bluuebunny/crossref_metadata_2025_split huggingface dataset:
Provider perspectives on general practice in Henan, China: a mixed-methods study
Authors: Zhu Jiming , Ariana Proochista 
Published: February 2020

ObjectiveSince 2011 China’s central government has committed to establishing a new ‘general practitioner’ (GP)-centred primary care system. To this end there have been great efforts to train an additional 300 000 GPs by 2020. This paper examines the perspective of practitioners in Henan, China, regarding general practice.DesignA mixed-methods approach using focus group discussions (FGD), and structured questionnaires.Setting/participantsSeven FGDs and responses to 1887 questionnaires included medical students, primary care doctors and GP residents in Henan.ResultsThe three surveyed medical groups have some awareness of the attributes of general practice (eg, comprehensiveness, first contact and coordination), but often misinterpret what being a GP entails. Five themes were identified through the FGDs and tested quantitatively for their prevalence with structured questionnaires. First, the GPs’ role as a comprehensive care provider was (mis)interpreted as an ‘all-round doctor’. Second, the GP’s responsibility as the first point of care was understood in two conflicting ways: private personal doctors of the rich and the powerful or village doctors for common people. Third, referral was understood as simply guiding patients to appropriate departments within the hospital while the gatekeeping role was interpreted to involve GPs being peoples’ health protectors rather than being also gatekeepers of specialty services. Traditional Chinese medicine now further complicates the understanding of GPs. And lastly, the GPs’ main responsibility was considered to be public health work.ConclusionThe misunderstandings of the roles and responsibilities of GPs render problematic the policy foundation of China’s GP-centred primary care system. Pursuing the quantity of GPs on its own is meaningless, since the number needed depends on the delineated role of GPs. Top priority is to establish clarity about the GP role, which requires reforming the health delivery system to address issues with fragmented care, strategically taking into account the development of GPs with work delegation and substitution and providing more clarity on the distinction between general practice and public health.
Wessex Acute Frailty Audit: applying quality improvement methodology to design and implement a regional frailty audit using a collaborative, multiprofessional approach
Authors: Lewis Lucy Anne , Corbett Teresa , Burrows Kerry , Spice Claire , Davies Cheryl , Wallis Kathy 
Published: February 2020

IntroductionAn acute hospital stay increases the risk of negative outcomes for those living with frailty. This paper describes the application of quality improvement methodology to design and implement a regional audit to gain an understanding of care provision.MethodsSmall scale tests of change (Plan–Do–Study–Act cycles) were used to design the audit structure and questions. Data collectors met face to face with 2–3 multiprofessional clinicians on 58 wards in 10 hospitals across the region, using an electronic tool to gather data. Outcomes were analysed manually in Excel by extracting from the electronic audit tool.Results58 wards across 10 hospitals participated in the audit, which identified three key themes: lack of awareness and frailty training outside medicine for older people specialties, and significant variability of both frailty identification and comprehensive geriatric assessment.ConclusionCombining quality improvement methodology with a collaborative, regional approach to design and implementation of a frailty audit creates a reliable tool ensuring all stakeholders are considering improvement from the outset. The results have facilitated an agreed regional approach on how best to use local resources to improve and standardise frailty care provision. By highlighting areas of good practice and significant gaps in frailty identification, personalised care planning and hospital wide provision of frailty training, this region of the UK will now be able to drive up standards of care.
Learning from complaints in healthcare: a realist review of academic literature, policy evidence and front-line insights
Authors: van Dael Jackie , Reader Tom W , Gillespie Alex , Neves Ana Luisa , Darzi Ara , Mayer Erik K 
Published: February 2020

