bluuebunny/crossref_metadata_2025_split huggingface dataset:
Determinants of Hospital Efficiency: insights from the literature
Authors: Asbu Eyob Zere , Masri Maysoun Dimachkie , Naboulsi Marwan Al 
Published: February 2020

Abstract

Background

Achieving Universal Health Coverage and other health and health-related targets of the sustainable development goals entails curbing waste in health spending due to inefficiency. Inefficiency is a pervasive problem in health systems. The World Health Organization estimates that on average, 20-40% of the global total health expenditure is wasted. The proportion of total health expenditure attributed to hospitals is high, which implies that improving the efficiency of hospitals will lead to more efficient health systems. This study aims to synthetize the major determinants of hospital inefficiency and to develop a framework to identify causes of inefficiency and develop multi-factor interventions to address inefficiencies.

Methods

The study is based on survey of the literature on hospital efficiency and its determinants. The studies include those that employ ratio methods of efficiency analysis, data envelopment analysis and stochastic frontier models and econometric models such as the tobit regression to assess determinants of technical efficiency. Data was extracted in a table format categorized as those that are within the hospital, outside the hospital but within the health system and those that are outside the hospital and health system in the broader macroeconomic system and analyzed.

Results

Hospital efficiency is influenced by factors that may be internal to the hospital or external and thus could be wholly or partially out of the control of the hospital. Hospital-level characteristics that influence efficiency include ownership, size, specialization/scope economies, teaching status, membership of multihospital system and other factors such as case-mix and ratio of outpatients to inpatients. However, the effects of these variables are not definitive and consistent; all depends on the context. Factors out of the direct control of the hospital include geographic location, competition and reimbursement systems. The findings further elucidate that no single factor is effective in addressing hospital inefficiencies in isolation from others.

Conclusion

There is no one single magic formula or intervention that can be adopted by different hospitals and can be effective in improving hospital efficiencies. Multiple factors influence the efficiency of hospitals and to address hospital inefficiency multi-intervention packages focusing on the hospital and its environment should be developed.
No man is an Island: spatial clustering and access to primary care as possible targets for the development of new community mental health approaches.
Authors: Nascimento Miguel , Lourenço Beatriz , Coelho Ines , Aguiar Joana , Lázaro Mariana , Silva Mariana , Pereira Camila , Neves-Caldas Inês , Gomes Filipe , Garcia Sara , Nascimento Sandra , Pereira Guilherme , Nogueira Violeta , Costa Pedro , Nobre Alice 
Published: February 2020

Abstract
Purpose: to understand if patients seen at Centro Hospitalar Psiquiátrico de Lisboa (CHPL) live in geographical clusters or randomly throughout the city, as well as determine their access to the psychiatric hospital and primary care facilities (PCF). Methods: spatial autocorrelation statistics regarding all patients observed at CHPL in 2017, at the census subsection level, considering a queen criterion of contiguity, regarding not only their overall number but also main diagnosis, and admission to the psychiatric ward - voluntary or compulsory. Distance to the hospital and to the closest PCF was measured (for each patient and the variables cited above), and the mean values were compared. Finally, the total number of patients around each PCF was counted, considering specified radius sizes of 656 and 1000m. Results: All 5161 patients (509 psychiatric admissions) were geolocated, and statistical significance regarding patient clustering was found for the total number (p-0.0001) and specific group of disorders, namely Schizophrenia and related disorders (p-0.007) and depressive disorders (p-0.0002). Patients who were admitted in a psychiatric ward live farther away from the hospital (p-0.002), with the compulsory admissions (versus voluntary ones) living even farther (p-0.004). Furthermore, defining a radius of 1000m for each PCF allowed the identification of two PCF with more than 1000 patients, and two others with more than 800. Conclusions: as patients seem to live in geographical clusters (and considering PCFs with the highest number of them), possible locations for the development of programs regarding mental health treatment and prevention can now be identified.
Psychometric Properties of Instrumented Postural Sway Measures Recorded in Community Settings in Independent Living Older Adults
Authors: Alqahtani Bader , Sparto Patrick J. , Whitney Susan L. , Greenspan Susan L. , Perera Subashan , Brach Jennifer S. 
Published: February 2020

