bluuebunny/crossref_metadata_2025_split huggingface dataset:
The final reason paediatric Cardiac ICU patients require care prior to discharge to the floor: a single-centre survey
Authors: Winder Melissa M. , Ou Zhining , Presson Angela P. , Witte Madolin K. , Ware Adam L. , Marietta Jennifer , Ward J.J. , Bailly David K. 
Published: June 2020

AbstractObjective:To determine the Final ICU Need in the 24 hours prior to ICU discharge for children with cardiac disease by utilising a single-centre survey.Methods:A cross-sectional survey was utilised to determine Final ICU Need, which was categorised as “Cardiovascular”, “Respiratory”, “Feeding”, “Sedation”, “Systems Issue”, or “Other” for each encounter. Survey responses were obtained from attending physicians who discharged children (≤18 years of age with ICU length of stay >24 hours) from the Cardiac ICU between April 2016 and July 2018.Measurements and results:Survey response rate was 99% (n = 1073), with 667 encounters eligible for analysis. “Cardiovascular” (61%) and “Respiratory” (26%) were the most frequently chosen Final ICU Needs. From a multivariable mixed effects logistic regression model fitted to “Cardiovascular” and “Respiratory”, operations with significantly reduced odds of having “Cardiovascular” Final ICU Need included Glenn palliation (p = 0.003), total anomalous pulmonary venous connection repair (p = 0.024), truncus arteriosus repair (p = 0.044), and vascular ring repair (p < 0.001). Short lengths of stay (<7.9 days) had significantly higher odds of “Cardiovascular” Final ICU Need (p < 0.001). “Cardiovascular” and “Respiratory” Final ICU Needs were also associated with provider and ICU discharge season.Conclusions:Final ICU Need is a novel metric to identify variations in Cardiac ICU utilisation and clinical trajectories. Final ICU Need was significantly influenced by benchmark operation, length of stay, provider, and season. Future applications of Final ICU Need include targeting quality and research initiatives, calibrating provider and family expectations, and identifying provider-level variability in care processes and mental models.
Health-related quality of life in adult CHD surgical patients in a low middle-income country: a mixed-methods study
Authors: Ladak Laila A. , Gallagher Robyn , Hasan Babar S. , Awais Khadija , Abdullah Ahmed , Gullick Janice 
Published: June 2020

AbstractBackground and objectives:This mixed-methods study aimed to assess health-related quality of life in young adults with CHD following surgery in a low middle-income country, Pakistan. Despite the knowledge that geographic, cultural and socio-economic factors may shape the way health and illness is experienced and managed and consequently determine a person’s health-related quality of life, few health-related quality of life studies are conducted in low middle-income countries. This deficit is pronounced in CHD, so there is little guidance for patient care.Methods:The study utilised concurrent, mixed methods. Adults with CHD (n = 59) completed health-related quality of life surveys (PedsQLTM4.0 Generic Core Scale, PedsQLTMCognitive Functioning Scale and PedsQLTM3.0 Cardiac Module). Semi-structured interview data were collected from a nested sub-sample of 17 participants and analysed using qualitative content analysis, guided by the revised Wilson–Cleary model of health-related quality of life.Results:The lowest health-related quality of life domain was emotional with the mean score (71.61 ± 20.6), followed by physical (78.81 ± 21.18) and heart problem (79.41 ± 18.05). There was no statistical difference in general or cardiac-specific health-related quality of life between mild, moderate or complex CHD. Qualitative findings suggested low health-related quality of life arose from a reduced capacity to contribute to family life including family income and gender. A sense of reduced marriageability and fear of dependency were important socio-cultural considerations.Conclusions:CHD surgical patients in this low-income country experience poor health-related quality of life, and contributing factors differ to those reported for high-income countries. Socio-cultural understandings should underpin assessment, management and care-partnering with young adults with CHD following surgical correction.
The aortic arch in tetralogy of Fallot: types of branching and clinical implications
Authors: Prabhu Sudesh , Kasturi Srikanth , Mehra Siddhant , Tiwari Rishi , Joshi Abhijit , John Colin , Karl Tom R. 
Published: June 2020

