bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lower Blood Pressure, Small‐Vessel Disease, and Apathy in Older Persons With Mild Cognitive Deficits
Authors: Bertens Anne Suzanne , Foster‐Dingley Jessica C. , van der Grond Jeroen , Moonen Justine E.F. , van der Mast Roos C. , Rius Ottenheim Nathaly 
Published: April 2020

BACKGROUNDIn older persons, both high and low blood pressure (BP) levels are associated with symptoms of apathy. Population characteristics, such as burden of cerebral small‐vessel disease (CSVD), may underlie these apparently contradictory findings. We aimed to explore, in older persons, whether the burden of CSVD affects the association between BP and apathy.DESIGNCross‐sectional study.SETTINGPrimary care setting, the Netherlands.PARTICIPANTSCommunity‐dwelling older persons (mean age = 80.7 years; SD = 4.1 years) with mild cognitive deficits and using antihypertensive treatment, participating in the baseline measurement of the magnetic resonance imaging substudy (n = 210) of the Discontinuation of Antihypertensive Treatment in the Elderly Study Leiden.MEASUREMENTSDuring home visits, BP was measured in a standardized way and apathy was assessed with the Apathy Scale (range = 0‐42). Stratified linear regression analyses were performed according to the burden of CSVD. A higher burden of CSVD was defined as 2 or more points on a compound CSVD score (range = 0‐3 points), defined as presence of white matter hyperintensities (greater than median), any lacunar infarct, and/or two or more microbleeds.RESULTSIn the entire population, those with a lower systolic and those with a lower diastolic BP had more symptoms of apathy (β = −.35 [P = .01] and β = −.66 [P = .02], respectively). In older persons with a higher burden of CSVD (n = 50 [24%]), both lower systolic BP (β = −.64, P = .02) and lower diastolic BP (β = −1.6, P = .01) were associated with more symptoms of apathy, whereas no significant association was found between BP and symptoms of apathy in older persons with a lower burden of CSVD (n = 160).CONCLUSIONSParticularly in older persons with a higher burden of CSVD, lower BP was associated with more symptoms of apathy. Adequate BP levels for optimal psychological functioning may vary across older populations with a different burden of CSVD. J Am Geriatr Soc 68:1811‐1817, 2020.
Mineral equilibrium constraints on the feasibility of diffusive H2O‐fluxed melting in the continental crust
Authors: Tafur Lorena A. , Diener Johann F. A. 
Published: April 2020

AbstractGeneration of granitic melt is believed to occur predominantly by melting through the breakdown of hydrous minerals. However, melting due to the influx of H2O has been recognized in anatectic amphibolite facies tonalitic grey gneisses, metagreywackes and low‐P metapelites, and has consequently been proposed as an alternative mechanism for the generation of granitic melt. Melting induced by H2O addition is recognized from voluminous melt production at relatively low temperature, where hydrous minerals are stable and anhydrous minerals are preferentially consumed during melting. Mineral equilibrium modelling to determine the P–T conditions, melt volumes, melting reactions and viable H2O sources reveals that the process is not restricted to specific compositions or P–T conditions, although lower pressure and lithologies with a low hydrous mineral content are more favourable. Melting reactions in all lithologies primarily consume quartz and feldspars to yield 5–6 mol.% melt for each mol.% of H2O added.

remains constant at ~0.70 to 0.77 during progressive melting as long as alkali feldspar is present. Once alkali feldspar is exhausted, plagioclase becomes the main reactant, producing more tonalitic melt compositions with gradually higher

