bluuebunny/crossref_metadata_2025_split huggingface dataset:
Supporting carers to manage pain medication in cancer patients at the end of life: A feasibility trial
Authors: Latter Sue , Hopkinson Jane B , Lowson Elizabeth , Hughes Jane A , Hughes Jacki , Duke Sue , Anstey Sally , Bennett Michael I , May Carl , Smith Peter , Richardson Alison 
Published: July 2017

Background: Carers of people with advanced cancer play a significant role in managing pain medication, yet they report insufficient information and support to do so confidently and competently. There is limited research evidence on the best ways for clinicians to help carers with medication management. Aims: To develop a pain medicines management intervention (Cancer Carers Medicines Management) for cancer patients’ carers near the end of life and evaluate feasibility and acceptability to nurses and carers. To test the feasibility of trial research procedures and to inform decisions concerning a full-scale randomised controlled trial. Design: Phase I-II clinical trial. A systematic, evidence-informed participatory method was used to develop CCMM: a nurse-delivered structured conversational process. A two-arm, cluster randomised controlled feasibility trial of Cancer Carers Medicines Management was conducted, with an embedded qualitative study to evaluate participants’ experiences of Cancer Carers Medicines Management and trial procedures. Setting: Community settings in two study sites. Participants: Phase I comprises 57 carers, patients and healthcare professionals and Phase II comprises 12 nurses and 15 carers. Results: A novel intervention was developed. Nurses were recruited and randomised. Carer recruitment to the trial was problematic with fewer than predicted eligible participants, and nurses judged a high proportion unsuitable to recruit into the study. Attrition rates following recruitment were typical for the study population. Cancer Carers Medicines Management was acceptable to carers and nurses who took part, and some benefits were identified. Conclusion: Cancer Carers Medicines Management is a robustly developed medicines management intervention which merits further research to test its effectiveness to improve carers’ management of pain medicines with patients at the end of life. The study highlighted aspects of trial design that need to be considered in future research.
National palliative care capacities around the world: Results from the World Health Organization Noncommunicable Disease Country Capacity Survey
Authors: Sharkey Lee , Loring Belinda , Cowan Melanie , Riley Leanne , Krakauer Eric L 
Published: July 2017

Background: Previous estimates of global palliative care development have not been based on official country data. Aim: The World Health Organization Noncommunicable Disease Country Capacity Survey of World Health Organization member state officials monitors countries’ capacities for the prevention and control of noncommunicable diseases. In 2015, for the first time, questions were included on a number of palliative care development metrics to generate baseline data for monitoring global palliative care development. Design: Participants were given instructions, a glossary of terms, and 3 months to complete this closed, non-randomized, online survey. Questions were developed through a consultative process with relevant technical World Health Organization departments. Setting/participants: Health ministry officials serving as noncommunicable disease focal points from 177 out of 194 (91%) of World Health Organization Member States completed the voluntary survey. Results: This survey reveals that (a) a minority (37%) of countries have an operational national policy for noncommunicable diseases that includes palliative care, (b) palliative care is least likely to have funding available compared with other core noncommunicable disease services, and (c) there is a large country-income gradient for palliative care funding, oral morphine availability, and integration of palliative care services at the primary levels of the health system. Conclusion: Palliative care for noncommunicable disease patients must be strengthened in a majority of countries. These data provide a baseline for trend measurement of official country-level and global palliative care development. A repeat assessment is taking place in the first half of 2017.
Implantable cardioverter defibrillator knowledge and end-of-life device deactivation: A cross-sectional survey
Authors: McEvedy Samantha M , Cameron Jan , Lugg Eugene , Miller Jennifer , Haedtke Chris , Hammash Muna , Biddle Martha J , Lee Kyoung Suk , Mariani Justin A , Ski Chantal F , Thompson David R , Chung Misook Lee , Moser Debra K 
Published: July 2017

