bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality improvement in general practice: what do GPs and practice managers think? Results from a nationally representative survey of UK GPs and practice managers
Authors: Gosling Jennifer , Mays Nicholas , Erens Bob , Reid David , Exley Josephine 
Published: May 2021

BackgroundThis paper presents the results of the first UK-wide survey of National Health Service (NHS) general practitioners (GPs) and practice managers (PMs) designed to explore the service improvement activities being undertaken in practices, and the factors that facilitated or obstructed that work. The research was prompted by growing policy and professional interest in the quality of general practice and its improvement. The analysis compares GP and PM involvement in, and experience of, quality improvement activities.MethodsThis was a mixed-method study comprising 26 semistructured interviews, a focus group and two surveys. The qualitative data supported the design of the surveys, which were sent to all 46 238 GPs on the Royal College of General Practitioners (RCGP) database and the PM at every practice across the UK (n=9153) in July 2017.ResultsResponses from 2377 GPs and 1424 PMs were received and were broadly representative of each group. Ninety-nine per cent reported having planned or undertaken improvement activities in the previous 12 months. The most frequent related to prescribing and access. Key facilitators of improvement included ‘good clinical leadership’. The two main barriers were ‘too many demands from external stakeholders’ and a lack of protected time. Audit and significant event audit were the most common improvement tools used, but respondents were interested in training on other quality improvement tools.ConclusionGPs and PMs are interested in improving service quality. As such, the new quality improvement domain in the Quality and Outcomes Framework used in the payment of practices is likely to be relatively easily accepted by GPs in England. However, if improving quality is to become routine work for practices, it will be important for the NHS in the four UK countries to work with practices to mitigate some of the barriers that they face, in particular the lack of protected time.
Development and evaluation of an online medication safety module for medical students at a rural teaching hospital: the Winchester District Memorial Hospital
Authors: Elbeddini Ali , Tayefehchamani Yasamin 
Published: May 2021

ObjectiveTo design, implement and assess an online learning module for third-year and fourth-year medical students addressing medication safety.DesignThis study was a prospective, parallel, open-label, randomised controlled trial with two arms: (1) a control arm in which students were given five articles to read about medication safety, and (2) an intervention arm in which students were given access to an interactive web-based learning module on medication safety. Pretesting and post-testing were done online to evaluate change in medication safety knowledge.ResultsTen students completed the study in the intervention group (online module) and six students completed the study in the control group. The increase in score obtained on the post-test, relative to the pretest, was 15.4% in the group who completed the online module and 2.0% in the control group (difference=13.4%, 95% CI 0.5% to 26.2%, p=0.04).ConclusionStudents who completed an online educational tool about medication safety demonstrated a significantly greater increase in knowledge than those who completed a few readings. Online learning modules can be a convenient and effective means of teaching safe prescribing concepts to medical trainees.
Distinct morning and evening fatigue profiles in gastrointestinal cancer during chemotherapy
Authors: Lin Yufen , Bailey Donald E , Docherty Sharron L , Porter Laura S , Cooper Bruce , Paul Steven , Kober Kord , Hammer Marilyn J , Wright Fay , Conley Yvette , Levine Jon , Miaskowski Christine 
Published: May 2021

