bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of regular, low-dose, sustained-release morphine for chronic breathlessness on caregiver burden: An exploratory analysis of the BEAMS trial
Authors: Kochovska Slavica , Ferreira Diana , Chang Sungwon , Luckett Tim , Roydhouse Jessica , Ekström Magnus , Currow David C 
Published: November 2023

Background: Chronic breathlessness adversely impacts people with chronic obstructive pulmonary disease and their caregivers (family and friends), who may, in turn, experience significant burden due to their caregiving role. Sustained-release morphine may reduce chronic breathlessness in some patients, which may have an impact on caregivers’ perceived burden. Aim: To explore the impact on caregiver burden of active treatment of people with chronic breathlessness (modified Medical Research Council (mMRC) ⩾ 3) and chronic obstructive pulmonary disease (COPD) with regular, low-dose, sustained-release morphine within a multi-site, double-blind, randomised, placebo-controlled trial. Design: Exploratory analysis of self-reported caregiver burden at baseline and end of week 3 in a randomised, double-blind, placebo-controlled study. Caregiver measures included: demographics and perceived burden (Zarit Burden Interview 12-item short-form questionnaire). Patient measures included: worst breathlessness and FitBitR-measures. Setting/participants: All consenting caregivers of trial patient participants in a multi-site study recruiting from palliative care and respiratory services. Results: Caregivers ( n = 49; 59% women; median age 68 years [IQR 50–75]) reported median baseline caregiver burden 12 [IQR 5–17], with 53% reporting high burden (⩾13). Eighty-four percent of caregivers reported no change in burden. In people whose worst breathlessness improved, caregiver burden moved in the same direction, though the correlation was not significant ( rs = 0.25, p = 0.17). Conversely, caregiver burden worsened as patients’ minutes lightly active increased, with the correlation being significant ( rs = 0.56, p = 0.04). Conclusions: Caregivers reported high levels of caregiver burden, but patients’ response to treatment in terms of their symptom and function may influence change in caregiver burden over a three-week period.
Transendoscopic flexible parallel continuum robotic mechanism for bimanual endoscopic submucosal dissection
Authors: Gao Huxin , Yang Xiaoxiao , Xiao Xiao , Zhu Xiaolong , Zhang Tao , Hou Cheng , Liu Huicong , Meng Max Q.-H. , Sun Lining , Zuo Xiuli , Li Yanqing , Ren Hongliang 
Published: November 2023

In endoscopic submucosal dissection (ESD), the gastrointestinal (GI) tract warrants the surgical instruments to navigate through a long, narrow and tortuous endoscope. This poses a great challenge in developing ESD instruments with small dimensions, flexibility, and high distal dexterity. In this work, we propose the first Transendoscopic Flexible Parallel Continuum Robotic mechanism to develop a miniature dexterous flexible-stiff-balanced Wrist (FPCW). Besides, it can steer multifunctional instruments of diameters 2.5 mm to 3.5 mm, including the electrosurgical knife, injection needle, and forceps. Our FPCW instruments are adaptable to commercially available dual-channel endoscopes (diameter: <12 mm, channel width: 2.8 mm and around 3.8 mm). Furthermore, we develop a surgical telerobotic system, called DREAMS (Dual-arm Robotic Endoscopic Assistant for Minimally Invasive Surgery), by using our smallest FPCW instruments for bimanual ESD procedures. First, we conduct a series of experiments to determine the FPCW’s design and kinematics parameters and to verify the mechanical properties of the FPCW instruments’ prototypes, including workspace, stiffness, strength, and teleoperation accuracy. Second, we validate the functionality of the FPCW instruments through ex-vivo tests by performing ESD steps on porcine stomachs. Finally, we perform an invivo test on a live porcine model and showcase that our developed DREAMS can be teleoperated intuitively to perform bimanual ESD efficiently with an average dissection speed of 108.95 mm2/min at the greater curvature in gastric body, which demonstrates that our DREAMS has satisfactory maneuverability as well as accuracy and is more competitive than counterpart robotic systems.
Impact of low skeletal muscle mass in oropharyngeal cancer patients treated with radical chemo-radiotherapy: A mono-institutional experience
Authors: Deantoni Chiara L. , Mirabile Aurora , Chiara Anna , Giannini Laura , Midulla Martina , Del Vecchio Antonella , Fiorino Claudio , Fodor Andrei , Di Muzio Nadia G. , Dell’Oca Italo 
Published: November 2023

