bluuebunny/crossref_metadata_2025_split huggingface dataset:
Care-seeking during fatal childhood illness in rural South Africa: a qualitative study
Authors: Price Jessica , Willcox Merlin , Dlamini Vuyiswa , Khosa Audrey , Khanyile Phindile , Seeley Janet , Harnden Anthony , Kahn Kathleen , Hinton Lisa 
Published: April 2021

ObjectivesThis study aimed to better understand reasons why children in South Africa die at home, including caregivers’ care-seeking experiences, decision-making, choice of treatment provider and barriers to accessing care during a child’s final illness.DesignThis qualitative study included semi-structured in-depth interviews and focus group discussions with caregivers of children who died below the age of 5 years. Data were thematically analysed, and key findings compared with the Pathways to Survival Framework—a model frequently used in the study of child mortality. An adapted model was developed.SettingTwo rural health and demographic surveillance system (HDSS) sites in South Africa—the Agincourt HDSS and the Africa Health Research Institute.ParticipantsThirty-eight caregivers of deceased children (29 participated in in-depth interviews and 9 were participants in two focus group discussions). Caregivers were purposively sampled to ensure maximum variation across place of death, child age at death, household socioeconomic status, maternal migration status and maternal HIV status.FindingsAlthough caregivers faced barriers in providing care to children (including insufficient knowledge and poor transport), almost all did seek care from the formal health system. Negative experiences in health facilities did not deter care-seeking, but most respondents still received poor quality care and were not given adequate safety-netting advice. Traditional healers were only consulted as a last resort when other approaches had failed.ConclusionBarriers to accessing healthcare disrupt the workings of previously accepted care-seeking models. The adapted model presented in this paper more realistically reflects care-seeking experiences and decision-making during severe childhood illness in rural South Africa and helps explain both the persistence of home deaths despite seeking healthcare, and the impact of a child’s death on care-seeking in future childhood illness. This model can be used as the basis for developing interventions to reduce under-5 mortality.
Enablers and barriers to primary healthcare for Aboriginal and Torres Strait Islander adolescents: study protocol for participatory mixed-methods research that builds on WHO global standards
Authors: Ritchie Tirritpa , Purcell Tara , Westhead Seth , Wenitong Mark , Cadet-James Yvonne , Brown Alex , Kirkham Renae , Neville Johanna , Saleh Clara , Brown Ngiare , Kennedy Elissa C , Hennegan Julie , Pearson Odette , Azzopardi Peter S 
Published: April 2021

IntroductionOne-third of Australia’s Aboriginal and Torres Strait Islander population are adolescents. Recent data highlight their health needs are substantial and poorly met by existing services. To design effective models of primary healthcare, we need to understand the enablers and barriers to care for Aboriginal and Torres Strait Islander adolescents, the focus of this study.Methods and analysisThis protocol was codesigned with Apunipima Cape York Health Council that supports the delivery of primary healthcare for 11 communities in Far North Queensland. We framed our study around the WHO global standards for high-quality health services for adolescents, adding an additional standard around culturally safe care. The study is participatory and mixed methods in design and builds on the recommended WHO assessment tools. Formative qualitative research with young people and their communities (exploring concepts in the WHO recommended quantitative surveys) seeks to understand demand-side enablers and barriers to care, as well as preferences for an enhanced response. Supply-side enablers and barriers will be explored through: a retrospective audit of clinic data (to identify current reasons for access and what can be strengthened); an objective assessment of the adolescent friendliness of clinical spaces; anonymous feedback from adolescent clients around quality of care received and what can be improved; and surveys and qualitative interviews with health providers to understand their perspectives and needs to provide enhanced care. This codesigned project has been approved by Apunipima Cape York Health Council and Far North Queensland Human Research Ethics Committee.Dissemination and implicationsThe findings from this project will inform a codesigned accessible and responsive model of primary healthcare for Aboriginal and Torres Strait Islander adolescents.
Reducing time to X-ray in emergency department ambulatory patients: a quality improvement project
Authors: Kwok Matthew Mo Kin , Chiu Allison , Chia James , Hansen Cindy 
Published: April 2021

