bluuebunny/crossref_metadata_2025_split huggingface dataset:
Integrating Doulas Into First‐Trimester Abortion Care: Physician, Clinic Staff, and Doula Experiences
Authors: Chor Julie , Lyman Phoebe , Ruth Jean , Patel Ashlesha , Gilliam Melissa 
Published: January 2018

IntroductionBalancing the need to provide individual support for patients and the need for an efficient clinic can be challenging in the abortion setting. This study explores physician, staff, and specially trained abortion doula perspectives on doula support, one approach to patient support.MethodsWe conducted separate focus groups with physicians, staff members, and doulas from a high‐volume, first‐trimester aspiration abortion clinic with a newly established volunteer abortion doula program. Focus groups explored 1) abortion doula training, 2) program implementation, 3) program benefits, and 4) opportunities for improvement. Interviews were transcribed and computer‐assisted content analysis was performed; salient findings are presented.ResultsFive physicians, 5 staff members, and 4 abortion doulas participated in separate focus group discussions. Doulas drew on both their prior personal skills and experiences in addition to their abortion doula training to provide women with support at the time of abortion. Having doulas in the clinic to assist with women's emotional needs allowed physicians and staff to focus on technical aspects of the procedure. In turn, both physicians and staff believed that introducing doulas resulted in more patient‐centered care. Although staff did not experience challenges to integrating doulas, physicians and doulas experienced initial challenges in incorporating doula support into the clinical flow. Staff and doulas reported exchanging skills and techniques that they subsequently used in their interactions with patients.DiscussionPhysicians, clinic staff, and doulas perceive abortion doula support as an approach to provide more patient‐centered care in a high‐volume aspiration abortion clinic.
Do fertile women have an inferior treatment for high‐grade precancerous lesions?
Authors: Kim Miseon , Cho Hye‐yon , Lee Jaeil , Suh Dong Hoon , Kim Kidong , No Jae Hong , Kim Yong Beom 
Published: January 2018

AbstractAimTo investigate whether a concern for future pregnancy is reflected in the extent of large loop excision of the transformation zone (LLETZ) and to assess the clinical outcome.MethodsWe reviewed the medical records of 275 women who underwent LLETZ for precancerous lesions in cervix. We divided them into two groups according to pregnancy possibility in the future: nonpotential versus potential group. The potential group was arbitrarily defined as women who met one of the following: (i) regardless of marital status, younger than 41 years with less than two parities and (ii) regardless of parity, younger than 46 years and unmarried. After propensity score matching (1:1, 44 women in each group), we compared the extent of LLETZ with respect to short‐term recurrence.ResultsAfter LLETZ, similar percentages of patients were finally diagnosed with ≥CIN3 (cervical intraepithelial neoplasia 3) in the two groups (27 [61.4%] vs 32 [72.7%], P = 0.257). Notably, the largest transverse diameter of LLETZ specimen was significantly larger in the nonpotential group (2.74 ± 1.06 vs 2.37 ± 0.62 cm, P = 0.047). There were more women with exocervical resection margin involvement in the potential group than in the nonpotential group (14 [31.8%] vs 6 [13.6%], P = 0.042). However, there was no significant difference in the incidence of short‐term recurrence ≥HSIL (high‐grade squamous intraepithelial lesion) within 24 months after LLETZ between the two groups (1 [2.3%] vs 1 [2.3%], P > 0.999).ConclusionPregnancy possibility in the future may affect the extent of LLETZ, as assessed by the largest transverse diameter obtained. This finding may be associated with increased resection margin involvement in women with future pregnancy possibility.
Continuing education: online monitoring of haemodialysis dose
Authors: Vartia Aarne 
Published: January 2018

SUMMARYBackgroundKt/Vurea reflects the efficacy of haemodialysis scaled to patient size (urea distribution volume). The guidelines recommend monthly Kt/V measurements based on blood samples. Modern haemodialysis machines are equipped with accessories monitoring the dose online at every session without extra costs, blood samples and computers.ObjectiveTo describe the principles, devices, benefits and shortcomings of online monitoring of haemodialysis dose.DesignA critical literature overview and discussion.ResultsUV absorbance methods measure Kt/V, ionic dialysance Kt (product of clearance and treatment time; cleared volume without scaling). Both are easy and useful methods, but comparison is difficult due to problems in scaling of the dialysis dose to the patient's size.ConclusionsThe best dose estimation method is the one which predicts the quality of life and survival most accurately. There is some evidence on the predictive value of ionic dialysance Kt, but more documentation is required on the UV method. Online monitoring is a useful tool in everyday quality assurance, but blood samples are still required for more accurate kinetic modelling.Learning outcomesAfter reading this article the reader should be able to:

