bluuebunny/crossref_metadata_2025_split huggingface dataset:
Key diagnostic characteristics of fever of unknown origin in Japanese patients: a prospective multicentre study
Authors: Naito Toshio , Tanei Mika , Ikeda Nobuhiro , Ishii Toshihiro , Suzuki Tomio , Morita Hiroyuki , Yamasaki Sho , Tamura Jun'ichi , Akazawa Kenichiro , Yamamoto Koji , Otani Hiroshi , Suzuki Satoshi , Kikuchi Motoo , Ono Shiro , Kobayashi Hiroyuki , Akita Hozuka , Tazuma Susumu , Hayashi Jun 
Published: November 2019

ObjectiveTo identify the key diagnostic features and causes of fever of unknown origin (FUO) in Japanese patients.DesignMulticentre prospective study.SettingSixteen hospitals affiliated with the Japanese Society of Hospital General Medicine, covering the East and West regions of Japan.ParticipantsPatient aged ≥20 years diagnosed with classic FUO (axillary temperature≥38.0°C at least twice within a 3-week period, cause unknown after three outpatient visits or 3 days of hospitalisation). A total of 141 cases met the criteria and were recruited from January 2016 to December 2017.InterventionJapanese standard diagnostic examinations.Outcome measuresData collected include usual biochemical blood tests, inflammatory markers (erythrocyte sedimentation rate (ESR), C reactive (CRP) protein level, procalcitonin level), imaging results, autopsy findings (if performed) and final diagnosis.ResultsThe most frequent age group was 65–79 years old (mean: 58.6±9.1 years). The most frequent cause of FUO was non-infectious inflammatory disease. After a 6-month follow-up period, 21.3% of cases remained undiagnosed. The types of diseases causing FUO were significantly correlated with age and prognosis. Between patients with and without a final diagnosis, there was no difference in CRP level between patients with and without a final diagnosis (p=0.121). A significant difference in diagnosis of a causative disease was found between patients who did or did not receive an ESR test (p=0.041). Of the 35 patients with an abnormal ESR value, 28 (80%) had causative disease identified.ConclusionsAge may be a key factor in the differential diagnosis of FUO; the ESR test may be of value in the FUO evaluation process. These results may provide clinicians with insight into the management of FUO to allow adequate treatment according to the cause of the disease.
Thematic analysis of spousal interaction patterns among Asian parents of children with chronic life-threatening illness
Authors: Ho Andy Hau Yan , Dutta Oindrila , Tan-Ho Geraldine , Choo Ping Ying , Low Xinyi Casuarine , Chong Poh Heng , Ng Carolyn , Ganapathy Sashikumar 
Published: November 2019

ObjectiveThis is the first known study which examines the evolutionary nature of spousal interaction patterns among Asian parents of children with chronic life-threatening illness, from the time of providing care to their child through bereavement. This study is informed by earlier findings that when a child is diagnosed with a chronic life-threatening illness, parents are faced with multiple stressors, leaving them with little time to invest in their spousal relationship.Participants and settingA constructivist-phenomenological research paradigm was adopted and meaning-oriented interviews were conducted with 20 parental units (i.e., 6 couples, 12 lone mothers and 2 lone fathers) of Chinese, Malay and Indian ethnicities who lost their child to chronic life-threatening illness in Singapore.ResultsQualitative thematic analysis of the data revealed four themes, which describe the evolutionary nature of spousal interaction patterns among Asian parents of children with chronic life-threatening illness, from caregiving through bereavement. Findings reveal participants’ tendency to concentrate on pragmatic, solution-focused communication during the period of caregiving (pragmatic interaction), avoid discussion about their emotional pain as a means of protecting their spouse (partner-oriented self-regulation), respect and acknowledge their spouse’s personal coping strategies (empathic responding) and show greater appreciation and emotional expression within the spousal relationship after their child’s death (affective appreciation).ConclusionEngaging in pragmatic discussions, deferring emotion-focused and potentially distressing conversations, and acknowledging their spouse’s need for personal space are important coping strategies for Asian couples facing their child’s chronic life-threatening illness and in the immediate aftermath of his/her death. Bereaved couples who have processed their grief individually feel ready to share their reflections with their spouse, deriving meaning and greater relational closeness through such disclosure. These findings are discussed from a cultural lens, with recommendations for healthcare professionals working with Asian parents of children with chronic life-threatening illness.
Trends in burden of work-related upper limb amputation in South Korea, 2004–2013: a nationwide retrospective cohort study
Authors: Ro Jun-soo , Leigh Ja-Ho , Jeon Inpyo , Bang Moon Suk 
Published: November 2019

