bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can health and social care integration make long-term progress? Findings from key informant surveys of the integration Pioneers in England
Authors: Erens Bob , Wistow Gerald , Mays Nicholas , Manacorda Tommaso , Douglas Nick , Mounier-Jack Sandra , Durand Mary Alison 
Published: October 2019

Purpose
All areas in England are expected by National Health Service (NHS) England to develop integrated care systems (ICSs) by April 2021. ICSs bring together primary, secondary and community health services, and involve local authorities and the voluntary sector. ICSs build on previous pilots, including the Integrated Care Pioneers in 25 areas from November 2013 to March 2018. This analysis tracks the Pioneers’ self-reported progress, and the facilitators and barriers to improve service coordination over three years, longer than previous evaluations in England. The paper aims to discuss these issues.

Design/methodology/approach
Annual online key informant (KI) surveys, 2016–2018, are used for this study.

Findings
By the fourth year of the programme (2017), KIs had shifted from reporting plans to implementation of a wide range of initiatives. In 2018, informants reported fewer “significant” barriers to change than previously. While some progress in achieving local integration objectives was evident, it was also clear that progress can take considerable time. In parallel, there appears to have been a move away from aspects of personalised care associated with user control, perhaps in part because the emphasis of national objectives has shifted towards establishing large-scale ICSs with a particular focus on organisational fragmentation within the NHS.

Research limitations/implications
Because these are self-reports of changes, they cannot be objectively verified. Later stages of the evaluation will look at changes in outcomes and user experiences.

Originality/value
The current study shows clearly that the benefits of integrating health and social care are unlikely to be apparent for several years, and expectations of policy makers to see rapid improvements in care and outcomes are likely to be unrealistic.
Consequences of corporate social responsibility on employees
Authors: Asante Boadi Evans , He Zheng , Boadi Eric Kofi , Bosompem Josephine , Avornyo Philip 
Published: October 2019

PurposeThe purpose of this paper is to draw on affect social exchange theory and related literature to develop and test a research model linking employees’ perception of corporate social responsibility (CSR) to their outcomes [performance and organisational pride (ORP)] with moderating variables: perceived work motivation patterns (autonomous and controlled motivation) to sustain firm’s operations through their employees.Design/methodology/approachThe authors used Ghana as a case for this study due to recent turbulences in the banking sector of Ghana. A sample data of 244 subordinate/supervisor dyads from rural and community banks was collected with a time-lagged technique and analysed through a structural equation modelling for this study.FindingsThese employee’s perceptions of CSR positively related to their performance and ORP. Autonomous motivated employees had a stronger positive moderated impact on perceived CSR-Performance link whereas controlled motivated employees recorded a stronger impact on perceived CSR-ORP link.Practical implicationsBased on these results, managers and human resource (HR) professionals can aim at acquiring favourable employees’ perception of their firms’ CSR initiatives. In that, it can help firms to remain in business particularly in difficult times. Also, autonomous and controlled motivators may seem inversely related, however, they are not contradictory to each other. Both can coexist within a firm and it is crucial that HR professionals and managers endeavour to balance them discreetly to attain organisational goals.Originality/valueDespite the growing interest in CSR across continents, CSR outcomes on employees among small and medium scale firms especially in Africa has fairly been toned-down by respective management of firms, governments and researchers.
Modeling enablers of supply chain quality risk management: a grey-DEMATEL approach
Authors: Prashar Anupama , Aggarwal Shikha 
Published: October 2019

PurposeThe purpose of this paper is to recognize and model the enablers of supply chain quality risk management (SCQRM) through an empirical study in the Indian automotive companies.Design/methodology/approachA systematic literature review was conducted to extract the key enablers of quality management (QM) and risk management in the context of manufacturing supply chains. A grey-based DEMATEL method was employed to identify and model the key enablers of SCQRM.FindingsThe results of empirical study showed that the effectiveness of QM and risk management systems for automotive supply chain is driven by a set of common enablers that could be employed for developing dedicated SCQRM systems. The common causal factors in the model such as the involvement of top leaders, inter-firm communication and strategic-level alignment between supply chain members on both these issues clearly state that there is a need for a broader policy at an early stage.Practical implicationsIt is crucial for the automotive companies to develop and implement structured systems for SCQRM keeping in view the impact of any unaddressed quality risk on missed production targets, vehicle recalls and safety hazards.Originality/valueThis study ascertains the key enablers of SCQRM with emblematic focus on automotive industry and identifies if there are commonalities in these enablers.
GATA‐type transcriptional factor Gat1 regulates nitrogen uptake and polymalic acid biosynthesis in polyextremotolerant fungus Aureobasidium pullulans
Authors: Song Xiaodan , Wang Yongkang , Wang Pan , Pu Guihong , Zou Xiang 
Published: October 2019

