bluuebunny/crossref_metadata_2025_split huggingface dataset:
Needs-based provision of medical care to nursing home residents: protocol for a mixed-methods study
Authors: Czwikla Jonas , Schulz Maike , Heinze Franziska , Kalwitzki Thomas , Gand Daniel , Schmidt Annika , Tsiasioti Chrysanthi , Schwinger Antje , Kloep Stephan , Schmiemann Guido , Wolf-Ostermann Karin , Gerhardus Ansgar , Rothgang Heinz 
Published: August 2019

IntroductionNursing home residents typically have greater needs for medical care than community-dwelling elderly. However, restricted cognitive abilities and limited mobility may impede their access to general practitioners and medical specialists. The provision of medical care in nursing homes may therefore be inappropriate in some areas of medical care. The purpose of this mixed-methods study is to systematically assess, evaluate and explain met and unmet medical care needs in German nursing homes and to develop solutions where medical care is found to be inappropriate.Methods and analysisFirst, statutory health insurance claims data are analysed to identify differences in the utilisation of medical care between nursing home residents and community-dwelling elderly with and without need for long-term care. Second, the health status and medical care of 500 nursing home residents are assessed and evaluated to quantify met and unmet medical care needs. Third, qualitative expert interviews and case conferences and, fourth, quantitative analyses of linked data are used to provide structural, case-specific and generalisable explanations of inappropriate medical care among nursing home residents. Fifth, a modified Delphi study is employed to develop pilot projects aiming to improve medical care in nursing homes.Ethics and disseminationThis study was approved by the Ethics Committee of the University of Bremen on 23 November 2017. Research findings are disseminated through presentations at national and international conferences and publications in peer-reviewed scientific journals.Trial registration numberDRKS00012383.
Observational study to assess the effects of social networks on the seasonal influenza vaccine uptake by early career doctors
Authors: Edge Rhiannon , Keegan Thomas , Isba Rachel , Diggle Peter 
Published: August 2019

ObjectivesTo evaluate the effect of social network influences on seasonal influenza vaccination uptake by healthcare workers.DesignCross-sectional, observational study.SettingA large secondary care NHS Trust which includes four hospital sites in Greater Manchester.ParticipantsFoundation doctors (FDs) working at the Pennine Acute Hospitals NHS Trust during the study period. Data collection took place during compulsory weekly teaching sessions, and there were no exclusions. Of the 200 eligible FDs, 138 (70%) provided complete data.Primary outcome measuresSelf-reported seasonal influenza vaccination status.ResultsAmong participants, 100 (72%) reported that they had received a seasonal influenza vaccination. Statistical modelling demonstrated that having a higher proportion of vaccinated neighbours increased an individual’s likelihood of being vaccinated. The coefficient for γ, the social network parameter, was 0.965 (95% CI: 0.248 to 1.682; odds: 2.625 (95% CI: 1.281 to 5.376)), that is, a diffusion effect. Adjusting for year group, geographical area and sex did not account for this effect.ConclusionsThis population exhibited higher than expected vaccination coverage levels–providing protection both in the workplace and for vulnerable patients. The modelling approach allowed covariate effects to be incorporated into social network analysis which gave us a better understanding of the network structure. These techniques have a range of applications in understanding the role of social networks on health behaviours.
Does parental concern about their child’s future risk of overweight vary by their ethnic background? Cross-sectional analysis of a national cohort study
Authors: Firman Nicola , Dezateux Carol 
Published: August 2019

