bluuebunny/crossref_metadata_2025_split huggingface dataset:
US Trends in Opioid Access Among Patients With Poor Prognosis Cancer Near the End-of-Life
Authors: Enzinger Andrea C. , Ghosh Kaushik , Keating Nancy L. , Cutler David M. , Landrum Mary Beth , Wright Alexi A. 
Published: July 2021

PURPOSE Heightened regulations have decreased opioid prescribing across the United States, yet little is known about trends in opioid access among patients dying of cancer. METHODS Among 270,632 Medicare fee-for-service decedents with poor prognosis cancers, we used part D data to examine trends from 2007 to 2017 in opioid prescription fills and opioid potency (morphine milligram equivalents per day [MMED]) near the end-of-life (EOL), defined as the 30 days before death or hospice enrollment. We used administrative claims to evaluate trends in pain-related emergency department (ED) visits near EOL. RESULTS Between 2007 and 2017, the proportion of decedents with poor prognosis cancers receiving ≥ 1 opioid prescription near EOL declined 15.5% (relative percent difference [RPD]), from 42.0% (95% CI, 41.4 to 42.7) to 35.5% (95% CI, 34.9 to 36.0) and the proportion receiving ≥ 1 long-acting opioid prescription declined 36.5% (RPD), from 18.1% (95% CI, 17.6 to 18.6) to 11.5% (95% CI, 11.1 to 11.9). Among decedents receiving opioids near EOL, the mean daily dose fell 24.5%, from 85.6 MMED (95% CI, 82.9 to 88.3) to 64.6 (95% CI, 62.7 to 66.6) MMED. Overall, the total amount of opioids prescribed per decedent near EOL (averaged across those who did and did not receive an opioid) fell 38.0%, from 1,075 morphine milligram equivalents per decedent (95% CI, 1,042 to 1,109) to 666 morphine milligram equivalents per decedent (95% CI, 646 to 686). Simultaneously, the proportion of patients with pain-related ED visits increased 50.8% (RPD), from 13.2% (95% CI, 12.7 to 13.6) to 19.9% (95% CI, 19.4 to 20.4). Sensitivity analyses demonstrated similar declines in opioid utilization in the 60 and 90 days before death or hospice, and suggested that trends in opioid access were not confounded by secular trends in hospice utilization. CONCLUSION Opioid use among patients dying of cancer has declined substantially from 2007 to 2017. Rising pain-related ED visits suggests that EOL cancer pain management may be worsening.
The wing scales of the mother-of-pearl butterfly, Protogoniomorpha parhassus, are thin film reflectors causing strong iridescence and polarization
Authors: Stavenga Doekele G. 
Published: July 2021

ABSTRACT
The dorsal wings of the mother-of-pearl butterfly, Protogoniomorpha parhassus, display an angle-dependent pink, structural color. This effect is created by light interference in the lower lamina of the wing scales, which acts as an optical thin film. The scales feature extremely large windows that enhance the scale reflectance, because the upper lamina of ridges and cross-ribs is very sparse. Characteristic for thin film reflectors, the spectral shape of the reflected light strongly depends on the angle of light incidence, shifting from pink to yellow when changing the angles of illumination and observation from normal to skew, and also the degree of polarization strongly varies. The simultaneous spectral and polarization changes serve a possibly widespread, highly effective system among butterflies for intraspecific communication during flight.
Prognostic Impact of Resection Margin Status in Distal Pancreatectomy for Ductal Adenocarcinoma
Authors: Sahakyan Mushegh A. , Verbeke Caroline S. , Tholfsen Tore , Ignjatovic Dejan , Kleive Dyre , Buanes Trond , Lassen Kristoffer , Røsok Bård I. , Labori Knut Jørgen , Edwin Bjørn 
Published: July 2021

Abstract
Background
Resection margin status is considered one of the few surgeon-controlled parameters affecting prognosis in pancreatic ductal adenocarcinoma (PDAC). While studies mostly focus on resection margins in pancreatoduodenectomy, little is known about their role in distal pancreatectomy (DP). This study aimed to investigate resection margins in DP for PDAC.

