bluuebunny/crossref_metadata_2025_split huggingface dataset:
Defining rehabilitation: An exploration of why it is attempted, and why it will always fail
Authors: Wade Derick T 
Published: June 2021

The problem: Over 187 definitions of rehabilitation exist, none widely agreed or used. Why? The word: Words represent a core concept, with a penumbra of associated meanings. A word means what is agreed among those who use it. The precise meaning will vary between different groups. Words evolve, the meaning changing with use. Other words may capture some of the concepts or meanings. A definition: A definition is used to control the unstable, nebulous meaning of a word. It delineates, creating a boundary. A non-binary spectrum of meaning is transformed into binary categories: rehabilitation, or not rehabilitation. In clinical terms, it is a diagnostic test to identify rehabilitation. There are many different reasons for categorising something as rehabilitation. Each will need its own definition. Categorisation: The ability of a definition to distinguish cases accurately must be validated by comparison with ‘the truth’. If there were an external ‘true’ test to identify rehabilitation, a definition would not be needed. As with most concepts, the only truth is agreement by people familiar with the required distinction. Any definition will generate misclassification. People familiar with the required distinction will also need to resolve mis-categorisation. Description: An alternative is a ‘descriptive definition’, listing features over several domains which must be present. This fails logically. Rehabilitation is an emergent concept, more than the sum of its parts. Conclusion: A useful definition cannot be achieved because no definition will cover all needs, and a specific definition for a purpose will misclassify some cases.
Deaths from novel psychoactive substances in England, Wales and Northern Ireland: Evaluating the impact of the UK psychoactive substances act 2016
Authors: Deen Adrian A , Claridge Hugh , Treble Richard D , Hamnett Hilary J , Copeland Caroline S 
Published: June 2021

Background: ‘Legal highs’ began appearing in the UK in the mid-2000s. Whilst many of these substances were controlled under the 1971 Misuse of Drugs Act, novel compounds and new variants of controlled compounds were continuously being introduced to the recreational drug market. The Psychoactive Substances Act (PSA) was therefore implemented in 2016 as a blanket ban on all novel psychoactive substances (NPS). Aim: To evaluate the impact of the PSA on deaths following NPS use in England, Wales and Northern Ireland. Methods: Cases reported to the National Programme on Substance Abuse Deaths where death had occurred 3 years pre- or post-implementation of the PSA were extracted. Cases with NPS detected at post-mortem were analysed and compared against cases non-NPS cases. Results: 293 deaths with NPS detected were identified; 91 occurring before the PSA and 202 afterwards, indicating an 222.0% post-PSA increase. Contrastingly, non-NPS drug-related death case reporting increased by only 8.0%. Synthetic cannabinoid, anxiolytic/sedative and stimulant NPS were detected in the largest proportions of deaths pre-PSA; post-PSA stimulant NPS detections reduced whilst synthetic cannabinoid and anxiolytic/sedative detections increased. Post-PSA, average decedent age increased significantly (mean age pre-PSA 34.4 ± 10.8 vs post-PSA 38.3 ± 9.4), and they were significantly more likely to have been living in deprived areas (pre-PSA 50.0% vs post-PSA 65.9%). Conclusions: Reporting of deaths following NPS use has risen despite introduction of the PSA. Whilst deaths amongst younger individuals and those living in more affluent areas has reduced, additional approaches to prohibition are needed to curb their persistence in deprived demographics.
Potential mechanism of circRNA_000585 in cholangiocarcinoma
Authors: Yi Fengming , Xin Longxiang , Feng Long 
Published: June 2021

