bluuebunny/crossref_metadata_2025 huggingface dataset:
Migration Planning Among Female Prospective Labour Migrants from Nepal: A Comparison of First‐Time and Repeat‐Migrants
Authors: Abramsky Tanya , Mak Joelle , Zimmerman Cathy , Kiss Ligia , Sijapati Bandita
Published: April 2018

As international female labour migration has increased, so too have efforts to prevent the exploitation of labour migrants. However, evidence to underpin prevention efforts remains limited, with little known about labour migrants’ migration planning processes. Using data from a survey of female prospective labour migrants from Nepal, this article compares socio‐demographics and migration‐planning processes between first‐time and repeat‐migrants. We identified several factors which might increase repeat‐migrants’ vulnerability to exploitation during the migration process, or obstruct their engagement in pre‐migration interventions: more rapid migration planning than first‐time migrants; lower involvement in community groups; and a perception that they already have the knowledge they need. Only one‐third of repeat‐migrants planned to go to the same destination and 42 per cent to work in the same sector as previously. With repeat‐migration a common livelihoods strategy, it is crucial that interventions are guided by evidence on the needs of both first‐time‐ and repeat‐migrants.
Six‐year follow‐up of the initial Dutch subcutaneous implantable cardioverter‐defibrillator cohort: Long‐term complications, replacements, and battery longevity
Authors: Quast Anne‐Floor B. E. , van Dijk Vincent F. , Yap Sing‐Chien , Maass Alexander H. , Boersma Lucas V. A. , Theuns Dominic A. , Knops Reinoud E.
Published: April 2018

Introduction

Experience with the subcutaneous implantable cardioverter‐defibrillator (S‐ICD) is expanding rapidly. However, data on long‐term performance or complications related to elective generator replacement are lacking.

Methods

Follow‐up (FU) data of all patients implanted between December 2008 and April 2011 were collected. Complications were defined as those requiring surgical intervention. Kaplan‐Meier estimates for complication and shock rates, with corresponding 95% confidence intervals (CI), were calculated.

Results

One hundred and eighteen patients were included. Median FU was 6.1 years (IQR 5.6–6.5 years). Short‐term complication rate (0–30 days) was 3% (CI 0–6%). Long‐term complication rate at 6 years was 19% (CI 12–26%), corresponding with an annual complication rate of 3%. One patient in this cohort developed a need for a transvenous ICD (TV‐ICD) in order to provide pacing for bradycardia (1%). Six patients were implanted with a TV‐ICD after experiencing an S‐ICD complication for which extraction was necessary. In total, 10 S‐ICDs were extracted; none resulted in a complication. Eight patients had a nonsystemic ICD‐related infection and no lead failures were observed. The majority, 68 (58%) patients, received an elective generator replacement. Two patients had a complication related to generator replacement (3%). Battery longevity was 5.6 years (IQR 5.2–6.1). Appropriate and inappropriate shock rates of 6‐year estimates were 17% (CI 9–25%) and 21% (CI 15–27%), respectively.

Conclusions

This cohort represents the longest follow‐up to date and shows a low annual complication rate without lead failures or systemic infections. Battery longevity of the first S‐ICD generation results in relative early generator replacement procedures.
The personalities of Danish MPs: Trait‐ and aspect‐level differences
Authors: Nørgaard Asbjørn Sonne , Klemmensen Robert
Published: April 2018

Objective

We study personality traits of Danish parliamentarians (MPs) and examine elite–voter congruence and elite differentiation. Whereas previous political elite studies have focused only on the Big Five level, we include aspect‐level differences.

Method

In a highly representative survey of Danish MPs (N = 81; response rate = 46.3%) and a representative study of Danish voters (N = 3,612), we used the 60‐item NEO‐PI‐R short version to examine personality differences on the Big Five level and, based on the NEO‐BFAS, the aspect level.

Results

MPs were more extraverted, conscientious, and open than the average voter. On the elite level, liberal MPs were more agreeable and, on the aspect level, more compassionate but not more polite than conservative MPs. MPs in center parties had stronger power aspirations and were less agreeable and more extraverted than MPs in peripheral parties. On the aspect level, MPs in center parties were more assertive and enthusiastic and less polite. Conscientiousness and Agreeableness were associated with power aspiration, but Extraversion was not because the assertiveness effect was suppressed by a non‐effect for enthusiasm.

Conclusions

The inclusion of the aspect level explains null findings at the Big Five level and adds important nuances to the personality portrait of political elites.
Toward understanding the relationship between personality and well‐being states and traits
Authors: Magee Carly , Biesanz Jeremy C.
Published: April 2018

Objective

Although there is a robust connection between dispositional personality traits and well‐being, relatively little research has comprehensively examined the ways in which all Big Five personality states are associated with short‐term experiences of well‐being within individuals. We address three central questions about the nature of the relationship between personality and well‐being states: First, to what extent do personality and well‐being states covary within individuals? Second, to what extent do personality and well‐being states influence one another within individuals? Finally, are these within‐person relationships moderated by dispositional personality traits and well‐being?

Method

Two experience sampling studies (N = 161 and N = 146) were conducted over 2 weeks.

