bluuebunny/crossref_metadata_2025_split huggingface dataset:
Humanização no cuidado em saúde mental: compreensões dos enfermeiros
Authors: Lima Deivson Wendell da Costa , Paixão Ana Karla Ramalho , Bezerra Kelianny Pinheiro , Freitas Rodrigo Jácob Moreira de , Azevedo Lívia Dayane Sousa , Morais Fátima Raquel Rosado 
Published: May 2021

Objetivo: conhecer as compreensões dos enfermeiros sobre humanização no cuidado em saúde mental. Método: tratase de uma pesquisa exploratória, de abordagem qualitativa, realizada com 12 enfermeiros em um hospital psiquiátrico do interior do Nordeste, Brasil, no período de setembro de 2014 a março de 2015. Para a coleta de dados, utilizou-se entrevista semiestruturada, observação não participante e observação dos registros de Enfermagem, analisando-os a partir da Análise de Conteúdo de Bardin. Resultados: emergiram quatro categorias: acolhimento, autonomia, protagonismo e corresponsabilidade. O cuidado humanizado aparece atrelado ao modelo manicomial, culminando em práticas focadas no uso da medicação, ações desarticuladas e sem participação do paciente no tratamento. A percepção da humanização é de dificuldade de atenção às pessoas em crises psíquicas, o que inviabiliza a produção do cuidado integral. Conclusão: o estudo contribui para a reflexão do cuidado de Enfermagem em saúde mental onde é preciso modificar as relações que o discurso biomédico mantém com os que buscam uma prática humanizada.
Polygenic Risk Score–Enhanced Risk Stratification of Coronary Artery Disease in Patients With Stable Chest Pain
Authors: Christiansen Morten Krogh , Winther Simon , Nissen Louise , Vilhjálmsson Bjarni Jóhann , Frost Lars , Johansen Jane Kirk , Møller Peter Loof , Schmidt Samuel Emil , Westra Jelmer , Holm Niels Ramsing , Jensen Henrik Kjærulf , Christiansen Evald Høj , Guðbjartsson Daníel Fannar , Hólm Hilma , Stefánsson Kári , Bøtker Hans Erik , Bøttcher Morten , Nyegaard Mette 
Published: May 2021

Background:
Polygenic risk scores (PRSs) are associated with coronary artery disease (CAD), but the clinical potential of using PRSs at the single-patient level for risk stratification has yet to be established. We investigated whether adding a PRS to clinical risk factors (CRFs) improves risk stratification in patients referred to coronary computed tomography angiography on a suspicion of obstructive CAD.

Methods:
In this prespecified diagnostic substudy of the Dan-NICAD trial (Danish study of Non-Invasive testing in Coronary Artery Disease), we included 1617 consecutive patients with stable chest symptoms and no history of CAD referred for coronary computed tomography angiography. CRFs used for risk stratification were age, sex, symptoms, prior or active smoking, antihypertensive treatment, lipid-lowering treatment, and diabetes. In addition, patients were genotyped, and their PRSs were calculated. All patients underwent coronary computed tomography angiography. Patients with a suspected ≥50% stenosis also underwent invasive coronary angiography with fractional flow reserve. A combined end point of obstructive CAD was defined as a visual invasive coronary angiography stenosis >90%, fractional flow reserve <0.80, or a quantitative coronary analysis stenosis >50% if fractional flow reserve measurements were not feasible.

Results:

The PRS was associated with obstructive CAD independent of CRFs (adjusted odds ratio, 1.8 [95% CI, 1.5–2.2] per SD). The PRS had an area under the curve of 0.63 (0.59–0.68), which was similar to that for age and sex. Combining the PRS with CRFs led to a CRF+PRS model with area under the curve of 0.75 (0.71–0.79), which was 0.04 more than the CRF model (
P
=0.0029). By using pretest probability (pretest probability) cutoffs at 5% and 15%, a net reclassification improvement of 15.8% (
P
=3.1×10
−4
) was obtained, with a down-classification of risk in 24% of patients (211 of 862) in whom the pretest probability was 5% to 15% based on CRFs alone.