Background: End-of-life implantable cardioverter defibrillator deactivation discussions should commence before device implantation and be ongoing, yet many implantable cardioverter defibrillators remain active in patients’ last days. Aim: To examine associations among implantable cardioverter defibrillator knowledge, patient characteristics and attitudes to implantable cardioverter defibrillator deactivation. Design: Cross-sectional survey using the Experiences, Attitudes and Knowledge of End-of-Life Issues in Implantable Cardioverter Defibrillator Patients Questionnaire. Participants were classified as insufficient or sufficient implantable cardioverter defibrillator knowledge and the two groups were compared. Setting/participants: Implantable cardioverter defibrillator recipients ( n = 270, mean age 61 ± 14 years; 73% male) were recruited from cardiology and implantable cardioverter defibrillator clinics attached to two tertiary hospitals in Melbourne, Australia, and two in Kentucky, the United States. Results: Participants with insufficient implantable cardioverter defibrillator knowledge ( n = 77, 29%) were significantly older (mean age 66 vs 60 years, p = 0.001), less likely to be Caucasian (77% vs 87%, p  = 0.047), less likely to have received implantable cardioverter defibrillator shocks (26% vs 40%, p = 0.031), and more likely to have indications of mild cognitive impairment (Montreal Cognitive Assessment score <24: 44% vs 16%, p < 0.001). Insufficient implantable cardioverter defibrillator knowledge was associated with attitudes suggesting unwillingness to discuss implantable cardioverter defibrillator deactivation, even during the last days towards end of life ( p < 0.05). Conclusion: Implantable cardioverter defibrillator recipients, especially those who are older or have mild cognitive impairment, often have limited knowledge about implantable cardioverter defibrillator deactivation. This study identified several potential teachable moments throughout the patients’ treatment trajectory. An interdisciplinary approach is required to ensure that discussions about implantable cardioverter defibrillator deactivation issues are initiated at appropriate time points, with family members ideally also included.
Is intervertebral disc degeneration related to segmental instability? An evaluation with two different grading systems based on clinical imaging
Authors: Volkheimer David , Galbusera Fabio , Liebsch Christian , Schlegel Sabine , Rohlmann Friederike , Kleiner Sebastian , Wilke Hans-Joachim 
Published: July 2017

Background Several in vitro studies investigated how degeneration affects spinal motion. However, no consensus has emerged from these studies. Purpose To investigate how degeneration grading systems influence the kinematic output of spinal specimens. Material and Methods Flexibility testing was performed with ten human T12-S1 specimens. Degeneration was graded using two different classifications, one based on X-ray and the other one on magnetic resonance imaging (MRI). Intersegmental rotation (expressed by range of motion [ROM] and neutral zone [NZ]) was determined in all principal motion directions. Further, shear translation was measured during flexion/extension motion. Results The X-ray grading system yielded systematically lesser degeneration. In flexion/extension, only small differences in ROM and NZ were found between moderately degenerated motion segments, with only NZ for the MRI grading reaching statistical significance. In axial rotation, a significant increase in NZ for moderately degenerated segments was found for both grading systems, whereas the difference in ROM was significant only for the MRI scheme. Generally, the relative increases were more pronounced for the MRI classification compared to the X-ray grading scheme. In lateral bending, only relatively small differences between the degeneration groups were found. When evaluating shear translations, a non-significant increase was found for moderately degenerated segments. Motion segment segments tended to regain stability as degeneration progressed without reaching the level of statistical significance. Conclusion We found a fair agreement between the grading schemes which, nonetheless, yielded similar degeneration-related effects on intersegmental kinematics. However, as the trends were more pronounced using the Pfirrmann classification, this grading scheme appears superior for degeneration assessment.
Reproducibility of migraine-like attacks induced by phosphodiesterase-3-inhibitor cilostazol
Authors: Khan Sabrina , Deen Marie , Hougaard Anders , Amin Faisal Mohammad , Ashina Messoud 
Published: July 2017

