bluuebunny/crossref_metadata_2025_split huggingface dataset:
FLUID trial: a protocol for a hospital-wide open-label cluster crossover pragmatic comparative effectiveness randomised pilot trial
Authors: McIntyre Lauralyn , Taljaard Monica , McArdle Tracy , Fox-Robichaud Alison , English Shane W , Martin Claudio , Marshall John , Menon Kusum , Muscedere John , Cook Deborah J , Weijer Charles , Saginur Raphael , Maybee Alies , Iyengar Akshai , Forster Alan , Graham Ian D , Hawken Steven , McCartney Colin , Seely Andrew JE , Stiell Ian G , Thavorn Kednapa , Fergusson Dean A 
Published: August 2018

Introduction0.9% saline and Ringer’s lactate are the two most common resuscitation crystalloid fluids. 0.9% saline may lead to hyperchloraemic metabolic acidosis and may be associated with impaired kidney function and death. Few large multicentre randomised trials have been conducted to evaluate the effect of these two fluids on clinically important outcomes.MethodsFLUID is a pragmatic pilot cluster randomised crossover trial in which four hospitals will be randomised to normal saline or Ringer’s lactate for 14 weeks, then crossover to the alternative fluid for the subsequent 14 weeks after 1 to 3 week transition. With waiver of informed consent, all adult and paediatric patients admitted to participating sites will be included in the FLUID trial except for neonates. Primary feasibility outcome is study fluid protocol adherence (target:≥80%). Secondary feasibility outcomes include time to research ethics board (REB) approval and readiness to trial initiation (≤3 months from REB submission and approval). Primary (composite of death or re-admission to hospital in first 90 days of index hospitalisation) and secondary clinical outcomes for the future large FLUID trial will be described. Protocol adherence will be collected by site at specified time points. All clinical data will be obtained at patient level through provincial health administrative data held at the Institute for Clinical Evaluative Sciences (ICES). Event rates for the primary and secondary outcomes will be described using frequencies and proportions with 95% CIs. Intracluster and interperiod correlation coefficients will be calculated from population-level data available at ICES.Ethics and disseminationThe study protocol has been approved by the Ottawa Health Science Research Ethics Board. The FLUID pilot will determine feasibility, and ICES data across all potential sites in Ontario will allow calculation of sample size parameter estimates to inform the design and implementation of the large trial.Trial registration numberNCT02721485; Pre-results.
Luminal Na+ homeostasis has an important role in intestinal peptide absorption in vivo
Authors: Ishizuka Noriko , Nakayama Michiko , Watanabe Miki , Tajima Haruna , Yamauchi Yuri , Ikari Akira , Hayashi Hisayoshi 
Published: August 2018

Intestinal cell line studies indicated luminal Na+ homeostasis is essential for proton-coupled peptide absorption, because the driving force of PepT1 activity is supported by the apical Na+/H+ exchanger NHE3. However, there is no direct evidence demonstrating the importance of in vivo luminal Na+ for peptide absorption in animal experiments. To investigate the relationship between luminal Na+ homeostasis and peptide absorption, we took advantage of claudin 15-deficient (cldn15−/−) mice, whereby Na+ homeostasis is disrupted. We quantitatively assessed the intestinal segment responsible for peptide absorption using radiolabeled nonhydrolyzable dipeptide (glycylsarcosine, Gly-Sar) and nonabsorbable fluid phase marker polyethylene glycol (PEG) 4000 in vivo. In wild-type (WT) mice, the concentration ratio of Gly-Sar to PEG 4000 decreased in the upper jejunum, suggesting the upper jejunum is responsible for peptide absorption. Gly-Sar absorption was decreased in the jejunum of cldn15−/− mice. To elucidate the mechanism underlining these impairments, a Gly-Sar-induced short-circuit ( Isc) current was measured. In WT mice, increments of Gly-Sar-induced Isc were inhibited by the luminal application of a NHE3-specific inhibitor S3226 in a dose-dependent fashion. In contrast to in vivo experiments, robust Gly-Sar-induced Isc increments were observed in the jejunal mucosa of cldn15−/− mice. Gly-Sar-induced Isc was inhibited by S3226 or a reduction of luminal Na+ concentration, which mimics low luminal Na+ concentrations in vivo . Our study demonstrates that luminal Na+ homeostasis is important for peptide absorption in native epithelia and that there is a cooperative functional relationship between PepT1 and NHE3. NEW & NOTEWORTHY Our study is the first to demonstrate that luminal Na+ homeostasis is important for proton-coupled peptide absorption in in vivo animal experiments.
Effect of localized microclimate heating on peripheral skin temperatures and manual dexterity during cold exposure
Authors: Castellani John W. , Yurkevicius Beau R. , Jones Myra L. , Driscoll Timothy J. , Cowell Courtney M. , Smith Laurel , Xu Xiaojiang , O’Brien Catherine 
Published: August 2018

