bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating “The REST of Your Life,” a Workplace Health Program to Improve Employee Sleep, Health, Energy, and Productivity
Authors: Robbins Rebecca , Yi Fanchao , Chobotar Todd , Hawkins Sarah , Putt Denise , Pepe Julie , Manoucheri Manoucher 
Published: January 2022

Purpose Sleep is critical for employee health, well-being, and productivity. Our purpose is to evaluate a sleep-focused interactive workplace health promotion program. Design We evaluate sleep and mental health before and after exposure to the program using a pre/post quasi-experimental pilot study design with surveys administered at baseline and 1-, 6-, and 12 months post-exposure (Phase 1). We design program evaluation surveys for dissemination when the program is offered broadly to hospital employees (Phase 2). Setting The study was conducted at a large teaching hospital in the Southeast U.S. in 2016. Subjects Subjects were full-time hospital employees. Intervention The program was presented to subjects in one four-hour interactive session. Measures In Phase 1 (n = 55), surveys included the validated Apnea Risk Evaluation System, Dysfunctional Beliefs About Sleep, Generalized Anxiety Disorder-7, Pittsburgh Sleep Quality Index and Patient Health Questionnaire. Phase 2 (n = 3935) utilized program evaluation surveys. Analysis We compare survey responses between pre- and post-program using a repeated measures analysis of variance with post-hoc tests. Results Statistically significant improvement in all sleep and mental health domains was demonstrated. In Phase 2, 81.9% reported “strongly agree” to willingness to recommend the program to co-workers. Conclusion We demonstrate improvement in employee sleep and mental health after exposure to a novel workplace health promotion program to improve sleep.
Experimental study on spray diffusion characteristics at various biodiesel-butanol blended ratios and ambient conditions
Authors: Zhang Qiankun , Xia Jin , Wang Jianping , He Zhuoyao , Zhao Wenbin , Qian Yong , Zheng Liang , Liu Rui , Lu Xingcai 
Published: January 2022

The depletion of fossil fuels and stringent emission regulations have encouraged the development of renewable fuels, especially biodiesel and alcohols fuels. The aim of the investigation is to explore the spray diffusion characteristics at different biodiesel-butanol blended ratios (0, 10%, 30%, and 50%), ambient temperatures (600 K, 700K, and 800 K), and pressures (1 MPa, 3 MPa, and 5 MPa). The experiment was carried out in a constant volume combustion chamber. The liquid- and vapor-phase spray images were captured by backlight illumination and schlieren imaging technique, respectively. The axial, radial, and spatial diffusion characteristics were analyzed, including spray penetration, cone angle, area, R-parameter, and perimeter ratio. Results show that in the case of biodiesel mixed with 10% n-butanol, for liquid-phase spray, the liquid-core spray with high concentration has the largest impact on axial diffusion, and for vapor-phase spray, axial dispersion is slower and radial diffusion is faster. The fuel density and ambient temperature have a more significant impact on the liquid-phase axial dispersion at the steady state compared with ambient pressure and injection pressure. At lower ambient pressures, increasing the injection pressure can accelerate the radial diffusion and increase the spray cone angle, which is opposite of the variation law at higher ambient pressures. The radial spray has a faster diffusion with adding a small or middle proportion of n-butanol, and the maximum values of liquid- and vapor-phase cone angles appear at biodiesel blended with 30% and 10% n-butanol, respectively. Moreover, the axial diffusion plays a dominant role in the spray spatial dispersion.
Ethical conflict among critical care nurses during the COVID-19 pandemic
Authors: Khanal Anjita , Franco-Correia Sara , Mosteiro-Diaz Maria-Pilar 
Published: January 2022