Results

Across both studies, all Big Five personality states were correlated with short‐term experiences of well‐being within individuals. Individuals were more extraverted, emotionally stable, conscientious, agreeable, and open in moments when they experienced higher well‐being (greater self‐esteem, life satisfaction and positive affect, and less negative affect). Moreover, personality and well‐being states dynamically influenced one another over time within individuals, and these associations were not generally moderated by dispositional traits or well‐being.

Conclusions

Behavior and well‐being are interconnected within the context of the Big Five model of personality.
A neuroscientific perspective on basic psychological needs
Authors: Reeve Johnmarshall , Lee Woogul
Published: April 2018

Objective

Self‐determination theory's (SDT) most basic propositions are, first, that all people possess an inherent set of psychological needs and, second, that autonomy, competence, and relatedness are the three critical psychological satisfactions needed to maintain and promote personal growth and well‐being. In this article, we identify the neural basis of the psychological needs and, in doing so, seek to advance the integration of SDT and neuroscience.

Method

We examine the neural underpinnings of SDT‐based motivational states and traits for autonomy, competence, and relatedness. To study motivational states, participants are exposed to situational conditions known to affect their psychological needs, and neuroscience methods (e.g., fMRI) are used to examine changes in their brain activity. To study motivational traits, participants complete self‐report trait measures that are then correlated with their brain activity observed during need‐satisfying activities.

Results

For both motivational states and traits and across all three needs, intrinsic satisfaction is associated with striatum‐based reward processing, anterior insula–based subjective feelings, and the integration of these subjective feelings with reward‐based processing.

Conclusions

Psychological need satisfaction is associated with striatum activity, anterior insula activity, and the functional coactivation between these two brain areas. Given these findings, it is now clear that several opportunities exist to integrate SDT motivational constructs with neuroscientific study, so we suggest eight new questions for future research.
Sexual dimorphism of substrate utilization: Differences in skeletal muscle mitochondrial volume density and function
Authors: Montero David , Madsen Klavs , Meinild‐Lundby Anne‐Kristine , Edin Fredrik , Lundby Carsten
Published: April 2018

New Findings

What is the central question of this study?

Females rely to a greater extent than males on fat oxidation during exercise. Whether any difference in skeletal muscle mitochondrial phenotype and oxidative capacity contributes to this sexual dimorphism remains incompletely explored.

What is the main finding and its importance?

Female prioritization of fat during exercise occurs in parallel to augmented mitochondrial volume density and intrinsic fatty acid and lactate oxidation in skeletal muscle fibres compared with males, independently of aerobic exercise capacity. The enlarged metabolic machinery in skeletal muscle of females is associated with lower body size and leg mass.

Fat oxidation during exercise is greater in females than in males. We sought to determine whether sex differences in substrate metabolism are paralleled by distinct skeletal muscle mitochondrial volume density and oxidative capacity. Whole‐body substrate (fat and carbohydrate) utilization during submaximal treadmill running was assessed, and skeletal muscle biopsies were taken to determine mitochondrial volume density and function in healthy young females (n = 12) and males (n = 12) matched by aerobic exercise capacity and exercise performance. Females presented a lower respiratory exchange ratio (0.87 ± 0.04 versus 0.91 ± 0.04, P = 0.023) and whole‐body carbohydrate oxidation (27.8 ± 8.3 versus 35.8 ± 6.5 mg kg−1 min−1, P = 0.027), whereas fat oxidation was higher (8.7 ± 2.8 versus 5.9 ± 2.6 mg kg−1 min−1, P = 0.034) during submaximal exercise compared with males. In skeletal muscle biopsies, females demonstrated augmented mitochondrial volume density (7.51 ± 1.77 versus 5.90 ± 1.72%, P = 0.035) and oxidative capacity for fatty acid [36.6 ± 12.8 versus 24.5 ± 7.3 pmol O2 s−1 (mg wet weight)−1, P = 0.009] and lactate [71.1 ± 24.4 versus 53.2 ± 14.6 pmol O2 s−1 (mg wet weight)−1, P = 0.040]. No sex differences in respiratory exchange ratio, whole‐body fat oxidation and skeletal muscle variables were detected when adjusted for anthropometric variables including body mass or leg mass, which were lower in females. In conclusion, female prioritization of fat over carbohydrate oxidation during exercise is underpinned by augmented body size‐related mitochondrial volume density, fatty acid and lactate oxidative capacity in skeletal muscle fibres.
The importance of intestinal ultrasound and elastographic techniques in inflammatory bowel diseases
Authors: Marin Andreea , Tribus Laura , Fierbinteanu-Braticevici Carmen
Published: April 2018

