bluuebunny/crossref_metadata_2025_split huggingface dataset:
Target Cascading in Optimal System Design
Authors: Kim Hyung Min , Michelena Nestor F. , Papalambros Panos Y. , Jiang Tao 
Published: December 2020

Abstract
Target cascading is a key challenge in the early product development stages of large complex artifacts: How to propagate the desirable top level design specifications (or targets) to appropriate specifications for the various subsystems and components in a consistent and efficient manner. Consistency means that all parts of the designed system should end up working well together, while efficiency means that the process itself should avoid iterations at later stages, which are costly in time and resources. In the present article target cascading is formalized in a process modeled as a multilevel optimal design problem. Design targets are cascaded down to lower levels using partitioning of the original problem into a hierarchical set of sub-problems. For each design problem at a given level, an optimization problem is formulated to minimize deviations from the propagated targets and thus achieve intersystem compatibility. A coordination strategy links all subproblem decisions so that the overall system performance targets are met. The process is illustrated with an explicit analytical problem and a simple chassis design model that demonstrates how the process can be applied in practice.
Nurse-led triage of new sleep referrals is associated with lower risk of potentially contraindicated sleep testing: a retrospective cohort study
Authors: Donovan Lucas M , Palen Brian N , Syed Adnan , Blankenhorn Richard , Blanchard Kelly , Feser William J , Magid Kate , Gamache Justina , Spece Laura J , Feemster Laura C , Fernandes Laurie , Kirsh Susan , Au David H 
Published: December 2020

BackgroundThe volume of specialty care referrals often outstrips specialists’ capacity. The Department of Veterans Affairs launched a system of referral coordination to augment our workforce, empowering registered nurses to use decision support tools to triage specialty referrals. While task shifting may improve access, there is limited evidence regarding the relative quality of nurses’ triage decisions to ensure such management is safe.ObjectiveWithin the specialty of sleep medicine, we compared receipt of contraindicated testing for obstructive sleep apnoea (OSA) between patients triaged to sleep testing by nurses in the referral coordination system (RCS) relative to our traditional specialist-led system (TSS).MethodsPatients referred for OSA evaluation can be triaged to either home sleep apnoea testing (HSAT) or polysomnography, and existing guidelines specify patients for whom HSAT is contraindicated. In RCS, nurses used a decision support tool to make triage decisions for sleep testing but were instructed to seek specialist oversight in complex cases. In TSS, specialists made triage decisions themselves. We performed a single-centre retrospective cohort study of patients without OSA who were referred to sleep testing between September 2018 and August 2019. Patients were assigned to triage by RCS or TSS in quasirandom fashion based on triager availability at time of referral. We compared receipt of contraindicated sleep tests between groups using a generalised linear model adjusted for day of the week and time of day of referral.ResultsRCS triaged 793 referrals for OSA evaluation relative to 1787 by TSS. Patients with RCS triages were at lower risk of receiving potentially contraindicated sleep tests relative risk 0.52 (95% CI 0.29 to 0.93).ConclusionOur results suggest that incorporating registered nurses into triage decision-making may improve the quality of diagnostic care for OSA.
Hospitalised patients with palliative care needs: Spain and Sweden compared
Authors: Sandgren Anna , García-Fernández Francisco P , Gutiérrez Sánchez Daniel , Strang Peter , López-Medina Isabel M 
Published: December 2020

