bluuebunny/crossref_metadata_2025_split huggingface dataset:
Scaling Anomaly in the Mechanical Response in Microscale Reverse Extrusion of Copper
Authors: Zhang Bin , Meng W. J. 
Published: January 2020

Abstract
The continuing trend of device miniaturization brings increasing demand for small metal parts and, consequently, significant interest in microscale metal forming technologies. In this work, the influence of grain size on mechanical response in microscale axisymmetric reverse extrusion of Cu 110 alloy was investigated in detail. A characteristic plastic strain associated with material deformation in the extrusion process was, for the first time to the best of our knowledge, defined, measured, and used to evaluate the material's bulk flow stress at this corresponding strain. This flow stress was then used to scale measured mechanical response in reverse extrusion and help identify deviations from scaling behavior expected in continuum plasticity. A scaling anomaly was indeed observed, indicating a dependence of mechanical response on both the initial grain size and the characteristic dimension of microforming operations. Detailed microstructural examination of grains in extruded Cu parts was conducted, and points to directions for future study to better understand mechanisms behind the observed scaling anomaly.
Material Ecocriticism and Peter Handke's <i>Versuch über den Pilznarren</i>
Authors: Kost Kiley M. 
Published: January 2020

Despite Peter Handke’s frequent focus on landscape and nature, his writing has rarely been considered by ecocritics as environmental. His recent fictional work, Versuch über den Pilznarren (Essay about the Mushroom Fool), details one man’s increasingly intense fascination with mushrooms, his eventual disappearance, and ultimate transformation into a “mushroom fool.” This essay examines the role of the mushrooms in Handke’s 2013 work as commentary on the reciprocal relationship between humans and nonhumans that warrants serious consideration, rather than theme or metaphor. In this article, I employ the lens of material ecocriticism to explore the dynamic material interplays and shared agencies between the mushroom, mushroom hunter, and the space of mushroom collecting. The analysis focuses in particular on border regions—of the human body and the forest in particular—to trace the mushroom’s role in the narrative and meaning in making. Key words: mushrooms, material ecocriticism, trans-corporeality, Peter Handke, Austrian studies
Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster randomised controlled trial
Authors: Thorn Joanna , Man Mei-See , Chaplin Katherine , Bower Peter , Brookes Sara , Gaunt Daisy , Fitzpatrick Bridie , Gardner Caroline , Guthrie Bruce , Hollinghurst Sandra , Lee Victoria , Mercer Stewart W , Salisbury Chris 
Published: January 2020

ObjectivePatients with multiple chronic health conditions are often managed in a disjointed fashion in primary care, with annual review clinic appointments offered separately for each condition. This study aimed to determine the cost-effectiveness of the 3D intervention, which was developed to improve the system of care.DesignEconomic evaluation conducted alongside a pragmatic cluster-randomised trial.SettingGeneral practices in three centres in England and Scotland.Participants797 adults with three or more chronic conditions were randomised to the 3D intervention, while 749 participants were randomised to receive usual care.InterventionThe 3D approach: comprehensive 6-monthly general practitioner consultations, supported by medication reviews and nurse appointments.Primary and secondary outcome measuresThe primary economic evaluation assessed the cost per quality-adjusted life year (QALY) gained from the perspective of the National Health Service (NHS) and personal social services (PSS). Costs were related to changes in a range of secondary outcomes (QALYs accrued by both participants and carers, and deaths) in a cost–consequences analysis from the perspectives of the NHS/PSS, patients/carers and productivity losses.ResultsVery small increases were found in both QALYs (adjusted mean difference 0.007 (−0.009 to 0.023)) and costs (adjusted mean difference £126 (£−739 to £991)) in the intervention arm compared with usual care after 15 months. The incremental cost-effectiveness ratio was £18 499, with a 50.8% chance of being cost-effective at a willingness-to-pay threshold of £20 000 per QALY (55.8% at £30 000 per QALY).ConclusionsThe small differences in costs and outcomes were consistent with chance, and the uncertainty was substantial; therefore, the evidence for the cost-effectiveness of the 3D approach from the NHS/PSS perspective should be considered equivocal.Trial registration numberISCRTN06180958
Burnout in consultants in child and adolescent mental health services (CAMHS) in Ireland: a cross-sectional study
Authors: McNicholas Fiona , Sharma Sonita , Oconnor Cliodhna , Barrett Elizabeth 
Published: January 2020

