bluuebunny/crossref_metadata_2025_split huggingface dataset:
How does the outcome of research training fellowships funded via the NHS compare with that from competitively funded fellowships from the MRC and other charities: a cross-sectional retrospective survey of trainees undertaking research training in the West Midlands
Authors: Maybury Charlotte , Morgan Matthew David , Smith Russell , Harper Lorraine 
Published: January 2018

ObjectivesThis study aimed to investigate the impact of research training funded via the National Health Service (NHS) on medical trainees compared with traditional clinical research training fellowships (CRTFs).Design, setting and participantsOnline survey of 221 clinical trainees who had completed a period of research during their clinical training between 2009 and 2015 in the West Midlands.Main outcome measuresResearch outcomes.ResultsOverall response rate was 59%, of whom 72 participants were funded by CRTFs and 51 funded by the NHS. Although participants with CRTFs were more likely to be awarded a higher degree compared with those on NHS-administered funding (66/72 CRTFs and 37/51 NHS, P=0.005), similar proportions of NHS-funded and CRTF-funded participants entered clinical lecturer posts on completing initial research training (8/51 NHS and 16/72 CRTF, P=0.37). 77% of participants had three or more publications (CRTF 57 and NHS 39, P=0.72). 57 participants had completed clinical training; similar proportions of CRTF-funded and NHS-funded trainees had research included in their consultant contract (12/22 NHS and 14/26 CRTF, P=0.96) or were appointed to academic posts (3 of 25 NHS funded and 6 of 32 CRTF, P>0.05). 95% of participants would recommend to colleagues and 82% of participants felt the research experience improved their provision of clinical care with no difference between CRTF-funded and NHS-funded participants (P=0.49). Continuing to participate in clinical work during the research reduced reports of trainee difficulty on returning to clinical work (23/108 continued clinical work vs 12/22 no clinical work, P=0.001).ConclusionResearch training funded by the NHS provides a quality experience and contributes to the clinical academic capacity within the UK. More needs to be done to support NHS participants to successfully achieve a higher degree.
Detection of Intense Ice Precipitation with GPM/DPR
Authors: Iguchi Toshio , Kawamoto Nozomi , Oki Riko 
Published: January 2018

AbstractDetection of ice precipitation is one of the objectives in the Global Precipitation Measurement (GPM) mission. The dual-frequency precipitation radar (DPR) can provide precipitation echoes at two different frequencies, which may enable differentiating solid precipitation echoes from liquid precipitation echoes. A simple algorithm that flags the pixels that contain intense ice precipitation above the height of C is implemented in version 5 of the DPR products. In the inner swath of DPR measurements in which both Ku- and Ka-band radar echoes are available, the measured dual-frequency ratio () together with the measured radar reflectivity factor is used to judge the existence of intense ice precipitation. Comparisons of the flagged pixels with surface measurements show that the algorithm correctly identifies relatively intense ice precipitation regions. The global distribution of the flagged pixels indicates an interesting difference between land and ocean, in particular in the distribution of ice precipitation that reaches the surface. The flag is also expected to be useful for improving precipitation retrieval algorithms by microwave radiometers.
Occupational needs and priorities of women experiencing homelessness
Authors: Salsi Sofia , Awadallah Yara , Leclair Aurélie B. , Breault Marie-Lyse , Duong Dan-Tam , Roy Laurence 
Published: January 2018

Background. Women in unstable housing or who are homeless experience disruptions of occupational engagement and performance. Little is known about their perspective on their occupational needs and priorities. Purpose. This study aimed to determine how patterns of occupational engagement and performance are facilitated or hindered by personal factors and resources available to sheltered women. Method. A participatory, descriptive mixed-methods study design was used. Twenty-one residents were interviewed using the Canadian Occupational Performance Measure, the Goal Attainment Scale, and a time-use inventory. Nineteen residents participated in semistructured qualitative interviews. Qualitative data were analysed using interpretive description. Findings. Participants spent most time on sleep and passive leisure and identified occupational performance issues and goals related to active leisure and employment. Participants’ occupational lives were described as transitional journeys comprising five subthemes: seeking safety and stability, being sheltered, shaping one’s identity, developing resilience, and engaging in contemplation, contribution, and connectedness through occupation. Implications. Trauma-informed and strengths-based approaches are recommended for this population. Future research should study the implementation of occupation-based interventions in community settings.
Blow/trauma to the chest and sudden cardiac death: Commotio cordis and contusio cordis are leading causes
Authors: Krexi Lydia , Sheppard Mary N 
Published: January 2018

