bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Heart Rate on the Pulsatile Flow Characteristics of a Stenotic Aortic Valve Model: An In Vitro Experimental Study
Authors: Zhang Ruihang , Zhang Yan 
Published: June 2020

Abstract
In this paper, the characteristics of pulsatile flow past a silicone-based artificial stenotic aortic valve under varied heart rates have been studied using particle image velocimetry (PIV). Pulsatile flow waveforms were generated by a closed-loop cardiovascular flow simulator. Phase-locked PIV was employed to quantify the average and turbulent flow field information. Pressure gradient waveforms were recorded to evaluate the severity of the stenosis. Results suggest that as the heart rate increases, the peak pressure gradient across the stenotic aortic valve increases significantly under the same cardiac output. Under the same cardiac output, the aortic valve area (AVA) estimated using Gorlin equation decreases as the heart rate increases, while the trend is reversed using Hakki equation estimation. PIV results suggest that the peak systolic jet velocity downstream of the valve increases as the heart rate increases, implying a longer pressure recovery distance as heart rate increases. While the turbulence at peak systole is higher under the slower heart rate, the faster heart rate contributes to higher turbulence during the late systole and early diastole phases. Based on the comparison with no-valve cases, the differences in turbulence kinetic energy (TKE) was mainly related to the dynamics of leaflets under different heart rates. Overall, the results obtained in this study demonstrate that the hemodynamics of a stenotic aortic valve is complex, and the assessment of AS could be significantly affected by the pulsating rate of the flow.
Effects of Exercises on a Hard, Soft, and Sand Surface on Functional Outcomes of Community-Dwelling Older Individuals: A Randomized Controlled Trial
Authors: Kaewjoho Chonticha , Thaweewannakij Thiwabhorn , Mato Lugkana , Nakmaroeng Saowanee , Phadungkit Supaporn , Amatachaya Sugalya 
Published: June 2020

This single-blind, randomized controlled trial compared the effects of Thai dance exercise training on hard, soft, and sand surfaces on the functional outcomes of 120 community-dwelling older adults (40 subjects/group). The subjects were involved in a Thai dance exercise program on each surface, according to their groups, for 50 min/day, 3 days/week, for 6 weeks. The functional outcomes were assessed prior to training, at Week 3, and Week 6 after training. Subjects showed a significant improvement in all functional tests at 3 and 6 weeks after training, particularly in those who were trained on a sand surface and a soft surface (7–30% improvement,p < .05). The improvement was especially demonstrated in the complex and demanding motor activities after exercise on a soft and sand surface. Aside from attempting to modify training programs on a hard surface, the current findings suggest an alternative and cost-effective program to promote the levels of independence and safety that can be applied easily in clinical, home-based, and community settings.
The silent epidemic of obesity in The Gambia: evidence from a nationwide, population-based, cross-sectional health examination survey
Authors: Cham Bai , Scholes Shaun , Ng Fat Linda , Badjie Omar , Groce Nora Ellen , Mindell Jennifer S 
Published: June 2020

ObjectivesNon-communicable diseases account for 70% of global deaths; 80% occur in low-income and middle-income countries. The rapid increase of obesity in sub-Saharan Africa is a concern. We assessed generalised and abdominal obesity and their associated risk factors among adults in The Gambia.DesignNationwide cross-sectional health examination survey using the WHO STEPwise survey methods.SettingThe Gambia.ParticipantsThis study uses secondary analysis of a 2010 nationally representative random sample of adults aged 25–64 years (78% response rate). The target sample size was 5280, and 4111 responded. Analysis was restricted to non-pregnant participants with valid weight and height measurements (n=3533).Primary and secondary outcome measuresThe primary outcome variable was generalised obesity, using WHO body mass index (BMI) thresholds. Analyses used non-response weighting and adjusted for the complex survey design. We conducted multinomial logistic regression analysis to identify factors associated with BMI categories. The secondary outcome variable was abdominal obesity, defined as high waist circumference (using the International Diabetes Federation thresholds for Europeans).ResultsTwo-fifths of adults were overweight/obese, with a higher obesity prevalence in women (17%, 95% CI 14.7 to 19.7; men 8%, 95% CI 6.0 to 11.0). 10% of men and 8% of women were underweight. Urban residence (adjusted relative risk ratio 5.8, 95% CI 2.4 to 14.5), higher education (2.3, 1.2 to 4.5), older age, ethnicity, and low fruit and vegetable intake (2.8, 1.1 to 6.8) were strongly associated with obesity among men. Urban residence (4.7, 2.7 to 8.2), higher education (2.6, 1.1 to 6.4), older age and ethnicity were associated with obesity in women.ConclusionThere is a high burden of overweight/obesity in The Gambia. While obesity rates in rural areas were lower than in urban areas, obesity prevalence was higher among rural residents in this study compared with previous findings. Preventive strategies should be directed at raising awareness, discouraging harmful beliefs on weight, and promoting healthy diets and physical activity.
Chinese physicians’ attitudes toward eco-directed sustainable prescribing from the perspective of ecopharmacovigilance: a cross-sectional study
Authors: Wang Jun , Li Shulan , He Bingshu 
Published: June 2020