Inflammatory bowel diseases have an important impact upon the economic and social status due to their increasing incidence and prevalence, often affecting young people. At the moment, the therapeutic goal goes beyond the improvement of symptoms and laboratory parameters, being represented by endoscopic mucosal healing, changing the disease’s natural history. Even though endoscopy is the gold standard for the assessment of mucosal healing, it is an invasive maneuver and it lacks good repeatability. These patients require frequent evaluation; therefore, interest for noninvasive techniques has risen.As a consequence, the importance of intestinal ultrasound has increased lately and recent studies support its use to assess the degree of inflammation, to differentiate between remission and relapse, to monitor therapy response and guide treatment, to evaluate prognosis, and to diagnose complications. Another promising noninvasive imagistic technique is elastography which has gained interest because of its capacity to discriminate between inflammatory and fibrotic tissue, taking into account the different therapeutic options for the fibrotic strictures compared to inflammatory processes. This review summarizes the actual recommendations regarding the use of intestinal ultrasound and elastographic techniques for the diagnosis and monitoring of inflammatory bowel diseases.
Light-induced lattice expansion leads to high-efficiency perovskite solar cells
Authors: Tsai Hsinhan , Asadpour Reza , Blancon Jean-Christophe , Stoumpos Constantinos C. , Durand Olivier , Strzalka Joseph W. , Chen Bo , Verduzco Rafael , Ajayan Pulickel M. , Tretiak Sergei , Even Jacky , Alam Muhammad Ashraf , Kanatzidis Mercouri G. , Nie Wanyi , Mohite Aditya D.
Published: April 2018

Light relaxes hybrid perovskites

Ion migration in organic-inorganic perovskite solar cells limits device stability and performance. Tsai
et al.
found that a cesium-doped lead triiodide perovskite with mixed organic cations underwent a uniform lattice expansion after 180 min of exposure at 1 sun of illumination. This structural change reduced the energy barriers for charge carriers at the contacts of solar cells. The resulting increase in power conversion efficiency from 18.5 to 20.5% was maintained for more than 1500 hours of illumination.

Science
, this issue p.
67
2001
, 50 years later
Space Odyssey: Stanley Kubrick, Arthur C. Clarke, and the Making of a Masterpiece
Michael Benson
Simon & Schuster, 2018. 525 pp.
Authors: Telotte J. P.
Published: April 2018

A new book celebrates the making of the iconic space odyssey and its enigmatic director
A Novel Polyaminocarboxylate Compound To Treat Murine Pulmonary Aspergillosis by Interfering with Zinc Metabolism
Authors: Laskaris Paris , Vicentefranqueira Rocío , Helynck Olivier , Jouvion Grégory , Calera José Antonio , du Merle Laurence , Suzenet Franck , Buron Frédéric , de Sousa Rodolphe Alves , Mansuy Daniel , Cavaillon Jean-Marc , Latgé Jean-Paul , Munier-Lehmann Hélène , Ibrahim-Granet Oumaima
Published: April 2018

Aspergillus fumigatus
can cause pulmonary aspergillosis in immunocompromised patients and is associated with a high mortality rate due to a lack of reliable treatment options. This opportunistic pathogen requires zinc in order to grow and cause disease. Novel compounds that interfere with fungal zinc metabolism may therefore be of therapeutic interest. We screened chemical libraries containing 59,223 small molecules using a resazurin assay that compared their effects on an
A. fumigatus
wild-type strain grown under zinc-limiting conditions and on a zinc transporter knockout strain grown under zinc-replete conditions to identify compounds affecting zinc metabolism. After a first screen, 116 molecules were selected whose inhibitory effects on fungal growth were further tested by using luminescence assays and hyphal length measurements to confirm their activity, as well as by toxicity assays on HeLa cells and mice. Six compounds were selected following a rescreening, of which two were pyrazolones, two were porphyrins, and two were polyaminocarboxylates. All three groups showed good
in vitro
activity, but only one of the polyaminocarboxylates was able to significantly improve the survival of immunosuppressed mice suffering from pulmonary aspergillosis. This two-tier screening approach led us to the identification of a novel small molecule with
in vivo
fungicidal effects and low murine toxicity that may lead to the development of new treatment options for fungal infections by administration of this compound either as a monotherapy or as part of a combination therapy.
Mechanisms of Mineral Substrate Acquisition in a Thermoacidophile
Authors: Amenabar Maximiliano J. , Boyd Eric S.
Published: April 2018

The thermoacidophile
Acidianus
is widely distributed in Yellowstone National Park hot springs that span large gradients in pH (1.60 to 4.84), temperature (42 to 90°C), and mineralogical composition. To characterize the potential role of flexibility in mineral-dependent energy metabolism in contributing to the widespread ecological distribution of this organism, we characterized the spectrum of minerals capable of supporting metabolism and the mechanisms that it uses to access these minerals. The energy metabolism of
Acidianus
strain DS80 was supported by elemental sulfur (S
0
), a variety of iron (hydr)oxides, and arsenic sulfide. Strain DS80 reduced, oxidized, and disproportionated S
0
. Cells growing via S
0
reduction and disproportionation did not require direct access to the mineral to reduce it, whereas cells growing via S
0
oxidation did require direct access, observations that are attributable to the role of H
2
S produced by S
0
reduction/disproportionation in solubilizing and increasing the bioavailability of S
0
. Cells growing via iron (hydr)oxide reduction did not require access to the mineral, suggesting that the cells reduce Fe(III) that is being leached by the acidic growth medium. Cells growing via oxidation of arsenic sulfide with Fe(III) did not require access to the mineral to grow. The stoichiometry of reactants to products indicates that cells oxidize soluble As(III) released from oxidation of arsenic sulfide by aqueous Fe(III). Taken together, these observations underscore the importance of feedbacks between abiotic and biotic reactions in influencing the bioavailability of mineral substrates and defining ecological niches capable of supporting microbial metabolism.

