bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient’s perspective on improving the quality of acute medical care: determining patient reported outcomes
Authors: Kremers Marjolein N T , Zaalberg Tessel , van den Ende Eva S , van Beneden Marlou , Holleman Frits , Nanayakkara Prabath W B , Haak Harm R 
Published: September 2019

RationaleThere is an increasing societal demand for quality assurance and transparency of medical care. The American National Academy of Medicine has determined patient centredness as a quality domain for improvement of healthcare. While many of the current quality indicators are disease specific, most emergency department (ED) patients present with undifferentiated complaints. Therefore, there is a need for generic outcome measures. Our objective was to determine relevant patient reported outcomes (PROs) for quality measurement of acute care.MethodsWe conducted semistructured interviews in patients ≥18 years presenting at the ED for internal medicine. Patients with a cognitive impairment or language barrier were excluded. Interviews were analysed using qualitative content analysis.ResultsThirty patients were interviewed. Patients reported outcomes as relevant in five domains: relief of symptoms, understanding the diagnosis, presence and understanding of the diagnostic and/or therapeutic plan, reassurance and patient experiences. Experiences were often mentioned as relevant to the perceived quality of care and appeared to influence the domain reassurance.ConclusionWe determined five domains of relevant PROs in acute care. These domains will be used for developing generic patient reported measures for acute care. The patients’ perspective will be incorporated in these measures with the ultimate aim of organising truly patient-centred care at the ED.
Metabolic Activity in Central Neural Structures of Patients With Myocardial Injury
Authors: Fiechter Michael , Roggo Andrea , Haider Ahmed , Bengs Susan , Burger Irene A. , Marędziak Monika , Portmann Angela , Treyer Valerie , Becker Anton S. , Messerli Michael , Mühlematter Urs J. , Kudura Ken , von Felten Elia , Benz Dominik C. , Fuchs Tobias A. , Gräni Christoph , Pazhenkottil Aju P. , Buechel Ronny R. , Kaufmann Philipp A. , Gebhard Catherine 
Published: September 2019

Background
Increasing evidence suggests a psychosomatic link between neural systems and the heart. In light of the growing burden of ischemic cardiovascular disease across the globe, a better understanding of heart‐brain interactions and their implications for cardiovascular treatment strategies is needed. Thus, we sought to investigate the interaction between myocardial injury and metabolic alterations in central neural areas in patients with suspected or known coronary artery disease.

Methods and Results

The association between resting metabolic activity in distinct neural structures and cardiac function was analyzed in 302 patients (aged 66.8±10.2 years; 70.9% men) undergoing fluor‐18‐deoxyglucose positron emission tomography and
99m
Tc‐tetrofosmin single‐photon emission computed tomography myocardial perfusion imaging. There was evidence for reduction of callosal, caudate, and brainstem fluor‐18‐deoxyglucose uptake in patients with impaired left ventricular ejection fraction (<55% versus ≥55%:
P
=0.047,
P
=0.022, and
P
=0.013, respectively) and/or in the presence of myocardial ischemia (versus normal perfusion:
P
=0.010,
P
=0.013, and
P
=0.016, respectively). In a sex‐stratified analysis, these differences were observed in men, but not in women. A first‐order interaction term consisting of sex and impaired left ventricular ejection fraction or myocardial ischemia was identified as predictor of metabolic activity in these neural regions (left ventricular ejection fraction:
P
=0.015 for brainstem; myocardial ischemia:
P
=0.004,
P
=0.018, and
P
=0.003 for callosal, caudate, or brainstem metabolism, respectively).

