bluuebunny/crossref_metadata_2025_split huggingface dataset:
As nurses, are we meeting the unique needs of the intact client?
Authors: Wodwaski Nadine , Munyan Kristen 
Published: August 2021

AbstractPurposeCurrent routine circumcision rates declined indicating a procedure reduction and because of this, nurses will encounter more intact male patients. Best practices are needed to provide appropriate, safe nursing care. The research aim was to understand what American nurses presently know about intact care and if any knowledge deficits exist.Design and MethodsThe research was conducted using a cross‐sectional survey design. American nurses currently in practice were invited to participate in a survey distributed via social media groups for nursing professionals. No incentive was offered for participation. An author‐developed instrument was used to assess knowledge levels regarding intact care. Analysis was performed using descriptive statistics as there was no intervention.MethodsAmerican nurses currently in practice were invited to participate in a survey distributed via social media groups for nursing professionals. No incentive was offered for participation. An author‐developed instrument was used to assess knowledge levels regarding intact care. Analysis was performed using descriptive statistics as there was no intervention.ResultsA convenient sample of 345 nursing professionals participated indicating an intact care knowledge deficit across the lifespan. Fourteen percent of respondents did not indicate that replacing the foreskin back over the glans was necessary with adult genital hygiene for intact patients. In pediatrics, 41.7% answered yes to the item statement “Do you retract the foreskin of an infant male child for catheter placement.”Practice ImplicationsThe results indicate a knowledge deficit among American nurses regarding genital hygiene, particularly for pediatric patients. Practicing without knowledge of intact care that scientifically based can endanger the caring relationship between nurse and patient, resulting in physical harm and may open themselves and their health systems to legal liability.
Enriched and discriminative convolutional neural network features for pedestrian re‐identification and trajectory modeling
Authors: Wong Peter Kok‐Yiu , Luo Han , Wang Mingzhu , Cheng Jack C. P. 
Published: August 2021

AbstractUnderstanding pedestrian flow patterns in urban areas could support the decision‐making for infrastructure planning. By incorporating computer vision techniques into surveillance video processing, human walking trajectories in a wide area could be identified by pedestrian re‐identification (ReID) across multiple cameras. Recent ReID methods mostly use convolutional neural networks equipped with deep learning techniques to extract discriminative human features from images for identity matching. However, they still suffer from realistic challenges such as occlusion and appearance variation. This paper develops a ReID‐based framework for pedestrian trajectory recognition across multiple cameras. Specifically, a generic approach of explainable model design is presented, which intuitively analyzes existing baseline models based on feature visualization. Hence, a new model named OSNet + BDB is developed that extracts discriminative‐and‐distributed features. Additionally, an incremental feature aggregation strategy is designed for more robust identity matching. Our ReID method notably outperforms its baselines by 4% identification F1 accuracy in public benchmarks. Practically, pedestrian flow statistics in a real building are extracted for behavioral modeling. Simulations of several what‐if layouts are then conducted for facility performance evaluation.
Variables influencing manometric parameters of deglutitive and non‐deglutitive upper esophageal sphincter: A study of 89 asymptomatic participants
Authors: Edeani Francis O. , Kern Mark , Ulualp Kenan , Kovacic Karlo , Sanvanson Patrick , Mei Ling , Shaker Reza 
Published: August 2021

