bluuebunny/crossref_metadata_2025_split huggingface dataset:
Frame analysis of psychotherapists’ perspectives on the development of psychological disorders
Authors: Riachi Eve , Holma Juha , Laitila Aarno 
Published: August 2021

AbstractThe development of psychological disorders has been explained by several psychological theories and remains under debate. Psychotherapists, however, have insights into the emergence and development of psychological disorders that stem from both theory and practice. The constantly evolving field of psychotherapy prompts reconsideration, specifically when psychotherapists’ views on the development of disorders impacts their treatment approach. In addition, theoretical orientation and years of clinical experience, while known to influence psychotherapists’ viewpoints also merit further study. Applying Erving Goffman’s frame analysis, semi structured interviews with psychotherapists were conducted to determine their perspectives on the emergence of mental disorders. Biological, environmental, and psychological factors were mentioned both separately and in combination by the therapists. These factors, or frames, were then analyzed in relation to the therapists’ therapeutic approaches and length of clinical experience. The analysis showed that the frames employed by the therapists were influenced by several therapeutic orientations. Moreover, therapists with more than ten years of clinical experience mentioned a combination of factors slightly more often than single factors alone. In sum, the findings showed that therapists perceived the development of mental disorders as highly complex and as an outcome of multiple factors. War was also mentioned as an environmental factor in the development of mental disorders. As this finding was clearly a country-specific environmental factor, future studies should explore the possible role of country-specific environmental factors in different countries.
Il gozzo multinodulare
Authors: Brancatella Alessandro , Viola Nicola , Sgrò Daniele , Ricci Debora , Vitti Paolo , Santini Ferruccio , Latrofa Francesco 
Published: August 2021

SommarioSi definisce gozzo l’incremento diffuso o nodulare della ghiandola tiroidea. Il suo sviluppo è legato a fattori genetici e ambientali, di cui il più importante è rappresentato dalla carenza iodica. L’inquadramento clinico prevede un’attenta valutazione dei sintomi, dei segni, dei risultati degli esami ormonali, delle caratteristiche ecografiche e citologiche. Il trattamento deve essere poi individualizzato tenendo conto della disponibilità di molteplici opzioni terapeutiche.
Understanding Stakeholder Preference for Contralateral Prophylactic Mastectomy: A Conjoint Analysis
Authors: Shamsunder Meghana G. , Panchal Hina , Pilewskie Melissa , Lee Clara , Razdan Shantanu N. , Matros Evan 
Published: August 2021

BACKGROUND:
Despite increasing numbers of women with unilateral breast cancer undergoing CPM, quantitative evidence of all stakeholder preferences regarding CPM is lacking, particularly for healthy volunteers. Conjoint analysis, a marketing tool, can be used to quantify tradeoffs surrounding CPM.

STUDY DESIGN:
The objective of this study was to quantify preferences for aspects of contralateral prophylactic mastectomy (CPM) decision-making process among key stakeholders. Healthy volunteers, women with cancer (WwCa), surgical oncologists, and plastic surgeons were surveyed with the same conjoint simulation exercise. Respondents chose between either single (SM) or double (DM) mastectomy under varying recurrence and complication rates, surveillance, and symmetry conditions. Hierarchical Bayesian models calculated partworth utilities and importance scores.

RESULTS:
Overall, 1,244 respondents participated. The top 3 important factors for all stakeholders were surgical complication rates after DM, type of surgery (SM vs DM) independent of other variables, and 10-year future contralateral cancer risk after SM. HV and surgeons placed greatest importance on high rates of surgical complications after DM. WwCa preferred DM, regardless of complication risk or low rates of a 10-year future cancer episode after SM. Surgical oncologists strongly preferred SM and were more accepting of future cancer risk of 3% or 10% than other stakeholders. Symmetry and need for surveillance were least important factors for all stakeholders.

