bluuebunny/crossref_metadata_2025_split huggingface dataset:
The feasibility of a randomised controlled trial to compare the cost-effectiveness of palliative cardiology or usual care in people with advanced heart failure: Two exploratory prospective cohorts
Authors: Johnson Miriam J , McSkimming Paula , McConnachie Alex , Geue Claudia , Millerick Yvonne , Briggs Andrew , Hogg Karen 
Published: April 2018

Background: The effectiveness of cardiology-led palliative care is unknown; we have insufficient information to conduct a full trial. Aim: To assess the feasibility (recruitment/retention, data quality, variability/sample size estimation, safety) of a clinical trial of palliative cardiology effectiveness. Design: Non-randomised feasibility. Setting/participants: Unmatched symptomatic heart failure patients on optimal cardiac treatment from (1) cardiology-led palliative service (caring together group) and (2) heart failure liaison service (usual care group). Outcomes/safety: Symptoms (Edmonton Symptom Assessment Scale), Kansas City Cardiomyopathy Questionnaire, performance, understanding of disease, anticipatory care planning, cost-effectiveness, survival and carer burden. Results: A total of 77 participants (caring together group = 43; usual care group = 34) were enrolled (53% men; mean age 77 years (33–100)). The caring together group scored worse in Edmonton Symptom Assessment Scale (43.5 vs 35.2) and Kansas City Cardiomyopathy Questionnaire (35.4 vs 39.9). The caring together group had a lower consent/screen ratio (1:1.7 vs 1: 2.8) and few died before approach (0.08% vs 16%) or declined invitation (17% vs 37%). Data quality: At 4 months, 74% in the caring together group and 71% in the usual care group provided data. Most attrition was due to death or deterioration. Data quality in self-report measures was otherwise good. Safety: There was no difference in survival. Symptoms and quality of life improved in both groups. A future trial requires 141 (202 allowing 30% attrition) to detect a minimal clinical difference (1 point) in Edmonton Symptom Assessment Scale score for breathlessness (80% power). More participants (176; 252 allowing 30% attrition) are needed to detect a 10.5 change in Kansas City Cardiomyopathy Questionnaire score (80% power; minimum clinical difference = 5). Conclusion: A trial to test the clinical effectiveness (improvement in breathlessness) of cardiology-led palliative care is feasible.
The Assessment and Treatment of Antipsychotic-Induced Akathisia
Authors: Pringsheim Tamara , Gardner David , Addington Donald , Martino Davide , Morgante Francesca , Ricciardi Lucia , Poole Norman , Remington Gary , Edwards Mark , Carson Alan , Barnes Thomas R. E. 
Published: April 2018

Background: Akathisia is a common and distressing neuropsychiatric syndrome associated with antipsychotic medication, characterised by subjective and objective psychomotor restlessness. The goal of this guideline is to provide clinicians with recommendations on the assessment and treatment of akathisia. Methods: We performed a systematic review of therapeutic studies assessing the treatment of antipsychotic-induced extrapyramidal symptoms. Forty studies on akathisia and 4 systematic reviews evaluating the adverse effects of antipsychotics were used in the formulation of recommendations. Studies were rated for methodological quality using the American Academy of Neurology Risk of Bias Classification system. The overall level of evidence classifications and grades of recommendation were made using the Scottish Intercollegiate Guidelines Network framework. Results: As a good practice point, clinicians should systematically assess akathisia with a validated scale before starting antipsychotics and during antipsychotic dosage titration. For the management of akathisia, there was adequate evidence to allow recommendations regarding antipsychotic dose reduction, antipsychotic polypharmacy, switching antipsychotic medication, and the use of adjuvant medications including beta-blockers, anticholinergics, 5HT2A antagonists, benzodiazepines, and vitamin B6. Conclusion: The treatment of antipsychotic-induced akathisia should be personalised, with consideration of antipsychotic dose reduction, cessation of antipsychotic polypharmacy, and switching to an antipsychotic with a perceived lower liability for akathisia, before the use of adjuvant medications. The choice of adjuvant medications should favour the more established treatments, with careful consideration of contraindications and side effects. Limitations in the evidence should be acknowledged and prompt cautious prescribing, particularly with respect to the duration of use of adjuvant medications, is warranted.
Use of echocardiography at diagnosis and detection of acute cardiac disease in youth with systemic lupus erythematosus
Authors: Chang J C , Knight A M , Xiao R , Mercer-Rosa L M , Weiss P F 
Published: April 2018