Reduced dexterity is a major problem in cold weather, with a need for a countermeasure that increases hand (Thand) and finger (Tfing) temperatures and improves dexterity. The purpose of this study was to determine whether electric heat (set point, 42°C) applied to the forearm (ARM, 82 W), face (FACE, 9.2 W), or combination of both (COMB, 91.2 W), either at the beginning of cold exposure (COLD; 0.5°C, 120 min; 2 clo insulation, seated, bare-handed) or after Tfing fell to 10.5°C [delayed trials (D)], improves Thand, Tfing, dexterity, and finger key pinch strength (Sfing). Volunteers ( n = 8; 26 ± 9 yr) completed 7 experimental trials in COLD: ARM, ARM-D, FACE, FACE-D, COMB, COMB-D, and no heating (CON). Temperatures were measured before (BASE) and throughout COLD. Tests of dexterity [Purdue Pegboard assembly (PP) and magazine loading (MAGLOAD)] and Sfing were measured at BASE and after 45 and 90 min of COLD. Data presented are at minute 90. Thand was warmer ( P < 0.001) during ARM (18.0 ± 2.6°C) and COMB (18.9 ± 2.0°C) versus CON (15.3 ± 1.5°C) and FACE (15.8 ± 1.5°C) for heating that was initiated at the beginning of COLD. Tfing was higher ( P < 0.04) during COMB (12.7 ± 5.1°C) versus CON (9.7 ± 2.1°C) and FACE (8.9 ± 2.2°C). The change from BASE for PP (no. of pieces) was less ( P < 0.005) in COMB (−4.5 ± 3.3) and ARM (−5.0 ± 6.0) versus CON (−13.0 ± 7.3) and FACE (−10.0 ± 8.3), and for MAGLOAD, it tended ( P = 0.06) to be less in COMB (−8.9 ± 6.2 cartridges) versus CON (−14.8 ± 3.7 cartridges). There was no change in Sfing from BASE (10.5 kg) to minute 90 in ARM or COMB (0.7 ± 1.4 and −0.2 ± 1.7 kg, respectively) but a decrease ( P < 0.01) in CON and FACE (−2.1 ± 2.0 and −1.6 ± 1.9 kg, respectively). There were no differences in Thand, Tfing, dexterity, and Sfing at minute 90 when comparing heating that was initiated at the beginning of COLD versus delayed heating. In conclusion, heating using either COMB or ARM, compared with CON and FACE, improved Thand and Tfing and reduced the decline in dexterity by 20%–50% and Sfing by 90%. Furthermore, delayed heating had no deleterious effect on Thand, Tfing, dexterity, and Sfing compared with heating that started at the beginning of cold exposure. NEW & NOTEWORTHY The present study demonstrated that, during sedentary cold air exposure, localized heating that was applied from the beginning of cold exposure on the forearm increases hand and finger temperatures and finger strength, leading to subsequent improvements in manual dexterity. In addition, localized heating that was delayed until finger temperatures cooled significantly also caused higher peripheral temperatures, leading to better strength and manual dexterity, compared with no heating.
The Role of WISHE in Secondary Eyewall Formation
Authors: Cheng Chieh-Jen , Wu Chun-Chieh 
Published: August 2018

