bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of pain reduction following manual therapy in patients with temporomandibular disorders: a protocol for a prospective observational study
Authors: Asquini Giacomo , Bianchi Andrea Edoardo , Heneghan Nicola R , Rushton Alison B , Borromeo Giulia , Locatelli Matteo , Falla Deborah 
Published: November 2019

IntroductionTemporomandibular disorders (TMDs) are principally characterised by pain in the craniomandibular area and probable limitations of jaw opening. Manual therapy, like other recommended conservative treatments included in clinical guidelines, is commonly used to treat patients with TMD to reduce pain and improve function. However, outcomes may be variable. The aim of this study is to identify predictors associated with pain reduction in patients with TMD following manual therapy by analysing a combination of patient-reported outcome measures and clinical tests. Such knowledge will support a more personalised management approach by facilitating clinical decision-making.Methods/analysisAn observational prospective design will recruit a cohort of 100 adults with a diagnosis of TMD (according to Axis I of the Diagnostic Criteria for TMD) at a Dental Hospital in Italy. Patients will be treated with four weekly sessions of manual therapy applied to craniomandibular structures. An array of predictors has been chosen based on previous research on prognostic factors for TMD and altered pain modulation in musculoskeletal disorders. Candidate predictors including demographic variables, general health variables, psychosocial features, TMD characteristics and clinical tests of the temporomandibular joint and masticatory muscles will be collected at baseline. Definition of good outcome is a clinically significant reduction of pain intensity over the last week (≥30% reduction Visual Analogue Scale) immediately following the four week intervention. Exploratory factor analysis will be applied to analyse factor loading of candidate predictors for good outcome at four weeks. Subsequently, a logistic multivariable regression model will be performed to calculate low and high risk of good outcome.Ethics and disseminationEthical approval has been obtained from the ‘Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico’ and University of Birmingham Ethics Committee. The results will be submitted for publication in a peer-reviewed journal and presented at conferences.Trial registration numberNCT03990662; Pre-results.
Barriers and enablers to monitoring and deprescribing opioid analgesics for chronic non-cancer pain: protocol for a qualitative evidence synthesis using the Theoretical Domains Framework
Authors: Cross Amanda J , Buchbinder Rachelle , Bourne Allison , Maher Christopher , Mathieson Stephanie , Lin Chung-Wei C , O’Connor Denise A 
Published: November 2019

IntroductionThe over-prescription and overuse of opioid analgesics for chronic non-cancer pain (CNCP) is a growing issue. Synthesis of evidence about the barriers and enablers to reducing long-term opioid prescribing and use will enable the development of tailored interventions to address both problems.ObjectiveTo synthesise the barriers and enablers to monitoring the ongoing appropriateness of opioid treatment and deprescribing opioids for CNCP from the clinician, patient and general public point of view, and to map the findings to the Theoretical Domains Framework (TDF).Methods and analysisWe will perform a qualitative evidence synthesis using the TDF. We will include qualitative research that has explored clinician, patient and the general public’s perceptions regarding barriers and enablers to monitoring and deprescribing opioids for CNCP. Studies will be identified via searches in MEDLINE, EMBASE, CINAHL, AMED and PsycINFO. Databases will be searched from inception to July 2019, and the studies must be published in English. Article selection and data extraction will be completed independently by two review authors. Methodological quality of included studies will be independently assessed by two review authors using the Critical Appraisal Skills Programme quality assessment tool. We will conduct thematic synthesis and then map identified themes and sub-themes to TDF domains. Confidence in synthesis findings will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation Confidence in the Evidence from Reviews of Qualitative Research tool.Ethics and disseminationEthical approval is not required to conduct this review. We will publish the results in a peer-reviewed journal.PROSPERO registration numberCRD42019140784
Work systems analysis of sterile processing: decontamination
Authors: Alfred Myrtede , Catchpole Ken , Huffer Emily , Fredendall Larry , Taaffe Kevin M 
Published: November 2019

