bluuebunny/crossref_metadata_2025_split huggingface dataset:
MAPPinfo, mapping quality of health information: study protocol for a validation study of an assessment instrument
Authors: Kasper Jürgen , Lühnen Julia , Hinneburg Jana , Siebenhofer Andrea , Posch Nicole , Berger-Höger Birte , Grafe Alexander , Keppler Jan , Steckelberg A 
Published: November 2020

IntroductionHealth information is a prerequisite of informed decision-making. Criteria for development, content and presentation have recently been published in a corresponding guideline. Within a systematic search, 27 relevant checklists were identified, none of them, however, complying with the guideline or providing reasonably operationalised measurement items. Therefore, a draft of a checklist with 19 criteria was drafted. The current study aims at developing and validating this measure of quality.Methods and analysisThe validation design consists of five single studies to be conducted at the University of Halle-Wittenberg/Germany and Graz/Austria. (1) Achieving content validity through expert reviews of the first draft, (2) achieving feasibility using ‘think aloud’ in piloting with untrained users, (3) pretesting the instrument applied to health information materials without use of secondary sources: determining inter-rater reliability and criterion validity, (4) determining construct validity using information on proceedings and methods in the development process provided by the developers and (5) determining divergent validity in comparison with the Ensuring Quality Information for Patients (EQUIP) (expanded) Scale. The substudies will use varying samples of experts, students and developers and will apply the instrument to materials of various domains. Sample sizes will be adjusted to the particular research designs and questions. Analyses will employ qualitative methods, such as content analyses and discourse within the expert panel, and correlation-based methods both for determining inter-rater reliability and validity.Ethics and disseminationThe project is approved by the ethics committee of the Martin Luther University Halle-Wittenberg (approval number: 2019 115). Results will be published, and the instrument made accessible on public health platforms. It is meant to become a certification standard. MAPPinfo can be used as a screening instrument without training or secondary sources. Although developed in the German language, the instrument will be applicable also in other languages.Trial registration numberAsPredected22546; date of registration: 24 July 2019.Protocol versionJuly 2020.
Mindfulness-based cognitive therapy experiences in youth with inflammatory bowel disease and depression: findings from a mixed methods qualitative study
Authors: Ewais Tatjana , Begun Jake , Kenny Maura , Headey Alan , Tefay Merilyn , Kisely Steve 
Published: November 2020

ObjectivesMindfulness-based cognitive therapy (MBCT) is effective in treating psychosocial comorbidities in inflammatory bowel disease (IBD); however, there have been no qualitative studies of MBCT experiences among youth with IBD. We aimed to examine the experiences of youth with IBD and depression who completed an adapted MBCT group programme, and the impact of common psychotherapy and group factors.DesignThis mixed method qualitative study, nested within a randomised controlled trial (RCT) of MBCT for youth with IBD, employed thematic analysis of qualitative data from three focus groups and open-ended survey questions.SettingThe study was conducted in the outpatient department of a tertiary hospital for young adults in Brisbane, Australia.ParticipantsOut of sixty-four adolescents and young adults recruited to the RCT of MBCT for youth with IBD and depression, 29 completed the MBCT evaluation survey and 19 attended the focus groups.ResultsFour key themes emerged: ‘connectedness and shared understanding’, ‘growing in wisdom’, ‘therapeutic alliance’ and ‘barriers to mindfulness practice’. Participants described MBCT experiences as healing and transformative with the themes of connectedness, growing in wisdom and therapeutic alliance laying the foundation for therapeutic change. Main barriers included fatigue, depression, time and travel constraints.ConclusionsThe study identified key themes facilitating the process of therapeutic change within the MBCT programme for youth with IBD and elucidated common and group psychotherapy factors underlying the key themes. Participants perceived connecting with peers as essential for learning mindfulness skills which in turn strengthened the connection. Study findings will facilitate interpretation of the results of the RCT of MBCT in youth with IBD and inform the design of future studies of MBCT in this cohort.Trial registration numberACTRN12617000876392; Results.
Controlled observational study and economic evaluation of the effect of city-centre night-time alcohol intoxication management services on the emergency care system compared with usual care
Authors: Moore Simon , Young Tracey , Irving Andy , Goodacre Steve , Brennan Alan , Amos Yvette 
Published: November 2020

