bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of hospital interventions to improve patient flow on emergency department clinical quality indicators
Authors: Sethi Simon , Boulind Caroline , Reeve Julie , Carney Amanda , Bruijns Stevan 
Published: September 2020

IntroductionThe Royal College of Emergency Medicine highlights poor flow through hospitals as a major challenge to improving emergency department flow. We describe the effect of several hospital-wide flow interventions on Yeovil District Hospital’s emergency department flow.MethodsDuring 2016, a design science research study addressed several areas disproportionally contributing to exit block within Yeovil District Hospital. In this follow-up study, we used a retrospective, before/after design, to describe the effect of these interventions on the ED. We used the Royal College of Emergency Medicine’s clinical quality indicators (4-hour standard, time to decision-maker, 7-day unplanned reattendance, left without being seen, ambulatory patient care and patient experience). Pearson correlation coefficient (r) was used to compare variables. Wilcoxon signed-rank test was used to compare performance before and after the intervention.ResultsYeovil District Hospital emergency department was attended by 160 373 patients between August 2015 and October 2018. Mean monthly attendance was 4112 (±342) patients, mean age was 43 (±28) years with equal male/female split (49/51%). The 4-hour standard made a recovery from 92% to 97% (p=0.01) that did not correlate with a recovery in national data (r=0.09); this despite rising attendances both at Yeovil and nationally (r=0.75). All clinical quality indicators improved significantly (except unplanned reattendance and patient feedback which improved but not significantly).DiscussionThe positive effect on emergency department clinical quality indicators reveals the beneficial impact of improving in-patient flow. Qualitative research is needed to better understand facilitators and barriers to flow improvement work.
Hypochloraemia is associated with 28-day mortality in patients with septic shock: a retrospective analysis of a multicentre prospective registry
Authors: Lee Min Sung , Shin Tae Gun , Kim Won Young , Jo You Hwan , Hwang Yoon Jung , Choi Sung Hyuk , Lim Taeho , Han Kap Su , Shin JongHwan , Suh Gil Joon , Kim Kyung Su , Kang Gu Hyun 
Published: September 2020

ObjectivesHyperchloraemia is associated with poor clinical outcomes in sepsis patients; however, this association is not well studied for hypochloraemia. We investigated the prevalence of chloride imbalance and the association between hypochloraemia and 28-day mortality in ED patients with septic shock.MethodsA retrospective analysis of data from 11 multicentre EDs in the Republic of Korea prospectively collected from October 2015 to April 2018 was performed. Initial chloride levels were categorised as hypochloraemia, normochloraemia and hyperchloraemia, according to sodium chloride difference adjusted criteria. The primary outcome was 28-day mortality. A multivariate logistic regression model adjusting for age, sex, comorbidities, acid-base state, sepsis-related organ failure assessment (SOFA) score, lactate and albumin level was used to test the association between the three chloride categories and 28-day mortality.ResultsAmong 2037 enrolled patients, 394 (19.3%), 1582 (77.7%) and 61 (3.0%) patients had hypochloraemia, normochloraemia and hyperchloraemia, respectively. The unadjusted 28-day mortality rate in patients with hypochloraemia was 27.4% (95% CI, 23.1% to 32.1%), which was higher than in patients with normochloraemia (19.7%; 95% CI, 17.8% to 21.8%). Hypochloraemia was associated with an increase in the risk of 28-day mortality (adjusted OR (aOR), 1.36, 95% CI, 1.00 to 1.83) after adjusting for confounders. However, hyperchloraemia was not associated with 28-day mortality (aOR 1.35, 95% CI, 0.82 to 2.24).ConclusionHypochloraemia was more frequently observed than hyperchloraemia in ED patients with septic shock and it was associated with 28-day mortality.
Immune landscape, evolution, hypoxia-mediated viral mimicry pathways and therapeutic potential in molecular subtypes of pancreatic neuroendocrine tumours
Authors: Young Kate , Lawlor Rita T , Ragulan Chanthirika , Patil Yatish , Mafficini Andrea , Bersani Samantha , Antonello Davide , Mansfield David , Cingarlini Sara , Landoni Luca , Pea Antonio , Luchini Claudio , Piredda Liliana , Kannan Nagarajan , Nyamundanda Gift , Morganstein Daniel , Chau Ian , Wiedenmann Bertram , Milella Michele , Melcher Alan , Cunningham David , Starling Naureen , Scarpa Aldo , Sadanandam Anguraj 
Published: September 2020