BackgroundPurposes were to identify subgroups of patients with gastrointestinal cancers with distinct morning and evening fatigue severity profiles and evaluate for differences among these subgroups in demographic and clinical characteristics, co-occurring symptoms and quality of life (QOL) outcomes.MethodsPatients with gastrointestinal cancers (n=405) completed questionnaires six times over two cycles of chemotherapy. Latent profile analysis was used to identify distinct morning and evening fatigue profiles. Differences in demographic and clinical characteristics, co-occurring symptoms and QOL outcomes among the subgroups were evaluated using parametric and nonparametric tests.ResultsTwo distinct mornings (ie, low and very high) and three distinct evenings (ie, low, moderate and very high) fatigue classes were identified. Common risk factors for both morning and evening fatigue included younger age, lower performance status, higher comorbidity burden and self-reported depression. Higher levels of morning fatigue were associated with being unmarried, living alone, being unemployed, having a lower income, lack of regular exercise and a self-reported diagnosis of anaemia. Higher levels of evening fatigue were associated with being women, white and having childcare responsibilities. Patients in the very high morning and evening fatigue classes reported higher levels of anxiety, depressive symptoms, sleep disturbance and pain and lower levels of attentional function and poorer QOL.ConclusionFindings provide new insights into risk factors for and deleterious effects of morning and evening fatigue in patients with gastrointestinal cancers. Clinicians can use this information to identify high-risk patients and develop individualised interventions for morning and evening fatigue and other co-occurring symptoms.
Describing taste changes and their potential impacts on paediatric patients receiving cancer treatments
Authors: Loves Robyn , Green Gloria , Joseph-Frederick Zakia , Palmert Sasha , Plenert Erin , Schechter Tal , Tomlinson Deborah , Vettese Emily , Zahra Serena , Zupanec Sue , Dupuis L Lee , Sung Lillian 
Published: May 2021

ObjectivesTaste changes are common among paediatric patients receiving cancer treatments although specific descriptions and associations are uncertain. Primary objective was to describe the number of paediatric patients receiving cancer therapies who experienced taste changes, its impact on food intake and enjoyment of eating, and coping strategies.MethodsThis was a cross-sectional study that included English-speaking paediatric patients aged 4–18 years with a diagnosis of cancer or haematopoietic stem cell transplantation recipients receiving active treatment. Using a structured interview, we asked participants about their experience with taste changes, impacts and coping strategies. The respondent was the paediatric patient.ResultsWe enrolled 108 patients; median age was 11 years (IQR 8–15). The taste changes reported yesterday or today were food tasting bland (34%), bad (31%), different (27%), bitter (25%), extreme (19%), metallic (15%) or sour (12%). Taste changes were associated with decreased food intake (31%) and decreased enjoyment in eating (25%) yesterday or today. The most common coping strategies were eating food they liked (42%), eating strong-tasting food (39%), drinking liquids (35%), brushing teeth (31%) and sucking on candy (25%). Factors significantly associated with food tasting bad were as follows: older age (p=0.003), shorter time since cancer diagnosis (p=0.027), nausea and vomiting (p=0.008) and mucositis (p=0.009).ConclusionsAmong paediatric patients receiving cancer treatments, taste changes were common and were associated with decreased food intake and enjoyment in eating. Common coping strategies were described. Reducing nausea, vomiting and mucositis may improve taste changes.
Socioeconomic gaps over time in colorectal cancer survival in England: flexible parametric survival analysis
Authors: Kajiwara Saito Mari , Quaresma Manuela , Fowler Helen , Benitez Majano Sara , Rachet Bernard 
Published: May 2021

Background
Despite persistent reports of socioeconomic inequalities in colorectal cancer survival in England, the magnitude of survival differences has not been fully evaluated.

Methods
Patients diagnosed with colon cancer (n=68 169) and rectal cancer (n=38 267) in England (diagnosed between January 2010 and March 2013) were analysed as a retrospective cohort study using the National Cancer Registry data linked with other population-based healthcare records. The flexible parametric model incorporating time-varying covariates was used to assess the difference in excess hazard of death and in net survival between the most affluent and the most deprived groups over time.

Results
Survival analyses showed a clear pattern by deprivation. Hazard ratio of death was consistently higher in the most deprived group than the least deprived for both colon and rectal cancer, ranging from 1.08 to 1.17 depending on the model. On the net survival scale, the socioeconomic gap between the most and the least deprived groups reached approximately −4% at the maximum (−3.7%, 95% CI −1.6 to −5.7% in men, −3.6%, 95% CI −1.6 to −5.7% in women) in stages III for colon and approximately −2% (−2.3%, 95% CI −0.2 to −4.5% in men, −2.3%, 95% CI −0.2 to −4.3% in women) in stage II for rectal cancer at 3 years from diagnosis, after controlling for age, emergency presentation, receipt of resection and comorbidities. The gap was smaller in other stages and sites. For both cancers, patients with emergency presentation persistently had a higher excess hazard of death than those without emergency presentation.

