bluuebunny/crossref_metadata_2025 huggingface dataset:
Atypical presentation of oncocytic parathyroid adenoma masquerading as metastatic carcinoma
Authors: Abdulla Suha , Shamil Eamon , Wilsher Mark , Jacob Antony
Published: September 2019

Parathyroid carcinoma is the rarest endocrine malignancy. Definitive diagnosis is challenging as it is difficult to distinguish malignant from benign disease. A 71-year-old man presented with weight loss and hypercalcaemia. CT scans revealed multiple lung nodules and lytic bone lesions that were consistent with metastatic dissemination. Technetium-99m-sestamibi-single-photon emission computed tomography scan showed an abnormal uptake in the right thyroid lobe. Fine-needle aspiration (FNA) was performed on three occasions. The patient underwent parathyroidectomy with ipsilateral hemithyroidectomy without postoperative complications. Microscopic examination showed a parathyroid neoplasm with fibrosis and intravascular tumour on a background of unremarkable thyroid parenchyma. This resulted in an initial impression of parathyroid carcinoma. Further review by two independent pathologists provided a final diagnosis of oncocytic parathyroid adenoma. This case highlights the subjectivity and interobserver variation with endocrine histological examination. FNA can induce changes that mimic parathyroid carcinoma on histology. An index of suspicion for benign parathyroid adenomas should be maintained.
Empirical evaluation of SUCRA-based treatment ranks in network meta-analysis: quantifying robustness using Cohen’s kappa
Authors: Daly Caitlin H , Neupane Binod , Beyene Joseph , Thabane Lehana , Straus Sharon E , Hamid Jemila S
Published: September 2019

Objective

To provide a framework for quantifying the robustness of treatment ranks based on Surface Under the Cumulative RAnking curve (SUCRA) in network meta-analysis (NMA) and investigating potential factors associated with lack of robustness.

Methods

We propose the use of Cohen’s kappa to quantify the agreement between SUCRA-based treatment ranks estimated through NMA of a complete data set and a subset of it. We illustrate our approach using five published NMA data sets, where robustness was assessed by removing studies one at a time.

Results

Overall, SUCRA-based treatment ranks were robust to individual studies in the five data sets we considered. We observed more incidences of disagreement between ranks in the networks with larger numbers of treatments. Most treatments moved only one or two ranks up or down. The lowest quadratic weighted kappa estimate observed across all networks was in the network with the smallest number of treatments (4), where weighted kappa=40%. In the network with the largest number of treatments (12), the lowest observed quadratic weighted kappa=89%, reflecting a small shift in this network's treatment ranks overall. Preliminary observations suggest that a study’s size, the number of studies making a treatment comparison, and the agreement of a study’s estimated treatment effect(s) with those estimated by other studies making the same comparison(s) may explain the overall robustness of treatment ranks to studies.

Conclusions

Investigating robustness or sensitivity in an NMA may reveal outlying rank changes that are clinically or policy-relevant. Cohen’s kappa is a useful measure that permits investigation into study characteristics that may explain varying sensitivity to individual studies. However, this study presents a framework as a proof of concept and further investigation is required to identify potential factors associated with the robustness of treatment ranks using more extensive empirical evaluations.
Out-of-sequence DTP and measles vaccinations and child mortality in Guinea-Bissau: a reanalysis
Authors: Thysen Sanne M , Rodrigues Amabelia , Aaby Peter , Fisker Ane B
Published: September 2019

Objectives

To assess whether the sequence of diphtheria-tetanus-pertussis vaccine (DTP) and measles vaccine (MV) was associated with child survival in a dataset previously used to assess non-specific effects of vaccines with no consideration of vaccination sequence.

Design

Prospective cohort study analysed using the landmark approach.

Setting

Bandim Health Project’s Health and Demographic Surveillance System covering 100 village clusters in rural Guinea-Bissau. The recommended vaccination schedule was BCG and oral polio vaccine (OPV) at birth, DTP and OPV at 6, 10 and 14 weeks, MV at 9 months and booster DTP and OPV at 18 months of age.

Participants

Children aged 9–17 months (main analysis) and 18–35 months (secondary analysis: age of booster DTP) with vaccination status assessed between April 1991 and April 1996.

Methods

Survival during the 6 months after assessing vaccination status was compared by vaccination sequence in Cox-proportional hazards models with age as underlying time. Analyses were stratified by sex and village cluster.

Main outcome measure

Mortality rate ratio (MRR) for out-of-sequence vaccinations compared with in-sequence vaccinations.

Results

Among children aged 9–17 months, 60% of observations (3574/5937) were from children who had received both MV and DTP. Among these, 1590 observations were classified as in-sequence vaccinations (last DTP before MV), and 1984 observations were out-of-sequence vaccinations (1491: MV with DTP and 493: MV before DTP). Out-of-sequence vaccinations were associated with higher mortality than in-sequence vaccinations (MRR 2.10, 95% CI 1.07 to 4.11); the MRR was 2.30 (95% CI 1.15 to 4.58) for MV with DTP and 1.45 (95% CI 0.50 to 4.22) for DTP after MV. Associations were similar for boys and girls (p=0.77). Between 18 and 35 months the mortality rate increased among children vaccinated in-sequence and the differential effect of out-of-sequence vaccinations disappeared.

