bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating the Outcomes of a Web‐Based Stress Management Program for Nurses and Nursing Assistants
Authors: Dutton Suzanne , Kozachik Sharon L. 
Published: January 2020

AbstractObjectiveThe purpose of this quality improvement project was to determine the utilization, satisfaction, and effect of a web‐based stress management program for nurses and nursing assistants (NAs).MethodsThis quality improvement project provided BREATHE, a web‐based stress management program that consisted of six modules that describe, identify, and help nurses manage stress for 31 nurses and NAs working on a subacute rehabilitation unit at a mid‐Atlantic community hospital.MeasurementsThe number of login attempts and time spent on the program were included, as were the nurse stress scale (NSS), a 34‐item validated instrument that captures seven dimensions of stress, and a seven‐item satisfaction survey given at the end of the modules.ResultsNurses utilized and were satisfied with the evidence‐based program BREATHE and reported significant improvement in NSS scores.Linking Evidence to ActionFindings suggest that BREATHE was effective at reducing the NSS score among nurses and NAs. The web‐based nature of the program allowed nurses to engage in it at times most convenient for them, which added to the program’s acceptability and overall satisfaction.
Topology Optimization With Many Right-Hand Sides Using Mirror Descent Stochastic Approximation—Reduction From Many to a Single Sample
Authors: Zhang Xiaojia Shelly , de Sturler Eric , Shapiro Alexander 
Published: January 2020

Abstract
Practical engineering designs typically involve many load cases. For topology optimization with many deterministic load cases, a large number of linear systems of equations must be solved at each optimization step, leading to an enormous computational cost. To address this challenge, we propose a mirror descent stochastic approximation (MD-SA) framework with various step size strategies to solve topology optimization problems with many load cases. We reformulate the deterministic objective function and gradient into stochastic ones through randomization, derive the MD-SA update, and develop algorithmic strategies. The proposed MD-SA algorithm requires only low accuracy in the stochastic gradient and thus uses only a single sample per optimization step (i.e., the sample size is always one). As a result, we reduce the number of linear systems to solve per step from hundreds to one, which drastically reduces the total computational cost, while maintaining a similar design quality. For example, for one of the design problems, the total number of linear systems to solve and wall clock time are reduced by factors of 223 and 22, respectively.
Oscillating Wave Surge Converter-Type Attachment for Extracting Wave Energy While Reducing Hydroelastic Responses of Very Large Floating Structures
Authors: Nguyen H. P. , Wang C. M. 
Published: January 2020

Abstract
This paper presents an oscillating wave surge converter (OWSC)-type attachment, comprising a submerged vertical flap connected to the fore edge of a very large floating structure (VLFS) with hinges and linear power take-off (PTO) systems, for extracting wave energy while reducing hydroelastic responses of VLFS. In terms of reductions in hydroelastic responses of VLFS, the OWSC-type attachment is better than the recently proposed raft wave energy converter (WEC)-type attachment for relatively short waves (T &lt; 7 s) and better than the conventional anti-motion device comprising a submerged vertical flap rigidly connected to the fore edge of VLFS for all wave periods. Importantly, the horizontal wave force acting on the submerged flap for the OWSC-type attachment is smaller than that for the conventional anti-motion device, leading to a more economical mooring system. In terms of wave energy extraction, the OWSC-type attachment is better than the raft WEC-type attachment for intermediate and long waves (T ≥ 7 s). In addition, for maximizing power production, the required flap length for the OWSC-type attachment is much smaller than the required pontoon length for the raft WEC-type attachment (about λ/10 as compared to about λ/3, where λ is the incident wavelength).
New Simplified Dynamic Modeling Method of Bolted Flange Joints of Launch Vehicle
Authors: Li Gang , Nie Zhaokun , Zeng Yan , Pan Jiacheng , Guan Zhenqun 
Published: January 2020