Objectives There are no guidelines on the use of echocardiography to detect cardiac manifestations of childhood-onset systemic lupus erythematosus (SLE). We quantify the prevalence of acute cardiac disease in youth with SLE, describe echocardiogram utilization at SLE diagnosis, and compare regional echocardiogram use with incident cardiac diagnoses. Methods Using the Clinformatics® DataMart (OptumInsight, Eden Prairie, MN) de-identified United States administrative database from 2000 to 2013, we identified youth ages 5–24 years with new-onset SLE (≥3 ICD-9 SLE codes 710.0, > 30 days apart) and determined the prevalence of diagnostic codes for pericardial disease, myocarditis, endocarditis, and valvular insufficiency. Multiple logistic regression was used to identify factors associated with echocardiography during the baseline period, up to one year before or six months after SLE diagnosis. We calculated a regional echocardiogram utilization index, which is the ratio of observed use over the mean predicted probability based on all available baseline characteristics. Spearman’s rank correlation coefficient was used to evaluate the association between regional echocardiogram utilization indices and percentage of imaged youth diagnosed with their first cardiac manifestation following echocardiography. Results Among 699 youth with new-onset SLE, 18% had ≥ 1 diagnosis code for acute cardiac disease, of which valvular insufficiency and pericarditis were most common. Twenty-five percent of all youth underwent echocardiogram during the baseline period. Regional echocardiogram use was positively correlated with the percentage of imaged youth found to have cardiac disease (ρ = 0.71, p = 0.05). There was up to a five-fold difference in adjusted odds of baseline echocardiography between low- and high-utilizing regions (OR = 0.19, p = 0.007). Conclusion Nearly one-fifth of youth with new-onset SLE have acute cardiac manifestations; however, use of echocardiograms at SLE diagnosis is highly variable. There may be incremental diagnostic value to early use of echocardiography, but prospective studies are needed to determine whether greater use of echocardiograms modifies outcomes.
Sutureless biplanar closure of leaking wounds in micro-incision vitreous surgery: A novel technique
Authors: Labauri Nikoloz , Mamageishvili Tekla , Tsomaia Keti , Omiadze Mikheil 
Published: April 2018

Aim: To describe a novel technique for sutureless hermetic closure of leaking scleral wounds in micro-incision vitreous surgery. Methods: This study is a two-centre, non-comparative, interventional case series. We studied 1240 scleral incisions on 870 eyes using different gauges (20, 23, 25) to evaluate the effectiveness of a new technique to seal scleral wounds without sutures. If wounds were found leaking after removing the trocar, we used the same trocar (or microvitreoretinal) blade to make an adjacent trans-scleral entry in the same direction as the main incision to access its internal flap supporting it from inside. Simultaneously, we applied a blunt smooth-surface instrument to massage the scleral wound from outside to close it hermetically. We treated 870 eyes using three types of tamponading agents, namely, silicone oil in 654 (75%) eyes, non-expansible gas in 128 (15%) eyes, and air in 88 (10%) eyes. We performed optical coherence tomography in the first 100 sclerotomies on the post-operative Day 1. Results: We closed leaking incisions at the first attempt in 1231 (99.3%) cases; in 9 (0.7%) cases of 20-gauge incisions, we closed the wounds at the second attempt. We observed no hypotony at the end of surgery. The mean intraocular pressure was 16 mmHg (8–51 mmHg) on the post-operative Day 1. Conclusion: Our results show the biplanar closure technique may be used as an effective, quick, sutureless approach to close leaking wounds hermetically in micro-incision vitreous surgery procedures. It is safe, less traumatic, cost-effective, and easy-to-perform typical surgical settings.
Adjustable- Versus Fixed-Loop Devices for Femoral Fixation in ACL Reconstruction: An In Vitro Full-Construct Biomechanical Study of Surgical Technique–Based Tibial Fixation and Graft Preparation
Authors: Smith Patrick A. , Piepenbrink Marina , Smith Shelby K. , Bachmaier Samuel , Bedi Asheesh , Wijdicks Coen A. 
Published: April 2018