IntroductionA global rise in patient complaints has been accompanied by growing research to effectively analyse complaints for safer, more patient-centric care. Most patients and families complain to improve the quality of healthcare, yet progress has been complicated by a system primarily designed for case-by-case complaint handling.AimTo understand how to effectively integrate patient-centric complaint handling with quality monitoring and improvement.MethodLiterature screening and patient codesign shaped the review’s aim in the first stage of this three-stage review. Ten sources were searched including academic databases and policy archives. In the second stage, 13 front-line experts were interviewed to develop initial practice-based programme theory. In the third stage, evidence identified in the first stage was appraised based on rigour and relevance, and selected to refine programme theory focusing on what works, why and under what circumstances.ResultsA total of 74 academic and 10 policy sources were included. The review identified 12 mechanisms to achieve: patient-centric complaint handling and system-wide quality improvement. The complaint handling pathway includes (1) access of information; (2) collaboration with support and advocacy services; (3) staff attitude and signposting; (4) bespoke responding; and (5) public accountability. The improvement pathway includes (6) a reliable coding taxonomy; (7) standardised training and guidelines; (8) a centralised informatics system; (9) appropriate data sampling; (10) mixed-methods spotlight analysis; (11) board priorities and leadership; and (12) just culture.DiscussionIf healthcare settings are better supported to report, analyse and use complaints data in a standardised manner, complaints could impact on care quality in important ways. This review has established a range of evidence-based, short-term recommendations to achieve this.
Nutrition impact symptoms and weight loss in head and neck cancer during radiotherapy: a longitudinal study
Authors: Jin Sanli , Lu Qian , Sun Yan , Xiao Shaowen , Zheng Baomin , Pang Dong , Yang Ping 
Published: February 2020

ObjectivePatients with head and neck cancer (HNC) receiving radiotherapy (RT) are at high risk of weight loss (WL) due to a variety of nutrition impact symptoms (NIS). This study aimed to describe the NIS through the Head and Neck patient Symptom Checklist and body weight over time and further explore the impact of NIS on WL in patients with HNC undergoing RT.MethodsThis was a prospective, longitudinal observational study. NIS and body weight of 117 participants were assessed at baseline, mid-treatment and post-treatment of RT. Generalised estimation equations (GEE) were used to conduct repeated measures analysis of NIS interference score and body weight at each time point and estimate the impact of NIS interference score on WL.ResultsAll participants experienced a substantial increase in the mean number of NIS during RT, with each patient having eight to nine NIS at mid-treatment and post-treatment. Marked increases were noted in almost each NIS score during RT. Compared with their baseline body weight, 97 (82.9%) and 111 (94.9%) participants experienced WL at mid-treatment and post-treatment, with the mean WL of 2.55±1.70 kg and 5.31±3.18 kg, respectively. NIS of dry mouth (β=−0.681, p=0.002, 95% CI −1.116 to −0.247), difficulty swallowing (β=−0.410, p=0.001, 95% CI −0.651 to −0.169) and taste change (β=−0.447, p=0.000, 95% CI −0.670 to −0.225) impacted WL significantly in GEE multivariate model.ConclusionsPatients with HNC experience a variety of NIS which have significant impact on WL during RT. Assessment of NIS, especially dry mouth, difficulty swallowing and taste change, should be given more considerable attention in the supportive care of patients with HNC.
Mentoring for postdoctoral researchers in rheumatology: the Emerging EULAR Network (EMEUNET) post-doc mentoring programme
Authors: Rodríguez-Carrio Javier , Putrik Polina , Gwinnutt James , Sepriano Alexandre , Alunno Alessia , Ramiro Sofia , Leipe Jan , Nikiphorou Elena 
Published: February 2020

ObjectiveThis study aims to (1) assess the perceived need for a postdoctoral (post-doc) mentoring programme in rheumatology, (2) describe the characteristics and organisational aspects of a pilot mentoring programme implemented by the EMerging European League Against Rheumatism NETwork (EMEUNET) and (3) report mentors’ and mentees’ evaluation of the pilot programme.MethodsAn online survey was conducted among young researchers in rheumatology to evaluate the need and preferred characteristics of a post-doc mentoring initiative. Informed by the survey, a pilot programme was designed and launched. The pilot programme was evaluated with 3-month, 6-moth and 12-month surveys and interviews with mentees and a 12-month survey among mentors, after completion.ResultsFrom 275 responses (43 countries, 86% from Europe) collected, analyses were restricted to the target population (total population=158; post-docs (n=103 (65%)) and PhD students (n=55 (35%))). There was a clear need (99% positive responses) for a post-doc mentoring programme. Discussions about current and new projects, and how to lead projects were ranked as priorities in post-doc mentoring. The most desired mentor attribute was generosity and interest in helping (86%), followed by research experience (68%) and having a well-established network (66%). The pilot programme included four mentees (through competitive application) allocated to three mentors. Evaluation surveys and interviews revealed that the programme organisation and content were well appreciated by mentees and mentors.ConclusionsThe EMEUNET post-doc mentoring programme addresses unmet need for mentoring, is viable and appreciated by mentors and mentees. The programme structure and content are transferable to other fields where there is need for academic career mentoring.
Abscessation associated with an intramuscular haemangiosarcoma in a dog
Authors: Gasparini Molly K , Selmic Laura E , Cook Matthew , Brown Megan , Wavreille Vincent A 
Published: February 2020

