bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medical students’ experiences with goals of care discussions and their impact on professional identity formation
Authors: Wang Xuyi Mimi , Swinton Marilyn , You John J 
Published: November 2019

ContextGoals of care (GoC) discussions occur amongst patients, family members and clinicians in order to establish plans of care and are invaluable aspects of end‐of‐life care. In previous research, medical learners have reported insufficient training and emotional distress about end‐of‐life decision making, but most studies have focused on postgraduate trainees and have been quantitative or have evaluated specific educational interventions. None have qualitatively explored medical students’ experiences with GoC discussions, their perceptions of associated hidden curricula, and the impacts of these on professional identity formation (PIF), the individualised developmental processes by which laypersons evolve to think, act and feel like, and ultimately become, medical professionals.MethodsUsing purposive sampling at one Canadian medical school, individual semi‐structured interviews were conducted with 18 medical students to explore their experiences with GoC discussions during their core internal medicine clerkship. Interviews were audiorecorded, transcribed and anonymised. Concurrently with data collection, transcripts were analysed iteratively and inductively using interpretative phenomenological analysis, a qualitative research approach that allows the rich exploration of subjective experiences.ResultsParticipants reported minimal support and supervision in conducting GoC discussions, which were experienced as ethically challenging, emotionally powerful encounters exemplifying tensions between formal and hidden curricula. Role modelling and institutional culture were key mechanisms through which hidden curricula were transmitted, subverting formal curricula in doing so and contributing to participants’ emotional distress. Participants’ coping responses were generally negative and included symptoms of burnout, the pursuit of standardisation, rationalisation, compartmentalisation and the adaptation of previously held, more idealised professional identities.ConclusionsGoC discussions in this study were often led by inexperienced medical students and impacted negatively on their PIF. Through complex emotional processes, they struggled to reconcile earlier concepts of physician identities with newly developing ones and often reluctantly adopted suboptimal professional behaviours and attitudes. Improved education about GoC discussions is necessary for patient care and may represent concrete and specific opportunities to influence students’ PIF positively.
ZafA‐mediated regulation of zinc homeostasis is required for virulence in the plant pathogen Fusarium oxysporum
Authors: López‐Berges Manuel S. 
Published: November 2019

SummaryDuring infection, soilborne fungal pathogens face limiting conditions of different metal ions, including zinc. The role of zinc homeostasis in fungal pathogenicity on plants remains poorly understood. Here it is shown that the transcription factor ZafA, orthologous to Saccharomyces cerevisiae Zap1, functions as a key regulator of zinc homeostasis and virulence in Fusarium oxysporum, a cross‐kingdom pathogen that causes vascular wilt on more than 100 plant species and opportunistic infections in humans. Expression of zafA is induced under zinc‐limiting conditions and repressed by zinc. Interestingly, zafA is markedly up‐regulated during early stages of plant infection, suggesting that F. oxysporum must cope with limited availability of zinc. Deletion of zafA results in deactivation of high‐affinity zinc transporters, leading to impaired growth under zinc deficiency. Fusarium oxysporum strains lacking ZafA are reduced in their capability to invade and kill tomato plants and the non‐vertebrate animal model Galleria mellonella. Collectively, the results indicate that ZafA‐mediated adaptation to zinc deficiency is required for full virulence of F. oxysporum on plant and animal hosts.
Sustainability standards, multicriteria maximin, and viability
Authors: Doyen Luc , Gajardo Pedro 
Published: November 2019

AbstractThis paper deals with sustainability criteria and standards. The maximin criterion, as the highest performance that can be sustained over time, promotes intergenerational equity, a pivotal issue for sustainability. The viable control approach, by investigating trajectories and actions complying over time with various standards and constraints, provides major insights into strong sustainability. The present paper addresses the links between maximin and viability approaches in a multicriteria context. It first shows how “Pareto maximin” can be characterized through viability kernels. Such a result makes it possible to determine the trade‐offs and/or synergies between nonsubstitutable economic and ecological standards underlying strong sustainability. The second main result of the paper is to propose algorithms derived from the viability version of dynamic programming to approximate numerically Pareto maximin values, controls, and sustainability standards. Two examples relying on renewable resource management illustrate these analytic and numerical findings. In particular, synergies between sustainability standards of resource conservation, production or profitability are identified for overexploited stocks.
‘We try’ – how nurses work with patient participation in forensic psychiatric care
Authors: Magnusson Emilie , Axelsson Anna Karin , Lindroth Malin 
Published: November 2019

