bluuebunny/crossref_metadata_2025_split huggingface dataset:
Protocol for a national cohort study to explore the long-term clinical and patient-reported outcomes and cost-effectiveness of implant-based and autologous breast reconstruction after mastectomy for breast cancer: the brighter study
Authors: Johnson Leigh , Holcombe Chris , O’Donoghue Joe M , Jeevan Ranjeet , Browne John , Fairbrother Patricia , MacKenzie Mairead , Gulliver-Clarke Carmel , White Paul , Mohiuddin Syed , Hollingworth William , Potter Shelley 
Published: August 2021

IntroductionBreast reconstruction (BR) is offered to improve quality of life for women with breast cancer undergoing mastectomy. As most women will be long-term breast cancer survivors, high-quality information regarding the long-term outcomes of different BR procedures is essential to support informed decision-making. As different techniques vary considerably in cost, policymakers also require high-quality cost-effectiveness evidence to inform care. The Brighter study aims to explore the long-term clinical and patient-reported outcomes (PROs) of implant-based and autologous BR and use health economic modelling to compare the long-term cost-effectiveness of different reconstructive techniques.Methods and analysisWomen undergoing mastectomy and/or BR following a diagnosis of breast cancer between 1 January 2008 and 31 March 2009 will be identified from hospital episode statistics (HES). Surviving women will be contacted and invited to complete validated PRO measures including the BREAST-Q, EQ-5D-5L and ICECAP-A, or opt out of having their data included in the HES analysis. Long-term clinical outcomes will be explored using HES data. The primary outcome will be rates of revisional surgery between implant-based and autologous procedures. Secondary outcomes will include rates of secondary reconstruction and reconstruction failure. The long-term PROs of implant-based and autologous reconstruction will be compared using BREAST-Q, EQ-5D-5L and ICECAP-A scores. Multivariable regression will be used to examine the relationship between long-term outcomes, patient comorbidities, sociodemographic and treatment factors. A Markov model will be developed using HES and PRO data and published literature to compare the relative long-term cost-effectiveness of implant-based and autologous BR.Ethics and disseminationThe Brighter study has been approved by the South-West -Central Bristol Research Ethics Committee (20/SW/0020), and the Confidentiality Advisory Group (20/CAG/0021). Results will be published in peer-reviewed journals and presented at national meetings. We will work with the professional associations, charities and patient groups to disseminate the results.
Waking Up in Pain: a prospective unselected cohort study of pain in 3702 patients immediately after surgery in the Danish Realm
Authors: Rasmussen Anders Mølgaard , Toft Mette Helene , Awada Hussein Nasser , Dirks Jesper , Brandsborg Birgitte , Rasmussen Line Kirkegaard , Kirkegaard Ellen , Hasfeldt-Hansen Dorthe , Larsen Thomas Egemose , Charalampidis Georgios , Mørk Emilie Louise Schjøtt , Rosager Chirstine Linaa , Salam Idress Ahmad , Rasmussen Bodil Steen , Jørgensen Marlene , Skjønnemand Martin , Lund Caterina Amanti , Schroder Save , Sørensen Johan Kløvgaard , Sølling Christoffer , Hansen Kristian Kraft , Rasmussen Christina Kirkegaard , Steen Nick Phaff , Nielsen Anne Staal , Geisler Anja , Køppen Kasper Storm , Pælestik Maria Bolther , Grøfte Thorbjørn , Meyhoff Christian Sylvest , Kroh Charlotte Loumann , Christensen Amalie Prien , Haugstvedt Aleksander Fjeld , Hansen Maria Aagaard , Nielsen Christian Viggo , Dybdal Bitten , Falcon Lars , Hägi-Pedersen Daniel , Jauho Kristian , Wolsted Henrik , Pedersen Christian Alves Kohler , Sommer Trine Nyboe , Kromberg Laurits Schou , Kristensen Danja Lykke , Svensson Camilla Kara , Nielsen Hans Fjeldsøe , Sørensen Martin Kryspin , Jacobsen Stig , Sundskard Martin , Brahe Nicole , Jakobsen Karina , Jensen Mette Skov , Odder Lillian , Selter Hansjörg , Mohr Tróndur Høgnason , Jensen Elin H , Jensen Pernille Pia , Skjold Christine , Aasvang Eske Kvanner 
Published: August 2021