ObjectiveA comprehensive analysis of the immune landscape of pancreatic neuroendocrine tumours (PanNETs) was performed according to clinicopathological parameters and previously defined molecular subtypes to identify potential therapeutic vulnerabilities in this disease.DesignDifferential expression analysis of 600 immune-related genes was performed on 207 PanNET samples, comprising a training cohort (n=72) and two validation cohorts (n=135) from multiple transcriptome profiling platforms. Different immune-related and subtype-related phenotypes, cell types and pathways were investigated using different in silico methods and were further validated using spatial multiplex immunofluorescence.ResultsThe study identified an immune signature of 132 genes segregating PanNETs (n=207) according to four previously defined molecular subtypes: metastasis-like primary (MLP)-1 and MLP-2, insulinoma-like and intermediate. The MLP-1 subtype (26%–31% samples across three cohorts) was strongly associated with elevated levels of immune-related genes, poor prognosis and a cascade of tumour evolutionary events: larger hypoxic and necroptotic tumours leading to increased damage-associated molecular patterns (viral mimicry), stimulator of interferon gene pathway, T cell-inflamed genes, immune checkpoint targets, and T cell-mediated and M1 macrophage-mediated immune escape mechanisms. Multiplex spatial profiling validated significantly increased macrophages in the MLP-1 subtype.ConclusionThis study provides novel data on the immune microenvironment of PanNETs and identifies MLP-1 subtype as an immune-high phenotype featuring a broad and robust activation of immune-related genes. This study, with further refinement, paves the way for future precision immunotherapy studies in PanNETs to potentially select a subset of MLP-1 patients who may be more likely to respond.
Is socioeconomic position associated with bronchiolitis seasonality? A cohort study
Authors: Lewis Kate , De Stavola Bianca , Hardelid Pia 
Published: September 2020

BackgroundUnderstanding differences in the seasonality of bronchiolitis can help to plan the timing of interventions. We quantified the extent to which seasonality in hospital admissions for bronchiolitis is modified by socioeconomic position.MethodsUsing Hospital Episode Statistics, we followed 3 717 329 infants born in English National Health Service hospitals between 2011 and 2016 for 1 year. We calculated the proportion of all infant admissions due to bronchiolitis and the incidence rate of bronchiolitis admissions per 1000 infant-years, according to year, month, age, socioeconomic position and region. We used harmonic Poisson regression analysis to assess whether socioeconomic position modified bronchiolitis seasonality.ResultsThe admission rate for bronchiolitis in England increased from 47.4 (95% CI 46.8 to 47.9) to 58.9 per 1000 infant-years (95% CI 58.3 to 59.5) between 2012 and 2016. We identified some variation in the seasonality of admissions by socioeconomic position: increased deprivation was associated with less seasonal variation and a slightly delayed epidemic peak. At week 50, the risk of admission was 38% greater (incidence rate ratios 1.38; 95% CI 1.35 to 1.41) for infants in the most deprived socioeconomic group compared with the least deprived group.ConclusionThese results do not support the need for differential timing of prophylaxis or vaccination by socioeconomic group but suggest that infants born into socioeconomic deprivation should be considered a priority group for future interventions. Further research is needed to establish if the viral aetiology of bronchiolitis varies by season and socioeconomic group, and to quantify risk factors mediating socioeconomic deprivation and bronchiolitis rates.
Ischaemic heart and cerebrovascular disease mortality in uranium enrichment workers
Authors: Anderson Jeri L , Bertke Stephen J , Yiin James , Kelly-Reif Kaitlin , Daniels Robert Douglas 
Published: September 2020

