bluuebunny/crossref_metadata_2025_split huggingface dataset:
Functional decline and associated factors in patients with multimorbidity at 8 months of follow-up in primary care: the functionality in pluripathological patients (FUNCIPLUR) longitudinal descriptive study
Authors: Martín Lesende Iñaki , Mendibil Crespo Luis Ignacio , Castaño Manzanares Sonia , Otter Anne-Sophie Denise , Garaizar Bilbao Irati , Pisón Rodríguez Jakobe , Negrete Pérez Ion , Sarduy Azcoaga Iraide , de la Rua Fernández María Jesús 
Published: July 2018

ObjectiveTo analyse short-term functional decline and associated factors in over 65-year-olds with multimorbidity.Design and settingProspective multicentre study conducted in three primary care centres, over an 8-month period. During this period, we also analysed admissions to two referral hospitals.ParticipantsOf the 241 patients ≥65 years included randomly in the study, 155 were already part of a multimorbidity programme (stratified by ‘Adjusted Clinical Groups’) and 86 were newly included (patients who met Ollero’s criteria and with ≥1 hospital admission the previous year). Patients who were institutionalised, unable to complete follow-up or receiving dialysis were excluded.Outcomes and variablesThe primary outcome was the decrease in functional status category (Barthel Index or Lawton Scale). Other variables considered were sociodemographic characteristics, comorbidity, medications, number of admissions and functional status on discharge.ResultsPatients had a median age of 82 years (P7586) and of five selected chronic conditions (IQR 4–6), and took 11 (IQR 9–14) regular medications; 46.9% were women; 38.2% had impaired function at baseline.Overall, 200 persons completed the follow-up; 10.4% (n=25) of the initial sample died within the 8 months. In 20.5% (95% CI 15.5% to 26.6%) of them we recorded a decrease in functionality, associated with older age (OR 1.1, 95% CI 1.0 to 1.2) and with having ≥1 admission during the follow-up (OR 3.6, 95% CI 1.6 to 7.7). There were 133 hospital admissions in total during the follow-up considering all the patients included, and a functional decline was observed in 35.5% (95% CI 25.7% to 46.7%) of the 76 discharges in which functional status was assessed.ConclusionsA fifth of patients showed functional decline or loss of independence in just 8 months. These findings are important as functional decline and the increasing care needs are potentially predictable and modifiable. Age and hospitalisation were closely associated with this decline
Changing use of antidiabetic drugs in the UK: trends in prescribing 2000–2017
Authors: Wilkinson Samantha , Douglas Ian , Stirnadel-Farrant Heide , Fogarty Damian , Pokrajac Ana , Smeeth Liam , Tomlinson Laurie 
Published: July 2018

ObjectivesGuidelines for the use of drugs for type 2 diabetes mellitus (T2DM) have changed since 2000, and new classes of drug have been introduced. Our aim was to describe how drug choice at initiation and first stage of intensification have changed over this period, and to what extent prescribing was in accord with clinical guidelines, including adherence to recommendations regarding kidney function.DesignRepeated cross-sectional study.SettingUK electronic primary care health records from the Clinical Practice Research Datalink.ParticipantsAdults initiating treatment with a drug for T2DM between January 2000 and July 2017.Primary and secondary outcome measuresThe primary outcomes were the proportion of each class of T2DM drug prescribed for initiation and first-stage intensification in each year. We also examined drug prescribing by kidney function and country within the UK.ResultsOf 280 241 people initiating treatment with T2DM drugs from 2000 to 2017, 73% (204 238/280 241) initiated metformin, 15% (42 288/280 241) a sulfonylurea, 5% (12 956/280 241) with metformin and sulfonylurea dual therapy and 7% (20 759/280 241) started other options. Clinicians have increasingly prescribed metformin at initiation: by 2017 this was 89% (2475/2778) of drug initiations. Among people with an estimated glomerular filtration rate of ≤30 mL/min/1.73 m2, the most common drug at initiation was a sulfonylurea, 58% (659/1135). In 2000, sulfonylureas were the predominant drug at the first stage of drug intensification (87%, 534/615) but by 2017 this fell to 30% (355/1183) as the use of newer drug classes increased. In 2017, new prescriptions for dipeptidyl peptidase-4 inhibitors (DPP4i) and sodium/glucose cotransporter-2 inhibitors (SGLT2i) accounted for 42% (502/1183) and 22% (256/1183) of intensification drugs, respectively. Uptake of new classes differs by country with DPP4is and SGLT2is prescribed more in Northern Ireland and Wales than England or Scotland.ConclusionsOur findings show markedly changing prescribing patterns for T2DM between 2000 and 2017, largely consistent with clinical guidelines.
A cross-sectional survey of awareness of human papillomavirus-associated oropharyngeal cancers among general practitioners in the UK
Authors: Lechner Matt , Vassie Claire , Kavasogullari Cemal , Jones Oliver , Howard James , Masterson Liam , Fenton Tim , Yarbrough Wendell , Waller Jo , Gilson Richard 
Published: July 2018