BackgroundFew studies have explored the work of sterile processing departments (SPD) from a systems perspective. Effective decontamination is critical for removing organic matter and reducing microbial levels from used surgical instruments prior to disinfection or sterilisation and is delivered through a combination of human work and supporting technologies and processes.ObjectiveIn this paper we report the results of a work systems analysis that sought to identify the complex multilevel interdependencies that create performance variation in decontamination and identify potential improvement interventions.MethodsThe research was conducted at a 700-bed academic hospital with two reprocessing facilities decontaminating approximately 23 000 units each month. Mixed methods, including 56 hours of observations of work as done, formal and informal interviews with relevant stakeholders and analysis of data collected about the system, were used to iteratively develop a process map, task analysis, abstraction hierarchy and a variance matrix.ResultsWe identified 21 different performance shaping factors, 30 potential failures, 16 types of process variance, and 10 outcome variances in decontamination. Approximately 2% of trays were returned to decontamination from assembly, while decontamination problems were found in about 1% of surgical cases. Staff knowledge, production pressures, instrument design, tray composition and workstation design contributed to outcomes such as reduced throughput, tray defects, staff injuries, increased inventory and equipment costs, and patient injuries.ConclusionsEnsuring patients and technicians’ safety and efficient SPD operation requires improved design of instruments and the decontamination area, skilled staff, proper equipment maintenance and effective coordination of reprocessing tasks.
Communicating with patients about breakdowns in care: a national randomised vignette-based survey
Authors: Fisher Kimberly A , Gallagher Thomas H , Smith Kelly M , Zhou Yanhua , Crawford Sybil , Amroze Azraa , Mazor Kathleen M 
Published: November 2019

BackgroundMany patients are reluctant to speak up about breakdowns in care, resulting in missed opportunities to respond to individual patients and improve the system. Effective approaches to encouraging patients to speak up and responding when they do are needed.ObjectiveTo identify factors which influence speaking up, and to examine the impact of apology when problems occur.DesignRandomised experiment using a vignette-based questionnaire describing 3 care breakdowns (slow response to call bell, rude aide, unanswered questions). The role of the person inquiring about concerns (doctor, nurse, patient care specialist), extent of the prompt (invitation to patient to share concerns) and level of apology were varied.SettingNational online survey.Participants1188 adults aged ≥35 years were sampled from an online panel representative of the entire US population, created and maintained by GfK, an international survey research organisation; 65.5% response rate.Main outcomes and measuresAffective responses to care breakdowns, intent to speak up, willingness to recommend the hospital.ResultsTwice as many participants receiving an in-depth prompt about care breakdowns would (probably/definitely) recommend the hospital compared with those receiving no prompt (18.4% vs 8.8% respectively (p=0.0067)). Almost three times as many participants receiving a full apology would (probably/definitely) recommend the hospital compared with those receiving no apology (34.1% vs 13.6% respectively ((p<0.0001)). Feeling upset was a strong determinant of greater intent to speak up, but a substantial number of upset participants would not ‘definitely’ speak up. A more extensive prompt did not result in greater likelihood of speaking up. The inquirer’s role influenced speaking up for two of the three breakdowns (rudeness and slow response).ConclusionsAsking about possible care breakdowns in detail, and offering a full apology when breakdowns are reported substantially increases patients’ willingness to recommend the hospital.
Hospice at Home services in England: a national survey
Authors: Rees-Roberts Melanie , Williams Peter , Hashem Ferhana , Brigden Charlotte , Greene Kay , Gage Heather , Goodwin Mary , Silsbury Graham , Wee Bee , Barclay Stephen , Wilson Patricia M , Butler Claire 
Published: November 2019