ObjectivesThis study aimed to measure the burden of work-related upper limb amputation in Korea over a 10-year period and assess its trend.DesignEcological study.SettingNational level data in Korea between 2004 and 2013.Participants49 535 subjects who claimed Korea industrial accident compensation insurance due to upper limb amputation.Main outcome measuresThe disability-adjusted life years (DALYs) were calculated by sex, age and the site of amputation using annual incidence.ResultsThe burden of work-related upper limb amputations in Korea reached its peak in 2007 and decreased thereafter. Males showed a higher burden of disease. Finger amputations showed a decreasing trend from 2007, whereas arm amputations continued to show an increasing trend. An increasing trend was found among participants older than 50 years.ConclusionsThe decrease in the burden of finger amputations may be attributable to the lower incidence as a result of policy efforts. The increase in the burden of arm amputations was particularly noticeable among the elderly population over 50 years old. This could be attributable to the high proportion of the elderly population working in the manufacturing sector and the lack of policy efforts regarding major amputations in Korea. Future regulatory efforts are needed to prevent amputations.
Are physical factors associated with poor prognosis following a whiplash trauma?: a protocol for a systematic review and data synthesis
Authors: Alalawi Ahmed , Gallina Alessio , Sterling Michele , Falla Deborah 
Published: November 2019

IntroductionMitigating the transition from acute to chronic whiplash-associated disorders (WAD) is fundamental, and this could be achieved through early identification of individuals at risk. Several physical factors such as angular velocity, smoothness of neck movement and coactivation of neck flexors and extensors, have been observed in patients with WAD, but their predictive ability after a whiplash injury have not been considered in previous reviews. Therefore, the aim of the current protocol is to outline the protocol for a systematic review that synthesises the current evidence of which physical factors can predict ongoing pain and disability following a whiplash trauma.Methods and analysisTwo independent reviewers will search for studies in several electronic databases including MEDLINE, Embase, CINAHL, PsycINFO, Scopus and Web of Science as well as grey literature. Observational cohort studies will be considered if they involve participants with acute WAD followed for at least 3 months post-injury. Studies will be required to assess the prognostic ability of one or more physical factors that directly involve a body function and/or structure and can be measured objectively. Further, patient-reported outcomes of physical function will be considered. The primary outcome for this review is Neck Disability Index, while all other validated measures will be considered as secondary outcomes. Risk of bias across individual studies will be assessed using the Quality In Prognostic Studies tool along with the Grades of Recommendation, Assessment, Development and Evaluation method to assess the quality of evidence. A meta-analysis will be conducted depending on homogeneity and the number of available studies. If appropriate, data will be pooled and presented as odds ratios, otherwise, a qualitative synthesis will be conducted.Ethics and disseminationEthical approval is not required for this systematic review. The result from this review will be published in peer-reviewed journals.PROSPERO registration numberCRD42019122559
Early warning score adjusted for age to predict the composite outcome of mortality, cardiac arrest or unplanned intensive care unit admission using observational vital-sign data: a multicentre development and validation
Authors: Shamout Farah , Zhu Tingting , Clifton Lei , Briggs Jim , Prytherch David , Meredith Paul , Tarassenko Lionel , Watkinson Peter J , Clifton David A 
Published: November 2019