ObjectivesChildren from South Asian ethnic backgrounds are at increased risk of obesity and its associated future health risks; however, evidence is lacking as to whether parental concern about their child’s future overweight risk varies by ethnic background. We hypothesised that parents of 5-year-old children from South Asian backgrounds would be more likely to express such concerns.DesignCross-sectional.SettingUK.Participants15 039 singleton 5-year-old Millennium Cohort Study participants (48.9% girls; 86.7% White).Primary outcome measureParent-reported concern (some/none) about future overweight risk.MethodsWe estimated the adjusted ORs (aORs) of some parental concern (ranging from a little to very concerned) by child’s ethnic background (reference group: White), adjusted for parent and child weight status, and child sex.ResultsParents of girls from Pakistani (aOR 0.4; 95% CI 0.2 to 0.5), Bangladeshi (0.3; 0.2 to 0.5), Black African (0.5; 0.3 to 0.7) and Mixed (0.7; 0.5 to 0.99) ethnic backgrounds and of boys from Pakistani ethnic backgrounds (0.6; 0.4 to 0.9) were less likely to report concern about their child’s future overweight risk than parents of White girls and boys, respectively. Overweight (2.5; 2.2 to 2.8) and obesity (6.7; 5.7 to 7.9) in children, and overweight (1.4; 1.2 to 1.5) and obesity (1.9; 1.7 to 2.2) in parents, were associated with increased likelihood of concern.ConclusionsParents of children from South Asian ethnic backgrounds express less concern about their child’s future overweight risk. Qualitative studies are needed to understand the concerns of parents from different ethnic backgrounds to inform weight-management interventions in ethnically diverse populations.
Cognitive training and neuroplasticity in mild cognitive impairment (COG-IT): protocol for a two-site, blinded, randomised, controlled treatment trial
Authors: D'Antonio Jessica , Simon-Pearson Laura , Goldberg Terry , Sneed Joel R , Rushia Sara , Kerner Nancy , Andrews Howard , Hellegers Caroline , Tolbert Sierra , Perea Elena , Petrella Jeffrey , Doraiswamy Murali , Devanand Davangere 
Published: August 2019

IntroductionMild cognitive impairment (MCI) is common in older adults and represents a high-risk group for progression to Alzheimer’s disease (AD). Medication trials in MCI have generally failed, but new discoveries with brain plasticity in ageing have led to the study of cognitive training as a potential treatment to improve cognitive abilities. Computerised cognitive training (CCT) involves computerised cognitive exercises that target specific cognitive abilities and neural networks to potentially improve cognitive functioning through neuroplasticity.Methods and analysisIn a two-site study (New York State Psychiatric Institute/Columbia University Medical Center and Duke University Medical Center), we will randomise 100 patients with MCI (Wechsler Memory Scale-III Logical Memory II score 0–11; Folstein Mini Mental State Examination ≥23) to home-based CCT (suite of exercises: memory, matching, spatial recognition, processing speed) or a home-based active control condition (computerised crossword puzzle training (CPT)) with 12 weeks of intensive training followed by regular booster sessions up to 78 weeks. All patients will receive standard neuropsychological and functional assessments in clinic as well as structural/functional brain MRI scans at study entry and endpoint. We will test if CCT, versus CPT, leads to improved cognitive functioning, transfers to functional ability and tasks of everyday life and impacts hippocampal volume changes and changes in the default mode network of the brain measured by resting-state functional MRI.Ethics and disseminationThe study will be conducted following ethics approval and written informed consent will be obtained from all subjects. Study results will be disseminated via publication, clinicaltrials.gov, media and conference presentations. This will be the first controlled long-term trial to evaluate the effects of home-based CCT versus computerised CPT on cognitive abilities and functional measures and neural outcomes as determined by MRI indices in patients with MCI. Positive results from trial may support further development of home-based CCT.Trial registration numberClinicalTrials.gov identifier (NCT03205709).
Lymphoedema in advanced cancer: does subcutaneous needle drainage improve quality of life?
Authors: Landers Amanda , Holyoake Julia 
Published: August 2019