ObjectiveHospice at Home (HAH) services aim to enable patients to be cared for and die at home, if that is their choice and achieve a ‘good death’. A national survey, in 2017, aimed to describe and compare the features of HAH services and understand key enablers to service provision.MethodsService managers of adult HAH services in the ‘Hospice UK’ and National Association for Hospice at Home directories within England were invited to participate. Information on service configuration, referral, staffing, finance, care provision and enablers to service provision were collected by telephone interview.ResultsOf 128 services invited, 70 (54.7%) provided data. Great diversity was found. Most services operated in mixed urban/rural (74.3%) and mixed deprivation (77.1%) areas and provided hands-on care (97.1%), symptom assessment and management (91.4%), psychosocial support (94.3%) and respite care (74.3%). Rapid response (within 4 hours) was available in 65.7%; hands-on care 24 hours a day in 52.2%. Charity donations were the main source of funding for 71.2%. Key enablers for service provision included working with local services (eg, district nursing, general practitioner services), integrated health records, funding and anticipatory care planning. Access to timely medication and equipment was critical.ConclusionThere is considerable variation in HAH services in England. Due to this variation it was not possible to categorise services into delivery types. Services work to supplement local care using a flexible approach benefitting from integration and funding. Further work defining service features related to patient and/or carer outcomes would support future service development.
Linear perturbations of an anisotropic Bianchi I model with a uniform magnetic field
Authors: Di Gioia Federico , Montani Giovanni 
Published: November 2019

AbstractIn this work, we study the effect of a magnetic field on the growth of cosmological perturbations. We develop a mathematical consistent treatment in which a perfect fluid and a uniform magnetic field evolve together in a Bianchi I universe. We then study the energy density perturbations on this background with particular emphasis on the effect of the background magnetic field. We develop a full relativistic solution which refines previous analysis in the relativistic limit, recovers the known ones in the Newtonian treatment with adiabatic sound speed, and it adds anisotropic effects to the relativistic ones for perturbations with wavelength within the Hubble horizon. This represents a refined approach on the perturbation theory of an isotropic universe in GR, since most of the present studies deal with fully isotropic systems.
Inflation with derivative self-interaction and coupling to gravity
Authors: Tumurtushaa Gansukh 
Published: November 2019

Abstract
We consider a subclass of Horndeski theories for studying cosmic inflation. In particular, we investigate models of inflation in which the derivative self-interaction of the scalar field and the non-minimal derivative coupling to gravity are present in the action and equally important during inflation. In order to control contributions of each term as well as to approach the single-term limit, we introduce a special relation between the derivative interaction and the coupling to gravity. By calculating observable quantities including the power spectra and spectral tilts of scalar and tensor perturbation modes, and the tensor-to-scalar ratio, we found that the tensor-to-scalar ratio is suppressed by a factor of $$(1+1/\gamma )$$(1+1/γ), where $$\gamma $$γ reflects the strength of the derivative self-interaction of the inflaton field with respect to the derivative coupling gravity. We placed observational constraints on the chaotic and natural inflation models and showed that the models are consistent with the current observational data mainly due to the suppressed tensor-to-scalar ratio.
Sequential activation of multiple persistent inward currents induces staircase currents in serotonergic neurons of medulla in ePet-EYFP mice
Authors: Cheng Yi , Zhang Qiang , Dai Yue 
Published: November 2019