BackgroundAcute and persistent pain after surgery is well described. However, no large-scale studies on immediate postoperative pain in the operating room (OR) exist, hindering potential areas of research to improve clinical outcomes. Thus, we aimed to describe the occurrence and severity of immediate postoperative pain in a large, unselected cohort.MethodsThis was a prospective cohort study, encompassing all procedures in 31 public hospitals in the Danish Realm, during a 5-day period including the weekend. Data on procedures and anesthesia were collected and the main outcome was occurrence of moderate or severe pain in the OR. Secondary outcomes included pain, sedation and nausea in the OR or during the first 15 min in the postanesthesia care unit (PACU) including relevant risk factors. Descriptive and logistic regression statistics were used.ResultsA total of 3675 procedures were included for analysis (87% inclusion rate). Moderate or severe pain occurred in 7.4% (95% CI 6.5% to 8.3%) of cases in the OR immediately after awakening, rising to 20.2% in the OR and/or PACU. Large intraprocedure and interprocedure variations occurred (0.0%–37.5%), and in 20% of cases with epidural-general anesthesia patients experienced moderate or severe pain. Independent risk factors were female sex, younger age, preoperative pain, daily opioid use and major surgical procedures.ConclusionModerate or severe pain in the immediate postoperative phase occurred in 20% of all cases with procedure and anesthesiological technique variations, suggesting a need for identification of relevant procedure-specific risk factors and development of preventive treatments.Trial registration numberRoPR ID 43191.
Design guidance for protection of geomembrane liners in landfill applications
Authors: Marcotte B.A. , Fleming I.R. 
Published: August 2021

A new method of evaluating strains and predicting required protection layers that are placed over geomembranes is developed based on the combined effects of the clay strength and stiffness and the cushioning effect of a nonwoven protection layer. Plots giving the required geotextile protection for different maximum strains are presented for expected landfill pressures under 300 kPa for angular, 38 mm gravel placed above a geomembrane liner for both drained and undrained loading conditions of the clay. A similar plot is also given for tire-derived aggregate placed above the liner for pressures under 500 kPa for undrained loading conditions. All tests were conducted at room temperature. For all cases, nonwoven geosynthetic protection layers with mass per unit area (MUA) exceeding at least 1200 g/m2were required to limit long-term strains below current threshold levels. The MUA of the protection layer, for the particular aggregates and geomembranes tested, is dependent on the loading rate, water content relative to optimum, the silt content, and the activity of the clay below.
Electronic performance of GaN nanowires cathode under electric field
Authors: Huang Siyuan , Liu Lei , Lu Feifei 
Published: August 2021

The built-in electric field of exponential doping can promote the concentration of the photogenerated carrier center to the top surface of the nanowire. The external electric field also can bend the motion trajectory of the emitted electrons toward the collecting side. These field-assisted methods promote the quantum efficiency. In this paper, the emission theory of a single GaN nanowire photocathode is studied for the first time. The effects of height and width of the nanowire, wavelength, intensity of electric field on quantum efficiency of uniformly doped or exponentially doped GaN nanowire photocathodes were explored. It shows that the top of the exponentially doped cathode has a higher quantum efficiency than uniformly doped cathode. With the absence of the field, quantum efficiency of a uniformly doped cathode reaches a maximum value of 55.29% when the width is 150 nm and the wavelength is 220 nm. The form of exponentially doped cathode can generate an internal field. With the internal field, a maximum value rises 56.73% when the height is 900 nm and the wavelength is 230 nm. The theoretical results can direct the preparation of this kind of photocathode.
“Camarão que dorme a onda leva”: ponderações éticas sobre o trabalho de campo em contextos perigosos
Authors: Lopes Maycon 
Published: August 2021

