bluuebunny/crossref_metadata_2025 huggingface dataset:
Hospital Maternity and Obstetrics Care and Management Integrated Information System Use and Impact Analysis
Authors: Li Yuxin , Cao Xuehua
Published: January 2020

This article takes the hospital maternal and obstetrics maternal and child care information system as the starting point, through process analysis, business organization, and information technology, to discuss how to achieve the city's maternal care and management network information
system construction work. Through the construction of the maternal nursing and management network information system in our city, we have summed up a set of scientific, rigorous and practical system construction methods to provide reference for the construction of the provincial obstetrics
and gynecology network information system platform. Through the use of the obstetrics and gynecology health care network information system, the business process is standardized, the work efficiency and management level are improved, and the decision-making basis for the nursing and health
care work of obstetrics and gynecology is provided. At the same time, the use of integrated management mobile care information system in maternal clinical care has become a new technology, which has been the earliest and most extensive application for the majority of nursing staff, and its
efficiency (executive execution and signature) Efficiency, safety (determination of clinical drug delivery and identification of patients), convenience (patient inquiry, record writing and health education) have been initially affirmed, but the operation process is still affected by many factors,
the thesis will Discuss this and propose a solution to this.
Research on the Examination Value of High-Frequency Ultrasound in the Postoperative Rehabilitation Treatment of Sports Injury Achilles Tendon Rupture
Authors: Wang Hai , Liu Ningning
Published: January 2020

The objective of the paper is to explore the examination value of high-frequency ultrasonography in the postoperative rehabilitation treatment of Achilles tendon injury occurred during sports events. The high-frequency ultrasound imaging technique was applied to examine the Achilles
tendon injuries of patients. After the patients accepted Achilles tendon rupture repair surgeries, ultrasound imaging was applied to detect the rehabilitation conditions during the recovery processes. The diagnosis was mainly performed through the Achilles tendon sonograms examined 4 weeks,
6 weeks, 12 weeks, 24 weeks after the surgeries respectively; in addition, the changes in the American Orthopedic Foot and Ankle Score (AOFAS) and the elasticity modulus of repaired Achilles tendons were observed 8 weeks, 12 weeks, 24 weeks, and 48 weeks after the surgeries respectively. The
results showed that the Achilles tendon was significantly improved after the postoperative rehabilitation, and the average AOFAS score was positively correlated with the elasticity modulus of the repaired Achilles tendon. In addition, the research results also indicated that the high-frequency
ultrasound technology could accurately observe the thickness, area, and internal echo of the Achilles tendons of patients dynamically in real-time, which was convenient and quick. After the patient had undergone rehabilitation training, high-frequency ultrasound could be used to detect the
postoperative rehabilitation conditions of patients, thereby the real-time rehabilitation conditions of the patients would be obtained.
The Extended-Range Tornado Activity Forecast (ERTAF) Project
Authors: Gensini Vittorio A. , Barrett Bradford S. , Allen John T. , Gold David , Sirvatka Paul
Published: January 2020

Large-scale weather patterns favorable for tornado occurrence have been understood for many decades. Yet prediction of tornadoes, especially at extended lead periods of more than a few days, remains an arduous task, partly due to the space and time scales involved. Recent research has shown that tropical convection, sea surface temperatures, and the Earth-relative atmospheric angular momentum can induce jet stream configurations that may increase or decrease the probability of tornado frequency across the United States. Applying this recent theoretical work in practice, on 1 March 2015, the authors began the Extended-Range Tornado Activity Forecast (ERTAF) project, with the following goals: 1) to have a map room–style discussion of the anticipated atmospheric state in the 2–3-week lead window; 2) to predict categorical level of tornado activity in that lead window; and 3) to learn from the forecasts through experience by identifying strengths and weaknesses in the methods, as well as identifying any potential scientific knowledge gaps. Over the last five years, the authors have shown skill in predicting U.S. tornado activity two to three weeks in advance during boreal spring. Unsurprisingly, skill is shown to be greater for forecasts spanning week 2 versus week 3. This manuscript documents these forecasting efforts, provides verification statistics, and shares the challenges and lessons learned from predicting tornado activity on the subseasonal time scale.
Creating a Disaggregated CGE Model for Trade Policy Analysis: GTAP-MVH
Authors: Dixon Peter B. , Rimmer Maureen , Tran Nhi
Published: January 2020

Thousands of economists spread across almost every country use the GTAP model to analyse trade policies including trade wars and trade agreements. GTAP has an impressive regional coverage (140 countries), but the standard commodity coverage (57 commodities/industries) can cause frustration when tariffs on narrowly defined products are being negotiated. This article sets out a method for disaggregating commodities/industries in computable general equilibrium models such as GTAP and applies it to GTAP’s motor vehicle sector. The method makes use of readily available highly disaggregated trade data supplemented by detailed input–output data where available and data from a variety of other sources such as commercial market reports.

JEL Codes: C68, F13, F14, F17
Circumnavigating the world of quality and patient safety: a compendium of highlights and perspectives
Authors: El-Farargy Nancy
Published: January 2020

Background

In the UK, estimates suggest that approximately 10% of hospital admissions and 1–2% of primary care consultations result in some sort of adverse event. Globally, medication errors cost approximately US$42 billion annually, and 15% of total health spending in Organisation for Economic Cooperation and Development countries is used to deal with adverse events.