Abstract
The bolted flange joint is an important source of nonlinearity in dynamical analysis of launch vehicles, which will lead to both longitudinal and transversal responses simultaneously subject to transversal dynamic loads, and may result in the failure of the connection structure. In this paper, a novel simplified dynamic modeling method via structural static analysis is proposed to simulate dynamical response of nonlinear bolted flange joints of launch vehicle, in which only static analysis of the detailed finite element model or static experiment is used for parameter identification of the model. Two types of nonlinear springs are designed for different tensile and compressive stiffness of the bolted flange joint, which affect longitudinal dynamic behaviour of the connection, and a shear spring is used to modify the transversal stiffness. The sections of launch vehicle are modeled as linear beams for efficiency. Effectiveness of the proposed modeling method is confirmed by a typical connection structure, bolted flange connected cylindrical shells, whose finite element models are verified with dynamic experiments. Superiority of the simplified dynamic model from the proposed method is demonstrated by comparing with the previous simplified model. The connection structures with different numbers of bolts are studied, and most of the dynamic responses calculated from the proposed model agree well with those from the finite element model. The coupling vibration of the connection structure is predicted successfully, in which longitudinal response of the structure is excited by the transversal load.
Association of unhealthy dietary behaviors with renal function decline in patients with diabetes
Authors: Lin Cheng-Wei , Chen I-Wen , Lin Ying-Tzu , Chen Hsin-Yun , Hung Shih-Yuan 
Published: January 2020

ObjectiveBalanced nutrition is important for patients with diabetes, and nutrition might well influence diabetes-related complications, although there is limited evidence for this supposition at present. Consequently, we investigate the association between dietary behaviors and renal function decline among patients with diabetes.Research design and methodsFrom 2011 to 2013, a total of 2797 patients with type 2 diabetes participated in the Diabetes Shared Care Program at Chang Gung Memorial Hospital. All received nutritional consulting by dieticians and an eight-item list of unhealthy dietary behaviors, which included the excessive intake of carbohydrates, fats, protein, fruit, pickled foods, dessert and alcohol, as well as inadequate dietary vegetable. Estimated glomerular filtration rate (eGFR) decline ≥40% was defined as a surrogate end point for kidney damage. Independent dietary risk factors predicting poor renal outcomes were assessed.ResultsStable mean glycated hemoglobin (A1c) (7.78% to 7.75%, p=0.151), improved cholesterol (174.04 to 170.13 mg/dL, p<0.001) and low-density lipoprotein (104.19 to 98.07 mg/dL, p<0.001) were found in patients throughout 2 years of therapy. However, significant eGFR decline was noted (94.20 to 88.08 mL/min/1.73 m2, p<0.001). A total of 125 subjects had eGFR decline ≥40% and 2672 had stable renal progression.In regression analysis, 625 stable renal patients (selected via propensity score matching) and 125 subjects with eGFR decline ≥40% demonstrated excessive pickled foods to be predictive of poor renal outcomes (OR 1.861, 95% CI 1.230 to 2.814, p=0.003).ConclusionsOur study suggests that excessive pickled foods deteriorate renal function more than other unhealthy dietary behaviors in patients with diabetes.
Prognostic value of a combination of innovative factors (gut microbiota, sarcopenia, obesity, metabolic syndrome) to predict surgical/oncologic outcomes following surgery for sporadic colorectal cancer: a prospective cohort study protocol (METABIOTE)
Authors: Veziant Julie , Poirot Karine , Chevarin Caroline , Cassagnes Lucie , Sauvanet Pierre , Chassaing Benoit , Robin Frederic , Godfraind Catherine , Barnich Nicolas , Pezet Denis , Pereira Bruno , Gagniere Johan , Bonnet Mathilde 
Published: January 2020

