bluuebunny/crossref_metadata_2025_split huggingface dataset:
A novel geometry of ECM-based RRAM with improved variability
Authors: Hong XiaoLiang , Dananjaya Putu Andhita , Krishnia Sachin , Gan Weiliang , Loy Desmond JiaJun , Tan Funan , Ng CheeMang , Lew WenSiang 
Published: May 2018

Abstract
Resistive random-access memory (RRAM) is promising for various low-power applications, including Internet of Things (IOTs), neuromorphic and data-centric computing. However, the poor reliability, mainly the variability in switching, is one of the biggest challenges for RRAM. Here, a novel geometry of electrochemical metallization memory (ECM)-based RRAM is proposed with lower switching voltage and less switching variability. From COMSOL Multiphysics simulation, the intensity and distribution of electric field can be tuned by design of RRAM geometry in C-shape. It is anticipated that a higher and more refined electric field can improve the RRAM variability. This hypothesis is validated with experiment on forming-free ECM-based RRAM in C-shape and traditional square-shape, where around 36% less set voltage and 32% less set variation observed for as-designed C-shaped RRAM.
Predictive factors of life quality among packaging workers in Taiwan
Authors: Yang Shang-Yu , Hsu Der-Jen , Yen Chun-Ming , Chang Jer-Hao 
Published: May 2018

AbstractThe semiconductor plants on the top of high-tech industrial chain hire many packaging workers to carry out miscellaneous packing tasks for various product orders from different companies and countries. Under tremendous workload the quality of life (QoL) of such packaging workers need to be concerned. The aim of this study was to explore factors influencing their QoL. This study recruited 247 packing workers (162 male and 85 female; mean age: 35.6 years old) in 2015 and 2016 from a semiconductor plant in Taiwan by convenience sampling. The questionnaire comprised four parts: demographics, the World Health Organization Quality of Life (WHOQOL-BREF), an occupational burnout inventory and the Nordic Musculoskeletal Questionnaire. The four domains of the WHOQOL-BREF were defined as outcome variables. Predictive factors included gender (reference: male), age (reference: ≤ 35), BMI (reference: ≤ 25), educational level (reference: below university), marital/partner status (reference: married/cohabiting), years of work (reference: ≤ 5), work shift (reference: day shift), personal burnout, work-related burnout, over-commitment to work and the number of body parts with discomfort (0–9). The findings showed that physical QoL was negatively correlated with night -shift work, personal burnout, and number of body parts with discomfort. Psychological QoL was negatively correlated with night shift work and personal burnout. Environment QoL was negatively correlated with being male, night shift work and personal burnout. The results showed that the QoL among the packaging workers could be improved by reducing musculoskeletal discomfort, personal burnout and by improving work schedules.
Comparing Survival After Recurrent vs De Novo Stage IV Advanced Breast, Lung, and Colorectal Cancer
Authors: Hassett Michael J , Uno Hajime , Cronin Angel M , Carroll Nikki M , Hornbrook Mark C , Ritzwoller Debra P 
Published: May 2018

Abstract
The treatments provided to and survival of patients with recurrent vs de novo stage IV advanced breast, lung, and colorectal cancer may differ but have not been well studied. Using population-based data from the Cancer Research Network for 4510 patients with advanced breast, lung, or colorectal cancer, we matched recurrent/de novo patients on demographic factors. We found longer survival for recurrent vs de novo lung cancer (182 matched pairs); no significant difference for colorectal cancer (332 matched pairs); and shorter survival for recurrent vs de novo breast cancer (219 matched pairs). Compared with recurrent cases, chemotherapy use and radiation therapy use were more common among de novo cases. Differences in treatment and survival between recurrent and de novo advanced cancer patients could inform prognostic estimates and clinical trial design.
Sudomotor dysfunction independently predicts incident cardiovascular–renal events and all-cause death in type 2 diabetes: the Joint Asia Diabetes Evaluation register
Authors: Lim Lee Ling , Fu Amy W C , Lau Eric S H , Ozaki Risa , Cheung Kitty K T , Ma Ronald C W , Luk Andrea O Y , Chan Juliana C N , Kong Alice P S 
Published: May 2018