Conclusion

Out-of-sequence vaccinations may increase child mortality. Hence, sequence of vaccinations should be considered when planning vaccination programmes or introducing new vaccines into the current vaccination schedule.
The relationship between early life urbanicity and depression in late adulthood: evidence from the Survey of Health, Ageing and Retirement in Europe
Authors: Howdon Daniel , Mierau Jochen , Liew Samuel
Published: September 2019

Objectives

We aimed to study the association of childhood urbanicity with depressive symptoms in late adulthood.

Design, setting and participants

We used linear and logistic regressions to analyse data drawn from 20 400 respondents from the Survey of Health, Ageing and Retirement in Europe, a panel dataset incorporating a representative sample of the 50+ population in 13 European countries.

Outcomes and analysis

Childhood urbanicity was determined using self-reports of the respondents’ circumstances at age 10, and late-adulthood depression using the EURO-D scale. We conditioned on circumstances early in life as well as later in life, most importantly late-adulthood urbanicity. We estimated the associations using linear regression models and limited dependent variable models.

Results

A pooled regression of both men and women suggested that childhood urbanicity is associated non-monotonically with depression in late adulthood and is particularly apparent for those spending their childhoods in suburban settings. We found that individuals who spend the longest time in their childhood in a suburban home exhibit an average increase in probability of 3.4 (CI 1.1 to 5.7) percentage points in reporting four or more depressive symptoms. The association was robust to the inclusion of a host of household characteristics associated with childhood urbanicity and was independent of current urbanicity and current income. When broken down by gender, we found some evidence of associations between depressive outcomes and urban living for men, and stronger evidence of such associations with urban and suburban living for women who exhibit an increase of 5.6 (CI 2.2 to 9.0) percentage points in reporting four or more depressive symptoms.

Conclusions

Our analysis reveals a relationship between childhood urbanicity and depression in late adulthood. The evidence presented on the nature of this relationship is not straightforward but is broadly suggestive of a link, differing by gender, between greater urbanicity and higher levels of depressive symptoms. The life-long nature of this association may potentially inform policy agendas aimed at improving urban and suburban living conditions.
The impact ofInfection Prevention and control (IPC) bundle implementationon IPC compliance during the Ebola virus outbreak in Mbandaka/Democratic Republic of the Congo: a before and after design
Authors: Ousman Kevin , Kabego Landry , Talisuna Ambrose , Diaz Janet , Mbuyi John , Houndjo Bienvenu , Ngandu Jean-Paul , Omba Gaston , Aruna Aaron , Mossoko Mathias , Djingarey Mamadou Harouna , Balde Thierno , Abok Patrick , Diallo Boubacar , Dovlo Delanyo , Yao Michel , Fortin Anne , Formenty Pierre , Fall Ibrahima Soce
Published: September 2019

Objectives

To assess the impact of refresher training of healthcare workers (HCWs) in infection prevention and control (IPC), ensuring consistent adequate supplies and availability of IPC kits and carrying out weekly monitoring of IPC performance in healthcare facilities (HCFs)

Design

This was a before and after comparison study

Settings

This study was conducted from June to July 2018 during an Ebola virus disease (EVD) outbreak in Equateur Province in the Democratic Republic of the Congo (DRC).

Participants

48 HCFs

Interventions

HCWs capacity building in basic IPC, IPC kit donation and IPC mentoring.

Primary outcome measures

IPC score

Results

48 HCFs were evaluated and 878 HCWs were trained, of whom 437 were women and 441 were men. The mean IPC score at baseline was modestly higher in hospitals (8%) compared with medical centres (4%) and health centres (4%), respectively. The mean IPC score at follow-up significantly increased to 50% in hospitals, 39% in medical centres and 36% in health centres (p value<0.001). The aggregate mean IPC score at baseline for all HCFs, combined was 4.41% and at follow-up it was 39.51% with a mean difference of 35.08% (p-value<0.001).

Conclusions

Implementation of HCW capacity building in IPC, IPC kit donation to HCF and mentoring in IPC improved IPC compliance during the ninth EVD outbreak in the DRC.
The influence of antiresorptive bone medication on the effect of high-intensity resistance and impact training on osteoporotic fracture risk in postmenopausal women with low bone mass: protocol for the MEDEX-OP randomised controlled trial
Authors: Fischbacher Melanie , Weeks Benjamin K , Beck Belinda R
Published: September 2019

Introduction

Antiresorptive medications increase bone density and decrease vertebral fracture, while high-intensity resistance and impact training (HiRIT) increases balance, bone and muscle strength decreasing risk for falls and fractures. Medications are typically prescribed by doctors and exercise by exercise specialists, frequently in isolation.

Objective

Our primary aim is to determine the effect of an 8-month HiRIT programme with or without osteoporosis medications on bone mineral density (BMD) of the spine and hip in postmenopausal women with low bone mass.

