bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reducing Hardships
Authors: Warren Ruby , Herter Joshua 
Published: May 2020

Objective – This study examines The University of Manitoba student attitudes toward technology’s role in University study spaces and in their own educational workflows.
Methods - A series of semi-structured group interviews were conducted with current undergraduate and graduate students at The University of Manitoba. Three group interviews were conducted with questions about individual technology and space use while studying in the library, and three group interviews were conducted with questions about group collaboration using technologies and tools in group study spaces. Transcripts were coded iteratively and separately by the researchers, analyzed for interrater reliability, categorized, and reviewed using axial coding to identify major themes. Through continued examination of these themes, a single theory emerged.
Results - The participants expressed a strong need for independence and feelings of control over their workflows, technological tools, and environments. They discussed how interpersonal concerns and anxieties motivated their workflow choices and acknowledged the (often conflicting) motivational forces of personal necessity and personal preference. When examining the motivations behind the selection of technologies and work practices, it became clear that the respondents make technology and workflow decisions in an attempt to minimize their experience of perceived hardships. These perceived hardships could be social, emotional, educational, environmental, or temporal in nature, and the weight of any one hardship on decision making varied according to the individual.
Conclusions - Libraries should be aware of this foundational user motivation and make choices accordingly - identifying and minimizing hardships whenever possible, unless they are necessary to achieve learning or service-specific goals. Additional research is required to help articulate the nuances experienced by particular student demographics. Librarians and future researchers should also consider investigating the potential disconnect between librarian and user attitudes toward technology, the prioritization of user-centered decision-making, and whether or not systematically disadvantaged social groups have different attitudes toward technology and its place in library spaces and academic work.
Constructing Stability – A Classic Grounded Theory of Next-of-Kin in Palliative Cancer Care
Authors: Harstade Carina Werkander , Sandgren Anna 
Published: May 2020

Abstract
Background: Being next-of-kin to someone with cancer requiring palliative care involves a complex life situation. Changes in roles and relationships might occur and the next-of-kin thereby try to adapt by being involved in the ill person’s experiences and care even though they can feel unprepared for the care they are expected to provide. Therefore, the aim of this study was to develop a classic grounded theory of next-of-kin in palliative cancer care. Method: Forty-two next-of-kin to persons with cancer in palliative phase or persons who had died from cancer were interviewed. Theoretical sampling was used during data collection. The data was analysed using classic Grounded Theory methodology to conceptualize patterns of human behaviour. Results: Constructing stability emerged as the pattern of behaviour through which next-of-kin deal with their main concern; struggling with helplessness. This helplessness includes an involuntary waiting for the inevitable. The waiting causes sadness and frustration, which in turn increases the helplessness. The theory involves; Shielding, Acknowledging the reality, Going all in, Putting up boundaries, Asking for help, and Planning for the inescapable. These strategies can be used separately or simultaneously and they can also overlap each other. There are several conditions that may impact the theory Constructing stability, which strategies are used, and what the outcomes might be. Some conditions that emerged in this theory are time, personal finances, attitudes from extended family and friends and availability of healthcare resources. Conclusions: The theory shows the complexities of being next-of-kin to someone receiving palliative care, while striving to construct stability. This theory can increase healthcare professionals’ awareness of how next-of-kin struggle with helplessness and thus generates insight into how to support them in this struggle.
Traditional and Cortical Trajectory Screws of Static and Dynamic Lumbar Fixation- A Finite Element Study
Authors: Liu Che-Wei , Wang Lu-Lin , Xu Yu-Kun , Chen Chun-Ming , Wang Jian-Cyuan , Tsai Wei-Tsung , Lin Shang-Chih 
Published: May 2020

