bluuebunny/crossref_metadata_2025_split huggingface dataset:
Repeated analyses of national clinical audit reports demonstrate improvements in feedback methods
Authors: Khan Tasneem , Alderson Sarah , Francis Jill J. , Lorencatto Fabiana , Grant-Casey John , Stanworth Simon J. , Foy Robbie 
Published: November 2020

Abstract
Background
There is growing interest in the impact of national clinical audit programmes on the quality of healthcare. There is also an evolving evidence-base for enhancing the design and delivery of audit and feedback. We assessed the extent to which a sample of UK national clinical audit feedback reports met a set of good practice criteria over three time points.

Methods
We undertook three cross-sectional content analyses. We developed good practice criteria for the content and delivery of feedback based upon evidence, behavioural theory and expert opinion. We applied these to a feedback reports from 23 national audits listed on the Healthcare Quality Improvement Partnership (HQIP) website in November 2015. We repeated our assessments in January 2017 for 20 repeat feedback reports, after HQIP had published reporting guidance for national audits, and in August 2019 for a further 14 repeat feedback reports. We verified our assessments, where possible, with audit leads.

Results
Feedback reports consistently included strengths at baseline, including past or planned repeated audit cycles (21; 91%), stating the importance of the topic in relation to patient care (22; 93%), using multi-modal data presentation (23; 100%), and summarising key findings (23; 100%).
We observed improvements over subsequent assessments, so that by 2019, at least 13 out of 14 (93%) feedback reports presented easily identifiable key findings and recommendations, linked recommendations to audit standards, and proposed easily identifiable action plans. Whilst the use of regional comparators did not improve, audit leads highlighted that programmes now provide local data via additional means.
The main shortcoming was the time lag between data collection and feedback; none of the 14 reports assessed in 2019 presented performance data less than 6 months old. Audit leads highlighted that some of these data might be available via programme websites.

Conclusion
We identified increased adherence to good practice in feedback by national clinical audit programmes that may enhance their impact on service delivery and outcomes. There is scope for improvement, especially in the recency of performance data. With further refinements, a criterion-based assessment offers an efficient means of monitoring the quality of national clinical audit feedback reports.
Visual process maps to support implementation efforts: a case example
Authors: Kononowech Jennifer , Landis-Lewis Zach , Carpenter Joan , Ersek Mary , Hogikyan Robert , Levy Cari , Phibbs Ciaran , Scott Winifred , Sales Anne E. 
Published: November 2020

Abstract
Background
Process mapping is often used in quality improvement work to examine current processes and workflow and to identify areas to intervene to improve quality. Our objective in this paper is to describe process maps as a visual means of understanding modifiable behaviors and activities, in this case example to ensure that goals of care conversations are part of admitting a veteran in long-term care settings.

Methods
We completed site visits to 6 VA nursing homes and reviewed their current admission processes. We conducted interviews to document behaviors and activities that occur when a veteran is referred to a long-term care setting, during admission, and during mandatory VA reassessments. We created visualizations of the data using process mapping approaches. Process maps for each site were created to document the admission activities for each VA nursing home and were reviewed by the research team to identify consistencies across sites and to identify potential opportunities for implementing goals of care conversations.

Results
We identified five consistent behaviors that take place when a veteran is referred and admitted in long-term care. These behaviors are assessing, discussing, decision-making, documenting, and re-assessing.

Conclusions
Based on the process maps, it seems feasible that the LST note and order template could be completed along with other routine assessment processes. However, this will require more robust multi-disciplinary collaboration among both prescribing and non-prescribing health care providers. Completing the LST template during the current admission process would increase the likelihood that the template is completed in a timely manner, potentially alleviate the perceived time burden, and help with the provision of veteran-centered care.
Evaluation of endoscopic ultrasound-guided gastric botulinum toxin injections in the treatment of obesity
Authors: Gameel Asmaa , Bahgat Monir , Seif Seham , Habeeb Maha , Abd El-Ghany Mohammed , Altonbary Ahmed Youssef 
Published: November 2020

Abstract
Background
Obesity is rapidly emerging as one of the greatest challenges of human health. Many randomized trials and open-label human studies described conflicting results of gastric intra-muscular injections of botulinum toxin type A (BTA). Endoscopic ultrasound (EUS) guidance can assure BTA injection into the subserosal layer and muscularis propria of the gastric wall which may optimize the efficacy of injection. The aim of the study is to assess the efficacy and safety of EUS-guided gastric BTA injections in weight reduction for obese subjects.

