bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term trajectories of chronic musculoskeletal pain: a 21-year prospective cohort latent class analysis
Authors: Aili Katarina , Campbell Paul , Michaleff Zoe A. , Strauss Vicky Y. , Jordan Kelvin P. , Bremander Ann , Croft Peter , Bergman Stefan 
Published: November 2020

Abstract
Our knowledge of the prevalence, impact, and outcomes of chronic pain in the general population is predominantly based on studies over relatively short periods of time. The aim of this study was to identify and describe trajectories of the chronic pain status over a period of 21 years. Self-reported population data (n = 1858) from 5 timepoints were analyzed. Pain was categorized by: no chronic pain (NCP), chronic regional pain (CRP), and chronic widespread pain (CWP). Latent class growth analysis was performed for identification of trajectories and logistic regression analysis for identification of predictors for pain prognosis. Five trajectories were identified: (1) persistent NCP (57%), (2) migrating from NCP to CRP or CWP (5%), (3) persistent CRP or migration between CRP and NCP (22%), (4) migration from CRP to CWP (10%), and (5) persistent CWP (6%). Age, sleeping problems, poor vitality, and physical function at baseline were associated with pain progression from NCP. Female gender, seeking care for pain, lack of social support, poor physical function, vitality, and mental health predicted poor pain prognosis among those with CRP. In conclusion, chronic pain was common in the population including 6% reporting persistent CWP, although the majority persistently reported NCP. Most people had stable pain status, but some had ongoing change in pain status over time including people who improved from chronic pain. It was possible to identify clinically relevant factors, characterizing trajectories of chronic pain development, that can be useful for identifying individuals at risk and potential targets for intervention.
Screening and diagnostic tools for complex regional pain syndrome: a systematic review
Authors: Mesaroli Giulia , Hundert Amos , Birnie Kathryn A. , Campbell Fiona , Stinson Jennifer 
Published: November 2020

Abstract
Complex regional pain syndrome (CRPS) is a severely painful condition that presents with a constellation of symptoms. The understanding of the pathophysiology of CRPS has evolved over time, as have the diagnostic criteria. Our primary objective was to identify screening and diagnostic tools for CRPS and summarize their feasibility, measurement properties, and study quality. A secondary objective was to identify screening and diagnostic tools used for CRPS in pediatric populations (0-21 years of age). A systematic review of English articles in electronic databases (PsycINFO, MEDLINE, Embase, CINAHL, CENTRAL, and Web of Science) was conducted with the aid of a librarian in November 2018 and updated in July 2020. Studies were included if the tool was a screening or diagnostic tool, the tool included self-report or physical examination, and the primary objective of the study was to evaluate the measurement properties or feasibility of use. For each study, data were extracted for quality indicators using the QUADAS-2 tool. No screening tools were identified. Four diagnostic tools were identified: the Veldman criteria, International Association for the Study of Pain criteria, Budapest Criteria, and Budapest Research Criteria. There are no diagnostic tools validated for use in pediatric CRPS. Because there are no extant screening tools for CRPS, all people with suspected disease should undergo rapid diagnostic assessment by a clinician. For adults, the Budapest Criteria are the preferred diagnostic tool. Future research is recommended to develop a diagnostic tool for pediatric populations and screening tools for both pediatric and adults.
Performance Characteristics, Intra‐ and Inter‐operator Agreement of Transient Elastography in Pediatric Nonalcoholic Fatty Liver Disease
Authors: Mandelia Chetan , Kabbany Mohammad Nasser , Worley Sarah , Conjeevaram Selvakumar Praveen Kumar 
Published: November 2020

ABSTRACTBackground and Aims:Transient elastography (TE) is a valuable tool in assessment of hepatic steatosis and fibrosis using liver stiffness measurement (LSM) and controlled attenuation parameter (CAP), respectively. Although widely used in adults, little is known about performance characteristics and reproducibility of TE (using Fibroscan device) in evaluation of pediatric nonalcoholic fatty liver disease (NAFLD).Methods:We prospectively recruited children with NAFLD. Three consecutive Fibroscan examinations were performed during the same visit—twice by a single expert operator and once by a different novice operator. Intra and inter‐operator agreement was calculated using concordance correlation coefficient (CCC). Failure was defined as inability to obtain 10 valid measurements and examination was considered unreliable if LSM interquartile range/median was greater 30%.Results:Fifty‐one children (34 boys; median age 15 years) were recruited. Failure rates for expert and novice operator were 10% (5/51) and 12% (6/51) while unreliable readings were obtained in 2% (1/46) and 4% (2/45) of patients, respectively. Patients with failed/unreliable measurements were significantly more obese (median BMI 46.2 vs 33.1 kg/m2, P = 0.002) compared with those with reliable measurements. The intra‐operator agreement was almost perfect for LSM and substantial for CAP values (CCC = 0.85 and 0.73, respectively). Inter‐operator agreement was substantial for LSM and moderate for CAP values (CCC = 0.76 and 0.58, respectively). The inter‐operator agreement in LSM did not vary significantly over time but showed an inverse correlation with BMI and CAP.Conclusion:Our study demonstrated that use of TE in assessment of hepatic fibrosis and steatosis in children with NAFLD is highly reliable with low failure rate and highly reproducible with high intra‐ and inter‐operator reproducibility.
Use of a prospective risk analysis method to improve the safety of healthcare workers in oncology hospitals during the COVID-19 spread among cancer patients
Authors: Ouasrhir Abdelali , Rabie Rahhali , Boukhatem Noureddine 
Published: November 2020

