bluuebunny/crossref_metadata_2025_split huggingface dataset:
Portable Ophthalmic Device for Remote Slit-Lamp Examinations and Visual Acuity Screening
Authors: Phan Alex , Truong Buu , Suen Benjamin , Melles Gerrit , Talke Frank E. 
Published: June 2021

Abstract
A multi-functional self-examination ophthalmic device for remote eye examinations has been studied in this paper. The device integrates two standard ophthalmic examinations: slit-lamp and visual acuity. Testing of the device has been performed in a preliminary clinical study. The results show good and comparable images to those of conventional instruments routinely used in ophthalmic clinics. The device can be used in a myriad of remote settings including home monitoring.
The Use of a Nonrefundable Tax Credit to Increase Children’s Participation in Physical Activity in Alberta, Canada
Authors: Stearns Jodie A. , Veugelers Paul J. , McHugh Tara-Leigh , Sprysak Chris , Spence John C. 
Published: June 2021

Background: Potential income disparities were examined in the (1) awareness and uptake of the Children’s Fitness Tax Credit (CFTC), and (2) physical activity (PA) of children from families who did and did not claim the credit in Alberta, Canada in 2012 and 2014. Methods: Secondary analyses of 3 cross-sectional data sets of grade 5 students (10–11 y) were performed, including Alberta Project Promoting healthy Living for Everyone Schools 2012 (N = 1037), and Raising healthy Eating and Active Living Kids Alberta 2012 (N = 2676), and 2014 (N = 3125). Parents reported whether they claimed the CFTC in the previous year, their education and household income, and their child’s gender and PA. Children self-reported their PA from the previous 7 days. In Alberta Project Promoting healthy Living for Everyone Schools, children also wore pedometers. Analyses adjusted for clustering within schools and demographic factors. Results: Higher income families (≥$50,000/y) were more likely to be aware of and to have claimed the CFTC compared with low-income families (<$50,000/y). The CFTC was associated with organized PA with larger associations for higher-income families (odds ratio = 9.03–9.32, Ps < .001) compared with lower-income families (odds ratio = 3.27–4.05, Ps < .01). No associations existed for overall PA or pedometer steps with the CFTC. Conclusions: Income disparities exist in the awareness, uptake, and potential impact of the CFTC. Tax credits are not effective in promoting overall PA.
Cancer Aging Research Group (CARG) score in older adults undergoing curative intent chemotherapy: a prospective cohort study
Authors: Ostwal Vikas , Ramaswamy Anant , Bhargava Prabhat , Hatkhambkar Tejaswee , Swami Rohit , Rastogi Sameer , Mandavkar Sarika , Ghosh Jaya , Bajpai Jyoti , Gulia Seema , Srinivas Sujay , Rath Sushmita , Gupta Sudeep 
Published: June 2021

ImportanceThe Cancer Aging Research Group (CARG) toxicity score is used to assess toxicity risk in geriatric patients receiving chemotherapy.ObjectiveThe primary aim was to validate the CARG score in geriatric patients treated with curative intent chemotherapy in predicting grade 3–5 toxicities.DesignThis was a longitudinal prospective observational study.SettingTata Memorial Hospital, Mumbai, India, a tertiary cancer care referral centre.ParticipantsPatients, aged ≥65 years, with gastrointestinal, breast or gynaecological stage I–III cancers being planned for curative intent chemotherapy. A total of 270 patients were required for accrual in the study.Exposure(s)Total risk score ranged from 0 (lowest toxicity risk) to 19 (highest toxicity risk).Main outcome(s) and measure(s)The primary endpoint of the study was to evaluate whether the CARG risk score predicted for grade 3–5 toxicities.ResultsThe study cohort of 270 patients had a mean age of 69 (65–83) years, with the most common cancers being gastrointestinal (79%). Fifty-two per cent of patients had atleast one grade 3–5 toxicity. The risk of toxicity was increased with an increasing risk score (42% low risk, 51% medium risk and 79% high risk; p<0.001). There was no association between either Eastern Cooperative Oncology Group (ECOG) performance status (p=0.69) or age-adjusted Charlson Comorbidity Index (p=0.79) risk categories and grade 3–5 chemotherapy toxicities.Conclusions and relevanceThis study validates the CARG risk score in predicting for grade 3–5 toxicities in geriatric oncology patients receiving curative intent chemotherapy and can be considered as the standard of care before planning chemotherapy in every elderly patient.Trial registration numberCTRI/2016/10/007357; Results.
Mixed-methods study protocol for an evaluation of the mental health transition navigator model in child and adolescent mental health services: the Navigator Evaluation Advancing Transitions (NEAT) study
Authors: Cleverley Kristin , Stevens Katye , Davies Julia , McCann Emma , Ashley Tracy , Brathwaite Daneisha , Gebreyohannes Mana , Nasir Saba , O"Reilly Katelyn , Bennett Kathryn J , Brennenstuhl Sarah , Charach Alice , Henderson Joanna , Jeffs Lianne , Korczak Daphne J , Monga Suneeta , de Oliveira Claire , Szatmari Peter 
Published: June 2021

