bluuebunny/crossref_metadata_2025_split huggingface dataset:
Widespread emergency department access block: a human rights issue in Australia?
Authors: Allison Stephen , Bastiampillai Tarun , O’Reilly Richard , Sharfstein Steven S , Castle David 
Published: October 2018

Objective: There are increasing demands on emergency psychiatrists with higher numbers of mental health presentations, and longer stays in emergency departments (EDs). Australia, like other English speaking countries, funds considerably lower numbers of psychiatric beds than average for Organisation for Economic Co-operation and Development (OECD) countries. Consequently, acute bed occupancy is high, and a bed is frequently unavailable when a person needs admission. Patients with serious mental illness can wait days in busy and overstimulating EDs, become agitated and assaultive, and then require chemical and physical restraint. All patients have a right to safe high quality care, but the paucity of beds deprives patients of this right. The Australasian College of Emergency Medicine recommends reporting ED access block to health ministers, and human rights and/or health rights commissioners, and recommends increased funding for inpatient psychiatric care, emergency mental health and after-hours community services, together with more alcohol and other drug programs. Conclusions: It is challenging for emergency physicians and psychiatrists to provide optimal care for acutely unwell patients who stay extended periods in the ED. Increasing the availability of inpatient care must be considered as part of a comprehensive solution for minimising ED lengths of stay in Australia.
Loss of Correction After Chevron Osteotomy for Hallux Valgus as a Function of Preoperative Deformity
Authors: Kaufmann Gerhard , Sinz Stefanie , Giesinger Johannes M. , Braito Matthias , Biedermann Rainer , Dammerer Dietmar 
Published: October 2018

Background: Recurrence is relatively common after surgical correction of hallux valgus. Multiple factors are discussed that could have an influence in the loss of correction. The aim of this study was to determine preoperative radiological factors with an influence on loss of correction after distal chevron osteotomy for hallux valgus. Methods: Five hundred twenty-four patients who underwent the correction of a hallux valgus by means of distal chevron osteotomy at our institution between 2002 and 2012 were included. We assessed weightbearing x-rays at 4 time points: preoperatively, postoperatively, and after 6 weeks and 3 months. We investigated the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), joint congruity, and the position of the sesamoids. Results: At all points of the survey, significant correction of the IMA and HVA was detected. The IMA improved from 12.9 (± 2.8) to 4.5 (± 2.4) degrees and the HVA from 27.5 (± 6.9) to 9.1 (± 5.3) degrees. Loss of correction was found in both HVA and IMA during follow-up with a mean of 4.5 and 1.9 degrees, respectively. Loss of correction showed a linear correlation with preoperative IMA and HVA, and a correlation between preoperative DMAA and sesamoid position. Conclusion: The chevron osteotomy showed significant correction for HVA, IMA, and DMAA. Preoperative deformity, in terms of IMA, HVA, DMAA, and sesamoid position, correlated with the loss of correction and could be assessed preoperatively for HVA and IMA. Loss of correction at 3 months persisted during the follow-up period. Level of Evidence: Level IV, retrospective case series.
Evaluation of corneal epithelial wound healing after penetrating keratoplasty in patients receiving a new matrix therapy agent (regenerating agent)
Authors: Jullienne Rémy , Garcin Thibaud , Crouzet Emmanuel , He Zhiguo , Renault Didier , Thuret Gilles , Gain Philippe 
Published: October 2018

