bluuebunny/crossref_metadata_2025_split huggingface dataset:
Central cardiovascular system limits to aerobic capacity
Authors: Joyner Michael J. , Dominelli Paolo B. 
Published: February 2020

New Findings
What is the topic of this review?The limits to maximal aerobic capacity.
What advances does it highlight?A synthesis of data and ideas about what limits maximal aerobic capacity demonstrates the central roles of cardiac output, stroke volume and red blood cell mass in the complex physiological responses to maximal exercise. In healthy humans these factors, along with skeletal muscle blood flow, dominate systemic delivery of oxygen to the contracting muscles and set the upper limit of aerobic energy production by skeletal muscles. In elite athletes and patients with pulmonary disease the lungs can also limit oxygen uptake and delivery.
AbstractIn this paper we review the physiological determinants of and discuss the role this variable plays as a determinant of endurance exercise performance. Because the ability to sustain a given pace during a competitive athletic event requires competitors to ‘manage’ fatigue and go as fast as possible without fatiguing prematurely, is one of the variables that sets the physiological upper limit for sustained energy production by the contracting skeletal muscles.
Reconstructing Tonian seawater 87Sr/86Sr using calcite microspar
Authors: Zhou Ying , Pogge von Strandmann Philip A.E. , Zhu Maoyan , Ling Hongfei , Manning Christina , Li Da , He Tianchen , Shields Graham A. 
Published: February 2020

Abstract
The Tonian Period followed a long interval of relative stasis and led into the climatic extremes and biological radiations of multicellular life during the Cryogenian and Ediacaran Periods, respectively. However, despite its pivotal situation, it remains relatively understudied, in large part due to the lack of robust age constraints. A combination of fossil evidence, radiometric ages, and isotopic constraints reveal that carbonate strata on the North China craton were deposited between ca. 980 and ca. 920 Ma, thereby filling a gap in marine archives. Here we present 87Sr/86Sr data from selected calcite microspar cements, which filled early diagenetic “molar tooth” cracks, along with data from demonstrably well-preserved bulk carbonate samples. These new data show that seawater 87Sr/87Sr rose in stages from ∼0.7052 at ca. 980 Ma to ∼0.7063 by ca. 920 Ma, after which a return to low values coincided with the eruption of the Dashigou large igneous province across the North China craton. We also present a new Neoproterozoic seawater 87Sr/86Sr curve, which reveals that the general trend toward higher 87Sr/87Sr during the Tonian Period was checked repeatedly by the input of less-radiogenic strontium from a series of eruptive events, both coincident with and prior to the main breakup of Rodinia. The weathering of Tonian volcanic provinces has been linked to higher carbon burial, glaciation, and oxygenation due to the high phosphorus content of flood basalts. Here we show that the weathering of major volcanic provinces affected material fluxes and ocean chemistry much earlier than previously envisaged.
The distance-quality trade-off in women’s choice of family planning provider in North Eastern Tanzania
Authors: Elewonibi Bilikisu , Sato Ryoko , Manongi Rachel , Msuya Sia , Shah Iqbal , Canning David 
Published: February 2020

IntroductionStudies on the determinants of contraceptive use often consider distance to the nearest health facility offering contraception as a key explanatory variable. Women, however, may not seek contraception from the nearest facility, rather opting for a more distant facility with better quality services or to ensure greater privacy and anonymity.MethodsThe dataset used include the name of facility where each women obtained contraception, measures of facility quality, and the distance between each woman’s home and 39 potential facilities she might visit. We use a conditional-multinomial logit model to estimate the determinants of her facility choice to visit and how women tradeoff travelling longer distances to use higher quality facilities.ResultsOnly 33% of woman who received contraception from a health facility used their nearest facility. While the nearest facility was 1.2 km away, the average distance to facility used was 2.9 km, indicating women are willing to travel significantly longer distances for higher quality. Women prefer facilities that specialise in providing contraception, provide a large range of methods, do not suffer from stock outs and do not charge fees. Furthermore, on average, women are willing to travel an additional 2 km for a facility that offers more family planning methods, 4.7 km for a facility without one additional health service, 9 km for a facility without fees for contraception and 11 km for a facility not experiencing stock out of an additional contraception.ConclusionOur results suggest that quality of services provided is an important driver of facility choice in addition to distance to facility.
Study protocol for efficacy and safety of steroid-containing mouthwash to prevent chemotherapy-induced stomatitis in women with breast cancer: a multicentre, open-label, randomised phase 2 study
Authors: Kuba Sayaka , Yamanouchi Kosho , Matsumoto Megumi , Maeda Shigeto , Hatachi Toshiko , Sakiko Soutome , Kawashita Yumiko , Morita Michi , Sakimura Chika , Inamasu Eiko , Shibata Kenichiro , Otsubo Ryota , Yano Hiroshi , Nose Seiichi , Miyamoto Junya , Sato Shuntaro , Kanetaka Kengo , Taniguchi Hideki , Umeda Masahiro , Nagayasu Takeshi , Eguchi Susumu 
Published: February 2020

