bluuebunny/crossref_metadata_2025_split huggingface dataset:
Burden in primary family caregivers caring for uremic patients on maintenance peritoneal dialysis
Authors: Zhang Rongzhi , Pu Congshan , Cui Xiaohui , Zhang Ning , Li Xue , Zheng Feng 
Published: July 2020

Background: Managing the burden of care for patients with chronic debilitating diseases is an important issue. Herein, we assessed the burden in primary family members caring for uremic patients on maintenance peritoneal dialysis. Methods: One hundred seventy caregivers and 170 patients were recruited. Self-perceived scoring along the Zarit Caregiver Burden Scale (ZCBS), World Health Organization Five-item Well-Being Index (WHO-5), and Warwick–Edinburgh Mental Well-being Scale (WEMWBS) were determined for caregivers. Results: There was an inverse relationship between ZCBS and WHO-5 or WEMWBS scores in caregivers, suggesting that the higher the burden, the lesser the self-perceived well-being. One hundred two of 170 caregivers (60%) reported mild to moderate burden, indicating a common presence of mild to moderate caring-related mental and physical stress. Moreover, 31 caregivers (18.2%) reported moderate to severe burden. Several patient disease factors, including diabetes and frailty, increased caregiver burden, while insurance coverage and out-of-pocket medical costs were also positively correlated. Caregivers who lived with patients and spent longer hours in caring-related activities had higher burden scores, while regular exercise seemed to partially alleviate the burden. Conclusion: Our study clearly showed that caring for patients with maintenance peritoneal dialysis caused physical, mental, and social burden in family caregivers, with the extent of the stress being influenced by patients’ disease severity and other demographic factors in both patients and caregivers.
Neuroanatomical relationship between Jingbi and the brachial plexus
Authors: Chia Kwan Leung , Teoh Jian Hung , Haberberger Rainer Viktor 
Published: July 2020

Background: This study examined the stratified anatomy of the traditional acupuncture point Jingbi and the neuroanatomical relationship between Jingbi and the brachial plexus, and investigated neural pathways that could be affected by acupuncture stimulation at Jingbi. Methods: Twelve dissected specimens were used to study the pathway of an acupuncture needle inserted at Jingbi. The stratified anatomy and the neuroanatomical relationship between Jingbi and the brachial plexus were studied. Our samples were grouped by gender and cause of death for comparative analysis. Results: All needles ( n = 24, on both sides of a total of 12 cadavers) punctured the anterior scalene muscle medial to the brachial plexus and external jugular vein, lateral to the phrenic nerve and internal jugular vein, and superior to the clavicle and subclavian artery/vein. The depth of needle insertion at Jingbi on the right side of male samples was 28.0 (interquartile range (IQR), 22.5–30.8) mm, which was approximately 8 mm deeper than for female subjects ( p < 0.05). The needle was 3.0 (IQR, 2.0–5.0) mm and 7.0 (IQR, 5.5–8.0) mm medial to the brachial plexus on the left and right sides, respectively. Conclusion: Deep needle insertion at Jingbi can puncture the anterior scalene muscle. The mechanism of action of acupuncture stimulation at Jingbi might be related to its close relationship with the brachial plexus. Significant differences in needling depth were observed when our samples were grouped by gender. More studies are needed.
How do Multilingual Children Experience English Language Acquisition in an Urban Indian School?
Authors: Rajasekaran Subhashini , Kumar Rajesh 
Published: July 2020

In the multilingual, multicultural emerging economy of India, the language debate may seem to have settled with the adoption of the Three-Language Formula in the first National Policy of Education 1968. However, 50 years later, does this policy still hold? Has research on language acquisition informed our education policy and classroom practices, at the school level and the system level? This research attempts to understand how language practices manifest themselves in an urban middle-class English-medium school with multilingual and non-English-speaking students. We examine the students’ communicative practices to uncover some of the patterns in language acquisition across three primary grades and two income levels, using empirical data from survey questionnaires, classroom observations, videography and closed- and open-ended interviews. We present some hypotheses and analyse these against the organisational structure and culture of the school and the larger socio-economic and political context of the education system. The findings suggest that strict compartmentalising of languages for learning, at the cost of isolating social and linguistic identities, is likely to be counterproductive and unsustainable. The sooner we adapt our education policies and practices to support the multilingual practices of students and by association, their diverse identities, greater the possibility of building a strong and confident citizenry.
Efficiency of Small-scale Irrigation Farmers in Northern Ghana: A Data Envelopment Analysis Approach
Authors: Adams Abdulai , Balana Bedru , Lefore Nicole 
Published: July 2020