Objective Circular RNA (circRNA) plays a vital role in the development and progression of malignancies, however, the function of circRNAs in cholangiocarcinoma (CCA) remains unexplored. The aim of this study was to investigate circRNA expression in CCA versus para-cancer tissues, and elucidate any potential associated mechanisms. Methods Differential expression of circRNAs between CCA and para-cancer tissue was analysed by microarray hybridization, and validated by real-time quantitative reverse transcription–polymerase chain reaction (qRT–PCR). The downstream pathway was investigated using bioinformatics and qRT–PCR. Results Microarray hybridization revealed 10 circRNAs with > 3-fold increased expression versus para-cancer (circRNA_002172, circRNA_002144, circRNA_001588, circRNA_000166, circRNA_000585, circRNA_000167, circRNA_402608, circRNA_006853, circRNA_001589, circRNA_008882), and three circRNAs with > 3-fold decreased expression (circRNA_406083, circRNA_104940, circRNA_006349). CircRNA_000585 was shown by qRT-PCR to be upregulated in tumour versus paired para-cancer tissue from 15 patients with CCA. Bioinformatics analysis revealed a potential pathway comprising circRNA_000585/microRNA-615-5p/angiomotin (AMOT)/Yes associated protein 1 (YAP) in CCA. RT–PCR validation of crucial molecule expression showed downregulation of miR-615-5p, and upregulation of AMOT and YAP in CCA tumours. Conclusion Multiple circRNAs are dysregulated in CCA. CircRNA_000585 is upregulated in CCA, and may function by a circRNA_000585/miR-615-5p/AMOT/YAP pathway, which may be a novel CCA pathway.
Thyroid dysfunction is associated with the loss of hepatitis B surface antigen in patients with chronic hepatitis B undergoing treatment with α-interferon
Authors: Luo Wenfan , Wu Shuai , Chen Hongjie , Wu Yin , Peng Jie 
Published: June 2021

Objective To investigate the influence of thyroid dysfunction on the antiviral efficacy of α-interferon in adult patients with chronic hepatitis B (CHB). Methods We performed a retrospective study of 342 patients with CHB who underwent interferon treatment for >12 weeks. Patients with thyroid dysfunction before or during treatment were defined as the thyroid dysfunction group (n = 141) and those with normal thyroid function were defined as the normal thyroid function group (n = 201). The prevalences of hepatitis B virus (HBV) DNA undetectability, low hepatitis B surface antigen (HBsAg) titre (<250 IU/mL), HBsAg loss, and hepatitis B envelope antigen loss were compared. Results During interferon treatment, 69 of 270 (25.6%) participants with normal thyroid function at baseline developed thyroid dysfunction, whereas 11 of 72 (15.3%) with thyroid dysfunction at baseline regained normal thyroid function. The thyroid dysfunction group had significantly higher prevalences of low HBsAg titre (29.8% vs. 18.9%) and HBV DNA undetectability (66.0% vs. 40.3%). Multivariate logistic regression analysis showed that thyroid dysfunction was associated with HBsAg loss (odds ratio 4.945, 95% confidence interval 1.325–18.462). Conclusions These results suggest that thyroid dysfunction is not an absolute contraindication, but is associated with HBsAg loss, in patients with CHB undergoing α-interferon treatment.
Early mechanical cardiopulmonary resuscitation can improve outcomes in patients with non-traumatic cardiac arrest in the emergency department
Authors: Luo Li , Zhang XiaoDong , Xiang Tao , Dai Hang , Zhang JiMei , Zhuo GuangYing , Sun YuFang , Deng XiaoJun , Zhang Wei , Du Ming 
Published: June 2021

Objective To compare the outcomes of patients with non-traumatic cardiac arrest (CA) who received early versus late mechanical cardiopulmonary resuscitation (CPR) with the Lund University Cardiac Assist System (LUCAS) device in the emergency department (ED). Methods This was a retrospective observational study in the ED of a single medical center performed from May 2018 to December 2019; 68 patients with CA were eligible. We grouped the patients according to the time to initiating LUCAS use after CA into an early group (≤4 minutes) and late group (>4 minutes). Results The rate of return of spontaneous circulation (ROSC) was higher in the early group vs the late group (69.2% vs 52.4%, respectively). The 4-hour survival rate was significantly higher in the early group vs the late group (83.3% vs 45.5%, respectively), and CPR duration was significantly shorter in the early group (23.3 ± 12.5 vs 31.1 ± 14.8 minutes, respectively). Conclusion Early mechanical CPR can improve the success of achieving ROSC and the 4-hour survival rate in patients with non-traumatic CA in the ED, considering that more benefits were observed in patients who received early vs late LUCAS device therapy.
Australian women with good financial knowledge fare better in divorce
Authors: West Tracey , Mitchell Elizabeth 
Published: June 2021

