gained during the trial. Conclusion The results of this study may provide a basis for improving and standardizing key components of non-specific effects in acupuncture treatment, and for improving the isolation of specific effects in future clinical trials involving acupuncture and sham acupuncture.
Elements of assisted bodily care: Ethical aspects
Authors: Holmberg Bodil , Hellström Ingrid , Österlind Jane 
Published: May 2020

Background: Many frail older persons who die in Swedish nursing homes need assisted bodily care. They must surrender their bodies to the authority of assistant nurses, which may affect their autonomy and dignity of identity. While assistant nurses claim to support older persons’ wishes, older persons claim they have to adapt to assistant nurses' routines. The provider–receiver incongruence revealed here warrants investigation. Aim: To describe the elements of assisted bodily care, as performed in a nursing home. Research design: Data were collected through thirty-nine observations of assisted bodily care, analyzed with qualitative content analysis. Participants and research context: Seventeen older persons and twenty-two assistant nurses from a Swedish nursing home. Ethical considerations: The research was conducted in line with the Declaration of Helsinki, further approved by the regional ethics committee. Findings: Findings show that assisted bodily care consists of assistant nurses’ practical work, performed at a high tempo. Assistant nurses still attempt to adapt this work to the older persons’ wishes for self-determination, taking into account their day-to-day state of health. In spite of time pressure and occasional interruptions, there is room for consideration and affection in assisted bodily care. Discussion: Assistant nurses try to promote older persons’ dignity of identity, but sometimes fail, possibly due to lack of time. They nevertheless seem to know the older persons well enough to adapt the assisted bodily care according to their preferences and to support self-determination. This indicates that openness to older persons’ lifeworlds may be more important than the amount of time available. Conclusion: Nursing home contexts might benefit from adopting a person-centered palliative care perspective, highlighting the value of relationships and shared decision-making. If so, older persons and assisted nurses could agree on practices and goals in assisted bodily care beforehand. Such routines may be time-saving and beneficial to all.
Clinical Characteristics, Management Strategies, and In-Hospital Outcomes of Acute Coronary Syndrome in a Low Socioeconomic Status Cohort: An Observational Study From Urban India
Authors: Sidhu Navdeep Singh , Rangaiah Sunil Kumar Kondethimmannahally , Ramesh Dwarikaprasad , Veerappa Kumaraswamy , Manjunath Cholenahally Nanjappa 
Published: May 2020

Background: Coronary artery disease is the leading cause of mortality in India. There is scarcity of data on demographic profile and outcomes of acute coronary syndrome (ACS) in low socioeconomic status (SES) population of India. Objectives: This study was undertaken to determine the clinical presentation, management strategies, and in-hospital outcomes of ACS in low SES population. Methods: We conducted 1-year prospective observational cohort study of ACS patients admitted at Employees State Insurance Corporation unit of our tertiary care cardiac center. Clinical parameters, management strategies, and in-hospital outcomes of 621 patients enrolled during the study period from February 2015 to January 2016 were studied. Results: Mean age of patients was 56.06 ± 11.29 years. Majority (62%) of the patients had ST elevation myocardial infarction (STEMI), whereas Non-ST elevation acute coronary syndrome (NSTE-ACS) was seen in 38% of the patients. Median time from symptom onset to hospital admission was 285 min with wide range from 105 to 1765 min. Coronary angiography was performed in 81% of patient population. Single-vessel disease (SVD) was the most common pattern (seen in 43.3%) of coronary artery involvement with left anterior descending coronary artery (LAD) being the most frequently involved vessel (62.8%). Pharmaco-invasive approach was the preferred strategy. Overall percutaneous coronary intervention (PCI) rates were 59.1% (62.1% in STEMI and 54.2% in NSTE-ACS). Overall in-hospital mortality was 3.2%, being significantly higher in STEMI (4.2%) as compared with NSTE-ACS (1.7%). Conclusions: With implementation of evidence-based pharmacotherapy and interventions, outcomes comparable with developed countries can be achieved even in low SES populations of developing world.
Lifestyle interventions after ablation for atrial fibrillation: a systematic review
Authors: Larsen Rasmus Tolstrup , Gottliebsen Christian Ryholm , Wood Kathryn A , Risom Signe Stelling 
Published: May 2020

Background Risk factors of atrial fibrillation include diabetes, obesity and physical inactivity. Positive effects such as decreased atrial fibrillation burden have been reported for atrial fibrillation patients who have participated in lifestyle changing interventions after atrial fibrillation ablation treatment. Aim The aim of this study was to assess the evidence on the benefits and harms of lifestyle and risk factor management interventions in patients undergoing atrial fibrillation ablation. Method Our systematic review searched MEDLINE, EMBASE, CINAHL, Psychinfo, Web of Science and CENTRAL using key terms related to atrial fibrillation and lifestyle, including interventional trials. The primary outcomes were mortality and serious adverse events. Random effects meta-analyses of outcomes were conducted when appropriate. Results Two randomised controlled trials and two non-randomised interventional trials with a total of 498 patients were included. Six primary events were reported for the intervention groups and five events for the control groups (relative risk of 1.03, 95% confidence interval (CI) 0.3 to 3.1, I2 0%, P = 0.537). Effects in favour of the intervention groups were found for atrial fibrillation frequency (0.82 points, 95% CI –1.60 to –0.03, I2 87.3%, P = 0.005), atrial fibrillation duration (–0.76 points, 95% CI –1.64 to 0.12, I2 89.1%, P = 0.002) and body mass index (–5.40 kg/m2, 95% CI 6.22 to –2.57, I2 83.9%, P = 0.013). Risk of bias in the four studies was judged to be low to moderate. Conclusion Lifestyle changing interventions seem to have a positive effect on outcomes relevant to patients undergoing atrial fibrillation ablation, but the included studies were small, interventions were inhomogeneous, and the quality of evidence was low to moderate. More studies are warranted.