Abstract
Numerical simulations are conducted to examine the role of the wind-induced surface heat exchange (WISHE) mechanism in secondary eyewall formation (SEF). The control experiment exhibits a coherent secondary eyewall structure as quantified by various parameters (e.g., the azimuthal-mean tangential wind and vertical velocity). Prior to SEF, an area characterized by increasing diabatic heating, enhanced inertial stability, and increasing supergradient winds at the top of the boundary layer is observed outside the eyewall. While these characteristics offer the possibility of both balanced and unbalanced dynamical pathways to SEF, the focus of this study is to evaluate the impact of WISHE. To examine the sensitivity of SEF to WISHE, the surface wind used for the calculation of surface heat fluxes is capped at several designated values and at different radial intervals. When the heat fluxes are moderately suppressed around and outside the SEF region observed in the control experiment, sensitivity experiments show that the formation of the outer eyewall is delayed, and the intensity of both eyewalls is weaker. When the heat fluxes are strongly suppressed in the same region, SEF does not occur. In contrast, suppressing the surface heat fluxes in the storm’s inner-core region has limited effect on the evolution of the outer eyewall. This study provides important physical insight into SEF, indicating that WISHE plays a crucial role in SEF and tropical cyclone evolution.
Kinematic arrangement optimization of a quadruped robot with genetic algorithms
Authors: Gülhan Mehmet Mert , Erbatur Kemalettin 
Published: August 2018

Background: As research on quadruped robots grows, so does the variety of designs available. These designs are often inspired by nature and finalized around various technical, instrumentation-based constraints. However, no systematic methodology of kinematic parameter selection to reach performance specifications is reported so far. Kinematic design optimization with objective functions derived from performance metrics in dynamic tasks is an underexplored, yet promising area. Methods: This article proposes to use genetic algorithms to handle the designing process. Given the dynamic tasks of jumping and trotting, body and leg link dimensions are optimized. The performance of a design in genetic algorithm search iterations is evaluated via full-dynamics simulations of the task. Results: The article presents comparisons of design results optimized for jumping and trotting separately. Significant dimensional dissimilarities and associated performance differences are observed in this comparison. A combined performance measure for jumping and trotting tasks is studied too. It is discussed how significantly various structural lengths affect dynamic performances in these tasks. Results are compared to a relatively more conventional quadruped design too. Conclusions: The task-specific nature of this optimization process improves the performances dramatically. This is a significant advantage of the systematic kinematic parameter optimization over straight mimicking of nature in quadruped designs. The performance improvements obtained by the genetic algorithm optimization with dynamic performance indices indicate that the proposed approach can find application area in the design process of a variety of robots with dynamic tasks.
Treatment of acute migraine by a partial rebreathing device: A randomized controlled pilot study
Authors: Fuglsang Cecilia H , Johansen Troels , Kaila Kai , Kasch Helge , Bach Flemming W 
Published: August 2018

Background Impaired brain oxygen delivery can trigger and exacerbate migraine attacks. Normoxic hypercapnia increases brain oxygen delivery markedly by vasodilation of the cerebral vasculature, and hypercapnia has been shown to abort migraine attacks. Stable normoxic hypercapnia can be induced by a compact partial rebreathing device. This pilot study aimed to provide initial data on the device’s efficacy and safety. Methods Using a double-blinded, randomized, cross-over study design, adult migraine-with-aura patients self-administered the partial rebreathing device or a sham device for 20 minutes at the onset of aura symptoms. Results Eleven participants (mean age 35.5, three men) self-treated 41 migraine attacks (20 with the partial rebreathing device, 21 with sham). The partial rebreathing device increased mean End Tidal CO2 by 24%, while retaining mean oxygen saturation above 97%. The primary end point (headache intensity difference between first aura symptoms and two hours after treatment (0–3 scale) – active/sham difference) did not reach statistical significance (−0.55 (95% CI: −1.13–0.04), p = 0.096), whereas the difference in percentage of attacks with pain relief at two hours was significant ( p = 0.043), as was user satisfaction ( p = 0.022). A marked efficacy increase was seen from first to second time use of the partial rebreathing device. No adverse events occurred, and side effects were absent or mild. Conclusion Normoxic hypercapnia shows promise as an adjunctive/alternative migraine treatment, meriting further investigation in a larger population. Clinical study registered at ClinicalTrials.gov with identifier NCT03472417
Lost in Aggregation: The Geographic Distribution of Kwashiorkor in Eastern Democratic Republic of the Congo
Authors: Fitzpatrick Merry , Ghosh Shibani , Kurpad Anura , Duggan Christopher , Maxwell Daniel 
Published: August 2018