RationalePatients in secure forensic psychiatric care have reduced autonomy because of the constraints imposed on them by compulsion laws. Thus, it is vital that nurses enable patient participation whenever possible. Patient participation, and it′s clinical use in forensic psychiatric care, is an understudied field.AimTo describe nurses’ experiences of their work with patient participation in forensic psychiatric care.MethodsManagers at different secure forensic psychiatric institutions in the south of Sweden approved the study, and oral consent was retrieved from informants. Interviews guided by a semi‐structured interview guide were conducted with nine nurses from five different forensic psychiatric institutions and analysed with content analysis.FindingsNurses describe diverse understandings and abilities in an inflexible setting. This indicates that what participation is, and how to achieve it, is not the same for nurses as for patients. Moreover, patients have different abilities to participate, and the secure setting in itself is perceived as hindering participatory work. Still, participation is described as a crucial part of work that requires a caring relationship. Furthermore, nurses pronounce potentially excluding attitudes and strategies that may obstruct patient participation for all, and at the same time, they have a belief that improvement is possible.ConclusionCompulsory forensic psychiatric care is a complex care context that requires constant efforts from nurses to balance patients’ rights and needs with mandatory care. The very nature of this caring context appears to be a major obstacle when promoting patient participation. Nevertheless, nurses express that they do aim for patient participation, ‘they try’. From a patient's perspective, trying is not sufficient and a need for improvement is evident. The results can be of clinical interest in similar secure forensic psychiatric nursing settings, and a point of departure in future development of care striving for increased patient participation for all.
Help‐seeking behaviour for cancer symptoms: an evolutionary concept analysis
Authors: Momeni Maryam , Rafii Forough 
Published: November 2019

BackgroundCancer survival largely depends on its early diagnosis. Therefore, assessing help‐seeking behaviours among people with potential symptoms of cancer is essential.AimThis study aimed to analyse the concept of help‐seeking behaviour for cancer symptoms.MethodsThis concept analysis was conducted using Rodger’s evolutionary method. An online literature search was conducted in the PubMed, Scopus and Cochrane databases to find relevant articles published from 2000 to 2017 in English peer‐reviewed journals. In total, ninety articles were included in the study. Through thematic analysis, the data were analysed for the definitions, attributes, antecedents and consequences of the concept of help‐seeking behaviour for cancer symptoms.ResultsThe concept of help‐seeking behaviour for cancer symptoms includes a chain of behaviours and is defined as the process of informed decision‐making for seeking medical help and using healthcare services after the detection of the first potential cancer symptoms. The attributes of the concept of help‐seeking behaviour for cancer symptoms include process, problem‐centeredness, intentional action and interpersonal interaction. Antecedents of the concept of help‐seeking behaviour for cancer symptoms were broadly categorised as its facilitators and barriers, among which old age, young age, marriage, low education level, positive family history of cancer, fear over cancer, low perceived threat, symptom disclosure to significant others are both facilitator and barrier. The consequences of the concept of help‐seeking behaviour for cancer symptoms were also broadly categorised in the two main categories of positive consequences and adverse consequences.ConclusionsHelp‐seeking behaviour is a multidimensional time‐dependent and context‐bound concept which is usually defined based on the concept of time in order to facilitate its measurement. It is generally used for assessing patients’ delay in seeking medical help. The findings of this study provide better understanding about the concept of help‐seeking behaviour for cancer symptoms and its implications for research and practice.
Stress and Suicidal Ideation: The Role of State or Trait Anhedonia in a Moderated Mediation Model
Authors: Yang Xinhua , Wang Dongfang , Liu Sixun , Liu Guangya , Harrison Phillippa 
Published: November 2019

