bluuebunny/crossref_metadata_2025_split huggingface dataset:
Both New and Chronic Potentially Inappropriate Medications Continued at Hospital Discharge Are Associated With Increased Risk of Adverse Events
Authors: Weir Daniala L. , Lee Todd C. , McDonald Emily G. , Motulsky Aude , Abrahamowicz Michal , Morgan Steven , Buckeridge David , Tamblyn Robyn 
Published: March 2020

BACKGROUNDAdmission to hospital provides the opportunity to review patient medications; however, the extent to which the safety of drug regimens changes after hospitalization is unclear.OBJECTIVETo estimate the number of potentially inappropriate medications (PIMs) prescribed to patients at hospital discharge and their association with the risk of adverse events 30 days after discharge.DESIGNProspective cohort study.SETTINGTertiary care hospitals within the McGill University Health Centre Network in Montreal, Quebec, Canada.PARTICIPANTSPatients from internal medicine, cardiac, and thoracic surgery, aged 65 years and older, admitted between October 2014 and November 2016.MEASURESAbstracted chart data were linked to provincial health databases. PIMs were identified using AGS (American Geriatrics Society) Beers Criteria®, STOPP, and Choosing Wisely statements. Multivariable logistic regression and Cox models were used to assess the association between PIMs and adverse events.RESULTSOf 2,402 included patients, 1,381 (57%) were male; median age was 76 years (interquartile range [IQR] = 70‐82 years); and eight discharge medications were prescribed (IQR = 2‐8). A total of 1,576 (66%) patients were prescribed at least one PIM at discharge; 1,176 (49%) continued a PIM from prior to admission, and 755 (31%) were prescribed at least one new PIM. In the 30 days after discharge, 218 (9%) experienced an adverse drug event (ADE) and 862 (36%) visited the emergency department (ED), were rehospitalized, or died. After adjustment, each additional new PIM and continued community PIM were respectively associated with a 21% (odds ratio [OR] = 1.21; 95% confidence interval [CI] = 1.01‐1.45) and a 10% (OR = 1.10; 95% CI = 1.01‐1.21) increased odds of ADEs. They were also respectively associated with a 13% (hazard ratio [HR] = 1.13; 95% CI = 1.03‐1.26) and a 5% (HR = 1.05; 95% CI = 1.00‐1.10) increased risk of ED visits, rehospitalization, and death.CONCLUSIONSTwo in three hospitalized patients were prescribed a PIM at discharge, and increasing numbers of PIMs were associated with an increased risk of ADEs and all‐cause adverse events. Improving hospital prescribing practices may reduce the frequency of PIMs and associated adverse events. J Am Geriatr Soc 68:1184–1192, 2020.
Clinician Perspectives on Overscreening for Cancer in Older Adults With Limited Life Expectancy
Authors: Schoenborn Nancy L. , Massare Jacqueline , Park Reuben , Pollack Craig E. , Choi Youngjee , Boyd Cynthia M. 
Published: March 2020