This quality improvement project began when physicians and nurses at our hospital observed patients waiting for excessive periods of time for a porter to escort patients from the emergency department (ED) to medical imaging (MI). However, certain patients may not need staff escort and are able to ambulate from ED to MI by themselves. This would reduce waiting time from when the X-ray is ordered to X-ray being done, which may reduce overall ED length of stay and improve patients’ experience.Our project aim is to decrease the time to X-ray by 50% within 6 months by having appropriate ambulatory patients walk from the ED to the X-ray department without a porter. To achieve our goal, several strategies were employed. First, brainstorm sessions were held to better understand the barriers and ways to implement the new process. Second, a patient survey was conducted to understand their thoughts on the change idea. Third, data were collected to assess the inefficiency problem on the number of times non-porter staff escorted patients due to porters being unavailable. A total of 14 PDSA (Plan-Do-Study-Act) cycles were completed between December 2018 and May 2019. A human factor specialist was consulted to examine the process for safety and optimisation of the patient journey.In our PDSA cycles, self-ambulatory patients were compared with ambulatory patients who required an escort. An improvement was found from time to X-ray of 28 min (11 min vs 39 min). The new self-ambulatory process was implemented in June 2019 on a daily basis.
Effects of a refined evidence-based toolkit and mentored implementation on medication reconciliation at 18 hospitals: results of the MARQUIS2 study
Authors: Schnipper Jeffrey L , Reyes Nieva Harry , Mallouk Meghan , Mixon Amanda , Rennke Stephanie , Chu Eugene , Mueller Stephanie , Smith Jr Gregory (Randy) R , Williams Mark V , Wetterneck Tosha B , Stein Jason , Dalal Anuj , Labonville Stephanie , Sridharan Anirudh , Stolldorf Deonni P , Orav E John , Levin Brian , Gresham Marcus , Yoon Cathy , Goldstein Jenna , Platt Sara , Nyenpan Christopher Tugbéh , Howell Eric , Kripalani Sunil ,   and MARQUIS2 Site Leaders
Published: April 2021

BackgroundThe first Multicenter Medication Reconciliation Quality Improvement (QI) Study (MARQUIS1) demonstrated that mentored implementation of a medication reconciliation best practices toolkit decreased total unintentional medication discrepancies in five hospitals, but results varied by site. The objective of this study was to determine the effects of a refined toolkit on a larger group of hospitals.MethodsWe conducted a pragmatic quality improvement study (MARQUIS2) at 18 North American hospitals or hospital systems from 2016 to 2018. Incorporating lessons learnt from MARQUIS1, we implemented a refined toolkit, offering 17 system-level and 6 patient-level interventions. One of eight physician mentors coached each site via monthly calls and performed one to two site visits. The primary outcome was number of unintentional medication discrepancies in admission or discharge orders per patient. Time series analysis used multivariable Poisson regression.ResultsA total of 4947 patients were sampled, including 1229 patients preimplementation and 3718 patients postimplementation. Both the number of system-level interventions adopted per site and the proportion of patients receiving patient-level interventions increased over time. During the intervention, patients experienced a steady decline in their medication discrepancy rate from 2.85 discrepancies per patient to 0.98 discrepancies per patient. An interrupted time series analysis of the 17 sites with sufficient data for analysis showed the intervention was associated with a 5% relative decrease in discrepancies per month over baseline temporal trends (adjusted incidence rate ratio: 0.95, 95% CI 0.93 to 0.97, p<0.001). Receipt of patient-level interventions was associated with decreased discrepancy rates, and these associations increased over time as sites adopted more system-level interventions.ConclusionA multicentre medication reconciliation QI initiative using mentored implementation of a refined best practices toolkit, including patient-level and system-level interventions, was associated with a substantial decrease in unintentional medication discrepancies over time. Future efforts should focus on sustainability and spread.
Association of imbalance between job workload and functional ability with return to work in ARDS survivors
Authors: Su Han , Hopkins Ramona O , Kamdar Biren B , May Susanne , Dinglas Victor D , Johnson Kurt L , Hosey Megan , Hough Catherine L , Needham Dale M , Thompson Hilaire J 
Published: April 2021

