bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optimization of molding process parameters for enhancing mechanical properties of jute fiber reinforced composites
Authors: He Liping , Xia Fan , Chen Dachuan , Peng Shuyi , Hou Shujuan , Zheng Junchao 
Published: November 2022

Compression molding is a manufacturing technique that is frequently and widely utilized in fabricating composites. However, bast fiber reinforced composites (BFRC) with good quality and high performance by compression molding are quite challenging because it is complicated to find suitable process parameters. Previous works on improving the mechanical performance of compression molded BFRCs normally considered the influence of a single process parameter and ignored the mutual effects of process parameters. To enhance the mechanical qualities of BFRCs and enlarge their applications, this paper studied the synergistic effects of two molding process parameters on the mechanical characteristics of jute reinforced polypropylene composites (jute/PP) from contour and surface plots through response surface methodology (RSM). The significance of each molding process factor on the mechanical behaviors of jute/PP was investigated by conducting the analysis of variance (ANOVA). Multi-parameter co-optimization achieved the optimal mechanical performance of molded jute/PP at 186.8°C, 5.6 MPa, and 10.1 min, which was consistent with experimental findings. This suggests that response surface equations obtained from RSM can accurately characterize the relationships between mechanical characteristics and molding parameters of jute/PP. The RSM provides a useful and reliable way to find the optimal process parameters for better mechanical behaviors.
A review of placenta accreta spectrum and its outcomes for perinatal mental health
Authors: Ayalde Jeremiah , Epee-Bekima Mathias , Jansen Brendan 
Published: November 2022

Objectives Placenta accreta spectrum conditions are rare, life-threatening disorders of placentation encountered in the perinatal period, with lasting impacts on maternal quality of life and psychological wellbeing. Although the obstetric outcomes are well-known, further review is warranted to explore the psychological sequelae that may accompany these conditions. Conclusions The occurrence of placenta accreta spectrum during pregnancy is a major life stressor that can contribute to the development of psychiatric co-morbidity including posttraumatic stress disorder, depression and anxiety disorders. Early recognition of psychological distress and symptomatic profile is recommended at all stages of perinatal care complicated by this rare spectrum of conditions.
Evaluating early-stage disk halo changes after small incision lenticule extraction
Authors: Zhao Wuxiao , Zhao Jing , Zhang Zhe , Han Tian , Wang Jifang , Zhou Xingtao 
Published: November 2022

Purpose To investigate early changes in the disk halo under different light conditions after myopic small incision lenticule extraction (SMILE). Methods This prospective study included 70 eyes of 70 myopic patients aged 18–33 years, with a spherical equivalent (SE) of −5.87 ± 1.86 D, who underwent SMILE. The subjective refraction, higher-order aberrations (HOAs), pupillometry, and halo were measured preoperatively and postoperatively to analyse disk halo variations and correlated factors. Results At 5 cd/m2 and 1 cd/m2 luminance, the halo radius in the high myopia (HM) group reached a postoperative peak after 1 week ( p = 0.000 and 0.019, respectively), and recovered to baseline after 3 months. In the low-to-moderate (LM) myopia group, the halo radius did not differ 1 week postoperatively compared to the preoperative level ( p = 0.015), but significantly improved after 3 months ( p = 0.000). The halo radius correlated with SE, uncorrected distance visual acuity (UDVA), ocular HOAs, coma, and the pupillary light reflex in the LM group at all time points, but there were no correlations in the HM group. Conclusions Halo symptoms occurred early after SMILE, but recovered within 3 months. The recovery process was slower in the HM group than in the LM group, and the halo radius correlated with SE, UDVA, ocular HOAs, coma, and the pupillary light reflex.
Serum neurofilament light levels in natalizumab-treated patients with multiple sclerosis who switch to extended interval dosing from every-4-week dosing in real-world clinical practice
Authors: Foley John , Xiong Kuangnan , Hoyt Tammy , Singh Carol M , Riddle Evan , de Moor Carl , Plavina Tatiana , Campbell Nolan 
Published: November 2022