ObjectivesThis study aimed to describe and compare symptoms, care needs and types of diagnoses in hospitalised patients with palliative care needs in Spain and Sweden.MethodsA cross-sectional, population-based study was carried out at two hospitals in both Spain and Sweden. Using a questionnaire, we performed 154 one-day inventories (n=4213) in Spain and 139 in Sweden (n=3356) to register symptoms, care needs and diagnoses. Descriptive analyses were used.ResultsThe proportion of patients with care needs in the two countries differed (Spain 7.7% vs Sweden 12.4%, p<0.001); however, the percentage of patients with cancer and non-cancer patients was similar. The most prevalent symptoms in cancer and non-cancer patients in both countries were deterioration, pain, fatigue and infection. The most common cancer diagnosis in both countries was lung cancer, although it was more common in Spain (p<0.01), whereas prostate cancer was more common among Swedish men (p<0.001). Congestive heart failure (p<0.001) was a predominant non-cancer diagnosis in Sweden, whereas in Spain, the most frequent diagnosis was dementia (p<0.001). Chronic obstructive pulmonary disease was common in both countries, although its frequency was higher in Spain (p<0.05). In total, patients with cancer had higher frequencies of pain (p<0.001) and nausea (p<0.001), whereas non-cancer patients had higher frequencies of deterioration (p<0.001) and infections (p<0.01).ConclusionsThe similarities in symptoms among the patients indicate that the main focus in care should be on patient care needs rather than diagnoses. Integrating palliative care in hospitals and increasing healthcare professional competency can result in providing optimal palliative care.
Multidimensional risk score to stratify community-dwelling older adults by future fall risk using the Stopping Elderly Accidents, Deaths and Injuries (STEADI) framework
Authors: Helsel Brian C , Kemper Karen A , Williams Joel E , Truong Khoa , Van Puymbroeck Marieke 
Published: December 2020

BackgroundThe Stopping Elderly Accidents, Deaths and Injuries (STEADI) screening algorithm aligns with current fall prevention guidelines and is easy to administer within clinical practice. However, the stratification into low, moderate and high risk categories limits the meaningful interpretation of the fall-related risk factors.MethodsBaseline measures from a modified STEADI were used to predict self-reported falls over 4 years in 3170 respondents who participated in the 2011–2015 National Health and Aging Trends Study. A point method was then applied to find coefficient-based integers and 4-year fall risk estimates from the predictive model. Sensitivity and specificity estimates from the point method and the combined moderate and high fall risk STEADI categories were compared.ResultsThere were 886 (27.95%) and 387 (12.21%) respondents who were classified as moderate and high risk, respectively, when applying the stratification method. Falls in the past year (OR: 2.16; 95% CI: 1.61 to 2.89), multiple falls (OR: 2.94; 95% CI: 1.89 to 4.55) and a fear of falling (OR: 1.77; 95% CI: 1.45 to 2.16) were among the significant predictors of 4-year falls in older adults. The point method revealed integers that ranged from 0 (risk: 27.21%) to 44 (risk: 99.71%) and a score of 10 points had comparable discriminatory capacity to the combined moderate and high STEADI categories.ConclusionCoefficient-based integers and their risk estimates can provide an alternative interpretation of a predictive model that may be useful in determining fall risk within a clinical setting, tracking changes longitudinally and defining the effectiveness of an intervention.
Update on the treatment options for canine hyperadrenocorticism
Authors: Schofield Imogen , Geddes Rebecca , Fenn Joe , Ramsey Ian 
Published: December 2020

BackgroundCanine hyperadrenocorticism (or Cushing's syndrome) occurs due to a functional pituitary or adrenal tumour, resulting in excessive circulatory glucocorticoids, which produce the classical clinical signs in affected dogs. Although management of the disease traditionally focuses on treating these endocrine consequences, the pathology reflects an oncological disease with the possibility of progression of the underlying neoplasia. Surgical options for these tumours are now becoming increasingly available and successful.Aim of the articleThis article covers how to distinguish between pituitary and adrenal hyperadrenocorticism as well as outlining the treatment options for this important disease in dogs.
Prognostic Value of Estimated Plasma Volume in Patients with Chronic Systolic Heart Failure
Authors: Lin Yuyao , Xue Yanbo , Liu Jing , Wang Xiqiang , Wei Linyan , Bai Ling , Ma Aiqun 
Published: December 2020

