bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multiscale Computational Fluid Dynamics Modeling for Personalized Liver Cancer Radioembolization Dosimetry
Authors: Taebi Amirtahà , Vu Catherine T. , Roncali Emilie 
Published: June 2020

Abstract
Yttrium-90 (90Y) radioembolization is a minimally invasive procedure increasingly used for advanced liver cancer treatment. In this method, radioactive microspheres are injected into the hepatic arterial bloodstream to target, irradiate, and kill cancer cells. Accurate and precise treatment planning can lead to more efficient and safer treatment by delivering a higher radiation dose to the tumor while minimizing the exposure of the surrounding liver parenchyma. Treatment planning primarily relies on the estimated radiation dose delivered to tissue. However, current methods used to estimate the dose are based on simplified assumptions that make the dosimetry results unreliable. In this work, we present a computational model to predict the radiation dose from the 90Y activity in different liver segments to provide a more realistic and personalized dosimetry. Computational fluid dynamics (CFD) simulations were performed in a 3D hepatic arterial tree model segmented from cone-beam CT angiographic data obtained from a patient with hepatocellular carcinoma (HCC). The microsphere trajectories were predicted from the velocity field. 90Y dose distribution was then calculated from the volumetric distribution of the microspheres. Two injection locations were considered for the microsphere administration, a lobar and a selective injection. Results showed that 22% and 82% of the microspheres were delivered to the tumor, after each injection, respectively, and the combination of both injections ultimately delivered 49% of the total administered 90Y microspheres to the tumor. Results also illustrated the nonhomogeneous distribution of microspheres between liver segments, indicating the importance of developing patient-specific dosimetry methods for effective radioembolization treatment.
U-Pb detrital zircon ages of Cambrian–Ordovician sandstones from the Taebaeksan Basin, Korea: Provenance variability in platform shelf sequences and paleogeographic implications
Authors: Cho Moonsup , Cheong Wonseok , Ernst W.G. , Kim Yoonsup , Yi Keewook 
Published: June 2020

Abstract
The early Paleozoic paleogeography of East Gondwanan terranes, including the North China Craton (NCC), is contentious, primarily reflecting the paucity of integrated geochronological, biogeographic, and tectonic data sets. Our new sensitive high-resolution ion microprobe data from 14 sandstones of the Taebaeksan Basin, Korea, indicate that its platform shelf sequences, typified by trilobite faunal assemblages diagnostic of the NCC, record the vestige of coeval arc magmatism. Detrital zircons analyzed from the sandstones yielded Eoarchean to Early Ordovician ages, which define three distinct types of distribution patterns characterized by: (1) double peaks at ca. 1.85 Ga and 2.50 Ga diagnostic of basement rocks in the NCC; (2) minor peaks at ca. 1.75, 1.6, and 1.2–1.1 Ga in addition to double peaks; and finally (3) a scattered array of late Paleoproterozoic to Neoproterozoic zircons lacking double peaks. The marked contrasts among the three types reflect significant changes in provenance, most likely linked to variations in paleo-water depths during the “Sauk” transgression. Longshore- or onshore-directed currents, associated with an increase in water depth, apparently brought outboard oceanic detritus and benthic trilobites into the relatively flat outer shelf of the Taebaeksan Basin. As a result, fine-grained sandstones received a large amount of detritus from distal sources, yielding mixed signatures in zircon age patterns and trilobite assemblages. Excluding the basal sandstone-conglomerate unit, five siliciclastic formations contain syndepositional zircon populations, and their weighted mean 206Pb/238U ages decrease upsection from 512 ± 5 Ma to 483 ± 2 Ma, indicating a sedimentary influx from contemporaneous volcanic activity. In conjunction with arc-related bulk-rock geochemistry and juvenile Nd isotopic signature, early Paleozoic detrital zircons likely represent the first-cycle detritus supplied for ∼30 m.y. from the proto-Japan arc that initially formed at ca. 520 Ma. Together with the occurrence of ca. 700–500 Ma detrital Pacific Gondwana zircons in fine-grained sandstones, Paleozoic arc-sourced detritus suggests that the Korean Peninsula was paleogeographically linked to an ancient convergent margin, perhaps extending from the Terra Australis orogen.
Remote assessment in sport and exercise medicine (SEM): a narrative review and teleSEM solutions for and beyond the COVID-19 pandemic
Authors: Dijkstra H Paul , Ergen Emin , Holtzhausen Louis , Beasley Ian , Alonso Juan Manuel , Geertsema Liesel , Geertsema Celeste , Nelis Sofie , Ngai Aston Seng Huey , Stankovic Ivan , Targett Stephen , Andersen Thor Einar 
Published: June 2020