IntroductionTransition from child and adolescent mental health services (CAMHS) to community or adult mental health services (AMHS) is a highly problematic health systems hurdle, especially for transition-aged youth. A planned and purposeful transition process is often non-existent or experienced negatively by youth and their caregivers. Stakeholders, including youth and their caregivers, have demanded interventions to support more effective transitions, such a transition navigator. The transition navigator model uses a navigator to facilitate complex transitions from acute care CAMHS to community or AMHS. However, despite the widespread implementation of this model, there has been no evaluation of the programme, hindering its scalability. This paper describes the study protocol of the Navigator Evaluation Advancing Transitions study that aims to collaborate with patients, caregivers and clinicians in the evaluation of the navigator model.Methods and analysisA pre and post mixed-method study will be conducted, using the Triple Aim Framework, to evaluate the navigator model. We will recruit participants from one large tertiary and two community hospitals in Toronto, Canada. For the quantitative portion of the study, we will recruit a sample of 45 youth (15 at each site), aged 16–18, and their caregivers at baseline (referral to navigator) (T1) and 6 months (T2). Youth and caregiver participants will complete a set of standardised measures to assess mental health, service utilisation, and satisfaction outcomes. For the qualitative portion of the study, semistructured interviews will be conducted at 6 months (T2) with youth, their caregivers and clinicians to better understand their experience and satisfaction with the model.Ethics and disseminationResearch Ethics Board (REB) approval has been obtained from the lead research sites, the University of Toronto and the Hospital for Sick Children. The results of the study will be reported in peer-reviewed publications, webinars and conferences and to all relevant stakeholders.
Palliative home care and emergency department visits in the last 30 and 90 days of life: a retrospective cohort study of patients with cancer
Authors: Mracek Jennifer , Earp Madalene , Sinnarajah Aynharan 
Published: June 2021

ObjectivesEvaluate the association of specialist palliative home care (HC) on emergency department (ED) visits in the 30 and 90 days prior to death.MethodsThis retrospective cohort study using administrative data identified 6976 adults deceased from cancer between 2008 and 2015, living ≥180 days after diagnosis of cancer, and residing in the urban Calgary Zone of Alberta Health Services. All palliative HC and generalist HC services were examined. Regression analyses examined the relationships of HC type to ED visits in the last 30 or 90 days of life.ResultsIn the last 30 days of life, compared with patients receiving palliative HC, patients receiving only generalist HC, or no HC, were more likely to visit the ED (OR)generalist-HC1.19; 95% CI 1.06 to 1.34; ORno-HC1.54; 95% CI 1.31 to 1.82). In the last 90 days of life, compared with patients receiving palliative HC, those receiving generalist HC (OR 1.48; 95% CI 1.32 to 1.67) and no HC (OR 1.66; 95% CI 1.39 to 1.99) had increased odds of visiting the ED.ConclusionsReceiving generalist HC and no HC was associated with increased odds of visiting the ED in the last 30 and 90 days of life, when compared with patients receiving palliative HC. Improving access to palliative HC for patients at high risk of visiting the ED may reduce ED visits and acute care costs and improve quality of life in the last 90 days of life.
Association of emergency department boarding times on hospital length of stay for patients with psychiatric illness
Authors: Lane Daniel J , Roberts Lauren , Currie Shawn , Grimminck Rachel , Lang Eddy 
Published: June 2021