Methods
Patients who underwent DP for PDAC between October 2004 and February 2020 were included (n = 124). Resection margins and associated parameters were studied in two consecutive time periods during which different pathology examination protocols were used: non-standardized (period 1: 2004–2014) and standardized (period 2: 2015–2020). Microscopic margin involvement (R1) was defined as ≤1 mm clearance.

Results
Laparoscopic and open resections were performed in 117 (94.4%) and 7 (5.6%) patients, respectively. The R1 rate for the entire cohort was 73.4%, increasing from 60.4% in period 1 to 83.1% in period 2 (p = 0.005). A significantly higher R1 rate was observed for the posterior margin (35.8 vs. 70.4%, p < 0.001) and anterior pancreatic surface (based on a 0 mm clearance; 18.9 vs. 35.4%, p = 0.045). Pathology examination period, poorly differentiated PDAC, and vascular invasion were associated with R1 in the multivariable model. Extended DP, positive anterior pancreatic surface, lymph node ratio, perineural invasion, and adjuvant chemotherapy, but not R1, were significant prognostic factors for overall survival in the entire cohort.

Conclusions
Pathology examination is a key determinant of resection margin status following DP for PDAC. A high R1 rate is to be expected when pathology examination is meticulous and standardized. Involvement of the anterior pancreatic surface affects prognosis.
Comparison of mobile health education messages verses face-to-face consultation for weight reduction among overweight female adolescents in Thailand
Authors: Wongtongtair Supim , Iamsupasit Sompoch , Somrongthong Ratana , Kumar Ramesh , Yamarat Khemika 
Published: July 2021

Background: Obesity is considered a significant public health problem in Thailand. This study was conducted to compare the impact of mobile health education messages verses face-to-face consultation on weight reduction among overweight female university students. Methods: This comparative cross-sectional study comprised three groups: a control group, a group receiving mobile health education, and a group receiving face-to-face consultation. Each group contained 26 participants taking part over a period of 12 weeks, with a 12-week follow-up thereafter. The data analysis used two-way repeated measures ANOVA with least significant difference testing. The study was ethically approved at Chulalongkorn University, Thailand. Results: The results revealed that the group receiving mobile health education had the lowest average body mass index and waist–hip ratio after intervention (p < 0.05). In addition, both intervention groups significantly improved their health belief, social support, and health behavior scores in comparison to the control group (p < 0.001). The results show that the average scores for social support for eating and exercise at baseline were significantly lower than at post-intervention or follow-up (p < 0.001). In addition, the results of both aspects of social support showed that the average social support score at post-intervention was significantly higher than at follow-up. Furthermore, the health behavior score measured post-intervention was higher than at follow-up. There was a statistically significant difference in average metabolism during physical activity (p < 0.001) but no statistical difference in average eating behavior score. Conclusion: The study found that the use of mobile health education to deliver health programs facilitates communication between the healthcare provider and individual, and can empower adolescent females in their pursuit of weight loss by improving their attitudes and knowledge, leading to better health behavior.
Accounting for complexity – Intervention design in the context of studying social accountability for reproductive health
Authors: McMullen Heather , Boydell Victoria , Cordero Joanna Paula , Steyn Petrus S. , Kiarie James , Kinemo Patrick , Monyo Alice , Addah Mary Awelana , Ahuno Jacob Tetteh , Gyamfi Osei-Bonsu 
Published: July 2021