Assessing congestion is challenging but important to patients with chronic heart failure (CHF). However, there are limited data regarding the association between estimated plasma volume status (ePVS) determined using hemoglobin/hematocrit data and outcomes in patients with stable CHF. We prospectively analyzed 231 patients; the median follow-up period was 35.6 months. We calculated ePVS at admission using the Duarte and Strauss formula, derived from hemoglobin and hematocrit ratios and divided patients into three groups. The primary outcome was a composite of all-cause mortality or heart failure rehospitalization. Among 274 patients (61.98 years of age, 2.3% male), the mean ePVS was 3.98±0.90 dL/g. The third ePVS tertile had a higher proportion of primary outcome (71.4%) than the first or second tertile (48.1% and 59.7%, respectively; p=0.013). On multivariable Cox analysis, after adjusting for potential confounders, higher ePVS remained significantly associated with increased rate of primary outcome (adjusted HR 1.567, 95% CI 1.267 to 1.936; p<0.001). Kaplan-Meier survival analyses showed that the occurrence of primary outcome, all-cause mortality and rehospitalization increased progressively from first to third tertiles (p=0.006, 0.014 and 0.001; respectively). In receiver operating characteristic analysis, the area under the curve of ePVS for primary outcome was 0.645. ePVS determined using hemoglobin and hematocrit was independently associated with clinical outcomes for patients with stable CHF. Our study thus further strengthens the evidence that ePVS has important prognostic value in patients with stable CHF. Trial registration number ChiCTR-ONC-14004463.
Navigating radial artery loops in neurointerventions
Authors: Luther Evan , Burks Joshua , Abecassis Isaac Josh , Nada Ahmed , Heath Rainya , Berry Katherine , McCarthy David J , Saini Vasu , Silva Michael , Huang Eric , Strickland Allison , Yavagal Dileep R , Peterson Eric C , Levitt Michael R , Starke Robert M 
Published: December 2020

BackgroundAlthough studies continue to demonstrate lower complications in neurointerventions using transradial access (TRA) compared with transfemoral approaches, anatomic radial variants can be difficult to navigate and remain one of the frequent causes of access site conversion.ObjectiveTo evaluate predictors of TRA failure in neuroendovascular patients with radial loops and suggest a protocol for managing these anomalies.MethodsA prospective collection of patients undergoing TRA at participating institutions from July 2018 to September 2020 was reviewed. Patients with a radial loop were identified. Patient demographics and procedural characteristics were evaluated to determine predictors of both TRA failure and successful reduction of the radial loop.ResultsWe identified 32 transradial neurointerventions in which patients had radial loops. Twenty-two (68.8%) were identified by diagnostic angiography, and the majority were performed for evaluation or treatment of an aneurysm (56.3%). TRA failure occurred in 13 (40.6%) of the cohort and happened more frequently in patients over 60 years of age (p=0.01) and those with recurrent radial artery diameters ≤2 mm (p=0.02). Of the 19 patients who had successful TRA, 12 (63.2%) procedures were performed through the recurrent radial artery.ConclusionAlthough radial loops are associated with high transradial failure rates, our results suggest that the presence of a loop is not an absolute contraindication to TRA. Therefore, we recommend attempting loop navigation using our protocol. Patient age, vascular tortuosity, and recurrent radial artery size should help dictate when to convert to an alternative access site.
International teleproctoring in neurointerventional surgery and its potential impact on clinical trials in the era of COVID-19: legal and technical considerations
Authors: Orru' Emanuele , Marosfoi Miklos , Patel Neil V , Coon Alexander L , Wald Christoph , Repucci Nicholas , Nicholson Patrick , Pereira Vitor M , Wakhloo Ajay K 
Published: December 2020

BackgroundExisting travel restrictions limit the mobility of proctors, significantly delaying clinical trials and the introduction of new neurointerventional devices. We aim to describe in detail technical and legal considerations regarding international teleproctoring, a tool that could waive the need for in-person supervision during procedures.MethodsInternational teleproctoring was chosen to provide remote supervision during the first three intracranial aneurysm treatments with a new flow diverter (currently subject of a clinical trial) in the US. Real-time, high-resolution transmission software streamed audiovisual data to a proctor located in Canada. The software allowed the transmission of images in a de-identified, HIPAA-compliant manner.ResultsAll three flow diverters were implanted as desired by operator and proctor and without complication. The proctor could swap between images from multiple sources and reported complete spatial and situational awareness, without any significant lag or delay in communication. Procedural times and radiologic dose were similar to those of uncomplicated, routine flow diversion cases at our institution.ConclusionsInternational teleproctoring was successfully implemented in our clinical practice. Its first use provided important insights for establishing this tool in our field. With no clear horizon for lifting the current travel restrictions, teleproctoring has the potential to remove the need for proctor presence in the angiography suite, thereby allowing the field to advance through the continuation of trials and the introduction of new devices in clinical practice. In order for this tool to be used safely and effectively, highly reliable connection and high-resolution equipment is necessary, and multiple legal nuances have to be considered.
Outcomes of pediatric thyroidectomy: a cross-sectional evaluation
Authors: Azari Sarah , Randolph Jackson , Shi Harry , Hoover Travis , Weaver Daniel , Mattioni Jillian , Chennupati Sri Kiran 
Published: December 2020

