bluuebunny/crossref_metadata_2025_split huggingface dataset:
Barriers in the Decision Making About and Performance of Continuous Sedation Until Death in Nursing Homes
Authors: Robijn Lenzo , Deliens Luc , Rietjens Judith , Pype Peter , Chambaere Kenneth 
Published: November 2019

AbstractBackground and ObjectivesWhile decision making about and performance of continuous sedation involve many challenges, they appear to be particularly pervasive in nursing homes. This study aims to identify barriers to the decision making and performance of continuous sedation until death in Flemish nursing homes as experienced by the health care professionals involved.Research Design and MethodsTen focus groups were held with 71 health care professionals including 16 palliative care physicians, 42 general practitioners, and 13 nursing home staff. Discussions were transcribed verbatim and analyzed using a constant comparative approach.ResultsPerceived barriers concerned factors prior to and during sedation and were classified according to three types: (a) personal barriers related to knowledge and skills including the lack of clarity on what continuous sedation should be used for (linguistic ambiguity) and when and how it should be used (practical ambiguity); (b) relational barriers concerning communication and collaboration both between health care professionals and with family; (c) organizational barriers related to the organization of care in nursing homes where, for example, there is no on-site physician, or where the recommended medication is not always available.Discussion and ImplicationsThe findings suggest there are considerable challenges for sound decision making about and performance of continuous sedation until death in nursing homes. There is a need for multicomponent initiatives that provide guidance in the context of the complexity of a resident’s medical situation, the family, and the specific organization of care, which would have the potential to facilitate and improve the decision-making process and performance of continuous sedation in nursing homes.
An Internal Replication Examining the Role of Issue Involvement, Relevance, and Additional Requirements to Maintain an Established Freedom among Older Adults
Authors: Al-Ghaithi Salah H , Reynolds-Tylus Tobias , Quick Brian L , Gonzalez Andrea Martinez , Nead Kaitlyn E 
Published: November 2019

Abstract
The current research aimed to advance the psychological reactance theory literature by extending this framework to older adults (N = 525) age 55 or older. In doing so, this project tests two principles of reactance theory as well as exploring the relationship between reactance and a behavioral outcome. Results demonstrated that the threat of additional driver’s license requirements, issue involvement, and the personal relevance of the threatened freedom increased freedom threat perceptions. In turn, freedom threat perceptions were positively associated with reactance. Reactance was positively associated with agreeing to sign a petition protesting the proposed requirements. The same pattern of findings was replicated within the context of maintaining low cost health insurance premiums. In addition to these main effects, two interactions (additional test requirements * issue involvement and additional test requirements * personal 2 relevance) were explored. Results are discussed with an emphasis on the theoretical and practical implications for psychological reactance theory among older adults.
‘Genes versus children’: if the goal is parenthood, are we using the optimal approach?
Authors: Kirkman-Brown Jackson C , Martins Mariana V 
Published: November 2019

Abstract
First medical contact for couples trying for a child will usually emphasise the array of assistance available to ‘help them have their own child’, usually with options involving ART, after diagnosis. For many poorer prognosis couples, this means repetitive unsuccessful cycles of invasive and stressful treatment. What is sometimes lost at this stage is a reflection on the likelihood of success of different options, which may lead patients to focus on hoping for their own ‘genetic’ progeny, but failing to consider the alternative and potentially more successful other options, including donation and adoption, for achieving parenthood of a child. Factors not only such as female age but also advanced requirements such as preimplantation genetic testing or even mitochondrial replacement therapies all have reduced chances of success but further tend to reinforce the importance of a genetic link. The financial, physical and psychosocial burden associated with cumulative failure also lead to a higher probability of dropout and consequently an even higher probability of remaining in involuntary childlessness. We advocate formulation of a detailed roadmap for discussion of parenthood, with reference explanation to genetics and epigenetics, which gives due consideration to the psychological effects from the beginning to end of the treatment process, alongside a balanced consideration of the likelihood of treatment success and discussion of other options. Only when we provide patients with the service of a clear and transparent discussion of these matters, we will really realise the true potential of our field, which may then be better considered as assisted families.
TuThor: an innovative new training model for video-assisted thoracic surgery
Authors: Domhan Lorenz , Johannink Jonas , Miller Johanna , Steger Volker , Linder Albert , Kirschniak Andreas , Wilhelm Peter 
Published: November 2019

