bluuebunny/crossref_metadata_2025_split huggingface dataset:
The VA National Teleneurology Program (NTNP): Implementing Teleneurology to Improve Equitable Access to Outpatient Neurology Care
Authors: Wilkinson Jayne , Myers Laura , Daggy Joanne , Martin Holly , Bastin Grace , Yang Ziyi , Damush Teresa , Narechania Aditi , Schriber Steve , Williams Linda S. 
Published: June 2023

AbstractBackgroundTelehealth is increasingly utilized in many healthcare systems to improve access to specialty care and better allocate limited resources, especially for rurally residing persons who face unique barriers to care.ObjectivesThe VHA sought to address critical gaps in access to neurology care by developing and implementing the first outpatient National Teleneurology Program (NTNP).DesignPre-post evaluation of intervention and control sites.ParticipantsNTNP sites and VA control sites; Veterans completing an NTNP consult and their referring providers.InterventionImplementation of the NTNP at participating sites.Main MeasuresNTNP and community care neurology (CCN) volume of consults before and after implementation; time to schedule and complete consults; Veteran satisfaction.Key ResultsIn FY2021, the NTNP was implemented at 12 VA sites; 1521 consults were placed and 1084 (71.3%) were completed. NTNP consults were scheduled (10.1 vs 29.0 days,p < 0.001) and completed (44.0 vs 96.9 days,p < 0.001) significantly faster than CCN consults. Post-implementation, monthly CCN consult volume was unchanged at NTNP sites compared to pre-implementation (mean change of 4.6 consults per month, [95% CI − 4.3, 13.6]), but control sites had a significant increase (mean change of 24.4 [5.2, 43.7]). The estimated difference in mean change in CCN consults between NTNP and control sites persisted after adjusting for local neurology availability (p < 0.001). Veterans (N = 259) were highly satisfied with NTNP care (mean (SD) overall satisfaction score 6.3 (1.2) on a 7-point Likert scale).ConclusionsImplementation of NTNP resulted in more timely neurologic care than care in the community. The observed significant increase in monthly CCN consults at non-participating sites during the post-implementation period was not seen at NTNP sites. Veterans were highly satisfied with Teleneurology care.
Current Programs and Incentives to Overcome Rural Physician Shortages in the United States: A Narrative Review
Authors: Arredondo Kelley , Touchett Hilary N. , Khan Sundas , Vincenti Matthew , Watts Bradley V. 
Published: June 2023

AbstractAccess to healthcare continues to be a top priority and prominent challenge in rural communities, with 20% of the total U.S. population living in rural areas while only 10% of physicians practice in rural areas. In response to physician shortages, a variety of programs and incentives have been implemented to recruit and retain physicians in rural areas; however, less is known about the types and structures of incentives that are offered in rural areas and how that compares to physician shortages. The purpose of our study is to conduct a narrative review of the literature to identify and compare current incentives that are offered by rural physician shortage areas to better understand how resources are being allocated to vulnerable areas. We reviewed published peer-reviewed articles from 2015–2022 to identify incentives and programs designed to address physician shortages in rural areas. We augment that review by examining the gray literature, including reports and white papers on the topic. Identified incentive programs were aggregated for comparison and translated into a map that depicts high, medium, and low levels of geographically designated Health Professional Shortage Areas (HPSAs) and the number of incentives offered by state. Surveying current literature regarding different types of incentivization strategies while comparing to primary care HPSAs provides general insights on the potential influence of incentive programs on shortages, allows easy visual review, and may provide greater awareness of available support for potential recruits. Providing a broad overview of the incentives offered in rural areas will help illuminate whether diverse and appealing incentives are offered in the most vulnerable areas and guide future efforts to address these issues.
Jumping Through Hoops: Community Care Clinician and Staff Experiences Providing Primary Care to Rural Veterans
Authors: Patzel Mary , Barnes Chrystal , Ramalingam NithyaPriya , Gunn Rose , Kenzie Erin S. , Ono Sarah S. , Davis Melinda M. 
Published: June 2023

