bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multisensory stimulation to promote upper extremity motor recovery in stroke: A pilot study
Authors: Law Lawla LF , Fong Kenneth NK , Li Ray KF 
Published: May 2018

Introduction Occupational therapists have been using various preparatory methods as part of the treatment sessions to prepare clients for occupational performance and participation in occupation. Studies have shown sensory stimulation both activates brain areas inducing cortical reorganization and modulates motor cortical excitability for the stimulated afferents, hence re-establishing the disrupted sensorimotor loop due to stroke. This pilot investigates the potential effects of using multisensory stimulation as a preparatory method prior to conventional training (CT) on upper-extremity motor recovery and self-care function in stroke patients. Method This was a quasi-randomized controlled pilot. Twelve participants (age in years = 67.17 + /−11.29) with upper extremity motor deficits were randomly allocated to multisensory therapy (n = 6) or conventional (n = 6) groups for 12-week training. Assessments were conducted at baseline and post-intervention using Fugl-Meyer Assessment of Motor Recovery after Stroke (FMA), Manual Muscle Testing (MMT), Functional Test for the Hemiplegic Upper Extremity (Hong Kong version FTHUE-HK) and Modified Barthel Index (MBI). Results Significant between-group differences were shown in FMA ( p = 0.003), FTHUE-HK ( p = 0.028) and MMT ( p = 0.034). Conclusion Multisensory stimulation could be used as a preparatory method prior to CT in improving upper extremity motor recovery in stroke rehabilitation. Further well-designed larger scale studies are needed to validate the potential benefits of this application.
Technology use to improve everyday occupations in older persons with mild dementia or mild cognitive impairment: A scoping review
Authors: Patomella Ann-Helen , Lovarini Meryl , Lindqvist Eva , Kottorp Anders , Nygård Louise 
Published: May 2018

Introduction Technology use is a highly relevant part of everyday occupations and difficulties can lead to challenges among older adults with cognitive impairments. The aim of this study was to review empirical studies reporting on the use of technology for improving performance in everyday occupations and evaluate the effect of training strategies in technology use in older people with mild-stage dementia or mild cognitive impairment. Method A scoping review methodology was used. Key databases were searched, covering January 2000 to October 2016, to identify studies, which were screened and assessed for inclusion. Results In total, 14 studies were included. Most studies used quantitative designs with small sample sizes. The methods used to measure performance in everyday occupations differed. Six studies focussed on the use of technology for improving performance. Eight studies evaluated the effect of training strategies in technology use. Conclusion Although positive effects of technology use and training in technology use have been reported for instrumental activities of daily living outcomes, the evidence supporting the use of technology in enhancing performance in occupations in people with mild-stage dementia or mild cognitive impairment is limited. Future studies should focus specifically on people with mild cognitive impairment, use more rigorous designs and include standardised methods.
Rare primary headaches in Italian tertiary Headache Centres: Three year nationwide retrospective data from the RegistRare Network
Authors: Lupi Chiara , Evangelista Luana , Favoni Valentina , Granato Antonio , Negro Andrea , Pellesi Lanfranco , Ornello Raffaele , Russo Antonio , Cevoli Sabina , Guerzoni Simona , Benemei Silvia 
Published: May 2018