PurposeLower limb lymphoedema in the palliative care population has limited treatment options. Subcutaneous needle drainage is an underused procedure that has previously been described in the literature for refractory lymphoedema. This study will quantify the potential improvements to quality of life and the adverse outcomes for this group of patients.MethodsThis was a multicentre, non-randomised, observational trial using a validated questionnaire before and after the procedure. A tailored mobility measurement was also used. It extends a published pilot previously undertaken.ResultsThirty-two procedures were performed on 31 patients across three sites. The average drainage volume was 5.5 L. The domain of appearance (3.2 vs 2.8 vs 2.6) improved significantly and was sustained. All of the domains, except appearance, showed a significant improvement at 2 weeks. The cellulitis rate was 6%.ConclusionSubcutaneous needle drainage appears to improve quality of life in those with lower limb lymphoedema facing a life-limiting illness.
First pass effect with contact aspiration and stent retrievers in the Aspiration versus Stent Retriever (ASTER) trial
Authors: Ducroux Célina , Piotin Michel , Gory Benjamin , Labreuche Julien , Blanc Raphael , Ben Maacha Malek , Lapergue Bertrand , Fahed Robert 
Published: August 2019

BackgroundThe ‘first pass effect’ (FPE), which was originally described with stent retrievers, designates a (near-)complete revascularization obtained after a single device pass with no rescue therapy, and is associated with improved clinical outcome and decreased mortality.ObjectiveWe report the rate and benefits of FPE in the Aspiration versus Stent Retriever (ASTER) trial.Materials and methodsASTER is a randomized trial comparing angiographic revascularization with the stent retriever (SR) and contact aspiration (CA) thrombectomy techniques, assessed by an external core laboratory using the modified Thrombolysis in Cerebral Infarction (mTICI) scale. Rates of FPE (defined by mTICI 2c/3 after a single pass with no rescue therapy) were compared between patients treated with SR and CA techniques. Outcomes were compared between FPE-SR and FPE-CA patients, and between FPE and non-FPE patients.ResultsFPE was achieved in 97/336 patients (28.9%), with no significant difference between SR and CA (respectively 53/169 patients (31.3%) vs 44/167 patients (26.3%), adjusted RR for CA versus SR 0.84, 95% CI 0.54 to 1.31; p=0.44). After prespecified adjustment for allocated arm and randomization stratification factors, FPE in patients was associated with a significantly improved clinical outcome and a decreased mortality, and a significantly lower rate of hemorrhagic transformation and procedural complications than in non-FPE patients.ConclusionIn the ASTER trial, similar rates of FPE were achieved with SR and CA, and FPE was associated with a significantly improved outcome. New techniques and devices to improve the rate of FPE are warranted.Trial registration numberUnique identifier:NCT02523261.
Q-switched all-fiber laser based on MoSe2 films with chemical vapor deposition method
Authors: Zhang Xin , Yao Yanli , Wang Shubin , Ma Guoli , Lei Ming , Liu Wenjun 
Published: August 2019

In this work, MoSe2 film is synthesized by the chemical vapor deposition method. Saturable absorber (SA) is assembled with the tapered fiber and MoSe2 films. Q-switched operation is achieved with the MoSe2-based SA. The experimental result reveals that the MoSe2-based SA has excellent saturable absorption characteristic with 23.41% modulation depth. When the pump power is greater than 289.2[Formula: see text]mW, Q-switched all-fiber lasing action is demonstrated. The repetition rate of the Q-switched pulses varies from 185.6 to 252.8[Formula: see text]kHz. The shortest pulse duration is 801.9[Formula: see text]ns, and the largest output energy is 69.3[Formula: see text]nJ. Results indicate that MoSe2 films can provide new opportunities for large-modulation-depth optical modulators in ultrafast photonics.
INFLUENCE OF FOOT INSOLE ON THE GAIT PERFORMANCE IN SUBJECTS WITH FLAT FOOT DISORDER
Authors: KARIMI M. T. , TAHMASEBI R. B. , SATVATI B. , FATOYE F. 
Published: August 2019