Method

Stemming from the Glasgow 2019 British Medical Journal and Institute for Healthcare Improvement International Forum on Quality and Safety in Healthcare (‘People Make Change’), a review of workforce characteristics, the psychology of change and design thinking in healthcare is presented. The concept of personalised care is also discussed.

Conclusion

In the last decade, the National Health Service in Scotland has undergone major reform around the integration of health and social care. In tandem with this, there have been a range of national initiatives to support patient safety and quality improvement. Moving forward, there is an increasing realisation of how service design, digital technologies and a national digitised infrastructure can improve services. Implications highlight the role of workforce development and in embedding design thinking in service organisation. This review article therefore presents an anthology of highlights and perspectives in improving healthcare quality and patient safety.
Peer tutoring for improvement in rhythm reading fluency and comprehension
Authors: Duran David , Ribosa Jesús , Sánchez Giovanni
Published: January 2020

Peer tutoring in music education is an under-researched but burgeoning area of study. This study aims to assess the effects of the same-age peer tutoring project Ritmos en dos on rhythm reading fluency and comprehension. For this purpose, 24 students from the third grade of secondary education participated in the project. This research utilises a mixed-methods sequential explanatory design, combining (a) a pretest-posttest control group design, with (b) a qualitative study to understand the possible quantitative changes using the interactivity analysis model. Results confirm our hypotheses that students’ participation in the project improved their proficiency across rhythm reading fluency and comprehension. Regarding fluency, quantitative results show a significant improvement for the experimental group, but not for the control group; in comprehension, both groups show gains, but statistically significant differences favour the experimental group in the final comprehension level. Findings reveal different actions that might explain these improvements identified in the interaction between students. Regarding fluency, these actions were mainly related to pulse constancy and reading accuracy while in reading comprehension, students were found to carry out syntactic analysis and metacognitive reflection. Implications suggested from this study point to initial training and cooperative interaction as key elements to be tackled.
Case Report: Correction of Class II Div 2 Malocclusion With Maxillary Arch Extraction and Lower IPR
Authors: Jajoo Atul
Published: January 2020

This case was submitted to the board under category IV for the Indian Board of Orthodontics examination, November 2013. The summary of the treatment, records, and treatment progress are reprinted with minimal editing and reformatting so that the manuscript resembles the actual documents submitted to the board.
Mechanisms of Acute Knee Injuries in Bouldering and Rock Climbing Athletes
Authors: Lutter Christoph , Tischer Thomas , Cooper Carrie , Frank Luisa , Hotfiel Thilo , Lenz Robert , Schöffl Volker
Published: January 2020

Background:

There is limited insight into the mechanisms of knee injuries in rock climbing and bouldering in noncompetitive and competitive athletes.

Purpose:

To examine the traumatic mechanisms of injury, demographics, distribution, and severity of knee injuries in affected athletes.

Study Design:

Case series; Level of evidence, 4.

Methods:

During a 4-year period, we performed a retrospective multicenter analysis of acute knee injuries in competitive and noncompetitive climbing athletes. Traumatic mechanisms were inquired and severity levels, therapies, and outcomes recorded with visual analog scale, Tegner, Lysholm, and climbing-specific outcome scores.

Results:

Within the observation period, 71 patients (35% competitive athletes, 65% noncompetitive athletes) with 77 independent acute knee injuries were recorded. Four trauma mechanisms were identified: high step (20.8%), drop knee (16.9%), heel hook (40.3%), and (ground) fall (22.1%). The leading structural damage was a medial meniscal tear (28.6%), found significantly more often in the noncompetitive group. A specific climbing injury is iliotibial band strain during the heel hook position. Most injuries resulted from indoor bouldering (46.8%). Surgical procedures were predominantly necessary in noncompetitive climbers. One year after the injury, the Tegner score was 5.9 ± 0.8 (mean ± SD; range, 3-7); the Lysholm score was 97 ± 4.8 (range, 74-100); and the climbing-specific outcome score was 4.8 ± 0.6 (range, 2-5).

Conclusion:

Increased attention should be placed on the climber’s knee, especially given the worldwide rise of indoor bouldering. Sport-specific awareness and training programs for noncompetitive and competitive climbing athletes to reduce knee injuries should be developed, and sports medical supervision is mandatory.
Bringing Order to Chaos: The Appropriation of Maithili by Colonial State, c 1870s–1940s
Authors: Jha Sneha
Published: January 2020