AbstractIntroduction:Tetralogy of Fallot is the most common form of cyanotic CHD, with an incidence of 421 cases per million live births, constituting around 10% of CHD. Variations in aortic arch anatomy associated with tetralogy of Fallot, other than the incidence of right aortic arch (13–34%), are not frequently reported. A comprehensive analysis of a large number of tetralogy of Fallot cases is required to arrive at a compendious description of aortic arch anatomy.Materials and methods:All patients with a diagnosis of tetralogy of Fallot who had CT or MRI either pre or post procedures between 1 January 2010 and 31 December 2019 at our hospital were included in the study. Using radiology consultants’ reports and analysis of individual images, we identified the various morphological patterns of aortic arches prevalent in these patients.Result:Out of 2684 patients who met the inclusion criteria, 1983 patients had left aortic arch (73.9%), 688 patients had right aortic arch (25.7%), four patients had cervical aortic arch (0.15%), eight patients had double aortic arch (0.3%), one patient had an aorto-pulmonary window (0.04%), and none of the patients had interrupted aortic arch. Sub-classification and clinical implications of the arch variations are described.Conclusion:Up to 10% of tetralogy of Fallot patients may have significant anatomical variations of aortic arch that would necessitate changes or additional steps in their surgical or interventional procedures.
Effects of inhaled nitric oxide on haemodynamics and gas exchange in children after having undergone cardiac surgery utilising cardiopulmonary bypass
Authors: Villarreal Enrique G. , Aiello Salvatore , Evey Lee W. , Flores Saul , Loomba Rohit S. 
Published: June 2020

AbstractIntroduction:For CHD patients undergoing corrective surgery utilising cardiopulmonary bypass, post-operative inhaled nitric oxide has been administered to alleviate pulmonary hypertension. We performed a systematic review and meta-analyses to determine the effect of inhaled nitric oxide on haemodynamics, gas exchange, and hospitalisation characteristics in children immediately after cardiopulmonary bypass.Materials and methods:A systematic review of the literature was performed to identify full-text manuscripts in English. PubMed, EMBASE, and the Cochrane databases were queried. Once manuscripts were identified for inclusion, a list of all the endpoints in each manuscript was created. Endpoints with data present from two or more studies were then kept for pooled analyses. All endpoints included were continuous variables and so mean and standard deviation were utilised as the effect data for comparison.Results:A total of eight studies were deemed appropriate for inclusion. There were significant differences with decreases in mean pulmonary artery pressure of −6.82 mmHg, left atrial pressure of −1.16 mmHg, arteriovenous oxygen difference of −1.63, arterial carbon dioxide concentration of −2.41 mmHg, mechanical ventilation duration of −8.56 hours, and length of cardiac ICU stay duration of −0.91 days. All significant variables achieved p < 0.001.Conclusion:Inhaled nitric oxide in children immediately after cardiopulmonary bypass decreases mean pulmonary artery pressure significantly and decreases the arterial carbon dioxide concentration significantly without significantly altering other haemodynamic parameters. This results in a statistically shorter duration of mechanical ventilation and cardiac ICU length of stay without altering overall hospital length of stay.
Deficit schizophrenia and its features are associated with PON1 Q192R genotypes and lowered paraoxonase 1 (PON1) enzymatic activity: effects on bacterial translocation
Authors: Matsumoto Andressa K. , Maes Michael , Supasitthumrong Thitiporn , Maes Annabel , Michelin Ana P. , de Oliveira Semeão Laura , de Lima Pedrão João V. , Moreira Estefania G. , Kanchanatawan Buranee , Barbosa Decio S. 
Published: June 2020