This study measures and explains technical efficiency (TE), economic efficiency and allocative efficiency of 110 small-scale vegetable farmers practicing various irrigation technologies for increased productivity. We employed the two-stage approach to estimate efficiency scores under constant returns to scale (CRS) and variable returns to scale (VRS) specifications. First, using a linear programming method, efficiency scores of the irrigated vegetable farmers were measured using the data envelopment analysis approach. The results show that about 27.3 per cent of the farmers currently operate on the production possibility frontier and are technically efficient, while 3.6 per cent were found to be both economically and allocatively efficient. The mean TE score for CRS was 50.6 per cent, compared with 78.1 per cent under the VRS. A Tobit regression at the second-stage analysis revealed that gender, experience, health and credit utilization have significant effects on TE. These results are valuable for stakeholders interested in promoting efficiency in smallholder irrigated production. JEL Classification: C14, C61, D24, D61, Q12
Does Education Produce Identical Labour Market Outcomes for All? A Study on India
Authors: Chaudhury Anjan Ray , Sinha Madhabendra 
Published: July 2020

According to the neoclassical economists, discrimination exists in the labour market if employers treat two equally qualified and skilled persons differently based on gender, race, age, disability, religion, caste, etc. In this article, we attempt to look at discrimination in the Indian labour market by applying the multinomial probit model of regression to the National Sample Survey Office data set. By taking years of schooling (as an indicator of skill and ability) as an independent variable in the model, we find that identically educated persons from different caste and gender groups are not equally likely to achieve similar occupational status, indicating the existence of discrimination in the Indian labour market. JEL Classifications: I31, C31
Low Tibial Valgization Osteotomy for More Severe Varus Ankle Arthritis
Authors: Choi Jun Young , Kim Kun Woo , Suh Jin Soo 
Published: July 2020

Background: Low tibial valgization osteotomy with medial opening wedge (LTO) is generally indicated for ankle arthritis with a small talar tilt (TT). We addressed the following research questions: the efficacy of LTO for more significant varus ankle arthritis, the effect of additional inframalleolar correction followed by LTO, and the preoperative or operation-related factors influencing postoperative TT decrease. Methods: We retrospectively reviewed the radiographic and clinical findings of 31 patients with more significant varus ankle arthritis (≥8 degrees) who underwent LTO or LTO plus inframalleolar correction. We grouped the included patients according to combination with inframalleolar correction and postoperative decreased TT. Furthermore, a binary logistic regression analysis was performed to determine the factors influencing postoperative TT decrease. Results: Even though the mean TT was unchanged postoperatively (from 12.1 to 9.9 degrees, P = .052), clinical parameters were significantly increased. In the group with concomitant inframalleolar correction, we found that TT was more corrected (3.9 vs 1.8 degrees, P = .023) with a greater lateralization of the talar center and a greater correction of the hindfoot alignment to valgus. The results of the binary logistic regression analysis showed a significant relationship between postoperative decreased TT and preoperative talar center migration ( P = .016), hindfoot alignment angle ( P = .033), hindfoot moment arm ( P = .041), and hindfoot alignment ratio ( P = .016). Conclusion: LTO in more significant varus ankle arthritis could result in clinical improvement, although TT was not significantly changed. We recommend adding inframalleolar correction after LTO for the patients with more significant varus ankle arthritis. Level of Evidence: Level III, comparative series.
A second administration of glucarpidase in a different cycle of high-dose methotrexate: Is it safe and effective in adults?
Authors: Domingo-González Amalia , Osorio Santiago , Landete Elena , Monsalvo Silvia , Díez-Martín Jose L. 
Published: July 2020