Conclusions
Myocardial dysfunction and injury are associated with reduced resting metabolic activity of central neural structures, including the corpus callosum, the caudate nucleus, and the brainstem. These associations differ in women and men, suggesting sex differences in the pathophysiological interplay of the nervous and cardiovascular systems.
Aircraft Observations of Tropical Cyclone Boundary Layer Turbulence over the South China Sea
Authors: Sparks N. , Hon K. K. , Chan P. W. , Wang S. , Chan J. C. L. , Lee T. C. , Toumi R. 
Published: September 2019

Abstract
There have been no high-frequency aircraft observations of tropical cyclone (TC) eyewall boundary layer turbulence since two flights into Atlantic hurricanes in the 1980s. We present an analysis of the first TC boundary layer flight observations in the South China Sea by the Hong Kong Observatory comprising four eyewall penetrations. We derive the vertical flux of momentum and vertical momentum diffusivity from observed turbulence parameters. We observe negative (upward) vertical fluxes of tangential momentum near the eyewall consistent with a jet below the flight level near the radius of maximum wind. Our observations of vertical momentum diffusivity support a superlinear relationship between diffusivity and wind speed at the high wind speeds in the inner-core of TCs (power-law exponent of 1.73 ± 0.20) while the few existing boundary layer hurricane observations in the North Atlantic suggest a more linear relationship.
Scanning Electron Microscopy in the Evaluation of Defects to the Ossicular Chain in the Course of Chronic Otitis Media
Authors: Wiatr Agnieszka , Swiezy Katarzyna , Skladzien Jacek , Wiatr Maciej 
Published: September 2019

Objective: Chronic otitis media is a heterogeneous disorder. Chronic suppurative otitis media with cholesteatoma and, to a lesser extent, chronic otitis media with granulation lead to the destruction of bone structures within the middle ear. Bone loss may appear in the prominence of the horizontal semicircular canals and the bony canal of the facial nerve. The inflammatory process may spread to the bony labyrinth of the sigmoidal sinuses and the cranial cavities. Materials and Methods: The analysis comprised the examination of fragments of auditory ossicles removed during surgery in 21 patients with various types of chronic inflammation of the middle ear. The purpose of this study was to evaluate the usefulness of scanning electron microscopy in evaluating the erosion of middle ear ossicles in different types of chronic otitis media. Images captured at various magnifications were used for the best possible illustration of the observed lesions in bone tissue. Results: The observed lesions and the degree of bone surface damage were dependent on the type of chronic inflammation of the middle ear. The largest destructive changes in the ossicular chain were observed in chronic otitis media with cholesteatoma; smaller changes were observed in chronic otitis media with granulation. Conclusion: In the case of damage to the ossicles inflicted by inflammation, the use of a modeled bone block made of a temporal bone taken from outside the tympanic cavity or a biomaterial prosthesis is a good choice in ossiculoplasty.
Vestibular Evoked Myogenic Potentials in Patients With Low Vitamin B12 Levels
Authors: Özdemir Doğukan , Mehel Dursun Mehmet , Küçüköner Ömer , Ağrı İbrahim , Yemiş Tuğba , Akgül Gökhan , Özgür Abdulkadir 
Published: September 2019

Objective: Vitamin B12 deficiency-induced hyperhomocysteinemia has been associated with impaired microarterial flow, demyelization, and neuronal damage, resulting in cochlear damage and auditory dysfunction. Therefore, we aimed to evaluate the possible vestibular-evoked myogenic potential (VEMP) abnormalities in patients with vitamin B12 deficiency. Material and Method: In this prospective study, 37 patients diagnosed with vitamin B12 deficiency (<220 pg/mL) were compared with 31 audiologically healthy participants with normal B12 levels. Burst-evoked cervical VEMP (cVEMP) measurements were performed on all participants. Additionally, cVEMP responses were analyzed for P1-N1 latency, interpeak amplitude, and amplitude asymmetry ratio. The results of audiometric examination and VEMP records as well as absent responses were evaluated and compared between groups. Results: The rate of absent VEMP responses was twice as high in the patient group than in the healthy control group (12 vs 6 cases, respectively). Moreover, the mean values of interpeak amplitude in both right and left ears were statistically shorter in the patient group than the control group ( P values = .024 and .007, respectively). Similarly, the mean amplitude asymmetry ratio was statistically higher in the patient group than the control group ( P = .050). There were no statistically significant differences in latency responses between groups. Furthermore, positive, statistically significant correlation was detected between values of the left P1-N1 interpeak amplitude and vitamin B12 levels ( r = 0.287, P = .037). Conclusions: Increased rates of absent VEMPs and decreased amplitudes with normal latencies are attributed to peripheral vestibular hypofunction in patients with vitamin B12 deficiency.
What is ‘moral distress’ in nursing? A feminist empirical bioethics study
Authors: Morley Georgina , Bradbury-Jones Caroline , Ives Jonathan 
Published: September 2019

