bluuebunny/crossref_metadata_2025_split huggingface dataset:
New geographic model of care to manage the post-COVID-19 elective surgery aftershock in England: a retrospective observational study
Authors: Clarke Jonathan , Murray Alice , Markar Sheraz Rehan , Barahona Mauricio , Kinross James 
Published: October 2020

ObjectivesThe suspension of elective surgery during the COVID-19 pandemic is unprecedented and has resulted in record volumes of patients waiting for operations. Novel approaches that maximise capacity and efficiency of surgical care are urgently required. This study applies Markov multiscale community detection (MMCD), an unsupervised graph-based clustering framework, to identify new surgical care models based on pooled waiting-lists delivered across an expanded network of surgical providers.DesignRetrospective observational study using Hospital Episode Statistics.SettingPublic and private hospitals providing surgical care to National Health Service (NHS) patients in England.ParticipantsAll adult patients resident in England undergoing NHS-funded planned surgical procedures between 1 April 2017 and 31 March 2018.Main outcome measuresThe identification of the most common planned surgical procedures in England (high-volume procedures (HVP)) and proportion of low, medium and high-risk patients undergoing each HVP. The mapping of hospitals providing surgical care onto optimised groupings based on patient usage data.ResultsA total of 7 811 891 planned operations were identified in 4 284 925 adults during the 1-year period of our study. The 28 most common surgical procedures accounted for a combined 3 907 474 operations (50.0% of the total). 2 412 613 (61.7%) of these most common procedures involved ‘low risk’ patients. Patients travelled an average of 11.3 km for these procedures. Based on the data, MMCD partitioned England into 45, 16 and 7 mutually exclusive and collectively exhaustive natural surgical communities of increasing coarseness. The coarser partitions into 16 and seven surgical communities were shown to be associated with balanced supply and demand for surgical care within communities.ConclusionsPooled waiting-lists for low-risk elective procedures and patients across integrated, expanded natural surgical community networks have the potential to increase efficiency by innovatively flexing existing supply to better match demand.
Fronto-striatal circuits for cognitive flexibility in far from onset Huntington’s disease: evidence from the Young Adult Study
Authors: Langley Christelle , Gregory Sarah , Osborne-Crowley Katie , O'Callaghan Claire , Zeun Paul , Lowe Jessica , Johnson Eileanoir B , Papoutsi Marina , Scahill Rachael I , Rees Geraint , Tabrizi Sarah J , Robbins Trevor W , Sahakian Barbara Jacquelyn 
Published: October 2020

ObjectivesCognitive flexibility, which is key for adaptive decision-making, engages prefrontal cortex (PFC)-striatal circuitry and is impaired in both manifest and premanifest Huntington’s disease (pre-HD). The aim of this study was to examine cognitive flexibility in a far from onset pre-HD cohort to determine whether an early impairment exists and if so, whether fronto-striatal circuits were associated with this deficit.MethodsIn the present study, we examined performance of 51 pre-HD participants (mean age=29.22 (SD=5.71) years) from the HD Young Adult Study cohort and 53 controls matched for age, sex and IQ, on the Cambridge Neuropsychological Test Automated Battery (CANTAB) Intra-Extra Dimensional Set-Shift (IED) task. This cohort is unique as it is the furthest from disease onset comprehensively studied to date (mean years=23.89 (SD=5.96) years). The IED task measures visual discrimination learning, cognitive flexibility and specifically attentional set-shifting. We used resting-state functional MRI to examine whether the functional connectivity between specific fronto-striatal circuits was dysfunctional in pre-HD, compared with controls, and whether these circuits were associated with performance on the critical extradimensional shift stage.ResultsOur results demonstrated that the CANTAB IED task detects a mild early impairment in cognitive flexibility in a pre-HD group far from onset. Attentional set-shifting was significantly related to functional connectivity between the ventrolateral PFC and ventral striatum in healthy controls and to functional connectivity between the dorsolateral PFC and caudate in pre-HD participants.ConclusionWe postulate that this incipient impairment of cognitive flexibility may be associated with intrinsically abnormal functional connectivity of fronto-striatal circuitry in pre-HD.
Classification of Human Metaspread Images Using Convolutional Neural Networks
Authors: Arora Tanvi 
Published: October 2020