Abstract
Background: In the last few decades, research related to balance in older adults has been conducted in lab-based settings. The lack of portability and high cost that is associated with the current gold standard methods to quantify body balance limits their application to community settings such as independent living facilities. The purpose of the study was to examine the relative and absolute reliability and the convergent validity of static standing balance performance using an accelerometer device. Methods: A total of 131 participants (85% female, mean age 80 ± 8 years) were included for the validity aim, and a subsample of 38 participants were enrolled in the reliability testing (89% female, mean age 76 ± 7 years). The root-mean-square (RMS) and normalized path length (NPL) for sway in antero-posterior (AP) and medio-lateral (ML) directions were calculated for different standing balance conditions. Test-retest reliability was assessed over two testing visits occurring one week apart using the intraclass correlation coefficient (ICC) for relative reliability, and the minimal detectable change (MDC) was calculated for the absolute reliability. Spearman’s rank correlation coefficient was used to test convergent validity at baseline between balance measurements and related mobility measures. Results: Reliability of balance performance using accelerometers was good to excellent with ICC values ranging from 0.41 to 0.83 for RMS sway and from 0.49 to 0.82 for NPL sway. However, the ICC during semi-tandem stance in A-P direction was 0.35, indicating poor reliability. The MDC of the sway measurements ranged from 2.4 to 9.4 for the RMS and 5.2 to 13.8 for the NPL. Balance measurements were correlated with mobility measurements. Conclusions: Using a portable accelerometer to quantify static standing postural control provides reliable measurements in community settings.
Prognostic factors and survival according to tumour subtype in women presenting with breast cancer bone metastases at initial diagnosis: a SEER based study
Authors: Li Xiao , Zhang Xiaoli , Liu Jie 
Published: February 2020

Abstract
Introduction : Tumour subtype have a significant effect on bone metastasis in breast cancer, but population-based estimates of the prognosis of bone metastases at diagnosis of breast cancer are lacking.The aim of this study was to analyse the influence of tumour subtype and other factors in the prognostic and survival of patients with bone metastases of stage IV breast cancer. Methods : Using the Surveillance, Epidemiology, and End Results Program (SEER) data of 2012 to 2016 conducted a retrospective cohort study to investigate stage IV patients with bone metastases in breast cancer. Stage IV Patients characteristic according subtype were compared using chi-square, overall survival (OS), prognostic factor calculated using the Kaplan-Meier method and the Cox proportional hazards model. Results : A total of 3384 stage IV patients were included in this study. 63.42% were HR+/HER2-, 19.86% were HR+/HER2+, 9.34% were HR-/HER2-, and 7.39% were HR-/HER2+. Median OS for the whole population was 38 months, 33.9% of the patients were alive at five-year. The median OS and five-year survival rate among the different subtype of breast cancer stage IV patients are significant differences ( p <0.05). Multivariate Cox regression analysis showed that age of 55-59 (HR=1.270 ), black race (HR=1.317 ), grade in III/IV ( HR=1.960 ), HR-/HER2- (HR=2.808 ), lung metastases (HR=1.378 ), live metastases ( HR= 2.085 ), brain metastases (HR=1.903 ) are independent risk factors of prognosis; married ( HR=0.819 ), HR+/HER2+ (HR= 0.631 ), HR-/HER2+ (HR= 0.716 ), insurance ( HR=0.587 ) and surgery (HR=0.504 ) are independent protection factors of prognosis. There is interaction between HR+/HER2+ subtype and other metastases (except bone metastases , HR=0.694 , 95%CI: 0.485 -0.992 on prognosis. Conclusions : There were substantial differences in OS according to tumour subtype. In addition to tumour subtype, other independent predictors of OS are age at diagnosis, race, marital status, insurance, grade, surgery and visceral metastases. There is interaction between HR+/HER2+ subtype and other metastases (except bone metastases ）on prognosis. Tumour subtype, as a significant prognostic factor, warrant further investigation.
How can gastro-intestinal tuberculosis diagnosis be improved? A prospective cohort study
Authors: Lowbridge Christopher , Fadhil Soraya A. M. , Krishnan Gayathri D. , Schimann Emma , Karuppan Raman Muthu , Sri Nagaraj , Rajahram Giri Shan , Menon Jayaram , Patel Aatish , William Timothy , Paul Dawn Carmel , Ralph Anna P. 
Published: February 2020

