bluuebunny/crossref_metadata_2025_split huggingface dataset:
A multidisciplinary community level approach to improving quality in early years’ settings
Authors: Buckley Lynn , Martin Shirley , Curtin Margaret 
Published: September 2020

This paper explores the processes involved in developing, embedding and sustaining an ECCE practitioner capacity building programme in the community through an interagency approach, which utilises mentoring and coaching strategies for increased knowledge and skills uptake. There is now conclusive international evidence that early childhood care and education (ECCE) is vital in children’s learning and development, and that the benefits are long-lasting, and are more cost-effective than educational investments and remedial interventions later in life. This signifies the importance of high quality ECCE for development and learning, and highlights the potential impact of early childhood intervention programmes. This paper explores the implementation of a quality improvement strategy in seven ECCE centres to improve child-outcomes as part of the Young Knocknaheeny Area Based Childhood Programme (YK). Utilising evidence-based programmes, practitioners from a range of disciplines, working in a low-income community with high levels of adversity, are immersed in an environment of continuous learning in line with best practice implementation science. The core elements of the quality improvement strategy focused on language supports for staff (Hanen Learning Language and Loving It™ training), curriculum enhancement ( HighScope curriculum training), onsite mentoring for staff, and an Environment Enhancement Fund for each centre. The implementation of a Mentoring Programme involved weekly site visits by a specialist onsite mentor in which the implementation of curriculum content and the suggested environmental changes and teaching strategies were overseen and supported. Pre and post Environmental Rating Scale (ERS) assessments; ITERS-R (crèche) and ECERS-3 (pre-school); showed significant improvements in the quality of ECCE services in the YK catchment area following ECCE practitioners participation in the quality improvement initiative. Pre-school rooms across the seven ECCE centres experienced an overall improvement of +2.5 on the ERS scales, and crèche rooms experienced an overall improvement of +2.4. Approximately 700 children aged 1 to 5 years indirectly benefitted from YK-delivered curriculum and language training programmes in their ECCE settings.
Weight Gain, Energy Intake, Energy Expenditure, and Immunosuppressive Therapy in Kidney Transplant Recipients
Authors: Taşdemir Deniz , Aksoy Nilgün 
Published: September 2020

Background: Weight gain after kidney transplantation is a common health problem. The factors in weight gain after kidney transplant include many factors such as age, ethnicity, gender, change in lifestyle (eg, kilocalorie intake and physical activity level), and immunosuppressive therapy. Research Questions: This study aimed to evaluate the relationship between weight gain and energy intake in dietary, energy expenditure in physical activity, and immunosuppressive therapy in kidney transplant recipients. Design: This prospective, observational study included 51 participants who underwent kidney transplant, during 6 months from the start of the study. Anthropometric measurements were performed at first week, third- and sixth-month follow-ups of transplant recipients. Participants also completed 3-day “Dietary Record Form” and the “Physical Activity Record Form” at each follow-up. Simple frequency, analysis of variance analysis, and correlation analysis were used for data analysis. Results: Weight gain in sixth month follow-up compared to baseline value was positively related to energy intake in first week (r = 0.59), third month (r = 0.75), and sixth month (r = 0.67) follow-ups, and energy expenditure in first week (r = 0.35) and sixth month (r = 0.34) follow-ups. However, weight gain was negatively related to mycophenolate mofetil dose (mg/d) in sixth month (r = −0.31) follow-up ( P < .05). Discussion: The results of this study provide an opportunity to reflect and discuss on modifiable risk factors such as energy intake and energy expenditure that affect weight gain posttransplantation in participants. It also examines the relationship between immunosuppressive therapy. Additionally, these results can be effective in designing interventions and managing risk factors to achieve weight management goals.
A Single-Center Assessment of Delayed Graft Function in Recipients of Simultaneous Liver and Kidney Transplant
Authors: Aziz Fahad , Gardezi Ali , Muth Brenda , Blazel Justin , Garg Neetika , Mohammed Maha , Mezrich Joshua , Djamali Arjang , Mandelbrot Didier , Parajuli Sandesh 
Published: September 2020

