bluuebunny/crossref_metadata_2025_split huggingface dataset:
The 'difficult patient' phenomenon in home nursing and 'self‐inflicted' illness
Authors: Michaelsen Jette Joost 
Published: July 2020

Rationale and aimHome nurses work largely alone, and consequently, 'difficult patients' can be challenging for them. Understanding of this phenomenon can have a major impact on the quality of care. The aim is to explore how nurses characterise, relate to and interact with these patients. Why do nurses perceive some patients as difficult and what are the consequences for the patient? What are these patients´ expectations of the nurses and their perceptions of illness?MethodsAn ethnographic study with 30 participant observations of 12 nurses visiting 146 patients was conducted. A total of 6 interviews were made with 4 'difficult patients' and 11 interviews with 5 nurses.FindingsIn the nurses' view, the 'difficult patients' had little insight into their illnesses, denied they were ill and were noncompliant. Some nurses had negative feelings about a patient, regarded the patient as too demanding or found the patient´s personal characteristics repulsive. The difficulty lies in the relationship between nurse and patient. Important health problems of some patients remained unrecognised. The nurses regarded the patients' illnesses as self‐inflicted. The patients had low expectations of nurses, lacked knowledge about what to expect of them, and their views on their illnesses differed from those of the nurses. Contributing causes of patients becoming difficult for nurses seemed to be different norms and values and the nurses' work situation.ConclusionIt is important that nurses communicate their knowledge about the connection between illness and pathogenic social conditions and discuss 'self‐inflicted' illness and their role in relation to this. Supervision is suggested. Improved working conditions could lead to fewer 'difficult patients'.Study limitationsThe perspectives of patients should be studied in greater detail.
Infections after hematopoietic cell transplantation are not a burden for mortality at a limited‐resource center in a developing country
Authors: Leon‐Rodriguez Eucario , Rivera‐Franco Monica M. , Terrazas‐Marin Ricardo A. , Virgen‐Cuevas Margarita , Aguirre‐Limon Melissa I. , Saldaña‐González Erika S. , Pacheco‐Arias Maria A. , Gomez‐Vázquez Oscar R. 
Published: July 2020

AbstractBackgroundHematopoietic cell transplantation (HCT) outcomes, including infectious complications, change between centers and countries. Thus, the aim of this study was to report the incidence of infections and isolated pathogens among recipients of HCT and the association with mortality at a tertiary referral center in Mexico.MethodsTwo hundred and eighty‐two patients undergoing autologous or allogeneic HCT between January 2005 and December 2018 at the National Institute of Medical Sciences and Nutricion Salvador Zubiran were included.ResultsIn autologous HCT (n = 176), within the preengraftment and the early postengraftment, 130 (74%) and 31 (18%) recipients presented infections, respectively. Within the preengraftment, the early postengraftment, and the late postengraftment, 81 (76%), 34 (33%), and 58 (60%) allogeneic HCT recipients presented infections, respectively. Non‐relapse mortality (NRM) as a result of infections occurred in 1 (0.6%) and 5 (5%) autologous and allogeneic HCT recipients, respectively.ConclusionsOur results demonstrated that despite our limited resources, infections were not a significant burden for NRM among HCT recipients. More importantly, the isolation rates were higher than international studies, which could be explained by the existence of a specialized infectious diseases department and laboratory, which we consider key elements for the establishment of an HCT program worldwide.
Liver transplant recipients infected with SARS‐CoV‐2 in the early postoperative period: Lessons from a single center in the epicenter of the pandemic
Authors: Waisberg Daniel Reis , Abdala Edson , Nacif Lucas Souto , Haddad Luciana Bertocco , Ducatti Liliana , Santos Vinicius Rocha , Gouveia Larissa Nunes , Lazari Carolina Santos , Martino Rodrigo Bronze , Pinheiro Rafael Soares , Arantes Rubens Macedo , Terrabuio Debora Raquel , Malbouisson Luiz Marcelo , Galvao Flavio Henrique , Andraus Wellington , Carneiro‐D'Albuquerque Luiz Augusto 
Published: July 2020