Methods and analysis

One hundred and sixty postmenopausal women with low bone mass will be recruited from the community to participate in an 8-month randomised controlled trial. Participants will be on stable doses of antiresorptive bone medication for at least 12 months (n=80) or have not taken bone medications for at least 12 months (n=80). Participants will be block randomised, stratified by medication intake, to twice-weekly 40-min supervised sessions of HiRIT or a low-intensity exercise programme (control). Primary outcomes include change in lumbar spine and total hip areal bone mineral density. Secondary outcomes include whole body, femoral neck and forearm BMD, proximal femur bone geometry and volumetric density, vertebral morphology, body composition, anthropometry, physical function, posture, rate of falls, osteoarthritis symptoms, pelvic floor health, quality of life, physical activity enjoyment, resting blood pressure, safety and compliance. All outcomes will be assessed at baseline and 8 months and intention-to-treat and per-protocol analyses will be conducted. Repeated measure analysis of covariance will be used to determine intervention effects on outcome measures, controlling for initial values, compliance and other variables found to differ between groups at baseline.

Ethics and dissemination

The study has been approved by Griffith University Human Research Ethics Committee (Ref: 2017/739). Results will be reported in peer-reviewed journals and at conferences.

Trial registration number

Australian New Zealand Clinical Trials Registry (ACTRN12617001511325).
How and why do participatory women’s groups (PWGs) improve the quality of maternal and child health (MCH) care? A systematic review protocol
Authors: Preston Robyn , Rannard Sam , Felton-Busch Catrina , Larkins Sarah , Canuto Karla , Carlisle Karen , Evans Rebecca , Redman-MacLaren Michelle , Taylor Judy , Turner Nalita Nungarrayi , Yeomans Lee , Sanguineti Emma , Passey Megan , Farmer Jane
Published: September 2019

Introduction

Community-based Participatory Women’s Groups (PWGs) have proven to be an effective intervention to improve maternal and child health (MCH) outcomes in low/middle-income countries (LMICs). Less is known about how PWGs exert their effects in LMICs and virtually nothing is known about the contextual issues, processes and power relationships that affect PWG outcomes in high resource settings. The aim of this systematic review is to synthesise and critically analyse the current evidence on how and why PWGs improve the quality of MCH care. We aim to demonstrate how PWGs function and why PWG interventions contribute to social and health outcomes.

Methods and analysis

The protocol will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. The databases Medline (Ovid): Cumulative Index to Nursing and Allied Health Literature (Ebsco); Informit health suite Scopus, Australian HealthInfoNet, the Cochrane Library and other sources will be searched under broad categories: intervention, context and outcomes to 30 June 2019.

Ethics and dissemination

As only secondary data will be analysed; ethical approval is not required. The review will be disseminated to relevant organisations and presented in peer-reviewed papers and at conferences. This will be the first attempt to summarise the current available evidence on the characteristics, contextual influences and mechanisms that are associated with the outcomes and effectiveness of PWGs.

PROSPERO registration number

CRD42019126533.
Cluster randomised controlled trial of an online intervention to improve healthy food purchases from primary school canteens: a study protocol of the ‘click & crunch’ trial
Authors: Wyse Rebecca , Delaney Tessa , Gibbins Pennie , Ball Kylie , Campbell Karen , Yoong Sze Lin , Seward Kirsty , Zoetemeyer Rachel , Rissel Chris , Wiggers John , Attia John , Oldmeadow Chris , Sutherland Rachel , Nathan Nicole , Reilly Kathryn , Reeves Penny , Wolfenden Luke
Published: September 2019

Introduction

School canteens are the most frequently accessed take-away food outlet by Australian children. The rapid development of online lunch ordering systems for school canteens presents new opportunities to deliver novel public health nutrition interventions to school-aged children. This study aims to assess the effectiveness and cost-effectiveness of a behavioural intervention in reducing the energy, saturated fat, sugar and sodium content of online canteen lunch orders for primary school children.

Methods and analysis

The study will employ a cluster randomised controlled trial design. Twenty-six primary schools in New South Wales, Australia, that have an existing online canteen ordering system will be randomised to receive either a multi-strategy behavioural intervention or a control (the standard online canteen ordering system). The intervention will be integrated into the existing online canteen system and will seek to encourage the purchase of healthier food and drinks for school lunch orders (ie, items lower in energy, saturated fat, sugar and sodium). The behavioural intervention will use evidence-based choice architecture strategies to redesign the online menu and ordering system including: menu labelling, placement, prompting and provision of feedback and incentives. The primary trial outcomes will be the mean energy (kilojoules), saturated fat (grams), sugar (grams) and sodium (milligrams) content of lunch orders placed via the online system, and will be assessed 12 months after baseline data collection.

Ethics and dissemination

The study was approved by the ethics committees of the University of Newcastle (H-2017–0402) and the New South Wales Department of Education and Communities (SERAP 2018065), and the Catholic Education Office Dioceses of Sydney, Parramatta, Lismore, Maitland-Newcastle, Bathurst, Canberra-Goulburn, Wollongong, Wagga Wagga and Wilcannia-Forbes. Study results will be disseminated through peer-reviewed publications, reports, presentations at relevant national and international conferences and via briefings to key stakeholders. Results will be used to inform future implementation of public health nutrition interventions through school canteens, and may be transferable to other food settings or online systems for ordering food.

