bluuebunny/crossref_metadata_2025_split huggingface dataset:
The experience of speech–language therapists and audiologists when delivering bad news: A qualitative analysis
Authors: Gold Rinat , Gold Azgad 
Published: March 2021

AbstractBackgroundAs part of their professional responsibilities, speech–language therapists and audiologists are required to deliver bad news.AimsThe aim of this qualitative study is to describe and characterize the subjective experience of speech–language therapists and audiologists when delivering bad news to clients or their family members.Methods & ProceduresA group of 156 speech–language therapists and audiologists replied in writing to an open question asking them to describe a clinical encounter in which they delivered bad news. The texts that were generated in response to this question served as a data base. Qualitative content analysis was used to analyse data and generate themes.Outcomes & ResultsThematic analysis of participants’ texts revealed the challenges inherent to the delivery of bad news. Four main themes emerged from text analysis: difficulty in phrasing the news; the deliverer's emotional experience; the receiver's reaction; and being alone or in companion with another healthcare provider during the delivery of the bad news.Conclusions & ImplicationsSpeech–language therapists and audiologists experience difficulties similar to those experienced by other healthcare professionals when delivering bad news. Nevertheless, speech–language therapists and audiologists seem to perceive the delivery of bad news situation in a broader sense than the conventional definition given to this term in the medical arena.What this paper addsWhat is already known on the subject

The task of delivering bad news is stressful to healthcare professionals. Most of the literature on the topic pertains to physicians. Little is known regarding the delivery of bad news in speech–language therapy and audiology.

What this paper adds to existing knowledge

This study highlights the challenges that speech–language therapists and audiologists encounter when delivering bad news. Furthermore, it illuminates the implicit perceptions of these professionals regarding what is considered ‘bad news’.

What are the potential or actual clinical implications of this work?

The emotional challenges associated with the delivery of bad news underscore the importance of support and training regarding the delivery of bad news. It is especially important to prepare for a client's difficult questions, and to prefer a collaborative approach to the delivery of bad news.
Prenatal tobacco smoke exposure and neurological impairment at 10 years of age among children born extremely preterm: a prospective cohort
Authors: Venkatesh KK , Leviton A , Fichorova RN , Joseph RM , Douglass LM , Frazier JA , Kuban KCK , Santos HP , Fry RC , O’Shea TM 
Published: March 2021

ObjectiveTo determine the association between prenatal tobacco smoke exposure and neurological impairment at 10 years of age among children born extremely preterm (<28 weeks of gestation).DesignThe Extremely Low Gestational Age Newborn (ELGAN) Study, a prospective cohort.SettingTen‐year follow‐up of extremely preterm infants born at 14 US hospitals between 2002 and 2004.MethodsPrenatal tobacco smoke exposure was defined as a mother’s report at enrolment of active (i.e. maternal) and passive smoking during pregnancy. Poisson regression with generalized estimating equations was used. Models adjusted for mother’s age, race/ethnicity, education, insurance, pre‐pregnancy body mass index, US region, multiple gestation and infant’s sex; and in sensitivity analysis, gestational age at delivery and clinical subtype of preterm birth, given their classification as intermediate and non‐confounding variables.Main outcomesNeurological impairment at 10 years, epilepsy, cerebral palsy and cognitive impairment.ResultsOf 1200 ELGAN study survivors, 856 were assessed at 10 years of age with neurological outcomes, of whom 14% (118/856) had active tobacco exposure during pregnancy and 24% (207/852) had passive tobacco exposure. Compared with children who were not exposed prenatally to tobacco, children exposed to active tobacco use during pregnancy had a higher risk of epilepsy (14% versus 5%; adjusted relative risk: 1.68, 95% CI 1.45–1.92). This risk remained after adjustment for gestational age at delivery and clinical subtype of preterm birth. Prenatal tobacco smoke exposure was not associated with other assessed neurological outcomes, including cerebral palsy and multiple measures of cognitive impairment.ConclusionsAmong children born extremely preterm, prenatal active tobacco smoke exposure was associated with an increased risk of epilepsy at 10 years of life.Tweetable abstractAmong infants born before 28 weeks of gestation, prenatal active tobacco smoke exposure was associated with an increased risk of epilepsy at 10 years of life.
Use of icodextrin solution to evaluate peritoneal transport capacity
Authors: Pereira Lucas de J. , Guimarães Érica A. , Mohrbacher Sarah , Pereira Benedito J. , Elias Rosilene M. , Abensur Hugo 
Published: March 2021