Flat foot is the most common foot disorder that influences the alignment of the lower limb structure. It is controversial whether the use of foot insole influences kinetic and kinematic of the leg or not. Therefore, this study investigated the influence of foot insole on the gait performance in subjects with flat foot disorder.A group of flat foot subject was recruited into this study (the number of subjects was 15). The motion of the leg joints was determined using the Qualysis motion analysis system. Moreover, the force applied on the lower limb was recorded by a Kistler force plate. The range of motion of the lower limb joints, the moments applied on the lower limb joints and force transmitted through the leg were the parameters used in this study. The difference between these parameters during walking with and without insole was evaluated using the paired [Formula: see text]-test. Significant value was set at [Formula: see text].There was no significant difference between the range of motion of ankle joint while walking with and without insole. However, the medial directed force applied on the leg decreased significantly [Formula: see text]. The use of foot insole did not influence the moments transmitted through the hip and knee joints. The walking speed of the subjects improved while walking with foot insole.Use of foot insole influenced the magnitude of the force applied on the leg and the adductor moment of ankle joint due to its influence on foot alignment. As the walking speed of the improved subjects follows the use of insole, it can be concluded that it may have a positive effects on the performance of flat foot subjects.
Future Prospects for Particle Therapy Accelerators
Authors: Myers S. , Degiovanni A. , Farr J. B. 
Published: August 2019

Particle therapy is the expanding radiotherapy treatment option of choice for cancer. Its cost, however, is currently hindering its worldwide expansion. Also, the ideal application of particle therapy is restricted by a series of unsolved technical challenges. Both the cost and technical limitations are directly traceable to dependence on legacy accelerators and their associated treatment possibilities. This chapter is written to address these needs. Firstly, a technical overview is presented of photon and particle therapy for cancer tumours. Secondly, the underlying limitations of the existing legacy systems are identified, especially those related to accelerators, and suggestions are made for current and future developments to address these shortcomings. The legacy systems referred to here are of the slow scanning variety using large, circular accelerators.This paper also attempts to make a scientific comparison of the various types of accelerators currently used or being developed for particle therapy.The following procedure is pursued to perform a comparison between various types of accelerators:(1)The parameters which are pertinent to particle therapy accelerators (‘specified parameters’) are identified from clinical efficiency and overall cost considerations.(2)The range and values of ‘specified parameters’ associated with each type of particle therapy accelerator are identified.(3)A comparison is made on the best match between the various types of accelerators for each of the ‘specified parameters,’ i.e., the best in class accelerator, when compared to each criterion.(4)Based on this match, an overall conclusion is made on the type of accelerator which best fits the needs for particle therapy.
Le personnage-prostitué dans quatre romans contemporains
Authors: Nankeu Bernard Bienvenu 
Published: August 2019

À l’aune de la poétique du personnage, notamment en tant que socle sur lequel repose la narration pour gagner en vraisemblance en traitant des questions qui relèvent de la condition humaine, cet article est une lecture de L’Immeuble Yacoubian (Alaa El Awany), Place des fêtes (Sami Tchak), Ève de ses décombres (Ananda Dévi) et La chair du maître (Dany Laferrière), sous l’angle des usages de la prostitution que ces romans représentent ou figurent. Il apparaît alors que l’on a affaire à des personnages-thèmes tels que la concubine, la libertine, l’absentéiste, la fille de rue et le beach boy, tous imaginés dans la perspective de mettre en lumière des états d’esprit et des états de société.
Internal Versus External Electrical Cardioversion of Atrial Arrhythmia in Patients With Implantable Cardioverter-Defibrillator
Authors: Lüker Jakob , Kuhr Kathrin , Sultan Arian , Nölker Georg , Omran Hazem , Willems Stephan , Andrié René , Schrickel Jan W. , Winter Stefan , Vollmann Dirk , Tilz Roland R. , Jobs Alexander , Heeger Christian-H. , Metzner Andreas , Meyer Sven , Mischke Karl , Napp Andreas , Fahrig Andreas , Steinhauser Susanne , Brachmann Johannes , Baldus Stephan , Mahajan Rajiv , Sanders Prashanthan , Steven Daniel 
Published: August 2019