Aims: Low skeletal muscle mass index (SMI) has recently emerged as an independent prognostic factor in oncological patients and it is linked with poor survival and higher treatment toxicity. The present study aims to determine the possible impact of low SMI on survival and acute toxicity in oropharyngeal patients. Methods: Seventy-six patients with locally advanced oropharyngeal squamous cell carcinoma (stage III-IVC) were treated in our institution with Helical TomoTherapy® (HT - Accuray, Maddison, WI, USA) between 2005 and 2021. All patients received concomitant platinum-based chemotherapy (CT) (at least 200 mg/m2). The SMI was determined using the calculation of cross-sectional area at C3. Twenty patients (26%) presented pre-treatment low SMI, according to Chargi definitions. Results: All patients concluded the treatment. Thirteen patients with low SMI (65%) and 22 patients with normal SMI (39%) presented acute toxicity greater than or equal to grade 3, but this difference was not statistically significant (p-value = 0.25). Overall survival was analyzed in 65 patients, excluding those who finished CT-RT less than six months before the analysis. Overall survival was significantly lower in low SMI versus normal SMI patients (p-value = 0.035). Same difference was observed in N0-N2a patients, suggesting an important role of SMI also in lower nodal burden and putatively better prognosis. Conclusions: Although the results are limited to a small population, our case series has the advantage to be very homogeneous in patients and treatment characteristics. In our setting, SMI demonstrated a crucial impact on overall survival. Further investigation with larger samples is necessary to confirm our results to improve patient outcomes.
Monocyte to eosinophil ratio as a diagnostic biomarker for overlap syndrome and predictor of disease exacerbation
Authors: Ali Asmaa , Abdelhafiz Ahmed Samir , Saleh Mai M , Salem Heba , Rakha Mohammed A , Ezzat Seham 
Published: November 2023

Objectives: Chronic Obstructive Pulmonary Disease (COPD) is one of the most common pulmonary diseases. The concomitant association of Obstructive Sleep Apnea (OSA) and COPD is known as the Overlap Syndrome (OS). This study aimed to identify markers for predicting OS, among routine laboratory tests, including differential blood counts. Methods: One hundred twenty-five patients with exacerbated COPD were enrolled in the study and screened for OSA using the Epworth Sleepiness Scale (ESS). Those with a positive ESS score underwent polysomnography (PSG) for confirmation. All patients were followed for 90 days to monitor for subsequent exacerbations. Results: Out of the 125 patients with exacerbated COPD, 25 were confirmed to have OSA. Those with OS had a significantly higher body mass index (BMI) ( p < 0.001). The monocyte to eosinophil ratio (MER) was significantly higher in the OS group, while the neutrophil to monocyte (NMR) ratio and platelets to monocyte (PMR) ratio were significantly lower. Younger age, male sex, and higher body mass index (BMI) were all associated with OS. During the 90-day follow-up period after hospital discharge, 60% of patients with OS were re-admitted due to acute exacerbations. The hazard ratio for a second exacerbation increased by two-fold for every one-unit increase MER. The MER demonstrated excellent utility in predicting a second exacerbation, with an area under the curve (AUC) of 83% and a p-value of .005. Conclusion: The monocyte to eosinophil ratio (MER) was independent predictors of OS among exacerbated COPD patients and had a very good prognostic utility for predicting the next exacerbation episodes. Long term follow up is recommended to evaluate the severity of exacerbations and the effect of complications of OS on the morbidity and mortality of these patients.
Lightweight sound insulation optimization of simply supported locally resonant plate
Authors: Zhang Yumei , Li Ye , Zhao Yue , Yao Dan , Ai Yi , Pan Weijun 
Published: November 2023

