bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of external assessment on quality and safety in surgery: a qualitative study of surgeons’ perspectives
Authors: Øyri Sina Furnes , Wiig Siri , Tjomsland Ole 
Published: May 2024

IntroductionTransparency about the occurrence of adverse events has been a decades-long governmental priority, defining external feedback to healthcare providers as a key measure to improve the services and reduce the number of adverse events. This study aimed to explore surgeons’ experiences of assessment by external bodies, with a focus on its impact on transparency, reporting and learning from serious adverse events. External bodies were defined as external inspection, police internal investigation, systems of patient injury compensation and media.MethodsBased on a qualitative study design, 15 surgeons were recruited from four Norwegian university hospitals and examined with individual semi-structured interviews. Data were analysed by deductive content analysis.ResultsFour overarching themes were identified, related to influence of external inspection, police investigation, patient injury compensation and media publicity, (re)presented by three categories: (1) sense of criminalisation and reinforcement of guilt, being treated as suspects, (2) lack of knowledge and competence among external bodies causing and reinforcing a sense of clashing cultures between the ‘medical and the outside world’ with minor influence on quality improvement and (3) involving external bodies could stimulate awareness about internal issues of quality and safety, depending on relevant competence, knowledge and communication skills.Conclusions and implicationsThis study found that external assessment might generate criminalisation and scapegoating, reinforcing the sense of having medical perspectives on one hand and external regulatory perspectives on the other, which might hinder efforts to improve quality and safety. External bodies could, however, inspire useful adjustment of internal routines and procedures. The study implies that the variety and interconnections between external bodies may expose the surgeons to challenging pressure. Further studies are required to investigate these challenges to quality and safety in surgery.
Paediatric laceration repair in the emergency department: post-discharge pain and maladaptive behavioural changes
Authors: Martin Sarah R , Heyming Theodore W , Fortier Michelle A , Kain Zeev N 
Published: May 2024

Background
Paediatric laceration repair procedures are common in the ED; however, post-discharge recovery remains understudied. Perioperative research demonstrates that children exhibit maladaptive behavioural changes following stressful and painful medical procedures. This study examined post-discharge recovery following paediatric laceration repair in the ED.

Methods
This prospective observational study included a convenience sample of 173 children 2–12 years old undergoing laceration repair in a paediatric ED in Orange, California, USA between April 2022 and August 2023. Demographics, laceration and treatment data (eg, anxiolytic medication), and caregiver-reported child pre-procedural and procedural pain (Numerical Rating Scale (NRS)) were collected. On days 1, 3, 7 and 14 post-discharge, caregivers reported children’s pain and new-onset maladaptive behavioural changes (eg, separation anxiety) via the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery. Univariate and logistic regression analyses were conducted to identify variables associated with the incidence of post-discharge maladaptive behavioural change.

Results
Post-discharge maladaptive behavioural changes were reported in 43.9% (n=69) of children. At 1 week post-discharge, approximately 20% (n=27) of children exhibited maladaptive behavioural changes and 10% (n=13) displayed behavioural changes 2 weeks post-discharge. Mild levels of pain (NRS ≥2) were reported in 46.7% (n=70) of children on post-discharge day 1, 10.3% (n=14) on day 7 and 3.1% (n=4) on day 14. An extremity laceration (p=0.029), pre-procedural midazolam (p=0.020), longer length of stay (p=0.043) and post-discharge pain on day 1 (p<0.001) were associated with incidence of maladaptive behavioural changes. Higher pain on post-discharge day 1 was the only variable independently associated with an increased likelihood of maladaptive behavioural change (OR=1.32 (95% CI 1.08 to 1.61), p=0.001).