AbstractBackgroundEarly detection and risk factor control prevent chronic kidney disease (CKD) progression. Evaluation of peripheral autonomic dysfunction may detect incident cardiovascular–renal events in type 2 diabetes (T2D).MethodsSUDOSCAN, a non-invasive tool, provides an age-adjusted electrochemical skin conductance (ESC) composite score incorporating hands/feet ESC measurements, with a score ≤53 indicating sudomotor dysfunction. A consecutive cohort of 2833 Chinese adults underwent structured diabetes assessment in 2012–13; 2028 participants without preexisting cardiovascular disease (CVD) and CKD were monitored for incident cardiovascular–renal events until 2015.ResultsIn this prospective cohort {mean age 57.0 [standard deviation (SD) 10.0] years; median T2D duration 7.0 [interquartile range (IQR) 3.0–13.0] years; 56.1% men; 72.5% never-smokers; baseline ESC composite score 60.7 (SD 14.5)}, 163 (8.0%) and 25 (1.2%) participants developed incident CKD and CVD, respectively, after 2.3 years of follow-up. The adjusted hazard ratios (aHRs) per 1-unit decrease in the ESC composite score for incident CKD, CVD and all-cause death were 1.02 [95% confidence interval (CI) 1.01–1.04], 1.04 (1.00–1.07) and 1.04 (1.00–1.08), respectively. Compared with participants with an ESC composite score >53, those with a score ≤53 had an aHR of 1.56 (95% CI 1.09–2.23) for CKD and 3.11 (95% CI 1.27–7.62) for CVD, independent of common risk markers. When added to clinical variables (sex and duration of diabetes), the ESC composite score improved discrimination of all outcomes with appropriate reclassification of CKD risk.ConclusionsA low ESC composite score independently predicts incident cardiovascular–renal events and death in T2D, which may improve the screening strategy for early intervention.
Usefulness of Simultaneous Screening for HIV- and Hepatitis C–Specific Antibodies and Hepatitis B Surface Antigen by Capillary-Based Multiplex Immunochromatographic Rapid Test to Strengthen Prevention Strategies and Linkage to Care in Childbearing-Aged Women Living in Resource-Limited Settings
Authors: Mboumba Bouassa Ralph-Sydney , Nodjikouambaye Zita Aleyo , Sadjoli Damtheou , Moussa Ali Mahamat , Adawaye Chatte , Koyalta Donato , Bélec Laurent 
Published: May 2018

Abstract
Childbearing-aged women (n = 266) attending a gynecological clinic in Chad were subjected to multiplex immunochromatographic rapid test for HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV). Ten (3.7%) and 8 (3.0%) were seropositive for HIV and HCV, respectively, and 20 (7.5%) for HBV surface antigen, allowing diagnosis of chronic viral infections in 1 of 7 (14.3%) women.
Creating a Quality Improvement Course for Undergraduate Medical Education: Practice What You Teach
Authors: Bradham Tamala S. , Sponsler Kelly C. , Watkins Scott C. , Ehrenfeld Jesse M. 
Published: May 2018

Problem
More than half of U.S. medical schools have implemented curricula addressing quality improvement (QI); however, the evidence on which pedagogical methods are most effective is limited.

Approach
As of January 2015, students at Vanderbilt University School of Medicine are required to take a QI course consisting of three 1-month-long (4 hours per week) blocks during their third or fourth year, in which student-identified faculty sponsors are paired with highly trained QI professionals from Vanderbilt University Medical Center. The three blocks of the course include didactic instruction using Institute for Healthcare Improvement Open School modules, readings, weekly assignments, and experiential learning activities (i.e., students develop and implement a QI project with two Plan–Do–Study–Act cycles using a systematic approach that employs the principles of improvement science, which they present as a poster on the last day of the third block).

Outcomes
From January 2015 to January 2017, 132 students completed all three blocks, resulting in 110 completed QI projects. On evaluations (distributed after each completed block), a majority of students rated the clinical relevance of the blocks highly (191/273; 70%), agreed the blocks contributed to their development as physicians (192/273; 70%), and reported the blocks motivated them to continue to learn more about QI (168/273; 62%).

Next Steps
The authors have applied QI methods to improve the course and will aim to assess the sustainability of the course by tracking clinical outcomes related to the projects and students’ ongoing involvement in QI after graduation.
Using Assessment Point Accumulation as a Guide to Identify Students at Risk for Interrupted Academic Progress
Authors: Cendán Juan C. , Joledo Oloruntomi , Soborowicz Mary Beth , Marchand Leslie , Selim Basma R. 
Published: May 2018

Problem
Interruptions in academic progress (IP) are problematic for students and educational programs alike. Early identification of students at risk for IP, to provide remediation, could be beneficial.

