bluuebunny/crossref_metadata_2025_split huggingface dataset:
Understanding Engagement in and Affective Experiences During Physical Activity: The Role of Meditation Interventions
Authors: Don Brian P. , Van Cappellen Patty , Fredrickson Barbara L. 
Published: January 2021

ABSTRACT

Objective
Meditation interventions promote an array of well-being outcomes. However, the way in which these interventions promote beneficial outcomes is less clear. Here, we expanded on prior work by examining the influence of mindfulness and loving-kindness meditation on a key health behavior: physical activity.

Methods
To test our hypotheses, we drew upon two randomized intervention studies. In the first study, 171 adults (73.0% female) received 6 weeks of training in either mindfulness meditation or loving-kindness meditation, or were assigned to a control condition. In the second study, 124 adults (60.0% female) were assigned to a 6-week mindfulness or loving-kindness meditation group.

Results
Study 1 demonstrated that individuals who received mindfulness training reported sustained levels of physical activity across the intervention period (Pre: mean [standard deviation], or M [SD] = 4.09 [2.07]; Post: M [SD] = 3.68 [2.00]; p = .054), whereas those in the control (Pre: M [SD] = 3.98 [2.25]; Post: M [SD] = 3.01 [2.07]; p < .001) and loving-kindness (Pre: M [SD] = 4.11 [2.26]; Post: M [SD] = 3.45 [1.96]; p < .001) conditions reported lower levels. Study 2 demonstrated those who received mindfulness training experienced increases in positive emotions during physical activity from preintervention to postintervention (Pre: M [SD] = 6.06 [2.51]; Post: M [SD] = 6.54 [2.43]; p = .001), whereas those trained in loving-kindness meditation experienced decreases in positive emotions during physical activity (Pre: M [SD] = 6.45 [2.35]; Post: M [SD] = 6.09 [2.46]; p = .040).

Conclusions
These results suggest mindfulness training (but not loving-kindness training) promotes sustained physical activity, and one plausible reason why this occurs is enhanced positive emotion during physical activity.
Diminished Age-Related Decline of the Amygdala in Long-Term Meditation Practitioners
Authors: Luders Eileen , Jain Felipe A. , Kurth Florian 
Published: January 2021

ABSTRACT

Objective
A growing body of scientific evidence suggests that meditation may slow brain aging. The amygdala—a heterogenous brain region known to decrease in volume with increasing age—seems to be involved in meditation and affected by meditation. Thus, we hypothesized that the age-related decline of the amygdala is diminished in meditation practitioners.

Methods
We investigated whether correlations between age and gray matter volumes of the amygdala are significantly reduced in 50 long-term meditators compared with 50 sex- and age-matched healthy controls. Both the meditator and control groups included 44% women. The age of the participants ranged between 24 and 77 years, with mean (standard deviation) ages of 50.4 (±11.8) years in meditators and 51.4 (±12.8) years in controls. In addition to studying the amygdala as a whole, we investigated its centromedial, laterobasal, and superficial subregions using a well-validated approach combining imaging-based signal intensities and cytoarchitectonically defined probabilities.

Results
We detected significant group-by-age interactions for the whole amygdala and for its subregions. Follow-up analyses indicated negative age-related correlations in both meditators and controls (the older the participants, the smaller the volumes) but with significantly steeper aging trajectories in controls.

Conclusions
Altogether, these findings suggest that the age-related volume loss of the amygdala is less pronounced in long-term meditators. This effect was particularly evident for the laterobasal subregion, which has been functionally linked to aspects of self-focused reflection.
Investigating Hospital Supervision: A Case Study of Regulatory Inspectors’ Roles as Potential Co-creators of Resilience
Authors: Øyri Sina Furnes , Braut Geir Sverre , Macrae Carl , Wiig Siri 
Published: January 2021

Objectives
The aim of this study was to explore if, and in what ways, there has been changes in the supervisory approach toward Norwegian hospitals due to the implementation of a new management and quality improvement regulation (Regulation on Management and Quality Improvement in the Healthcare Services, hereinafter referred to as “Quality Improvement Regulation”). Moreover, we aimed to understand how inspectors’ work promotes or hampers resilience potentials of adaptive capacity and learning in hospitals.