AbstractThe impact of coronavirus disease‐19 (COVID‐19) in liver recipients remains largely unknown. Most data derive from small retrospective series of patients transplanted years ago. We aimed to report a single‐center case series of five consecutive patients in the early postoperative period of deceased‐donor liver transplantation who developed nosocomial COVID‐19. Two patients presented important respiratory discomfort and eventually died. One was 69 years old and had severe coronary disease. She rapidly worsened after COVID‐19 diagnosis on 9th postoperative day. The other was 67 years old with non‐alcoholic steatohepatitis, who experienced prolonged postoperative course, complicated with cytomegalovirus infection and kidney failure. He was diagnosed on 36th postoperative day and remained on mechanical ventilation for 20 days, ultimately succumbing of secondary bacterial infection. The third, fourth, and fifth patients were diagnosed on 10th, 11th, and 18th postoperative day, respectively, and presented satisfactory clinical evolution. These last two patients were severely immunosuppressed, since one underwent steroid bolus for acute cellular rejection and another also used anti‐thymocyte globulin for treating steroid‐resistant rejection. Our novel experience highlights that COVID‐19 may negatively impact the postoperative course, especially in elder and obese patients with comorbidities, and draws attention to COVID‐19 nosocomial spread in the early postoperative period.
UK trading patterns within and between regions in the automotive sector—A network analysis
Authors: Smith Matthew , Sarabi Yasaman 
Published: July 2020

AbstractThis study provides an analysis of the UK's role in the automotive sector, focusing on the trading relationship of the UK within and between regions. It additionally provides an examination of the countries that hold equivalent trading positions to the UK in various segments of the automotive sector. The results indicate a high level of integration with Europe & Central Asia; outside the region, there appears to be a trend towards sourcing inputs from East Asia & Pacific, along with the Middle East & North Africa acting as an export destination. The equivalence analysis results provide a set of nations that could reposition themselves to gain from the UK's departure from the European Union. Amongst them are traditional key European players in the sector, along with Eastern European nations, which have been developing key strengths within the sector in recent years.
Impact of acute conjunctivitis on ocular surface homeostasis in dogs
Authors: Sebbag Lionel , Soler Elizabeth A. , Allbaugh Rachel A. , Mochel Jonathan P. 
Published: July 2020

AbstractObjectiveTo investigate the effects of acute conjunctivitis on tear film characteristics and corneal sensitivity in dogs.Animals studiedEight female spayed Beagle dogs (1.5‐2 years old, 7.5‐10 kg).ProceduresOn two consecutive days, one randomly selected eye in each dog received 1 or 375 mg/mL histamine solution to induce mild or severe conjunctivitis, while the contralateral eye served as control. Diagnostic tests were performed in the following order: fluorescein instillation and repeated tear collection over 20 minutes (to determine tear volume [TV] and turnover rate [TTR] by fluorophotometry), Schirmer tear test‐1 (STT‐1), tear ferning, corneal esthesiometry, and tear film breakup time (TFBUT).ResultsResults are presented as median values for severe conjunctivitis, mild conjunctivitis, and control eyes. Eyes with severe conjunctivitis had significantly higher STT‐1 (24, 19.5, 17.5 mm/min; P = .002) and significantly lower TFBUT (10.5, 13.5, 15.5 s; P = .002), but no changes were noted in corneal tactile sensation (2, 2.5, 2.5 cm) or tear ferning (grades 2, 2, 2.5). Severe conjunctivitis significantly increased TV by nearly 10‐fold (631, 97, 65 µL) initially (reflex tearing), although basal TV returned rapidly (<5 minutes) in all eyes (46, 58, 48 µL). Finally, there was a nonsignificant trend for higher reflex TTR in the conjunctivitis vs control eyes (68, 58, 43%/min).ConclusionsExperimentally induced conjunctivitis increases tear quantity and decreases tear quality in dogs, but has no impact on corneal sensitivity. Changes in tear film dynamics could affect ocular pharmacology (eg, precorneal retention time), although homeostasis of lacrimal volume and drainage is rapidly restored.
Nonlinear Vibrations of Embedded Nanoplates Under In-Plane Magnetic Field Based on Nonlocal Elasticity Theory
Authors: Mazur Olga , Awrejcewicz Jan 
Published: July 2020