Conclusion
Over 40% of children exhibited maladaptive behavioural changes after ED discharge. Although the incidence declined over time, 10% of children continued to exhibit behavioural changes 2 weeks post-discharge. Pain on the day following discharge emerged as a key predictor, highlighting the potential critical role of proactive post-procedural pain management in mitigating adverse behavioural changes.
Neurophysiological features of STN LFP underlying sleep fragmentation in Parkinson’s disease
Authors: Zhang Guokun , Yu Huiling , Chen Yue , Gong Chen , Hao Hongwei , Guo Yi , Xu Shujun , Zhang Yuhuan , Yuan Xuemei , Yin Guoping , Zhang Jian-guo , Tan Huiling , Li Luming 
Published: May 2024

BackgroundSleep fragmentation is a persistent problem throughout the course of Parkinson’s disease (PD). However, the related neurophysiological patterns and the underlying mechanisms remained unclear.MethodWe recorded subthalamic nucleus (STN) local field potentials (LFPs) using deep brain stimulation (DBS) with real-time wireless recording capacity from 13 patients with PD undergoing a one-night polysomnography recording, 1 month after DBS surgery before initial programming and when the patients were off-medication. The STN LFP features that characterised different sleep stages, correlated with arousal and sleep fragmentation index, and preceded stage transitions during N2 and REM sleep were analysed.ResultsBoth beta and low gamma oscillations in non-rapid eye movement (NREM) sleep increased with the severity of sleep disturbance (arousal index (ArI)-betaNREM: r=0.9, p=0.0001, sleep fragmentation index (SFI)-betaNREM: r=0.6, p=0.0301; SFI-gammaNREM: r=0.6, p=0.0324). We next examined the low-to-high power ratio (LHPR), which was the power ratio of theta oscillations to beta and low gamma oscillations, and found it to be an indicator of sleep fragmentation (ArI-LHPRNREM: r=−0.8, p=0.0053; ArI-LHPRREM: r=−0.6, p=0.0373; SFI-LHPRNREM: r=−0.7, p=0.0204; SFI-LHPRREM: r=−0.6, p=0.0428). In addition, long beta bursts (>0.25 s) during NREM stage 2 were found preceding the completion of transition to stages with more cortical activities (towards Wake/N1/REM compared with towards N3 (p<0.01)) and negatively correlated with STN spindles, which were detected in STN LFPs with peak frequency distinguishable from long beta bursts (STN spindle: 11.5 Hz, STN long beta bursts: 23.8 Hz), in occupation during NREM sleep (β=−0.24, p<0.001).ConclusionFeatures of STN LFPs help explain neurophysiological mechanisms underlying sleep fragmentations in PD, which can inform new intervention for sleep dysfunction.Trial registration numberNCT02937727.
Opportunistic atrial fibrillation screening in primary care in Ireland: results of a pilot screening programme
Authors: Callanan Aileen , Quinlan Diarmuid , Kearney Patricia M , O’Sullivan Susanne , Zhi Gerald Tan Ying , Crichton Alyssa , Howell Mackenzie Wynn , Bradley Colin , Buckley Claire 
Published: May 2024

BackgroundAtrial fibrillation (AF), a common, frequently asymptomatic cardiac arrhythmia, is a major risk factor for stroke. Identification of AF enables effective preventive treatment to be offered, potentially reducing stroke risk by up to two-thirds. There is international consensus that opportunistic AF screening is valuable though uncertainty remains about the optimum screening location and method. Primary care has been identified as a potential location for AF screening using one-lead ECG devices.MethodsA pilot AF screening programme is in primary care in the south of Ireland. General practitioners (GPs) were recruited from Cork and Kerry. GPs invited patients ≥65 years to undergo AF screening. The screening comprised a one-lead ECG device, Kardia Mobile, blood pressure check and ascertainment of smoking status. Possible AF on one-lead ECG was confirmed with a 12-lead ECG. GPs also recorded information including medical history, current medication and onward referral. The Keele Decision Support tool was used to assess patients for oral anticoagulation (OAC).Results3555 eligible patients, attending 52 GPs across 34 GP practices, agreed to undergo screening. 1720 (48%) were female, 1780 (50%) were hypertensive and 285 (8%) were current smokers. On the one-lead ECG, 3282 (92%) were in normal sinus rhythm, 101 (3%) had possible AF and among 124 (4%) the one-lead ECG was unreadable or unclassified. Of the 101 patients with possible AF, 45 (45%) had AF confirmed with 12-lead ECG, an incidence rate of AF of 1.3%. Among the 45 confirmed AF cases, 27 (60%) were commenced on OAC therapy by their GP.ConclusionThese findings suggest that AF screening in primary care may prove useful for early detection of AF cases that can be assessed for treatment. One-lead ECG devices may be useful in the detection of paroxysmal AF in this population and setting. Current OAC of AF may be suboptimal.
Prolonged administration of intrathecal baclofen in a patient with generalized grade 4 tetanus
Authors: Aiello Michael , Roy Sounak , Chitty Lyndsey , Johnson Brittany , Warrick Matthew 
Published: May 2024