Chromosomes are the genetic information carriers. Any modification to the structure or the number of chromosomes results in a medical condition termed as genetic defect. In order to uncover the genetic defects, the chromosomes are imaged during the cell division process. The images thus generated are termed as metaspread images and are used for identifying the genetic defects. It has been observed that the metaspread images generally suffer from intensity inhomogeneity and the chromosomes are also present in varied orientations, and as a result finding genetic defects from such images is a tedious process. Therefore, cytogeneticists manually select the images that can be used for the purpose of uncovering the genetic defects and the generation of the karyotype. In the proposed approach, a novel method is being presented using DenseNet architecture of the convolutional neural networks-based classifier, which classifies the human metaspread images into two distinct categories, namely, analyzable and non-analyzable based on the orientation of the chromosomes present in the metaspread images. This classification process will help to select the most prominent metaspread images for karyotype generation that has least amount of touching and overlapping chromosomes. The proposed method is novel in comparison to the earlier methods as it works on any type of image, be it G band images, MFISH images or the Q-banded images. The proposed method has been trained by using a ground truth of 156 750 metaspread images. The proposed classifier has been able to achieve an error rate of 1.46%.
Giant Lipoma Presents from the Buccal Vestibule
Authors: Sakamoto Yuki , Oyama Gohei 
Published: October 2020

A lipoma is a benign tumor, where the parenchyma is composed of adipose tissue. Lipomas comprise 0.1%–5% of all benign tumors in the oral cavity. A 43-year-old man, with a known masticatory disorder, visited the Department of Oral Surgery at our hospital because of a facial swelling. The swelling, which had worsened over 15 years, was not painful, but the patient had discomfort while eating and talking. A detailed examination revealed a smooth, elastic, soft, circular, and yellowish pink pedunculated tumor-like lesion, with a diameter of approximately 40 mm, on the right buccal mucosa. An oval-shaped neoplastic lesion with a well-defined border of

40

mm
×
20

mm

was noted on MRI. Based on these results, the lesion was characterized as being a benign lipoma. The tumor was resected under local anesthesia. The pedunculated tumor was excised with an electric knife, and the wound was sutured. No trismus or paresthesia was noted on the postoperative follow-up.
“Together We Can Return to Balance”—Eastern Woodlands Native Perspectives and Type 2 Diabetes: A Qualitative Study
Authors: Sadlon Penni , Charron-Prochownik Denise , Sullivan-Bolyai Susan 
Published: October 2020

Purpose To explore the perspectives of Eastern Woodlands Native people with type 2 diabetes (T2DM) in the context of health beliefs, T2DM disease self-management, and family and community connections. Methods A qualitative descriptive method using face-to-face or telephonic semistructured interviews was employed with Native people ages 18 years or older who have a diagnosis of T2DM (N = 12) from an unidentified Eastern Woodlands tribe. The PEN-3 Cultural Model guided the study initially. Results The overarching theme “together we can return to balance” corresponded to 5 subthemes: coming to know life paths with T2DM, acknowledging the imbalance, negotiating my way forward, making important connections, and sticking closer to Mother Earth. Dimensions within the subthemes suggest why Native people may not be reaching T2DM treatment goals. Reasons include incomplete diabetes knowledge, difficulty accessing resources, and contextual variations in adoption of conventional diabetes treatments. Conclusion This study identified themes from Native perspectives about T2DM self-management and about prospects that may mitigate incomplete knowledge and support. Integrating indigenous health and wellness knowledge with conventional principles of diabetes care presents several opportunities for nurses to advance diabetes self-management (DSM) education and support. Including Native health concepts when educating patients about DSM should be viewed as desirable for holistic family and community involvement that is central toward preventing disease progression.
Comparison of atrio-femoral and femoro-atrial venovenous extracorporeal membrane oxygenation in adult
Authors: Ling Steven Kin-ho 
Published: October 2020

