bluuebunny/crossref_metadata_2025_split huggingface dataset:
P59 Supporting student nurses/trainee nurse associates during insight visits to a paediatric rheumatology service: the development of a student workbook
Authors: Salvesani Catherine , Smith Liz , Camina Nikki 
Published: September 2019

Abstract

Background
As clinical nurse specialists (CNS), we must be able to support student nurses (SN) and trainee nursing associates (TNA) to help them to develop their professional competencies. We achieve this by offering insight visits to SN/TNA during their placement on our day care unit. SN/TNAs are invited to attend the rheumatology service MDT meeting and then observe the nurse-led clinic. We must ensure there is support and oversight of practice supervision to ensure safe and effective learning. We reviewed the insight visits and asked the SN/TNA to complete a questionnaire.

Methods
The feedback was analysed and a common theme emerged that they would have liked some pre-visit literature to read prior to attending so they could research rheumatological conditions. When explored; this was due to limited knowledge of conditions.
A workbook was developed to focus the SN/TNA on the most common conditions; juvenile idiopathica arthritis (JIA) and uveitis. The workbook was adapted from an education workbook for a new clinical nurse specialist to paediatric rheumatology. It offered a structured and methodical approach to the introduction of JIA and uveitis. It guided them to consider the medical definition of the condition, explore the epidemiology and aetiology of the disease, how a diagnosis is made by the use of investigations, disease classification and the subsequent various treatments available. In concludes by prompting the SN/TNA to consider the various roles within a multidisciplinary team (MDT). The workbook also directs to appropriate websites for information gathering. The workbook is then discussed with the SN/TNA at the end of the visit to ensure they developed better knowledge of rheumatological conditions and the role of the CNS within the service.

Results
The service continues to ask for feedback from all SN/TNA on insight visits and the feedback on the pre-visit workbook is very positive; “The workbook was definitely helpful because I was able to research about the conditions before coming to the insight visit”- Student Nurse A. The workbook begins the foundation of knowledge which the SN/TNA’s then build upon during the insight visit.

Conclusion
The paediatric rheumatology service has successfully developed an effective workbook which facilitates SN/TNA’s learning during insight visits to the service. The feedback forms are evidence that the CNS are appropriately supporting SN/TNA’s. The development of this tool has aided the structure of insights visits and essentially improved the quality and learning outcomes for the SN/TNA’s.

Conflicts of Interest
The authors declare no conflicts of interest.
Minimal Clinically Important Difference and Substantial Clinical Benefit Using PROMIS CAT in Cervical Spine Surgery
Authors: Steinhaus Michael E. , Iyer Sravisht , Lovecchio Francis , Khechen Benjamin , Stein Daniel , Ross Thomas , Yang Jingyan , Singh Kern , Albert Todd J. , Lebl Darren , Huang Russel , Sandhu Harvinder , Rawlins Bernard , Schwab Frank , Lafage Virginie , Kim Han Jo 
Published: September 2019

Study Design:
This was a prospective cohort study.

Objective:
The objective of this study was to establish minimal clinically important difference (MCID) and substantial clinical benefit (SCB) thresholds for Patient-Reported Outcomes Measurement Information System (PROMIS) in cervical spine pathology.

Summary of Background Data:
PROMIS enables improved psychometric properties with reduced questionnaire burden through computer adaptive testing. Despite studies showing good correlation with “legacy” outcome measures, literature on the clinical significance of changes in PROMIS scores is scarce.

Materials and Methods:
Adult patients undergoing cervical spine surgery at a single institution between 2016 and 2018 were prospectively enrolled. Patients completed questionnaires [Short Form-36 (SF-36), Neck Disability Index (NDI), Visual Analogue Scale Arm/Neck, and PROMIS Pain Interference (PI) and Physical Function (PF)] preoperatively and at 6 months postoperatively. MCID was calculated using distribution-based and SCB using anchor-based methods. The SF-36 Health Transition Item was utilized as an anchor with the cutoff values chosen using receiver operating characteristic curve analysis.

