bluuebunny/crossref_metadata_2025_split huggingface dataset:
Augmented Feedback for Manual Wheelchair Propulsion Technique Training in a Virtual Reality Simulator
Authors: Yan Hui , Archambault Philippe S. 
Published: October 2020

Abstract
Background: Motor learning of appropriate manual wheelchair propulsion is critical, as incorrect technique elevates risk for upper extremity pain. Virtual reality simulators allow users to practice this complex task in a safe and realistic environment. Additionally, augmented feedback may be provided in order to optimize learning. The purpose of this study was to investigate the effects of providing augmented feedback with various delivery schedules on motor learning and transfer of this skill to over-ground propulsion.Methods: Thirty healthy young adults were randomly assigned to three groups. During a virtual reality propulsion training session, the high-frequency feedback group received augmented feedback throughout all propulsion training; the faded feedback group received this information in a faded schedule; and the control group underwent training with no augmented feedback. Propulsion assessments were performed at baseline and 48 hours after practice in both virtual and real environments to measure retention and transfer, respectively.Results: Compared to the control group, both feedback groups exhibited significant improvements in contact angle and push frequency in both environments after training. Small, non-significant differences were also found between the high-frequency and faded feedback groups.Conclusion: Virtual reality training is an effective learning intervention for acquisition, retention, and transfer of appropriate manual wheelchair propulsion technique when such training includes augmented feedback about propulsion biomechanics.
Impact of Goal-directed Hemodynamic Management on the Incidence of Acute Kidney Injury in Patients Undergoing Partial Nephrectomy: A Pilot Randomized Controlled Trial
Authors: Wu Qiong-Fang , Kong Hao , Xu Zhen-Zhen , Li Huai-Jin , Mu Dong-Liang , Wang Dong-Xin 
Published: October 2020

Abstract
Background: The incidence of acute kidney injury (AKI) remains high after partial nephrectomy. Ischemia-reperfusion injury produced by renal hilum clamping during surgery might have contributed to the development of AKI. In this study we tested the hypothesis that goal-directed fluid and blood pressure management could reduce AKI in patients following partial nephrectomy. Methods: This was a pilot randomized controlled trial. Adult patients who were scheduled to undergo partial nephrectomy were randomized into two groups. In the intervention group, goal-directed hemodynamic management was performed from renal hilum clamping until end of surgery; the target was to maintain stroke volume variation < 6%, cardiac index 3.0 - 4.0 L/min/m2 and mean arterial pressure > 95mmHg with crystalloid fluids and infusion of dobutamine and/or norepinephrine. In the control group, hemodynamic management was performed according to routine practice. The primary outcome was the incidence of AKI within the first 3 postoperative days. Results: From June 2016 to January 2017, 144 patients were enrolled and randomized (intervention group, n = 72, control group, n = 72). AKI developed in 12.5% of patients in the intervention group and in 20.8% of patients in the control group; the relative reduction of AKI was 39.9% in the intervention group but the difference was not statistically significant (relative risk 0.60, 95% confidence interval [CI] 0.28-1.28; P = 0.180). No significant differences were found regarding AKI classification, change of estimated glomerular filtration rate over time, incidence of postoperative 30-day complications, postoperative length of hospital stay, as well as 30-day and 6-month mortality between the two groups.Conclusion: For patients undergoing partial nephrectomy, goal-directed circulatory management during surgery reduced postoperative AKI by about 40%, although not significantly so. The trial was underpowered. Large sample size randomized trials are needed to confirm our results.Trial registration: Clinicaltrials.gov identifier: NCT02803372. Date of registration: June 6, 2016.
High-dose CytoSorb hemoadsorption is associated with improved survival in patients with septic shock: A retrospective cohort study
Authors: Schultz Philipp , Schwier Elke , Eickmeyer Claas , Henzler Dietrich , Koehler Thomas 
Published: October 2020