Background: Serum levels of neurofilament light chain (sNfL) are a potentially useful biomarker for assessing the efficacy of multiple sclerosis (MS) treatments. Objective: To compare levels of sNfL in patients with MS who switched from natalizumab every 4 weeks (Q4W) to extended interval dosing (EID) and patients who remained on Q4W dosing in real-world clinical practice. Methods: This was a retrospective analysis of samples from patients treated with natalizumab from 2010 to 2015 at a single center in the United States. Levels of sNfL were compared in patients who stayed on Q4W dosing or who switched to EID (parallel-arm analyses) and during Q4W and EID periods in patients who switched to EID (pre- and post-switch analyses). Results: The analysis included 139 patients (Q4W: n = 79; EID: n = 60). After adjustment, levels of sNfL did not significantly differ between patients who remained on Q4W dosing and those who switched to EID in parallel-arm analyses (adjusted Q4W-EID difference = 0.51 pg/mL; p = 0.60) or pre- and post-switch analyses (adjusted difference = 0.96 pg/mL; p = 0.10). Conclusion: These sNfL biomarker results suggest that the effectiveness of natalizumab is maintained in patients who switch from Q4W dosing to EID.
Orthodontic retention experience of university students: A qualitative study
Authors: Wilson Sophie , Idicula David , Littlewood Simon J , Barber Sophy 
Published: November 2022

Objective: To explore university students’ experience of retention and identify potential barriers and facilitators to long-term adherence. Design: Cross-sectional qualitative study using virtual focus groups. Setting: University of Leeds. Participants: Dental and non-dental students from the University of Leeds, who had previously undergone orthodontic treatment and had received removable retainers. Methods: Students were invited to participate via email. Virtual focus groups were undertaken using Microsoft Teams. A topic guide was used to explore the experience of orthodontic retention including factors that influence long-term retainer wear. Focus groups were recorded and analysed using an inductive thematic approach. Results: In total, 23 students participated in four focus groups, including 13 dental students. The period since the end of orthodontic treatment varied from 9 months to 10 years. Of the 23 participants, 8 (35%) were no longer wearing their retainers. Four themes were identified: (1) experience of orthodontic treatment including knowledge of relapse; (2) experience of retainer wear, including motivators and barriers; (3) role of others; and (4) increasing adherence. Key factors influencing use of retainers were the importance placed on maintaining treatment outcomes, awareness of unwanted tooth movement and understanding of the role of the retainer, access to replacement retainers, and ongoing support to encourage retainer wear. Greater knowledge and dental awareness reported by dental students did not necessarily increase adherence. Conclusion: Adherence to removable retainer wear is an important aspect of orthodontic treatment but it is recognised that long-term retainer wear is highly variable. The understanding of relapse and retention is variable. Challenges in gaining access to replacement retainers are a common cause of cessation of retainer wear. Dental professionals are perceived to be important in encouraging and supporting retainer wear and individuals reported they would like more follow-up.
Interobserver Variability in the Assessment of Fluorescence Angiography in the Colon
Authors: Soares Antonio S. , Clancy Neil T. , Bano Sophia , Raza Imran , Diana Michelle , Lovat Laurence B. , Stoyanov Danail , Chand Manish 
Published: November 2022

Background Fluorescence angiography in colorectal surgery is a technique that may lead to lower anastomotic leak rates. However, the interpretation of the fluorescent signal is not standardised and there is a paucity of data regarding interobserver agreement. The aim of this study is to assess interobserver variability in selection of the transection point during fluorescence angiography before anastomosis. Methods An online survey with still images of fluorescence angiography was distributed through colorectal surgery channels containing images from 13 patients where several areas for transection were displayed to be chosen by raters. Agreement was assessed overall and between pre-planned rater cohorts (experts vs non-experts; trainees vs consultants; colorectal specialists vs non colorectal specialists), using Fleiss’ kappa statistic. Results 101 raters had complete image ratings. No significant difference was found between raters when choosing a point of optimal bowel transection based on fluorescence angiography still images. There was no difference between pre-planned cohorts analysed (experts vs non-experts; trainees vs consultants; colorectal specialists vs non colorectal specialists). Agreement between these cohorts was poor (<.26). Conclusion Whilst there is no learning curve for the technical adoption of FA, understanding the fluorescent signal characteristics is key to successful use. We found significant variation exists in interpretation of static fluorescence angiography data. Further efforts should be employed to standardise fluorescence angiography assessment.
Navigating data governance approvals to use routine health and social care data to evidence the hidden population with severe obesity: a case study from a clinical academic’s perspective
Authors: Williamson Kath , Nimegeer Amy , Lean Mike 
Published: November 2022