IntroductionEco-directed sustainable prescribing (EDSP) is an effective upstream way to reduce the environmental footprints of active pharmaceutical ingredients (APIs), a kind of emerging contaminants, from the patients’ excretion. EDSP is one of the key steps in the programme of ecopharmacovigilance (EPV), a drug administration route on API pollution.ObjectiveTo assess the attitudes of physicians prescribing medicines regarding EDSP from the perspective of EPV.DesignA cross-sectional study conducted from March 2019 to June 2019.Setting5 government general hospitals in Hubei province, China.Participants405 physicians were randomly selected and 262 valid questionnaires were obtained.Outcome measuresA self-developed questionnaire, which inquired about the participant characteristics, perceptions and attitudes toward API pollution, EPV and EDSP from an EPV perspective, was emailed to collect data from physicians.ResultsMost physicians agreed the existence of APIs in environment, worried about the potential environmental and ecological risks of API residues, supported the effectiveness and necessity of EDSP under an EPV perspective in decreasing environmental exposure of excreted APIs, and showed their willingness to participate in the EDSP practices. Nevertheless, no respondent identified the environmental impacts as the aspects regarding medicines affecting his(her) prescription decision, none was satisfied with knowledge on EDSP and showed confidence toward EDSP. The most important barrier to the effective implementation of EDSP was identified as ‘poor awareness of EDSP and EPV‘. Most responding physicians (97%) reported that they held the wait-and-see or conservative attitudes towards EDSP practice. The biggest concerns in low-dose prescribing and prescribing of drugs possessing environment-friendly excretion profiles, two EDSP approaches, were the possible negative impact on therapeutic outcomes and too complicated and professional drug evaluation process, respectively.ConclusionsChinese physicians had positive attitudes towards EDSP from the perspective of EPV. However, their environmental consciousness during prescribing and the related education were insufficient.
Questionnaire validation practice within a theoretical framework: a systematic descriptive literature review of health literacy assessments
Authors: Hawkins Melanie , Elsworth Gerald R , Hoban Elizabeth , Osborne Richard H 
Published: June 2020

ObjectiveValidity refers to the extent to which evidence and theory support the adequacy and appropriateness of inferences based on score interpretations. The health sector is lacking a theoretically-driven framework for the development, testing and use of health assessments. This study used the Standards for Educational and Psychological Testing framework of five sources of validity evidence to assess the types of evidence reported for health literacy assessments, and to identify studies that referred to a theoretical validity testing framework.MethodsA systematic descriptive literature review investigated methods and results in health literacy assessment development, application and validity testing studies. Electronic searches were conducted in EBSCOhost, Embase, Open Access Theses and Dissertations and ProQuest Dissertations. Data were coded to the Standards’ five sources of validity evidence, and for reference to a validity testing framework.ResultsCoding on 46 studies resulted in 195 instances of validity evidence across the five sources. Only nine studies directly or indirectly referenced a validity testing framework. Evidence based on relations to other variables is most frequently reported.ConclusionsThe health and health equity of individuals and populations are increasingly dependent on decisions based on data collected through health assessments. An evidence-based theoretical framework provides structure and coherence to existing evidence and stipulates where further evidence is required to evaluate the extent to which data are valid for an intended purpose. This review demonstrates the use of the Standards’ theoretical validity testing framework to evaluate sources of evidence reported for health literacy assessments. Findings indicate that theoretical validity testing frameworks are rarely used to collate and evaluate evidence in validation practice for health literacy assessments. Use of the Standards’ theoretical validity testing framework would improve evaluation of the evidence for inferences derived from health assessment data on which public health and health equity decisions are based.
Built to last? The sustainability of healthcare system improvements, programmes and interventions: a systematic integrative review
Authors: Braithwaite Jeffrey , Ludlow Kristiana , Testa Luke , Herkes Jessica , Augustsson Hanna , Lamprell Gina , McPherson Elise , Zurynski Yvonne 
Published: June 2020