This article, through the use of several surveys, grammar books and articles on language written by colonial officials, in the late nineteenth and early twentieth centuries, has explored how language became an instrument in the exercise of colonial power in Bihar in the late nineteenth and early twentieth centuries. Taking the case of a particular language Maithili, spoken in the Mithila region of Bihar, the paper has engaged with the suggestion by Bernard S. Cohn that the history of language can help us understand the mechanism of power in a colonial context. The aspirations of the rulers, as well as the intended and unintended implications caused by such experiments, are worth examining. They would help us answer many general questions about colonial policies and power – not just on the theme of language – such as the following: How does one situate the understanding of the rulers while writing a history of colonialism? How do different debates among the colonial administrators shape the policies of the government, and what does that tell us about the nature of colonial rule? How does one see the role of the ‘native’, both as an informant as well as the subject of study? How does one read the native agency?
Coordination of fuel reactivity and injection timing to achieve highly efficient and stable gasoline compression ignition combustion in a wide load range
Authors: Jiang Chenxu , Li Zilong , Liu Guibin , Qian Yong , Lu Xingcai
Published: January 2020

Gasoline compression ignition combustion is a new combustion mode with great development potential and is highly influenced by fuel reactivity and injection strategy. This paper coordinates the fuel octane number and single-injection timing to operate gasoline compression ignition combustion with high efficiency in a wide load range, with the speed fixed at 1500 r/min. The primary reference fuels with octane numbers 60, 70, 80, and 90 were used, labeled as PRF60, PRF70, PRF80, and PRF90, respectively. The results proved that under steady-state conditions where the speed and load changed slightly, taking the fuel economy and combustion and emission performance into account, PRF60 and PRF70 should be applied at a load lower than 2 bar and 2–8 bar, respectively, and the start of injection timing should be set at 13 °CA before top dead center. When the load is higher than 8 bar, PRF90 should be applied at the start of injection timing of 11 °CA before top dead center. It is noteworthy that PRF70 under medium-load conditions could achieve the indicated thermal efficiency of up to 47%. The injection timing of PRF90 was limited to 9–1711 °CA before top dead center due to the limit of the peak value of pressure rise rate, whereas PRF60 had a wider injection timing boundary than PRF90.
Pulmonary cryptococcal immune reconstitution syndrome in a person living with HIV: a case report
Authors: Hu Zhiliang , Xu Chuanjun , Liu Duxian , Meng Fanqing , Chi Yun , Chen Wei
Published: January 2020

Cryptococcal immune reconstitution inflammatory syndrome (C-IRIS) in human immunodeficiency virus (HIV)-1 infection manifests as a clinical worsening or new presentation of cryptococcal disease after initiating antiretroviral therapy (ART). C-IRIS involving the respiratory system has been scarcely reported. Here, we report a case of pulmonary C-IRIS in a person living with HIV after initiating ART, characterized by an exacerbation of a pulmonary nodule and new occurrence of pleural effusions, which responded well to corticosteroid treatment.
Book review: Tsega Etafa, The Origins of Ethnic Conflict in Africa: Politics and Violence in Darfur, Oromia, and the Tana Delta, African Histories and Modernities
Authors: Pan Jashobanta
Published: January 2020

Tsega Etafa, The Origins of Ethnic Conflict in Africa: Politics and Violence in Darfur, Oromia, and the Tana Delta, African Histories and Modernities. Switzerland AG: Springer Nature, 2019, p. 271, Hardback, ISBN: 978-3-030-10539-6.
Damping control in viscoelastic beam dynamics
Authors: Pierro Elena
Published: January 2020

Viscoelasticity plays a key role in many practical applications and in different research fields, such as in seals, sliding-rolling contacts, and crack propagation. In all these contexts, a proper knowledge of the viscoelastic modulus is very important. However, experimental characterization of the frequency-dependent modulus, carried out through different standard procedures, still presents some complexities; then possible alternative approaches are desirable. For example, experimental investigation of viscoelastic beam dynamics would be challenging, especially for the intrinsic simplicity of this kind of test. This is why a deep understanding of damping mechanisms in viscoelastic beams is found to be a quite important task to better predict their dynamics. With the aim to enlighten damping properties in such structures, an analytical study of the transversal vibrations of a viscoelastic beam is presented in this article. Some dimensionless parameters are defined, depending on the material properties and the beam geometry, which enable to accurately design the beam dynamics. In this way, by properly tuning such disclosed parameters, for example the dimensionless beam length or a chosen material, it is possible to enhance or suppress some resonant peaks, one at a time or more simultaneously. This is a remarkable possibility to efficiently control damping in these structures, and the results presented in this article may help in elucidating experimental procedures for the characterization of viscoelastic materials.
Digital transformation and revenue management: Evidence from the hotel industry
Authors: Alrawadieh Ziad , Alrawadieh Zaid , Cetin Gurel
Published: January 2020

To maximize their revenues and protect their market share against traditional competitors (e.g. formal lodging businesses) and disruptive business models (e.g. Airbnb), the lodging industry increasingly relies on technology in various operations. However, the extent to which hotels adopt technology innovation in their revenue management (RM) operations, as well as the benefits of and barriers for digitalization, remains unclear. Moreover, the possible impacts of digital transformation on the future of revenue managers’ professions have been largely overlooked in previous studies. Drawing on qualitative data collected through 23 semistructured interviews with revenue managers in luxury and upscale hotels across Jordan, the findings suggest that RM is going through digital transformation with different levels of sophistication. While acknowledging the benefits of digital transformation in saving time, supporting the decision-making process, and yielding more revenues, the high cost of RM software emerges as a key barrier for digital transformation. The findings also reveal that the automation of various manual heuristics in RM is far from being possible, and therefore, digital transformation is unlikely to pose a threat to the future of the RM profession.
Mediating and moderating effects in golf tourism: Evidence from Hainan Island
Authors: Song Huimin , Chen Jamie M , Chen Yibin
Published: January 2020