AbstractNonlinear vibrations of the orthotropic nanoplates subjected to an influence of in-plane magnetic field are considered. The model is based on the nonlocal elasticity theory. The governing equations for geometrically nonlinear vibrations use the von Kármán plate theory. Both the stress formulation and the Airy stress function are employed. The influence of the magnetic field is taken into account due to the Lorentz force yielded by Maxwell's equations. The developed approach is based on applying the Bubnov–Galerkin method and reducing partial differential equations to an ordinary differential equation. The effect of the magnetic field, elastic foundation, nonlocal parameter, and plate aspect ratio on the linear frequencies and the nonlinear ratio is illustrated and discussed.
Aerodynamic Optimisation of the Low Pressure Turbine Module: Exploiting Surrogate Models in a High-Dimensional Design Space
Authors: Baert Lieven , Lepot Ingrid , Sainvitu Caroline , Chérière Emmanuel , Nouvellon Arnaud , Leonardon Vincent 
Published: July 2020

Abstract
Further improvement of state-of-the-art Low Pressure (LP) turbines has become progressively more challenging. LP design is more than ever confronted to the need to further integrate complex models and to shift from single component design to the design of the complete LPT module at once. This leads to high-dimensional design spaces and automatically challenges its applicability within an industrial context, where CPU resources are limited and the cycle time crucial.
The aerodynamic design of a multistage LP turbine is discussed for a design space defined by 350 parameters. Using an online surrogate-based optimisation (SBO) approach a significant efficiency gain of almost 0.5pt has been achieved. By discussing the sampling of the design space, the quality of the surrogate models, and the application of adequate data mining capabilities to steer the optimisation, it is shown that despite the high-dimensional nature of the design space the followed approach allows to obtain performance gains beyond target.
The ability to control both global as well as local characteristics of the flow throughout the full LP turbine, in combination with an agile reaction of the search process after dynamically strengthening and/or enforcing new constraints in order to adapt to the review feedback, illustrates not only the feasibility but also the potential of a global design space for the LP module. It is demonstrated that intertwining the capabilities of dynamic SBO and efficient data mining allows to incorporate high-fidelity simulations in design cycle practices of certified engines or novel engine concepts to jointly optimise the multiple stages of the LPT.
The Effects of Caffeine Mouth Rinsing on Exercise Performance: A Systematic Review
Authors: Ehlert Alex M. , Twiddy Hannah M. , Wilson Patrick B. 
Published: July 2020

Caffeine ingestion can improve performance across a variety of exercise modalities but can also elicit negative side effects in some individuals. Thus, there is a growing interest in the use of caffeine mouth rinse solutions to improve sport and exercise performance while minimizing caffeine’s potentially adverse effects. Mouth rinse protocols involve swilling a solution within the oral cavity for a short time (e.g., 5–10 s) before expectorating it to avoid systemic absorption. This is believed to improve performance via activation of taste receptors and stimulation of the central nervous system. Although reviews of the literature indicate that carbohydrate mouth rinsing can improve exercise performance in some situations, there has been no attempt to systematically review the available literature on caffeine mouth rinsing and its effects on exercise performance. To fill this gap, a systematic literature search of three databases (PubMed, SPORTDiscus, and Web of Science) was conducted by two independent reviewers. The search resulted in 11 randomized crossover studies that were appraised and reviewed. Three studies found significant positive effects of caffeine mouth rinsing on exercise performance, whereas the remaining eight found no improvements or only suggestive benefits. The mixed results may be due to heterogeneity in the methods across studies, interindividual differences in bitter tasting, and differences in the concentrations of caffeine solutions. Future studies should evaluate how manipulating the concentration of caffeine solutions, habitual caffeine intake, and genetic modifiers of bitter taste influence the efficacy of caffeine mouth rinsing as an ergogenic strategy.
Burnout in gastroenterology registrars: a feasibility study conducted in the East of England using a 31-item questionnaire
Authors: Ong John , Swift Carla , Ong Sharon , Lim Wan Yen , Al-Naeeb Yasseen , Shankar Arun 
Published: July 2020

