bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Trajectory of Motor Deterioration to Death in Parkinson's Disease
Authors: Poonja Sabrina , Miyasaki Janis , Fu Xilai , Camicioli Richard , Sang Tina , Yuan Yan , Ba Fang 
Published: August 2021

Background: Motor progression varies even among those with a single diagnosis such as Parkinson's disease (PD) and little is known about the trajectory of motor signs prior to death. Understanding deterioration patterns may help clinicians counsel patients and proactively plan interdisciplinary care, including palliative care. The objective of this study was to examine and describe Unified Parkinson's Disease Rating Scale motor score (UPDRS-III) trajectories at the end of life in PD.Methods: A retrospective chart review was performed for deceased PD patients who attended the Parkinson and Movement Disorders Program at the University of Alberta for at least 5 years between 1999 and 2018. UPDRS-III scores were recorded for all visits. Trajectory patterns were visualized with Loess curves stratified by sex and age at diagnosis. Piecewise linear models were used to individually model the UPDRS-III scores, and the trajectories obtained were clustered based on their features.Results: Among the 202 charts reviewed, 84 meeting inclusion criteria were analyzed. The UPDRS-III increased over time regardless of sex and age. Distinct trajectory variations present in PD (e.g., Consistent Deterioration, Stability-Deterioration, Improvement-Deterioration, Deterioration-Improvement-Deterioration) were identified. Twenty-five percent of the patients were classified as Undetermined/Irregular trajectories. In addition, regardless of trajectory type, many patients experienced a steep increase in UPDRS-III approaching death. Those with disease diagnosis after age 65 years had a shorter survival time, compared to PD patients with a younger age of onset.Conclusion: Our study identified dominant types of motor trajectory in PD that can help clinicians understand their patients' course of illness. This information can help counsel patients regarding the variability in motor deterioration and should alert physicians to recognize a terminal decline. Age of disease onset was correlated with survival time.
Nicotine Enhances Goal-Tracking in Ethanol and Food Pavlovian Conditioned Approach Paradigms
Authors: Angelyn Hailley , Loney Gregory C. , Meyer Paul J. 
Published: August 2021

RationaleNicotine promotes alcohol intake through pharmacological and behavioral interactions. As an example of the latter, nicotine can facilitate approach toward food- and alcohol-associated stimuli (“sign-tracking”) in lever-Pavlovian conditioned approach (PavCA) paradigms. However, we recently reported that nicotine can also enhance approach toward locations of reward delivery (“goal-tracking”) triggered by ethanol-predictive stimuli when the location of ethanol delivery is non-static (i.e., a retractable sipper bottle).ObjectiveTo determine whether the non-static nature of the reward location could have biased the development of goal-tracking in our previous study (Loney et al., 2019); we assessed the effect of nicotine in a lever-PavCA paradigm wherein the location of ethanol delivery was static (i.e., a stationary liquid receptacle). Then, to determine whether nicotine’s enhancement of goal-tracking is unique to ethanol-predictive stimuli, we assessed the effect of systemic nicotine on approach triggered by food-predictive stimuli in a lever-PavCA paradigm.MethodsLong–Evans rats were used in two PavCA experiments wherein a lever predicted the receipt of ethanol (15% vol/vol; experiment 1) or food (experiment 2) into a stationary receptacle. Prior to testing, rats were administered nicotine (0.4 mg/kg subcutaneously) or saline systemically.ResultsIn both experiments, nicotine increased measures of goal-tracking, but not sign-tracking.ConclusionNicotine can facilitate approach to reward locations without facilitating approach to reward-predictive stimuli. As such, conceptualization of the mechanisms by which nicotine affects behavior must be expanded to explain an enhancement of goal-tracking by nicotine.
Effective Organs-at-Risk Dose Sparing in Volumetric Modulated Arc Therapy Using a Half-Beam Technique in Whole Pelvic Irradiation
Authors: Jang Hyunsoo , Park Jiyeon , Artz Mark , Zhang Yawei , Ricci Jacob C. , Huh Soon , Johnson Perry B. , Kim Mi-Hwa , Chun Mison , Oh Young-Taek , Noh O Kyu , Park Hae-Jin 
Published: August 2021

