bluuebunny/crossref_metadata_2025_split huggingface dataset:
ECONOMIC ANALYSIS OF COSTS FOR PATIENTS WITH END STAGE LIVER DISEASE OVER THE LAST YEAR OF LIFE
Authors: Gola A , Davis S , Greenslade L , Hopkins K , Low J , Marshall A , Thorburn D , Vickerstaff V , Jones L 
Published: February 2015

IntroductionLiver disease is the third largest cause of death in the UK in people under the age of 65. With predicted increases in alcohol consumption, viral hepatitis and obesity, it is anticipated that the economic burden on the healthcare system will continue to rise.Aim(s) and method(s)To evaluate costs of hospital admissions for patients with end-stage liver disease over the 12 months prior to death obtained from hospital records and case-note audit. The analysis includes all costs incurred during the admission, such as bed and board, nursing, specialist consultations, medications, investigations and surgery.We also compared costs of care for a cohort with terminal hospital admission and costs of care for those who spent the last days at a hospice.ResultsThe mean cost per patient in the twelve months prior to death was £18,458, (SD=15,267), the mean total cost per hospital admission was £6,863 (SD=£6,631), the mean cost for individual admissions that ended in the patient's death i.e. the terminal admission, was £9,615 (SD=£8,443). Comparatively, for the patients who had a terminal admission at a hospice, the mean cost per terminal admission was £4,598 (SD=£5,818). There was no statistically significant difference in costs between patients with and without alcohol-related liver disease.Conclusion(s)Our analysis underlines the significant economic burden placed on the healthcare system by patients with end stage liver disease. On average, compared to costs associated with hospice death, costs for hospital deaths were double. With rates of liver disease set to increase, government policy needs to address challenges for future funding of care.
HOW DO PATIENTS SHARE NEWS OF A CANCER DIAGNOSIS WITH FAMILY/FRIENDS; NEW UNDERSTANDINGS OF THE PROCESS AFTER BAD NEWS HAS BEEN BROKEN
Authors: Ewing G , Ngwenya N , Farquhar M , Benson J , Gilligan D , Seymour J , Bailey S 
Published: February 2015

The study was funded by a grant from Dimbleby Cancer Care.IntroductionExtensive research exists on how bad news is broken by physicians to patients, but little is known about the subsequent stage: when patients face the difficult task of sharing this news with family members and friends.Aim(s)To understand the experience of sharing news of a lung cancer diagnosis with wider family members and friends to inform a supportive intervention to prepare patients for sharing bad news.MethodsQualitative interviews with 20 patients with lung cancer and 17 family members/friends present at diagnosis-giving to explore experiences of receiving their diagnosis and how news was shared with wider family/friends.Thematic framework analysis was conducted.ResultsThree key findings: (1) sharing bad news happened over time, at any point along the illness trajectory—it was a process, not a discrete event;(2) timing of sharing bad news was very individual—people needed to feel ready to share their diagnosis and had to prepare themselves to do so;(3) regardless of when news was shared it had consequences in terms of the reactions of those told, which required managing. Illustrative timelines of processes of early and later sharing of bad news will be presented.Conclusion(s)Understanding sharing bad news as a process which happens over time is a significant finding for design and delivery of a supportive intervention. Preparing patients to share news of a lung cancer diagnosis, which often presents at an advanced stage, is highly relevant for future palliative care delivery.
“IT'S NOT JUST ABOUT THE PATIENT, IT'S THE FAMILIES TOO”: END-OF-LIFE CARE IN THE HOME ENVIRONMENT
Authors: Brooks JM , Bravington A , Hardy B , Melvin J , King N 
Published: February 2015