Abstract

OBJECTIVES
Video-assisted thoracic surgery (VATS) is a complex technique requiring dedicated surgical training. Platforms for such training are scarce and often rely on the use of live animals, which raises ethical concerns. The objective of this study was to develop a box trainer that is dedicated for VATS training and able to reproduce bleeding scenarios.

METHODS
The developed Tuebingen Thorax Trainer comprises 5 components that are mounted on a human anatomy-like thoracic cavity containing a porcine organ complex. Any standard thoracoscopic instrument can be used. The organ complex is attached to a perfusion module. We assessed the applicability of the system in four 1-day VATS training courses at the Tuebingen Surgical Training Center. Assessment was performed using a questionnaire handed out to all participants.

RESULTS
Forty participants have been trained with the Tuebingen Thorax Trainer at our institution since November 2016. Thirty-five (87.5%) participants stated that the Tuebingen Thorax Trainer is an adequate model for VATS training. The ex vivo organ complex was reported to be realistic with regards to the level of detail and scale (76%). A large proportion of participants (27.5%) were experienced with VATS and reported having performed &gt;50 procedures before taking the training course.

CONCLUSIONS
This new training device allows realistic training for VATS procedures. ‘Stagnant hydrostatic perfusion’ permits simulation of reproducible bleeding scenarios. The device is low in production costs and offers a strong resemblance to the clinical scenario. It reduces the use of animal models and contributes to the efforts in making surgical skills training for VATS more accessible.
Appraising causal relationships of dietary, nutritional and physical-activity exposures with overall and aggressive prostate cancer: two-sample Mendelian-randomization study based on 79 148 prostate-cancer cases and 61 106 controls
Authors: Kazmi Nabila , Haycock Philip , Tsilidis Konstantinos , Lynch Brigid M , Truong Therese ,   The PRACTICAL Consortium, CRUK, BPC3, CAPS, PEGASUS, Martin Richard M , Lewis Sarah J 
Published: November 2019

Abstract

Background
Prostate cancer is the second most common male cancer worldwide, but there is substantial geographical variation, suggesting a potential role for modifiable risk factors in prostate carcinogenesis.

Methods
We identified previously reported prostate cancer risk factors from the World Cancer Research Fund (WCRF)’s systematic appraisal of the global evidence (2018). We assessed whether each identified risk factor was causally associated with risk of overall (79 148 cases and 61 106 controls) or aggressive (15 167 cases and 58 308 controls) prostate cancer using Mendelian randomization (MR) based on genome-wide association-study summary statistics from the PRACTICAL and GAME-ON/ELLIPSE consortia. We assessed evidence for replication in UK Biobank (7844 prostate-cancer cases and 204 001 controls).

Results
WCRF identified 57 potential risk factors, of which 22 could be instrumented for MR analyses using single nucleotide polymorphisms. For overall prostate cancer, we identified evidence compatible with causality for the following risk factors (odds ratio [OR] per standard deviation increase; 95% confidence interval): accelerometer-measured physical activity, OR = 0.49 (0.33–0.72; P = 0.0003); serum iron, OR = 0.92 (0.86–0.98; P = 0.007); body mass index (BMI), OR = 0.90 (0.84–0.97; P = 0.003); and monounsaturated fat, OR = 1.11 (1.02–1.20; P = 0.02). Findings in our replication analyses in UK Biobank were compatible with our main analyses (albeit with wide confidence intervals). In MR analysis, height was positively associated with aggressive-prostate-cancer risk: OR = 1.07 (1.01–1.15; P = 0.03).

