bluuebunny/crossref_metadata_2025_split huggingface dataset:
The complementary nature of query-based and directed health information exchange in primary care practice
Authors: Vest Joshua R , Unruh Mark A , Casalino Lawrence P , Shapiro Jason S 
Published: July 2019

AbstractObjectiveMany policymakers and advocates assume that directed and query-based health information exchange (HIE) work together to meet organizations’ interoperability needs, but this is not grounded in a substantial evidence base. This study sought to clarify the relationship between the usage of these 2 approaches to HIE.Materials and MethodsSystem user log files from a regional HIE organization and electronic health record system were combined to model the usage of HIE associated with a patient visit at 3 federally qualified health centers in New York. Regression models tested the hypothesis that directed HIE usage was associated with query-based usage and adjusted for factors reflective of the FITT (Fit between Individuals, Task & Technology) framework. Follow-up interviews with 8 key informants helped interpret findings.ResultsUsage of query-based HIE occurred in 3.1% of encounters and directed HIE in 23.5%. Query-based usage was 0.6 percentage points higher when directed HIE provided imaging information, and 4.8 percentage points higher when directed HIE provided clinical documents. The probability of query-based HIE was lower for specialist visits, higher for postdischarge visits, and higher for encounters with nurse practitioners. Informants used query-based HIE after directed HIE to obtain additional information, support transitions of care, or in cases of abnormal results.DiscussionThe complementary nature of directed and query-based HIE indicates that both HIE functionalities should be incorporated into EHR Certification Criteria.ConclusionsQuantitative and qualitative findings suggest that directed and query-based HIE exist in a complementary manner in ambulatory care settings.
Indirect Effects of a Cognitive-Behavioral Intervention on Adolescent Weight and Insulin Resistance Through Decreasing Depression in a Randomized Controlled Trial
Authors: Gulley Lauren D , Shomaker Lauren B , Kelly Nichole R , Chen Kong Y , Stice Eric , Olsen Cara H , Tanofsky-Kraff Marian , Yanovski Jack A 
Published: July 2019

Abstract

Objective
Depression is linked to excess weight, insulin resistance, and type 2 diabetes (T2D). We previously reported that in adolescent girls at-risk for T2D with moderately elevated depression, randomization to cognitive-behavioral therapy (CBT) produced greater decreases in depression at post-treament and greater decreases in fasting/2-h insulin at 1 year, compared to health education (HE). The current study is a secondary analysis of this parallel-group randomized controlled trial. We examined whether decreasing depression explained intervention effects on body composition and insulin outcomes. We hypothesized that decreases in depression would be an explanatory mediator and that indirect effects would be strongest at higher levels of baseline depression.

Methods
Participants were 12–17 years girls with overweight/obesity and family history of T2D randomized to 6-week group CBT (n = 58) or HE (n = 61). Procedures took place at an outpatient pediatric clinic. At baseline, post-treatment, and 1 year, adolescents completed the Center for Epidemiologic Studies-Depression Scale to assess depression symptoms; body mass index (BMI [kg/m2]) was measured from height/fasting weight; insulin resistance was derived from 2-h oral glucose testing. Adiposity was assessed with dual-energy X-ray absorptiometry at baseline and 1 year. Indirect effects of intervention were tested on 1-year changes in BMI, adiposity, and insulin through decreases in depression. Baseline depression was tested as a moderator of mediation.

Results
There was an indirect effect of CBT on decreased 1-year fasting insulin via decreases in depression during treatment, among adolescents with more elevated baseline depression.