Methods
The study design is a case study of implementation and impact of the Quality Improvement Regulation. We performed a document analysis, and conducted and analyzed 3 focus groups and 2 individual interviews with regulatory inspectors, recruited from 3 county governor offices who are responsible for implementation and supervision of the Quality Improvement Regulation in Norwegian regions.

Results
Data analysis resulted in 5 themes. Informants described no substantial change in their approach owing to the Quality Improvement Regulation. Regardless, data pointed to a development in their practices and expectations. Although the Norwegian Board of Health Supervision, at the national level, occasionally provides guidance, supervision is adapted to specific contexts and inspectors balance trade-offs. Informants expressed concern about the impact of supervision on hospital performance. Benefits and disadvantage with positive feedback from inspectors were debated. Inspectors could nurture learning by improving their follow-up and add more hospital self-assessment.

Conclusions
A nondetailed regulatory framework such as the Quality Improvement Regulation provides hospitals with room to maneuver, and self-assessment might reduce resource demands. The impact of supervision is scarce with an unfulfilled potential to learn from supervision. The Government could contribute to a shift in focus by instructing the county governors to actively reflect on and communicate positive experiences from, and smart adaptations in, hospital practice.
The Development of a Surgical Oncology Center During the COVID-19 Pandemic
Authors: Moriarty Peter , Chang Justin , Kayani Babar , Roberts Lois , Bourke Neil , Dann Christopher , MacArthur Emma , Haddad Fares S. 
Published: January 2021

Abstract
Coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization on March 11, 2020. By mid-March, London had emerged as the epicenter in the United Kingdom, accounting for 45% of the COVID-19–related mortality. A cancer COVID-19–free “cold hub,” through National Health Service partnership with independent institutions, was established to maintain a throughput of surgical oncology patients with an accessible triage system for oncologic specialties. The high population density, commuter volume, and rising COVID-19 incidence heightened the challenge of segregating a vulnerable population that was already at high risk for surgical morbidity and mortality.
The aim of this review is to report the experience of developing a multicenter COVID-19–free cold hub with the aim of providing safe surgery for surgical oncology patients. We discuss the timeline, structure, and infection control policy and suggest practical points that may guide other health care systems.
The surgical oncology hub treated 1542 patients between March 1 and July 1, 2020. There were no cases of COVID-19–related mortality in a 30-day follow-up. Key strategies for the restructuring of the cancer service included the following: (1) formation of an accessible referral pathway, (2) creation and structuring of cold hub hospitals, (3) development of protocols for infection control and preoperative testing, (4) rapid reorganization of services based on initial feedback, and (5) clear communication and leadership.
It has been shown that a surgical oncology cold hub with an accessible referral system and an effective system of preoperative screening system can minimize COVID-19 transmission, morbidity, and mortality, in a region with heavy disease prevalence. This structure represents a safe, ethical, and viable system that can be replicated in other health care systems.
Examining the Relationship Between Perceived Quality of Care and Actual Quality of Care as Measured by 30-Day Readmission Rates
Authors: Salinas Stanley R. 
Published: January 2021

Objective:
To test the relationship between patient experience, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), and actual quality of care, as measured by 30-day readmission rates.

Data Sources:
Both HCAHPS data and outcome data reported to the Centers of Medicare & Medicaid Services (CMS).

Study Design:
This secondary, nationwide (N = 4060), hospital-level study focused only on acute care hospitals. HCAHPS question 22 “Would you recommend this hospital to your friends and family?” was used to determine level of overall satisfaction, and 30-day readmission rates, as reported to the CMS, was used as a proxy for actual quality of care.

Principal Findings:
A statistically significant relationship was found between patient experience and actual quality outcomes.

Conclusion:
The results of this study reinforce the inclusion of patient experience in Medicare's Value Based Purchasing program as a matter of good public policy.
Does the Proportion of Same-Day and 24-Hour Appointments Impact Patient Satisfaction?
Authors: Richter Jason P. , Downs Lynn , Beauvais Brad , Huynh Peter V. , Hamilton Jessica E. , Kim Forest , Weigel Fred 
Published: January 2021

Background:
The relationship between open access and patient satisfaction is mixed. Our study is the first to assess the relationship between open access appointment scheduling and patient satisfaction in the Military Health System (MHS). It is also unique in that we examine both same-day and 24-hour access through a relationship with satisfaction.