Background: The effects of delayed graft function on long-term kidney allograft outcomes are poorly defined among simultaneous liver and kidney transplant recipients. Methods: We analyzed data of all simultaneous liver and kidney recipients transplanted at the University of Wisconsin between 2010 and 2017. Risk factors for the development of delayed graft function, kidney graft failure, and patient mortality were outcomes of interest. Results: There were a total of 60 simultaneous liver and kidney recipients; 28 (47%) had delayed graft function. After adjustment for multiple variables, we found that pretransplant dialysis >6 weeks (hazard ratio [HR] = 5.6, 95% CI: 1.23-25.59, P = .02), pretransplant albumin <3 g/dL (HR = 5.75, 95% CI: 1.76-16.94, P = .003), and presence of pretransplant diabetes (HR = 2.5, 95% CI: 0.97-4.77, P = .05) were significantly associated with delayed graft function. Multivariate analysis showed that pretransplant albumin <3 (HR = 4.86, 95% CI: 1.07-22.02, P = .02) was associated with a higher risk of all-cause kidney allograft failure, whereas the duration of delayed graft function (HR = 1.07 per day, 95% CI: 1.01-1.14, P = .01) was associated with a higher risk of death-censored kidney allograft failure. The presence of delayed graft function was not associated with all-cause or death-censored kidney or liver allograft failure. Similarly, the presence of delayed graft function was not associated with patient mortality. Conclusion: The incidence of delayed graft function was high in simultaneous liver and kidney recipients. However, with appropriate management, delayed graft function may not have a negative impact on patient or kidney allograft survival.
State of the Science of Palliative Care in Solid Organ Transplantation
Authors: Gustafson Carolina , Song Mi-Kyung 
Published: September 2020

Introduction: Both solid organ transplant candidates and recipients and their family caregivers have complex care needs and may benefit from palliative care. But palliative care is not often considered as part of transplant care despite palliative care being promoted as an important component of transplant care both before and after solid organ transplantation. Further, the current state of the science of palliative care in solid organ transplantation has not been well-documented. Objective: To describe the state of the science of palliative care in solid organ transplant and identify gaps in the literature. Methods: Four electronic databases were searched using controlled vocabulary words and synonymous free text to find articles on palliative care and solid organ transplant. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist were also used. Results: Twenty articles were included in the final review for synthesis, 18 of which involved transplants for adults only. Twelve articles described palliative care for patients before transplant, four articles examined palliative care for patients after transplant, primarily at the end-of-life, and four articles described transplant provider perspectives on palliative care. The reviewed evidence suggested that patients could be benefited by palliative care both pre and posttransplant, particularly for symptom management and advance care planning and that transplant providers faced many barriers to implementing palliative care in practice. Discussion: There is limited research on palliative care following solid organ transplantation, particularly outside of hospice care. Much of the prior research on this topic has described adult patients.
Long-term follow-up results of the SMART coil in the endovascular treatment of intracranial aneurysms
Authors: McAvoy Malia B , Cappuzzo Justin M , Stapleton Christopher J , Koch Matthew J , Raymond Scott B , Torok Collin M , Patel Aman B 
Published: September 2020

Background The Penumbra SMART coil is a novel device that becomes progressively softer from its distal to proximal end to maximize coil packing and prevent microcatheter prolapse or coil migration. Here, we report a large series of patients detailing the long-term experience of a single institution using the SMART coil among patients with intracranial aneurysms (IAs). Methods Prospective data of 105 consecutive patients with 106 IAs treated using SMART coils was collected between March 2015 and July 2018. Clinical and angiographic data were analyzed. Results Forty-nine patients (46.7%) presented with subarachnoid hemorrhage and 16 (14.2%) had recurrent aneurysms. Two patients had minor intraprocedural ruptures and remained neurologically stable. One patient had a thromboembolic complication with progressive neurologic decline. There was only one case microcatheter prolapse related to placement of a stent before coiling. An initial post-treatment modified Raymond-Roy Occlusion Classification (mRROC) I or II closure was achieved in 56 (52.8%) aneurysms. The average time to last follow-up was 8.4 months at which 70 (81.4%) aneurysms had mRROC I or II occlusion and a major recurrence was seen in 5 (5.8%) patients. Thirteen (12.3%) aneurysms required re-treatment of which one aneurysm was clipped. Conclusions The Penumbra SMART coil is safe and effective for the endovascular treatment of appropriately selected IAs. Additional studies at multiple centers comparing safety and efficacy profile over long-term periods to other mainstream coils are necessary.
Prognostic value of myeloperoxidase in patients with peripheral artery disease
Authors: Schahab Nadjib , Mansuroglu Seyid , Schaefer Christian , Fimmers Rolf , Nickenig Georg , Tiyerili Vedat 
Published: September 2020