Abstract
Background: Septic shock and SIRS are life-threatening diseases with persistent high mortality. Hemoadsorption with CytoSorb® offers a possible therapeutic approach, but the optimal timing, dosing and indications are still unclear.Methods: Observational data from 70 patients with septic shock or SIRS, treated in a university hospital with hemoadsorption by CytoSorb® in addition to renal replacement therapy were analyzed retrospectively. Physiologic parameters and clinical outcomes were extracted from the electronic charts. The predicted mortality was calculated based on APACHE II and SOFA scores and compared with the actual 28-day survival. The total amount of blood purified was correlated with outcome.Results: The main origins of septic shock were abdominal (n=29) or pulmonary (n=22). The mean age was 70.6±13.3 years. Hemoadsorption was applied for 85.6±53.8h with 3.2±1.7 cycles lasting 26.75±11.1h each. The severity was characterized by a mean APACHE II score of 30.2±6.3 and SOFA score of 13.8±3.5, which calculated to a predicted mortality of 73.3% and 62.1%, respectively. The observed mortality was significantly lower (35/70 patients (50%), p<0.05). Interleukin-6 levels at baseline were high (survivors: 7964±11242pg/ml; nonsurvivors: 8.755±15.800pg/ml, p=0.27) and decreased rapidly within 4-24h. Survival was independently associated with lower IL-6 levels and norepinephrine dosage after 24h. An increase in IL-6 after 48h was predictive of poor outcome.The treatment duration and amount of blood purified was higher in survivors than in non-survivors (8.47±4.42 vs. 6.07±3.57l/kg BW, p=0.017). We identified 3 clusters of <6l/kg, 6-13l/kg and ≥13l/kg BW with a linear dose-response relation between blood purification volume and survival. Although the predicted mortality was comparable among the clusters (p=ns), survival was best in the highest volume cluster (16.7%; p=0.045).Conclusions: The application of CytoSorb® seems to be safe and effective in various conditions of septic shock and SIRS, although the optimal duration and dosing remain unclear. In a cohort of severely ill patients the observed mortality rate was lower than predicted and decreased linearly with blood purification volumes exceeding 6l/kg BW. These results suggest that hemoadsorption with CytoSorb® improves survival in septic shock or SIRS, provided that the applied dose is high enough.
Evaluation of Early Postoperative Intravenous Opioid Rescue as a Novel Quality Measure in Patients who Receive Thoracic Epidural Analgesia: A Retrospective Cohort Analysis and Prospective Performance Improvement Intervention
Authors: Levy Nadav , Santer Peter , Zucco Liana , Nabel Sarah , Korsunsky Galina , Ramachandran Satya Krishna 
Published: October 2020

Abstract
Background: In this study, we explored the prevalence of intravenous opioid rescue analgesia in the post-anesthesia care unit (PACU-OpResc) as a single marker of thoracic epidural analgesia (TEA) failure and evaluated the resource implications and quality improvement applications of this measure. Methods: We performed a retrospective analysis of all TEA placements during 2016-2018 at a single academic medical center in Boston, Massachusetts. The study exposure was the need for intravenous opioid rescue analgesia in the PACU (PACU-OpResc). Primary outcome was PACU length of stay (LOS). Secondary outcomes included delayed PACU discharge and intraoperative hypotension. The analyses were adjusted for confounding variables including patient comorbidities, surgical complexity, intraoperative intravenous opioids, chronic opioid use and local anesthetic bolus through TEA catheter. Post analysis chart review was conducted to determine the positive predictive value (PPV) of PACU-OpResc for inadequate TEA. As a first Plan-Do-Study-Act cycle, we then introduced a checkbox for documentation of a sensory level check (SLC) after TEA placement. Post implementation data was collected for 7 months. Results: PACU-OpResc was required by 211 (22.1%) patients who received preoperative TEA, was associated with longer PACU LOS (incidence rate ratio 1.20, 95% CI:1.07–1.34, p=0.001) and delayed discharge due to inadequate pain control (odds ratio 5.15, 95% CI 3.51–7.57, p<0.001). PACU-OpResc had a PPV of 76.3% and 60.4% for re-evaluation and manipulation of the TEA catheter in PACU, respectively. Following implementation of a checkbox, average monthly compliance with documented SLCs after TEA placement was noted to be 39.7%. During this time, a reduction of 8.2% in the rate of PACU-OpResc was observed.Conclusions: This study demonstrates that PACU-OpResc can be used as a quality assurance measure or surrogate for TEA efficiency, to track performance and monitor innovation efforts aimed at improving analgesia, such as our intervention to facilitate SLCs and reduced PACU-OpResc.
Home Range Characteristics and Diel Patterns in Space Use of Mutton Snapper, Lutjanus Analis, in St. Thomas, Us Virgin Islands
Authors: Heidmann Sarah L. , Jossart Jonathan , Nemeth Richard S. 
Published: October 2020