IntroductionMost people when asked say they would prefer to die at home. However, ‘Death in Usual Place of Residence’ (DiUPR) does not give any real insight into the quality and experiences of care received. Additionally, DiUPR involves other family members resident in the home environment and their needs, preferences and experiences also need consideration.Aim(s) and method(s)The aim of this work was to explore the experiences of patients and informal caregivers receiving at-home care from a specialist palliative care service. We undertook individual interviews with 11 patients and 10 significant others. We used the Pictor technique, a novel interview tool used to sensitively explore networks of support and experiences of palliative care. Interviews were analysed thematically.ResultsCaring for a loved one at home was acknowledged as draining, but participants were effusive about the excellent at-home professional support they received from the specialist service. The care provided evidently recognised the needs of both patients and their families. Effective co-ordination of care, including liaison with other services was especially appreciated.Conclusion(s)With increasing trends towards DiUPR, it is vital that there are sufficient well-resourced palliative care services available in the community to support both patients and their families at the end of life. Pictor is a useful means to obtain detailed insight into individual experiences of end of life care. Care co-ordination emerged as key concern for patients receiving End of Life Care and their families.
ORGANISATIONAL FACTORS INFLUENCING UPTAKE OF A CARER SUPPORT NEEDS ASSESSMENT TOOL IN PALLIATIVE HOME CARE
Authors: Austin L , Ewing G , Grande G 
Published: February 2015

IntroductionThe Carer Support Needs Assessment Tool (CSNAT) is a comprehensive, evidence-based tool for carer assessment and support. Successful implementation requires a change from existing practitioner led approaches to carer assessment to one which is facilitated by the practitioner, but led by the carer.Aim(s) and method(s)To identify organisational factors which facilitate or hinder implementation of the CSNAT. The CSNAT was implemented in 6 palliative home care services. Qualitative data were collected via interviews (15), focus groups (2) and workshops (3), with practitioner ‘champions’ and service managers. All were audio-recorded, transcribed and analysed thematically.ResultsUptake of the CSNAT varied between services and was influenced by the receptivity of the context into which it was introduced. ‘Organisational preparedness’, with regard to existing administration systems, working patterns and competing demands, was a key factor. Additionally, facilitation to support implementation of the CSNAT was paramount; this included ‘internal facilitation’ from within the service (e.g. clear organisation steer) and ‘external facilitation’ from the research team (e.g. provision of training and on-going support).Conclusion(s)The study identified two main factors which influence effective implementation of the CSNAT: a) receptivity of the organisational context and b) level of facilitation). These findings are in keeping with theory and practice models relating to sustainable implementation of practice developments. Further work is underway to explore how organisations can best be supported when implementing the CSNAT.Funder NIHR Research for Patient Benefit.
MARIE CURIE PALLIATIVE CARE DEMENTIA SERVICE—AN EVALUATION OF PROCESSES, OUTCOMES AND IMPACT AFTER THE FIRST YEAR OF OPERATION
Authors: Borkowska Monika 
Published: February 2015

IntroductionAccess to the end of life care received for patients with dementia and their carers is of paramount importance–by 2021 the number of people with dementia in Wales is projected to increase by 31%. Currently, inappropriate hospital admissions are common and patients are less likely to be referred to palliative care services. Primarily this is because patients and carers are infrequently informed of the terminal nature of dementia and advance planning discussions are rare.The Marie Curie Palliative Care Dementia Service has been developed to; support dementia patients in achieving their preferred place of care and death, other health and social care professionals in understanding and meeting the needs of dementia patients at the end of their lives.Having reached its first year of operations, an evaluation has been conducted to establish the impact of the service thus far.Aim(s) and method(s)The evaluation has been conducted through the analysis of service performance data, case notes, and interviews with carers, patients, primary and secondary care professionals, using content analysis.ResultsThis paper will focus on the primary aims of the MCPC Dementia services; processes, outcomes and impact. Service performances and outcomes will be presented against relevant frameworks for end of life care for dementia, and the impact of the service on patients, their carers, and NHS services will also be.Conclusion(s)This paper will conclude with its vision for the future direction and development of the MCPC Dementia service, outlining its recommendations for palliative care for dementia patients.
THE EXPERIENCES OF CAREGIVERS OF PATIENTS WITH DELIRIUM AND THEIR ROLE IN ITS MANAGEMENT IN A PALLIATIVE CARE SETTING
Authors: Lugton J , Finucane A M , Kennedy C , Spiller J 
Published: February 2015