IMPORTANCE
Mineral sources of electron donor and acceptor that support microbial metabolism are abundant in the natural environment. However, the spectrum of minerals capable of supporting a given microbial strain and the mechanisms that are used to access these minerals in support of microbial energy metabolism are often unknown, in particular among thermoacidophiles. Here, we show that the thermoacidophile
Acidianus
strain DS80 is adapted to use a variety of iron (hydro)oxide minerals, elemental sulfur, and arsenic sulfide to support growth. Cells rely on a complex interplay of abiologically and biologically catalyzed reactions that increase the solubility or bioavailability of minerals, thereby enabling their use in microbial metabolism.
Social relationships and GP use of middle-aged and older adults in Europe: a moderator analysis
Authors: Bremer Daniel , Lüdecke Daniel , Vonneilich Nico , von dem Knesebeck Olaf
Published: April 2018

Objectives

This paper investigates (1) how social relationships (SRs) relate to the frequency of general practitioner (GP) visits among middle-aged and older adults in Europe, (2) if SRs moderate the association between self-rated health and GP visits, and (3) how the associations vary regarding employment status.

Methods

Data stem from the Survey of Health, Ageing and Retirement in Europe project (wave 4, 56 989 respondents, 50 years or older). GP use was assessed by frequency of contacts with GPs in the last 12 months. Predictors were self-rated health and structural (Social Integration Index (SII), social contact frequency) and functional (emotional closeness) aspects of SR. Regressions were used to measure the associations between GP use and those predictors. Sociodemographic and socioeconomic factors were used as covariates. Additional models were computed with interactions.

Results

Analyses did not reveal significant associations of functional and structural aspects of SR with frequency of GP visits (SII: incidence rate ratio (IRR)=0.99, 95% CI 0.97 to 1.01, social contact frequency: IRR=1.04, 95% CI 1.00 to 1.07, emotional closeness: IRR=1.02, 95% CI 1.00 to 1.04). Moderator analyses showed that ‘high social contact frequency people’ with better health had more statistically significant GP visits than ‘low social contact frequency people’ with better health. Furthermore, people with poor health and an emotionally close network showed a significantly higher number of GP visits compared with people with same health, but less close networks. Three-way interaction analyses indicated employment status specific behavioural patterns with regard to SR and GP use, but coefficients were mostly not significant. All in all, the not employed groups showed a higher number of GP visits.

Conclusions

Different indicators of SR showed statistically insignificantly associations with GP visits. Consequently, the relevance of SR may be rated rather low in quantitative terms for investigating GP use behaviour of middle-aged and older adults in Europe. Nevertheless, investigating the two-way and three-way interactions indicated potential inequalities in GP use due to different characteristics of SR accounting for health and employment status.
Descriptive epidemiology of changes in weight and weight-related behaviours of Australian children aged 5 years: two population-based cross-sectional studies in 2010 and 2015
Authors: Hardy Louise L , Baur Louise A , Wen Li Ming , Garnett Sarah P , Mihrshahi Seema
Published: April 2018

Objective

Over the past 10–15 years there has been substantial investment in New South Wales (NSW), Australia, to reduce child obesity through interventions in children aged 0–5 years. We report changes in weight and weight-related behaviours of 5-year-old children.

Design

Cross-sectional surveys conducted in 2010 and 2015.

Setting

NSW schools (2010 n=44; 2015 n=41)

Participants

Australian children in kindergarten (2010 n=1141 and 2015 n=1150).

Outcome measures

Change in anthropometry and indicators of diet, screen time, school travel and awareness of health recommendations. Additionally, we examined 2015 differences in weight-related behaviours by sociodemographic characteristics.

Results

Prevalence of overweight/obesity was 2.1% lower (adjusted OR (AOR) 0.83, 95% CI 0.67 to 1.04) and abdominal obesity 1.7% higher (AOR 1.35, 95% CI 0.93 to 1.98) in 2015 than 2010. Significant improvements in multiple weight-related behaviours were observed among children in the highest tertile of junk food consumption (AOR 0.63, 95% CI 0.50 to 0.80), rewarded for good behaviour with sweets (AOR 0.59, 95% CI 0.47 to 0.74) and had a TV in their bedroom (AOR 0.65, 95% CI 0.43 to 0.96). In 2015, children from low socioeconomic neighbourhoods and non-English-speaking backgrounds were generally less likely to engage in healthy weight-related behaviours than children from high socioeconomic status neighbourhoods and from English-speaking backgrounds. Children in these demographic groups were less likely to eat breakfast daily, have high junk food intake and eat fast food regularly. Children from rural areas tended to have healthier weight-related behaviours than children from urban areas.

