bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prospective study to explore changes in quality of care and perinatal outcomes after implementation of perinatal death audit in Uganda
Authors: Kirabira Victoria Nakibuuka , Aminu Mamuda , Dewez Juan Emmanuel , Byaruhanga Romano , Okong Pius , van den Broek Nynke 
Published: July 2020

ObjectiveTo assess the effects of perinatal death (PND) audit on perinatal outcomes in a tertiary hospital in Kampala.DesignInterrupted time series (ITS) analysis.SettingNsambya Hospital, Uganda.ParticipantsLive births and stillbirths.InterventionsPND audit.Primary and secondary outcome measuresPrimary outcomes: perinatal mortality rate, stillbirth rate, early neonatal mortality rate. Secondary outcomes: case fatality rates (CFR) for asphyxia, complications of prematurity and neonatal sepsis.Results526 PNDs were audited: 142 (27.0%) fresh stillbirths, 125 (23.8%) macerated stillbirths and 259 (49.2%) early neonatal deaths. The ITS analysis showed a decrease in perinatal death (PND) rates without the introduction of PND audits (incidence risk ratio (IRR) (95% CI) for time=0.94, p<0.001), but an increase in PND (IRR (95% CI)=1.17 (1.0 to –1.34), p=0.0021) following the intervention. However, when overdispersion was included in the model, there were no statistically significant differences in PND with or without the intervention (p=0.06 and p=0.44, respectively). Stillbirth rates exhibited a similar pattern. By contrast, early neonatal death rates showed an overall upward trend without the intervention (IRR (95% CI)=1.09 (1.01 to 1.17), p=0.01), but a decrease following the introduction of the PND audits (IRR (95% CI)=0.35 (0.22 to 0.56), p<0.001), when overdispersion was included. The CFR for prematurity showed a downward trend over time (IRR (95% CI)=0.94 (0.88 to 0.99), p=0.04) but not for the intervention. With regards CFRs for intrapartum-related hypoxia or infection, no statistically significant effect was detected for either time or the intervention.ConclusionThe introduction of PND audit showed no statistically significant effect on perinatal mortality or stillbirth rate, but a significant decrease in early neonatal mortality rate. No effect was detected on CFRs for prematurity, intrapartum-related hypoxia or infections. These findings should encourage more research to assess the effectiveness of PND reviews on perinatal deaths in general, but also on stillbirths and neonatal deaths in particular, in low-resource settings.
Variability in hospital treatment costs: a time-driven activity-based costing approach for early-stage invasive breast cancer patients
Authors: Roman Erin , Cardoen Brecht , Decloedt Jan , Roodhooft Filip 
Published: July 2020

ObjectivesUsing a standardised diagnostic and generic treatment path for breast cancer, and the molecular subtype perspective, we aim to measure the impact of several patient and disease characteristics on the overall treatment cost for patients. Additionally, we aim to generate insights into the drivers of cost variability within one medical domain.Design, setting and participantsWe conducted a retrospective study at a breast clinic in Belgium. We used 14 anonymous patient files for conducting our analysis.ResultsSignificant cost variations within each molecular subtype and across molecular subtypes were found. For the luminal A classification, the cost differential amounts to roughly 166%, with the greatest treatment cost amounting to US$29 780 relative to US$11 208 for a patient requiring fewer medical activities. The major driver for these cost variations relates to disease characteristics. For the luminal B classification, a cost difference of roughly 242% exists due to both disease-related and patient-related factors. The average treatment cost for triple negative patients amounted to US$26 923, this is considered to be a more aggressive type of cancer. The overall cost for HER2-enriched is driven by the inclusion of Herceptin, thus this subtype is impacted by disease characteristics. Cost variability across molecular classifications is impacted by the severity of the disease, thus disease-related factors are the major drivers of cost.ConclusionsGiven the cost challenge in healthcare, the need for greater cost transparency has become imperative. Through our analysis, we generate initial insights into the drivers of cost variability for breast cancer. We found evidence that disease characteristics such as severity and more aggressive cancer forms such as HER2-enriched and triple negative have a significant impact on treatment cost across the different subtypes. Similarly, patient factors such as age and presence of gene mutation contribute to differences in treatment cost variability within molecular subtypes.
Provision of medical assistance in dying: a scoping review
Authors: Zworth Max , Saleh Carol , Ball Ian , Kalles Gaelen , Chkaroubo Anatoli , Kekewich Mike , Miller Paul Q , Dees Marianne , Frolic Andrea , Oczkowski Simon 
Published: July 2020

