bluuebunny/crossref_metadata_2025_split huggingface dataset:
Depth‐resolved variations in visibility of retinal nerve fibre bundles across the retina in enface OCT images of healthy eyes
Authors: Cheloni Riccardo , Denniss Jonathan 
Published: November 2020

AbstractPurposeRecent developments in optical coherence tomography (OCT) technology enable direct enface visualisation of retinal nerve fibre bundle (RNFB) loss in glaucoma. However, the optimum depth at which to visualise RNFBs across the retina is unknown. We aimed to evaluate the range of depths and optimum depth at which RNFBs can be visualised across the retina in healthy eyes.MethodsThe central ± 25° retina of 10 healthy eyes from 10 people aged 57–75 years (median 68.5 years) were imaged with spectral domain OCT. Slab images of maximum axial resolution (4 μm) containing depth‐resolved attenuation coefficients were extracted from 0 to 193.5 μm below the inner limiting membrane (ILM). Bundle visibility within 10 regions of a superimposed grid was assessed subjectively by trained optometrists (n = 8), according to written instructions. Anterior and posterior limits of RNFB visibility and depth of best visibility were identified for each grid sector. Effects of retinal location and individual eye on RNFB visibility were explored using linear mixed modelling with likelihood ratio tests. Intraclass correlation coefficient (ICC) was used to measure overall agreement and repeatability of grading. Spearman’s correlation was used to measure correlation between depth range of visible RNFBs and retinal nerve fibre layer thickness (RNFLT).ResultsRetinal location and individual eye affected anterior limit of visibility (χ2(9) = 58.6 and 60.5, both p < 0.0001), but none of the differences exceeded instrument resolution, making anterior limit consistent across the retina and different eyes. Greater differences were observed in the posterior limit of visibility across retinal areas (χ2(9) = 1671.1, p < 0.0001) and different eyes (χ2(9) = 88.7, p < 0.0001). Optimal depth for visualisation of RNFBs was around 20 µm below the ILM in most regions. It varied slightly with retinal location (χ2(9) = 58.8, p < 0.0001), but it was not affected by individual eye (χ2(9) = 10.7, p = 0.29). RNFB visibility showed good agreement between graders (ICC 0.89, 95%CI 0.87–0.91), and excellent repeatability (ICC 0.96–0.99). Depth range of visible RNFBs was highly correlated with RNFLT (ρ = 0.9, 95%CI: 0.86–0.95).ConclusionsThe range of depths with visible RNFBs varies markedly across the healthy retina, consistently with RNFLT. To extract all RNFB information consistently across the retina, slab properties should account for differences across retinal locations and between individual eyes.
Sustaining statehood: A comparative analysis of vertical policy‐process integration in Denmark and Italy
Authors: Knill Christoph , Steinbacher Christina , Steinebach Yves 
Published: November 2020

AbstractIn response to societal demands, democratic governments constantly adopt new policies. As existing policies are rarely abandoned, policies accumulate over time. Policy accumulation bears the challenge of overburdening implementation bodies, hence undermining policy effectiveness. Any escape from this situation requires democratic governments to strike a balance between policy responsiveness and effectiveness. We posit that the extent to which countries are able to achieve this depends on the vertical integration of processes of policy formulation and implementation. We provide a novel conceptualization of vertical policy‐process integration (VPI) that is based on two channels. While bottom‐up integration captures the extent to which policy implementers can communicate reasons for potential policy failure from the bottom up, top‐down integration indicates the degree to which the policy formulation level has to cover the implementation costs of the policies they produce. We illustrate our argument by an empirical analysis of VPI patterns in Denmark and Italy.
The Effect of Ketamine on Acute and Chronic Wound Pain in Patients Undergoing Breast Surgery: A Meta‐Analysis and Systematic Review
Authors: Bi Yaodan , Ye Yu , Zhu Yinchao , Ma Jun , Zhang Xiuqian , Liu Bin 
Published: November 2020

