bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health insurers' operations in the face of health care reform: An analysis of the Supplemental Health Care Exhibit
Authors: Lei Yu , Browne Mark J. 
Published: August 2020

AbstractThe Patient Protection and Affordable Care Act (ACA) introduced significant changes to the health insurance marketplace in the United States. The act also imposed reporting requirements on insurers. The law has required insurers since 2010 to file yearly the Supplemental Health Care Exhibit (SHCE). The SHCE provides unique information on how health insurers operate. We analyze data in the SCHE to understand how insurers have complied with one of the major new regulations affecting health insurers' operations arising from the ACA—the Medical Loss Ratio (MLR) Provision. This requires that insurers spend a minimum percentage of their premium revenue on medical claims, quality improvement expenses, and deductible fraud and abuse detection and recovery expenses. Our analysis of the 2010–2017 SHCE indicates that insurers' underwriting performance worsened in the early years of the ACA as they worked to increase MLRs to become ACA‐compliant. Analysis of the SHCE further reveals that insurers' profits from managing uninsured plans grew as the profitability of underwriting insured plans decreased. Future research on health insurer operations is warranted. The currently underutilized and data‐rich SHCE provides unique information that makes future research possible.
Expanding the conceptualisation of the Art of Caring
Authors: Suárez‐Baquero Daniel F.M. , Champion Jane D. 
Published: August 2020

ObjectiveTo analyze the concept Art of Caring and expand its conceptualization in the Nursing discipline.MethodsA conceptual analysis in Spanish and English was developed based on the steps proposed by Walker and Avant.FindingsFive principal historical stages of development of the concept were identified. Attributes, antecedents, consequences, and cases are provided. An analogy is proposed to illustrate this concept through the representation of a four‐dimensional figure (tesseract).ConclusionsArt of Caring embeds the core disciplinary nursing knowledge. Exploring this concept leads to a broad perspective of Nursing and the act of caring, with the potential of uniting the discipline globally.Implications for nursing practiceWith the increasing use of Nursing knowledge in different languages, the global understanding of its foundations is key for advancement of the discipline. This concept analysis provides tools to help nurses to understand and be understood regardless of linguistic differences.
Evolution of Anand Parameters With Elevated Temperature Aging for SnAgCu Lead-free Alloys
Authors: Lall Pradeep , Yadav Vikas , Suhling Jeff , Locker David 
Published: August 2020

Abstract
Electronic components in downhole oil drilling and gas industry applications, automotive, and avionics may be exposed to high temperatures (&gt;150 °C) and high strain rates (1–100 per sec) during storage, operation, and handling, which can contribute to the failures of electronic devices. Temperatures in these applications can exceed 200 °C, which is close to melting point for SnAgCu (SAC) alloys. Prior studies at low strain rates have shown property evolution even under moderate exposure to high temperature. In this paper, the evolution of Anand parameters for unaged and aged SAC (SAC105 and SAC-Q) lead-free solder alloys at high strain rates has been investigated induced under sustained periods of thermal aging. The thermal aged lead-free SAC solder alloys specimen has been tested at high strain rates (10–75 per sec) at elevated temperatures of (25 °C–200 °C). The SAC lead-free solder samples were subjected to isothermal aging at 50 °C up to 1-year before testing. To describe the material constitutive behavior, the Anand Viscoplastic model has been used. The effect of thermal aging on Anand parameters also has been investigated. In order to verify the accuracy of the model, the computed Anand parameters have been used to simulate the uni-axial tensile test. The material constitutive behavior has been implemented in a finite element framework to simulate the drop events using the Anand constitutive model and determine the plastic work per shock event. The plastic work per shock event is a measure of the damage progression in the solder interconnects. The constitutive model has been used to simulate the shock event of a ball-grid array package on printed circuit board assembly.
Metabolic Cost of Paddling on Different Commercially Available Kayak Ergometers
Authors: Oliveira Borges Thiago , Bullock Nicola , Aitken David , Cox Gregory R. , Coutts Aaron J. 
Published: August 2020