BACKGROUND/OBJECTIVESGuidelines recommend against routine screening for breast, colorectal, and prostate cancers in older adults with less than 10 years of life expectancy. However, clinicians often continue to recommend cancer screening for these patients. We examined primary care cliniciansʼ perspectives regarding overscreening, as defined by limited life expectancy.DESIGNSemistructured, in‐depth individual interviews.SETTINGTwenty‐one academic and nonacademic primary care clinics in Maryland.PARTICIPANTSThirty primary care clinicians from internal medicine, family medicine, medicine/pediatrics, and geriatric medicine.MEASUREMENTSInterviews explored whether the clinicians believed that overscreening for breast, colorectal, or prostate cancers existed in older adults and their views on using life expectancy to decide on stopping routine screening. Audio recordings of the interviews were transcribed verbatim. Two investigators independently coded all transcripts using qualitative content analysis.RESULTSMost clinicians were physicians (24/30) and women (16/30). Content analysis generated three major themes. (1) Many, but not all, clinicians perceived overscreening in older adults as a problem. (2) There was controversy around using limited life expectancy to define overscreening due to concerns that the guidelines did not capture potential nonmortality benefits of screening; that population‐based screening data could not be easily applied to individuals; that this approach failed to account for patient choice; and that life expectancy predictions were inaccurate. (3) Some clinicians worried that using life expectancy to define overscreening may inadvertently introduce bias and lead to unintended harms.CONCLUSIONSSeveral clinicians disagreed with guideline frameworks of using limited life expectancy to guide cancer screening cessation. Some disagreement stems from inadequate knowledge about the benefits and harms of cancer screening and indicates a need for education or decision support. Other reasons for disagreement highlight the need to refine the current recommended cancer screening approaches and identify strategies to avoid unintended consequences, such as introducing bias or exacerbating existing disparities. J Am Geriatr Soc 68:1462‐1468, 2020.
Usefulness of autocidal gravid ovitraps for the surveillance and control of Aedes (Stegomyia) aegypti (Diptera: Culicidae) in eastern Colombia
Authors: Montenegro D. , Martinez L. , Tay K. , Hernandez T. , Noriega D. , Barbosa L. , Muñoz J. , Mateus H. , Daza J. , Teherán A. , Ramírez J. D. 
Published: March 2020

AbstractIn the past decade, new strategies have been developed to control the Aedes aegypti (Diptera: Culicidae) mosquito vector, as well as a broad range of arboviral agents. Vector control surveillance programmes in Puerto Rico and Australia have implemented the Centers for Disease Control and Prevention autocidal gravid ovitrap (AGO), which has had an impact on vector density and, consequently, the epidemiology of arboviral infections. Colombia intends to establish the AGO as a new tool for the surveillance and control of the A. aegypti vector. AGOs were evaluated in a hyperendemic area for dengue virus during an 8‐week period in Villavicencio city, eastern Colombia. The results indicated that the AGOs detect a high density of A. aegypti, with positive results for these traps of over 80% and an average catch of six individuals per trap per week. Acceptance of AGOs in the community exceeded 95%, and adherence was around 89%. This study's results demonstrate, for the first time in Colombia, that traps are a useful tool for the surveillance of A. aegypti. Future studies must consider the implementation of AGOs in the region.
Effectiveness of an educational intervention on vulvo‐vaginal discharge for family healthcare workers: A nonrandomized controlled trial
Authors: Ilankoon Ilankoon M. P. Sumudrika , Goonewardena Christine S. E. , Fernandopulle Rukshan C. , Perera Poruthotage P. Rasika 
Published: March 2020

AbstractWomen's delay in seeking medical advice for abnormal vaginal discharge can cause serious effects such as infertility, ectopic pregnancy, and advanced cervical cancer. Family healthcare workers are in a unique position to help in the promotion of vaginal health. A nonrandomized controlled trial was conducted among a sample of family healthcare workers in the intervention (n = 37) and a control (n = 37) group to assess the effectiveness of an educational intervention, which was a 2‐day intensive workshop combining reading materials. Data were analyzed using SPSS software (version 20), and the effectiveness of the intervention was determined using a mixed between‐within subjects analysis of variance. The total knowledge and attitude scores were significantly greater for family healthcare workers in the intervention group immediately and at 3 and 6 months after the educational intervention, compared to the control group. A substantial main effect was observed concerning the time, showing an increase in family healthcare workers' knowledge and attitude scores across the four time periods. A statistically significant difference in the median overall health education competency score across the two groups was also observed. The mean score differences in all sub‐competencies in health education were significantly higher among the intervention group, compared to the control group between second postintervention and the baseline. The educational intervention had revealed successful and sustainable improvements in family healthcare workers' knowledge, attitude on vaginal discharge, and health education competency. This can be implemented as an in‐service program for family healthcare workers to improve health education practices.
Researching South African Englishes
Authors: Botha Werner , van Rooy Bertus , Coetzee‐Van Rooy Susan 
Published: March 2020