Abstract
Background: The movement ecology of mutton snapper Lutjanus analis is poorly understood despite their ecological and economic importance in the Caribbean. Passive acoustic telemetry was used to determine home ranges of six adult L. analis, including diel patterns, in Brewers Bay, St. Thomas, US Virgin Islands. Understanding long-term space use, including site fidelity and habitat usage, is necessary to implement effective and appropriate management actions for a species with extensive space and resource needs.Results: Individual L. analis were tracked over an average period of 316 days (range 125 - 509 days) and showed high site fidelity to relatively small home ranges (mean ± SD: 0.103 ± 0.028 km2, range 0.019 - 0.190 km2) and core use areas with low overlap among individuals. Most home ranges had a habitat composition dominated by seagrass and to a lesser degree, coral reef and/or pavement. Nighttime activity spaces were distinct from but contained within daytime areas.Conclusions: Mutton snapper showed strong site fidelity to home ranges in Brewers Bay. Two individuals that were absent from the array for more than a few hours were detected at separate arrays at spawning aggregation sites. This study expands upon knowledge of mutton snapper home range characteristics, highlights the importance of maintaining adjacent high-quality habitat types in any spatial management plan, and encourages the adoption of other types of management strategies, particularly for transient-aggregating species.
Impact of Therapeutic Hypothermia During Cardiopulmonary Resuscitation on Neurologic Outcome: A Systematic Review and Meta-analysis
Authors: Annoni Filippo , PELUSO Lorenzo , FIORE Marco , NORDBERG Per , SVENSSON Leif , ABELLA Benjamin , CALABRO' Lorenzo , SCOLLETTA Sabino , VINCENT Jean-Louis , CRETEUR Jacques , TACCONE Fabio Silvio 
Published: October 2020

Abstract
Background: Therapeutic cooling initiated during cardiopulmonary resuscitation (intra arrest therapeutic hypothermia, IATH) provided diverging effect on neurological outcome of out-of-hospital cardiac arrest (OHCA) patients depending on the initial cardiac rhythm and the cooling methods used. Methods: We performed a systematic search of PubMed, EMBASE and the CENTRAL databases using established Medical Subject Headings (MeSH) terms for IATH and OHCA. Only studies comparing IATH to standard in-hospital targeted temperature management (TTM – control group) were selected. We used the revised Cochrane RoB-2 and the Newcastle-Ottawa scale tool to assess risk of bias of each study. Primary outcome was favorable neurological outcome (FO); secondary outcomes included return of spontaneous circulation (ROSC) rate and overall survival to hospital discharge. Two authors independently assessed the validity of included human studies and extracted data regarding characteristics of the studied cohorts and main outcomes. Results: Out of 20950 studies, 8 studies (n=3493 patients, including 4 randomized trials, RCTs) were included in the final analysis. When compared to controls, the use of IATH was not associated with improved favorable neurological outcome (OR 0.96 [95% CIs 0.68-1.37]; p= 0.84), increased ROSC rate (OR 1.11 [95% CIs 0.83-1.49]; p= 0.46) or survival to hospital discharge (OR 0.91 [95% CIs 0.73-1.14]; p= 0.43). Significant heterogeneity among studies was observed only for the analysis of ROSC rate (I2=69%). Trans-nasal evaporative cooling and cold fluids were explored in two RCTs each and no significant differences were observed on neurological outcome. However, trans-nasal evaporative cooling was associated with a higher probability of favorable neurological outcome when compared to controls in patients with an initial shockable rhythm (OR 1.62 [95% CI 1.00-2.64]; p=0.05]. Conclusions: In this meta-analysis, IATH was not associated with improved neurological outcome when compared to standard in-hospital TTM. However, there are considerable outcome differences depending on the methods used and the studied population that need to be explored in future trials. Clinical Trial Registration: PROSPERO (CRD42019130322)
A microplanning strategy to improve door-to-door health service delivery: The case of Seasonal Malaria Chemoprevention in Sub-Saharan African villages
Authors: Ouedraogo Andre Lin , Zhang Julie , Tinto Halidou , Valéa Innocent , Wenger Edward A. 
Published: October 2020