Background: Femoral suspensory fixation for anterior cruciate ligament (ACL) reconstruction has evolved from fixed- to adjustable-loop devices. However, there are still controversies regarding undesired lengthening of adjustable-loop devices. Hypothesis: Adjustable-loop fixation will achieve similar elongation to that of fixed-loop devices, and intraoperative preconditioning will reduce initial elongation for adjustable-loop constructs. Study Design: Controlled laboratory study. Methods: Three adjustable-loop devices (GraftMax, TightRope, and Ultrabutton) and 2 fixed-loop devices (Endobutton and RetroButton) were used in an intraoperative surgical technique workflow according to an in vitro model with porcine bone and bovine tendons (8 specimens per device; N = 40 constructs tested). Each construct underwent 1000 cycles of position- and force-controlled dynamic loading, whereby a total elongation threshold of 3 mm was defined as clinical failure. Constructs were finally pulled to failure at 50 mm/min. Results: There were no statistically significant differences among the devices for total or dynamic elongation. Total elongation (mean ± SD) for adjustable-loop constructs was 4.13 ± 1.46 mm for GraftMax, 2.78 ± 0.85 mm for TightRope, and 2.76 ± 0.45 mm for Ultrabutton; for the fixed-loop devices, total elongation was 2.85 ± 0.74 mm for Endobutton and 2.85 ± 1.03 mm for RetroButton. The GraftMax had a significantly lower initial force (95.5 ± 58.0 N) after retensioning, with the highest initial elongation (0.99 ± 0.60 mm). The Ultrabutton showed the greatest force loss (–105.9 ± 13.5 N) during position control cycling, which was significantly different from the GraftMax (–22.3 ± 28.2 N), with the smallest force loss ( P < .001). The TightRope construct had a significantly smaller initial elongation (–0.36 ± 0.22 mm) and the greatest pull-to-failure load (958 ± 40 N) as compared with all of the other devices. Conclusion: Adjustable- and fixed-loop configurations achieved statistically comparable fixation strength for total elongation. However, the GraftMax construct exceeded the total elongation threshold of clinical failure. The Ultrabutton produced the greatest loss of force during position control cycling, and the GraftMax button design prevented proper retensioning. The TightRope had a significant greater ultimate strength when compared with all other devices. Clinical Relevance: Biomechanical testing according to a surgical technique workflow suggests that adjustable-loop devices can be considered a safe alternative to fixed-loop devices in ACL reconstruction.
Reducing Body Image–Related Distress in Women With Breast Cancer Using a Structured Online Writing Exercise: Results From the My Changed Body Randomized Controlled Trial
Authors: Sherman Kerry A. , Przezdziecki Astrid , Alcorso Jessica , Kilby Christopher Jon , Elder Elisabeth , Boyages John , Koelmeyer Louise , Mackie Helen 
Published: April 2018

PurposeBreast cancer treatment adverse effects result in one in three survivors experiencing body image–related distress (BID) that negatively impacts on a woman’s ability to recover after cancer and into survivorship. My Changed Body (MyCB) is a Web-based psychological intervention to alleviate BID and improve body appreciation in survivors of breast cancer (BCSs) through a single-session, self-compassion focused writing activity. This randomized controlled trial evaluated the impact of MyCB on BID and body appreciation in BCSs. The moderating effect of lymphedema status (affected or unaffected) and appearance investment (self-importance placed on personal appearance) and the mediating effect of self-compassion were evaluated.Patients and MethodsWomen (disease-free stage I to III BCSs who had experienced at least one negative event related to bodily changes after breast cancer) were randomly assigned to MyCB (n = 149) or an expressive writing control arm (n = 155). Primary outcomes were reduction in BID and improvement in body appreciation 1 week after intervention. Secondary outcomes included psychological distress (depression and anxiety) and self-compassion. Follow-up assessments occurred 1 week, 1 month, and 3 months after writing.ResultsCompliance with the MyCB intervention was 88%, and attrition was 9.2%. Intent-to-treat linear mixed models indicated that participants who received MyCB reported significantly less BID ( P = .035) and greater body appreciation ( P = .004) and self-compassion ( P < .001) than expressive writing participants. Intervention effects on BID were moderated by lymphedema status ( P = .007) and appearance investment ( P = .042). Self-compassion mediated effects on both primary outcomes. Therapeutic effects were maintained at 1 month (BID and body appreciation) and 3 months (body appreciation) after intervention. Significant reductions in psychological distress (1-month depression, P = .001; 1-week and 1-month anxiety, P = .007) were evident for MyCB participants with lymphedema.ConclusionThis study supports the efficacy of MyCB for reducing BID and enhancing body appreciation among BCSs.
Distinct behavior of myelomonocytic cells and CD8 T cells underlies the hepatic response to Listeria monocytogenes
Authors: Velázquez Peter , Williams Cassandra , Leiner Ingrid , Pamer Eric G. , Dustin Michael L. 
Published: April 2018