Background: Social accountability interventions aim to propel change by raising community voices and holding duty bearers accountable for delivering on rights and entitlements. Evidence on the role of such interventions for improving community health outcomes is steadily emerging, including for sexual and reproductive health and rights (SRHR). However, these interventions are complex social processes with numerous actors, multiple components, and a highly influential local context. Unsurprisingly, determining the mechanisms of change and what outcomes may be transferable to other similar settings can be a challenge. We report our methodological considerations to account for complexity in a social accountability intervention exploring contraceptive uptake and use in Ghana and Tanzania. Main Body: The Community and Provider driven Social Accountability Intervention (CaPSAI) study explores the relationship between a health facility-focused social accountability intervention and contraceptive service provision in two countries. This 24-month mixed-method quasi-experimental study, using an interrupted time series with a parallel control group, is being undertaken in 16 sites across Ghana and Tanzania in collaboration with local research and implementation partners. The primary outcomes include changes in contraceptive uptake and use. We also measure outcomes related to current social accountability theories of change and undertake a process evaluation. We present three design features: co-design, ‘conceptual’ fidelity, and how we aim to track the intervention as ‘intended vs. implemented’ to explore how the intervention could be responsive to the embedded routines, local contextual realities, and the processual nature of the social accountability intervention. Conclusions: Through a discussion of these design features and their rationale, we conclude by suggesting approaches to intervention design that may go some way in responding to recent challenges in accounting for social accountability interventions, bearing relevance for evaluating health system interventions.
Content analysis of behaviour change techniques in government physical distancing communications for the reopening of schools during the COVID-19 pandemic in Ireland
Authors: Durand Hannah , Mc Sharry Jenny , Meade Oonagh , Byrne Molly , Kenny Eanna , Lavoie Kim L. , Molloy Gerard J. 
Published: July 2021

Background:Effective government communications and leadership are central to the management of pandemics. Behavioural science can offer important insight into the development of such communications strategies. The extent to which established behaviour-change science is reflected in current government messaging campaigns to promote adherence to physical distancing measures in the context of the coronavirus disease 2019 (COVID-19) pandemic is unclear. The current study aimed to describe the behaviour-change content of a set of government-issued poster communications for the reopening of schools in Ireland during the COVID-19 pandemic in September 2020.Methods:Posters targeting physical distancing behaviours in school settings were retrieved from the Government of Ireland website for analysis. Posters were independently coded for behaviour change techniques (BCTs) using the BCT Taxonomy Version 1, a hierarchically clustered taxonomy of 93 distinct BCTs across 16 groups. The Theories and Techniques tool was used to identify mechanisms of action (MoAs) linked to each of the identified BCTs. Eight posters were independently content-analysed by two members of the research team for BCTs and linked MoAs.Results:Eight unique BCTs from six unique groups were identified in at least one poster. These BCTs were linked with 11 unique MoAs through which behaviour change is theorised to occur. Several theoretically important groups of BCTs, such as Natural Consequences, Social Support, Shaping Knowledge, and Comparison of Behaviour, were underutilised or not included in any of the posters.Conclusion:Future poster communications could benefit from including additional BCTs from key groups, particularly Natural Consequences. This article provides proof-of-concept evidence for future evaluations of government public health communications for behaviour-change content using existing taxonomies and tools.
Confronting behaviour in palliative care: a qualitative study of the lived experience of nursing staff
Authors: Pejoski Natalie , Skaczkowski Gemma , Moran Juli , Hodgson Hilary , Wilson Carlene 
Published: July 2021

Background:Little research examines the extent and impact of aggressive or uncomfortable ‘confronting behaviour’ experienced by palliative care nurses, despite palliative wards being an emotionally labile environment.Methods:Qualitative data on nurses' experiences of confrontation were collected from 17 palliative care nurses at a major metropolitan hospital via a focus group and individual interviews. Data were analysed using inductive thematic analysis.Findings:Results indicated that family members were the main perpetrators and tolerance of confrontation varied dependent on the characteristics of the aggressor. Confrontation was described as arising in response to grief, and because of misunderstandings of palliative care goals. Nurses reported a perceived lack of appreciation for their work from some patients' families and feelings of discontent with the nature and amount of structured support available following a confrontation. Informal workplace support helped nurses to deal with these incidents and, despite bad experiences, nurses affirmed their commitment to working in this area.Conclusion:The findings demonstrate the demands placed on nurses working in palliative care, and the importance of compassion in moderating the impact of a challenging environment.
Effect of Vibration on Rapeseed Header Loss and Optimization of Header Frame
Authors: Li Yang , Xu Lizhang , Gao Zhipeng , Lu En , Li Yaoming 
Published: July 2021