IntroductionStomatitis is a frequent adverse event in patients undergoing chemotherapy for breast cancer. Stomatitis can hamper oral nutrition resulting in malnutrition, reduce quality of life and introduce the need for dose reductions and interruption of chemotherapy; however, there is currently no standard approach for preventing chemotherapy-induced stomatitis. We aimed to assess the safety and efficacy of a dexamethasone-based elixir mouthwash for preventing chemotherapy-induced stomatitis in patients with early breast cancer.Methods and analysisIn this multicenter, randomised, controlled phase 2 trial, we will randomly assign 120 women with early breast cancer undergoing chemotherapy to use of a dexamethasone-based elixir or standard oral care, to compare their preventive effects on chemotherapy-induced stomatitis. Patients will be assigned in a 1:1 ratio. Patients in the intervention group will receive chemotherapy, oral care and a dexamethasone-based elixir (10 mL 0.1 mg/mL; swish for 2 min and spit, four times daily for 9 weeks), and patients in the control group will receive chemotherapy and oral care. The primary endpoint is the difference in incidence of stomatitis between the two groups. The sample size allows for the detection of a minimum difference of 20% in the incidence of stomatitis between the two groups. Secondary endpoints are severity of stomatitis, duration of stomatitis, completion rate of chemotherapy and adverse events.Ethics and disseminationAll participants signed a written consent form, and the study protocol has been reviewed and approved by the Clinical Research Review Board of Nagasaki University (CRB7180001).Trial registration numberUMIN Clinical Trials Registry (UMIN000030489).
Effectiveness and cost of integrating a pragmatic pathway for prescribing liraglutide 3.0 mg in obesity services (STRIVE study): study protocol of an open-label, real-world, randomised, controlled trial
Authors: Papamargaritis Dimitris , Al-Najim Werd , Lim Jonathan , Crane James , Lean Mike , le Roux Carel , McGowan Barbara , O'Shea Donal , Webb David , Wilding John , Davies Melanie J 
Published: February 2020

