bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of summary indices of antenatal care service quality in Haiti, Malawi and Tanzania
Authors: Sheffel Ashley , Zeger Scott , Heidkamp Rebecca , Munos Melinda Kay 
Published: December 2019

IntroductionMeasuring quality of care in low-income and middle-income countries is complicated by the lack of a standard, universally accepted definition for ‘quality’ for any particular service, as well as limited guidance on which indicators to include in measures of quality of care, and how to incorporate those indicators into summary indices. The aim of this paper is to develop, characterise and compare a set of antenatal care (ANC) indices for facility readiness and provision of care.MethodsWe created nine indices for facility readiness using three methods for selecting items and three methods for combining items. In addition, we created three indices for provision of care using one method for selecting items and three methods for combining items. For each index, we calculated descriptive statistics, categorised the continuous index scores using tercile cut points to assess comparability of facility classification, and examined the variability and distribution of scores.ResultsOur results showed that, within a country, the indices were quite similar in terms of mean index score, facility classification, coefficient of variation, floor and ceiling effects, and the inclusion of items in an index with a range of variability. Notably, the indices created using principal components analysis to combine the items were the most different from the other indices. In addition, the index created by taking a weighted average of a core set of items had lower agreement with the other indices when looking at facility classification.ConclusionsAs improving quality of care becomes integral to global efforts to produce better health outcomes, demand for guidance on creating standardised measures of service quality will grow. This study provides health systems researchers with a comparison of methodologies commonly used to create summary indices of ANC service quality and it highlights the similarities and differences between methods.
Uptake of routine viral load testing among people living with HIV and its implementation challenges in Yangon region of Myanmar: a mixed-methods study
Authors: Thinn Khine Khine , Thekkur Pruthu , Kyaw Nang Thu Thu , Aye Nyein Su , Zaw Tin Maung , Soan Pyae , Hone San , Oo Htun Nyunt 
Published: December 2019

ObjectivesIn 2017, Myanmar implemented routine viral load (VL) monitoring for assessing the response to antiretroviral therapy (ART) among people living with HIV (PLHIV). The performance of routine VL testing and implementation challenges has not yet assessed. We aimed to determine the uptake of VL testing and factors associated with it among PLHIV initiated on ART during 2017 in ART clinics of Yangon region and to explore the implementation challenges as perceived by the healthcare providers.DesignAn explanatory mixed-methods study was conducted. The quantitative component was a cohort study, and the qualitative part was a descriptive study with in-depth interviews.SettingSix ART clinics operated by AIDS/sexually transmitted infection teams under the National AIDS Programme.Primary outcome measures(1) The proportion who underwent VL testing by 30 March 2019 and the proportion with virological suppression (plasma VL <1000 copies/mL); (2) association between patient characteristics and ‘not tested’ was assessed using log binomial regression and (3) qualitative codes on implementation challenges.ResultsOf the 567 PLHIV started on ART, 498 (87.8%) retained in care for more than 6 months and were eligible for VL testing. 288 (57.8%, 95% CI: 53.3% to 62.2%) PLHIV underwent VL testing, of which 263 (91.3%, 95% CI: 87.1% to 94.4%) had virological suppression. PLHIV with WHO clinical stage 4 had significantly higher rates of ‘not being tested’ for VL. Collection of sample for VL testing only twice a month, difficulties in sample collection and transportation, limited trained workforce, wage loss and out-of-pocket expenditure for patients due to added visits were major implementation challenges.ConclusionsThe VL test uptake was low, with only six out of ten PLHIV tested. The VL testing uptake needs to be improved by strengthening sample collection and transportation, adopting point-of-care VL tests, increasing trained workforce, providing compensation to patients for wage loss and travel costs for additional visits.
Road to recovery: a study protocol quantifying neurological outcome in cardiac surgery patients and the role of cerebral oximetry
Authors: Semrau Joanna S , Scott Stephen H , Hamilton Andrew G , Petsikas Dimitri , Payne Darrin M , Bisleri Gianluigi , Saha Tarit , Boyd John Gordon 
Published: December 2019

