bluuebunny/crossref_metadata_2025_split huggingface dataset:
LAGOS: learning health systems and how they can integrate with patient care
Authors: McLachlan Scott , Dube Kudakwashe , Kyrimi Evangelia , Fenton Norman 
Published: April 2020

ProblemLearning health systems (LHS) are an underexplored concept. How LHS will operate in clinical practice is not well understood. This paper investigates the relationships between LHS, clinical care process specifications (CCPS) and the established levels of medical practice to enable LHS integration into daily healthcare practice.MethodsConcept analysis and thematic analysis were used to develop an LHS characterisation. Pathway theory was used to create a framework by relating LHS, CCPS, health information systems and the levels of medical practice. A case study approach evaluates the framework in an established health informatics project.ResultsFive concepts were identified and used to define the LHS learning cycle. A framework was developed with five pathways, each having three levels of practice specificity spanning population to precision medicine. The framework was evaluated through application to case studies not previously understood to be LHS.DiscussionClinicians show limited understanding of LHS, increasing resistance and limiting adoption and integration into care routine. Evaluation of the presented framework demonstrates that its use enables: (1) correct analysis and characterisation of LHS; (2) alignment and integration into the healthcare conceptual setting; (3) identification of the degree and level of patient application; and (4) impact on the overall healthcare system.ConclusionThis paper contributes a theoretical framework for analysis, characterisation and use of LHS. The framework allows clinicians and informaticians to correctly identify, characterise and integrate LHS within their daily routine. The overall contribution improves understanding, practice and evaluation of the LHS application in healthcare.
Cerebral palsy information system with an approach to information architecture: a systematic review
Authors: Afzali Mina , Etemad Korosh , Kazemi Alireza , Rabiei Reza 
Published: April 2020

BackgroundLong-term complications and high costs of cerebral palsy (CP) as well as inconsistency in data related to this disease reveal the need for extensive planning to obtain accurate and complete data for the effective management of patients.ObjectiveThe present study reviews the information architecture of CP information system.MethodThe relevant articles published from early 1988 to 31 July 2018 were extracted through searching PubMed, Scopus, Cochran, Web of Science and Embase databases conducted independently by two researchers.ResultsA total of 39 articles on CP information system were reviewed. Hospitals, rehabilitation centres and outpatient clinics were found to be the main organisations in charge of generating CP data. Each CP database used several data sources, with hospitals serving as the most important sources of information and the main generators of data. The main CP datasets were categorised into four groups of demographic data, diagnosis, motor function and visual impairment. The majority of data standards were related to the use of the International Classification of Functioning, Disability and Health and the Gross Motor Function Classification System. Finally, accuracy, completeness and consistency were the criteria employed in data quality control.ConclusionDeveloping a robust CP information system requires deploying the principles of information architecture when developing the system, as these can improve data structure and content of CP system, as well as data quality and data sharing.
Measuring the outcomes of using person-generated health data: a case study of developing a PROM item bank
Authors: Dimaguila Gerardo Luis , Gray Kathleen , Merolli Mark 
Published: April 2020

IntroductionPatient-reported outcome measures (PROMs) allow patients to self-report the status of their health condition or experience independently. A key area for PROMs to contribute in building the evidence base is in understanding the effects of using person-generated health data (PGHD), and using PROMs to measure outcomes of using PGHD has been suggested in the literature. Key considerations inherent in the stroke rehabilitation context makes the measurement of PGHD outcomes in home-based poststroke rehabilitation, which uses body-tracking technologies, an important use case.ObjectiveThis paper describes the development of a preliminary item bank of a PROM-PGHD for Kinect-based stroke rehabilitation systems (K-SRS), or PROM-PGHD for K-SRS.MethodsThe authors designed a method to develop PROMs of using PGHD, or PROM-PGHD. The PROM-PGHD Development Method was designed by augmenting a key PROM development process, the Qualitative Item Review, and follows PROM development best practice. It has five steps, namely, literature review; binning and winnowing; initial item revision; eliciting patient input and final item Revision.ResultsA preliminary item bank of the PROM-PGHD for K-SRS is presented. This is the result of implementing the first three steps of the PROM-PGHD Development Method within the domains of interest, that is, stroke and Kinect-based simulated rehabilitation.ConclusionsThis paper has set out a case study of our method, showing what needs to be done to ensure that the PROM-PGHD items are suited to the health condition and technology category. We described it as a case study because we argue that it is possible for the PROM-PGHD method to be used by others to measure effects of PGHD utilisation in other cases of health conditions and technology categories. Hence, it offers generalisability and has broader clinical relevance for evidence-based practice with PGHD. This paper is the first to offer a case study of developing a PROM-PGHD.
Using normalisation process theory to understand workflow implications of decision support implementation across diverse primary care settings
Authors: Mishuris Rebecca G , Palmisano Joseph , McCullagh Lauren , Hess Rachel , Feldstein David A , Smith Paul D , McGinn Thomas , Mann Devin M 
Published: April 2020