IntroductionIn the UK and Ireland, severe and complex obesity is managed in specialist weight management services (SWMS), which provide multicomponent lifestyle interventions to support weight loss, and use of medication if available. Liraglutide 3 mg (LIRA 3 mg) is an effective weight-loss medication, but weight loss in individual patients is variable, and its efficacy has not been assessed in SWMS. This study aims to investigate whether a targeted prescribing pathway for LIRA 3 mg with multiple prespecified stopping rules could help people with severe obesity and established complications achieve ≥15% weight loss in order to determine whether this could be considered a clinically effective and cost-effective strategy for managing severe and complex obesity in SWMS.Methods and analysisIn this 2-year, multicentre, open-label, real-world randomised controlled trial, 384 adults with severe and complex obesity (defined as body mass index ≥35 kg/m2plus either prediabetes, type 2 diabetes, hypertension or sleep apnoea) will be randomised via a 2:1 ratio to receive either standard SWMS care (n=128) or standard SWMS care plus a targeted prescribing pathway for LIRA 3 mg with prespecified stopping rules at 16, 32 and 52 weeks (n=256).The primary outcome is to compare the proportion of participants achieving a weight loss of ≥15% at 52 weeks with a targeted prescribing pathway versus standard care. Secondary outcomes include a comparison of (1) the weight loss maintenance at 104 weeks and (2) the budget impact and cost effectiveness between the two groups in a real-world setting.Ethics and disseminationThe Health Research Authority and the Medicines and Healthcare products Regulatory Authority in UK, the Health Products Regulatory Authority in Ireland, the North West Deanery Research Ethics Committee (UK) and the St Vincent’s University Hospital European Research Ethics Committee (Ireland) have approved the study. The findings of the study will be published in peer-reviewed journals.Trial registration numberClinicalTrials.gov—Identifier:NCT03036800.European Clinical Trials Database—Identifier: EudraCT Number 2017-002998-20.
Individual participant data (IPD) meta-analysis of psychological relapse prevention interventions versus control for patients in remission from depression: a protocol
Authors: Breedvelt Josefien J F , Warren Fiona C , Brouwer Marlies E , Karyotaki Eirini , Kuyken Willem , Cuijpers Pim , van Oppen Patricia , Gilbody Simon , Bockting Claudi L H 
Published: February 2020

IntroductionPsychological interventions and antidepressant medication can be effective interventions to prevent depressive relapse for patients currently in remission of depression. Less is known about overall factors that predict or moderate treatment response for patients receiving a psychological intervention for recurrent depression. This is a protocol for an individual participant data (IPD) meta-analysis which aims to assess predictors and moderators of relapse or recurrence for patients currently in remission from depression.Methods and analysisSearches of PubMed, PsycINFO, Embase and Cochrane Central Register of Controlled Trials were completed on 13 October 2019. Study extractions and risk of bias assessments have been completed. Study authors will be asked to contribute IPD. Standard aggregate meta-analysis and IPD analysis will be conducted, and the outcomes will be compared with assess whether results differ between studies supplying data and those that did not. IPD files of individual data will be merged and variables homogenised where possible for consistency. IPD will be analysed via Cox regression and one and two-stage analyses will be conducted.Ethics and disseminationThe results will be published in peer review journals and shared in a policy briefing as well as accessible formats and shared with a range of stakeholders. The results will inform patients and clinicians and researchers about our current understanding of more personalised ways to prevent a depressive relapse. No local ethics approval was necessary following consultation with the legal department. Guidance on patient data storage and management will be adhered to.PROSPERO registration numberCRD42019127844.
Race-ethnic and gender differences in representation within the English National Health Service: a quantitative analysis
Authors: Milner Adrienne , Baker Elizabeth , Jeraj Samir , Butt Jabeer 
Published: February 2020

ObjectivesTo evaluate race-ethnic and gender disparities in National Health Service (NHS) England employment in position, prestige and pay.DesignNational study using data from NHS Digital.SettingTrusts and clinical commissioning groups in England.Participants1 105 390 NHS Hospital and Community Health Service staff.ResultsChinese people (42.9%, 95% CI 41.7% to 44.1%) are the most likely to be employed as doctors, followed by Asians (28.6%, 95% CI 28.3% to 28.8%) and people of mixed race/ethnicity (17.9%, 95% CI 17.3% to 18.4%); while white people (6.8%, 95% CI 6.7% to 6.8%) are less likely to be employed as doctors. However, white doctors are the most likely to be in the highest paid positions: 46.0% (95% CI 45.6% to 46.4%) of white doctors are consultants, whereas only 33.4% (95% CI 31.6% to 35.2%) of Chinese doctors are consultants. Black people are under-represented both among doctors and as consultants: 6.5% (95% CI 6.4% to 6.7%) of black employees are doctors and 30.6% (95% CI 29.2% to 32.0%) of black doctors are consultants. We found similar results for nurses and health visitors, where white people are over-represented in the higher pay bands. However, among support staff for doctors, nurses and midwives, we found that Chinese people were over-represented in the higher pay bands. These race-ethnic differences were similar for women and men. Additionally, we found that men were more likely to be employed in higher pay bands than women, and this gender disparity was apparent across race-ethnic groups.ConclusionsRace-ethnic and gender disparities exist in the NHS in position, prestige and pay. To begin to overcome such disparities, the NHS must collect data using consistent race-ethnic categories in order to examine differences over time.
Reproducible research practices, openness and transparency in health economic evaluations: study protocol for a cross-sectional comparative analysis
Authors: Catalá-López Ferrán , Caulley Lisa , Ridao Manuel , Hutton Brian , Husereau Don , Drummond Michael F , Alonso-Arroyo Adolfo , Pardo-Fernández Manuel , Bernal-Delgado Enrique , Meneu Ricard , Tabarés-Seisdedos Rafael , Repullo José Ramón , Moher David 
Published: February 2020