Understand the elements of the Kt/V equation for dialysis dose.
Compare and contrast different methods of measurement of dialysis dose.
Reflect on the importance of adequate dialysis dose for patient survival and life quality.
Sleep‐disordered breathing in hypertensive disorders of pregnancy: a BMI‐matched study
Authors: Wilson Danielle L. , Walker Susan P. , Fung Alison M. , Pell Gabrielle , O'Donoghue Fergal J. , Barnes Maree , Howard Mark E. 
Published: January 2018

SummarySleep‐disordered breathing is more common in hypertensive disorders during pregnancy; however, most studies have not adequately accounted for the potential confounding impact of obesity. This study evaluated the frequency of sleep‐disordered breathing in women with gestational hypertension and pre‐eclampsia compared with body mass index‐ and gestation‐matched normotensive pregnant women. Women diagnosed with gestational hypertension or pre‐eclampsia underwent polysomnography shortly after diagnosis. Normotensive controls body mass index‐matched within ±4 kg m−2 underwent polysomnography within ±4 weeks of gestational age of their matched case. The mean body mass index and gestational age at polysomnography were successfully matched for 40 women with gestational hypertension/pre‐eclampsia and 40 controls. The frequency of sleep‐disordered breathing in the cases was 52.5% compared with 37.5% in the control group (P = 0.18), and the respiratory disturbance index overall did not differ (P = 0.20). However, more severe sleep‐disordered breathing was more than twice as common in women with gestational hypertension or pre‐eclampsia (35% versus 15%, P = 0.039). While more than half of women with a hypertensive disorder of pregnancy meet the clinical criteria for sleep‐disordered breathing, it is also very common in normotensive women of similar body mass index. This underscores the importance of adjusting for obesity when exploring the relationship between sleep‐disordered breathing and hypertension in pregnancy. More severe degrees of sleep‐disordered breathing are significantly associated with gestational hypertension and pre‐eclampsia, and sleep‐disordered breathing may plausibly play a role in the pathophysiology of pregnancy hypertension in these women. This suggests that more severe sleep‐disordered breathing is a potential therapeutic target for reducing the prevalence or severity of hypertensive disorders in pregnancy.
Introduction to Special Issue: Null Effects and Publication Bias in Learning Disabilities Research
Authors: Therrien William J. , Cook Bryan G. 
Published: January 2018

AbstractThe importance of publishing studies with null findings to the scientific enterprise is garnering attention in social science at large and education in particular. In this article, we first define null findings and publication bias as they relate to group and single‐subject instructional intervention research. We then explore the prevalence of instructional intervention studies that report null findings in the learning disabilities literature. Overall, we found that few studies have been published in learning disability journals that reported all null results. However, a significant number of group studies reported mixed findings (i.e., at least one, but not all, outcome measures were not statistically significant). Next, we summarize the experimental studies that comprise this special issue on null findings. Last, we speculate regarding strategies that might be enacted to increase the publication of studies with null findings in the learning disabilities field.
Multiple lithic clasts in lunar breccia Northwest Africa 7948 and implication for the lithologic components of lunar crust
Authors: Zeng Xiaojia , Joy Katherine H. , Li Shijie , Pernet‐Fisher John F. , Li Xiongyao , Martin Dayl J. P. , Li Yang , Wang Shijie 
Published: January 2018