This article examines the relationship between golf activities and tourist perceptions and intentions using data from 592 golf tourists on Hainan Island, China. The results obtained from structural equation modeling show that the attractiveness of the destination can improve the identity of the location, and both factors significantly increase the travel intentions of golf tourists (i.e. revisit intentions and word-of-mouth recommendations). The results also show that place identity has significant mediating effects between destination attractiveness and travel intentions. In addition, the results reveal that the disposable income of golf tourists has significant moderating effects on the attractiveness of the destination, the identity of the destination, and the intention to revisit. This study has some important economic implications for golf destination management. Golf course managers can improve the attractiveness of the destination and strengthen the identity of the location to enhance the behavioral intentions of golf tourists.
Student voice to improve schools: Perspectives from students, teachers and leaders in ‘perfect’ conditions
Authors: Jones Mari-Ana , Bubb Sara
Published: January 2020

This article explores the use of student voice to contribute to improving schools. Through the gathering of perspectives and experiences of staff and students, it considers how the responses to requirements for both student voice and school improvement interrelate and identifies challenges to be addressed. The research was conducted in Norway because, with its long-standing engagement with children’s well-being and rights expressed through its comprehensive framework of legislation and allocation of resources, it has arguably created ideal conditions for students to be involved in improving schools. Findings revealed some recognition of the centrality of student voice in the enactment of democracy in schools: students and teachers had positive perceptions of student voice, and school leaders were willing to incorporate student voice in school improvement processes. Current uses of student voice were, however, largely restricted to the operations of the student council for a range of reasons. The absence of alternative structures, time constraints and doubts about competence were reported, leading to student voice having little impact on school improvement, even in what might be considered ‘perfect’ conditions.
Elevated 1-h postload plasma glucose levels identify coronary heart disease patients with greater severity of coronary artery lesions and higher risk of 1-year re-admission
Authors: Cao Lifei , Wang Ping , Luan Hui , Chen Hui , Luo Chaodi , Zhu Danjun , Tian Gang
Published: January 2020

Objective:

To investigate the relationship of 1-h postload plasma glucose during the oral glucose tolerance test with the severity of coronary artery lesions and risk of 1-year re-admission in coronary heart disease patients with normal glucose tolerance.

Methods:

A total of 266 consecutive coronary heart disease patients who underwent coronary angiography and had normal glucose tolerance confirmed by oral glucose tolerance test during hospitalization were prospectively enrolled and followed in two groups according to the 1-h postload plasma glucose cut-off point (1-h postload plasma glucose <155 mg/dL, n = 149 and 1-h postload plasma glucose ⩾155 mg/dL, n = 117). Angiographic severity was assessed by number of diseased vessels, lesion morphology and Gensini score. The risk of 1-year re-admission with adverse cardiovascular events after discharge was analysed.

Results:

Subjects with a 1-h postload plasma glucose ⩾155 mg/dL had higher incidence of multivessel disease and complex lesions, Gensini score and risk of 1-year re-admission than subjects with a 1-h postload plasma glucose <155 mg/dL (all p < 0.05). In the stepwise multivariate regression analysis, 1-h postload plasma glucose was the major determinant of the Gensini score. Subgroup analyses by sex showed that men with a 1-h postload plasma glucose ⩾155 mg/dL had higher incidence of complex lesions and risk of 1-year re-admission than men with a 1-h postload plasma glucose <155 mg/dL (all p < 0.05).

Conclusion:

Coronary heart disease patients with normal glucose tolerance and elevated 1-h postload plasma glucose levels had a greater severity of coronary artery lesions and an increased risk of re-admission with adverse cardiovascular events, particularly in men.
Development of the Knowledge Related to Oral Health Literacy for Spanish Speakers Scale
Authors: Spivakovsky Silvia E. , Katz Ralph V.
Published: January 2020

The Hispanic population has one of the highest levels of untreated oral disease of any linguistic or ethnic population in the United States. Research examining the factors leading to such outcomes is limited. Since health literacy has been identified as a mediator of health disparities, it is important to identify the most appropriate tool to assess it. The Knowledge Related to Oral Health Literacy model for Spanish speakers (KROHL-S) is an inclusive framework to evaluate oral health knowledge and other modifiable factors at the individual level among the Hispanic population as related to oral health literacy. KROHL-S intends to provide concrete, practical information to help customize interpersonal interactions and educational experiences to individuals’ needs and capabilities. The questionnaire that will allow the creation of the KROHL-S scale consists of orally administered open-ended questions to measure knowledge that is condition specific (caries, periodontal disease, oral cancer, tooth loss, and malocclusion) and domain that is knowledge specific (identification of condition, causes, prevention, treatment, general knowledge). Implementation of the KROHL-S framework will provide in depth information that could be shared among health care providers and the creation of patient-centred initiatives.
Effect of preload on the dynamic characteristics of ceramic bearings based on a dynamic thermal coupling model
Authors: Zhang Ke , Wang Zinan , Bai Xiaotian , Shi Huaitao , Wang Qi
Published: January 2020