IntroductionThis case report presents the management of a 62-year-old woman with generalized grade 4 tetanus, focusing on the innovative use of intrathecal baclofen (ITB) therapy. The patient initially presented with a laceration and subsequently developed severe tetanic spasms, necessitating interventions beyond standard tetanus immunoglobulin and antibiotics due to the condition’s progressive and life-threatening nature. The preference for ITB over oral baclofen is highlighted, considering ITB’s enhanced bioavailability in the central nervous system and its efficacy in reducing spinal cord reflexes, which is critical for managing severe spasticity.On her return to the emergency department with symptoms of tetanus, the patient received ITB following the failure of oral baclofen to control the spasms. ITB administration necessitated a lumbar drain, which was later substituted with a tunneled intrathecal catheter due to the extended requirement for baclofen infusion and the unavailability of suitable infusion pumps. This scenario represented a significant application of a CADD-Solis external pump for continuous ITB infusion.Transitioning the patient from ITB to oral baclofen was a crucial management step to facilitate discharge and recovery, underscoring the importance of a careful approach to prevent withdrawal symptoms and maintain care continuity. Despite initial complications, including an infection signaled by leucocytosis and confirmed through cerebrospinal fluid culture, the patient was effectively treated and discharged.ConclusionThis report contributes to the sparse literature on prolonged ITB use for generalized grade 4 tetanus treatment, underlining the need for interdisciplinary collaboration for the best patient outcomes. It showcases the potential of ITB in spasticity management, in reducing the need for sedation, and in shortening the duration of mechanical ventilation, advocating for a tailored approach that utilizes a full spectrum of pharmacological and supportive therapies.
Comparative anatomical study of digital block with the WALANT, interdigital, and transthecal techniques
Authors: Morales Lorena , Goffin Pierre , Jorcano Enrique , Reina Miguel Angel , Sala-Blanch Xavier 
Published: May 2024

IntroductionInterdigital block and transthecal block through the flexor sheath are commonly used techniques for the anesthesia of isolated fingers. The wide-awake local anesthetic no-tourniquet technique is a relatively new approach for local anesthesia during finger procedures. The anatomical spread of local anesthetics with the wide-awake local anesthetic no tourniquet technique has not been described adequately.This anatomical study aimed to assess the distribution of a local anesthetic dye solution to the digital nerves. The study was designed to compare the nerve staining effect using the wide-awake local anesthetic no tourniquet and the transthecal and interdigital techniques in cadavers. We hypothesized that the wide-awake local anesthetic no tourniquet technique stains digital nerves more effectively than the interdigital and transthecal digital injection techniques.Methods14 blocks were performed using anatomical landmarks. 2 mL of a mixture of local anesthetic, methylene blue, and contrast medium were injected. Before dissection, the specimens were passed through an X-ray scanner to assess the spread of the mixture. Finally, anatomical dissections were performed to evaluate the specific hand nerve implications.ResultsIn the wide-awake local anesthetic no tourniquet group, the local anesthetics spread to the nerves of each finger but not the common nerve. In the transthecal and interdigital groups, the spread extended from the common nerve to the lateral aspect of the adjacent fingers.ConclusionThe wide-awake local anesthetic no tourniquet technique was as effective as conventional techniques in the digital blockade, achieving specific spread on the targeted nerves.
Financial toxicity and health-related quality of life in long-term survivors of acute promyelocytic leukaemia
Authors: Sparano Francesco , Voso Maria Teresa , Venditti Adriano , Giesinger Johannes M , Baldi Thomas , Breccia Massimo , Fazi Paola , Vignetti Marco , Efficace Fabio 
Published: May 2024