Physician burnout has reached epidemic levels in many countries, contributing to adverse personal, patient and service outcomes. Adverse socioeconomic conditions, such as the economic downturn in the Ireland post 2008, contribute to a situation of increased demand but inadequate resources. Given a recent unprecedented increase in referrals to Irish child and adolescent mental health services (CAMHS), coupled with a fragmented and poorly resourced service, it is important to reflect on consultant child psychiatrists’ well-being.ObjectivesTo report on the level of burnout among consultants working in CAMHS in Ireland using a cross-sectional design.SettingCommunity CAMHS in Ireland.ParticipantsAn online questionnaire was sent to all consultant child psychiatrists registered with the Irish Medical Council (n=112). Fifty-two consultants replied (46% response rate).Primary outcome measuresQuestions assessed demographic and occupational details, career satisfaction and perceived management, government and public support. The Copenhagen Burnout Inventory measured personal, work and patient-related burnout.ResultsThe prevalence of moderate or higher levels of work-related and personal burnout was 75% and 72.3%, respectively. Fewer (n=14, 26.9%) experienced patient-related burnout. There was a strong correlation between work burnout and personal (r=0.851, n=52, p<0.001) and patient-related burnout (r=0.476, n=52, p<0.001). Lack of confidence in government commitment to investment in CAMHS (p<0.001) and perceived ineffective management by health authorities (p=0.002) were associated with higher burnout scores. Few consultants (n=11, 21%) felt valued in their job. The majority (n=36, 69%) had seriously considered changing jobs, and this was positively associated with higher burnout (p<0.001). Higher burnout scores were present in those (n=15, 28.8%) who would not retrain in child psychiatry (p=0.002).ConclusionThe high level of burnout reported by respondents in this study, and ambivalence about child psychiatry as a career choice has huge professional and service implications. Urgent organisational intervention to support consultant psychiatrists’ well-being is required.
Knowledge level and motivation of Hong Kong young adults towards blood donation: a cross-sectional survey
Authors: Suen Lorna Kwai Ping , Siu Judy Yuen-man , Lee Yik Mun , Chan Engle Angela 
Published: January 2020

ObjectivesThis study aimed to (1) determine the knowledge level of young adults towards blood donation, and (2) to understand their donor identity and the meanings of blood donation to them.DesignA questionnaire-based cross-sectional survey.Setting and participantsUndergraduate students of a university in Hong Kong recruited by convenience sampling, at public facilities in campus such as student canteens and the Campus Blood Donor Centre of the university.Outcome measuresThe questionnaire which consisted of three parts was used for data collection. Part 1 collected sociodemographic information and items associated with blood donation; part 2 related to knowledge on blood donation and part 3 focused on blood donor identity. Univariate and multivariate logistic regression analyses were conducted to determine the OR and identify the predictors for blood donation.ResultsAmong the 542 respondents, 274 were non-blood donors and 268 were blood donors. Blood donors generally have a better knowledge towards blood donation than non-blood donors. The results of univariate analyses indicated that being a female (OR=1.99, p<0.001), aged 22 years or above (OR=234, p<0.001), studying at year 4 or 5 (OR=2.12, p=0.003), studying health-related programmes (OR=1.96, p<0.001), being registered as an organ donor (OR=6.59, p<0.001), had prior experience of receiving blood (OR=7.60, p<0.001) or prior experience of being refused for blood donation (OR=5.14, p<0.001) were significantly associated with being a blood donor. Having prior experience of receiving blood was the strongest predictor for being a blood donor, followed by being registered as an organ donor, after controlling for all other factors in the logistic regression model.ConclusionsThe findings are consistent with self-determination theory, which hypothesises that people are more likely to abide with blood donation behaviours that are internally rather than externally motivated.
Does chronic hyperglycaemia increase the risk of kidney stone disease? results from a systematic review and meta-analysis
Authors: Geraghty Robert , Abdi Abdihakim , Somani Bhaskar , Cook Paul , Roderick Paul 
Published: January 2020