Abstract
Background : To evaluate kinetic and kinematic behavior in both static and dynamic CBT fixation a finite element study was designed. Two types of screw trajectories are commonly used in lumbar surgery. Both traditional trajectory (TT) and cortical bone trajectory (CBT) provide equivalent pull-out strengths of a screw. Dynesys fixation of TT screws, but not dynamization of CBT screws, has been used extensively in lumbar surgery. This study aimed to simulate the biomechanics of CBT-based dynamic system for an evaluation of CBT dynamization.Methods: A validated nonlinearly lumbosacral finite-element model was used to simulate four variations of screw fixation. Responses of both implant (screw stress) and tissues (disc motion, disc stress, and facet force) at the upper adjacent (L3-L4) and fixed (L4-L5) segments were used as the evaluation indices. Flexion, extension, bending, and rotation of both TT and CBT screws were simulated in this study for comparison.Results: The results showed that the TT static was the most effective stabilizer to the L4-L5 segment, followed by CBT static, TT dynamic, and the CBT dynamic, which was the least effective. Dynamization of the TT and CBT fixators decreased stability of the fixed segment and alleviate adjacent segment stress compensation. The 3.5-mm diameter CBT screw deteriorated stress distribution and rendered it vulnerable to bone-screw loosening and fatigue cracking.Conclusions: A systematic analysis of the effects of TT and CBT fixation constructs on kinematic and kinetic responses in a full lumbosacral model is currently lacking. This study examined both the static fixation effect and its dynamic counterpart and identified that dynamization of CBT have slightly inferior structural stiffness than dynamic TT and cautious preoperative evaluation is essential if 3.5-mm diameter CBT screws are used. Therefore, 4.5-mm or 5.5-mm diameter CBT screws, or as big as tolerated, are recommended to avoid loosening and cracking.
Efficacy of Parent-Infant-Psychotherapy with mothers with postpartum mental disorder: study protocol of the randomized controlled trial as part of the SKKIPPI project.
Authors: Mattheß Janna , Eckert Melanie , Richter Katharina , Koch Gabriele , Reinhold Thomas , Vienhues Petra , Berghöfer Anne , Roll Stephanie , Keil Thomas , Schlensog-Schuster Franziska , von Klitzing Kai , Ludwig-Körner Christiane , Kuchinke Lars 
Published: May 2020

Abstract
Background: After the birth of a child, many mothers and fathers experience postpartum mental disorders like depression, anxiety, obsessive-compulsive disorder, stress or other illnesses. This endangers the establishment of a secure attachment between the children and their primary caregivers. Early problems in parent-child interaction can have adverse long-term effects on the family and the child’s well-being. In order to prevent a transgenerational transmission of mental disorders, it is necessary to evaluate psychotherapeutic interventions that target psychologically burdened parents of infants or toddlers. The aim of this trial is to investigate the efficacy of Parent-Infant-Psychotherapy (PIP) for mothers with postpartum mental disorder and their infants (0-12 month).Methods: In this open randomized controlled intervention trial 180 mother-infant dyads will be included and randomly allocated to 12 sessions of PIP or care as usual. The interventions take place either in inpatient adult psychiatric departments or in outpatient settings with home visits. The primary outcome is the change in maternal sensitivity assessed by the Sensitivity subscale of the Emotional Availability Scale (EAS) through videotaped dyadic play-interactions after 6 weeks. Secondary outcomes are maternal psychopathology, stress, parental reflective functioning, infant development and attachment after 6 weeks and 12 months. In addition, maternal attachment (AAI) and reflective functioning (AAI) will be analyzed as potential moderators, and resource usage in the German health system as well as associated costs will be evaluated. Discussion: There is increasing demand for well-controlled studies on psychotherapeutic interventions in the postpartum period that do not only focus on particular risk groups. This RCT represents one of the first studies to investigate the efficacy of PIP in inpatient psychiatric departments and outpatient care centres in Germany. The results will fill knowledge gaps on the factors contributing to symptom reduction in postpartum mental disorders and improvements in mother-child relationships and help developing preventive and therapeutic strategies for the fragmented German health care system.Trial registration: German Register for Clinical Trials: DRKS00016353.
Utilization pattern of kangaroo mother care after introduction in eight selected neonatal intensive care units in China
Authors: Liu Xin , Li Zhankui , Chen Xiaohui , Cao Bei , Yue Shaojie , Yang Changyi , Liu QiongYu , Yang Chuanzhong , Zhao Gengli , Feng Qi 
Published: May 2020

Abstract
Background: Kangaroo mother care (KMC) is an evidence-based and cost-effective intervention that could prevent severe complications for preterm babies, however it has not been widely adopted in China. In this study, we aim to investigate the feasibility and parental experience of adopting KMC in a Chinese context by studying the implementation of a KMC program in eight self-selected neonatal intensive care units (NICUs).Methods: A cross-sectional study of 135 preterm infants discharged from eight NICUs in April 2018. For infants information was collected on postnatal day and corrected gestational age (GA) at KMC initiation, frequency and duration of KMC provision and whether the infant was receiving respiratory support. A nurse-administered questionnaire on parents’ knowledge and experience of KMC provision was administered to parents providing KMC.Results: 135 preterm infants received KMC, 21.2% of all preterm infants discharged. 91.1% of those who received KMC were below 34 weeks GA, 91.1% had a birth weight below 2000g, and 20.7% needed respiratory support at KMC initiation. Average KMC exposure was greater in infants born at GA <28 weeks that babies born at greater GA. 94.8% of parents that participated in the parental survey indicated that KMC was positively accepted by their family members; 60.4% of the parents claimed that KMC could relieve anxiety, 57.3% claimed it prompted more interactions with medical staff and 69.8% suggested it increased parental confidence in care for their infants.Conclusions: After advocacy, training and promotion, intermittent KMC was initiated on more immature and high-risk infants, and well-accepted by parents. We suggest continuing to promote KMC education to parents and enhancing preterm infant health.
Randomized trial: inflammatory response to corticoids versus placebo in moderate and severe bronchiolitis. COTHEBstudy.
Authors: Felipe Aida , Balaguer Mònica , Alejandre Carme , Esteban Elisabeth , Alsina Laia , Muñoz-Almagro Carmen , Esteban Maria Esther , Cambra Francisco José , Jordan Iolanda 
Published: May 2020