SummaryPolymalic acid (PMA) is a novel biopolymer produced by the polyextremotolerant fungus Aureobasidium pullulans. In this study, a GATA‐family transcriptional factor, Gat1, which regulates nitrogen uptake and PMA biosynthesis, was investigated. PMA production increased to 11.2% in the mutant overexpressing gat1 but decreased to 49.1% of the PMA titre when gat1 was knocked out from the genome of A. pullulans. Comparative transcriptome analysis of wild‐type and mutant strains (∆gat1 and OE::gat1) revealed that 23 common differentially expressed genes were related to oxidative phosphorylation, ribosome biogenesis, and nitrogen metabolism. Under nitrogen‐limited stress, regardless of the preferred nitrogen (glutamine, Gln) or non‐preferred nitrogen (proline, Pro), 70% of Gat1 in the cells was located in the nucleus–cytoplasm, which resulted in an increase in nitrogen uptake and PMA biosynthesis regulation. Quantitative RT‐PCR revealed that glucosekinase (GLK) in the glycolytic pathway and malate synthase (MLS) in the glyoxylate shunt pathway may be cross‐regulated by Gat1 and nitrogen concentration (Gln or Pro), Therefore, glk was overexpressed in mutant strain (OE::gat1), which resulted in an increased PMA titre and yield of 12.6% and 13.0% respectively. These findings indicate that Gat1 may play an important role in the dual regulation of the nitrogen and carbon metabolisms in PMA biosynthesis.
Incidence of residual neuromuscular blockade in children below 3 years after a single bolus of cisatracurium 0.1 mg/kg: A quality assurance study
Authors: Vested Matias , Tarpgaard Mona , Eriksen Kirsten , Rasmussen Lars S. 
Published: October 2019

BackgroundThe aim of this quality assurance study was to determine the proportion of patients with residual block (train‐of‐four (TOF) ratio <0.9) upon conclusion of surgery after a bolus of cisatracurium 0.1 mg/kg. It was considered good quality if less than 10% of the study population had residual block upon conclusion of surgery.MethodsA total of 40 patients ≤3 years of age scheduled for cleft lip and palate repair were consecutively enrolled. They received general anaesthesia with either sevoflurane and fentanyl (n = 20) or propofol and remifentanil (n = 20). TOF stimulation using acceleromyography was applied on the tibial nerve. Cisatracurium 0.1 mg/kg was administered to facilitate tracheal intubation.ResultsThree patients (8%; 95% CI: 1.7‐21) had a TOF ratio <0.9 at conclusion of surgery, all three receiving sevoflurane. In the sevoflurane group, this corresponded to 16% (95% CI: 3.3‐40) of the patients. Mean duration of action of cisatracurium 0.1 mg/kg was 119 minutes (SD 40) with sevoflurane and 73 minutes (SD 29) during total intravenous anaesthesia (P < .001). Onset time of cisatracurium 0.1 mg/kg was 166 seconds (SD 37) with sevoflurane and 199 seconds (SD 60) during total intravenous anaesthesia.ConclusionWe found that 8% of the children had residual neuromuscular blockade (TOF ratio <0.9) after administration of a single bolus of cisatracurium 0.1 mg/kg but we cannot exclude that the true proportion is around 20%.
An iliopsoas plane block does not cause motor blockade—A blinded randomized volunteer trial
Authors: Nielsen Niels D. , Madsen Merete N. , Østergaard Helle K. , Bjørn Siska , Pedersen Erik M. , Nielsen Thomas D. , Søballe Kjeld , Børglum Jens , Bendtsen Thomas F. 
Published: October 2019