IntroductionPatients undergoing cardiac surgery may experience both short-term and long-term postoperative neurological problems. However, the underlying cause of this impairment is unclear. Regional cerebral oxygen saturation (rSO2) levels may play a role in the development of acute dysfunction, known as postoperative delirium, in addition to longer term outcomes after cardiac surgery. Yet the degree of impairment has been difficult to define, partly due to subjective methods of assessments. This study aims to fill this knowledge gap by determining the relationship between rSO2, postoperative delirium and long-term neurological outcome after cardiac surgery using quantitative robotic technology.Methods and analysis95 patients scheduled for elective cardiac surgery will be recruited for this single-centre prospective observational study. Patients will be assessed before as well as 3 and 12 months after their surgery using the Kinarm End-Point Lab and standardised tasks. Intraoperatively, rSO2 and other haemodynamic data will be collected for the duration of the procedure. Following their operation, patients will also be screened daily for delirium during their hospital stay.Ethics and disseminationThis study has been approved by the Health Sciences Research Ethics Board at Queen’s University (DMED-1672–14). The results of this study will be published in a peer-review journal and presented at international and/or national conferences as poster or oral presentations. Participants wishing to know the results of this study will be contacted directly on data publication.Trial registration numberNCT04081649
Development of a revised Jalowiec Coping Scale for use by emergency clinicians: a cross-sectional scale development study
Authors: Greenslade Jaimi H , Wallis Marianne C , Johnston Amy , Carlström Eric , Wilhelms Daniel , Thom Ogilvie , Abraham Louisa , Crilly Julia 
Published: December 2019

ObjectivesThe aim of this study was to develop and validate a scale to measure the coping strategies used by emergency staff in response to workplace stress. To achieve this aim, we developed a refined Jalowiec Coping Scale (JCS), termed the Jalowiec Coping Scale-Emergency Department (JCS-ED) and validated this scale on a sample of emergency clinicians.DesignA cross-sectional survey incorporating the JCS, the working environment scale-10 and a measure of workplace stressors was administered between July 2016 and June 2017. The JCS-ED was developed in three stages: 1) item reduction through content matter experts, 2) exploratory factor analysis for further item reduction and to identify the factor structure of the revised scale and 3) confirmatory factor analyses to confirm the factors identified within the exploratory factor analysis.SettingSix Emergency Departments (EDs) in Australia and four in Sweden. There were three tertiary hospitals, five large urban hospitals and two small urban hospitals.ParticipantsParticipants were eligible for inclusion if they worked full-time or part-time as medical or nursing staff in the study EDs. The median age of participants was 35 years (IQR: 28–45 years) and they had been working in the ED for a median of 5 years (IQR: 2–10 years). 79% were females and 76% were nurses.ResultsA total of 875 ED staff completed the survey (response rate 51%). The content matter experts reduced the 60-item scale to 32 items. Exploratory factor analyses then further reduced the scale to 18 items assessing three categories of coping: problem-focussed coping, positive emotion-focussed coping and negative emotion-focussed coping. Confirmatory factor analysis supported this three-factor structure. Negative coping strategies were associated with poor perceptions of the work environment and higher ratings of stress.ConclusionsThe JCS-ED assesses maladaptive coping strategies along with problem-focussed and emotion-focussed coping styles. It is a short instrument that is likely to be useful in measuring the types of coping strategies employed by staff.
Induced pluripotent stem cell–based Drug Repurposing for Amyotrophic lateral sclerosis Medicine (iDReAM) study: protocol for a phase I dose escalation study of bosutinib for amyotrophic lateral sclerosis patients
Authors: Imamura Keiko , Izumi Yuishin , Banno Haruhiko , Uozumi Ryuji , Morita Satoshi , Egawa Naohiro , Ayaki Takashi , Nagai Makiko , Nishiyama Kazutoshi , Watanabe Yasuhiro , Hanajima Ritsuko , Oki Ryosuke , Fujita Koji , Takahashi Naoto , Ikeda Takafumi , Shimizu Akira , Morinaga Akiko , Hirohashi Tomoko , Fujii Yosuke , Takahashi Ryosuke , Inoue Haruhisa 
Published: December 2019

