bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mobile technology and delegated work in specialist community services: the EnComPaSS Integration project
Authors: Ariss Steven Mark Brian , Taylor Paul , Fitzsimmons Deborah , Kyeremateng Sam , Mawson Susan 
Published: December 2021

ObjectivesThe current UK healthcare workforce crisis is particularly severe in community services. A key limitation with traditional service-delivery models is the reliance on practitioners with levels of training and experience to enable them to operate independently. This paper describes a real-world evaluation of the implementation of digital health technology designed to provide remote, real-time support and task delegation in community palliative care services. It explores the ability of technology to support sustainable community workforce models and reports on key indicators of quality and efficiency.MethodsThe study was a mixed-methods, theory-driven evaluation, incorporating interviews, observations and analysis of routine data. The focus of this paper is the reporting of findings from pre–post implementation comparison and interrupted time series analysis. Data include community hospice service visits, hospital use by hospice patients and patient reported experiences.ResultsThe digital health intervention allowed the service to include a more junior workforce (p<0.001, Cramer’s V=0.241), requiring fewer joint visits (p<0.001, Cramer’s V=0.087). No negative changes in hospitalisation were observed and patient reported experiences improved (p=0.023). Changes in hospital non-emergency bed days were inconclusive. However, emergency department admissions reduced significantly (−76.9 /month at 17 months, p=0.001). The cost per hour for visits reduced from £16.71 to £16.23 and annual savings of £135 153 are estimated for reduced emergency admissions.ConclusionsThe evaluation demonstrates the value of digital innovation to support programmes of service redesign and begin to address the healthcare workforce crisis, while having a positive economic effect and indicating an improvement to patient experiences.
Hospice delivery models and survival differences in the terminally ill: a large cohort study
Authors: Lai Wei-Shu , Liu I-Ting , Tsai Jui-Hung , Su Pei-Fang , Chiu Pin-Hsuan , Huang Ying-Tzu , Chiu Ge-Lin , Chen Yu-Yeh , Lin Peng-Chan 
Published: December 2021

ObjectiveA common difficulty at the end of life (EOL) is to determine an appropriate service model, such as hospice share care (HSC), hospice inpatient care (HIC) and hospice home care (HHC). This study aimed to recommend the appropriate hospice delivery model based on the physical, psychosocial and spiritual needs of patients referred for hospice care.MethodsThis cohort study included patients who received only one kind of hospice delivery model between 2006 and 2020. Data were analysed with descriptive statistics, Fisher’s exact test, non-parametric analysis of variance, Kaplan-Meier curves and Cox proportional hazards model that determined the patients’ clinical characteristics for a hospice delivery model and overall survival.ResultsA total of 8874 hospice patients were recruited, of which 7076 (79.7%) were HSC patients, 918 (10.4%) were HIC patients and 880 (9.9%) were HHC patients. There were significant differences in the physical symptoms and demographic, psychosocial and spiritual factors among the three groups (p<0.001). The patients who received the HHC were less to have dyspnoea (18.5%) and dysphagia (28.7%). The HIC patients showed higher severity of symptoms and experienced greater psychosocial distress (73.2%). The HSC is appropriate for noncancer patients . Patients with cancer were associated with less dyspnoea (32.4%) and dysphagia (46.5%). Patients with lung cancer who received the HHC had better survival than those who received other types of hospice care (HR=0.75, 95% CI: 0.66 to 0.86, p<0.001).ConclusionsThis study provides guidance regarding the appropriate hospice service model, based on individualised palliative needs, targeting improvement in EOL care.
Circulating mitochondrial DNA copy numbers represent a sensitive marker for diagnosis and monitoring of disease activity in systemic lupus erythematosus
Authors: Giaglis Stavros , Daoudlarian Douglas , Voll Reinhard E , Kyburz Diego , Venhoff Nils , Walker Ulrich A 
Published: December 2021

