bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of pillow height on the biomechanics of the head-neck complex: investigation of the cranio-cervical pressure and cervical spine alignment
Authors: Ren Sicong , Wong Duo Wai-Chi , Yang Hui , Zhou Yan , Lin Jin , Zhang Ming 
Published: August 2016

BackgroundWhile appropriate pillow height is crucial to maintaining the quality of sleep and overall health, there are no universal, evidence-based guidelines for pillow design or selection. We aimed to evaluate the effect of pillow height on cranio-cervical pressure and cervical spine alignment.MethodsTen healthy subjects (five males) aged 26 ± 3.6 years were recruited. The average height, weight, and neck length were 167 ± 9.3 cm, 59.6 ± 11.9 kg, and 12.9 ± 1.2 cm respectively. The subjects lay on pillows of four different heights (H0, 110 mm; H1, 130 mm; H2, 150 mm; and H3, 170 mm). The cranio-cervical pressure distribution over the pillow was recorded; the peak and average pressures for each pillow height were compared by one-way ANOVA with repeated measures. Cervical spine alignment was studied using a finite element model constructed based on data from the Visible Human Project. The coordinate of the center of each cervical vertebra were predicted for each pillow height. Three spine alignment parameters (cervical angle, lordosis distance and kyphosis distance) were identified.ResultsThe average cranial pressure at pillow height H3 was approximately 30% higher than that at H0, and significantly different from those at H1 and H2 (p< 0.05). The average cervical pressure at pillow height H0 was 65% lower than that at H3, and significantly different from those at H1 and H2 (p< 0.05). The peak cervical pressures at pillow heights H2 and H3 were significantly different from that at H0 (p< 0.05). With respect to cervical spine alignment, raising pillow height from H0 to H3 caused an increase of 66.4% and 25.1% in cervical angle and lordosis distance, respectively, and a reduction of 43.4% in kyphosis distance.DiscussionPillow height elevation significantly increased the average and peak pressures of the cranial and cervical regions, and increased the extension and lordosis of the cervical spine. The cranio-cervical pressures and cervical spine alignment were height-specific, and they were believed to reflect quality of sleep. Our results provide a quantitative and objective evaluation of the effect of pillow height on the biomechanics of the head-neck complex, and have application in pillow design and selection.
Introduction to Parkinson disease (PD) and its complications
Authors: Marvanova Marketa 
Published: August 2016

Abstract
Parkinson disease (PD) is a common neurodegenerative disorder in older adults characterized by motor and nonmotor symptoms and complications. Impulse control disorders (ICDs), such as pathological gambling, compulsive shopping, compulsive sexual behavior (hypersexuality), and binge eating disorder, affect 13.6% of the PD population. Use of dopamine receptor agonists (DRAs) is considered a major risk factor for ICD development. Amantadine and a high dose of levodopa were linked to ICDs to a lesser extent than DRAs. Based on the severity of behavior(s), ICDs can negatively impact social, professional, and familial lives of patients and their families. Ideally, all PD patients taking DRAs, high doses of levodopa, and/or amantadine should be routinely asked about or monitored for ICDs during therapy initiation and continuation. Dose decrease or withdrawal of the offending agent, primarily DRAs, is usually the most effective first step in ICD management. Careful dose adjustment with close monitoring is warranted due to risk for worsening of motor symptoms or emergence of dopamine agonist withdrawal syndrome (DAWS). About 1/3 of PD patients with ICD who decrease or discontinue DRA experienced DAWS. The lowest dose of DRA will need to be continued to balance ICDs and DAWS as it is not alleviated by other dopaminergic or psychotropic medications. Other therapies with low empiric evidence, such as amantadine, naloxone, cognitive behavior therapy, deep brain stimulation, and psychopharmacotherapy showed mixed results for ICD management. It is crucial that clinicians are familiar with the psychiatric complications of PD, including ICDs, beyond mere recognition and management of motor symptoms.
Quantitative and economic analysis of clinical pharmacist interventions during rounds in an acute care psychiatric hospital
Authors: Gunterus Alicia , Lopchuk Shruti , Dunn Christina , Floyd Ronald , Normandin Brad 
Published: August 2016