BackgroundRecent works suggested taking into account the severity and the type of anhedonia when examining suicidal ideation. The present study investigated a moderated mediation model addressing the psychosocial mechanisms that account for the association between state or trait anhedonia and suicidal ideation.MethodsState anhedonia was assessed using the Snaith‐Hamilton Pleasure Scale, while trait anhedonia was assessed using the Temporal Experience of Pleasure Scale. A total number of 1,361 of undergraduates completed questionnaires at three different times, with one‐year intervals.ResultsThe direct effect of stress on suicidal ideation was significantly greater for those students who had lower trait anticipatory and consummatory anhedonia, whereas the indirect effect from stress on suicidal ideation through depression was significantly greater for those who had higher state anhedonia. Moreover, trait consummatory anhedonia moderated the relationship between stress and suicidal ideation after one year, and trait anticipatory anhedonia moderated the relationship between stress and suicidal ideation after two years.ConclusionsLow levels of trait anhedonia were associated with elevated suicidal ideation, while high levels of state anhedonia were associated with elevated suicidal ideation. Trait consummatory anhedonia was associated with short‐term suicidal ideation, while trait anticipatory anhedonia was associated with long‐term suicidal ideation.
Emerging therapeutic approaches for canine sarcomas: Pushing the boundaries beyond the conventional
Authors: Borgatti Antonella , Dickerson Erin B. , Lawrence Jessica 
Published: November 2019

AbstractSarcomas represent a group of genomically chaotic, highly heterogenous tumours of mesenchymal origin with variable mutational load. Conventional therapy with surgery and radiation therapy is effective for managing small, low‐grade sarcomas and remains the standard therapeutic approach. For advanced, high‐grade, recurrent, or metastatic sarcomas, systemic chemotherapy provides minimal benefit, therefore, there is a drive to develop novel approaches. The discovery of “Coley's toxins” in the 19th century, and their use to stimulate the immune system supported the application of unconventional therapies for the treatment of sarcomas. While promising, this initial work was abandoned and treatment paradigm and disease course of sarcomas was largely unchanged for several decades. Exciting new therapies are currently changing treatment algorithms for advanced carcinomas and melanomas, and similar approaches are being applied to advance the field of sarcoma research. Recent discoveries in subtype‐specific cancer biology and the identification of distinct molecular targets have led to the development of promising targeted strategies with remarkable potential to change the landscape of sarcoma therapy in dogs. The purpose of this review article is to describe the current standard of care and limitations as well as emerging approaches for sarcoma therapy that span many of the most active paradigms in oncologic research, including immunotherapies, checkpoint inhibitors, and drugs capable of cellular metabolic reprogramming.
Sinocutaneous fistula repair with a masseter muscle transposition flap combined with wound matrix and cancellous bone graft in a horse: A new technique
Authors: Yoshimura Seiji , Barber Spencer M. , Tucker Michelle L. , Bracamonte José L. , Mund Suzanne J. K. , Thomas Keri L. 
Published: November 2019

AbstractObjectiveTo describe a new technique to repair a sinocutaneous fistula with a masseter muscle transposition flap.Study designCase report.AnimalOne 13‐year‐old thoroughbred stallion.MethodsOne 13‐year‐old stallion with a 3.5 × 6‐cm sinocutaneous fistula over the right caudal maxillary sinus was treated with a transpositional masseter muscle flap. This repair consisted of a commercial wound matrix dressing placed directly over the hole in the maxilla and secured with suture material; a cancellous bone graft collected from the right tuber coxa placed on the dressing; and a portion of the superficial layer of the masseter muscle, with its pedicle at the facial crest, transposed dorsally over the bone graft, followed by a rotational skin flap with skin rostral to the fistula to close the defect.ResultsSeroma formation and dehiscence of the skin flap occurred, but the transposed muscle flap survived, and the technique resulted in successful closure of the sinocutaneous fistula with excellent cosmetic and functional outcome.ConclusionA chronic maxillary sinocutaneous fistula was successfully treated by using a transposition flap of the masseter muscle and a rotational skin flap with minor complications.Clinical impactTransposition of the superficial layer of the masseter muscle should be considered for a repair of large maxillary sinocutaneous fistulas in horses.
Effect of Fuel Nozzle Geometry on Swirling Partially Premixed Methane Flames
Authors: Ahmed Mahmoud M. A. , Birouk Madjid 
Published: November 2019