A partir do relato de uma situação extrema – de violência e ameaça direta à vida – experimentada no curso de uma etnografia, pretendo neste texto abordar questões metodológicas e éticas mais amplas inerentes à dinâmica de trabalho de campo. Exploro, entre outros pontos, a introdução (neste caso, indevida) de dispositivos fotográficos durante a observação participante e os desdobramentos deste episódio na produção dos dados e na conformação da investigação de modo geral. Argumento que diante da violência que permeia a cidade contemporânea, e a que necessariamente – com níveis de risco variados – os estudiosos estão expostos nas chamadas pesquisas in loco em contextos marcados pela criminalidade (como favelas dominadas pelo tráfico de drogas), é fundamental discutirmos medidas que possam vir ao auxílio dos mesmos, seja para não comprometer a realização do estudo, seja, principalmente, para salvaguardar sua integridade física e psíquica.
Protein Phosphatase 2A Activation Via ApoER2 in Trophoblasts Drives Preeclampsia in a Mouse Model of the Antiphospholipid Syndrome
Authors: Chu Haiyan , Sacharidou Anastasia , Nguyen An , Li Chun , Chambliss Ken L. , Salmon Jane E. , Shen Yu-Min , Lo Julie , Leone Gustavo W. , Herz Joachim , Hui David Y. , Marciano Denise K. , Abrahams Vikki M. , Natale Bryony V. , Montalbano Alina P. , Xiao Xue , Xu Lin , Natale David R. , Shaul Philip W. , Mineo Chieko 
Published: August 2021

Rationale:
Preeclampsia is a potentially life-threatening, placenta-based hypertensive disorder during pregnancy, and the antiphospholipid syndrome (APS) frequently leads to preeclampsia. APS pregnancies are also complicated by fetal demise and intrauterine growth restriction.

Objective:
Here, we determined how the circulating antiphospholipid antibodies (aPL) characteristic of APS alter placental trophoblast function to cause preeclampsia and also endanger the fetus.

Methods and Results:
Experiments were performed in mice, in cultured human trophoblasts, and in human placenta samples. Effects of aPL and IgG from healthy subjects were compared. Based on prior findings in culture, in vivo studies were done in mice deficient in ApoER2 (apolipoprotein E receptor 2) in trophoblasts. End points in tissues and cells were determined by enzymatic assay, quantitative polymerase chain reaction, ELISA, or immunoblotting. Whereas in wild-type mice aPL caused maternal hypertension and proteinuria, fetal demise and intrauterine growth restriction, mice lacking trophoblast ApoER2 were protected. In culture, aPL attenuated trophoblast proliferation and migration via an ApoER2-related protein complex comprised of the PP2A (protein phosphatase 2A), Dab2 (disabled-2), and JIP4 (Jun-N-terminal kinase-interacting protein 4). Via trophoblast ApoER2 in mice and in culture, aPL-stimulated PP2A activity, leading to MMP14 (matrix metallopeptidase 14) and HIF1α (hypoxia-inducible factor 1) upregulation and increased soluble endoglin production. HIF1α and soluble endoglin upregulation was related to PP2A desphosphorylation of PHD2 (prolyl hydroxylase domain containing protein 2). In mice PP2A inhibition prevented aPL-induced maternal hypertension and proteinuria, and fetal demise and intrauterine growth restriction. Placentas from patients with APS displayed PP2A hyperactivation, PHD2 dephosphorylation and HIF1α upregulation, and these findings were generalizable to placentas of women with preeclampsia from causes other from APS.

Conclusions:
In APS, pregnancies trophoblasts are the critical cell target of aPL, and via ApoER2-dependent PP2A activation, aPL cause preeclampsia through MMP14 upregulation and PHD2 dephosphorylation leading to HIF1α and soluble endoglin upregulation. Moreover, parallel processes may be operative in preeclampsia in non-APS patients. Interventions targeting PP2A may provide novel means to combat APS-related preeclampsia and preeclampsia unrelated to APS.
Motivational Salience Guides Attention to Valuable and Threatening Stimuli: Evidence from Behavior and Functional Magnetic Resonance Imaging
Authors: Kim Haena , Nanavaty Namrata , Ahmed Humza , Mathur Vani A. , Anderson Brian A. 
Published: August 2021

Abstract
Rewarding and aversive outcomes have opposing effects on behavior, facilitating approach and avoidance, although we need to accurately anticipate each type of outcome to behave effectively. Attention is biased toward stimuli that have been learned to predict either type of outcome, and it remains an open question whether such orienting is driven by separate systems for value- and threat-based orienting or whether there exists a common underlying mechanism of attentional control driven by motivational salience. Here, we provide a direct comparison of the neural correlates of value- and threat-based attentional capture after associative learning. Across multiple measures of behavior and brain activation, our findings overwhelmingly support a motivational salience account of the control of attention. We conclude that there exists a core mechanism of experience-dependent attentional control driven by motivational salience and that prior characterizations of attention as being value driven or supporting threat monitoring need to be revisited.
Content Word Production during Discourse in Aphasia: Deficits in Word Quantity, Not Lexical–Semantic Complexity
Authors: Alyahya Reem S. W. , Halai Ajay D. , Conroy Paul , Lambon Ralph Matthew A. 
Published: August 2021