Background The phenomenon of ‘moral distress’ has continued to be a popular topic for nursing research. However, much of the scholarship has lacked conceptual clarity, and there is debate about what it means to experience moral distress. Moral distress remains an obscure concept to many clinical nurses, especially those outside of North America, and there is a lack of empirical research regarding its impact on nurses in the United Kingdom and its relevance to clinical practice. Research aim To explore the concept of moral distress in nursing both empirically and conceptually. Methodology Feminist interpretive phenomenology was used to explore and analyse the experiences of critical care nurses at two acute care trauma hospitals in the United Kingdom. Empirical data were analysed using Van Manen’s six steps for data analysis. Ethical considerations The study was approved locally by the university ethics review committee and nationally by the Health Research Authority in the United Kingdom. Findings The empirical findings suggest that psychological distress can occur in response to a variety of moral events. The moral events identified as causing psychological distress in the participants’ narratives were moral tension, moral uncertainty, moral constraint, moral conflict and moral dilemmas. Discussion We suggest a new definition of moral distress which captures this broader range of moral events as legitimate causes of distress. We also suggest that moral distress can be sub-categroised according to the source of distress, for example, ‘moral-uncertainty distress’. We argue that this could aid in the development of interventions which attempt to address and mitigate moral distress. Conclusion The empirical findings support the notion that narrow conceptions of moral distress fail to capture the real-life experiences of this group of critical care nurses. If these experiences resonate with other nurses and healthcare professionals, then it is likely that the definition needs to be broadened to recognise these experiences as ‘moral distress’.
Impact of Hospice on Spending and Utilization Among Patients With Lung Cancer in Medicare
Authors: Kalidindi Yamini , Segel Joel , Jung Jeah 
Published: September 2019

Objectives: To compare patterns and understand drivers of spending and utilization by month in the last 6 months of life between patients with lung cancer who used hospice versus those who did not. Study Design: Retrospective cohort analysis using 2009 to 2013 Medicare claims. Methods: We used a 10% random sample of Medicare fee-for-service beneficiaries with lung cancer who died between 2010 and 2013 (43 789 beneficiaries). Patients were assigned to 2 groups depending on whether they used hospice care in the last 6 months of life. The following outcomes were constructed by month: (1) all-cause Medicare spending, (2) indicator of hospitalization, (3) indicator of emergency department (ED) visit, (4) number of part B chemotherapy claims, and (5) number of radiation therapy sessions. We used a combination of propensity score matching and regression analysis to compare outcomes between the 2 groups. Results: Patients who used hospice had significantly lower spending in the last month of life compared to nonusers (US$16 907 vs US$26 906, P < .00). The spending differences in the last month of life between the 2 groups were largely driven by lower likelihood of hospitalization (54% vs 80%, P < .01) and ED visits (15% vs 22%, P < .01) and fewer chemotherapy (0.12 vs 0.32, P < .01) and radiation therapy sessions (0.80 vs 1.26, P < .01). During the other months in the 6-month period, spending was similar between the 2 groups. Conclusions: Timely hospice enrollment of patients with lung cancer—the group suffering from high morbidity and mortality among patients with cancer—may lead to significant cost savings.
Emerging Contribution of Histopathology to Our Understanding of Chronic Rhinosinusitis Endotypes: Tissue Eosinophil Count and Aggregates
Authors: Brescia Giuseppe , Alessandrini Lara , Parrino Daniela , Franz Leonardo , Barion Umberto , Marioni Gino 
Published: September 2019