AbstractBackgroundThe 2019 VA Maintaining Systems and Strengthening Integrated Outside Networks Act, or MISSION Act, aimed to improve rural veteran access to care by expanding coverage for services in the community. Increased access to clinicians outside the US Department of Veterans Affairs (VA) could benefit rural veterans, who often face obstacles obtaining VA care. This solution, however, relies on clinics willing to navigate VA administrative processes.ObjectiveTo investigate the experiences rural, non-VA clinicians and staff have while providing care to rural veterans and inform challenges and opportunities for high-quality, equitable care access and delivery.DesignPhenomenological qualitative study.ParticipantsNon-VA-affiliated primary care clinicians and staff in the Pacific Northwest.ApproachSemi-structured interviews with a purposive sample of eligible clinicians and staff between May and August 2020; data analyzed using thematic analysis.Key ResultsWe interviewed 13 clinicians and staff and identified four themes and multiple challenges related to providing care for rural veterans: (1) Confusion, variability and delays for VA administrative processes, (2) clarifying responsibility for dual-user veteran care, (3) accessing and sharing medical records outside the VA, and (4) negotiating communication pathways between systems and clinicians. Informants reported using workarounds to combat challenges, including using trial and error to gain expertise in VA system navigation, relying on veterans to act as intermediaries to coordinate their care, and depending on individual VA employees to support provider-to-provider communication and share system knowledge. Informants expressed concerns that dual-user veterans were more likely to have duplication or gaps in services.ConclusionsFindings highlight the need to reduce the bureaucratic burden of interacting with the VA. Further work is needed to tailor structures to address challenges rural community providers experience and to identify strategies to reduce care fragmentation across VA and non-VA providers and encourage long-term commitment to care for veterans.
Impact of Recreational Cannabis Legalization on Opioid Prescribing and Opioid-Related Hospital Visits in Colorado: an Observational Study
Authors: Buttorff Christine , Wang George Sam , Wilks Asa , Tung Gregory , Kress Amii , Schwam Dan , Pacula Rosalie Liccardo 
Published: June 2023

Abstract
Background
Cannabis may be a substitute for opioids but previous studies have found conflicting results when using data from more recent years. Most studies have examined the relationship using state-level data, missing important sub-state variation in cannabis access.

Objective
To examine cannabis legalization on opioid use at the county level, using Colorado as a case study. Colorado allowed recreational cannabis stores in January 2014. Local communities could decide whether to allow dispensaries, creating variation in the level of exposure to cannabis outlets.

Design
Observational, quasi-experimental design exploiting county-level variation in allowance of recreational dispensaries.

Subjects
Colorado residents

Measures
We use licensing information from the Colorado Department of Revenue to measure county-level exposure to cannabis outlets. We use the state’s Prescription Drug Monitoring Program (2013–2018) to construct opioid-prescribing measures of number of 30-day fills and total morphine equivalents, both per county resident per quarter. We construct outcomes of opioid-related inpatient visits (2011–2018) and emergency department visits (2013–2018) with Colorado Hospital Association data. We use linear models in a differences-in-differences framework that accounts for the varying exposure to medical and recreational cannabis over time. There are 2048 county-quarter observations used in the analysis.

Results
We find mixed evidence of cannabis exposure on opioid-related outcomes at the county level. We find increasing exposure to recreational cannabis is associated with a statistically significant decrease in number of 30-day fills (coefficient: −117.6, p-value<0.01) and inpatient visits (coefficient: −0.8, p-value: 0.03), but not total MME nor ED visits. Counties with no medical exposure prior to recreational legalization experience greater reductions in the number of 30-day fills and MME than counties with prior medical exposure (p=0.02 for both).

Conclusions
Our mixed findings suggest that further increases in cannabis beyond medical access may not always reduce opioid prescribing or opioid-related hospital visits at a population level.
Rolling out PRIDE in All Who Served: Barriers and Facilitators for Sites Implementing an LGBTQ+ Health Education Group for Military Veterans
Authors: Wilson Sarah M. , Mulcahy Abigail C. , Lange Tiffany M. , Eldridge Madeleine R. , Weidenbacher Hollis J. , Jackson George L. , Gierisch Jennifer M. , Crowley Matthew J. , Calhoun Patrick S. , Hilgeman Michelle M. 
Published: June 2023

Abstract
Background/Objective
The Veterans Health Administration (VHA) PRIDE in All Who Served health education group (PRIDE) was developed to improve health equity and access to care for military veterans who are lesbian, gay, bisexual, transgender, queer, and/or other sexual/gender-diverse identities (LGBTQ+). This 10-week program rapidly spread to over 30 VHA facilities in 4 years. Veterans receiving PRIDE experience improved LGBTQ+ identity-related resilience and reductions in suicide attempt likelihood. Despite PRIDE’s rapid spread across facilities, information is lacking on implementation determinants. The current study’s goal was to clarify determinants of PRIDE group implementation and sustainment.