Divorce dissolves couple households, who likely specialised in household financial decision-making tasks, into singles who need to learn new skills. Financial decisions will be particularly challenging for those newly separated people that are lacking knowledge and confidence. Given the substantive literature supporting the lack of financial knowledge of women in comparison to men, women are likely to be more disadvantaged by this aspect of divorce. We employ the HILDA Survey and find support for the role of financial literacy in improving wealth outcomes in divorce, particularly for women. We find that the positive impact is significant over the long term. This research contributes to knowledge of the role of financial education in building resilience to endure financial shocks. JEL classification: D14; G53; G50; J12; J16
Ethics in financial planning: Analysis of ombudsman decisions using codes of ethics and fiduciary duty standards
Authors: Richards Daniel W , Ahmed Abdullahi D , Bruce Kenneth 
Published: June 2021

Scandals show that ethics is an important topic in financial planning. Our research analyses 212 financial ombudsman decisions (2013–2018) to understand the nature of financial planning misconduct in complaint decisions. We develop a coding structure to ascertain what professional conduct involves and then use content analysis and cluster analysis to identify the aspects of professional conduct occurring in these misconduct decisions. Diligence, acting in the client’s best interest and having no reasonable basis for advice are interconnected elements in over half of these decisions. Secondary elements are misleading statements, conflicts of interest and disclosure. Analysis of decisions involving fiduciary duty showed that financial planners failed to ascertain a client’s circumstances and did not form advice based on their client’s information. As financial planning professionalises, future research, financial planning education, policy and practice should address these issues. JEL Classification: D14, G20, G50
The readability of 10-K reports and insider trading profitability
Authors: Rahman Dewan , Oliver Barry 
Published: June 2021

This study links the readability of 10-K reports to insider trading profitability. Using a sample of 102,060 insider transactions in the United States between 1994 and 2016, we empirically demonstrate that less readable 10-K reports increase profitability from insider trading. Consistent with the proprietary cost argument, we also document that readability impacts on insider trading profitability are more pronounced for research and development–intensive firms, for firms facing higher product market competition and trade secrecy, and for firms with lower levels of voluntary management disclosures. Overall, this study supports the proprietary cost and strategic information asymmetry channel of readability and suggests that less readable reports lead to the exploitation of information advantages by insiders. JEL Classification: D4, G14, G34, G40
Understanding Nurses’ Experiences and Perceptions of End-of-Life Care for Cancer Patients in Korea: A Scoping Review
Authors: Jung Min Young , Matthews Alicia K 
Published: June 2021

Background: Quality end-of-life care for cancer patients is a global health priority, and nurses are instrumental in providing this care. However, little is known about nurses’ experiences and perceptions in end-of-life care settings in Korea. Aims: This scoping review examined Korean nurses’ end-of-life care experiences and assessed the state of research in this area. Methods: Systematic searches were conducted using 7 electronic databases (PubMed, CINAHL, Scopus, Embase, WPRIM, KCI, and RISS), and 17 studies were selected for review. Findings: Most studies were limited to cross-sectional, descriptive designs. Outcomes regarding end-of-life care measured in the studies were categorized into cognitive variables, emotional variables, participation/performance, and educational needs. Study results suggested low nurse knowledge and self-efficacy with regard to provision of end-of-life care. Perceived barriers to quality end of life care included difficulties in meeting family members’ needs. In addition, emotional outcomes associated with end-of-life care included high levels of nurse stress and burnout. Predictors of elevated stress included inability to provide adequate pain control, inability to reconcile patient requests with physician orders, and heavy workload. Although most nurses had end-of-life care experience, fewer than half reported receiving related education. The lack of knowledge and skill related to end of life care was a primary contributor to stress. Conclusions: Korean nurses providing end-of-life care for cancer patients need additional education and support to help them manage high stress levels. Further study is needed to identify strategies for meeting nurses’ end-of-life care education needs and of improving their overall performance in such practice.
Midterm Outcomes of Unstable Ankle Fractures in Young Patients Treated by Closed Reduction and Fixation With an Intramedullary Fibular Nail vs Open Reduction Internal Fixation Using a Lateral Locking Plate
Authors: Kho Duk-hwan , Cho Byung-Ki , Choi Seung-Myung 
Published: June 2021