Background: Kwashiorkor is a major classification of severe acute malnutrition whose etiology remains elusive. It is estimated to affect hundreds of thousands of children annually, but no accurate global prevalence figures are available. Little is known how prevalence varies within populations, an important undocumented aspect of kwashiorkor obscured by the aggregation of prevalence or incidence of the condition across large populations and geographic areas. Objective: To estimate the prevalence of kwashiorkor in select neighboring villages of the eastern Democratic Republic of the Congo (DRC) and assess if prevalence can vary dramatically among neighboring villages. Methods: An anthropometric census survey evaluated 1328 children aged 12 to 59 months within all 19 villages in one health area of eastern DRC, recording all cases of kwashiorkor, diagnosed by bipedal pitting edema. Results: Village-level prevalence of kwashiorkor in the study area varied from 0% to 14.9%. Interviews with health services staff in the study area and across 2 provinces confirmed that current differences in prevalence reflect a long-term pattern and are a common feature of kwashiorkor throughout this region. Conclusions: Aggregation of kwashiorkor prevalence and incidence data across large populations or geographic regions poses several risks to understanding the epidemiology of kwashiorkor. If clustering of kwashiorkor is not taken into account, (1) nutritional crises in particular villages may go undetected; (2) the real effect of interventions may be underestimated; (3) interventions may be inappropriately targeted, leading to reduced coverage, efficacy, and cost-efficiency; and (4) important insights into the root causes of kwashiorkor may be lost.
Moral distress in healthcare assistants: A discussion with recommendations
Authors: Rodger Daniel , Blackshaw Bruce , Young Amanda 
Published: August 2018

Background: Moral distress can be broadly described as the psychological distress that can develop in response to a morally challenging event. In the context of healthcare, its effects are well documented in the nursing profession, but there is a paucity of research exploring its relevance to healthcare assistants. Objective: This article aims to examine the existing research on moral distress in healthcare assistants, identity the important factors that are likely to contribute to moral distress, and propose preventative measures. Research Design: This is a survey of the existing literature on moral distress in healthcare assistants. It uses insights from moral distress in nursing to argue that healthcare assistants are also likely to experience moral distress in certain contexts. Participants and Research Context: No research participants were part of this analysis. Ethical Considerations: This article offers a conceptual analysis and recommendations only. Findings: The analysis identifies certain factors that may be particularly applicable to healthcare assistants such as powerlessness and a lack of ethical knowledge. We demonstrate that these factors contribute to moral distress. Discussion: Recommendations include various preventative measures such as regular reflective debriefing sessions involving healthcare assistants, nurses and other clinicians, joint workplace ethical training, and modifications to the Care Certificate. Implementation of these measures should be monitored carefully and the results published to augment our existing knowledge of moral distress in healthcare assistants. Conclusion: This analysis establishes the need for more research and discussion on this topic. Future research should focus on evaluating the effectiveness of the proposed recommendations.
The relationship between ethical conflict and nurses’ personal and organisational characteristics
Authors: Saberi Zahra , Shahriari Mohsen , Yazdannik Ahmad Reza 
Published: August 2018

Introduction: Critical care nurses work in a complex and stressful environment with diverse norms, values, interactions, and relationships. Therefore, they inevitably experience some levels of ethical conflict. Aim: The aim of this study is to analyze the relationship of ethical conflict with personal and organizational characteristics among critical care nurses. Methods: This descriptive-correlational study was conducted in 2017 on a random sample of 216 critical care nurses. Participants were recruited through stratified random sampling. Data collection tools were a demographic and professional characteristics questionnaire, the Ethical Conflict in Nursing Questionnaire-Critical Care Version, and the Organizational and Managerial Factors Questionnaire. The data were analyzed using the SPSS software (v. 22.0). Ethical considerations: All participants were informed about the study’s aim and were assured that participation in and withdrawal from the study would be voluntary. Findings: The mean score of exposure to ethical conflict was 201.91 ± 80.38. The highest-scored conflict-inducing clinical situation was “working with professionally incompetent nurses or nurse assistants.” Married nurses, nurses with official employment, nurses with master’s degree, and nurses with the history of attending ethics education programs had significantly higher exposure to ethical conflict than the other nurses (p < 0.05). The significant predictors of exposure to ethical conflict were marital status, educational status, reward system, organizational culture, manager’s conduct, and organizational structure and regulations (p < 0.05). These predictors accounted for 37.2% of the total variance of exposure to ethical conflict. Conclusion: Critical care nurses experience moderate levels of exposure to ethical conflict. A wide range of personal and organizational factors can contribute to such exposure, the most significant of which is the professional incompetence of nursing colleagues, nurse assistants, and physicians. Therefore, many improvements at personal and organizational levels are needed to reduce critical care nurses’ exposure to ethical conflict.
Exploring the uptake and implementation of tele-monitored home-exercise programmes in adults with Parkinson’s disease: A mixed-methods pilot study
Authors: Lai Byron , Bond Kristina , Kim Yumi , Barstow Beth , Jovanov Emil , Bickel C Scott 
Published: August 2018