Introduction The phosphodiesterase-3-inhibitor cilostazol induces migraine-like attacks in patients with migraine without aura, and may be used as a pharmacological trigger in human experimental models of migraine. However, the reproducibility of cilostazol-induced migraine-like attacks has never been investigated. Methods We performed a post-hoc analysis of clinical data from two brain-imaging studies including subjects who had received cilostazol 200 mg orally. Only subjects who developed migraine-like attacks on study day 1 were included on study day 2. After cilostazol ingestion, subjects and the investigator recorded headache intensity and characteristics once every hour on a purpose-developed questionnaire. Primary end-points included incidence and time to onset of migraine-like attacks between two separate study days. Results Thirty-four subjects completed both experimental days and were included in this study. Thirty-four out of 34 subjects (100%) developed migraine-like attacks after cilostazol ingestion on both study days 1 and 2. Time to onset of migraine was five hours (range 1–8 hours) on study day 1 and four hours (range 1–8 hours) on study day 2, p = 0.16. We found no difference in median peak headache score, median time to peak headache score, or median time to intake of rescue medication between study days 1 and 2. Conclusion A second-time administration of cilostazol reproduces migraine-like attacks in all subjects who report an attack after their first cilostazol induction. There was no difference in time to migraine onset between separate inductions. Experimental migraine provocation using cilostazol is a highly efficient and useful approach for studying the ictal phase of migraine without aura.
Return-to-Play Guidelines After Medial Patellofemoral Ligament Surgery for Recurrent Patellar Instability: A Systematic Review
Authors: Zaman Saif , White Alex , Shi Weilong J. , Freedman Kevin B. , Dodson Christopher C. 
Published: July 2017

Background: Medial patellofemoral ligament (MPFL) reconstruction and repair continue to gain acceptance as viable treatment options for recurrent patellar instability in patients who wish to return to sports after surgery. Return-to-play guidelines with objective or subjective criteria for athletes after MPFL surgery, however, have not been uniformly defined. Purpose: To determine whether a concise and objective protocol exists that may help athletes return to their sport more safely after MPFL surgery. Study Design: Systematic review. Methods: The clinical evidence for return to play after MPFL reconstruction was evaluated through a systematic review of the literature. Studies that measured outcomes for isolated MPFL surgery with greater than a 12-month follow-up were included in our study. We analyzed each study for a return-to-play timeline, rehabilitation protocol, and any measurements used to determine a safe return to play after surgery. Results: Fifty-three studies met the inclusion criteria, with a total of 1756 patients and 1838 knees. The most commonly cited rehabilitation guidelines included weightbearing restrictions and range of motion restrictions in 90.6% and 84.9% of studies, respectively. Thirty-five of 53 studies (66.0%) included an expected timeline for either return to play or return to full activity. Ten of 53 studies (18.9%) in our analysis included either objective or subjective criteria to determine return to activity within their rehabilitation protocol. Conclusion: Most studies in our analysis utilized time-based criteria for determining return to play after MPFL surgery, while only a minority utilized objective or subjective patient-centric criteria. Further investigation is needed to determine safe and effective guidelines for return to play after MPFL reconstruction and repair.
Modeling of In-Plane Shear Modulus of Composite Materials for Aerospace Applications
Authors: Munro M. , Lee S. 
Published: July 2017

An evaluation of micromechanical models for predicting the in-plane shear modulus, G,2, of five composite materials for aerospace applications has been carried out for three test methods (10° off-axis tensile, -45O tensile and 900 Iosipescu). Seven existing micromechanical models predicted similar trends, however, they did not accurately predict the experimental results. The use of mathematically simplified micromechanical models containing only G,m and V. resulted in values within 10% of those for the original models. This led to the development of individual, simplified design-oriented expressions of the form: [ILLEGIBLE] for which the predicted results are in better agreement with the experimentally determined values than those of the existing micromechanical models.
Optimization of Stresses in the End-Fittings of Composite Insulators for Distribution and Transmission Lines
Authors: Lanteigne J. , Lalonde S. , De Tourreil C. 
Published: July 2017