Introduction: Different cannulation approaches existed for veno-venous extracorporeal membrane oxygenation (VV ECMO). We aimed to compare the atrio-femoral (AF) and femoro-atrial (FA) configuration in terms of their flow efficiency and influence on patient outcome. Method: This was a single-centre, retrospective case control study. Adult patients admitted to the Intensive Care Unit and required VV ECMO service at Tuen Mun Hospital, Hong Kong, from June 2015 to January 2020 were included. Data were collected from our ECMO database for comparison. Results: Between June 2015 and January 2020, eight patients received AF configuration and 19 patients received FA configuration. The maximum achieved flow in the AF group was significantly higher than that in the FA group (4.08 ± 0.57 L/min vs. 3.52 ± 0.58 L/min, p = 0.03). The fluid balance in first 3 days of ECMO was significantly lower in the AF group compared to that in the FA group (1.16 ± 2.71 L vs. 3.46 ± 1.97 L, p = 0.02). As well, the chance for successful awake ECMO was statistically higher in the AF group (p = 0.048). Conclusion: Atrio-femoral configuration in VV ECMO was associated with a higher maximum achieved ECMO flow, less fluid gain in first 3 days of ECMO and more successful awake ECMO.
The art and science of recruitment to a cancer rapid autopsy programme: A qualitative study exploring patient and clinician experiences
Authors: Tutty Erin , Horsley Philomena , Forbes Shepherd Rowan , Forrest Laura E. 
Published: October 2020

Background: CASCADE is a successful, Australia-first cancer rapid autopsy programme. Patients are recruited to the programme by their clinician once they understand that further treatment has only palliative intent. Despite its value, rapid autopsy is a rare research method owing partly to recruitment challenges. Aim: This research aimed to explore (1) how, in practice, clinicians select and recruit patients to the programme and (2) patient experiences of this process. Design: This was a qualitative study grounded in phenomenology. CASCADE team members (clinicians and researchers) and patients participated in semi-structured interviews. Data were analysed using an inductive, team-based approach to thematic analysis. Participants: Interviews were conducted with 31 participants (11 patients and 20 CASCADE team members). Results: Patient selection and recruitment to a rapid autopsy programme is both an art and science. In practice, patient selection is a subjective process that involves assessing a patient’s psychosocial suitability for the programme. Trust and rapport are necessary for informing this assessment and to create an environment conducive to discussing rapid autopsy. Clinicians have also crafted their own ways of delivering information about CASCADE, with both clinicians and patients acknowledging that, if not handled sensitively, recruitment could cause distress. Overall, patients were satisfied with the way in which they were recruited. Conclusion: Findings provide insight into how clinicians successfully select and recruit patients to a rapid autopsy programme and suggests that discussing such topics are acceptable to end-of-life patients. This research also raises thought-provoking questions about the ‘gatekeeping’ role of clinicians in recruitment.
Healthcare professionals’ experiences of inter-professional collaboration during patient’s transfers between care settings in palliative care: A focus group study
Authors: Mertens Fien , Debrulle Zoë , Lindskog Evelyn , Deliens Luc , Deveugele Myriam , Pype Peter 
Published: October 2020