Conclusions:
Adding a PRS improved risk stratification of obstructive CAD beyond CRFs, suggesting a modest clinical potential of using PRSs to guide diagnostic testing in the contemporary clinical setting.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02264717.
Cardiovascular Events, Acute Hospitalizations, and Mortality in Patients With Type 2 Diabetes Mellitus Who Initiate Empagliflozin Versus Liraglutide: A Comparative Effectiveness Study
Authors: Thomsen Reimar W. , Knudsen Jakob S. , Kahlert Johnny , Baggesen Lisbeth M. , Lajer Maria , Holmgaard Pia H. , Vedin Ola , Ustyugova Anastasia , Sørensen Henrik T. 
Published: May 2021

Background
In cardiovascular outcome trials, the sodium glucose cotransporter 2 inhibitor empagliflozin and glucagon‐like peptide‐1 (GLP‐1) receptor agonist liraglutide caused similar reductions in major adverse cardiac events (MACE). We compared clinical outcomes in routine clinical care.

Methods and Results
EMPLACE (Cardiovascular and Renal Outcomes, and Mortality in Danish Patients with Type 2 Diabetes Who Initiate Empagliflozin Versus GLP‐1RA: A Danish Nationwide Comparative Effectiveness Study) is an ongoing nationwide population‐based comparative effectiveness cohort study in Denmark. For the present study, we included 14 498 new users of empagliflozin and 12 706 new users of liraglutide, 2015 to 2018. Co‐primary outcomes were expanded major adverse cardiac events (stroke, myocardial infarction, unstable angina, coronary revascularization, hospitalization for heart failure [HHF], or all‐cause death); HHF or all‐cause death; and first HHF or first initiation of loop‐diuretic therapy. Secondary outcomes included all‐cause hospitalization or death. We applied propensity score balancing and Cox regression to compute adjusted hazard ratios (aHRs) in on‐treatment (OT) and intention‐to‐treat (ITT) analyses. Cohorts were well balanced at baseline (median age 61 years, 59% men, diabetes mellitus duration 6.6 years, 30% with preexisting cardiovascular disease). During mean follow‐up of 1.1 years in OT and 1.5 years in ITT analyses, empagliflozin versus liraglutide was associated with a similar rate of expanded major adverse cardiac events (OT aHR, 1.02; 95% CI, 0.91–1.14; ITT aHR, 1.06; 95% CI, 0.96–1.17), and HHF or all‐cause death (OT aHR, 0.97; 95% CI, 0.85–1.11; ITT aHR, 1.02; 95% CI, 0.91–1.14); and a decreased rate of a first incident HHF or loop‐diuretic initiation (OT aHR, 0.80; 95% CI, 0.68–0.94; ITT aHR, 0.87; 95% CI, 0.76–1.00), and of all‐cause hospitalization or death (OT aHR, 0.93; 95% CI, 0.89–0.98; ITT aHR, 0.93; 95% CI, 0.90–0.97).

Conclusions
Empagliflozin and liraglutide initiators had comparable rates of expanded major adverse cardiac events, and HHF or all‐cause death, whereas empagliflozin initiators had a lower rate of a first HHF or loop‐diuretic initiation.
Long‐Term Cardiovascular Outcomes After Pregnancy in Women With Heart Disease
Authors: Siu Samuel C. , Lee Douglas S. , Rashid Mohammed , Fang Jiming , Austin Peter C. , Silversides Candice K. 
Published: May 2021

Background
Women with heart disease are at risk for pregnancy complications, but their long‐term cardiovascular outcomes after pregnancy are not known.

Methods and Results

We examined long‐term cardiovascular outcomes after pregnancy in 1014 consecutive women with heart disease and a matched group of 2028 women without heart disease. The primary outcome was a composite of mortality, heart failure, atrial fibrillation, stroke, myocardial infarction, or arrhythmia. Secondary outcomes included cardiac procedures and new hypertension or diabetes mellitus. We compared the rates of these outcomes between women with and without heart disease and adjusted for maternal and pregnancy characteristics. We also determined if pregnancy risk prediction tools (CARPREG [Canadian Cardiac Disease in Pregnancy] and World Health Organization) could stratify long‐term risks. At 20‐year follow‐up, a primary outcome occurred in 33.1% of women with heart disease, compared with 2.1% of women without heart disease. Thirty‐one percent of women with heart disease required a cardiac procedure. The primary outcome (adjusted hazard ratio, 19.6; 95% CI, 13.8–29.0;
P
<0.0001) and new hypertension or diabetes mellitus (adjusted hazard ratio, 1.6; 95% CI, 1.4–2.0;
P
<0.0001) were more frequent in women with heart disease compared with those without. Pregnancy risk prediction tools further stratified the late cardiovascular risks in women with heart disease, a primary outcome occurring in up to 54% of women in the highest pregnancy risk category.