IntroductionThere has been a growing awareness of the need for rigorously and transparent reported health research, to ensure the reproducibility of studies by future researchers. Health economic evaluations, the comparative analysis of alternative interventions in terms of their costs and consequences, have been promoted as an important tool to inform decision-making. The objective of this study will be to investigate the extent to which articles of economic evaluations of healthcare interventions indexed in MEDLINE incorporate research practices that promote transparency, openness and reproducibility.Methods and analysisThis is the study protocol for a cross-sectional comparative analysis. We registered the study protocol within the Open Science Framework (osf.io/gzaxr). We will evaluate a random sample of 600 cost-effectiveness analysis publications, a specific form of health economic evaluations, indexed in MEDLINE during 2012 (n=200), 2019 (n=200) and 2022 (n=200). We will include published papers written in English reporting an incremental cost-effectiveness ratio in terms of costs per life years gained, quality-adjusted life years and/or disability-adjusted life years. Screening and selection of articles will be conducted by at least two researchers. Reproducible research practices, openness and transparency in each article will be extracted using a standardised data extraction form by multiple researchers, with a 33% random sample (n=200) extracted in duplicate. Information on general, methodological and reproducibility items will be reported, stratified by year, citation of the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement and journal. Risk ratios with 95% CIs will be calculated to represent changes in reporting between 2012–2019 and 2019–2022.Ethics and disseminationDue to the nature of the proposed study, no ethical approval will be required. All data will be deposited in a cross-disciplinary public repository. It is anticipated the study findings could be relevant to a variety of audiences. Study findings will be disseminated at scientific conferences and published in peer-reviewed journals.
Time to recovery from severe acute malnutrition and its predictors: a multicentre retrospective follow-up study in Amhara region, north-west Ethiopia
Authors: Baraki Adhanom Gebreegziabher , Akalu Temesgen Yihunie , Wolde Haileab Fekadu , Takele Wubet Worku , Mamo Worku Nigussu , Derseh Behailu , Desyibelew Hanna Demelash , Dadi Abel Fekadu 
Published: February 2020

ObjectivesThis study aimed to determine the time to recovery from severe acute malnutrition (SAM) and its predictors in selected public health institutions in Amhara Regional State, Ethiopia.DesignAn institution-based retrospective follow-up study was conducted using data extracted from 1690 patient cards from September 2012 to November 2016.SettingSelected government health institutions in the Amhara region, Ethiopia.ParticipantsChildren treated in therapeutic feeding units for SAM were included.Outcome measuresTime to recovery from SAM.ResultsOne thousand and fifty children have recovered from SAM, 62.13% (95% CI 59.8% to 64.5%). The median time to recovery was 16 days (IQR=11–28). Female gender (adjusted HR (AHR)=0.81, 95% CI 0.67 to 0.98), oedematous malnutrition (AHR=0.74 95% CI 0.59 to 0.93), pneumonia (AHR=0.66, 95% CI 0.53 to 0.83), tuberculosis (AHR=0.53, 95% CI 0.36 to 0.77), HIV/AIDS (AHR=0.47, 95% CI 0.28 to 0.79), anaemia (AHR=0.73, 95% CI 0.60 to 0.89) and receiving vitamin A (AHR=1.43, 95% CI 1.12 to 1.82) were notably associated with time to recovery.ConclusionsThe time to recovery in this study was acceptable but the proportion of recovery was far below the minimum standard. Special emphasis should be given to the prevention and treatment of comorbidities besides the therapeutic feeding. Supplementing vitamin A would also help to improve the recovery rate.
Psychometric properties of the Georgian version of the Safety Attitudes Questionnaire: a cross-sectional study
Authors: Gambashidze Nikoloz , Hammer Antje , Ernstmann Nicole , Manser Tanja 
Published: February 2020