IntroductionDelirium remains the most common and distressing neuropsychiatric complication in patients with advanced cancer. This study examines the experiences of caregivers of patients with delirium and their role in its management. It explores evidence for interventions that improve support for these caregivers and which help them support the patient.Aim(s) and method(s)An integrative literature review was undertaken. Four databases were searched using the terms ‘delirium’, ‘terminal restlessness’ or ‘terminal agitation’ combined with ‘carer’ or ‘caregiver’, ‘family’ or ‘families’. Twenty five papers were included in the final review.ResultsDistress is experienced by many caregivers of patients with delirium. Fear, anger, disappointment and sadness are common. However, caregivers potentially play an important role in caring for patients with delirium in (i) prevention and detection of delirium ii) acting as advocates for patients, and iii) assisting in monitoring patient symptoms. Caregivers desire more information about delirium and advice on how to behave towards patients during a delirium episode however there is little evidence for specific interventions in this regard.Conclusion(s)Caregiver focused interventions need to be developed and evaluated to determine the type of approaches that help the caregiver support the patient, and increase support for caregivers themselves.
THE USE OF MEDICATIONS IN THE LAST 24 HOURS OF LIFE IN THE ACUTE HOSPITAL SETTING—A DESCRIPTIVE COMPARISON OF CANCER AND NON CANCER PATIENTS USING DATA FROM THE NATIONAL CARE OF THE DYING AUDIT HOSPITALS—ENGLAND (NCDAH) 2013/14
Authors: Tewani K , Mulholland H , Gambles M , Lowe D , Husk J , Stewart K , Ellershaw J 
Published: February 2015

IntroductionInternational consensus exists for the use of 4 key drugs pertinent to care of the dying and the use of CSCI is advocated, where appropriate, to support patient comfort. In the NCDAH 2008/09, 54% of 3,893 patients had CSCI prescribed; of these 1026 were cancer patients (67% of all cancer patients) and 1080 were non-cancer patients (46% of all non-cancer patients).Aim(s) and method(s)Aim: to explore medications and dosages prescribed via CSCI in the last 24 hours of life for cancer and non-cancer patients.Using clinical data from 6,580 cases (from 149 sites) reported within the NCDAH 2013/14, combinations and doses of drugs given via CSCI in the last 24 hours of life were analysed descriptively.ResultsCSCI prescribed for 1,850 (28%) patients. 722 were cancer patients; 1128 were non-cancer patients (representing 46% and 22% of all cancer and non-cancer patients, respectively). Non-cancer patients were older (83 vs 74) and had recognition of ‘dying’ earlier (75 hours vs 62 hours prior to death). The 4 key drugs were regularly prescribed. Most (both groups) received 2 or 3 drugs; most common 2 drug combination – sedative (usually Midazolam) and opiate (usually Morphine). Median doses – Midazolam (both groups) – 10 mg over 24 hours; Opiates: Morphine – cancer 15 mg, non-cancer 10 mg; Diamorphine – cancer 12.5 mg, non-cancer 10 mg; Oxycodone – cancer 20 mg, non-cancer 10 mg.Conclusion(s)The use of CSCI is around half of that in 2008/9. Type of drugs administered was similar in both groups. Dose of opiates for non-cancer patients was lower on average.
Synthesis, structural and magnetic behavior of undoped andMn-doped anataseTiO2nanoparticles
Authors: Mahmood Asif , Ramay Shahid M. , Al-Zaghayer Yousef S. , Atiq Shahid , Saleem Murtaza , Al Masary Waheed A. , Haider Sajjad 
Published: February 2015