AbstractPeritoneal equilibration test (PET) is the gold standard for evaluating peritoneal transport, and measurement of the drain volume after 4‐h dwell time with glucose 4.25% is a simple means of evaluating failure of ultrafiltration. The study objective was to verify if the measurement of the volume drained after 4 h dwell of icodextrin at 7.5% (ICO), has a better correlation with the parameters of PET. Patients in a peritoneal dialysis program (N = 35) underwent three procedures: PET; determination of the drain volume after a 4‐h dwell with glucose 4.25%; and determination of the drain volume after a 4‐h dwell with ICO. Among patients who were classified as high transporters, the ultrafiltration volume was greater after ICO use. The ICO ultrafiltration volume correlated negatively with the ratio between the 4‐ and 0‐h dialysate glucose concentrations (D4/D0 ratio, r = −0.579; P = 0.002), correlating positively with the dialysate‐to‐plasma ratio for creatinine (D/PCr ratio, r = 0.474; P = 0.002). For ICO, the area under the receiver operating characteristic curve was 0.867 and 0.792 for the D/PCr and D4/D0 ratios (P < 0.0001 and P = 0.004, respectively), compared with 0.738 and 0.710 for glucose 4.25% (P = 0.020 and P = 0.041, respectively). A cut‐off volume of 141 mL discriminated high/high‐average transporters from low/low‐average transporters. Volume drained after ICO use better predicts peritoneal transport patterns than does that drained after the use of glucose 4.25%.
Interventions for oral lichen planus: A systematic review and network meta‐analysis of randomized clinical trials
Authors: Sridharan K , Sivaramakrishnan G 
Published: March 2021

AbstractBackgroundCorticosteroids, calcineurin inhibitors, vitamin D, photodynamic therapy, herbal drugs are some of the interventions tried in clinical trials for treating oral lichen planus. We carried out the present network meta‐analysis to compare the above‐mentioned interventions.MethodsElectronic databases were searched for randomized clinical trials evaluating interventions in patients with symptomatic oral lichen planus. Clinical resolution, clinical score, pain resolution, pain score, and adverse effects were the outcomes evaluated.ResultsFifty‐five (2831 patients) trials were included. Corticosteroids (OR: 13.6; 95% CI: 1.2, 155.4), pimecrolimus (OR: 14.7; 95% CI: 1.7, 125), purslane (OR: 18.4; 95% CI: 3.5, 97), and ozonized water/corticosteroids (OR: 52; 95% CI: 1.4, 1882.6) had better rates of clinical resolution compared to placebo. Corticosteroids (OR: 3.18; 95% CI: 1.2, 8.43), ozonized water/corticosteroids (OR: 9.9; 95% CI: 2.7, 36.2), aloe vera (OR: 13; 95%: 1.5, 111.8), pimecrolimus (OR: 18.8; 95% CI: 2, 177.4) and hyaluronic acid (OR: 24.8; 95% CI: 1.3, 457.6) were significantly associated with superior rates of pain resolution compared to placebo. Pimecrolimus and cyclosporine were associated with significantly higher risk of adverse effects than placebo.ConclusionTopical corticosteroids were the most effective drug class for treating oral lichen planus.
Gene mapping reveals the association between tyrosine protein kinase Abl1 and the silk yield of Bombyxmori
Authors: Luan Y. , Li C. , Zuo W. , Hu H. , Gao R. , Zhang B. , Tong X. , Lu C. , Dai F. 
Published: March 2021