ObjectivesTo examine the level of awareness of the link between human papillomavirus (HPV) and oropharyngeal cancer (OPC) and epidemiological trends in HPV-related OPC among general practitioners (GPs) in the UK.DesignCross-sectional survey.Participants384 GPs from England, Scotland, Wales and Northern Ireland.SettingThe survey was administered at GP training courses and via email to lists of training course attendees.Primary and secondary outcome measuresProportion of respondents aware of the link between HPV and OPC; respondents’ self-rated knowledge of OPC; proportion of participants aware of the epidemiological trends in HPV-associated OPC.Results384 questionnaires were completed with an overall response rate of 72.9%. 74.0% of participants recognised HPV as a risk factor for OPC, which was lower than knowledge about the role of smoking, chewing tobacco and alcohol consumption (all >90% recognition). Overall, 19.4% rated their knowledge of OPC as very good or good, 62.7% as average and 17.7% as poor or very poor. The majority (71.9%) were aware that rates of HPV-associated OPC have increased over the last two decades. Fewer than half (41.5%) of the participants correctly identified being male as a risk factor of HPV-associated OPC, while 58.8% were aware that patients with HPV-associated OPC tend to be younger than those with non-HPV-associated disease.ConclusionsThe association of HPV infection with OPC is a relatively recent discovery. Although the level of awareness of HPV and OPC among GPs was high, the characteristics of HPV-associated OPC were less well recognised, indicating the need for further education.
Using primary care-based paper and telephone interventions to increase uptake of bowel scope screening in Yorkshire: a protocol of a randomised controlled trial
Authors: McGregor Lesley M , Kerrison Robert S , Green Trish , Macleod Una , Hughes Mark , Gibbins Monica , Morris Stephen , Rees Colin , von Wagner Christian 
Published: July 2018

IntroductionEvidence suggests bowel scope screening (BSS) can significantly reduce an individual’s risk of developing colorectal cancer (CRC). BSS for 55 year olds was therefore introduced to the English Bowel Cancer Screening Programme (BCSP) in 2013. However, the benefits are only gained from test completion and uptake is low (43%). Primary care involvement has consistently shown benefits to cancer screening uptake and so this study aims to build on this knowledge and evaluate general practitioner (GP) practice led interventions designed to increase BSS attendance.Methods and analysisA three-arm randomised controlled trial will be conducted to evaluate three interventions: one intervention for prospective BSS invitees (primer letter with locally tailored leaflet sent by an individual’s GP practice) and two interventions for those who do not attend their BSS appointment (a self-referral letter sent by an individual’s GP practice and a patient navigation call made on behalf of an individual’s GP practice). The trial will be set in Yorkshire. Individuals soon to receive their invitation to attend BSS at one of the Hull and East Yorkshire Bowel Cancer Screening centre sites, will be randomly assigned to one of three groups: control (usual care; no input from GP practice), Intervention group A (primer letter/leaflet and a self-referral letter), Intervention group B (primer letter/leaflet and a patient navigation call). Attendance data will be obtained from the BCSP database (via National Health Service (NHS) Digital) 3 months after the last intervention. Regression analysis will compare uptake, and additional clinical outcomes, across the three groups. The analysis will be multivariate and adjust for several covariates including gender and area-level deprivation.Ethics and disseminationNHS ethical approval has been obtained from London-Harrow Research Ethics Committee. The results will be submitted for publication in a peer-reviewed journal and presented at conferences.Trial registration numberISRCTN16252122; Pre-results.
Multi-scale simulation of nonlinear thin-shell sound with wave turbulence
Authors: Cirio Gabriel , Qu Ante , Drettakis George , Grinspun Eitan , Zheng Changxi 
Published: July 2018