ObjectivesThe purpose of this study is to map the characteristics of the existing medical literature describing the medications, settings, participants and outcomes of medical assistance in dying (MAID) in order to identify knowledge gaps and areas for future research.DesignScoping review.Search strategyWe searched electronic databases (MEDLINE, EMBASE, PsychINFO, CINAHL and CENTRAL), clinical trial registries, conference abstracts and professional guidelines from jurisdictions where MAID is legal, up to February 2020. Eligible report types included technical summaries, institutional policies, practice surveys, practice guidelines and clinical studies that describe MAID provision in adults who have provided informed consent for MAID.Results163 articles published between 1989 and 2020 met eligibility criteria. 75 studies described details for MAID administered by intravenous medications and 50 studies provided data on oral medications. In intravenous protocols, MAID was most commonly administered using a barbiturate (34/163) or propofol (22/163) followed by a neuromuscular blocker. Oral protocols most often used barbiturates alone (37/163) or in conjunction with an opioid medication (7/163) and often recommended using a prokinetic agent prior to lethal drug ingestion. Complications included prolonged duration of the dying process, difficulty in obtaining intravenous access and difficulty in swallowing oral agents. Most commonly, the role of physicians was prescribing (83/163) and administering medications (75/163). Nurses’ roles included administering medications (17/163) and supporting the patient (16/163) or family (13/163). The role of families involved providing support to the patient (17/163) and bringing medications from the pharmacy for self-administration (4/163).ConclusionsWe identified several trends in MAID provision including common medications and doses for oral and parenteral administration, roles of healthcare professionals and families, and complications that may cause patient, family and provider distress. Future research should aim to identify the medications, dosages, and administration techniques and procedures that produce the most predictable outcomes and mitigate distress for those involved.
A/C study protocol: a cross-sectional study of HIV epidemiology among African, Caribbean and Black people in Ontario
Authors: Mbuagbaw Lawrence , Tharao Wangari , Husbands Winston , Nelson Laron E , Aden Muna , Arnold Keresa , Baidoobonso Shamara , Dabone Charles , Dryden OmiSoore , Etowa Egbe , Hamid Jemila , Jackson-Best Fatimah , Kohoun Bagnini , Lawson Daeria O , Lofters Aisha K , Luyombya Henry , Mbulaheni Tola , Mkandawire Paul , Ndungu Mary , Nyambi Agatha , Obiorah Suzanne , Ongoiba Fanta , Ongolo-Zogo Clémence , Oraka Chinedu , Shahin Rita , Yaya Sanni , Hendricks Andrew , Gebremeskel Aster , Inoua Haoua , Etowa Josephine 
Published: July 2020

IntroductionAfrican, Caribbean and Black (ACB) communities are disproportionately infected by HIV in Ontario, Canada. They constitute only 5% of the population of Ontario yet account for 25% of new diagnoses of HIV. The aim of this study is to understand underlying factors that augment the HIV risk in ACB communities and to inform policy and practice in Ontario.Methods and analysisWe will conduct a cross-sectional study of first-generation and second-generation ACB adults aged 15–64 in Toronto (n=1000) and Ottawa (n=500) and collect data on sociodemographic information, sexual behaviours, substance use, blood donation, access and use of health services and HIV-related care. We will use dried blood spot testing to determine the incidence and prevalence of HIV infection among ACB people, and link participant data to administrative databases to investigate health service access and use. Factors associated with key outcomes (HIV infection, testing behaviours, knowledge about HIV transmission and acquisition, HIV vulnerability, access and use of health services) will be evaluated using generalised linear mixed models, adjusted for relevant covariates.Ethics and disseminationThis study has been reviewed and approved by the following Research Ethics Boards: Toronto Public Health, Ottawa Public Health, Laurentian University; the University of Ottawa and the University of Toronto. Our findings will be disseminated as community reports, fact sheets, digital stories, oral and poster presentations, peer-reviewed manuscripts and social media.
Integrated strategies to prevent intradialytic hypotension: research protocol of the DialHypot study, a prospective randomised clinical trial in hypotension-prone haemodialysis patients
Authors: Peyronel Francesco , Parenti Elisabetta , Fenaroli Paride , Benigno Giuseppe Daniele , Rossi Giovanni Maria , Maggiore Umberto , Fiaccadori Enrico 
Published: July 2020