Abstract
Introduction: Clinical pharmacists have become an integral part of multidisciplinary medical teams, including in the area of psychiatry. Previous studies have shown that having pharmacists in multidisciplinary medical teams has led to improved medication use, reduction of adverse drug events, and improved patient outcomes. The purpose of this study is to conduct a quantitative and economic analysis of the impact of clinical pharmacist interventions during hospital rounds in an acute care psychiatric hospital setting.
Methods: This is a retrospective analysis of 200 clinical pharmacist interventions documented between September 2013 and September 2014. Clinical pharmacist interventions were classified into several categories and types. Only clinical pharmacist interventions made during multidisciplinary team rounds were included in the study. Descriptive statistics were used for the quantitative analysis of clinical pharmacist interventions. The acceptance rate was calculated. Only the accepted clinical interventions were included in the economic analysis. Economic outcome involved an assessment of cost saving and cost avoidance.
Results: The most frequent types of clinical pharmacist interventions were discontinuation of medications (38.5%), laboratory monitoring (26%), and medication order modification (13.5%). The most common reason for drug discontinuation was polypharmacy. Clinical pharmacist interventions were associated with a 92.5% acceptance rate. Two hundred clinical pharmacist interventions were associated with $6760.19 medication cost saving and $62 806.67 cost avoidance.
Discussion: Clinical pharmacist interventions during rounds in an acute care psychiatric hospital setting mostly involve medication order modification and laboratory monitoring. They are also associated with significant cost saving and cost avoidance.
Impact on length of stay and readmission rates when converting oral to long-acting injectable antipsychotics in schizophrenia or schizoaffective disorder
Authors: Chou Fabienne , Reome Earle , Davis Patricia 
Published: August 2016

Abstract
Introduction: Nonadherence with oral antipsychotics in patients with schizophrenia has been associated with symptom relapse and rehospitalizations, resulting in increased morbidity and health care costs. Long-acting injectable antipsychotics (LAIAs) are an alternative to enhance adherence and decrease relapse requiring hospitalization. The objectives of this study are to determine the impact of LAIAs on reducing length of stay, the rate of annual readmissions, and the number of failed annual discharges (defined as a readmission in less than 30 days) in patients with schizophrenia or schizoaffective disorder admitted to an acute inpatient psychiatric unit.
Methods: Using the hospital database, 52 patients receiving a diagnosis of schizophrenia or schizoaffective disorders treated with oral antipsychotics and later transitioned to LAIAs were evaluated retrospectively.
Results: Patients treated with LAIAs did not show a statistically significant reduction in length of stay compared with their length of stay on oral antipsychotics. Patients treated with LAIAs experienced a statistically significant reduction in the rate of annual readmissions and a reduction in the number of failed annual discharges, although the latter was not statistically significant (P = .076 when compared to treatment with oral antipsychotics).
Discussion: These findings suggest a potential role for maintaining patients with a diagnosis of schizophrenia or schizoaffective disorder on LAIAs to prevent relapse and rehospitalizations. The reduction in the number of failed annual discharges between the oral versus LAIA group, although not statistically significant, warrants further investigation to determine the impact of LAIAs on readmission within 30 days.
Electronic Health Record Nudges and Health Care Quality and Outcomes in Primary Care
Authors: Nguyen Oliver T. , Kunta Avaneesh R. , Katoju SriVarsha , Gheytasvand Sara , Masoumi Niloofar , Tavasolian Ronia , Alishahi Tabriz Amir , Hong Young-Rock , Hanna Karim , Perkins Randa , Parekh Arpan , Turner Kea 
Published: September 2024