BackgroundInability to return to work (RTW) is common after acute respiratory distress syndrome (ARDS). Mismatch in an individual’s job workload and his or her functional ability, termed work ability imbalance, is negatively associated with RTW, but has not been evaluated in ARDS survivors.ObjectWe examine associations between work ability imbalance at 6 months and RTW at 6 months and 12 months, as well as the ability to sustain employment in ARDS survivors.MethodsPreviously employed participants from the ARDS Network Long-Term Outcomes Study (N=341) were evaluated. Pre-ARDS workload was determined based on the US Occupational Information Network classification. Post-ARDS functional ability was assessed using self-reported 36-Item Short Form Health Survey (SF-36) physical functioning, social functioning and mental health subscales, and Mini-Mental State Examination. ARDS survivors were categorised into four work ability imbalance categories: none, psychosocial, physical, and both psychosocial and physical.ResultsAlmost 90% of ARDS survivors had a physical and/or psychosocial work ability imbalance at both 6-month and 12-month follow-up. Compared with survivors with no imbalance at 6 months, those with both physical and psychosocial imbalance had lower odds of RTW (6 months: OR=0.33, 95% CI=0.13 to 0.82; 12 months: OR=0.22, 95% CI=0.07 to 0.65). Thirty-eight (19%) of those who ever RTW were subsequently jobless at 12 months.ConclusionInterventions aimed at rebalancing ARDS survivors’ work ability by addressing physical and psychosocial aspects of their functional ability and workload should be explored as part of efforts to improve RTW, maintain employment and reduce the financial impact of joblessness.
The vulnerability of tidal flats and multi-channel estuaries to dredging and disposal
Authors: van Dijk Wout M. , Cox Jana R. , Leuven Jasper R. F. W. , Cleveringa Jelmer , Taal Marcel , Hiatt Matthew R. , Sonke Willem , Verbeek Kevin , Speckmann Bettina , Kleinhans Maarten G. 
Published: April 2021

Abstract
Shipping fairways in estuaries are continuously dredged to maintain access for large vessels to major ports. However, several estuaries worldwide show adverse side effects to dredging activities, in particular affecting morphology and ecologically valuable habitats. We used physical scale experiments, field assessments of the Western Scheldt estuary (the Netherlands), and morphodynamic model runs to analyse the effects of dredging and future stresses (climate and sediment management) on a multi-channel system and its ecologically valuable intertidal flats. All methods indicate that dredging and disposal strategies are unfavourable to long-term morphology because dredging creates and propagates the imbalance between shallow and deeper parts of the estuary, causing a loss of valuable connecting channels and fixation of the tidal flats and main channel positions, while countering adverse effects by disposal strategy has limited effectiveness. Changing the disposal strategy towards main channel scour disposal can be economically and ecologically beneficial for the preservation of the multi-channel system. Further channel deepening will accelerate the adverse side effects, whereas future sea-level rise may revive the multi-channel system.
The Application of Selective Hepatic Inflow Vascular Occlusion with Anterior Approach in Liver Resection: Effectiveness in Managing Major Complications and Long-Term Survival
Authors: Ninh Khai Viet , Nguyen Nghia Quang , Trinh Son Hong , Pham Anh Gia , Doan Thi-Ngoc-Ha 
Published: April 2021

Background. Hepatectomy is always a challenge to surgeons and requires an appropriate approach for specific tumors to achieve effective complication management. Selective hepatic pedicle clamping is more considerable strategy when comparing with total hepatic pedicle clamping in the balance between reducing blood loss and transfusion with causing the hepatic parenchyma damages (two main complications affecting liver resection result). Objectives. In this study, we aim to describe the application of selective hepatic inflow vascular occlusion (SHIVO) and anatomical anterior approach in liver resection and evaluate the results, focusing on intraoperative and postoperative complications. Methods. We enrolled 72 patients who underwent liver resection with SHIVO at Viet Duc University Hospital in 4-year period (2011-2014) and then followed up all of them until June 2020 (in

52.6
±
33

months; range, 2-105 months) or up to the time of death. All the patients were diagnosed with primary or secondary liver cancer, and their future remnant liver volume measured on 64-slice CT scan (dm3) to

body

weight

kg

>
0.8

% (for right hepatectomy). Perioperative parameters were collected and analyzed. Results. The average operation time was