Purpose: To compare the metabolic cost of paddling on different commercially available kayak ergometers using a standardized kayak incremental exercise protocol. Methods: Six male sprint kayak athletes undertook an incremental exercise protocol on 3 different kayak ergometers utilizing a randomized counterbalanced pair-matched design. Results: Mean maximal aerobic power on the WEBA ergometer (265 [14] W) was significantly higher than on the Dansprint (238 [9] W) and KayakPro® (247 [21] W, P < .01, effect size [ES] = 0.80). At the fifth stage, absolute oxygen consumption on the WEBA (3.82 [0.25] L·min−1) was significantly lower (P < 0.05, ES = 0.20) than KayakPro and Dansprint (4.10 [0.28] and 4.08 [0.27] L·min−1, respectively). Blood lactate concentration response at the sixth stage was significantly lower for the WEBA (3.5 [0.8] mmol·L−1), compared with KayakPro and Dansprint (5.4 [1.2] and 5.6 [1.5] mmol·L−1, P = .012, ES = 0.20). Stroke rate was significantly higher, without any effect of pacing during the submaximal stages for the Dansprint, compared with the WEBA (P < .001, ES = 0.28) and KayakPro (P < .001, ES = 0.38). A pacing effect was present at the maximal stage for all ergometers. Conclusions: This study demonstrated that paddling on different kayak ergometers when controlling power output elicits different metabolic and work outputs. It is recommended that scientists and coaches avoid testing on different ergometers and regularly calibrate these devices. Moreover, when an ergometer has been calibrated against a first principle device, it is necessary to consider calibration of various drag settings, due to their impact on stroke rate. Further research should explore the relationship between drag settings and stroke rate.
Acute Effects of Single- Versus Double-Leg Postactivation Potentiation on Postural Balance of Older Women: An Age-Matched Controlled Study
Authors: Fernandes Ilha G. , Souza Matheus A. , Oliveira Matheus L. , Miarka Bianca , Barbosa Michelle A. , Queiroz Andreia C. , Barbosa Alexandre C. 
Published: August 2020

Aims:To compare the postactivation potentiation effects of isometric contraction until failure in double- and single-leg tasks on older women’s balance.Methods:The one-legged balance test was performed before and immediately after a rise-to-toes task until the task failure. Older women were divided into two groups: a group performed the task with double leg (n = 43) and the other group with single-leg support (n = 55).Results:The single-leg group showed slower velocity of sway post rise-to-toes task (pre = 4.02 ± 1; post = 3.78 ± 1.15 m/s;p = .04) without differences for the center of pressure path length (pre = 79 ± 21; post = 75 ± 23 cm;p = .08). In the double-leg group, faster velocity of sway (pre = 4 ± 1.22; post = 4.25 ± 1.13;p = .03) and increased center of pressure path length (pre = 80 ± 24; post = 85 ± 23 cm;p = .03) were observed after the task.Conclusions:The single-leg group showed improved balance outcomes due to postactivation potentiation, while the double-leg group showed worsened balance consistent with muscle fatigue.
The Effects of Attentional Focus Instructions Specific to Body Movements on Movement Quality and Performance
Authors: Yamada Masahiro , Raisbeck Louisa D. 
Published: August 2020

Contexts: Directing an individual’s attention to the effect of the movements (external focus) has been shown to improve performance than directing attention to body movements (internal focus). However, the effect of attentional focus instructions specific to movement quality has not been investigated thoroughly. Objective: To compare the effects of internal and external focus instructions specific to body movements. Design: Mixed design, 2 (sex) × 2 (instructions). Settings: Laboratory setting. Participants: A total of 40 participants (males, n = 20; mean [SD]; age = 22.0 [2.19] y; height = 179.33 [5.90] cm; mass = 77.7 [13.04] kg; females, n = 20; age = 22.0 [3.87] y; height = 164.84 [5.80] cm; mass = 71.48 [20.66] kg) were recruited. Intervention: Participants completed 2 consecutive jumps (ie, a forward jump from a height and then a maximal vertical jump) with internal focus and external focus instructions. External focus was elicited by placing pieces of tape on the participants’ legs. Main Outcome measures: Landing quality was measured by the Landing Error Scoring System to assess movement quality, and the vertical jump height was measured by Vertec. Results: The performance results showed that the external focus condition resulted in superior vertical jump height compared with the internal focus condition (P < .05). Although landing quality did not show significant differences between 2 conditions, the effect size (η2 = .09) indicated that landing quality was better when participants adopted an external, rather than an internal focus of attention (P = .07). Conclusions: The body-oriented instructions can be provided externally by adding artificial external cues and directing attention to them. Importantly, the findings were evident in a qualitative assessment that can be adopted by practitioners. The results suggest that practitioners should adopt an external focus cue for performance and also consider using an external focus for movement quality.
Pretreatment with transcutaneous electrical acupoint stimulation to prevent postoperative ileus in patients undergoing laparoscopic colon surgery: study protocol for a randomised controlled trial
Authors: Wang Jian , Li Dongli , Tang Wei , Guo Jun , Chen Wenting , Yong Yue , Song Wei , Yu Guijie , Feng Rui , Yuan Lan , Fu Guoqiang , Song Jiangang , Fan Lihua 
Published: August 2020