AbstractIntroductionPerioperative use of ketamine has been discussed widely in many kinds of surgery. The aim of our study was to evaluate the short‐term and long‐term benefits and safety of ketamine after breast surgery.MethodWe performed a quantitative systematic review. We included randomized controlled trials that compared intravenous administration of ketamine to a placebo control group, or compared bupivacaine in combination with ketamine to bupivacaine alone in thoracic paravertebral blocks or pectoral blocks among patients undergoing breast surgery. The primary outcome was postoperative pain intensity. Secondary outcomes included cumulative opioid consumption during the 0‐ to 24‐hour postoperative period, the effect on postmastectomy pain syndrome, the effect on postoperative depression, and the adverse events associated with the use of ketamine.ResultsThirteen randomized controlled trials with 1,182 patients were included for analysis. Compared with placebo, intravenous ketamine was effective in reducing wound pain intensity during the first 6 hours after surgery (weighted mean difference [WMD] −0.83; 95% confidence interval [CI] −1.65, −0.01; P = 0.048) and during the first 24 hours after surgery (WMD −0.65; 95% CI −0.95, −0.35; P < 0.001), and in decreasing opioid consumption (WMD −4.14; 95% CI −8.00, −0.29; P = 0.035) during the first 24 hours after surgery, without increasing the risks for gastrointestinal and central nervous system adverse events. Adding ketamine to bupivacaine in thoracic paravertebral blocks was also effective in reducing postoperative wound pain during the first 6 hours after surgery (WMD −0.59; 95% CI, −1.06, −0.12; P = 0.014) and during the first 24 hours after surgery (WMD −0.90; 95% CI −1.27, −0.53; P < 0.001), and in decreasing opioid consumption (WMD − 4.59; 95% CI −5.76, −3.42; P < 0.001) during the first 24 hours after surgery. Perioperative use of ketamine was associated with improved postoperative depression symptoms (standardized mean difference −0.80; 95% CI − 1.34, −0.27; P = 0.003) and less incidence of postmastectomy pain syndrome (relative risk 0.79; 95% CI 0.63, 0.99; P = 0.043).ConclusionKetamine is an effective and safe multimodal analgesic in patients undergoing breast surgery, administered both intravenously and when added to bupivacaine in paravertebral blocks. In addition, ketamine showed a long‐term benefit for preventing postoperative depression and postmastectomy pain syndrome.
Factors associated with ewe and lamb survival, and subsequent reproductive performance of sheep undergoing emergency caesarean section
Authors: Voigt Katja , Najm Nour‐Addeen , Zablotski Yury , Rieger Anna , Vassiliadis Panajota , Steckeler Patricia , Schabmeyer Simone , Balasopoulou Viktoria , Zerbe Holm 
Published: November 2020

AbstractClinical records of all 212 ewes undergoing emergency caesarean surgery at a veterinary teaching hospital between January 2008 and December 2019 were evaluated retrospectively. Their age ranged from 1 to 10 years (median = 4 years), with German merino the predominant breed (48.1% of cases). The most frequently diagnosed indications were insufficient cervical dilatation (n = 94, 44.3%), uterine torsion (n = 50, 23.6%), foetopelvic disproportion (n = 31, 14.6%) and vaginal prolapse intra partum (n = 11, 5.2%). Fifty‐four (25.5%) of the 212 ewes additionally suffered from one or more concurrent, pre‐existing conditions. Overall ewe mortality until hospital discharge was 10.8% (23/212), and 3.8% (n = 6) for the 158 ewes without a history of concurrent disorders. Mortality during hospitalization increased to 31.5% (17/54) for those with pre‐existing conditions. Total lamb mortality was 49.1% (173/352) until hospital discharge. Pre‐existing conditions (p = .001) and the presence of post‐surgical complications (p = .025) were identified as significant factors influencing dam mortality, while delayed presentation for veterinary attention with an observed duration of labour of >12 hr was identified as the most influential factor on total lamb mortality (p = .010). The presence of dead or emphysematous foetuses was not significant for ewe mortality. Follow‐up information on further outcomes was available for 156 (82.5%) of the 189 discharged ewes. Eighty‐nine animals (57.1%) were re‐bred in the following season and achieved a 93.3% (83/89) pregnancy rate, while the remainder had either been slaughtered (n = 56, 35.9%), sold (n = 5, 3.2%) or had died of unknown causes (n = 3, 1.9%). The subsequent incidence of dystocia was 15.6% (n = 12) in the 77 ewes with available information on lambing ease. Adequate management of underlying conditions and timely intervention are important factors for best possible short‐term outcomes. In the long term, the subsequent pregnancy rate was good and the incidence of subsequent dystocia was within the normal range.
Effectiveness of physical stimulation on injection pain in adults receiving intramuscular injections: a systematic review protocol
Authors: CMC Serena , Lord Heidi , Vargese Saritha Susan , Kurian Nisha , Cherian Sunu Alice , Mathew Elsheba , Fernandez Ritin 
Published: November 2020