Persistent inward currents (PICs) are widely reported in rodent spinal neurons. A distinctive pattern observed recently is staircase-like PICs induced by voltage ramp in serotonergic neurons of mouse medulla. The mechanism underlying this pattern of PICs is unclear. Combining electrophysiological, pharmacological, and computational approaches, we investigated the staircase PICs in serotonergic neurons of medulla in ePet-EYFP transgenic mice (postnatal days 1–7). Staircase PICs induced by 10-s voltage biramps were observed in 70% of serotonergic neurons ( n = 73). Staircase PICs activated at −48.8 ± 5 mV and consisted of two components, with the first PIC of 45.8 ± 51 pA and the second PIC of 197.3 ± 126 pA ( n = 51). Staircase PICs were also composed of low-voltage-activated sodium PIC (Na-PIC; onset −46.2 ± 5 mV, n = 34), high-voltage-activated calcium PIC (Ca-PIC; onset −29.3 ± 6 mV, n = 23), and high-voltage-activated tetrodotoxin (TTX)- and dihydropyridine-resistant sodium PIC (TDR-PIC; onset −16.8 ± 4 mV, n = 28). Serotonergic neurons expressing Na-PIC, Ca-PIC, and TDR-PIC were evenly distributed in medulla. Bath application of 1–2 μM TTX blocked the first PIC and decreased the second PIC by 36% ( n = 23, P < 0.05). Nimodipine (25 μM) reduced the second PIC by 38% ( n = 34, P < 0.001) without altering the first PIC. TTX and nimodipine removed the first PIC and reduced the second PIC by 59% ( n = 28, P < 0.01). A modeling study mimicked the staircase PICs and verified experimental conclusions that sequential activation of Na-PIC, Ca-PIC, and TDR-PIC in order of voltage thresholds induced staircase PICs in serotonergic neurons. Further experimental results suggested that the multiple components of staircase PICs play functional roles in regulating excitability of serotonergic neurons in medulla. NEW & NOTEWORTHY Staircase persistent inward currents (PICs) are mediated by activation of L-type calcium channels in dendrites of mouse spinal motoneurons. A novel mechanism is explored in this study. Here we report that the staircase PICs are mediated by sequentially activating sodium and calcium PICs in serotonergic neurons of mouse medulla.
Consultoria e ligação em saúde mental na perspectiva da equipe da Estratégia de Saúde da Família
Authors: Zanetti Ana Carolina Guidorizzi , Galera Sueli Aparecida Frari , Souza Jacqueline De , Vedana Kelly Graziani Giacchero , Gherardi-Dona Edilaine Cristina da Silva , Luis Margarita Antonia Villar , Camargo Lisa Laredo de , Marques João Mazzoncini de Azevedo 
Published: November 2019

Objetivo: analisar as atividades de consultoria e ligação, realizadas pelos profissionais especializados em Saúde Mental, na perspectiva dos profissionais da ESF. Método: estudo exploratório, realizado em cinco núcleos de Saúde da Família, em um município do interior paulista, em 2010. Os dados foram obtidos por meio de entrevistas, os quais foram submetidos à Análise de Conteúdo. Resultados: as atividades de consultoria e ligação mostraram-se como um espaço de aprendizado mútuo entre especialistas de Psiquiatria e Saúde Mental e equipes da ESF. Conclusão: recomenda-se a ampliação do número de atividades que articulem as ações de saúde mental com a ESF, como a consultoria e ligação, a fim favorecer a sensibilidade das equipes para as demandas de saúde mental na ESF e consolidação da integralidade do cuidado.
Characteristics and Healthcare Utilization Among Veterans Treated for Heart Failure With Reduced Ejection Fraction Who Switched to Sacubitril/Valsartan
Authors: Mohanty April F. , Levitan Emily B. , Dodson John A. , Vardeny Orly , King Jordan B. , LaFleur Joanne , He Tao , Patterson Olga V. , Alba Patrick R. , Russo Patricia A. , Choi Michelle E. , Bress Adam P. 
Published: November 2019

Background:
US guidelines recommend that patients with heart failure with reduced ejection fraction (HFrEF), who tolerate an ACEI (angiotensin-converting enzyme inhibitor) or ARB (angiotensin II receptor blocker), be switched to sacubitril/valsartan to reduce morbidity and mortality. We compared characteristics and healthcare utilization between Veterans with HFrEF who were switched to sacubitril/valsartan versus maintained on an ACEI or ARB.

Methods:
retrospective cohort study of treated HFrEF (July 2015–June 2017) using Veterans Affairs data. The index date was the first fill for sacubitril/valsartan and if none, for an ACEI or ARB. Treated HFrEF was defined by (1) left ventricular ejection fraction ≤40%, (2) ≥1 in/outpatient HF encounter, and (3) ≥1 ACEI or ARB fill, all within 1-year preindex. Poisson regression models were used to compare baseline characteristics and 1:1 propensity score-matched adjusted 4-month follow-up healthcare utilization between sacubitril/valsartan switchers and ACEI or ARB maintainers.

Results:

Switchers (1612; 4.2%) were less likely than maintainers (37 065; 95.8%) to have a history of myocardial infarction or hypertension, and more likely to be black, have a lower left ventricular ejection fraction, and higher preindex healthcare utilization. Switchers were less likely to experience follow-up all-cause hospitalizations (11.2% versus 14.0%; risk ratio 0.80 [95% CI, 0.65–0.98],
P
value 0.035).