Objectives: Complete epithelial wound healing is a milestone in early postoperative care after penetrating keratoplasty. The re-epithelialization rate after penetrating keratoplasty was measured in patients receiving a new matrix therapy agent (regenerating agent, Cacicol®) that mimics heparan sulphates. Methods: This was a prospective, open-label, uncontrolled, single-centre observational study. A total of 33 consecutive patients (33 eyes) who underwent an 8.25-mm diameter penetrating keratoplasty were treated with regenerating agent eye drops: one drop in the operating theatre immediately after graft, then on alternate days. Patients were divided into those at low risk (13 patients) and high risk (20 patients) of delayed wound healing, and follow-up was performed by digital slit lamp with fluorescein-dye testing repeated daily at a fixed time. Dye area was measured using ImageJ freeware. The main endpoint was epithelial healing after regenerating agent therapy. Results: The mean ± standard deviation time to complete healing for all patients was 2.7 ± 1.1 (median: 3, range: 1–6) days. This was obtained on Day 1 for 15% of patients, Day 2 for 33%, Day 3 for 88%, Day 4 for 94% and Day 6 for 100%. There was no significant difference between low- and high-risk patients. The area of epithelial defect decreased by a mean ± standard deviation of 75% ± 22% between Day 1 and Day 2, corresponding to a mean ± standard deviation wound-healing rate of 11.5 ± 6.5 mm2/D. There were no systemic or local side effects related to regenerating agent. Conclusion: These preliminary data suggest that regenerating agent could be a useful, non-invasive therapeutic approach in postoperative management of penetrating keratoplasty with the potential to accelerate re-epithelialization.
Examining symptom trajectories that predict worse outcomes in post-CABG patients
Authors: Tsai Ming-Fen , Tsay Shiow-Luan , Moser Debra , Huang Tsuey-Yuan , Tsai Feng-Chun 
Published: October 2018

Background: Coronary artery bypass grafting is one of the most common interventional revascularisation procedures used to treat coronary artery disease worldwide. With a wide variability in postoperative cardiac symptoms, identification of symptom trajectories during the 3-month postoperative recovery period may improve clinicians’ abilities to support symptom recovery. Aims: To identify distinct trajectories of cardiac symptoms seen over time in a cohort of patients during the 3-month post-coronary artery bypass grafting period, and determine clinical characteristics associated with different symptom trajectories postoperatively. Methods: A prospective trial used the cardiac symptom survey to determine patient symptoms at baseline prior to surgery, and at 1 week, 6 weeks and 3 months following coronary artery bypass grafting. A latent class growth model and multivariate logistic regression analyses were used. Results: Data were obtained from patients ( N=198) undergoing coronary artery bypass grafting in six medical centres of Taiwan, through patient medical records and interviews. Based on their frequency, trajectories were explored for the six most common postoperative symptoms including angina, dyspnoea, fatigue, depression, sleep problems and anxiety. We identified two to three distinct classes of trajectories for each symptom. Age, longer intensive care unit stay, fewer vessels bypassed, off-pump coronary artery bypass grafting, smoking history and lack of regular exercise were associated with worse symptom outcome trends over time. Conclusions: Using this unique trajectories-based research method, we are able to achieve a better understanding of symptom recovery patterns over time among coronary artery bypass grafting patients. Recognising risk factors and potential recovery patterns prior to surgery may allow healthcare providers to deliver targeted discharge planning and individualised care after coronary artery bypass grafting.
Understanding Internationalization at Home: Perspectives from the Global North and South
Authors: Almeida Joana , Robson Sue , Morosini Marilia , Baranzeli Caroline 
Published: October 2018

Internationalization at Home (IaH) has become a strategic priority in higher education research, policy and practice, although there is still a lack of conceptual clarity around its meaning and practical applications and implications. This paper aims to shed empirical insight into how this concept is understood by higher education staff. It follows a multiple-case study design to explore bottom-up understandings of IaH by 18 staff in two universities in Brazil and the UK. Findings yielded by a thematic analysis of two focus group sessions forefront three dimensions when enacting an IaH agenda: (1) the institutional or organizational side of internationalization, (2) teaching and learning aspects, and (3) personal experiences of the social actors involved in internationalization processes. Within these dimensions, four baseline features should be considered for a bottom-up understanding of IaH: institutional strategizing, international curricula, student integration, and inclusivity of IaH. Implications for future research highlight the importance of furthering empirically grounded definitions of IaH via a bottom-up and top-down development of the concept that clarifies the epistemology of equity it represents. Implications for practice point to the urge of attending to staff perceptions whilst exploring macro-, meso- and micro-contextual conditions and needs.
A cross-sectional study of long-term satisfaction after surgery for congenital syndactyly: does skin grafting influence satisfaction?
Authors: Ferrari Bien R. , Werker Paul M.N. 
Published: October 2018