Thin shells --- solids that are thin in one dimension compared to the other two --- often emit rich nonlinear sounds when struck. Strong excitations can even cause chaotic thin-shell vibrations, producing sounds whose energy spectrum diffuses from low to high frequencies over time --- a phenomenon known as wave turbulence. It is all these nonlinearities that grant shells such as cymbals and gongs their characteristic "glinting" sound. Yet, simulation models that efficiently capture these sound effects remain elusive.
We propose a physically based, multi-scale reduced simulation method to synthesize nonlinear thin-shell sounds. We first split nonlinear vibrations into two scales, with a small low-frequency part simulated in a fully nonlinear way, and a high-frequency part containing many more modes approximated through time-varying linearization. This allows us to capture interesting nonlinearities in the shells' deformation, tens of times faster than previous approaches. Furthermore, we propose a method that enriches simulated sounds with wave turbulent sound details through a phenomenological diffusion model in the frequency domain, and thereby sidestep the expensive simulation of chaotic high-frequency dynamics. We show several examples of our simulations, illustrating the efficiency and realism of our model.
Lightweight Monitoring of Distributed Streams
Authors: Lazerson Arnon , Keren Daniel , Schuster Assaf 
Published: July 2018

As data becomes dynamic, large, and distributed, there is increasing demand for what have become known asdistributed stream algorithms. Since continuously collecting the data to a central server and processing it there is infeasible, a common approach is to definelocalconditions at the distributed nodes, such that—as long as they are maintained—some desirableglobalcondition holds.Previous methods derived local conditions focusing on communication efficiency. While proving very useful for reducing the communication volume, these local conditions often suffer from heavy computational burden at the nodes. The computational complexity of the local conditions affects both the runtime and the energy consumption. These are especially critical for resource-limited devices like smartphones and sensor nodes. Such devices are becoming more ubiquitous due to the recent trend toward smart cities and the Internet of Things. To accommodate for high data rates and limited resources of these devices, it is crucial that the local conditions be quickly and efficiently evaluated.Here we propose a novel approach, designated CB (for Convex/Concave Bounds). CB defines local conditions using suitably chosen convex and concave functions. Lightweight and simple, these local conditions can be rapidly checked on the fly. CB’s superiority over the state-of-the-art is demonstrated in its reduced runtime and power consumption, by up to six orders of magnitude in some cases. As an added bonus, CB also reduced communication overhead in all the tested application scenarios.
Utinam Avum Tuum Meminisses! Threats and Allusions in the First Philippic
Authors: Zarecki Jonathan P. 
Published: July 2018

Abstract
In sections 34-35 of the First Philippic, Cicero makes a powerful threat against Antony by engaging in allusive role-play that makes dual use of Marcus Antonius orator as an exemplum. Cicero first declares himself Antonius to Antony’s Cinna, thus acknowledging the limitations of rhetoric in the face of violence and indicating that he is prepared to accept a martyr’s role. Second, Cicero invites conflation of himself with Marius/Cinna and Antony to his grandfather Antonius, thereby declaring that Cicero had decided to oppose Antony and work towards Antony’s destruction. This role-play represents not only a powerful warning to Antony, but also a sign of Cicero’s change in attitude towards Antony, an attitudinal change reinforced by Cicero’s wordplay on reversio. The allusive threats in sections 34-35 also indicate that Cicero had decided by no later than 2 September 44, and not with the dissemination of the Second Philippic, that there would be no reconciliation between himself and Antony.
Violent Christians, the Nigerian Public Square, and the Utility of Jesus’ Forgiveness Sayings for Tackling Religious Violence
Authors: Ezigbo Victor I. 
Published: July 2018