AbstractThis study presents the petrography, mineralogy, and bulk composition of lunar regolith breccia meteorite Northwest Africa (NWA) 7948. We identify a range of lunar lithologies including basaltic clasts (very low‐titanium and low‐titanium basalts), feldspathic lithologies (ferroan anorthosite, magnesian‐suite rock, and alkali suite), granulites, impact melt breccias (including crystalline impact melt breccias, clast‐bearing impact melt breccias, and glassy melt breccias), as well as regolith components (volcanic glass and impact glass). A compositionally unusual metal‐rich clast was also identified, which may represent an impact melt lithology sourced from a unique Mg‐suite parent rock. NWA 7948 has a mingled bulk rock composition (Al2O3 = 21.6 wt% and FeO = 9.4 wt%) and relatively low concentrations of incompatible trace elements (e.g., Th = 1.07 ppm and Sm = 2.99 ppm) compared with Apollo regolith breccias. Comparing the bulk composition of the meteorite with remotely sensed geochemical data sets suggests that the sample was derived from a region of the lunar surface distal from the nearside Th‐rich Procellarum KREEP Terrane. Our investigations suggest that it may have been ejected from a nearside highlands‐mare boundary (e.g., around Mare Crisium or Orientale) or a cryptomare region (e.g., Schickard‐Schiller or Mare smythii) or a farside highlands‐mare boundary (e.g., Mare Australe, Apollo basin in the South Pole–Aitken basin). The distinctive mineralogical and geochemical features of NWA 7948 suggest that the meteorite may represent lunar material that has not been reported before, and indicate that the lunar highlands exhibit wide geological diversity.
3D Parametric Modeling of Complex Geological Structures for Geotechnical Engineering of Dam Foundation Based on T‐Splines
Authors: Zhang Yichi , Zhong Denghua , Wu Binping , Guan Tao , Yue Pan , Wu Han 
Published: January 2018

AbstractWe propose a novel geological modeling method based on T‐splines for computer‐aided design (CAD) and building information modeling (BIM) systems of geotechnical engineering and perform original research on special T‐splines modeling strategies and the algorithm aiming at depicting structural complexity to develop and introduce the T‐splines technology into engineering geological modeling. A methodology of parametric geological modeling with T‐splines is established, where a topology‐geometry modeling strategy is adopted, the inhomogeneity, arbitrary connectivity and discontinuity of geological structures are quantified and associated with T‐spline surface elements in the topology phase. A representative parametric algorithm called IBALR is presented in the context of dam foundation geological modeling to generate an inhomogeneous local refined T‐mesh with high genus topology which can fit a complex geological layer. The proposed method is flexible and effective in improving geological representation within geotechnical engineering.
Ecological characterization of a tick community across a landscape gradient exhibiting differential anthropogenic disturbance in the Atlantic Forest ecoregion in Argentina
Authors: Lamattina D. , Venzal J. M. , Costa S. A. , Arrabal J. P. , Flores S. , Berrozpe P. E. , González‐Acuña D. , Guglielmone A. A. , Nava S. 
Published: January 2018

AbstractAn ecological analysis of a tick (Ixodida: Ixodidae) community across a landscape gradient presenting differential anthropogenic disturbance in the Atlantic Forest ecoregion in Argentina was performed. Ticks were collected from vegetation and hosts between September 2014 and August 2016. A total of 12 697 free‐living ticks and 3347 specimens from hosts were collected, including 317 ticks infesting humans. The values obtained show considerable species diversity in the forest environment accompanied by low equitability. The similarity index derived from a comparison of forest and agricultural environments was higher than that calculated by comparing forest and urban environments. The data suggest that although a cycle of one generation per year is apparent in some species, more than one cohort may co‐exist within the populations of some of these species. Well‐marked patterns of the seasonal distribution of free‐living tick species emerged in environments with no anthropic modification. The results indicate that forest environments are more suitable habitats than agricultural and urban environments for many species of native tick, but are unsuitable for exotic species that have successfully established in environments that have been modified by man.
In ineffective esophageal motility, failed swallows are more functionally relevant than weak swallows
Authors: Jain A. , Baker J. R. , Chen J. W. 
Published: January 2018