196.2
±
62.2

minutes, and blood loss was

261.4
±
202.9

ml; total blood transfusion proportion during and after surgery was 16.7%. Complications accounted for 44.5% of patients in which pleural effusion was the most common one (41.7%). There were no liver failure and biliary fistula after surgery. No deaths were recorded during 30 days postoperatively. Average hospital stay was

11.4
±
3.7

days. Blood transfusions during the operation and major liver resection were the factors significantly affecting the percentage of complications after liver surgery in our study. In the last follow-up evaluation, 44 patients were dead and 28 patients were alive, in which 7 with recurrence and 21 without recurrence. The overall survival rate was 38.9%. Conclusion. SHIVO in anatomical liver resection is a safe and feasible approach to help resect precisely targeted tumors and manage several complications in liver resection.
First-in-Human Phase 1 Study of MORAb-202, an Antibody–Drug Conjugate Comprising Farletuzumab Linked to Eribulin Mesylate, in Patients with Folate Receptor-α–Positive Advanced Solid Tumors
Authors: Shimizu Toshio , Fujiwara Yutaka , Yonemori Kan , Koyama Takafumi , Sato Jun , Tamura Kenji , Shimomura Akihiko , Ikezawa Hiroki , Nomoto Maiko , Furuuchi Keiji , Nakajima Ryo , Miura Takuma , Yamamoto Noboru 
Published: April 2021

AbstractPurpose:MORAb-202, an antibody–drug conjugate containing farletuzumab and eribulin with a cathepsin-B cleavable linker, targets folate receptor α (FRα)–expressing tumor cells. The primary objective of this first-in-human study was to evaluate the safety and tolerability of MORAb-202 in patients with solid tumors.Patients and Methods:Patients ≥20 years with adequate organ function and FRα-positive solid tumors who failed to respond to standard therapy were eligible. Patients received MORAb-202 intravenously at doses of 0.3 to 1.2 mg/kg once every three weeks. Endpoints included dose-limiting toxicities, safety, tumor responses, pharmacokinetics, and pharmacodynamics. Trial registration number: NCT03386942 (ClinicalTrials.gov).Results:Between November 28, 2017 and June 4, 2019, 22 patients (median age, 58.0 years) with advanced solid tumors were enrolled. Treatment-emergent adverse events occurred in 21 (95%) patients, with leukopenia and neutropenia in 10 (45%) patients each. One patient (0.9 mg/kg cohort) experienced two grade 3 dose-limiting toxicities: serum alanine aminotransferase and γ-glutamyl transferase increases. Following review by an independent adjudication committee, grade 1/2 interstitial lung disease thought to be related to MORAb-202 was identified in five (23%) patients. Complete response, partial response, and stable disease were observed in one, nine, and eight patients, respectively. The normalized predose serum FRα tended to be positively correlated with the maximum tumor shrinkage (R2 = 0.2379; P = 0.0291).Conclusions:The MTD of MORAb-202 was not reached. MORAb-202 demonstrated promising antitumor activity in FRα-positive solid tumors and was generally well-tolerated at the tested doses. Further investigations are required to establish appropriate dosage and clinical utility of MORAb-202.
Additional, Mechanized Upper Limb Self-Rehabilitation in Patients With Subacute Stroke: The REM-AVC Randomized Trial
Authors: Rémy-Néris Olivier , Le Jeannic Anaïs , Dion Angelina , Médée Béatrice , Nowak Emmanuel , Poiroux Élodie , Durand-Zaleski Isabelle , Beis Jean-Marie , Bensmaïl Djamel , Benaim Charles , Luaute Jacques , Bonan Isabelle , Boyer François , Coudeyre Emmanuel , Daviet Jean-Christophe , Dehail Patrick , Ferrapie Anne-Laure , Isambert Jean-Luc , Kerdraon Jacques , Marque Philippe , Froger Jerome , Allart Etienne , Gross Raphaël , Yelnik Alain , Bensoussan Laurent , Tasseel-Ponche Sophie 
Published: April 2021

Background and Purpose:
Additional therapy may improve poststroke outcomes. Self-rehabilitation is a useful means to increase rehabilitation time. Mechanized systems are usual means to extend time for motor training. The primary aim was to compare the effects of self-rehabilitation using a mechanized device with control self-exercises on upper extremity impairment in patients with stroke.