BackgroundThe COVID-19 pandemic forces sport and exercise medicine (SEM) physicians to think differently about the clinical care of patients. Many rapidly implement eHealth and telemedicine solutions specific to SEM without guidance on how best to provide these services.AimThe aim of this paper is to present some guiding principles on how to plan for and perform an SEM consultation remotely (teleSEM) based on a narrative review of the literature. A secondary aim is to develop a generic teleSEM injury template.ResultseHealth and telemedicine are essential solutions to effective remote patient care, also in SEM. This paper provides guidance for wise planning and delivery of teleSEM. It is crucial for SEM physicians, technology providers and organisations to codesign teleSEM services, ideally involving athletes, coaches and other clinicians involved in the clinical care of athletes, and to gradually implement these services with appropriate support and education.ConclusionteleSEM provides solutions for remote athlete clinical care during and after the COVID-19 pandemic. We define two new terms—eSEM and teleSEM and discuss guiding principles on how to plan for and perform SEM consultations remotely (teleSEM). We provide an example of a generic teleSEM injury assessment guide.
Time-to-scene for opioid overdoses: are unmanned aerial drones faster than traditional first responders in an urban environment?
Authors: Tukel Connor Andrew , Tukel Matthew Ryan , Weinbaum Robert Jacob , Mika Valerie H , Levy Phillip D 
Published: June 2020

IntroductionOpioid overdoses claim tens of thousands of lives every year. Many of these deaths might be prevented if overdose-reversal medications such as naloxone are administered in a timely manner. Drones may help overcome barriers to timely arrival on scene for opioid overdoses. This study analyses the time required for a drone carrying naloxone to traverse various distances, simulating the response time for a drone to the scene of an opioid overdose. For comparison, we used the time required for ambulances to traverse similar distances while responding to the scene of actual or suspected opioid overdoses.MethodsFifty flight trials, using a modified Dà-Jiāng Innovations (DJI) ‘Inspire 2’ drone, were conducted across seven distances, and the travel time for the drone was then compared with historical response time data from 200 actual or suspected opioid overdose cases that occurred within Detroit, Michigan.ResultsWe determined with 95% certainty that drone arrival times were discernibly quicker than ambulance arrival times at all distances where sufficient data were available to perform statistical comparisons including 0.5 km, 1.0 km, 1.5 km, 2.0 km and 3.0 km.ConclusionWe have shown that a drone is capable of travelling several ranges of straight-line (ie, ‘as the crow flies’) distance faster than an ambulance. Further exploration into the use of drones to deliver life-saving therapies in urban and rural settings is warranted. Head-to-head prospective trials that consider the practical challenges of medical drone delivery are needed to better understand the viability of incorporating this technology into existing emergency response infrastructure.
Effects of adding adjunctive hyperbaric oxygen therapy to standard wound care for diabetic foot ulcers: a protocol for a systematic review with meta-analysis and trial sequential analysis
Authors: Vinkel Julie , Holm Niels Frederich Rose , Jakobsen Janus C , Hyldegaard Ole 
Published: June 2020