IntroductionThe sustainability of healthcare delivery systems is challenged by ageing populations, complex systems, increasing rates of chronic disease, increasing costs associated with new medical technologies and growing expectations by healthcare consumers. Healthcare programmes, innovations and interventions are increasingly implemented at the front lines of care to increase effectiveness and efficiency; however, little is known about how sustainability is conceptualised and measured in programme evaluations.ObjectivesWe aimed to describe theoretical frameworks, definitions and measures of sustainability, as applied in published evaluations of healthcare improvement programmes and interventions.DesignSystematic integrative review.MethodsWe searched six academic databases, CINAHL, Embase, Ovid MEDLINE, Emerald Management, Scopus and Web of Science, for peer-reviewed English journal articles (July 2011–March 2018). Articles were included if they assessed programme sustainability or sustained outcomes of a programme at the healthcare system level. Six reviewers conducted the abstract and full-text review. Data were extracted on study characteristics, definitions, terminology, theoretical frameworks, methods and tools. Hawker’s Quality Assessment Tool was applied to included studies.ResultsOf the 92 included studies, 75.0% were classified as high quality. Twenty-seven (29.3%) studies provided 32 different definitions of sustainability. Terms used interchangeably for sustainability included continuation, maintenance, follow-up or long term. Eighty studies (87.0%) clearly reported the timepoints at which sustainability was evaluated: 43.0% at 1–2 years and 11.3% at <12 months. Eighteen studies (19.6%) used a theoretical framework to conceptualise or assess programme sustainability, including frameworks that were not specifically designed to assess sustainability.ConclusionsThe body of literature is limited by the use of inconsistent definitions and measures of programme sustainability. Evaluations of service improvement programmes and interventions seldom used theoretical frameworks. Embedding implementation science and healthcare service researchers into the healthcare system is a promising strategy to improve the rigour of programme sustainability evaluations.
Financial burden of HIV and TB among patients in Ethiopia: a cross-sectional survey
Authors: Assebe Lelisa Fekadu , Negussie Eyerusalem Kebede , Jbaily Abdulrahman , Tolla Mieraf Taddesse Taddesse , Johansson Kjell Arne 
Published: June 2020

ObjectivesHIV and tuberculosis (TB) are major global health threats and can result in household financial hardships. Here, we aim to estimate the household economic burden and the incidence of catastrophic health expenditures (CHE) incurred by HIV and TB care across income quintiles in Ethiopia.DesignA cross-sectional survey.Setting27 health facilities in Afar and Oromia regions for TB, and nationwide household survey for HIV.ParticipantsA total of 1006 and 787 individuals seeking HIV and TB care were enrolled, respectively.Outcome measuresThe economic burden (ie, direct and indirect cost) of HIV and TB care was estimated. In addition, the CHE incidence and intensity were determined using direct costs exceeding 10% of the household income threshold.ResultsThe mean (SD) age of HIV and TB patient was 40 (10), and 30 (14) years, respectively. The mean (SD) patient cost of HIV was $78 ($170) per year and $115 ($118) per TB episode. Out of the total cost, the direct cost of HIV and TB constituted 69% and 46%, respectively. The mean (SD) indirect cost was $24 ($66) per year for HIV and $63 ($83) per TB episode. The incidence of CHE for HIV was 20%; ranges from 43% in the poorest to 4% in the richest income quintile (p<0.001). Similarly, for TB, the CHE incidence was 40% and ranged between 58% and 20% among the poorest and richest income quintiles, respectively (p<0.001). This figure was higher for drug-resistant TB (62%).ConclusionsHIV and TB are causes of substantial economic burden and CHE, inequitably, affecting those in the poorest income quintile. Broadening the health policies to encompass interventions that reduce the high cost of HIV and TB care, particularly for the poor, is urgently needed.
Structuring mental health support for frontline caregivers during COVID-19: lessons from organisational scholarship on unit-aligned support
Authors: DiBenigno Julia , Kerrissey Michaela 
Published: June 2020