. Our results demonstrate that, at the site of melting, melting is driven by diffusion of H2O into the target rock along chemical potential gradients, rather than the advective flow of a mechanically distinct water‐rich fluid phase. Melting will initiate and proceed as long as a

gradient exists between the H2O source and target lithology. Our calculations show that an ordinary magma, such as an I‐type magma with typical H2O content, has a

high enough to be a viable H2O source, allowing diffusive H2O‐fluxed melting to produce melt proportions and fertility comparable to that of dehydration melting. However, high degrees of partial melting require a considerable amount of H2O, which necessitates a continuously advecting H2O source such as a magma conduit or melt‐bearing shear zone. A magmatic H2O source at emplacement level will undergo a similar amount of crystallization as the melt fraction produced in the target rock such that there will be no net melt production. Considering that shear‐zone hosted magma conduits are localized features, diffusive H2O‐fluxed melting is likely to only be viable in a small fraction of the anatectic orogenic crust. Although it may play an important role in locally raising melt volumes and modifying magma chemistry through mingling and hybridization, it does not appear to, of itself, be able to generate significant volumes of granitic melt.
Women's Perceptions of Barriers and Facilitators to Vaginal Birth After Cesarean in the United States: An Integrative Review
Authors: Basile Ibrahim Bridget , Kennedy Holly Powell , Whittemore Robin 
Published: April 2020

IntroductionThe purpose of this integrative review was to synthesize the literature on women's perceived barriers and facilitators to achieving a vaginal birth after cesarean.MethodsA search of Scopus and PubMed databases and relevant citations from 2000 to 2018 was conducted to identify resources meeting inclusion criteria. Conclusion drawing and verification were completed using data displays, data analysis, and comparison.ResultsSixteen resources met inclusion criteria. Factors identified by women with a history of cesarean that act as facilitators or barriers to achieving a vaginal birth after cesarean included (1) individual factors (knowledge, body, and psychological), (2) social factors (culture and social support), and (3) systemic factors (perinatal care provider, health system, and financial). Some factors related to barriers and facilitators reflected opposing aspects of the same phenomenon on a continuum.DiscussionEnhancing facilitators identified by women, while addressing perceived barriers, may increase access to labor after cesarean for women in the United States. Increasing access to labor after cesarean may subsequently improve women's experiences of care and decrease the US cesarean rate, positively affecting individual health outcomes and overall health of childbearing women in the United States.
The day‐to‐day experiences of caring for children with Osteogenesis Imperfecta: A qualitative descriptive study
Authors: Castro Aimee R. , Marinello Jessica , Chougui Khadidja , Morand Marilyn , Bilodeau Claudette , Tsimicalis Argerie 
Published: April 2020

AbstractAims and objectivesTo explore the day‐to‐day experiences of family caregivers who are caring for children with Osteogenesis Imperfecta (OI).BackgroundOsteogenesis Imperfecta is a rare genetic condition known to cause bone fragility. Family caregivers of children with OI play an important role in helping these children live well at home.DesignA qualitative descriptive design was used.MethodsA qualitative descriptive study was conducted in accordance with the COREQ guidelines. Adult family caregivers (n = 18) of children with OI were recruited from a university‐affiliated, paediatric orthopaedic hospital in Montreal, Canada. Individual interviews were conducted, transcribed verbatim and inductively thematically analysed.ResultsOsteogenesis Imperfecta family caregiving entailed: (a) managing regular day‐to‐day caregiving activities, including morning routines, evening routines and the facilitation of their child's mobilisation; (b) coping with periods that made the caregiving routine more challenging, such as fractures, surgeries and pain; and (c) devising long‐term strategies to support day‐to‐day care, such as managing the environment, accessing medical and school resources, and coordinating care and respite.ConclusionsThe day‐to‐day routine of caring for a child with OI may be disrupted by challenging periods and improved by long‐term strategies developed to ease day‐to‐day care. These strategies suggest future directions for clinicians and policymakers to improve health services and caregiver well‐being.Relevance to clinical practiceClinical, policy and research endeavours need to incorporate new interventions to support the needs of family caregivers. These recommendations may be relevant to other clinicians and policymakers working with families living with rare and chronic physical conditions.
Maternal mental health modifies the association of food insecurity and early child development
Authors: Pedroso Jéssica , Buccini Gabriela , Venancio Sonia Isoyama , Pérez‐Escamilla Rafael , Gubert Muriel Bauermann 
Published: April 2020