A theoretical model of the normal sound insulation of a rectangular locally resonant (LR) plate with simply supported boundary conditions is established. The accuracy of the model is verified through comparison with finite element simulation results. Considering a 1-m2 aluminum plate as the research object, a non-dominated genetic algorithm is introduced. The algorithm optimizes the lightweight sound insulation of an LR finite plate with a center frequency band of 20–800 Hz as the optimization objective of maximum average sound insulation and minimum mass. The optimization parameters are substrate thickness and local resonance parameters (including resonator target frequency ( fobj), number of resonators, additional mass ratio, and resonator damping). Optimization results indicate that the average sound insulation fluctuates at approximately 2 dB due to changes in fobj. The results also provide an optimal solution to the algorithm. The optimal sound insulation value curve of LR plates corresponding to different surface densities of intermediate improved cases is fitted and compared with the sound insulation value of an equal-mass bare plate. Under lightweight optimization, the resonators are deemed capable of improving the local frequency band sound insulation. In contrast, the wideband average sound insulation can approximate but not surpass the insulation provided by the equal-mass bare plate. In practical applications, an LR plate that can improve the local frequency band sound insulation and ensure the overall lightweight sound insulation performance of the wide frequency band can be obtained. This can be achieved by analyzing the frequency spectrum of optimal points in the lightweight sound insulation optimization process. Relevant research can provide a basis for the evaluation and design of the low-frequency sound insulation of plates for transportation equipment, such as airplanes, high-speed trains, and cars.
Improvements in quality of life over 2 years with cladribine tablets in people with relapsing multiple sclerosis: The CLARIFY-MS study
Authors: Brochet Bruno , Solari Alessandra , Lechner-Scott Jeannette , Piehl Fredrik , Langdon Dawn , Hupperts Raymond , Selmaj Krzysztof , Patti Francesco , Brieva Luis , Maida Eva Maria , Alexandri Nektaria , Smyk Andrzej , Nolting Axel , Keller Birgit , Montalban Xavier , Kubala Havrdova Eva 
Published: November 2023

Background: Multiple sclerosis (MS) negatively affects health-related quality of life (HRQoL). Objective: To evaluate HRQoL in people with highly active relapsing MS treated with cladribine tablets (CladT; 3.5 mg/kg cumulative dose over 2 years) in CLARIFY-MS. Methods: Changes in the MS quality of life (MSQoL)-54 scores were analysed using a repeated mixed-effects linear model. Subgroup analyses were performed for participants who were pretreatment-naïve and those pretreated with disease-modifying therapies (DMTs) before initiating CladT. Safety and tolerability of CladT were also assessed. Results: MSQoL-54 physical (mean change = 4.86; 95% confidence interval (CI) = 3.18, 6.53) and mental health (4.80; 95% CI = 3.13, 6.46) composite scores (primary endpoints) showed significant improvement at Month 24 versus Baseline ( p < 0.0001). Changes in the MSQoL-54 scores were consistent across the pretreatment-naïve and DMT-pretreated subgroups. No new severe or opportunistic infections occurred. Most post-baseline lymphopenia events were Grade 1–2 in severity. Transient Grade-3 lymphopenia was observed in 19.7% (95/482) of participants. Grade-4 lymphopenia was not observed. Conclusions: CladT treatment significantly improved the mean MSQoL-54 physical and mental health composite scores over 2 years. CladT efficacy in HRQoL, relapse rates and Expanded Disability Status Scale scores demonstrates its multidimensional effects in MS treatment.
Has the NHS national extended access scheme delivered its policy aims? A case study of two large scale extended access providers
Authors: Burch Patrick , Whittaker William , Bower Peter , Checkland Katherine 
Published: November 2023