Results
The present study included 25 patients (2 males and 23 females with mean age 35.84 ± 7.776). For nutrient drink tests, median maximum tolerated volumes (MTVs) decreased from 720 cc (range 480–1680) as a baseline value 2 weeks before BTA injection to 360 cc (range 140–820) at 16 weeks after injection. Mean body weight reduction was 11.92 kg (10.8%) after 16 weeks of BTA injection. Mean body weight continued to decrease during the study period from a baseline value of 110 to 98 kg with significant reduction of mean BMI from baseline value of 41.2 to 36.7 at 16 weeks after BTA injection (p < 0.001). The study was completed without major adverse events.

Conclusion
EUS-guided BTA injection into the antral subserosa and muscularis propria could be an effective technique for weight reduction, or as a bridge for surgery, which can be done safely with minimal complications.

Trial registration
NCT03901040
Tracheostomy tube change during the COVID-19 pandemic: timing and safety considerations
Authors: Zahran Mohamed , Youssef Ahmed 
Published: November 2020

Abstract
Background
The recent outbreak of SARS-CoV-2 has become pandemic since it began in late 2019. Tracheostomy is considered an aerosol-generating procedure which increases potential viral exposure to the health care staff.

Main body
Since many patients diagnosed with SARS-CoV-2 underwent tracheostomy, the need for a standardized practice for tracheostomy tube change and care is mandatory. Articles listed in PubMed and guidelines from the otolaryngology societies were reviewed, and the state-of-the-art practice related to the topic is highlighted.

Conclusions
Tracheostomy care in COVID-19 patients requires significant decision-making and preparation to carry out the task in a safe way and eliminate the risk of viral transmission.
Discordant GH and IGF-1 Results in Treated Acromegaly: Impact of GH Cutoffs and Mean Values Assessment
Authors: Campana Claudia , Cocchiara Francesco , Corica Giuliana , Nista Federica , Arvigo Marica , Amarù Jessica , Rossi Diego Criminelli , Zona Gianluigi , Ferone Diego , Gatto Federico 
Published: November 2020

Abstract

Context
Discordant growth hormone (GH) and insulin-like growth factor-1 (IGF-1) values are frequent in acromegaly.

Objective
To evaluate the impact of different GH cutoffs on discordance rate. To investigate whether the mean of consecutive GH measurements impacts discordance rate when matched to the last available IGF-1 value.

Design
Retrospective study.

Setting
Referral center for pituitary diseases.

Patients
Ninety acromegaly patients with at least 3 consecutive evaluations for GH and IGF-1 using the same assay in the same laboratory (median follow-up 13 years).

Interventions
Multimodal treatment of acromegaly.

Main Outcome Measures
Single fasting GH (GHf) and IGF-1 (IGF-1f). Mean of 3 GH measurements (GHm), collected during consecutive routine patients’ evaluations.

Results
At last evaluation GHf values were 1.99 ± 2.79 µg/L and age-adjusted IGF-1f was 0.86 ± 0.44 × upper limit of normality (mean ± SD). The discordance rate using GHf was 52.2% (cutoff 1 µg/L) and 35.6% (cutoff 2.5 µg/L) (P = 0.025). “High GH” discordance was more common for GHf &lt;1.0 µg/L, while “high IGF-1” was predominant for GHf &lt;2.5 µg/L (P &lt; 0.0001). Using GHm mitigated the impact of GH cutoffs on discordance (GHm &lt;1.0 µg/L: 43.3%; GHm &lt;2.5 µg/L: 38.9%; P = 0.265). At receiver-operator characteristic curve (ROC) analysis, both GHf and GHm were poor predictors of IGF-1f normalization (area under the curve [AUC] = 0.611 and AUC = 0.645, respectively). The prevalence of disease-related comorbidities did not significantly differ between controlled, discordant, and active disease patients.