Conclusions
Decreasing elevated depression may be one mechanism in the targeted prevention of T2D in at-risk adolescents.
Oh What an Unholy Mesh! Diamond v Royal Devon & Exeter NHS Foundation Trust [2019] EWCA Civ 585
Authors: Manning Joanna M 
Published: July 2019

Abstract
In Diamond v Royal Devon and Exeter NHS Foundation Trust [2019] EWCA Civ 585, the Court of Appeal mistakenly applied the wrong test to the issue of the causal link between the surgeon’s failure to disclose material information and her physical injury. Even had that test been correct, its application to the facts was open to question and arguably unsympathetic. The decision is also of note for adding to a line of previous Court of Appeal decisions, which have held that breach of the duty of disclosure does not create a stand-alone right to damages for loss of autonomy.
Sex-Ratio Meiotic Drive Shapes the Evolution of the Y Chromosome in Drosophila simulans
Authors: Helleu Quentin , Courret Cécile , Ogereau David , Burnham Katie L , Chaminade Nicole , Chakir Mohamed , Aulard Sylvie , Montchamp-Moreau Catherine 
Published: July 2019

AbstractThe recent emergence and spread of X-linked segregation distorters—called “Paris” system—in the worldwide species Drosophila simulans has elicited the selection of drive-resistant Y chromosomes. Here, we investigate the evolutionary history of 386 Y chromosomes originating from 29 population samples collected over a period of 20 years, showing a wide continuum of phenotypes when tested against the Paris distorters, from high sensitivity to complete resistance (males sire ∼95% to ∼40% female progeny). Analyzing around 13 kb of Y-linked gene sequences in a representative subset of nine Y chromosomes, we identified only three polymorphic sites resulting in three haplotypes. Remarkably, one of the haplotypes is associated with resistance. This haplotype is fixed in all samples from Sub-Saharan Africa, the region of origin of the drivers. Exceptionally, with the spread of the drivers in Egypt and Morocco, we were able to record the replacement of the sensitive lineage by the resistant haplotype in real time, within only a few years. In addition, we performed in situ hybridization, using satellite DNA probes, on a subset of 21 Y chromosomes from six locations. In contrast to the low molecular polymorphism, this revealed extensive structural variation suggestive of rapid evolution, either neutral or adaptive. Moreover, our results show that intragenomic conflicts can drive astonishingly rapid replacement of Y chromosomes and suggest that the emergence of Paris segregation distorters in East Africa occurred less than half a century ago.
Trends in Direct Hospital Payments to Anesthesia Groups
Authors: O’Connell Chloe , Dexter Franklin , Mauler David J. , Sun Eric C. 
Published: July 2019

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
In addition to payments for services, anesthesia groups in the United States often receive revenue from direct hospital payments. Understanding the magnitude of these payments and their association with the hospitals’ payer mixes has important policy implications.

Methods
Using a dataset of financial reports from 240 nonacademic California hospitals between 2002 and 2014, the authors characterized the prevalence and magnitude of direct hospital payments to anesthesia groups, and analyzed the association between these payments and the fraction of anesthesia revenue derived from public payers (e.g., Medicaid).

Results
Of hospitals analyzed, 69% (124 of 180) made direct payments to an anesthesia group in 2014, compared to 52% (76 of 147) in 2002; the median payment increased from $242,351 (mean, $578,322; interquartile range, $72,753 to $523,861; all dollar values in 2018 U.S. dollars) to $765,128 (mean, $1,295,369; interquartile range, $267,006 to $1,503,163) during this time period. After adjusting for relevant covariates, hospitals where public insurers accounted for a larger fraction of anesthesia revenues were more likely to make direct payments to anesthesia groups (β = 0.45; 95% CI, 0.10 to 0.81; P = 0.013), so that a 10–percentage point increase in the fraction of anesthesia revenue derived from public payers would be associated with a 4.5–percentage point increase in the probability of receiving any payment. Among hospitals making payments, our results (β = 2.10; 95% CI, 0.74 to 3.45; P = 0.003) suggest that a 1–percentage point increase in the fraction of anesthesia revenue derived from public payers would be associated with a 2% relative increase in the amount paid.