Objectives The involvement of myeloperoxidase in the production of dysfunctional high-density lipoproteins and oxidised biomolecules leads to oxidative stress in the blood vessel endothelium. This prospective cohort study aimed to examine the prognostic value of myeloperoxidase in patients with peripheral artery disease in relation to major adverse cardiac events (MACEs), target lesion revascularisation, and major adverse limb events (MALEs) and its association with multi-bed vascular disease, which is defined as any combination of the following: peripheral artery disease and coronary artery disease. Methods Myeloperoxidase levels were measured in patients with peripheral artery disease and coronary artery disease during angiography. A total of 94 patients were analysed and followed up regarding their MACEs, target lesion revascularisation, and MALEs from August 2016 until February 2019. Results Among patients with peripheral artery disease, the rates of MACE and mortality were higher in patients with high myeloperoxidase levels than in those with low myeloperoxidase levels; the myeloperoxidase levels were 3.68 times higher in these patients ( p < 0.0001). Patients with peripheral artery disease and coronary artery disease (multi-bed vascular disease) had higher myeloperoxidase levels than those with only peripheral artery disease and only coronary artery disease (one-bed vascular disease). Peripheral artery disease patients with higher myeloperoxidase levels had significantly higher rates of limb ischaemia, requiring further revascularisation than those with low myeloperoxidase levels. Conclusions High myeloperoxidase levels suggest poor outcomes and are associated with MACE and limb ischaemia. Our findings indicated that myeloperoxidase levels could become a prognostic marker and may be used in conjunction with other methods for risk stratification in patients with peripheral artery disease and multi-bed vascular disease.
Establishing professional expectations in further education middle management: The human resource manager’s perspective
Authors: Corbett Stephen 
Published: September 2020

The further education sector is a challenging working environment with expectations to deliver high-quality education against a backdrop of continuous policy and structural reforms. Further education managers play a key part in how further education institutions respond to this dynamic operating environment. However, despite the importance of this role there is an absence of an agreed set of professional expectations for further education middle managers. Sector bodies have commissioned research to address recruitment challenges and support workforce development, but this is often directed towards teachers. As a result, the credibility of further education teachers has increased markedly, which is welcomed. However, further education middle managers who are responsible for the management of teachers and operationalisation of organisational strategies have not benefited from comparable opportunities for professionalisation. In contrast, they suffer from a lack of support when assimilating into the role. This paper investigates the role of further education middle managers through the lens of those responsible for their recruitment and development, human resource managers. Through the administration of a national survey of human resource managers, drawing on quantitative and qualitative data, this paper establishes a new theoretical framework: four pillars of professional expectations for further education middle managers. Furthermore, it highlights the value in a contextualised approach, moving away from generic management standards.
Prognostic significance of forced vital capacity decline prior to and following antifibrotic therapy in idiopathic pulmonary fibrosis
Authors: Aono Yuya , Nakamura Yutaro , Kono Masato , Nakamura Hidenori , Yokomura Koshi , Imokawa Shiro , Toyoshima Mikio , Yasui Hideki , Hozumi Hironao , Karayama Masato , Suzuki Yuzo , Furuhashi Kazuki , Enomoto Noriyuki , Fujisawa Tomoyuki , Inui Naoki , Suda Takafumi 
Published: September 2020

