bluuebunny/crossref_metadata_2025_split huggingface dataset:
Working hours, common mental disorder and suicidal ideation among junior doctors in Australia: a cross-sectional survey
Authors: Petrie Katherine , Crawford Joanna , LaMontagne Anthony D , Milner Allison , Dean Jessica , Veness Benjamin G , Christensen Helen , Harvey Samuel B 
Published: January 2020

ObjectiveDespite concern regarding high rates of mental illness and suicide amongst the medical profession, the link between working hours and doctors’ mental health remains unclear. This study examines the relationship between average weekly working hours and junior doctors’ (JDs’) mental health in Australia.Design and participantsA randomly selected sample of 42 942 Australian doctors were invited to take part in an anonymous Beyondblue National Mental Health Survey in 2013, of whom 12 252 doctors provided valid data (response rate approximately 27%). The sample of interest comprised 2706 full-time graduate medical trainees in various specialties, at either intern, prevocational or vocational training stage. Consultants and retired doctors were excluded.Outcome measuresMain outcomes of interest were caseness of common mental disorder (CMD) (assessed using a cut-off of 4 as a threshold on total General Health Questionnaire-28 score), presence of suicidal ideation (SI) (assessed with a single item) and average weekly working hours. Logistic regression modelling was used to account for the impact of age, gender, stage of training, location of work, specialty, marital status and whether JDs had trained outside Australia.ResultsJDs reported working an average of 50.1 hours per week (SD=13.4). JDs who worked over 55 hours a week were more than twice as likely to report CMD (adjusted OR=2.05; 95% CI 1.62 to 2.59, p<0.001) and SI (adjusted OR=2.00; 95% CI 1.42 to 2.81, p<0.001) compared to those working 40–44 hours per week.ConclusionsOur results show that around one in four JDs are currently working hours that are associated with a doubling of their risk of common mental health problems and SI. These findings suggest that management of working hours represents an important focus for workplaces to improve the mental health of medical trainees.
In-match physical demands on elite Japanese rugby union players using a global positioning system
Authors: Yamamoto Hayato , Takemura Masanori , Iguchi Junta , Tachibana Misato , Tsujita Junzo , Hojo Tatsuya 
Published: January 2020

ObjectivesOur aim of this study was to quantify the physical demands of elite rugby union players by each position as a step towards designing position-specific training programme using a Global Positioning System/accelerometer system.MethodsThis study was performed as a retrospective observational study. Data were obtained from 45 official matches. The sample size used for the analysis was 298. The per-match total distances, accelerations and impacts were calculated and statistically compared for the forwards and backs and for individual positions.ResultsTotal distances for the forwards and backs were 5731.1±507.8 and 6392.1±646.8 m, respectively. The high-velocity running distances (>18.0 km/hour) covered by the forwards and backs were 317.4±136.9 and 715.0±242.9 m, respectively. The number of accelerations (>1.5 m/s2) for the forwards and backs were 76.3±18.9 and 100.8±19.6 times, respectively, and the number of high impacts (>10 g) were 48.0±46.9 and 35.6±28.3 times for the forwards and backs, respectively. All characteristics were significantly different between the forwards and backs (p<0.05). The per-position characteristics were also calculated. Within the backs, scrum half (SH) and wingers (WTBs) covered high-velocity running significantly higher distance than fly-half (SHd=2.571, WTBsd=1.556) and centres (SHd=1.299, WTBsd=0.685) (p<0.05).ConclusionBy clarifying the physical demands according to the positions, it will be possible to create optimised position-specific training programmes.
Prevalence and associations of prescribing of long-acting reversible contraception by general practitioner registrars: a secondary analysis of ReCEnT data
Authors: Turner Rachel , Tapley Amanda , Sweeney Sally , Davey Andrew , Holliday Elizabeth , van Driel Mieke , Henderson Kim , Ball Jean , Morgan Simon , Spike Neil , FitzGerald Kristen , Magin Parker 
Published: January 2020