Background People with Parkinson’s disease experience numerous barriers to exercise participation at fitness facilities. Advances in tele-monitoring technologies create alternative channels for managing and supervising exercise programmes in the home. However, the success of these programmes will depend on participants’ perceptions of using the technology and their exercise adherence. Thus, this pilot explored the uptake and implementation of two common methods of Internet-exercise training in Parkinson’s disease. Methods Twenty adults with Parkinson’s disease were randomized into either: telecoach-assisted exercise (TAE) or self-regulated exercise (SRE) groups. Both groups received the same eight-week exercise prescription (combined strength and aerobic exercise) and telehealth system that streamed and recorded vital signs and exercise data. TAE participants exercised under a telecoach’s supervision via videoconferencing. SRE participants independently managed their exercise training. Quantitative data were described and qualitative data underwent thematic analysis. Results Quantitative results demonstrated that TAE participants achieved strong attendance (99.2%), whereas SRE participants demonstrated 35.9% lower attendance, 48% less total time exercising, and 74.5% less time exercising at moderate intensity. Qualitatively, TAE participants reported overtly favourable programme experiences and that assistance from a telecoach enhanced their exercise motivation. SRE participants noted several challenges that impeded adherence. Conclusion Findings demonstrate that adults with Parkinson’s disease acknowledge benefits of exercising through a telehealth system and are open to utilizing this channel as a means of exercise. However, human-interactive support may be required to overcome unique impediments to participation. Study findings warrant validation in larger trials that can transfer the success of TAE towards more scalable methods of delivery.
The Mutual Impact of Smoking and Low Cholesterol on All-Cause, Non-Cardiovascular, and Cardiovascular Mortalities in Males
Authors: Parsa Nader , Taravatmanesh Samira , Trevisan Maurizio , Zaheri Pari Mahlagha 
Published: August 2018

The aim of the current study was to examine the possible relationship between the mutual effects of smoking and low cholesterol on all-cause, non-cardiovascular, and cardiovascular mortalities in males. This is a prospective cohort study of 30,179 males sampled from the Risk Factors and Life Expectancy (RIFLE) studies in the Italian population. The RIFLE data are from 19 different large-scale studies over a 9.5-year follow-up period. The Cox Proportional Hazard model was applied to analyze the data. The associations are presented as hazard ratios (HRs) with 95% confidence interval (CI). Cholesterol data were reported in categories. There were significant mortality risk mutual associations for never-smokers and those in the low cholesterol category (<160 mg/dl) for all-cause (HR = 3.13, 95% CI [1.69, 5.80]), and non-cardiovascular disease (CVD) (HR = 6.51, 95% CI [2.19, 19.33]) mortality in men with an insignificant risk for CVD mortality (HR = 1.90, 95% CI [0.85, 4.22]). There were significant mortality risk associations of the mutual effects of ex-smokers and low cholesterol for non-CVD in the first to third cholesterol categories (HR = 2.50, 95% CI [1.40, 4.46]; HR = 2.65, 95% CI [1.50, 4.71]; HR = 2.12, 95% CI [1.17, 3.82], respectively), but no significant findings for all-cause and CVD deaths. Furthermore, there were significant mortality risk association of mutual effects of current-smokers and low cholesterol for non-CVD (HR = 1.56, 95% CI [1.11, 2.28]) in the first category of cholesterol level, but insignificant risk associations for all-cause deaths (HR = 1.21, 95% CI [0.89, 1.66]). Interestingly, findings indicate a mutual protective association for current-smokers and low cholesterol (<160 mg/dl) for CVD risk in males (HR = 0.42, 95% CI [0.19, 0.91]). Findings of this study identified significant mortality risk association for mutual effects of never-smokers, ex-smokers, and low cholesterol for non-CVD. However, there is significant protective association for current-smokers and low cholesterol for CVD.