BackgroundEffective implementation of technologies into clinical workflow is hampered by lack of integration into daily activities. Normalisation process theory (NPT) can be used to describe the kinds of ‘work’ necessary to implement and embed complex new practices. We determined the suitability of NPT to assess the facilitators, barriers and ‘work’ of implementation of two clinical decision support (CDS) tools across diverse care settings.MethodsWe conducted baseline and 6-month follow-up quantitative surveys of clinic leadership at two academic institutions’ primary care clinics randomised to the intervention arm of a larger study. The survey was adapted from the NPT toolkit, analysing four implementation domains: sense-making, participation, action, monitoring. Domains were summarised among completed responses (n=60) and examined by role, institution, and time.ResultsThe median score for each NPT domain was the same across roles and institutions at baseline, and decreased at 6 months. At 6 months, clinic managers’ participation domain (p=0.003), and all domains for medical directors (p<0.003) declined. At 6 months, the action domain decreased among Utah respondents (p=0.03), and all domains decreased among Wisconsin respondents (p≤0.008).ConclusionsThis study employed NPT to longitudinally assess the implementation barriers of new CDS. The consistency of results across participant roles suggests similarities in the work each role took on during implementation. The decline in engagement over time suggests the need for more frequent contact to maintain momentum. Using NPT to evaluate this implementation provides insight into domains which can be addressed with participants to improve success of new electronic health record technologies.Trial registration numberNCT02534987.
Effect of preoperative education and ICU tour on patient and family satisfaction and anxiety in the intensive care unit after elective cardiac surgery: a randomised controlled trial
Authors: Lai Veronica Ka Wai , Ho Ka Man , Wong Wai Tat , Leung Patricia , Gomersall Charles David , Underwood Malcolm John , Joynt Gavin Matthew , Lee Anna 
Published: April 2020

BackgroundPreoperative education may help participants to psychologically prepare themselves for surgery, but the outcomes of such preparation have rarely been assessed in patients requiring postoperative care in the intensive care unit (ICU) as well as in family members.ObjectiveTo assess the effect of a preoperative multifaceted education intervention on patient and family satisfaction levels in the ICU and measures of perioperative patients’ anxiety and depression.Trial designSingle-centre, two-armed, parallel, superiority, randomised controlled trial. Healthcare professionals in ICU and outcome assessor were blinded to treatment allocation.Participants100 elective coronary artery bypass grafting±valve surgery patients and their family members.InterventionsPreoperative education comprising of a video and ICU tour in addition to standard care (treatment), versus standard care (control).OutcomesPatient and family satisfaction levels with ICU using validated PS-ICU23 and FS-ICU24 questionnaires (0–100), respectively; change in perioperative anxiety and depression scores between 1 day presurgery and 3 days postsurgery.ResultsAmong 100 (50 treatment, 50 control) patients and 98 (49 treatment, 49 control) family members, 94 (48 treatment, 46 control) patients and 94 (47 treatment, 47 control) family members completed the trial. Preoperative education was associated with higher overall patient (mean difference (MD) 6.7, 95% CI 0.2 to 13.2) and family (MD 10.0, 95% CI 3.8 to 16.3) satisfaction scores. There was a weak association between preoperative education and a reduction in patient’s anxiety scores over time (MD −1.7, 95% CI −3.5 to 0.0). However, there was no evidence of a treatment effect on patient’s depression scores over time (MD −0.6, 95% CI −2.3 to 1.2).ConclusionProviding comprehensive preoperative information about ICU to elective cardiac surgical patients improved patient and family satisfaction levels and may decrease patients’ anxiety levels.Trial registration numberChiCTR-IOR-15006971.
Trends in place of death in a small developing country: a population-level study using death certificate data
Authors: Jennings Nicholas , Chambaere Kenneth , Deliens Luc , Cohen Joachim 
Published: April 2020