IntroductionPediatric thyroidectomy is performed by a variety of surgical specialties. Thyroidectomy can result in a number of complications. Previous studies cite that the most common complications in children are pain and transient hypocalcemia. The purposes of this report are to assess the adverse events of thyroidectomies performed in the pediatric population and to assess the relationship between surgical specialties and postoperative thyroidectomy complications.MethodsWe conducted a cross-sectional analysis of cases from January 1, 2014 through November 1, 2015 using the National Surgical Quality Improvement Program database for patients undergoing excision of cyst or adenoma of the thyroid, unilateral thyroid lobectomy, or total thyroidectomy.ResultsOf the 344 patients who underwent thyroidectomy, 10 (2.9%) experienced at least one complication. The most common complications were readmission, surgical site infections, and wound disruption. There was a statistically significant association between complication incidence and surgical specialty (p=0.006). Pediatric otolaryngology had a statistically significantly higher number of complications than pediatric surgery (p<0.008).ConclusionOverall, the incidence of adverse events following pediatric thyroidectomy was low.
LRRC8A homohexameric channels poorly recapitulate VRAC regulation and pharmacology
Authors: Yamada Toshiki , Figueroa Eric E. , Denton Jerod S. , Strange Kevin 
Published: December 2020

Swelling-activated volume-regulated anion channels (VRACs) are heteromeric channels comprising LRRC8A and at least one other LRRC8 paralog. Cryoelectron microscopy (cryo-EM) structures of nonnative LRRC8A and LRRC8D homohexamers have been described. We demonstrate here that LRRC8A homohexamers poorly recapitulate VRAC functional properties. Unlike VRACs, LRRC8A channels heterologously expressed in Lrr8c−/− HCT116 cells are poorly activated by low intracellular ionic strength (µ) and insensitive to cell swelling with normal µ. Combining low µ with swelling modestly activates LRRC8A, allowing characterization of pore properties. VRACs are strongly inhibited by 10 µM 4-[(2-butyl-6,7-dichloro-2-cyclopentyl-2,3-dihydro-1-oxo-1 H-inden-5-yl)oxy]butanoic acid (DCPIB) in a voltage-independent manner. In contrast, DCPIB block of LRRC8A is weak and voltage sensitive. Cryo-EM structures indicate that DCPIB block is dependent on arginine 103. Consistent with this, LRRC8A R103F mutants are insensitive to DCPIB. However, an LRRC8 chimeric channel in which R103 is replaced by a leucine at the homologous position is inhibited ∼90% by 10 µM DCPIB in a voltage-independent manner. Coexpression of LRRC8A and LRRC8C gives rise to channels with DCPIB sensitivity that is strongly µ dependent. At normal intracellular µ, LRRC8A + LRRC8C heteromers exhibit strong, voltage-independent DCPIB block that is insensitive to R103F. DCPIB inhibition is greatly reduced and exhibits voltage dependence with low intracellular µ. The R103F mutation has no effect on maximal DCPIB inhibition but eliminates voltage dependence under low µ conditions. Our findings demonstrate that the LRRC8A cryo-EM structure and the use of heterologously expressed LRRC8 heteromeric channels pose significant limitations for VRAC mutagenesis-based structure-function analysis. Native VRAC function is most closely mimicked by chimeric LRRC8 homomeric channels.
Antiochus III’s Decree for Jerusalem and the Persian Decrees in Ezra-Nehemiah and LXX 1 Esdras
Authors: Honigman Sylvie 
Published: December 2020

