bluuebunny/crossref_metadata_2025_split huggingface dataset:
Estimation of planning organ at risk volumes for ocular structures in dogs undergoing three‐dimensional image‐guided periocular radiotherapy with rigid bite block immobilization
Authors: Wolf Friederike , Rohrer Bley Carla , Besserer Jürgen , Meier Valeria 
Published: January 2021

AbstractPlanning organ at risk volume (PRV) estimates have been reported as methods for sparing organs at risk (OARs) during radiation therapy, especially for hypofractioned and/or dose‐escalated protocols. The objectives of this retrospective, analytical, observational study were to evaluate peri‐ocular OAR shifts and derive PRVs in a sample of dogs undergoing radiation therapy for periocular tumors. Inclusion criteria were as follows: dogs irradiated for periocular tumors, with 3D‐image‐guidance and at least four cone‐beam CTs (CBCTs) used for position verification, and positioning in a rigid bite block immobilization device. Peri‐ocular OARs were contoured on each CBCT and the systematic and random error of the shifts in relation to the planning CT position computed. The formula 1.3×Σ+0.5xσ was used to generate a PRV of each OAR in the dorsoventral, mediolateral, and craniocaudal axis. A total of 30 dogs were sampled, with 450 OARs contoured, and 2145 shifts assessed. The PRV expansion was qualitatively different for each organ (1‐4 mm for the dorsoventral and 1‐2 mm for the mediolateral and craniocaudal axes). Maximal PRV expansion was ≤4 mm and directional for the majority; most pronounced for corneas and retinas. Findings from the current study may help improve awareness of and minimization of radiation dose in peri‐ocular OARs for future canine patients. Because some OARs were difficult to visualize on CBCTs and/ or to delineate on the planning CT, authors recommend that PRV estimates be institution‐specific and applied with caution.
Lower third chest wall reconstruction in a bilateral sequential lung transplant recipient
Authors: Hever Pennylouise , Singh Prateush , Nikkhah Dariush , Anikin Vladimir 
Published: January 2021

Reconstruction of the sternum following deep sternal wound infection (DSWI) can be challenging, and despite advances in reconstructive surgery, DSWI remains a significant cause of morbidity and mortality in cardiothoracic patients. Transplantation patients present an additional, unique challenge for the reconstructive surgeon. These patients are often on immunosuppressant therapy, with multiple comorbidities, and cannot tolerate prolonged operations for reconstruction. They often have a prior extensive surgical history, which may limit donor options; and their wounds are often in the lower third of the sternum, which is a challenging location to reconstruct with locoregional tissues.We report a case of successful lower third chest wall reconstruction in a bilateral lung transplant recipient with a combination of bilateral pectoralis advancement flaps and omentoplasty.
Clinical decision support to improve management of diabetes and dysglycemia in the hospital: a path to optimizing practice and outcomes
Authors: Pichardo-Lowden Ariana , Umpierrez Guillermo , Lehman Erik B , Bolton Matthew D , DeFlitch Christopher J , Chinchilli Vernon M , Haidet Paul M 
Published: January 2021

IntroductionInnovative approaches are needed to design robust clinical decision support (CDS) to optimize hospital glycemic management. We piloted an electronic medical record (EMR), evidence-based algorithmic CDS tool in an academic center to alert clinicians in real time about gaps in care related to inpatient glucose control and insulin utilization, and to provide management recommendations.Research design and methodsThe tool was designed to identify clinical situations in need for action: (1) severe or recurrent hyperglycemia in patients with diabetes: blood glucose (BG) ≥13.88 mmol/L (250 mg/dL) at least once or BG ≥10.0 mmol/L (180 mg/dL) at least twice, respectively; (2) recurrent hyperglycemia in patients with stress hyperglycemia: BG ≥10.0 mmol/L (180 mg/dL) at least twice; (3) impending or established hypoglycemia: BG 3.9–4.4 mmol/L (70–80 mg/dL) or ≤3.9 mmol/L (70 mg/dL); and (4) inappropriate sliding scale insulin (SSI) monotherapy in recurrent hyperglycemia, or anytime in patients with type 1 diabetes. The EMR CDS was active (ON) for 6 months for all adult hospital patients and inactive (OFF) for 6 months. We prospectively identified and compared gaps in care between ON and OFF periods.ResultsWhen active, the hospital CDS tool significantly reduced events of recurrent hyperglycemia in patients with type 1 and type 2 diabetes (3342 vs 3701, OR=0.88, p=0.050) and in patients with stress hyperglycemia (288 vs 506, OR=0.60, p<0.001). Hypoglycemia or impending hypoglycemia (1548 vs 1349, OR=1.15, p=0.050) were unrelated to the CDS tool on subsequent analysis. Inappropriate use of SSI monotherapy in type 1 diabetes (10 vs 22, OR=0.36, p=0.073), inappropriate use of SSI monotherapy in type 2 diabetes (2519 vs 2748, OR=0.97, p=0.632), and in stress hyperglycemia subjects (1617 vs 1488, OR=1.30, p<0.001) were recognized.ConclusionEMR CDS was successful in reducing hyperglycemic events among hospitalized patients with dysglycemia and diabetes, and inappropriate insulin use in patients with type 1 diabetes.
Performance of the Safer Nursing Care Tool to measure nurse staffing requirements in acute hospitals: a multicentre observational study
Authors: Griffiths Peter , Saville Christina , Ball Jane , Culliford David , Pattison Natalie , Monks Thomas 
Published: January 2021