Background Rhinologists are currently trying to find evidence useful for classifying chronic rhinosinusitis with nasal polyps (CRSwNP) in terms of pathophysiology-based endotypes. This would help us to tailor targeted therapies and follow-up protocols to each patient, improving treatment efficacy and reducing relapse risk. The histopathological study of inflammatory cells in tissue and their tendency to form aggregates has shown promise in determining the pathogenesis and predicting the clinical outcome. Objective The main purpose of this study was to assess tissue eosinophil count, eosinophil aggregation, and their relationship to different CRSwNP phenotypes. Methods A consecutive series of 96 patients who underwent endoscopic sinus surgery for CRSwNP was retrospectively assessed. Our structured histopathological approach considered eosinophil count and eosinophil aggregates. Results Patients’ clinical features included allergic fungal rhinosinusitis (AFRS) in 17 cases, nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (NERD) in 19 cases, intrinsic asthma in 18 cases, extrinsic asthma in 21 cases, and allergy in 21 cases. Statistical analysis revealed more eosinophil aggregates in patients with NERD than in those with AFRS ( P = .020), intrinsic asthma ( P = .019), or extrinsic asthma ( P = .029). NERD patients had a significantly higher tissue eosinophil count than the other groups considered, apart from the AFRS ones. AFRS patients had a higher tissue eosinophil count than patients with intrinsic asthma. Conclusion Our results showed in particular that the NERD patient group’s rhinosinusitis was sustained by a significantly more severe eosinophilic reaction than in the other groups. Structured histopathology can provide useful information for classifying CRSwNP on pathophysiological grounds.
Effect of thoracic and pelvic anteroposterior diameters on spinal sagittal alignment
Authors: Heo Jeong , Min Woo-Kie , Min Seung-Gi , Kim Kyung-Rok 
Published: September 2019

Purpose: This study aimed to analyze the effect of the thoracic anteroposterior diameter (TAPD) and pelvic anteroposterior diameter (PAPD) on global sagittal alignment in asymptomatic patients with normal sagittal alignment. Patient sample: The study investigated 2042 adult patients who initially presented at our hospital with a hip and knee problem without history of symptoms related to the entire spine. Only 57 patients with normal global sagittal alignment (C2–7 sagittal vertical axis (SVA) and C7–S1 SVA of <10 mm) were considered. Methods: The whole-spine standing lateral radiographs were obtained to analyze the following parameters: pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic inlet angle (TIA), T1 slope, cervical spinal parameters (angle of C0–2, C2–7, and C0–7), TAPD, and PAPD. Statistical analysis was performed using Pearson correlation coefficients and multiple regression analyses. Results: All the parameters showed a normal distribution. TAPD had a significant relationship with thoracic kyphosis (TK; r = 0.458), TIA ( r = 0.677), and C0–2 angle ( r = 0.294) but no significant relationship with T1 slope and other cervical parameters. PAPD had a significant relationship with PI ( r = 0.309) and PT ( r = 0.463) but no significant relationship with LL, SS, and TK. The multiple regression analysis showed that TIA = 21.974 + 0.405 (TK) + 0.188 (TAPD) ( p < 0.0001). Conclusions: TAPD and PAPD are associated with TIA, TK, C0–2 angle, PI, and PT, all of which act as key factors in spinal sagittal alignment. Although they did not directly correlate with other cervical parameters, T1 slope, and LL, TAPD and PAPD might have indirect effects on cervical and lumbar spinal sagittal alignment through their relationships with TIA, TK, and PI.
CXCR4
S338X clonality is an important determinant of ibrutinib outcomes in patients with Waldenström macroglobulinemia
Authors: Gustine Joshua N. , Xu Lian , Tsakmaklis Nicholas , Demos Maria G. , Kofides Amanda , Chen Jiaji G. , Liu Xia , Munshi Manit , Guerrera Maria Luisa , Chan Gloria G. , Patterson Christopher J. , Keezer Andrew , Meid Kirsten , Dubeau Toni , Yang Guang , Hunter Zachary R. , Treon Steven P. , Castillo Jorge J. 
Published: September 2019