ObjectiveLong-acting reversible contraception (LARC) is the most effective form of contraception but use in Australia is low. Uptake of LARC prescribing by early-career general practitioners (GPs) has important implications for community reproductive health. We aimed to investigate the prevalence and associations of Australian GP registrars’ LARC prescribing.MethodsA cross-sectional analysis of the Registrar Clinical Encounters in Training (ReCEnT) cohort study 2010–2017. GP registrars collected data on 60 consecutive consultations on three occasions during their training. The outcome factor was prescription of LARC (compared with non-LARC). A secondary analysis was performed with problems involving prescription of LARC (compared with other problems). Associations with patient, practice, registrar and consultation independent variables were assessed by univariate and multivariable logistic regression.Results1737 registrars recorded 5382 problems/diagnoses involving women aged 12–55 years in which contraception was prescribed. 1356 (25%) involved LARC. Significant multivariable associations of prescribing LARC included patient age (OR 2.85, 95% CI 3.17 to 3.74, for age 36–45 years compared with age 12–18 years), practice rurality - inner-regional (OR 1.47, 95% CI 1.22 to 1.79) and outer-regional/remote/very remote (OR 1.47 95% CI 1.15 to 1.87) compared with major cities, practices in areas of lower socioeconomic status (SES) (OR 0.93, 95% CI 0.91 to 0.96 for SES by decile), generating learning goals (OR 1.37, 95% CI 1.04 to 1.79), in-consultation assistance-seeking (OR 1.58, 95% CI 1.24 to 2.01), and the registrar having reproductive health-related postgraduate qualifications (OR 1.33, 95% CI 1.01 to 1.76).ConclusionsThe prevalence of LARC prescribing by Australian GP registrars is higher than has been previously estimated in established GPs. Postgraduate qualifications in reproductive health are associated with prescribing LARC. Prescribing practice differs according to rurality and relative socioeconomic disadvantage.
Intravenous supplementation type and volume are associated with 1-year outcome and major complications in patients with chronic intestinal failure
Authors: Pironi Loris , Steiger Ezra , Joly Francisca , Wanten Geert J A , Chambrier Cecile , Aimasso Umberto , Sasdelli Anna Simona , Szczepanek Kinga , Jukes Amelia , Theilla Miriam , Kunecki Marek , Daniels Joanne , Serlie Mireille J , Cooper Sheldon C , Poullenot Florian , Rasmussen Henrik Højgaard , Compher Charlene W , Crivelli Adriana , Hughes Sarah-Jane , Santarpia Lidia , Guglielmi Francesco William , Rotovnik Kozjek Nada , Ellegard Lars , Schneider Stéphane M , Matras Przemysław , Forbes Alastair , Wyer Nicola , Zmarzly Anna , Taus Marina , O'Callaghan Margie , Osland Emma , Thibault Ronan , Cuerda Cristina , Jones Lynn , Chapman Brooke , Sahin Peter , Virgili Núria M , Lee Andre Dong Won , Orlandoni Paolo , Matysiak Konrad , Di Caro Simona , Doitchinova-Simeonova Maryana , Masconale Luisa , Spaggiari Corrado , Garde Carmen , Serralde-Zúñiga Aurora E , Olveira Gabriel , Krznaric Zeljko , Petrina Jáuregui Estrella , Zugasti Murillo Ana , Suárez-Llanos José P , Nardi Elena , Van Gossum André , Lal Simon 
Published: January 2020

Background and aimNo marker to categorise the severity of chronic intestinal failure (CIF) has been developed. A 1-year international survey was carried out to investigate whether the European Society for Clinical Nutrition and Metabolism clinical classification of CIF, based on the type and volume of the intravenous supplementation (IVS), could be an indicator of CIF severity.MethodsAt baseline, participating home parenteral nutrition (HPN) centres enrolled all adults with ongoing CIF due to non-malignant disease; demographic data, body mass index, CIF mechanism, underlying disease, HPN duration and IVS category were recorded for each patient. The type of IVS was classified as fluid and electrolyte alone (FE) or parenteral nutrition admixture (PN). The mean daily IVS volume, calculated on a weekly basis, was categorised as <1, 1–2, 2–3 and >3 L/day. The severity of CIF was determined by patient outcome (still on HPN, weaned from HPN, deceased) and the occurrence of major HPN/CIF-related complications: intestinal failure-associated liver disease (IFALD), catheter-related venous thrombosis and catheter-related bloodstream infection (CRBSI).ResultsFifty-one HPN centres included 2194 patients. The analysis showed that both IVS type and volume were independently associated with the odds of weaning from HPN (significantly higher for PN <1 L/day than for FE and all PN >1 L/day), patients’ death (lower for FE, p=0.079), presence of IFALD cholestasis/liver failure and occurrence of CRBSI (significantly higher for PN 2–3 and PN >3 L/day).ConclusionsThe type and volume of IVS required by patients with CIF could be indicators to categorise the severity of CIF in both clinical practice and research protocols.
Morphological changes of intracranial pressure quantifies vasodilatory effect of verapamil to treat cerebral vasospasm
Authors: Liu Xiuyun , Vitt Jeffrey R , Hetts Steven W , Gudelunas Koa , Ho Nhi , Ko Nerissa , Hu Xiao 
Published: January 2020