BackgroundAlthough there are some controversies regarding whole pelvic radiation therapy (WPRT) due to its gastrointestinal and hematologic toxicities, it is considered for patients with gynecological, rectal, and prostate cancer. To effectively spare organs-at-risk (OAR) doses using multi-leaf collimator (MLC)’s optimal segments, potential dosimetric benefits in volumetric modulated arc therapy (VMAT) using a half-beam technique (HF) were investigated for WPRT.MethodsWhile the size of a fully opened field (FF) was decided to entirely include a planning target volume in all beam’s eye view across arc angles, the HF was designed to use half the FF from the isocenter for dose optimization. The left or the right half of the FF was alternatively opened in VMAT-HF using a pair of arcs rotating clockwise and counterclockwise. Dosimetric benefits of VMAT-HF, presented with dose conformity, homogeneity, and dose–volume parameters in terms of modulation complex score, were compared to VMAT optimized using the FF (VMAT-FF). Consequent normal tissue complication probability (NTCP) by reducing the irradiated volumes was evaluated as well as dose–volume parameters with statistical analysis for OAR. Moreover, beam-on time and MLC position precision were analyzed with log files to assess plan deliverability and clinical applicability of VMAT-HF as compared to VMAT-FF.ResultsWhile VMAT-HF used 60%–70% less intensity modulation complexity than VMAT-FF, it showed superior dose conformity. The small intestine and colon in VMAT-HF showed a noticeable reduction in the irradiated volumes of up to 35% and 15%, respectively, at an intermediate dose of 20–45 Gy. The small intestine showed statistically significant dose sparing at the volumes that received a dose from 15 to 45 Gy. Such a dose reduction for the small intestine and colon in VMAT-HF presented a significant NTCP reduction from that in VMAT-FF. Without sacrificing the beam delivery efficiency, VMAT-HF achieved effective OAR dose reduction in dose–volume histograms.ConclusionsVMAT-HF led to deliver conformal doses with effective gastrointestinal-OAR dose sparing despite using less modulation complexity. The dose of VMAT-HF was delivered with the same beam-on time with VMAT-FF but precise MLC leaf motions. The VMAT-HF potentially can play a valuable role in reducing OAR toxicities associated with WPRT.
Prevalence of Musculoskeletal Pain and Its Relation With Weight of Backpacks in School-Going Children in Eastern India
Authors: Sankaran Sindhu , John Joseph , Patra Sameer Sekhar , Das Rashmi Ranjan , Satapathy Amit Kumar 
Published: August 2021

Background: Recently, heavy school backpacks have become a significant concern among parents and health professionals, as well as the media, but evidence for the same is limited in the Indian context.Aim: To find the prevalence of musculoskeletal pain among school-going children and its relationship with backpack weight.Design: Cross-sectional study.Method: This study was carried out among school-going children from grade 6 to 10 with age of 10 to 16 years from an urban and rural location. Schools were selected randomly from all enlisted schools in the district of Khurdha, Odisha state of India. A structured questionnaire was administered to assess symptoms of musculoskeletal pain. Anthropometric measurements along with backpack weight were taken.Statistical Analysis: Chi-square test was performed for categorical variables and Student's t-test for continuous variables. Multivariate regression analysis was performed to identify factors with maximum effect on musculoskeletal pain.Results: The prevalence of musculoskeletal pain was 18.8% in the preceding year. Backpacks weights were higher among children of urban schools as compared with rural areas. Children from urban schools were more likely to have pain than those from rural schools (OR 1.88, 95% CI 1.41–2.49). Those children with a backpack weight more than 10% of body weight had almost twice the risk of musculoskeletal pain compared to backpack weight less than 10% (OR 1.91, 95% CI 1.4–2.6) in univariate analysis where as no significant association was found on multivariate analysis.Conclusion: The prevalence of musculoskeletal pain was high in school-going children. In children, carrying higher backpack weight, and a higher percentage of the backpack to bodyweight had a significant association with musculoskeletal pain. Gender, height, body mass index, and backpack weight to body weight &gt; 10% had no association with musculoskeletal pain.
Exploration of Hospital Inpatients' Use of the Verbal Rating Scale of Pain
Authors: Bosdet Luke , Herron Katie , Williams Amanda C. de C. 
Published: August 2021