ObjectivesCell-free DNA is involved in the pathogenesis of systemic lupus erythematosus (SLE) but the clinical value of cell-free DNA measurements in SLE is unknown. Our aim was therefore to examine the utility of mitochondrial (mt) DNA and nuclear (n) DNA quantification in SLE.MethodsEDTA plasma was drawn from 103 consecutive patients with SLE and from 56 healthy blood donors. mtDNA and nDNA copy numbers were quantified by PCR from cell-free plasma. Clinical parameters were recorded prospectively.ResultsCirculating mtDNA copy numbers were increased 8.8-fold in the plasma of patients with SLE (median 6.6×107 /mL) compared with controls (median 7.6×106 /mL, p<0.0001). Among all 159 individuals, a cut-off set at 1.8×107 mtDNA copies in a receiver operated curve identified patients with SLE with 87.4% sensitivity and 94.6% specificity; the area under the curve was 0.95 (p<0.0001). mtDNA levels were independent of age or gender, but correlated with Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) on multivariable analysis (p=0.004). Conversely, SLEDAI was associated with prednisone dose (p<0.001), anti-double stranded DNA-titres (p=0.003) and mtDNA levels (p=0.005), but not nDNA copy numbers. In 33 patients with SLE with available follow-up, the changes of mtDNA, but not those of nDNA concentrations, robustly correlated with the evolution of the SLEDAI (r=0.55, p=0.001).ConclusionsCirculating mtDNA unlike nDNA molecules are markedly increased in SLE plasma. Regardless of disease activity, circulating mtDNA levels distinguish patients with SLE from healthy controls with high sensitivity and represent an independent marker of SLE activity.
Offline computing resources for FCC-ee and related challenges
Authors: Helsens Clément , Ganis Gerardo 
Published: December 2021

AbstractThe international Future Circular Collider (FCC) study aims at designing $$\mathrm {pp}$$
pp
, $$\mathrm {e^{+}e^{-}}$$

e
+

e
-

, $$\mathrm {e^{\pm }p}$$

e
±

p

colliders to be built in a new 100-km tunnel in the Geneva region. The electroweak, Higgs and top factory (FCC-ee) is designed to provide collisions at a centre-of-mass energy range between 90 (Z-pole) and 365 GeV ($$\mathrm {t}\bar{\mathrm {t}}$$

t

t

¯

) and unprecedented integrated luminosities, producing huge amounts of data which will pose significant challenges to data processing. In this study, we discuss the needs in terms of storage and CPU for the diverse phases of the project, and the possible solutions mostly based on the models developed for HL-LHC.
Trigger Factors for Spontaneous Intracerebral Hemorrhage: A Case-Crossover Study
Authors: van Etten Ellis S. , Kaushik Kanishk , Jolink Wilmar M.T. , Koemans Emma A. , Ekker Merel S. , Rasing Ingeborg , Voigt Sabine , Schreuder Floris H.B.M. , Cannegieter Suzanne C. , Rinkel Gabriël J.E. , Lijfering Willem M. , Klijn Catharina J.M. , Wermer Marieke J.H. 
Published: December 2021

Background:
Whether certain activities can trigger spontaneous intracerebral hemorrhage (ICH) remains unknown. Insights into factors that trigger vessel rupture resulting in ICH improves knowledge on the pathophysiology of ICH. We assessed potential trigger factors and their risk for ICH onset.

Methods:
We included consecutive patients diagnosed with ICH between July 1, 2013, and December 31, 2019. We interviewed patients on their exposure to 12 potential trigger factors (eg, Valsalva maneuvers) in the (hazard) period soon before onset of ICH and their normal exposure to these trigger factors in the year before the ICH. We used the case-crossover design to calculate relative risks (RR) for potential trigger factors.

Results:
We interviewed 149 patients (mean age 64, 66% male) with ICH. Sixty-seven (45%) had a lobar hemorrhage, 60 (40%) had a deep hemorrhage, 19 (13%) had a cerebellar hemorrhage, and 3 (2%) had an intraventricular hemorrhage. For ICH in general, there was an increased risk within an hour after caffeine consumption (RR=2.5 [95% CI=1.8–3.6]), within an hour after coffee consumption alone (RR=4.8 [95% CI=3.3–6.9]), within an hour after lifting >25 kg (RR=6.6 [95% CI=2.2–19.9]), within an hour after minor head trauma (RR=10.1 [95% CI=1.7–60.2]), within an hour after sexual activity (RR=30.4 [95% CI=16.8–55.0]), within an hour after straining for defecation (RR=37.6 [95% CI=22.4–63.4]), and within an hour after vigorous exercise (RR=21.8 [95% CI=12.6–37.8]). Within 24 hours after flu-like disease or fever, the risk for ICH was also increased (RR=50.7 [95% CI=27.1–95.1]). Within an hour after Valsalva maneuvers, the RR for deep ICH was 3.5 (95% CI=1.7–6.9) and for lobar ICH the RR was 2.0 (95% CI=0.9–4.2).