Introduction Methotrexate intoxication following high-dose methotrexate-induced acute kidney injury is a life-threatening complication. Glucarpidase can quickly reduce extracellular methotrexate to safe levels, but the effectiveness and safety of its use in different episodes of nephrotoxicity remain an unknown area. Case Report A 30-year-old male diagnosed with acute lymphoblastic T-cell lymphoma received methotrexate 5 g/m2 intravenous (IV) as part of the first consolidation cycle. On Consolidation 3, he restarted methotrexate at a dose of 3 g/m2 IV showing slow methotrexate elimination, associated myelosuppression, and hepatic toxicity. Glucarpidase was administered (total dose of 2000 International Units (IU)). No adverse events were observed, and his renal function returned to normal. One hundred and six days later, he was diagnosed with leptomeningeal and cerebellar relapse and treatment with methotrexate 3,5 g/m2 IV day 1 and cytosine arabinoside (Ara-C) 2 g/m2 IV twice per day days 1, 3, and 5 was started. At 36 h from methotrexate infusion, serum creatinine increased up to 1.89 mg/dL and methotrexate concentration was 100 µmol/L. Management and Outcome: Ara-C was suspended, and a second administration of glucarpidase (2000 IU) was dispensed. No adverse events were noticed, methotrexate levels decreased and renal function progressively improved, recovering completely three weeks later. Discussion The effectiveness and safety of the use of glucarpidase in different episodes of nephrotoxicity remain an unknown area, and the rate and consequences of antiglucarpidase antibody formation remain poorly understood. This case report is, to our knowledge, the first case of a second administration of glucarpidase in a different cycle of high-dose methotrexate in an adult patient.
Noncoplanar Radiation using Tomotherapy: A Phantom Study
Authors: Yuasa Masahiro , Kurosaki Hiromasa 
Published: July 2020

Background: There are very few studies on noncoplanar radiation in tomotherapy because deformable image registration is not implemented in the TomoTherapy Planning Station, a treatment planning device used in tomotherapy. This study examined whether noncoplanar radiation can be performed on the head using a tilt-type head and neck fixture and deformable image registration. Methods: Planning target volume spheres with diameters of 2, 3, and 4 cm were set on a head phantom, and computed tomography images were taken at 0° and 40° using a tilt-type head and neck fixture. Irradiation plans were created in the Tomotherapy Planning Station. Noncoplanar radiation was simulated, and the dose volume was evaluated by adding the 0° dose distribution and 40° dose distribution using the deformable image registration of the RayStation treatment planning system. Results: The ratio of the phantom volume to the irradiation dose for 20% to 30% of the planning target volume in noncoplanar radiation was smaller than that for 40% to 90% of the planning target volume in single-section irradiation at 0° or 40°. Conclusions: Noncoplanar radiation on the head region using tomotherapy was possible by using a tilt-type head and neck fixture, and the dose distribution could be evaluated using deformable image registration. This method helps reduce the dose of the organ-at-risk region located slightly away from the planning target volume.
The Changes in Pharyngeal Constrictor Muscles Related to Head and Neck Radiotherapy: A Systematic Review
Authors: Grepl Jakub , Sirak Igor , Vosmik Milan , Tichy Ales 
Published: July 2020

It is well known that radiation damage of the pharyngeal constrictor muscles, the glottic larynx, and the supraglottic larynx may lead to dysphagia, an unwanted effect of head and neck radiotherapy. The reduction of radiotherapy-induced dysphagia might be achieved by adaptive radiotherapy. Although the number of studies concerning adaptive radiotherapy of head and neck cancer is continuously increasing, there are only a few studies concerning changes in dysphagia-related structures during radiotherapy. The goal of this review is to summarize the current knowledge about volumetric, dosimetric, and other changes of the pharyngeal constrictor muscles associated with head and neck radiotherapy. A literature search was performed in the MEDLINE database according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The conclusions of 8 studies that passed the criteria indicate a significant increase in the volume and the thickness of the pharyngeal constrictor muscles during radiotherapy. Moreover, the changes in magnetic resonance imaging signal intensity of the pharyngeal constrictor muscles correlate with the absorbed dose (typically higher than 50 Gy) and also with the grade of dysphagia. This systematic review presents 2 variables, which are suitable for estimation of radiotherapy-related pharyngeal constrictor muscles changes—magnetic resonance imaging signal intensity and the thickness. In the case of the thickness, there is no consensus in the level of the measurement—C2 vertebra, C3 vertebra, and the middle of the craniocaudal axis are used. It seems that reference to a position associated with a vertebral body could be more reproducible and beneficial for future research. Although late pharyngeal toxicity remains a challenge in head and neck cancer treatment, better knowledge of radiotherapy-related changes in the pharyngeal constrictor muscles contributes to adaptive radiotherapy development and thus improves the treatment results.
Clinical Utility and Cost of Inpatient Transthoracic Echocardiography Following Acute Ischemic Stroke
Authors: Moores Margaret , Yogendrakumar Vignan , Bereznyakova Olena , Alesefir Walid , Thavorn Kednapa , Pettem Hailey , Stotts Grant , Dowlatshahi Dar , Shamy Michel 
Published: July 2020