Background: We aimed to compare midterm radiological and clinical outcomes between closed reduction and internal fixation (CRIF) using the fibular intramedullary nail (IMN) and open reduction and internal fixation (ORIF) using the locking plate for the treatment of unstable ankle fractures in active young patients. Methods: In this retrospective cohort study, 204 patients treated with CRIF using the fibular IMN (94 patients) or ORIF using the locking plate (110 patients) were included after at least 3 years of follow-up. The mean patient age was 41.4 years. Radiographic evaluation included the quality of reduction assessed by plain radiography and 3-dimensional (3D)–reconstructed computed tomography as well as the development of posttraumatic osteoarthritis (PTOA) of the ankle assessed by weightbearing plain radiography. Clinical evaluation included the American Orthopaedic Foot & Ankle Society hindfoot score, Olerud and Molander Score, the Foot and Ankle Outcome Score, and visual analog scale pain score as well as complications. Results: At median follow-up greater than 4 years, we found no significant differences in measured clinical outcomes between the 2 groups. There were signiﬁcantly fewer postoperative complications in the IMN group than in the ORIF group (9.5% vs 39%, P < .001). However, we did find a greater proportion of radiographically fair or poor reductions in the IMN group than in the ORIF group ( P < .001). The poor reductions in the IMN group were primarily related to Weber type C, pronation-type injury, and comminuted fibular and trimalleolar fractures ( P < .001). PTOA was also more frequently observed in the IMN group than in the ORIF group (21.3% vs 9.1%, P = .024). Conclusion: Given the current prevailing technologies for fracture fixation, this study suggests that surgeons should consider ORIF for unstable ankle fractures in active young patients with Weber type C, pronation-type injury, and comminuted fibular and trimalleolar fractures. Level of Evidence: Level III, retrospective comparative study.
A quantitative analysis of age-related differences in Hindi–English code-switching
Authors: Ellison T. Mark , Si Aung 
Published: June 2021

Aims and objectives: Numerical indices developed by Guzman et al. that helped characterize code-switching (CS) patterns in Spanish–English bilingual corpora, were tested on a Hindi–English bilingual corpus. Two main research questions were addressed: first, how does Hindi–English compare with Spanish–English, and second, are there measurable differences in broad CS patterns between older and younger speakers? Methodology: Television interviews of Hindi movie (Bollywood) personalities were transcribed and coded for Hindi and English lexemes. Bespoke software in Python was used to calculate the required indices, which provided information on variables such as the level of language mixing, switching probability, and the distributions of single-language spans. Further indices, such as mean span length and an approximate ratio of insertions to alternations were also calculated. Data and analysis: The indices calculated for the Hindi–English corpus broadly match those calculated for Spanish–English. Statistically significant differences between the older and younger group were detected for some key indices, with older speakers generally using less English. High levels of intra-group variability may be responsible for some indices not showing statistically significant diachronic change. Conclusions: The Guzman et al. indices suggest that Hindi–English and Spanish–English CS resemble each other in certain ways. There have been broad changes in Hindi–English CS patterns over the last few decades, but there are indications that the CS behaviour of individual speakers might change in different ways. Originality: This is the first study to systematically and quantitatively investigate age-related differences in Hindi–English CS, using naturalistic speech in semi-controlled conditions. Implications: The quantitative indices investigated in this study can be used to compare CS behaviour in different language pairs, and can also help detect diachronic changes in CS patterns.
Healing below the ankle is possible in patients with diabetes mellitus and a forefoot gangrene
Authors: Elgzyri Targ , Apelqvist Jan , Lindholm Eero , Örneholm Hedvig , Annersten Gershater Magdalena 
Published: June 2021