Methods
A purposive sample of VHA staff (N = 19) with experience delivering or implementing PRIDE completed teleconference interviews January–April 2021. The interview guide was informed by the Consolidated Framework for Implementation Research. Rapid qualitative matrix analysis was completed with methods to ensure rigor (e.g., triangulation and investigator reflexivity).

Results
Key barriers and facilitators of PRIDE implementation were heavily related to facility inner setting (what is happening inside the facility), including implementation readiness (e.g., leadership support for LGBTQ+-affirming programming, access to LGBTQ+-affirming care training) and facility culture (e.g., systemic anti-LGBTQ+ stigma). Several implementation process facilitators enhanced engagement at sites, such as a centrally facilitated PRIDE learning collaborative and a formal process of contracting/training for new PRIDE sites.

Discussion/Conclusion
Although aspects of the outer setting and larger societal influences were mentioned, the majority of factors impacting implementation success were at the VHA facility level and therefore may be more readily addressable through tailored implementation support. The importance of LGBTQ+ equity at the facility level indicates that implementation facilitation should ideally address institutional equity in addition to implementation logistics. Combining effective interventions with attention to local implementation needs will be required before LGBTQ+ veterans in all areas will benefit from PRIDE and other health equity-focused interventions.
Utility of histopathological revision in the management of gastro-entero-pancreatic neuroendocrine neoplasia
Authors: Marasco Matteo , Magi Ludovica , Rogges Evelina , Dell’Unto Elisabetta , Rinzivillo Maria , Pilozzi Emanuela , Annibale Bruno , Panzuto Francesco 
Published: June 2023

Abstract
Background
Histological evaluation and grading assessment are key points in the diagnostic work-up of gastroentero-pancreatic neuroendocrine neoplasms (GEP-NENs).

Aim
To analyze the impact of histopathological revision on the clinical management of patients with GEP-NEN.

Materials and methods
Patients referred to our Center of Excellence between 2015 and 2021 were included in this study. Immunohistochemical slides at the time of initial diagnosis were reviewed to assess tumor morphology, diagnostic immunohistochemistry, and Ki67.

Results
101 patients were evaluated, with 65 (64.4%) gastrointestinal, 25 (24.7%) pancreatic, and 11 (10.9%) occult neoplastic lesions suspected to be of GEP origin. The main changes resulting from the revision were: first Ki-67 assessment in 15.8% of patients, Ki-67 change in 59.2% of patients and grading modification in 23.5% of patients. An additional immunohistochemical evaluation was performed in 78 (77.2%) patients, leading to a confirmation of GEP origin in 10 of 11 (90.9%) of unknown primary site neoplastic lesions and an exclusion of NEN diagnosis in 2 (2%) patients. After histopathological revision, a significant modification in clinical management was proposed in 42 (41.6%) patients.

Conclusions
Histopathological revision in a referral NEN center is strongly advised in newly diagnosed GEP-NENs to properly plan prognostic stratification and therapeutic choice.
Impact of film thickness in laser-induced periodic structures on amorphous Si films
Authors: Xu Liye , Geng Jiao , Shi Liping , Cui Weicheng , Qiu Min 
Published: June 2023

AbstractWe report self-organized periodic nanostructures on amorphous silicon thin films by femtosecond laser-induced oxidation. The dependence of structural periodicity on the thickness of silicon films and the substrate materials is investigated. The results reveal that when silicon film is 200 nm, the period of self-organized nanostructures is close to the laser wavelength and is insensitive to the substrates. In contrast, when the silicon film is 50 nm, the period of nanostructures is much shorter than the laser wavelength, and is dependent on the substrates. Furthermore, we demonstrate that, for the thick silicon films, quasi-cylindrical waves dominate the formation of periodic nanostructures, while for the thin silicon films, the formation originates from slab waveguide modes. Finite-difference time-domain method-based numerical simulations support the experimental discoveries.
Graphical abstract
Bij welke sociaal-demografische groepen komt suïcide het meest voor?
Authors: Berkelmans Guus , Gilissen Renske , Bhulai Sandjai , van der Mei Rob , Schweren Lizanne 
Published: June 2023