Background: Idiopathic pulmonary fibrosis (IPF) is a progressive and fatal interstitial lung disease (ILD). Currently, two antifibrotic drugs are available for reducing forced vital capacity (FVC) decline in IPF. However, many pulmonologists wait before initiating treatment, especially when IPF patients have stable disease. This study aimed to investigate the impact on survival outcome of FVC decline and a slow rate of FVC decline prior to and following treatment with these two antifibrotic drugs. Methods: Out of the 235 IPF patients treated with antifibrotic therapy that were screened, 105 cases were eligible, who then underwent physiological evaluation at 6 months prior to and following antifibrotic therapy. Clinical characteristics and prognostic outcomes were compared among groups, and prognostic factors were evaluated using a Cox proportional hazards analysis. Results: In terms of %FVC decline prior to the therapy and a slow rate of FVC decline, there was no significant difference between stable and worsened groups and responder and non-responder groups, respectively. On the other hand, in terms of %FVC decline (decline >5%) following antifibrotic therapy, the stable/improved group had significantly better prognosis than the worsened group. Prognostic analysis revealed that a stable/improved status following antifibrotic therapy [HR: 0.35 (0.15–0.87)] was significantly associated with a better prognosis. Conclusions: Concerning the FVC decline prior to and following antifibrotic therapy and a slow rate of FVC decline, only the FVC decline following the therapy is associated with a greater survival outcome. An early treatment decision may thus be beneficial for IPF. The reviews of this paper are available via the supplemental material section.
The role of the gut microbiome and exercise in non-alcoholic fatty liver disease
Authors: Houttu Veera , Boulund Ulrika , Grefhorst Aldo , Soeters Maarten R. , Pinto-Sietsma Sara-Joan , Nieuwdorp Max , Holleboom Adriaan G. 
Published: September 2020

In recent years, the human gut microbiome has been found to influence a multitude of non-communicable diseases such as cardiovascular disease and metabolic syndrome, with its components type 2 diabetes mellitus and obesity. It is recognized to be mainly influenced by environmental factors, such as lifestyle, but also genetics may play a role. The interaction of gut microbiota and obesity has been widely studied, but in regard to non-alcoholic fatty liver disease (NAFLD) as a manifestation of obesity and insulin resistance, the causal role of the gut microbiome has not been fully established. The mechanisms by which the gut microbiome influences lipid accumulation, inflammatory responses, and occurrence of fibrosis in the liver are a topic of active research. In addition, the influence of exercise on gut microbiome composition is also being investigated. In clinical trials, exercise reduced hepatic steatosis independently of weight reduction. Other studies indicate that exercise may modulate the gut microbiome. This puts forward the question whether exercise could mediate its beneficial effects on NAFLD via changes in gut microbiome. Yet, the specific mechanisms underlying this potential connection are largely unknown. Thus, associative evidence from clinical trials, as well as mechanistic studies in vivo are called for to elucidate the relationship between exercise and the gut microbiome in NAFLD. Here, we review the current literature on exercise and the gut microbiome in NAFLD.
Variables and Outcomes in Patient Room Design: A Study of Design Hypotheses
Authors: Greer Valerie , Johnson Emily , Hsu Josephine 
Published: September 2020

Objective: Research was conducted to evaluate the correlation between design hypotheses and performance outcomes in single-occupancy patient rooms. Background: Health environments host complex interactions between patients and clinicians, and patient rooms offer a unique lens to understanding the impact of design on interactions and outcomes. This places importance on articulating, measuring, and assessing design hypotheses. This study of documented strategies and measured outcomes in patient room design investigates the relationship between design variables and clinical interactions. Methods: Design hypotheses were identified for the strategic approach to four key elements of patient room design: the room configuration, charting location, personal protective equipment (PPE) supply, and mobile supply cart. Researchers collected observational data from existing and newly constructed patient rooms in order to evaluate performance outcomes related to design hypotheses. Results: Observation data supported hypotheses behind three of the four design components and revealed greater insight into how design variables impacted interactions in patient rooms. Conclusions: The study identified a distinction between “fixed” design elements, such as the configuration of the patient room, and “dynamic” elements such as the design of the mobile cart. This was more prevalent in evaluating the use of supply carts and PPE cabinets, which may be more influenced by training, while the room configuration and charting location require little training to benefit both clinicians and patients. This study points to the value of research that evaluates correlations between design hypotheses and outcomes in healthcare design.
The Representational Function of Clinic Design: Staff and Patient Perceptions of Teamwork
Authors: Lim Lisa , Kanfer Ruth , Stroebel Robert J. , Zimring Craig M. 
Published: September 2020