Conclusions

There were significant positive changes in 5-year-old children’s weight-related behaviours but children from low socioeconomic neighbourhoods and from non-English-speaking backgrounds were more likely to engage in unhealthy weight-related behaviours than children from high socioeconomic neighbourhoods and English-speaking backgrounds. The findings indicate that there is a need to enhance population-level efforts and ensure community programmes are targeted and tailored to meet different subpopulation needs.
Cause-specific sickness absence trends by occupational class and industrial sector in the context of recent labour market changes: a Finnish panel data study
Authors: Leinonen Taina , Viikari-Juntura Eira , Husgafvel-Pursiainen Kirsti , Solovieva Svetlana
Published: April 2018

Objectives

We aimed to provide previously unestablished information on population-based differences in cause-specific sickness absence trends between occupational classes and further between four large industrial sectors within the different occupational classes while controlling for other socioeconomic factors and employment patterns. We focused on the period 2005–2013, during which the labour market underwent large economic and structural changes in many countries.

Design

Register-based panel data study.

Setting

Large representative datasets on Finnish wage earners aged 25–59 years.

Outcome measure

Annual risk of sickness absence (>10 working days) based on repeated logistic regression.

Results

Between 2005 and 2013, the proportion of employees with sickness absence decreased. Occupational class differences in sickness absence trends varied by disease group. Overall, the decrease in absences was smallest among lower non-manual employees. Sickness absence levels were highest in the health and social work sector and in the manufacturing sector within the non-manual and manual classes, respectively. Absences due to musculoskeletal diseases decreased temporarily during the peak of the economic recession in 2009, particularly in the manufacturing sector within the manual class. The decrease in absences due to musculoskeletal diseases was smallest in the trade sector within the lower occupational classes. Overall, education, income and employment patterns partly explained the differences in the absence levels, but not in the trends.

Conclusions

We found a complex interplay between the associations of occupational class and industrial sector with sickness absence trends. During the economic recession, absences due to musculoskeletal diseases decreased temporarily in a segment of wage earners who were known to have been hit hard by the recession. However, the trend differences were not explained by the measured structural changes in the characteristics of the study population. Both occupational class and industrial sector should be taken into account when tackling problems of work disability.
Global epidemiology and patterns of cerebral venous thrombosis: a systematic review and meta-analysis protocol
Authors: Danwang Celestin , Mazou Temgoua Ngou , Tochie Joël Noutakdie , Tankeu Ronni , Bigna Jean Joel
Published: April 2018

Introduction

Venous thrombosis can affect all veins in the body including cerebral veins, where it causes cerebral venous thrombosis (CVT). CVT is an aetiology of stroke, particularly in children and young adults. Its clinical features vary widely according to the occluded vessel. Data concerning the epidemiology of CVT are scant. This protocol for a systematic review and meta-analysis aims to critically synthesise data concerning prevalence, incidence, risk factors, anatomical patterns, diagnostic and therapeutic delays, and mortality rate of CVT in the global population.

Methods and analysis

MEDLINE, EMBASE and ISI Web of Science databases will be searched for relevant abstracts of studies published between 1 January 1990 and 31 October 2017, without language restriction. After the screening of abstracts, study selection, data extraction and assessment of risk of bias, we will assess studies individually for heterogeneity. Random effects meta-analysis will then be used to pool studies judged to be clinically homogenous. Funnel plot analysis and Egger’s test will be used to detect publication bias. Results will be presented according to economic level of the various countries (high-income vs low/middle-income countries).

Ethics and dissemination

Since the current study will be based on published data, ethical approval is not required. This review is expected to provide relevant data to help in evaluating the global burden of CVT. The final report of this study will be published in a peer-reviewed journal.

PROSPERO registration number

CRD42017074266.
Role of maternal characteristics and epidural analgesia on caesarean section rate in groups 1 and 3 according to Robson’s classification: a cohort study in an Italian university hospital setting
Authors: Triunfo Stefania , Ferrazzani Sergio , Draisci Gaetano , Zanfini Bruno Antonio , Scambia Giovanni , Lanzone Antonio
Published: April 2018

Objective

To investigate the role of maternal characteristics and epidural analgesia (EA) on caesarean section (CS) rates in selected groups by using the Robson 10-Group Classification System (RTGCS).

Design

Cohort study.

Setting

Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario ‘A. Gemelli’, Rome, Italy.

Patients

A total of 12 098 deliveries in periods I (1998–1999) and II (2010–2011).

Main outcome measures

CS rates in groups 1 and 3 of RTGCS.

Results

In group 1, 1144 (20%) patients were assigned to period I and 1302 (20.4%) to period II, while in group 3, 1587 (27.8%) were assigned to period I and 1502 (23.5%) to period II. CS rates were 16.4% and 23.1% in group 1 and 12.7% and 10.9% in group 3 in periods I and II, respectively. In group 1, significant and independent contributions to CS rate were provided by maternal age (p=0.018; OR 0.95 (95% CI 0.85 to 0.97)), body mass index (BMI) (p=0.022; OR 0.89 (95% CI 0.85 to 0.91)) and EA administration (p=0.037; OR 0.59 (95% CI 0.43 to 0.77)). In group 3, maternal age (p<0.001; OR 0.93 (95% CI 0.89 to 0.96)) and BMI (p=0.023; OR 0.98 (95% CI 0.96 to 0.99)) were found to be significantly associated with CS.