Conclusions:
Few Veterans with treated HFrEF were switched to sacubitril/valsartan within the first 2 years of Food and Drug Administration approval. Sacubitril/valsartan use was associated with a lower risk for all-cause hospitalizations at 4 months follow-up. Reasons for lack of guideline-recommended sacubitril/valsartan initiation warrant investigation and may reveal opportunities for HFrEF care optimization.
Long-Term Survival After Heart Transplantation at Centers Stratified by Short-Term Performance
Authors: Singh Tajinder P. , Mehra Mandeep R. , Gauvreau Kimberlee 
Published: November 2019

Background:
Center differences in short-term survival after heart transplant (HT) are known. We sought to compare long-term graft survival (freedom from death or retransplantation) at currently active United States HT centers stratified by performance for short-term survival.

Methods:
We used the Organ Procurement and Transplant Network database to identify subjects ≥18 years old who received primary HT during 2000 to 2014 at US centers active during 2013 and 2014. Follow-up was available until March 2016. Center case-mix was assessed by computing expected 90-day mortality and short-term performance by 90-day standardized mortality ratio (SMR; observed/expected mortality). Centers were stratified by case-mix as transplanting low-, intermediate-, and high-risk patients and by short-term performance as SMR quintiles. Center-level differences in long-term graft survival were assessed by risk-adjusted, mixed-effects Weibull survival models with center as a random effect.

Results:

We analyzed 25 467 HT recipients at 96 centers. Those receiving HT at centers with superior (lower) 90-day SMR had longer graft survival (
P
for trend <0.001). Survival difference among SMR groups remained significant in 90-day conditional survivors (
P
for trend <0.001). There was significant center-level variation in risk-adjusted graft survival censored at 5 years (
P
<0.001) and with all follow-up (
P
<0.001). Adjusting for 90-day SMR was associated with 62% reduction in center variation in 5-year graft survival and 56% reduction in center variation in overall graft survival.

Conclusions:
HT recipients at centers with superior short-term outcomes have longer graft survival on long-term follow-up. Allocating resources to improve patient care processes and transplant expertise at high-SMR centers may improve short-term and overall survival after HT.
Value of Computed Tomography Radiomic Features for Differentiation of Periprosthetic Mass in Patients With Suspected Prosthetic Valve Obstruction
Authors: Nam Kyungsun , Suh Young Joo , Han Kyunghwa , Park Sang Joon , Kim Young Jin , Choi Byoung Wook 
Published: November 2019

Background:
We aimed to determine whether quantitative computed tomography radiomic features can aid in differentiating between the causes of prosthetic valve obstruction (PVO) in patients who had undergone prosthetic valve replacement.

Methods:
This retrospective study included 39 periprosthetic masses in 34 patients who underwent cardiac computed tomography scan from January 2014 to August 2017 and were clinically suspected as PVO. The cause of PVO was assessed by redo-surgery and follow-up imaging as standard reference, and classified as pannus, thrombus, or vegetation. Visual analysis was performed to assess the possible cause of PVO on axial and valve-dedicated views. Computed tomography radiomic analysis of periprosthetic masses was performed and radiomic features were extracted. The advantage of radiomic score compared with visual analysis for differentiation of pannus from other abnormalities was assessed.

Results:

Of 39 masses, there were 20 cases of pannus, 11 of thrombus, and 8 of vegetation on final diagnosis. The radiomic score was significantly higher in the pannus group compared with nonpannus group (mean, −0.156±0.422 versus −0.883±0.474;
P
<0.001). The area under the curve of radiomic score for diagnosis of pannus was 0.876 (95% CI, 0.731–0.960). Combination of radiomic score and visual analysis showed a better performance for the differentiation of pannus than visual analysis alone.

Conclusions:
Compared with visual analysis, computed tomography radiomic features may have added value for differentiating pannus from thrombus or vegetation in patients with suspected PVO.