IntroductionAmyotrophic lateral sclerosis (ALS) is a progressive and severe neurodegenerative disease caused by motor neuron death. There have as yet been no fundamental curative medicines, and the development of a medicine for ALS is urgently required. Induced pluripotent stem cell (iPSC)-based drug repurposing identified an Src/c-Abl inhibitor, bosutinib, as a candidate molecular targeted therapy for ALS. The objectives of this study are to evaluate the safety and tolerability of bosutinib for the treatment of patients with ALS and to explore the efficacy of bosutinib on ALS. This study is the first clinical trial of administered bosutinib for patients with ALS.Methods and analysisAn open-label, multicentre phase I dose escalation study has been designed. The study consists of a 12-week observation period, a 1-week transitional period, a 12-week study treatment period and a 4-week follow-up period. After completion of the transitional period, subjects whose total ALS Functional Rating Scale-Revised (ALSFRS-R) score decreased by 1–3 points during the 12-week observation period receive bosutinib for 12 weeks. Three to six patients with ALS are enrolled in each of the four bosutinib dose levels (100, 200, 300 or 400 mg/day) to evaluate the safety and tolerability under a 3+3 dose escalation study design. Dose escalation and maximum tolerated dose are determined by the safety assessment committee comprising oncologists/haematologists and neurologists based on the incidence of dose-limiting toxicity in the first 4 weeks of the treatment at each dose level. A recommended phase II dose is determined by the safety assessment committee on completion of the 12-week study treatment in all subjects at all dose levels. The efficacy of bosutinib is also evaluated exploratorily using ALS clinical scores and biomarkers.Ethics and disseminationThis study received full ethical approval from the institutional review board of each participating site. The findings of the study will be disseminated in peer-reviewed journals and at scientific conferences.Trial registration numberUMIN000036295; Pre-results, JMA-IIA00419; Pre-results.
Implementation of clinical decision support to manage acute kidney injury in secondary care: an ethnographic study
Authors: Bailey Simon , Hunt Carianne , Brisley Adam , Howard Susan , Sykes Lynne , Blakeman Thomas 
Published: December 2019

BackgroundOver the past decade, acute kidney injury (AKI) has become a global priority for improving patient safety and health outcomes. In the UK, a confidential inquiry into AKI led to the publication of clinical guidance and a range of policy initiatives. National patient safety directives have focused on the mandatory establishment of clinical decision support systems (CDSSs) within all acute National Health Service (NHS) trusts to improve the detection, alerting and response to AKI. We studied the organisational work of implementing AKI CDSSs within routine hospital care.MethodsAn ethnographic study comprising non-participant observation and interviews was conducted in two NHS hospitals, delivering AKI quality improvement programmes, located in one region of England. Three researchers conducted a total of 49 interviews and 150 hours of observation over an 18-month period. Analysis was conducted collaboratively and iteratively around emergent themes, relating to the organisational work of technology adoption.ResultsThe two hospitals developed and implemented AKI CDSSs using very different approaches. Nevertheless, both resulted in adaptive work and trade-offs relating to the technology, the users, the organisation and the wider system of care. A common tension was associated with attempts to maximise benefit while minimise additional burden. In both hospitals, resource pressures exacerbated the tensions of translating AKI recommendations into routine practice.ConclusionsOur analysis highlights a conflicted relationship between external context (policy and resources), and organisational structure and culture (eg, digital capability, attitudes to quality improvement). Greater consideration is required to the long-term effectiveness of the approaches taken, particularly in light of the ongoing need for adaptation to incorporate new practices into routine work.
Simulation-based evaluation of anaesthesia residents: optimising resource use in a competency-based assessment framework
Authors: Fleming Melinda , McMullen Michael , Beesley Theresa , Egan Rylan , Field Sean 
Published: December 2019