Background: Continuity of care is challenging when transferring patients across palliative care settings. These transfers are common due to the complexity of palliative care, which has increased significantly since the advent of palliative care services. It is unclear how palliative care services and professionals currently collaborate and communicate to ensure the continuity of care across settings, and how patient and family members are involved. Aim: To explore healthcare professionals’ experiences regarding the communicative aspects of inter-professional collaboration and the involvement of patient and family members. Design: Qualitative design, including focus group discussions. Setting/participants: The study focused on one palliative care network in Belgium and involved all palliative care settings: hospital, hospital’s palliative care unit, home care, nursing home. Nine group discussions were conducted, with diverse professionals ( n = 53) from different care settings. Results: Timely and effective inter-professional information exchange was considered fundamental. A perceived barrier for interprofessional collaboration was the lack of a shared electronic health record. Efficiency regarding multidisciplinary team meetings and inter-professional communication were subject to improvement. A striking study finding was the perceived insufficient open communication of specialists towards patients and the lack of shared decision making. This not only hampered advance care planning discussions and early integration of palliative home care, but also the functioning of other professionals. Conclusion: From the perspective of the integrated care framework, several areas of improvement on different levels of care and collaboration are identified. Support from policymakers and researchers is required to achieve integrated palliative care in regional networks.
Biomechanical evaluation of axial-loading simulated experiment in wrist fractures: a finite element analysis
Authors: Fan You-Liang , Xu Hai-Yun , Xia Ming-Yang , Zhang Wen , Wen Hui-Long , Gao Li-Bo , Pei Yan-Hui 
Published: October 2020

Objective To assess the biomechanical properties that influence wrist fracture, so as to provide the theoretical basis for simulation experiments to aid the optimal design of wrist protectors. Methods Six cadaveric wrists were included as experimental specimens. Wrist specimens wearing wrist protectors formed the experimental group and unprotected wrist specimens formed the control group. The wrist specimens were axially loaded under physiological loads and the stress magnitude and distribution of the experimental and control groups were obtained. A three-dimensional wrist finite element model of a healthy volunteer was developed to verify the rationality and effectiveness of the cadaveric wrist models. Results Under normal physiological loads, the stress on the radioulnar palmar unit was high and manifested in the form of pressure, while the stress on the radioulnar dorsal unit was lower and manifested in the form of tension. The stresses on the radial distal palmar, ulnar distal palmar, radial distal dorsal, ulnar distal dorsal, radial proximal palmar and ulnar proximal palmar units in the experimental group were less than those in the control group. Conclusion Under physiological loads, wearing a wrist protector can reduce the stress on the radioulnar distal palmar, radioulnar proximal palmar and radioulnar distal dorsal units, while having no obvious effect on the radioulnar proximal dorsal units.
Food insecurity and healthcare access, utilization, and quality among middle and later life adults in California
Authors: Janio Emily A. , Sorkin Dara H. 
Published: October 2020

Objectives: This study examined the association between food insecurity status and healthcare access, utilization, and quality among adults aged 55 years and older. Methods: Data collected between 2011 and 2016 for the California Health Interview Survey were used. The sample included 72,212 individuals who were divided into three groups: food secure (FS), low food security (L-FS), and very low food security (VL-FS). Results: Logistic regression analyses controlled for demographics. Food insecurity was associated with decreased access to and quality of care and increased utilization. Specifically, VL-FS was more likely to delay care than FS. Additionally, VL-FS and L-FS had greater odds of visiting an emergency room than FS. Furthermore, VL-FS and L-FS were more likely to have a doctor who did not always explain aspects of care carefully compared to FS. Discussion: These findings suggest a need for increased screening for food insecurity in healthcare settings.
Perspective sur la responsabilité de l’industrie pharmaceutique dans la promotion de la recherche pédiatrique et dans l’accès aux médicaments essentiels
Authors: Dahane Neyla , Godard Béatrice 
Published: October 2020