BackgroundAlcohol intoxication management services (AIMS) provide an alternative care pathway for alcohol-intoxicated adults otherwise requiring emergency department (ED) services and at times of high incidence. We estimate the effectiveness and cost-effectiveness of AIMS on ED attendance rates with ED and ambulance service performance indicators as secondary outcomes.MethodsA controlled longitudinal retrospective observational study in English and Welsh towns, six with AIMS and six without. Control and intervention cities were matched by sociodemographic characteristics. The primary outcome was ED attendance rate per night, secondary analyses explored hospital admission rates and ambulance response times. Interrupted time series analyses compared control and matched intervention sites pre-AIMS and post-AIMS. Cost-effectiveness analyses compared the component costs of AIMS to usual care before with results presented from the National Health Service and social care prospective. The number of diversions away from ED required for a service to be cost neutral was determined.ResultsAnalyses found considerable variation across sites, only one service was associated with a significant reduction in ED attendances (−4.89, p<0.01). The services offered by AIMS varied. On average AIMS had 7.57 (mean minimum=1.33, SD=1.37 to mean maximum=24.66, SD=12.58) in attendance per session, below the 11.02 diversions away from ED at which services would be expected to be cost neutral.ConclusionsAIMSs have variable effects on the emergency care system, reflecting variable structures and processes, but may be associated with modest reductions in the burden on ED and ambulance services. The more expensive model, supported by the ED, was the only configuration likely to divert patients away from ED. AIMS should be regarded as fledgling services that require further work to realise benefit.Trial registration numberISRCTN63096364.
Trainee burnout: when does the fire start?
Authors: Robinson David Bryan Thomas , James Osian Penri , Hopkins Luke , Brown Chris , Powell Arfon , Abdelrahman Tarig , Egan Richard John , Lewis Wyn 
Published: November 2020

AbstractPurpose of the studyBurnout is an increasingly recognised phenomenon in acute healthcare specialities and associated with depersonalisation, ill health and training programme attrition. This study aimed to quantify contributory physiological variables that may indicate stress in newly qualified doctors.Study designPost Graduate Year 1 doctors (n=13, 7 f, 6 m) were fitted with a VivaLNK wellness device during four prior induction days, followed by their first 14 days work as qualified doctors. Minute-by-minute Heart Rate (HR), Respiratory Rate (RR), and Stress Index (SI) data were correlated with Maslach Burnout Inventories, Short Grit Scales (SGS) and clinical rota duties: Induction vs Normal Working-Day (NWD) versus On-call shift.ResultsIn a total 125 recorded shift episodes, on comparing Induction versus NWD versus On-call shift work, no variation was observed in HR above baseline (25.47 vs 27.14 vs 24.34, p=0.240), RR above baseline (2.21 vs 1.86 vs 1.54, p=0.126) or SI (32.98 vs 38.02 vs 35.47, p=0.449). However, analysis of participant-specific temporal SIs correlated with shift-related clinical duties; that is, study participants who were most stressed during a NWD, were also more stressed during Induction (R2 0.442, p=0.026), and also during On-call shifts (R2 0.564, p=0.012). Higher SGS scores were inversely related to lower SIs (coefficient −32.52, 95% CI −45.881 to 19.154, p=0.001).ConclusionStress and burnout stimulus appear to start on day one of induction for susceptible PGY1 doctors, and continues into front-line clinical work irrespective of shift pattern. Short Grit Scale questionnaires appear an effective tool to facilitate targeted stress countermeasures.
Accuracy of plain radiography in detecting fractures in older individuals after low-energy falls: current evidence
Authors: Pedersen Vera , Lampart Alina , Bingisser Roland , Nickel Christian Hans 
Published: November 2020