AbstractWe examined the association between household food insecurity and early child development and whether or not maternal depression and anxiety modifies this association. The cross‐sectional study included 468 mother–infant pairs recruited at primary health centers of the Federal District, Brazil. Mothers answered a questionnaire that evaluated early child development (outcome), household food insecurity (independent variable), maternal depression and trait anxiety (effect modifiers). Variables were collected with validated questionnaires for the Brazilian population. Pearson's χ2 test and logistic regression analyses were conducted. Infants who lived in a moderate or severe food insecure household had 2.52 times (95% confidence interval [CI] [1.13, 5.65]) the odds of having early child development delays compared with infants in secure households. Maternal depression and anxiety modified the strength of association between household food insecurity and early child development, which is an innovative finding. Among infants with depressed mothers, those experiencing mild (adjusted odds ratio [aOR] 3.33, 95% CI [1.17, 9.46]) and moderate/severe household food insecurity (aOR 10.13, 95% CI [2.18, 47.10]) had higher odds of having early child development delays, compared with infants in food secure households. Among infants with both anxious and depressed mothers, these associations were even stronger for mild (aOR 4.69, 95% CI [1.41, 15.59]) and moderate/severe household food insecurity (aOR 16.07, 95% CI [2.70, 95.66]). In conclusion, household food insecurity is a risk factor for early child development delays, and this association is modified by maternal depression and anxiety. Future studies should evaluate the impact of intervention packages that address maternal depression and anxiety and household food insecurity on preventing early child development delays.
Patient involvement in medical education: To what problem is engagement the solution?
Authors: Rowland Paula , MacKinnon Kinnon R. , McNaughton Nancy 
Published: April 2020

AbstractContextPatient and public engagement is gaining momentum across many domains of health care, inclusive of education and research. In this framing, engagement is offered as a solution to a myriad of problems. Yet, the way problems and solutions are linked together may be assumed, rather than made explicit. In the absence of clarity, there is a risk that solutions that may have worked in one domain of health care could falter, or even create new problems, in another.MethodsWe use a model from organisational studies as a way to make sense of the relationships between the problems, solutions and stakeholders operating in the name of patient and public engagement in health care. The ‘garbage can model’ is a playfully phrased but meaningful attempt to decipher the complex world of decision making in organisations. We use this model to guide our framing of the solutions of patient engagement practice and the wide range of problem statements that animate all of this activity.ResultsFollowing a discussion of the complexity of the field of patient engagement, we identify strategies for educators to conceptually weave problem statements, solutions and stakeholders together in mosaics of engagement activity. We further suggest a movement away from considering problems to be solved to thinking about polarities to be navigated.ConclusionsAs patient engagement becomes more embedded in decision‐making spaces in health professions education, we need a better understanding of how decisions are actually made in these organisations. We also need to consider that our most treasured solutions may have an uneasy fit, and some unintended consequences, as they enter new domains of health care. Finally, we advocate for critical approaches not just to the solutions of patient engagement, but to understand problem statements as they are defined, upheld and disrupted through all of this work.
The case for faculty development: A realist evaluation
Authors: Proctor Dominic , Leeder David , Mattick Karen 
Published: April 2020

AbstractContextIt seems logical to suggest that investing in educators will lead to improved educational outcomes. However, in the case of faculty development, it is unclear how these benefits arise and decisions about investment typically have little basis in evidence. The aim of this realist evaluation was to understand the mechanisms by which investment in faculty development may lead to improved educational outcomes for staff and students.MethodsThis realist evaluation involved three phases: the development of an initial programme theory based on existing peer‐reviewed literature (Phase 1), which was used within 32 realist interviews with key stakeholders at 17 UK medical schools (Phase 2), to underpin the creation of a series of recommendations for faculty development programme designers (Phase 3).ResultsThe findings highlighted the complex and heterogeneous nature of faculty development programmes. Programme developers must consider a range of contexts (accreditation, meeting educational needs, learning culture, accessibility and interactivity) that can impact faculty members in variable ways (engagement, sense of value and belonging, motivation, reassurance and building relationships), potentially resulting in a range of staff outcomes (improved competence, satisfaction, confidence, faculty member collaboration and curriculum changes) that may ultimately benefit students. The improved understanding resulting from Phases 1 and 2, and the recommendations from Phase 3, will enable the design and tailoring of new and existing faculty development initiatives.ConclusionsThis study deepens our understanding of the role of context in faculty development through the realist methodology employed and extends pre‐existing knowledge to provide insights into evidence‐based interventional strategies that may be effective. In particular, faculty development leads need to develop a clear implementation strategy, improve transparency of cashflow, establish effective formal or informal communication systems and evaluate the efficacy of their faculty development initiatives.
Exceptional “We” or Exceptional “Me”? Donald Trump, American Exceptionalism, and the Remaking of the Modern Jeremiad
Authors: Gilmore Jason , Rowling Charles M. , Edwards Jason A. , Allen Nicole T. 
Published: April 2020