AbstractBackgroundPrimary deficit schizophrenia (DS) is characterized by enduring negative symptoms and represents a qualitatively different disease entity with respect to non-deficit schizophrenia (NDS). No studies investigated the association between the enzyme paraoxonase 1 (PON1) and DS and its phenomenology.MethodsIn this case-control study, Thai women and men, aged 18 to 65 years, were divided in DS (n = 40) and NDS (n = 40) and were compared to controls (n = 40). PON1 activities against 4-(chloromethyl)phenyl acetate (CMPA) and phenylacetate were determined. Moreover, subjects were genotyped for their PON1 Q192R polymorphism and immunoglobulin A (IgA) levels responses directed to Gram-negative bacteria were measured.ResultsDS is significantly associated with the QQ genotype and the Q allele as compared with NDS and controls. PON1 activities are significantly and inversely associated with negative symptoms, formal thought disorders, psychomotor retardation, excitation and DS. The presence of the Q allele is associated with increased IgA responses toPseudomonas aeruginosa, Morganella morganii,andPseudomonas putidaas compared with RR carriers.ConclusionsThe PON1 Q allele and lower PON1 activities especially against CMPA are associated with DS, indicating lowered quorum quenching abilities as well as lowered defenses against lipoperoxidation and immune activation. It is suggested that lowered PON1 activity in DS constitutes an impairment in the innate immune system which together with lowered natural IgM may cause lower immune regulation thereby predisposing toward greater neurotoxic effects of immune-inflammatory, oxidative and nitrosative pathways and Gram-negative microbiota.
Health care cost of overweight-related diseases in Bangladesh
Authors: Hoque Mohammad E , Molla Azaher A , Hoque Dewan ME , Long Kurt Z , Mamun Abdullah A 
Published: June 2020

AbstractObjective:To estimate the economic burden of overweight in Bangladesh.Design:We used data from Household Income and Expenditure Survey, 2010. A prevalence-based approach was used to calculate the population attributable fraction (PAF) for diseases attributable to overweight. Cost of illness methodology was used to calculate annual out of pocket (OOP) expenditure for each disease using nationally representative survey data. The cost attributable to overweight for each disease was estimated by multiplying the PAF by annual OOP expenditure. The total cost of overweight was estimated by adding PAF-weighted costs of treating the diseases.Setting:Nationwide, covering the whole of Bangladesh.Participants:Individuals whose BMI ≥ 25 kg/m2.Results:The total cost attributable to overweight in Bangladesh in 2010 was estimated at US$147·38 million. This represented about 0·13 % of Bangladesh’s Gross Domestic Product and 3·69 % of total health care expenditure in 2010. The sensitivity analysis revealed that the total cost could be as high as US$334 million or as low as US$71 million.Conclusions:A substantial amount of health care resource is devoted to the treatment of overweight-related diseases in Bangladesh. Effective national strategies for overweight prevention programme should be established and implemented.
An evaluation of the clinical microsystems approach in general practice quality improvement
Authors: Abrahamson Vanessa , Jaswal Sabrena , Wilson Patricia M. 
Published: June 2020

AbstractBackground:Changes to the general practice (GP) contract in England (April 2019) introduced a new quality improvement (QI) domain. The clinical microsystems programme is an approach to QI with limited evidence in primary care.Aim:To explore experiences of GP staff participating in a clinical microsystems programme.Design and setting:GPs within one clinical commissioning group (CCG) in South East England. Normalisation process theory informed qualitative approach.Method:Review of all CCG clinical microsystems projects using pre-existing data. The Diffusion of Innovation Cycle was used to inform the sampling frame and GPs were invited to participate in interviews or focus groups. Ten practices participated; 11 coaches and 16 staff were interviewed.Results:The majority of projects wereprocess-drivenactivities related to administrative systems. Projects directly related tohealth outputswere fewer and related to externally imposed targets. Four key elements facilitated practices to engage: feeling in control; receiving enhanced service payment; having a senior staff member championing the approach; and good practice–coach relationship. There appeared to be three key benefits in addition to project-specific ones: improved working relationships between CCG and practice; more cohesive practice team; and time to reflect.Conclusion:Small projects with clear parameters were more successful than larger ones or those spanning organisations. However, there was little evidence suggesting the key benefits were unique attributes of the microsystems approach and sustainability was problematic. Future research should focus on cross-organisational approaches to QI and identify what, if any, added value the approach provides.
Artificial versus biological intelligence in the Cosmos: clues from a stochastic analysis of the Drake equation
Authors: De Visscher Alex 
Published: June 2020

