bluuebunny/crossref_metadata_2025_split huggingface dataset:
The importance of learning and knowledge sharing to support implementation of total quality management in healthcare
Authors: Lebcir Reda M , Sideras James D 
Published: October 2021

Background/AimsImplementation of total quality management in healthcare services has often been unsuccessful. This is a result of a variety of factors, including the inadequacy of learning and knowledge sharing methods to support implementation. This study aimed to explore how learning and knowledge sharing policies influence total quality management initiatives in the healthcare sector.MethodsAn extended total quality management model, named the ethical, adaptive, learning, and improvement model, was developed and implemented in a private healthcare organisation in the UK. Using action research, data were collected from 91 participants over a 21-month period from qualitative interviews, focus groups and participant observations.ResultsPractice-based training was found to increase employee competence, reflecting the importance of tacit knowledge sharing. The model led to the prevalent blame culture changing to a learning culture through an appreciative management style that focused on recognising what is done right. In addition, patients' satisfaction and quality of care improved through community groups that were set up to address quality problems and patients' needs.ConclusionsAdequate knowledge sharing methods play an important role in improving quality in healthcare. Greater consideration should be given to this widely ignored aspect when implementing total quality management in NHS trusts.
Lisfranc injuries: fix or fuse?
Authors: van den Boom Noortje Anna Clasina , Stollenwerck Guido A. N. L. , Lodewijks Laureanne , Bransen Jeroen , Evers Silvia M. A. A. , Poeze Martijn 
Published: October 2021

AimsThis systematic review and meta-analysis was conducted to compare open reduction and internal fixation (ORIF) with primary arthrodesis (PA) in the treatment of Lisfranc injuries, regarding patient-reported outcome measures (PROMs), and risk of secondary surgery. The aim was to conclusively determine the best available treatment based on the most complete and recent evidence available.MethodsA systematic search was conducted in PubMed, Cochrane Controlled Register of Trials (CENTRAL), EMBASE, CINAHL, PEDro, and SPORTDiscus. Additionally, ongoing trial registers and reference lists of included articles were screened. Risk of bias (RoB) and level of evidence were assessed using the Cochrane risk of bias tools and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. The random and fixed-effect models were used for the statistical analysis.ResultsA total of 20 studies were selected for this review, of which 12 were comparative studies fit for meta-analysis, including three randomized controlled trials (RCTs). This resulted in a total analyzed population of 392 patients treated with ORIF and 249 patients treated with PA. The mean differences between the two groups in American Orthopedic Foot and Ankle Society (AOFAS), VAS, and SF-36 scores were -7.41 (95% confidence interval (CI) -13.31 to -1.51), 0.77 (95% CI -0.85 to 2.39), and -1.20 (95% CI -3.86 to 1.46), respectively.ConclusionThis is the first study to find a statistically significant difference in PROMs, as measured by the AOFAS score, in favour of PA for the treatment of Lisfranc injuries. However, this difference may not be clinically relevant, and therefore drawing a definitive conclusion requires confirmation by a large prospective high-quality RCT. Such a study should also assess cost-effectiveness, as cost considerations might be decisive in decision-making. Level of Evidence: I Cite this article: Bone Jt Open 2021;2(10):842–849.
Orchestration versus bookkeeping: How stakeholder pressures drive a healthcare purchaser’s institutional logics
Authors: Noort Bart A. C. , van der Vaart Taco , Ahaus Kees 
Published: October 2021