BackgroundExtended periods awaiting an inpatient bed in the emergency department (ED) may exacerbate the state of patients with acute psychiatric illness, increasing the time it takes to stabilise their acute problem in hospital. Therefore, we assessed the association between boarding time and hospital length of stay for psychiatric patients.MethodsED clinical records were linked to inpatient administrative records for all patients with a primary psychiatric diagnosis admitted to a Calgary, Alberta hospital between April 2014 and March 2018. The primary exposure was boarding time (admission decision to inpatient bed transfer), and primary outcome was inpatient length of stay. Confounders for this relationship, including indicators of illness severity, were selected a priori then the association was assessed using hierarchical Bayesian Poisson regression, which accounts for repeat observations of the same patient and differences between hospital sites. Changes in length of stay were measured using a rate ratio (ie, expected change in length of stay for each 1 hour increase in boarding time).ResultsA total of 19 212 admissions (14 261 unique patients) were included in the analysis. The average boarding time was 14 hours (range: 0–186 hours). Patients who were boarded for greater than 14 hours more frequently required a high-observation bed (14% vs 3.5%), received an antipsychotic (44% vs 14%) or received sedation (55% vs 33%) while in the ED. The probability that boarding time increased hospital length of stay (rate ratio: >1) was 92%, with a median increase for a patient boarded for 24 hours of 0.01 days.ConclusionBoarding in the ED was associated with a high probability of increasing the hospital length of stay for psychiatric patients; however, the absolute increase is minimal. Although slight, this signal for longer length of stay may be a sign of increased morbidity for psychiatric patients held in the ED.
Identification of the source events for aerosol generation during oesophago-gastro-duodenoscopy
Authors: Gregson Florence K A , Shrimpton Andrew J , Hamilton Fergus , Cook Tim M , Reid Jonathan P , Pickering Anthony E , Pournaras Dimitri J , Bzdek Bryan R , Brown Jules 
Published: June 2021

ObjectiveTo determine if oesophago-gastro-duodenoscopy (OGD) generates increased levels of aerosol in conscious patients and identify the source events.DesignA prospective, environmental aerosol monitoring study, undertaken in an ultraclean environment, on patients undergoing OGD. Sampling was performed 20 cm away from the patient’s mouth using an optical particle sizer. Aerosol levels during OGD were compared with tidal breathing and voluntary coughs within subject.ResultsPatients undergoing bariatric surgical assessment were recruited (mean body mass index 44 and mean age 40 years, n=15). A low background particle concentration in theatres (3 L−1) enabled detection of aerosol generation by tidal breathing (mean particle concentration 118 L−1). Aerosol recording during OGD showed an average particle number concentration of 595 L−1with a wide range (3–4320 L−1). Bioaerosol-generating events, namely, coughing or burping, were common. Coughing was evoked in 60% of the endoscopies, with a greater peak concentration and a greater total number of sampled particles than the patient’s reference voluntary coughs (11 710 vs 2320 L−1and 780 vs 191 particles, n=9 and p=0.008). Endoscopies with coughs generated a higher level of aerosol than tidal breathing, whereas those without coughs were not different to the background. Burps also generated increased aerosol concentration, similar to those recorded during voluntary coughs. The insertion and removal of the endoscope were not aerosol generating unless a cough was triggered.ConclusionCoughing evoked during OGD is the main source of the increased aerosol levels, and therefore, OGD should be regarded as a procedure with high risk of producing respiratory aerosols. OGD should be conducted with airborne personal protective equipment and appropriate precautions in those patients who are at risk of having COVID-19 or other respiratory pathogens.
Learning from minor injury care restructure during the COVID-19 pandemic: a phenomenological study of orthopaedic clinical leaders
Authors: Gatfield Sophie , Yeomans Daniel , Walton Henry , Mason Will , Takwale Vinay 
Published: June 2021