IntroductionAfter aneurysmal subarachnoid hemorrhage (SAH), both proximal and distal cerebral vasospasm can contribute to the development of delayed cerebral ischemia. Intra-arterial (IA) vasodilators are a mainstay of treatment for distal arterial vasospasm, but no methods of assessing the efficacy of interventions in real time have been established.ObjectiveTo introduce a new method for continuous intraprocedural assessment of endovascular treatment for cerebral vasospasm.MethodsThe premise of our approach was that distal cerebral arterial changes induce a consistent pattern in the morphological changes of intracranial pressure (ICP) pulse. This premise was demonstrated using a published algorithm in previous papers. In this study, we applied the algorithm to calculate the likelihood of cerebral vasodilation (VDI) and cerebral vasoconstriction (VCI) from intraprocedural ICP signals that are synchronized with injection of the IA vasodilator, verapamil. Cerebral blood flow velocities (CBFVs) on bilateral cerebral arteries were studied before and after IA therapy.Results192 recordings of patients with SAH were reviewed, and 27 recordings had high-quality ICP waveforms. The VCI was significantly lower after the first verapamil injection (0.47±0.017) than VCI at baseline (0.49±0.020, p<0.001). A larger dose of injected verapamil resulted in a larger and longer VDI increase. CBFV of the middle cerebral artery increases across the days before the injection of verapamil and decreases after IA therapy.ConclusionThis study provides preliminary validation of an algorithm for continuous assessment of distal cerebral arterial changes in response to IA vasodilator infusion in patients with vasospasm and aneurysmal SAH.
Prospective evaluation of admission cortisol in trauma
Authors: Kwok Amy M , Davis James W , Dirks Rachel C , Sue Lawrence P , Wolfe Mary M , Kaups Krista 
Published: January 2020

BackgroundA low cortisol level has been shown to occur soon after trauma, and is associated with increased mortality. The purpose of this study was to investigate the impact of low cortisol levels in acute critically ill trauma patients. We hypothesized that patients would require increase vasopressor use, have a greater blood product administration, and increased mortality rate.MethodsA blinded, prospective observational study was performed at an American College of Surgeons verified Level I trauma center. Adult patients who met trauma activation criteria, received initial treatment at Community Regional Medical Center and were admitted to the intensive care unit were included. Total serum cortisol levels were measured from the initial blood draw in the emergency department. Patients were categorized according to cortisol ≤15 µg/dL (severe low cortisol, SLC), 15.01–25 µg/dL (relative low cortisol, RLC), or >25 µg/dL (normal cortisol, NC) and compared on demographics, injury severity score, initial vital signs, blood product usage, vasopressor requirements, and mortality.ResultsCortisol levels were ordered for 280 patients; 91 were excluded and 189 were included. Penetrating trauma accounted for 19% of injuries and blunt trauma for 81%. 22 patients (12%) had SLC, 83 (44%) had RLC, and 84 (44%) had NC. This study found patients with admission SLC had higher rates of vasopressor requirements, required more units of blood, and had a higher mortality rate than both the RLC and NC groups.ConclusionLow cortisol level can be identified acutely after severe trauma. Trauma patients with SLC had larger blood product requirements, vasopressor use, and increase mortality. Initial cortisol levels are useful in identifying these high-risk patients.Level of evidencePrognostic/epidemiologic study, level III
Facile and Scalable Electrochemical Synthesis of Ta-Nb Alloy Powders for Capacitors
Authors: Sri Maha Vishnu D. , Sure Jagadeesh , Kim Hyun-Kyung , Schwandt Carsten 
Published: January 2020