HighlightsThe relationship of vibration and header loss was studied by multi-point vibration measurement and loss collection test.There was an approximately linear positive correlation between total header vibration and total rapeseed header loss.The header frame was analyzed and optimized through modal simulation and testing.The total rapeseed header loss of the improved header was reduced by 33.2% to 46.9%.Abstract. In view of the current large rapeseed header losses of rape combine harvesters, the effects of the header on rapeseed header loss were studied from the perspective of vibration. First, the vibrations at various measuring points on the header during rape harvest were studied using a data acquisition and analysis system while performing collection tests of rapeseed header loss with the sample slot method. The relationships between total header vibration and total rapeseed header loss and between vertical cutter vibration and rapeseed vertical cutter loss were shown to have a positive correlation, and they all increased with the increase in engine speed. Vertical cutter loss accounted for 31.2% to 42.4% of the total rapeseed header loss. Modal analysis and optimization of the header frame were then performed by simulation and test. The natural frequencies of the first-order and second-order modes of the optimized header were increased, and the possibility of resonance with other working parts was eliminated. Finally, the improved header was tested during rape harvest. The results showed that the total vibration of the improved header was reduced by 19.9% to 43.9%, and the total rapeseed header loss was reduced by 33.2% to 46.9%. The vertical cutter vibration was reduced by 30.5% to 49.8%, and the rapeseed vertical cutter loss was reduced by 20.8% to 34.7%. In addition, the vibration and rapeseed loss of the improved header had relatively slow rates of increase with the increase in engine speed. The method of reducing rapeseed loss by reducing the header vibration achieved an obvious and positive effect. Keywords: Frame optimization, Modal analysis, Rape combine harvester, Rapeseed header loss, Vibration.
Digitalisation in Agriculture: Knowledge and Learning Requirements of German Dairy Farmers
Authors: Goller Michael , Caruso Carina , Harteis Christian 
Published: July 2021

Purpose: This study aims at investigating how digitalisation (in the sense of industry 4.0) has changed the work of farmers and how they experience the changes from more traditional work to digitalised agriculture. It also investigates what knowledge farmers require on digitalised farms and how they acquire it. Dairy farming was used as domain of investigation since it, unlike other industries, has strongly been affected by digitalisation throughout the last years.Method: Exploratory interviews with 10 livestock farmers working on digitalised dairy farms were analysed using qualitative content analysis. A deductive and inductive coding strategy was used. Findings: Farming work has changed from more manual tasks towards symbol manipulation and data processing. Farmers must be able to use computers and other digital devices to retrieve and analyse sensor data that allow them to monitor and control the processes on their farm. For this new kind of work, farmers require elaborated mental models that link traditional farming knowledge with knowledge about digital systems, including a strong understanding of production processes underlying their farm. Learning is mostly based on instructions offered by manufacturers of the new technology as well as informal and non-formal learning modes. Even younger farmers report that digital technology was not sufficiently covered in their (vocational) degrees. In general, farmers emphasises the positive effects of digitalisation both on their working as well as private life. Conclusions: Farmers should be aware of the opportunities as well as the potential drawbacks of the digitalisation of work processes in agriculture. Providers of agricultural education (like vocational schools or training institutes) need to incorporate the knowledge and skills required to work in digitalised environments (e.g., data literacy) in their syllabi. Further studies are required to assess how digitalisation changes farming practices and what knowledge as well as skills linked to these developments are required in the future.
Realization of carrier envelope phase control in an erbium-doped all-fiber comb via an intracavity electrical polarization controller
Authors: Liu Tingting , Yan Ming , Shen Xuling , Zeng Heping 
Published: July 2021