Conclusions

RTGCS is an effective tool for analysing changes in obstetric care, allowing for the recognition of maternal age, BMI and EA administration in the strategic planning for mitigation of CS rates in selected groups.
Protocol for a mixed methods study of hospital readmissions: sensemaking in Veterans Health Administration healthcare system in the USA
Authors: Penney Lauren S , Leykum Luci K , Noël Polly , Finley Erin P , Lanham Holly Jordan , Pugh Jacqueline
Published: April 2018

Introduction

Effective delivery of healthcare in complex systems requires managing interdependencies between professions and organisational units. Reducing 30-day hospital readmissions may be one of the most complex tasks that a healthcare system can undertake. We propose that these less than optimal outcomes are related to difficulties managing the complex interdependencies among organisational units and to a lack of effective sensemaking among individuals and organisational units regarding how best to coordinate patient needs.

Methods and analysis

This is a mixed method, multistepped study. We will conduct in-depth qualitative organisational case studies in 10 Veterans Health Administration facilities (6 with improving and 4 with worsening readmission rates), focusing on relationships, sensemaking and improvisation around care transition processes intended to reduce early readmissions. Data will be gathered through multiple methods (eg, chart reviews, surveys, interviews, observations) and analysed using analytic memos, qualitative coding and statistical analyses. We will construct an agent-based model based on those results to explore the influence of sensemaking and specific care transition processes on early readmissions.

Ethics and dissemination

Ethical approval has been obtained through the Institutional Review Board of the University of Texas Health Science Center at San Antonio (approval number: 14–258 hour). We will disseminate our findings in manuscripts in peer-reviewed journals, professional conferences and through short reports back to participating entities and stakeholders.
Effects of dietary antioxidant vitamins on lung functions according to gender and smoking status in Korea: a population-based cross-sectional study
Authors: Hong Ji Young , Lee Chang Youl , Lee Myung Goo , Kim Young Sam
Published: April 2018

Objective

Cigarette smoke-induced oxidative stress plays an important role in the pathogenesis of chronic obstructive pulmonary disease (COPD). Dietary antioxidants are thought to prevent smoke-induced oxidative damage. The aim of this study was to investigate associations between lung function and the consumption of antioxidant vitamins in Korean adults.

Methods

In total, 21 148 participants from the Korean National Health and Nutrition Examination Survey (2007–2014) were divided into four groups based on smoking history and gender. Multivariate regression models were used to evaluate associations between lung function and intake of dietary antioxidants.

Results

Subjects in the highest intake quintile (Q5) of vitamin A, carotene and vitamin C intake had mean forced expiratory volume in 1 s (FEV1) measurements that were 30 mL, 32 mL and 36 mL higher than those of individuals in the lowest intake quintile (Q1), respectively (p for trend; p=0.008, p=0.010 and p<0.001, respectively). The risks of COPD for male smokers in Q1 increased 7.60-fold (95% CI 5.92 to 9.76), 7.16-fold (95% CI 5.58 to 9.19) and 7.79-fold (95% CI 6.12 to 9.92), for vitamin A, carotene and vitamin C, respectively, compared with those of female non-smokers in Q5. Among patients with COPD, men who smoked >20 pack-years had mean FEV1measurements that were 192 mL, 149 mL and 177 mL higher than those of patients in Q1 (p for trend; p=0.018, p=0.024 and p=0.043, for vitamin A, carotene and vitamin C, respectively).

Conclusions

These findings indicate that the influence of antioxidant vitamins on lung function depends on gender and smoking status in the Korean COPD population.
Building motivation to participate in a quality improvement collaborative in NHS hospital trusts in Southeast England: a qualitative participatory evaluation
Authors: Lalani Mirza , Hall Kate , Skrypak Mirek , Laing Chris , Welch John , Toohey Peter , Seaholme Sarah , Weijburg Thomas , Eyre Laura , Marshall Martin
Published: April 2018

Objectives

This study explores the barriers and facilitators that impact on the motivation of practitioners to participate in a quality improvement collaborative.

Design

A qualitative and formative evaluation using a participatory approach, the researcher-in-residence model which embraces the concept of ‘coproducing’ knowledge between researchers and practitioners using a range of research methods such as participant observation, interviews and documentary analysis. The design, creation and application of newly generated evidence are facilitated by the researcher through negotiation and compromise with team members.

Participants

Senior and middle managers, doctors and nurses.

Setting

Two hospitals in Southeast England participating in a Patient Safety Improvement Collaborative and the facilitator (host) of the collaborative, based in Central London.

Results

The evaluation has revealed facilitators and barriers to motivation categorised under two main themes: (1) inherent motivation and (2) factors that influence motivation, interorganisational and intraorganisational features as well as external factors. Facilitators included collaborative ‘champions,’ individuals who drove the quality improvement agenda at a local level, raising awareness and inspiring colleagues. The collaborative itself acted as a facilitator, promoting shared learning as well as building motivation for participation. A key barrier was the lack of board engagement in the participating National Health Service organisations which may have affected motivation among front-line staff.