Conclusions
The results for physical activity, serum iron, BMI, monounsaturated fat and height are compatible with causality for prostate cancer. The results suggest that interventions aimed at increasing physical activity may reduce prostate-cancer risk, although interventions to change other risk factors may have negative consequences on other diseases.
Learning Experience Reverses Catecholaminergic Effects on Adaptive Behavior
Authors: Mückschel Moritz , Eggert Elena , Prochnow Astrid , Beste Christian 
Published: November 2019

Abstract

Background
Catecholamines are important for cognitive control and the ability to adapt behavior (e.g., after response errors). A prominent drug that modulates the catecholaminergic system is methylphenidate. On the basis of theoretical consideration, we propose that the effects of methylphenidate on behavioral adaptation depend on prior learning experience.

Methods
In a double-blind, randomized, placebo-controlled crossover study design, we examined the effect of methylphenidate (0.25 mg/kg) on post error behavioral adaptation processes in a group of n = 43 healthy young adults. Behavioral adaptation processes were examined in a working memory, modulated response selection task. The focus of the analysis was on order effects within the crossover study design to evaluate effects of prior learning/task experience.

Results
The effect of methylphenidate/placebo on post-error behavioral adaptation processes reverses depending on prior task experience. When there was no prior experience with the task, methylphenidate increased post-error slowing and thus intensified behavioral adaptation processes. However, when there was prior task experience, (i.e., when the placebo session was conducted first in the crossover design), methylphenidate even decreased post-error slowing and behavioral adaptation. Effect sizes were large and the power of the observed effects was higher than 95%.

Conclusions
The data suggest that catecholaminergic effects on cognitive control functions vary as a function of prior learning/task experience. The data establish a close link between learning/task familiarization and catecholaminergic effects for executive functions, which has not yet been studied, to our knowledge, but is of considerable clinical relevance. Theoretical implications are discussed.
Breast Imaging During Pregnancy and Lactation
Authors: Abramson Lisa , Massaro Lindsey , Alberty-Oller J Jaime , Melsaether Amy 
Published: November 2019

Abstract
Breast imaging during pregnancy and lactation is important in order to avoid delays in the diagnosis and treatment of pregnancy-associated breast cancers. Radiologists have an opportunity to improve breast cancer detection by becoming familiar with appropriate breast imaging and providing recommendations to women and their referring physicians. Importantly, during pregnancy and lactation, both screening and diagnostic breast imaging can be safely performed. Here we describe when and how to screen, how to work up palpable masses, and evaluate bloody nipple discharge. The imaging features of common findings in the breasts of pregnant and lactating women are also reviewed. Finally, we address breast cancer staging and provide a brief primer on treatment options for pregnancy-associated breast cancers.
Dialysis initiation improves calcification propensity
Authors: Ponte Belen , Pruijm Menno , Pasch Andreas , Dufey-Teso Anne , Martin Pierre-Yves , de Seigneux Sophie 
Published: November 2019