AbstractBackgroundEsophageal pressure topography (EPT) diagnosis of ineffective esophageal motility (IEM) can be non‐specific with unclear clinical significance.AimsTo determine whether peristaltic vigor or lower esophageal sphincter (LES) integrity is associated with poor clearance and acid reflux in IEM.MethodsBolus clearance on high‐resolution impedance manometry (HRIM) and available reflux studies in patients with IEM were retrospectively reviewed. Bolus clearance was assessed using both line tracing and colored contour methods on HRIM. EPT parameters, bolus clearance, and acid reflux variables were explored.Key ResultsEighty‐eight patients with IEM were included. Bolus clearance occurred in 71% of all swallows, and 55.7% of patients had complete bolus transit (CBT, bolus clearance in ≥80% of swallows). Bolus clearance was impaired in swallows with distal contractile integral (DCI) <100 mmHg•cm•s compared to DCI 100‐450 (0.43 vs 0.79, P < .0001). A cutoff at DCI 100 mmHg•cm•s was associated with clearance with an accuracy of 76% compared to 49% at DCI 450 (P = .0001 for both). A median DCI <100 was associated with a higher Eckardt score (9 vs 3, P = .03), and on reflux testing available in 47 patients, with abnormal acid exposure time (P = .002). Peristaltic reserve (PR) defined as (DCI of multiple rapid swallow/median DCI of wet swallows), integrated relaxation pressure, and resting lower esophageal sphincter pressure were not associated with clearance or acid exposure.Conclusions & InferencesFailed peristalsis, as defined by DCI <100 mmHg•cm•s, is associated with impaired bolus clearance and more severe dysphagia in IEM, and likely abnormal acid exposure.
Rituximab in myasthenia gravis: a “to be or not to be” inhibitor of T cell function
Authors: Marino Mariapaola , Bartoccioni Emanuela , Alboini Paolo Emilio , Evoli Amelia 
Published: January 2018

AbstractIn recent years, rituximab (RTX), a monoclonal antibody that binds the B lymphocyte membrane protein CD20, has been increasingly used for the treatment of autoimmune diseases, with the rationale of destroying pathogenic B lymphocytes and decreasing autoantibody formation. Surprisingly, RTX has also proven effective in predominantly T cell–mediated diseases, raising the question whether additional mechanisms may play roles in determining the therapeutic response. Here, we review the current literature on the effects of RTX in autoimmune diseases, with special emphasis on myasthenia gravis (MG). To elicit a complete and effective immune response, B and T lymphocytes cooperate in a loop in which they affect each other. Disruption of this cross talk has profound effects on the immune system. RTX is likely to affect the whole spectrum of B cell function, including antigen presentation, cytokine production, and T cell stimulation. In addition, as a small subset of T lymphocytes expresses CD20, its direct targeting by RTX may contribute to the therapeutic effect. Owing to its distinctive immune characteristics, MG proved to be a useful model to investigate the multifaceted implications of B cell depletion.
Evaluation of QT dispersion and Tp‐e interval in children with subclinical hypothyroidism
Authors: Akın Alper , Unal Edip , Yıldırım Ruken , Ture Mehmet , Balık Hasan , Haspolat Yusuf Kenan 
Published: January 2018

AbstractBackgroundStudies on adults have shown increased dispersion of QT and corrected QT (QTc), peak‐to‐end interval of the T wave (Tp‐e), Tp‐e/QT ratio, and Tp‐e/QTc ratio in subclinical hypothyroidism (SH), but there have been no pediatric studies.Materials and methodsA total of 40 SH patients were compared with 40 healthy children in respect to serum thyroid‐stimulating hormone (TSH), serum‐free level of triiodothyronine, and free level of thyroxine (fT4). SH diagnosis was accepted as TSH above the laboratory accepted upper limit (>4.2 mU/L) and normal fT4 values. The patient and control group data were compared by calculating the QT interval, QTc, QT dispersion (QTd), QTc dispersion (QTcd), Tp‐e, Tp‐e/QT ratio, and Tp‐e/QTc ratio on 12‐lead surface electrocardiogram.ResultsThe mean age was 7.91 ± 3.6 years in the SH group and 8.8 ± 2.4 years in the control group. In the SH group, the minimum QT (QTmin) was determined to be statistically significantly lower (P < 0.001) and maximum QT (QTmax), QTd, QTcd, Tp‐e, Tp‐e/QT ratio, and Tp‐e/QTc ratio were statistically significantly higher (P = 0.028, P < 0.001, P = 0.003, P < 0.001, P = 0.001, P < 0.001, respectively). A positive correlation was determined between TSH and QTmax (r: +0.331, P = 0.037).ConclusionsThe current study is the first to have shown significantly increased QTd, QTcd, Tp‐e, Tp‐e/QT ratio, and Tp‐e/QTc ratio in children diagnosed with SH. A positive correlation was determined between TSH and maximum QT values, Tp‐e, Tp‐e/QT ratio, and Tp‐e/QTc ratio. These results suggest the need to further assess the long‐term risks of prolonged QT dispersion in the setting of subclinical hypothyroidism.
Safety and efficacy of epicutaneous immunotherapy for food allergy
Authors: Wang Julie , Sampson Hugh A. 
Published: January 2018