ObjectivesThe best way to determine nurse staffing requirements on hospital wards is unclear. This study explores the precision of estimates of nurse staffing requirements made using the Safer Nursing Care Tool (SNCT) patient classification system for different sample sizes and investigates whether recommended staff levels correspond with professional judgements of adequate staffing.DesignObservational study linking datasets of staffing requirements (estimated using a tool) to professional judgements of adequate staffing. Multilevel logistic regression modelling.Setting81 medical/surgical units in four acute care hospitals.Participants22 364 unit days where staffing levels and SNCT ratings were linked to nurse reports of "enough staff for quality".Primary outcome measuresSNCT-estimated staffing requirements and nurses’ assessments of staffing adequacy.ResultsThe recommended minimum sample of 20 days allowed the required number to employ (the establishment) to be estimated with a mean precision (defined as half the width of the CI as a percentage of the mean) of 4.1%. For most units, much larger samples were required to estimate establishments within ±1 whole time equivalent staff member. When staffing was lower than that required according to the SNCT, for each hour per patient day of registered nurse staffing below the required staffing level, the odds of nurses reporting that there were enough staff to provide quality care were reduced by 11%. Correspondingly, the odds of nurses reporting that necessary nursing care was left undone were increased by 14%. No threshold indicating an optimal staffing level was observed. Surgical specialty, patient turnover and more single rooms were associated with lower odds of staffing adequacy.ConclusionsThe SNCT can provide reliable estimates of the number of nurses to employ on a unit, but larger samples than the recommended minimum are usually required. The SNCT provides a measure of nursing workload that correlates with professional judgements, but the recommended staffing levels may not be optimal. Some important sources of systematic variations in staffing requirements for some units are not accounted for. SNCT measurements are a potentially useful adjunct to professional judgement but cannot replace it.Trial registration numberISRCTN12307968.
Protocol for a cluster randomised controlled trial of the DAFNEplus(Dose Adjustment For Normal Eating) intervention compared with 5x1 DAFNE: a lifelong approach to promote effective self-management in adults with type 1 diabetes
Authors: Coates Elizabeth , Amiel Stephanie , Baird Wendy , Benaissa Mohammed , Brennan Alan , Campbell Michael Joseph , Chadwick Paul , Chater Tim , Choudhary Pratik , Cooke Debbie , Cooper Cindy , Cross Elizabeth , De Zoysa Nicole , Eissa Mohammad , Elliott Jackie , Gianfrancesco Carla , Good Tim , Hopkins David , Hui Zheng , Lawton Julia , Lorencatto Fabiana , Michie Susan , Pollard Daniel John , Rankin David , Schutter Jose , Scott Elaine , Speight Jane , Stanton-Fay Stephanie , Taylor Carolin , Thompson Gillian , Totton Nikki , Yardley Lucy , Zaitcev Aleksandr , Heller Simon 
Published: January 2021