The cost of tantalum (Ta), and thus of Ta capacitors, is undesirably high owing to the limited availability of its ores and the energy-intensive production. Reported herein is the economically viable electrochemical synthesis of Ta-Nb alloys as a potential replacement for Ta in capacitors. Ta-xNb (x = 20, 50, 80) alloys were prepared directly by electro-deoxidation of Ta2O5-Nb2O5mixed oxide disks in CaCl2melt at 900 °C and the results were compared with those for the pure metals. The alloys and metals thus made were in the form of powders and consisted solely of the body-centered cubic phase. The overall compositions of the alloys were close to the target values. EDX and XPS analyses revealed that the particles underwent surface oxidation during the post-electrolytic washing process, thereby forming the required dielectric coating around the metallic cores. Cyclic voltammetry in an aqueous electrolytic cell demonstrated that all powders behaved as typical capacitor materials. TG/DSC studies on Ta and Ta-50Nb in air showed that oxidation commenced at 531 °C and 363 °C, respectively, with Ta-50Nb exhibiting an inversion in the temperature coefficient of the oxidation reaction at 650 °C. In overall, the method presented here for producing commercially relevant Ta-Nb alloys is both facile and scalable.
Simultaneous Left Ventricular Volume and Strain Changes During Chemotherapy Associate With 2‐Year Postchemotherapy Measures of Left Ventricular Ejection Fraction
Authors: Suerken Cynthia K. , D'Agostino Ralph B. , Jordan Jennifer H. , Meléndez Giselle C. , Vasu Sujethra , Lamar Zanetta S. , Hundley W. Gregory 
Published: January 2020

Background

Although changes in left ventricular end‐systolic volume (
LVESV
), left ventricular end‐diastolic volume, and global circumferential strain occur during cancer treatment, the relationship of these changes to the 2‐year post–cancer‐treatment measures of left ventricular ejection fraction (
LVEF
) are unknown.

Methods and Results

In a prospective, continuously recruited cohort of 95 patients scheduled to receive potentially cardiotoxic chemotherapy for breast cancer, lymphoma, or soft tissue sarcoma, measures of left ventricular end‐diastolic volume,
LVESV
, global circumferential strain, and
LVEF
were acquired via cardiac magnetic resonance imaging before and then 3 and 24 months after initiating treatment by individuals blinded to all patient identifiers. Participants had an average age of 54±15 years; 68% were women, and 82% were of white race.
LVEF
declined from 62±7% to 58±9% over the 24 months (
P
<0.0001), with 42% of participants experiencing a >5% decline in
LVEF
at 24 months. Predictors of a 24‐month >5% decline in
LVEF
included the following factors from baseline to 3 months into treatment: (1) >3‐mL increases in
LVESV
(
P
=0.033), (2) >3‐mL increases in
LVESV
or 10‐mL declines in left ventricular end‐diastolic volume with little change in
LVESV
(
P
=0.001), or (3) ≥10% deteriorations in global circumferential strain with little change in
LVESV
(
P
=0.036).

Conclusion

During receipt of potentially cardiotoxic chemotherapy, increases in
LVESV
, the absence of its deterioration during decreases of left ventricular end‐diastolic volume, or the deterioration of global circumferential strain without a marked decrease in
LVESV
help identify those who will develop more permanent 2‐year declines in
LVEF
.
3. Naval Architecture. The Hellenistic Hull Design
Authors: Pomey Patrice 
Published: January 2020

During the Hellenistic period and the Roman Republic, there was a dominant architectural design in Mediterranean naval architecture, which was eventually adopted by Greek and Roman shipyards as well as Punic. This system is characterised by a tripartite structure (keel, planking, framing). It allows the building of large ships with an elaborate hull shape, capable of good nautical performance, and this was clearly one of the factors behind the significant maritime expansion at the end of the first millennium BC. Of course, many other architectural approaches continued to be used in shipbuilding, which were testament to regional and local traditions.
The origin of this architectural system lies in the Greco-Roman evolution — between the second half of the sixth and the end of the fourth century BC — of sewn boats in the Greek tradition (influenced by the Phoenicians), which introduced the method of assembly by mortise and tenon. This resulted, throughout the Mediterranean, in a convergence of Greek and Phoenico-Punic architectural systems. However, during the Roman Empire, this approach — which presents a structural weakness at the level of the keel — was replaced by a new architectural type, apparently more robust, characterized by a flat bottom section, overlapping frames, and a keelson/mast step timber fitted on lateral sister-keelson.
Between Two Rocks and in a Hard Place: Reflecting on the Biomechanical Basis of Shoulder Occupational Musculoskeletal Disorders
Authors: Dickerson Clark R. , McDonald Alison C. , Chopp-Hurley Jaclyn N. 
Published: January 2020