Ti1-xMnxO2(x = 0, 0.05) nanoparticles have been synthesized using chemically derived self-propagating combustion reaction method. X-ray diffraction studies demonstrate the formation of anatase phase of TiO2belonging to 141/amd space group in both samples without the formation of any impurity phase. The incorporation of 5 at.% Mn content does not produce any changes in crystal structure which reveals the exact substitution of Mn atoms at Ti sites. Some change in lattice parameters and crystallite size is observed in Mn -doped composition, attributed to the difference in ionic radii. The size of grains obtained using scanning electron micrographs shows the consistent trend with the crystallite size evaluated from X-ray diffraction analysis. Energy dispersive X-ray analysis confirms the incorporation of Mn content in TiO2structure. Ferromagnetic behavior detected only in Mn -doped TiO2composition correspond to the strong Mn d-shell contribution.
A Tornado Watch Scale to Improve Public Response
Authors: Mason Jonathan B. , Senkbeil Jason C. 
Published: February 2015

AbstractA tornado refuge rubric was revised into a six-level, hierarchical Tornado Watch Scale (TWS) from level 0 to level 5 based on the likelihood of high or low-impact tornadic events. Levels correspond to an estimate of the maximum potential tornado intensity for a given day and include refuge/shelter categories of “adequate,” “questionable,” or “inadequate,” which encompass a range of refuge/shelter locations taken from the Enhanced Fujita scale. Ratings are based on a conservative estimate of damage indicators in high winds and the safety of a person taking refuge inside buildings of varying structural design. Audio recordings similar to those used in current NOAA weather radio communications were developed for each TWS intensity level. Recordings representing an existing tornado watch, existing particularly dangerous situation (PDS) tornado watch, and three proposed levels from the TWS were then used in interviews with Alabama residents to determine how changes to the information contained in the watch statements would affect each participant’s tornado safety actions and risk perception. Participants were also questioned about their knowledge and past experience with tornado hazards and their preference between the existing NWS tornado watches and the TWS. Results indicate a strong preference for the TWS when compared to existing products. The TWS was favored for providing additional information, containing descriptions of expected severity, and being easy to understand. The TWS also elicits more adequate safety decisions and more appropriate risk perception when compared to existing products, and these increases in safety were statistically significant.
Diagnosing Fish Bone and Chicken Bone Impactions in the Emergency Department Setting
Authors: Devarajan Karthik , Voigt Stanley , Shroff Sunil , Weiner Scott G. , Wein Richard O. 
Published: February 2015

Objectives: In the emergency department, fish and chicken bone impactions are typically evaluated with screening x-rays. We sought to determine whether this modality ultimately improves system outcomes, including length of stay (LOS), cost, and radiation dosage. Methods: We reviewed patients ≥18 years old presenting to an urban academic emergency department over a 4-year period who received a screening soft-tissue x-ray to determine the presence of a retained fish or chicken bone. We calculated the diagnostic accuracy of x-ray and computed tomography (CT) evaluations, respectively, in addition to system outcomes. Results: Twenty-seven of the 78 patients included for analysis were ultimately positive for bone impaction. Initial x-ray interpretations demonstrated a sensitivity of 24.0% (95% CI, 9.4%-45.1%) and a specificity of 90.0% (95% CI, 78.2%-96.7%). However, initial CT interpretation (ie, a preliminary read from on-call residents) demonstrated a sensitivity of 75% (95% CI, 19.4%-99.4%) and a specificity of 100% (95% CI, 59.0%-100%). LOS, cost, and radiation dosage were not significantly different between patients who ultimately had true bone impactions and those who did not ( P > .05). Conclusions: X-rays are poor screening tools in determining fish or chicken bone impactions with poor diagnostic and system utility. Further studies should be performed to evaluate the role of a low-radiation CT screen.
Prevalence and disability of headache among Norwegian adolescents: A cross-sectional school-based study
Authors: Krogh Anne-Berit , Larsson Bo , Linde Mattias 
Published: February 2015