ObjectiveTo study the psychometric properties of the Georgian version of the Safety Attitudes Questionnaire short version.DesignCross-sectional study.SettingThree Georgian hospitals.ParticipantsPersonnel of participating hospitals (n=305 responses, estimated response rate 30%).InterventionsNone.Primary and secondary outcome measuresPsychometric properties (model fit, internal consistency, construct validity, convergent and discriminant validity) of the instrument, factor structure derived from the data.ResultsThe Georgian version of Safety Attitudes Questionnaire demonstrated acceptable construct validity and internal consistency (Cronbach’s alpha 0.61–0.91). Three factors, Teamwork Climate, Safety Climate and Working Conditions, had limited convergent and discriminant validity. Confirmatory factor analysis with the original six-factor model resulted in limited model fit (χ2/df=2.14, root mean square error of approximation (RMSEA)=0.06, goodness of fit index (GFI)=0.83, CFI=0.88, TLI=0.86). Exploratory factor analysis resulted in a modified four-factor model with satisfactory model fit (χ2/df=2.09, RMSEA=0.06, GFI=0.88, CFI=0.93, TLI=0.91).ConclusionsThe Georgian version of the Safety Attitudes Questionnaire (short version) demonstrated acceptable psychometric properties, with acceptable to good internal consistency and construct validity. While the whole model had limited fit to the data, a modified factor model resulted in good model fit. Our findings suggest the dimension Working Conditions has questionable psychometric properties and should be interpreted with caution. Other two correlated dimensions Teamwork Climate and Safety Climate share considerable variance and may be merged. Overall, the instrument can provide valuable information relevant for advancement of patient safety culture in Georgian hospitals.
Assessment of staffing needs for physicians and nurses at Upazila health complexes in Bangladesh using WHO workload indicators of staffing need (WISN) method
Authors: Joarder Taufique , Tune Samiun Nazrin Bente Kamal , Nuruzzaman Md , Alam Sabina , de Oliveira Cruz Valeria , Zapata Tomas 
Published: February 2020

ObjectiveThis study aimed to assess the current workload and staffing need of physicians and nurses for delivering optimum healthcare services at the Upazila Health Complexes (UpHCs) in Bangladesh.DesignMixed-methods, combining qualitative (eg, document reviews, key informant interviews, in-depth interviews, observations) and quantitative methods (time-motion survey).SettingStudy was conducted in 24 health facilities of Bangladesh. However, UpHCs being the nucleus of primary healthcare in Bangladesh, this manuscript limits itself to reporting the findings from the providers at four UpHCs under this project.Participants18 physicians and 51 nurses, males and females.Primary outcome measuresWorkload components were defined based on inputs from five experts, refined by nine service providers. Using WHO Workload Indicator of Staffing Need (WISN) software, standard workload, category allowance factor, individual allowance factor, total required number of staff, WISN difference and WISN ratio were calculated.ResultsPhysicians have very high (WISN ratio 0.43) and nurse high (WISN ratio 0.69) workload pressure. 50% of nurses’ time are occupied with support activities, instead of nursing care. There are different workloads among the same staff category in different health facilities. If only the vacant posts are filled, the workload is reduced. In fact, sanctioned number of physicians and nurses is more than actual need.ConclusionsIt is evident that high workload pressures prevail for physicians and nurses at the UpHCs. This reveals high demand for these health workforces in the respective subdistricts. WISN method can aid the policy-makers in optimising utilisation of existing human resources. Therefore, the government should adopt flexible health workforce planning and recruitment policy to manage the patient load and disease burden. WISN should, thus, be incorporated as a planning tool for health managers. There should be a regular review of health workforce management decisions, and these should be amended based on periodic reviews.