Samenvatting
Inleiding
Voor suïcidepreventie is het van belang om groepen met een verhoogd risico op suïcide zo goed mogelijk te identificeren. Tot nog toe is er weinig bekend over interacties van meerdere risicofactoren. Machine learning-methoden bieden nieuwe mogelijkheden voor flexibel, datagedreven, hypothesevrij en robuust onderzoek naar de interacties van risicofactoren voor suïcide.

Methode
In dit onderzoek is gebruikgemaakt van microdata van het Centraal Bureau voor de Statistiek met sociaal-demografische gegevens van alle Nederlandse inwoners. Er is een machine learning-model ontwikkeld en uitgevoerd om interacties van risicofactoren voor suïcide te vinden.

Resultaten
De resultaten laten disproportioneel hoge suïcide-incidenties zien onder 1) mensen met een arbeidsongeschiktheidsuitkering die nooit getrouwd zijn geweest, 2) arbeidsongeschikte mannen, 3) mensen tussen de 55 en 69 jaar oud, die alleen wonen, nooit getrouwd zijn en wiens huishoudinkomen laag is. Daarnaast hebben we hoge suïcidecijfers gevonden onder mensen tussen de 25 en 39 jaar met een laag opleidingsniveau en onder verweduwde mannen.

Conclusie
De bevindingen helpen om gericht interventies in te kunnen zetten om het aantal suïcides te verminderen.
How specific combinations of epoch length, non-wear time and cut-points influence physical activity
Authors: Burchartz Alexander , Kolb Simon , Klos Leon , Schmidt Steffen C. E. , von Haaren-Mack Birte , Niessner Claudia , Woll Alexander 
Published: June 2023

AbstractThis study assesses three factors that influence the quantification of children’s and adolescents’ physical activity (PA) using accelerometers: selection of (1) non-wear algorithm, (2) epoch length and (3) cut-points. A total of 1525 participants from MoMo wave 3 (2018–2022), aged 6–17 years, wore GT3X accelerometers (ActiGraph, LLC, Pensacola, FL, USA) during waking hours. Acceleration counts were reintegrated into lengths of 1, 5, 15, 30, and 60 s epochs. Two non-wear time algorithms and two sets of cut-points were applied to each epoch length. Differences were found in both the comparison of the non-wear time algorithms and the comparison of the cut-points when the different epoch lengths were considered. This may result in large differences in estimated sedentary behavior and PA values. We propose to pool the data by merging and combining multiple accelerometer datasets from different studies and evaluate them in a harmonized way in the future. In addition to the need for future validation studies using short epoch lengths for young children, we also propose to conduct meta-analyses. This allows the use of data from multiple studies to validate cut-points and to propose a consensual set of cut-points that can be used in different settings and projects. The high discrepancy between results when comparing different epoch lengths has to be considered when interpreting accelerometer data and is regarded a confounding variable when comparing levels of PA between studies.
Survival nomogram for patients with thymic squamous cell carcinoma, based on the SEER database and an external validation cohort
Authors: Guan Yelan , Xu Feiqi , Zheng Shuai , Gu Xiaodong , Sun Yan 
Published: June 2023

Abstract
Objective
This study aimed to construct a nomogram to effectively predict the 3 years and 5 years overall survival of patients with thymic squamous cell carcinoma (TSCC).

Method
From 2000 to 2019, a total of 355 patients with TSCC were enrolled in our research from the Surveillance, Epidemiology, and End Results (SEER) database and used as the training cohort. 106 patients were included from the Zhejiang Cancer Hospital, for the external validation cohort. A nomogram was constructed based on the risk factors affecting prognosis using a Cox proportional hazards regression model. The discrimination and calibration of the nomogram were evaluated by C-index and curve of calibration. The two cohorts were divided into low-risk and high-risk subgroups based on the median risk score.