Abstract
Background Malaria incidence has plateaued in Sub-Saharan Africa despite Seasonal Malaria Chemoprevention’s (SMC) introduction. Community health workers (CHW) use a door-to-door delivery strategy to treat children with SMC drugs, but for SMC to be as effective as in clinical trials, coverage must be high over successive seasons. Methods We developed and used a microplanning model that `utilizes raster to estimate population size, generates optimal households visit itinerary, and quantifies SMC coverage based on CHWs’ time investment for treatment and walking. CHWs’ performance under current SMC deployment mode was assessed using CHWs’ tracking data and compared to microplanning in villages with varying demographics and geographies. Results Estimates showed that microplanning significantly reduces CHWs’ walking distance by 25%, increases the number of visited households by 36% (p < 0.001) and increases SMC coverage by 21% from 37.3% under current SMC deployment mode up to 58.3% under microplanning (p < 0.001). Optimal visit itinerary alone increased SMC coverage up to 100% in small villages whereas in larger or hard-to-reach villages, filling the gap additionally needed an optimization of the CHW ratio.Conclusion We estimate that for a pair of CHWs, the daily optimal number of visited children (assuming 8.5mn spent per child) and walking distance should not exceed 45 and 5km respectively. Our work contributes to extend SMC coverage by 21-63% and may have broader applicability for other community health programs.
The impact of government subsidy programs on equity in health financing
Authors: Mohammadzadeh Yousef , Dizaj Jafar Yahyavi , Mosadeghrad Ali Mohammad , Kazemi Ali , Yusefzadeh Hasan 
Published: October 2020

Abstract
Background: Iran government launched the targeted subsidy plan (TSP) in December 2011 to reduce inequality and poverty. In addition, Health Transformation Plan (HTP) was implemented in ministry of health to reduce people out of pocket payment. This study aimed to examine the impact of these two government subsidy programs on equity in health financing. Method: In this longitudinal study, data on 413,201 households were collected using household surveys during 11 years (2007-2017). The Fairness in Financial Contribution (FFCI) index and Catastrophic Health Expenditures (CHE) index were calculated.Also Logistic regression model was performed by the applied software of Stata V.14 to examine the effects of TSP and HTP policies and other socioeconomic characteristics of households on their exposure to CHE.Results: The FFC index was 0.829 and 0.830 respectively in 2007 and 2017. The trend analysis did not show significant changes in FFC index between 2007 and 2017. TSP and HTP implementation die not reduce households’ exposure to CHE significantly. Crowded households with more elder people, belonging to low income deciles, without houses, living in rural areas and deprived provinces, are more likely to be at risk of CHE. Health insurance coverage did not protect households from CHE. High educated and employed households were exposed to less CHE.Conclusion: The government subsidy programs have not been effective in improving FFC and reducing CHE indices. None of them has been able to realize the goal of the 6th National Development Plan of reducing CHE to 1%. The government should devise support packages for target household (households with more elderly people, lower incomes, without private house, crowded, rural and inhabited in deprived provinces), so they can protect households against CHE. Modifying and improving the quality of insurance coverage is strongly recommended due to its inefficiency.
Physical and Psychological Characteristics of Nitrous Oxide Abusers During the COVID-19 Pandemic: An Observational Study.
Authors: Wang Shanshan , Wu Gang , Wang Tingling , Yu Anna , Wang Yajing , Liu Suzhi 
Published: October 2020