Background In forensic practice, a blow to the chest can lead to sudden cardiac death (SCD). Commotio cordis and contusio cordis are leading causes. Methods From a database of 4678 patients who suffered from SCD, we found three patients with commotio cordis and two patients with contusio cordis. All the patients were examined macroscopically and microscopically and had negative toxicology screen. Results The three patients who died due to commotio cordis were young males (16, 23 and 38 years old). The circumstances of death were: a blow to the chest by a football, by a friend during a party and during an assault. The hearts were completely normal at autopsy. The two patients who had contusio cordis were older males (42 and 63 years old). Both patients died during traffic accidents. At autopsy, one had significant contusion over the left ventricle, and the second had contusion over the right ventricle. Conclusion This study indicates that a blow to the chest is very important to document in the circumstances of death, and a detailed history is vital. It raises the left ventricular intra-cavitary pressure, leading to commotio cordis with immediate death with a normal heart. Blunt chest trauma can cause direct myocardial lesions, with acute changes leading to contusio cordis.
High Protein Intake during Continuous Hemodiafiltration: Impact on Amino Acids and Nitrogen Balance
Authors: Bellomo R. , Tan H. K. , Bhonagiri S. , Gopal I. , Seacombe J. , Daskalakis M. , Boyce N. 
Published: January 2018

Aims To study the effect of combined continuous veno-venous hemodiafiltration (CVVHDF) and high (2.5 g/kg/day) parenteral amino acid supplementation on nitrogen balance, amino acid losses and azotemic control in a cohort of patients with severe acute renal failure (ARF). Methods We administered 2.5 grams/kg/day of amino acids intravenously to seven critically ill patients with ARF. We obtained paired blood and ultrafiltrate (UF) samples (n=20) and calculated amino acid clearances and losses, nitrogen balance, protein catabolic rate and total nitrogen losses. Results The median total serum amino acid concentration was high at 5.2 mmol/L with particularly high concentrations of ornithine, lysine, and phenylalanine, but a low level of histidine. The median overall amino acid clearance was 18.6 ml/min (range: 12 to 29 ml/min). UF losses as percentage of administered dose were high for tyrosine (53.6 %) but low for methionine (3.0 %) and arginine (2.3 %). A positive nitrogen balance was achieved in 7 (35%) of the 20 study days with an overall median nitrogen balance of -1.8 g/day. Urea levels were maintained at a median of 26.6 mmol/L. Conclusions High protein intake increases the serum concentrations of most amino acids. Such protein supplementation, when coupled with CVVHDF, achieves a slightly negative overall nitrogen balance in extremely catabolic patients while still allowing adequate azotemic control.
Measurements of Hemodialysis Catheter Blood Flow in Vivo
Authors: Twardowski Z. J. , Haynie J. D. 
Published: January 2018

The relationship between the blood flow and inflow and outflow pressures was determined in PermCath, dual lumen catheters during regular hemodialyses in vivo in eight patients with average hematocrit of 38%. From the luer lock connector the catheters had an average length of 32 cm to the outflow tip and 30 cm to the inflow tip. The catheters had an internal diameter of 0.2 cm and were straight before implantation. Dialyses were performed on Fresenius 2008 D or E machines with ReadySet™ blood lines with an 8 mm ID pump segment and a noncollapsible arterial chamber. Pressures and blood flows were measured at pump speeds from 50 to 500 ml/min in increments of 50 ml/min with lines in normal configuration. Blood flow was measured continuously using ultrasound. The correlations between pressures and flows are not linear. The best correlations are according to the Stirling model of exponential growth category equation. Inflow pressure = -9.07–0.4865*(exp(0.0020*blood flow)-1)/0.0020 Outflow pressure = -28.14+0.5002*(exp(0.0015*blood flow)-1/0.0015 Based on these results and Poiseuille's equation a table was developed for the optimal relationship between catheter length and diameter to achieve standardized (average, low and high) blood flows regardless of the lengths of the catheters. The diameter/length relationships are based on theoretical considerations. Because resistances depend on the material and shape of the tubing, the actual measurements of flow/pressure relationships should be done once tubings of different diameters are manufactured, and final catheter design has to be based on these measurements.
Transplantation or Alternative Surgical Treatment of Patients with Ischemic Dilative Cardiomyopathy and Aneurysmatic Dilation of the Left Ventricular Cavity
Authors: Mitrev Z. , Anguseva T. , Vasileva A. , Hristov N. , Risteski P. 
Published: January 2018