ObjectivesWe aimed to investigate the association between financial toxicity (FT) and the health-related quality of life profile of long-term survivors of acute promyelocytic leukaemia (APL) treated within a universal healthcare system.MethodsWe evaluated FT using the financial difficulties item of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). We also compared the prevalence of clinically important problems and symptoms between the survivors of APL with or without FT, using evidence-based thresholds for the EORTC QLQ-C30. A multivariable logistic regression analysis was performed to explore potential risk factors associated with FT.ResultsOverall, 352 long-term survivors of APL, with a median age of 53.9 years and a median time since diagnosis of 12.2 years, were analysed. Of these, 71 (20.2%) reported having FT. The prevalence of clinically important problems and symptoms was generally higher across most EORTC QLQ-C30 scales for those survivors who reported FT. The three largest differences between patients with and without FT were observed for emotional functioning (+35.4 percentage points), dyspnoea (+33.1 percentage points) and physical functioning (+27.0 percentage points). The presence of FT was independently associated with having comorbidities and not receiving a salary/pension.ConclusionsThese findings suggest that even many years after being diagnosed, one-fifth of long-term survivors of APL experience FT. Interventions to assist with employment may be critical to minimise the risk of FT in the most vulnerable survivors.
New Tsallis holographic dark energy with Granda–Oliveros as IR-cutoff
Authors: Sharma Umesh Kumar , Pankaj  , Muttathazhathu Ali Nisha , Mishra Krishna Kant 
Published: May 2024

In the current study, a theoretical model for non-interacting new Tsallis holographic dark energy is constructed using the Granda–Oliveros as the IR cutoff with specified scale factor [Formula: see text]. The time-dependent deceleration parameter, with appropriate assumptions, yields this scale factor. The features of the deceleration parameter, equation of state parameter, density parameter, and jerk parameter are then investigated for this model. According to our findings, the cosmos has a normal thermal history, dark matter and dark energy eras occurring one after the other until dark energy eventually takes over entirely in the far future. Additionally, the evolution of the potential and pressure to indicate the universe’s accelerated expansion by using our model are studied. We investigate the evolution trajectory of statefinder parameters, which is consistent with ΛCDM model.
Pulse shape discrimination technique for diffuse supernova neutrino background search with JUNO
Authors: Cheng Jie , Luo Xiao-Jie , Li Gao-Song , Li Yu-Feng , Li Ze-Peng , Lu Hao-Qi , Wen Liang-Jian , Wurm Michael , Zhang Yi-Yu 
Published: May 2024

AbstractPulse shape discrimination (PSD) is widely used in particle and nuclear physics. Specifically in liquid scintillator detectors, PSD facilitates the classification of different particle types based on their energy deposition patterns. This technique is particularly valuable for studies of the diffuse supernova neutrino background (DSNB), nucleon decay, and dark matter searches. This paper presents a detailed investigation of the PSD technique, applied in the DSNB search performed with the Jiangmen Underground Neutrino Observatory (JUNO). Instead of using conventional cut-and-count methods, we employ methods based on boosted decision trees and neural networks and compare their capability to distinguish the DSNB signals from the atmospheric neutrino neutral-current background events. The two methods demonstrate comparable performance, resulting in a 50–80% improvement in signal efficiency compared to a previous study performed for JUNO (An et al. [JUNO] in J Phys G 43(3):030401, 2016). Moreover, we study the dependence of the PSD performance on the visible energy and final state composition of the events and find a significant dependence on the presence/absence of $$^{11}$$