AbstractBackgroundHigh‐resolution manometry overcomes limitations imposed by axial and radial asymmetry as well as swallow and respiration‐induced movement of the upper esophageal sphincter (UES), allowing for its reliable use in evaluation of dysphagic and reflux patients. The aim of this study was to determine normative values and their variability across position, sex, age, height, weight, BMI, and volume for clinically relevant deglutitive and non‐deglutitive UES parameters.MethodsWe studied 89 asymptomatic volunteers age 19–90 years, (45 female) during 3–10 repetitions of dry, 5 and 10 ml water swallows at 30‐s intervals using high‐resolution manometry.Key ResultsUpper esophageal sphincter high‐pressure zone was longer in men than women and in supine than upright position. UES basal contractile integral and mean basal pressure were higher in supine compared to upright; higher in men than women, inversely correlated with age, correlated positively with height and with weight in the supine position only. UES relaxation duration was longer in upright than in supine position but not affected by age, sex, height, weight, or BMI. It was longer with 5 and 10 ml compared with dry swallows. UES minimum/nadir relaxation and mean relaxation pressures were lower in upright than supine position, increased with increase in age and were higher in men than women.Conclusions and InferencesPosition, sex, age, height, weight, and volume affect some deglutitive and non‐deglutitve UES manometric parameters. BMI does not affect the studied manometric parameters. These effects should be taken into consideration in clinical evaluation of UES.
Gastric mesenchymal tumor with smooth muscle differentiation and echinoderm microtubule‐associated protein‐like 4‐anaplastic lymphoma kinase (EML4‐ALK) fusion
Authors: Akimoto Eigo , Tokunaga Masanori , Sato Reo , Yoshida Akihiko , Naito Yoichi , Yamashita Riu , Kinoshita Takahiro , Kuwata Takeshi 
Published: August 2021

AbstractGastric mesenchymal tumors are relatively rare, and their molecular pathogeneses are poorly understood, except for gastrointestinal stromal tumor, desmoid, and inflammatory myofibroblastic tumors. We report a case of a gastric mesenchymal tumor with prominent smooth muscle cell differentiation and an echinoderm microtubule‐associated protein‐like 4‐anaplastic lymphoma kinase (EML4‐ALK) fusion. On gross section, the tumor was 26 mm at the largest diameter, well‐circumscribed, and located in the submucosal and muscular layers of the stomach wall. Histologically, the tumor comprised intersecting fascicles of spindle cells, non‐atypical nuclei, and highly eosinophilic cytoplasm. Myxoid changes were observed focally, but inflammatory infiltrates were only evident in limited areas. Immunochemical staining revealed that the tumor was positive for α‐smooth muscle actin and desmin. Diffuse positive staining for h‐caldesmon was observed throughout the tumor, which suggested smooth muscle cell differentiation. Intracytoplasmic staining for ALK protein was also observed, and fluorescence in situ hybridization using ALK break‐apart probes showed split chromosomal signals. RNA‐sequencing analysis identified EML4‐ALK fusion transcripts. We concluded that the tumor was a gastric mesenchymal tumor with smooth muscle differentiation based on its distinct differential smooth muscle properties, such as highly eosinophilic cytoplasm and diffuse expression of h‐caldesmon. Furthermore, activated ALK may underly the tumor's pathogenesis.
Beginnings of coinhibition
Authors: Sinclair Nicholas R. StC. 
Published: August 2021

AbstractCostimulatory and coinhibitory mechanisms appear to be involved throughout immune responses to control their specificity and level. Many mechanisms operate; therefore, various theoretical models should be considered complementary rather than competing. One such coinhibitory model, pictured in 1971, involves the crosslinking of antigen receptors with inhibitory Fc receptors by antigen/antibody complexes. This model was prompted by observations that the Fc portion of antibody was required for potent suppression of immune responses by antibody. The signal via the antigen receptor wakes up T or B cells, providing specificity, while costimulators and coinhibitors stimulate or inhibit these awoken cells. The recent observations that administration of monoclonal anti‐SARS‐CoV‐2 spike antibodies in early COVID‐19 patients inhibits the induction of clinically damaging autoimmune antibodies suggest they may provide negative Fc signals that are blocked in COVID‐19 patients. Furthermore, the reduced ability of SARS‐CoV‐2 antigen to localize to germinal centres in COVID‐19 patients also suggests a block in binding of the Fc of antibody bound to antigen on FcγRIIb of follicular dendritic cells. The distinction between self and foreign is made not only at the beginning of immune responses but also throughout, and involves multiple mechanisms and models. There are past beginnings (history of models) and current and future beginnings for solving serious clinical problems (such as COVID‐19) and different types of models used for understanding the complexities of fundamental immunology.
Specific Features of the Macrozoobenthic Communities of Small Arctic Lakes in Eurasia
Authors: Chertoprud M. V. , Krylenko S. V. , Lukinych A. I. , Glazov P. M. , Dubovskaya O. P. , Chertoprud E. S. 
Published: August 2021