Background: Assessment of pain largely relies on self-report. Hospitals routinely use pain scales, such as the Verbal Rating Scale (VRS), to record patients' pain, but such scales are unidimensional, concatenating pain intensity and other dimensions of pain with significant loss of clinical information. This study explored how inpatients understand and use the VRS in a hospital setting.Methods: Forty five participants were interviewed, with data analysed by thematic analysis, and completed a task concerned with the VRS and communication of other dimensions of pain.Results: Participants anchored their pain experience in the physical properties of pain, its tolerability, and its impact on functioning. Their relationship to analgesic medication, personal coping styles, and experiences of staff all influenced how they used the VRS to communicate their pain.Conclusion: Participants grounded and explained their pain in semantically similar but idiosyncratic ways. The VRS was used to combine pain intensity with multiple other elements of pain and often as a way to request analgesic medication. Pain scores need to be explored and elaborated by patient and staff, content of which will imply access to non-pharmacological resources to manage pain.
Operative Management of Neonatal Lymphatic Malformations: Lesson Learned From 57 Consecutive Cases
Authors: Scuglia Marianna , Conforti Andrea , Valfrè Laura , Totonelli Giorgia , Iacusso Chiara , Iacobelli Barbara D. , Meucci Duino , Viggiano Milena , Fusaro Fabio , Diociaiuti Andrea , Morini Francesco , El Hachem May , Bagolan Pietro 
Published: August 2021

Aim of the study: Lymphatic malformations (LMs) are rare entities, sometimes difficult to treat, that may be life-threatening when intricately connected to airway structures. Invasive treatments are occasionally required, with sclerotherapy considered the treatment of choice and surgery as a second-line approach. The aim of the present study was to evaluate our multidisciplinary team experience in treating newborns affected by LMs requiring operative management, while defining early outcomes.Methods: Retrospective review of all consecutive patients admitted for LMs requiring operative management between January 2000 and January 2019. Patients were mainly characterized based on anatomical district of the LM (and further stratified based on the development of respiratory distress), need for tracheostomy, number of sclerotherapies, indication for surgery, and residual disease beyond the 1st year. Morbidity and mortality were also evaluated. Fisher exact test and Mann–Whitney test were used as appropriate. Statistical significance was set at p &lt; 0.05.Results: Fifty-seven patients were included in the study, 36 with cervicofacial and/or mediastinal LMs and 21 with LMs of other anatomical districts. Due to the risk of developing respiratory distress at birth, patients with cervicofacial and/or mediastinal LMs were divided into two groups (8/36 group A vs. 28/36 group B). Group A patients are at higher risk for tracheostomy (7/8 group A vs. 1/28 group B, p = 0.0001) and more often require surgical reduction of the residual lymphatic abnormality (5/8 group A vs. 4/28 group B, p = 0.013). They also require sclerotherapies more often, but the difference is not statistically significant (8/8 group A vs. 19/28 group B, p = 0.15). Patients with cervicofacial/mediastinal LMs frequently suffer from persistent residual disease beyond the 1st year of life, significantly more often in group A (7/8 group A vs. 12/28 group B, p = 0.043).Conclusion: LMs are rare conditions with potential life-threatening behavior. Their intrinsic clinical complexity requires a multidisciplinary approach to the affected patients. Planning a long-term follow-up is essential because of the late-term problems those patients may experience.
Testing Scalability of a Diabetes Self-Management Intervention in Northern Mexico: An Ecological Approach
Authors: Aceves Benjamin , Denman Catalina A. , Ingram Maia , Torres Jose Francisco , Nuño Tomas , Garcia David O. , Madhivanan Purnima , Rosales Cecilia B. 
Published: August 2021