Abstract
This article explores the questions: Is Jesus’ teaching on forgiveness compatible with Nigerian Christians’ strategies of preemptive violence or counter-violent responses in light of harms done to them by people of other faiths? Are there some Christological reasons that might motivate Nigerian Christians to refrain from using violence as the only effective means available to them to protect Christian communities against attacks from people of other faiths? To answer these questions, I will focus on three main issues. Firstly, I will discuss the theological rhetoric of some pastors that are shaping Christian discourse on Christian-Muslim and Christian-traditional religion relations. Secondly, I will discuss the idea of ‘disciple’ and ‘non-disciple’ dialectics in Jesus’ thought vis-à-vis how his followers are to live in relation to his non-followers. Finally, I will also discuss Jesus’ teaching on forgiveness, highlighting some of its theological implications for tackling religious violence that are rooted in some Nigerian Christians’ anxieties about other religious faiths.
Growth rate of serous pancreatic neoplasms in vivo: a retrospective, observational study
Authors: Park Chan , Kim Hyoung Jung , Kim So Yeon , Lee Seung Soo , Byun Jae Ho , Kim Song Cheol , Kim Myung-Hwan 
Published: July 2018

Background Determining the growth rate of pancreatic cystic lesions on follow-up imaging is important in managing patients with these lesions. However, the growth rates of serous pancreatic neoplasms (SPNs) have been reported to vary among studies. Purpose To determine the in vivo growth rate of SPNs. Material and Methods This retrospective, single-institutional study included patients diagnosed with SPNs during 2006–2015. The diagnosis of SPNs was based on the results of surgery, endoscopic ultrasonography (EUS)-guided fine needle aspiration (FNA) or core needle biopsy (CNB), or typical radiologic features of SPN. A linear mixed-effects model was utilized to determine whether the diagnostic intervention was associated with tumor growth rate in all patients. The in vivo growth rate of SPNs was estimated from patients without or before diagnostic intervention. SPN growth rates were compared before and after diagnostic intervention. Results SPN growth rates in the overall patient cohort (n = 304) differed significantly between patients who did and did not undergo diagnostic interventions. The in vivo SPN growth rate in 204 patients without or before diagnostic intervention was 1.9 mm/year (95% confidence interval [CI] = 1.6–2.2). In the 130 patients who underwent diagnostic intervention, the SPN growth rate was significantly greater before than after diagnostic intervention (1.8 vs. 0.2 mm/year). Conclusions In the absence of diagnostic intervention, the in vivo growth rate of SPNs was 1.9 mm/year (95% CI = 1.6–2.2). EUS-guided FNA or CNB may affect the growth rate of SPNs.
Regional differences of fat depot attenuation using non-contrast, contrast-enhanced, and delayed-enhanced cardiac CT
Authors: Rodriguez-Granillo Gaston A , Capunay Carlos , Deviggiano Alejandro , De Zan Macarena , Carrascosa Patricia 
Published: July 2018

Background Regional fat density assessed by computed tomography (CT) has been suggested as a marker of perivascular adipose tissue inflammation. Dual energy CT (DECT) allows improved tissue characterization compared to conventional CT. Purpose To explore whether DECT might aid regional fat density discrimination. Material and Methods We included patients who had completed a non-enhanced cardiac CT scan, CT coronary angiography (CTCA), and a delayed enhancement CT. Attenuation levels (Hounsfield units [HU]) were assessed at the epicardial, paracardial, visceral, and subcutaneous fat. The number of coronary segments with disease (SIS) was calculated. Results A total of 36 patients were included in the analysis. Twenty-six (72%) patients had evidence of obstructive disease at CCTA and 25 (69%) patients had evidence of previous myocardial infarction. At non-contrast CT, we did not identify significant attenuation differences between epicardial, paracardial, subcutaneous, and visceral fat depots (−110.8 ± 9 HU, vs. −113.7 ± 9 HU, vs. −114.7 ± 8 HU, vs. −113.8 ± 11 HU, P = 0.36). Significant attenuation differences were detected between fat depots at mid and low energy levels, both at CTCA and delayed-enhancement scans ( P < 0.05 for all). Epicardial fat showed the least negative attenuation, irrespective of the acquisition mode; epicardial fat evaluated at 40 keV was related to the SIS (r = 0.37, P = 0.03). Conclusions In this study, regional fat depots amenable to examination during thoracic CT scans have distinctive regional attenuation values. Furthermore, such differences were better displayed using contrast-enhanced monochromatic imaging at low energy levels.
Effect of Ketogenic Diet on Motor Functions and Daily Living Activities of Children With Multidrug-Resistant Epilepsy: A Prospective Study
Authors: Çubukçu Duygu , Güzel Orkide , Arslan Nur 
Published: July 2018