Background and Purpose: It is unclear whether it is clinically necessary or cost-effective to routinely obtain a transthoracic echocardiogram (TTE) during inpatient admission for ischemic stroke. Methods: We assessed consecutive patients presenting with acute ischemic stroke at a comprehensive stroke center from 2015 to 2017 who underwent TTE. We assessed for findings on TTE that would warrant urgent intervention including cardiac thrombus, atrial myxoma, mitral stenosis, valve vegetation, valve dysfunction requiring surgery, and low ejection fraction. Subsequent changes in management included changes in anticoagulation, antibiotics, or valve surgery. We calculated in-hospital resource utilization and associated costs for inpatient TTE using individual direct cost details within a case-costing system. Results: Of 695 patients admitted with acute ischemic stroke, 516 (74%) had a TTE and were included in our analysis. TTE findings were potentially clinically significant in 30 patients (5.8%) and changed management in 17 patients (3.3%). Inpatient admission was prolonged to expedite TTE in 24 patients, while TTE occurred after discharge in 76 patients. After correcting for the cost of TTE, the mean difference in cost to prolong an admission for TTE was $555.52 (USD), or $16 832 per change in management. Conclusions: Given the low clinical utility of inpatient TTE after acute ischemic stroke and the costs associated with prolonging admission, discharge from hospital should not be delayed solely to obtain TTE.
How to manage an athlete with mitral valve prolapse
Authors: Cavarretta Elena , Peruzzi Mariangela , Versaci Francesco , Frati Giacomo , Sciarra Luigi 
Published: July 2020

Abstract

Introduction
Under the term degenerative mitral valve prolapse different pathophysiological and clinical entities coexist in a spectrum ranging from Barlow’s disease to fibroelastic deficiency, and represent the most common cause of mitral regurgitation in the general population and in athletes. Carrying a mitral valve prolapse is usually considered a benign condition for athletes, but recently the scientific literature has focused on the malignant, thus rare, arrhythmic mitral valve prolapse and its dramatic association with sudden cardiac death, so that specific features should be considered a red flag and prompt additional exams before clear for competition.

Discussion
As the athlete’s heart is morphologically accompanied by remodelling and dilatation of the cardiac chambers induced by exercise, it may be challenging to differentiate the degree of left ventricular and atrial dilation induced by significant mitral regurgitation from physiological remodelling, especially in endurance athletes.

Conclusion
This how-to article provides clinical and useful data to manage athletes with mitral valve prolapse and to distinguish high-risk athletes carrying the features of arrhythmic mitral valve prolapse.
Veterans’ interests, perceptions, and use of mindfulness
Authors: Herrmann Tracy , Marchand William R , Yabko Brandon , Lackner Ryan , Beckstrom Julie , Parker Ashley 
Published: July 2020