Background: Front-line professionals are uniquely placed to identify evidence gaps and the way routinely-collected data can help address them. This knowledge can enable incisive, clinically-relevant research. Aim: To document an example of the real-world approvals journey within the current NHS/Higher Education regulatory landscape, from the perspective of an experienced nurse undertaking doctoral study as a clinical academic. Methods: An instrumental case-study approach is used to explore the approvals process for a mixed-methods study. Relevant context is highlighted to aid understanding, including introduction of the General Data Protection Regulation and the integration of health and social care services. Results: Formal approvals by nine separate stakeholders from four different organisations took nearly 3 years, including 15 initial or revised applications, assessments or agreements. Obstacles included: conflicting views on what constitutes ‘research’ or ‘service evaluation’; isolated decision-making; fragmented data systems; multiple data controllers and a changing data governance environment. The dual perspectives of being both clinician and academic using routine data are explored. Conclusions: Practitioners face a complex approvals process to use data they routinely collect, for research or evaluation purposes. Use of data during the COVID-19 pandemic has demonstrated the need for streamlining of data governance processes. Practical recommendations are outlined.
Extreme Hyponatremia Complicated by Osmotic Demyelination in a Previously Healthy Young Individual
Authors: Quigley Nicholas , Garneau Alexandre P. , Haydock Ludwig , Isenring Paul 
Published: November 2022

Rationale: Severe hyponatremia can lead to dramatic complications whether it is treated or not. At times, it may be very severe (serum Na concentration: NaS < 115 mmol/L) or even extreme (NaS < 105 mmol/L)a and its cause difficult to identify, especially in younger individuals with no history of water disorders. The case presented herein illustrates these points quite eloquently and leads us to believe that the current recommendations for the treatment of very severe hyponatremia require some fine-tuning. Presenting Concerns: A 26-year-old man was admitted to our intensive care unit for a NaS of 88 mmol/L in the absence of obvious extracellular fluid volume contraction. He had been experiencing vomiting, diarrhea, fatigue, and excessive thirst for the past 6 weeks and minor neurological symptoms just before admission. Laboratory tests at presentation also showed a urine osmolarity of 697 mOsm/L and urine Na of 40 mmol/L. Diagnoses: The presenting concerns were consistent with syndrome of inappropriate antidiuretic hormone secretion (SIADH) manifesting as extreme, yet mildly symptomatic hyponatremia. At the same time, they did not point toward a specific cause initially. Interventions: The patient was treated through water restriction, subcutaneous desmopressin, and various intravenous (IV) fluids. Our goal had been to increase NaS at a rate of 4 to 6 mmol/L/day and required the amount of NaCl and free water perfused hourly to be readjusted constantly. Access to water also had to be opposed as the patient was unable to tolerate his thirst. Outcomes: During the first 6 days, the rate of NaS correction achieved was ~6 mmol/L/day. The patient improved initially but at the end of day 6, he experienced severe extrapontine osmotic demyelination (with widespread pyramidal and extrapyramidal deficits) that did not respond to intravenous immunoglobulin and NaS relowering. A little more than 3 weeks later, he began to develop low blood pressure and a subfebrile state that revealed secondary to severe Addison disease. The water disorder and insatiable thirst subsided gradually upon replacing the deficient hormones but the neurological disorder went on to become permanent and highly disabling. Teaching points: (1) Very severe hyponatremia should always be handled as an emergency and monitored stringently in view of its potential to cause irreparable damage. (2) Because it is a major risk factor for osmotic demyelination, it should probably be corrected at a rate of less than 4 mmol/L/day especially if it is in the extreme range, chronic, or of unknown duration. (3) It can be a presenting manifestation of Addison disease.
Prescription Pattern of Cation Exchange Resins and Their Efficacy in Treating Chronic Hyperkalemia Among Patients With Chronic Kidney Diseases: Findings From a Population-Based Analysis in British Columbia, Canada
Authors: Atiquzzaman Mohammad , Birks Peter , Bevilacqua Micheli , Wong Michelle M. Y. , Zheng Yuyan , Djurdjev Ognjenka , Levin Adeera 
Published: November 2022