Background Ethical conflict is a problem with negative consequences, which can compromise the quality and ethical standards of the nursing profession and it is a source of stress for health care practitioners’, especially for nurses. Objectives The main aim of this study was to analyze Spanish critical care nurses’ level of exposure to ethical conflict and its association with sociodemographic, occupational, and COVID-19–related variables. Research Design, Participants, and Research context: This was a quantitative cross-sectional descriptive study conducted among 117 nurses working in critical care units. Data collection tools were sociodemographic, occupational, and COVID-19–related questionnaires and previously validated Spanish version of Ethical Conflict in Nursing Questionnaire-Critical Care Version. Ethical Considerations We obtained permission from the Ethics Committee and participants' informed consent. Findings Data indicates a moderate level of exposure to ethical conflicts. The most frequent ethical conflicts were related to situations about "treatment and clinical procedures." The most intensity of ethical conflicts was related to situations about "treatment and clinical procedures" and "dynamics of the service and working environment." No statistical significance was identified between the socio-demographic variables and level of exposure to ethical conflicts. However, for critical care nurses working in ICU, nurses with perceived worked stress had a higher level of exposure to ethical conflicts. Likewise, critical care nurses whose family/friends were infected with COVID-19 had a higher level of exposure. Conclusions Critical care nurses experience a moderate level of exposure to ethical conflicts which is consistent with the results of previous studies. A deeper understanding of ethical conflicts in conflictive situations allows recognition of the situations that occur in everyday clinical practice, identification of the ethical conflicts, and facilitation of the nurses working in the challenging clinical situation.
A pilot study to explore societal, patient, and public authority perception on ‘Value-Added Tax’ system for healthcare financing in Zimbabwe: A case for cancer treatment
Authors: Tavengwa Martin , Mensah Kofi Boamah , Marume Amos , Yamoah Peter , Padayachee Neelaveni , Bangalee Varsha 
Published: January 2022

Background Many of the cancer cases in Zimbabwe are HIV related, making it a significant health concern in the country. This concern requires innovative ways, such as implementing Value-Added Tax (VAT) to finance cancer management through health insurance. The study explores the general public, cancer patients, and public authorities' perception regarding using the VAT system for financing cancer treatment. Method A qualitative cross-sectional study was conducted to explore the perception of study participants on ‘Value Added Tax’ as a source of healthcare financing in Harare. This was done through the use of in-depth interview guides. A total of 25 participants took part in the study. Fifteen were members of the general public, 5 were cancer patients, and 5 were key informants representing public authority. Members of the general public and cancer patients were conveniently selected, while key informants were purposively selected. Data were analyzed descriptively and by grounded theory whereby codes were developed by induction. Results The general public and cancer patients perceived cancer treatment as generally unaffordable and showed readiness to pay for a cancer levy through VAT. Cancer patients expressed disappointment at the low support for cancer treatment compared to HIV treatment concerning the already established AIDS levy. Public authorities also perceived the VAT system as an appropriate programme for health care financing. Conclusion This preliminary study found that a ‘Value-Added-Tax’ system could potentially be an acceptable model to finance public healthcare, including cancer treatment in highly informal settings like Zimbabwe.
Parent peer coaching program: A cascading intervention for parents of children with autism in Mongolia
Authors: Lee James D , Meadan Hedda , Oyunbaatar Enkhjin 
Published: January 2022