ObjectivesEarly warning scores (EWS) alerting for in-hospital deterioration are commonly developed using routinely collected vital-sign data from the whole in-hospital population. As these in-hospital populations are dominated by those over the age of 45 years, resultant scores may perform less well in younger age groups. We developed and validated an age-specific early warning score (ASEWS) derived from statistical distributions of vital signs.DesignObservational cohort study.SettingOxford University Hospitals (OUH) July 2013 to March 2018 and Portsmouth Hospitals (PH) NHS Trust January 2010 to March 2017 within the Hospital Alerting Via Electronic Noticeboard database.ParticipantsHospitalised patients with electronically documented vital-sign observationsOutcomeComposite outcome of unplanned intensive care unit admission, mortality and cardiac arrest.Methods and resultsStatistical distributions of vital signs were used to develop an ASEWS to predict the composite outcome within 24 hours. The OUH development set consisted of 2 538 099 vital-sign observation sets from 142 806 admissions (mean age (SD): 59.8 (20.3)). We compared the performance of ASEWS to the National Early Warning Score (NEWS) and our previous EWS (MCEWS) on an OUH validation set consisting of 581 571 observation sets from 25 407 emergency admissions (mean age (SD): 63.0 (21.4)) and a PH validation set consisting of 5 865 997 observation sets from 233 632 emergency admissions (mean age (SD): 64.3 (21.1)). ASEWS performed better in the 16–45 years age group in the OUH validation set (AUROC 0.820 (95% CI 0.815 to 0.824)) and PH validation set (AUROC 0.840 (95% CI 0.839 to 0.841)) than NEWS (AUROC 0.763 (95% CI 0.758 to 0.768) and AUROC 0.836 (95% CI 0.835 to 0.838) respectively) and MCEWS (AUROC 0.808 (95% CI 0.803 to 0.812) and AUROC 0.833 (95% CI 0.831 to 0.834) respectively). Differences in performance were not consistent in the elder age group.ConclusionsAccounting for age-related vital sign changes can more accurately detect deterioration in younger patients.
Home care for terminally ill patients: the experiences of family caregivers with and without paid work
Authors: Bijnsdorp Femmy M , van der Beek Allard J , Pasman H Roeline W , Boot Cécile R L , de Boer Alice H , Plaisier Inger , Onwuteaka-Philipsen Bregje D 
Published: November 2019

ObjectivesTo facilitate care at the end of life at home, support from family caregivers is crucial. A substantial number of these family caregivers also work. Work in relation to care for terminally ill patients has received limited attention. To better understand the context in which these family caregivers provide care, we provide a detailed overview of the situation and experiences of family caregivers of terminally ill patients at home, with and without paid work.MethodsWe used a pooled cross-section of data from the Dutch Informal Care Study, collected in 2014 and 2016. All working and non-working family caregivers of terminally ill patients at home were included (n=292).ResultsWorking family caregivers reported more care tasks, and shared care tasks with others more often than non-working caregivers. No differences between working and non-working caregivers were found in negative and positive experiences. Non-working caregivers provided care more often because the care recipient wanted to be helped by them or because there was no one else available than working caregivers. About 70% of the working caregivers were able to combine work and family caregiving successfully.ConclusionsWorking and non-working family caregivers of terminally ill patients at home have similar burden and positive experiences. Working family caregivers vary in their ability to combine work and care. Although the majority of working family caregivers successfully combine work and care, a substantial number struggle and need more support with care tasks at home or responsibilities at work.
Palliative care training in undergraduate medical, nursing and allied health: a survey
Authors: White Nicola , Oostendorp Linda JM , Minton Ollie , Yardley Sarah , Stone Patrick 
Published: November 2019