Background: Little was known about how chronic hyperkalemia (cHK) in patients with chronic kidney disease (CKD) is managed in British Columbia, Canada. Objective: To investigate the trend in sodium polystyrene sulfonate (SPS) and calcium polystyrene sulfonate (CPS) utilization and their efficacy in treating cHK in CKD patients from British Columbia, Canada. Study Design: Retrospective cohort. Setting & Patients: CKD patients aged ≥18 years, followed in Kidney Care Clinic (KCC), who had at least 2 potassium values ≥5.0 mmol/L separated by no more than 91 days during the period of June 1, 2015, to July 31, 2021, were included. Index date was the first date of the 2 potassium values ≥5.0 mmol/L. Patients who received SPS or CPS within 90 days before index date were excluded. Patients who were on dialysis or received kidney transplantation on or before index date were also excluded. Exposure: Continuous exposure to SPS and CPS. Outcome: SPS/CPS prescription utilization trend was described by the proportion of patients ever treated with SPS/CPS, median time in days between cHK diagnosis and initiating treatment with SPS/CPS, total and median number of SPS/CPS prescriptions dispensed. Change in mean serum potassium concentration before and after a 90-day continuous treatment with SPS/CPS was estimated. Analytical Approach: Descriptive. Results: This study included 10 495 patients with cHK (median age 74 years, 60% were male). Median follow-up time was 625 days. Only 2864 (27%) patients were dispensed at least 1 prescription of either SPS or CPS. A total 7300 prescriptions were dispensed; median prescriptions dispensed per patients were 2 (interquartile range [IQR]: 1-3). Median time from index date to the first prescription dispensing date was 154 days (IQR: 36-455). Continuous 90-day treatment with SPS/CPS decreased the mean serum potassium concentration by 0.60 mmol/L, from 5.58 to 4.98 mmol/L. Limitations: Descriptive observational study without control group. Conclusions: In British Columbia, only 1 in 4 CKD patients with cHK were dispensed with SPS/CPS, mostly with higher degrees of hyperkalemia. These medications appeared to be moderately effective in reducing the serum potassium concentration. Future research is necessary to evaluate the comparative effectiveness of newer generation medications.
The use of a smartphone application to improve stroke code workflow metrics: A pilot study in a comprehensive stroke centre
Authors: Gutiérrez-Zúñiga Raquel , Uclés Jorge , Sánchez-Manso Juan Carlos , Fuentes Blanca , de Celis Elena , Ruiz-Ares Gerardo , Rodríguez-Pardo Jorge , Rigual Ricardo , Casado Laura , Alonso Elisa , Fernández-Prieto Andrés , Navia Pedro , Álvarez-Muelas Alberto , Marín Begoña , Díez Tejedor Exuperio , Alonso de Leciñana María 
Published: November 2022

Background Timely coordination between stroke team members is of relevance for stroke code management. We explore the feasibility and potential utility of a smartphone application for clinical and neuroimaging data sharing for improving workflow metrics of stroke code pathways, and professionals’ opinions about its use. Methods We performed an observational pilot study including stroke code activations at La Paz University Hospital in Madrid, from June 2019 to March 2020. Patients were classified according to the activation or not of the JOIN app by the attending physician. Clinical data and time-to-procedures were retrieved from the app or from the hospital records and the Madrid regional stroke registry as appropriate and compared between both groups. An anonymous survey collected professionals’ opinions about the app and its use. Results A total of 282 stroke code activations were registered. The JOIN app was activated in 111 (39%) cases. They had a significant reduction in imaging-to-thrombolysis (31 vs 20 min, p = .026) and in door-to-thrombolysis times (51 vs 36 min, p = .004), with more patients achieving a door-to-needle time below 45 min (68.8% vs 37.8%, p = .016). About 50% of the users found the app useful for facilitating the diagnosis and decision-making; interoperability with clinical files was considered an opportunity for improvement. Conclusions This pilot study suggests that JOIN helps improve and document workflow metrics in acute stroke management in a comprehensive stroke centre. These results support testing JOIN in a prospective randomised study to confirm its usefulness and the general applicability of the results.
Should Mindfulness for Health Care Workers Go Virtual? A Mindfulness-Based Intervention Using Virtual Reality and Heart Rate Variability in the Emergency Department
Authors: Pascual King , Fredman Amiad , Naum Athanasios , Patil Chaitrali , Sikka Neal 
Published: November 2022