This paper addresses the problem of stress calculation and optimization in a FRP (Fibre-glass Reinforced Plastic) pultruded rod crimped into a metal end-fitting. This type of assembly is used mainly for suspension and line post insulators. We discuss herein some aspects that merit consideration in any given design approach. In many respects FRP pultruded materials are anisotropic. The anisotropy of their elastic constants influences the distribution of stresses while the anisotropy of their mechanical properties (ultimate strengths) limits their load carrying capacity. Finally, the anisotropy of their failure modes governs the progression and the spread of the damage. Each level of anisotropy will be discussed distinctly. Geometrical considerations are also necessary to arrive at an efficient design. Namely, we will consider the frictional interactions between the end-fitting inner wall and the rod, then we will present our approach in selecting the appropriate LID ratio (i.e., the ratio of the end-fitting length over the rod diameter), and finally we will discuss the influence of the compression profile, i.e., the permanent radial displacement imparted to the rod due to the action of the crimping force.
Building of a Composite Transmission Tower
Authors: Yeh Hsein-Yang , Yang Samuel C. 
Published: July 2017

This paper will study the feasibility of building a transmission tower from a composite material, E-glass and Vinylester. The tower was fabricated using a fabrication process called pultrusion. Also instead of using the conventional fastener method to join the cross members to the leg members, the design team utilized a slip joint that was developed by Goldsworthy Engineering The lamina of the leg member and the cross bracing were tested and compared with two analytical failure criteria, Yeh-Stratton Criterion and Quadratic (strain space) Criterion. In addition to ply failure analysis a full scale tower tests were performed at Electrical and Power Research Institute.
Acid Resistance of Glass Fibre Composites with Different Layup Sequencing: Part I-Diffusion Studies
Authors: Pai Raghavendra , Kamath M. S. , RAO R. M. V. G. K. 
Published: July 2017

The effects of sulphuric acid concentration and the sequential layup of glass fibre reinforcements on the diffusion behaviour of glass epoxy composite laminates were studied. In all, composites of six different resin systems viz., general purpose polyester, bis phenol-A polyester, vinyl ester, LY 556 epoxy, and MY 750 epoxy resins, reinforced with different layup sequencing consisting of chopped strand mat (CSM) and woven roving mat (WR) were exposed to sulphuric acid environments of different concentrations. The results of the study indicated that isophthalic polyester resin exhibited maximum resistance to sulphuric acid while general purpose polyester resin performed relatively inferior. The diffusion phenomenon became anamalous as the concentration of the sulphuric acid increased. Among the layup sequences considered, composite specimens with CSM as the skin layers exhibited higher weight gain than those with WR as the skin layers.
On the Effective Moduli of Anisotropic Composites with Aligned Ellipsoidal Inclusions
Authors: Demakos C. B. 
Published: July 2017

The effective elastic and shear moduli of a 3-D composite containing aligned ellipsoidal inclusions are evaluated in this paper. The material considered is transversely isotropic due to the uniform dispersion of inclusions in plane sections normal to their major axis. The method followed for the solution of the problem is based upon Eshelby's theory. We evaluate the strain field around a single ellipsoidal inhomogeneity surrounded by the effective anisotropic medium. Considering the mutual interaction of the neighbouring inclusions inside the matrix, we may evaluate the effective stiffness of composites with inclusions at dilute concentrations by using Mori-Tanaka's concept. The parameters involved in the analysis are the aspect ratio of the inclusions, their volume fraction and the ratio of the elastic moduli of the constituent phases forming the composite. The results show that the anisotropy of the composite is rather affected by the hardness of the inclusions relatively to the matrix than by the aspect ratio of inclusions. On the other hand, the stiffness of the composite is rather greater in models with inclusions of a needleshape form than in composites with spheroidal inclusions.
Comparative Evaluation of Impact Performance of Laminate Composites Containing Impact Induced/Mechanically Inserted Defects
Authors: Khan B. 
Published: July 2017