Ceramic bearings have a good dynamic output performance under an ultra-high, ultra-low temperature due to their small deformation property. Based on the Harris and Palmgren empirical equation, this article establishes the thermal transfer model of a ceramic motorized spindle. The thermal deformation of a ceramic angular contact ball bearing is calculated. A dynamic and thermal coupling model of the ceramic motorized spindle is built using the Hertz contact theory, which can determine the optimal preload force under different rotating speed conditions. The influence of different temperatures, preload, and rotation speeds on the bearing vibration characteristics was studied. The accuracy of the dynamic and thermal coupling model was verified by the motorized spindle experimental platform. The results show that the thermal deformation of the bearing is an important influencing factor for the output of the dynamic characteristics. Considering the thermal displacement of the bearing, the simulation accuracy of the ceramic motorized spindle-bearing system is in good agreement with the experimental results. By adjusting the bearing preload, the parameters of the rotating speed can effectively reduce the temperature rise and suppress the vibration. The spindle-bearing system model provides a theoretical basis for the dynamic development of a high-speed ceramic bearing.
New chalcone-substituted metallophthalocyanines: Synthesis, characterization, and investigation of their properties
Authors: Kamiloglu Ayse Aktas , Karaca Hüseyin , Celik Gonca , Acar Irfan , Kantekin Halit
Published: January 2020

The synthesis of novel metallophthalocyanines (M = Zn, Mg, and Co) derived from ( E)-3-(3-bromophenyl)-1-(3-hydroxyphenyl)prop-2-en-1-one and ( E)-3-(3-fluorophenyl)-1-(3-hydroxyphenyl)prop-2-en-1-one is achieved. These complexes and the synthesized novel phthalonitrile derivatives are characterized by FTIR, 1H NMR, 13C NMR, UV-Vis, mass spectrometry, and elemental analysis. The aggregation properties of the metallophthalocyanines ZnPc, MgPc, and CoPc are investigated in different solvents and at different concentrations in dimethyl formamide. The electrochemical behavior is also investigated. The cyclic voltammograms give one oxidation reaction for all the bromo-derived metallophthalocyanines and one reduction reaction for all the fluoro-derived metallophthalocyanines. Fe3+, Cd2+, Hg2+, Cu2+, Ni2+, and Co2+ ions are titrated fluorometrically with the phthalocyanines. The bromo- and fluoro-substituted phthalocyanine compounds show different effects on the metal ion titrations.
C5-8 neonatal brachial plexus palsy. Operative findings, reconstructive strategy and outcome
Authors: Lombard Aude , Bachy Manon , Fitoussi Frank
Published: January 2020

From 1998 to 2014, we performed primary brachial plexus repair in 260 children with neonatal brachial plexus palsy. Thirty-three presented with a C5-8 palsy and 24 were reviewed for this study. The surgical strategy was to focus on repairing the upper trunk. Secondary surgical procedures were performed in 21 patients, mainly for shoulder external rotation deficit or weak wrist extension. After a mean follow-up of 9.7 years (range 3 to 19), the median Mallet score for the shoulder was 9.5 and the mean Raimondi score for the hand was 3.3. Median active movement scale was 5, 7 and 5.5 for the deltoid, biceps and triceps, respectively. We conclude that primary C5-8 brachial plexus reconstruction provides restoration of elbow flexion and most patients have a sensitive and functional hand. We also found that secondary surgery to improve shoulder and wrist function is often necessary, which should initially be explained to the family.

Level of evidence: IV
Personalized risk prediction of symptomatic intracerebral hemorrhage after stroke thrombolysis using a machine-learning model
Authors: Wang Feng , Huang Yuanhanqing , Xia Yong , Zhang Wei , Fang Kun , Zhou Xiaoyu , Yu Xiaofei , Cheng Xin , Li Gang , Wang Xiaoping , Luo Guojun , Wu Danhong , Liu Xueyuan , Campbell Bruce C.V. , Dong Qiang , Zhao Yuwu
Published: January 2020

Background:

Personalized prediction of the risk of symptomatic intracerebral hemorrhage (sICH) after stroke thrombolysis is clinically useful. Machine-learning-based modeling may provide the personalized prediction of the risk of sICH after stroke thrombolysis.

Methods:

We identified 2578 thrombolysis-treated ischemic stroke patients between January 2013 and December 2016 from a multicenter database, where 70% were used to train models and the remaining 30% were used as the nominal test sets. Another 136 consecutive tissue plasminogen-activated-treated patients between January 2017 and December 2017 from our institute were enrolled as the independent test sets for clinical usability evaluation. Five machine-learning models were developed to predict the risk of sICH after stroke thrombolysis, and the receiving operating characteristic (ROC) was used to compare the prediction performance.