Approach
Considering the clinically familiar pediatric growth curve as a metaphor, researchers hypothesized they could identify students at risk of IP. They organized course-related examination performance data for 518 students in five classes (2013–2014 through 2017–2018), adding students’ percentage scores cumulatively over time. At every examination point, they analyzed the data for dis-tribution and calculated a mean class score. They plotted each student’s accumulated points and accommodated a linear fit. Using the mean of the class as the horizontal axis, students gaining points against the mean show a positive slope; conversely, students losing points reveal a negative slope. The authors compared their findings against students who had faced IP—those who had repeated at least one course or an academic year, or who had left medical school.

Outcomes
Using a receiver operating characteristic approach, the authors identified a slope of −5 as an excellent screening test with 85% accuracy (sensitivity = 82%, specificity = 86%, area under curve = 0.917). Of 38 students facing IP, 25 would have been identified at risk for IP as early as the fifth assessment using a slope of −5.

Next Steps
Given the outcomes of this innovative, inexpensive, highly accurate approach to identifying students at risk of IP, the authors have plans to optimize interventions and to validate the approach at other programs.
The Effect of Combination Pharmacotherapy on Low Back Pain
Authors: Song Liyang , Qiu Pencheng , Xu Jiaqi , Lv Jiawen , Wang Shengyu , Xia Chen , Chen Pengfei , Fan Shunwu , Fang Xiangqian , Lin Xianfeng 
Published: May 2018

Objective:
To evaluate the difference between combination pharmacotherapy and monotherapy on low back pain (LBP).

Methods:
We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials databases up to March 14, 2017. Two authors independently extracted the data and assessed the validity of included trials.

Results:
Twelve randomized controlled trials comparing the effect of LBP combination pharmacotherapy to monotherapy or placebo were included. In chronic LBP, combination pharmacotherapy was more effective than placebo in pain relief (P<0.001; standardized mean difference [SMD], −0.50; 95% confidence interval [CI], −0.70 to −0.29; I²=0%) and function improvement (P<0.001; SMD, −0.27; 95% CI, −0.41 to −0.13; I²=0%) and showed improved pain relief compared with monotherapy (P<0.001; SMD, −0.84; 95% CI, −1.12 to −0.56; I²=0%). Combination pharmacotherapy did not outperform monotherapy pain relief and function improvement in acute LBP. In addition, risk of adverse effects of combination pharmacotherapy was much higher compared with placebo (P<0.05; relative risk, 1.80; 95% CI, 1.33-2.42; I²>50%) and monotherapy (P<0.05; relative risk, 1.44; 95% CI, 1.01-2.06; I²>50%) in both settings.

Discussion:
Combination pharmacotherapy is more effective than placebo or monotherapy in the management of pain and disability in chronic LBP, but not in acute LBP. Further, combination pharmacotherapy has a higher risk of adverse effects than placebo and monotherapy.
Acute Procedural Pain in Children
Authors: Kristensen Helle Nygaard , Lundbye-Christensen Søren , Haslund-Thomsen Helle , Graven-Nielsen Thomas , Elgaard Sørensen Erik 
Published: May 2018

Introduction:
Hospitalized children often describe needle-related procedures as the worst pain possible and such procedures may be emotionally traumatic. The use of hospital clowns (HCs) related to painful medical procedures in children may offer pain relief, but this has not been systematically evaluated. The objective of this study was to assess the effect of a therapeutic clown in comparison with standard care on the experience of pain in children receiving venipuncture.

Materials and Methods:
A sample of 116 children aged 4 to 15 years consecutively admitted to the hospital was allocated to either the experimental (presence of HC) or control group (standard care) before venipuncture. Self-reported pain after the procedure was assessed using the Faces Pain Scale combined with a 0 to 10 Numerical Rating Scale. Separate analysis was conducted in age groups from 4 to 6 (N=37) and 7 to 15 (N=74) years.

Results:
Without the clown present, the mean pain score (2.7±2.8) was not significantly different between the 2 age groups. Children aged 7 to 15 years had lower pain scores when the clown was present compared with the control group (P=0.025). Children aged 4 to 6 years had higher pain scores with the clown present, although the difference was not statistically significant (P=0.054). Children with pain (N=49) or previous experiences with venipuncture (N=56) did not score pain significantly differently.