Background Patients with terminal ischemic heart disease (IHD), severely depressed pump function with large LV dyskinesis with or without fibrosis do not benefit from revascularization alone; in time they are listed for transplantation. The long waiting list and lack of organ donors have imposed implementation of Direct Circular Repair (DCR) with total revascularization as an alternative. Methods DCR was performed on 17 patients with terminal IHD, after total revascularisation. The resected dyskinetic tissue was pathohistologicaly examined. Transesophageal ultrasound was performed pre- and early post-operatively and hemodynamic parameters measured invasively. Results Pathohistology showed that even in macroscopically viable myocardium where only dyskinesia without fibrosis persists, there are irreversible lesions on the ultrastructural level. Along with revascularization, with the application of DCR the LV spherical geometry was reconstructed with hemodynamic improvement. Conclusion Total revascularisation with DCR offers an alternative to transplantation in patients with wide anterior wall dyskinesia with or without fibrosis due to terminal IHD, the most frequent group listed for transplantation.
Validation of a Two-Pool Model for the Kinetics of ß2-Microglobulin
Authors: Stiller S. , Xu X.Q. , Gruner N. , Vienken J. , Mann H. 
Published: January 2018

Secondary amyloidosis due to beta-2-microglobulin (ß2-m) is a serious long-term complication in patients on regular dialysis therapy. ß2-m can be considered a middle-molecule marker used to facilitate the assessment of dialysis efficacy. For this purpose, a validated model that calculates characteristic efficacy parameters, such as Kt/V, TAC and generation rate, is needed. There is general agreement that ß2-m-kinetics should be described by a two-pool model, but little has been published to validate such an approach. We measured the ß2-m concentration profiles of eight stable patients during hemodialysis (HD) at the start of treatment, after 30 minutes, after 60 minutes, and every hour until the end. Thereafter they were measured at 10-minute intervals for an hour. The dialyser clearances were determined from the plasma concentrations in front of and behind the dialyser twice during each session – after 1 hour, and 4 hours from the start of treatment. The kinetic parameters of a two-pool model (e.g. the compartment volumes V1 and V2, the mass transfer coefficient K12 and the generation rate G) were determined from the optimal fit of the measured concentration profile. The table below summarises the results by giving the mean and standard deviation for each parameter: V (liters) V1/V2 V % TBW K12 m(ml/min) G (mg/kg/day) 10.0 ± 1.6 4.60 ± 1.8 28.4 ± 3.1 56.3 ± 25.2 2.50 ± 0.66 Inter-individual differences in V1/V2 and K12 were high, ranging from 2.5 to 10.0 for V1/V2 and from 26 to 140 for K12. Error analysis suggested that these wide ranges were due to the method and that in reality the probable range of V is 25–36% of TBW, of V1/V2 3.5–5.3, and of K12 30–80 ml/min. With standard values for these three parameters (V = 30% of TBW, V1/V2 = 4.4 and K12 = 55 ml/m), equal for all patients, and their respective ranges, Kt/V can be calculated with a standard deviation of 13%. Kt/V > 1.2 secures the maximum possible ß2-m removal with three HD treatments a week. Conclusions The parameters of a two-pool model of ß2-m kinetics can be derived from concentration profiles obtained under routine dialysis conditions, but accuracy is not completely satisfactory. Similar to the dialysis dose for urea (Kt/Vurea) the dialysis dose for ß2-m (Kt/Vß2-m) can be calculated from the pre- and post-dialysis concentrations of ß2-m, body weight, ultrafiltration and dialysis time. Kt/Vß2-m > 1.2 secures the maximum possible removal of ß2-m in HD with three sessions per week.
The First Case of Ureteral Duplication in a Combined Liver-Kidney Transplantation
Authors: Nardo B. , Montalti R. , Pacilè V. , Bertelli R. , Beltempo P. , Cavallari G. , Puviani L. , Licursi M. , Stefoni S. , Cavallari A. , Faenza A. 
Published: January 2018