Abstract
Although limited and reduced connected speech production is one, if not the most, prominent feature of aphasia, few studies have examined the properties of content words produced during discourse in aphasia, in comparison to the many investigations of single-word production. In this study, we used a distributional analysis approach to investigate the properties of content word production during discourse by 46 participants spanning a wide range of chronic poststroke aphasia and 20 neurotypical adults, using different stimuli that elicited three discourse genres (descriptive, narrative, and procedural). Initially, we inspected the discourse data with respect to the quantity of production, lexical–semantic diversity, and psycholinguistic features (frequency and imageability) of content words. Subsequently, we created a “lexical–semantic landscape,” which is sensitive to subtle changes and allowed us to evaluate the pattern of changes in discourse production across groups. Relative to neurotypical adults, all persons with aphasia (both fluent and nonfluent) showed significant reduction in the quantity and diversity of production, but the lexical–semantic complexity of word production directly mirrored neurotypical performance. Specifically, persons with aphasia produced the same rate of nouns/verbs, and their discourse samples covered the full range of word frequency and imageability, albeit with reduced word quantity. These findings provide novel evidence that, unlike in other disorders (e.g., semantic dementia), discourse production in poststroke aphasia has relatively preserved lexical–semantic complexity but demonstrates significantly compromised quantity of content word production. Voxel-wise lesion-symptom mapping using both univariate and multivariate approaches revealed left frontal regions particularly the pars opercularis, insular cortex, and central and frontal opercular cortices supporting word retrieval during connected speech, irrespective of their word class or lexical–semantic complexity.
Update on “Treatment of orthostatic headache without intracranial hypotension: A case report” – nine years later
Authors: Bonifácio Gonçalo V , Gil-Gouveia Raquel 
Published: August 2021

Background In 2013, one of the authors described a 36-year-old female with orthostatic headache without documented intracranial hypotension or evidence of cerebrospinal fluid leak, despite extensive workup. Headache was unresponsive to conservative treatment since 2010, showed only transient benefit after repeated epidural blood patches while vitamin A supplementation resulted in progressive improvement. Case Since 2013, the patient followed a relapsing and remitting course yet relapse control became difficult after a drug induced liver injury required vitamin A discontinuation in 2017, when her headache became chronic. Greater occipital nerve blocks provided pain relief as alternative but were stopped due to the pandemic and her latest severe relapse, in late 2020, required not only restarting anaesthetic blocks and aggressive medication management, but also reassessing and treating comorbidities (obstructive sleep apnoea and major depressive disorder) with modest benefit. Conclusion Orthostatic headache without intracranial hypotension is rare, with only 28 cases reported so far, all treated empirically and all treatment options revealing to be mostly ineffective. Vitamin A anecdotally appeared to be useful in our case but had to be stopped for severe side effects, so unfavourable long-term prognosis, in ours and 2/3 of the reported cases, seems to be the rule in this intriguing entity.
Health care Affordability and Associated Concerns Among Adults Aged 65 and above in Florida
Authors: Wiltshire Jacqueline , Garcia Colato Edlin , Conner Kyaien O. , Anderson Erica , Orban Barbara 
Published: August 2021

Objective: This study assessed affordability of care in a diverse sample of Floridians aged ≥ 65 to ascertain concerns about health care costs. Methods: We surveyed 170 adults (40.6% white, 27.6% black, and 31.8% Hispanic) and conducted three race/ethnic-stratified focus groups ( n = 27). Results: Most participants had Medicare (97.1%). Among whites, 11.6% reported problems paying medical bills in the past 12 months versus 14.9% of blacks and 24.1% of Hispanics. In addition, 13% of whites, 19.2% of blacks, and 20.4% of Hispanics reported not getting needed prescription drugs because of costs. The most frequently identified concerns from the focus groups were the cost of prescription drugs, out-of-pocket expenses, and medical billing. Concerns about medical billing included understanding bills, transparency, timely postings, and uncertainty about who to contact about problems. Discussion: Our findings suggest that practices that help older adults effectively manage medical bills and costs may alleviate their concerns and guard against financial burdens.
« Statistiquement significatif » ? Respectons l’incertitude de l’effet testé
Authors: Bultez Alain , Derbaix Christian , Herrmann Jean-Luc 
Published: August 2021