The low mass, low energy pendulum impact on carbon-epoxy (C-E) composite system under varied conditions are reported in this work. While in one case repeated low mass impacts were followed by a single higher mass impact leading to failure, in others, between these two impact events, slits of depth 1 mm, 3 mm and 5 mm were introduced. Also, in one experiment a variation in the programme involved a 45° notch being inserted instead of the slits. Fracture features were also examined using a light microscope. For the case of unnotched specimens, the investigation points to a maximum energy absorption and a fracture surface which is grooved with a rough terrain. The data, on the other hand, point to a minimum energy absorption and a comparatively flat feature for the fractured surface for the case of 5 mm slit introduced specimen. Samples with other depths of slits showed features that lie in between these two extremes.
Direct Oral Anticoagulants in the Real World
Authors: Piran Siavash , Delaney Jennifer , Schulman Sam , Salib Mary , Panju Mohamed , Pai Menaka 
Published: July 2017

Background Direct oral anticoagulants are convenient because of their fixed dosing and without laboratory monitoring. There are instructions on avoidance of moisture, no crushing of capsules, and administration with food for some direct oral anticoagulants. Whether patients adhere to this and are prescribed appropriate doses are unknown. Aims To assess direct oral anticoagulant dosing and medication use. Methods Patients ≥18 years old, receiving a direct oral anticoagulant for any diagnosis, were prospectively included. Nurses at our perioperative anticoagulation clinic helped patients complete a 12-item questionnaire. Results Ninety-three consecutive patients were recruited. Forty-nine were on dabigatran, 18 on apixaban, and 26 were on rivaroxaban. Sixty-two patients (67%) received appropriate direct oral anticoagulant dosing and administered the medication correctly. Eighteen patients (19%) administered the direct oral anticoagulant properly but at an inappropriate dose. Thirteen patients (14%) received an appropriate dose but administered the direct oral anticoagulant inappropriately: 10 (11%) removed dabigatran from its packaging before administration (exposing it to moisture); 2 (2%) did not take rivaroxaban with food; and 1 (1%) crushed the dabigatran capsule. Conclusion Our study demonstrates a large variability in how direct oral anticoagulants are dosed, and how patients take them. Improved medication literacy around direct oral anticoagulants is needed. Our study highlights opportunities that nurses have to improve patients’ medication literacy.
Frailty Syndrome and Risk of Sepsis in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Cohort
Authors: Mahalingam Mythreyi , Moore Justin Xavier , Donnelly John P. , Safford Monika M. , Wang Henry E. 
Published: July 2017

Background: Frailty is associated with increased morbidity and mortality in older persons. We sought to characterize the associations between the frailty syndrome and long-term risk of sepsis in a large cohort of community-dwelling adults. Methods: We analyzed data on 30 239 community-dwelling adult participants in the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. We defined frailty as the presence of at least 2 frailty indicators (weakness, exhaustion, and low physical activity). We defined sepsis as hospitalization for a serious infection with ≥2 system inflammatory response syndrome criteria, identified for the period 2003-2012. We determined the associations between frailty and risk of first sepsis and sepsis 30-day case fatality. Results: Among REGARDS participants, frailty was present in 6018 (19.9%). Over the 10-year observation period, there were 1529 first-sepsis hospitalizations. Frailty was associated with increased risk of sepsis (adjusted hazard ratio [HR] 1.44; 95% CI: 1.26 to 1.64). The total number of frailty indicators was associated with increased risk of sepsis ( P trend <.001). Among first-sepsis hospitalizations, frailty was associated with increased sepsis 30-day case fatality (adjusted OR 1.62; 95% CI: 1.06 to 2.50). Conclusions: In the REGARDS cohort, frailty was associated with increased long-term risk of sepsis and sepsis 30-day case fatality.