BackgroundDuring peaks of the COVID-19 pandemic, trauma and orthopaedic departments in England have been asked to support emergency departments by providing first contact care for minor injuries. The subsequent requirement for departmental restructure has resulted in a variety of service pathways across the country. This study aimed to explore the experiences of different clinical teams and identify any consistent themes or reflections, which could be applied to continuous improvement of minor injury care.MethodsUsing a phenomenological approach, nine semistructured interviews were conducted with trauma and orthopaedic clinical leads across England whose departments provided support to minor injuries service. Detailed transcripts were then analysed to identify themes for discussion. Interviews were conducted via video conferencing in November 2020 at the end of England’s second national lockdown.ResultsEach of the nine orthopaedic departments provided support for minor injuries, six of which involved creating a new unit. Themes included the value of collaborative working between the emergency department and orthopaedic staff across multiple professions and the benefit to patients of early definitive decision making. A common theme was reduced barriers to change during the pandemic. Examples of long-term service improvements triggered by the pandemic focus on pathways to enable consultant to provide early opinions for injured patients.ConclusionsA range of experiences have demonstrated themes in reflection from service leaders. Departments across the country should be encouraged to consider what improvements to their own service may be applied long term. Resource limitations, staff well-being and education must all be considered.
A Dutchman in London: reflections of a hospital chief executive from the Netherlands in the NHS
Authors: Levi Marcel 
Published: June 2021

BackgroundThe NHS is a fascinating health care system and is enjoying a lot of support from all layers of British society. However, it is clear that the system has excellent features but also areas that can be improved.Story of selfA number of years as a chief executive in one of London’s largest hospital has brought me a wealth of impressions, experiences, and understanding about working in the NHS. Contrasting those to my previous experience as chief executive in Amsterdam (The Netherlands) provides an interesting insight.ObservationsVery strong features of the NHS are the high level of health care professionals, the focus on quality and safety, and involvement of patients and the public. However, the NHS can significantly improve by addressing the lack of clinical professionals in the lead, curtailing ever increasing bureaucracy, and reducing its peculiar preference for outsourcing even the most crucial activities to private parties. The frequent inability to swiftly and successfully complete goal-directed negotiations as well as the large but from a clinical point of view irrelevant private sector are areas of sustained bewilderment. Lastly, the drive for innovation and transformation as well as the level of biomedical research in the NHS and supported by the British universities is fascinating and outstanding.
Prevalence and risk factors for anogenital HPV infection and neoplasia among women living with HIV in China
Authors: Duan Rufei , Zhang Hongyun , Wu Aihui , Li Chongxi , Li Le , Xu Xiaoqian , Qiao Youlin , Zhao Fanghui , Clifford Gary 
Published: June 2021

ObjectivesTo explore the prevalence and risk factors of anogenital human papillomavirus (HPV) infection and neoplasia among women living with HIV (WLHIV) in China.MethodsA cross-sectional survey was conducted from 2019 to 2020, 409 WLHIV aged 18 years and older were recruited from an HIV treatment clinic in Yunnan, China. Cervical and anal samples were collected for HPV testing of 15 HPV genotypes and cytological interpretation. Women positive for cervical HPV or cytological abnormalities were recalled for colposcopy examination and biopsy when necessary. Prevalence of anogenital HPV infection and neoplasia were compared by logistic regression.ResultsHPV prevalence was 34.2% (140/409) for cervical and 34.7% (142/409) for anal (high-risk HPV being 30.6% (125/409) and 30.3% (124/409), respectively). The most frequent genotypes were HPV-52, HPV-16 and HPV-58 in the cervix, HPV-52, HPV-53 and HPV-39 in the anus, with strong correlation between cervical and anal positivity, both overall and at a type-specific level. Cervical HPV was most associated with short duration of combination antiretroviral therapies (cART) (≤2 vs >2 years, adjusted OR (aOR)=2.25, 95% CI: 1.22 to 4.12) and high initial HIV viral load (≥1000 vs <1000 copies/mL, aOR=1.98, 95% CI: 1.10 to 3.58). Anal HPV was most associated with low nadir CD4 count (<200 vs ≥200 cells/µL, aOR=1.80, 95% CI: 1.01 to 3.22) and low current CD4 count (<350 vs ≥500 cells/µL, aOR=2.06, 95% CI: 1.00 to 4.36). CIN2+ prevalence was 4.6% and associated with low nadir CD4 count (aOR=4.63, 95% CI: 1.24 to 17.25).ConclusionsCervical and anal HPV were strongly correlated and, together with associated neoplasia, were highly prevalent among WLHIV in China. Early initiation of cART to avoid severe immunodeficiency should decrease anogenital HPV prevalence and related cancer burden among WLHIV. Incorporating anogenital cancer prevention services into HIV/AIDS care is warranted.
Brain plasticity in response to short-term exposure to corticosterone in larval amphibians
Authors: Cha Elizabeth S. , Uhrin Madison T. , McClelland Sara J. , Woodley Sarah K. 
Published: June 2021