Trial registration number

ACTRN12618000855224.
Development of a tool for assessing quality of comprehensive care provided by community health workers in a community-based care programme in South Africa
Authors: Griffiths Frances , Babalola Olukemi , Brown Celia , de Kadt Julia , Malatji Hlologelo , Thorogood Margaret , Tseng Yu-hwei , Goudge Jane
Published: September 2019

Objective

To develop a tool for use by non-clinical fieldworkers for assessing the quality of care delivered by community health workers providing comprehensive care in households in low- and middle-income countries.

Design

We determined the content of the tool using multiple sources of information, including interactions with district managers, national training manuals and an exploratory study that included observations of 70 community health workers undertaking 518 household visits collected as part of a wider study. We also reviewed relevant literature, selecting relevant domains and quality markers. To refine the tool and manual we worked with the fieldworkers who had undertaken the observations. We constructed two scores summarising key aspects of care: (1) delivering messages and actions during household visit, and (2) communicating with the household; we also collected contextual data. The fieldworkers used the tool with community health workers in a different area to test feasibility.

Setting

South Africa, where community health workers have been brought into the public health system to address the shortage of healthcare workers and limited access to healthcare. It was embedded in an intervention study to improve quality of community health worker supervision.

Primary and secondary outcomes

Our primary outcome was the completion of a tool and user manual.

Results

The tool consists of four sections, completed at different stages during community health worker household visits: before setting out, at entry to a household, during the household visit and after leaving the household. Following tool refinement, we found no problems on field-testing the tool.

Conclusions

We have developed a tool for assessing quality of care delivered by community health workers at home visits, often an unobserved part of their role. The tool was developed for evaluating an intervention but could also be used to support training and management of community health workers.
Modelling the lifetime cost-effectiveness of catheter ablation for atrial fibrillation with heart failure
Authors: Gao Lan , Moodie Marj
Published: September 2019

Objectives

Assessing the cost-effectiveness credentials of this intervention in patients with concomitant atrial fibrillation (AF) and heart failure (HF) compared with usual medical therapy.

Design

A Markov model comprising two health states (ie, alive or dead) was constructed. The transition probabilities were directly derived from published Kaplan-Meier curves of the pivotal randomised controlled trial and extrapolated over the cohort’s lifetime using recommended methods. Costs of catheter ablation, outpatient consultations, hospitalisation, medications and examinations were included. Resource use and unit costs were sourced from government websites or published literature. A lifetime horizon and a healthcare system perspective were taken. All costs and benefits were discounted at 3% annually. Deterministic (DSA) and probabilistic sensitivity analyses (PSA) were run around the key model parameters to test the robustness of the base case results.

Participants

A hypothetical Australian cohort of patients with concomitant AF and HF who are resistant to antiarrhythmic treatment.

Interventions

Catheter ablation versus medical therapy.

Results

The catheter ablation was associated with a cost of $A44 377 per person, in comparison to $A28 506 for the medical therapy alone over a lifetime. Catheter ablation contributed to 4.58 quality-adjusted life years (QALYs) and 6.99 LY gains compared with 4.30 QALYs and 6.53 LY gains, respectively, in the medical therapy arm. The incremental cost-effectiveness ratio was $A55 942/QALY or $A35 020/LY. The DSA showed that results were highly sensitive to costs of ablation and time horizon. The PSA yielded very consistent results with the base case.

Conclusions

Offering catheter ablation procedure to patients with systematic paroxysmal or persistent AF who failed to respond to antiarrhythmic drugs was associated with higher costs, greater benefits. When compared with medical therapy alone, this intervention is not cost-effective from an Australia healthcare system perspective.
Impact of a comprehensive prevention programme aimed at reducing incivility and verbal violence against healthcare workers in a French ophthalmic emergency department: an interrupted time-series study
Authors: Touzet Sandrine , Occelli Pauline , Denis Angelique , Cornut Pierre-Loïc , Fassier Jean-Baptiste , Le Pogam Marie-Annick , Duclos Antoine , Burillon Carole
Published: September 2019

Objective and setting

Primary prevention, comprising patient-oriented and environmental interventions, is considered to be one of the best ways to reduce violence in the emergency department (ED). We assessed the impact of a comprehensive prevention programme aimed at preventing incivility and verbal violence against healthcare professionals working in the ophthalmology ED (OED) of a university hospital.

Intervention

The programme was designed to address long waiting times and lack of information. It combined a computerised triage algorithm linked to a waiting room patient call system, signage to assist patients to navigate in the OED, educational messages broadcast in the waiting room, presence of a mediator and video surveillance.

Participants

All patients admitted to the OED and those accompanying them.

Design

Single-centre prospective interrupted time-series study conducted over 18 months.

Primary outcome

Violent acts self-reported by healthcare workers committed by patients or those accompanying them against healthcare workers.

Secondary outcomes

Waiting time and length of stay.