Key Points
CXCR4 S338X clonality ≥25% is associated with lower very good partial response and shorter progression-free survival to ibrutinib. CXCR4 S338X clonality assessment represents a novel biomarker to predict outcomes to ibrutinib in Waldenström macroglobulinemia patients.
A avaliação da atuação da colonoscopia no tratamento do volvo colônico
Authors: Ferreira Lucas Fortes Portela , Ferreira Filho Francisco , Ferreira Amanda Fortes Portela , Lopes Victor Valente 
Published: September 2019

Objetivo: por meio dessa revisão sistemática qualitativa, objetivamos esclarecer qual o papel atual do endoscopista no volvo colônico. Métodos: a pesquisa da literatura foi realizada via PUBMED on-line bancos de dados de janeiro de 2004 a maio de 2017 com os termos "Intestinal Volvulus"[MeSH], "Colonoscopy"[Majr] e adult [MeSH]. Resultados: inicialmente, as estratégias de pesquisa acima mencionadas resultaram em 23 referências. Depois, com base nos critérios de elegibilidade, foram excluídas 12 referências, e 11 foram incluídas. Conclusão: desde a introdução da distorção endoscópica na década de 1940, essa abordagem, juntamente com a ressecção subsequente, tornou-se a principal modalidade terapêutica. A descompressão endoscópica é aceita como o tratamento primário do volvo colônico, no entanto, se houver suspeita de gangrena ou perfuração, pacientes com volvo colônico devem ser submetidos à cirurgia de emergência.
Δύο «ανέκδοτα» χειρόγραφα έργων του Νεόφυτου Βάμβα
Authors: Dieli Marta 
Published: September 2019