BackgroundOlder individuals sustaining low-energy falls (LEF) and presenting to the emergency department (ED) demand straightforward diagnostic measures for injury detection. Plain radiography (XR) series for diagnosis of fall-related injuries are standard of care, but frequently subsequent CT examination is required for diagnostic assurance. A systematic database search of diagnostic accuracy of XR for detection of fractures in older LEF patients was performed.MethodsWe searched PubMed, Embase, Cochrane Library, WHO International Clinical Trial Platform, and Clinical trials.gov databases from inception to January 2020 for studies including older patients (≥65 years) with LEF and obtaining CT examination and XR of the skeleton in an ED setting.ResultsFrom 8944 references screened, 11 studies met the criteria for inclusion. Performance of XR for detection of fractures of the pelvic ring and hip was analyzed in nine studies, two studies investigated XR performance to detect rib fractures, and two studies compared diagnostic accuracy of thoracolumbar spine XR. Sensitivity estimates ranged from 10% to 58% and specificity estimates from 55% to 100%. Clinical and statistical heterogeneity was significant among included studies, with an overall considerable risk of bias.DiscussionHigh-quality evidence on accurate imaging strategies in older patients with LEF is lacking to date. XR is missing a reasonable amount of fractures of the pelvic ring, rib cage, and thoracic and lumbar spine. However, the utility of first-line CT imaging and the benefit of diagnosing every fracture is unknown, demanding high-quality prospective trials considering patient-oriented outcome as well.
Initial clinical experience with the Quantra QStat System in adult trauma patients
Authors: Michelson Edward A , Cripps Michael W , Ray Bradford , Winegar Deborah A , Viola Francesco 
Published: November 2020

BackgroundWhole blood viscoelastic testing (VET) devices are routinely used in a variety of clinical settings to assess hemostasis. The Quantra QStat System is a cartridge-based point of care VET device that measures changes in clot stiffness during coagulation and fibrinolysis using ultrasound detection of resonance. The objective of this study was to assess the ability of the Quantra QStat System to detect coagulopathies in trauma patients.MethodsA multicenter observational study was conducted on adult subjects at two level 1 trauma centers. For each subject, whole blood samples were drawn upon arrival to the emergency department and again, in some cases, after administration of blood products and/or antifibrinolytics. Samples were analyzed on the Quantra in parallel to ROTEMdelta. The QStat cartridge provides measures of Clot Time (CT), Clot Stiffness (CS), Fibrinogen and Platelet Contributions to clot stiffness (FCS and PCS), and Clot Stability to Lysis (CSL). Data analyses included linear regression of Quantra and ROTEM parameters and an assessment of the concordance of the two devices for the assessment of hyperfibrinolysis.ResultsA total of 56 patients were analyzed. 42% of samples had a low QStat CS value suggestive of an hypocoagulable state. The low stiffness values could be attributed to either low PCS, FCS or combination. Additionally, 13% of samples showed evidence of hyperfibrinolysis based on the QStat CSL parameter. Samples analyzed with ROTEM assays showed a lower prevalence of low CS and hyperfibrinolysis based on EXTEM and FIBTEM results. The correlation of CS, FCS and CT versus equivalent ROTEM parameters was strong with r-values of 0.83, 0.79 and 0.79, respectively.DiscussionThis first clinical experience with the Quantra in trauma patients showed that the QStat Cartridge was strongly correlated with ROTEM parameters and that it could detect coagulopathies associated with critical bleeding.Level of evidenceDiagnostic test, Level II.
Dexmedetomidine and ketamine simultaneous administration in tigers (Panthera tigris): pharmacokinetics and clinical effects
Authors: Di Cesare Federica , Cagnardi Petra , Villa Roberto , Rabbogliatti Vanessa , Lucatello Lorena , Capolongo Francesca , Gioeni Daniela , Capasso Michele , Magnone William , Ravasio Giuliano 
Published: November 2020

BackgroundThe study determines the pharmacokinetic profiles of dexmedetomidine (DEX), ketamine (KET) and its active metabolite, norketamine (NORKET), after simultaneous administration. Moreover, the study evaluates the sedative effects of this protocol, its influence on the main physiological variables and the occurrence of adverse effects.MethodsEighteen captive tigers were initially administered with a mixture of DEX (10 µg/kg) and KET (2 mg/kg) by remote intramuscular injection. In case of individual and specific needs, the protocol was modified and tigers could receive general anaesthesia, propofol or additional doses of DEX and KET.ResultsBased on the immobilisation protocol, nine animals were assigned to the standard protocol group and the other nine to the non‐standard protocol group. Higher area under the first moment curve (AUMC0‐last) and longer mean residence time (MRT0‐last) (P<0.05) were observed in the non‐standard protocol group for DEX, KET and NORKET, and higher area under the concentration‐time curve from administration to the last measurable concentration (AUC0‐last) only for KET. The KET metabolisation rate was similar (P=0.296) between groups. No differences between groups were detected in terms of stages of sedation and recoveries. All physiological variables remained within normality ranges during the whole observation period. During the hospitalisation period, no severe adverse reactions and signs of resedation were observed.ConclusionThe simultaneous administration of 10 µg/kg of DEX and 2 mg/kg of KET can be considered an effective protocol for chemical immobilisation of captive tigers, along with dosage adjusments or when other drugs are needed.
Noether symmetries of Einstein-aether scalar field cosmology
Authors: Kucukakca Yusuf , Akbarieh Amin Rezaei 
Published: November 2020