Haemangiosarcoma (HSA) is a neoplasm of the endothelial cells. Intramuscular HSA is an uncommon presentation of this endothelial cell neoplasm. This report describes an unusual case of an intramuscular HSA arising in the hindlimb of a dog with associated abscessation. Diagnosis of underlying HSA was complicated by associated infection and initial cytological evaluation showed only septic suppurative inflammation. However, due to the heterogeneously contrast enhancing appearance of the area on CT, underlying neoplasia was suspected. Definitive diagnosis of HSA could only be made following excision and histopathology of the affected muscle in addition to immunohistochemistical stains. This dog received multimodal treatment including surgery, radiation and chemotherapy, and despite developing metastatic lesions, was alive 12 months after presentation, at the time of manuscript writing. Deep abscessation can occur concurrently with neoplasia, and neoplasia should remain on the differential diagnosis list for deep abscesses of unknown aetiology.
Polarization-insensitive electromagnetically-induced transparency in planar metamaterial based on coupling of ring and zigzag spiral resonators
Authors: Tung Bui Son , Khuyen Bui Xuan , Linh Pham The , Tung Nguyen Thanh , Manh Do Hung , Lam Vu Dinh 
Published: February 2020

A planar metamaterial (MM) mimicking electromagnetically-induced transparency (EIT) effect is demonstrated numerically and experimentally in the microwave region. The structure of MM is a periodicity of ring and zigzag spiral resonators, in which each resonator can be excited directly by the external field. By matching the characteristic resonance frequencies of two resonators, the coupling of two bright modes appears, leading to an EIT effect with a transparency peak at 4.86 GHz. Although the geometry of the structure is not perfectly symmetric, the proposed electromagnetically-induced transparency metamaterial (EIT-MM) is insensitive to the polarization of incoming wave. Furthermore, the EIT-MM exhibits a strong dispersion behavior, which leads to a high group index of 2785 and a group delay of 0.83 ns. Our work might be useful to potential applications using EIT-MM such as modulators, filters and sensors.
Metamaterial sensor application concrete material reinforced with carbon steel fiber
Authors: Dalgaç Şekip , Karadağ Faruk , Ünal Emin , Özkaner Vedat , Bakır Mehmet , Akgöl Oğuzhan , Sevim Umur Korkut , Delihacıoğlu Kemal , Öztürk Murat , Karaaslan Muharrem , Sabah Cumali 
Published: February 2020

In this paper, a rectangular split ring resonator-type metamaterial (MTM) sensor application is demonstrated in order to examine concrete materials. First, different types of concrete materials including carbon steel fiber with the purity ratio of 0.5%, 1% and 1.5% were prepared by using cement and water and their electrical properties were determined via Nicolson–Ross–Weir tehcnique. After that, compatible MTM-based sensor structure was designed and proposed. In order to find out the effect of the humidity on the concrete material, all samples were kept in the water pool for 28 days, the samples were then taken out and the temperature effect on the concrete materials was observed by increasing the heat up to 30[Formula: see text] and 70[Formula: see text] in the oven. The simulated resonance frequency shifts were observed at 910 MHz for concrete material sensor, 120 MHz for humidity sensor validation and 400 MHz for temperature sensor applications. By having large bandwidth in different fiber contents and validating the physical sensor applications as temperature and humidity, it was shown that the proposed study has novelty in the area of MTM-based sensor applications when it is compared with current state-of-the-art.
Korean Red Ginseng Inhibits Amyloid-β-Induced Apoptosis and Nucling Expression in Human Neuronal Cells
Authors: Choi Suyun , Lim Joo Weon , Kim Hyeyoung 
Published: February 2020