Abstract
Background
Gastrointestinal tuberculosis (TB) is diagnostically challenging; therefore, many cases are treated presumptively. We aimed to describe features and outcomes of gastrointestinal TB, determine whether a clinical algorithm could distinguish TB from non-TB diagnoses, and calculate accuracy of diagnostic tests.
Methods
We conducted a prospective cohort study of hospitalized patients in Kota Kinabalu, Malaysia, with suspected gastrointestinal TB. We recorded clinical and laboratory characteristics and outcomes. Tissue samples were submitted for histology, microscopy, culture and GeneXpert MTB/RIF®. Patients were followed for up to two years.
Results
Among 88 patients with suspected gastrointestinal TB, 69 were included in analyses; 52 (75%) had a final diagnosis of gastrointestinal TB; 17 had a non-TB diagnosis. People with TB were younger (42.7 versus 61.5 years, p=0.01) and more likely to have weight loss (91% versus 64%, p=0.03). An algorithm using age <44, weight loss, cough, fever, no vomiting, albumin >26 g/L, platelets >340 x10 9 /L and immunocompromise had good specificity (96.2%) in predicting TB, but very poor sensitivity (16.0%). GeneXpert® performed very well on gastrointestinal biopsies (sensitivity 95.7% versus 35.0% for culture against a gold standard composite case definition of confirmed TB). Most patients (79%) successfully completed treatment and no treatment failure occurred, however adverse events (21%) and mortality (13%) among TB cases were high. We found no evidence that six months of treatment was inferior to longer courses.
Conclusions
The prospective design provides important insights for clinicians managing gastrointestinal TB. We recommend wider implementation of high-performing diagnostic tests such as GeneXpert® on extra-pulmonary samples.
The association between dietary antioxidants intakes and the risk of cardiovascular disease: Tehran Lipid and Glucose Study
Authors: Mirmiran Parvin , Esfandiar Zohreh , Hosseini-Esfahani Firoozeh , Hosseinpour-Niazi somayeh , Azizi Fereidoun 
Published: February 2020

Abstract
Aim: This study aimed at investigating the association between daily consumption of dietary vitamins A, E, and C, and zinc and the incidence of cardiovascular disease (CVD).
Methods: Eligible adults (n=5102) were selected from the participants of the Tehran Lipid and Glucose Study with an average follow-up of 5.3 years. Dietary intakes were assessed using a valid and reliable semi-quantitative food frequency questionnaire. Anthropometrics and biochemical variables were evaluated at baseline and follow-up examinations. Multivariate Cox proportional hazard regression models were used to estimate the development of CVD associated with total intakes of vitamins A, E, and C, and zinc.
Results: This study was conducted on 2,253 men and 2,849 women aged 47.0±11.6 and 45.6±10.5 years, respectively. The main sources of dietary vitamins A, E, and C and zinc were fruits, vegetables, and legumes. Risk of CVD decreased from quartile 1 to quartile 4 for vitamin E intake (HR (95% CI): 1.00, 0.91, 0.77, and 0.57; P trend =0.03). The association between risk of CVD and the quartiles of vitamins A and C and zinc intake was not significant.
Conclusion : Our study suggested an inverse association between vitamin E intake and the risk of CVD. The results emphasized a potential protective role of its dietary sources in the prevention of CVD.
How much of skin improvement over time in systemic sclerosis is due to normal ageing? A prospective study with shear-wave elastography.
Authors: Santiago Tania , Santiago Tania Louza , Santiago Mariana Galante , Coutinho Margarida Macedo , Salvador Maria Joao , Silva José António Pereira Da 
Published: February 2020