AbstractIn this paper, we explore an Einstein-aether cosmological model by adding the scalar field in which it has an interaction with the aether field. For the cosmological implications of the model, we consider that the universe can be described by the spatially flat FRW metric together with the matter dominated universe. Applying Noether symmetry approach to the point-like Lagrangian we determine the explicit forms of unknown functions i.e. the potential and coupling function. We solve the analytical cosmological solutions of the field equations admitting the Noether symmetry, basically divided into two parts. Our results show that the obtained solutions lead to an accelerated expansion of the universe. We also discuss the tensor perturbations within the framework of this model in order to get information about the mass of gravitational waves.
Multicenter solutions in Eddington-inspired Born–Infeld gravity
Authors: Olmo Gonzalo J. , Orazi Emanuele , Rubiera-Garcia Diego 
Published: November 2020

AbstractWe find multicenter (Majumdar–Papapetrou type) solutions of Eddington-inspired Born–Infeld gravity coupled to electromagnetic fields governed by a Born–Infeld-like Lagrangian. We construct the general solution for an arbitrary number of centers in equilibrium and then discuss the properties of their one-particle configurations, including the existence of bounces and the regularity (geodesic completeness) of these spacetimes. Our method can be used to construct multicenter solutions in other theories of gravity.
Integrative Analysis of miRNAs Identifies Clinically Relevant Epithelial and Stromal Subtypes of Head and Neck Squamous Cell Carcinoma
Authors: Holt Jeremiah , Walter Vonn , Yin Xiaoying , Marron David , Wilkerson Matthew D. , Choi Hyo Young , Zhao Xiaobei , Jo Heejoon , Hayes David Neil , Ko Yoon Ho 
Published: November 2020

Abstract

Purpose:
The objective of this study is to characterize the role of miRNAs in the classification of head and neck squamous cell carcinoma (HNSCC).

Experimental Design:
Here, we analyzed 562 HNSCC samples, 88 from a novel cohort and 474 from The Cancer Genome Atlas, using miRNA microarray and miRNA sequencing, respectively. Using an integrative correlations method followed by miRNA expression–based hierarchical clustering, we validated miRNA clusters across cohorts. Evaluation of clusters by logistic regression and gene ontology approaches revealed subtype-based clinical and biological characteristics.

Results:
We identified two independently validated and statistically significant (P &lt; 0.01) tumor subtypes and named them “epithelial” and “stromal” based on associations with functional target gene ontology relating to differing stages of epithelial cell differentiation. miRNA-based subtypes were correlated with individual gene expression targets based on miRNA seed sequences, as well as with miRNA families and clusters including the miR-17 and miR-200 families. These correlated genes defined pathways relevant to normal squamous cell function and pathophysiology. miRNA clusters statistically associated with differential mutation patterns including higher proportions of TP53 mutations in the stromal class and higher NSD1 and HRAS mutation frequencies in the epithelial class. miRNA classes correlated with previously reported gene expression subtypes, clinical characteristics, and clinical outcomes in a multivariate Cox proportional hazards model with stromal patients demonstrating worse prognoses (HR, 1.5646; P = 0.006).

Conclusions:
We report a reproducible classification of HNSCC based on miRNA that associates with known pathologically altered pathways and mutations of squamous tumors and is clinically relevant.
Periprocedural Hydrogen Sulfide Therapy Improves Vascular Remodeling and Attenuates Vein Graft Disease
Authors: Kip Peter , Tao Ming , Trocha Kaspar M. , MacArthur Michael R. , Peters Hendrika A. B. , Mitchell Sarah J. , Mann Charlotte G. , Sluiter Thijs J. , Jung Jonathan , Patterson Suzannah , Quax Paul H. A. , de Vries Margreet R. , Mitchell James R. , Keith Ozaki C. 
Published: November 2020

Background
Failure rates after revascularization surgery remain high, both in vein grafts (VG) and arterial interventions. One promising approach to improve outcomes is endogenous upregulation of the gaseous transmitter‐molecule hydrogen sulfide, via short‐term dietary restriction. However, strict patient compliance stands as a potential translational barrier in the vascular surgery patient population. Here we present a new therapeutic approach, via a locally applicable gel containing the hydrogen sulfide releasing prodrug (GYY), to both mitigate graft failure and improve arterial remodeling.