Syndactyly correction without skin grafting is advocated because it prevents graft-related complications and donor site morbidity. In this cross-sectional study, we compared satisfaction among patients who underwent correction with and without skin grafting to determine preference based on subjective and objective parameters. Retrospective chart analysis was performed among 27 patients (49 webs) who were seen at follow-up after a median follow-up period of 7.4 years, at which the Patient and Observer Scar Assessment Scale, the Withey score and a satisfaction survey were used. Notably, there were no significant differences in complication rates or observer rated scar scores. Although the need for an additional surgical procedure was higher after skin grafting, patient-rated satisfaction scores were similar irrespective of the use of grafting. Our data suggest that corrections can best be performed without skin grafts if seeking to minimize the need for an additional procedure, but that the use of skin grafts does not appear to affect patient satisfaction. Level of evidence: IV
Co-creating Value in People’s Interactions with Cognitive Assistants: A Service-System View
Authors: Siddike Md Abul Kalam , Kohda Youji 
Published: October 2018

Purpose—The main purpose of this study was to develop a service-system framework in which people interact with cognitive assistants (CAs) for co-creation of value, such as enhanced communication and better task management. Methodology—Qualitative research was undertaken to deeply investigate and explore the value co-created through people’s interactions with CAs. A total of 32 interviews were conducted in three phases. The interview data were analysed using MAXQDA 12. Results—The results of this study indicate that most of the users use Apple’s Siri, Amazon Eco or Google Home as their CAs and that people’s interactions with CAs are influenced by their trust in and relative advantages of using CAs. The results also indicate that a diversity of value, such as enhanced communication, better task management, enhanced information retrieval, enhanced learning and better data-driven decisions, is co-created through interactions between people and CAs. Implications—We developed a service-system framework in which CAs are considered as actors and introduced the concept of ‘autonomous agency’ for controlling and coordinating people’s interactions with CAs. Originality—This is the first study on the value co-creation from people’s interactions with CAs (artificial-intelligence-based systems) by proposing a service-system framework in which CAs are considered as actors.
Three-Year Outcomes With Hypofractionated Versus Conventionally Fractionated Whole-Breast Irradiation: Results of a Randomized, Noninferiority Clinical Trial
Authors: Shaitelman Simona F. , Lei Xiudong , Thompson Alastair , Schlembach Pamela , Bloom Elizabeth S. , Arzu Isidora Y. , Buchholz Daniel , Chronowski Gregory , Dvorak Tomas , Grade Emily , Hoffman Karen , Perkins George , Reed Valerie K. , Shah Shalin J. , Stauder Michael C. , Strom Eric A. , Tereffe Welela , Woodward Wendy A. , Amaya Diana N. , Shen Yu , Hortobagyi Gabriel N. , Hunt Kelly K. , Buchholz Thomas A. , Smith Benjamin D. 
Published: October 2018

Purpose The adoption of hypofractionated whole-breast irradiation (HF-WBI) remains low, in part because of concerns regarding its safety when used with a tumor bed boost or in patients who have received chemotherapy or have large breast size. To address this, we conducted a randomized, multicenter trial to compare conventionally fractionated whole-breast irradiation (CF-WBI; 50 Gy/25 fx + 10 to 14 Gy/5 to 7 fx) with HF-WBI (42.56 Gy/16 fx + 10 to 12.5 Gy/4 to 5 fx). Patients and Methods From 2011 to 2014, 287 women with stage 0 to II breast cancer were randomly assigned to CF-WBI or HF-WBI, stratified by chemotherapy, margin status, cosmesis, and breast size. The trial was designed to test the hypothesis that HF-WBI is not inferior to CF-WBI with regard to the proportion of patients with adverse cosmetic outcome 3 years after radiation, assessed using the Breast Cancer Treatment Outcomes Scale. Secondary outcomes included photographically assessed cosmesis scored by a three-physician panel and local recurrence-free survival. Analyses were intention to treat. Results A total of 286 patients received the protocol-specified radiation dose, 30% received chemotherapy, and 36.9% had large breast size. Baseline characteristics were well balanced. Median follow-up was 4.1 years. Three-year adverse cosmetic outcome was 5.4% lower with HF-WBI ( Pnoninferiority = .002; absolute risks were 8.2% [n = 8] with HF-WBI v 13.6% [n = 15] with CF-WBI). For those treated with chemotherapy, adverse cosmetic outcome was higher by 4.1% (90% upper confidence limit, 15.0%) with HF-WBI than with CF-WBI; for large breast size, adverse cosmetic outcome was 18.6% lower (90% upper confidence limit, −8.0%) with HF-WBI. Poor or fair photographically assessed cosmesis was noted in 28.8% of CF-WBI patients and 35.4% of HF-WBI patients ( P = .31). Three-year local recurrence-free survival was 99% with both HF-WBI and CF-WBI ( P = .37). Conclusion Three years after WBI followed by a tumor bed boost, outcomes with hypofractionation and conventional fractionation are similar. Tumor bed boost, chemotherapy, and larger breast size do not seem to be strong contraindications to HF-WBI.
Deciphering V̇O2,max: limits of the genetic approach
Authors: Hoppeler Hans 
Published: October 2018