Objectives In 2018, NHS England mandated that all patients in England should be able to access general practice services outside of ordinary hours. While some patients would access additional hours at their own practice, others would need supra-practice level provision – that is, they would be seen in a different location and by a different care team. The policy aim was to enhance patient access to care, with a particular focus on those who work during the day. This study examines (a) how supra-practice level provision of extended access appointments for general medical problems are operationalised and (b) whether the aims of the policy are being met. Methods This study presents qualitative comparative case studies of two contrasting service providers offering extended access. The data collected included 30 hours of clinician-patient observations, 25 interviews with staff, managers, and commissioners, 20 interviews with patients, organisational protocols/documentation, and routinely collected appointment data. Thematic analysis ran concurrently with data gathering and facilitated the iterative adaptation of data collection. Results Three cross-cutting themes were identified: extended access is being used to bolster a struggling primary care system, extended access provides a different service to in-hours general practice, and it is difficult for extended access to provide seamless care. Conclusions Supra-practice access models can provide effective care for most patients with straightforward issues. When ongoing management of complex problems is required, this model of patient care can be problematic.
Health-related quality of life among adolescents and young adults with mood and anxiety concerns
Authors: Kazi Ayman A , Osuch Elizabeth A , Wammes Michael , John-Baptiste Ava 
Published: November 2023

Objectives To characterize health related quality of life (HRQOL) for Canadians aged 16 to 25 (adolescents and young adults, AYAs) seeking care for mood and anxiety concerns at the First Episode Mood and Anxiety Program, in London, Ontario and to identify factors associated with HRQOL in this population. Methods AYAs completed demographic, psychometric, and HRQOL questionnaires. We calculated 36-Item Short-Form Health Survey (SF-36) scores standardized to Canadian and US population norms. We computed Short Form 6 Dimension (SF-6D) utilities conducting multivariable linear regression analysis, adjusting for age, sex, ethnoracial minority status, parental marital/cohabitation status, parental education, the Anxiety Sensitivity Index (ASI-R), Montgomery-Åsberg Depression Rating Scale Self-Report (MADRS-S), Sheehan Disability Scale (SDS), and a modified Inventory of College Students’ Recent Life Experiences (ICSRLE-M). Results Amongst 182 AYAs who completed questionnaires, mean physical component summary (PCS), mental component summary (MCS) and SF-6D utility scores were low, 43.8 (SD = 16.6), 19.0 (SD = 11.9) and .576 (SD = .074), respectively. Maternal post-secondary education, depression (MADRS-S) and functional impairment (SDS) were significantly associated with SF-6D utility. Conclusion This cohort of mental healthcare-seeking AYAs had significantly impaired psychometric and utility-based measures of quality of life, underscoring the importance of timely access to healthcare services for this population.
Mindreading beliefs in same- and cross-neurotype interactions
Authors: Sheppard Elizabeth , Webb Sophie , Wilkinson Helen 
Published: November 2023

A large sample of autistic and non-autistic adults was recruited to investigate whether self-reported beliefs about their own and other people’s mindreading abilities were in line with either mindreading deficit accounts of autism or the double empathy problem (DEP) (which proposes mindreading difficulties are relational in autism). Three hundred and forty-eight (139 autistic) participants completed an online questionnaire which asked about autism identification and diagnostic status and their beliefs about their own mindreading abilities in relation to autistic and non-autistic others, and about autistic and non-autistic others’ abilities to read their (the participant’s) own minds. While autistic participants did report weaker mindreading abilities, this was only true in relation to non-autistic others. Both groups reported better mindreading abilities in same- than other-neurotype interactions, with autistic participants reporting mindreading abilities commensurate with non-autistic participants in relation to autistic targets. The same pattern was found when participants were asked about other people’s mindreading abilities. The findings were more consistent with the DEP than deficit theories, as the target reference group strongly impacted participants’ perceived mindreading abilities. While self-reported beliefs do not necessarily reflect actual mindreading abilities, they may still have important consequences for intergroup relations and social outcomes for autistic people. Lay Abstract Autistic people are often characterised as having problems with mindreading, which refers to understanding other people’s thoughts, beliefs and feelings. However, it has recently been suggested that mindreading difficulties may be a two-way issue between autistic and non-autistic people. This would imply that autistic people may not have difficulty reading the minds of other autistic people, whereas non-autistic people may struggle to read autistic people effectively. In this study, we created a survey in which we asked a relatively large sample of autistic and non-autistic people to rate their own and others’ mindreading abilities in relation to autistic and non-autistic others, respectively. Both groups believed that they were better at reading others in their own group than the other group. The autistic respondents reported levels of mindreading skill at least commensurate with the non-autistic respondents when the mind to be read was specified as autistic. Thus, both groups of participants’ responses were consistent with the notion that mindreading abilities are relational. Although self-reports are subjective, such beliefs could have important consequences for well-being and intergroup relations.
Parental language practices and children’s use of the minority language: The mediating role of children’s language attitudes
Authors: Humeau Camille , Guimard Philippe , Nocus Isabelle , Galharret Jean-Michel 
Published: November 2023