IntroductionDiabetic foot ulcer represents a major health problem globally. Preliminary studies have indicated that systemic treatment of diabetic foot ulcer patients with hyperbaric oxygen therapy have beneficial effects on wound healing, risk of amputation, glycaemic control, atherosclerosis, inflammatory markers and other clinical and laboratory parameters. This protocol for a systematic review aims at identifying the beneficial and harmful effects of adding hyperbaric oxygen therapy to standard wound care for diabetic foot ulcers.Methods and analysisThis protocol was performed following the recommendations of the Cochrane Collaboration and the eight-step assessment procedure suggested by Jakobsen and colleagues. We plan to include all relevant randomised clinical trials assessing the effects of hyperbaric oxygen therapy in the treatment of diabetic foot ulcer versus any control group with any intervention defined as standard wound care or similar, together with sham interventions. Our primary outcome will be: all-cause mortality, serious adverse events and quality of life. Our secondary outcomes will be: healing of index wound, major amputation and wound infection. Any eligible trial will be assessed and classified as either high risk of bias or low risk of bias, and our conclusions will be based on trials with low risk of bias. The analyses of the extracted data will be performed using Review Manager 5 and Trial Sequential Analysis. For both our primary and secondary outcomes, we will create a ‘Summary of Findings’ table and use GRADE (Grading of Recommendations Assessment, Development and Evaluation) assessment to assess the quality of the evidence.Ethics and disseminationWe use publicly accessible documents as evidence, there is no participant involvement at an individual level and an institutional ethics approval is not required. The results of the review will be sought published in a peer-reviewed journals, also in the event of insignificant results or null results, and thereby it will be disseminated to clinicians and public available.PROSPERO registration numberCRD42019139256.
Supervised treatment in outpatients for schizophrenia plus (STOPS+): protocol for a cluster randomised trial of a community-based intervention to improve treatment adherence and reduce the treatment gap for schizophrenia in Pakistan
Authors: Shepherd Thomas Andrew , Ul-Haq Zia , Ul-Haq Mian , Khan Muhammad Firaz , Afridi Adil , Dikomitis Lisa , Robinson Michelle E , Lewis Martyn , Rahman Atif , Dziedzic Krysia , Saeed Umaima , Awan Naila Riaz , Mallen Christian , Farooq Saeed 
Published: June 2020

IntroductionThere is a significant treatment gap, with only a few community-based services for people with schizophrenia in low-income and middle-income countries. Poor treatment adherence in schizophrenia is associated with poorer health outcomes, suicide attempts and death. We previously reported the effectiveness of supervised treatment in outpatients for schizophrenia (STOPS) for improving treatment adherence in patients with schizophrenia. However, STOPS was evaluated in a tertiary care setting with no primary care involvement, limiting its generalisability to the wider at-risk population. We aim to evaluate the effectiveness of STOPS+ in scaling up the primary care treatment of schizophrenia to a real-world setting.Methods and analysisThe effectiveness of the STOPS+ intervention in improving the level of functioning and medication adherence in patients with schizophrenia in Pakistan will be evaluated using a cluster randomised controlled trial design. We aim to recruit 526 participants from 24 primary healthcare centres randomly allocated in 1:1 ratio to STOPS+ intervention and enhanced treatment as usual arms. Participants will be followed-up for 12 months postrecruitment. The sample size is estimated for two outcomes (1) the primary clinical outcome is level of functioning, measured using the Global Assessment of Functioning scale and (2) the primary process outcome is adherence to treatment regimen measured using a validated measure. An intention-to-treat approach will be used for the primary analysis.Ethics and disseminationEthical approval has been obtained from Keele University Ethical Review Panel (ref: MH-190017) and Khyber Medical University Ethical Review Board (ref: DIR-KMU-EB/ST/000648). The results of the STOPS+ trial will be reported in peer-reviewed journals and academic conferences and disseminated to local stakeholders and policymakers.Trial registration numberISRCTN93243890.
Patients’ experiences of using an e-Health tool for self-management support after prostate cancer surgery: a deductive interview study explained through the FITT framework
Authors: Nilsson Lina , Hellström Amanda , Wennerberg Camilla , Ekstedt Mirjam , Schildmeijer Kristina 
Published: June 2020