Conclusions
Direct payments from hospitals are becoming a larger financial consideration for anesthesia groups in California serving nonacademic hospitals, and are larger for groups working at hospitals serving publicly insured patients.
Superior Trunk Block
Authors: Kim David H. , Lin Yi , Beathe Jonathan C. , Liu Jiabin , Oxendine Joseph A. , Haskins Stephen C. , Ho Michael C. , Wetmore Douglas S. , Allen Answorth A. , Wilson Lauren , Garnett Christopher , Memtsoudis Stavros G. 
Published: July 2019

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Interscalene nerve blockade remains one of the most commonly used anesthetic and analgesic approaches for shoulder surgery. The high incidence of hemidiaphragmatic paralysis associated with the block, however, precludes its use among patients with compromised pulmonary function. To address this issue, recent studies have investigated phrenic-sparing alternatives that provide analgesia. None, however, have been able to reliably demonstrate surgical anesthesia without significant risk for hemidiaphragmatic paralysis. The utility of the superior trunk block has yet to be studied. The hypothesis was that compared with the interscalene block, the superior trunk block will provide noninferior surgical anesthesia and analgesia while sparing the phrenic nerve.

Methods
This randomized controlled trial included 126 patients undergoing arthroscopic ambulatory shoulder surgery. Patients either received a superior trunk block (n = 63) or an interscalene block (n = 63). The primary outcomes were the incidence of hemidiaphragmatic paralysis and worst pain score in the recovery room. Ultrasound was used to assess for hemidiaphragmatic paralysis. Secondary outcomes included noninvasively measured parameters of respiratory function, opioid consumption, handgrip strength, adverse effects, and patient satisfaction.

Results
The superior trunk group had a significantly lower incidence of hemidiaphragmatic paralysis compared with the interscalene group (3 of 62 [4.8%] vs. 45 of 63 [71.4%]; P < 0.001, adjusted odds ratio 0.02 [95% CI, 0.01, 0.07]), whereas the worst pain scores in the recovery room were noninferior (0 [0, 2] vs. 0 [0, 3]; P = 0.951). The superior trunk group were more satisfied, had unaffected respiratory parameters, and had a lower incidence of hoarseness. No difference in handgrip strength or opioid consumption were detected. Superior trunk block was associated with lower worst pain scores on postoperative day 1.

Conclusions
Compared with the interscalene block, the superior trunk block provides noninferior surgical anesthesia while preserving diaphragmatic function. The superior trunk block may therefore be considered an alternative to traditional interscalene block for shoulder surgery.
Hernio-abdominoplasty with or without Scarpa’s Fascia Preservation for Ventral Hernia and Abdominal Wall Deformity
Authors: Eltantawy Mahmoud , Elshobaky Ayman , Thabet Waleed , Emile Sameh , El-Said Mohammed , Elshobaky Mohamed Taher , Mahmoud Sabry Ahmed 
Published: July 2019

Background:
Scarpa’s fascia preservation plays a great role in decreasing the volume of wound drainage and reducing seroma after abdominoplasty. This study aimed to assess the role of Scarpa’s fascia preservation in patients with ventral hernias associated with abdominal wall deformity who underwent concomitant hernio-abdominoplasty in terms of early and late postoperative outcome and quality of life.

Methods:
Patients with ventral hernia and abdominal wall deformity underwent combined hernio-abdominoplasty. Patients were randomly allocated to 1 of 2 equal groups: group I underwent Scarpa’s fascia preserving hernio-abdominoplasty and group II underwent hernio-abdominoplasty with removal of Scarpa’s fascia. Volume of drainage, time to remove drains, return to work, and complications were recorded.

Results:
Fifty patients (49 female) were included to the study. Both groups had comparable operation time, pain score, and complication rate (24% versus 40%, P = 0.36). The mean total volume of postoperative drainage was significantly lower in group I than group II (686 ± 183.5 versus 1410.8 ± 371.6 ml; P < 0.0001). Group I had earlier drain removal (11.6 ± 1.9 versus 20.5 ± 4.2 days, P < 0.0001) and earlier return to work (16.4 ± 2.3 versus 23.3 ± 3.8 days, P < 0.0001) than group II. There were no recorded cases of hematoma or hernia recurrence after repair.