IntroductionColorectal cancer (CRC) is still associated with poor prognosis, especially in patients with advanced disease. Development of new prognostic tools replacing or supplementing those routinely used is definitely needed, with the aim to optimise and personalise treatment strategies. Gut microbiota composition and body composition profile (obesity, sarcopenia and metabolic syndrome) have recently been reported separately as new relevant prognostic factors for postoperative surgical and oncologic outcomes following CRC surgery. However interactions that exist between these factors have been poorly studied. The purpose of this translational prospective cohort study (METABIOTE) is to investigate potential interactions between gut microbiota, body composition profile and postoperative outcomes and recurrence in patients undergoing surgery for non-metastatic sporadic CRC.Methods and analysisThis single-centre project aims to prospectively enrol 300 consecutive patients undergoing surgery for non-metastatic sporadic CRC at the University Hospital of Clermont-Ferrand, France for the identification of specific microbial signatures (from tumour, colonic mucosa and stools samples) associated with particular metabolic profiles that could impact postoperative morbidity and oncologic outcomes, using microbiological, molecular and imaging approaches. The primary outcome is the 5-year overall survival (OS). Other outcomes are 5-year CRC-related OS, 5-year disease-free survival, 30-day postoperative morbidity, 90-day postoperative mortality and length of hospital stay.Ethics and disseminationThis study protocol was reviewed and approved by an independent French regional review board (n°2018-A00352-53, ‘Comité de Protection des Personnes Ile de France VII’ on 4 July 2018, declared to the competent French authority (‘Agence Nationale de Sécurité du Médicament et des produits de santé’, France), and registered on the Clinical Trials web-based platform (NCT 03843905). Oral and written informed consent will be obtained from each included patient. Study results will be reported to the scientific community at conferences and in peer-reviewed scientific journals.Trial registration numberNCT03843905..
Rationale and design for studying organisation of care for intra-arterial thrombectomy in the Netherlands: simulation modelling study
Authors: Lahr Maarten M H , Maas Willemijn J , van der Zee Durk-Jouke , Uyttenboogaart Maarten , Buskens Erik 
Published: January 2020

IntroductionThe introduction of intra-arterial thrombectomy (IAT) challenges acute stroke care organisations to provide fast access to acute stroke therapies. Parameters of pathway performance include distances to primary and comprehensive stroke centres (CSCs), time to treatment and availability of ambulance services. Further expansion of IAT centres may increase treatment rates yet could affect efficient use of resources and quality of care due to lower treatment volume. The aim was to study the organisation of care and patient logistics of IAT for patients with ischaemic stroke in the Netherlands.Methods and analysesUsing a simulation modelling approach, we will quantify performance of 16 primary and CSCs offering IAT in the Netherlands. Patient data concerning both prehospital and intrahospital pathway logistics will be collected and used as input for model validation. A previously validated simulation model for intravenous thrombolysis (IVT) patients will be expanded with data of the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry and trials performed in the Collaboration for New Treatments in Acute Stroke consortium to represent patient logistics, time delays and outcomes in IAT patients. Simulation experiments aim to assess effectiveness and efficiency of alternative network topologies, that is, IAT with or without IVT at the nearest primary stroke centre (PSC) versus centralised care at a CSC. Primary outcomes are IAT treatment rates and clinical outcome according to the modified Rankin Scale. Secondary outcomes include onset-to-treatment time and resource use. Mann-Whitney U and Fisher’s exact tests will be used to estimate differences for continuous and categorical variables. Model and parameter uncertainty will be tested using sensitivity analyses.Ethics and disseminationThis will be the first study to examine the organisation of acute stroke care for IAT delivery on a national scale using discrete event simulation. There are no ethics or safety concerns regarding the dissemination of information, which includes publication in peer-reviewed journals and (inter)national conference presentations.Trial registration numberISRCTN99503308,ISRCTN76741621,ISRCTN19922220,ISRCTN80619088,NCT03608423; Pre-results.
Embedding best transfusion practice and blood management in neonatal intensive care
Authors: Flores Cindy J , Lakkundi Anil , McIntosh Joanne , Freeman Peter , Thomson Amanda , Saxon Ben , Parsons Justine , Spigiel Tracey , Milton Sarah , Ross Bryony 
Published: January 2020

BackgroundTransfusion is a common procedure for neonates receiving intensive care management. Recognising a paucity of patient blood management (PBM) programmes in neonates, we aimed to embed blood management and best transfusion principles in the neonatal intensive care unit (NICU) by aligning local policies, providing targeted education and partnering with parents.MethodsPractice-based evidence for clinical practice improvement (PBE-CPI) methodology was used. Previous hospital accreditation audits were reviewed and a neonate-specific transfusion audit was developed. Audit was performed at baseline and repeated following the intervention period. NICU clinicians received targeted education in obtaining informed consent, prescription and safe administration of blood components during a ‘Blood Month’ awareness period. A neonate-specific parent handout about transfusion was developed in partnership with parents. A pilot video demonstrating a shared consent discussion was also developed to assist in the consent process. Parents’ knowledge, concerns and feedback regarding transfusion practice was sought at baseline (survey) and on project completion (experience trackers).ResultsNeonate-specific baseline transfusion audit showed inconsistent consent, monitoring and documentation processes in neonatal transfusions. Post-targeted education audit showed improvement in these parameters. The targeted PBM and transfusion-related education delivered during ‘Blood Month’ was well-received by staff. Parents’ feedback about the NICU transfusion consenting process was consistently positive. NICU medical and nursing clinicians (n=25) surveyed agreed that the parent handout was well set out, easy to understand and recommended that it be used to complement practice.ConclusionPBE-CPI tools aligned with Australian PBM guidelines for clinicians and parents were well-accepted by clinical stakeholders and were associated with practice improvement in PBM awareness and transfusion consent processes. This PBE-CPI project developed NICU-specific consent information, not previously available, by partnering with parents to ensure quality of care in transfusion practice. Adoption of this also helps to meet accreditation for Australian Blood Management Standards. These strategies and tools translate readily into other NICUs to embed and support best PBM and transfusion practice.
Discrete event simulation modelling to evaluate the impact of a quality improvement initiative on patient flow in a paediatric emergency department
Authors: McKinley Kenneth W , Babineau John , Roskind Cindy G , Sonnett Meridith , Doan Quynh 
Published: January 2020