AbstractBackgroundCardiovascular morbidity and mortality is high in patients starting dialysis and could be related to modifications of calcification inducers and inhibitors by dialysis, promoting cardiovascular events. The impact of dialysis initiation on serum calcification propensity evolution and arterial stiffness is unknown. We therefore prospectively determined the evolution of the one-half maximal transition time (T50) value and its main determinants as well as pulse wave velocity over the first 3 months of dialysis initiation.MethodsWe analysed the evolution of T50, fetuin-A and mineral metabolism parameters before dialysis initiation (M0) and monthly until Month 3 (M3) in incident patients starting haemodialysis (HD) or peritoneal dialysis (PD) in two tertiary Swiss university hospitals. Arterial stiffness was assessed by pulse tonometry at M0 and M3 and biological parameters were compared between M0 and M3 and before/after HD. Linear mixed models were used to assess parameter evolution over time, taking into account repeated measures and other influencing variables.ResultsForty-six patients on HD and 12 on PD were followed. Among them, 45 were male (78%) with a median age of 67 years (25th–75th quartile range 54–77). T50 significantly increased between M0 and M3 from 183 (120–266) to 246 min (175–330) (P &lt; 0.001). Fetuin-A, calcium and magnesium also increased while phosphate decreased. Factors associated with T50 changes over time were fetuin-A, phosphate and magnesium (P &lt; 0.001). Fetuin-A changes were associated with inflammation-related factors (albumin, C-reactive protein) but not calcium and phosphate levels. Arterial stiffness was not significantly modified over 3 months. PD and HD initiation showed similar trends.ConclusionsDialysis initiation significantly improves calcification propensity and fetuin-A levels. These modifications do not explain the high mortality related to dialysis initiation. The clinical relevance of using T50 values to initiate dialysis awaits further studies.
Seizures in Human Immunodeficiency Virus-Associated Cryptococcal Meningitis: Predictors and Outcomes
Authors: Pastick Katelyn A , Bangdiwala Ananta S , Abassi Mahsa , Flynn Andrew G , Morawski Bozena M , Musubire Abdu K , Eneh Prosperity C , Schutz Charlotte , Taseera Kabanda , Rhein Joshua , Hullsiek Kathy Huppler , Nicol Melanie R , Vidal Jose E , Nakasujja Noeline , Meintjes Graeme , Muzoora Conrad , Meya David B , Boulware David R 
Published: November 2019

AbstractBackgroundSeizures commonly occur in patients with cryptococcal meningitis, yet risk factors and outcomes related to seizures are not well described.MethodsWe performed post hoc analyses on participants prospectively enrolled in 3 separate human immunodeficiency virus (HIV)-associated cryptococcal meningitis clinical trials during 2010–2017. Documentation of seizures at presentation or during hospitalization and antiseizure medication receipt identified participants with seizures. We summarized participant characteristics by seizure status via Kruskal-Wallis and χ 2 tests. Cox proportional hazards models analyzed the relationship between seizures and mortality. We compared mean quantitative neurocognitive performance Z (QNPZ-8) scores, and individual domain z-scores, at 3-months using independent t tests.ResultsAmong 821 HIV-infected cryptococcal meningitis participants, 28% (231 of 821) experienced seizures: 15.5% (127 of 821) experienced seizures at presentation, and 12.7% (104 of 821) experienced incident seizures. Participants with seizures at presentation had a significantly lower Glasgow coma scale ([GCS] &lt;15; P &lt; .001), CD4 count (&lt;50 cells/mcL; P = .02), and higher cerebrospinal fluid (CSF) opening pressure (&gt;25 cm H2O; P = .004) when compared with participants who never experienced seizures. Cerebrospinal fluid fungal burden was higher among those with seizures at presentation (125 000 Cryptococcus colony-forming units [CFU]/mL CSF) and with seizures during follow-up (92 000 CFU/mL) compared with those who never experienced seizures (36 000 CFU/mL, P &lt; .001). Seizures were associated with increased 10-week mortality (adjusted hazard ratio = 1.45; 95% confidence interval, 1.11–1.89). Participants with seizures had lower neurocognitive function at 3 months (QNPZ-8 = −1.87) compared with those without seizures (QNPZ-8 = −1.36; P &lt; .001).ConclusionsSeizures were common in this HIV-associated cryptococcal meningitis cohort and were associated with decreased survival and neurocognitive function.
On the detection of stellar differential rotation based on the Fourier transform of spectral line profiles
Authors: Takeda Yoichi 
Published: November 2019