IntroductionSimulation training in anaesthesiology bridges the gap between theory and practice by allowing trainees to engage in high-stakes clinical training without jeopardising patient safety. However, implementing simulation-based assessments within an academic programme is highly resource intensive, and the optimal number of scenarios and faculty required for accurate competency-based assessment remains to be determined. Using a generalisability study methodology, we examine the structure of simulation-based assessment in regard to the minimal number of scenarios and faculty assessors required for optimal competency-based assessments.MethodsSeventeen anaesthesiology residents each performed four simulations which were assessed by two expert raters. Generalisability analysis (G-analysis) was used to estimate the extent of variance attributable to (1) the scenarios, (2) the assessors and (3) the participants. The D-coefficient and the G-coefficient were used to determine accuracy targets and to predict the impact of adjusting the number of scenarios or faculty assessors.ResultsWe showed that multivariate G-analysis can be used to estimate the number of simulations and raters required to optimise assessment. In this study, the optimal balance was obtained when four scenarios were assessed by two simulation experts.ConclusionSimulation-based assessment is becoming an increasingly important tool for assessing the competency of medical residents in conjunction with other assessment methods. G-analysis can be used to assist in planning for optimal resource use and cost-efficacy.
Risk orientation predicts hypoxic time during difficult airway simulation: a mixed-methods pilot study
Authors: Hayward Jake , Velmurugiah Niresha , Duff Jonathan 
Published: December 2019

Personality factors may explain some of the practice variation observed in medicine. In this pilot study, we used simulation to investigate the relationship between risk orientation and airway management. We hypothesised that higher risk tolerance would predict earlier intervention.Ten emergency medicine residents from the University of Alberta participated in a standardised difficult airway simulation. There was a constant rate of oxygen desaturation necessitating eventual airway intervention. A debriefing interview and a risk orientation questionnaire followed. Time of hypoxia prior to intervention was the outcome measure. Audio interview transcripts underwent thematic analysis.Nine participants were included; one did not complete the simulation as instructed. Higher risk tolerance predicted longer hypoxic time prior to intubation (r=0.72, p=0.03). Theme analysis revealed consistent fears regarding patient instability and chances of a failed airway intervention. Patient instability was emphasised more so by those who intervened earlier.We show that personality characteristics influence resuscitation decision-making at an early stage of training. Trainees may therefore be susceptible to certain types of medical error based on their risk aversion. Implications for resident training, care quality and patient safety are discussed.
Pilot evaluation of a HER2 testing in non-small-cell lung cancer
Authors: Hotta Katsuyuki , Yanai Hiroyuki , Ohashi Kadoaki , Ninomiya Kiichiro , Nakashima Hiromi , Kayatani Hiroe , Takata Minoru , Kiura Katsuyuki 
Published: December 2019

AimsHER2-positivity pattern in the specimens of immunohistochemistry (IHC) and ﬂuorescence in situ hybridisation (FISH) has been hardly reported in non-small-cell lung cancer (NSCLC).MethodsWe evaluated the characteristics of HER2-positivity pattern in formalin-ﬁxed parafﬁn-embedded samples using IHC and FISH in 15 patients enrolled in a larger prospective cohort study to survey a HER2-positive NSCLC.ResultsAs for the immunostaining pattern, most specimens (79%) demonstrated incomplete or mixed-typed membranous immunoreactivity with heterogeneity, resembling that observed in gastric cancer rather than breast cancer. Concordance between IHC-positivity and FISH-positivity was 87.5% according to the criteria for breast cancer scoring system. On application of the gastric cancer scoring system to the examined tumours, the IHC score increased in the seven (43.8%) specimens, and the concordance between IHC positivity and FISH positivity rose to 93.8%.ConclusionsIn our pilot series, the pattern of IHC reactivity closely resembled that observed in gastric cancer rather than breast cancer.Trial registration number000017003.
Autoantibody clustering of lupus-associated pulmonary hypertension
Authors: Mizus Marisa , Li Jessica , Goldman Daniel , Petri Michelle A 
Published: December 2019