BackgroundValuable information for planning future end-of-life care (EOLC) services and care facilities can be gained by studying trends in place of death (POD). Scarce data exist on the POD in small developing countries. This study aims to examine shifts in the POD of all persons dying between 1999 and 2010 in Trinidad and Tobago, to draw conclusions about changes in the distribution of POD over time and the possible implications for EOLC practice and policy.MethodsA population-level analysis of routinely collected death certificate data of the most recent available fully coded years at the time of the study—1999 to 2010. Observed proportions for the POD of all deaths were standardised according to the age, sex and cause of death distribution in 1999. Trends for a subgroup of persons who died from causes indicative of a palliative care (PC) need were also examined.ResultsThe proportion of deaths in government hospitals increased from 48.9% to 55.4% and decreased from 38.7% to 29.7% at private homes. There was little variation between observed and standardised rates. The decrease in home deaths was stronger when the PC subcategory was considered, most notably from cancer.ConclusionInternationally, the proportion of deaths at institutions is increasing. A national strategy on palliative and EOLC is needed to facilitate the increasing number of people who seek EOLC at government hospitals in Trinidad and Tobago, including an investigation into the reasons for the trend. Alternatives to accommodate out-of-hospital deaths can be considered.
Secondary prevention and outcomes in outpatients with coronary artery disease, atrial fibrillation or heart failure: a focus on disease overlap
Authors: Lamblin Nicolas , Ninni Sandro , Tricot Olivier , Meurice Thibaud , Lemesle Gilles , Bauters Christophe 
Published: April 2020

ObjectiveTo assess secondary prevention and outcomes in patients with chronic coronary artery disease (CAD), atrial fibrillation (AF) and heart failure (HF), focusing on disease overlap.MethodsWe analysed the data of 10 517 outpatients with a diagnosis of CAD, AF and/or HF included in a prospective cohort study. Follow-up (median 3.2 years) was achieved in 10 478 (99.6%) patients. Seven mutually exclusive patient groups were formed: CAD alone (n=4303), AF alone (n=2604), CAD+AF (n=700), HF alone (n=513), HF+CAD (n=728), HF+AF (n=1087) and HF+CAD+AF (n=582).ResultsPatients with disease overlaps represented 29.4% of the total population. The level of secondary prevention was high in all subgroups and in accordance with European class I – level A guidelines. Among patients with CAD, 99% received an antithrombotic and 91% received a statin. Among patients with AF, 81.7% were treated with an anticoagulant if indicated. Among HF patients with left ventricular ejection fraction <40%, 90.9% received a renin-angiotensin system antagonist and 91% a beta-blocker. Three-year all cause/cardiovascular mortality rates were: 6.4%/2%, 9.7%/3.3%, 15.6%/6.7%, 19.2%/9.4%, 24.3%/13.6%, 28%/15.7% and 35.4%/24.8%, for patients with CAD alone, AF alone, CAD+AF, HF alone, HF+CAD, HF+AF and HF+CAD+AF, respectively. In all groups with HF, observed all-cause mortality was higher (p<0.0001) than expected mortality for age-matched, gender-matched and geography-matched persons. In contrast, observed mortality was lower than expected for patients with CAD alone and AF alone (p<0.0001).ConclusionsIn a context of adequate secondary prevention, overlap between diseases is a frequent and high-risk situation with incremental increases in mortality. These patients deserve specific attention.
Cervical erector spinae plane block: a cadaver study
Authors: Elsharkawy Hesham , Ince Ilker , Hamadnalla Hassan , Drake Richard L , Tsui Ban C H 
Published: April 2020