Abstract

Background:
Because of their vulnerability, cancer patients were exposed to viral infections and especially by the spread of the COVID-19, the coronavirus pandemic. According to published scientific data, the coronavirus was spread by sneezing, coughing, or the contact of the eyes, nose, and mouth through contaminated spaces. For these reasons, the oncology center's staff needs more protection and more precaution. A multidisciplinary hospital team was assembled to define critical failures linked to cancer patient process in hospital and proposed different actions to secure them and improve this process.

Methods:
According to a risk management tool (Failures Modes Effect and Criticality Analysis), the cancer patient process was mapped in many steps. During the videoconference brainstorming, many ideas were expressed and were classified into an Ishikawa diagram. The criticality indices were calculated from the severity, the occurrence, and the detection probability.

Results:
The cancer patient process has been described; 20 failures have been identified with 8029 points of the sum of critical indices. The new organization of the cancer patient process, the program of training of administrative staff and security agents of hospitals, wearing the protective resources were reduced to the criticality index of 6615 points, a mean of factor reduction of 1291, and the standard deviation was 5007.75.

Conclusion:
Modification of cancer patient process in oncology center resulted in an important risk reduction as shown by risk analysis. Our study illustrates the usefulness of risk analysis methods in the healthcare system. A systematic use of risk analysis was needed to improve the safety of high-risk activities in healthcare processes.
When Is Primary Metacarpal Corrective Osteotomy Recommended in Patients with Flatt Type IV Radial Polydactyly?
Authors: Hong Seok Woo , Kim Jihyeung , Oh Sohee , Lee Min Ho , Baek Goo Hyun 
Published: November 2020

Background:
The aim of this study was to determine when primary metacarpal corrective osteotomy is recommended in patients with Flatt type IV radial polydactyly.

Methods:
A total of 78 patients with Flatt type IV radial polydactyly were included. The authors performed metacarpal osteotomy if the angulation of the metacarpophalangeal joint was not correctable by the intraoperative radial stress test. The authors measured the metacarpal deviation angle of the thumb in simple posteroanterior radiographs. The clinical outcomes were assessed using Japanese Society for Surgery of the Hand evaluation total score and the metacarpal deviation angle correction angle. These outcomes were compared between the patients who underwent metacarpal osteotomy and those who did not. Of the patients who did not undergo metacarpal osteotomy, the relationships between preoperative metacarpal deviation angle and the metacarpal deviation angle correction angle were formulated using segmented linear regression analysis.

Results:
There were no significant differences in the demographic features and the value of preoperative metacarpal deviation angle between the two groups. However, the metacarpal deviation angle correction angle and Japanese Society for Surgery of the Hand evaluation total score were significantly higher in the patients who underwent metacarpal osteotomy. The segmented linear regression analysis demonstrated a breakpoint, indicating that the soft-tissue procedure alone does not sufficiently correct the metacarpal deviation angle. For the postoperative metacarpal deviation angle to be 5 degrees, the preoperative metacarpal deviation angle was calculated as 10.8 degrees.

Conclusion:
If the preoperative metacarpal deviation angle is greater than 10.8 degrees, metacarpal osteotomy can be considered even in patients with correctable metacarpophalangeal joint by intraoperative radial stress test.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
A Roadmap for Navigating Occupational Exposures for Surgeons: A Special Consideration for the Pregnant Surgeon
Authors: Landford Wilmina N. , Stewart Talia , Abousy Mya , Ngaage Ledibabari M. , Kambouris Adrienne , Slezak Sheri 
Published: November 2020

Summary:
Surgeons are exposed to occupational hazards daily. Risks include chemical, biological, and physical hazards that place providers at risk of serious harm. Departmental policies or written guides to help pregnant surgeons navigate the hospital are lacking. In response to the scarcity in the literature, the authors have summarized current guidelines and recommendations to aid surgeons in making an informed decision. In addition, the authors present a brief narrative of the impact of these exposures during pregnancy and methods of transmission and, where relevant, include specialties that are at risk of these exposures.
Lean Management and Breakthrough Performance Improvement in Health Care
Authors: Ahn Christie , Rundall Thomas G. , Shortell Stephen M. , Blodgett Janet C. , Reponen Elina 
Published: November 2020

Background and Objectives:
Lean management in health care organizations attempts to empower staff to generate continuous improvement through incremental but regular improvements in work processes. However, because of the increasing pressure on health care organizations to substantially improve quality of care and patient outcomes while containing costs in the relatively short term, many health care leaders are looking for ways to achieve large breakthrough improvements in their organization's performance. The objective of this research is to understand whether and how Lean management can be used to achieve breakthrough improvements in performance.