Objective: Mindfulness-based interventions are an evidence-based approach utilized in health care. There is developing evidence for effective use with military Veterans. However, little is known about Veterans’ view of mindfulness. This study aims to understand their interests, perceptions, and use of mindfulness to enhance educational outreach and treatment engagement. Methods: A cross-sectional study was conducted across the Veterans Health Administration in Salt Lake City, UT by administering a questionnaire to military Veterans. The questionnaire included the following themes: (1) demographics and respondents’ mindfulness practice; (2) respondents’ perceptions and beliefs about mindfulness; and (3) respondents’ knowledge and interest in learning about mindfulness. Results: In all, 185 military Veterans were surveyed; 30% practiced mindfulness in the past year, mainly for stress, posttraumatic stress disorder, sleep, and depression. Over 75% who practiced reported perceived benefit. Veterans rarely reported negative beliefs about mindfulness; 56% perceived an understanding of mindfulness and 46% were aware of Veterans Health Administration mindfulness offerings. In all, 55% were interested in learning about mindfulness, 58% were interested in learning how it could help, and 43% were interested in combining mindfulness with a pleasurable activity. Conclusion: Educational engagement approaches should be directed toward the benefits of mindfulness practice with minimal need to address negative beliefs. Outreach including education, with an experiential component, about mindfulness classes, availability of evening and weekend classes, individual sessions, and virtual offerings into Veteran’s homes, may enhance engagement in mindfulness-based interventions. Mindfulness-based interventions that combine mindfulness training with an experiential pleasurable activity may be one mechanism to enhance treatment engagement.
Blood pressure control practice and determinants among ambulatory hypertensive patients attending primary health care facilities in Addis Ababa
Authors: Amare Firehiwot , Nedi Teshome , Berhe Derbew Fikadu 
Published: July 2020

Background: Hypertension is the major risk factor for cardiovascular diseases related morbidity and mortality. Blood pressure is often not adequately controlled in clinical practice. Information regarding blood pressure control in primary care settings is limited in Ethiopia. Objectives: This study aimed to assess blood pressure control practice and determinates among hypertensive patients attending primary health care facilities in Addis Ababa. Methods: A cross-sectional study was conducted on 616 hypertension patients in 12 health centers in Addis Ababa city. Data were collected by interviewing patients and reviewing their medical records. Data were collected from 3 August to 30 October 2015. Results: A complete information was obtained from 616 patients’ medical records, and patients were then interviewed. The mean age was 58.90 (SD ± 13.04) years, and most of them (n = 321, 52.1%) were 60 years old or above, and more than three-fourth (n = 485) were on monotherapy. Methyldopa was the most monotherapy medication prescribed, 128 (20.8%). Only 31% (n = 191) of the patients had controlled blood pressure. Determinants for poor blood pressure control were age less than 60 years (adjusted odds ratio (AOR) = 3.06, 95% confidence interval (CI): 1.96, 4.78); work status: government employee (AOR = 2.41, 95% CI: 1.18, 4.90), retired (AOR = 1.79, 95% CI: 1.01, 3.18), and private business (AOR = 2.09, 95% CI: 1.17, 3.74); and being hypertensive for 10 or more years (AOR = 1.96, 95% CI: 1.11, 3.43). Significant predictors of achieving controlled blood pressure were weekly blood pressure measurement practice (AOR = 0.57, 95% CI: 0.36, 0.90) and tertiary-level education (AOR = 0.26, 95% CI: 0.13, 0.54). Conclusions: Only one-third of the patients had controlled blood pressure. Efforts should be made to address identified determinants including age, regular blood pressure monitoring practice, and level of education.
A Motivation Perspective on College Admission Reform in Shanghai: The Effect of Providing More Choices and Multiple Evaluation Criteria
Authors: Wang (汪靖) Jing 
Published: July 2020

Purpose: This study offered insights into how Chinese college admission reform brought about school changes and influenced students’ motivation and learning behaviors. Design/Approach/Methods: Four classes in one public high school in the Shanghai Municipality were observed in their homeroom activities and during class breaks. Students and teachers were purposively selected and interviewed. Findings: Due to the more choices on national college entrance examination-examined subjects, career development courses and internships were offered to give students guidance on subject selection. A class shifting system was adopted. In response to the comprehensive evaluation criteria, more free time and club activities were offered so that students can develop their own interests in nonacademic areas. While the reform promoted some students’ intrinsic motivation and mastery goals—that is, students reported their intention to develop interests and improve competences—some students made strategic decisions (e.g., avoiding choosing Physics, intensive preparation, and extracurricular academic tutoring) to maximize college admission possibilities at the cost of ignoring their personal interests. Originality/Value: This is a timely study that provides insights into school changes and impacts on students’ learning in a changing educational context. Implications for future research and practices are discussed.