ObjectiveTo define the SLE phenotype associated with pulmonary hypertension using multiple autoantibodies.Methods207 (8%) patients with SLE with pulmonary hypertension, defined as a right ventricular systolic pressure greater than 40 mm Hg on transthoracic echocardiogram or as pulmonary artery dilatation on CT of the chest, were identified from the Hopkins Lupus Cohort (94.2% female; 56.5% African–American, 39% Caucasian; mean age 45.6 years). 53 patients were excluded from the clustering analysis due to incomplete autoantibody profiles. Agglomerative hierarchical clustering algorithm with Ward’s method was used to cluster the patients with pulmonary hypertension, based on their autoantibodies. Autoantibodies used in the clustering analysis included lupus anticoagulant, anticardiolipin, anti-beta 2 glycoprotein I, antidouble-stranded DNA, anti-Sm (anti-Smith), antiribonucleoprotein, false positive-rapid plasma reagin, anti-Ro, anti-La and hypocomplementaemia (C3 ever low or C4 ever low). The Dunn index was used to internally validate the clusters. Bootstrap resampling derived the mean Jaccard coefficient for each cluster. All analyses were performed in R V.3.6.1 using the packages cluster, fpc and gplots.ResultsA significantly higher prevalence of pulmonary hypertension in African–American patients with SLE, compared with Caucasian patients with SLE (11.5% vs 5.9%, p<0.0001), was found. Based on equivalent Dunn indices, the 154 patients with SLE-associated pulmonary hypertension with complete autoantibody data were divided into five clusters, three of which had mean Jaccard coefficients greater than 0.6. Hypocomplementaemia, renal disorder and age at diagnosis significantly differed across clusters. One cluster was defined by antiphospholipid antibodies. One cluster was defined by anti-Ro and anti-La. One cluster had low frequencies of all antibodies.ConclusionSLE-associated pulmonary hypertension disproportionately affects African–American patients. Pulmonary hypertension in SLE is defined by five autoantibody clusters. Antiphospholipid antibodies, anti-Ro and anti-La positivity, serological activity, and age at pulmonary hypertension diagnosis significantly differed across clusters, possibly indicating different pathophysiological mechanisms.
QCD, from its inception to its stubbornly unsolved problems
Authors: De Rújula A. 
Published: December 2019

Whenever one has witnessed some event and then sees it reported in the media, one’s reaction is the same: it was not quite like that. It is in this spirit of a frequent first-hand witness that I write this article. I discuss a few selected points which — to my judgement — illustrate well the QCD evolution (in time) from the theoretical, phenomenological and experimental points of view.
First-principles study of hydrogen incorporation into the Ti3SiC2/Zr heterojunction
Authors: Li Yingying , Yang Xuxin , Wang Zihao , Hu Yonghong , Mao Caixia , Wang Juntao , Li Huailin , Wu Yunyi 
Published: December 2019

The geometric structure, energy barrier and electronic properties of H-incorporated [Formula: see text] heterojunctions were investigated by first-principles calculations. Hydrogen atom settles in [Formula: see text] as interstitial impurity due to its small radius. Through calculating and analyzing the total energies of H-incorporated [Formula: see text] heterojunction, a much higher potential barrier (1.75 eV) was found when H atom diffuses from the interface into the [Formula: see text] material than that (0.25 eV) into the Zr metal. The encountered potential barriers of H atom diffusing from vacuum into the [Formula: see text] and Zr metal are also calculated, and they are both positive. These findings indicate that [Formula: see text] is a suitable coating material to prevent the hydrogen embrittlement and corrosion in Zr metal. The electronic properties and valence bond properties of H-incorporated [Formula: see text] were analyzed based on the band structure, electronic density of states and Mulliken distribution. The calculated results show that all the H-incorporated [Formula: see text] heterojunctions exhibit metallic, covalent and ionic properties. These investigations may provide new insight into the underlying mechanisms of hydrogen diffusion in the [Formula: see text] heterojunction.