IntroductionThe successful treatment of type 1 diabetes (T1D) requires those affected to employ insulin therapy to maintain their blood glucose levels as close to normal to avoid complications in the long-term. The Dose Adjustment For Normal Eating (DAFNE) intervention is a group education course designed to help adults with T1D develop and sustain the complex self-management skills needed to adjust insulin in everyday life. It leads to improved glucose levels in the short term (manifest by falls in glycated haemoglobin, HbA1c), reduced rates of hypoglycaemia and sustained improvements in quality of life but overall glucose levels remain well above national targets. The DAFNEplusintervention is a development of DAFNE designed to incorporate behavioural change techniques, technology and longer-term structured support from healthcare professionals (HCPs).Methods and analysisA pragmatic cluster randomised controlled trial in adults with T1D, delivered in diabetes centres in National Health Service secondary care hospitals in the UK. Centres will be randomised on a 1:1 basis to standard DAFNE or DAFNEplus. Primary clinical outcome is the change in HbA1c and the primary endpoint is HbA1c at 12 months, in those entering the trial with HbA1c >7.5% (58 mmol/mol), and HbA1c at 6 months is the secondary endpoint. Sample size is 662 participants (approximately 47 per centre); 92% power to detect a 0.5% difference in the primary outcome of HbA1c between treatment groups. The trial also measures rates of hypoglycaemia, psychological outcomes, an economic evaluation and process evaluation.Ethics and disseminationEthics approval was granted by South West-Exeter Research Ethics Committee (REC ref: 18/SW/0100) on 14 May 2018. The results of the trial will be published in a National Institute for Health Research monograph and relevant high-impact journals.Trial registration numberISRCTN42908016.
Perceptions of the provision of drug information, pharmaceutical detailing and engagement with non-personal promotion at a large physicians network: a mixed-methods study
Authors: Hincapie Ana , Schlosser Elizabeth , Damachi Udim , Neff Erica , Llambi Leandro , Groves Kent , MacKinnon Neil J 
Published: January 2021

ObjectiveNon-personal promotion (NPP) such as digital, print-based marketing, direct promotional visits and free drug samples are means of pharmaceutical marketing. This study described practices of drug information, pharmaceutical detailing and engagement with NPP at an integrated network of providers.DesignThis was a sequential explanatory mixed-methods study. A survey was followed by semistructured interviews. The questionnaire elicited preferred sources of drug information, management of drug information and perceptions on drug samples, coupons and pharmaceutical representative visits. Interviews were audio-recorded and transcribed. Data were analysed using descriptive statistics (quantitative) and content analysis (qualitative).SettingFace-to-face or telephonic interviews were conducted at a large physicians network in Northern Kentucky.ParticipantsEighty-two medical assistants, primary care, specialty providers and other office staff who completed the survey and 16 interviewees.ResultsMost respondents were women (79.3%), office managers (26.8%) and individuals employed for 15 years or longer within the organisation (30.5%). Most participants (85.3%) indicated that pharmaceutical representative visits are the most common source of drug information. Paper-based material was the most frequent form in which information was received in physician offices (62.2%). Medical assistants were usually responsible for handling drug information (46.3%) on arrival in the office, compared with 15.3% of physicians. Drug representative detailing and lunches (62.2%) were the desired method of drug information communication followed by electronic mail or e-journals (11%). Interviewees generated three themes that described pharmaceutical representative visits and interactions with prescriber and non-prescriber personnel in the offices.ConclusionsWe found significant involvement of non-prescriber personnel in drug information management at primary and specialty care offices. Participants perceived that pharmaceutical representatives have an important role in keeping the offices informed and supplied with relevant drug information, coupons and samples. Findings highlight the importance of engaging prescriber and non-prescriber personnel to guarantee relevant information reaches providers.
Mortality of Japanese Olympic athletes in 1964 Tokyo Olympic Games
Authors: Takeuchi Taro , Kitamura Yuri , Ishizuka Soya , Yamada Sachiko , Aono Hiroshi , Kawahara Takashi , Sobue Tomotaka 
Published: January 2021