AbstractIn this paper we provide an overview of the current status as well as broad functions of Englishes in South Africa. We also provide a discussion of some of the contemporary concerns related to the complex and multivaried nature of English in the country. This paper further serves to introduce the major themes that are of concern to those researchers that are interested in the study of South African Englishes, through an introduction of the papers that form part of this Special Issue. Finally, we discuss the current state of the art with regards to researching English in the country where we suggest potential future areas of investigation.
Longitudinal Seismic Response of Train–Bridge Interaction System With Slip in Moderate Earthquakes
Authors: Lu Xuzhao , Kim Chul-Woo , Chang Kai-Chun 
Published: March 2020

Abstract
This study assesses the seismic responses of viaduct structures in the Japanese high-speed rail system under moderate earthquake forces considering the slip between tracks and wheels. Equations of motion for the train–bridge interaction system were derived, where the track–wheel interaction was described by the Coulomb friction law. A full train–bridge finite element model incorporating nonslip and stick–slip interaction models was built using commercial finite element analysis software: abaqus. Simulation results indicate that the slip phenomenon might occur under a moderate earthquake and that a conventional nonslip model with an infinitely large friction coefficient is inappropriate. A parametric study revealed that the braking-train-induced slip friction little influenced the bridge response to moderate earthquake forces. The bridge's dynamic motions were dominated by ground motion irrespective of the values assigned as the train's initial speed and track–wheel friction coefficient. A computationally efficient method was proposed for calculating the longitudinal seismic responses of a bridge interacting with a braking train, following the linear superposition principle. As illustrated, this method could be helpful in reliability or uncertainty analysis when a great number of computationally expensive seismic analyses are required for train–bridge interaction systems.
Design and Biomechanical Analysis of a Novel Retrievable Peripheral Vascular Stent
Authors: Guo Jingzhen , Mao Lin , Yu Xitong , Song Chengli , Zhao Xue 
Published: March 2020

Abstract
Structurally retrievable drug-eluting stents may have valuable clinical applications because they do not leave any foreign materials inside the patient's body. This article presents a novel design of retrievable peripheral vascular stent and the results from biomechanical analysis of its performance. Using the finite element analysis method, principal parameters of the stent were studied. Moreover, to ensure the practicability of the retrieval process, simulation, and in vitro experiments were performed. The retrieval force reached the maximum value when the whole retrievable part had been retrieved. Furthermore, the force was gradually increased during the retrieval process and remained constant after the main part had been retrieved. When the stent was being compressed, the maximum strain of the stent occurred at the connection between the stent's retrieval part and the main body part, at a value of 4%. The index of nonuniformity of the stent was too small to be counted both at the end of the compression and self-expansion processes. With the increase of moment, the bending stiffness (EI) of the stent decreased gradually. After bending moment was applied, the large strain region was mainly located in the stent's main body part rather than the retrieval part. The results of preliminary stent retrieval experiments demonstrated that the stent could be retrieved successfully. This novel retrievable stent displays promising biomechanical performance. The preliminary experiments demonstrated that the stent could be retrieved smoothly from the blood vessels.
Evaluation of an Improved Suspension System Concept for Surgical Luminaires
Authors: Knulst Arjan J. , Harms Jan Jouke , Dankelman Jenny 
Published: March 2020

Abstract
Surgeons have indicated ergonomic problems with the surgical luminaire, which have been observed to occur during repositioning. The possibility of singularity, within the movement space of the translational subsystem of the current double-arm suspension systems, is confirmed to be the cause of these problems. In this study, a redesign of the translational subsystem is compared to the conventional translational subsystem. A user experiment with 14 participants is setup to compare the redesigned and alternative system. The experiment is performed outside the operating room (OR), with one setup that can be altered between two designs; an uncoupled state with the kinematics of the conventional subsystem, and a coupled state with the redesigned kinematics. Work cost, duration, and jerk cost are compared, as well as NASA TLX score. The work cost of a movement in the conventional uncoupled state is confirmed to depend on the spatial orientation of the mechanism, which is not the case in the new coupled state. Due to these different kinetics, the movement patterns with the coupled mechanism are more consistent between participants, the duration of movements is shorter, less problems occur, and participants are able to better control the movements as demonstrated by lower jerk costs. This result validates the redesign and confirms the hypothesis that a translational subsystem without the possibility of singularity within its movement space will improve luminaire repositioning. The conceptual design can now be used as base for a clinically usable design.
Characterization of RelA inAcinetobacter baumannii
Authors: Pérez-Varela María , Tierney Aimee R. P. , Kim Ju-Sim , Vázquez-Torres Andrés , Rather Philip 
Published: March 2020