Conclusions
Following pregnancy, women with heart disease are at high risk for adverse long‐term cardiovascular outcomes. Current pregnancy risk prediction tools can identify women at highest risk for long‐term cardiovascular events.
The Tabula in the Collège de Sorbonne and the Discovery of the 1529 Bomberg Siddur
Authors: Kogel Judith 
Published: May 2021

Abstract
Interest was aroused recently concerning a booklet of 28 folios entitled Tabula in universum indicans libros singularum disciplinarum. Formerly considered a 17th-century catalogue, it actually reflects the contents of the library of the Collège de Sorbonne in the mid-16th century. A project, directed by Gilbert Fournier, will identify the authors and works mentioned in the document and localize the books in Parisian and French libraries. Entrusted with the rubric Rabbini Hebraeorum, I quickly realized that I needed to work simultaneously on the catalogue and the dispersion of the library of the Collège. This back and forth process led to the discovery of the 1529 Bomberg Ashkenazic Siddur.
Understanding the Roles of Convective Trigger Functions in the Diurnal Cycle of Precipitation in the NCAR CAM5
Authors: Cui Zeyu , Zhang Guang J. , Wang Yong , Xie Shaocheng 
Published: May 2021

AbstractThe wrong diurnal cycle of precipitation is a common weakness of current global climate models (GCMs). To improve the simulation of the diurnal cycle of precipitation and understand what physical processes control it, we test a convective trigger function described in Xie et al. with additional optimizations in the NCAR Community Atmosphere Model version 5 (CAM5). The revised trigger function consists of three modifications: 1) replacing the convective available potential energy (CAPE) trigger with a dynamic CAPE (dCAPE) trigger, 2) allowing convection to originate above the top of planetary boundary layer [i.e., the unrestricted air parcel launch level (ULL)], and 3) optimizing the entrainment rate and threshold value of the dynamic CAPE generation rate for convection onset based on observations. Results from 1° resolution simulations show that the revised trigger can alleviate the long-standing GCM problem of too early maximum precipitation during the day and missing the nocturnal precipitation peak that is observed in many regions, including the U.S. southern Great Plains (SGP). The revised trigger also improves the simulation of the propagation of precipitation systems downstream of the Rockies and the Amazon region. A further composite analysis over the SGP unravels the mechanisms through which the revised trigger affects convection. Additional sensitivity tests show that both the peak time and the amplitude of the diurnal cycle of precipitation are sensitive to the entrainment rate and dCAPE threshold values.
Stratified shear instabilities in diurnal warm layers
Authors: Hughes Kenneth G. , Moum James N. , Shroyer Emily L. , Smyth William D. 
Published: May 2021

AbstractIn low winds (≲2 m s−1), diurnal warm layers form but shear in the near-surface jet is too weak to generate shear instability and mixing. In high winds (≳8ms−1), surface heat is rapidly mixed downward and diurnal warm layers do not form. Under moderate winds of 3–5 m s−1, the jet persists for several hours in a state that is susceptible to shear instability. We observe low Richardson numbers of Ri ≈ 0.1 in the top 2 m between 10:00 and 16:00 local time (from 4 h after sunrise to 2 h before sunset). Despite Ri being well below the Ri = 1/4 threshold, instabilities do not grow quickly, nor do they overturn. The stabilizing influence of the sea surface limits growth, a result demonstrated by both linear stability analysis and two-dimensional simulations initialized from observed profiles. In some cases, growth rates are sufficiently small (≪1 h−1) that mixing is not expected even though Ri < 1/4. This changes around 16:00–17:00. Thereafter, convective cooling causes the region of unstable flow to move downward, away from the surface. This allows shear instabilities to grow an order of magnitude faster and mix effectively. We corroborate the overall observed diurnal cycle of instability with a freely evolving, two-dimensional simulation that is initialized from rest before sunrise.
Services Trade: The Great Gender Equaliser?
Authors: Johannesson Louise , Nordås Hildegunn Kyvik 
Published: May 2021