Conclusions:
We identified one infection and several blood pressure related trigger factors for ICH onset, providing new insights into the pathophysiology of vessel rupture resulting in ICH.
Textual Memorial Temples: Writing Hagiographies for Mothers in Late Imperial China
Authors: Ma Xu 
Published: December 2021

Abstract
In Chinese culture, the honor of textual immortality was traditionally reserved for a select, extraordinary few. As Martin Huang points out, however, the Ming-Qing era witnessed a general “secularization” process in which eulogistic writings were increasingly dedicated to women who lived relatively “trivial” lives. Building on Huang’s insights, this paper examines another important evolution within this genre of secularized elegies dedicated to women: the simultaneous sacralizing of deceased mothers by filial sons writing their mothers’ lives as hagiography. As these authors energetically extolled their mothers’ religious piety and identified them with Bodhisattvas/deities, the hitherto lackluster biographies became saturated with supernatural occurrences and miraculous events. Transformed into cultural and emotional sites where ordinary women could be commemorated, immortalized, and apotheosized, these otherwise insignificant life stories evoked a kind of textual memorial temple. Such infusions of spirituality into the writing of Confucian mourning both signal and fuel the broader penetration of heterodox worship (Buddhism) into Confucian society. This practice also allows a glimpse into important gender dimensions in the religious syncretism and secularism of late imperial China.
The Gender of Knowledge in Forensic Drama of Late Imperial China
Authors: Wang Guojun 
Published: December 2021

Abstract
In late imperial China practitioners of forensic investigation in legal cases were predominantly male. While crime literature frequently features female characters, the question of how this literature represents the gender dimension of forensic knowledge remains unanswered. This paper aims to answer this question with an examination of a number of late imperial era theatrical works that depict how forensic knowledge differed across the male and female divide. It argues court-case literature increasingly valorized male forensic knowledge and its relevance to the state legal system. At the same time, these theatrical pieces signify female forensic knowledge following two literary traditions, namely, the commendation of exemplary women and the condemnation of “wanton women.” Investigating these theatrical works at the interstices between court-case literature, women’s history, and forensic history, this paper suggests that the representations of forensic knowledge in Chinese drama accord with major developments in the history of women and gender in premodern China.
The Effect of Tongue-Tie Release on Speech Articulation and Intelligibility
Authors: Melong Jonathan , Bezuhly Michael , Hong Paul 
Published: December 2021

Objective The relationship between ankyloglossia and speech is controversial. The objective of this study was to determine the effect of tongue-tie release on speech articulation and intelligibility. Methods A prospective cohort study was conducted. Pediatric patients (>2 years of age) being referred for speech concerns due to ankyloglossia were assessed by a pediatric otolaryngologist, and speech articulation was formally assessed by a speech language pathologist using the Goldman-Fristoe Test of Articulation 2 (GFTA-2). Patients then underwent a tongue-tie release procedure in clinic. After 1 month, speech articulation was reassessed with GFTA-2. Audio-recordings of sessions were evaluated by independent reviewers to assess speech intelligibility before and after tongue-tie release. Results Twenty-five participants were included (mean age 3.7 years; 20 boys). The most common speech errors identified were phonological substitutions (80%) and gliding errors (56%). Seven children (28%) had abnormal lingual-alveolar and interdental sounds. Most speech sound errors (87.9%) were age/developmentally appropriate. GFTA-2 standard scores before and after tongue-tie release were 85.61 (SD 9.75) and 87.54 (SD 10.21), respectively, (P=.5). Mean intelligibility scores before and after tongue-tie release were 3.15 (SD .22) and 3.21 (SD .31), respectively, (P=.43). Conclusion The majority of children being referred for speech concerns thought to be due to ankyloglossia had age-appropriate speech errors at presentation. Ankyloglossia was not associated with isolated tongue mobility related speech articulation errors in a consistent manner, and there was no benefit of tongue-tie release in improving speech articulation or intelligibility.
Extraglomerular immune complex deposition in lupus nephritis
Authors: Papa Valentina , Brainer James , Henriksen Kammi J , Cenacchi Giovanna , Chang Anthony 
Published: December 2021