<b><i>Introduction:</i></b> The accumulation of amyloid-β (Aβ) plaque in the brain is a characteristic feature of Alzheimer’s disease (AD) and the cause of fatal oxidative damage to neuronal cells. Korean red ginseng (RG) is used extensively in traditional medicine and is known to have anti-oxidative and anti-inflammatory properties. <b><i>Objective:</i></b> This study aims to investigate whether Korean RG extract inhibits Aβ-induced neuronal apoptosis. <b><i>Methods:</i></b> Human neuronal cells (SH-SY5Y cells) were stimulated with Aβ (5 μmol/L) and treated with RG dissolved in phosphate-buffered saline (0.2, 2, 20 μg/mL). <b><i>Results:</i></b> RG suppressed the reduction of cell viability and the increase in apoptotic factors (Bax/Bcl-2 ratio and caspase-3 activity) in Aβ-treated cells. RG suppressed Aβ-induced increases in intracellular and mitochondrial reactive oxygen species (ROS) levels and mitochondrial dysfunction (determined by low mitochondrial membrane potential and oxygen consumption rate) in a dose-dependent manner. RG inhibited nuclear factor kappa-light-chain-enhancer of activated B cells (NF-ĸB) activation and expression of the pro-apoptotic gene Nucling in Aβ-treated cells. <b><i>Conclusion:</i></b> RG confers protection against neuronal apoptosis by reducing ROS levels and suppressing mitochondrial dysfunction and NF-κB activation, which results in suppression of NF-κB-mediated activation of Nucling expression in Aβ-treated cells. Supplementation with RG may be beneficial for preventing Aβ-induced neuronal cell death associated with AD.
Neural Mechanisms of Strategic Adaptation in Attentional Flexibility
Authors: Sali Anthony W. , Jiang Jiefeng , Egner Tobias 
Published: February 2020

Abstract
Individuals are able to adjust their readiness to shift spatial attention, referred to as “attentional flexibility,” according to the changing demands of the environment, but the neural mechanisms underlying learned adjustments in flexibility are unknown. In the current study, we used fMRI to identify the brain structures responsible for learning shift likelihood. Participants were cued to covertly hold or shift attention among continuous streams of alphanumeric characters and to indicate the parity of target stimuli. Unbeknown to the participants, the stream locations were predictive of the likelihood of having to shift (or hold) attention. Participants adapted their attentional flexibility according to contextual demands, such that the RT cost associated with shifting attention was smallest when shift cues were most likely. Learning model-derived shift prediction error scaled positively with activity within dorsal and ventral frontoparietal regions, documenting that these regions track and update shift likelihood. A complementary inverted encoding model analysis revealed that the pretrial difference in attentional selection strength between to-be-attended and to-be-ignored locations did not change with increasing shift likelihood. The behavioral improvement associated with learned flexibility may primarily arise from a speeding of the shift process rather than from preparatory broadening of attentional selection.
Descending into the Indeterminate State between the Determinate
Authors: Yama Megumi 
Published: February 2020

Abstract
When Jung received the manuscript of the Taoist-alchemical treatise entitled The Secret of the Golden Flower from Richard Wilhelm he realized what his drawings of mandalas meant and received confirmation of his theories about the Self. At the same time, Jung realized that he had encountered ‘the East’ within, as he was digging into the depths of his own psyche. Today, thanks to the publication of The Red Book (RB) and Memories, Dreams, Reflections (MDR), we can understand that through that process, Jung held dialogues with the dead. This is considered to mean that he had contact with the world of death to reach another culture—the East. Yama argues that the indeterminate state between the determinate culture and another is chaotic and uncertain, a space which may possibly lead to the world of death. Nowadays, amongst rapid globalization, many people from diverse backgrounds have opportunities to encounter different cultures for various reasons, sometimes out of interest and sometimes out of necessity. In some cases, but not all, individuals simply step across into the other culture without the experience of ‘descending into the depth,’ as Jung had. Yama explores Jung’s inner journey and his childhood memories from the view of what was taking place while he was moving symbolically from the West to the East. For further exploration of the life of someone who is destined to live between different cultures, Yama introduces a Japanese old folk tale and presents clinical material, as well as her personal experience as one who spent her adolescence outside of her native culture.
Rūmī’s Verse at the Crossroads of Language and Music
Authors: Sedaghat Amir Artaban 
Published: February 2020