ObjectiveTo evaluate patients’ experiences of using a web-based application, especially its usability as support for self-care activities after prostate cancer surgery.DesignA deductive content analysis was used, stemming from the Fit between Individuals, Task and Technology (FITT) framework.SettingOne surgical department in south of Sweden between October 2015 and April 2016 and between September 2017 and July 2018.ParticipantsFifteen men who had undergone radical prostatectomy for prostate cancer.ResultsBy organising data in accordance with the FITT model, three main categories with ten subcategories were identified. Patients gave feedback on functions that suited them and their needs, as well as potential adjustments and improvements. Patients experienced that ePATH gave them easy access to reliable information regarding their rehabilitation. Directed information about ePATH at enrolment was seen as important. ePATH was perceived to have a logical structure that was easy to follow. However, when the structure was unclear, patients became less motivated to use a function.ConclusionsPatients experienced ePATH as satisfactorily user-friendly and useful as a complementary self-management support after prostate cancer surgery, especially when the information and tasks were tailored to their preferences and the system design features supported individual autonomy.
Effect of reactive balance training on physical fitness poststroke: study protocol for a randomised non-inferiority trial
Authors: Barzideh Azadeh , Marzolini Susan , Danells Cynthia , Jagroop David , Huntley Andrew H , Inness Elizabeth L , Mathur Sunita , Mochizuki George , Oh Paul , Mansfield Avril 
Published: June 2020

IntroductionRegular exercise is essential in the chronic phase of stroke recovery for improving or maintaining function, and reducing the risk of a second stroke. To achieve these goals, multiple components of fitness should be targeted with poststroke exercise, including aerobic capacity, strength and balance. However, following the recommended frequency and duration of each component separately can take a long time and lead to fatigue in people with stroke. Therefore, finding types of exercise that target multiple components of fitness all together is valuable.Reactive balance training (RBT) is a novel type of exercise where individuals repeatedly lose their balance in order to practise balance reactions. When people do RBT, they increase their heart rate and exert forces with their leg muscles which could improve aerobic fitness and muscle strength, respectively. This means that RBT could have the potential to improve multiple components of fitness, simultaneously.Methods and analysisThis is a randomised controlled non-inferiority trial with internal pilot study. Participants with chronic stroke will be randomly assigned to one of two groups: (1) RBT or (2) aerobic and strength training (AST). Participants in both groups will complete 1 hour of exercise, three times/week for 12 weeks. The primary objective is to determine the effect of RBT on aerobic capacity and knee muscles’ strength. The secondary objective is to determine the effects of RBT and AST on balance control and balance confidence. We expect to find that RBT is superior to AST in terms of improving balance control and balance confidence, yet not inferior to AST in terms of its effects on aerobic capacity and strength.Ethics and disseminationResearch ethics approval has been received. Results will be disseminated directly to study participants at the end of the trial, and to other stakeholders via publication in a peer-reviewed journal.Trial registration numberNCT04042961.
Relationship of CT densitometry to lung physiological parameters and health status in alpha-1 antitrypsin deficiency: initial report of a centralised database of the NIHR rare diseases translational research collaborative
Authors: Crossley Diana , Stockley James , Bolton Charlotte E , Hopkinson Nicholas S , Mahadeva Ravi , Steiner Michael , Wilkinson Tom , Hurst John R , Gooptu Bibek , Stockley Robert A 
Published: June 2020

ObjectivesTo establish a database network for the study of alpha-1 antitrypsin deficiency (AATD) and compare the results to CT lung density as the most direct measure of emphysema.DesignA central electronic database was established to permit the upload of anonymised patient data from remote sites. Prospectively collected CT data were recorded onto disc, anonymised, analysed at the coordinating centre and compared with the clinical features of the disease.SettingTertiary referral centres with expertise in the management of AATD focused on academic Biomedical Research Units and Wellcome Clinical Research Facilities.ParticipantsData were collected from 187 patients over 1 year from eight UK academic sites. This included patient demographics, postbronchodilator physiology, health status and CT. Analysis was undertaken at the coordinating centre in Birmingham.ResultsPatient recruitment in the 12 months reached 94% of target (set at 200) covering the whole spectrum of the disease from those with normal lung function to very severe chronic obstructive lung disease. CT scan suitable for analysis was available from 147 (79%) of the patients. CT density, analysed as the threshold for the lowest 15% of lung voxels, showed statistically significant relationships with the objective physiological parameters of lung function as determined by spirometric Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity staging (p<0.001) and carbon monoxide gas transfer (p<0.01). Density also correlated with subjective measures of quality of life (p=0.02).ConclusionsEstablishment of the network for data collection and its transfer was highly successful facilitating future collaboration for the study of this rare disease and its management. CT densitometry correlated well with the objective clinical features of the disease supporting its role as the specific marker of the associated emphysema and its severity. Correlations with subjective measures of health, however, were generally weak indicating other factors play a role.
Social capital and peer influence of tobacco consumption: a cross-sectional study among household heads in rural Uttar Pradesh, India
Authors: Hasan Md Zabir , Cohen Joanna E , Bishai David , Kennedy Caitlin E , Rao Krishna D , Ahuja Akshay , Gupta Shivam 
Published: June 2020