Background Rare primary headaches are mainly included in Chapters 3, Trigeminal autonomic cephalalgias, and 4, Other primary headache disorders, Part One of the International Classification of Headache Disorders 3rd edition. Epidemiological data are scarce, mostly emerging from case series or small studies, with the exception of cluster headache. In order to overcome the knowledge gap about rare primary headaches, the RegistRare Network was launched in 2017 to promote research in the field. Methods A retrospective cohort study including patients who, from April 30, 2014 to May 1, 2017, visited seven Italian tertiary Headache Centres, was undertaken to estimate in that clinical setting prevalence and incidence of headaches included in Chapters 3 and 4, Part One of the International Classification of Headache Disorders 3rd edition. Prevalent headache is defined as a headache recorded within the study timeframe, regardless of when the diagnosis was made. Incident headache is defined as a headache diagnosed for the first time in the patient during the study period. Results Twenty thousand and eighty-three patients visited the participating centres, and 822 (4.1%) prevalent cases, of which 461 (2.3%) were incident cases, were registered. Headaches listed in Chapter 3 affected 668 patients, representing 81.3% of the total number of prevalent cases. Headaches listed in Chapter 4 affected 154 patients and represent 18.7% of the total number of prevalent cases. Cluster headaches represent the most frequently diagnosed rare headaches (70.4%). For 13 entities out of 20, no cases were registered in more than 50% (n ≥ 4) of the centres, and for 14 entities more than 50% of diagnoses were incident. Conclusions This large, multicentre study gives the first wide-ranging snapshot of the burden in clinical practice of rare headaches and confirms that cooperative networks are necessary to study rare headaches, as their prevalence is often very low. The launch of a disease registry by the RegistRare Network will favour research in this neglected population of headache patients. Trial registration NCT03416114.
Getting Hit by Pitch in Professional Baseball: Analysis of Injury Patterns, Risk Factors, Concussions, and Days Missed for Batters
Authors: Camp Christopher L. , Wang Dean , Sinatro Alec S. , D’Angelo John , Coleman Struan H. , Dines Joshua S. , Fealy Stephen , Conte Stan 
Published: May 2018

Background: Although batters are frequently hit by pitch (HBP) in baseball, the effect of HBP injuries remains undefined in the literature. Purpose: To determine the effect of HBP injuries in terms of time out of play, injury patterns resulting in the greatest time out of play, and the value of protective gear such as helmets and elbow pads. Study Design: Descriptive laboratory study. Methods: Based on the Major League Baseball (MLB) Health and Injury Tracking System, all injuries to batters HBP during the 2011-2015 MLB and Minor League Baseball (MiLB) seasons were identified and analyzed. Video analysis was performed on all HBP events from the 2015 MLB season. Multivariate stepwise regression analysis was utilized to determine the predictive capacity of multiple variables (velocity, pitch type, location, etc) on injury status and severity. Results: A total of 2920 HBP injuries resulted in 24,624 days missed (DM) over the 5 seasons. MLB HBP injuries occurred at a rate of 1 per 2554 plate appearances (1 per 9780 pitches thrown). Mean DM per injury were 8.4 (11.7 for MLB vs 8.0 for MiLB, P < .001). Surgery was required for 3.1% of MLB injuries and 1.2% of MiLB injuries ( P = .005). The most common body regions injured were the hand/fingers (n = 638, 21.8%), head/face (n = 497, 17.0%), and elbow (n = 440, 15.7%), and there were 146 (5.0%) concussions. Injury rates and mean DM correlated with velocity in a near linear fashion. Players hit in the head/face (odds ratio, 28.7) or distal upper extremity (odds ratio, 6.4) were more likely to be injured than players HBP in other locations. Players with an unprotected elbow missed 1.7 more days (95% CI, –4.1 to 7.6) than those with an elbow protector ( P = .554) when injured after being HBP. Conclusion/Clinical Relevance: Although HBP injuries occur infrequently in the course of normal play, they collectively represent a significant source of time out of play. The most common body regions injured include the hands/fingers and head/face, and batters hit in these locations are significantly more likely to be injured. After contusions, concussions were the most common injury diagnosis.
More care out of hospital? A qualitative exploration of the factors influencing the development of the district nursing workforce in England
Authors: Drennan Vari M 
Published: May 2018

Objectives Many countries seek to improve care for people with chronic conditions and increase delivery of care outside of hospitals, including in the home. Despite these policy objectives in the United Kingdom, the home visiting nursing service workforce, known as district nursing, is declining. This study aimed to investigate the factors influencing the development of district nursing workforces in a metropolitan area of England. Methods A qualitative study in a metropolitan area of three million residents in diverse socio-economic communities using semi-structured interviews with a purposive sample of senior nurses in provider and commissioning organizations. Thematic analysis was framed by theories of workforce development. Findings: All participants reported that the context for the district nursing service was one of major reorganizations in the face of wider National Health Service changes and financial pressures. The analysis identified five themes that can be seen to impact the ways in which the district nursing workforce was developed. These were: the challenge of recruitment and retention, a changing case-mix of patients and the requirement for different clinical skills, the growth of specialist home visiting nursing services and its impact on generalist nursing, the capacity of the district nursing service to meet growing demand, and the influence of the short-term service commissioning process on the need for long-term workforce development. Conclusion There is an apparent paradox between health policies which promote more care within and closer to home and the reported decline in district nursing services. Using the lens of workforce development theory, an explanatory framework was offered with factors such as the nature of the nursing labour market, human resource practices, career advancement opportunities as well as the contractual context and the economic environment.
An economic cost analysis of an expanding, multi-state behavioural telehealth intervention
Authors: Yilmaz Siobhan K , Horn Brady P , Fore Chris , Bonham Caroline A 
Published: May 2018