Aim Kidney transplantation with ureteral duplication may represent a doubled risk factor in terms of ureteral stenosis or necrosis with urinary leakage usually from the site of ureteroneocystostomy. The incidence of complete duplication is very low at 0.19%. We report a kidney with ureteral duplication in the specific setting of multiorgan transplantation since it could be considered a adjunctive risk factor for urological complications. Methods The recipient was a 67-year old man, suffering from terminal renal insufficiency. He was also affected by HCV-related cirrhosis. The patient had been waiting for the combined transplantation for 27 months and in the last two months his hepatic function dramatically worsened. The donor was a 53-year old man who died of non-traumatic subarachnoid hemorrhage. Good HLA compatibility was observed between donor and recipient. During harvest both kidneys presented a complete ureteral duplication. So the ureters were freed together with a wide cuff of periureteral tissue and dissected distally. No vascular abnormalities were noted during the removal of either kidney. The grafts were flushed with University of Wisconsin solution and stored in the same solution. Results The liver was reperfused after 9 hours of cold ischemia. Subsequently the kidney was vascularized after 15 hours of cold ischemia. Urine production occurred immediately after revascularization. Two separated ureteroneocystostomies with a single antireflux technique were performed. Cyclosporine and steroids were given. Post-operative course was uneventful and liver and kidney function were normal. The 7-day cystography was normal. The 6, 12, 24 month ultrasonographies showed no signs of hydronephrosis or hydroureter. After 28 months renal cancer was diagnosed and the patient underwent a right nephrectomy. The liver-kidney recipient had excellent hepatic and renal function for 84.7 months. He died of malignancy from de novo tumor. Conclusions On the basis of this experience, a kidney with an ureteral duplication, while rare, can be satisfactorily used also in combined liver-kidney transplantation.
“UroMaix” Scaffolds: Novel Collagen Matrices for Application in Tissue Engineering of the Urinary Tract
Authors: Becker C. , Olde Damink L. , Laeufer T. , Brehmer B. , Heschel I. , Jakse G. 
Published: January 2018

Reconstruction of bladder and ureter tissue is indicated in cases of injury, stenosis, infection or tumor. Substitution by ileum, colon or pure synthetic polymers generates a variety of complications. Biohybrid tissue mimicking structural and functional attributes of the multilayered wall architecture of the urinary conduit may be the solution to current problems. This study reports on porcine urinary tract cells isolated and placed on UroMaix matrices with different degrees of cross-linking produced from highly purified type I collagen from medically approved porcine tissue. A patented procedure revealed membrane structures composed of a dense fibrous side and an open fibrous side. These scaffolds with the porcine urinary tract cells were incubated in a batch culture system for up to 14 days. Cell growth and topographical orientation were examined. Urothelial cells showed maximum attachment and a significant increase of living cells on the dense fiber layer of UroMaix-1. No attachment of urothelial cells occurred on the other prototypes. Smooth muscle cells showed similar behavior within the open fiber layer of all UroMaix matrices. Both urothelial and smooth muscle cells retained their phenotypes as demonstrated by the immunostaining of epithelial cytokeratin 18 and the smooth muscle myosin heavy chain respectively. Thus we could show that UroMaix scaffolds support the attachment and proliferation of urinary tract cells. The elastomeric properties of the collagenous matrices promise attractive applications in the tissue engineering of the urinary tract with its high mechanical demands.
Predictors of Sleep Quality in Hemodialysis Patients
Authors: Guney Ibrahim , Atalay Huseyin , Solak Yalcin , Altintepe Lutfullah , Toy Hasan , Tonbul H. Zeki , Turk Suleyman 
Published: January 2018