BackgroundA femoral nerve block relieves pain after total hip arthroplasty, but its use is controversial due to motor paralysis accompanied by an increased risk of fall. Assumedly, the iliopsoas plane block (IPB) targets the hip articular branches of the femoral nerve without motor blockade. However, this has only been indicated in a cadaver study. Therefore, we designed this volunteer study.MethodsTwenty healthy volunteers were randomly allocated to blinded paired active vs. sham IPB (5 mL lidocaine 18 mg/mL with epinephrine vs saline). The primary outcome was reduction of maximal force of knee extension after IPB compared to baseline. Secondary outcomes included reduction of maximal force of hip adduction, and the pattern of injectate spread assessed with magnetic resonance imaging.ResultsMean (confidence interval) change of maximal force of knee extension from baseline to after IPB was −9.7 N (−22, 3.0) (P = .12) (n = 14). The injectate was consistently observed in an anatomically well‐defined closed fascial compartment between the intra‐ and extra‐pelvic components of the iliopsoas muscle anterior to the hip joint.ConclusionWe observed no significant reduction of maximal force of knee extension after an IPB. The injectate was contained in a fascial compartment previously shown to contain all sensory branches from the femoral nerve to the hip joint. The clinical consequence of selective anesthesia of all sensory femoral nerve branches from the hip could be a reduced risk of fall compared to a traditional femoral nerve block.Registration of Trial: The trial was prospectively registered in EudraCT (Reference: 2018‐000089‐12, https://www.clinicaltrialsregister.eu/ctr-search/search?query=2018-000089-12).
Comparing volumetric and biochemical assessment of intravasation caused by hysteroscopic surgery
Authors: Haude Oscar , Overdijk Lucilla E. , van Kesteren Paul J. M. , Geerts Bart F. , Rademaker Bart M. P. 
Published: October 2019

BackgroundDuring hysteroscopic surgery intravasation of irrigation fluid occurs, leading to potentially dangerous intravascular fluid overload. Currently, intravasation is usually measured volumetrically as fluid deficit. Intravasation could also be calculated using the decrease in hemoglobin or increase in chloride ion concentration, both phenomena known to result from intravasation. We compared the values of intravasation measured volumetrically as fluid deficit versus calculated from the biochemical change in hemoglobin and chloride. We expected that these values would show strong correlation and agreement.MethodsIn a retrospective data analysis of 51 patients who underwent hysteroscopic resection of myomas or endometrium a pre and post procedure concentration of haemoglobin and chloride was available. The fluid deficit was plotted against the two versions of calculated intravasation. Furthermore, we put the data into Bland‐Altman plots to scrutinize their relationship.ResultsThe volumetric assessed fluid deficit and both versions of biochemically assessed intravasation, either using the change in hemoglobin or chloride ion concentration, turned out to be three totally different entities with weak correlation. Bland‐Altman plots show too wide limits of agreement, and a striking difference between the two methods of calculated intravasation.ConclusionOur study shows significant differences and poor agreement between volumetric and biochemically assessed intravasation. Based on this study, routinely assessing intravasation by biochemical methods does not have additional benefit compared to the volumetric fluid deficit. It remains unclear which method resembles true intravasation.
Association Between Perceived Threat and the Development of Posttraumatic Stress Disorder Symptoms in Patients With Life‐threatening Medical Emergencies
Authors: Moss Jeena , Roberts Michael B. , Shea Lisa , Jones Christopher W. , Kilgannon Hope , Edmondson Donald E. , Trzeciak Stephen , Roberts Brian W. 
Published: October 2019

AbstractBackgroundOur objectives were to test whether during a potentially life‐threatening medical emergency, perceived threat (a patient’s sense of life endangerment) in the emergency department (ED) is common and associated with the subsequent development of posttraumatic stress disorder (PTSD) symptoms.MethodsThis study was an ED‐based prospective cohort study in an academic hospital. We included adult patients requiring acute intervention in the ED for resuscitation of a potentially life‐threatening medical emergency, defined as respiratory or cardiovascular instability. We measured patient‐perceived threat in the ED using a validated patient self‐assessment measure (score range = 0 to 21, with higher scores indicating greater perceived threat). We performed blinded assessment of PTSD symptoms 30 days after discharge using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders‐Fifth Edition (PCL‐5).ResultsNinety‐nine of 113 (88%) patients completed follow‐up, with 98% reporting some degree of perceived threat, median (interquartile range [IQR]) perceived threat score 12 (6 to 17), and 72% reported PTSD symptoms in relation to their ED visit (median [IQR] PCL‐5 score = 7 [0 to 30]). Patients with respiratory instability had higher median (IQR) perceived threat scores (16 [9 to 18] vs. 9 [6 to 14)] and PCL‐5 scores (10 [2 to 40] vs. 3 [0 to 17]) compared to patients without respiratory instability. In a multivariable linear regression model adjusting for potential confounders, greater perceived threat in the ED was independently associated with higher PCL‐5 scores (β = 0.79, 95% confidence interval [CI] = 0.15 to 1.42). Among the individual perceived threat items, the feeling of helplessness during resuscitation had the strongest association with PCL‐5 score (β = 5.24, 95% CI = 2.29 to 8.18).ConclusionsPerceived threat during potentially life‐threatening emergencies is common and independently associated with development of PTSD symptoms. Additional research to test whether reduction of perceived threat in the ED attenuates the development of PTSD symptoms following potentially life‐threatening emergencies is warranted.
Introduction of an interprofessional gynaecology surgical skills workshop for undergraduate medical and nursing students
Authors: Yang Amy , Fernando Shavi , Tighe Josie , O‐Halloran Monica , Morphet Julia , Kumar Arunaz 
Published: October 2019