IntroductionPostoperative ileus (POI), a common complication after surgery, severely affects postoperative recovery. It is unclear whether pretreatment with transcutaneous electrical acupoint stimulation (TEAS) can improve recovery from POI. This trial will evaluate the effects of pretreatment with TEAS on POI.Methods and analysisThis will be a prospective, randomised controlled trial. American Society of Anesthesiologists (ASA) physical status classification I–III level patients, aged 18–75 years and scheduled for laparoscopic colon surgery, will be included in the study. It is planned that 146 subjects will be randomised to the TEAS and sham TEAS (STEAS) groups. The groups will undergo two sessions of TEAS/STEAS daily for 3 days before surgery, with a final TEAS/STEAS treatment 30 min before anaesthesia. The primary endpoint of the study will be time to first defaecation. Secondary endpoints will include time to first flatus, time to tolerance of oral diet, GI-2 (composite outcome of time to first defaecation and time to tolerance of oral diet), time to independent walking, length of hospital stay, postoperative pain Visual Analogue Scale score on the first 3 days after surgery, analgesic requirements, complications and plasma concentrations of interferon-β (IFN-β), IFN-γ, interleukin-6 (IL-6) and IL-1β. Multiple linear regression will be used to identify independent predictors of outcome measures.Ethics and disseminationThis study has been approved by the Chinese Registered Clinical Trial Ethics Review Committee (No. ChiECRCT-20170084). The results of the trial will be published in an international peer-reviewed journal.Trial registration numberThis study has been registered with the Chinese Clinical Trial Registry (No. ChiCTR-INR-17013184).Trial statusThe study was in the recruitment phase at the time of manuscript submission.
Comparative effect of nutraceuticals on lipid profile: a protocol for systematic review and network meta-analysis
Authors: Morze Jakub , Osadnik Tadeusz , Osadnik Kamila , Lejawa Mateusz , Jakubiak Grzegorz , Pawlas Natalia , Gasior Mariusz , Schwingshackl Lukas , Banach Maciej 
Published: August 2020

IntroductionAccording to the common definition, nutraceuticals are components found in food that can act as therapeutic substances. Recently, the International Lipid Expert Panel published two position papers covering the topic of lipid-lowering nutraceuticals and their potential use as a complementary treatment in addition to statins or as an alternative treatment in statin-intolerant patients. The aim of this study was to compare the effect of different nutraceuticals on lipid profiles in a systematic review with pairwise and network meta-analyses.Methods and analysisThree databases, including PubMed, Embase and the Cochrane Central Register of Controlled Trials, will be searched without time or publication language restrictions. The estimated end date for the searches will be 29 March 2020. Each stage of the review, including the study section, data extraction, and risk of bias and quality of evidence assessments, will be performed in duplicate. Randomised controlled trials meeting the following criteria will be eligible for inclusion: (1) participants aged ≥18 years, (2) intervention with a selected nutraceutical (artichoke, berberine, bergamot, soluble fibres, green tea, garlic, lupin, plant sterols and stanols, red yeast rice, soybean, spirulina or a combination of the aforementioned nutraceuticals), (3) administration of the treatment in the form of capsules, pills, powders, solutions, tablets or enriched food items, (4) comparison with another nutraceutical or placebo, (5) intervention period ≥3 weeks and (6) lipid profile (low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, total cholesterol, triglycerides) as an outcome. Random-effect pairwise and network meta-analyses will be used to summarise the relative effect of each nutraceutical in comparison to the effect of every other nutraceutical. Subgroup analyses will be stratified by age, sex, ethnicity, sample size, length of trial follow-up, baseline cholesterol level and presence of other comorbidities.Ethics and disseminationThis review will summarise findings from primary studies, and therefore no ethics approval is required. The results will be presented at conferences as well as published in a peer-reviewed journal.PROSPERO registration numberCRD42019132877.
Is the Yale Global Tic Severity Scale a valid tool for parent-reported assessment in the paediatric population? A prospective observational study in Taiwan
Authors: Ho Che‑Sheng , Huang Jia‑Yun , Yang Chien-Hui , Lin Yi-Jie , Huang Ming-Yuan , Su Yung-Cheng 
Published: August 2020