ObjectivesImpending death is poorly recognised. Many undergraduate healthcare professionals will not have experience of meeting or caring for someone who is dying. As death can occur in any setting, at any time, it is vital that all healthcare students, regardless of the setting they go on to work in, have end-of-life care (EOLC) training. The aim was to determine current palliative care training at the undergraduate level, in multiple professions, in recognising and communicating dying.MethodsCurrent UK undergraduate courses in medicine, adult nursing, occupational therapy, social work and physiotherapy were included. All courses received an email asking what training is currently offered in the recognition and communication of dying, and what time was dedicated to this.ResultsA total of 73/198 (37%) courses responded to the request for information. 18/20 medical courses provided training in recognising when patients were dying (median 2 hours), and 17/20 provided training in the communication of dying (median 3 hours). 80% (43/54) of nursing and allied health professional courses provided some training in EOLC. Many of the course organisers expressed frustration at the lack of resources, funding and time to include more training. Those courses with more palliative care provision often had a ‘champion’ to advocate for it.ConclusionsTraining in EOLC was inconsistent across courses and professions. Further research is needed to understand how to remove the barriers identified and to improve the consistency of current training.
Submaximal angioplasty in the treatment of patients with symptomatic ICAD: a systematic review and meta-analysis
Authors: Seyedsaadat Seyed Mohammad , Yolcu Yagiz Ugur , Neuhaus Ain , Rizvi Asim , Alzuabi Muayad , Murad Mohammad H , Brinjikji Waleed , Bydon Mohamad , Kallmes David F 
Published: November 2019

IntroductionManagement approaches for intracranial atherosclerosis include medical, surgical, or endovascular treatment. Among endovascular treatments, recent studies have stated that submaximal angioplasty (SA) may offer considerable benefits and be a promising alternative to aggressive medical therapyand/or stenting in the treatment of intracranial atherosclerotic disease (ICAD).ObjectiveTo investigate the rates of periprocedural and long-term cerebrovascular accidents, mortality, and restenosis in patients with symptomatic ICAD who were treated with SA.MethodsAn electronic database search was performed for relevant studies that reported clinical outcomes of patients with ICAD following SA. Outcomes of interest were incidence of transient ischemic attack, intracerebral hemorrhage, stroke, and mortality in the periprocedural period and at 1 year. The periprocedural period was defined as the time from SA until 30 days after the procedure. Technical success and restenosis rates after the procedure were also analyzed.ResultsA total of 19 studies with 777 patients were identified. The technical success rate was 93% (95% CI 85% to 98%). The incidence of 30-day and 1-year stroke (all types) was 3% (95% CI 1% to 5%) and 5% (95% CI 4% to 8%), respectively. Thirty-day and 1-year mortality was found to be 1% (95% CI 0% to 2%) and 2% (95% CI 0% to 4%), respectively. The combined incidence of stroke or death was 5% (95% CI 3% to 8%) at 30 days, and 9% (95% CI 7% to 12%) at 1 year.ConclusionThe findings suggest that SA might be a promising alternative treatment in the treatment of symptomatic ICAD due to its favorable technical profile, periprocedural safety, and long-term efficacy. A randomized clinical trial is warranted to compare the safety and efficacy of SA with 'gold standard' medical treatment.
Diagnostic value of plasma biochemistry, haematology, radiography and endoscopic visualisation for hepatic disease in psittacine birds
Authors: Hung Cher Shi‐Yee , Sladakovic Izidora , Divers Stephen J 
Published: November 2019

BackgroundHepatic disease in psittacine birds is common but challenging to diagnose. This retrospective study evaluates the diagnostic value of plasma biochemistry, haematology, radiography and endoscopic visualisation in psittaciforms with suspected hepatic disease that underwent endoscopic liver biopsy.MethodsClinical records of 28 companion psittaciforms from a veterinary teaching hospital (2007–2016) were reviewed. Diagnostic results were categorised as abnormal or normal and compared with histopathology for agreement or disagreement. Statistical significance was determined by kappa test for agreement and McNemar's test for disagreement.Results11 of 28 psittaciforms (39.3 per cent) had clinical signs considered specific for liver disease. 25 of 28 (89.3 per cent) psittaciforms had histopathological liver lesions. Gross changes radiographically and endoscopically agreed with histopathology in 57.1 per cent and 53.6 per cent of cases, respectively. Aspartate aminotransferase (AST) (48.1 per cent), creatine phosphokinase (73.1 per cent) and albumin by protein electrophoresis (50 per cent) showed the highest agreement. Kappa was not significant for any parameters, while McNemar's test for disagreement was significant for radiography, endoscopy, AST, lactate dehydrogenase, bile acid, total protein (chemistry), cholesterol, triglycerides, uric acid and glucose.ConclusionOverall, changes on plasma biochemistry, radiography or endoscopy are non‐specific and do not consistently agree with histopathology results. Endoscopic liver biopsy is highly recommended if there is clinical suspicion of hepatic disease.
Prevalence and clinical significance of the medullary rim sign identified on ultrasound of feline kidneys
Authors: Ferreira Amy , Marwood Rachel , Batchelor Daniel , Maddox Thomas , Mortier Jeremy R 
Published: November 2019