ImportanceNudges have been increasingly studied as a tool for facilitating behavior change and may represent a novel way to modify the electronic health record (EHR) to encourage evidence-based care.ObjectiveTo evaluate the association between EHR nudges and health care outcomes in primary care settings and describe implementation facilitators and barriers.Evidence ReviewOn June 9, 2023, an electronic search was performed in PubMed, Embase, PsycINFO, CINAHL, and Web of Science for all articles about clinician-facing EHR nudges. After reviewing titles, abstracts, and full texts, the present review was restricted to articles that used a randomized clinical trial (RCT) design, focused on primary care settings, and evaluated the association between EHR nudges and health care quality and patient outcome measures. Two reviewers abstracted the following elements: country, targeted clinician types, medical conditions studied, length of evaluation period, study design, sample size, intervention conditions, nudge mechanisms, implementation facilitators and barriers encountered, and major findings. The findings were qualitatively reported by type of health care quality and patient outcome and type of primary care condition targeted. The Risk of Bias 2.0 tool was adapted to evaluate the studies based on RCT design (cluster, parallel, crossover). Studies were scored from 0 to 5 points, with higher scores indicating lower risk of bias.FindingsFifty-four studies met the inclusion criteria. Overall, most studies (79.6%) were assessed to have a moderate risk of bias. Most or all descriptive (eg, documentation patterns) (30 of 38) or patient-centeredness measures (4 of 4) had positive associations with EHR nudges. As for other measures of health care quality and patient outcomes, few had positive associations between EHR nudges and patient safety (4 of 12), effectiveness (19 of 48), efficiency (0 of 4), patient-reported outcomes (0 of 3), patient adherence (1 of 2), or clinical outcome measures (1 of 7).Conclusions and RelevanceThis systematic review found low- and moderate-quality evidence that suggested that EHR nudges were associated with improved descriptive measures (eg, documentation patterns). Meanwhile, it was unclear whether EHR nudges were associated with improvements in other areas of health care quality, such as effectiveness and patient safety outcomes. Future research is needed using longer evaluation periods, a broader range of primary care conditions, and in deimplementation contexts.
Development of a 3D‐printed phantom for total skin electron therapy dose assessment
Authors: Lee Andrew , Alkhatib Zaid , Ibrahim Mounir , McCallum‐Hee Broderick , Dass Joshua , Fernandez de Viana Matthew , Rowshanfarzad Pejman 
Published: September 2024

AbstractPurposeTotal skin electron therapy (TSET) is a complex radiotherapy technique, posing challenges in commissioning and quality assurance (QA), especially due to significant variability in patient body shapes. Previous studies have correlated dose with factors such as obesity index, height, and gender. However, current treatment planning systems cannot simulate TSET plans, necessitating heavy reliance on QA methods using standardized anthropomorphic phantoms and in‐vivo dosimetry. Given the relatively few studies on rotational techniques, comprehensive data in commissioning could streamline the process.MethodsDeveloping a full‐body phantom would enable a more thorough TSET commissioning process, including testing for position‐specific dose distributions and comprehensive measurements across all body surfaces, unlike the typical torso‐only phantoms. This was created using digital modeling software, fabricated using 3D‐printing FDM technology, and filled with tissue‐equivalent gelatine. The phantom was positioned at an SSD of 340 cm and irradiated with a standard rotational TSET plan using the 6E HDTSE mode on a Varian TrueBeam linac at gantry angles of ± 18° from the horizontal. The dose was measured at over 50 points across the surface using Gafchromic EBT3 film.ResultsDose distributions were generally consistent with existing literature values from in‐vivo dosimetry, with several position‐specific differences identified, including the hands and scalp compared to conventional positions. Hotspots were observed for the mid‐dorsum of the foot and nose, with areas under 80% of the dose identified as the soles of the feet, perineum, vertex of the scalp, top of the shoulder, and palm of the hand. Additionally, analysis using an interpolated dose heatmap found that 90% of the pixel area received a dose within 10% of the prescribed dose, indicating good uniformity with the commissioned technique.ConclusionsWith high agreement with the current literature, a 3D‐printed phantom proves effective for measuring doses in areas typically unmeasurable in TSET commissioning.
Long‐term stability of a PTW 34070 large‐area parallel ionization chamber in clinical proton scanning beams
Authors: Yamanaka Masashi , Mori Yutaro , Matsumoto Kazuki , Moriya Shunsuke , Yamano Akihiro , Shimo Takahiro , Shirata Ryosuke , Nitta Kazunori , Nagata Hironori , Tokuuye Koichi 
Published: September 2024