Results

There were a total of 22 107 admissions, including 272 (1.4%) with at least one act of violence reported by the healthcare workers. Almost all acts of violence were incivility or verbal harassment. The rate of violence significantly decreased from the pre-intervention to the intervention period (24.8, 95% CI 20.0 to 29.5, to 9.5, 95% CI 8.0 to 10.9, acts per 1000 admissions, p<0.001). An immediate 53% decrease in the violence rate (incidence rate ratio=0.47, 95% CI 0.27 to 0.82, p=0.0121) was observed in the first month of the intervention period, after implementation of the triage algorithm.

Conclusion

A comprehensive prevention programme targeting patients and environment can reduce self-reported incivility and verbal violence against healthcare workers in an OED.

Trial registration number

NCT02015884
Sociodemographic, clinical and pharmacological profiles of medication misuse and dependence in hospitalised older patients in Norway: a prospective cross-sectional study
Authors: Cheng Socheat , Siddiqui Tahreem Ghazal , Gossop Michael , Kristoffersen Espen Saxhaug , Lundqvist Christofer
Published: September 2019

Objectives

Timely recognition of medication misuse and dependence is crucial to avoid both adverse drug events and increasing health expenditure. Yet the detection of these disorders in older people remains challenging due to the paucity of evidence on characteristics of patients at risk. This study investigates sociodemographic, pharmacological and clinical characteristics and factors associated with prolonged medication use, misuse and dependence in hospitalised older patients, focusing on three commonly prescribed central nervous system depressants (CNSDs): opioid analgesics, benzodiazepines and z-hypnotics.

Design

A prospective, cross-sectional study complying with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.

Setting

Somatic departments of the Akershus University Hospital, Norway.

Participants

246 patients aged 65–90 were included.

Outcome measures

Prolonged use was defined as using CNSDs for ≥4 weeks. Misuse and dependence were assessed with the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria for substance abuse and dependence. We used descriptive statistics to report patients’ characteristics and logistic regression to demonstrate factors associated with prolonged use, and misuse or dependence.

Results

Forty per cent of participants reported using CNSDs for ≥4 weeks. The odds of prolonged use were higher for patients aged 75–84 (OR=2.32, 95% CI 1.16 to 4.65) and ≥85 (OR=3.33, 95% CI 1.25 to 8.87) vs <75 years, for pain intensity (OR=1.02, 95% CI 1.01 to 1.04), and polypharmacy versus no polypharmacy (OR=5.16, 95% CI 2.13 to 12.55). The odds were lower for patients who completed secondary education (OR=0.33, 95% CI 0.13 to 0.83) compared with those with only basic education. Factors associated with misuse or dependence were pain intensity (OR=1.02, 95% CI 1.01 to 1.04) and concurrent use of ≥2 CNSDs (OR=3.99, 95% CI 1.34 to 11.88).

Conclusion

CNSD overuse is prevalent among hospitalised older patients, despite clear guidelines and recommendations. Our findings underline a need for stronger focus on responsible prescribing, timely detection and prevention of this issue, with special attention towards older patients, those with enhanced pain, polypharmacy and/or concurrent use of several CNSDs.

Trial registration number

NCT03162081.
Evaluation of the impact of the GRACE risk score on the management and outcome of patients hospitalised with non-ST elevation acute coronary syndrome in the UK: protocol of the UKGRIS cluster-randomised registry-based trial
Authors: Everett Colin C , Fox Keith AA , Reynolds Catherine , Fernandez Catherine , Sharples Linda , Stocken Deborah D , Carruthers Kathryn , Hemingway Harry , Yan Andrew T , Goodman Shaun G , Brieger David , Chew Derek P , Gale Chris P
Published: September 2019

Introduction

For non-ST-segment elevation acute coronary syndrome (NSTEACS) there is a gap between the use of class I guideline recommended therapies and clinical practice. The Global Registry of Acute Coronary Events (GRACE) risk score is recommended in international guidelines for the risk stratification of NSTEACS, but its impact on adherence to guideline-indicated treatments and reducing adverse clinical outcomes is unknown. The objective of the UK GRACE Risk Score Intervention Study (UKGRIS) trial is to assess the effectiveness of the GRACE risk score tool and associated treatment recommendations on the use of guideline-indicated care and clinical outcomes.

Methods and analysis

The UKGRIS, a parallel-group cluster randomised registry-based controlled trial, will allocate hospitals in a 1:1 ratio to manage NSTEACS by standard care or according to the GRACE risk score and associated international guidelines. UKGRIS will recruit a minimum of 3000 patients from at least 30 English National Health Service hospitals and collect healthcare data from national electronic health records. The co-primary endpoints are the use of guideline-indicated therapies, and the composite of cardiovascular death, non-fatal myocardial infarction, new onset heart failure hospitalisation or cardiovascular readmission at 12 months. Secondary endpoints include duration of inpatient hospital stay over 12 months, EQ-5D-5L responses and utilities, unscheduled revascularisation and the components of the composite endpoint over 12 months follow-up.

Ethics and dissemination

The study has ethical approval (North East - Tyne & Wear South Research Ethics Committee reference: 14/NE/1180). Findings will be announced at relevant conferences and published in peer-reviewed journals in line with the funder’s open access policy.