ABSTRACT

Objective:
The objective of this review is to evaluate the effectiveness of physical stimulation on injection pain in adults receiving intramuscular injections.

Introduction:
Intramuscular injections are the most commonly used modality for administration of pharmacological treatments. Despite this, pain from intramuscular injections is the most commonly reported side effect. Reducing patients’ pain from intramuscular injections is important; however, the challenge is in selecting from the current methods available to alleviate pain, which are varied. The findings of this review may identify the most effective physical stimulation method to reduce the side effect of pain from an intramuscular injection.

Inclusion criteria:
This review will consider studies that include adults aged 18 years and over that use physical stimulation interventions during intramuscular injections. Any physical stimulation strategies used during intramuscular injections including devices, skin tapping, manual pressure, massage, pinch, and traction will be considered. Studies that evaluate pain using validated tools such as pain scales will be included.

Methods:
The review will undertake to find both published and unpublished studies. The key information sources to be searched are MEDLINE, Embase, CINAHL, the Cochrane Library, Cochrane Central Register of Controlled Trials, Google Scholar, Dissertation Abstracts International, ProQuest Dissertations and Theses, and MedNar. Two independent reviewers will conduct a critical appraisal of eligible studies, assess the methodological quality, and extract the data. Studies will, where possible, be pooled in a statistical meta-analysis.

Systematic review registration number:
PROSPERO CRD42020168586
Numerical Consideration of LTNE and Darcy Extended Forchheimer Models for the Analysis of Forced Convection in a Horizontal Pipe in the Presence of Metal Foam
Authors: Jadhav Prakash H. , Gnanasekaran N. , Arumuga Perumal D. 
Published: November 2020

Abstract
The intent of the current research work is to emphasize the computational modeling of forced convection heat dissipation in the presence of high porosity and thermal conductivity metallic foam in a horizontal pipe for different regimes of the fluid flow for a range of Reynolds number. A two-dimensional physical domain is considered in which Darcy extended Forchheimer (DEF) model is adopted in the aluminum metallic foam to predict the features of fluid flow and local thermal nonequilibrium (LTNE) model is employed for the analysis of heat transfer in a horizontal pipe for different flow regimes. The numerical results are initially matched with experimental and analytical results for the purpose of validation. The average Nusselt number for fully filled foam is found to be higher compared to other filling rate of metallic foams and the clear pipe at the cost of pressure drop. As an important finding, it has been observed that the laminar and transition flow gives higher heat transfer enhancement ratio and thermal performance factor compared to turbulent flow. This work resembles numerous industrial applications such as solar collectors, heat exchangers, electronic cooling, and microporous heat exchangers. The novelty of the work is the selection of suitable flow and thermal models in order to clearly assimilate the flow and heat transfer in metallic foam. The presence of aluminum metal foam is highlighted for the augmentation of heat dissipation in terms of PPI and porosity. The parametric study proposed in this work surrogates the complexity and cost involved in developing an expensive experimental setup.
Perceptions and experiences of healthcare workers during the COVID-19 pandemic in the UK
Authors: Vindrola-Padros Cecilia , Andrews Lily , Dowrick Anna , Djellouli Nehla , Fillmore Harrison , Bautista Gonzalez Elysse , Javadi Dena , Lewis-Jackson Sasha , Manby Louisa , Mitchinson Lucy , Mulcahy Symmons Sophie , Martin Sam , Regenold Nina , Robinson Hannah , Sumray Kirsi , Singleton Georgina , Syversen Aron , Vanderslott Samantha , Johnson Ginger 
Published: November 2020