Results:

In total, 2237 cases were included in our study, of which 102 had sICH transformation (4.56%). Finally, the three-layer neuro network was selected with the best performance on nominal test sets (AUC = 0.82). The probability of the model score was further categorized into three risk ranks (18.97%, 5.63%, and 0.81%) according to the risk distribution. Implementing our system in clinical practice was associated with reduced computed tomography (CT)-to-treatment time (CTT; 41 min versus 52 min, p < 0.001). All sICH patients were correctly predicted to be within the high-sICH risk rank.

Conclusions:

The machine-learning-based modeling is feasible for providing personalized risk prediction of sICH after stroke thrombolysis, and is able to reduce the CTT. More data are needed to further optimize the model and improve the accuracy of prediction.
An Evaluation of the Arcus Corneae For Age Estimation
Authors: Hanterdsith Boonsak
Published: January 2020

Although the arcus corneae (AC) has long been used as an age indicator for forensic purposes, its diagnostic value has not been evaluated. To evaluate the AC as a predictor of chronological age, the author has studied the correlation of AC with respect to age of the deceased. A cross-sectional study was conducted of 342 Thai corpses at the Maharat Nakhon Ratchasima Hospital, Thailand. AC was graded into three levels: no AC, incomplete ring, and complete ring. One-way analysis of variance, chi-square test, binomial logistic regression, sensitivity, specificity, predictive values, and likelihood ratios were used for analysis. The Cohen’s kappa was used to determine the intraobserver and interobserver reliability. The prevalence of AC and the probability of complete AC were significant higher in corpses aged 60 years and above than in those under 60 years. Consequently, this study confirmed that the prevalence of AC was significantly correlated with the age of Thai individuals. If the complete AC is used as an indicator of age of 60 years and above, complete AC has high sensitivity (92.56%) but low specificity (72.85%), low positive predictive value (65.12%), but high negative predictive value (94.71%). For diagnostic value, the presence of AC can be used for age screening but not for absolute confirmation. The absence of AC indicates young age, incomplete AC indicates middle age, and complete AC indicates old age. The high intraobserver and interobserver reliability provides assurance of the value of AC as a means to estimate personal age.
Cost-utility of venoarterial extracorporeal membrane oxygenation in cardiogenic shock and cardiac arrest
Authors: Jäämaa-Holmberg Salla , Salmela Birgitta , Suojaranta Raili , Lemström Karl B , Lommi Jyri
Published: January 2020

Background:

The use of venoarterial extracorporeal membrane oxygenation in cardiogenic shock keeps increasing, but its cost-utility is unknown.

Methods:

We studied retrospectively the cost-utility of venoarterial extracorporeal membrane oxygenation in a five-year cohort of consequent patients treated due to refractory cardiogenic shock or cardiac arrest in a transplant centre in 2013–2017. In our centre, venoarterial extracorporeal membrane oxygenation is considered for all cardiogenic shock patients potentially eligible for heart transplantation, and for selected postcardiotomy patients. We assessed the costs of the index hospitalization and of the one-year hospital costs, and the patients’ health-related quality of life (response rate 71.7%). Based on the data and the population-based life expectancies, we calculated the amount and the costs of quality-adjusted life years gained both without discount and with an annual discount of 3.5%.

Results:

The cohort included 102 patients (78 cardiogenic shock; 24 cardiac arrest) of whom 67 (65.7%) survived to discharge and 66 (64.7%) to one year. The effective costs per one hospital survivor were 242,303€. Median in-hospital costs of the index hospitalization per patient were 129,967€ (interquartile range 150,340€). Mean predicted number of quality-adjusted life years gained by the treatment was 20.9 (standard deviation 9.7) without discount, and the median cost per quality-adjusted life year was 7474€ (interquartile range 10,973€). With the annual discount of 3.5%, 13.0 (standard deviation 4.8) quality-adjusted life years were gained with the cost of 12,642€ per quality-adjusted life year (interquartile range 15,059€).

Conclusions:

We found the use of venoarterial extracorporeal membrane oxygenation in refractory cardiogenic shock and cardiac arrest justified from the cost-utility point of view in a transplant centre setting.
A randomised double-blind pilot trial comparing a mean arterial pressure target of 65 mm Hg versus 72 mm Hg after out-of-hospital cardiac arrest
Authors: Grand Johannes , Meyer Anna SP , Kjaergaard Jesper , Wiberg Sebastian , Thomsen Jakob H , Frydland Martin , Ostrowski Sisse R , Johansson Pär I , Hassager Christian
Published: January 2020

Background:

After resuscitation from out-of-hospital cardiac arrest, mean arterial pressure below 65 mm Hg is avoided with vasopressors. A higher blood-pressure target could potentially improve outcome. The aim of this pilot trial was to investigate the effect of a higher mean arterial pressure target on biomarkers of organ injury.

Methods:

This was a single-centre, double-blind trial of 50 consecutive, comatose out-of-hospital cardiac arrest patients randomly assigned in a 1:1 ratio to a mean arterial pressure target of 65 mm Hg (MAP65) or 72 mm Hg (MAP72). Modified blood pressure modules with a –10% offset were used, enabling a double-blind study design. End-points were biomarkers of organ injury including markers of endothelial integrity (soluble trombomodulin) brain damage (neuron-specific enolase) and renal function (estimated glomerular filtration rate).