Methods:
This study used grounded theory and content analysis of in-depth, semistructured interviews with 10 nationally recognized experts in the use of Lean management in health care organizations. The 10 participants constitute a purposive sample of experts with in-depth understanding of the strengths and limitations of Lean management in health care organizations.

Results:
Two out of 10 participants defined breakthrough improvement as a major change in a performance metric; 2 participants defined it as a fundamental redesign in a process or service; the remaining 6 participants defined breakthrough improvement as having both these characteristics. The extent to which participants believed Lean was an effective means for achieving breakthrough improvement in performance was related to how they defined breakthrough improvement. The 2 participants who defined breakthrough improvement as a significant change in a performance metric believed Lean methods alone were sufficient. The 2 participants who defined breakthrough improvement to be a fundamental redesign tended not to view Lean alone as an effective approach. Rather, they, and the 6 participants who defined breakthrough improvement as having both change-in-metric and process redesign characteristics, viewed human-centered design thinking as the primary or important complementary approach to achieving breakthrough improvement. Participants identified resources, culture change, and leadership commitment beyond what would be required to achieve incremental improvement as the main facilitators and barriers to achieving breakthrough improvements.

Conclusion:
This research reveals some differences in experts' definitions of breakthrough improvement, and illuminates the value of human-centered design thinking, alone or as a complement to Lean management, in achieving breakthrough improvement in health care organizations. Most of our expert participants agreed that supplementing Lean management methods with the contributions of innovation design and investing significant resources, strengthening the organizational culture to support the necessary changes, and providing stronger leadership commitment to the effort are important facilitators for achieving breakthroughs in organizational performance.
Superdeterministic hidden-variables models II: conspiracy
Authors: Sen Indrajit , Valentini Antony 
Published: November 2020

We prove that superdeterministic models of quantum mechanics are conspiratorial in a mathematically well-defined sense, by further development of the ideas presented in a previous article

A

. We consider a Bell scenario where, in each run and at each wing, the experimenter chooses one of
N
devices to determine the local measurement setting. We prove, without assuming any features of quantum statistics, that superdeterministic models of this scenario must have a finely tuned distribution of hidden variables. Specifically, fine-tuning is required so that the measurement statistics depend on the measurement settings but not on the details of how the settings are chosen. We quantify this as the overhead fine-tuning
F
of the model, and show that
F
> 0 (corresponding to ‘fine-tuned’) for any
N
> 1. The notion of fine-tuning assumes that arbitrary (‘non-equilibrium’) hidden-variables distributions are possible in principle. We also show how to quantify superdeterministic conspiracy without using non-equilibrium. This second approach is based on the fact that superdeterministic correlations can mimic actual signalling. We argue that an analogous situation occurs in equilibrium where, for every run, the devices that the hidden variables are correlated with are coincidentally the same as the devices in fact used. This results in extremely large superdeterministic correlations, which we quantify as a drop of an appropriately defined formal entropy. Non-local and retrocausal models turn out to be non-conspiratorial according to both approaches.
Phycobilins as potent food bioactive broad-spectrum inhibitor compounds against Mproand PLproof SARS-CoV-2 and other coronaviruses: A preliminary Study
Authors: Pendyala Brahmaiah , Patras Ankit , Dash Chandravanu 
Published: November 2020

AbstractIn the twenty first century, we have witnessed three corona virus outbreaks; SARS in 2003, MERS in 2012 and ongoing pandemic COVID-19. To prevent outbreaks by novel mutant strains, we need broad-spectrum antiviral agents that are effective against wide array of coronaviruses. In this study, we scientifically investigated potent food bioactive broad-spectrum antiviral compounds by targeting Mproand PLproproteases of CoVs usingin silicoandin vitroapproaches. The results revealed that phycocyanobilin (PCB) showed potential inhibitor activity against both proteases. PCB had best binding affinity to Mproand PLprowith IC50values of 71 μm and 62 μm, respectively. In addition,in silicostudies of Mproand PLproenzymes of other human and animal CoVs indicated broad spectrum inhibitor activity of the PCB. Like PCB, other phycobilins such as phycourobilin (PUB), Phycoerythrobilin (PEB) and Phycoviolobilin (PVB) showed similar binding affinity to SARS-CoV-2 Mproand PLpro
Development and validation of risk scores for all-cause mortality for the purposes of a smartphone-based ‘general health score’ application: a prospective cohort study using the UK Biobank
Authors: Clift Ashley K. , Lannou Erwann Le , Tighe Christian P. , Shah Sachin S. , Beatty Matthew , Hyvärinen Arsi , Lane Stephen J. , Strauss Tamir , Dunn Devin D. , Lu Jiahe , Aral Mert , Vahdat Dan , Ponzo Sonia , Plans David 
Published: November 2020