ObjectivesTo compare the mortality of Japanese athletes in the 1964 Tokyo Olympic Games with that of the Japanese population, and to elucidate factors associated with their mortality.MethodsWe obtained from the Japan Sport Association study subjects’ biographical information, information on lifestyles and medical data. Missing data were obtained from online databases. Standardised mortality ratio (SMR) was calculated to compare athletes’ mortality with the Japanese population. Cox proportional hazards model was applied to estimate the HR for each category of body mass index (BMI), smoking history and handgrip strength. This analysis was limited to male athletes due to the small number of female athletes.ResultsAmong 342 (283 men, 59 women) athletes, deaths were confirmed for 70 (64 men, 6 women) athletes between September 1964 and December 2017. Total person years was 15 974.8, and the SMR was 0.64 (95% CI 0.50 to 0.81). Multivariate analysis performed on 181 male athletes. Mortality was significantly higher for BMI≥25 kg/m2than for 21–23 kg/m2(HR: 3.03, 95% CI 1.01 to 9.07). We found no statistically significant associations between smoking history and mortality; the HR (95% CI) for occasional and daily smokers were 0.82 (0.26 to 2.57) and 1.30 (0.55 to 3.03) compared with never smokers. We also found no statistically significant associations between handgrip strength and mortality (P for trend: 0.51).ConclusionJapanese athletes in the 1964 Tokyo Olympic Games lived longer than the Japanese population. BMI≥25 kg/m2was associated with higher mortality, but smoking history and handgrip strength were not associated with mortality.
Commercial validation of a modified method for delivering low nitrogen, phosphorus, and potassium inputs to greenhouse-grown subirrigated pot chrysanthemums
Authors: Shelp Barry J. , Flaherty Edward J. , Sutton William J. , Schenck Lou M. , Aalbers Jamie 
Published: January 2021

Subirrigation systems are popular for reducing nutrient usage in indoor floricultural production. Two open subirrigation experiments were conducted in a commercial setting using multiple chrysanthemum cultivars and up to 75% less N–P–K than industry standards. The lowest N–P–K levels supplied in the nutrient solution (in mmol·L−1: 5.4 N, 0.71−0.97 P, 1.9−4.1 K) up to bud break, were associated with acceptable leaf N–P–K levels [4.5−5.4% dry matter (DM), 0.23−0.60% DM, and 3.3−5.6% DM, respectively]. These findings validate our modified delivery practice and the use of lower N–P–K inputs in the production of subirrigated pot chrysanthemums.
Cryogenic control system operational experience at SNS
Authors: Howell M. , Kim S.-H. , Martinez M. , White K. 
Published: January 2021

AbstractThe helium cryogenic system at Spallation Neutron Source (SNS) provides cooling to 81 superconducting radio frequency cavities. To support the operation of the cryogenic facility, a highly reliable control system consisting of software, hardware, and Human Machine Interface (HMI) has been developed and improved during the first fifteen years of operation. Integrating the cryogenic control system with other subsystems of the SNS complex is an important aspect to the success of the operation. The operating experience, lessons learned and recommendations to consider for future facilities will be detailed in this paper.
Prevalence and patterns of musculoskeletal pain among undergraduate students of occupational therapy and physiotherapy in a South African university
Authors: Ogunlana Michael O. , Govender Pragashnie , Oyewole Olufemi O. 
Published: January 2021

Background: Musculoskeletal pain (MSP) conditions are common in the educational leaning environment and are often associated with poor ergonomic conditions. Objective: This study investigated the prevalence, pattern and possible risk factors of MSP among undergraduate students of occupational therapy and physiotherapy in a South African university. Methods: A cross-sectional survey using an internet-based self-designed electronic questionnaire was used to obtain information about participants’ socio-demography, ergonomic hazards, MSP, and relevant personal information. Descriptive statistics, chi-square, and logistic regression were used in analyzing the data. Results: There were 145 participants (females 115 (79.3%); physiotherapy (74) 51.03%), making 36.7% of the present undergraduate student population in the two departments. The most prevalent ergonomic work hazards were prolonged sitting (71.7%) and repetitive movements (53.8%). The 12 months prevalence of MSP among the students was 89.7%. The pattern of MSP revealed that pain on the neck region was most prevalent (66.2%) followed by pain in the low back region (64.4%). Duration of daily travels and participation in regular exercise activities were significantly associated with the prevalence of MSP. Logistic model explained 23.6% of the variance in prevalence of MSP and correctly classified 94.1% of cases ([Formula: see text], [Formula: see text]). The right-handed students were 0.13 times more likely to present with MSP than left-handed students. Also, students who exercised regularly were 9.47 times less likely to present with MSP. Conclusion: MSP is highly prevalent among health science undergraduates and is significantly associated with sedentary postures and inadequacy in structured physical activity participation.
Oncogenic Ras Disrupts Epithelial Integrity by Activating the Transmembrane Serine Protease Hepsin
Authors: Tervonen Topi A. , Pant Shishir M. , Belitškin Denis , Englund Johanna I. , Närhi Katja , Haglund Caj , Kovanen Panu E. , Verschuren Emmy W. , Klefström Juha 
Published: January 2021