ObjectiveLinear and non-linear dose–response relationships between radiation absorbed dose to the lung from internally deposited uranium and external sources and circulatory system disease (CSD) mortality were examined in a cohort of 23 731 male and 5552 female US uranium enrichment workers.MethodsRate ratios (RRs) for categories of lung dose and linear excess relative rates (ERRs) per unit lung dose were estimated to evaluate the associations between lung absorbed dose and death from ischaemic heart disease (IHD) and cerebrovascular disease.ResultsThere was a suggestion of modestly increased IHD risk in workers with internal uranium lung dose above 1 milligray (mGy) (RR=1.4, 95% CI 0.76 to 2.3) and a statistically significantly increased IHD risk with external dose exceeding 150 mGy (RR=1.3, 95% CI 1.1 to 1.6) compared with the lowest exposed groups. ERRs per milligray were positive for IHD and uranium internal dose and for both outcomes per gray external dose, although the CIs generally included the null.ConclusionsNon-linear dose–response models using restricted cubic splines revealed sublinear responses at lower internal doses, suggesting that linear models that are common in radioepidemiological cancer studies may poorly describe the association between uranium internal dose and CSD mortality.
Differential attainment in the MRCPsych according to ethnicity and place of qualification between 2013 and 2018: a UK cohort study
Authors: Tiffin Paul A , Paton Lewis W 
Published: September 2020

ABSTRACTPurpose of the studyTo explore if differential pass rates exist in the clinical component of the UK postgraduate clinical psychiatry exam, the Clinical Assessment of Skills and Competencies (CASC), according to ethnicity and place of qualification (UK vs EEA vs overseas graduates).Study designObservational study using data from the UK Medical Education Database for 2140 doctors sitting the CASC for the first time between 2013 and 2018.ResultsAfter controlling for age, sex, time of sitting and performance in the written components of the MRCPsych, differences in CASC pass rates persisted between UK graduates self-identifying as Black and Minority Ethnicity (BME) and non-BME (OR for passing 0.36, 95% CI 0.23 to 0.56, p&lt;0.001). Both EEA (OR 0.25, 0.15 to 0.40, p&lt;0.001) and overseas graduates (OR 0.07, 0.05 to 0.11, p&lt;0.001) were less likely to pass the CASC at first attempt, even after controlling for the influence of educational and background variables. These groups, on average, had lower scores on written exams with substantial content relating to procedural skills (eg, critical appraisal) rather than pure recall of factual knowledge.ConclusionsSubstantial differences exist in clinical examination performance between UK BME and non-BME candidates, as well as between UK and non-UK graduates. These differences are not explained by differing levels of clinical knowledge. In the interests of equality, this situation requires further investigation and remediation. Future research should focus on understanding how potential bias may be acting within different stages of recruitment, training and assessment within psychiatry.
Early-onset dementia: key issues using a relationship-centred care approach
Authors: Nwadiugwu Martin 
Published: September 2020

ABSTRACT
People with early-onset dementia have a potential risk of being marginalised with respect to care and social support as a result of the blame and stigma associated with their condition, and because they have reduced access to treatment options and postdiagnostic care. The limited use of community services and the resulting psychological implications are two key issues facing the group and their caregivers. Early diagnosis, behavioural therapies such as talking therapy, meaningful Montessori activities and friendly community services tailored to meet the needs of people with early-onset dementia are relationship-centred care approaches that could be implemented in practice, using the ‘Senses Framework’ to promote an enriched supportive environment of care with zero tolerance for marginalisation and discriminatory tendencies. Support for caregivers is invaluable in controlling behavioural changes in people with early-onset dementia. A combined approach involving pharmacological and behavioural interventions could be used in severe mood and behavioural changes.
Assessment of competences in rheumatology training: results of a systematic literature review to inform EULAR points to consider
Authors: Alunno Alessia , Najm Aurélie , Sivera Francisca , Haines Catherine , Falzon Louise , Ramiro Sofia 
Published: September 2020