Background: The immune response toListeria monocytogenes(LM) is characterized by formation of leukocyte rich foci of infection in liver and spleen. Although much has been gained in our understanding of immune response through the study of LM, little is known about spatio-temporal regulation of immune response to Listeria in liver.Methods:We utilize a combination of molecular, genetic and intravital microscopic approaches to gain insight into the dynamics of foci and leukocyte behavior during hepatic Listeriosis. Results: LM foci efficiently exclude blood flow, indicating the presence of a barrier separating the foci and healthy tissue. Despite this barrier, sinusoidal myelomonocytic cells readily enter or transiently interact with cells at the edge of foci of infection. Next, utilizing L9.6 transgenic CD8+T cells specific for an endogenously processed LM antigen, p60 217-225, along with LM deficient in this epitope, we define the role of TCR in T cell migratory behavior in infected liver. Surprisingly, T cell behavior varies with micro-anatomic locale. Near foci, non-specific adhesion mechanisms dominate lymphocyte behavior. Antigen specific effects on motility became detectable only distal to foci. Conclusions:These data suggest that LM antigens act in a paracrine manner to mediate protection from Listeriosis in the liver.
The Liverpool Care Pathway for the Dying Patient: a critical analysis of its rise, demise and legacy in England
Authors: Seymour Jane , Clark David 
Published: April 2018

Background: The Liverpool Care Pathway for the Dying Patient (‘LCP’) was an integrated care pathway (ICP) recommended by successive governments in England and Wales to improve end-of-life care. It was discontinued in 2014 following mounting criticism and a national review. Understanding the problems encountered in the roll out of the LCP has crucial importance for future policy making in end of life care. We provide an in-depth account of LCP development and implementation with explanatory theoretical perspectives. We address three critical questions: 1) why and how did the LCP come to prominence as a vehicle of policy and practice? 2) what factors contributed to its demise? 3) what immediate implications and lessons resulted from its withdrawal? Methods: We use primary and secondary sources in the public domain to assemble a critical and historical review. We also draw on the ‘boundary object’ concept and on wider analyses of the use of ICPs. Results: The rapidity of transfer and translation of the LCP reflected uncritical enthusiasm for ICPs in the early 2000s. While the LCP had some weaknesses in its formulation and implementation, it became the bearer of responsibility for all aspects of NHS end-of-life care. It exposed fault lines in the NHS, provided a platform for debates about the ‘evidence’ required to underpin innovations in palliative care and became a conduit of discord about ‘good’ or ‘bad’ practice in care of the dying. It also fostered a previously unseen critique of assumptions within palliative care. Conclusions: In contrast to most observers of the LCP story who refer to the dangers of scaling up clinical interventions without an evidence base, we call for greater assessment of the wider risks and more careful consideration of the unintended consequences that might result from the roll out of new end-of-life interventions.
Design and Implementation of a Knowledge-Based Nutrient Solution Irrigation System for Hydroponic Applications
Authors: Chang Chung-Liang , Hong Guo-Fong , Fu Wei-Lun 
Published: April 2018

Abstract. Hydroponics can allow crops to grow faster and can reduce plant pathogens. However, hydroponic systems have several disadvantages, of which the two most important are: (1) improper management or dramatic changes in the electrical conductivity (EC) and pH of the nutrient solution can harm the plant roots and affect the plant growth, and (2) system operators need to monitor the nutrient solution and replenish it regularly, thereby increasing the labor cost. Therefore, this study developed a micro-electro-mechanical systems (MEMs) based mixing system for hydroponic nutrient solutions based on fuzzy rule-based inference, which uses a micro-controller as the core and controls the output of five nutrient solution tanks to the mixing tank. The proposed system maintained an appropriate range of pH and EC in the mixing tank. Operators can view the changes in pH, EC, dissolved oxygen (DO), and other values in the nutrient solution on a graphic user interface. Moreover, operators can manually or automatically mix the nutrient solution. The system has been implemented in a hydroponic cultivation system, and the analysis results are discussed in this article. Keywords: Fuzzy logic, Hydroponics, Microcomputer.
Design and Construction of a Precision Weighing Lysimeter in Southeast Colorado
Authors: Andales Allan A. , Straw Dale , Marek Thomas H. , Simmons Lane H. , Bartolo Michael E. , Ley Thomas W. 
Published: April 2018