Background: Type 2 diabetes mellitus (T2DM) has become a major issue in Mexico, reporting almost 100,000 attributable deaths in 2016. Low-income Mexican citizens who face various issues associated with T2DM, including the lack of access to self-management services, are particularly affected by the condition. Health centers have been designated to serve T2DM patients by providing resources on chronic disease prevention. Meta Salud Diabetes (MSD) is a self-management intervention developed to address cardiovascular complications and other health issues within the T2DM population, which have been proven effective and useful for health centers. The intervention was designed for T2DM support groups—grupos de ayuda mutua (GAMs) located within health centers.Methods: From February to June 2019, a binational research team conducted a test scale-up study in Northwest Sonora under the Ministry of Health utilizing the Institute for Healthcare Improvement Framework for scaling up health interventions. Investigators worked in collaboration and trained 19 stakeholders from a regional health system identified from various ecological levels on MSD and implementation process.Results: All five GAMs within the regional health system received and completed the intervention. In total, 72 participants were enrolled with behavioral and biological [HbA1c, blood pressure, body mass index (BMI)] measures taken at baseline. Post-intervention measurements were taken from 72% of participants who completed the intervention. Statistical analysis demonstrated improved behavioral and biological measures when comparing baseline to post-intervention, specifically statistically significant improvements in HbA1c and sugar-sweetened beverage consumption. Implementation fidelity (IF) measures indicated extensive adherence to the intervention curriculum, and moderators specifically demonstrated influences on implementation. Stakeholders from various ecological levels provided support to those facilitating the MSD intervention by allotting time and resources to properly prepare for sessions. An implementation coordinator from the regional health office assisted MSD facilitators by resolving barriers to implementation and worked toward federal accreditation for GAMs to receive additional funding.Conclusion: Results provide evidence for using regional health systems as a scalable unit when implementing chronic disease self-management interventions state- and nationwide. This study will help inform future efforts to scale up the health intervention in various states throughout Mexico.Clinical Trial Registration:www.ClinicalTrials.gov; https://www.clinicaltrials.gov/ct2/show/NCT02804698?term=NCT02804698&amp;draw=2&amp;rank=1, identifier: NCT02804698.
Predictive Analysis of Health/Physical Fitness in Health-Promoting Lifestyle of Adolescents
Authors: Liu Hao , Liu Yiwen , Li Bin 
Published: August 2021

Objective: Explore the correlation and predictive power of health physical fitness on health-promoting lifestyle of adolescents to provide an important reference for reform in middle school physical education classroom teaching.Methods: Taking some junior and senior high school students in Nanchong City of Sichuan Province as survey objects, a stratified random sampling method was used to carry out a health/fitness test and conduct a questionnaire survey. SPSS17.0, amos 21.0, and other statistical analysis software were used to process the relevant data.Results: (1) Male adolescents had 14.4% predictive power for their overall health-promoting lifestyle through the combined effects of cardiopulmonary endurance, muscle strength, and explosive strength, while female adolescents had 16.8% predictive power for their overall health-promoting lifestyle through the combined effects of cardiopulmonary endurance, flexibility, and body mass index (BMI). (2) Ten percent of the variation in the health-promoting lifestyle of men under 14 years old was caused by the combined effects of muscle endurance and muscle strength, while 14.4% of the variation in the health-promoting lifestyle of female adolescents was caused by the combined effects of muscle endurance, muscle strength, flexibility, and cardiopulmonary endurance. (3) Some 10.9 and 17.6% of the variation in health-promoting lifestyle of male and female adolescents aged between 14 and 17 was caused by the combined effects of cardiopulmonary endurance, muscle strength, and flexibility, respectively. (4) Some 20.7% of the variation in health promoting lifestyle of male adolescents aged 17 years or above was caused by cardiopulmonary endurance, explosive force, and muscle endurance, while 16.8% of the variation in health-promoting lifestyle of female adolescents was caused by the combined effect of cardiopulmonary endurance, BMI, and muscle endurance.Conclusion: Health and physical fitness of adolescents can significantly predict their health-promoting lifestyle, and the predictive power and typical correlation between them are affected by demographic factors.
High-Velocity Impacts of Pyrophoric Alloy Fragments on Thin Armour Steel Plates
Authors: Santamaria Ferraro Evaristo , Seidl Marina , De Vuyst Tom , Faderl Norbert 
Published: August 2021