IntroductionIn patients on maintenance haemodialysis (HD), intradialytic hypotension (IDH) is a clinical problem that nephrologists and dialysis nurses face daily in their clinical routine. Despite the technological advances in the field of HD, the incidence of hypotensive events occurring during a standard dialytic treatment is still very high. Frequently recurring hypotensive episodes during HD sessions expose patients not only to severe immediate complications but also to a higher mortality risk in the medium term. Various strategies aimed at preventing IDH are currently available, but there is lack of conclusive data on more integrated approaches combining different interventions.Methods and analysisThis is a prospective, randomised, open-label, crossover trial (each subject will be used as his/her own control) that will be performed in two distinct phases, each of which is divided into several subphases. In the first phase, 27 HD sessions for each patient will be used, and will be aimed at the validation of a new ultrafiltration (UF) profile, designed with an ascending/descending shape, and a standard dialysate sodium concentration. In the second phase, 33 HD sessions for each patient will be used and will be aimed at evaluating the combination of different UF and sodium profiling strategies through individualised dialysate sodium concentration.Ethics and disseminationThe trial protocol has been reviewed and approved by the local Institutional Ethics Committee (Comitato Etico AVEN, prot. 43391 22.10.19). The results of the trial will be presented at local and international conferences and submitted for publication to a peer-reviewed journal.Trial registration numberClinicalTrials.gov Registry (NCT03949088).
Service evaluation of faecal immunochemical testing introduced for use in North East London for patients at low risk of colorectal cancer
Authors: Ayling Ruth M , Machesney Michael 
Published: July 2020

AimsColorectal cancer (CRC) is the fourth most common cancer in the UK. Following National Institute of Clinical Excellence (NICE) guidance for faecal immunochemical testing (FIT) (DG30), we introduced a service for the measurement of faecal haemoglobin (fHb) in symptomatic patients in line with the 2017 update of the NG12 guidance. The purpose of this study was to audit the use of FIT, focussing on the indication for request and referral for diagnostic tests as recommended in NICE guidance.MethodsTesting was rolled out after careful introduction with extensive education led by the local Cancer Alliance and reinforced by the laboratory. After 6 months, the outcomes of all patients tested were reviewed.Results1203 samples were received, of which 894 (74.3%) were suitable for analysis. Of these, 482 (53.9%) actually met the criteria for FIT analysis stipulated in our patient pathway. Eight patients were diagnosed with CRC; fHb was detectable in all and was ≥200 µg/g in seven and <10 µg/g in one. 217 patients underwent gastrointestinal investigations, and the sensitivity and specificity of FIT for CRC were found to be 87.5% (95% CI 46.6% to 99.7%) and 52.6% (95% CI 45.6% to 59.6%), respectively. Patients with anaemia were more likely to have fHb ≥10 µg/g.ConclusionsThese findings suggest benefits from the introduction of FIT in terms of more efficient use of diagnostic investigations, while revealing initial problems relating to familiarity with a new test. This merits further intervention with education and awareness programmes for Primary Care and further audit.
Effect of sex differences on prognosis of intravenous thrombolysis: data from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China)
Authors: Zhou Hongyu , Chen Weiqi , Pan Yuesong , Suo Yue , Meng Xia , Li Hao , Wang Yongjun 
Published: July 2020