Resumé : L’industrie pharmaceutique a permis à de nombreux patients d’améliorer leur santé. Mais elle reste critiquée à cause d’un certain désengagement envers les maladies dans les pays en voie de développement et notamment les maladies pédiatriques. Considérant le cercle vicieux de la pauvreté et de la maladie affectant les enfants dans ces pays, il apparait primordial que les multinationales pharmaceutiques impliquent leur responsabilité à plusieurs niveaux : par la mise en place d’actions concrètes pour mener plus de recherches sur les enfants, vu leurs besoins ; puis en rendant les médicaments accessibles à un plus grand nombre d’enfants.
Posaconazole for the prophylaxis of invasive aspergillosis in acute myeloid leukemia: Is it still useful outside the clinical trial setting?
Authors: Chen Tsung-Chih , Wang Ren Ching , Lin Yu-Hui , Chang Kuang-Hsi , Hung Li-Ya , Teng Chieh-Lin Jerry 
Published: October 2020

Background: Posaconazole prophylaxis during remission induction chemotherapy not only decreases the incidence of invasive aspergillosis (IA) but also improves the overall survival rate among patients with acute myeloid leukemia (AML). However, it remains debatable whether this result applies to patients in a real-world setting. Methods: We retrospectively assessed 208 adult patients with newly diagnosed AML who underwent remission induction therapy. These 208 patients were stratified into the posaconazole prophylaxis group ( n = 58) and no antifungal prophylaxis group ( n = 150). Results: Multivariate analyses showed that induction failure significantly increased the risk of proven or probable IA during the first induction chemotherapy [hazard ratio (HR), 10.47; 95% confidence interval (CI), 1.73–63.45; p = 0.011] and the entire course of AML treatment (HR, 4.48; 95% CI, 1.71–11.75; p = 0.002). However, posaconazole prophylaxis did not reduce the risk of IA during the first induction chemotherapy (HR, 1.47; 95% CI, 0.14–15.04; p = 0.746) and during the entire course of AML treatment (HR, 1.09; 95% CI, 0.29–4.09; p = 0.896). Furthermore, there was no significant difference in overall survival between these two groups of patients (514 versus 689 days; p = 0.454). Conclusion: Successful induction remains fundamental to reducing the risk of IA among AML patients undergoing remission induction chemotherapy.
The relation between serum adipose differentiation-related protein and non-alcoholic fatty liver disease in type 2 diabetes mellitus
Authors: Fan Huaying , Diao Hongjie , Lu Yan , Xie Jing , Cheng Xingbo 
Published: October 2020

Background: Adipose differentiation-related protein (ADRP) is an adipokine. In vitro and animal studies have verified the role of ADRP in lipid metabolism and non-alcoholic fatty liver disease (NAFLD). The aim of this study was to evaluate the interaction between levels of ADRP and NAFLD in type 2 diabetes mellitus (T2DM). Methods: Cross-sectional design. A total of 142 patients with T2DM were assigned to NAFLD (Group-I) and non-NAFLD (Group-II). Anthropometric data were collected. Serum ADRP levels and biochemical parameters were also determined. t test or χ2 test was conducted to compare the data between two groups. Receiver operating characteristic (ROC) curve analysis and logistic regression models were used to assess the interaction between ADRP levels and NAFLD in T2DM. Pearson correlation analysis and linear regression model were used to assess the correlations between serum ADRP levels and other parameters. Results: The serum ADRP level was higher in Group-I than in Group-II. Further, binary logistic regression models demonstrated that ADRP was an independent risk factor related to NAFLD in patients with T2DM. Moreover, as the ADRP level elevated across its tertiles, the percentage of NAFLD in T2DM increased. Multivariate logistic regression models demonstrated that the odds ratio of NAFLD was 8.831 in the highest tertile of ADRP, after adjustment for potential confounders. Area under THE ROC curve of ADRP for predicting the presence of NAFLD in T2DM was 0.738. Finally, multiple stepwise regression analysis indicated that age, waist circumference (WC), homeostasis model assessment of insulin resistance index (HOMA-IR) and triglyceride (TG) were independent factors associated with ADRP levels. Conclusion: High serum ADRP level may be used as an independent risk factor for NAFLD in T2DM. The expression of ADRP may be affected by age, WC, HOMA-IR and TG.