Objectives: This study examines the mediating role of children’s language attitudes in the relationship between parental language practices and children’s use of the minority language. Methodology: This cross-sectional study uses questionnaires filled out by children individually, focusing on their and their parents’ language attitudes and practices. Data and analysis: The study was conducted with 135 children ( Mage = 10.76 years) living in a bilingual family in France. We tested our hypotheses using regression analyses (logistic and linear) and a mediation analysis. Findings: Our findings indicate that (1) parents’ use of the minority language significantly predicts children’s; (2) children’s attitudes towards their minority language significantly predict its use; and (3) children’s language attitudes mediate a more important part of the relationship between their own and their parents’ use of the minority language when both parents use the majority language and only one uses the minority language. Implications: Reinforcing children’s positive attitudes towards their minority language can foster its use. Children have a role in the development of their bilingualism. When the child’s bilingual development is not supported by active language use by both parents at home, the children’s attitudes are crucial and decisive. Originality: This study focuses on the role of 10-year-old children’s perceptions of their bilingual development. This study provides interesting new insights into children’s agency in minority languages maintenance.
Does Brand Choice Matter: Associations Between Usual E-Cigarette Brands and E-Cigarette Use Patterns Among U.S. Youth, 2021
Authors: Chen-Sankey Julia , Elhabashy Maryam , Schroth Kevin R. J. 
Published: November 2023

Background. To inform youth about e-cigarette use prevention, it is important to understand whether using e-cigarette products from certain brands is associated with youth’s differential e-cigarette use patterns and willingness to quit e-cigarettes. Methods. Data for this study come from the 2021 U.S. National Youth Tobacco Survey (NYTS). The sample was current (past-30-day) e-cigarette users (unweighted n = 1,436). We examined the associations between users’ usual e-cigarette brands (Puff, Vuse, Smoke, JUUL, and others) and e-cigarette use patterns (use frequency, use with nicotine, use with flavors) and willingness to quit, controlling for covariates. Results. In 2021, 25.6%, 9.7%, 8.1%, and 6.5% of users reported Puff, Vuse, Smok, and JUUL as their usual brands, respectively. Having Smok as a usual brand increased the odds of frequent e-cigarette use compared with other brands. Using Puff, Vuse, and Smok increased the odds of using e-cigarettes with nicotine. Using Puff and Smok increased the odds of using e-cigarettes with any flavors and fruit flavors, and using Smok and JUUL increased the odds of using mint flavors. Finally, using Vuse reduced the odds of having a willingness to quit e-cigarettes. Conclusion. Puff products, which are likely to be used infrequently and with fruit flavors, were the most endorsed usual brand by youth users. Vuse and Smok brand users demonstrated problematic use patterns, including high-frequency use of nicotine and reduced willingness to quit. The high prevalence of using flavors, especially banned flavors (e.g., mint for JUUL products), suggests the need for tightened restrictions on youth’s access to flavored e-cigarettes.