Results:
There were 139 patients meeting inclusion criteria, with a mean age of 56.4 years and diagnoses of myelopathy (n=36), radiculopathy (n=48) and myeloradiculopathy (n=49). There were significant improvements in PROMIS PF, PROMIS PI, NDI, and SF-36 preoperatively to postoperatively (P<0.001). The test-retest reliability of all tests was excellent (intraclass correlation coefficients=0.87–0.94). PROMIS, SF-36, and NDI were all correlated with the anchor question (|r|=0.34–0.48, P<0.001). MCIDs were 8.5 (NDI), 11.1 (SF-36 Physical Component Score), 9.7 (SF-36 Mental Component Score), 4.9 (PROMIS PI), and 4.5 (PROMIS PF). SCB was 13.0 (NDI), 24.0 (SF-36 Physical Component Score), 11.8 (SF-36 Mental Component Score), 6.9 (PROMIS PI), and 6.8 (PROMIS PF). MCIDs were greater than standard error of measurement for all measures.

Conclusions:
We report MCID of 4.9 (PI) and 4.5 (PF) and SCB of 6.9 (PI) and 6.8 (PF). These data support the use of PROMIS computer adaptive tests in cervical spine patients and provide important reference as PROMIS reporting becomes more widespread in the literature.
Progression of Cervical Ossification of Posterior Longitudinal Ligament After Laminoplasty or Laminectomy With Posterior Fixation
Authors: Kang Moo Sung , Kim Kyung Hyun , Park Jeong Yoon , Kuh Sung Uk , Chin Dong Kyu , Kim Keun Su , Jin Byung Ho , Cho Yong Eun 
Published: September 2019

Study Design:
Retrospective case analysis.

Objective:
This study was conducted to investigate the course of ossification of the posterior longitudinal ligament (OPLL) progression after laminoplasty (LP) or laminectomy with posterior fixation (PF).

Summary of Background Data:
LP is now recognized as a standard technique for the treatment of cervical multisegment OPLL; however, PF is beneficial for patients with severe stenosis. In recent years, there has been increasing interest in mechanical stress in OPLL, which is assumed to significantly impact progression.

Methods:
The progression of OPLL was assessed using midline sagittal computed tomography images of the cervical spine at various follow-up points. Radiographic parameters including the C2–C7 Cobb angle, C2–C7 range of motion (ROM), and adjacent cranial and caudal segmental ROMs were measured. Postoperative changes and differences between the LP and PF groups in the radiographic parameters were calculated to assess biomechanical stress. Logistic regression analysis was used to analyze the risk factors affecting the progression rate.

Results:
The authors included 14 PF and 36 LP patients, with a mean follow-up period of 28.9±20.8 and 37.6±16.8 months, respectively (P=0.069). After surgical treatment, both groups showed loss of cervical lordosis (9.2±6.9 vs. 5.3±8.2 degrees, P=0.220) and C2–C7 ROM (14.6± 13.5 vs. 13.1±12.2 degrees, P=0.861). The decrease of ROM in the cranial adjacent segment was larger in the LP group than in the PF group (0.7±4.1 vs. 1.4±5.5 degrees, P=0.453). The ROM in the caudal adjacent segment decreased in the LP group but increased in the PF group (−1.4±6.2 vs. 2.6±5.1 degrees, P=0.041). The progression rate was 2.15±1.31 mm2/mo in the PF group and 1.53±1.04 mm2/mo in the LP group (P=0.041). PF showed an odds ratio of 12.917 for a higher progression rate (95% confidence interval, 1.397–119.443; P=0.024).

Conclusion:
The rate of progression of cervical OPLL was significantly higher after PF than after LP.

Level of Evidence:

Level III—a retrospective analysis.
Are there really only 2 kinds of people in the world? Evaluating the distribution of change from baseline in pain clinical trials
Authors: Mbowe Omar B. , Gewandter Jennifer S. , Turk Dennis C. , Dworkin Robert H. , McDermott Michael P. 
Published: September 2019