ObjectiveHaving the world’s second-largest tobacco-consuming population, tobacco control is a priority agenda of the Indian Government. Yet, there is no evidence of how peer influence and nature of social relationships—defined as social capital—affect tobacco use. This study aimed to explore the role of social capital and peer influence on tobacco consumption among household heads in rural Uttar Pradesh (UP), India.Design and settingThis study was embedded within the baseline evaluation of Project Samuday. A cross-sectional multistage cluster survey was implemented in six census blocks of Hardoi and Sitapur districts of UP from June to August 2017. Self-reported tobacco consumption status of randomly selected 6218 household heads (≥18 years; men vs women=5312 vs 906) was assessed from 346 rural communities. Peer influence of tobacco use was measured by the non-self cluster proportion of tobacco consumption among respondents. Community engagement, social support, trust and social cohesion were separately measured as unique facets of social capital both at individual and community levels using the Shortened Adapted Social Capital Assessment Tool in India (SASCAT-I). The explanatory power of covariates was assessed using gender-stratified generalised estimating equations (GEE) with robust-variance estimator.ResultTobacco consumption patterns were starkly different for men and women (71% vs 14%). The peer influence only affected men (adjusted odds ratio (AOR)=1.10, 95% CI: 1.05 to 1.16, p<0.01), whereas women were more likely to consume tobacco if they were more engaged with community organisations (AOR=1.33, 95% CI=1.07 to 1.66, p<0.01).ConclusionGender alters the way social engagement affects tobacco use in rural India. Countering peer influence on Indian men should be prioritised as a tobacco control strategy. Moreover, as gender mainstreaming is a critical egalitarian agenda in India, further research is needed to understand how social engagement affects tobacco consumption behaviours among women.
Identification of factors associated with morbidity and postoperative length of stay in surgically managed chronic subdural haematoma using electronic health records: a retrospective cohort study
Authors: Stubbs Daniel J , Davies Benjamin M , Bashford Tom , Joannides Alexis J , Hutchinson Peter J , Menon David K , Ercole Ari , Burnstein Rowan M 
Published: June 2020

IntroductionChronic subdural haematoma (cSDH) tends to occur in older patients, often with significant comorbidity. The incidence and effect of medical complications as well as the impact of intraoperative management strategies are now attracting increasing interest.ObjectivesWe used electronic health record data to study the profile of in-hospital morbidity and examine associations between various intraoperative events and postoperative stay.Design, setting and participantsSingle-centre, retrospective cohort of 530 cases of cSDH (2014–2019) surgically evacuated under general anaesthesia at a neurosciences centre in Cambridge, UK.Methods and outcome definitionComplications were defined using a modified Electronic Postoperative Morbidity Score. Association between complications and intraoperative care (time with mean arterial pressure <80 mm Hg, time outside of end-tidal carbon dioxide (ETCO2) range of 3–5 kPa, maintenance anaesthetic, operative time and opioid dose) on postoperative stay was assessed using Cox regression.Results53 (10%) patients suffered myocardial injury, while 24 (4.5%) suffered acute renal injury. On postoperative day 3 (D3), 280 (58% of remaining) inpatients suffered at least 1 complication. D7 rate was comparable (57%). Operative time was the only intraoperative event associated with postoperative stay (HR for discharge: 0.97 (95% CI: 0.95 to 0.99)). On multivariable analysis, postoperative complications (0.61 (0.55 to 0.68)), anticoagulation (0.45 (0.37 to 0.54)) and cognitive impairment (0.71 (0.58 to 0.87)) were associated with time to discharge.ConclusionsThere is a high postoperative morbidity burden in this cohort, which was associated with postoperative stay. We found no evidence of an association between intraoperative events and postoperative stay.