Results
Age (p = 0.002), stage (p = 0.003), surgery therapy (p < 0.001), and radiotherapy (p = 0.030) were the independent prognostic factors for overall survival and were incorporated in the prognostic model. The discrimination of the nomogram revealed a good prognostic accuracy and clinical applicability as indicated by C-index values of 0.696 (95% confidence interval [CI] 0.676–0.716) and 0.717 (95% CI 0.640–0.794) for the training cohort and external validation cohort, respectively. In addition, the two cohorts were divided into a high-risk group and a low-risk group according to the median risk score. Significant differences in overall survival were observed between the high-risk and low-risk groups in the training (p < 0.0001) and external validation cohort (p < 0.0001).

Conclusion
We developed a nomogram to predict 3- and 5 year survival rate for TSCC. This nomogram provides a convenient and reliable tool for assessing the condition of patients with TSCC and assisting clinicians in making decisions.
What Takes the Wind out of Their Sails? A Micro-Foundational Perspective of Challenges for Building Dynamic Capabilities Towards Digital Business Model Innovation
Authors: Witschel Daliborka , Müller Julian Marius , Voigt Kai-Ingo 
Published: June 2023

AbstractWhile dynamic capabilities (DCs) are recognized as an important enabler of digital transformation, research lacks knowledge about the underlying challenges and adequate responses of building these capabilities. More specifically, this study aims to shed light into successful digital business model innovation (BMI) by adopting a micro-foundational approach that covers both challenges and successful measures on this path for incumbent industrial firms. Therefore, six case studies building on qualitative empirical research are analyzed that either focus on Internet of Things (IoT)-driven platform BMI or software as a service (SaaS) BMI. The results offer a variety of insights regarding challenges and respective responses. These findings are attributed to DCs and its subdimensions of sensing, seizing and transforming, further revealing the interplay of various factors for specific contexts. Additionally, the study reveals that many challenges and thus required responses are the result of individuals, processes, and structures.
A Decision Support GIS Framework for Establishing Zero-Emission Maritime Networks: The Case of the Greek Coastal Shipping Network
Authors: Karountzos Orfeas , Kagkelis Georgios , Kepaptsoglou Konstantinos 
Published: June 2023

AbstractSustainability of maritime operations is a topic widely considered in recent years, as the shipping industry attempts to limit its environmental impact and meet the decarbonization goals set by the International Maritime Organization (IMO). As alternative fuels and newer ship technologies are gaining interest, the shift to more environmentally friendly fleets is quickly becoming a reality. In this context, potential areas for such shifts need to be determined, to expedite decarbonization efforts and provide passengers with a more sustainable way of travel. Greece is an insular country, with a complex coastal shipping network connecting the mainland with the islands and being of paramount importance for their economic growth. Recognizing accessibility and decarbonization needs, this paper examines whether the Greek coastal shipping network (GCSN) can be restructured, by introducing zero-emission sub-networks operated by electric ferries. The aim is to propose a methodological framework for the spatial analysis and evaluation of coastal networks, with the implementation of exploratory spatial data analysis (ESDA) methods and determination of local indicators of spatial association (LISA) with the help of geographic information systems (GIS). The proposed framework provides insight on whether and where such a restructuring is possible, with the introduction of new transshipment port hubs in the islands from which electric ferries could operate, thus determining potential electrification areas with additionally high renewable resource potential. Final conclusions indicate that a potential electrification of certain parts of the GCSN could be possible, while results for GHG emissions reduced by the introduction of electric ferries are calculated.
Wiriyamu and the Colonial Archive: Reading It Against the Grain? Along the Grain? Read It at All!
Authors: Zeman Andreas 
Published: June 2023

Abstract“The archives are silent.” The starting point of this article is the alleged non-existence of archival sources on the Portuguese massacre of Wiriyamu (1972). The article proves this claim to be false and shows how the available sources can be used to improve our knowledge of the massacre. The article suggests that scholars’ ignorance of these sources is connected to general misconceptions about colonial archives and their alleged silence on wartime atrocities, which are based on the belief that such atrocities do only appear in the sources, if they are read against the grain. Revealing the explicit presence of war atrocities in the sources, the article argues that the legitimate concern about reading such sources against the grain should not prevent us from reading them at all.