Background and purposePrevious studies have reported conflicting results as to whether women have poorer functional outcome than men after thrombolytic therapy. This study aims to investigate the relationship between sex differences and the prognosis of intravenous thrombolysis in Chinese patients with acute ischaemic stroke.MethodsThe patients enrolled in this study were from the Chinese Acute Ischemic Stroke Thrombolysis Monitoring and Registration study. The primary outcome was poor functional outcome, defined as a 3-month modified Rankin score of 3–6. The safe outcome was symptomatic intracranial haemorrhage (SICH) and mortality within 7 days and 90 days. Multiple Cox regression model was used to correct the potential covariates to evaluate the association between sex disparities and prognosis. Furthermore, the interaction of preonset Rankin scores, baseline National Institute of Health Stroke Scale (NIHSS) scores and Trial of Org 10172 in Acute Stroke Treatment (TOAST) types was statistically analysed.ResultsA total of 1440 patients were recruited, including 541 women and 899 men. The baseline information indicated that women were older at the time of onset (66.2±11.2 years vs 61.0±11.3 years, p<0.001), and more likely to have a history of atrial fibrillation (25.3% vs 11.2%, p<0.001), and had a higher NIHSS score on admission (12.3±6.8 vs 11.6±6.7, p=0.04). According to the prognosis analysis of unsatisfactory functional recovery, there was no significant difference between women and men (45.9% vs 37.1%; adjusted OR 1.01, 95% CI 0.75 to 1.37). As for the safe outcome, the proportion of SICH and mortality in women is relatively high but did not reach statistical significance. There was no significant interaction with sex, age, preonset Rankin score, NIHSS score, TOAST classification and the prognosis of intravenous thrombolysis.ConclusionsFor Chinese patients with ischaemic stroke, although women are older and more severe at the time of onset, the prognosis after intravenous thrombolysis is not significantly different from men.
Low-Level Nanog Expression in the Regulation of Quiescent Endothelium
Authors: Baruah Jugajyoti , Chaudhuri Suhnrita , Mastej Victoria , Axen Cassondra , Hitzman Ryan , Ribeiro Isabella M.B. , Wary Kishore K. 
Published: July 2020

Objective:
Nanog is expressed in adult endothelial cells (ECs) at a low-level, however, its functional significance is not known. The goal of our study was to elucidate the role of Nanog in adult ECs using a genetically engineered mouse model system.

Approach and Results:

Biochemical analyses showed that Nanog is expressed in both adult human and mouse tissues. Primary ECs isolated from adult mice showed detectable levels of Nanog, Tert (telomerase reverse transcriptase), and eNos (endothelial nitric oxide synthase). Wnt3a (Wnt family member 3A) increased the expression of Nanog and hTERT (human telomerase reverse transcriptase) in ECs and increased telomerase activity in these cells. In a chromatin immunoprecipitation experiment, Nanog directly bound to the
hTERT
and
eNOS
promoter/enhancer DNA elements, thereby regulating their transcription. Administration of low-dose tamoxifen to
ROSA

mT/mG

::Nanog

fl/+

::Cdh5

CreERT2

mice induced deletion of a single
Nanog
allele, simultaneously labeling ECs with green fluorescent protein and resulting in decreased Tert and eNos levels. Histological and morphometric analyses of heart tissue sections prepared from these mice revealed cell death, microvascular rarefaction, and increased fibrosis in cardiac vessels. Accordingly, EC-specific
Nanog
-haploinsufficiency resulted in impaired EC homeostasis and angiogenesis. Conversely, re-expression of cDNA encoding the
hTERT
in Nanog-depleted ECs, in part, restored the effect of loss of Nanog.

Conclusions:
We showed that low-level Nanog expression is required for normal EC homeostasis and angiogenesis in adulthood.
Utility-Weighted Modified Rankin Scale Scores for the Assessment of Stroke Outcome
Authors: Wang Xia , Moullaali Tom J. , Li Qiang , Berge Eivind , Robinson Thompson G. , Lindley Richard , Zheng Danni , Delcourt Candice , Arima Hisatomi , Song Lili , Chen Xiaoying , Yang Jie , Chalmers John , Anderson Craig S. , Sandset Else Charlotte 
Published: July 2020

Background and Purpose:
Patient-centered care prioritizes patient beliefs and values towards wellbeing. We aimed to map functional status (modified Rankin Scale [mRS] scores) and health-related quality of life on the European Quality of Life 5-dimensional questionnaire (EQ-5D) to derive utility-weighted (UW) stroke outcome measures and test their statistical properties and construct validity.

Methods:
UW-mRS scores were derived using linear regression, with mRS as a discrete ordinal explanatory response variable in 8 large international acute stroke trials. Linear regression models were used to validate UW-mRS scores by assessing differences in mean UW-mRS scores between the treatment groups of each trial. To explore the variability in EQ-5D between individual mRS categories, we generated receiver operator characteristic curves for EQ-5D to differentiate between sequential mRS categories and misclassification matrix to classify individual patients into a matched mRS category based on the closest UW-mRS value to their observed individual EQ-5D value.