Results:

Mean arterial pressure was significantly higher in MAP72 with a mean difference of 5 mm Hg (pgroup=0.03). After 48 h, soluble trombomodulin (median (interquartile range)) was 8.2 (6.7–12.9) ng/ml and 8.3 (6.0–10.8) ng/ml (p=0.29), neuron-specific enolase was 20 (13–31 μg/l) and 18 (13–44 μg/l) p=0.79) and estimated glomerular filtration rate (mean (±standard deviation)) was 61±19 ml/min/1.73m2 and 48±22 ml/min/1.73 m2 (p=0.08) for the MAP72 and MAP65 groups, respectively. Renal replacement therapy was needed in eight patients (31%) in MAP65 and three patients (13%) in MAP72 (p=0.14).

Conclusions:

Double-blind allocation to different mean arterial pressure targets is feasible in comatose out-of-hospital cardiac arrest patients. A mean arterial pressure target of 72 mm Hg compared to 65 mm Hg did not result in improved biomarkers of organ injury. We observed a trend towards preserved renal function in the MAP72 group.
Nonsteroidal Anti-Inflammatory Drugs and Their Neuroprotective Role After an Acute Spinal Cord Injury: A Systematic Review of Animal Models
Authors: Lambrechts Mark J. , Cook James L.
Published: January 2020

Study Design:

Systematic review.

Objective:

Spinal cord injuries (SCIs) resulting in motor deficits can be devastating injuries resulting in millions of health care dollars spent per incident. Nonsteroidal anti-inflammatory drugs (NSAIDs) are a potential class of drugs that could improve motor function after an SCI. This systematic review utilizes PRISMA guidelines to evaluate the effectiveness of NSAIDs for SCI.

Methods:

PubMed/MEDLINE, CINAHL, PsycINFO, Embase, and Scopus were reviewed linking the keywords of “ibuprofen,” “meloxicam,” “naproxen,” “ketorolac,” “indomethacin,” “celecoxib,” “ATB-346,” “NSAID,” and “nonsteroidal anti-inflammatory drug” with “spinal.” Results were reviewed for relevance and included if they met inclusion criteria. The SYRCLE checklist was used to assess sources of bias.

Results:

A total of 2960 studies were identified in the PubMed/MEDLINE database using the above-mentioned search criteria. A total of 461 abstracts were reviewed in Scopus, 340 in CINAHL, 179 in PsycINFO, and 7632 in Embase. A total of 15 articles met the inclusion criteria.

Conclusions:

NSAIDs’ effectiveness after SCI is largely determined by its ability to inhibit Rho-A. NSAIDs are a promising therapeutic option in acute SCI patients because they appear to decrease cord edema and inflammation, increase axonal sprouting, and improve motor function with minimal side effects. Studies are limited by heterogeneity, small sample size, and the use of animal models, which might not replicate the therapeutic effects in humans. There are no published human studies evaluating the safety and efficacy of these drugs after a traumatic cord injury. There is a need for well-designed prospective studies evaluating ibuprofen or indomethacin after adult spinal cord injuries.
Statelessness in West Africa: An Assessment of Stateless Populations and Legal, Policy, and Administrative Frameworks in Ghana
Authors: Atuguba Raymond A. , Tuokuu Francis Xavier Dery , Gbang Vitus
Published: January 2020

Executive Summary

Drawing on qualitative interviews that are complemented by the analysis of government policy documents, this study examines statelessness in Ghana. It addresses a range of policy, legal, institutional, administrative, and other politico-socioeconomic matters attendant to the concept. The study defines statelessness in its strict legal sense. It recognizes populations at risk of statelessness that may be restricted from benefiting from the protection and privileges of their host state. Persons identified by the study as stateless or at risk of statelessness include persons from traditionally nomadic migratory communities, former refugees, persons residing in border communities, members of Zongo communities, trafficked persons, and those affected by gaps in previous constitutions. The study also identifies the consequences of statelessness, including lack of access to healthcare, education, justice, and work. The study offers several recommendations to prevent and reduce statelessness in Ghana.
Elobixibat alleviates chronic constipation in hemodialysis patients: a questionnaire-based study
Authors: Kamei Daigo , Kamei Yuiko , Nagano Masashi , Mineshima Michio , Nitta Kosaku , Tsuchiya Ken
Published: January 2020

Background

Hemodialysis patients are prone to constipation, which can adversely affect their quality of life (QOL). Elobixibat, a highly selective inhibitor of the ileal bile acid transporter, can increase the bile acid level in the colon and, subsequently, enhance colonic motility and secretion. In hemodialysis patients with chronic constipation, it may have a novel action mechanism. However, the effect of elobixibat on such patients’ QOL had not been reported. This study aimed to evaluate the effect of elobixibat on the QOL of hemodialysis patients with chronic constipation.

Methods

This was a multicenter, observational study that used the Japanese version of the Patient Assessment of Constipation-Quality of Life (PAC-QOL) questionnaire on 27 patients (18 men and nine women, age range 47–90 years), who satisfied the Rome 3 diagnostic criteria for functional constipation and were already taking other drugs for constipation. These patients were administered elobixibat 10 mg/day and were asked to respond to the PAC-QOL questionnaire at baseline and after 4 weeks. Bayesian statistics were used to confirm our results.