Discussion
GH/IGF-1 discordance strongly depends on GH cutoffs. The use of GHm lessen the impact of GH cutoffs. Measurement of fasting GH levels (both GHf and GHm) is a poor predictor of IGF-1f normalization in our cohort.
Impact of Lean Body Mass and Insulin Sensitivity on the IGF-1–Bone Mass Axis in Adolescence: the EPICOM Study
Authors: Jensen Rikke Beck , Bytoft Birgitte , Lohse Zuzana , Johnsen Sine Knorr , Nielsen Morten Frost , Oturai Peter Sandor , Højlund Kurt , Damm Peter , Clausen Tine D , Jensen Dorte M 
Published: November 2020

AbstractContextInsulin-like growth factor-1 (IGF-1) is involved in the growth of muscle and bone mass and contributes to glucose homeostasis. The offspring of mothers with diabetes during pregnancy have an increased risk of insulin resistance (IR).ObjectiveWe hypothesized that bone mass was decreased in the offspring of mothers with type 1 diabetes (T1D), and that the IGF-1–bone mass relationship would be negatively influenced by IR.DesignData from the Epigenetic, Genetic and Environmental Effects on Growth, Metabolism and Cognitive Functions in Offspring of Women with Type 1 Diabetes (EPICOM) study performed from 2012 to 2013 were included.SettingThis work is a follow-up study of a nationwide register study.PatientsA total of 278 adolescent index offspring whose mothers had T1D and 303 matched controls were studied.Main Outcome MeasureBone mineral content (BMC) determined by a dual-energy x-ray absorptiometry scan and the interaction with IGF-1 and insulin sensitivity were measured.ResultsThere was no difference in BMC, bone mineral density, height (SD score [SDS]), or BMC/height between index and control offspring. IGF-1 (SDS) did not differ between the groups but insulin-like growth factor-binding protein 3 (SDS) was higher in index boys compared to controls (B = .31 [95% CI, 0.06-0.57], P = .02). The statistical path analysis showed that IGF-1 predicted BMC/height (B = .24 [95% CI, 0.02-0.45], P = .03), but lean mass was a mediator of this. IGF-1 and the homeostatic model assessment of IR were positively associated (B = .75 [95% CI, 0.37-1.12], P &lt; .001). There was no moderating effect of the interaction between IR and IGF-1 on lean mass in the entire cohort (B = .005 [95% CI, –0.03 to 0.04], P = .81) or when analyzing index cases and controls separately.ConclusionWe found that lean mass was an intermediary factor in the IGF-1–bone mass relationship in a large cohort of adolescents, and this relationship was not moderated by IR.
Familial Nervous System Tumor Syndromes
Authors: Strowd Roy E. , Plotkin Scott R. 
Published: November 2020

ABSTRACTPURPOSE OF REVIEWAlthough sporadic primary neoplasms account for the majority of nervous system tumors, familial nervous system tumor syndromes are important and clinically relevant conditions for the neurologist to understand. This article reviews common inherited nervous system tumor syndromes including neurofibromatosis type 1, neurofibromatosis type 2, schwannomatosis, tuberous sclerosis complex, and von Hippel-Lindau syndrome. The epidemiology, genetics, approach to diagnosis, neurologic and nonneurologic manifestations, and management options are reviewed.RECENT FINDINGSAwareness of the more common and clinically relevant familial nervous system tumor syndromes is important. These conditions teach us about the underlying biology that drives tumor development in the central and peripheral nervous systems including peripheral nerve sheath tumors (eg, neurofibroma, schwannoma), meningioma, vestibular schwannoma, subependymal giant cell astrocytoma, and hemangioblastoma. Knowledge of the clinical manifestations ensures that the neurologist will be able to diagnose these conditions, recommend appropriate surveillance, refer to specialists, and support optimal management. Important discoveries in the role of the underlying genetics have contributed to the launch of several novel drug trials for these tumors, which are changing therapeutic options for patients.SUMMARYFamilial nervous system tumor syndromes are uncommon conditions that require specialized surveillance and management strategies. Coordination across a multidisciplinary team that includes neurologists, neuro-oncologists, radiologists, neurosurgeons, radiation oncologists, otolaryngologists, pathologists, neuropsychologists, physical medicine and rehabilitation specialists, and geneticists is necessary for the optimal treatment of these patients.
It takes two to tango – molecular links between plant immunity and brassinosteroid signalling
Authors: Ortiz-Morea Fausto Andres , He Ping , Shan Libo , Russinova Eugenia 
Published: November 2020