Background Lupus nephritis (LN) is a common manifestation and a major cause of morbidity and mortality in systemic lupus erythematosus (SLE) patients. It is characterized by glomerular and often extraglomerular immune complex deposition. Purpose Given the emerging importance of the tubulointerstitial compartment, we conducted a retrospective study of 78 LN biopsies to enumerate the spectrum of extraglomerular immune complex deposition that can be observed in lupus nephritis by electron microscopy and to identify possible clinical or pathologic correlates. Results The presence of tubulointerstitial immune complex deposition often accompanied interstitial inflammation, but some discrepancies were also seen. Conclusions As target antigens are identified, correlation with glomerular, tubulointerstitial, and vascular immune complex deposition will be of increasing interest.
Singing at menopause: A systematic review with pedagogical implications
Authors: Fiuza Mauro B. , Sevillano Maria Luisa , Lã Filipa M.B. 
Published: December 2021

Menopause is a certainty in a female singer’s life; depletion of estrogens may lead to physical, mental, and vocal symptoms. To investigate the extent to which these symptoms affect singers, a systematic literature review was carried out using eight interdisciplinary bibliographic databases. Combinations of the following key words were used: menopause, climacterium, singing, singers, and choir. From 18 studies, including three doctoral dissertations and a master’s thesis, only 10 met the inclusion criteria. The heterogeneity of study designs and methods of data collection and analysis precluded the carrying out of a meta-analysis. Instead, descriptors of symptoms affecting the voice, and vocal characteristics associated with menopause (menopause descriptors) were categorized, and their frequency of occurrence determined, according to six types of primary dataset: (1) self-reported symptoms, (2) acoustic characteristics, (3) observations of the larynx, (4) perceptual evaluations, (5) analysis of electrolaryngographic waveform characteristics, and (6) analysis of hormone concentrations. The descriptors that occurred most frequently in the literature concerned aspects of voice production, whereas those concerning vocal health, and vocal practice and performance, were less common. Of the three subsystems that comprise the vocal instrument, the vibrating vocal folds seem to be more affected than breathing and resonance. Changes in vocal range, timbre, endurance, and vocal fold mobility occur during menopause, affecting singers’ voice quality. Some singers reported that their ability to perform was compromised, mainly due to memory lapses and lack of confidence. Maintaining regular singing and practicing semi-occluded vocal tract exercises throughout the menopausal transition seem to help singers to overcome the negative impacts of menopause on vocal performance.
Comparing High School Sport Specialization Trends Between Division I and Club Collegiate Athletes
Authors: Biese Kevin M. , Winans Madeline , Hernandez Mayrena I. , Schaefer Daniel A. , Post Eric G. , Sanfilippo Jennifer L. , Bell David R. 
Published: December 2021

Background: Adolescent athletes report that sports specialization improves their ability to receive a collegiate athletics scholarship, though this is not well-understood. The purpose of this study was to examine self-reported trends in high school specialization and influences for sport participation between Division I (D-I) and college-aged club (club) athletes. Hypothesis: There would be no difference in high school sport specialization or sport participation influences between D-I and club athletes. Study Design: Retrospective cross-sectional study. Level of Evidence: Level 3. Methods: A survey included specialization classification (low, moderate, and high) for 9th to 12th grade, age that the athlete started organized sport and his or her collegiate sport, and several influential factors for participation in one’s primary high school sport (1 = no influence to 5 = extremely influential). Chi-square analyses were used to compare specialization classifications between groups. Nonparametric tests were used to determine significant differences in age-related variables and influential factors between D-I and club athletes. All analysis were also conducted with boys and girls separately. Results: Participants included 266 D-I (girls, 155; 58%) and 180 club (girls, 122; 68%) athletes. Club athletes were more likely to be classified as low specialization at every grade in high school, and this difference was more pronounced between D-I and club female athletes than male athletes. The number of years an athlete was classified as highly specialized in high school was not different between D-I and club athletes. Club athletes were more influenced by playing with friends than D-I athletes and D-I athletes were more influenced by pursuing a collegiate scholarship than club athletes. Conclusion: High levels of specialization in high school sport may not be necessary for playing at the collegiate level, though some level of specialization in high school might be necessary. Clinical Relevance: Clinicians should advocate for healthy long-term athlete development, which does not support high specialization in high school sports.
The results of a 24-month controlled, prospective study of relapsing multiple sclerosis patients at risk for progressive multifocal encephalopathy, who switched from prolonged use of natalizumab to teriflunomide
Authors: Cohan Stanley , Gervasi-Follmar Tiffany , Kamath Aneesh , Kamath Vineetha , Chen Chiayi , Smoot Kyle , Baraban Elizabeth , Edwards Keith 
Published: December 2021