Abstract
The taxonomic structure, typology, species richness, and total abundance of bentic and littoral macroinvertebrate communities from small lakes of the Arctic and Subarctic zones are considered on the basis of original data from three northern Palearctic regions (the foot of the Putorana Plateau, Kolguev Island, and Western Svalbard Island). A comparative analysis of the communities of these regions has been carried out. The features of High Arctic insular, Low Arctic, subarctic, and boreal lake communities are discussed using a large volume of literature data. The complex pattern of changes in the total benthos biomass of small lakes has been revealed: it decreases in the subarctic taiga, increases in the hypoarctic tundra, and decreases again in the High Arctic.
Accuracy of emergency medical services (EMS) telephone triage in identifying acute coronary syndrome (ACS) for patients with chest pain: a systematic literature review
Authors: Alotaibi Ahmed , Alghamdi Abdulrhman , Reynard Charles , Body Richard 
Published: August 2021

ObjectiveTo systematically appraise the available evidence to determine the accuracy of decision aids for emergency medical services (EMS) telephone triage of patients with chest pain suspected to be caused by acute coronary syndrome (ACS) or life-threatening conditions.DesignSystematic review.Data sourcesElectronic searches were performed in Embase 1974, Medline 1946 and CINAHL 1937 databases from 3 March 2020 to 4 March 2020.Eligibility criteriaThe review included all types of original studies that included adult patients (>18 years) who called EMS with a primary complaint of chest pain and evaluated dispatch triage priority by telephone. Outcomes of interest were a final diagnosis of ACS, acute myocardial infarction or other life-threatening conditions.Data extraction and synthesisTwo authors independently extracted data on study design, population, study period, outcome and all data for assessment of accuracy, including cross-tabulation of triage priority against the outcomes of interest. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 assessment tool.ResultsSearches identified 553 papers, of which 3 were eligible for inclusion. Those reports described the evaluation of three different prediction models with variation in the variables used to detect ACS. The overall results showed that dispatch triage tools have good sensitivity to detect ACS and life-threatening conditions, even though they are used to triage signs and symptoms rather than diagnosing the patients. On the other hand, prediction models were built to detect ACS and life-threatening conditions, and therefore, prediction models showed better sensitivity and negative predictive value than dispatch triage tools.ConclusionWe have identified three prediction models for telephone triage of patients with chest pain. While they have been found to have greater accuracy than standard EMS dispatch systems, prospective external validation is essential before clinical use is considered.PROSPERO registration numberThis systematic review was pre-registered on the International prospective register of systematic reviews (PROSPERO) database (reference CRD42020171184).
Resource availability, utilisation and cost in the provision of critical care in Tanzania: a protocol for a systematic review
Authors: Kazibwe Joseph , Shah Hiral A , Kuwawenaruwa A , Schell Carl Otto , Khalid Karima , Tran Phuong Bich , Ghosh Srobana , Baker Tim , Guinness Lorna 
Published: August 2021

IntroductionCritical care is essential in saving lives of those that are critically ill, however, provision of critical care can be costly and heterogeneous across lower-resource settings. This paper describes the protocol for a systematic review of the literature that aims to identify the reported costs and resources available for the provision of critical care and the forms of critical care provision in Tanzania.Methods and analysisThe review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three databases (MEDLINE, Embase and Global Health) will be searched to identify articles that report the forms of critical care, resources used in the provision of critical care in Tanzania, their availability and the associated costs. The search strategy will be developed from four key concepts; critical care provision, critical illness, resource use, Tanzania. The articles that fulfil the inclusion and exclusion criteria will be assessed for quality using the Reference Case for Estimating the Costs of Global Health Services and Interventions checklist. The extracted data will be summarised using descriptive statistics including frequencies, mean and median of the quantity and costs of resources used in the components of critical care services, depending on the data availability. This study will be carried out between February and November 2021.Ethics and disseminationThis study is a review of secondary data and ethical clearance was sought from and granted by the Tanzanian National Institute of Medical Research (reference: NIMR/HQ/R.8a/Vol. IX/3537) and London School of Hygiene and Tropical Medicine (ethics ref: 22866). We will publish the review in a peer-reviewed journal as an open access article in addition to presenting the findings at conferences and public scientific gatherings.PROSPERO registration numberThe protocol was registered with PROSPERO; registration number: CRD42020221923.
Lived experience of dietary change among Chinese colorectal cancer survivors in Hong Kong: A qualitative study
Authors: Wong Janet Yuen Ha , Ho Judy Wai Chu , Lee Antoinette Marie , Fong Daniel Yee Tak , Chu Natural , Leung Sharron , Chan Y Y Wynnie , Lam Sharon HS , Leung Ivy P F , Macfarlane Duncan , Cerin Ester , Taylor Aliki J , Cheng Kar Keung 
Published: August 2021