AbstractFood allergy is increasingly common in children, affecting about 4%‐8%. The mainstays of management remain allergen avoidance and emergency preparedness to treat allergic reactions with emergency medications. Unfortunately, these approaches are unsatisfactory for many patients and their families as the restrictions, constant vigilance, and unpredictable severity of allergic reactions negatively impact quality of life. In recent decades, there has been significant interest in developing treatments for food allergy that lead to desensitization to increase thresholds for triggering allergic reactions and decrease the risk of reacting to allergen‐contaminated food products. Epicutaneous immunotherapy (EPIT) is a novel therapy that is currently under investigation, delivering allergen via repeated applications to the skin and targeting antigen‐presenting cells in the superficial skin layers. Murine models have demonstrated that allergen uptake is an active process by skin dendritic cells with subsequent migration to draining lymph nodes. Allergen exposure to the non‐vascularized epidermis limits systemic absorption, contributing to the high‐safety profile. Results from murine experiments showed that EPIT has comparable efficacy as subcutaneous immunotherapy in terms of challenge outcomes, airway hyper‐responsiveness, and immunologic parameters. Several clinical trials of EPIT have recently been completed or are ongoing. Results support the high safety and tolerability of this approach. Efficacy data suggest that the change in threshold eliciting dose following 1 year of therapy is less than that seen compared to high‐dose (2‐4 g peanut protein) oral immunotherapy, but more prolonged treatment with EPIT appears to lead to increasing desensitization. Additional data from larger‐scale studies should provide a more robust assessment of safety and efficacy of EPIT.
Mothers' informational needs when deciding to have their newborn infant vaccinated with BCG. A Mixed‐methods design
Authors: Pihl Gitte Thybo , Ammentorp Jette , Johannessen Helle , Kjærgaard Jesper , Nissen Thomas Nørrelykke , Birk Nina Marie , Stensballe Lone Graff , Thøstesen Lisbeth Marianne , Kofoed Poul‐Erik 
Published: January 2018

ObjectiveTo explore the informational needs of mothers with different levels of education in order to improve counselling about vaccination.MethodsIn the setting of a large vaccination trial, mothers' assessments and yield of written information in combination with telephone consultations were evaluated in a survey. Furthermore, searching strategies for additional information were investigated. Mothers' perspectives on informational needs were explored in focus group discussions.ResultsOut of 2025 mothers, 95% felt well‐informed. Of the 4% not feeling well‐informed, there were significantly more mothers with basic schooling and nontheoretical education. There was no correlation between searching for additional information and feeling well‐informed. The telephone consultation was found to be very supportive for the decision.ConclusionThe written information was digestible over time. The telephone consultation ensured the mothers' understanding by tailoring and deriving meaning from the information to her special needs. Moreover, it helped the mothers gain an overview of risks and benefits and inspired confidence. These findings indicate that the telephone consultation improved health literacy.Practice implicationsIndividual counselling about vaccines is required in addition to information about side effects and accurate instructions on how to react upon them.
Value choices in a mixed economy of care: How politics shapes the implementation of complex social policies
Authors: Nevile Ann , Kay Adrian , Carey Gemma 
Published: January 2018

AbstractWhile social and public policy studies recognize the diversity of actors and processes occurring in the implementation of policy and the organization of public service delivery, analysis of the role of value pluralism in implementation remains underdeveloped. This article contributes to a more nuanced understanding of the relationship between value pluralism and organizational responses to value conflict by exploring the effect of politics on the value choices of senior public servants involved in the design and implementation of Australia's National Disability Insurance Scheme. Our analysis shows that politics may play an essential role in facilitating implementation of a complex social policy that contains a number of incommensurable values because successful politics allows these incommensurable values to co‐exist and adaption to take place, thereby avoiding organizational dysfunction.