BackgroundMedical and nursing students may feel under‐prepared to perform basic surgical and gynaecology procedural skills. There also remains scope within undergraduate programs to integrate interprofessional education, and better prepare students for interprofessional collaboration to improve patient care.AimsA simulation‐based gynaecology surgical skills workshop program was introduced for undergraduate medical and nursing students. The aim of this study was to explore students’ perceptions of a simulation‐based interprofessional gynaecological skills program, using students’ pre‐ and post‐workshop confidence in taught skills reported in a post‐workshop questionnaire as an outcome measure.Materials and methodsOne hundred and sixty undergraduate medical (n = 133) and nursing (n = 27) students attended the workshop program at a tertiary university in Melbourne, Australia. A survey was completed by all students immediately after the workshop, addressing students’ perceptions of surgical education, the four skill‐stations (gowning/gloving, suturing, intrauterine device insertion, and urethral catheterisation), and interprofessional education. A Wilcoxon signed‐rank test was performed to compare students’ pre‐ and post‐workshop confidence scores.ResultsMost medical and nursing students (86%) agreed their course should provide more structured surgical education. There was a statistically significant increase in post‐workshop self‐reported confidence scores for medical and nursing students in all four taught skills. Confidence in interprofessional behaviours also improved in both cohorts, but the improvement in nursing students did not reach statistical significance.ConclusionsSimulation‐based, interprofessional, gynaecological surgery skills workshops are practical and valuable additions to undergraduate medical and nursing curricula. Further research should explore long‐term retention of procedural skills and changes in interprofessional attitudes in clinical practice.
Expert consensus: practical algorithms for management of inflammatory bowel disease patients presenting with back pain or peripheral arthropathies
Authors: Varkas Gaëlle , Ribbens Clio , Louis Edouard , Van den Bosch Filip , Lories Rik , Vermeire Séverine , Elewaut Dirk , De Vos Martine 
Published: October 2019

SummaryBackgroundSpondyloarthritis is the most frequent extra‐intestinal manifestation of IBD.AimTo present simple strategies to identify and differentiate inflammatory joint pain in IBD patients.MethodsA panel of Belgian gastroenterologists and rheumatologists developed seven algorithms for IBD patients with joint symptoms based on a Delphi exercise conducted between April and December 2016. Here, we focus on referral strategies for patients with chronic back pain (evidence‐based strategy), large joint monoarthritis, oligo‐ or polyarticular arthritis or arthralgia (based on expert opinion). We also present management tools for IBD patients with acute back pain and small joint monoarthritis (Supplementary file).ResultsThe reported algorithm for IBD patients with chronic back pain uses basic clinical criteria to identify which patients should be referred to the emergency room (spondylodiscitis), physical medicine and rehabilitation (mechanical back pain) or rheumatologist (spondyloarthritis). IBD patients with large joint monoarthritis should be referred to emergency room if septic arthritis is suspected; in other patients, blood analyses and referral to a rheumatologist for articular puncture with evacuation of synovial fluid are recommended. The analysis of synovial fluid allows for identification of non‐inflammatory (e.g., osteoarthritis) and inflammatory (e.g., [pseudo]‐gout, peripheral spondyloarthritis and Borrelia burgdorferi arthritis) conditions. In patients with inflammatory oligoarticular or polyarticular arthralgia, erythrocyte sedimentation rate, concomitant therapies, anti‐nuclear factor and anti‐double‐stranded DNA antibody levels should be evaluated; in anti‐tumour necrosis factor‐treated patients, a drug‐induced lupus‐like syndrome should be considered.ConclusionWe propose straightforward strategies for IBD patients with joint symptoms, which are specific enough to select initial treatment and referral pattern.
Impact of CYP3A5 genotype on tolvaptan pharmacokinetics and their relationships with endogenous markers of CYP3A activity and serum sodium level in heart failure patients
Authors: Hoshikawa Kohei , Naito Takafumi , Akutsu Shunta , Saotome Masao , Maekawa Yuichiro , Kawakami Junichi 
Published: October 2019