Purpose Poor sleep quality (SQ) is common in hemodialysis (HD) patients. Factors associated with poor SQ are not well understood. The objectives of the present study were to determine the prevalence of poor SQ in HD patients in our region and to examine the association between SQ and health-related quality of life (HRQoL), depression, and certain clinical and laboratory parameters. Methods A total of 233 HD patients at 5 centers in the city center of Konya, Turkey were included in this study. Their demographic data and biochemical parameters were analyzed. All patients were instructed to complete Turkish versions of three questionnaires, namely, a modified post-sleep inventory (PSI), Beck Depression Inventory (BDI) and a Short Form of Medical Outcomes Study (SF-36). Results The mean age of the patients was 52.8±15.3 years and the male to female ratio was 1.33:1. The prevalence of poor sleepers, defined as those having a total sleep score (PSI-4 score) ≥ 4, was 60.9%. Compared with good sleepers, poor sleepers had higher BDI scores and as well as lower PCS and MCS domains of HRQoL. In addition, poor sleepers were older and more likely to be unemployed. There was a significant inverse correlation of PSI-4 score with PCS and MCS, and significant positive correlation of PSI-4 score with BDI and age (p<0.001). The significant independent predictors of PSI-4 score were BDI score, MCS score and employment status. Conclusions Depression, MCS score and employment status were the most important predictors of sleep quality in HD patients.
Efficacy of Local Rifampin/Minocycline Delivery (AIGISRX®) to Eliminate Biofilm Formation on Implanted Pacing Devices in a Rabbit Model
Authors: Hansen Linda K. , Berg Kim , Johnson Dave , Sanders Mark , Citron Mark 
Published: January 2018

Purpose Device-related infections represent a significant clinical challenge. Once established, these infections prove difficult to treat with existing antibiotic regimens, compromising the health of device recipients, and usually requiring surgical intervention to resolve. The purpose of this study was to determine the ability of the AIGISRX® Anti-Bacterial envelope to reduce the formation of bacterial biofilm on implanted pacing devices. Methods An infection was established in a rabbit model by creating bilateral subcutaneous implant pockets, into which a pacing device with or without AIGISRX® was placed. The incisions were closed, and a defined dose of bacteria was infused into each implant pocket. After seven days, devices were explanted and assessed for viable bacteria by a sonication/vortex procedure to quantify bacteria, and by imaging of the device surface by scanning electron microscopy and laser scanning confocal microscopy. Results The presence of the AIGISRX® envelope eliminated recoverable, viable bacteria from the explanted devices using a vortex/sonication technique from in vivo models of Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus capitis, and Escherichia coli infections. Scanning electron microscopy and confocal microscopy demonstrate greatly reduced biological material on the pacemaker surfaces in the presence of the AIGISRX® envelope compared to untreated controls. Conclusion These results demonstrate that in this animal model, the AIGISRX® device reduces the formation of adherent bacteria and reduces bioburden on implanted, infected pacemaker devices.
Troublesome Knowledge: A New Approach to Quality Assurance in Mental Health Nursing Education
Authors: Leidl Donald M. 
Published: January 2018

Background Quality assurance and quality enhancement processes in nursing education are vital to the establishment of a strong program. Existing quality assurance methods in nursing education such as professional self-regulation and external examination rely on provincial and national nursing associations for evaluation, putting minimal responsibility and accountability on internal program examiners. Threshold concepts and troublesome knowledge provide a framework as outlined by Land that utilizes internal examiners from both student and faculty groups and represents an alternative to traditional quality assurance in nursing education. Purpose To identify troublesome mental health nursing content in a nursing curriculum by exploring students and faculty perspectives. Method A sequential mixed methods design that utilized surveys and focus groups to explore student and faculty perspectives on troublesome mental health nursing content. Results The project data were able to be organized into five main content themes that were identified as being troublesome: the spectrum of mental illness, therapeutic relationships and boundaries, praxis, professionalism in nursing, and brain chemistry and its management. Conclusion The findings from this project are unique to the program of review but show the potential of this new approach to quality assurance and program enhancement initiatives in nursing education.