ObjectiveThe Yale Global Tic Severity Scale (YGTSS) is the most commonly used clinician-rated evaluation tool for Tourette syndrome (TS), with established reliability and validity. This study aims to determine whether the YGTSS is a valid parent-reported assessment in the TS population.DesignA prospective cohort study.SettingA major medical centre in Taiwan.MethodsA total of 594 patients were enrolled. A revised traditional Chinese version of the YGTSS was made available to parents via Google docs. Parents were encouraged to complete the YGTSS the day before each outpatient clinic visit. At each visit, a paediatric neurology fellow also administered the YGTSS assessment. We investigated whether differences in scores between physicians and parents changed as the number of parent evaluations increased. The results of the physician assessments were also taken as the expert standard for evaluating the sensitivity and specificity of the parent-reported assessments was conducted for the same visit.ResultsThe differences in the YGTSS scores between participants and physicians were small. The mean difference in the total assessment score was 4.15 points. As the number of times the parent evaluation was performed increased, the difference between the parent and physician scores decreased. Discrimination of moderate-to-severe attacks was good using the parent-assessed YGTSS (area under the receiver operating characteristic curve, 0.858; 95% CI 0.839 to 0.876). The sensitivity for detecting a moderate-to-severe attack by YGTSS parent assessment was 79.7% (95% CI 76.6 to 82.8), and the specificity was 91.8% (95% CI 89.9 to 93.7).ConclusionThe parent-reported YGTSS is a promising tool for TS assessment, demonstrating good discriminative ability for disease severity, with user precision increasing with experience.
Fast track rehabilitation after reversed total shoulder arthroplasty: a protocol for an international multicentre prospective cohort study
Authors: van Essen Tom , Kornuijt Anke , de Vries Lieke Maria Anna , Stokman Remco , van der Weegen Walter , Bogie Rob , Hillen Robert Jan , van Kampen DA 
Published: August 2020

IntroductionThe use of reversed total shoulder arthroplasty (rTSA) has increased because of an increasing number of indications for this procedure and by ageing of the population. Usual postoperative care consists of immobilisation of the shoulder for a period of 2–6 weeks to allow healing of the subscapularis tendon and protection of the joint. However, new literature proved that reattachment of the subscapularis tendon is unnecessary. Therefore we hypothesised that immobilisation of the shoulder is not necessary and patients can start safely with mobilisation on the first postoperative day. We expect this fast track protocol to be safe and result in better short-term and long-term functional outcomes.Methods and analysisIn our prospective cohort, we will include at least 75 patients aged 50 years and older indicated for rTSA, with acute fracture treatment as an exclusion criterion. Patients will be selected and operated in three hospitals: two in the Netherlands and one in Curacao.Patients will visit the outpatient clinic preoperative, at 6 weeks, 3 months and 1 year postoperative. The data that will be collected includes baseline characteristics, reason for surgery, complications and adverse events, patient reported outcomes (Oxford Shoulder Score, EuroQol-5D and Numeric Rating Scale for pain) and range of motion of the shoulder.All patients will be instructed to use a sling only for 1 day and to follow a progressive physiotherapy schedule for 12 weeks. The primary outcome is the occurrence of complications and adverse events.Ethics and disseminationThe Medical Ethics Committee from the VUmc and Curacao reviewed this study protocol and granted exemption from ethical approval (METC VUmc 2019.111, METC Curacao 2019-02). Study results will be presented at (inter)national conferences and published in peer-reviewed journals.Trial registration numberNetherlands Trial Register (NL7656).
State-level variation in opioid prescribing after knee arthroscopy among the opioid-naïve in the USA: 2015–2019
Authors: Ukert Benjamin , Huang Yanlan , Sennett Brian , Delgado Kit 
Published: August 2020