Conclusion
Survival disparities were profound particularly among patients in the stages, which benefit from appropriate and timely treatment. For the patients with emergency presentation, excess hazard of death remained high throughout three years from the diagnosis. Public health measures should be taken to reduce access inequalities to improve survival disparities.
Identification and validation of viral antigens sharing sequence and structural homology with tumor-associated antigens (TAAs).
Authors: Ragone Concetta , Manolio Carmen , Cavalluzzo Beatrice , Mauriello Angela , Tornesello Maria Lina , Buonaguro Franco M , Castiglione Filippo , Vitagliano Luigi , Iaccarino Emanuela , Ruvo Menotti , Tagliamonte Maria , Buonaguro Luigi 
Published: May 2021

BackgroundThe host’s immune system develops in equilibrium with both cellular self-antigens and non-self-antigens derived from microorganisms which enter the body during lifetime. In addition, during the years, a tumor may arise presenting to the immune system an additional pool of non-self-antigens, namely tumor antigens (tumor-associated antigens, TAAs; tumor-specific antigens, TSAs).MethodsIn the present study, we looked for homology between published TAAs and non-self-viral-derived epitopes. Bioinformatics analyses and ex vivo immunological validations have been performed.ResultsSurprisingly, several of such homologies have been found. Moreover, structural similarities between paired TAAs and viral peptides as well as comparable patterns of contact with HLA and T cell receptor (TCR) α and β chains have been observed. Therefore, the two classes of non-self-antigens (viral antigens and tumor antigens) may converge, eliciting cross-reacting CD8+T cell responses which possibly drive the fate of cancer development and progression.ConclusionsAn established antiviral T cell memory may turn out to be an anticancer T cell memory, able to control the growth of a cancer developed during the lifetime if the expressed TAA is similar to the viral epitope. This may ultimately represent a relevant selective advantage for patients with cancer and may lead to a novel preventive anticancer vaccine strategy.
Histopathological analysis of retrieved thrombi from patients with acute ischemic stroke with malignant tumors
Authors: Kataoka Yuko , Sonoda Kazutaka , Takahashi Jun C , Ishibashi-Ueda Hatsue , Toyoda Kazunori , Yakushiji Yusuke , Kusaka Hirofumi , Koga Masatoshi 
Published: May 2021

BackgroundThe procoagulant state in cancer increases the thrombotic risk, and underlying cancer could affect treatment strategies and outcomes in patients with ischemic stroke. However, the histopathological characteristics of retrieved thrombi in patients with cancer have not been well studied. This study aimed to assess the histopathological difference between thrombi in patients with and without cancer.MethodsWe studied consecutive patients with acute major cerebral artery occlusion who were treated with endovascular therapy between October 2010 and December 2016 in our single-center registry. The retrieved thrombi were histopathologically investigated with hematoxylin and eosin and Masson’s trichrome staining. The organization and proportions of erythrocyte and fibrin/platelet components were studied using a lattice composed of 10×10 squares.ResultsOf the 180 patients studied, 17 (8 women, age 76.5±11.5 years) had cancer and 163 (69 women, age 74.1±11.2 years) did not. Those with cancer had a higher proportion of fibrin/platelets (56.6±27.4% vs 40.1±23.9%, p=0.008), a smaller proportion of erythrocytes (42.1±28.3% vs 57.5±25.1%, p=0.019), and higher serum D-dimer levels (5.9±8.2 vs 2.4±4.3 mg/dL, p=0.005) compared with the non-cancer cases. Receiver operating characteristic curve analysis showed the cut-off ratio of fibrin/platelet components related to cancer was 55.7% with a sensitivity of 74.8%, specificity 58.8% and area under the curve (AUC) value of 0.67 (95% CI 0.53 to 0.81), and the cut-off ratio of erythrocyte components was 44.7% with a sensitivity of 71.2%, specificity 58.9% and AUC value of 0.66 (95% CI 0.51 to 0.80).ConclusionsThromboemboli of major cerebral arteries in patients with cancer were mainly composed of fibrin/platelet-rich components.
CT-like images of the sacroiliac joint generated from MRI using susceptibility-weighted imaging (SWI) in patients with axial spondyloarthritis
Authors: Deppe Dominik , Hermann Kay-Geert , Proft Fabian , Poddubnyy Denis , Radny Felix , Protopopov Mikhail , Makowski Marcus R , Diekhoff Torsten 
Published: May 2021