SummaryThe Z chromosome of the silkworm contains a major gene that influences silk yield. This major locus on chromosome Z accounts for 35.10% of the phenotypic variance. The location and identification of the gene have been a focus of silkworm genetics research. Unfortunately, identification of this gene has been difficult. We used extreme phenotype subpopulations and selected from a backcross population, BC1M, which was obtained using the high‐yield strain 872B and the low‐yield strain IS‐Dazao as parents, for mapping the gene on the chromosome Z. The candidate region was narrowed down to 134 kb at the tip of the chromosome. BmAbl1 in this region correlated with silk gland development by spatiotemporal expression analysis. This gene was differentially expressed in the posterior silk glands of the high‐ and low‐yield strains. In BmAbl1, an insertion–deletion (indel) within the 10th exonic region and an SNP within the 6th intronic region were detected and shown to be associated with cocoon shell weight in 84 Bombyx mori strains with different yields. Nucleotide diversity analysis of BmAbl1 and its 50 kb flanking regions indicated that BmAbl1 has experienced strong artificial selection during silkworm domestication. This study is the first to identify the genes controlling silk yield in the major QTL of the Z chromosome using forward genetics.
Obesity in women: anaesthetic implications for peri‐operative and peripartum management
Authors: Tan H. S. , Habib A. S. 
Published: March 2021

SummaryThe prevalence, healthcare and socio‐economic impact of obesity (defined as having a body mass index of ≥ 30 kg.m‐2) are disproportionately higher in women than men. A combination of biological and social factors, including the adaptation of energy homeostasis to the increased demands of pregnancy and lactation and poor access to healthy foods or exercise facilities, contribute to the increasing prevalence of obesity in women. Obesity‐related physiological changes stem from mass loading and increased metabolism of adipose tissue, as well as secretion of bioactive substances from adipocytes leading to chronic low‐grade inflammation. As a result, obesity is associated with increased risks of: infertility; malignancy; sleep‐disordered breathing; cardiovascular disease; diabetes; and thromboembolism. Hence, obese women are at markedly increased risk of peri‐operative morbidity and mortality and require comprehensive evaluation and targeted comorbidity optimisation by a multidisciplinary team. In addition to routine obstetric challenges, pregnancy in women with obesity further exacerbates the above risks, making multidisciplinary management starting at pre‐conception even more important. Weight loss, lifestyle management and optimisation of comorbidity are the cornerstone of reducing obesity‐related risks. The anaesthetist plays a vital role within the multidisciplinary team by emphasising weight loss as part of pre‐operative comorbidity optimisation, formulation of individualised peri‐operative management plans, supervising postoperative care in the high dependency or intensive care settings and providing safe labour analgesia and careful peripartum management for obese parturients.
The effect of iron deficiency and anaemia on women’s health
Authors: Benson C. S. , Shah A. , Stanworth S. J. , Frise C. J. , Spiby H. , Lax S. J. , Murray J. , Klein A. A. 
Published: March 2021

SummaryIron deficiency and anaemia are global health problems and major causes of morbidity in women. Current definitions of anaemia in women are historic and have been challenged by recent data from observational studies. Menstrual loss, abnormal uterine bleeding and pregnancy put women at risk of developing iron deficiency which can result in severe fatigue, reduced exercise capacity and poor work performance. Iron deficiency and anaemia during pregnancy are associated with adverse maternal and fetal outcomes, including neurocognitive deficits in children born to iron‐deficient mothers. Both iron deficiency and anaemia are common in women undergoing surgery but their association with poor outcomes remains uncertain. The enduring burden of iron deficiency and anaemia in women suggests that current strategies for recognition, prevention and treatment are limited in their utility. Improvements in our understanding of iron homeostasis and the development of new iron preparations, which are better absorbed with fewer side‐effects, may improve therapeutic effectiveness of oral iron. Intravenous iron is efficacious for correcting anaemia rapidly but high‐quality data on patient‐centred outcomes and cost‐effectiveness are currently lacking. Many recommendations for the treatment of iron deficiency and anaemia in national guidelines are not supported by high‐quality evidence. There is a need for robust epidemiological data and well‐designed clinical trials. The latter will require collaborative working between researchers and patients to design studies in ways that incorporate patients’ perspectives on the research process and target outcomes that matter to them.
Pandemics and maternal health: the indirect effects of COVID‐19
Authors: Lucas D. N. , Bamber J. H. 
Published: March 2021