DesignSystematic review and meta-analysis of observational studies was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies reporting on diabetes mellitus (DM) or metabolic syndrome (MetS) and kidney stone disease (KSD).ObjectiveTo examine the association between chronic hyperglycaemia, in the form of DM and impaired glucose tolerance (IGT) in the context of MetS and KSD.SettingPopulation-based observational studies. Databases searched: Ovid MEDLINE without revisions (1996 to June 2018), Cochrane Library (2018), CINAHL (1990 to June 2018), ClinicalTrials.gov, Google Scholar and individual journals including the Journal of Urology, European Urology and Kidney International.ParticipantsPatients with and without chronic hyperglycaemic states (DM and MetS).Main outcome measuresEnglish language articles from January 2001 to June 2018 reporting on observational studies. Exclusions: No comparator group or fewer than 100 patients. Unadjusted values were used for meta-analysis, with further meta-regression presented as adjusted values. Bias was assessed using Newcastle-Ottawa scale.Results2340 articles were screened with 13 studies included for meta-analysis, 7 DM (three cohort) and 6 MetS. Five of the MetS studies provided data on IGT alone. These included: DM, n=28 329; MetS, n=31 767; IGT, n=12 770. Controls: DM, n=5 89 791; MetS, n=1 78 050; IGT, n=2 93 852 patients. Adjusted risk for DM cohort studies, RR=1.23 (0.94 to 1.51) (p<0.001). Adjusted ORs for: DM cross-sectional/case-control studies, OR=1.32 (1.21 to 1.43) (p<0.001); IGT, OR=1.26 (0.92 to 1.58) (p<0.0001) and MetS, OR=1.35 (1.16 to 1.54) (p<0.0001). There was no significant difference between IGT and DM (cross-sectional/case-control), nor IGT and MetS. There was a moderate risk of publication bias. Statistical heterogeneity remained significant in adjusted DM cohort values and adjusted IGT (cross-sectional/case-control), but non-signficant for adjusted DM (cross-sectional/case-control).ConclusionChronic hyperglycaemia increases the risk of developing kidney stone disease. In the context of the diabetes pandemic, this will increase the burden of stone related morbidity and mortality.PROSPERO registration numberCRD42018093382
Cancer caregivers’ experiences of prognosis in Australia: a qualitative interview study
Authors: Lewis Sophie , Broom Alex , Kenny Katherine , Kirby Emma 
Published: January 2020

ObjectivesForecasting survival in cancer is a particularly challenging facet of oncological work and can involve complex interactions with patients and their families. While there is considerable research on patient experiences of being provided with, or becoming aware of, their prognosis, there has been much less emphasis placed on the experiences of caregivers. The aim of this paper was to examine caregivers’ experiences of prognosis.DesignThis study used semistructured interviews; transcripts were analysed thematically using the framework approach. These data are part of a larger research project focused on experiences of cancer survivorship.SettingRecruitment was from two metropolitan hospitals in Queensland, Australia.Participants50 caregivers of patients living with cancer and receiving treatment at two metropolitan hospitals (32% male, 68% female) participated in this study.ResultsFour main themes were identified: (1) caregivers’ uncertainty around the meaning and implications of prognosis, (2) caregivers’ sense of exclusion in prognostic conversations, (3) the practice of situating prognosis within a context of hope and (4) the precarious balance between realism, optimism and strategic ‘ignorance’.ConclusionsCaregivers are in many respects the unseen third party of prognostic communication. Developing a better understanding of caregivers’ perceptions of prognosis, including how this may be challenged, accepted or otherwise, is important in engaging caregivers in the process of communicating prognostic information. Facilitating greater participation by caregivers in prognostic conversations could potentially address evident complexities and even improve the experiences of all stakeholders in cancer care settings.
Children’s neighbourhood physical environment and early development: an individual child level linked data study
Authors: Bell Megan F , Turrell Gavin , Beesley Bridget , Boruff Bryan , Trapp Gina , Zubrick Stephen R , Christian Hayley E 
Published: January 2020