ABSTRACT
Maximal oxygen consumption (V̇O2,max) denotes the upper limit of aerobic energy flux through the cascade of oxygen transfer from the environment to tissue mitochondria, essentially to skeletal muscle mitochondria during intense exercise. A high V̇O2,max is a key component for athletic success in human and animal endurance sports. From a public health perspective, a high V̇O2,max is a validated negative predictor for cardiovascular disease and all-cause mortality. V̇O2,max varies by more than twofold between sedentary subjects and shows a heritability value greater than 50%. Likewise, the capacity for an individual's V̇O2,max to be increased with exercise training (i.e. its trainability) varies massively between subjects, independent of each subject's V̇O2,max in the absence of training (i.e. their sedentary V̇O2,max), and with a similarly high heritability. Athletic as well as public health interests have prompted a search for the genetic profile of sedentary V̇O2,max and of trainability. Candidate-gene studies, gene-expression studies and genome-wide-association studies (GWAS) have not been able to identify a genetic signature that distinguishes subjects or athletes with a favorable V̇O2,max phenotype or a high trainability from controls. Here, I propose that multigenetic phenotypes such as V̇O2,max are emergent properties of multiple underlying transcriptomic networks modified by epistasis, the epigenome and the epitranscriptome. The genetic approach is thus considered to be necessary but insufficient for furthering our understanding of multigenetic higher-level functions.
Contrato administrativo de prestação de serviço executado de forma contínua: prorrogação de prazo efetuada após seu termo final
Authors: Sarai Leandro 
Published: October 2018

Administrative contract for the provision of service performed continuously: deadline extension made after its final term O presente artigo, de natureza dogmática, elaborado segundo o método hipotético-dedutivo, analisa a prorrogação do contrato administrativo de prestação de serviços executados de forma contínua. A hipótese tomada para análise é a de que é possível essa prorrogação, ainda que o contrato esteja vencido. Para tanto, analisa o que justificaria a prorrogação desses contratos de modo geral, os problemas envolvidos com os contratos de prazo mais longo, o que caracterizaria os serviços executados de forma contínua, além da possibilidade de contratos com esse tipo de objeto terem vigência superior a 12 meses. Efetua ainda uma distinção entre contratos com prazo determinado e contratos por escopo. Finalmente, após verificar que a preocupação da lei em tratar as prorrogações como exceções decorre da vigência anual do orçamento e que o próprio sistema jurídico reconheceria a existência de despesas que ultrapassariam o exercício, conclui que não há vedação à prorrogação do contrato após seu termo final, desde que atendidas certas condições. This paper, of dogmatic nature and using the hypothetical-deductive reasoning, explores the term extension of administrative contracts made after its expiration. The focus is on contracts of services that are performed continuously. The main hypothesis is that the term extension is possible. To treat this issue, it studies what justifies the extension of such contracts in general, the problems involved with longer-term contracts, the distinguish element of services that are performed continuously, besides the possibility of contracts with this type of object having duration exceeding 12 months. It makes a distinction between fixed term contracts and contracts for scope. Finally, after checking that the concern of the law in dealing with extensions as exceptions are due to the annual duration of the budget and that the legal system recognizes the existence of expenses that exceed this duration, it points out that there is no prohibition to the contract’s deadline extension made after its expiration, provided that certain conditions are fulfilled.
Improbidade administrativa por dispensa indevida de licitação: sobre os efeitos da desatualização dos valores limites para dispensa de licitação
Authors: Cristóvam José Sérgio da Silva , Silva Eliza Maria da 
Published: October 2018