SummaryInfectious diseases can directly affect women and men differently. During the COVID‐19 pandemic, higher case fatality rates have been observed in men in most countries. There is growing evidence, however, that while organisational changes to healthcare delivery have occurred to protect those vulnerable to the virus (staff and patients), these may lead to indirect, potentially harmful consequences, particularly to vulnerable groups including pregnant women. These encompass reduced access to antenatal and postnatal care, with a lack of in‐person clinics impacting the ability to screen for physical, psychological and social issues such as elevated blood pressure, mental health issues and sex‐based violence. Indirect consequences also encompass a lack of equity when considering the inclusion of pregnant women in COVID‐19 research and their absence from vaccine trials, leading to a lack of safety data for breastfeeding and pregnant women. The risk‐benefit analysis of these changes to healthcare delivery remains to be fully evaluated, but the battle against COVID‐19 cannot come at the expense of losing existing quality standards in other areas of healthcare, especially for maternal health.
An update on the management of chronic pelvic pain in women
Authors: Vincent K. , Evans E. 
Published: March 2021

SummaryChronic pelvic pain represents a major public health problem for women and impacts significantly on their quality of life. Yet it is under‐researched and a challenge to manage. Women who suffer from chronic pelvic pain frequently describe their healthcare journey as long, via a variety of specialists and frustrating, with their pain often dismissed. Aetiological factors and associations are best conceptualised using the ‘three P’s’ model of predisposing, precipitating and perpetuating factors. This integrates the numerous biological, psychological and social contributors to the complex, multifactorial nature of chronic pelvic pain. Overall management involves analgesia, hormonal therapies, physiotherapy, psychological approaches and lifestyle advice, which like other chronic pain conditions relies on a multidisciplinary team approach delivered by professionals experienced and trained in managing chronic pelvic pain.
Mental disorder in pregnancy and the early postpartum
Authors: Cantwell R. 
Published: March 2021

AbstractPerinatal mental illness is common, affecting up to 20% of women, but remains under‐recognised and under‐diagnosed. It may have adverse effects on pregnancy and neonatal outcomes, and mental disorder remains one of the leading causes of maternal death in the UK. Women with mental ill health face difficult decisions in balancing risks and benefits of treatment. Stigma related to mental disorder may lead to non‐engagement with maternity care. Some disorders bring specific challenges for anaesthetists working in maternity settings and it is vital that anaesthetists have knowledge of these disorders so they may offer care which is sensitive and appropriate.
Sarcopenia is a strong predictive factor of clinical and oncological outcomes following curative colorectal cancer resection
Authors: Chai Victor W. , Chia Marc , Cocco Anthony , Bhamidipaty Madhu , D'Souza Basil 
Published: March 2021

AbstractBackgroundSkeletal muscle depletion and subsequent functional loss is common in gastrointestinal malignancy. Usual markers of nutritional status may not be part of routine workup. The predictive value of sarcopenia was assessed and compared with clinically utilized factors. The aim of this was to assess the association between computed tomography assessed sarcopenia with outcomes in colorectal cancer resection.MethodsA total of 228 consecutive patients who underwent curative colorectal cancer resection were included. Skeletal muscle area was measured at L3, with pre‐defined gender‐specific cut‐offs applied to a height standardized index. Albumin, body mass index and Subjective Global Assessment scores were recorded alongside measures of comorbidity. Predictors of complications, mortality, and recurrence were identified through multivariate logistic regression.ResultsComputed tomography assessed sarcopenia was significantly associated with longer stays, complications, 30‐day mortality, readmissions and recurrence at 1 year. Specific associations with major, respiratory and cardiac complications were seen. It independently predicted overall complications (odds ratio 2.96, confidence interval 1.19–7.35 P = 0.019), recurrence at 1 year (odds ratio 8.00, confidence interval 1.45–44.21, P = 0.017) and an increase in comprehensive complication index of 14 (P = 0.002). Subgroup analysis found sarcopenia predicted overall complications in rectal surgery and major complications in colonic surgery. American Society of Anesthesiologists predicted complications but not major complications while cancer stage also predicted recurrence rates.ConclusionsSarcopenia presents an objective, available predictive factor that may be superior to current biochemical and clinical measures of nutritional and functional status. This study found it to be predictive of complication rates and recurrence after curative in colorectal cancer resection.
A consequentialist argument for considering age in triage decisions during the coronavirus pandemic
Authors: Altman Matthew C. 
Published: March 2021