Background: Research on burnout in the medical community has extensively studied the impact of mindfulness-based interventions (MBIs), which can include meditation, outdoor retreats, in-person didactics, and/or online wellness modules. However, in addition to these MBIs lacking objective, physiological measures for wellness, there has been little to no research involving virtual reality (VR) as an MBI modality for healthcare professionals in the United States. Methods: A randomized controlled intervention trial was used to study the impact of VR-based guided-meditations in the form of brief paced-breathing exercises. Heart-rate variability (HRV), a biomarker for relaxation, was measured during each session. Thirty-two participants, consisting of primarily medical students, resident physicians, and registered nurses, were recruited to complete brief guided-meditations via a VR headset or a standalone mobile app in the emergency department (ED) on-call room of a large urban academic medical center. Results: A total of 213 guided-meditation sessions were completed over the course of 4 weeks. Self-reported ratings of anxiety improved in both VR and mobile groups post-study. However, the VR group demonstrated higher intrasession HRV progress, indicating increased state of relaxation that also correlated with the number of sessions completed. Analysis by gender revealed disparity in HRV metrics between male and female VR participants. Conclusion/Application to Practice: VR-based guided meditations prove to be a feasible and accessible MBI that does not require extensive time commitment for healthcare workers. VR may be a more effective meditation platform compared with standalone mobile meditation apps, especially when used on a routine basis.
Comparison of Clinical and Ultrasound Imaging Outcomes Between Corticosteroid and Hypertonic Dextrose Injections for Chronic Supraspinatus Tendinopathy
Authors: Lin Che-Li , Yang Ming-Ta , Lee Yu-Hao , Chen Yi-Wen , Vitoonpong Timporn , Huang Shih-Wei 
Published: November 2022

Background: Both corticosteroids and hypertonic dextrose injections are commonly used for chronic supraspinatus tendinopathy. Purpose: To compare the supraspinatus echogenicity and clinical effects of echo-guided hypertonic dextrose versus corticosteroid injection for treating chronic supraspinatus tendinopathy. Study Design: Cohort study; Level of evidence, 3. Methods: The authors performed a secondary data analysis of a previous clinical trial including patients who received normal saline versus hypertonic dextrose injection; patients who received corticosteroid injection were recruited between August 2017 and July 2021. Baseline patient data were matched among these 3 groups at a 1:1:1 ratio. At baseline and 2, 6, and 12 weeks after the intervention, the authors compared morphological changes (supraspinatus thickness and echogenicity) and clinical parameters (visual analog scale [VAS] for pain, Shoulder Pain and Disability Index [SPADI], and range of motion [ROM]). Analysis of variance was used to compare mean changes from baseline among the groups. Results: A total of 75 patients (25 in each group) were included. At 2-week follow-up, both the dextrose and the steroid groups exhibited improvement in VAS scores (mean difference [MD] from baseline: –2.0 in dextrose group; –3.3 in steroid group (P < .001)), SPADI scores (MD from baseline: –10.6 in dextrose group; –24.6 in steroid group (P < .001)), and flexion ROM (MD from baseline: 13.6° in dextrose group; 21.1° in steroid group) ( P =.001). At 6 weeks after injection, the hypertonic dextrose group exhibited more favorable echogenic improvement in supraspinatus tendon morphology compared with the other 2 groups ( P < .001). However, the steroid group showed significantly more improvement in clinical parameters compared with the other 2 groups at both week 6 (MD from baseline: VAS, –3.2; SPADI, –26.6; flexion ROM, 21.5°) and week 12 (MD from baseline: VAS, –2.5; SPADI, –20.4; flexion ROM, 15.2°) ( P < .001 for all). Conclusion: Hypertonic dextrose injection improved supraspinatus echogenicity after 6 weeks but provided short-term symptomatic relief in the patients with chronic supraspinatus tendinopathy when compared with corticosteroid or saline injections. Steroid injection exerted a more favorable clinical effect at weeks 6 and 12 but demonstrated a negative effect on the supraspinatus.