Conclusions

Collaboratives maybe an important way of engaging practitioners in quality improvement initiatives. This study highlights that despite a challenging healthcare environment in the UK, there remains motivation among individuals to participate in quality improvement programmes as they recognise that improvement approaches may facilitate positive change in local clinical processes and systems. Collaboratives can harness this individual motivation to facilitate spread and adoption of improvement methodology and build engagement across their membership.
Errors and discrepancies in the administration of intravenous infusions: a mixed methods multihospital observational study
Authors: Lyons Imogen , Furniss Dominic , Blandford Ann , Chumbley Gillian , Iacovides Ioanna , Wei Li , Cox Anna , Mayer Astrid , Vos Jolien , Galal-Edeen Galal H , Schnock Kumiko O , Dykes Patricia C , Bates David W , Franklin Bryony Dean
Published: April 2018

Introduction

Intravenous medication administration has traditionally been regarded as error prone, with high potential for harm. A recent US multisite study revealed few potentially harmful errors despite a high overall error rate. However, there is limited evidence about infusion practices in England and how they relate to prevalence and types of error.

Objectives

To determine the prevalence, types and severity of errors and discrepancies in infusion administration in English hospitals, and to explore sources of variation, including the contribution of smart pumps.

Methods

We conducted an observational point prevalence study of intravenous infusions in 16 National Health Service hospital trusts. Observers compared each infusion against the medication order and local policy. Deviations were classified as errors or discrepancies based on their potential for patient harm. Contextual issues and reasons for deviations were explored qualitatively during observer debriefs.

Results

Data were collected from 1326 patients and 2008 infusions. Errors were observed in 231 infusions (11.5%, 95% CI 10.2% to 13.0%). Discrepancies were observed in 1065 infusions (53.0%, 95% CI 50.8% to 55.2%). Twenty-three errors (1.1% of all infusions) were considered potentially harmful; none were judged likely to prolong hospital stay or result in long-term harm. Types and prevalence of errors and discrepancies varied widely among trusts, as did local policies. Deviations from medication orders and local policies were sometimes made for efficiency or patient need. Smart pumps, as currently implemented, had little effect, with similar error rates observed in infusions delivered with and without a smart pump (10.3% vs 10.8%, p=0.8).

Conclusion

Errors and discrepancies are relatively common in everyday infusion administrations but most have low potential for patient harm. Better understanding of performance variability to strategically manage risk may be a more helpful tactic than striving to eliminate all deviations.
Development and validation of an admission prediction tool for emergency departments in the Netherlands
Authors: Kraaijvanger Nicole , Rijpsma Douwe , Roovers Lian , van Leeuwen Henk , Kaasjager Karin , van den Brand Lillian , Horstink Laura , Edwards Michael
Published: April 2018

Objective

Early prediction of admission has the potential to reduce length of stay in the ED. The aim of this study is to create a computerised tool to predict admission probability.

Methods

The prediction rule was derived from data on all patients who visited the ED of the Rijnstate Hospital over two random weeks. Performing a multivariate logistic regression analysis factors associated with hospitalisation were explored. Using these data, a model was developed to predict admission probability. Prospective validation was performed at Rijnstate Hospital and in two regional hospitals with different baseline admission rates. The model was converted into a computerised tool that reported the admission probability for any patient at the time of triage.

Results

Data from 1261 visits were included in the derivation of the rule. Four contributing factors for admission that could be determined at triage were identified: age, triage category, arrival mode and main symptom. Prospective validation showed that this model reliably predicts hospital admission in two community hospitals (area under the curve (AUC) 0.87, 95% CI 0.85 to 0.89) and in an academic hospital (AUC 0.76, 95% CI 0.72 to 0.80). In the community hospitals, using a cut-off of 80% for admission probability resulted in the highest number of true positives (actual admissions) with the greatest specificity (positive predictive value (PPV): 89.6, 95% CI 84.5 to 93.6; negative predictive value (NPV): 70.3, 95% CI 67.6 to 72.9). For the academic hospital, with a higher admission rate, a 90% probability was a better cut-off (PPV: 83.0, 95% CI 73.8 to 90.0; NPV: 59.3, 95% CI 54.2 to 64.2).

Conclusion

Admission probability for ED patients can be calculated using a prediction tool. Further research must show whether using this tool can improve patient flow in the ED.
Essential medicines for emergency care in Africa
Authors: Broccoli Morgan C , Pigoga Jennifer L , Nyirenda Mulinda , Wallis Lee , Calvello Hynes Emilie J
Published: April 2018

Objectives

Essential medicines lists (EMLs) are efficient means to ensure access to safe and effective medications. The WHO has led this initiative, generating a biannual EML since 1977. Nearly all countries have implemented national EMLs based on the WHO EML. Although EMLs have given careful consideration to many public health priorities, they have yet to comprehensively address the importance of medicines for treating acute illness and injury.

Methods

We undertook a multistep consensus process to establish an EML for emergency care in Africa. After a review of existing literature and international EMLs, we generated a candidate list for emergency care. This list was reviewed by expert clinicians who ranked the medicines for overall inclusion and strength of recommendation. These medications and recommendations were then evaluated by an expert group. Medications that reached consensus in both the online survey and expert review were included in a draft emergency care EML, which underwent a final inperson consensus process.

Results

The final emergency care EML included 213 medicines, 25 of which are not in the 2017 WHO EML, but were deemed essential for clinical practice by regional emergency providers. The final EML has associated recommendations of desirable or essential and is subdivided by facility level. Thirty-nine medicines were recommended for basic facilities, an additional 96 for intermediate facilities (eg, district hospitals) and an additional 78 for advanced facilities (eg, tertiary centres).