Standing at 24% in 2018, India’s female labour force participation is only half of the global average (48%). At the same time, India has one of the widest gender wage gaps in the world and women are less likely to be employed in the formal sector compared to men. This article focuses on how international trade affects relative wages and formal employment between men and women in India. Using the Revealed Symmetrical Comparative Advantage index, sectors of comparative advantage and disadvantage are identified and matched to Indian labour force surveys that contain information on sectoral employment and earnings. We find that sectors of comparative advantage in services have the lowest gender wage gap, with women earning 24% less than their male counterparts, while women in manufacturing earned on average 40% less than male workers. Using the Oaxaca–Blinder decomposition, we find that the total gender wage gap in sectors of comparative advantage in services are minor while it is quite substantial in manufacturing, regardless of comparative advantage status. The article concludes that services trade goes hand in hand with a smaller gender wage gap as women leverage their skills better in services than in manufacturing. JEL Codes: F16, F14
Can I Leave the House? A Coded Analysis of the Interpretation of the Reasonable Excuse Provision by NSW Police During the COVID-19 Lockdown
Authors: Mostyn Ben , Kinchin Niamh 
Published: May 2021

AbstractThis article looks at the recent Public Health (COVID-19 Restrictions on Gathering and Movement) Order 2020, which was in force in New South Wales from 31 March 2020 to 14 May 2020. The order allowed police to fine people who left their houses without a ‘reasonable excuse’. This article considers the confusion around the order in the community and upper levels of the government. Publicly available information about the fines issued by the police is analysed and it is argued that an overly narrow application of the order by police meant that its application was not reasonably proportionate to the authorising legislation, the Public Health Act 2010 (NSW). It is concluded that if future lockdowns are required, care will need to be taken to ensure that Ministerial orders are crafted in line with the legislation and that police officers clearly understand their operation.
Tracking Home Language Production and Environment in Children Who Are Deaf or Hard of Hearing
Authors: Sola Ana Marija , Brodie Kara D. , Stephans Jihyun , Scarpelli Chiara , Chan Dylan K. 
Published: May 2021

ObjectiveTo use an automated speech‐processing technology to identify patterns in sound environments and language output for deaf or hard‐of‐hearing infants and toddlers.Study DesignObservational study based on a convenience sample.SettingHome observation conducted by tertiary children’s hospital.MethodsThe system analyzed 115 naturalistic recordings of 28 children <3.5 years old. Hearing ability was stratified into groups by access to sound. Outcomes were compared across hearing groups, and multivariable linear regression was used to test associations.ResultsThere was a significant difference in age‐adjusted child vocalizations (P =. 042), conversational turns (P =. 022), and language development scores (P =. 05) between hearing groups but no significant difference in adult words (P =. 11). Conversational turns were positively associated with each language development measure, while adult words were not. For each hour of electronic media, there were significant reductions in child vocalizations (β = −0.47; 95% CI, −0.71 to −0.19), conversational turns (β = −0.45; 95% CI, −0.65 to −0.22), and language development (β = −0.37; 95% CI, −0.61 to −0.15).ConclusionsConversational turn scores differ among hearing groups and are positively associated with language development outcomes. Electronic media is associated with reduced discernible adult speech, child vocalizations, conversational turns, and language development scores. This effect was larger in children who are deaf or hard of hearing as compared with other reports in typically hearing populations. These findings underscore the need to optimize early language environments and limit electronic noise exposure in children who are deaf or hard of hearing.
Variation in end-of-life care and hospital palliative care among hospitals and local authorities: A preliminary contribution of big data
Authors: Gusmano Michael K. , Rodwin Victor G. , Weisz Daniel , Cottenet Jonathan , Quantin Catherine 
Published: May 2021

Background: Many studies explore the clinical and ethical dimensions of care at the end-of-life, but fewer use administrative data to examine individual and geographic differences, including the use of palliative care. Aim: Provide a population-based perspective on end-of-life and hospital palliative care among local authorities and hospitals in France. Design: Retrospective cohort study of care received by 17,928 decedents 65 and over (last 6 months of life), using the French national health insurance database Results: 55.7% of decedents died in acute-care hospitals; 79% were hospitalized in them at least once; 11.7% were admitted at least once for hospital palliative care. Among 31 academic medical centers, intensive care unit admissions ranged from 12% to 67.4%; hospital palliative care admissions, from 2% to 30.6%. Across local authorities, for intensive care unit days and hospital palliative care admissions, the ratios between the values at the third and the first quartile were 2.4 and 1.5. The odds of admission for hospital palliative care or to an intensive care unit for more than 7 days were more than twice as high among people ⩽85 years (aOR = 2.11 (1.84–2.43) and aOR = 2.59 (2.12–3.17), respectively). The odds of admission for hospital palliative care were about 25% lower ( p = 0.04) among decedents living in local authorities with the lowest levels of education than those with the highest levels. Conclusion: The variation we document in end-of-life and hospital palliative care across different categories of hospitals and 95 local authorities raises important questions as to what constitutes appropriate hospital use and intensity at the end-of-life.
Efficacy and safety of intravitreal Fluocinolone Acetonide microimplant (ILUVIEN®) in patients with chronic diabetic macular edema: 1 year follow-up
Authors: Pacella Fernanda , Pacella Elena , Trovato Battagliola Edoardo , Malvasi Mariaelena , Scalinci Sergio Zaccaria , Turchetti Paolo , Salducci Mauro , Lucchino Luca , Arrico Loredana 
Published: May 2021