BackgroundTo analyse the added value of susceptibility-weighted imaging (SWI) compared with standard T1-weighted (T1) MRI for detecting structural lesions of the sacroiliac joint (SIJ) in patients with axial spondyloarthritis (axSpA) using CT as reference standard.Material and methodsSixty-eight patients with suspected or proven axSpA underwent both MRI and CT of the SIJ on the same day. Two readers separately scored CT, T1 and SWI for the presence of erosions, sclerosis and joint space changes using an established 24-region SIJ model. Disagreement was resolved by a third reader. Diagnostic accuracy (McNemar test), Cohen’s kappa (k), sensitivity (SE) and specificity were calculated on the joint level using CT as reference.ResultsIn CT, 38 joints showed erosions, 67 sclerosis and 37 joint space changes. Agreement with CT for erosions was 92.6% (k=0.811 (0.7–0.92)) in SWI and 87.5% (k=0.682 (0.54–0.82)) in T1 (p=0.143) and agreement for sclerosis 84.6% (k=0.69 (0.57–0.81)) and 62.5% (k=0.241 (0.13–0.35)) (p<0.001), respectively. This resulted in superior SE of SWI (81.6% vs 73.7%) for erosions and sclerosis (74.6% vs 23.9%) at a minor expense of SP. No differences were detected for joint space changes.ConclusionIn patients with axSpA, SWI depicts erosions and sclerosis more accurately than T1 spin echo MRI at 1.5 T.
Renal expression and urinary excretion of aquaporin-2 in postobstructive uropathy in rats
Authors: Brandoni Anabel , Torres Adriana M. 
Published: May 2021

This work assessed the time course of water renal management together with aquaporin-2 (AQP2) kidney expression and urinary AQP2 levels (AQP2u) in obstructive nephropathy. Adult male Wistar rats were monitored after 1, 2, and 7 days of bilateral ureteral release (bilateral ureteral obstruction (BUO); BUO-1, BUO-2 and BUO-7). Renal water handling was evaluated using conventional clearance techniques. AQP2 levels were assessed by immunoblotting and immunohistochemical techniques. AQP2 expression in apical membranes was downregulated in BUO-1 rats and upregulated both in BUO-2 and BUO-7 animals. AQP2 protein expression in whole cell lysate fraction from kidney cortex and medulla were significantly decreased in all the experimental groups. Concomitantly, mRNA levels of AQP2 decreased in renal medulla of all groups and in renal cortex from BUO-1; however, in renal cortex from BUO-2 and BUO-7 a recovery and an increase in the level of AQP2 mRNA were, respectively, observed. BUO-7 group showed a significant increase in AQP2u. The alterations observed in apical membranes AQP2 expression could explain, at least in part, the evolution time of water kidney management in the postobstructive phase of BUO. Additionally, the AQP2u increase after 7 days of ureteral release may be postulated as a biomarker of improvement in the kidney function.
Transformation of electrical energy into hydrogen and its storage
Authors: Wanner Manfred 
Published: May 2021

AbstractThe German national hydrogen strategy strongly supports the development of technologies to produce, store and distribute green hydrogen in large quantities to reduce greenhouse gas emissions. In the public debate, it is often argued that the economic success of green hydrogen depends primarily on improved efficiencies, and reduced plant costs over large volumes and higher capacities. However, an economy based on the large-scale use of green hydrogen must also take into account the thermodynamic and technical limitations of the processes and components. This study therefore aims to assess the main technical challenges of the German approach to the large-scale use green hydrogen as a future energy carrier.
Acupoint Injection for Alleviating Side Effects of Chemotherapy in People with Cancer: A Systematic Review and Meta-Analysis
Authors: Yang Yulan , Su Hairong , Wen Jian , Hong Jianyun 
Published: May 2021