Discussion:
Assessing the pain experience of children receiving venipuncture with the presence of an HC indicates a pain relieving effect for children older than 6 years. However, future studies should carefully study the effects on younger children where mixed effects may be present.
Three-dimensional MRI Analysis of Femoral Head Remodeling After Reduction in Patients With Developmental Dysplasia of the Hip
Authors: Tsukagoshi Yuta , Kamada Hiroshi , Kamegaya Makoto , Takeuchi Ryoko , Nakagawa Shogo , Tomaru Yohei , Tanaka Kenta , Onishi Mio , Nishino Tomofumi , Yamazaki Masashi 
Published: May 2018

Background:
Previous reports on patients with developmental dysplasia of the hip (DDH) showed that the prereduced femoral head was notably smaller and more nonspherical than the intact head, with growth failure observed at the proximal posteromedial area. We evaluated the shape of the femoral head cartilage in patients with DDH before and after reduction, with size and sphericity assessed using 3-dimensional (3D) magnetic resonance imaging (MRI).

Methods:
We studied 10 patients with unilateral DDH (all female) who underwent closed reduction. Patients with avascular necrosis of the femoral head on the plain radiograph 1 year after reduction were excluded. 3D MRI was performed before reduction and after reduction, at 2 years of age. 3D-image analysis software was used to reconstruct the multiplanes. After setting the axial, coronal, and sagittal planes in the software (based on the femoral shaft and neck axes), the smallest sphere that included the femoral head cartilage was drawn, the diameter was measured, and the center of the sphere was defined as the femoral head center. We measured the distance between the center and cartilage surface every 30 degrees on the 3 reconstructed planes. Sphericity of the femoral head was calculated using a ratio (the distance divided by each radius) and compared between prereduction and postreduction.

Results:
The mean patient age was 7±3 and 26±3 months at the first and second MRI, respectively. The mean duration between the reduction and second MRI was 18±3 months. The femoral head diameter was 26.7±1.5 and 26.0±1.6 mm on the diseased and intact sides, respectively (P=0.069). The ratios of the posteromedial area on the axial plane and the proximoposterior area on the sagittal plane after reduction were significantly larger than before reduction (P<0.01).

Conclusions:
We demonstrated that the size of the reduced femoral head was nearly equal to that of the intact femoral head and that the growth failure area of the head before reduction, in the proximal posteromedial area, was remodeled after reduction.

Level of Evidence:
Level IV—case series.
How Much Will My Child’s Operation Cost? Availability of Consumer Prices From US Hospitals for a Common Pediatric Orthopaedic Surgical Procedure
Authors: Racimo Allison R. , Talathi Nakul S. , Zelenski Nicole A. , Wells Lawrence , Shah Apurva S. 
Published: May 2018

Background:
Price transparency allows patients to make value-based health care decisions and is particularly important for individuals who are uninsured or enrolled in high-deductible health care plans. The availability of consumer prices for children undergoing orthopaedic surgery has not been previously investigated. We aimed to determine the availability of price estimates from hospitals in the United States for an archetypal pediatric orthopaedic surgical procedure (closed reduction and percutaneous pinning of a distal radius fracture) and identify variations in price estimates across hospitals.

Methods:
This prospective investigation utilized a scripted telephone call to obtain price estimates from 50 “top-ranked hospitals” for pediatric orthopaedics and 1 “non-top-ranked hospital” from each state and the District of Columbia. Price estimates were requested using a standardized script, in which an investigator posed as the mother of a child with a displaced distal radius fracture that needed closed reduction and pinning. Price estimates (complete or partial) were recorded for each hospital. The number of calls and the duration of time required to obtain the pricing information was also recorded. Variation was assessed, and hospitals were compared on the basis of ranking, teaching status, and region.

Results:
Less than half (44%) of the 101 hospitals provided a complete price estimate. The mean price estimate for top-ranked hospitals ($17,813; range, $2742 to $49,063) was 50% higher than the price estimate for non-top-ranked hospitals ($11,866; range, $3623 to $22,967) (P=0.020). Differences in price estimates were attributable to differences in hospital fees (P=0.003), not surgeon fees. Top-ranked hospitals required more calls than non-top-ranked hospitals (4.4±2.9 vs. 2.8±2.3 calls, P=0.003). A longer duration of time was required to obtain price estimates from top-ranked hospitals than from non-top-ranked hospitals (8.2±9.4 vs. 4.1±5.1 d, P=0.024).