Purpose: Evaluate the efficacy and safety of intravitreal 0.19 mg fluocinolone acetonide (FAc) micro implant in patients with chronic diabetic macular edema (cDME). Methods: Prospective study recruiting subjects with cDME. Inclusion criteria: cDME for at least 2 years documented with OCT imaging; pseudophakia; previous treatments with laser photocoagulation and intravitreal injections of anti-VEGF and/or dexamethasone. Exclusion criteria: phakia; ocular hypertension; tractional component visible on OCT; glaucoma; previous vitrectomy. Outcome measures included best-corrected visual acuity (BVCA), intraocular pressure (IOP), and central macular thickness (CMT), measured 1, 3, 6, and 12 months post-injection. Data were compared with the Friedman test and significance was set at p < 0.05. Results: A total of 18 eyes with a median duration of cDME of 45 months (25–118 months). The 77% of subjects either maintained or improved their BVCA. About 17% and 33% of subjects showed an improvement of 15 ETDRS letters or more at 3 and 12 months respectively. The 17% and 28% of subjects showed a CMT <250 microns at 3 and 12 months, respectively. The median change in CMT thickness was of −370 and −373.5 microns at 3 and 12 months post-injection respectively ( p-value is 0.025). Changes in median IOP at 3 and 12 months post-injection were not statistically significant ( p-value is 0.210). Ocular hypertension (OHT) was detected in two eyes (11%). Conclusion: The FAc micro implant has proved efficacy in improving and/or maintaining BVCA in 77% of patients with cDME up to 12 months post-injection. Ocular hypertension is the most common side effect but responds well to topical therapy.
A prospective randomised comparison of earlier function after total hip arthroplasty with a mini posterior approach or supercapsular percutaneously-assisted total hip approach: a gait analysis study
Authors: Korytkin Andrey A , El Moudni Younes M , Novikova Yana S , Kovaldov Kirill A , Morozova Ekaterina A 
Published: May 2021

Background: The supercapsular percutaneously-assisted total hip (SuperPATH) approach is a muscle sparing surgical technique for total hip arthroplasty (THA). The literature reports good clinical and functional results of the SuperPATH technique in the short term. We aimed to compare early outcomes and gait analysis of THA using the mini posterior approach (MPA) and supercapsular percutaneously-assisted total hip (SuperPATH) approach. Methods: 44 patients who underwent THA, were randomly allocated to either MPA or SuperPATH. The data were then collected prospectively (preoperatively and postoperatively at 6 weeks). Plain anteroposterior radiographs of the pelvis and instrumental gait analysis were obtained. The visual analogue scale (VAS), Harris Hip Score (HHS) and Hip disability and Osteoarthritis Outcome Scores (HOOS) were used to assess functional and clinical outcomes. Results: No significant difference was found in patients’ surgical outcomes. Patients in the SuperPATH group had less pain according to the VAS score at follow-up than the MPA group ( p < 0.01). There was also a significant improvement in HHS and HOOS scores for all patients ( p < 0.001) with the SuperPATH group showing superior changes. The comparison of mean differences in gait velocity between preoperative and 6 weeks postoperative result, revealed improvement in the SuperPATH group over the MPA group ( p = 0.06). Limping was more persistent in the MPA group. Kinematic parameters demonstrated improved hip joint excursion slightly higher in the MPA group. There was no significant improvement in kinetic and kinematic parameters at different walking moments for all patients at 6 weeks compared to preoperative gait patterns. Conclusions: SuperPATH and MPA both show excellent results. This study reveals that the SuperPATH technique was associated with lower postoperative pain levels, and higher physical function and quality of life. Improved functional outcomes allowed earlier postoperative rehabilitation and faster recovery. Specific improvement in gait patterns were identified with nonsignificant differences between the 2 approaches at 6 weeks follow-up.