Methods:
Phase III, parallel, concealed allocation, randomized controlled, multicenter trial, with 12-month follow-up. Patients aged 18 to 80 years, 3 weeks to 3 months poststroke with a Fugl-Meyer Assessment score of 10 to 40 points, were randomized to the Exo or control groups. All undertook two 30-minute self-rehabilitation sessions/day, 5 days/wk for 4 weeks in addition to usual rehabilitation. The Exo group performed games-based exercises using a gravity-supported mechanical exoskeleton (Armeo Spring). The control group performed stretching plus basic active exercises. Primary outcome was change in upper extremity Fugl-Meyer Assessment score at 4 weeks.

Results:

Two hundred fifteen participants were randomly allocated to the Exo group (107) or the control group (108). Mean age (SD), 58.3 (13.6) years; mean time poststroke, 54.8 (22.1) days; and mean baseline Fugl-Meyer Assessment score, 26.1 (9.5). There was no between-group difference in mean change in Fugl-Meyer Assessment score following the intervention: 13.3 (9.0) in the Exo group and 11.8 (8.8) in the control group (
P
=0.22). There were no significant between-group differences in changes for any of the other outcomes at any time point (except for perception of the self-rehabilitation). There was no between-group difference in cost utility at 12 months.

Conclusions:
In patients with moderate-to-severe impairment in the subacute phase of stroke, the purchase and use of complex devices to provide additional upper limb training may not be necessary: simply educating patients to regularly move and stretch their limbs appears sufficient.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01383512.
Selection for Action: The Medial Frontal Cortex Is an Executive Hub for Stimulus and Response Selection
Authors: Asanowicz Dariusz , Panek Bartłomiej , Kotlewska Ilona 
Published: April 2021

Abstract
This EEG study investigates the electrophysiological activity underlying processes of stimulus and response selection, and their executive orchestration via long-range functional connectivity under conflict condition, in order to shed more light on how these brain dynamics shape individual behavioral performance. Participants (n = 91) performed a modified flanker task, in which bilateral visual stimulation and a bimanual response pattern were employed to isolate the stimulus and response selection-related lateralized activity. First, we identified conflict-related markers of task-relevant processes; most importantly, the stimulus and response selection were evidenced by contra–ipsilateral differences in visual and motor activity, respectively, and executive control was evidenced by modulations of midfrontal activity. Second, we identified conflict-related functional connectivity between midfrontal and other task-relevant areas. The results showed that interregional phase synchronization in theta band was centered at the midfrontal site, interpreted here as a “hub” of executive communication. Importantly, the theta functional connectivity was more robust under the condition of increased demands for stimulus and response selection, including connectivity between the medial frontal cortex and the lateral frontal and motor areas, as well as cross-frequency theta–alpha coupling between the medial frontal cortex and contralateral visual areas. Third, we showed that individual differences in the measured conflict-related EEG activity, particularly the midfrontal N2, theta power, and global theta connectivity, predict the behavioral efficiency in conflict resolution.
Postproverbials in Igbo Language
Authors: Abana Ifeoma , Eke Obiora 
Published: April 2021

Abstract
This treatise assesses the pragmatic implicature derived during the use of postproverbials in Igbo language and culture. Igbo proverbs have been so much studied that it would certainly be monotonous for a paroemiographer to resume making belated significance of Igbo speculations on the meaning and essence of a proverb. It is a glaring fact that that there is virtually no substantial controversy about the importance of proverbs in culture and the significance of proverbs in Igbo traditional society as a repository and verbal effulgence of wisdom is indeed proverbial. This study relies on Austin’s pragmatic theory of speech acts, conversational implicature and presupposition. The data is drawn from oral interview conducted by the researchers on ten Igbo elders with the aim of unraveling the linguistic idiosyncrasies associated with the connotation of postproverbials as it relates to different contextual usages. The paper will look at the development of this threat to the fixability of Igbo proverbs, the normative rapture and by extension establish the presence of “new” proverbs with new syntactic forms, new meanings and perhaps, new values. The analytic emphasis is based on the type of transformation, the shift in the construction of users. This paper concludes that postproverbiality is situated in the dynamic space of informal speech of a younger and adventurous generation.