AbstractThis article examines how Donald Trump remade the modern jeremiad during his 2016 presidential campaign. We argue that Trump differed from recent oppositional candidates for the presidency in his invocation of American exceptionalism. Our findings show that unlike his predecessors: (1) Trump's use of the jeremiad was constrained by his limited conception of American exceptionalism; (2) Trump routinely portrayed the country as no longer exceptional; and (3) Trump offered a vision for restoring American exceptionalism, focusing primarily on “self‐exceptionalism.” We discuss how these findings contribute to our understanding of the modern jeremiad and examine how these dynamics may play out during Trump’s reelection campaign.
Effect of a tailored home‐based exercise program in patients with systemic sclerosis: A randomized controlled trial
Authors: Filippetti Mirko , Cazzoletti Lucia , Zamboni Francesco , Ferrari Pietro , Caimmi Cristian , Smania Nicola , Tardivo Stefano , Ferrari Marcello 
Published: April 2020

ObjectiveThe aim was to evaluate the effect of a home‐based exercise program on functional capacity, health‐related quality of life (HRQoL), and disability, in patients with systemic sclerosis (SSc).MethodsA 6‐month randomized controlled trial was conducted on SSc patients by comparing a home‐based minimally supervised exercise program (exercise on a stationary cycle and strengthening of upper limbs; stretching of the hands) with usual care. At baseline and after 3 and 6 months, the patients underwent: 6 minutes walking test; hand mobility in scleroderma test; maximal exercise test on an ergocycle; strength measures (handgrip, quadriceps, and biceps). HRQoL (short‐form 36 [SF‐36]) and disability (health assessment questionnaire disability index [HAQ‐DI]) were measured at the same time.ResultsForty‐four patients participated in the study. Twenty‐two were randomly assigned to the intervention group (IG, mean age 63.60 ± 10.40 years) and 22 to the control group (CG, 61.80 ± 14.40 years). At 6 months, the distance walked in 6 minutes increased by 46 m (baseline 486, 95% CI 458‐513 m; 6 months 532, 95% CI 504‐561 m) in IG, whereas it decreased by 5 m (baseline 464, 95% CI 431‐497 m; 6 months 459, 95% CI 427‐490 m) in CG with a significantly different temporal trend at the between‐groups comparison (P < .001). An improvement was also observed for strength measures (handgrip, P = .003; quadriceps, P < .001; biceps, P < .001), for the SF‐36 physical component score (P < .001) and for the HAQ‐DI (P = .011).ConclusionsThis study indicates that in SSc patients, a minimally supervised home‐based exercise program improves physical performance, quality of life, and disability in comparison with usual care.
Serial abdominal radiographs do not significantly increase accuracy of diagnosis of gastrointestinal mechanical obstruction due to occult foreign bodies in dogs and cats
Authors: Elser Emily B. , Mai Wilfried , Reetz Jennifer A. , Thawley Vince , Bagshaw Hadley , Suran Jantra N. 
Published: April 2020