ObjectiveIt has been established that most patients prescribed opioids after minor surgery have tablets left over, better understanding the variation in opioid prescribing and variation in dosage of the prescription could guide efforts to reduce prescribing. This study describes the state-level variation in opioid prescribing after a knee arthroscopy among opioid-naïve patients.DesignRetrospective cohort study.SettingCommercial insurance claims data.Participants98 623 individual across the USA with commercial insurance who were opioid-naïve and had a knee arthroscopy between 2015 and 2019.ExposurePatients who filled an opioid prescription within 3 days of a knee arthroscopy.Outcome measuresOpioid prescriptions were measured as a pharmacy claim for filling an opioid within 3 days of a knee arthroscopy. We measured the patient and state-level opioid prescribing rate, tablet count, morphine milligram equivalent dose per prescription and risk-adjusted predicted opioid quantity.ResultsOverall, 72% of patients filled an opioid prescription with a median tablet count of 40 and median morphine milligram equivalent of 250. Patients with an invasive procedure (27.9% vs 22.4%; p<0.001), higher education level (p<0.001) and fewer comorbidities (0.9 vs 1.2, p<0.001) had higher rates of opioid prescribing. The prescribing rate in the highest state, Nebraska (85%), was double the prescribing rate in the lowest state, South Dakota (40%). Comparing the casemix adjusted expected prescribing rate to the observed prescribing rate displayed that 18 states had observed prescribing rates that were higher than their expected prescribing rates.ConclusionWide variation in the likelihood of receiving a prescription, depending on state of residence, was observed. The dosages prescribed were high and have been associated with transition to long-term use. These findings suggest that there is substantial opportunity for the development of guidelines to reduce variability in opioid prescribing for this common ambulatory procedure.
Household coverage, quality and costs of care provided by community health worker teams and the determining factors: findings from a mixed methods study in South Africa
Authors: Goudge Jane , de Kadt Julia , Babalola Olukemi , Muteba Michel , Tseng Yu-hwei , Malatji Hlologelo , Rwafa Teurai , Nxumalo Nonhlanhla , Levin Jonathan , Thorogood Margaret , Daviaud Emmanuelle , Watkins Jocelyn , Griffiths Frances 
Published: August 2020

ObjectiveCommunity health workers (CHWs) are undertaking more complex tasks as part of the move towards universal health coverage in South Africa. CHW programmes can improve access to care for vulnerable communities, but many such programmes struggle with insufficient supervision. In this paper, we assess coverage (proportion of households visited by a CHW in the past year and month), quality of care and costs of the service provided by CHW teams with differing configurations of supervisors, some based in formal clinics and some in community health posts.ParticipantsCHW, their supervisors, clinic staff, CHW clients.MethodsWe used mixed methods (a random household survey, focus group discussions, interviews and observations of the CHW at work) to examine the performance of six CHW teams in vulnerable communities in Sedibeng, South Africa.ResultsA CHW had visited 17% of households in the last year, and we estimated they were conducting one to two visits per day. At household registration visits, the CHW asked half of the questions required. Respondents remembered 20%–25% of the health messages that CHW delivered from a visit in the last month, and half of the respondents took the action recommended by the CHW. Training, supervision and motivation of the CHW, and collaboration with other clinic staff, were better with a senior nurse supervisor. We estimated that if CHW carried out four visits a day, coverage would increase to 30%–90% of households, suggesting that some teams need more CHW, as well as better supervision.ConclusionHousehold coverage was low, and the service was limited. Support from the local facility was key to providing a quality service, and a senior supervisor facilitated this collaboration. Greater investment in numbers of CHW, supervisors, training and equipment is required for the potential benefits of the programme to be delivered.