Conclusion:
Scarpa’s fascia preservation in combined ventral hernia repair and abdominoplasty was associated with significantly lower volume of postoperative drainage, earlier removal of drains, and similar recurrence rate to hernio-abdominoplasty with removal of Scarpa’s fascia.
The Effect of Nonpharmacological Interventions on Managing Symptom Clusters Among Cancer Patients
Authors: So Winnie K. W. , Law Bernard M. H. , Chan Dorothy N. S. , Xing Weijie , Chan Carmen W. H. , McCarthy Alexandra L. 
Published: July 2019

Background
Cancer patients often experience multiple concurrent and related symptoms, or symptom clusters. Research increasingly indicates that targeting a symptom cluster as an overall entity instead of individual symptoms could be more effective and efficient in improving patients’ quality of life. Various nonpharmacological interventions are used to manage symptom clusters in cancer patients during and after treatment, but the effect of such interventions is uncertain.

Objective
To provide a summary of such interventions and evaluate their effects in terms of symptom cluster severity, quality of life, and functional ability of patients with cancer.

Methods
A comprehensive literature search of 5 English and 2 Chinese electronic databases (PubMed, MEDLINE, EMBASE, PsycINFO, CINAHL, CNKI, and Wanfang) was combined with hand searching, to identify eligible research studies from 2001 to January 2018. Two reviewers carried out data selection, data extraction, and quality appraisal independently. A narrative approach was used to summarize data.

Results
Thirteen randomized controlled trials, involving 1490 patients, were included in the review. The methodological quality of the studies was generally fair. Nonpharmacological interventions can reduce the severity of symptom clusters, especially the pain–fatigue–sleep disturbance, cognitive, and gastrointestinal clusters, and improve both quality of life and functional ability.

Conclusions
While symptom cluster interventions are potentially useful in cancer care, further well-designed research is needed to test them rigorously on various types of cancer symptom clusters.

Implications for Practice
Nonpharmacological interventions are shown to be effective in managing cancer-associated symptom clusters and could be considered as part of the existing healthcare services for cancer patients.
Review of Mixed-Methods Research in Nursing
Authors: Younas Ahtisham , Pedersen Maria , Tayaben Jude Laoagan 
Published: July 2019

Background
Inadequate justification for using mixed-methods and inadequate data integration compromises the rigor of mixed-methods studies, and data integration remains a challenge for nurse researchers.

Objectives
The aim of the study was to determine the 5-year prevalence of mixed-methods research in nursing journals and to determine the extent of integration of qualitative and quantitative findings.

Methods
Ten journals were hand-searched, and additional search was conducted within three databases. Prevalence was calculated by counting the number of published mixed-methods studies divided by the number of published studies over 5 years. Three reviewers independently performed methodological assessment using a checklist based on guidelines by expert methodologists.

Results
Prevalence of mixed-methods studies was 1.89%. Concerning methodological assessment, of 175 studies, 29% did not provide an explicit label of the study design and four studies incorrectly labeled the design. In total, 31% of the studies did not justify using mixed methods, 95% did not identify the research paradigm, and 78% did not state the weight given to individual phases. The extent of data integration was 73%, but 83% of studies integrated data using narrative summaries with integration occurring at the interpretation (69.8%). Few studies used joint displays (10.9%), transformation (3.1%), and triangulation (1.6%) for data integration.

Discussion
Mixed-methods research is still in its infancy in nursing, and researchers encounter challenges during its conduct, analysis, and reporting. There is a need to determine researchers’ attitudes and challenges toward using mixed methods and educate them about advanced mixed methods. Emphasis should be placed on use of advanced data integration methods so that the rigor and quality of mixed research can be enhanced in nursing research.
Patients With Spinal Muscular Atrophy Use High Percentages of Trunk Muscle Capacity to Perform Seated Tasks
Authors: Peeters Laura H. C. , Janssen Mariska M. H. P. , Kingma Idsart , van Dieën Jaap H. , de Groot Imelda J. M. 
Published: July 2019

Objective
The aim of the study was to investigate trunk function during seated upper limb tasks in patients with spinal muscular atrophy types 2 and 3.

Design
Seventeen persons with spinal muscular atrophy and 15 healthy controls performed several tasks when sitting unsupported, such as reaching (and placing) forward and sideward. Joint torque and muscle activity were measured during maximum voluntary isometric contractions. Three-dimensional kinematics and normalized muscle activity were analyzed when performing tasks.