Résumé Ne rêvons-nous pas tous de pouvoir conclure que nos résultats sont « statistiquement significatifs », c’est-à-dire associés à une probabilité p inférieure à un seuil, généralement de 5% ? Dans cet article, nous montrons d’abord que p n’est pas ce qu’on croit, et qu’il conduit à une dichotomisation fallacieuse et à une sous-évaluation de l’incertitude de l’effet testé. Nous proposons ensuite une nouvelle mesure directe de la plausibilité de cet effet. A partir d’un exemple tiré d’un article, nous l’illustrons et la complétons de contextualisations concrètes reposant sur des contrastes graphiques entre intervalles crédibles. Finalement, nous soulignons que la démarche proposée contribue à réaliser à quel point l’interprétation de p, ou de toute autre probabilité, doit être prudente dès lors qu’il s’agit d’émettre une conclusion dans un environnement incertain à propos de l’existence ou non d’un effet.
Sense of Purpose in Life and Subsequent Physical, Behavioral, and Psychosocial Health: An Outcome-Wide Approach
Authors: Kim Eric S. , Chen Ying , Nakamura Julia S. , Ryff Carol D. , VanderWeele Tyler J. 
Published: August 2021

Purpose: Growing evidence indicates that a higher sense of purpose in life ( purpose) is associated with reduced risk of chronic diseases and mortality. However, epidemiological studies have not evaluated if change in purpose is associated with subsequent health and well-being outcomes. Design: We evaluated if positive change in purpose (between t0; 2006/2008 and t1;2010/2012) was associated with better outcomes on 35 indicators of physical health, health behaviors, and psychosocial well-being (at t2;2014/2016). Sample: We used data from 12,998 participants in the Health and Retirement study—a prospective and nationally representative cohort of U.S. adults aged >50. Analysis: We conducted multiple linear-, logistic-, and generalized linear regressions. Results: Over the 4-year follow-up period, people with the highest (versus lowest) purpose had better subsequent physical health outcomes (e.g., 46% reduced risk of mortality (95% CI [0.44, 0.66])), health behaviors (e.g., 13% reduced risk of sleep problems (95% CI [0.77, 0.99])), and psychosocial outcomes (e.g., higher optimism (β = 0.41, 95% CI [0.35, 0.47]), 43% reduced risk of depression (95% CI [0.46, 0.69]), lower loneliness (β = −0.35, 95% CI [−0.41, −0.29])). Importantly, however, purpose was not associated with other physical health outcomes, health behaviors, and social factors. Conclusion: With further research, these results suggest that sense of purpose might be a valuable target for innovative policy and intervention work aimed at improving health and well-being.
Injury-Related Emergency Department Presentations Among Residential Aged Care Residents in Victoria, Australia
Authors: Yeganeh Ladan , Bugeja Lyndal , Berecki Janneke , Laughlin Adrian , Ibrahim Joseph 
Published: August 2021

Objective This study aimed to quantify and describe the characteristics of emergency department (ED) injury presentations and subsequent hospital admissions among residents of residential aged-care facilities (RACFs) in Victoria, Australia between 2008 and 2018. Methods This study comprised a single jurisdiction population-based study of consecutive injury-related ED presentations of RACFs residents using the Victorian Emergency Minimum Dataset (VEMD). Results The rate of ED injury presentations per 100,000 population decreased by .8% per year over 10 years ( P = .03); however, the rate per 100,000 RACF bed days increased by .6% per year ( P = .05). The proportion of presentations subsequently admitted to hospital increased 4.0% per year ( P<.0001). The majority of presentations were due to falls (82.5%), with fracture(s) being the most common injury type (34.0%). Discussion The increased rate of ED visits and hospital admissions in RACFs residents highlights the need to design specialized emergency care services and/or provide better direct access to hospital care for this vulnerable population.