Abstract
Objective To assess changes in skin stiffness in SSc patients using SWE during a five-year follow-up. Methods Skin stiffness [i.e. shear-wave velocity values (SWV) in m/s] was assessed by SWE ultrasound (using virtual touch image quantification) at the 17 sites of the mRSS, in each participant, at baseline and follow-up. mRSS was performed at both time points. Differences between groups were analysed using the related-samples Wilcoxon Signed Rank test and the Mann–Whitney U test. Results We included 21 patients [85.7% females; mean age 56.3 (10.4) years at baseline, 57.1% with limited SSc] and, 15 healthy controls [73.3% females; mean age 53.6 (14.1) years)]. The median follow-up was 4.9 (0.4) years. Skin stiffness decreased significantly at all Rodnan sites (p≤0.001), (except in the fingers), in SSc patients, over time. The same phenomenon occurred in controls, but to a lesser degree, in terms of percentage change. The percentage reduction in skin stiffness varied in the different Rodnan sites and in different phases of the disease. In addition, SWV values also decreased significantly in 15/16 skin sites with local normal Rodnan at baseline, whereas local Rodnan skin score only changed significantly in the upperarm (p=0.046) and forearm (p=0.026). Conclusion This study provides first-time evidence suggesting that skin SWV values are more sensitive to change over time than mRSS, and reduce significantly over time in SSc and normal controls.
A nationwide survey on the use of Heated Humidified High Flow Oxygen therapy on the paediatric wards in the UK: Current practice and research priorities
Authors: Hosheh Osama , Edwards Christopher T , Ramnarayan Padmanabhan 
Published: February 2020

Abstract
Background:
Heated Humidified High Flow Nasal Cannula Oxygen Therapy (HHFNC) is increasingly used on the paediatric wards and High Dependency Units (HDU) for different types of pathologies and different age groups. We aimed to describe current practice related to the use of HHFNC on the paediatric wards and HDUs, weaning practices and preferred outcome measures for future research.
Methods:
We carried out a cross-sectional online survey of UK paediatric consultants or their delegates working on the paediatric wards. Descriptive analysis of their geographical, and organizational characteristics, their specialties, and their level of experience was investigated. Reasons for HHFNC initiation, weaning criteria, patients’ characteristics and their primary pathologies were also analysed.
Results:
Participation of 218 paediatricians from 81 hospitals (Median: 2.7, Range: 1-11) was registered. HHFNC was provided in most of the surveyed hospitals (93%, 75/81). A High Dependency Unit (HDU) was available in 47 hospitals (58%); less than a third of those have a dedicated paediatrician. Decisions around HHFNC were made solely by paediatricians in (75%) of the cases, mostly at hospitals with no HDU compared to those with dedicated HDUs (70.3% VS 36.6%, 95%CI:22.6%-50.4%, P< .001). Sixty-eight percent of the respondents agreed that HHFNC is either the same or superior to CPAP (Continuous Positive Airway Pressure) with fewer complications. Failure rate while on HHFNC was identified as the most important outcome measure in any future research followed by the length of need for HHFNC support (37.1%, and 28% respectively).
Conclusion:
This survey showed support for developing paediatric-specific national guidance on the use of HHFNC on the wards. Our list of defined research priorities may help guide further collaborative research efforts in this field.
Ticks and associated pathogens in camels (Camelus dromedarius) from Riyadh province, Saudi Arabia
Authors: Alanazi Abdullah Daria , Nguyen Viet Linh , Alyousif Mohamed Saleh , Manoj Ranju Ravindran Santhakumari , Alouffi Abdulaziz Saleh , Donato Ridolfi , Sazmand Alireza , Mendoza-Roldan Jairo Alfonso , Dantas-Torres Filipe , Otranto Domenico 
Published: February 2020

Abstract
Background: Camel production in Saudi Arabia is severely affected by various diseases and by inadequate veterinary services. Ticks and tick-borne pathogens (TBPs ) affect the health and wellbeing of camels consequently diminishing their productivity and performances. In addition, camels may act as hosts for TBPs (e.g. Anaplasma phagocytophilum ) causing diseases in humans. The current study aimed to determine the prevalence of ixodid ticks and molecularly investigate the associated pathogens in camels from Saudi Arabia. Methods: Blood and tick samples were collected from camels ( n = 170) in Riyad Province of Saudi Arabia. Ticks were morphologically identified, and blood of camels were molecularly screened for apicomplexan (i.e. Babesia spp . , Theileria spp., Hepatozoon spp.) and rickettsial parasites (i.e. Ehrlichia spp. and Anaplasma spp.). Results: Of the 170 camels examined, 116 (68.2%; 95% CI: 60.9–75.1%) were infested by ticks with a mean intensity of 2.53 (95% CI: 2.4–2.6). In total of 296 ticks collected, Hyalomma dromedarii was the most prevalent (76.4%), followed by Hyalomma impeltatum (23.3%) and Hyalomma excavatum (0.3%). Of the tested animals, 13 (7.6%; 95% CI: 4.3–12.8%) scored positive to at least one TBP, with Anaplasma platys (5.3%; 95% CI: 2.7–9.9%) being the most prevalent species, followed by Anaplasma phagocytophilum , Anaplasma sp., Ehrlichia canis and Hepatozoon canis (0.6% each; 95% CI: 0.04–3.4%). None of the camels were found to be co-infected with more than one pathogen. All samples tested negative for Babesia spp. and Theileria spp. Conclusions: The present study reveals the occurrence of different tick species and tick-borne pathogens in camels from Saudi Arabia. Importantly, these camels may carry A. phagocytophilum and A. platys , representing a potential risk to humans.
Res-WGAN: Image Classification for Plant Small-scale Datasets
Authors: Jiaqi Mi , Xia Hao , Si Yang , Wanlin Gao , Minzan Li , Wang Minjuan , Lihua Zheng 
Published: February 2020