CONCLUSIONS:
The threshold of acceptability for future cancer episodes and risk tolerance for complications varies by stakeholder, with a profound influence upon WwCA. Current findings suggest room for improved provider and patient alignment through behavioral techniques, such as framing, meanwhile highlighting changes in risk perception after a breast cancer diagnosis.
US Medical Licensing Exam Performance and American Board of Surgery Qualifying and Certifying Examinations
Authors: Stain Steven C. , Matthews Jeffrey B. , Ata Ashar , Adams David B. , Chen Herbert , Potts John R. 
Published: August 2021

Background
Program directors use US Medical Licensing Exam (USMLE) scores as criteria for ranking applicants. First-time pass rates of the American Board of Surgery (ABS) Qualifying (QE) and Certifying (CE) Examinations have become important measures of residency program quality. USMLE Step 1 will become pass/fail in 2022.

Study design
American Board of Surgery QE and CE success rates were assessed considering multiple characteristics of highly ranked (top 20) applicants to 22 general surgery programs in 2011. Chi-square, t-test, Wilcoxon Rank sum, linear and logistic regression were used, as appropriate.

Results
The QE and CE first attempt pass rates were 96% (235/244) and 86% (190/221), respectively. QE/CE success was not significantly associated with sex, race, research experience, or publications. Alpha Omega Alpha (AΩA) status was associated with success on the index CE (98% vs 83%; p = 0.008). Step 1 and Step 2 Clinical Knowledge (CK) scores of surgeons who passed QE on their first attempt were higher than scores of those who failed (Step 1: 233 vs 218; p = 0.016); (Step 2CK: 244 vs 228, p = 0.009). For every 10-point increase in Step 1 and 2CK scores, the odds of passing CE on the first attempt increased 1.5 times (95% CI 1.12, 2.0; p = 0.006) and 1.5 times (95% CI 1.11, 2.02, p = 0.008), respectively. For every 10-point increase in Steps 1 and 2CK scores, the odds of passing the QE on the first attempt increased 1.85 times (95% CI 1.11, 3.09; p = 0.018) and 1.86 times (95% CI 1.14, 3.06, p = 0.013), respectively.

Conclusions
USMLE Step 1 and Step 2 CK examination scores correlate with American Board of Surgery QE and CE performance and success. The USMLE decision to transition Step 1 to a pass/fail examination will require program directors to identify other factors that predict ABS performance for ranking applicants.

Visual Abstract
Implementation of a Frailty Assessment and Targeted Care Interventions and Its Association with Reduced Postoperative Complications in Elderly Surgical Patients
Authors: Wilson Spencer , Sutherland Evan , Razak Alina , O’Brien Mollie , Ding Callie , Nguyen Thien , Rosenkranz Pam , Sanchez Sabrina E. 
Published: August 2021

Background
Older patients with frailty syndrome have a greater risk of poor postoperative outcomes. In this study, we used a RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to implement an assessment tool to identify frail patients and targeted interventions to improve their outcomes.

Study Design
We implemented a 5-question frailty assessment tool for patients 65 years and older admitted to the general and vascular surgery services from January 1, 2018 to December 31, 2019. Identified frail patients received evidence-based clinical orders and nursing care plan interventions tailored to optimize recovery. A RE-AIM framework was used to assess implementation effectiveness through provider and nurse surveys, floor audits, and chart review.

Results
Of 1,158 patients included in this study, 696 (60.1%) were assessed for frailty. Among these, 611 patients (87.8%) scored as frail or intermediately frail. After implementation, there were significant increases in the completion rates of frailty-specific care orders for frail patients, including delirium precautions (52.1% vs 30.7%; p < 0.001), aspiration precautions (50.0% vs 26.9%; p < 0.001), and avoidance of overnight vitals (32.5% vs 0%). Floor audits, however, showed high variability in completion of care plan components by nursing staff. Multivariate analysis showed significant decreases in 30-day complication rates (odds ratio 0.532; p < 0.001) after implementation.

Conclusions
A frailty assessment was able to identify elderly patients for provision of targeted, evidence-based frailty care. Despite limited uptake of the assessment by providers and completion of care plan components by nursing staff, implementation of the assessment and care interventions was associated with substantial decreases in complications among elderly surgical patients.