AbstractIt is known that stellar differential rotation can be detected by analyzing the Fourier transform of spectral line profiles, since the ratio of the first and second zero frequencies is a useful indicator. This approach essentially relies on the conventional formulation that the observed flux profile is expressible as a convolution of the rotational broadening function and the intrinsic profile, which implicitly assumes that the local intensity profile does not change over the disk. Although this postulation is unrealistic in the strict sense, how the result is affected by this approximation is still unclear. With the aim of examining this problem, flux profiles of several test lines (showing different center-to-limb variations) were simulated using a model atmosphere corresponding to a mid-F dwarf by integrating the intensity profiles for various combinations of vesin i (projected rotational velocity), α (differential degree), and i (inclination angle), and their Fourier transforms were computed to check whether the zeros are detected at the predicted positions or not. For this comparison a large grid of standard rotational broadening functions and their transforms/zeros were also calculated. It turned out that the situation depends critically on vesin i: In the case of vesin i ≳ 20 km s−1, where rotational broadening is predominant over other line broadening velocities (typically several km s−1), the first/second zeros of the transform are confirmed almost at the expected positions. In contrast, deviations begin to appear as vesin i is lowered, and the zero features of the transform are totally different from those expected at vesin i as low as ∼10 km s−1, which means that the classical formulation is no longer valid. Accordingly, while the zero-frequency approach is safely applicable to studying differential rotation in the former broader-line case, it would be difficult to practice for the latter sharp-line case.
Ultrasound-Guided Peripheral Nerve Stimulation for Knee Pain: A Mini-Review of the Neuroanatomy and the Evidence from Clinical Studies
Authors: Lin Chih-Peng , Chang Ke-Vin , Wu Wei-Ting , Özçakar Levent 
Published: November 2019

AbstractObjectivesPeri- and postoperative pain frequently develops after joint replacement for severe knee osteoarthritis. A continuous nerve block is commonly used for pain relief, but the risks of infection and catheter dislodgement should be considered. The present mini-review aimed to brief the innervation and neural sonoanatomy of the knee joint and summarize the newest evidence of peripheral nerve stimulation (PNS) use in the management of knee pain.MethodsWe used a systematic approach to search for relevant articles. We used the combination of “peripheral nerve stimulation” and “knee pain” as the key words for the literature search using the electronic database without language or article type restriction. The search period was from the earliest record to August 2019.ResultsThe present review identified six studies, four of which were related to PNS for management of postoperative knee pain and two of which probed neuropathic pain. Most of the studies were either case series or case reports. Based on our search result, PNS is likely to be a feasible and safe treatment for knee pain, but its effectiveness remains uncertain.ConclusionsThe present review reveals that PNS is feasible for the management of knee pain, especially in the postoperative period. The procedure is safe under ultrasound guidance used for proper placement of the electrodes near the target nerves. In the future, more prospective randomized controlled trials are needed to validate the effectiveness of PNS in acute and chronic knee pain.
Public Order Policing Approaches to Minimize Crowd Confrontation During Disputes and Protests in Australia
Authors: Baker David 
Published: November 2019

AbstractTraditionally, public order clashes between police and protesters in Australia were intermittent and erratic, but police responses were often repressive and violent. By the 1990s, most police leadership was advocating a low-key strategy: one of communication and dialogue, negotiated management, and a less coercive approach to large-scale protests. This article argues that policing of demonstrations responds to the dynamics of differing protest contexts and behaviours. It explores the policing of some significant contemporary demonstrations in Australia ranging from industrial disputes to anti-globalization protests (1998 national waterfront dispute, 2007 Sydney Asia-Pacific Economic Corporation summit, and the 2014 G20 mega event in Brisbane). Although the policing approaches were markedly diverse, these case studies involved limited confrontation. Despite some notable exceptions, modern-day policing of protest in Australia has usually been non-confrontational, partly the result of police–protester liaison and dialogue. The psychological threat of police force, rather than its actual implementation, has restricted potential protest participation and limited violent clashes. A delicate and fragile balance exists between the police maintenance of order and security and the facilitation of a peaceful protest.