Methods:
We conducted a panel time-series analysis with general estimating equations on the Army population of outpatient facilities (N = 32), with 32 364 957 total observations. Our primary independent variables were the proportion of a facility's appointments within 24 hours and same day from July 2013 to May 2015.

Results:
We identified that a higher proportion of same-day appointments is associated with increased patient satisfaction with the ability to see their provider when needed. We did not find the same result when examining access within 24 hours.

Conclusions:
Open access appointment scheduling appears to have a greater impact on patient satisfaction with timeliness of care if that appointment is made the same day the patient presents to the facility. Facilities should consider opening more of their schedule to accommodate same-day appointments. This can result in less costly primary care instead of emergency department usage.
Promoting Continuous Quality Improvement in the Alabama Child Health Improvement Alliance Through Q-Sort Methodology and Learning Collaboratives
Authors: Fifolt Matthew , Preskitt Julie , Rucks Andrew , Corvey Kathryn , Benton Elizabeth Cason 
Published: January 2021

Objective:
Q-sort methodology is an underutilized tool for differentiating among multiple priority measures. The authors describe steps to identify, delimit, and sort potential health measures and use selected priority measures to establish an overall agenda for continuous quality improvement (CQI) activities within learning collaboratives.

Methods:
Through an iterative process, the authors vetted a list of potential child and adolescent health measures. Multiple stakeholders, including payers, direct care providers, and organizational representatives sorted and prioritized measures, using Q-methodology.

Results:
Q-methodology provided the Alabama Child Health Improvement Alliance (ACHIA) an objective and rigorous approach to system improvement. Selected priority measures were used to design learning collaboratives. An open dialogue among stakeholders about state health priorities spurred greater organizational buy-in for ACHIA and increased its credibility as a statewide provider of learning collaboratives.

Conclusions:
The integrated processes of Q-sort methodology, learning collaboratives, and CQI offer a practical yet innovative way to identify and prioritize state measures for child and adolescent health and establish a learning agenda for targeted quality improvement activities.
“Reuma-Check”
Authors: García Salinas Rodrigo , Ruta Santiago , Chichande Jessica Torres , Prado Einer Sanchez , Ruta Alvaro , Salvatori Facundo , Aguerre Dario , Magri Sebastián 
Published: January 2021

Objectives
The aim of this study was to evaluate the performance of a comprehensive diagnosis program called “Reuma-check” for the diagnosis of axial spondyloarthritis (SpA) in patients with low back pain (LBP).

Methods
This is a cross-sectional study. Patients with LBP aged 18 years or older were preselected, and those with at least 1 SpA feature completed the circuit. They were referred after 2 strategies: education for orthopedists and a campaign on social networks. All patients underwent a clinical evaluation, laboratory testing, and imaging (including human leukocyte antigen B27 evaluation and magnetic resonance imaging). The diagnosis of axial SpA was established by an expert rheumatologist opinion. Time from onset of symptoms to “Reuma-check,” time from patient referral to admission of the checkup, and time from “Reuma-check” to diagnosis were evaluated.

Results
A total of 175 of 246 patients were included, most of them came from the social media campaign (55%). Seventy-five (43%) of 175 patients were diagnosed as axial SpA. The median time from referral (or self-referral) to access to the program was 1.3 months. The median time from symptoms onset to access to the program was 31.7 months, and the median time from the performance of “Reuma-check” to final diagnosis was 2 weeks. Features associated with a diagnosis of axial SpA were as follows: inflammatory LBP (odds ratio [OR], 6.64; 95% confidence interval [CI], 1.6–28), clinical enthesopathy (OR, 4.56; 95% CI, 1.1–18.4), positive human leukocyte antigen B27 (OR, 23.02; 95% CI, 3.5–58), and positive magnetic resonance imaging (OR, 14.34; 95% CI, 3.5–58).