Trial registration number

ISRCTN29731761; Pre-results.
Mapping outcomes in quality improvement and system design activities: the outcome identification loop and system impact model
Authors: Akinluyi Emmanuel Adeoluwa , Ison Keith , Clarkson P John
Published: September 2019

Background

Whether explicit or implicit, models of value are fundamental in quality improvement (QI) initiatives. They embody the desirability of the impact of interventions—with either foresight or hindsight. Increasingly impact is articulated in terms of outcomes, which are often prescribed and sometimes inappropriate. Currently, there is little methodological guidance for deriving an appropriate set of outcomes for a given QI initiative. This paper describes a structured approach for identifying and mapping outcomes.

Overall approach

Central to the approach presented here is the engagement of teams in the exploration of the system that is being designed into. This methodology has emerged from the analysis and abstraction of existing methods that define systems in terms of outcomes, stakeholders and their analogues. It is based on a sequence of questions that underpin these methods.

Outcome elicitation tools

The fundamental questions of outcome elicitation can be concatenated into a structured process, within the Outcome Identification Loop. This system-analysis process stimulates new insights that can be captured within a System Impact Model.

The System Impact Model reconciles principles of intended cause/effect, with knowledge of unintended effects more typically emphasised by risk approaches. This system representation may be used to select sets of outcomes that signify the greatest impact on patients, staff and other stakeholders. It may also be used to identify potential QI interventions and to forecast their impact.

Discussion and conclusions

The Outcome Identification Loop has proven to be an effective tool for designing workshops and interviews that engage stakeholders, critically in the early stages of QI planning. By applying this process in different ways, existing knowledge is captured in System Impact Models and mobilised towards QI endeavours.
Sleep problems, behavioural problems and respiratory health in children born extremely preterm: a parental questionnaire study
Authors: Stangenes Kristine Marie , Hysing Mari , Elgen Irene Bircow , Halvorsen Thomas , Markestad Trond , Bjorvatn Bjørn
Published: September 2019

Objective

To explore whether children born extremely preterm (EPT) with different types of sleep problems had more behavioural and respiratory health problems than EPT children without sleep problems.

Design

Prospective, nationwide, questionnaire-based study. At 11 years of age, parents reported on four current sleep problems: difficulty falling asleep or frequent awakenings, snoring, daytime sleepiness and not recommended sleep duration (<9 hours). Behavioural problems were assessed by parents and teachers with the Strengths and Difficulties Questionnaire (SDQ). Parents assessed respiratory symptoms with the International Study of Asthma and Allergies in Childhood questionnaire and described use of asthma medication.

Setting

Norway.

Patients

EPT children.

Main outcome measures

Specified sleep problems, behavioural problems and respiratory health.

Results

Data were obtained from 216 of 372 (58 %) of eligible children. All four specified sleep problems were associated with significantly higher parent-reported SDQ total-score (OR 1.1 for all), and except for not recommended sleep duration, also with higher teacher-reported SDQ total-score (OR 1.1 for all). Daytime sleepiness was strongly associated with wheezing last 12 months (OR 3.4), disturbed sleep due to wheezing (OR 3.9), wheeze during or after exercise (OR 2.9), use of inhaled corticosteroids or oral leukotriene modifiers (OR 3.4) and use of bronchodilators (OR 3.9). Snoring was associated with wheezing during or after exercise (OR 2.8) and current asthma (OR 4.2).

Conclusion

EPT children with different types of sleep problems had more behavioural and respiratory health problems than EPT children without sleep problems.
Guideline-directed therapy at discharge in patients with heart failure and atrial fibrillation
Authors: Ahn Min-Soo , Yoo Byung Su , Yoon Junghan , Lee Seung-Hwan , Kim Jang Young , Ahn Sung Gyun , Youn Young Jin , Lee Jun-Won , Son Jung-Woo , Kim Hye Sim , Kang Dae Ryong , Cho Hyun-Jai , Lee Hae-Young , Jeon Eun Seok , Kang Seok-Min , Choi Dong-Ju , Cho Myeong-Chan
Published: September 2019

Objectives

This study evaluated the relationship between guideline adherence for recommended therapy on discharge and relevant 60-day and 1-year clinical outcomes in patients with acute heart failure (HF) with reduced ejection fraction and atrial fibrillation (AF).

Methods

Of 5625 acute patients with HF in the Korean Acute Heart Failure registry, 986 patients with HF and documented AF were analysed. Guideline adherence scores were calculated for the prescription of ACE inhibitors, angiotensin receptor blockers, β-blockers, mineralocorticoid receptor antagonists and anticoagulants.

Results

In patients with HF with AF, there was a significant trend of reduced 60-day and 1-year mortality rates and the composite end point with guideline adherence. According to the Cox proportion hazard model, poor adherence was associated with a significantly higher risk of 60-day mortality (HR 4.75; 95% CI 1.77 to 12.74) and the composite end point (HR 2.36; 95% CI 1.33 to 4.18) compared with good adherence. Furthermore, poor adherence was associated with a significantly higher risk of 1-year mortality compared with moderate (HR 1.64; 95% CI 1.15 to 2.33) and good adherence (HR 2.34; 95% CI 1.39 to 3.97) and with a higher risk of the 1-year composite end point compared with good adherence (HR 1.58; 95% CI 1.07 to 2.33).