ObjectivesThis is a qualitative study which aims to understand the lived experience of dietary changes among Chinese survivors of colorectal cancer who participated in a dietary intervention.SettingThe surgical and oncological departments of four public hospitals in Hong Kong.ParticipantsFifty-five Chinese colorectal cancer survivors who were aged 18 years or above and had received potentially curative treatment in the surgical and oncological departments in Hong Kong were examined. Participants’ mean age was 64 years, with 29 (53%) males.InterventionA 12-month dietary intervention delivered via face-to-face motivational interviews, fortnightly motivational phone calls, monthly electronic pamphlets, quarterly newsletters and quarterly group meeting.Outcome measureWe adopted the qualitative approach to capture participants’ perspectives and to apply the understanding pragmatically in everyday life. Content analysis was conducted.ResultsWe identified themes of motives to changes of dietary practices including (1) individual commitment to dietary change; (2) adaptive strategies in interpersonal contexts and (3) working with healthcare professionals during the journey.ConclusionsThe findings demonstrated how Chinese custom and culture posing unique challenges to colorectal cancer survivors and the need of having dietary advice from healthcare professionals. Participants were motivated to change their eating habits by support from family, friends and healthcare professionals. Our findings could help healthcare professionals provide specific dietary advice and guidance to Chinese colorectal cancer survivors.Trial registration numberNCT01708824.
Evaluating the safety of mental health-related prescribing in UK primary care: a cross-sectional study using the Clinical Practice Research Datalink (CPRD)
Authors: Khawagi Wael Y , Steinke Douglas , Carr Matthew J , Wright Alison K , Ashcroft Darren M , Avery Anthony , Keers Richard Neil 
Published: August 2021

BackgroundMost patients with mental illness are managed in primary care, yet there is a lack of data exploring potential prescribing safety issues in this setting for this population.ObjectivesExamine the prevalence of, between-practice variation in, and patient and practice-level risk factors for, 18 mental health-related potentially hazardous prescribing indicators and four inadequate medication monitoring indicators in UK primary care.MethodCross-sectional analyses of routinely collected electronic health records from 361 practices contributing to Clinical Practice Research Datalink GOLD database. The proportion of patients ‘at risk’ (based on an existing diagnosis, medication, age and/or sex) triggering each indicator and composite indicator was calculated. To examine between-practice variation, intraclass correlation coefficient (ICC) and median OR (MOR) were estimated using two-level logistic regression models. The relationship between patient and practice characteristics and risk of triggering composites including 16 of the 18 prescribing indicators and four monitoring indicators were assessed using multilevel logistic regression.Results9.4% of patients ‘at risk’ (151 469 of 1 611 129) triggered at least one potentially hazardous prescribing indicator; between practices this ranged from 3.2% to 24.1% (ICC 0.03, MOR 1.22). For inadequate monitoring, 90.2% of patients ‘at risk’ (38 671 of 42 879) triggered at least one indicator; between practices this ranged from 33.3% to 100% (ICC 0.26, MOR 2.86). Patients aged 35–44, females and those receiving more than 10 repeat prescriptions were at greatest risk of triggering a prescribing indicator. Patients aged less than 25, females and those with one or no repeat prescription were at greatest risk of triggering a monitoring indicator.ConclusionPotentially hazardous prescribing and inadequate medication monitoring commonly affect patients with mental illness in primary care, with marked between-practice variation for some indicators. These findings support health providers to identify improvement targets and inform development of improvement efforts to reduce medication-related harm.
Trajectories of phenotypical frailty over a decade in young–old community-dwelling adults: results from the Lc65+ study
Authors: Fustinoni Sarah , Santos-Eggimann Brigitte , Henchoz Yves 
Published: August 2021