ObjectiveTo summarise the literature on the assessment of competences in postgraduate medical training.MethodsA systematic literature review was performed within a EULAR taskforce on the assessment of competences in rheumatology training and other related specialities (July 2019). Two searches were performed: one search for rheumatology and one for related medical specialities. Two reviewers independently identified eligible studies and extracted data on assessment methods. Risk of bias was assessed using the medical education research study quality instrument.ResultsOf 7335 articles in rheumatology and 2324 reviews in other specialities, 5 and 31 original studies were included, respectively. Studies in rheumatology were at variable risk of bias and explored only direct observation of practical skills (DOPS) and objective structured clinical examinations (OSCEs). OSCEs, including clinical, laboratory and imaging stations, performed best, with a good to very good internal consistency (Cronbach’s α=0.83–0.92), and intrarater reliability (r=0.80–0.95). OSCEs moderately correlated with other assessment tools: r=0.48 vs rating by programme directors; r=0.2–0.44 vs multiple-choice questionnaires; r=0.48 vs DOPS. In other specialities, OSCEs on clinical skills had a good to very good inter-rater reliability and OSCEs on communication skills demonstrated a good to very good internal consistency. Multisource feedback and the mini-clinical evaluation exercise showed good feasibility and internal consistency (reliability), but other data on validity and reliability were conflicting.ConclusionDespite consistent data on competence assessment in other specialities, evidence in rheumatology is scarce and conflicting. Overall, OSCEs seem an appropriate tool to assess the competence of clinical skills and correlate well with other assessment strategies. DOPS, multisource feedback and the mini-clinical evaluation exercise are feasible alternatives.
Dynamics in varying vacuum Finsler–Randers cosmology
Authors: Papagiannopoulos G. , Basilakos S. , Paliathanasis A. , Pan Supriya , Stavrinos P. 
Published: September 2020

AbstractIn the context of Finsler–Randers theory we consider, for the first time, the cosmological scenario of the varying vacuum. In particular, we assume the existence of a cosmological fluid source described by an ideal fluid and the varying vacuum terms. We determine the cosmological history of this model by performing a detailed study on the dynamics of the field equations. We determine the limit of General Relativity, while we find new eras in the cosmological history provided by the geometrodynamical terms provided by the Finsler–Randers theory.
Resonance contributions $$\phi (1020, 1680)\rightarrow K\bar{K}$$ for the three-body decays $$B\rightarrow K\bar{K} h$$
Authors: Fan Ying-Ying , Wang Wen-Fei 
Published: September 2020

AbstractWe study the contributions for the$$K^+K^-$$K+K-and$$K^0\bar{K}^0$$K0K¯0originating from the intermediate states$$\phi (1020)$$ϕ(1020)and$$\phi (1680)$$ϕ(1680)in the charmless three-body decays$$B\rightarrow K\bar{K} h$$B→KK¯h, with$$h=(\pi , K)$$h=(π,K), in the perturbative QCD approach. The subprocesses$$\phi (1020,1680)\rightarrow K\bar{K}$$ϕ(1020,1680)→KK¯are introduced into the distribution amplitudes of$$K\bar{K}$$KK¯system via the kaon electromagnetic form factors with the coefficients taken from the fitted results. The predictions of the branching fractions for the decays$$B\rightarrow \phi (1680)h$$B→ϕ(1680)hwith the intermediate state$$\phi (1680)$$ϕ(1680)decays into$$K^+K^-$$K+K-or$$K^0\bar{K}^0$$K0K¯0are about$$6{-}8\%$$6-8%of the corresponding results for the quasi-two-body decays$$B\rightarrow \phi (1020)h \rightarrow K^+ K^- h$$B→ϕ(1020)h→K+K-hin this work.
Rings with fine idempotents
Authors: Călugăreanu Grigore , Zhou Yiqiang 
Published: September 2020

An idempotent in a ring is called fine (see G. Călugăreanu and T. Y. Lam, Fine rings: A new class of simple rings, J. Algebra Appl. 15(9) (2016) 18) if it is a sum of a nilpotent and a unit. A ring is called an idempotent-fine ring (briefly, an [Formula: see text] ring) if all its nonzero idempotents are fine. In this paper, the properties of [Formula: see text] rings are studied. A notable result is proved: The diagonal idempotents [Formula: see text] ([Formula: see text]) are fine in the matrix ring [Formula: see text] for any unital ring [Formula: see text] and any positive integer [Formula: see text]. This yields many classes of rings over which matrix rings are [Formula: see text].
Comparative study on the oily exudation of aluminized explosives containing EVA and F2603
Authors: Tao Jun , Wang Xiaofeng , Zhang Kun 
Published: September 2020