ObjectiveThe scale of burnout in UK gastroenterology trainees and the feasibility to determine its prevalence using the validated Maslach Burnout Inventory-Human Services Survey (MBI-HSS) tool are unknown. The primary objective of this region-wide pilot study was to evaluate the response rate to a 31-item questionnaire. The secondary objectives were to estimate the prevalence of burnout in gastroenterology trainees within the East of England deanery (EoE) and identify common stressors that trainees experience.DesignThis was a cross-sectional study involving gastroenterology trainees from 16 hospitals across the EoE using a 31-item questionnaire. The questionnaire consisted of the 22-item MBI-HSS and nine additional free-text questions. All gastroenterology trainees in the EoE were invited to complete the anonymised survey online. Data were analysed quantitatively and qualitatively.ResultsThe response rate for the survey was acceptable: 44.0% (40/91). 57.5% (23/40) of gastroenterology trainees reported emotional exhaustion. 23.5% (8/34) had depersonalisation and 63.9% (23/36) experienced low professional accomplishment. Burnout prevalence was 35.3% (12/34). 48.4% (15/31) of gastroenterology trainees were aware of professional support services within EoE. Stressors related to service requirements (eg, workload, staffing levels) and professional relationships with colleagues and patients were commonly reported: 65.6% and 25.0%, respectively.ConclusionsIt is feasible to use a 31-item questionnaire in a national cohort of UK gastroenterology trainees for future burnout studies. Burnout in EoE gastroenterology trainees was high and this may reflect a national prevalence within the specialty. More extensive studies, greater awareness of burnout and improved access to professional support services are required.
Primary care physicians’ attitudes and perceptions towards antibiotic resistance and outpatient antibiotic stewardship in the USA: a qualitative study
Authors: Zetts Rachel M , Stoesz Andrea , Garcia Andrea M , Doctor Jason N , Gerber Jeffrey S , Linder Jeffrey A , Hyun David Y 
Published: July 2020

ObjectivesAt least 30% of outpatient antibiotic prescriptions are unnecessary. Outpatient antibiotic stewardship is needed to improve prescribing and address the threat of antibiotic resistance. A better understanding of primary care physicians (PCPs) attitudes towards antibiotic prescribing and outpatient antibiotic stewardship is needed to identify barriers to stewardship implementation and help tailor stewardship strategies. The aim of this study was to assess PCPs current attitudes towards antibiotic resistance, inappropriate antibiotic prescribing and the feasibility of outpatient stewardship efforts.DesignEight focus groups with PCPs were conducted by an independent moderator using a moderator guide. Focus groups were audio recorded, transcribed and coded for major themes using deductive and inductive content analysis methods.SettingFocus groups were conducted in four US cities: Philadelphia, Birmingham, Chicago and Los Angeles.ParticipantsTwo focus groups were conducted in each city—one with family medicine and internal medicine physicians and one with paediatricians. A total of 26 family medicine/internal medicine physicians and 26 paediatricians participated.ResultsParticipants acknowledged that resistance is an important public health issue, but not as important as other pressing problems (eg, obesity, opioids). Many considered resistance to be more of a hospital issue. While participants recognised inappropriate prescribing as a problem in outpatient settings, many felt that the key drivers were non-primary care settings (eg, urgent care clinics, retail clinics) and patient demand. Participants reacted positively to stewardship efforts aimed at educating patients and clinicians. They questioned the validity of antibiotic prescribing metrics. This scepticism was due to a number of factors, including the feasibility of capturing prescribing quality, a belief that physicians will ‘game the system’ to improve their measures, and dissatisfaction and distrust of quality measurement in general.ConclusionsStakeholders will need to consider physician attitudes and beliefs about antibiotic stewardship when implementing interventions aimed at improving prescribing.
Research priorities for pregnancy hypertension: a UK priority setting partnership with the James Lind Alliance
Authors: Ho Alison , Webster Louise , Bowen Liza , Creighton Fiona , Findlay Sarah , Gale Chris , Green Marcus , Gronlund Toto , Magee Laura A , McManus Richard J , Mistry Hiten D , Singleton Gemma , Thornton Jim , Whybrow Rebecca , Chappell Lucy 
Published: July 2020