ΔΥΟ «ΑΝΕΚΔΟΤΑ» ΧΕΙΡΟΓΡΑΦΑ ΕΡΓΩΝ ΤΟΥ ΝΕΟΦΥΤΟΥ ΒΑΜΒΑ Στὸ Τμῆμα Χειρογράφων τῆς Ἐθνικῆς Βιβλιοθήκης τῆς Ἑλλάδος ἀπόκεινται δύο χειρόγραφα μὲ ἔργα τοῦ Νεοφύτου Βάμβα (1776-1855): α) Ἐγχειρίδιον ῾Ρητορικῆς (ΕΒΕ 4072) καὶ β) Στοιχεῖα τῆς Ἰδεολογίας (ΕΒΕ 4295), ἕνα φιλοσοφικὸ σύγγραμμα σχετικὰ μὲ τὴ γλώσσα. Πρόκειται γιὰ δύο διδακτικὰ ἐγχειρίδια, ἀπὸ τὰ πιὸ γνωστὰ καὶ σημαντικὰ ἔργα ἑνὸς ἀπὸ τοὺς πρωτεργάτες τοῦ Νεοελληνικοῦ Διαφωτισμοῦ, μὲ μεγάλη πιθανότητα νὰ ἔχουν συντεθεῖ γύρω στὰ 1830. Ὕστερα ἀπὸ λεπτομερὴ ἀντιβολὴ τῶν χειρογράφων τῆς ΕΒΕ μὲ τὰ γνωστὰ καὶ ἐκδεδομένα ἔργα τοῦ Νεόφυτου Βάμβα, καταλήγουμε στὰ παρακάτω συμπεράσματα: α) τὸ πρῶτο περιέχει ἕνα κείμενο τῆς ῾Ρητορικῆς, τὸ ὁποῖο σὲ ἀρκετὰ σημεῖα μοιάζει μὲ ἐκεῖνο τῆς πρώτης ἔκδοσης (1813) καὶ σὲ ἄλλα σημεῖα μὲ ἐκεῖνο τῆς δεύτερης (1841), ἀλλὰ στὴν οὐσία πρόκειται γιὰ μιὰ ἄλλη μορφὴ ποὺ δὲν ἐκδόθηκε ποτέ. Ἐπιπλέον, τὸ τρίτο μέρος τοῦ χφ περιέχει ἀποσπάσματα ἀπὸ ἔργο τοῦ Hugh Blair, ὅπως δείχνει καὶ ἡ ἀναγραφὴ ἐπὶ τοῦ χφ: Περὶγεύσεως (ἐκ τοῦ Βλαίρου). β) Τὸ δεύτερο χφ, γραμμένο ἀπὸ δύο χέρια –ἕνα τρίτο πρόσθεσε τὸν τίτλο Στοιχεῖα Ἰδεολογίας–, περιέχει συμπιληματικὸ κείμενο φιλοσοφικοῦ περιεχομένου, ποὺ εἶναι δύσκολο νὰ ταυτισθεῖ καὶ πάντως ἔχει σχέση μὲ τὴν ἰδεολογικὴ προσέγγιση τῆς γλώσσας.Τὰ δύο χειρόγραφα τῆς ΕΒΕ, τὰ ὁποῖα χρονολογοῦνται στὴ δεκαετία τοῦ 1830, πιθανὸν ἀντιγράφτηκαν ἀπὸ μαθητὲς τοῦ Βάμβα, καθὼς ὅπως γνωρίζουμε, ὁ ἴδιος ἔδινε στοὺς μαθητές του στὴν Ἰόνια Ἀκαδημία νὰ ἀντιγράφουν κείμενα ποὺ χρησιμοποιοῦσε στὰ μαθήματά του καὶ μποροῦμε νὰ θεωρήσουμε ὅτι ἀποτελοῦν καὶ τεκμήρια ἀπὸ τὴν παρουσία του στὴν Ἰόνιο Ἀκαδημία. MARTA DIELI
Studying the relationship of localization parameters of solar sources of magnetic clouds with their characteristics and substorm activity
Authors: Бархатов Николай , Barhatov Nikolay , Ревунова Елена , Revunova Elena , Романов Роман , Romanov Roman , Бархатова Оксана , Barhatova Oksana , Ревунов Сергей , Revunov Sergey 
Published: September 2019

We propose a method for determining location and orientation of extended solar sources of magnetic clouds, using coronagraph data and SOHO EIT/MDI images of the photosphere. To estimate the probability of formation of magnetic clouds, we use a simple cylindrical force-free model. We have established that more extended sources and those having a slight inclination to the solar equator and located on the solar limb as compared to those that are nonextended and strongly inclined can generate expanding clouds, which with high probability can reach the magnetosphere like clouds from a source near the zero meridian and low latitudes.
We determine the relationship between extreme values of substorm activity and parameters of solar sources under study during the impact of magnetic clouds on Earth’s magnetosphere from the AL index. We note that there are no substorms associated with extended sources outside the heliolatitude range ~5–20°. The established relationship between solar source coordinates and geomagnetic activity of the magnetic cloud sheath and body are consistent with the most probable distribution of magnetoactive regions over the solar disk.
Conflict prevention and how to make conflict productive
Authors: Dale Louise 
Published: September 2019

Conflict in the work place can take many forms and can have both positive and negative impacts on the team. It is imperative that a manager identifies the cause/type of conflict and puts in place the required measures to resolve any issues that may impact on the team's performance and lead to reduced job satisfaction. This article discusses the potential causes of conflict that arise in the workplace such as competing for resources, differing styles, differing perception, conflicting goals, conflicting pressures, role overlap, differing personal values and unpredictable policies. Measures in order to mitigate any conflict are discussed along with techniques to resolve any conflict when it does occur. Such prevention measures focus on communication at the individual and team level and encourage input from all team members on how the team's goals are achieved.