ABSTRACT
In response to the invasion of microorganisms, plants actively balance their resources for growth and defence, thus ensuring their survival. The regulatory mechanisms underlying plant immunity and growth operate through complex networks, in which the brassinosteroid phytohormone is one of the central players. In the past decades, a growing number of studies have revealed a multi-layered crosstalk between brassinosteroid-mediated growth and plant immunity. In this Review, by means of the tango metaphor, we immerse ourselves into the intimate relationship between brassinosteroid and plant immune signalling pathways that is tailored by the lifestyle of the pathogen and modulated by other phytohormones. The plasma membrane is the unique stage where brassinosteroid and immune signals are dynamically integrated and where compartmentalization into nanodomains that host distinct protein consortia is crucial for the dance. Shared downstream signalling components and transcription factors relay the tango play to the nucleus to activate the plant defence response and other phytohormonal signalling pathways for the finale. Understanding how brassinosteroid and immune signalling pathways are integrated in plants will help develop strategies to minimize the growth–defence trade-off, a key challenge for crop improvement.
Parotid gland tumors: comparison of conventional and diffusion-weighted MRI findings with histopathological results
Authors: Karaman Can Zafer , Tanyeri Ahmet , Özgür Recep , Öztürk Veli Süha 
Published: November 2020

Objectives: The aim of this study was to investigate the relationship between pathological classification of parotid gland tumors and conventional MRI – diffusion-weighted imaging findings and also contribute the possible effect of apparent diffusion coefficient (ADC) to diagnosis. Methods: 60 patients with parotid masses diagnosed using histopathology and/or cytology were enrolled in this retrospective study. All patients were evaluated using a 1.5 T MRI. Demographic features, conventional MRI findings, and ADC values (mean, minimum, maximum, and relative) were recorded. MRI findings and ADC values were compared between benign–malignant groups and pleomorphic adenoma vs Warthin’s tumor groups. Results: 60 tumors (48 benign, 12 malignant) were evaluated in a total of 60 patients (39 males, 21 females). The mean age was 59 (±14, 18–86) years old; the mean lesion size was 26 (±10, 11–61) mm. On the texture of conventional MRI, T2 dominantly hyperintense/with hypointensity signal was seen in 87% of pleomorphic adenomas and T2 dominantly hypointense/with hyperintesity signal was encountered in 64% of all Warthin’s tumors. Seven (28%) Warthin’s tumors were misdiagnosed as pleomorphic adenomas and two others (8%) as malignant tumors. The commonly used mean ADC value was 1.6 ± 0.6 × 10–3 mm2 s−1 for benign tumors, 0.8 ± 0.3 × 10–3 mm2 s−1 for malign tumors, 1 (0.9–1.8) × 10–3 mm2 s−1 for Warthin’s tumors, and 1.9 ± 0.3 × 10–3 mm2 s−1 for pleomorphic adenomas. There was a statistically significant difference in ADC values between benign-malignant tumors and pleomorphic adenomas-Warthin’s tumors. Conclusions: Warthin’s tumor may occasionally be misdiagnosed as pleomorphic adenoma and malignant tumor because of variable morphologic features. In addition to benign–malignant differentiation, the added ADC measurement may also be useful for differentiating Warthin’s tumors from pleomorphic adenomas.
The effect of halogen bulb and light-emitting diode light curing units on temperature increase and fibroblast viability
Authors: Memari Trava Georgia , Almeida Santos Juliane , Paula Ramos Lucas , Rosário Estevam dos Santos Pamela Beatriz , Abu Hasna Amjad , Yui Karen Cristina , Bressane Adriano , Dias de Oliveira Luciane , Spalding Marianne 
Published: November 2020