BackgroundAlthough the COVID-19 pandemic exposes frontline caregivers to severe prolonged stresses and trauma, there has been little clarity on how healthcare organisations can structure support to address these mental health needs. This article translates organisational scholarship on professionals working in organisations to elucidate why traditional approaches to supporting employee mental health, which often ask employees to seek assistance from centralised resources that separate mental health personnel from frontline units, may be insufficient under crisis conditions. We identify a critical but often overlooked aspect of employee mental health support: how frontline professionals respond to mental health services. In high-risk, high-pressure fields, frontline professionals may perceive mental health support as coming at the expense of urgent frontline work goals (ie, patient care) and as clashing with their central professional identities (ie, as expert, self-reliant ironmen/women).FindingsTo address these pervasive goal and identity conflicts in professional organisations, we translate the results of a multiyear research study examining the US Army’s efforts to transform its mental health support during the wars in Iraq and Afghanistan. We highlight parallels between providing support to frontline military units and frontline healthcare units during COVID-19 and surface implications for structuring mental health supports during a crisis. We describe how an intentional organisational design used by the US Army that assigned specific mental health personnel to frontline units helped to mitigate professional goal and identity conflicts by creating personalised relationships and contextualising mental health offerings.ConclusionAddressing frontline caregivers’ mental health needs is a vital part of health delivery organisations’ response to COVID-19, but without thoughtful organisational design, well-intentioned efforts may fall short. An approach that assigns individual mental health personnel to support specific frontline units may be particularly promising.
Leukoaraiosis and acute ischemic stroke: 90-day clinical outcome following endovascular recanalization, with proposed “L-ASPECTS”
Authors: Benson John C , Seyedsaadat Seyed Mohammad , Mark Ian , Nasr Deena M , Rabinstein Alejandro A , Kallmes David F , Brinjikji Waleed 
Published: June 2020

BackgroundTo assess if leukoaraiosis severity is associated with outcome in patients with acute ischemic stroke (AIS) following endovascular thrombectomy, and to propose a leukoaraiosis-related modification to the ASPECTS score.MethodsA retrospective review was completed of AIS patients that underwent mechanical thrombectomy for anterior circulation large vessel occlusion. The primary outcome measure was 90-day mRS. A proposed Leukoaraiosis-ASPECTS (“L-ASPECTS”) was calculated by subtracting from the traditional ASPECT based on leukoaraiosis severity (1 point subtracted if mild, 2 if moderate, 3 if severe). L-ASEPCTS score performance was validated using a consecutive cohort of 75 AIS LVO patients.Results174 patients were included in this retrospective analysis: average age: 68.0±9.1. 28 (16.1%) had no leukoaraiosis, 66 (37.9%) had mild, 62 (35.6%) had moderate, and 18 (10.3%) had severe. Leukoaraiosis severity was associated with worse 90-day mRS among all patients (P=0.0005). Both L-ASPECTS and ASPECTS were associated with poor outcomes, but the area under the curve (AUC) was higher with L-ASPECTS (P<0.0001 and AUC=0.7 for L-ASPECTS; P=0.04 and AUC=0.59 for ASPECTS). In the validation cohort, the AUC for L-ASPECTS was 0.79 while the AUC for ASPECTS was 0.70. Of patients that had successful reperfusion (mTICI 2b/3), the AUC for traditional ASPECTS in predicting good functional outcome was 0.80: AUC for L-ASPECTS was 0.89.ConclusionsLeukoaraiosis severity on pre-mechanical thrombectomy NCCT is associated with worse 90-day outcome in patients with AIS following endovascular recanalization, and is an independent risk factor for worse outcomes. A proposed L-ASPECTS score had stronger association with outcome than the traditional ASPECTS score.
Preclinical safety and efficacy evaluation of the Pipeline Vantage Embolization Device with Shield Technology
Authors: Starke Robert M , Thompson John , Pagani Ariana , Choubey Animesh , Wainwright John M , Wolf Michael F , Jahanbekam Reza , Girdhar Gaurav 
Published: June 2020