Introduction In this paper the economic costs associated with a growing, multi-state telepsychiatry intervention serving rural American Indian/Alaska Native populations were compared to costs of travelling to provide/receive in-person treatment. Methods Telepsychiatry costs were calculated using administrative, information-technology, equipment and technology components, and were compared to travel cost models. Both a patient travel and a psychiatrist travel model were estimated utilising ArcGIS software and unit costs gathered from literature and government sources. Cost structure and sensitivity analysis was also calculated by varying modeling parameters and assumptions. Results and Discussion It is estimated that per-session costs were $93.90, $183.34, and $268.23 for telemedicine, provider-travel, and patient-travel, respectively. Restricting the analysis to satellite locations with a larger number of visits reduced telemedicine per-patient encounter costs (50 or more visits: $83.52; 100 or more visits: $80.41; and 150 or more visits: $76.25). The estimated cost efficiencies of telemedicine were more evident for highly rural communities. Finally, we found that a multi-state centre was cheaper than each state operating independently. Conclusions Consistent with previous research, this study provides additional evidence of the economic efficiency associated with telemedicine interventions for rural American Indian/Alaska Native populations. Our results suggest that there are economies of scale in providing behavioural telemedicine and that bigger, multi-state telemedicine centres have lower overall costs compared to smaller, state-level centres. Additionally, results suggest that telemedicine structures with a higher number of per-satellite patient encounters have lower costs, and telemedicine centres delivering care to highly rural populations produce greater economic benefits.
Door to needle time and functional outcome for mild ischemic stroke over telestroke
Authors: Harvey Jillian , Al Kasab Sami , Almallouhi Eyad , Guerrero Waldo R , Debenham Ellen , Turner Nancy , Aysse Patricia , Holmstedt Christine A 
Published: May 2018

Introduction Faster intravenous alteplase (tPA) administration from time of symptom onset is associated with better functional outcome. Lack of recognition of mild ischemic stroke (MIS) might result in delay in treatment with tPA. We hypothesise that patients with MIS have a longer door to needle (DTN) time when compared to patients with severe stroke symptoms. Methods Data on all patients who received tPA at spoke hospitals through the Medical University of South Carolina (MUSC) telestroke network were analysed. Collected data included baseline characteristics, stroke severity on presentation measured by the National Institute of Health Stroke Scale (NIHSS), the rate of symptomatic intracerebral haemorrhage, discharge location, and discharge functional outcome measured by the modified Rankin scale. Results and Discussion Of the 454 patients treated with tPA through the MUSC telestroke network in the period from January 2013 to April 2017, 98 (22%) had MIS defined as NIHSS ≤ 5 on presentation; the remaining 356 (78%) patients were found to have severe stroke defined as NIHSS > 5 on presentation. Patients presenting with MIS were found to have a delay in receiving intravenous tPA by ∼10 min ( p = 0.007) and approximately 15% of them had poor functional outcome at discharge. Patients with a MIS on presentation have significantly more prolonged DTN time. Nearly 15% of low severity strokes had poor outcome even after receiving tPA.
Cardiology electronic consultation (e-consult) use by primary care providers at VA medical centres in New England
Authors: Kim Eun Ji , Orlander Jay D , Afable Melissa , Pawar Sumeet , Cutrona Sarah L , Simon Steven R , Strymish Judith , Vimalananda Varsha G 
Published: May 2018