ABSTRACTIn response to nutrient depletion, the RelA and SpoT proteins generate the signaling molecule (p)ppGpp, which then controls a number of downstream effectors to modulate cell physiology. InAcinetobacter baumanniistrain AB5075, arelAortholog (ABUW_3302) was identified by a transposon insertion that conferred an unusual colony phenotype. An in-frame deletion inrelA(ΔrelA) failed to produce detectable levels of ppGpp when amino acid starvation was induced with serine hydroxamate. The ΔrelAmutant was blocked from switching from the virulent opaque colony variant (VIR-O) to the avirulent translucent colony variant (AV-T), but the rate of AV-T to VIR-O switching was unchanged. In addition, the ΔrelAmutation resulted in a pronounced hypermotile phenotype on 0.35% agar plates. This hypermotility was dependent on the activation of a LysR regulator ABUW_1132, which was required for expression of AbaR, a LuxR family quorum-sensing regulator. In the ΔrelAmutant, ABUW_1132 was also required for the increased expression of an operon composed of theABUW_3766-ABUW_3773genes required for production of the surfactant-like lipopeptide acinetin 505. Additional phenotypes identified in the ΔrelAmutant included (i) cell elongation at high density, (ii) reduced formation of persister cells tolerant to colistin and rifampin, and (iii) decreased virulence in aGalleria mellonellamodel.IMPORTANCEAcinetobacter baumanniiis a pathogen of worldwide importance. Due to the increasing prevalence of antibiotic resistance, these infections are becoming increasingly difficult to treat. New therapies are required to combat multidrug-resistant isolates. The role of RelA inA. baumanniiis largely unknown. This study demonstrates that like in other bacteria, RelA controls a variety of functions, including virulence. Strategies to inhibit the activity of RelA and the resulting production of ppGpp could inhibit virulence and may represent a new therapeutic approach.
Data for tracking SDGs: challenges in capturing neonatal data from hospitals in Kenya
Authors: Hagel Christiane , Paton Chris , Mbevi George , English Mike 
Published: March 2020

BackgroundTarget 3.2 of the United Nations Sustainable Development Goals (SDGs) is to reduce neonatal mortality. In low-income and middle-income countries (LMICs), the District Health Information Software, V.2 (DHIS2) is widely used to help improve indicator data reporting. There are few reports on its use for collecting neonatal hospital data that are of increasing importance as births within facilities increase. To address this gap, we investigated implementation experiences of DHIS2 in LMICs and mapped the information flow relevant for neonatal data reporting in Kenyan hospitals.MethodsA narrative review of published literature and policy documents from LMICs was conducted. Information gathered was used to identify the challenges around DHIS2 and to map information flows from healthcare facilities to the national level. Two use cases explore how newborn data collection and reporting happens in hospitals. The results were validated, adjusted and system challenges identified.ResultsLiterature and policy documents report that DHIS2 is a useful tool with strong technical capabilities, but significant challenges can emerge with the implementation. Visualisations of information flows highlight how a complex, people-based and paper-based subsystem for inpatient information capture precedes digitisation. Use cases point to major challenges in these subsystems in accurately identifying newborn deaths and appropriate data for the calculation of mortality even in hospitals.ConclusionsDHIS2 is a tool with potential to improve availability of health information that is key to health systems, but it critically depends on people-based and paper-based subsystems. In hospitals, the subsystems are subject to multiple micro level challenges. Work is needed to design and implement better standardised information processes, recording and reporting tools, and to strengthen the information system workforce. If the challenges are addressed and data quality improved, DHIS2 can support countries to track progress towards the SDG target of improving neonatal mortality.
Prioritising gender, equity, and human rights in a GRADE-based framework to inform future research on self care for sexual and reproductive health and rights
Authors: Siegfried Nandi , Narasimhan Manjulaa , Logie Carmen H , Thomas Rebekah , Ferguson Laura , Moody Kevin , Remme Michelle 
Published: March 2020