Visual Abstract
Realisation and testing of novel fully articulated bird-inspired flapping wings for efficient and agile UAVs
Authors: Kumar D. , Goyal T. , Kamle S. , Mohite P.M. , Lau E.M. 
Published: August 2021

AbstractLarge birds have evolved an effective wing anatomy and mechanics, enabling airborne mastery of manoeuvres and endurance. For these very reasons, they are difficult to replicate and study. The aim of the present work is to achieve active wing articulations to mimic natural bird flapping towards efficient and agile Unmanned Aerial Vehicles (UAVs). The proposed design, bio-mimicking the black-headed gull,Larus ridibundus, has three active and independent servo-controlled wing joints at the shoulder, elbow and wrist to achieve complex controls. The construction of the wing is realised through a polymeric skin and carbon fibre–epoxy composite spars and ribs. The wing movements (flapping, span reduction and twisting) envelopes of the full-scale robotic gull (Robogull) are examined using the Digital Image Correlation (DIC) technique and laser displacement sensing. Its aerodynamic performance was evaluated in a wind tunnel at various flapping parameters, wind speeds and angles of attack. It is observed that a flapping amplitude of 45$^\circ$is more favourable than 90$^\circ$for generating higher lift and thrust, while also depending on the presence of span reduction, twist and wind speed. The model performs better at a flying velocity of 4m/s as compared with 8m/s. Both lift and thrust are high at a higher flapping frequency of 2.5Hz. Combined variation of the flapping frequency and stroke ratio should be considered for better aerodynamic performance. The combination of a lower stroke ratio of 0.5 with a flapping frequency of 2.5Hz generates higher lift and thrust than other combinations. Span reduction and wing twist notably and independently enhance lift and thrust, respectively. An increase in the angle-of-attack increases lift but decreases thrust. The model can also generate a significant rolling moment when set at a bank angle of 20$^\circ$and operated with independently controlled flapping amplitudes for the wings (45$^\circ$for the left wing and 90$^\circ$for the right wing). Based on the optimal values for the flapping amplitude (45$^\circ$), flapping frequency (2.5Hz) and flying velocity (4m/s), the Strouhal number (St) of the Robogull model is 0.24, lying in the optimal range ($0.2 < \mathrm{St} < 0.4$) for natural flyers and swimmers.
Lock-in phenomenon of vortex shedding in flows excited with two commensurate frequencies: a theoretical investigation pertaining to combustion instability
Authors: Britto Abraham Benjamin , Mariappan Sathesh 
Published: August 2021

An analytical investigation is performed to study the dynamics of vortex shedding behaviour during two commensurate frequency velocity excitations, with an emphasis on the phenomenon of lock-in. We attempt to theoretically study the dynamical features of lock-in under two-frequency excitations and contrast the behaviour with single-frequency excitation. We employ an existing low-order model to characterise the vortex shedding process behind a step/bluff-body. The continuous-time domain model is transformed to a nonlinear dynamical map that relates time instances of successive vortex shedding. Further, these time instances are converted to phase instances, involving which criteria for a generic p : q phase lock-in is obtained. Four parameters are involved: amplitude and frequency of the two excitation components termed as primary and secondary. Bifurcations occurring are investigated using return maps. The inclusion of secondary excitation leads to the existence of two orders of lock-in within a single lock-in boundary. Furthermore, our results indicate that secondary excitation can be used as a control in order to tailor the 1:1 lock-in region formed by the primary excitation. Finally, analytical expressions are obtained to identify lock-in boundaries and their salient geometrical features. Interesting features such as the occurrence of bistability and change in the order of lock-in are observed, which can be explored further with future experiments.
Predictors of adverse birth outcomes among pregnant adolescents in Ashanti Region, Ghana
Authors: Annan Reginald Adjetey , Gyimah Linda Afriyie , Apprey Charles , Asamoah-Boakye Odeafo , Aduku Linda Nana Esi , Azanu Wisdom , Luterodt Herman E. , Edusei Anthony K. 
Published: August 2021