Exposure to stressors and elevation of glucocorticoid hormones such as corticosterone (CORT) has widespread effects on vertebrate brain development. Previous studies have shown that exposure to environmental stressors alters larval amphibian brain morphology and behavior, yet the effects of CORT on amphibian brain morphology are still unknown. We exposed prometamorphic Northern Leopard Frog (Lithobates pipiens (Schreber, 1782)) tadpoles for 7 days to a concentration of exogenous CORT (45.56 μg/L) that produced physiologically relevant increases in plasma CORT. This brief exposure to CORT, relatively late in development, resulted in a significantly larger diencephalon width (relative to body mass) when compared with controls. Although we were unable to detect changes in behavior or body morphology, our results indicate that brain shape is modulated by exposure to CORT. More studies are needed to better understand what accounts for the CORT-induced change in brain shape as well as the functional consequences of these changes.
Edge-state influence on high-order harmonic generation in topological nanoribbons
Authors: Jürß Hannah , Bauer Dieter 
Published: June 2021

Abstract
The high-order harmonic generation in finite topological nanoribbons is investigated using a tight-binding approximation. The narrow, two-dimensional ribbons consist of hexagonal structures. A topological phase transition is defined by a sudden change of the topological invariant. In the bulk, this kind of phase transition might occur if an existing band gap closes and reopens again. Through the bulk-boundary correspondence, this is related to the emergence of topologically protected edge states in the respective finite systems. For the finite ribbons studied in this work, the variation of the tight-binding parameters leads to the emergence of two edge states after the closing of the band gap. The energies of those edge states as functions of the tight-binding parameters display crossings and avoided crossings, which influence the high-harmonic spectra.

Graphic Abstract
Effect of Uygur medicine maturants on related factors of liver energy metabolism in rats
Authors: Talifu Ainiwaer , Samat Rapkat , Kuerban Yilifanjinag , Kader Mamatali , Tursun Dilnur 
Published: June 2021

Objective: To investigate the effects of five Uygur medicine maturants on the related factors of liver energy metabolism in rats. Methods: After 30 days of preparation and intragastric administration, the weight changes of rats were observed. Enzyme-linked immunosorbent assay (ELISA) was used to detect Na[Formula: see text] K[Formula: see text] ATPase, Ca2[Formula: see text] Mg2[Formula: see text] ATPase and succinate dehydrogenase (SDH) activities; hepatic glycogen (HG) and muscle glycogen (MG) content, plasma triiodothyronine (T3), tetraiodothyronine (T4), and thyrotropin (TSH) content were detected. Results: The Kan (blood) quality regulator reduced the weight of rats, the Sapra regulator increased the weight of rats, the Savda maturant group, and the Balham maturant group increased the Na[Formula: see text] K[Formula: see text] ATPase, Ca2[Formula: see text] Mg2[Formula: see text] ATP, SDH activity, HG, MG, T3, T4, and TSH content of rats significantly, while the other groups had no significant effect on the energy metabolism-related factors. Conclusion: Five kinds of Uygur medicine maturants have effects on the related factors of energy metabolism in the liver of normal rats, and their elevation of serum thyroxine level is related, among which the effects of the Savda maturant group and the Balham maturant group are more significant.