Objective: This study empirically investigates the relationships between visibility attributes and both patients’ and staff members’ teamwork experiences. Background: Teamwork among healthcare professionals is critical for the safety and quality of patient care. While a patient-centered, team-based care approach is promoted in primary care clinics, little is known about how clinic layouts can support the teamwork experiences of staff and patients in team-based primary clinics. Methods: This article measured teamwork perceptions of staff members and patients at four primary care clinics providing team-based care. Visual access to staff workstations from both staff and patient perspectives was analyzed using VisualPower tool(version 21). The relationships between teamwork perception and visibility attributes were analyzed for each entity: staff members and patients. Results: The results showed that the visual relationships among staff members and those between staff members and patients have significant associations with overall perceptions of teamwork. While clinics providing more visual connections between staff workstations reported higher teamwork perception of staff members, patient perceptions of staff teamwork were inversely related to the number of visual connections between patients and staff workstations. Conclusions: The findings of the study provide implications for designing team-based primary care clinics to enhance the teamwork experience of both staff members and patients, which is also applicable to teamwork perceptions in other settings where both inhabitants and visitors are main user groups of the spaces. This study illustrates the representational function of space: Organizations can emphasize their values via layout design by regulating what they show to inhabitants or visitors.
The apparent diffusion coefficient is a useful biomarker in predicting treatment response in patients with locally advanced rectal cancer
Authors: Jiménez de los Santos Mayra Evelia , Reyes-Pérez Juan Armando , Sandoval-Nava Rosa Martha , Villalobos-Juárez José Luis , Villaseñor-Navarro Yolanda , Vela-Sarmiento Itzel , Sollozo-Dupont Isabel 
Published: September 2020

Background Apparent diffusion coefficient (ADC) values achieve promising results in treatment response prediction in patients with several types of cancers. Purpose To determine whether ADC values predict neoadjuvant chemoradiation treatment (nCRT) response in patients with locally advanced rectal cancer (LARC). Material and Methods Forty-four patients with LARC who underwent magnetic resonance imaging scans before and after nCRT followed by delayed surgery were enrolled retrospectively. The sample was distributed as follows: responders (R), n = 8; and non-responders (Non-R), n = 36. Three markers of treatment response were considered: post-nCRT measures; ΔADC; and Δ%ADC. Statistical analysis included a Wilcoxon test, a Mann–Whitney U test, and a receiver operating characteristic (ROC) analysis in order to evaluate the diagnostic accuracy for each ADC value marker to differentiate between R and Non-R. Results Both minimum and mean ADC values were significantly higher after nCRT in the R group, while non-significant differences between basal and control ADC values were found in the non-R group. In addition, ΔADC and Δ%ADC exhibited increased values after nCRT in R when compared with non-R. ROC analysis revealed the following diagnostic performance parameters: post-nCRT: ADCmin = 1.05 × 10−3 mm2/s (sensitivity 61.1% and specificity 66.7%), ADCmean = 1.50 × 10−3 mm2/s (sensitivity 72.2% and specificity 83.3%), ΔADC: ADCmin = 0.35 (sensitivity 66.7% and specificity 83.3%), ADCmean = 0.50 (sensitivity 72% and specificity 83%); and Δ%ADC: ADCmin = 44% (sensitivity 66.7% and specificity 83.3%) and ADCmean = 60% (sensitivity 83% and specificity 99%). Conclusion Our findings suggest that post-treatment rectal tumor ADC values, as well changes between pre- and post-treatment values, may be biomarkers for predicting treatment response in patients with LARC who underwent nCRT.