Abstract
Adolescent pregnancy is associated with adverse birth outcomes. However, the determinants of these outcomes are understudied. The present study sought to identify the predictors of adverse birth outcomes among pregnant adolescents in Ghana. In this prospective health centre-based study, 416 pregnant adolescents, aged 13–19 years old, were followed, and 270 birth outcomes were evaluated. We collected data on socio-demographic variables, eating behaviour, household hunger scale (HHS), lived poverty index (LPI) and compliance to antenatal interventions. The prevalence of low birth weight (LBW) and preterm births (PTB) were 15⋅2 and 12⋅5 %, respectively. Pregnant adolescents with no formal education (AOR 9⋅0; P = 0⋅004; 95 % CI 2⋅1, 39⋅8), those who experienced illness (AOR 3⋅0; P = 0⋅011; 95 % CI 1⋅3, 7⋅0), those who experienced hunger (OR 2⋅9; P = 0⋅010; 95 % CI 1⋅3, 6⋅5) and those with high LPI (OR 2⋅5; P = 0⋅014; 95 % CI 1⋅2, 5⋅3) presented increased odds of delivering preterm babies compared with those who have had secondary education, did not experience any illness, were not hungry or having low LPI, respectively. Pregnant adolescents who used insecticide-treated net (ITN) (AOR 0⋅4; P = 0⋅013; 95 % CI 0⋅2, 0⋅9) presented reduced odds LBW children; while those who experienced illness (AOR 2⋅7; P = 0⋅020; 95 % CI 1⋅2, 6⋅0), poorer pregnant adolescents (OR 2⋅5; P = 0⋅014; 95 % CI 1⋅1, 4⋅8) and those who experienced hunger (AOR 3⋅0; P = 0⋅028; 95 % CI 1⋅1, 8⋅1) presented increased odds of LBW children compared with those who used ITN, were not ill, were not poor or did not experience hunger. Adverse birth outcomes were associated with ANC compliance and socioeconomic factors of the pregnant adolescents. Hence, strengthening antenatal uptake and compliance by pregnant adolescents, promoting their livelihood and socioeconomic status, and interventions to prevent teenage pregnancies are strongly recommended.
Managing Complementary Assets to Build Cross-Functional Ambidexterity: The Transformation of Huawei Mobile
Authors: Yan Mengling , Hu Yanni , Dong Xiaoying 
Published: August 2021

ABSTRACTDuring technology transitions, incumbents are frequently faced with the ambidextrous challenge of exploiting existing capabilities and exploring new ones. While extant studies focus on radical changes in the product domain, we notice radical changes can happen in both product and market domains. Pioneering studies indicate that cross-functional ambidexterity addresses this challenge at the business-unit level by juxtaposing exploration and exploitation across different functional domains (particularly in product and market domains) and that complementary assets address this challenge at the organizational level. However, how efforts at two levels can be combined to build cross-functional ambidexterity and what roles complementary assets play remain unclear. Therefore, this study conducts an in-depth case study of Huawei Mobile, which managed to achieve superior performance during a technology transition that triggers radical changes in both product and market domains. We find that multi-level synergies contribute to the transition process. Specifically, cross-functional ambidexterity is constructed by prioritizing exploration in the product domain ahead of that in the market domain, and that it generates learning, brand and channel extension, matching, and brand alliance benefits at the business-unit level. Complementary assets help to reduce the uncertainty of exploration and resolve functional conflicts at the organizational level.
The Mediterranean dietary pattern for optimising health and performance in competitive athletes: a narrative review
Authors: Griffiths Alex , Matu Jamie , Whyte Eleanor , Akin-Nibosun Petros , Clifford Tom , Stevenson Emma , Shannon Oliver Michael 
Published: August 2021

AbstractNutrition plays a key role in training for, and competing in, competitive sport, and is essential for reducing risk of injury and illness, recovering and adapting between bouts of activity, and enhancing performance. Consumption of a Mediterranean diet (MedDiet) has been demonstrated to reduce risk of various non-communicable diseases and increase longevity. Following the key principles of a MedDiet could also represent a useful framework for good nutrition in competitive athletes under most circumstances, with potential benefits for health and performance parameters. In this review, we discuss the potential effects of a MedDiet, or individual foods and compounds readily available in this dietary pattern, on oxidative stress and inflammation, injury and illness risk, vascular and cognitive function, and exercise performance in competitive athletes. We also highlight potential modifications which could be made to the MedDiet (whilst otherwise adhering to the key principles of this dietary pattern) in accordance with contemporary sports nutrition practices, to maximise health and performance effects. In addition, we discuss potential directions for future research.
Higher habitual dietary flavonoid intake associates with lower central blood pressure and arterial stiffness in healthy older adults
Authors: Parmenter Benjamin H. , Croft Kevin D. , Cribb Lachlan , Cooke Matthew B. , Bondonno Catherine P. , Lea Ana , McPhee Grace M. , Komanduri Mrudhula , Nolidin Karen , Savage Karen , Pase Matthew P. , Hodgson Jonathan M. , Stough Con , Bondonno Nicola P. 
Published: August 2021