BackgroundIdentification of features of the neighbourhood physical environment that have a causal association with positive child development is important for promoting long-term developmental health. Previous research on these associations have been conducted at the neighbourhood level, and do not account for individual variation in exposure to these features.MethodsThis cross-sectional study utilised de-identified linked administrative data. Neighbourhood features were measured with Geographic Information Systems and identified within a 1600 m service area around the child’s home address. The study population included a random selection of 5024 Western Australian children who participated in the 2012 Australian Early Development Census (AEDC; median age 5 years, 5 months). Multi-level logistic regressions modelled the odds of children scoring in the bottom 10% on the physical, social or emotional AEDC domains as an outcome of neighbourhood features.ResultsAfter adjustment for individual and neighbourhood sociodemographic factors, lower odds of physical vulnerability were associated with increased neighbourhood residential density, presence of railway station, and higher counts of playgroups and kindergartens. Larger areas of neighbourhood home-yard space were associated with increased odds of physical and social vulnerability. Presence of high-quality green spaces was associated with lower odds of social vulnerability. Increased road traffic exposure was associated with higher odds of social and emotional vulnerability.ConclusionsThe neighbourhood physical environment has a weak but significant association with early childhood development. Future research should consider the interplay between the neighbourhood environment and proximal influences, including parenting attributes and socioeconomic status, and how they influence early child development.
HHLA2 and PD-L1 co-expression predicts poor prognosis in patients with clear cell renal cell carcinoma
Authors: Zhou Qiang-Hua , Li Kai-Wen , Chen Xu , He Hai-Xia , Peng Sheng-Meng , Peng Shi-Rong , Wang Qiong , Li Ze-An , Tao Yi-Ran , Cai Wen-Li , Liu Ran-Yi , Huang Hai 
Published: January 2020

BackgroundAlthough clear cell renal cell carcinoma (ccRCC) is well known as a highly immunogenic tumor, only a small subset of patients could benefit from current immunotherapy, which might be due to the heterogeneity of immune microenvironment in ccRCC. So, it is meaningful to explore novel immunotherapy or combination therapy for improving therapeutic efficacy. HHLA2, a newly discovered B7 family member, is prevalently expressed in numerous tumors, including ccRCC. This study aimed to investigate the prognostic impact of HHLA2/PD-L1 co-expression and its relationship with tumor-infiltrating lymphocytes (TILs).MethodsThe expression levels of HHLA2, PD-L1, CD8, and CD4 in cancer tissues from cases (206 in the training cohort and 197 in the validation cohort) with surgically resectable primary ccRCC were evaluated by immunohistochemistry.ResultsThe positive rates of HHLA2 were much higher than those of PD-L1 in ccRCC tissues. HHLA2-positive expression was significantly associated with necrosis, microvascular invasion, advanced Fuhrman nuclear, and TNM stage and indicated a shorter progression-free survival (PFS) and overall survival (OS) in both cohorts. Moreover, patients with HHLA2/PD-L1 co-expression suffered the highest risk of disease progression and death by a significant margin. Besides, HHLA2/PD-L1 co-expression was significantly associated with a high density of CD8+and CD4+TILs. Notably, a new immune classification, based on HHLA2/PD-L1 co-expression and TILs, successfully stratified PFS and OS, especially in patients with TILs positivity.ConclusionsThe expression of HHLA2 is more frequent than PD-L1 in ccRCC. HHLA2/PD-L1 co-expression had an adverse impact on the prognoses of patients with ccRCC; this finding provides a rationale for combination immunotherapy with anti-HHLA2 and PD-L1 blockage for patients with ccRCC in the future.
Treatment and diagnosis of cerebral aneurysms in the post-International Subarachnoid Aneurysm Trial (ISAT) era: trends and outcomes
Authors: Luther Evan , McCarthy David J , Brunet Marie-Christine , Sur Samir , Chen Stephanie H , Sheinberg Dallas , Hasan David , Jabbour Pascal , Yavagal Dileep R , Peterson Eric C , Starke Robert M 
Published: January 2020