ObjectivesThe medullary rim sign (MRS) is an ultrasonographic (US) feature identified in normal and diseased feline kidneys. The prevalence and potential clinical significance of the MRS in a referral hospital cat population was investigated.MethodsRetrospective case–control study. US images from 661 cats were reviewed. Cats with an MRS were identified and compared with equal number of time‐matched control cats. Medical data and MRS features, including thickness, intensity and symmetry, were collected. Associations between independent variables and the MRS were examined with conditional and unconditional logistic regression, with initial univariable, and subsequent multivariable analysis.ResultsOf the 661 reviewed cats, 243 (36.8 per cent) showed a variation of the MRS. A thin MRS (133 cats) was not associated with azotaemic renal disease (P=0.87). A thick MRS (110 cats) was associated with azotaemic renal disease (P=0.001). There was an association between the presence of MRS and a final diagnosis of feline infectious peritonitis (FIP) (P=0.028).ConclusionsThe MRS is a common finding in cats. In this cat population, a thick MRS was associated with azotaemic renal disease, while a thin MRS was not. In cases with a clinical suspicion of FIP, the MRS may be related to the underlying disease process and not be an incidental finding.
On the sigma chromatic number of the join of a finite number of paths and cycles
Authors: Garciano Agnes D. , Lagura Maria Czarina T. , Marcelo Reginaldo M. 
Published: November 2019

Let [Formula: see text] be a simple connected graph and [Formula: see text] a coloring of the vertices in [Formula: see text] For any [Formula: see text], let [Formula: see text] be the sum of colors of the vertices adjacent to [Formula: see text]. Then [Formula: see text] is called a sigma coloring of [Formula: see text] if for any two adjacent vertices [Formula: see text]. The minimum number of colors needed in a sigma coloring of [Formula: see text] is the sigma chromatic number of [Formula: see text], denoted by [Formula: see text] In this paper, we prescribe a sigma coloring of the join of paths and cycles. As a consequence, we determine the sigma chromatic number of the join of a finite number of paths and cycles. In particular, let [Formula: see text], where [Formula: see text] or [Formula: see text] with [Formula: see text] If [Formula: see text], where [Formula: see text] and [Formula: see text], then [Formula: see text] if [Formula: see text] is an odd cycle, for some [Formula: see text] and [Formula: see text] otherwise.
Symmetries of the quaternionic Ginibre ensemble
Authors: Dubach Guillaume 
Published: November 2019

We establish a few properties of eigenvalues and eigenvectors of the quaternionic Ginibre ensemble (QGE), analogous to what is known in the complex Ginibre case (see [7, 11, 14]). We first recover a version of Kostlan’s theorem that was already at the heart of an argument by Rider [1], namely, that the set of the squared radii of the eigenvalues is distributed as a set of independent gamma variables. Our proof technique uses the De Bruijn identity and properties of Pfaffians; it also allows to prove that the high powers of these eigenvalues are independent. These results extend to any potential beyond the Gaussian case, as long as radial symmetry holds; this includes for instance truncations of quaternionic unitary matrices, products of quaternionic Ginibre matrices, and the quaternionic spherical ensemble. We then study the eigenvectors of quaternionic Ginibre matrices. Angles between eigenvectors and the matrix of overlaps both exhibit some specific features that can be compared to the complex case. In particular, we compute the distribution and the limit of the diagonal overlap associated to an eigenvalue that is conditioned to be at the origin. This complements a recent study of overlaps in quaternionic ensembles by Akemann, Förster and Kieburg [1, 2].