Abstract
Background: The artificial identification of rare plants is always a challenging problem in plant taxonomy. Although the convolutional neural network (CNN) in the deep learning method can better realize the automatic classification of plant samples through training, the model accuracy is difficult to reach the human eye discrimination due to the quantitative limit of training samples. Thus, effective data enhancement is vital to improve the generalization ability and robustness of deep learning models, especially for plant small-scale data classification task. Different from traditional methods, the Generative adversarial network (GAN) mimics original data distribution and produces new samples with similar features which can help classifiers equip with extraordinary generalization ability. It has not been studied that data enhancement for plant samples’ characteristics with GAN since sliced bread. Result: In this study, we present a novel GAN model named as Residual Wasserstein GAN (Res-WGAN) for data enhancement. To further adapt to plant small-scale datasets, residual blocks were introduced into the classic WGAN-GP as the basic network unit. These blocks enrich the presentation skills and sustained parameters unchanged simultaneously. Moreover, we enforce the idea from SRGAN to take content loss into a final function, which guarantes the similarity between generated samples and original samples in high-dimensional features. Benefiting from these improvements, the proposed Res-WGAN expanded original datasets efficiently. We test it on the ResNet and the experimental results show that new datasets combined transfer learning significantly promoted the accuracy of classification, especially at testing data. To illustrate the generalization of the model, more particular small datasets are applied for expansion and classification in this paper. Conclusions: Our works report competitive accuracy results than other data enhancement methods, and user study confirms it’s an ideal alternative strategy for small-scale plant datasets enhancement. Developing robust and effective small-scale plants classification method to replace expert testimony, is highly relevant for agricultural automation development.
Sentinel node theory helps tracking of primary lesions of cancers of unknown primary
Authors: Shao Yilin , Liu Xin , Hu Silong , Zhang Yingjian , Li Wentao , Zhou Xiaoyan , Wang Qifeng , Hou Yifeng , Chen Yong , Wang Yanli , Wang Yaohui , Luo Zhiguo , Hu Xichun 
Published: February 2020

Abstract
Background: Sentinel lymph node is the first stop of lymphatic spreading of cancer with known primary. The lymph node metastasis pattern of cancer of unknown primary (CUP) is unclear and has been presumed to follow the same pathway. To test this hypothesis, data of all 716 patients clinically diagnosed as CUP in our center were collected.Methods: Diagnoses of lymph node metastasis were established by 18F-FDG PET-CT and/or biopsy pathology. Three hundred and forty-seven cases meeting the criteria were divided into three groups: pathology-confirmed primary with invasive biopsy or surgery of the suspicious lesion (group A, n=64), primary still unknown even with invasive biopsy or surgery of the suspicious lesion (group B, n=204), and others with no suspicious lesion or lesions who had not been sampled due to medical or other reasons (group C, n=79). We assessed the clinicopathological features between these groups, and the relationship between lymph node metastasis pattern and confirmed primary site. Results: In group A, the primary sites of 61 cases were compatible with sentinel node theory, resulting in a positive predictive value of 95%. No significant differences in age, sex, bone metastasis, or visceral metastasis observed between group A and group B, except that group A had a higher ratio of differentiated carcinoma (94% vs. 77%, P=0.003). Conclusion: To our knowledge, this is the first evidence indicating that the majority of clinical CUP cases follow the sentinel node theory to spread in lymph nodes, which helps tracking the primary, especially for differentiated carcinoma.