BackgroundCervical erector spinae plane (ESP) block has been described to anesthetize the brachial plexus (BP), however, the mechanism of its clinical effect remains unknown. As the prevertebral fascia encloses the phrenic nerves, BP and erector spinae muscles to form a prevertebral compartment, a local anesthetic injected in the cervical ESP could potentially spread throughout the prevertebral compartment. This study utilizes cadaveric models to evaluate the spread of ESP injections at the C6 and C7 levels to determine whether the injection can reach the BP and its surrounding structures.MethodsFor each of the five cadavers, an ESP injection posterior to the transverse process of C6 was performed on one side, and an ESP injection posterior to the transverse process of C7 was performed on the contralateral side. Injections were performed under ultrasound guidance and consisted of a 20 mL mixture of 18 mL water and 2 mL India ink. After cadaver dissection, craniocaudal and medial-lateral extent of the dye spread in relation to musculoskeletal anatomy as well as direct staining relevant nerves was recorded. The degree of dye staining was categorized as “deep,” “faint,” or “no.”ResultsThe phrenic nerve was deeply stained in 1 injection and faintly stained in 2 injections. Caudally, variable staining of C8 (100%) and T1 (50%) roots were seen. Faintly staining at C4 root was only seen in one sample (10%). There was variable staining of the anterior scalene muscles (40%) anterior to the BP and the rhomboid intercostal plane caudally (30%).ConclusionsUltrasound-guided cervical (C6 and C7) ESP injections consistently stain the roots of the BP and dorsal rami. This study supports the notion that the cervical ESP block has the potential to provide analgesia for patients undergoing shoulder and cervical spine surgeries.
Longitudinal pathways of exclusive and polytobacco hookah use among youth, young adults and adults in the USA: findings from the PATH Study Waves 1–3 (2013–2016)
Authors: Sharma Eva , Bansal-Travers Maansi , Edwards Kathryn C , Halenar Michael J , Taylor Kristie A , Kasza Karin A , Day Hannah , Hammad Hoda T , Anic Gabriella , Limpert Jean , Gardner Lisa D , Borek Nicolette , Kimmel Heather L , Compton Wilson M , Hyland Andrew , Stanton Cassandra A 
Published: April 2020

ObjectiveThe goal of this study is to examine cross-sectional rates of use and longitudinal pathways of hookah use among US youth (ages 12-17), young adults (ages 18-24), and adults 25+ (ages 25 and older).DesignData were drawn from the first three waves (2013–2016) of the Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal cohort study of US adults and youth. Respondents with data at all three waves (youth, n=11 046; young adults, n=6478; adults 25+, n=17 188) were included in longitudinal analyses.ResultsYoung adults had higher ever, past 12-month (P12M) and past 30-day cross-sectional prevalence of hookah use at each wave than youth or adults 25+. The majority of Wave 1 (W1) hookah users were P12M users of other tobacco products (youth: 73.9%, young adults: 80.5%, adults 25+: 83.2%). Most youth and adult W1 P12M hookah users discontinued use in Wave 2 or Wave 3 (youth: 58.0%, young adults: 47.5%, adults 25+: 63.4%). Most W1 P12M hookah polytobacco users used cigarettes (youth: 49.4%, young adults: 59.4%, adults 25+: 63.2%) and had lower rates of quitting all tobacco than exclusive hookah users or hookah polytobacco users who did not use cigarettes.ConclusionsHookah use is more common among young adults than among youth or adults 25+. Discontinuing hookah use is the most common pathway among exclusive or polytobacco hookah users. Understanding longitudinal transitions in hookah use is important in understanding behavioural outcomes at the population level.
Longitudinal pathways of exclusive and polytobacco smokeless use among youth, young adults and adults in the USA: findings from the PATH Study Waves 1–3 (2013–2016)
Authors: Sharma Eva , Edwards Kathryn C , Halenar Michael J , Taylor Kristie A , Kasza Karin A , Day Hannah , Gardner Lisa D , Anic Gabriella , Bansal-Travers Maansi , Limpert Jean , Hammad Hoda T , Borek Nicolette , Kimmel Heather L , Compton Wilson M , Hyland Andrew , Stanton Cassandra A 
Published: April 2020