ObjectiveThe COVID-19 pandemic has set unprecedented demand on the healthcare workforce around the world. The UK has been one of the most affected countries in Europe. The aim of this study was to explore the perceptions and experiences of healthcare workers (HCWs) in relation to COVID-19 and care delivery models implemented to deal with the pandemic in the UK.MethodsThe study was designed as a rapid appraisal combining: (1) a review of UK healthcare policies (n=35 policies), (2) mass media and social media analysis of front-line staff experiences and perceptions (n=101 newspaper articles, n=1 46 000 posts) and (3) in-depth (telephone) interviews with front-line staff (n=30 interviews). The findings from all streams were analysed using framework analysis.ResultsLimited personal protective equipment (PPE) and lack of routine testing created anxiety and distress and had a tangible impact on the workforce. When PPE was available, incorrect size and overheating complicated routine work. Lack of training for redeployed staff and the failure to consider the skills of redeployed staff for new areas were identified as problems. Positive aspects of daily work reported by HCWs included solidarity between colleagues, the establishment of well-being support structures and feeling valued by society.ConclusionOur study highlighted the importance of taking into consideration the experiences and concerns of front-line staff during a pandemic. Staff working in the UK during the COVID-19 pandemic advocated clear and consistent guidelines, streamlined testing of HCWs, administration of PPE and acknowledgement of the effects of PPE on routine practice.
Perceptions of medical students towards online teaching during the COVID-19 pandemic: a national cross-sectional survey of 2721 UK medical students
Authors: Dost Samiullah , Hossain Aleena , Shehab Mai , Abdelwahed Aida , Al-Nusair Lana 
Published: November 2020

ObjectivesTo investigate perceptions of medical students on the role of online teaching in facilitating medical education during the COVID-19 pandemic.DesignCross-sectional, online national survey.SettingResponses collected online from 4th May 2020 to 11th May 2020 across 40 UK medical schools.ParticipantsMedical students across all years from UK-registered medical schools.Main outcome measuresThe uses, experiences, perceived benefits and barriers of online teaching during the COVID-19 pandemic.Results2721 medical students across 39 medical schools responded. Medical schools adapted to the pandemic in different ways. The changes included the development of new distance-learning platforms on which content was released, remote delivery of lectures using platforms and the use of question banks and other online active recall resources. A significant difference was found between time spent on online platforms before and during COVID-19, with 7.35% students before versus 23.56% students during the pandemic spending >15 hours per week (p<0.05). The greatest perceived benefits of online teaching platforms included their flexibility. Whereas the commonly perceived barriers to using online teaching platforms included family distraction (26.76%) and poor internet connection (21.53%).ConclusionsOnline teaching has enabled the continuation of medical education during these unprecedented times. Moving forward from this pandemic, in order to maximise the benefits of both face-to-face and online teaching and to improve the efficacy of medical education in the future, we suggest medical schools resort to teaching formats such as team-based/problem-based learning. This uses online teaching platforms allowing students to digest information in their own time but also allows students to then constructively discuss this material with peers. It has also been shown to be effective in terms of achieving learning outcomes. Beyond COVID-19, we anticipate further incorporation of online teaching methods within traditional medical education. This may accompany the observed shift in medical practice towards virtual consultations.
Evaluation of the uptake and delivery of the NHS Health Check programme in England, using primary care data from 9.5 million people: a cross-sectional study
Authors: Patel Riyaz , Barnard Sharmani , Thompson Katherine , Lagord Catherine , Clegg Emma , Worrall Robert , Evans Tim , Carter Slade , Flowers Julian , Roberts Dave , Nuttall Michaela , Samani Nilesh J , Robson John , Kearney Matt , Deanfield John , Waterall Jamie 
Published: November 2020