AbstractPurposeIn the modeling of beam data for proton therapy planning systems, absolute dose measurements are performed utilizing a Bragg peak chamber (BPC), which is a parallel‐plate ionization chamber. The long‐term stability of the BPC is crucial for ensuring accurate absolute dose measurement. The study aims to assess the long‐term stability of the BPC in clinical proton pencil beam scanning delivery.MethodsThe long‐term stability evaluation focused on the BPC‐Type 34070 (PTW Freiburg, Germany), utilizing clinical proton scanning beams from December 2022 to November 2023. Monthly investigations were conducted to evaluate the response and cross‐calibration factor of the BPC and a reference chamber, employing the spread‐out Bragg peak (SOBP) field. Additionally, assessments were made regarding the BPC's response to monoenergetic beams, along with an examination of the impact of polarity and ion recombination on the BPC.ResultsThe response and cross‐calibration factor of the BPC varied up to 1.9% and 1.8%, respectively, while the response of the reference chamber remained within a 0.5% range. The BPC's response to the mono‐energetic beams varied up to 2.0% across all energies, demonstrating similar variation trends in both the SOBP field and mono‐energetic beams. Furthermore, the variations in polarity and ion recombination effect remained stable within a 0.4% range throughout the year. Notably, the reproducibility of the BPC remained high for each measurement conducted, whether for the SOBP field or mono‐energetic beams, with a maximum deviation observed at 0.1%.ConclusionsThe response and cross‐calibration factor of the BPC demonstrated significant variations, with maximum changes of 1.9% and 1.8%, respectively. However, the reproducibility of the BPC remained consistently high for each measurement. It is recommended that when conducting absolute dose measurements using a BPC, its response should be compared and corrected against the reference chamber for each measurement.
Brain tumor segmentation by combining MultiEncoder UNet with wavelet fusion
Authors: Pan Yuheng , Yong Haohan , Lu Weijia , Li Guoyan , Cong Jia 
Published: September 2024

AbstractBackground and objectiveAccurate segmentation of brain tumors from multimodal magnetic resonance imaging (MRI) holds significant importance in clinical diagnosis and surgical intervention, while current deep learning methods cope with situations of multimodal MRI by an early fusion strategy that implicitly assumes that the modal relationships are linear, which tends to ignore the complementary information between modalities, negatively impacting the model's performance. Meanwhile, long‐range relationships between voxels cannot be captured due to the localized character of the convolution procedure.MethodAiming at this problem, we propose a multimodal segmentation network based on a late fusion strategy that employs multiple encoders and a decoder for the segmentation of brain tumors. Each encoder is specialized for processing distinct modalities. Notably, our framework includes a feature fusion module based on a 3D discrete wavelet transform aimed at extracting complementary features among the encoders. Additionally, a 3D global context‐aware module was introduced to capture the long‐range dependencies of tumor voxels at a high level of features. The decoder combines fused and global features to enhance the network's segmentation performance.ResultOur proposed model is experimented on the publicly available BraTS2018 and BraTS2021 datasets. The experimental results show competitiveness with state‐of‐the‐art methods.ConclusionThe results demonstrate that our approach applies a novel concept for multimodal fusion within deep neural networks and delivers more accurate and promising brain tumor segmentation, with the potential to assist physicians in diagnosis.
Is an all‐phase ITV (internal target volume) a gold standard in the target definition of hepatocellular carcinoma?
Authors: Kumar Rishabh , Gupta Anil , Vishwanathan Bhaskar , Kamal Rose , Thaper Deepak 
Published: September 2024