Abstract
The article endorses the view that the royal decrees for the Jerusalem temple inserted in Ezra-Nehemiah (and First Esdras) are not genuine, and explores the historical conditions in which they were composed. It points to similarities between the topical content of Antiochus III’s decree issued in 200/198 BCE (Josephus, Ant. 12.138–144) and that of the Persian decrees, and argues that the latter were based on the former. They were composed in the context of the Maccabean crisis, when it was claimed that Jason cancelled the privileges (political and fiscal) which Antiochus had granted (2 Macc 4:7–15), as a legitimizing precedent to Antiochus’ decree. Moreover, the Persian decrees were used to explore the economic aspect of the relationship between the local community and imperial ruler in Hellenistic times (taxes and euergetism), and to provide a template for he ideal (Hellenistic) imperial king.
Factors Influencing Nurse Assistants’ Job Satisfaction in Nursing Homes in Canada and Spain: A Comparison of Two Cross-Sectional Observational Studies
Authors: McGilton Katherine S. , Stewart Steven , Bethell Jennifer , Chu Charlene H. , Mateos Jose T. , Pastells-Peiró Roland , Blanco-Blanco Joan , Rodriguez-Monforte Miriam , Escrig-Pinol Astrid , Gea-Sánchez Montserrat 
Published: December 2020

Objectives: To access associations between job satisfaction and supervisory support as moderated by stress. Methods: For this cross-sectional study, data collected from 591 nursing assistants in 42 nursing homes in Canada and Spain were analyzed with mixed-effects regression. Results: In both countries, stress related to residents’ behaviors was negatively associated with job satisfaction, and, in Canada, it moderated the positive association between supervisory support and job satisfaction. Stress related to family conflict issues moderated the positive association of supervisory support and job satisfaction differently in each location: in Canada, greater stress was associated with a weaker association between supervisory support and job satisfaction; in Spain, this was also observed but only when supervisory support was sufficiently weak. Discussion: Stress was associated with lower job satisfaction and moderated the association of supervisory support and job satisfaction, reinforcing the importance of supervisors supporting nursing assistants, especially during the COVID-19 pandemic.
Cerliponase Alfa for the Treatment of Atypical Phenotypes of CLN2 Disease: A Retrospective Case Series
Authors: Wibbeler Eva , Wang Raymond , Reyes Emily de los , Specchio Nicola , Gissen Paul , Guelbert Norberto , Nickel Miriam , Schwering Christoph , Lehwald Lenora , Trivisano Marina , Lee Laura , Amato Gianni , Cohen-Pfeffer Jessica , Shediac Renée , Leal-Pardinas Fernanda , Schulz Angela 
Published: December 2020

Background: The classic phenotype of CLN2 disease (neuronal ceroid lipofuscinosis type 2) typically manifests between ages 2 and 4 years with a predictable clinical course marked by epilepsy, language developmental delay, and rapid psychomotor decline. Atypical phenotypes exhibit variable time of onset, symptomatology, and/or progression. Intracerebroventricular-administered cerliponase alfa (rhTPP1 enzyme) has been shown to stabilize motor and language function loss in patients with classic CLN2 disease, but its impact on individuals with atypical phenotypes has not been described. Methods: A chart review was conducted of 14 patients (8 male, 6 female) with atypical CLN2 phenotypes who received cerliponase alfa. Pre- and posttreatment CLN2 Clinical Rating Scale Motor and Language (ML) domain scores were compared. Results: Median age at first presenting symptom was 5.9 years. First reported symptoms were language abnormalities (6 [43%] patients), seizures (4 [29%]), ataxia/language abnormalities (3 [21%]), and ataxia alone (1 [7%]). Median age at diagnosis was 10.8 years. ML score declined before treatment in 13 (93%) patients. Median age at treatment initiation was 11.7 years; treatment duration ranged from 11 to 58 months. From treatment start, ML score remained stable in 11 patients (treatment duration 11-43 months), improved 1 point in 1 patient after 13 months, and declined 1 point in 2 patients after 15 and 58 months, respectively. There were 13 device-related infections in 8 patients (57%) and 10 hypersensitivity reactions in 6 (43%). Conclusions: Cerliponase alfa is well tolerated and has the potential to stabilize motor and language function in patients with atypical phenotypes of CLN2 disease.