ObjectivesTo describe the uptake and outputs of the National Health Service Health Check (NHSHC) programme in England.DesignObservational study.SettingNational primary care data extracted directly by NHS Digital from 90% of general practices (GP) in England.ParticipantsIndividuals aged 40–74 years, invited to or completing a NHSHC between 2012 and 2017, defined using primary care Read codes.InterventionThe NHSHC, a structured assessment of non-communicable disease risk factors and 10-year cardiovascular disease (CVD) risk, with recommendations for behavioural change support and therapeutic interventions.ResultsDuring the 5-year cycle, 9 694 979 individuals were offered an NHSHC and 5 102 758 (52.6%) took up the offer. There was geographical variation in uptake between local authorities across England ranging from 25.1% to 84.7%. Invitation methods changed over time to incorporate greater digitalisation, opportunistic delivery and delivery by third-party providers.The population offered an NHSHC resembled the English population in ethnicity and deprivation characteristics. Attendees were more likely to be older and women, but were similar in terms of ethnicity and deprivation, compared with non-attendees. Among attendees, risk factor prevalence reflected population survey estimates for England. Where a CVD risk score was documented, 25.9% had a 10-year CVD risk ≥10%, of which 20.3% were prescribed a statin. Advice, information and referrals were coded as delivered to over 2.5 million individuals identified to have risk factors.ConclusionThis national analysis of the NHSHC programme, using primary care data from over 9.5 million individuals offered a check, reveals an uptake rate of over 50% and no significant evidence of inequity by ethnicity or deprivation. To maximise the anticipated value of the NHSHC, we suggest continued action is needed to invite more eligible people for a check, reduce geographical variation in uptake, prioritise engagement with non-attendees and promote greater use of evidence-based interventions especially where risk is identified.
Efficacy of spoken word comprehension therapy in patients with chronic aphasia: a cross-over randomised controlled trial with structural imaging
Authors: Fleming Victoria , Brownsett Sonia , Krason Anna , Maegli Maria A , Coley-Fisher Henry , Ong Yean-Hoon , Nardo Davide , Leach Rupert , Howard David , Robson Holly , Warburton Elizabeth , Ashburner John , Price Cathy J , Crinion Jenny T , Leff Alexander P 
Published: November 2020

ObjectiveThe efficacy of spoken language comprehension therapies for persons with aphasia remains equivocal. We investigated the efficacy of a self-led therapy app, ‘Listen-In’, and examined the relation between brain structure and therapy response.MethodsA cross-over randomised repeated measures trial with five testing time points (12-week intervals), conducted at the university or participants' homes, captured baseline (T1), therapy (T2-T4) and maintenance (T5) effects. Participants with chronic poststroke aphasia and spoken language comprehension impairments completed consecutive Listen-In and standard care blocks (both 12 weeks with order randomised). Repeated measures analyses of variance compared change in spoken language comprehension on two co-primary outcomes over therapy versus standard care. Three structural MRI scans (T2-T4) for each participant (subgroup, n=25) were analysed using cross-sectional and longitudinal voxel-based morphometry.ResultsThirty-five participants completed, on average, 85 hours (IQR=70–100) of Listen-In (therapy first, n=18). The first study-specific co-primary outcome (Auditory Comprehension Test (ACT)) showed large and significant improvements for trained spoken words over therapy versus standard care (11%, Cohen’s d=1.12). Gains were largely maintained at 12 and 24 weeks. There were no therapy effects on the second standardised co-primary outcome (Comprehensive Aphasia Test: Spoken Words and Sentences). Change on ACT trained words was associated with volume of pretherapy right hemisphere white matter and post-therapy grey matter tissue density changes in bilateral temporal lobes.ConclusionsIndividuals with chronic aphasia can improve their spoken word comprehension many years after stroke. Results contribute to hemispheric debates implicating the right hemisphere in therapy-driven language recovery. Listen-In will soon be available on GooglePlay.Trial registration numberNCT02540889.