Conclusions:
Price estimates for pediatric orthopaedic procedures are difficult to obtain. Top-ranked hospitals are more expensive and less likely to provide price information than non-top-ranked hospitals, with price differences primarily caused by variation in hospital fees, not surgeon fees.

Level of Evidence:
Level II—economic and decision analyses.
Improving Patient Compliance With Mechanical Venous Thromboembolism Prophylaxis
Authors: Nahar Deepti , Nizam Aaron , Farrow Monique , Restifo Andrea , Nimaroff Michael 
Published: May 2018

Abstract
Venous thromboembolic events (VTE) occurring in the postoperative period are serious yet preventable conditions. Multiple studies have demonstrated that the risk of postoperative VTE can be successfully reduced with mechanical prophylaxis and/or chemoprophylaxis. Patients are often noncompliant with mechanical prophylaxis in the postoperative period. We performed a prospective nonrandomized controlled study to determine if providing an educational pamphlet would increase knowledge and compliance with mechanical VTE prophylaxis. Patients receiving the educational pamphlet were more likely to rate their knowledge of VTE prophylaxis as “very good” when compared to the control group (73.1% vs. 30.2%, p < .001). Patients were also more likely to be compliant with mechanical prophylaxis in the educational group (53.9% vs. 30.2%, p = .014). Our study demonstrated that providing a simple educational pamphlet increased patient knowledge regarding VTE prophylaxis and increased compliance with mechanical prophylaxis.
Blended tube feeding prevalence, efficacy, and safety: What does the literature say?
Authors: Carter Holly , Johnson Kelly , Johnson Teresa W. , Spurlock Amy 
Published: May 2018

Background and purpose:
For most of human history, physicians used blended whole foods for patients who are unable to eat by mouth. However, by the 1960s and 1970s, advances in enteral nutrition resulted in the gradual displacement of blenderized tube feedings (BTFs) with commercial formulas. There are advantages and disadvantages to commercial formulas and BTFs. The purpose of this article was to review the literature for the incidence of blended tube feeding use and its safety, efficacy, and implications for clinical practice.

Methods:
A search of the scientific literature in PubMed, CINAHL, Cochrane, ProQuest, and Ovid was conducted using the keywords “blenderized tube feeding” and “blended tube feeding.” Articles were divided into two categories: 1) frequency of use and experiences of BTF in patients or caregivers and health care providers and 2) safety/efficacy studies.

Conclusions:
The literature review shows a rising interest in BTF, with more research on efficacy indicated.

Implications for practice:
The use of BTF is primarily patient or caregiver driven. Blenderized tube feeding requires oversight by health care providers just as commercial formulas. Health care providers should be aware of the use of BTF and the effect it can have on different patient populations regarding content, cost, safety, and efficacy in the clinical and home settings.
Brief report of a novel advanced practice provider–led course for ultrasound novices
Authors: Santos Christan D. , Rose Mariah Q. , Tomlinson Amanda D. , McLaughlin Diane C. 
Published: May 2018

Background and purpose:
Formal training for ultrasound use is essential for critical care providers. Despite a national increase in the utilization of advanced practice providers in critical care, ultrasound education is not routinely provided in their training programs. This study describes and evaluates a 1-day advanced care provider (APP)-led course designed to provide fellow APPs with the skills to obtain and evaluate basic ultrasound images.

Methods:
A 15-question pretest was administered via anonymous use of a clicker response system. Participants had didactic lectures followed by hands-on experience with live models and instructor. Posttest was administered after achievement of basic ultrasound views. Postcourse evaluations were also administered.

Conclusions:
Pretest and posttest questions included identifying anatomy, pathology, quantifying cardiac function, and clinical decision making. Scores improved from 58% on the pretest to 78% on the posttest. All participants acknowledged the need for the course and their ability to transfer the course into practice.

Implications for practice:
This course established that APPs can both teach and learn from their peers in a formal setting. In addition, this course demonstrated that an APP-led course with a combined hands-on and didactic approach is an effective method for critical care ultrasound skills acquisition in ultrasound-novice APPs.