ObjectivesTo identify research priorities for hypertensive disorders of pregnancy from individuals with lived experience and healthcare professionals.DesignProspective surveys and consensus meetings using principles outlined by the James Lind Alliance.SettingUK.MethodsA steering group was established and ‘uncertainties’ were gathered using an online survey and literature search. An interim online survey ranked long-listed questions and the top 10 research questions were reached by consensus at a final prioritisation workshop.ParticipantsWomen, partners, relatives and friends of those with lived experience of pregnancy hypertension, researchers and healthcare professionals.ResultsThe initial online survey was answered by 278 participants (180 women with lived experience, 9 partners/relatives/friends, 71 healthcare professionals and 18 researchers). Together with a literature search, this identified 764 questions which were refined into 50 summary questions. All summary questions were presented in an interim prioritisation survey that was answered by 155 participants (87 women with lived experience, 4 partners/relatives/friends, 49 healthcare professionals and 15 researchers). The top 25 highest ranked questions were considered by the final prioritisation workshop. The top 10 uncertainties were identified by consensus and ranked as follows in order of priority: long-term consequences of pregnancy hypertension (for the woman and baby), short-term complications of pregnancy hypertension (for the woman and baby), screening tests for pre-eclampsia, prevention of long-term problems (for the woman and baby), causes of pregnancy hypertension, prevention of recurrent pregnancy hypertension, educational needs of healthcare professionals, diagnosis of pre-eclampsia, management of pregnancy hypertension, provision of support for women and families.ConclusionsResearch priorities shared by those with lived experience of pregnancy hypertension and healthcare professionals have been identified. Researchers should use these to inform the choice of future studies in this area.
Protocol for a systematic review of economic analyses of nosocomial infection prevention and control interventions in OECD hospitals
Authors: Tchouaket Eric Nguemeleu , Beogo Idrissa , Sia Drissa , Kilpatrick Kelley , Séguin Catherine , Baillot Aurelie , Nadar Mahmoud , Parisien Natasha , Boivin Sandra 
Published: July 2020

BackgroundNosocomial infections (NIs) are associated with extra treatment costs, medical complications, reduction of quality of life and mortality. This systematic review intends to consolidate the evidence on the economic evaluation of four clinical best practices (CBPs) related to NI prevention and control interventions: hand hygiene, hygiene and sanitation, admission screening and basic and additional precautions. It will measure the return on investment of these CBPs.Methods and analysisElectronic searches will be conducted on MEDLINE, CINAHL, EMBASE, Cochrane, Web of Science and JSTOR. OpenGrey will also be consulted for articles from 2000 to 2018, published in English or French. The population includes studies undertaken in medical or surgical units of hospitals of the Organisation for Economic Co-operation and Development countries. Studies will report the prevention and control ofClostridium difficile-associated diarrhoea, methicillin-resistantStaphylococcus aureus, vancomycin-resistant enterococci and carbapenem-resistant Gram-negative bacilli. Interventions evaluating any of the four CBPs will be included. The design of articles will fall within randomised clinical trials, quasi-experimental, case-control, cohort, longitudinal and cross-sectional studies. Outcomes will include incremental cost-effectiveness ratio, incremental cost per quality-adjusted life-year, incremental cost per disability-adjusted life year and the incremental cost-benefit ratio, net costs and net cost savings. Two authors will independently screen studies, extract data and assess risk of bias using the Scottish Intercollegiate Guidelines, the Drummond Economic Evaluation criteria and the Cochrane criteria for Systematic Reviews of Interventions. Consolidated Health Economic Evaluation Reporting Standards will be used for data extraction. All values will be adjusted to Canadian dollars ($C) indexed to 2019 using the discount rates (3%, 5% and 8%) for sensitivity analyses. This review will demonstrate the effectiveness of the CBPs in prevention and control of NIs. Decision-makers will thus have evidence to facilitate sound decision-making according to the financial gains generated.Ethics and disseminationThe results of this systematic review will be published in a peer-reviewed journal and presented at a relevant scientific conference. Ethical approval is not required because the data we will use do not include individual patient data.