We present an erbium-doped all-fiber comb that is realized via intracavity piezoelectric mechanical responses by inserting an electrical polarization controller (EPC) for carrier envelope phase offset (

f

ceo

) control and sticking a piezoelectric transducer (PZT) for repetition rate (

f
r

)

stabilization. With only three components inside the oscillator, it facilitates an all-fiber comb system with high integration and robustness. Besides

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ceo

control, smart, recoverable, and precise searching of mode-locked states can also be achieved by finely tuning the EPC driving voltages. The

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ceo

signal can be tightly phase-locked due to the 20 kHz 3 dB bandwidth of the EPC device. Compared with the traditional pump feedback mode, the EPC approach exhibits a larger and flatter gain in the near-zero-dispersion zone of the fiber comb, corresponding to less EPC induced intracavity fluctuations. It is also a benefit for reducing cross regulation between

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r

and

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ceo

in long-term stabilization of the comb.
Mapping survey of schistosomiasis and soil-transmitted helminthiases towards mass drug administration in The Gambia
Authors: Camara Yaya , Sanneh Bakary , Joof Ebrima , Sanyang Abdoulie M. , Sambou Sana M. , Sey Alhagie Papa , Sowe Fatou O. , Jallow Amadou Woury , Jatta Balla , Lareef-Jah Sharmila , Sanneh Sainey , Njiokou Flobert , Jack Abdoulie , Ceesay Serign Jawo , Ukaga Chinyere 
Published: July 2021

Background
A national mapping survey of schistosomiasis (SCH) and soil-transmitted helminthiases (STH) was conducted in The Gambia in May, 2015. The survey aimed at establishing endemicity of schistosomiasis and soil-transmitted helminthiases to inform decisions on program planning and implementation of mass drug administration (MDA).

Methodology/Principal findings
A cross-section of 10,434 eligible school aged children (SAC), aged 7 to 14 years old were enrolled in the survey. The participants were randomly sampled from 209 schools countrywide using N/50, where N = total eligible children per school. Stool, and urine samples were provided by each child and examined for schistosomiasis and soil-transmitted helminthic infections using double Kato-Katz, urine filtration, dipstick techniques and CCA rapid test kits. Data were managed using online LINKS system enabling real-time data availability and access. Epi Info version 3.5.3 and health mapper version 4.3.2 were used to generate outputs of endemicity and distribution. Descriptions of mapped districts for MDA eligibility and frequency were done with reference to WHO PC strategy recommendations. Mapping results indicated that nationally, the prevalence of schistosomiasis (SCH) and soil-transmitted helminthiases (STH) was 4.3% and 2.5% respectively. In terms of distribution STH are more common in Western Region One (WR1) at 4.1% prevalence, then Lower River Region (LRR) 3.6%, and Western Region Two (WR2) 3.0%. In contrast, SCH indicated much higher prevalence in Central River Region (CRR) at a rate of 14.2%. This is within medium prevalence range, and is followed by Upper River Region (URR) at 9.4%, which is within low prevalence range. At the district level, schistosomiasis prevalence seems to be highest in Niani district (22%) in CRR. Banjul island, the capital city, seems to have the highest prevalence of STH (up to 55%), followed by Kombo South with 22% prevalence. Schistosoma haematobium characterised by haematuria, was the most dominant infection of schistosomiasis discovered followed by Schistosoma mansoni which reported in 0.1% of infections. Out of 42 districts mapped 14, or 38%, of them are co-endemic for soil-transmitted helminthiases (ascariasis, trichuriasis, and hook-worm infections) and schistosomiasis (S. haematobium and S. mansoni).

Conclusions
We identified that 24/42(57%) districts mapped in The Gambia are endemic for schistosomiasis expressing the need for preventive chemotherapy. Twenty (47%) of the districts mapped are endemic for STH. However, only two STH endemic districts namely Banjul (55%) and Kombo South (22%) were within rates eligible for mass drug administration.