AbstractBackgroundEven though established links exist between individuals behaviours and potentially adverse health outcomes, to date either univariate, simpler models or multivariate, yet difficult to employ ones, have been developed. Such models are unlikely to be successful at capturing the wider determinants of health in the broader population. Hence, there is a need for a multidimensional, yet widely employable and accessible, way to obtain a comprehensive health metric.ObjectiveTo develop and validate a novel, easily interpretable points-based health score (“C-Score”) derived from metrics measurable using smartphone components, and iterations thereof that utilise statistical modelling and machine learning approaches.MethodsComprehensive literature review to identify suitable predictor variables for inclusion in a first iteration points-based model. This was followed by a prospective cohort study in a UK Biobank population for the purposes of validating the C-Score, and developing and comparatively validating variations of the score using statistical/machine learning models to assess the balance between expediency and ease of interpretability versus model complexity. Primary and secondary outcome measures: Discrimination of a points-based score for all-cause mortality within 10 years (Harrell’s c-statistic). Discrimination and calibration of Cox proportional hazards models and machine learning models that incorporate C-Score values (or raw data inputs) and other predictors to predict risk of all-cause mortality within 10 years.ResultsThe cohort comprised 420,560 individuals. During a cohort follow-up of 4,526,452 person-years, there were 16,188 deaths from any cause (3.85%). The points-based model had good discrimination (c-statistic = 0.66). There was a 31% relative reduction in risk of all-cause mortality per decile of increasing C-Score (hazard ratio: 0.69, 95% CI: 0.663 to 0.675). A Cox model integrating age and C-Score had improved discrimination (8% percentage points, c-statistic = 0.74) and good calibration. Machine learning approaches did not offer improved discrimination over statistical modelling.ConclusionsThe novel health metric (‘C-Score’) has good predictive capabilities for all-cause mortality within 10 years. Embedding C-Score within a smartphone application may represent a useful tool for democratised, individualised health risk prediction. A simple Cox model using C-Score and age optimally balances parsimony and accuracy of risk predictions and could be used to produce absolute risk estimations for application users.
Probiotics-induced changes in gut microbial composition and its effects on cognitive performance after stress
Authors: Bloemendaal Mirjam , Szopinska-Tokov Joanna , Belzer Clara , Boverhoff David , Papalini Silvia , Michels Franziska , van Hemert Saskia , Vasquez Alejandro Arias , Aarts Esther 
Published: November 2020

AbstractStress negatively affects cognitive performance. Probiotics remediate somatic and behavioral stress responses, hypothetically by acting on the gut microbiota. Here, we assessed gut microbial alterations after 28-days supplementation of multi-strain probiotics (EcologicBarrier consisting of Lactobacilli, Lactococci and Bifidobacteria in healthy, female subjects (probiotics group n=27, placebo group n=29). In an identical pre- and post-session, subjects performed a working memory task before and after an acute stress intervention. One-month supplementation of probiotics changed the gut microbial community (within probiotics group Pweighted unifrac=0.008). This change was driven by a nominal increase in eight genera in the probiotics group relative to the placebo group: Butyricimonas, Parabacteroides, Alistipes, Christensenellaceae_R-7_group, Family_XIII_AD3011_group, Ruminococcaceae_UCG-003, Ruminococcaceae_UCG-005 and Ruminococcaceae_UCG-010. Of these, the probiotics-induced change in genus Ruminococcaceae_UCG-003 was significantly associated with probiotics’ effect on stress-induced working memory changes (rspearman(27) = 0.565; pFDR = 0.014) in the probiotics group only and independent of potential confounders (i.e., age, BMI, and baseline dietary fibre intake). That is, subjects with a higher increase in Ruminococcaceae_UCG-003 abundance after probiotics were also more protected from negative effects of stress on working memory after probiotic supplementation. The bacterial taxa showing an increase in relative abundance in the probiotics group are plant fibre degrading bacteria and produce short-chain fatty acids that are known for their beneficial effect on gut and brain health, e.g. maintaining intestinal- and blood-brain-barrier integrity. This study shows that gut microbial alterations, modulated through probiotics use, are related to improved cognitive performance in acute stress circumstances.