Background: This study aimed to compare the temperature increase produced by halogen bulb (HAL) and light-emitting diode (LED) light curing units (LCUs) by irradiating dentin discs (0.5 mm and 1 mm thickness), and to evaluate their cytotoxic effects on fibroblast culture in the presence of dentin discs due to the increasing demand on resin composite restorations and teeth bleaching for esthetic purposes. Methods: A total of 20 bovine incisors were used to obtain dentin discs and divided into four experimental groups (n=10): HAL0.5: irradiation with halogen-tungsten bulb Curing Light XL 3000 at an intensity of 470 mW/cm2 over a dentin disc of 0.5 mm; LED0.5: irradiation with LED Optilight Max (GNATUS- Ribeirão Preto, SP, Brazil) at an intensity of 1200 mW/cm2 over a dentin disc of 0.5 mm; HAL1: irradiation as in HAL0.5 but over a dentin disc of 1 mm; LED1: irradiation as in LED0.5 but over a dentin disc of 1 mm. The temperature increase was measured using a digital thermometer and the cytotoxicity was evaluated using an MTT assay with a mouse fibroblast cell line (L929). Parametric Data were analyzed by ANOVA and Tukey and non-parametric data were analyzed by Kruskal Wallis with Conover-Iman for non-parametric data (all with α=0.05). Results: A significant statistical difference was found between the groups HAL0.5 and HAL1 and both were different of LED0.5 and LED1 which presented higher temperature. All the experimental groups were different of the control group (without irradiation), and promoted reduction of cellular viability. Conclusions: HAL LCU promoted a lower temperature change in the dentin compared to LED, regardless of the dentin thickness (0.5-1 mm). Both HAL and LED LCUs decreased fibroblast viability; however, LED promoted more significant cytotoxic effects.
Early targeted patent ductus arteriosus treatment in premature neonates using a risk based severity score: study protocol for a randomised controlled trial (PDA RCT)
Authors: EL-Khuffash Afif , Bussmann Neidin , Breatnach Colm R. , Smith Aisling , Tully Elizabeth , Griffin Joanna , McCallion Naomi , Corcoran John David , Fernandez Elena , Looi Claudia , Cleary Brian , Franklin Orla , McNamara Patrick J. 
Published: November 2020

A patent ductus arteriosus (PDA) in preterm infants is associated with increased ventilator dependence and chronic lung disease, necrotizing enterocolitis, intraventricular haemorrhage, and poor neurodevelopmental outcome. Randomised controlled trials of early PDA treatment have not established a drop in the aforementioned morbidities. Those trials did not physiologically categorise PDA severity. Incorporating the specific physiological features of a haemodynamic significant PDA may evolve our understanding of this phenomenon, allowing accurate triaging using echocardiography and targeted treatment. Our group has recently demonstrated that a PDA severity score (PDAsc) derived at 36-48 hours of age can accurately predict the later occurrence of chronic lung disease or death (CLD/Death). Using echocardiography, we assessed PDA characteristics, as well as left ventricular diastolic function and markers of pulmonary overcirculation, and from this formulated a PDAsc. Gestation was also incorporated into the score. We hypothesise that in preterm infants at high risk of developing CLD/Death based on a PDAsc, early treatment with Ibuprofen compared with placebo will result in a reduction in CLD/Death. This is a single centre double-blind two arm randomised controlled trial conducted in the neonatal intensive care unit in the Rotunda Hospital, Dublin. Echocardiogram is carried out in the first 36-48 hours of life to identify preterm infants with a PDAsc ≥ 5.0 and these infants are randomised to Ibuprofen or placebo. Primary outcomes are assessed at 36 weeks post menstrual age. This pilot study’s purpose is to assess the feasibility of performing the trial and to obtain preliminary data to calculate a sample size for a definitive multi-centre trial of early PDA treatment using a PDAsc. We aim to recruit a total of 60 infants with a high risk PDA over three years. Trial Registration: ISRCTN ISRCTN13281214 (26/07/2016) and the European Union Drug Regulating Authorities Clinical Trials Database 2015-004526-33 (03/12/2015).
Translating Polish Fantasy – translational challenges and problems concerning culture‑rooted elements
Authors: Mucha Aleksandra 
Published: November 2020

Tłumacząc polską fantasy – wyzwania i problemy tłumaczeniowe związane z elementami kulturowymi
Niniejszy artykuł porusza kwestię trudności i problemów, które może napotkać tłumacz podczas przekładu polskich powieści z gatunku fantasy na język angielski. Zwrócono szczególną uwagę na charakterystykę i specyfikę gatunku oraz jego historię w polskiej tradycji literackiej. Druga część artykułu została poświęcona możliwym wyzwaniom towarzyszącym przekładowi gatunku fantasy zaprezentowanym przez Guttfeld [2008] oraz związanym z tłumaczeniem elementów nacechowanych kulturowo omówionym przez Hejwowskiego [2004]. W trzeciej części podano wybrane przykłady elementów kulturowych i ich tłumaczeń zaczerpnięte z dostępnych tłumaczeń powieści fantasy Andrzeja Sapkowskiego. Celem niniejszego artykułu jest ukazanie, jak trudnym wyzwaniem jest tłumaczenie zwiększającego swoją popularność gatunku literackiego, jakim jest fantasy.