Abstract

Ras proteins play a causal role in human cancer by activating multiple pathways that promote cancer growth and invasion. However, little is known about how Ras induces the first diagnostic features of invasion in solid tumors, including loss of epithelial integrity and breaching of the basement membrane (BM). In this study, we found that oncogenic Ras strongly promotes the activation of hepsin, a member of the hepsin/TMPRSS type II transmembrane serine protease family. Mechanistically, the Ras-dependent hepsin activation was mediated via Raf–MEK–ERK signaling, which controlled hepsin protein stability through the heat shock transcription factor-1 stress pathway. In Ras-transformed three-dimensional mammary epithelial culture, ablation of hepsin restored desmosomal cell–cell junctions, hemidesmosomes, and BM integrity and epithelial cohesion. In tumor xenografts harboring mutant KRas, silencing of hepsin increased local invasion concomitantly with accumulation of collagen IV. These findings suggest that hepsin is a critical protease for Ras-dependent tumorigenesis, executing cell–cell and cell–matrix pathologies important for early tumor dissemination.

Significance:
These findings identify the cell-surface serine protease hepsin as a potential therapeutic target for its role in oncogenic Ras-mediated deregulation of epithelial cell–cell and cell–matrix interactions and cohesion of epithelial structure.
An integrative description of a new Cephalothrix species (Nemertea: Palaeonemertea) from the South China Sea
Authors: CHERNYSHEV ALEXEI V. , POLYAKOVA NEONILA E. 
Published: January 2021

A new nemertean species of the genus Cephalothrix from intertidal calcareous red algae off the Vietnam coast is described based on histological sections, confocal laser scanning microscopy, and nucleotide sequences of three nuclear (18S rRNA, 28S rRNA, H3) and two mitochondrial (COI, 16S rRNA) DNA fragments. Cephalothrix suni sp. nov. is characterized by a unique body colour pattern consisting of transverse brown on ventral body side. A molecular phylogenetic analysis of the family Cephalotrichidae using a multigene approach has identified three clades for Cephalothrix: Cephalothrix, Procephalothrix, and interstitial cephalotrichids. The new species belongs to clade Procephalothrix sensu Chernyshev & Kajihara 2019 and a subclade of species with red, orange, or dark yellow anterior tip.
Evaluation of Inflammatory Blood Markers in Sinonasal Inverted Papilloma
Authors: Erdur Zülküf Burak , Özdoğan Hasan Ahmet , Yener Haydar Murat , Karaman Emin , Cansız Harun , Aliyeva Çınare , Batur Şebnem , İnan Hakkı Caner 
Published: January 2021

Objective: Sinonasal inverted papillomas are benign neoplasms of the nasal cavity and paranasal sinuses. They have characteristic features such as a high risk of recurrence and possible malignant transformation. This study was conducted to investigate the relationship between sinonasal inverted papilloma and inflammatory blood markers. Patients and Methods: Sixty-five patients who were diagnosed histologically as having sinonasal inverted papilloma and 65 age- and sex-matched healthy controls were included in the study. Inflammatory blood markers such as neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), red cell distribution width (RDW), mean platelet volume (MPV), and platelet distribution width (PDW) of the patient and control groups were compared. Results: There were no statistically significant differences between the patients and controls for white blood cell, platelet, hemoglobin, neutrophil, and lymphocyte counts ( P > .05). No statistically significant difference was found between the patients and controls for NLR, PLR, RDW, MPV, and PDW ( P > .05). In the logistic regression analysis model, which was created to investigate the effects of inflammatory blood markers in determining the patient group, the increase in the NLR and decrease in the PLR were found to be statistically significant factors ( P = .008, P = .039). Conclusion: This is the first study in the literature to investigate the relationship between sinonasal inverted papilloma and inflammatory blood markers, and the results suggest that NLR and PLR may be used to distinguish patients with sinonasal inverted papilloma from controls.