ObjectiveWe developed a discrete event simulation model to evaluate the impact on system flow of a quality improvement (QI) initiative that included a time-specific protocol to decrease the time to antibiotic delivery for children with cancer and central venous catheters who present to a paediatric ED with fever.MethodsThe model was based on prospective observations and retrospective review of ED processes during the maintenance phase of the QI initiative between January 2016 and June 2017 in a large, urban, academic children’s hospital in New York City, USA. We compared waiting time for full evaluation (WT) and length of stay (LOS) between a model with and a model without the protocol. We then gradually increased the proportion of patients receiving the protocol in the model and recorded changes in WT and LOS.ResultsWe validated model outputs against administrative data from 2016, with no statistically significant differences in average WT or LOS for any emergency severity index (ESI). There were no statistically significant differences in these flow metrics between the model with and the model without the protocol. By increasing the proportion of total patients receiving this protocol, from 0.2% to 1.3%, the WT increased by 2.8 min (95% CI: 0.6 to 5.0) and 7.6 min (95% CI: 2.0 to 13.2) for ESI 2 and ESI 3 patients, respectively. This represents a 14.0% increase in WT for ESI 3 patients.ConclusionsSimulation modelling facilitated the testing of system effects for a time-specific protocol implemented in a large, urban, academic paediatric ED, showing no significant impact on patient flow. The model suggests system resilience, demonstrating no detrimental effect on WT until there is a 7-fold increase in the proportion of patients receiving the protocol.
Physical multimorbidity patterns and depressive symptoms: a nationwide cross-sectional study in Japan
Authors: Aoki Takuya , Yamamoto Yosuke , Shimizu Sayaka , Fukuhara Shunichi 
Published: January 2020

ObjectiveThe associations of physical multimorbidity with depressive symptoms have been investigated in a number of studies. However, whether patterns of chronic physical conditions have comparatively different associations with depressive symptoms remains unclear. This study aimed to investigate the associations of physical multimorbidity patterns with depressive symptoms.DesignThis study was designed as a nationwide cross-sectional survey in Japan.SettingGeneral sample of the Japanese population.ParticipantsAdult Japanese residents were selected by a quota sampling method. Data were analysed from 1788 residents who reported one or more chronic health conditions.ResultsAmong four physical multimorbidity patterns: cardiovascular-renal-metabolic (CRM), skeletal-articular-digestive (SAD), respiratory-dermal (RDE) and malignant-digestive-urologic (MDU), multivariable logistic regression analyses revealed that the RDE pattern showed the strongest association with depressive symptoms (aOR=1.68, 95% CI: 1.21 to 2.31 for the pattern score highest quartile, compared with the lowest quartile), followed by SAD and MDU patterns (aOR=1.41, 95% CI: 1.01 to 1.98 for the SAD pattern score highest quartile; 1.41, 95% CI: 1.01 to 1.96 for the MDU pattern score highest quartile, compared with the lowest quartile). In contrast, the CRM pattern score was not significantly associated with depressive symptoms (aOR=1.31, 95% CI: 0.90 to 1.89 for the pattern score highest quartile, compared with the lowest quartile).ConclusionsPhysical multimorbidity patterns have different associations with depressive symptoms. Among these patterns, patients with the RDE pattern may be at a higher risk for developing depressive symptoms. This study reinforces the evidence that cluster pattern of chronic health conditions is a useful measure for clinical management of multimorbidity as it is differently associated with mental health status, which is one of the crucial outcomes for multimorbid patients.
Burden of injuries in Nepal, 1990–2017: findings from the Global Burden of Disease Study 2017
Authors: Pant Puspa Raj , Banstola Amrit , Bhatta Santosh , Mytton Julie A , Acharya Dilaram , Bhattarai Suraj , Bisignano Catherine , Castle Chris D , Prasad Dhungana Govinda , Dingels Zachary V , Fox Jack T , Kumar Hamal Pawan , Liu Zichen , Bahadur Mahotra Narayan , Paudel Deepak , Narayan Pokhrel Khem , Lal Ranabhat Chhabi , Roberts Nicholas L S , Sylte Dillon O , James Spencer L 
Published: January 2020