Objective. This study aimed to investigate the efficacy of acupoint injection for alleviating side effects of chemotherapy in people with cancer. Methods. PubMed, EMBASE, Cochrane library databases, CNKI, VIP, WanFang Date, and CBM were searched for randomized controlled trials (RCTs) from inception through December 28, 2020. This meta-analysis was performed using Review Manager 5.3. Results. A total of 8 RCTs including 557 participants were eligible and included in the meta-analysis. The selected RCTs studied acupoint injection for alleviating side effects of chemotherapy in people with cancer. Statistically significant improvements were observed for the incidence of nausea and vomiting (RR = 0.39; 95% CI 0.26, 0.58;

P

< 0.00001), the number of leukocyte (MD = 1.89; 95%CI 0.74, 3.03;

P

= 0.001), and the number of platelet (MD = 28.82; 95%CI 19.33, 38.30;

P

< 0.00001). Two of these studies suggested that acupoint injection can also reduce some other adverse reactions, which showed a statistical difference (RR = 0.29; 95% CI 0.11, 0.75;

P

= 0.01). Conclusion. The analysis indicated that acupoint injection can alleviate side effects of chemotherapy in people with cancer. However, due to the high risk of bias and small sample size in the included studies, the results need to be further confirmed by further large, rigorously designed trials.
Lignification and cell wall thickening of ray parenchyma cells in Scots pine sapwood
Authors: Zimmer Katrin , Treu Andreas 
Published: May 2021

Abstract
Scots pine exhibits variations in ray anatomy, which are poorly understood. Some ray parenchyma cells develop thick and lignified cell walls before heartwood formation. We hypothesized that some stands and trees show high numbers of lignified and thick-walled parenchyma cells early in the sapwood. Therefore, a microscopic analysis of Scots pine sapwood from four different stands in Northern Europe was performed on Safranin — Astra blue-stained tangential micro sections from outer and inner sapwood areas. Significant differences in lignification and cell wall thickening of ray parenchyma cells were observed in the outer sapwood between all of the stands for the trees analyzed. On a single tree level, the relative lignification and cell wall thickening of ray parenchyma cells ranged from 4.3% to 74.3% in the outer sapwood. In the inner sapwood, lignification and cell wall thickening of ray parenchyma cells were more frequent. In some trees, however, the difference in lignification and cell wall thickening between inner and outer sapwood was small since early lignification, and cell wall thickening was already more common in the outer sapwood. Ray composition and number of rays per area were not significantly different within the studied material. However, only one Scottish tree had a significantly higher number of ray parenchyma cells per ray. The differences discovered in lignification and cell wall thickening in ray parenchyma cells early in the sapwood of Scots pine are relevant for wood utilization in general and impregnation treatments with protection agents in particular.
Predicting Urban Surface Roughness Aerodynamic Parameters Using Random Forest
Authors: Duan G. , Takemi T. 
Published: May 2021

AbstractThe surface roughness aerodynamic parameters z0 (roughness length) and d (zero-plane displacement height) are vital to the accuracy of the Monin–Obukhov similarity theory. Deriving improved urban canopy parameterization (UCP) schemes within the conventional framework remains mathematically challenging. The current study explores the potential of a machine-learning (ML) algorithm, a random forest (RF), as a complement to the traditional UCP schemes. Using large-eddy simulation and ensemble sampling, in combination with nonlinear least squares regression of the logarithmic-layer wind profiles, a dataset of approximately 4.5 × 103 samples is established for the aerodynamic parameters and the morphometric statistics, enabling the training of the ML model. While the prediction for d is not as good as the UCP after Kanda et al., the performance for z0 is notable. The RF algorithm also categorizes z0 and d with an exceptional performance score: the overall bell-shaped distributions are well predicted, and the ±0.5σ category (i.e., the 38% percentile) is competently captured (37.8% for z0 and 36.5% for d). Among the morphometric features, the mean and maximum building heights (Have and Hmax, respectively) are found to be of predominant influence on the prediction of z0 and d. A perhaps counterintuitive result is the considerably less striking importance of the building-height variability. Possible reasons are discussed. The feature importance scores could be useful for identifying the contributing factors to the surface aerodynamic characteristics. The results may shed some light on the development of ML-based UCP for mesoscale modeling.