Methods and Results
All experiments were performed on C57BL/6 (male, 12 weeks old) mice. VG surgery was performed by grafting a donor‐mouse cava vein into the right common carotid artery of a recipient via an end‐to‐end anastomosis. In separate experiments arterial intimal hyperplasia was assayed via a right common carotid artery focal stenosis model. All mice were harvested at postoperative day 28 and artery/graft was processed for histology. Efficacy of hydrogen sulfide was first tested via GYY supplementation of drinking water either 1 week before VG surgery (pre‐GYY) or starting immediately postoperatively (post‐GYY). Pre‐GYY mice had a 36.5% decrease in intimal/media+adventitia area ratio compared with controls. GYY in a 40% Pluronic gel (or vehicle) locally applied to the graft/artery had decreased intimal/media area ratios (right common carotid artery) and improved vessel diameters. GYY‐geltreated VG had larger diameters at both postoperative days 14 and 28, and a 56.7% reduction in intimal/media+adventitia area ratios. Intimal vascular smooth muscle cell migration was decreased 30.6% after GYY gel treatment, which was reproduced in vitro.

Conclusions
Local gel‐based treatment with the hydrogen sulfide‐donor GYY stands as a translatable therapy to improve VG durability and arterial remodeling after injury.
An Ecological Whodunit: The Story of Colony Collapse Disorder
Authors: Portus Rosamund 
Published: November 2020

Abstract
As life on Earth becomes increasingly precarious, it becomes ever clearer that, while some nonhuman losses are perceived as tragic and controversial, many more are left to slip away, unnoticed and unmourned. The purpose of this study, then, is to determine what renders a nonhuman animal life as significant and why. Specifically, the story of colony collapse disorder is traced, illustrating how the loss of honeybees became framed as an ecological whodunit. This framing incited widespread interest in and anxiety about the disappearance of honeybees. Moreover, the controversy surrounding colony collapse disorder encouraged the preemptive mourning of honeybees’ extinction, a fact which has consequently increased their chances of survival. Therefore, I argue that the stories told about nonhuman animals have influence. This article contributes to literature that recognizes extinction as a distinctly biocultural process, shaped as much by cultural values as it is by scientific fact.
Comparative Outcomes in Patients With Small- and Large-Cell Neuroendocrine Carcinoma (NEC) and Mixed Neuroendocrine-Non-Neuroendocrine Neoplasm (MiNEN) of the Stomach
Authors: Choi Nam Young , Kim Byung-Sik , Oh Sung Tae , Yook Jeong Hwan , Kim Beom Su 
Published: November 2020

Background Gastric neuroendocrine carcinomas (NECs), consisting of both large- and small-cell NECs, and mixed adenoneuroendocrine carcinomas (MANECs), including mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs), are a group of high-grade malignancies. Few studies to date have reported clinical outcomes, including prognosis, in patients with these tumors. This study therefore evaluated the clinicopathologic outcomes and prognosis in patients with NECs and MANECs. Methods This study included 36 patients diagnosed with gastric NECs, including 23 with large-cell and 13 with small-cell NECs, and 85 with MiNENs, including 70 with high-grade and 15 with intermediate-grade MiNENs. Clinical outcomes, including overall survival (OS) and disease-free survival (DFS), were assessed. Results DFS was significantly poorer in patients with NEC than in patients with intermediate-grade MiNEN ( P < .05), whereas both OS and DFS were similar in patients with NEC and high-grade MiNEN ( P > .05). Patients with large-cell NEC were more likely to undergo aggressive surgery than patients with high-grade MiNEN ( P < .05). Lymphovascular invasion was more frequent and DFS poorer in patients with large-cell than small-cell NECs ( P < .05 each). Conclusion DFS is significantly poorer in patients with NEC than in patients with intermediate-grade MiNEN and significantly lower in patients with large-cell than small-cell NECs.