Background:
Atrial arrhythmias are common in patients with implantable cardioverter-defibrillator (ICD). External shocks and internal cardioversion through commanded ICD shock for electrical cardioversion are used for rhythm-control. However, there is a paucity of data on efficacy of external versus internal cardioversion and on the risk of lead and device malfunction. We hypothesized that external cardioversion is noninferior to internal cardioversion for safety, and superior for successful restoration of sinus rhythm.

Methods:
Consecutive patients with ICD undergoing elective cardioversion for atrial arrhythmias at 13 centers were randomized in 1:1 fashion to either internal or external cardioversion. The primary safety end point was a composite of surrogate events of lead or device malfunction. Conversion of atrial arrhythmia to sinus rhythm was the primary efficacy end point. Myocardial damage was studied by measuring troponin release in both groups.

Results:

N=230 patients were randomized. Shock efficacy was 93% in the external cardioversion group and 65% in the internal cardioversion group (
P
<0.001). Clinically relevant adverse events caused by external or internal cardioversion were not observed. Three cases of pre-existing silent lead malfunction were unmasked by internal shock, resulting in lead failure. Troponin release did not differ between groups.

Conclusions:
This is the first randomized trial on external vs internal cardioversion in patients with ICDs. External cardioversion was superior for the restoration of sinus rhythm. The unmasking of silent lead malfunction in the internal cardioversion group suggests that an internal shock attempt may be reasonable in selected ICD patients presenting for electrical cardioversion.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT03247738.
A Stairway to Heaven? Jacob’s Dream in Genesis 28:10-22
Authors: van Wolde Ellen 
Published: August 2019

AbstractThe question implied in the title of this article “A stairway to heaven?” in reference to Genesis 28:10-22 can be answered negatively. The word סלם does not designate a ladder or a stairway, since it has no steps. It is not even set up to heaven. It is, first of all, the gradient access road of a city, envisioned here as a descent road built from the top downwards, leading from the city of gods to the earth.
Validation of Animal Models for Simulation Training in Pediatric Laryngotracheal Reconstruction
Authors: Okhovat Saleh , Milner Thomas D. , Clement William A. , Wynne David M. , Kunanandam Thushitha 
Published: August 2019

Objectives: To assess and compare the face (FV) and content validity (CV) of three ex vivo animal models for simulation training in pediatric laryngotracheal reconstruction (LTR). Methods: Feasibility of performing LTR was assessed on the head and neck of three different animals (lamb/suckling-pig/rabbit) and laryngeal dimensions and qualitative observations were recorded. A 19-item five-point Likert scale questionnaire was completed for each model to assess FV and CV. Data was prospectively collected and analyzed using descriptive and nonparametric statistics. Results: All three models were suitable for LTR simulation with laryngeal dimensions corresponding to 0-2 years (rabbit), 5-10 (pig) and >10 years (lamb model). Five trainees and five expert pediatric otolaryngologists performed LTR on each model. The overall median FV score was 5 for the lamb model (IQR 4-5), 3 for the rabbit (IQR 2-3), and 4 for the pig (IQR 4-4). The overall median CV score was 5 for the lamb (IQR 5-5), 2 for the rabbit (IQR 2-3), and 4 for the pig model (IQR 4-4). Comparison of the models demonstrated the lamb to be favored as the most realistic and practical model for simulation training in pediatric LTR, with both the lamb and the porcine model attaining validation thresholds. Conclusion: Our study is the first comparative validation assessment of animal models for use in pediatric LTR simulation and it supports the use of ex vivo lamb and porcine models for use in LTR surgical skills training. The lamb model was the favored simulation model while the rabbit was considered inferior for simulation training in pediatric LTR. Level of Evidence: 3b