AbstractAbdominal radiographs are commonly used in dogs and cats that present with gastrointestinal signs. When initial abdominal radiographs are equivocal for the presence or absence of gastrointestinal mechanical obstruction, follow‐up abdominal radiographs may be recommended. Based on our review of the literature, no published study has been performed to evaluate the clinical utility of serial abdominal radiographs in such cases. The purpose of this study is to determine whether follow‐up abdominal radiographs increase diagnostic accuracy for mechanical obstruction. A prospective cohort study was performed on client‐owned dogs and cats with clinical concern for gastrointestinal mechanical obstruction and initial abdominal radiographs inconclusive for the presence of obstruction. Follow‐up abdominal radiographs were performed between 7 and 28 h of the initial radiographs; an abdominal ultrasound performed within 3 h of the follow‐up study served as the gold standard. A total of 57 patients (40 dogs and 17 cats) were recruited; 19 of 57 cases (11 dogs; 8 cats) were mechanically obstructed, all with nonradiopaque foreign bodies. Four blinded reviewers (2 radiologists, 1 radiology resident, 1 criticalist) separately assessed the initial and the combined initial/follow‐up radiographic studies for diagnosis of mechanical obstruction; for each observer, there was no significant change in accuracy (P = .058‐.87) for the diagnosis of mechanical obstruction. Given the lack of significant increase in diagnostic accuracy using follow‐up radiographs in cases of occult gastrointestinal mechanical obstruction, other diagnostic options (eg, abdominal ultrasonography) could be considered when survey abdominal radiographs are inconclusive for the diagnosis of mechanical obstruction in dogs and cats.
Criticality Characteristics and Sensitivity Analysis of Fukushima Debris Beds Containing MCCI Products
Authors: Freiría López María , Buck Michael , Starflinger Jörg 
Published: May 2020

Abstract
This study investigates the criticality characteristics of debris beds that may have been formed through the molten–core–concrete-interaction (MCCI) at the pedestal floor of the damaged reactors in Fukushima Daiichi Nuclear Power Station. These were modeled as UO2-concrete systems submerged in water. First, a conservative model was used to evaluate the impact that the presence of concrete has on the neutron multiplication factor (keff) of debris beds. The good moderation capacities of concrete were proved, and it was found that recriticality would be possible under the considered conservative assumptions. Second, a more realistic model was used to perform an uncertainty and sensitivity analysis of a wide range of debris parameters (debris porosity, core meltdown grade, debris size, debris composition, concrete erosion factor, etc.). In this case, the results indicate that the probability of a recriticality event is very remote. It was also found that the presence of boron (B4C) from the control rods within debris has by far the highest influence on keff.
Depression, quality of life and coping style among Thai doctors before their first year of residency training
Authors: Pariwatcharakul Pornjira , Ratta-apha Woraphat , Sumalrot Thanayot , Wankaew Julaluck , Sitdhiraksa Nantawat 
Published: April 2020

AbstractObjectivesDepression and suicide often affect young physicians coping with the demands of residency training. To support effective prevention programmes, we aim to assess depression, quality of life (QoL) and coping style of doctors prior to beginning residency training.MethodsA cross-sectional study of physicians prior to their first year of residency training at the Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand, was conducted. Questionnaires including the Thai versions of the Proactive Coping Inventory, Patient Health Questionnaire and the Pictorial Thai Quality of Life (PTQL) scale were emailed to all first-year residents 1 week before the beginning of residency training in 2015. Descriptive statistics, χ2 test, independent-sample t-test and Pearson’s correlation test were analysed.ResultsAmong 277 doctors, 102 (36.8%) responded to the survey. The average age of respondents was 26.8 (range 25–33; SD=1.2) and 69.6% were women. Nearly all (99.0%) had moderate-to-high overall QoL scores. Depression was found in 10 (9.8%) of respondents. Depression severity was negatively correlated with proactive coping and QoL. Proactive coping (r=0.509, p&lt;0.001), reflective coping (r=0.266, p=0.007), strategic planning (r=0.347, p&lt;0.001), preventive coping (r=0.298, p=0.002) and emotional support seeking (r=0.252, p=0.011) were positively correlated with QoL. Furthermore, proactive was correlated with lower depressive symptoms severity (r=−0.303, p=0.002).ConclusionsAlthough nearly all doctors reported moderate-to-high QoL, positive screening for depression was observed in 9.8% of doctors which is much higher than the prevalence in Thais (1.2%). Mental health promotion policies are essential to help residents effectively cope with the stress and demands of training.