Abstract
Background: The use of corticosteroids has been shown not to improve the prognosis of patients with bronchiolitis, but it could be assumed that steroids will reduce inflammation. This study aimed to assess whether corticoid therapy influenced the inflammatory and clinical response of critically ill infants. Methods: Prospective, randomized, double blind placebo-controlled trial of glucocorticoids (GCT) in infants of less than 12 monthswith severe or moderate bronchiolitis. Patients were randomized to receive systemic corticoid therapy or placebo. The main outcomes were: a) levels of lymphocyte subsets; b) levels of IL-2, IL-12, and IFNγ as pro-inflammatory factors,and c) levels of IL-4 and IL-10 as anti-inflammatory response. Secondary outcomes related with the clinical response were also analyzed. Results: 97 patients were randomized. Evolution of lymphocyte subsets was similar in both groups. Pro-inflammatory interleukins and interferon decreased, but without differences. Anti-inflammatory interleukins showed a significant decrease from baseline to the end of the study, and IL-10 values were significantly lower (p = 0.046) in the GCT group [1.82 pg/ml (1.2-3.5)] vs non-GCT [4 pg/ml (1.5-6.3)]. GCT group showed a lower time of mechanical ventilation and of hospitalization, but without statistically significant differences. No cases of severe adverse reaction to steroids were detected. Conclusions: administration of systemic GCT did not modify the inflammatory nor the clinical response of patients with severe bronchiolitis, except for IL-10 levels that were significantly lower in the GCT group. This can open a line of investigation about the relation of IL-10 and response to bronchiolitis.Trial registration: Glucocorticoid Therapy Impact on the Inflammatory Response and Clinical Evolution in Patients With Severe Bronchiolitis, Clinical Trials.gov registration number: NCT02571517.Study start date: Nov 2011.
Percutaneous stent placement for malignant hilar biliary obstruction: side-by-side versus stent-in-stent technique
Authors: Zhou Wei-zhong , Liu Sheng , Yang Zheng-Qiang , Xian Yu-Tao , Xu Hong-Dou , Wu Jun-Zheng , Shi Hai-bin 
Published: May 2020

Abstract
Background: Currently, side-by-side (SBS) and stent-in-stent (SIS) are the two main techniques for stent deployment to treat hilar biliary obstructions. Previous studies comparing these two techniques are very limited, and thus, no consensus has been reached on which technique is better. The purpose of this study is to compare the clinical efficacy and safety of SBS and SIS deployment via a percutaneous approach for malignant hilar biliary obstruction.Methods: From July 2012 to April 2019, 65 patients with malignant hilar biliary obstruction who underwent bilateral stenting using either the SBS or SIS techniques were included in this study. Among them, 27 patients underwent SIS stent insertion (SIS group), and the remaining 38 patients underwent SBS stent insertion (SBS group). Technical success, improvement of jaundice, complications, duration of stent patency, and overall survival were evaluated.Results: Technical success was achieved in all patients in the two groups. The serum bilirubin level decreased more rapidly 1 week after the procedures in the SBS group than in the SIS group (P=0.02). Although the total complication rate did not differ between the two groups, cholangitis was found to be more frequent in the SIS group (P=0.04). The median stent patency was significantly longer in the SBS group (149 days) than in the SIS group (75 days; P=0.02). The median overall survival did not significantly differ between the two groups (SBS vs. SIS, 155 days vs. 143 days; P>0.05).Conclusions: Percutaneous transhepatic bilateral stenting using either the SBS or SIS technique is safe and effective in the management of malignant hilar biliary obstruction. However, SBS offers a quicker improvement of jaundice, a lower incidence of cholangitis after the procedure, and a longer stent patency period than SIS.
Maximum emergency department overcrowding is correlated with occurrence of unexpected cardiac arrest
Authors: Kim June-sung , Bae Hyun-Jin , Sohn Chang Hwan , Cho Sung-Eun , Hwang Jeongeun , Kim Won Young , Kim Namkug , Seo Dong-Woo 
Published: May 2020