Conclusions
“Reuma-check” allowed a high frequency of axial SpA diagnosis and improved access to rapid diagnosis, shortening the time from referral to diagnosis with a shorter acquisition time for the ancillary studies. Patients with a final diagnosis of axial SpA presented distinctive features.
A novel partial resuscitative endovascular balloon aortic occlusion device that can be deployed in zone 1 for more than 2 hours with minimal provider titration
Authors: Kemp Michael T. , Wakam Glenn K. , Williams Aaron M. , Biesterveld Ben E. , O’Connell Rachel L. , Vercruysse Claire A. , Chtraklin Kiril , Russo Rachel M. , Alam Hasan B. 
Published: January 2021

BACKGROUND
Hemorrhage is a leading cause of mortality in trauma. Resuscitative endovascular balloon occlusion of the aorta (REBOA) can control hemorrhage, but distal ischemia, subsequent reperfusion injury, and the need for frequent balloon titration remain problems. Improved device design can allow for partial REBOA (pREBOA) that may provide hemorrhage control while also perfusing distally without need for significant provider titration.

METHODS
Female Yorkshire swine (N = 10) were subjected to 40% hemorrhagic shock for 1 hour (mean arterial pressure [MAP], 28–32 mm Hg). Animals were then randomized to either complete aortic occlusion (ER-REBOA) or partial occlusion (novel pREBOA-PRO) without frequent provider titration or distal MAP targets. Detection of a trace distal waveform determined partial occlusion in the pREBOA-PRO arm. After 2 hours of zone 1 occlusion, the hemorrhaged whole blood was returned. After 50% autotransfusion, the balloon was deflated over a 10-minute period. Following transfusion, the animals were survived for 2 hours while receiving resuscitation based on objective targets: lactated Ringer’s fluid boluses (goal central venous pressure, ≥ 6 mm Hg), a norepinephrine infusion (goal MAP, 55–60 mm Hg), and acid-base correction (goal pH, >7.2). Hemodynamic variables, arterial lactate, lactate dehydrogenase, aspartate aminotransferase, and creatinine levels were measured.

RESULTS
All animals survived throughout the experiment, with similar increase in proximal MAPs in both groups. Animals that underwent partial occlusion had slightly higher distal MAPs. At the end of the experiment, the partial occlusion group had lower end levels of serum lactate (p = 0.006), lactate dehydrogenase (p = 0.0004) and aspartate aminotransferase (p = 0.004). Animals that underwent partial occlusion required less norepinephrine (p = 0.002), less bicarbonate administration (p = 0.006), and less fluid resuscitation (p = 0.042).

CONCLUSION
Improved design for pREBOA can decrease the degree of distal ischemia and reperfusion injury compared with complete aortic occlusion, while providing a similar increase in proximal MAPs. This can allow pREBOA zone-1 deployment for longer periods without the need for significant balloon titration.
Causes of early mortality in pediatric trauma patients
Authors: Theodorou Christina M. , Galganski Laura A. , Jurkovich Gregory J. , Farmer Diana L. , Hirose Shinjiro , Stephenson Jacob T. , Trappey A. Francois 
Published: January 2021

BACKGROUND
Trauma is the leading cause of death in children, and most deaths occur within 24 hours of injury. A better understanding of the causes of death in the immediate period of hospital care is needed.

METHODS
Trauma admissions younger than 18 years from 2009 to 2019 at a Level I pediatric trauma center were reviewed for deaths (n = 7,145). Patients were stratified into ages 0–6, 7–12, and 13–17 years old. The primary outcome was cause of death, with early death defined as less than 24 hours after trauma center arrival.

RESULTS
There were 134 (2%) deaths with a median age of 7 years. The median time from arrival to death was 14.4 hours (interquartile range, 0.5–87.8 hours). Half (54%) occurred within 24 hours. However, most patients who survived initial resuscitation in the emergency department died longer than 24 hours after arrival (69%). Traumatic brain injury was the most common cause of death (66%), followed by anoxia (9.7%) and hemorrhage (8%). Deaths from hemorrhage were most often in patients sustaining gunshot wounds (73% vs. 11% of all other deaths, p < 0.0001), more likely to occur early (100% vs. 50% of all other deaths, p = 0.0009), and all died within 6 hours of arrival. Death from hemorrhage was more common in adolescents (21.4% of children aged 13–17 vs. 6.3% of children aged 0–6, and 0% of children aged 7–12 p = 0.03). The highest case fatality rates were seen in hangings (38.5%) and gunshot wounds (9.6%).