Abstract
It is often assumed that there are 2 types of pain patients: those who respond well to efficacious pain therapies and those who do not respond at all, with few people in the middle. This assumption is based on research that claims that changes in pain intensity have a bimodal distribution. The claim of bimodality has led to calls for a change in how pain clinical trials are designed and analyzed, eg, performing “responder” analyses instead of comparing group mean values to evaluate the treatment effect. We analyzed data from 4 clinical trials, 2 each of duloxetine and pregabalin, for chronic musculoskeletal and neuropathic pain conditions to critically examine the claim of bimodality of the distribution of change in pain intensity. We found that the improper construction of histograms, using unequal bin widths, was the principal flaw leading to the bimodality claim, along with the use of the oft-criticized baseline observation carried forward method for imputing missing data also serving as a contributing factor. Properly constructed histograms of absolute change in pain intensity using equal bin widths, combined with more principled methods for handling missing data, resulted in distributions that had a more unimodal appearance. Although our findings neither support nor refute the hypothesis that distinct populations of “responders” and “nonresponders” to pain interventions exist, the analyses presented in earlier work do not provide support for this hypothesis, nor for the recommendation that pain clinical trials prioritize “responder” analyses, a less efficient analysis strategy.
The Experience of Complex Pain Dynamics in Oncology Outpatients
Authors: Schumacher Karen L. , Plano Clark Vicki L. , Rabow Michael W. , Paul Steven M. , Miaskowski Christine 
Published: September 2019

Background
Few qualitative studies of cancer patients’ everyday experiences with pain exist within the large body of cancer pain research. Longitudinal qualitative studies are particularly sparse, and no studies have qualitatively described patients’ pain experience over time during participation in a self-management intervention.

Objective
To longitudinally describe patients’ pain experiences during a 10-week pain self-management intervention.

Methods
This qualitative study was embedded in a randomized controlled trial of a psychoeducational pain management intervention. The data consisted of transcribed audio recordings of each intervention session. An emergent, interpretive approach was used in this longitudinal qualitative analysis.

Results
Forty-two adult patients were included. The analysis revealed the strikingly dynamic nature of individual patient’s pain experiences. Multiple facets of pain contributed to its dynamic nature, including pain in changing locations, co-occurring sources of pain, and varying patterns of pain intensity over time. For individual patients, the cumulative effect of these multiple facets resulted in a phenomenon we termed “complex pain dynamics.”

Conclusion
The results contribute to knowledge about the dynamic nature of cancer patients’ pain experiences over a relatively short period. They suggest the need for a new paradigm for management of pain in cancer patients and raise questions about the interpretation of randomized controlled trial results in the absence of qualitative data.

Implications for Practice
Frequent assessments and reassessments of pain are needed in cancer patients with the ongoing development of highly individualized self-management strategies. A large repertoire of interventions is needed to effectively manage pain in cancer patients over time.
Cluster Randomized Trial Reducing Missed Elevated Blood Pressure in Pediatric Primary Care: Project RedDE
Authors: Rinke Michael L. , Singh Hardeep , Brady Tammy M. , Heo Moonseong , Kairys Steven W. , Orringer Kelly , Dadlez Nina M. , Bundy David G. 
Published: September 2019

Background:
Recognition of childhood hypertension is essential, but pediatricians routinely fail to identify elevated blood pressure (BP). This study investigated if a quality improvement collaborative (QIC) reduces missed elevated BP in primary care.

Methods:
During a cluster-randomized clinical trial, a national cohort worked sequentially to reduce each of three different errors, including missed elevated BP. While working on their first error during an 8-month action period, practices collected control data for a different error. Practices worked to reduce two additional errors in subsequent action periods but continued to provide sustain and maintainenance data on BP. QIC intervention included video learning sessions, transparent data, failures analysis, coaching, and tools to reduce errors. Mixed-effects logistic regression models compared the mean percentage of patients with an elevated BP with appropriate actions taken and documented.

Results:
We randomized 43 practices and included 30 in the final analysis. Control and intervention phases included 1,728 and 1,834 patients with an elevated BP, respectively. Comparing control versus intervention phases, the mean percentage of patients who received appropriate actions increased from 58% to 74% [risk difference (RD) 16%; 95% CI;12%, 20%]. Practices continued to improve during the sustain phase as compared to the intervention phase (RD 5%; 95% CI; 2%, 9%) and did not worsen during the maintenance phase (RD 0.9%; 95% CI -5%, 7%).