Abstract. Accurate estimates of crop evapotranspiration (ET) are needed to effectively manage irrigation resources in the Arkansas River basin in Colorado and to maintain compliance with the Arkansas River compact with Kansas. This was a major impetus for the construction of a precision weighing lysimeter in the Arkansas River basin at the Colorado State University (CSU) Arkansas Valley Research Center (AVRC) near Rocky Ford, Colorado. The objective of this article is to describe the design and construction of the weighing lysimeter and characterize its performance and unique features. The main components of the lysimeter facility are the foundation, the scale system, the soil monolith tank, and the outer tank that houses the aforementioned components. The foundation, which was 4.12 m below the ground surface, consisted of a reinforced concrete slab 2.00 m wide by 6.31 m long and 0.20 m thick that was anchored to six square shaft helical anchors. The outer tank was secured onto the foundation and had a rectangular floor area of 6.10 m × 1.79 m (10.92 m2), an interior vertical clearance of 2.15 m, and walls made of reinforced 8 mm thick steel plates. The floor scale system (mechanical levers and load cell) was installed inside the outer tank and had a gross capacity of 17 Mg. The monolith tank (1.50 m × 1.50 m area, 2.44 m depth, 10 mm steel walls) containing an undisturbed soil profile was set on the scale system. The lysimeter facility was installed in the middle of a 3.5 ha field. Calibration of the scale system resulted in a linear response (R2 = 1.000), with an equivalent conversion coefficient (slope) of 151.09 mm H2O (mV V-1)-1. The sensitivity of the scale system was 0.023 mm of water, which is sufficient for measuring diurnal (15 min to hourly) changes in ET and soil water. Load cell readings taken at a frequency of 0.5 Hz were averaged in 15 min intervals (450 readings per 15 min) to filter out the measurement noise that was attributed to wind. The lysimeter was found to adequately detect ET, irrigation, and precipitation perturbations with an actively growing alfalfa hay crop ( L.) in 2011. The lysimeter facility is a state-of-the-art tool for quantifying ET of irrigated crops in the lower Arkansas basin in southeast Colorado. Keywords: Calibration, Evapotranspiration, Load cell, Weighing lysimeter.
Porosity and Drag Determination of a Single-Row Vegetative Barrier (Maclura pomifera)
Authors: Gonzales Howell B. , Casada Mark E. , Hagen Lawrence J. , Tatarko John , Maghirang Ronaldo G. , Barden Charles J. 
Published: April 2018

Abstract. Deciduous trees of the species (Osage orange) are commonly established as vegetative barriers for wind erosion control throughout the U.S. Great Plains. Because there is no previous research on the aerodynamic effectiveness of these vegetative barriers during different seasons (leaf-on and leaf-off conditions), this study focused on determining the porosity and drag characteristics of this tree species. Digital image analyses were used to determine optical porosities that were then correlated with barrier drag coefficients. Images were taken in the field during calm wind conditions when the sunlight was suitable for digital imaging. Wind speeds were measured at different heights for a single-row Osage orange barrier using cup anemometers. Two anemometer towers were positioned relative to the barrier. One was located windward at 10H distance from the barrier; the other was located leeward and was movable to distances of 1H, 2H, 4H, 7H, 10H, 12H, 15H, and 20H from the barrier, where H is the average barrier height. The wind speeds measured in the field ranged from 4 to 7 m s-1, with lower wind speeds encountered during the leaf-off condition. As expected, wind speed reductions were greater for the leaf-on condition and ranged from 40% to 80% at 1H from the barrier, while the reduction was 20% to 38% for the leaf-off condition. The crown portion of the barrier was found to be responsible for much of the reduction. Mean values of the drag coefficient were 1.3 for the leaf-on condition, decreasing to 0.9 for the leaf-off condition of the Osage orange barrier, which corresponded to mean optical porosities of 20% and 61%, respectively Keywords: Drag coefficient, Image analysis, Osage orange, Porosity, Vegetative barrier, Wind erosion.