Abstract
This paper presents an experimental study of the effect of fuel nozzle geometry on swirling partially premixed methane flames, where the focus is put on the ensuing flowfield and its role on coherent structures' suppression. The burner consists of a central interchangeable fuel nozzle surrounded by a swirling co-airflow where both discharge into a short mixing tube. The nozzle geometry is classified into two groups, namely, single- and multi-orifice nozzles. The swirling motion of the co-airflow is produced using a radial-type swirl generator with a swirl number of 1.15. The flowfield characteristics and coherent structures are documented using particle image velocimetry (PIV). Flame front dynamics are captured using Mie scattering technique. Quantitative laser sheet (QLS) is used to qualitatively shed light on the mixing characteristics downstream of the mixing tube exit, and laser Doppler velocimetry (LDV) is used to extract the coherent structures' peak frequency from the power spectra. The results revealed that the fuel nozzle geometry significantly affects the mean flowfield, mean, and root-mean-square (RMS) of the flame front location, flame front asymmetry, and coherent structures' amplitude. Higher spread rate and faster decay caused by single-orifice nozzles inside the mixing tube result in divergent flames with higher degree of flame front asymmetry downstream of the mixing tube exit. On the other hand, multi-orifice nozzles mitigate coherent structures, enhance mixing, and hence, promote the most appropriate conditions for coherent structures' suppression.
High-Momentum Jet Flames at Elevated Pressure, C: Statistical Distribution of Thermochemical States Obtained From Laser-Raman Measurements
Authors: Ax Holger , Lammel Oliver , Lückerath Rainer , Severin Michael 
Published: November 2019

Abstract
A detailed investigation on flame structures and stabilization mechanisms of confined high momentum jet flames by one-dimensional (1D)-laser Raman measurements is presented. The flames were operated with natural gas (NG) at gas turbine relevant conditions in an optically accessible high-pressure test rig. The generic burner represents a full scale single nozzle of a high temperature FLOX® gas turbine combustor including a pilot stage. 1D-laser Raman measurements were performed on both an unpiloted and a piloted flame and evaluated on a single shot basis revealing the thermochemical states from unburned inflow conditions to burned hot gas in terms of average and statistical values of the major species concentrations, the mixture fraction and the temperature. The results show a distinct difference in the flame stabilization mechanism between the unpiloted and the piloted case. The former is apparently driven by strong mixing of fresh unburned gas and recirculated hot burned gas that eventually causes autoignition. The piloted flame is stabilized by the pilot stage followed by turbulent flame propagation. The findings help to understand the underlying combustion mechanisms and to further develop gas turbine burners following the FLOX concept.
Toward Estimating the Uncertainty Associated With Three-Dimensional Geometry Reconstructed From Medical Image Data
Authors: Horner Marc , Luke Stephen M. , Genc Kerim O. , Pietila Todd M. , Cotton Ross T. , Ache Benjamin A. , Levine Zachary H. , Townsend Kevin C. 
Published: November 2019