Conclusions:
Missed pediatric elevated BP can be sustainably reduced via a QIC intervention, demonstrating a possible model for other error reduction efforts.
Project RedDE: Cluster Randomized Trial to Reduce Missed or Delayed Abnormal Laboratory Value Actions
Authors: Rinke Michael L. , Bundy David G. , Lehmann Christoph U. , Heo Moonseong , Adelman Jason S. , Norton Amanda , Singh Hardeep 
Published: September 2019

Introduction:
Failure of timely abnormal laboratory result follow-up is relatively common and may lead to harm. This study hypothesized that a quality improvement collaborative (QIC) could reduce the frequency of missed or delayed action on abnormal laboratory values.

Methods:
A national cohort of pediatric practices was cluster-randomized to sequentially receive a QIC intervention: video conferences, transparent data sharing, a “focus on failures,” QI coaching, and tools to help reduce missed or delayed action on abnormal laboratory values. Practices recorded the percentage of patients with 5 specific abnormal laboratory values who received an appropriate provider action (control), and then, during an 8-month intervention phase, implemented QI strategies to reduce errors (intervention). Subsequently, practices collected data on laboratory errors while working to reduce unrelated second (sustain phase), and third (maintenance phase) errors. Generalized mixed-effects regression models compared the mean percentage of patients with appropriate actions.

Results:
We randomized 43 practices, of which 31 were included in analyses. Control and intervention phases included 1,357 and 1,426 patients with abnormal laboratory values, respectively. The mean percentage of patients who received appropriate actions did not change comparing control and intervention phases [risk difference (RD) 1%; 95% CI −1%, 3%]. In post-hoc analyses, practices significantly improved comparing control to sustain (RD 3%; 95% CI 0.3%, 6%) and maintenance phases (RD 6%; 95% CI 3%, 9%).

Conclusion:
Implementation of a QIC did not reduce the frequency of abnormal laboratory errors in the initial 8-month intervention phase. A significant reduction was appreciated comparing sustain and maintenance phases (months 9–24) to the control phase.
Dufourmentel Flap as an Aesthetic and Anatomic Refinement Tool in Upper Lip Repair
Authors: Yordanov Yordan P. 
Published: September 2019

Abstract
Reconstruction of the upper lip represents a unique challenge because of its anatomical, functional and aesthetic requirements. In all the scientific sources and practical manuals the algorithms for central and lateral upper lip defects revolve around using advancement flaps, lip-switch techniques, and skin grafts only. The author offers a new approach for upper lip repair by using the Dufourmentel flap which is a pivotal local flap. The advantages and some tips are discussed.
Vortex crystals on the surface of a torus
Authors: Sakajo Takashi 
Published: September 2019

Vortex crystals are equilibrium states of point vortices whose relative configuration is unchanged throughout the evolution. They are examples of stationary point configurations subject to a logarithmic particle interaction energy, which give rise to phenomenological models of pattern formations in incompressible fluids, superconductors, superfluids and Bose–Einstein condensates. In this paper, we consider vortex crystals rotating at a constant speed in the latitudinal direction on the surface of a torus. The problem of finding vortex crystals is formulated as a linear null equation
A

Γ

= 0 for a non-normal matrix
A
whose entities are derived from the locations of point vortices, and a vector

Γ

consisting of the strengths of point vortices and the latitudinal speed of rotation. Point configurations of vortex crystals are obtained numerically through the singular value decomposition by prescribing their locations and/or by moving them randomly so that the matrix
A
becomes rank deficient. Their strengths are taken from the null space corresponding to the zero singular values. The toroidal surface has a non-constant curvature and a handle structure, which are geometrically different from the plane and the spherical surface where vortex crystals have been constructed in the preceding studies. We find new vortex crystals that are associated with these toroidal geometry: (i) a polygonal arrangement of point vortices around the line of longitude; (ii) multiple latitudinal polygonal ring configurations of point vortices that are evenly arranged around the handle; and (iii) point configurations along helical curves corresponding to the fundamental group of the toroidal surface. We observe the strengths of point vortices and the behaviour of their distribution as the number of point vortices gets larger. Their linear stability is also examined.