BackgroundFollowing publication of the International Subarachnoid Aneurysm Trial (ISAT), treatment paradigms for cerebral aneurysms (CAs) shifted from open surgical clipping to endovascular embolization as primary therapy in a majority of cases. However, comprehensive analyses evaluating more recent CA diagnosis patterns, patient populations and outcomes as a function of treatment modality remain rare.MethodsThe National Inpatient Sample from 2004 to 2014 was reviewed. Aneurysmal subarachnoid hemorrhages (aSAHs) and unruptured intracranial aneurysms (UIAs) with a treatment of surgical clipping or endovascular therapy (EVT) were identified. Time trend series plots were created. Linear and logistic regressions were utilized to quantify treatment changes.Results114 137 aSAHs and 122 916 UIAs were reviewed. aSAH (+732/year, p=0.014) and UIA (+2550/year, p<0.0001) discharges increased annually. The annual caseload of surgical clippings for aSAH decreased (−264/year, p=0.0002) while EVT increased (+366/year, p=0.0003). For UIAs, the annual caseload for surgical clipping remained stable but increased for EVT (+615/year, p<0.0001). The rate of incidentally diagnosed UIAs increased annually (+1987/year; p<0.0001). Inpatient mortality decreased for clipping (p<0.0001) and EVT in aSAH (p<0.0001) (2004 vs 2014—clipping 13% vs 11.7%, EVT 15.8% vs 12.7%). Mortality rates for clipped UIAs decreased over time (p<0.0001) and remained stable for EVT (2004 vs 2014—clipping 1.57% vs 0.40%, EVT 0.59% vs 0.52%).ConclusionRuptured and unruptured CAs are increasingly being treated with EVT over clipping. Incidental unruptured aneurysm diagnoses are increasing dramatically. Mortality rates of ruptured aneurysms are improving regardless of treatment modality, whereas mortality in unruptured aneurysms is only improving for surgical clipping.
Versatile use of catheter systems for deployment of the Pipeline embolization device: a comparison of biaxial and triaxial catheter systems
Authors: Vakharia Kunal , Waqas Muhammad , Shakir Hakeem J , Chin Felix , Hartke Joelle N , Shallwani Hussain , Beecher Jeffrey S , Siddiqui Adnan H , Levy Elad I 
Published: January 2020

BackgroundA Pipeline embolization device (PED; Medtronic, Dublin, Ireland) can be deployed using either a biaxial or a triaxial catheter delivery system.ObjectiveTo compare the use of these two catheter delivery systems for intracranial aneurysm treatment with the PED.MethodsA retrospective study of patients undergoing PED deployment with biaxial or triaxial catheter systems between 2014 and 2016 was conducted. Experienced neurointerventionalists performed the procedures. Patients who received multiple PEDs or adjunctive coils were excluded. The two groups were compared for PED deployment time, total fluoroscopy time, patient radiation exposure, complications, and cost.ResultsEighty-two patients with 89 intracranial aneurysms were treated with one PED each. In 49 cases, PEDs were deployed using biaxial access; triaxial access was used in 33 cases. Time (min) from guide catheter run to PED deployment was significantly shorter in the biaxial group (24.0±18.7 vs 38.4±31.1, P=0.006) as was fluoroscopy time (28.8±23.0 vs 50.3±27.1, P=0.001). Peak radiation skin exposure (mGy) in the biaxial group was less than in the triaxial group (1243.7±808.2 vs 2074.6±1505.6, P=0.003). No statistically significant differences were observed in transient and permanent complication rates or modified Rankin Scale scores at 30 days. The triaxial access system cost more than the biaxial access system (average $3285 vs $1790, respectively). Occlusion rates at last follow-up (mean 6 months) were similar between the two systems (average 88.1%: biaxial, 89.2%: triaxial).ConclusionOur results indicate near-equivalent safety and effectiveness between biaxial and triaxial approaches. Some reductions in cost and procedure time were noted with the biaxial system.