Background Natalizumab (NTZ) is a highly effective disease modifying treatment for relapsing multiple sclerosis (RMS), but it increases risk of progressive multifocal leukoencephalopathy (PML) in patients with serum anti- John Cunningham virus (JCV) antibodies. Objective To assess the safety and efficacy of rapid transition, from NTZ to teriflunomide (TFM) in RMS patients. Methods Clinically stable NTZ-treated, anti-JCV antibody positive RMS patients were switched to TFM 28 ± 7 days after their last dose of NTZ. The primary endpoint was proportion of relapse free patients at 24 months. Results Median [IQR] age of the 55 enrolled patients was 47 [40.7, 56.3] years, 76% were female. The median [IQR] number of prior NTZ treatments was 34 [18, 64]. annualized relapse rate (ARR) was 0.07 and 77% of the patients were relapse free at 24 months. Mean time to first GAD + lesion was 19.6 months, and to new/enlarging T2 lesion was 19.2 months. Mean time to 3 month sustained disability worsening (SDW) was 22 months and proportion free of 3-month SDW was 0.87. There were no cases of PML. Conclusions The washout-free transition of NTZ to TFM was an efficacious and safe strategy for patients at risk of developing PML. ClinicalTrials.gov Identifier: NCT01970410
Is single-inhaler triple therapy for COPD cost-effective in the UK? The IMPACT trial
Authors: Martin Alan , Shah Dhvani , Ndirangu Kerigo , Anley Glenn A. , Okorogheye Gabriel , Schroeder Melanie , Risebrough Nancy , Ismaila Afisi S. 
Published: December 2021

BackgroundThe IMPACT trial demonstrated superior outcomes following 52 weeks of once-daily single-inhaler treatment with fluticasone furoate (FF)/umeclidinium (UMEC)/vilanterol (VI) (100/62.5/25 μg) compared with once-daily FF/VI (100/25 μg) or UMEC/VI (62.5/25 μg). This study evaluated the cost-effectiveness of FF/UMEC/VI compared with FF/VI or UMEC/VI for the treatment of chronic obstructive pulmonary disease (COPD) from a UK National Health Service perspective.MethodsPatient characteristics and treatment effects from IMPACT were populated into a hybrid decision tree/Markov economic model. Costs (GB£ inflated to 2018 equivalents) and health outcomes were modelled over a lifetime horizon, with a discount rate of 3.5% per annum applied to both. Sensitivity analyses were performed to test the robustness of key assumptions and input parameters.ResultsCompared with FF/VI and UMEC/VI, FF/UMEC/VI provided an additional 0.296 and 0.145 life years (LYs) (discounted) and 0.275 and 0.118 quality-adjusted life years (QALYs), at an additional cost of £1129 and £760, respectively. Incremental cost-effectiveness ratios (ICERs) for FF/UMEC/VI were £4104/QALY and £3809/LY gainedversusFF/VI and £6418/QALY and £5225/LY gainedversusUMEC/VI. At a willingness-to-pay threshold of £20 000/QALY, the probability that FF/UMEC/VI was cost-effective was 96%versusFF/VI and 74%versusUMEC/VI. Results were similar in a subgroup of patients recommended triple therapy in the 2019 National Institute for Health and Care Excellence COPD guideline.ConclusionsFF/UMEC/VI single-inhaler triple therapy improved health outcomes and was a cost-effective option compared with FF/VI or UMEC/VI for patients with symptomatic COPD and a history of exacerbations in the UK at recognised cost-effectiveness threshold levels.