In order to compare the influence of binders on the oily exudation of cyclotrimethylenetrinitramine (RDX) based aluminized explosives, polyvinyl acetate (EVA) and copolymer of vinylidene fluoride and perfluoropropylene (F2603) were selected as binders, which are most commonly used in the press-packed explosives. Herein, the binding energies of wax with the components of RDX-based aluminized explosives containing EVA and F2603 were predicted. Then, the migration models of wax in EVA and F2603 were constructed respectively, and the migration rate of wax in two binders was also calculated. Finally, experimental verification was carried out for wax migration in the two aluminized explosives. The results show that the binding energies of wax with other components of RDX-based composite explosive are all positive, which indicates that the physical compatibility of RDX-based aluminized explosives containing EVA and F2603 is excellent. In addition, wax interacts with the other components of RDX-based explosives mainly via Van der Waals force. However, the binding strength of wax with RDX crystals and binders decreases with the increase of temperature. The type of binders has a great influence on the migration rate of wax, and the oily exudation rate of wax in F2603 is about 4 times than that in EVA both at 298 K and 344 K. Meanwhile, the polymer configuration greatly changes the migration rate of wax. The calculated results are in good agreement with the experimental results.
Binomial incidence matrix of a semigraph
Authors: Shetty Jyoti , Sudhakara G. 
Published: September 2020

A semigraph, defined as a generalization of graph by Sampathkumar, allows an edge to have more than two vertices. The idea of multiple vertices on edges gives rise to multiplicity in every concept in the theory of graphs when generalized to semigraphs. In this paper, we define a representing matrix of a semigraph [Formula: see text] and call it binomial incidence matrix of the semigraph [Formula: see text]. This matrix, which becomes the well-known incidence matrix when the semigraph is a graph, represents the semigraph uniquely, up to isomorphism. We characterize this matrix and derive some results on the rank of the matrix. We also show that a matrix derived from the binomial incidence matrix satisfies a result in graph theory which relates incidence matrix of a graph and adjacency matrix of its line graph. We extend the concept of “twin vertices” in the theory of graphs to semigraph theory, and characterize them. Finally, we derive a systematic approach to show that the binomial incidence matrix of any semigraph on [Formula: see text] vertices can be obtained from the incidence matrix of the complete graph [Formula: see text].
Modeled Climate Responses to Realistic Extremes of Northern Hemisphere Spring and Summer Snow Anomalies
Authors: Liu Shizuo , Wu Qigang , Wang Lin , Schroeder Steven R. , Zhang Yang , Yao Yonghong , Hu Haibo 
Published: September 2020

AbstractNorthern Hemisphere (NH) snow cover extent (SCE) has diminished in spring and early summer since the 1960s. Historical simulations from phase 5 of the Coupled Model Intercomparison Project (CMIP5) estimated about half as much NH SCE reduction as observed, and thus underestimated the associated climate responses. This study investigates atmospheric responses to realistic decreasing snow anomalies using multiple ensemble transient integrations of climate models forced by observed light and heavy NH snow cover years, specifically satellite-based observations of NH SCE and snow water equivalent from March to August in 1990 (light snow) and 1985 (heavy snow), as a proxy for the trend. The primary atmospheric responses to March–August NH snow reduction are decreased soil moisture, increased surface air temperature, general tropospheric warming in the extratropics and the Arctic, increased geopotential heights, and weakening of the midlatitude jet stream and eddy kinetic energy. The localized response is maintained by persistent increased diabatic heating due to reduced snow anomalies and resulting soil moisture drying, and the remote atmospheric response results partly from horizontal propagation of stationary Rossby wave energy and also from a transient eddy feedback mechanism. In summer, atmospheric responses are significant in both the Arctic and the tropics and are mostly induced by contemporaneous snow forcing, but also by the summer soil moisture dry anomaly associated with early snow melting.