IntroductionIn January 2019, the WHO reviewed evidence to develop global recommendations on self-care interventions for sexual and reproductive health and rights (SRHR). Identification of research gaps is part of the WHO guidelines development process, but reliable methods to do so are currently lacking with gender, equity and human rights (GER) infrequently prioritised.MethodsWe expanded a prior framework based on Grading of Evidence, Assessment, Development and Evaluation (GRADE) to include GER. The revised framework is applied systematically during the formulation of research questions and comprises: (1) assessment of the GRADE strength and quality rating of recommendations; (2) mandatory inclusion of research questions identified from a global stakeholder survey; and (3) selection of the GER standards and principles most relevant to the question through discussion and consensus. For each question, we articulated: (1) the most appropriate and robust study design; (2) an alternative pragmatic design if the ideal design was not feasible; and (3) the methodological challenges facing researchers through identifying potential biases.ResultsWe identified 39 research questions, 7 overarching research approaches and 13 discrete feasible study designs. Availability and accessibility were most frequently identified as the GER standards and principles to consider when planning studies, followed by privacy and confidentiality. Selection and detection bias were the primary methodological challenges across mixed methods, quantitative and qualitative studies. A lack of generalisability potentially limits the use of study results with non-participation in research potentially highest in more vulnerable populations.ConclusionA framework based on GRADE that includes stakeholders’ values and identification of core GER standards and principles provides a practical, systematic approach to identifying research questions from a WHO guideline. Clear guidance for future studies will contribute to an anticipated ‘living guidelines’ approach within WHO. Foregrounding GER as a separate component of the framework is innovative but further elaboration to operationalise appropriate indicators for SRHR self-care interventions is required.
Impact of electronic palliative care coordination systems (EPaCCS) on care at the end of life across multiple care sectors, in one clinical commissioning group area, in England: a realist evaluation protocol
Authors: Pocock Lucy , French Lydia , Farr Michelle , Morris Richard , Purdy Sarah 
Published: March 2020

IntroductionElectronic palliative care coordination systems (EPaCCS) aim to support people approaching the end of life (EOL) to receive consistent care, according to their wishes, that is coordinated effectively across multiple care sectors. They are in use across the UK although empirical evidence into their effectiveness is poor. This paper presents a protocol of a mixed-methods study, to understand how, and by whom, EPaCCS are being used and whether EPaCCS are enabling Healthcare Professionals (HCPs) to coordinate patients’ EOL care.Methods and analysisThis is a mixed-methods study, carried out within a realist paradigm, to evaluate the impact of an EPaCCS on EOL care as provided by a Clinical Commissioning Group (CCG) in England. This study has two aims: (1) Describe the socio-demographic characteristics of patients who die with an EPaCCS record, their underlying cause of death and place of death and compare these with patients who die without an EPaCCS record. (2) Explore the impact of an EPaCCS on the experience of receiving EOL care for patients and their carers, and understand HCPs’ views and experiences of utilising an EPaCCS to coordinate care for their patients. The study will be conducted in five phases: (1) development of the initial programme theory; (2) focus group with CCG stakeholder board; (3) individual interviews with HCPs, patients, current and bereaved carers; (4) retrospective cohort study of routinely collected data on EPaCCS usage and (5) data analysis and synthesis of study findings.Ethics and disseminationThe study has been approved by National Health Service South West–Frenchay Research Ethics Committee (REC reference number: 18/SW/0198). Findings will be published in a wide range of outputs targeted at key audiences.