Results
Trunk joint torques were significantly decreased, approximately 45%, in patients with spinal muscular atrophy compared with healthy controls. Active range of trunk motion was also significantly decreased in all directions. When performing tasks, the average back muscle activity was 27% and 56% of maximum voluntary isometric contractions for healthy controls and spinal muscular atrophy and for abdominal muscles 10% and 44% of maximum voluntary isometric contractions, respectively. Trunk range of motion did not differ when performing daily tasks.

Conclusions
The trunk of patients with spinal muscular atrophy is weaker compared with healthy controls, reflected by reduced trunk torques and decreased active range of motion. In addition, patients with spinal muscular atrophy use high percentages of their trunk muscle capacity to perform tasks. Clinicians should take this into account for intervention development, because using high percentages of the maximum muscle capacity results in fatigue and muscle overloading.
Integra in Scalp Reconstruction After Tumor Excision: Recommendations From a Multidisciplinary Advisory Board
Authors: Magnoni Cristina , De Santis Giorgio , Fraccalvieri Marco , Bellini Pietrantonio , Portincasa Aurelio , Giacomelli Luca , Papa Giovanni 
Published: July 2019

Abstract
Integra is a dermal regeneration template used in the reconstruction of burns, traumatic injuries, or excision lesions in patients who present particular risk factors for traditional surgical procedures. A multidisciplinary advisory board of expert dermatologists and plastic surgeons have discussed the use of Integra in the reconstruction of scalp defects after tumor excision, focusing on the evidence derived from literature and on their experience in the treatment of approximately 400 patients. In this position paper, the authors summarize the main evidence discussed during the board, and the common practice guidelines proposed by the experts. The use of Integra is recommended in elderly patients with multiple comorbidities who have a higher risk for potential complications in traditional surgery; these patients may in fact benefit from a lower anesthetic risk, a less complicated postsurgical care and limited morbidity at the donor site obtained with the dermal template. Integra should also be used in the reconstruction of large and complex wounds and in case of bone exposure, as it helps to overcome the challenges related to wound healing in difficult areas. Notably, Integra has proven to be effective in patients who have undergone previous surgical procedures or adjuvant radiation therapy, in which previous incisions, scarring and radiation damages may hamper the effectiveness of traditional procedures. Finally, Integra is recommended in patients with recurrent and aggressive tumors who need closer tumor surveillance, as it gives easy access to the tumor site for oncologic follow-up examination.
Quantification of Student Radiographic Patient Positioning Using an Immersive Virtual Reality Simulation
Authors: Sapkaroski Daniel , Baird Marilyn , Mundy Matthew , Dimmock Matthew Richard 
Published: July 2019

Introduction
Immersive virtual reality (VR) simulation environments facilitate novel ways for users to visualize anatomy and quantify performance relative to expert users. The ability of software to provide positional feedback before a practitioner progresses with subsequent stages of examinations has broad implications for primary and allied healthcare professionals, particularly with respect to health and safety (eg, exposing to x-rays). The effect of training student-radiographers (radiology technicians), with a VR simulation environment was quantitatively assessed.

Methods
Year 1 radiography students (N = 76) were randomly split into 2 cohorts, each of which were trained at performing the same tasks relating to optimal hand positioning for projection x-ray imaging; group 1 was trained using the CETSOL VR Clinic software, whereas group 2 was trained using conventional simulated role-play in a real clinical environment. All participants completed an examination 3 weeks after training. The examination required both posterior-anterior and oblique hand x-ray positioning tasks to be performed on a real patient model. The analysis of images from the examination enabled quantification of the students' performance. The results were contextualized through a comparison with 4 expert radiographers.

Results
Students in group 1 performed on average 36% (P < 0.001) better in relation to digit separation, 11% (P ≤ 0.001) better in terms of palm flatness and 23% (P < 0.05) better in terms of central ray positioning onto the third metacarpal.

Conclusion
A significant difference in patient positioning was evident between the groups; the VR clinic cohort demonstrated improved patient positioning outcomes. The observed improvement is attributed to the inherent task deconstruction and variety of visualization mechanisms available in immersive VR environments.