Conclusion

The 25 novel medications not currently on the WHO EML should be considered by planners when making rational formularies for developing emergency care systems. It is our hope that these resource-stratified lists will allow for easier implementation and will be a useful tool for practical expansion of emergency care delivery in Africa.
Combined healthy lifestyle behaviours and incident disability in an elderly population: the Ohsaki Cohort 2006 Study
Authors: Zhang Shu , Tomata Yasutake , Newson Roger B , Sugawara Yumi , Tsuji Ichiro
Published: April 2018

Background

The joint impact of healthy lifestyle behaviours (HLBs) on incident disability among elderly populations is still uncertain. This cohort study was conducted to estimate the population-attributable fraction (PAF) of combined HLBs for disability reduction in elderly Japanese.

Methods

We analysed 10-year follow-up data for 9910 community-dwelling elderly people (≥65 years) in a prospective cohort study. Information on lifestyle behaviours and food consumption was collected via a questionnaire in 2006. The exposure variable was defined as a healthy lifestyle index (HLI), which represented the summed number of HLBs (‘never or former smoker’, ‘time spent walking ≥0.5 hour/day’ and ‘vegetable and fruit consumption volume ≥median’). Data on incident disability were retrieved from the public Long term Care Insurance database. HRs and 95% CIs were estimated by Cox proportional regression and the PAFs and their 95% CIs were estimated with the multivariate-adjusted model.

Results

The 10-year incidence of disability was 35.7%. An inverse dose–response relationship was observed (HR (95% CI): 0.85(0.81 to 0.90) for each one-point increase of the HLI score, p-trend <0.001). Based on multivariate-adjustment, adherence to each one additional HLB gives PAF of 10.5%(95% CI 9.0% to 12.0%) for disability reduction. The PAF would have been 25.9%(14.2% to 36.0%) if all subjects had adhered to all three HLBs.

Conclusion

Combined HLBs may have a substantial impact on reducing the risk of incident disability among elderly people. Even having one more healthy lifestyle habit may bring considerable benefit.
Republished: Delayed extrusion of embolic coils into the airway after embolization of an external carotid artery pseudoaneurysm
Authors: Wilseck Zachary , Savastano Luis , Chaudhary Neeraj , Pandey Aditya S , Griauzde Julius , Sankaran Sumanna , Wilkinson David , Gemmete Joseph J
Published: April 2018

Carotid blowout syndrome (CBS) is a known devastating complication of head and neck surgery. The risk of developing CBS increases in the setting of radiation therapy, wound breakdown, or tumor recurrence. Traditionally, the treatment of choice for CBS is surgical ligation of the bleeding artery; however, recently, endovascular occlusion has become a more common option. If a pseudoaneurysm is present, treatment consists of trapping with endovascular coils or occlusion with a liquid embolic agent. Delayed migration of embolization coils into the airway causing acute respiratory distress is a rare occurrence. This report presents a case of a 57-year-old woman who presented to her otolaryngologist after experiencing an episode of acute respiratory distress which resolved when she expectorated embolization coil material from her tracheostomy tube. Three months prior to the episode she underwent coil embolization of an external carotid artery pseudoaneurysm for life-threatening hemorrhage.
Republished: Late recanalization of basilar artery occlusion in a previously healthy 17-month-old child
Authors: Wilkinson D Andrew , Pandey Aditya S , Garton Hugh J , Savastano Luis , Griauzde Julius , Chaudhary Neeraj , Gemmete Joseph J
Published: April 2018

Endovascular treatment of acute ischemic stroke in children is increasingly being reported, although the time window for intervention is unclear. We describe a previously healthy 17-month-old child who presented with vertebral artery thrombosis and cerebellar stroke requiring posterior fossa decompression. She later progressed to basilar artery thrombosis treated with mechanical thrombectomy 50 hours after clinical decline. At 3 month follow-up, the patient had a modified Rankin Scale score of 0.
Republished: Thrombectomy for late occlusion of high flow extracranial–intracranial saphenous vein bypass graft after 27 years of patency
Authors: Silva Michael A , Alcedo Guardia Rodolfo E , Aziz-Sultan Mohammad Ali , Patel Nirav J
Published: April 2018

High flow extracranial–intracranial (EC-IC) bypass with a saphenous vein graft (SVG) has been used for more than 40 years in patients with giant aneurysms of the posterior circulation refractory to medical management, and has demonstrated high long term patency rates. We report the case of a patient treated with external carotid artery (ECA)–posterior cerebral artery SVG bypass in 1989 who presented 27 years later with paresthesias and confusion, and was found to have partial occlusion of her SVG bypass graft and a basilar occlusion. She was treated with mechanical thrombectomy of the basilar occlusion via the partially thrombosed graft, the first report of such a procedure through a high flow posterior circulation EC-IC SVG, resulting in improvement of the patient’s neurologic examination. At 27 years, this is the longest reported delay in thrombosis of a high flow SVG bypass graft, highlighting the long term patency of these grafts and the feasibility of thrombectomy through occluded bypass grafts.