AbstractThe Drake equation has been used many times to estimate the number of observable civilizations in the galaxy. However, the uncertainty of the outcome is so great that any individual result is of limited use, as predictions can range from a handful of observable civilizations in the observable universe to tens of millions per Milky Way-sized galaxy. A statistical investigation shows that the Drake equation, despite its uncertainties, delivers robust predictions of the likelihood that the prevalent form of intelligence in the universe is artificial rather than biological. The likelihood of artificial intelligence far exceeds the likelihood of biological intelligence in all cases investigated. This conclusion is contingent upon a limited number of plausible assumptions. The significance of this outcome for the Fermi paradox is discussed.
Goals of care and COVID-19: A GOOD framework for dealing with uncertainty
Authors: Petriceks Aldis H. , Schwartz Andrea Wershof 
Published: June 2020

AbstractAs the COVID-19 pandemic continues, more patients will require palliative and end-of-life care. In order to ensure goal-concordant-care when possible, clinicians should initiate goals-of-care conversations among our most vulnerable patients and, ideally, among all patients. However, many non-palliative care clinicians face deep uncertainty in planning, conducting, and evaluating such interactions. We believe that specialists within palliative care are aptly positioned to address such uncertainties, and in this article offer a relevant update to a concise framework for clinicians to plan, conduct, and evaluate goals-of-care conversations: the GOOD framework. Once familiar with this framework, palliative care clinicians may use it to educate their non-palliative care colleagues about a timely and critical component of care, now and beyond the COVID-19 era.
Hurricane or fresh breeze? Disentangling the populist effect on the quality of democracy
Authors: Juon Andreas , Bochsler Daniel 
Published: June 2020

AbstractAre populist actors more like a hurricane that risks undermining democracy? Or do they aim for a different type of democracy, which strengthens popular control? This article offers one of the most extensive, systematic analyses on the impact of populism on multiple functions of the Quality of Democracy. Going beyond the view of ‘high-’ or ‘low-quality’ democracies, we emphasize that the Quality of Democracy is related to multiple dimensions or ‘functions of democracy’, characterized by important trade-offs. We argue that populist actors exert differentiated effects across these functions, depending on their degree of government access and host ideology. Our analysis relies on a new disaggregated dataset covering 53 established democracies in diverse world regions over the period between 1990 and 2016. We find that populist actors increase participation and representation, especially if they are confined to the opposition and especially if they belong to the political left-wing. In contrast, we find a negative impact of populists across the spectrum on institutional safeguards, such as the rule of law and state transparency. In sum, our findings indicate that populism has a variable impact on multiple aspects of democratic quality which should be systematically investigated in a disaggregated manner that is sensitive to these differences.
Intermittent explosive disorder subtypes in the general population: association with comorbidity, impairment and suicidality
Authors: Scott K. M. , de Vries Y. A. , Aguilar-Gaxiola S. , Al-Hamzawi A. , Alonso J. , Bromet E. J. , Bunting B. , Caldas-de-Almeida J. M. , Cía A. , Florescu S. , Gureje O. , Hu C-Y. , Karam E. G. , Karam A. , Kawakami N. , Kessler R. C. , Lee S. , McGrath J. , Oladeji B. , Posada-Villa J. , Stein D. J. , Zarkov Z. , de Jonge P. 
Published: June 2020

Abstract

Aims
Intermittent explosive disorder (IED) is characterised by impulsive anger attacks that vary greatly across individuals in severity and consequence. Understanding IED subtypes has been limited by lack of large, general population datasets including assessment of IED. Using the 17-country World Mental Health surveys dataset, this study examined whether behavioural subtypes of IED are associated with differing patterns of comorbidity, suicidality and functional impairment.

Methods
IED was assessed using the Composite International Diagnostic Interview in the World Mental Health surveys (n = 45 266). Five behavioural subtypes were created based on type of anger attack. Logistic regression assessed association of these subtypes with lifetime comorbidity, lifetime suicidality and 12-month functional impairment.

Results
The lifetime prevalence of IED in all countries was 0.8% (s.e.: 0.0). The two subtypes involving anger attacks that harmed people (‘hurt people only’ and ‘destroy property and hurt people’), collectively comprising 73% of those with IED, were characterised by high rates of externalising comorbid disorders. The remaining three subtypes involving anger attacks that destroyed property only, destroyed property and threatened people, and threatened people only, were characterised by higher rates of internalising than externalising comorbid disorders. Suicidal behaviour did not vary across the five behavioural subtypes but was higher among those with (v. those without) comorbid disorders, and among those who perpetrated more violent assaults.