Objective The aim was to review the biomechanical origins of occupational shoulder damage, while considering the complexity of shoulder mechanics and musculoskeletal consequences of diverse task demands. Background Accessible measures of physical exposures are the primary focus of occupational shoulder assessments and analyses. This approach has led to guidelines and intervention strategies that are often inadequate for mitigating shoulder disorders amongst the complexity of modern workplace demands. Integration of complex shoulder mechanics into occupational assessments, analyses, and interventions is critical for reducing occupational shoulder injury risk. Method This narrative review describes shoulder biomechanics in the context of common injury mechanisms and consequent injuries, with a particular focus on subacromial impingement syndrome. Several modulators of shoulder injury risk are reviewed, including fatigue, overhead work, office ergonomics considerations, and pushing and pulling task configurations. Results Relationships between work requirements, muscular demands, fatigue, and biomechanical tissue loads exist. This review highlights that consideration of specific workplace factors should be integrated with our knowledge of the intricate arrangement and interpersonal variability of the shoulder complex to proactively evaluate occupational shoulder demands and exposures. Conclusion A standard method for evaluating shoulder muscle exposures during workplace tasks does not exist. An integrated approach is critical for improved work design and prevention of shoulder tissue damage and accompanying disability. Application This review is particularly relevant for researchers and practitioners, providing guidance for work design and evaluation for shoulder injury prevention by understanding the importance of the unique and complex mechanics of the shoulder.
Microscopic vs Endoscopic Ear Surgery for Congenital Ossicular Anomaly
Authors: Chung Jaein , Kang Jae‐Yoon , Kim Min‐Su , Kim Bongjik , Choi Jin Woong 
Published: January 2020

ObjectiveTo compare surgical outcomes of transcanal endoscopic ear surgery (TEES) for congenital ossicular anomalies with those of conventional microscopic surgery.Study DesignRetrospective case review.SettingTertiary referral academic center.Subjects and MethodsFrom March 2012 to November 2018, 42 consecutive ears in 40 patients with congenital ossicular anomaly who underwent ossiculoplasty or stapes surgery using either ear endoscopes (TEES group) or an operating microscope (microscopic group) were included. Postoperative audiometric results, operation time, switch of approach, and complications were compared between the 2 groups.ResultsTwenty‐four ears (66.1%) were in the microscopic group and 18 ears (33.9%) were in the TEES group. The mean (SD) preoperative air‐bone gap was 31.8 (10.0) dB in the microscopic group and 35.2 (11.1) dB in the TEES group. The mean (SD) postoperative air‐bone gap was 7.4 (6.5) dB in the microscopic group and 5.6 (5.0) dB in the TEES group. The differences in the preoperative and postoperative air‐bone gaps between the 2 groups were not statistically significant (P =. 316 and P =. 412, respectively). Average operation time in the TEES group was 24.6 minutes shorter than that in the microscopic group, which was statistically significant (P =. 019). None of patients in the TEES group did require a switch of approach. There was no significant difference in complication incidence between the 2 groups.ConclusionsTEES for congenital ossicular anomaly has comparable audiometric results and complication rates to conventional microscopic surgery. TEES appears to have the advantages of shorter operation times.
Timing of Initial Posttracheostomy Surveillance Endoscopy in Pediatric Patients
Authors: Smith Matthew M. , de Alarcon Alessandro , Meinzen‐Derr Jareen , Cohen Aliza P. , Born Hayley , Wilcox Lyndy J. , Benscoter Dan T. , Hart Catherine K. 
Published: January 2020

ObjectiveTo determine the optimal timing of the first posttracheostomy microlaryngoscopy and bronchoscopy (MLB).Study DesignCase series with chart review.SettingTertiary pediatric medical center.Subjects and MethodsPatients (<21 years of age) who underwent tracheostomy placement from January 1, 2011, to December 31, 2016. Patients were divided into early and late posttracheostomy surveillance groups (<6 weeks vs 6 to 14 weeks, respectively) based on the timing of their first posttracheostomy MLB. The primary outcome was to ascertain the clinical yield of the initial posttracheostomy MLB by documenting whether a medical or surgical treatment decision was made based on MLB findings.ResultsIn total, 202 patients were included; of these patients, 162 met criteria for placement in the early group and 40 met criteria for the late group. There was no significant difference between the early and late groups regarding whether a medical or surgical decision was made at the time of the first MLB (21.5% vs 19%, respectively; P =. 49). Multiple logistic regression identified that the presence of tracheostomy‐related symptoms prior to MLB (odds ratio, 6.75; 95% confidence interval, 2.78‐16.39) was the sole predictor of a medical or surgical decision being made at the first posttracheostomy MLB.ConclusionThe presence of tracheostomy‐related symptoms was predictive of a medical or surgical decision being made using information obtained at the time of the first posttracheostomy MLB. We thus recommend that surveillance endoscopy be initiated when tracheotomized children start to develop tracheostomy‐related symptoms.