Introduction E-consultations (e-consults) were implemented at VA medical centers to improve access to specialty care. Cardiology e-consults are among the most commonly requested, but little is known about how primary care providers (PCPs) use cardiology e-consults to access specialty care. Methods This is a retrospective analysis of 750 patients’ medical charts with cardiology e-consults requested by medical providers (October 2013–September 2015) in the VA New England Healthcare System. We described the patients and referring provider characteristics, and e-consult questions. We reviewed cardiologists’ responses and examined their recommendations. Results Among the 424 e-consults requested from PCPs, 92.7% were used to request answers to clinical questions, while 7.3% were used for administrative purposes. Among the 393 e-consults with clinical questions, 60 e-consults were regarding preoperative management; these questions most commonly addressed general risk assessment ( n = 44), anti-coagulation/anti-platelet management ( n = 33), and EKG interpretation ( n = 20). Cardiologists provided answers for the majority (89.6%) of clinical questions. Among the e-consults in which cardiologists did not provide answers or clinical guidance ( n = 41), the reasons included missing or insufficient clinical information ( n = 18), medical complexity ( n = 6), and deferment to the patient’s non-VA primary cardiologist ( n = 7). Cardiologists recommended that the patients be seen as face-to-face consults for 7.9% of e-consults. Discussion Primary care providers are the most frequent requesters of cardiology e-consults, using them primarily to obtain input on clinical questions. Cardiologists did not provide answers for one in ten, owing principally to insufficient available clinical information. Educating PCPs and standardizing the template for requesting e-consultation may help to reduce the number of unanswered e-consults.
Cirrhosis increases complication rate and overall mortality in patients with traumatic lung injury
Authors: Grigorian Areg , Albertson Spencer , Delaplain Patrick T , Gabriel Viktor , Maithel Shelley , Dosch Austin , Schubl Sebastian , Joe Victor , Nahmias Jeffry 
Published: May 2018

Introduction Hepatic cirrhosis is associated with an increased mortality in trauma. However, the association between cirrhosis and outcomes in traumatic lung injury has not been investigated. We hypothesize that cirrhosis adversely affects mortality and increases complications after traumatic lung injury. Methods A retrospective analysis of the National Trauma Data Bank was performed between 2007 and 2015. Patients ≥ 18 years of age with traumatic lung injury were identified and grouped by the presence or absence of cirrhosis. Patients that died in the emergency department or those with a severe (grade > 3) abbreviated injury scale for head trauma were excluded. The primary outcome was mortality. Results Out of 6,774,260 patients, 578,883 (8.5%) presented with traumatic lung injury. Of these, 1971 (0.3%) had a concomitant diagnosis of cirrhosis. The cirrhotic group was significantly older (median age, 56 versus 42 years, p < 0.001) and more likely to be hypotensive on admission (9.3% versus 6.7%, p < 0.001). There was no difference in injury severity score (p > 0.05). Patients with cirrhosis had a significantly longer median length of stay (12.5 versus 8.8 days, p < 0.001), rates of acute kidney injury (7.6% versus 1.4%, p < 0.001), acute respiratory distress syndrome (7.3% versus 2.9%, p < 0.001), pneumonia (12.9% versus 5.9%, p < 0.001), and overall mortality (20.6% versus 5.6%, p < 0.001). After adjusting for significant covariates, cirrhosis (OR = 6.26, 95% CI = 5.49–7.14, p < 0.001) was found to be an independent risk factor for mortality in patients with traumatic lung injury. Conclusion Cirrhosis in patients with traumatic lung injury is associated with more than a sixfold higher risk of mortality and increased rates of complications such as acute kidney injury and acute respiratory distress syndrome. While much focus has been on increased mortality of cirrhosis in patients with concomitant abdominal solid organ or traumatic brain injury, our study suggests cirrhosis with traumatic lung injury to possibly be an even worse prognosticator.
The influence of incorporation of silica and carbon nanoparticles on the mechanical properties of hybrid glass fiber reinforced epoxy
Authors: Megahed M , Megahed AA , Agwa MA 
Published: May 2018