Parents of children with autism in low-resource settings have reported exacerbated difficulties related to raising their children. In this single-case research using multiple probe design, four parent mentors and five parent peers and their children with autism in Mongolia participated in the parent peer coaching program. The intervention package, including training and coaching in evidence-based practices, was delivered via telepractice. Parent mentors completed online training and were coached by a bilingual and bicultural research assistant in a staggered fashion. Visual analysis revealed a functional relation between the intervention package and the coaching fidelity of parent mentors. Social validity data indicated that all participants were satisfied with the program and reported it was acceptable, feasible, and effective. Implications for conducting intervention research in a low-resource setting are described. Lay abstract Parents of children with autism are known to experience severe hardships related to raising their children. These hardships are exacerbated in low-resource settings internationally where there is very little resource for children and their families, including professionals who provide evidence-based treatment. Mongolia was chosen as an example of such low-resource settings in this single-case research, and four parent mentors and five parent peers and their children with autism participated and completed the study. A local parent group, the Autism Association of Mongolia, was actively involved in this study and helped with recruitment, development, adaptation, and implementation of the intervention to increase acceptability and feasibility. In addition, a local bilingual research assistant was also utilized as the purpose of this study was to build capacity of diverse stakeholders of children with autism in Mongolia. The research assistant was trained and coached by the research team on both content (communication teaching strategies and behavior management) and delivery (coaching adults), who then provided coaching to parent mentors via live videoconferencing in Mongolian. Parent mentors then similarly provided coaching to parent peers after observing the interactions with their children with autism. The findings suggest that parents can effectively deliver high-fidelity coaching to disseminate evidence-based treatment in low-resource settings when given proper training and coaching. Further examination on scalability and sustainment of effects is suggested.
Crosslinguistic influence in child L3 English: An empirical study on Russian-German heritage bilinguals
Authors: Kolb Nadine , Mitrofanova Natalia , Westergaard Marit 
Published: January 2022

Aims and objectives: This empirical study investigates variables affecting crosslinguistic influence (CLI) in child third language (L3) acquisition. We examine whether structural or typological similarity leads to CLI from one or both of the previously acquired languages at later stages of acquisition. Design/methodology: We compare Russian-German heritage bilinguals acquiring L3 English to L2 English learners with either L1 German or L1 Russian (matched in age, proficiency, age of onset, length of exposure), which allows us to assess whether CLI obtains from one language or both. We carried out an acceptability judgment task: Two of the structures under investigation in English are structurally similar to German (subject-auxiliary inversion, determiner use) and two to Russian (adverb placement, non-subject-initial declaratives). Data and analysis: We tested 10- to 12-year-old L3 learners ( n = 66), L2 learners with L1 Russian ( n = 26), and L1 German ( n = 33). The L3 learners were tested in both previously acquired languages. Findings/conclusions: Our findings suggest that structural proximity may override typological similarity at later stages and indicate that CLI obtains cumulatively from both languages. We found facilitative and non-facilitative CLI from Russian and German. For properties that are structurally similar in English and Russian, the L3 learners outperformed the L2 learners with L1 German and were outperformed by the L2 learners with L1 Russian, and vice versa for properties similar in English and German. Originality: Our research adds child L3 data to the current debate on whether morpho-syntactic properties from previously acquired languages are transferred wholesale or property by property, based on typological primacy or linguistic proximity. Significance: Previous research has shown that surface typological similarity is an important factor at early stages of acquisition. Our study investigates whether structural similarity can override this strong factor at later stages of child L3 acquisition.
Patient-Reported Lower Extremity Outcomes Following Fibula or Medial Femoral Condyle Free Flaps for Upper Extremity Defects
Authors: Miles Megan R. , Jacobson Lauren , Hill John B. , Higgins James P. , Giladi Aviram M. , Pet Mitchell A. 
Published: January 2022

Background: Free fibula flap (FFF) and medial femoral condyle (MFC) flap are commonly used for upper extremity osseous reconstruction, yet donor-site morbidity has never been systematically compared. Methods: Patients who underwent an FFF or MFC for upper extremity extra-carpal osseous reconstruction at 3 academic hand centers were retrospectively identified. Only patients who underwent reconstruction for a defect in which either flap type is routinely used or has been described in the literature were deemed eligible. Patients who agreed to participate were asked to complete the Lower Extremity Functional Scale (LEFS) and Lower Limb Core Scale (LLCS). The reported population norm median score of LEFS is 77 points. The LLCS population norm mean score is 90.52 points. Results: Twenty-one patients (10 MFC, 11 FFF) were enrolled. The median LEFS score for patients after MFC was 76 (interquartile range [IQR], 49-80) points and 75 (IQR, 56-79) points after FFF. The median LLCS score for patients after MFC was 96.4 (IQR, 87.9-100) points and 100 (IQR, 91-100) points after FFF. Median LEFS scores were slightly below the population norm, whereas median LLCS scores were above the norm for both FFF and MFC. All patients stated they would have the surgery again and that any dysfunction or pain in the leg was justified by the benefit in the arm. Conclusions: When considering whether to use an MFC or FFF for upper extremity reconstruction, both flap types appear to result in modest and comparable donor-site morbidity.
Experiences of running a stratified medicine adaptive platform trial: Challenges and lessons learned from 10 years of the FOCUS4 trial in metastatic colorectal cancer
Authors: Brown Louise C , Graham Janet , Fisher David , Adams Richard , Seligmann Jenny , Seymour Matthew , Kaplan Richard , Yates Emma , Parmar Mahesh , Richman Susan D , Quirke Philip , Butler Rachel , Shiu Kaikeen , Middleton Gary , Samuel Leslie , Wilson Richard H , Maughan Timothy S ,   On Behalf of the FOCUS4 Trial Investigators
Published: January 2022