Abstract
Patient-specific computational modeling is increasingly used to assist with visualization, planning, and execution of medical treatments. This trend is placing more reliance on medical imaging to provide accurate representations of anatomical structures. Digital image analysis is used to extract anatomical data for use in clinical assessment/planning. However, the presence of image artifacts, whether due to interactions between the physical object and the scanning modality or the scanning process, can degrade image accuracy. The process of extracting anatomical structures from medical images introduces additional sources of variability, e.g., when thresholding or when eroding along apparent edges of biological structures. An estimate of the uncertainty associated with extracting anatomical data from medical images would therefore assist with assessing the reliability of patient-specific treatment plans. To this end, two image datasets were developed and analyzed using standard image analysis procedures. The first dataset was developed by performing a “virtual voxelization” of a computer-aided design (CAD) model of a sphere, representing the idealized scenario of no error in the image acquisition and reconstruction algorithms (i.e., a perfect scan). The second dataset was acquired by scanning three spherical balls using a laboratory-grade computed tomography (CT) scanner. For the idealized sphere, the error in sphere diameter was less than or equal to 2% if five or more voxels were present across the diameter. The measurement error degraded to approximately 4% for a similar degree of voxelization of the physical phantom. The adaptation of established thresholding procedures to improve segmentation accuracy was also investigated.
Three-Dimensional Inflation Response of Porcine Optic Nerve Head Using High-Frequency Ultrasound Elastography
Authors: Ma Yanhui , Pavlatos Elias , Clayson Keyton , Kwok Sunny , Pan Xueliang , Liu Jun 
Published: November 2019

Abstract
Characterization of the biomechanical behavior of the optic nerve head (ONH) in response to intraocular pressure (IOP) elevation is important for understanding glaucoma susceptibility. In this study, we aimed to develop and validate a three-dimensional (3D) ultrasound elastographic technique to obtain mapping and visualization of the 3D distributive displacements and strains of the ONH and surrounding peripapillary tissue (PPT) during whole globe inflation from 15 to 30 mmHg. 3D scans of the posterior eye around the ONH were acquired through full tissue thickness with a high-frequency ultrasound system (50 MHz). A 3D cross-correlation-based speckle-tracking algorithm was used to compute tissue displacements at ∼30,000 kernels distributed within the region of interest (ROI), and the components of the strain tensors were calculated at each kernel by using least square estimation of the displacement gradients. The accuracy of displacement calculation was evaluated using simulated rigid-body translation on ultrasound radiofrequency (RF) data obtained from a porcine posterior eye. The accuracy of strain calculation was evaluated using finite element (FE) models. Three porcine eyes were tested showing that ONH deformation was heterogeneous with localized high strains. Substantial radial (i.e., through-thickness) compression was observed in the anterior ONH and out-of-plane (i.e., perpendicular to the surface of the shell) shear was shown to concentrate in the vicinity of ONH/PPT border. These preliminary results demonstrated the feasibility of this technique to achieve comprehensive 3D evaluation of the mechanical responses of the posterior eye, which may provide mechanistic insights into the regional susceptibility in glaucoma.
Comprehensive Performance Analysis of the Turbofan With a Multi-Annular Rotating Detonation Duct Burner
Authors: Ji Zifei , Zhang Huiqiang , Wang Bing , He Wei 
Published: November 2019

Abstract
The performance analysis of mixed-exhaust turbofan engine with multi-annular rotating detonation duct burner (RDDB) is conducted for the first time, considering that the flow path of the bypass duct is ideal for a rotating detonation combustor (RDC). The configuration of the multi-annular rotating detonation combustor is constructed aiming at the advantages of a wider operation range and uniform outlet parameters over the single-annular one. Then, a parametric analysis model of the mixed-exhaust turbofan engine with a rotating detonation duct burner is developed. Thereafter, the effects of duct burner parameters on the engine performance and operating characteristics are investigated. The mixed-exhaust turbofan engine with a rotating detonation duct burner shows superior overall performance to that of one with an isobaric afterburner (ICAB) over a wide operation range. The separate-exhaust rotating detonation duct burner can hold characteristics that are higher than those of the mixed-exhaust one at lower values of fan pressure ratio, while the mixed-exhaust one corresponds to lower values of turbine inlet temperature. When the rotating detonation duct burner is “on,” the low-pressure rotor operating line moves toward the surge line on the low corrected shaft speed side but away from the surge line on the high corrected shaft speed side.