CONCLUSION
Half of pediatric trauma deaths occurred within 24 hours. Death from hemorrhage was rare, but all occurred within 6 hours of arrival. This is a critical time for interventions for bleeding control to prevent death from hemorrhage in children. Analysis of these deaths can focus efforts on the urgent need for development of new hemorrhage control adjuncts in children.

LEVEL OF EVIDENCE
Epidemiological study, level IV.
The effect of the Affordable Care Act on rates on inpatient rehabilitation hospital admission in a mature trauma system
Authors: Winter Mike , Vernon Tawnya , Morgan Madison , Bresz Kellie , Cook Alan , Bradburn Eric , Rogers Frederick 
Published: January 2021

BACKGROUND
The beneficial effects of acute rehabilitation for trauma patients are well documented but can be limited because of insurance coverage. The Patient Protection and Affordable Care Act (ACA) went into effect on March 23, 2010. The ACA allowed patients who previously did not have insurance to be fully incorporated into the health system. We sought to analyze the likelihood of discharge to rehab for trauma patients before and after the implementation of the ACA. We hypothesized that there would be a higher rate of inpatient rehabilitation hospital (IRH) admission after the ACA was put into effect.

METHODS
The Pennsylvania Trauma Outcome Study (PTOS) database was retrospectively queried from 2003 to 2017 for all trauma patients admitted to accredited trauma centers in Pennsylvania, who also had a functional status at discharge (FSD). Admission to an IRH was determined using discharge destination. Two categories were created to represent periods before and after ACA was implemented, 2003 to 2009 (pre-ACA) and 2010–2017 (post-ACA). A multilevel mixed-effects logistic regression model controlling for demographics, injury severity, and FSD assessed the adjusted impact of ACA implementation on IRH admissions.

RESULTS
From the Pennsylvania Trauma Outcome Study query, 341,252 patients had FSD scores and of these patients, 47,522 (13.9%) were admitted to IRH. Patients who were severely injured were more likely to be admitted to IRH. Compared with FSD scores signifying complete independence at discharge, those with lower FSD had significantly increased odds of IRH admission. The odds of IRH admission post-ACA implementation significantly increased when compared with pre-ACA years (adjusted odds ratio, 1.14; 95% confidence interval, 1.12–1.17; p < 0.001; area under the receiver operating curve, 0.818).

CONCLUSION
The implementation of the ACA significantly increased the likelihood of discharge to IRH for trauma patients.

LEVEL OF EVIDENCE
Care management, level III
Characterisation of the RNA-interference pathway as a Tool for Genetics in the Nascent Phototrophic Endosymbiosis,Paramecium bursaria
Authors: Jenkins Benjamin H. , Maguire Finlay , Leonard Guy , Eaton Joshua D. , West Steven , Housden Benjamin E. , Milner David S. , Richards Thomas A. 
Published: January 2021

ABSTRACTEndosymbiosis was fundamental for the evolution of eukaryotic complexity. Endosymbiotic interactions can be dissected through forward and reverse-genetic experiments, such as RNA-interference (RNAi). However, distinguishing small (s)RNA pathways in a eukaryote-eukaryote endosymbiotic interaction is challenging. Here, we investigate the repertoire of RNAi pathway protein-encoding genes in the model nascent endosymbiotic system,Paramecium bursaria–Chlorellaspp. Using comparative genomics and transcriptomics supported by phylogentics, we identify essential proteome components of the small interfering (si)RNA, scan (scn)RNA, and internal eliminated sequence (ies)RNA pathways. Our analyses reveal that copies of these components have been retained throughout successive whole genome duplication (WGD) events in theParameciumclade. We then validate feeding-induced siRNA-based RNAi inP. bursariavia knock-down of the splicing factor,u2af1, which we show to be crucial to host growth. Finally, using simultaneous knock-down paradox controls to rescue the effectu2af1knock-down, we demonstrate that feeding-induced RNAi inP. bursariais dependent upon a core pathway of host-encodedDcr1,PiwiandPds1components. Our experiments confirm the presence of a functional, host-derived RNAi pathway inP. bursariathat generates 23-nt siRNA, validating use of theP. bursaria-Chlorellaspp. system to investigate the genetic basis of a nascent endosymbiosis.