Background: Forefoot gangrene in patients with diabetes is a severe form of foot ulcers with risk of progress and major amputation. No large cohort studies have examined clinical characteristics and outcome of forefoot gangrene in patients with diabetes. The aim was to examine clinical characteristics and outcome of forefoot gangrene in patients with diabetes admitted to a diabetic foot centre. Methods: Patients with diabetes and foot ulcer consecutively presenting were included if they had forefoot gangrene (Wagner grade 4) at initial visit or developed forefoot gangrene during follow-up at diabetic foot centre. Patients were prospectively followed up until final outcome, either healing or death. The median follow-up period until healing was 41 (3–234) weeks. Results: Four hundred and seventy-six patients were included. The median age was 73 (35–95) years and 63% were males. Of the patients, 82% had cardiovascular disease and 16% had diabetic nephropathy. Vascular intervention was performed in 64%. Fifty-one patients (17% of surviving patients) healed after auto-amputation, 150 after minor amputation (48% of surviving patients), 103 had major amputation (33% of surviving patients) and 162 patients deceased unhealed. Ten patients were lost at follow-up. The median time to healing for all surviving patients was 41 (3–234) weeks; for auto-amputated, 48 (10–228) weeks; for minor amputated, 48 (6–234) weeks; and for major amputation, 32 (3–116) weeks. Conclusion: Healing without major amputation is possible in a large proportion of patients with diabetes and forefoot gangrene, despite these patients being elderly and with extensive co-morbidity.
Patellofemoral Pain After Arthroscopy: Muscle Atrophy Is Not Everything
Authors: Amestoy Jorge , Pérez-Prieto Daniel , Torres-Claramunt Raúl , Sánchez-Soler Juan Francisco , Leal-Blanquet Joan , Ares-Vidal Jesús , Hinarejos Pedro , Monllau Joan Carles 
Published: June 2021

Background: It remains unclear as to why patellofemoral pain (PFP) appears in some patients after knee arthroscopy and what influence the quadriceps muscle has on its onset. Purpose: To compare muscle thickness, neuromuscular contractility, and quadriceps femoris muscle strength between patients who develop PFP after arthroscopic partial meniscectomy and a control group and to compare functional outcomes between these entities. Study Design: Cohort study; Level of evidence, 3. Methods: A prospective longitudinal cohort study was carried out on patients scheduled for arthroscopic partial meniscectomy. Patients were excluded if they had preoperative PFP, previous knee surgery, or additional surgical procedures (eg, meniscal repair or microfracture). The following were performed preoperatively: magnetic resonance imaging to quantify muscle thickness, surface electromyography to analyze electrical contractility, and an isokinetic study to assess the strength of the quadriceps femoris muscle. Patients also completed a Lysholm functional questionnaire. Six weeks after the index procedure, patients were questioned about the presence of PFP, and the same tests were repeated. The PFP group included patients who developed anterior knee pain postoperatively, while the control group included those who did not develop pain. Results: Of 90 initial study patients, 20 were included in the PFP group (23.8%) and 64 in the control group (76.2%); 6 patients were lost to follow-up. Both study groups were comparable on all of the analyzed preoperative variables. Patients in the PFP group had worse results in terms of muscle thickness (9.67 vs 16.55 cm2), electrical contractility (1226.30 vs 1946.11 µV), and quadriceps strength (12.27 vs 20.02 kg; all P < .001). They also presented worse functional results on the Lysholm score (63.05 vs 74.45; P < .001). Conclusion: Patients who developed PFP after arthroscopic partial meniscectomy had more quadriceps femoris muscle atrophy as well as a greater decrease in electrical contractility and muscle strength at 6 weeks postsurgically as compared with a control group. The PFP group also had worse postoperative functional results.