Aims: To investigate the effect of ketogenic diet on motor function and daily living activities in children with epilepsy. Methods: A total of 62 children (median age 5.0 years) were enrolled. Motor function was assessed using the Gross Motor Function Measure (GMFM), and daily living activities and cognitive functions were assessed using the Functional Independence Measure (WeeFIM) before treatment and 3, 6, and 12 months after ketogenic diet treatment. Results: Significant improvement in total GMFM and WeeFIM scores ( P < .001) were found during the 12 months of ketogenic diet treatment. There was a positive correlation between total GMFM scores and WeeFIM scores at baseline (r= 0.792, P = .0001), and at 3 (r= 0.780, P = .0001), 6 (r= 0.744, P = .0001), and 12 months (r= 0.692, P = .0001) of treatment. Both the responder (50 patients, 80.7%) and nonresponder (12 patients, 19.3%) patient groups showed significantly higher GMFM and WeeFIM scores at 12 months of treatment compared to baseline values. A ≥50% reduction in seizure frequency was observed in 77.4%, 72.6%, and 80.7% of the patients after 3, 6, and 12 months of treatment, respectively. Conclusion: Ketogenic diet treatment improves motor functions and daily living activities in children with epilepsy during the 12 months of treatment.
The Implementation of Extended Examination Duration for Students With ADHD in Higher Education
Authors: Jansen Dorien , Petry Katja , Evans Steven W. , Noens Ilse , Baeyens Dieter 
Published: July 2018

Objective: Recently, research indicated that extended examination duration was perceived as effective by students with ADHD. However, the objective effectiveness of this accommodation has not been researched extensively. This study addresses this gap in literature. Method: A total of 30 students with ADHD and 30 matched typically developing controls (TDC) participated in a simulation of a real-life examination. They filled in three parallel versions of a paper-and-pencil test in three time conditions: 1 hr (+0%), 1 hr 20 min (+33%), and 1 hr 30 min (+50%). Results: When granted extended examination duration, students with ADHD and TDC use extra time but their performance does not increase. In addition, test-taking strategies were altered to a limited extent, and strategies that are perceived as effective (e.g., marking key words) were rarely used by the students. Conclusion: It is concluded that extended examination duration is not objectively effective in an experimental design. Limitations and guidelines for future research are formulated.
Intraocular lens implantation in children with unilateral congenital cataract in the first 4 years of life
Authors: Yangzes Sonam , Kaur Savleen , Gupta Parul Chawla , Sharma Manu , Jinagal Jitender , Singh Jaspreet , Ram Jagat 
Published: July 2018

Purpose: To describe the outcome of phacoaspiration with intraocular lens implantation in children with unilateral congenital cataract in the first 4 years of life. Methods: A retrospective chart review of children with visually significant unilateral congenital cataract presenting in the first 4 years of life was done. Children with a minimum postsurgical follow-up of 1 year were included. Outcome measures were mean spherical equivalent, visual axis clarity, visual acuity and complications till the last follow-up. Results: Ninety-three children met the inclusion criteria. The mean age of surgery was 13.23 ± 11.89 months and the mean follow-up period was 24.37 ± 17.35 months. Nearly 40% of children presented during their first year of life. No difference was noted between the subgroups in terms of age ( p = 0.310), sex ( p = 0.475) or laterality ( p = 0.349). Surgical membranectomy was performed in 22 eyes (23.6%) after an average period of 4.85 ± 2.58 months after surgery. One eye underwent piggy back intraocular lens and four eyes underwent intraocular lens exchange after a mean duration of 50 months (range 40–60 months). The mean visual acuity was 0.79 ± 0.11 (log MAR chart). A total of 60.7% of these children ( n = 31) achieved best corrected visual acuity or 20/80 or better. Conclusion: The results of our study suggest that primary intraocular lens implantation in children with unilateral congenital cataract gives good structural and functional results. Besides a meticulous surgery, visual outcome is affected by the time of presentation and postoperative compliance to amblyopia therapy.