AbstractMost ethics guidelines for distributing scarce medical resources during the coronavirus pandemic seek to save the most lives and the most life‐years. A patient’s prognosis is determined using a SOFA or MSOFA score to measure likelihood of survival to discharge, as well as a consideration of relevant comorbidities and their effects on likelihood of survival up to one or five years. Although some guidelines use age as a tiebreaker when two patients’ prognoses are identical, others refuse to consider age for fear of discriminating against the elderly. In this paper, I argue that age is directly relevant for maximizing health benefits, so current ethics guidelines are wrongly excluding or deemphasizing life‐stage in their triage algorithms. Research on COVID‐19 has shown that age is a risk factor in adverse outcomes, independent of comorbidities. And limiting a consideration of life‐years to only one or five years past discharge does not maximize health benefits. Therefore, based on their own stated values, triage algorithms for coronavirus patients ought to include life‐stage as a primary consideration, along with the SOFA score and comorbidities, rather than excluding it or using it merely as a tiebreaker. This is not discriminatory because patients ought to have equal opportunity to experience life‐stages. The equitable enforcement of that right justifies unequal treatment based on age in cases when there is a scarcity of life‐saving resources. A consideration of life‐stage would thus allow healthcare workers to responsibly steward public resources in order to maximize lives and life‐years saved.
Using feathers to map continental‐scale movements of waterbirds and wetland importance
Authors: Brandis Kate J. , Mazumder Debashish , Gadd Patricia , Ji Boyu , Kingsford Richard T. , Ramp Daniel 
Published: March 2021

AbstractWaterbirds are highly mobile, moving over large distances to access resources. Although consistent migration routes are observed in highly seasonal and predictable environments, movement patterns to utilize ephemeral resources in dryland environments are largely unknown. This makes conservation planning and water policy challenging as the relative importance of widely dispersed wetlands is difficult to rank. We addressed this challenge by combining a citizen science project with the novel application of X‐ray fluorescence of feathers to detect continental scale movement of waterbirds using elemental signatures. By doing so, we gained important insight into the movements of 24 waterbird species, including the significance of the Murray–Darling basin as a key source of waterbirds across the continent. Our approach highlights the benefits of elemental signatures to identify key areas of habitat use and priorities for wetland management.
Evolutionary process modeling with Bayesian inference of Spodoptera frugiperda ballooning and walking dispersal in Bt and non‐Bt cotton plant mixtures
Authors: Malaquias José Bruno , Godoy Wesley Augusto Conde , Caprio Michael A. , Pachú Jéssica Karina da Silva , de Sousa Ramalho Francisco , Omoto Celso , Ferreira Claudia Pio 
Published: March 2021

AbstractTransgenic crops expressing Bacillus thuringiensis Berliner (Bt) have been cultivated throughout the world as a great technological tool for developing integrated pest management. We hypothesized that artificial landscapes containing Bt and non‐Bt cotton plants (Gossypium hirsutum L., Malvaceae) at small scales could influence dispersal by ballooning of Spodoptera frugiperda (JE Smith) (Lepidoptera: Noctuidae). We also simulated how ballooning dispersal combined with walking movement could impact resistance evolution in various scenarios of plant mixtures involving non‐Bt and Bt cotton plants with high‐dose and low‐dose events. The ballooning frequency of Cry1F‐resistant larvae in a treatment with non‐Bt cotton as a natal plant and Bt cotton in adjacent sites was two‐fold lower compared to when Bt cotton was the natal plant and non‐Bt cotton was in the adjacent sites. Our model results suggested that the higher rate of walking movement associated with ballooning promoted faster resistance evolution in low‐dose events, and contamination of Bt cotton fields with non‐Bt cotton plants in a high‐dose event showed the longest time to resistance. Therefore, a high rate of walking movement associated with ballooning negatively impacted the time for resistance to evolve in low‐dose events.