ObjectiveUse of smokeless tobacco (SLT) with other tobacco products is growing, yet gaps in understanding transitions among SLT and other product use remain. The aim of this study is to examine cross-sectional prevalence and longitudinal pathways of SLT use among US youth (12–17 years), young adults (18–24 years) and adults 25+ (25 years and older).DesignData were drawn from the first three waves (2013–2016) of the Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal cohort study of US youth and adults. Respondents with data at all three waves (youth, n=11 046; young adults, n=6478; adults 25+, n=17 188) were included in longitudinal analyses.ResultsYoung adults had the highest current SLT use compared with other age groups. Among Wave 1 (W1) past 30-day youth and young adult SLT users, most were SLT and cigarette polytobacco users compared with adults 25+, who more often used SLT exclusively. Among W1 exclusive SLT users, persistent exclusive use across all three waves was more common among adults 25+, while transitioning from exclusive SLT use to SLT polytobacco use at Wave 2 or Wave 3 was more common among youth and young adults. Among W1 SLT and cigarette polytobacco users, a common pathway was discontinuing SLT use but continuing other tobacco use.ConclusionsOur results showed distinct longitudinal transitions among exclusive and SLT polytobacco users. Deeper understanding of these critical product transitions will allow for further assessment of population health impact of these products.
Modified black hole solution with a background Kalb–Ramond field
Authors: Lessa L. A. , Silva J. E. G , Maluf R. V. , Almeida C. A. S. 
Published: April 2020

AbstractWe study the gravitation effects on a static and spherically symmetric spacetime due to the vacuum expectation value (VEV) of a Kalb–Ramond field. The Kalb–Ramond VEV is a background tensor field which produces a local Lorentz symmetry breaking (LSB) of spacetime. Considering a non-minimal coupling between the Kalb–Ramond (VEV) and the Ricci tensor, we obtain an exact parameterdependent power-law modified black hole. For a particular choice of the LSB parameter, the Lorentz violation produces a solution similar to the Reissner–Nordstrom, despite the absence of charge. The near-horizon geometry is modified by including a new inner horizon and shifting the Schwarzschild horizon. Asymptotically, the usual Minkowski spacetime with a background tensor field is recovered. The vacuum configurations are studied considering the energy conditions and the Lorentz violating source properties. By means of the mercury perihelion test, an upper bound to the local Lorentz violation (LV) is obtained, and its corresponding effects on the black hole temperature is investigated.
Long Noncoding RNAs Control the Modulation of Immune Checkpoint Molecules in Cancer
Authors: Xu Shouping , Wang Qin , Kang Yujuan , Liu Jiena , Yin Yanling , Liu Lei , Wu Hao , Li Siwei , Sui Shiyao , Shen Meiying , Zheng Wei , Pang Da 
Published: April 2020

Abstract
Long noncoding RNAs (lncRNA) that are associated with immune checkpoints have not been identified, and the mechanism by which such lncRNAs might regulate the expression of immune checkpoints is unknown in human cancer. Immune checkpoint–associated lncRNAs (ICP-lncRNA) were identified and validated via a comprehensive bioinformatic analysis of The Cancer Genome Atlas data. These ICP-lncRNAs were involved in key immune response and immune cell receptor signaling pathways. The expression of ICP-lncRNAs was upregulated and correlated with a poor prognosis in patients with cancer. HLA complex P5 (HCP5) and myocardial infarction associated transcript (MIAT) promoted tumor growth and upregulated the expression of PD-L1/CD274 via a competing endogenous RNA mechanism of sponging miR-150-5p. The combination of MIAT knockdown and PD-L1 antibody administration showed a synergistic inhibitory effect on tumor growth. Finally, the expression of both HCP5 and MIAT was confirmed to be transcriptionally suppressed by CCCTC-binding factor (CTCF), and lipopolysaccharide induced CTCF eviction from the HCP5 and MIAT promoters, attenuating the transcriptionally suppressive activity of CTCF. This study enlarges the functional landscape of known lncRNAs in human cancer and indicates novel insights into their roles in the field of tumor immunity and immunotherapy. These findings may aid in the comprehensive management of human cancer with immunotherapy.