Conclusion

Better adherence to guidelines was associated with better 60-day and 1-year prognoses in patients with HF with AF.
The influence of larval growth rate on juvenile recruitment in Lake Erie walleye (Sander vitreus)
Authors: May Cassandra J. , Ludsin Stuart A. , Glover David C. , Marschall Elizabeth A.
Published: September 2019

Growth-selective mortality as larvae can influence recruitment in marine fishes. Its importance in freshwater fishes, however, remains speculative. We quantified growth trajectories within annual cohorts (2011–2013) of Lake Erie walleye (Sander vitreus) and their relationship with recruitment. We hypothesized that selection against slow or fast growth would be associated with high mortality and poor recruitment, whereas weak or nonexistent growth-selective mortality co-occurring with fast growth would be associated with good recruitment. We used otoliths to reconstruct growth rates during the first 15 days of life from larvae collected during spring and juvenile recruits (survivors) collected during late summer. We documented growth-selective mortality during 2011 and 2013, which exhibited poor recruitment as expected. During 2012, growth selection was absent, but growth was slow when compared to historical averages, resulting in poor recruitment. Growth was also considered slow in 2011 and 2013, due to multiple interacting conditions. Our study indicates that the relationship among larval growth, mortality, and future recruitment is complex, highlighting the need for continued research into how larval processes affect recruitment dynamics in freshwater fishes.
Reverse transcription – loop-mediated isothermal amplification assay for the rapid detection of pathogenic Listeria monocytogenes in meat products
Authors: Zhan Ling-Zhi , Song Da-Feng , Gu Qing , Yan Ting-Ting , Ma Cong-Cong
Published: September 2019

This study reports the use of reverse transcription – loop-mediated isothermal amplification (RT–LAMP) to detect Listeria monocytogenes in meat. The assay was designed to target the iap gene of L. monocytogenes, to which four primers, recognizing six distinct iap sites, were designed. We optimized the RT–LAMP conditions and established the following optimal systems: 60 min, 63 °C, 2.0 mmol/L MgSO4, 1.0 mol/L betaine, 2.0 mmol/L dNTPs, 320 U/mL Bst DNA polymerase, 0.4 μmol/L outer primers, and 0.8 μmol/L inner primers. The RT–LAMP amplification products were identified by a visible white Mg2P2O7 precipitate or electrophoresis on a 2% agarose gel. RT–LAMP has a sensitivity of 7.3 × 101 CFU/mL, which is 2-fold higher than that of LAMP. When commercially available raw meat samples (including beef, pork, mutton, and rabbit) were analyzed simultaneously with RT–LAMP and the Chinese National Standard GB 4789.30-2016, their abilities to detect L. monocytogenes were the same. Samples containing L. monocytogenes killed by 15 psi at 121 °C for 15 min were used to confirm the specificity of RT–LAMP for live microorganisms. Thus, we used RT–LAMP to efficiently detect L. monocytogenes in meat products.
Time series classification based on triadic time series motifs
Authors: Xie Wen-Jie , Han Rui-Qi , Zhou Wei-Xing
Published: September 2019

It is of great significance to identify the characteristics of time series to quantify their similarity and classify different classes of time series. We define six types of triadic time-series motifs and investigate the motif occurrence profiles extracted from the time series. Based on triadic time series motif profiles, we further propose to estimate the similarity coefficients between different time series and classify these time series with high accuracy. We validate the method with time series generated from nonlinear dynamic systems (logistic map, chaotic logistic map, chaotic Henon map, chaotic Ikeda map, hyperchaotic generalized Henon map and hyperchaotic folded-tower map) and retrieved from the UCR Time Series Classification Archive. Our analysis shows that the proposed triadic time series motif analysis performs better than the classic dynamic time wrapping method in classifying time series for certain datasets investigated in this work.
A Novel Strategy for Retrieving Large Scale Scene Images Based on Emotional Feature Clustering
Authors: He Yueshun , Zhang Wei , Du Ping , Yang Qiaohe
Published: September 2019

Due to complicated data structure, image can present rich information, and so images are applied widely at different fields. Although the image can offer a lot of convenience, handling such data consume much time and multi-dimensional space. Especially when users need to retrieve some images from larger-scale image datasets, the disadvantage is more obvious. So, in order to retrieve larger-scale image data effectively, a scene images retrieval strategy based on the MapReduce parallel programming model is proposed. The proposed strategy first, investigates how to effectively store large-scale scene images under a Hadoop cluster parallel processing architecture. Second, a distributed feature clustering algorithm MeanShift is introduced to implement the clustering process of emotional feature of scene images. Finally, several experiments are conducted to verify the effectiveness and efficiency of the proposed strategy in terms of different aspects such as retrieval accuracy, speedup ratio and efficiency and data scalability.
Systems of Oscillators Designed for a Specific Conscious Percept
Authors: Kraikivski Pavel
Published: September 2019