The terminal ballistics effects of Intermetallic Reactive Materials (IRM) fragments have been the object of intense research in recent years. IRM fragments flying at velocities up to 2000 m/s represent a realistic threat in modern warfare scenarios as these materials are substituting conventional solutions in defense applications. The IRM add Impact Induced Energy Release (IIER) to the mechanical interaction with a target. Therefore, the necessity of investigations on IIER to quantify potential threats to existing protection systems. In this study, Mixed Rare Earths (MRE) fragments were used due to the mechanical and pyrophoric affinity with IRM, the commercial availability and cost-effectiveness. High-Velocity Impacts (HVI) of MRE were performed at velocities ranging from 800 to 1600 m/s and recorded using a high-speed camera. 70 MREs cylindrical fragments and 24 steel fragments were shot on armour steel plates with thicknesses ranging from 2 mm to 3 mm. The influence of the impact pitch angle (α) on HVI outcomes was assessed, defining a threshold value at α of 20°. The influence of the failure modes of MRE and steel fragments on the critical impact velocities (CIV) and critical kinetic energy (Ekin crit) was evaluated. An energy-based model was developed and fitted with sufficient accuracy the Normalised EKin crit (E˜kincrit) determined from the experiments. IIER was observed in all the experiments involving MRE. From the analyses, it was observed that the IIER spreads behind the targets with velocities comparable to the residual velocities of plugs and shattered fragment.
Effectiveness of professional and patient-oriented strategies in reducing vitamin D and B12 test ordering in primary care: a cluster randomised intervention study
Authors: Vugt Saskia van , de Schepper Evelien , van Delft Sanne , Zuithoff Nicolaas , de Wit Niek , Bindels Patrick 
Published: August 2021

BackgroundVitamin tests are increasingly ordered by GPs, but a clinical and evidence-based indication is often lacking. Harnessing technology (that is, decision support tools and redesigning request forms) have been shown to reduce vitamin requests.AimTo investigate whether the number of vitamin tests may be reduced by providing a multi-level intervention programme based on training, monitoring, and feedback.Design & settingThis was a cluster randomised intervention study performed in 26 primary care health centres (>195 000 patients) in the Netherlands. The relative reduction in ordered vitamin D and B12 tests was determined after introduction of two de-implementation strategies (1 May 2017 to 30 April 2018).MethodHealth centres randomised to de-implementation strategy 1 received education and benchmarking of their own vitamin test ordering behaviour every 3 months. Health centres in de-implementation strategy 2 received the same education and benchmarking, but supplemented with educational material for patients.ResultsThe number of vitamin D tests decreased by 23% compared to the 1-year pre-intervention period (1 May 2016 to 30 April 2017). For vitamin B12 tests an overall reduction of 20% was found. Provision of patient educational information showed additional value over training and benchmarking of GPs alone for vitamin D test ordering (10% extra reduction, odds ratio [OR] 0.88, 95% confidence interval [CI] = 0.83 to 0.92), but not for vitamin B12 ordering (4% extra reduction, OR 0.96, 95% CI = 0.91 to 1.02). Nationwide, this would result in over €3 200 000 in savings on healthcare expenditure a year.ConclusionA structured intervention programme, including training and benchmarking of GPs regarding their diagnostic test ordering, resulted in a significant reduction in ordered vitamin tests. Additional information provision to patients resulted in a small but still relevant additional reduction. If implemented on a national level, a substantial cost saving could be achieved.
Enseñanza virtual en tiempos de emergencias: continuidades y transformaciones
Authors: Rodríguez Sanabia Eduardo , Moreira Natalia , Hortegano Romina 
Published: August 2021

Con la pandemia por el Covid-19, la virtualidad se instaló en nuestras vidas ofreciendo una alternativa para sostener actividades y relaciones, incluyendo las prácticas de enseñanza universitaria. En tal contexto, este estudio se propuso analizar las prácticas de enseñanza de una institución de educación superior, a partir de las respuestas y adecuaciones realizadas por los equipos docentes, dando cuenta de las transformaciones, las continuidades y los nuevos desafíos que implican las nuevas realidades educativas y sociales. Utilizamos la sistematización de experiencias, no sólo organizando información que se generó desde el inicio de la pandemia, sino poniendo tales insumos en diálogo con otros nudos críticos que muestran el devenir de la experiencia y que se sometieron a valoración con diversos actores; para lograrlo, se utiliza la metodología narrativa recuperando testimonios, inquietudes y reflexiones por parte del colectivo docente. Como resultado se pudieron visibilizar los aspectos más relevantes dentro de un momento en que los cambios en las prácticas de enseñanza no sólo deben organizarse para atender la eventualidad pandémica, sino que deben reflexionarse de modo crítico en atención al modelo de universidad y de sociedad que se quiere edificar en Uruguay hoy.