BackgroundThe Pipeline Vantage Embolization Device with Shield Technology is a next generation flow diverter developed to improve aneurysm occlusion and implant endothelialization in addition to lowering thrombogenicity. We report here the in vivo biocompatibility and in vitro hemocompatibility performance of the Pipeline Vantage Embolization Device with Shield Technology (Vantage) compared with the Pipeline Flex Embolization Device (Flex).MethodsBiocompatibility (via histology), aneurysm occlusion and vessel patency (via angiography), and endothelial coverage (via scanning electron microscopy (SEM)) for the Vantage and Flex devices were assessed in the rabbit elastase aneurysm model at 90 days (n=29) and 180 days (n=27). In vitro thrombogenicity for Flex and Vantage (n=16) was assessed using a human blood flow loop model at low heparin concentration (0.6 U/mL) with thrombin generation, platelet activation and thrombus visualization as outputs.ResultsRaymond Roy Occlusion Classification grade 1 was higher for Vantage (61%) compared with Flex (46%), but was not statistically significant (p>0.05). All branch vessels were patent. Histological measures for both devices were similar (p>0.05). Endothelial coverage of the implant was significantly better for Vantage compared with Flex (p<0.05). In vitro measurements of thrombin generation (thrombin-antithrombin complex (µg/mL): Vantage 0.49±0.45; Flex 10.57±9.84) and platelet activation (β-thromboglobulin (IU/µl): Vantage 0.41±0.19; Flex 4.14±2.38) were both statistically lower (p<0.05) for Vantage compared with Flex. High resolution microscopy showed less accumulation of thrombus on Vantage as compared with Flex.ConclusionVantage improved aneurysm occlusion and implant endothelialization and had significantly lower thrombogenicity as compared with Flex, while preserving the biocompatibility safety profile of Flex.
Moving beyond PARP Inhibition in ATM-Deficient Prostate Cancer
Authors: Setton Jeremy S. , Powell Simon N. 
Published: June 2020

Abstract
DNA repair defects are found in primary and metastatic prostate cancer. Alterations in the ATM gene are the second most common defect after BRCA2, but their sensitivity to PARP inhibitors has been questioned by recent clinical literature. The work by Rafiei and colleagues in this issue of Cancer Research now supports this observation with genetically engineered cells and quantitative responses. ATR inhibitors have not yet found a clear role in the clinic, but the new work suggests that ATM-deficient cancers may be more vulnerable to ATR inhibition rather than PARP inhibitors, which is a testable hypothesis for clinical trials.
See related article by Rafiei et al., p. 2094
PD-1 Blockade in Chinese versus Western Patients with Melanoma
Authors: Shoushtari Alexander N. , Bao Riyue , Luke Jason J. 
Published: June 2020

Abstract
In this trial of programmed cell death-1 (PD-1) blockade with toripalimab in previously treated Chinese patients with melanoma, unique histologic and molecular features may explain why the objective response rate is lower than those defined in Western populations. This work suggests future avenues for investigating mechanisms of melanoma formation and resistance to PD-1 blockade.
See related article by Tang et al., p. 4250
The effect of static and dynamic eccentricities on the performance of flux reversal permanent magnet machine
Authors: Shuraiji Ahlam Luaibi 
Published: June 2020

This study investigates the effect of static and dynamic eccentricities on the performances of flux reversal permanent magnet (FRPM) machine with even rotor pole number, i.e. FRPM machine with 12/10 stator/rotor combination. No-load and load performances of the machine are investigated under three rotor operating conditions including centricity, static eccentricity and dynamic eccentricity. The investigation has been carried out using 2D-FEA. It has been revealed that the 12/10 FRPM machine under normal operating condition has no unbalanced magnetic force, due to the even pole number of the rotor. On the other hand, such undesirable feature would be presented in the 12/10 FRPM machine as a result of the existing of static and dynamic eccentricities. Both static and dynamic eccentric machines exhibit unbalanced three-phase flux linkage as well as back-EMF. Moreover, three operating conditions of the investigated machine have the same fundamental cogging torque harmonic. However, low order harmonics are existed in the static and dynamic centric machines and are not found in the centric machine. Furthermore, about 16% less torque ripple delivered by the centric machine compared with both static and dynamic counterparts.