Results:
Among 22 946 acute stroke patients, derived UW-mRS across mRS scores 0 to 6 were 0.96, 0.83, 0.72, 0.54, 0.22, −0.18, and 0, respectively. Both UW-mRS and ordinal mRS scores captured divergent treatment effects across all 8 acute stroke trials. The sample sizes required to detect the treatment effects using UW-mRS scores as a continuous variable were almost half that required in trials for a binary cut point on the mRS. Area under receiver operator characteristic curves based on EQ-5D utility values varied from 0.66 to 0.81. Misclassification matrix showed moderate agreement between actual and matched mRS scores (kappa, 0.68 [95% CI, 0.67–0.68]).

Conclusions:
Medical strategies that target avoiding dependency may provide maximum benefit in terms of poststroke health-related quality of life. Despite variable differences with mRS scores, the UW-mRS provides efficiency gains as a smaller sample size is required to detect a treatment effect in acute stroke trials through use of continuous scores.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifiers: NCT00226096, NCT00716079, NCT01422616, NCT02162017, NCT00120003, NCT02123875. URL:
http://ctri.nic.in
; Unique identifier: CTRI/2013/04/003557. URL:
https://www.isrctn.com
; Unique identifier: ISRCTN89712435.
A unified approach for characterizing static/dynamic connectivity frequency profiles using filter banks
Authors: Faghiri Ashkan , Iraji Armin , Damaraju Eswar , Turner Jessica , Calhoun Vince D. 
Published: July 2020

Static and dynamic functional network connectivity (FNC) are typically studied separately, which makes us unable to see the full spectrum of connectivity in each analysis. Here, we propose an approach called filter-banked connectivity (FBC) to estimate connectivity while preserving its full frequency range and subsequently examine both static and dynamic connectivity in one unified approach.First, we demonstrate that FBC can estimate connectivity across multiple frequencies missed by a sliding-window approach. Next, we use FBC to estimate FNC in a resting-state fMRI dataset including schizophrenia patients (SZ) and typical controls (TC). The FBC results are clustered into different network states. Some states showed weak low-frequency strength and as such were not captured in the window-based approach. Additionally, we found that SZs tend to spend more time in states exhibiting higher frequencies compared with TCs who spent more time in lower frequency states. Finally, we show that FBC enables us to analyze static and dynamic connectivity in a unified way. In summary, FBC offers a novel way to unify static and dynamic connectivity analyses and can provide additional information about the frequency profile of connectivity patterns.
Forecasters’ Cognitive Task Analysis and Mental Workload Analysis of Issuing Probabilistic Hazard Information (PHI) during FACETs PHI Prototype Experiment
Authors: James Joseph J. J. , Ling Chen , Karstens Christopher D. , Jr. James Correia , Calhoun Kristin , Meyer Tiffany , LaDue Daphne 
Published: July 2020

AbstractDuring spring 2016 the Probabilistic Hazard Information (PHI) prototype experiment was run in the National Oceanic and Atmospheric Administration (NOAA) Hazardous Weather Testbed (HWT) as part of the Forecasting a Continuum of Environmental Threats (FACETS) program. Nine National Weather Service forecasters were trained to use the web-based PHI prototype tool to produce dynamic PHI for severe weather threats. Archived and real-time weather scenarios were used to test this new paradigm of issuing probabilistic information, rather than deterministic information. The forecasters’ mental workload was evaluated after each scenario using the NASA-Task Load Index (TLX) questionnaire. This study summarizes the analysis results of mental workload experienced by forecasters while using the PHI prototype. Six subdimensions of mental workload: mental demand, physical demand, temporal demand, performance, effort, and frustration were analyzed to derive top contributing factors to workload. Average mental workload was 46.6 (out of 100, standard deviation: 19, range 70.8). Top contributing factors to workload included using automated guidance, PHI object quantity, multiple displays, and formulating probabilities in the new paradigm. Automated guidance provided support to forecasters in maintaining situational awareness and managing increased quantities of threats. The results of this study provided understanding of forecasters’ mental workload and task strategies and developed insights to improve usability of the PHI prototype tool.