AbstractBackgroundStereotactic ablative body radiation (SABR) is a well‐recognized treatment option for hepatocellular carcinoma (HCC). Due to the inherent motion of liver tumors, effective motion management is crucial for successful SABR. In the motion‐encompassing motion management technique, all 10 respiratory phase image datasets are delineated and designated as the internal target volume (ITV). Some treatment centers use single or combination image sets to delineate the target volume. This study determines which specialty image set most closely matches an all‐phase ITV contour on a synchronized contrast‐enhanced 4DCT.Materials and methodsSynchronized 4DCT contrast and delayed scans were acquired for 10 patients in the study. The maximum intensity projection (MiP), average intensity projection (AvgIP), and minimum intensity projection (MinIP) images were generated. The ITV delineation was done in all 10 phases (ITV_all_phase). The ITV_2phase combines the peak inhale and exhale phase, ITV_2 M combines MiP and MinIP, and ITV_3 M combines MiP, MinIP, and AvgIP. All ITVs were compared to ITV_all_phase with Dice similarity index (DSI) and volumes.ResultsUsing ITV_all_phase as the reference, the DSI and the mean ITV volumes for the different ITVs were as follows: ITV_all_phase (1 and 116.69 cc), ITV_2phase (0.87 and 105.27 cc), MiP (0.76 and 98.24 cc), AvgIP (0.72 and 94.54 cc), ITV_MinIP (0.67 and 81.08 cc), ITV_2 M (0.84 and 106.26 cc), and ITV_3 M (0.86 and 112.51 cc).ConclusionThe study demonstrates that in the motion‐encompassing technique of motion management, the target volume generated by delineating all phases of 4DCT provides the most accurate representation for patients with HCC. Specialty image sets and their combinations, while sometimes close, tend to result in less accurate targeting. Hence, the all‐phase 4DCT method should be preferred to avoid geographical misses and ensure optimal treatment outcomes. However, our conclusion may be limited by the technique we employed.
How to Help Students Make Informed Assessments of Cognitive Load: Examining the Role of Training Interventions
Authors: Krieglstein Felix , Schmitz Manuel , Wesenberg Lukas , Rey Günter Daniel 
Published: September 2024

ABSTRACTMeasuring cognitive load and its different types is a significant challenge that is closely related to the development of cognitive load theory (CLT). Previous research has shown that students have difficulty assessing cognitive load after learning or problem‐solving. Accordingly, they may not reliably differentiate between the different types of cognitive load. Moreover, students may not consider the entire problem‐solving process in their overall cognitive load assessment. The purpose of this work was to examine two training interventions designed to assist students in making informed cognitive load assessments. Study 1 (N = 99) included pre‐training with a theoretical introduction to CLT to improve differentiation between cognitive load types. Study 2 (N = 80) implemented post‐training by instructing students to consider all impressions during problem‐solving for the overall load assessment. As both interventions were unsuccessful, further research is needed to assist students in assessing cognitive load in an informed manner.
Microenvironments‐Modulated Biomaterials Enhance Spinal Cord Injury Therapy
Authors: Li Yuehong , Zhang Qingzheng , Liu Zongtai , Fu Changfeng , Ding Jianxun 
Published: September 2024

AbstractSpinal cord injury (SCI) results from various causes, including sports‐related incidents, degenerative cervical myelopathy, traffic accidents, and falls. SCI typically leads to sensory and motor dysfunction and even paralysis. Current treatments for SCI include systemic administration of high‐dose steroids and surgical decompression and stabilization. However, excessive use of glucocorticoids may increase susceptibility to infections and systemic bleeding. The long‐term effect of surgery intervention remains unclear, with ongoing debates regarding its timing, efficacy, and safety. Therefore, innovative approaches are urgently needed to alleviate secondary injuries and promote spinal recovery. One emerging therapeutic approach for SCI is modulating the microenvironments to achieve neuroprotection and neurogenesis during recovery. Several biomaterials with favorable physicochemical properties have been developed to enhance therapeutic effects by regulating microenvironments. This Review first discusses the pathology of SCI microenvironments and then introduces biomaterials‐based regulatory strategies targeting various microenvironmental components, including anti‐inflammation, anti‐oxidation, reduction of excitotoxicity, revascularization, neurogenesis, and scar density reduction. Additionally, the research and clinical application prospects for microenvironment regulation are presented.