Conclusions
The most common IED behavioural subtypes in these general population samples are associated with high rates of externalising disorders. This contrasts with the findings from clinical studies of IED, which observe a preponderance of internalising disorder comorbidity. This disparity in findings across population and clinical studies, together with the marked heterogeneity that characterises the diagnostic entity of IED, suggests that it is a disorder that requires much greater research.
Structural and Geophysical Characterization of the Western Termination of the South Pyrenean Triangle Zone
Authors: Santolaria P. , Ayala C. , Pueyo E. L. , Rubio F. M. , Soto R. , Calvín P. , Luzón A. , Rodríguez‐Pintó A. , Oliván C. , Casas‐Sainz A. M. 
Published: June 2020

AbstractThe South Pyrenean triangle zone represents the southernmost front of the Pyrenees at its central portion deforming the Upper Eocene‐Miocene Ebro Basin deposits. Two main structures characterize its western termination, the Barbastro anticline and the San Román backthrust, which detached on the Barbastro Formation (and lateral equivalents), an Upper Eocene‐Lower Oligocene syntectonic evaporite‐rich formation that acted as a multidetachment unit. Northward, the south directed Pyrenean thrust unit (i.e., Gavarnie‐Sierras thrust sheet) detached along the Middle‐Upper Triassic evaporitic rocks to finally ramp up and glide along the same Upper Eocene‐Lower Oligocene multidetachment unit. A multidisciplinary approach allowed constructing a detailed structural and stratigraphic model of the study area. The workflow consisted of (1) constraining the geometry and structural architecture based on surface geology, interpretation of seismic lines (>900 km), and wells and (2) obtaining the 3‐D density distribution of the multidetachment unit using gravity stochastic inversion (more than 7,000 gravity stations and 1,500 density data). The geometry of the sole thrust of the Gavarnie‐Sierras thrust sheet was controlled by the distribution of the evaporite‐rich units of the Barbastro Fm. Weak detachments promoted thrust salient formation and thrust flat geometries. The western termination of the South Pyrenean triangle zone is defined as a westward transition from a ramp‐dominated and multiple triangle zone to a detachment‐dominated one. Its geometry, kinematics, and location were controlled by the heterogeneous lithology of the Barbastro Fm. and its basal, halite‐based detachment southern pinch‐out.
The Evolving Paleobathymetry of the Circum‐Antarctic Southern Ocean Since 34 Ma: A Key to Understanding Past Cryosphere‐Ocean Developments
Authors: Hochmuth K. , Gohl K. , Leitchenkov G. , Sauermilch I. , Whittaker J. M. , Uenzelmann‐Neben G. , Davy B. , De Santis L. 
Published: June 2020

AbstractThe Southern Ocean is a key player in the climate, ocean, and atmospheric system. As the only direct connection between all three major oceans since the opening of the Southern Ocean gateways, the development of the Southern Ocean and its relationship with the Antarctic cryosphere has influenced the climate of the entire planet. Although the depths of the ocean floor have been recognized as an important factor in climate and paleoclimate models, appropriate paleobathymetric models including a detailed analysis of the sediment cover are not available. Here we utilize more than 40 years of seismic reflection data acquisition along the margins of Antarctica and its conjugate margins, along with multiple drilling campaigns by the International Ocean Discovery Program (IODP) and its predecessor programs. We combine and update the seismic stratigraphy across the regions of the Southern Ocean and calculate ocean‐wide paleobathymetry grids via a backstripping method. We present a suite of high‐resolution paleobathymetric grids from the Eocene‐Oligocene Boundary to modern times. The grids reveal the development of the Southern Ocean from isolated basins to an interconnected ocean affected by the onset and vigor of an Antarctic Circumpolar Current, as well as the glacial sedimentation and erosion of the Antarctic continent. The ocean‐wide comparison through time exposes patterns of ice sheet development such as switching of glacial outlets and the change from wet‐based to dry‐based ice sheets. Ocean currents and bottom‐water production interact with the sedimentation along the continental shelf and slope and profit from the opening of the ocean gateways.