AbstractTolvaptan efficacy for heart failure has a large interindividual variation. This study aimed to evaluate the influence of CYP3A5 and ABCB1 genotypes on tolvaptan pharmacokinetics and their relationships with plasma markers of CYP3A activity and laboratory test values in heart failure patients. Fifty‐eight heart failure patients receiving oral tolvaptan for volume overload were enrolled. Blood samples for determination of pre‐dose plasma concentrations of tolvaptan and its metabolites were collected. CYP3A5 and ABCB1 genotypes, plasma 4β‐hydroxycholesterol/total cholesterol ratio (4β‐OHC/TC) and 25‐hydroxyvitamin D (25‐OHD), and serum laboratory test values were evaluated. The CYP3A5*3/*3 genotype was associated with a higher plasma concentration of tolvaptan but not with its metabolic ratios. The ABCB1 3435C > T, 2677G > T/A and 1236C > T polymorphisms affected neither tolvaptan pharmacokinetics nor its metabolism. Plasma 4β‐OHC/TC and 25‐OHD concentration were not correlated with plasma tolvaptan concentration. In a stratified analysis based on CYP3A5 genotype, plasma 4β‐OHC/TC had a negative correlation with plasma tolvaptan concentration in the patients with the CYP3A5*1 allele, while the plasma concentration of 25‐OHD did not. The CYP3A5*3/*3 genotype was associated with a higher serum sodium level in the patients with volume overload. The plasma concentration of 25‐OHD had a positive correlation with the serum total bilirubin level. In conclusion, CYP3A5*3 but not ABCB1 genotypes elevated tolvaptan plasma exposure in heart failure patients. CYP3A5‐deficient patients treated with tolvaptan had a higher serum sodium level. The CYP3A5 genotype altered the relationship between plasma tolvaptan and 4β‐OHC.
Long‐lasting correction of in vivo LTP and cognitive deficits of mice modelling Down syndrome with an α5‐selective GABAA inverse agonist
Authors: Duchon Arnaud , Gruart Agnès , Albac Christelle , Delatour Benoît , Zorrilla de San Martin Javier , Delgado‐García José María , Hérault Yann , Potier Marie‐Claude 
Published: October 2019

Background and PurposeExcessive GABAergic inhibition contributes to cognitive dysfunctions in Down syndrome (DS). Selective negative allosteric modulators (NAMs) of α5‐containing GABAA receptors such as the α5 inverse agonist (α5IA) restore learning and memory deficits in Ts65Dn mice, a model of DS. In this study we have assessed the long‐lasting effects of α5IA on in vivo LTP and behaviour in Ts65Dn mice.Experimental ApproachWe made in vivo LTP recordings for six consecutive days in freely moving Ts65Dn mice and their wild‐type littermates, treated with vehicle or α5IA. In parallel, Ts65Dn mice were assessed by various learning and memory tests (Y maze, Morris water maze, or the novel object recognition) for up to 7 days, following one single injection of α5IA or vehicle.Key ResultsLTP was not evoked in vivo in Ts65Dn mice at hippocampal CA3‐CA1 synapses. However, this deficit was sustainably reversed for at least six consecutive days following a single injection of α5IA. This long‐lasting effect of α5IA was also observed when assessing working and long‐term memory deficits in Ts65Dn mice.Conclusion and ImplicationsWe show for the first time in vivo LTP deficits in Ts65Dn mice. These deficits were restored for at least 6 days following acute treatment with α5IA and might be the substrate for the long‐lasting pharmacological effects of α5IA on spatial working and long‐term recognition and spatial memory tasks. Our results demonstrate the relevance of negative allosteric modulators of α5‐containing GABAA receptors to the treatment of cognitive deficits associated with DS.