Recently, the study of hybrid nanocomposites has attracted much attention because they are highly expected for being used in many applications. In this context, there is an insisting need to investigate the effect of incorporation of silica and carbon particulates nanofillers into epoxy reinforced with woven and nonwoven tissue glass fiber. The influence of incorporation of silica (SiO2) and carbon black nanoparticles (C) with different weight fractions on the tensile properties, impact strength and fatigue performance of epoxy matrix reinforced with two types of E-glass fiber was investigated. The results showed an improvement in tensile properties, impact strength and fatigue life with addition of almost all nanoparticles contents considerably with respect to that of the neat glass fiber reinforced epoxy composites (NGFRE). Hybrid composites filled with 0.5 wt.% C exhibited the highest tensile strength and fatigue performance with an enhancement of 19% and 60% compared to NGFRE, respectively. An increase of 57% and 28% in tensile modulus and impact strength over NGFRE was obtained respectively with hybrid composites filled with 1 wt.% C. Adding 0.25 wt.% SiO2 and 0.25 wt.% C simultaneously showed an improvement in mechanical properties. SEM images of tensile and impact fracture surfaces are presented for CS 0.5 specimens which in turn reveal weak fiber/matrix interface.
Spider peptide toxin lycosin-I induces apoptosis and inhibits migration of prostate cancer cells
Authors: Shen Hongwei , Xie Yuan , Ye Senlin , He Kancheng , Yi Lu , Cui Rongrong 
Published: May 2018

Spider toxins are molecularly diverse and some display not only a strong antibacterial effect but also exhibit significant inhibition of tumor growth and promote tumor cell apoptosis. The aim of the present investigation was to explore different antitumor effects of the spider peptide toxin lycosin-I through different pathways at different concentrations. It was found that by inactivating STAT3 pathway, high concentrations of lycosin-I induce apoptosis in prostate cancer cells and low concentrations of lycosin-I inhibit the migration of prostate cancer cells. This finding provides favorable evidence for further study of the molecular diversity of spider toxins. Impact statement The spider peptide toxin has become an important research topic. These toxins are molecularly diverse and some display not only a strong antibacterial effect but also exhibit significant inhibition of tumor growth and promote tumor cell apoptosis. Inspired by previous studies, the present study aims to investigate the effects of different concentrations of lycosin-I on the invasiveness and apoptosis of human prostate cancer cells. The findings provide favorable evidence for further study of the molecular diversity of spider toxins.
Novel interleukin-33 and its soluble ST2 receptor as potential serum biomarkers in parotid gland tumors
Authors: Pawel Sowa , Maciej Misiolek , Maciej Zielinski , Bogdan Mazur , Monika Adamczyk-Sowa 
Published: May 2018

An increasing number of patients with parotid gland tumors have been observed in recent years. The relationship between the immune system and tumor formation is thoroughly investigated. However, newly discovered molecules offer a new insight into the pathophysiology of malignancies. It would be ideal to find an easily determinable biomarker of tumor existence, its malignant potential or a biomarker suggesting the probability of disease recurrence. Our study is the first to examine serum concentrations of IL-33 and its sST2 receptor in patients with various types of parotid gland tumors. Serum IL33, sST2, IL-4 and IL-10 concentrations were determined in patients with benign and malignant parotid gland tumors (pleomorphic adenoma, Warthin’s tumor, myoepithelioma and acinic cell carcinoma). We observed for the first time that serum IL-33 level was significantly elevated in patients with various types of parotid gland tumors and sST2 levels were significantly higher in pleomorphic adenoma and acinic cell carcinoma patients compared to the controls. Our results demonstrate for the first time that serum IL-33 and its sST2 receptor may be important factors in the pathology of parotid gland tumors. Although our results are promising, further investigations are required to detect if serum concentrations of those molecules may be a biomarker in parotid gland tumors.Impact statementParotid gland tumors seem to be an increasingly important medical challenge, mostly due to a noticeable increase in the incidence. It would be crucial to find an easily determinable biomarker of tumor existence, its recurrence or malignant potential. We observed for the first time that serum IL-33 level was significantly elevated in patients with various types of parotid gland tumors and its sST2 receptor levels were significantly higher in pleomorphic adenoma and acinic cell carcinoma patients compared to the controls. We believe that our study helps to understand the biology of the tumors and a potential role of a relatively newly identified cytokine IL-33 in the pathophysiology of the parotid gland tumors.