AbstractThis article demonstrates how Rūmī has made use of the Iranian musical system and Persian classical prosody, two separate semiotic systems with overlapping forms and aesthetic principles, in order to create a hybrid semiotic system in his poetry. His poetic feat can be observed through a comparative analysis of the linguistic and musical components of his poems in the Divān-e Shams-e Tabrizi, used extensively in the sacred tradition of samāʿ as well as in Iranian musical performances. This essay shows how the systematic use of rhythm and music in versification reaches new heights in Rumi’s ghazals, where the combination of language and music gives birth to a transcendental mode of expression devised with the aim of expressing the ineffable Ultimate Truth. Rumi employed this unique sign system to communicate a mystical message that cannot be conveyed using ordinary language. His unparalleled means of expression, in direct relation with the mystic experience of wajd, is used to incarnate what Sufis call maʿnā (the archetypal meaning). These archetypal ideas cannot be understood through dialectic means of the intellect but can only be taken in by the heart of the mystic in a state of ecstasy.
Child Development Outcomes of DIR/Floortime TM-based Programs: A Systematic Review
Authors: Boshoff Kobie , Bowen Henry , Paton Hazel , Cameron-Smith Sally , Graetz Sean , Young Alexander , Lane Katelyn 
Published: February 2020

Background. Occupational therapy is often part of the multi-disciplinary approach within the Developmental, Individual-differences, Relationship-based (DIR) FloortimeTM Model. The model addresses the emotional development of children, which is considered to be critical for the other child developmental areas. Purpose. This review serves to inform practitioner decision-making about the use of this model, as no systematic reviews exist on child development outcomes. Methods. The systematic search included Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Cochrane. For critical appraisal, the McMaster Critical Review was utilized. Findings. Nine studies were identified with varying quality levels. Outcomes were mostly reported for increased socio-emotional development. Implications. The evidence base for this model is emerging from a published research perspective. It is recommended that the use of this model be supported by sound clinical reasoning processes, intervention fidelity, use of valid outcome measures, and regular monitoring. Higher quality research is urgently needed to progress the research base for this intervention.
Effects of Two Passive Back-Support Exoskeletons on Muscle Activity, Energy Expenditure, and Subjective Assessments During Repetitive Lifting
Authors: Alemi Mohammad Mehdi , Madinei Saman , Kim Sunwook , Srinivasan Divya , Nussbaum Maury A. 
Published: February 2020

Objective The aim of this study was to explore the efficacy of two different passive back-support exoskeleton (BSE) designs during repetitive lifting in different postures. Background Although BSEs have been proposed as a potential intervention for reducing physical demands, limited information is available about the impacts of different exoskeleton designs in diverse work scenarios. Method Eighteen participants (gender-balanced) performed lab-based simulations of repetitive lifting tasks. These tasks were performed in 12 different conditions, involving two BSEs and a control condition, two levels of lifting symmetry (symmetric and asymmetric), and two postures (standing and kneeling). Outcome measures described muscle activity and energy expenditure, along with perceived discomfort, balance, and usability. Results Using both BSEs significantly reduced peak activity of the trunk extensor muscles (by ~10%–28%) and energy expenditure (by ~4%–13%) in all conditions tested. Such reductions, though, were task dependent and differed between the two BSEs. In most of the tested conditions, using BSEs positively affected subjective responses regarding perceived exertion and usability. Conclusion Our results suggest that the beneficial effects of a BSE are task specific and depend on the specific BSE design approach. More work is needed, though, to better characterize this task specificity and to determine the generalizability of BSE effects on objective and subjective outcomes for a wider range of conditions and users. Application Our results provide new evidence to guide the selection and application of passive BSE designs in diverse lifting tasks.