Abstract
Background Emergency department overcrowding negatively impacts critically ill patients and could lead to the occurrence of cardiac arrest. However, association between emergency department crowding and occurrence of in-hospital cardiac arrest has not been thoroughly investigated. This study aimed to evaluate the correlation between emergency department occupancy rates and incidence of in-hospital cardiac arrest. Methods A single-center, observational, registry-based cohort study was performed including all consecutive adult, non-traumatic in-hospital cardiac arrest patients between January 2014 and June 2017. We used emergency department occupancy rates as a crowding index at time of presentation time of cardiac arrest and at the time of maximum crowding, and the average crowding rate for the duration of emergency department stay for each patient. To calculate incidence rate, we divided the number of arrest cases for each emergency department occupancy period by accumulated time. The primary outcome is association between the incidence of in-hospital cardiac arrest and emergency department occupancy rates. Results During the study period, 629 adult, non-traumatic cardiac arrest patients were enrolled in our registry. Among these, 187 patients experienced in-hospital cardiac arrest. Overall survival discharge rate was 24.6%, and 20.3% of patients showed favorable neurologic outcomes at discharge. Emergency department occupancy rates were positively correlated with in-hospital cardiac arrest occurrence. Moreover, maximum emergency department occupancy in the critical zone had the strongest positive correlation with in-hospital cardiac arrest occurrence (Spearman rank correlation ρ = 1.0, P < .01). Meanwhile, occupancy rates were not associated with the ED mortality. Conclusion Maximum emergency department occupancy was strongly associated with in-hospital cardiac arrest occurrence. Adequate monitoring and managing the maximum occupancy rate would be important to reduce unexpected cardiac arrest.
Predictors of infant-survival practices among mothers attending paediatric clinics in Ijebu-Ode, Ogun State, Nigeria
Authors: Sokefun Eniolufolake Elizabeth , Atulomah Nnodimele Onuigbo 
Published: May 2020

Abstract
Background: Despite concerted global efforts towards achieving infant-survival, infant mortality lingers as a problem in developing countries. Environmental and personal-level factors are assumed to account for this situation. This study was undertaken to provide better understanding of the dynamics of predictors of infant-survival practices among mothers with infants attending paediatric clinics.Methods: A cross-sectional survey design was adopted. Data was collected from 386 nursing mothers selected by convenience sampling. Interviewer-administered questionnaires were used for data collection. The questionnaire consisted of 38-items including demographic information of respondents, health-literacy counsels received during antenatal care, social-support from significant others, and self-efficacy to carry-out infant-survival instructions. Responses were transformed into rating scales for each variable and data analysis was conducted by linear regression analysis with test of hypotheses at 5% level of significance.Results: The mean age of respondents was 29.8 ± 5.8 years. Majority (81.6%) were married. Yorubas (83.90%) were predominant. Participants had mean scores of 10.50±3.83, 10.56±3.70 and 16.61±4.56 respectively computed for levels of health-literacy, social-support, and self-efficacy. The dependent variable measured level of infant-survival practices and respondents scored 16.53±4.71. The study found a significant association among variables. Self-efficacy was the major predictor variable of self-reported infant-survival practices (R=0.466; R2=0.217; P˂0.05).Conclusion: We conclude that participants had average levels of health-literacy, social-support, self-efficacy, and infant-survival practices. Healthcare providers should make efforts to empower pregnant women on activities essential for infant-survival. Family members of nursing mothers should as well be knowledgeable about the advantages of supporting them.
40 years after Alma Ata: How people trust in primary health care?
Authors: Bazargani Homayoun Sadeghi , Saadati Mohammad , Tabrizi Jafar Sadegh , Farahbakhsh Mostafa , Golestani Mina 
Published: May 2020

Abstract
Background: Primary Health Care (PHC) was introduced as the first level of health services delivery after Alma Ata declaration. It needs to be more trustful to achieve its defined goals. Public trust in PHC is one of the ignored issues in the context. The aim of this study was to explore public trust in PHC in Iran.Methods: This was a household survey study conducted in East Azerbaijan Province, Iran. Two-stage cluster sampling method with probability proportional to size (PPS) approach was used. Totally 1178 households were enrolled in the study. PHC trust questionnaire and Ultra-short version of socio-economic status assessment questionnaire (SES-Iran) was used for data collection. Data were analyzed using STATA 15 through descriptive statistics and linear regression. Results: The mean age of the participants was 41.2, (SD: 15.1) and most of them (53.7%) were female. Mean score of PHC trust was 56.9±24.7 (out of 100). It was significantly different between inhabitants of Tabriz (the province capital city) and other cities in the province (p<0.001). Linear regression showed that younger age, gender, insurance type, being married and households higher socio-economic situation had a significant positive influence on PHC trust level with R2 = 0.14383 .Conclusions: Public trust in PHC system in Iran needs to be improved. Individual variables had a small but significant share in trust level. PHC trust not only influenced by individual variables and experience but also by health system and health providers characteristics and public sphere about PHC system. PHC trust level could be used as a public indicator in health systems especially in Low and Middle income countries to lead system strengthening policies in national and international levels.