AbstractFlavonoids have shown anti-hypertensive and anti-atherosclerotic properties: the impact of habitual flavonoid intake on vascular function, central haemodynamics and arterial stiffness may be important. We investigated the relationship between habitual flavonoid consumption and measures of central blood pressure and arterial stiffness. We performed cross-sectional analysis of 381 non-smoking healthy older adults (mean age 66·0 (sd 4·1) years; BMI, 26·4 (sd 4·41) kg/m2; 41 % male) recruited as part of the Australian Research Council Longevity Intervention study. Flavonoid intake (i.e. flavonols, flavones, flavanones, anthocyanins, isoflavones, flavan-3-ol monomers, proanthocyanidins, theaflavins/thearubigins and total consumption) was estimated from FFQ using the US Department of Agriculture food composition databases. Measures of central haemodynamics and arterial stiffness included systolic blood pressure (cSBP), diastolic blood pressure (cDBP), mean arterial pressure (cMAP) and augmentation index (cAIx). After adjusting for demographic and lifestyle confounders, each sd/d higher intake of anthocyanins ((sd 44·3) mg/d) was associated with significantly lower cDBP (−1·56 mmHg, 95 % CI −2·65, −0·48) and cMAP (−1·62 mmHg, 95 % CI −2·82, −0·41). Similarly, each sd/d higher intake of flavanones ((sd 19·5) mg/d) was associated with ~1 % lower cAIx (−0·93 %, 95 % CI −1·77, −0·09). These associations remained signiﬁcant after additional adjustment for (1) a dietary quality score and (2) other major nutrients that may affect blood pressure or arterial stiffness (i.e. Na, K, Ca, Mg, n-3, total protein and fibre). This study suggests a possible benefit of dietary anthocyanin and flavanone intake on central haemodynamics and arterial stiffness; these findings require corroboration in further research.
The Puzzling Persistence of Racial Inequality in Canada
Authors: Banting Keith , Thompson Debra 
Published: August 2021

AbstractThis article examines the failure of Canadian public policy in addressing racial economic inequality directly. Our analysis contends that Canada's key policy regimes were established in the postwar era, when approximately 96 per cent of Canadians were of European descent. As a result, the frameworks, problem definitions and policy tools inherited from that era were never intended to mitigate racial economic inequality. Moreover, this policy inheritance was deeply shaped by liberal universalism, which rejected racial distinctions in law and policy. These norms were carried forward into the more racially diverse Canada of today, where they have steered attention away from the use of racial categories in policy design. As a result, racial inequality was not a central priority during major policy reforms to core policy regimes in recent decades. In theoretical terms, our analysis contributes to Canadian Political Development through a sustained consideration of the intersecting roles of ideational frameworks, path dependency and policy inertia.
Rhinological manifestations of Sjögren's syndrome: a cohort-matched, prospective, cross-sectional, observational study
Authors: Kamel U F , Maddison P J 
Published: August 2021

AbstractObjectiveTo assess the prevalence of abnormal rhinological findings in a Sjögren's syndrome population.MethodsA cohort-matched, prospective, cross-sectional, observational study was conducted. Sixty-seven subjects (30 patients and 37 controls) were enrolled. Rhinological assessment including smell threshold was evaluated using a standardised, validated clinical test as part of a larger study.ResultsSmell thresholds were –4.4 and –5.4 in the Sjögren's syndrome and control groups, respectively (p = 0.001). Hyposmia (threshold values of less than −4.5) was demonstrated in the Sjögren's syndrome group (47 per cent). Smell was negatively correlated with age (p = 0.040). Nasal septal perforation was noted in 3 Sjögren's syndrome patients (10 per cent) and nasal mucosal dryness in 10 patients (33 per cent), but none of the control group were affected.ConclusionHyposmia in Sjögren's syndrome was demonstrated using the Smell Threshold Test. Nasal septal perforation and nasal mucosa dryness were also noted in patients with Sjögren's syndrome. A diagnosis of Sjögren's syndrome should be considered and investigated in smell deprivation and/or nasal septal perforation patients.