Background Headache is common in adolescents and affects schoolwork and relations with friends and family. In most previous epidemiological surveys, only the most bothersome headache has been documented. The aim was to determine headache prevalence not only taking into account the most bothersome headache, but also to compare characteristics of the most bothersome and less bothersome headaches, and to investigate headache-related disability. Methods A cross-sectional school-based study was conducted in which 493 representative adolescents aged 12–18 years were recruited by stratified cluster sampling and interviewed. Headache diagnosis was made according to the new classification system of the International Headache Society (ICHD-3 beta), and the Pediatric Migraine Disability Assessment (PedMIDAS) was used to evaluate disability. Results The one-year prevalence of any headache type, definite migraine, probable migraine and tension-type headache was 88%, 23%, 13% and 58%, respectively. The point prevalence of any headache was 38%. Nine percent of participants fulfilled criteria for more than one headache diagnosis. The most bothersome headache had a significantly longer duration ( p < 0.001) and higher intensity ( p < 0.001) than the less bothersome headache, but similar frequency ( p = 0.86). Adolescents with headaches lost up to nine days of activity each year, implicating headache as a major health issue. Conclusions Headaches are very common and disabling among adolescents. The full extent of this health problem is better appreciated if inquiry is not limited to the most bothersome subtypes.
Height, Weight, and Age Predict Quadriceps Tendon Length and Thickness in Skeletally Immature Patients
Authors: Todd Dane C. , Ghasem Alexander D. , Xerogeanes John W. 
Published: February 2015

Background: Quadriceps tendon autografts have been used with success in adults and are becoming a popular graft option in pediatric patients because of size, decreased donor site morbidity, ease of harvest, and favorable biomechanical characteristics. However, little is known about the length and thickness of the quadriceps tendon in pediatric patients. Purpose: This study aimed to determine whether quadriceps tendon length and thickness follow a predictable pattern of development based on height, weight, age, and body mass index in skeletally immature patients. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The height, weight, age, and sex of 151 children between 4 and 16 years old were recorded. Ultrasound measurements of the length and thickness of bilateral quadriceps tendons were performed by a single technician and recorded for statistical analysis. Results: The average quadriceps tendon length and thickness were 6.87 ± 1.49 cm and 0.37 ± 0.12 cm, respectively. Tendon length averaged 3.89 cm at age 4 years and 7.98 cm at 16 years, whereas thickness averaged 0.24 cm at 4 years and 0.40 cm at 16 years of age. There was no significant difference in tendon length or thickness between males and females ( P = .97). Tendon length and thickness increased significantly with age, weight, and height ( P < .01 for all). Conclusion: The quadriceps tendon is of sufficient length and thickness to be used as an autograft for pediatric patients. The size of the graft is predictable using the age, height, and weight of the patient. Graft length and thickness can be easily confirmed using ultrasound.
Investigation on the passivated Si/Al2O3 interface fabricated by non-vacuum spatial atomic layer deposition system
Authors: Lien Shui-Yang , Yang Chih-Hsiang , Wu Kuei-Ching , Kung Chung-Yuan 
Published: February 2015

Abstract
Currently, aluminum oxide stacked with silicon nitride (Al2O3/SiNx:H) is a promising rear passivation material for high-efficiency P-type passivated emitter and rear cell (PERC). It has been indicated that atomic layer deposition system (ALD) is much more suitable to prepare high-quality Al2O3 films than plasma-enhanced chemical vapor deposition system and other process techniques. In this study, an ultrafast, non-vacuum spatial ALD with the deposition rate of around 10 nm/min, developed by our group, is hired to deposit Al2O3 films. Upon post-annealing for the Al2O3 films, the unwanted delamination, regarded as blisters, was found by an optical microscope. This may lead to a worse contact within the Si/Al2O3 interface, deteriorating the passivation quality. Thin stoichiometric silicon dioxide films prepared on the Si surface prior to Al2O3 fabrication effectively reduce a considerable amount of blisters. The residual blisters can be further out-gassed when the Al2O3 films are thinned to 8 nm and annealed above 650°C. Eventually, the entire PERC with the improved triple-layer SiO2/Al2O3/SiNx:H stacked passivation film has an obvious gain in open-circuit voltage (V
oc) and short-circuit current (J
sc) because of the increased minority carrier lifetime and internal rear-side reflectance, respectively. The electrical performance of the optimized PERC with the V
oc of 0.647 V, J
sc of 38.2 mA/cm2, fill factor of 0.776, and the efficiency of 19.18% can be achieved.