BackgroundNepal is a low-income country undergoing rapid political, economic and social development. To date, there has been little evidence published on the burden of injuries during this period of transition.MethodsThe Global Burden of Disease Study (GBD) is a comprehensive measurement of population health outcomes in terms of morbidity and mortality. We analysed the GBD 2017 estimates for deaths, years of life lost, years lived with disability, incidence and disability-adjusted life years (DALYs) from injuries to ascertain the burden of injuries in Nepal from 1990 to 2017.ResultsThere were 16 831 (95% uncertainty interval 13 323 to 20 579) deaths caused by injuries (9.21% of all-cause deaths (7.45% to 11.25%)) in 2017 while the proportion of deaths from injuries was 6.31% in 1990. Overall, the injury-specific age-standardised mortality rate declined from 88.91 (71.54 to 105.31) per 100 000 in 1990 to 70.25 (56.75 to 85.11) per 100 000 in 2017. In 2017, 4.11% (2.47% to 6.10%) of all deaths in Nepal were attributed to transport injuries, 3.54% (2.86% to 4.08%) were attributed to unintentional injuries and 1.55% (1.16% to 1.85%) were attributed to self-harm and interpersonal violence. From 1990 to 2017, road injuries, falls and self-harm all rose in rank for all causes of death.ConclusionsThe increase in injury-related deaths and DALYs in Nepal between 1990 and 2017 indicates the need for further research and prevention interventions. Injuries remain an important public health burden in Nepal with the magnitude and trend of burden varying over time by cause-specific, sex and age group. Findings from this study may be used by the federal, provincial and local governments in Nepal to prioritise injury prevention as a public health agenda and as evidence for country-specific interventions.
Long-term functional outcome following minimally invasive endoscopic intracerebral hemorrhage evacuation
Authors: Kellner Christopher P , Song Rui , Pan Jonathan , Nistal Dominic A , Scaggiante Jacopo , Chartrain Alexander G , Rumsey Jamie , Hom Danny , Dangayach Neha , Swarup Rupendra , Tuhrim Stanley , Ghatan Saadi , Bederson Joshua B , Mocco J 
Published: January 2020

Background and purposePreclinical studies suggest that clot removal may mitigate primary and secondary brain injury following intracerebral hemorrhage (ICH). Although the MISTIE trial did not demonstrate an overall outcome benefit, it did demonstrate outcome benefit from effective reduction of clot burden. Minimally invasive endoscopic ICH evacuation may provide an alternative option for clot evacuation.MethodsPatients presenting to a single healthcare system from December 2015 to October 2018 with supratentorial spontaneous ICH were evaluated for minimally invasive endoscopic evacuation. Inclusion and exclusion criteria were prospectively established by a multidisciplinary group in the healthcare system. The prespecified primary analysis was the proportion of patients with modified Rankin Score (mRS) 0–3 at 6 months.ResultsOne hundred patients met the inclusion and exclusion criteria and underwent minimally invasive endoscopic ICH evacuation. The mean (SD) hematoma size was 49.7 (30.6) mL, the mean (SD) evacuation percentage was 88.2 (20.3)%, and 86% of patients had postoperative residual hematoma ≤15 mL. At 6 months the proportion of patients with an mRS of 0–3 was 46%.ConclusionsThis study suggests that minimally invasive endoscopic ICH evacuation may produce favorable long-term functional outcomes. Further evaluation of this technique in a randomized clinical trial is necessary.