11

C. Finally, we evaluate the impact of the detector effects (photon propagation, PMT dark noise, and waveform reconstruction) on the PSD performance.
Simulations of galaxies in an expanding Universe with modified Newtonian dynamics (MOND) and with modified gravitational attractions (MOGA)
Authors: Toxvaerd Søren 
Published: May 2024

AbstractThe stability of galaxies is either explained by the existence of dark matter or caused by a modification of Newtonian acceleration (MOND). Here, we show that the modification of the Newtonian dynamics can equally well be obtained by a modification of Newton’s law of universal gravitational attraction (MOGA) when Newton’s inverse square attraction from a distant object is replaced with an inverse attraction. This modification is often proposed in the standard model, and with the modification of the attraction caused by dark matter. The recently derived algorithm, Eur Phys J Plus, 137:99, 2022; Class Quantum Grav, 39:225006, 2022, for classical celestial dynamics is used to simulate models of the Milky Way in an expanding universe and with either MOND or MOGA. The simulations show that the galaxies with MOND dynamics are unstable, whereas MOGA stabilizes the galaxies. The rotation velocities for objects in galaxies with classical Newtonian dynamics decline inversely proportional to the square root of the distance r to the center of the galaxy. But the rotation velocities is relatively independent of r for MOGA and qualitatively in agreement with experimentally determined rotation curves for galaxies in the Universe. The modification of the attractions may be caused by the masses of the objects in the central part of the galaxy by the lensing of gravitational waves from far-away objects in the galaxy.
Asynchronous Memory Access Unit: Exploiting Massive Parallelism for Far Memory Access
Authors: Wang Luming , Zhang Xu , Wang Songyue , Jiang Zhuolun , Lu Tianyue , Chen Mingyu , Luo Siwei , Huang Keji 
Published: May 2024

The growing memory demands of modern applications have driven the adoption of far memory technologies in data centers to provide cost-effective, high-capacity memory solutions. However, far memory presents new performance challenges because its access latencies are significantly longer and more variable than local DRAM. For applications to achieve acceptable performance on far memory, a high degree of memory-level parallelism (MLP) is needed to tolerate the long access latency.
While modern out-of-order processors are capable of exploiting a certain degree of MLP, they are constrained by resource limitations and hardware complexity. The key obstacle is the synchronous memory access semantics of traditional load/store instructions, which occupy critical hardware resources for a long time. The longer far memory latencies exacerbate this limitation.
This article proposes a set of Asynchronous Memory Access Instructions (AMI) and its supporting function unit, Asynchronous Memory Access Unit (AMU), inside contemporary Out-of-Order Core. AMI separates memory request issuing from response handling to reduce resource occupation. Additionally, AMU architecture supports up to several hundreds of asynchronous memory requests through re-purposing a portion of L2 Cache as scratchpad memory (SPM) to provide sufficient temporal storage. Together with a coroutine-based programming framework, this scheme can achieve significantly higher MLP for hiding far memory latencies.
Evaluation with a cycle-accurate simulation shows AMI achieves 2.42× speedup on average for memory-bound benchmarks with 1μs additional far memory latency. Over 130 outstanding requests are supported with 26.86× speedup for GUPS (random access) with 5 μs latency. These demonstrate how the techniques tackle far memory performance impacts through explicit MLP expression and latency adaptation.
On Second-Order Cone Functions
Authors: Jibrin Shafiu , Swift James W. 
Published: May 2024

We consider the second-order cone function (SOCF)f:Rn⟶Rdefined byfx=cTx+d−Ax+b, with parametersc∈Rn,d∈R,A∈Rm×n, andb∈Rm. Every SOCF is concave. We give necessary and sufficient conditions for strict concavity off. The parametersAandbare not uniquely determined. We show that every SOCF can be written in the formfx=cTx+d−δ2+x−x∗TMx−x∗. We give necessary and sufficient conditions for the parametersc,d,δ,M=ATA, andx∗to be uniquely determined. We also give necessary and sufficient conditions forfto be bounded above.