Background: Complex innovative design trials are becoming increasingly common and offer potential for improving patient outcomes in a faster time frame. FOCUS4 was the first molecularly stratified trial in metastatic colorectal cancer and it remains one of the first umbrella trial designs to be launched globally. Here, we aim to describe lessons learned from delivery of the trial over the last 10 years. Methods: FOCUS4 was a Phase II/III molecularly stratified umbrella trial testing the safety and efficacy of targeted therapies in metastatic colorectal cancer. It used adaptive statistical methodology to decide which sub-trial should close early, and new therapies were added as protocol amendments. Patients with newly diagnosed metastatic colorectal cancer were registered, and central laboratory testing was used to stratify their tumour into molecular subtypes. Following 16 weeks of first-line therapy, patients with stable or responding disease were eligible for randomisation into either a molecularly stratified sub-trial (FOCUS4-B, C or D) or non-stratified FOCUS4-N. The primary outcome for all studies was progression-free survival comparing the intervention with active monitoring/placebo. At the close of the trial, feedback was elicited from all investigators through surveys and interviews and consolidated into a series of recommendations and lessons learned for the delivery of similar future trials. Results: Between January 2014 and October 2020, 1434 patients were registered from 88 UK hospitals. Of the 20 drug combinations that were explored for inclusion in the platform trial, three molecularly targeted sub-trials were activated: FOCUS4-D (February 2014–March 2016) evaluated AZD8931 in the BRAF-PIK3CA-RAS wildtype subgroup; FOCUS4-B (February 2016–July 2018) evaluated aspirin in the PIK3CA mutant subgroup and FOCUS4-C (June 2017–October 2020) evaluated adavosertib in the RAS+TP53 double mutant subgroup. FOCUS4-N was active throughout and evaluated capecitabine monotherapy versus a treatment break. A total of 361 (25%) registered patients were randomised into a sub-trial. Feedback on the experiences of delivery of FOCUS4 could be grouped into three main areas of challenge: funding/infrastructure, biomarker testing procedures and trial design efficiencies within which 20 recommendations are summarised. Conclusion: Adaptive stratified medicine platform studies are feasible in common cancers but present challenges. Our stakeholder feedback has helped to inform how these trial designs can succeed and answer multiple questions efficiently, providing resource is adequate.
Prevention of type 2 diabetes in sub-Saharan Africa, a review
Authors: L. McCrory-Churchill Shannon , Hill Ellen 
Published: January 2022