Administrative improbity due to improper waiver of bidding: on the effects of the devaluation of limit values for waiver of bidding O presente estudo pretende analisar o conceito de dispensa de licitação em razão do valor ante o fator de instabilidade econômica a ela inerente, observando as normas constitucionais e infraconstitucionais vigentes. Para tanto, discutem-se os parâmetros de dosagem e configuração do ato de improbidade por dispensa indevida de licitação (ante a necessidade de atualização dos valores limites das modalidades licitatórias), bem como as sanções e penalidades dela decorrentes. Prima-se, nessa análise, pelo debate pautado em parâmetros como a razoabilidade e a proporcionalidade, segundo os quais são incluídas, necessariamente, a análise conjunta das normas que prescrevem o ilícito administrativo (pelo viés unificado do ordenamento jurídico), bem como a valoração da lesividade da conduta — conduzida pelos ditames do princípio da insignificância. O método utilizado é o dedutivo e monográfico, e a técnica de pesquisa é bibliográfica. This study intends to analyze the concept of waiver of bidding due to the value under the light of its inherent fact of economic instability, observing the constitutional and infra-constitutional current regulations. For so, it is discussed the parameters of dosing and configuration of the improbity act for improper waiver of bidding (towards the need of the limit values actualization for bidding modalities), and its stemming sanctions and penalties. This analysis excels the debate founded on the reasonableness and proportionality parameters, in what are included, necessarily, the joint analysis of the norms that prescribe the ilegal administrative (by the unified bias of legal system), as well as the valuation of conduct lesivity — led by the precepts from the principle of insignificance. The method and technique used are, respectively, the deductive and monographic, and the bibliographic research.
A indispensável coisa julgada administrativa
Authors: Moreira Egon Bockmann , Gomes Gabriel Jamur 
Published: October 2018

The indispensable administrative preclusion (res judicata) O artigo revisa e reelabora o conceito de coisa julgada administrativa, compatibilizando-o com a realidade constitucional brasileira. Além disso, verifica seus parâmetros de aplicabilidade, bem como os precedentes do Supremo Tribunal Federal (STF) e do Superior Tribunal de Justiça (STJ) acerca da matéria. The article reviews and re-elaborates the concept of administrative res judicata, making it compatible with the Brazilian constitutional reality. Besides, the article verifies its applicability parameters, and the precedents of the Federal Supreme Court (STF) and the Superior Court of Justice (STJ).
DomainBuilder: the knowledge authoring system for SlideTutor Intelligent Tutoring system
Authors: Tseytlin Eugene , Linkov Faina , Castine Melissa , Legowski Elizabeth , Jacobson Rebecca S. 
Published: October 2018

One of the major challenges in the development of medical Intelligent Tutoring Systems (ITS) is the development of authored content, a time-consuming process that requires participation of discipline experts. In this publication, we describe the development of software systems called DomainBuilder and TutorBuilder, designed to streamline and simplify the authoring process for general medical ITSs. The aim of these systems is to allow physicians without programming or ITSs background to create a domain knowledge base and author tutor cases in a time efficient manner. DomainBuilder combined knowledge authoring, case authoring, and validation tasks into a single work environment, enabling multiple authoring strategies. Natural Language Processing (NLP) methods were integrated for parsing existing clinical reports to speed case authoring. Similarly, TutorBuilder was designed to allow users to customize all aspects of ITSs, including user interface, pedagogic module, feedback module, etc. Both systems underwent formal usability studies with physicians specializing in dermatology. Open-ended questions assessed usability of the system and satisfaction with its features. Incorporating feedback from usability studies, DomainBuilder and TutorBuilder systems were deployed and used across multiple universities to create customized medical tutoring curriculum. Overall, both systems were well received by medical professionals participating in usability studies with participants highlighting ease of utilization and clarity of presentation. Usability study participants were able to successfully use the system for the authoring tasks. DomainBuilder and TutorBuilder are novel tools that combine comprehensive aspects of content creation, including creation of domain ontologies, case authoring, and validation.