BackgroundFew studies have examined the frailty trajectories of young–old adults using Fried frailty phenotype. Dropouts due to death were rarely taken into account. This longitudinal study aimed to identify trajectories with and without adjustment for non-random attrition and to analyse related factors.MethodsWe used the first two samples of community-dwelling people in the Lausanne cohort 65+. Frailty phenotype was assessed at age 66–71 years and every third year over 10 years. A group-based trajectory modelling—first without and then with adjustment for non-random attrition—identified trajectories among all individuals with at least two observations (n=2286), excluding dropouts for reasons other than death. Multinomial logistic regressions estimated independent effects of participants’ baseline characteristics.ResultsWe identified three frailty trajectories (low, medium and high). Participants in the highest trajectory had a higher mortality over 10 years. (Pre)frailty at baseline was the main factor associated with adverse trajectories. Smoking, obesity, comorbidity and negative self-perceived health were associated with unfavourable trajectories independently of baseline frailty, while social engagement was related to the lowest frailty trajectory. Ignoring transitions to death attenuated the estimated effects of age on trajectories.ConclusionsFried frailty phenotype should be assessed in individuals aged late 60s as it is strongly associated with frailty trajectories in the following decade of their life. Lifetime prevention of behavioural risk factors such as smoking and obesity is the strategy most likely to influence the development of frailty in older populations. Furthermore, our results underline social engagement as an important area of interest for future research.
High-resolution CT with arch/neck/head CT angiography on a mobile stroke unit
Authors: Alexandrov Anne W , Arthur Adam S , Bryndziar Tomas , Swatzell Victoria M , Dusenbury Wendy , Hardage Keri , McCormick Sarah , Rhudy James P , Maleki Ana Hossein Zadeh , Singh Savdeep , Krishnaiah Balaji , Nearing Katherine , Rubin Mark N , Malkoff Marc D , McKendry Christopher , Metter E Jeffrey , Alexandrov Andrei V 
Published: August 2021

BackgroundMobile stroke units (MSUs) performance dependability and diagnostic yield of 16-slice, ultra-fast CT with auto-injection angiography (CTA) of the aortic arch/neck/circle of Willis has not been previously reported.MethodsWe performed a prospective observational study of the first-of-its kind MSU equipped with high resolution, 16-slice CT with multiphasic CTA. Field CT/CTA was performed on all suspected stroke patients regardless of symptom severity or resolution. Performance dependability, efficiency and diagnostic yield over 365 days was quantified.Results1031 MSU emergency activations occurred; of these, 629 (61%) were disregarded with unrelated diagnoses, and 402 patients transported: 245 (61%) ischemic or hemorrhagic stroke, 17 (4%) transient ischemic attack, 140 (35%) other neurologic emergencies. Total time from non-contrast CT/CTA start to images ready for viewing was 4.0 (IQR 3.5–4.5) min. Hemorrhagic stroke totaled 24 (10%): aneurysmal subarachnoid hemorrhage 3, hemorrhagic infarct 1, and 20 intraparenchymal hemorrhages (median intracerebral hemorrhage score was 2 (IQR 1–3), 4 (20%) spot sign positive). In 221 patients with ischemic stroke, 73 (33%) received alteplase with 31.5% treated within 60 min of onset. CTA revealed large vessel occlusion in 66 patients (30%) of which 9 (14%) were extracranial; 27 (41%) underwent thrombectomy with onset to puncture time averaging 141±90 min (median 112 (IQR 90–139) min) with full emergency department (ED) bypass. No imaging needed to be repeated for image quality; all patients were triaged correctly with no inter-hospital transfer required.ConclusionsMSU use of advanced imaging including multiphasic head/neck CTA is feasible, offers high LVO yield and enables full ED bypass.