As put forward by neuroscientists, the mechanisms of consciousness can be elucidated by revealing correlations between neural dynamics and specific conscious percepts. Recently, I have elaborated on the mathematical formulation for a system of processes that are mutually connected to be isomorphic to a conscious percept of a point in space. Importantly, in such a system, any process can be derived through all other processes that form its complement, or “interpretation.” To generate such a solution, I am proposing a dynamical system of oscillators coupled in a manner to preserve the properties of a percept. Specifically, I crafted a dynamical system that retains the mutual relationships among processes, forming an operational map isomorphic to a distance matrix that mimics a percept of space-like properties. The study and results pave a novel way to analyze the dynamics of neural-like (oscillatory) processes with a purpose of extracting the information relevant to specific conscious percepts, which will facilitate the search for neural correlates of consciousness.
Initial Development and Testing of a Convection-Allowing Model Scorecard
Authors: Gallo Burkely T. , Kalb Christina P. , Gotway John Halley , Fisher Henry H. , Roberts Brett , Jirak Israel L. , Clark Adam J. , Alexander Curtis , Jensen Tara L.
Published: September 2019

Evaluation of numerical weather prediction (NWP) is critical for both forecasters and researchers. Through such evaluation, forecasters can understand the strengths and weaknesses of NWP guidance, and researchers can work to improve NWP models. However, evaluating high-resolution convection-allowing models (CAMs) requires unique verification metrics tailored to high-resolution output, particularly when considering extreme events. Metrics used and fields evaluated often differ between verification studies, hindering the effort to broadly compare CAMs. The purpose of this article is to summarize the development and initial testing of a CAM-based scorecard, which is intended for broad use across research and operational communities and is similar to scorecards currently available within the enhanced Model Evaluation Tools package (METplus) for evaluating coarser models. Scorecards visualize many verification metrics and attributes simultaneously, providing a broad overview of model performance. A preliminary CAM scorecard was developed and tested during the 2018 Spring Forecasting Experiment using METplus, focused on metrics and attributes relevant to severe convective forecasting. The scorecard compared attributes specific to convection-allowing scales such as reflectivity and surrogate severe fields, using metrics like the critical success index (CSI) and fractions skill score (FSS). While this preliminary scorecard focuses on attributes relevant to severe convective storms, the scorecard framework allows for the inclusion of further metrics relevant to other applications. Development of a CAM scorecard allows for evidence-based decision-making regarding future operational CAM systems as the National Weather Service transitions to a Unified Forecast system as part of the Next-Generation Global Prediction System initiative.
Strategic Conflict Management? A Study of Workplace Dispute Resolution in Wales
Authors: Nash David , Hann Deborah
Published: September 2019

In this article, the authors examine the relationship between organizational strategy and the approach taken to conflict management using a large-scale survey of companies in Wales, a constituent part of the United Kingdom. They focus on conflicts among employees, an under-researched form of conflict, to examine which types of organizations adopt a more strategic approach to conflict management that aligns with broader HR objectives. They find that organizations with a unitarist, and often anti-union, orientation are more likely to make strategic choices about how they address conflict. Equally, the authors argue that some evidence suggests that organizations that take high-road approaches to HR are more likely to take an intentional approach to how they address conflict.
It’s Still about Race: Peremptory Challenge Use on Black Prospective Jurors
Authors: DeCamp Whitney , DeCamp Elise
Published: September 2019

Objectives:

The use of race as a motive for excluding individuals from serving on juries in American criminal trials is unconstitutional. Nevertheless, Black individuals remain substantially more likely than others to be removed during jury selection through peremptory challenges. This study tests whether and to what extent there is a racial effect on peremptory challenge use by the prosecution or the defense.

Method:

Using data from 2,542 venire members in Mississippi, propensity score matching is used to examine racial differences in jury selection by comparing Black venire members to similarly situated White venire member counterparts.

Results:

Findings suggest that Black venire members are 4.51 times as likely to be excluded from a jury due to peremptory challenges from the prosecution in comparison to White venire members. Conversely, White venire members are 4.21 times as likely to be excluded through peremptory challenges by the defense in comparison to Black venire members.

Conclusions:

After controlling for all observed variables, there remain significant differences between White and Black venire members, suggesting racial discrimination by both the prosecution and the defense in peremptory challenge usage. Black individuals are more likely to be excluded from juries through these effects, resulting in less racially diverse juries.
The Treatment Group and Recidivism: A Multilevel Analysis of Prison-Based Substance Abuse Treatment
Authors: Kelly Christopher E. , Welsh Wayne N. , Stanley Jennifer N.
Published: September 2019

This study contributes to the substance abuse treatment literature by examining recidivism across treatment groups, the level of aggregation between the individual and the program. The sample consisted of 618 drug-involved offenders who participated in 12 different treatment groups within a single prison. Reincarceration significantly varied across groups, controlling for time at risk and treatment modality. This between-unit variation was explained by individual level treatment response measures and control variables. Results demonstrated that treatment effectiveness is impacted by the group in which the individual participates. These findings have substantial implications for correctional treatment theory, research, and policy.