Background: Type 2 diabetes (T2D) is a significant factor in the overall burden of non-communicable diseases (NCDs) in sub-Saharan Africa (SSA). While many health organizations call for increased attention to this disease, far fewer resources are being allocated to evidence-based prevention programs. The literature demonstrates a lack of reporting on prevention programs, interventions targeted to decrease the development of T2D, and success stories. Methods: This review followed the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Databases searched were PubMed, Google Scholar, Ovid, Medline, World Health Organization (WHO) Library Information System, and African Journals Online. The following terms were searched individually and in multiple combinations: prevention, intervention, type 2 diabetes, sub-Saharan Africa, education, strategy, strategic plan, risk factors. In total, 253 articles were found and 17 were removed as duplicates. Of these, 78 abstracts were reviewed, with 20 being excluded for not meeting criteria, one was excluded as it was not available in English and one was excluded for lack of availability. After the remaining 56 full-text studies were assessed, seven were included in the review. Results: Throughout the review, the common theme between articles was a lack of resources, lack of prevention strategies, and increasing risk factors. The review highlights the fact that while there are WHO guidelines and packages targeted at primary care level interventions for the prevention and treatment of NCDs, they remain underutilized. Included studies looked at the knowledge level of family members, social marketing and sugar consumption, and primary prevention strategies. Conclusion: There is an overall lack of reporting on interventions targeting the prevention of type 2 diabetes in SSA. Further research is warranted on interventions, prevention strategies, and implementation of the WHO package targeted at NCDs
Seizures Associated With Bone Density Conservation Agents
Authors: Sturgill Kuan , Reinert Justin P. 
Published: January 2022

Objective The purpose of this review is to discuss the existing literature regarding patients who have experienced seizures after administration of a bone density conservation agent (BDCA). Data Sources A comprehensive literature review was performed between September and October 2021 using the following keywords: osteoporosis/drug therapy, seizures/chemically induced, hypercalcemia, hypocalcemia, osteoporosis, seizure risk, osteoclast medication, seizures, bisphosphonates, risedronate, zoledronic acid, pamidronate, denosumab, Prolia, Xgeva, calcitonin, BDCAs. Study Selection and Data Extraction A total of 90 articles were identified, but only 6 articles met prespecified inclusion and exclusion criteria. These articles included 4 case reports, 1 case series, and 1 retrospective cohort study. Data Synthesis Two case reports and 1 case series described the occurrence of seizures with the use of zoledronic acid. One case report described the occurrence of seizures with the use of alendronate, 1 retrospective cohort study with the use of denosumab, and 1 case report with the use of calcitonin. The articles displayed a variety of contributing factors that could have caused seizures including those with a prior history of seizures, calcium or vitamin D deficiency prior to starting therapy, a history of gastrectomy impairing glucose homeostasis, or concurrent infection. Conclusion While there is not a direct link to BDCA causing seizures, the hypocalcemic effect may be severe enough in some patients to precipitate a seizure. The correction of underlying conditions and electrolyte disturbances should be addressed before initiating a BDCA. Further studies are needed to better explore the relationship between BDCA and seizures.
Structure of shear-induced platelet aggregated clot formed in an in vitro arterial thrombosis model
Authors: Kim Dongjune A. , Ku David N. 
Published: January 2022

Abstract
The structure of occlusive arterial thrombi is described herein. Macroscopic thrombi were made from whole blood in a collagen-coated, large-scale stenosis model with high shear flow similar to an atherosclerotic artery. The millimeter-sized thrombi were harvested for histology and scanning electron microscopy. Histological images showed 3 distinctive structures of the thrombus. (1) The upstream region showed string-like platelet aggregates growing out from the wall that protrude into the central lumen, with red blood cells trapped between the strings. The strings were &gt;10 times as long as they were wide and reached out to join the strings from the opposite wall. (2) Near the apex, the platelet strings coalesced into a dense mass with microchannels that effectively occluded the lumen. (3) In the expansion region, the thrombus ended abruptly with an annulus of free blood in the flow-separation zone. Scanning electron microscopy showed dense clusters of spherical platelets upstream and downstream, with amorphous platelets in the occluded throat consistent with prior activation. The total clot is estimated to contain 1.23 billion platelets with pores 10 to 100 μm in diameter. The results revealed a complex structure of arterial thrombi that grow from their tips under high shear stress to bridge the 2.5-mm lumen quickly with von Willebrand factor platelet strings. The occlusion leaves many microchannels that allow for some flow through the bulk of the thrombus. This architecture can create occlusion or hemostasis rapidly with minimal material, yet can remain porous for potential delivery of lytic agents to the core of the thrombus.