Abstract
Background The coronavirus disease 2019 (COVID-19) was classified as a global pandemic by the World Health Organization. In addition to health effects, it has also brought about psychological problems due to its economic and social impact. Psychological effects have led to drug and alcohol abuse. To inform physician decisions, there is a need to characterize the physical and psychological characteristics of nitrous oxide abusers during the COVID-19 Pandemic. Methods: We enrolled six nitrous oxide abusers who sought treatment at Taizhou Hospital of Zhejiang province between May 2020 and June 2020. Clinical data including socio-demographic, physical examination, laboratory examination, electromyography, neuroimaging, and psychological assessment were collected. Results: The enrolled patients had a mean age of 22±4.3. Clinical presentations included varying degrees of limb numbness and an ataxic gait. Under laboratory examination, it was revealed that all the patients did not have pernicious anemia, 4 patients had decreased vitamin B12 while 3 patients exhibited elevated homocysteine levels. MR of the spinal cord revealed that 4 patients had abnormal signals in the cervical spinal cord. These signals were of high symmetry with splayed or inverted V sign after T2WI. Peripheral nerve damage was observed in 5 patients who were subjected to an electromyogram (EMG) test. The Symptom Checklist 90 (SCL-90) psychological evaluation indicated that all patients had severe anxiety, depression and psychosis. The psychological status of nitrous oxide abusers was significantly different from that of health controls. After treatment by vitamin B12, the patients’ physical symptoms improved, and they were discharged from the hospital. For the evaluation of mental and psychological outcomes post-discharge, patients were asked to go to the psychological department for check-up and follow-up.Conclusion: The enrolled 6 patients caused by abuse of nitrous oxide presented with symptoms of subacute combined with spinal degeneration. They had more serious psychological problems related to the COVID-19 pandemic. These problems require immediate attention and interventional approaches. The national government and other departments should take active measures to control abuse of nitrous oxide. Trial registration: Not applicable.
Investigating primary health care practitioners’ barriers and enablers to referral of COPD patients to Pulmonary Rehabilitation: an exploratory sequential mixed methods study using the Theoretical Domains Framework
Authors: Watson Jane Suzanne , Jordan Rachel Elizabeth , Adab Peymane , Vlaev Ivo , Enocson Alexandra , Greenfield Sheila 
Published: October 2020

Abstract
BackgroundPulmonary rehabilitation is a highly effective, globally recommended intervention for patients with Chronic Obstructive Pulmonary Disease (COPD). Understanding why referral rates remain persistently low is important and enables the development of targeted interventions in order to improve future uptake. MethodsWe undertook an exploratory sequential mixed methods study to investigate the referral practices of Primary Health Care Practitioners (PHCPs) in the United Kingdom (UK). In phase 1 semi structured interviews were undertaken. Content analysis was used to map arising themes to the Theoretical Domains Framework (TDF) and the development of a 54-item TDF based questionnaire.In Phase 2 we distributed the questionnaire through relevant conferences and organisation memberships, to obtain views from a larger, more generalisable PHCP population. We used descriptive analyses to identify the most important barriers and enablers, and key TDF domains. Mixing of data occurred at 2 time points; instrument design and interpretation. Results19 PHCP took part in interviews and 233 responded to the survey. Integrated results revealed that PHCPs with a post qualifying respiratory qualification (154/241; 63.9%) referred more frequently (91/154; 59.1%) than those without (28/87; 32.2%).There were more barriers than enablers for referral in all 13 mapped TDF domains. Key barriers included: infrequent engagement from PR provider to referrer, concern around patient’s physical ability and access to PR (particularly for those in work), assumed poor patient motivation, no clear practice referrer and few referral opportunities. These mapped to the following domains: belief about capabilities, social influences, environment, optimism, skills and social and professional role.Enablers to referral were observed within the knowledge, social influences memory and environment domains. Many PHCPs believed in the physical and psychological value of PR, and helpful enablers were out-of-practice support from respiratory interested colleagues, dedicated referral time (annual review) and on-screen referral prompts. ConclusionsReferral to PR is a complex process. Barriers outweighed enablers. Aligning these findings to behaviour change techniques will identify practice-based interventions to overcome current barriers and strengthen enablers, thereby increasing referral of COPD patients to PR as recommended by international COPD guidelines