Results

The number of spontaneous bowel movements per week increased significantly from 2.6 ± 1.2 to 4.1 ± 2.1 (p < 0.001), and the Bristol Stool Form Scale score significantly improved from 1.9 ± 0.8 to 3.6 ± 0.7 (p < 0.001). The Cronbach’s alpha was 0.95, and the Guttman split-half reliability coefficient was 0.90. There were significant decreases in the physical discomfort scores from 1.94 ± 0.79 to 0.97 ± 0.72 (p < 0.001); psychosocial discomfort from 1.16 ± 0.93 to 0.63 ± 0.58 (p < 0.001); worries/ concerns from 1.84 ± 0.73 to 1.27 ± 0.59 (p < 0.001), and satisfaction from 2.79 ± 0.61 to 1.98 ± 0.77 (p < 0.001). The total PAC-QOL score significantly decreased from 1.83 ± 0.79 to 1.17 ± 0.56 (p < 0.001). Bayesian statistics confirmed the results’ significance.

Conclusions

Elobixibat reduced the PAC-QOL scores for hemodialysis patients with chronic constipation and improved the patients’ QOL. It may serve as a new option for treating constipation in hemodialysis patients.
The tumour response of postmenopausal hormone receptor-positive breast cancers undergoing different types of neoadjuvant therapy: a meta-analysis
Authors: Wang Yaling , He Lin , Song Yuhua , Wu Qian , Wang Haiji , Zhang Biyuan , Ma Xuezhen
Published: January 2020

Background

To investigate the efficacy of neoadjuvant chemotherapy (NCT), neoadjuvant endocrine therapy (NET) and neoadjuvant chemoendocrine therapy (NCET) on the tumour response, including pathological complete response (pCR) rate and overall response rate (ORR), in postmenopausal women with hormone receptor (HR)-positive breast cancer.

Methods

Based on a PRISMA-IPD statement, the PubMed, Embase and Cochrane Library databases were used to identify eligible trials published from inception to 7 May 2019. Pooled odds ratio (OR) with 95% confidential interval (CI) was calculated to assess the pCR rate and ORR of tumours among those three treatments via fixed- or random-effect Mantel-Haenszel models in terms of a Heterogeneity Chi2test with a significant level ofp < 0.1. All statistical tests were performed by the software of StataSE, version 12.0.

Results

The analysed data consisted of 10 eligible clinical trials with 971 unique HR-positive breast cancer patients. The pooled results indicated that the pCR rate of those patients undergoing NET was significantly lower than those undergoing NCT (pooled OR, 0.48; 95% CI, 0.26–0.90), whereas the difference of ORR between both therapies was not statistically significant (pooled OR, 1.05; 95% CI, 0.73–1.52). The combined paradigm of NCET compared with the monotherapy of NET or NCT did not present a significantly improved pCR rate or ORR (pooled OR, 2.61; 95% CI, 0.94–7.25; and 2.25; 95% CI, 0.39–13.05; respectively).

Conclusion

Postmenopausal HR-positive breast cancer patients after NCT may have better tumour response than those after NET, while those undergoing NCET may not manifest the apparently improved clinical efficacies compared to those receiving monotherapy.
Self-reported confidence in patient safety competencies among Chinese nursing students: a multi-site cross-sectional survey
Authors: Huang Fei Fei , Shen Xiao Ying , Chen Xue Lei , He Li Ping , Huang Su Fen , Li Jin Xiu
Published: January 2020

Background

Nursing interns are an important backup force for nursing professionals, so efforts to strengthen their patient safety (PS) competencies are a major priority. To do so requires assessing the strengths and weaknesses of Chinese nursing students’ PS competence and identifying the influencing factors.

Methods

This was a multi-site, cross-sectional, web-based study that was carried out between September 2018 and January 2019. A national online survey was completed by 732 Chinese undergraduate nursing students. Our primary outcome factor was the Health Professional Education in Patient Safety Survey score. We also collected socio-demographic and clinical practice-related characteristics as independent variables.

Multiple stepwise linear regression was performed to identify predictors of PS competence.

Results

Chinese undergraduate nursing students were fairly confident in their clinical safety skills but less confident in what they learned about sociocultural or context-dependent aspects of PS and speaking up about PS, including effective communication and understanding human and environmental factors. Less than half of the students felt that they could approach someone engaging in unsafe practice and were reluctant to voice concern about adverse events. We observed significant differences in PS competence between students from different regions, across different PS learning styles (self-study and classroom theoretical study), with different self-assessed PS competence levels, and with experiences of adverse events (p < 0.05). These factors accounted for almost 15% of the total variance in PS competence scores (adjusted R2 = 0.15, p = 0.00).

Conclusions

The results of this study provide a better understanding of PS competence among final-year nursing students in China. Our findings may help nursing educators or healthcare organizations to cultivate and improve PS competence by establishing documented policies or by improving the efficacy of intervention.