This article is part of the theme issue ‘Topological and geometrical aspects of mass and vortex dynamics’.
Lambert's theorem and projective dynamics
Authors: Albouy Alain , Zhao Lei 
Published: September 2019

We prove that the classical Lambert theorem about the elapsed time on an arc of Keplerian orbit extends without change to the Kepler problem on a space of constant curvature. We prove that the Hooke problem has a property similar to Lambert's theorem, which also extends to the spaces of constant curvature.This article is part of the theme issue ‘Topological and geometrical aspects of mass and vortex dynamics’.
Geometrical aspects of rapid vibrations and rotations
Authors: Levi Mark 
Published: September 2019

The counterintuitive phenomenon of stabilization of the inverted pendulum by the vertical vibration of its pivot has been known for over a century. This remarkable effect attracted attention of many mathematicians and physicists, including Kapitsa, Feynman, Arnold, Moser and others. The 1989 Nobel Prize in Physics was awarded to W. Paul for his discovery of the particle trap based on this phenomenon. The inverted pendulum is a tip of an ‘iceberg’ of related phenomena arising in systems with high-frequency time-dependence. This article surveys some related phenomena discovered more recently, some connections with differential geometry and mechanics, and some new geometrical insights.
This article is part of the theme issue ‘Topological and geometrical aspects of mass and vortex dynamics’.
On then-body problem in R4
Authors: Schmah Tanya , Stoica Cristina 
Published: September 2019

Using geometric mechanics methods, we examine aspects of the dynamics ofnmass points inR4with a general pairwise potential. We investigate the central force problem, set up then-body problem and discuss certain properties of relative equilibria. We describe regularn-gons inR4, and when the masses are equal we determine the invariant manifold of motions with regularn-gon configurations. In the casen = 3, we reduce the dynamics to a 6 d.f. system and we show that for generic potentials and momenta, relative equilibria with equilateral configuration are unstable.This article is part of the theme issue ‘Topological and geometrical aspects of mass and vortex dynamics’.
Respiratory Intervention Techniques Increase Selection Rate for Special Forces
Authors: Nina Bausek , Susanne Summers , Sonnon Scott B 
Published: September 2019

SummarySpecial Forces Selection Rates have declined over recent years, partly due to reduced fitness rates of applicationsPostural changes incurred prior to the recruitment may contribute to compromised respiratory function, resulting in fatigue, overexertion, and Selection Course failurePerformance breathing training and respiratory muscle strengthening can reverse impaired respiratory function and optimize cardiopulmonary fitness.In this study, a 6-week intervention program including performance breathing training improved fitness and performance of SF Selection Course participants.The intervention program including performance breathing training increased the SF Selection Course pass rate from 0% to 30%, compared to prior years.
A decade of epigenetic change in aging twins: genetic and environmental contributions to longitudinal DNA methylation
Authors: Reynolds Chandra A. , Tan Qihua , Munoz Elizabeth , Jylhävä Juulia , Hjelmborg Jacob , Christiansen Lene , Hägg Sara , Pedersen Nancy L. 
Published: September 2019

Summary/AbstractBackgroundEpigenetic changes may result from the interplay of environmental exposures and genetic influences and contribute to differences in age-related disease, disability and mortality risk. However, the etiologies contributing to stability and change in DNA methylation have rarely been examined longitudinally.MethodsWe considered DNA methylation in whole blood leukocyte DNA across a 10-year span in two samples of same-sex aging twins: (a) Swedish Adoption Twin Study of Aging (SATSA; N = 53 pairs, 53% female; 62.9 and 72.5 years, SD=7.2 years); (b) Longitudinal Study of Aging Danish Twins (LSADT; N = 43 pairs, 72% female, 76.2 and 86.1 years, SD=1.8 years). Joint biometrical analyses were conducted on 358,836 methylation probes in common. Bivariate twin models were fitted, adjusting for age, sex and country.ResultsOverall, results suggest genetic contributions to DNA methylation across 358,836 sites tended to be small and lessen across 10 years (broad heritability M=23.8% and 18.0%) but contributed to stability across time while person-specific factors explained emergent influences across the decade. Aging-specific sites identified from prior EWAS and methylation age clocks were more heritable than background sites. The 5,037 sites that showed the greatest heritable/familial-environmental influences (p<1E-07) were enriched for immune and inflammation pathways while 2,020 low stability sites showed enrichment in stress-related pathways.ConclusionsAcross time, stability in methylation is primarily due to genetic contributions, while novel experiences and exposures contribute to methylation differences. Elevated genetic contributions at age-related methylation sites suggest that adaptions to aging and senescence may be differentially impacted by genetic background.