BackgroundHealthcare purchasers such as health insurers and governmental bodies are expected to strategically manage chronic care chains. In doing so, purchasers can contribute to the goal of improving task division and collaboration between chronic care providers as has been recommended by numerous studies. However, healthcare purchasing research indicates that, in most countries, purchasers still struggle to fulfil a proactive, strategic approach. Consequently, a typical pattern occurs in which care improvement initiatives are instigated, but not transformed into regular care. By acknowledging that healthcare purchasers are embedded in a care chain of stakeholders who have different, sometimes conflicting, interests and, by taking an institutional logics lens, we seek to explain why achieving strategic purchasing and sustainable improvement is so elusive.Method and findingsWe present a longitudinal case study in which we follow a health insurer and care providers aiming to improve the care of patients with Chronic Obstructive Pulmonary Disease (COPD) in a region of the Netherlands. Taking a theoretical lens of institutional logics, our aim was to answer ‘how stakeholder pressures influence a purchaser’s use of institutional logics when pursuing the right care at the right place’. The insurer by default predominantly expressed a bookkeeper’s logic, reflecting a focus on controlling short-term care costs by managing individual providers. Over time, a contrasting orchestrator’s logic emerged in an attempt to achieve chain-wide improvement, striving for better health outcomes and lower long-term costs. We established five types of stakeholder pressure to explain the shift in logic adoption: relationship pressures, cost pressures, medical demands, public health demands and uncertainty. Linking the changes in logic over time with stakeholder pressures showed that, firstly, the different pressures interact in influencing the purchaser. Secondly, we saw that the lack of intra-organisational alignment affects how the purchaser deals with the different stakeholder pressures.ConclusionsBy highlighting the purchaser’s difficult position in the care chain and the consequences of their own internal responses, we now better understand why the intended orchestrator’s logic and thereby a strategic approach to purchasing chronic care proves unsustainable within the Dutch healthcare system of managed competition.
Sex- and age- specific normal values of left ventricular functional and myocardial mass parameters using threshold-based trabeculae quantification
Authors: Gregor Zsófia , Kiss Anna Réka , Szabó Liliána Erzsébet , Tóth Attila , Grebur Kinga , Horváth Márton , Dohy Zsófia , Merkely Béla , Vágó Hajnalka , Szűcs Andrea 
Published: October 2021

Background
The threshold-based (TB) trabeculated and papillary muscle mass (TPM) quantification method for cardiac MRI (CMR) calculates different values than conventional contouring techniques. We aimed to identify the sex- and age-related normal reference ranges for left ventricular (LV) myocardial mass values, volumetric and functional parameters and the correspondence of these parameters using the TB method.

Methods
Healthy European adults (n = 200, age: 39.4 ± 12 years, males: 100) were examined with CMR and evaluated with a TB postprocessing method. They were stratified by sex and age (Group A: 18–29, Group B: 30–39, Group C: 40–49, Group D: >50 years). The calculated parameters were indexed to body surface area (i).

Results
The normal reference ranges for the studied parameters were assessed in each age group. Significant biometric differences in LV parameters and mass-to-volume ratios were found between males and females, and the left ventricular compacted myocardial mass (LVCMi) and TPMi differences remained significant after stratification by age. Unlike other LV volumetric and functional parameters and mass-to-volume ratios, the TPMi, the LVCMi and the TPMi-to-LVCMi ratio did not differ among age groups in males or females. This finding was strengthened by the lack of correlation between TPMi and age.

Conclusions
Age- and sex-related normal reference ranges for LV volumetric and functional parameters and LVCMi and TPMi values were established using a TB postprocessing method. TPMi, LVCMi and their ratio did not change over time. The TPMi-to-LVCMi and the mass-to-volume ratios might have clinical utility in the differential diagnosis of conditions with LV hypertrabeculation.
Four-year safety and effectiveness data from patients with multiple sclerosis treated with fingolimod: The Spanish GILENYA registry
Authors: Meca-Lallana J. E. , Oreja-Guevara C. , Muñoz D. , Olascoaga J. , Pato A. , Ramió-Torrentà L. , Meca-Lallana V. , Hernández M. A. , Marzo M. E. , Álvarez- Cermeño J. C. , Rodríguez-Antigüedad A. , Montalbán X. , Fernández O. ,   on behalf of the Spanish GILENYA Registry Investigators
Published: October 2021

ObjectiveTo describe the profile of patients with multiple sclerosis (MS) treated with fingolimod in Spain and to assess the effectiveness and safety of fingolimod after 4 years of inclusion in the Spanish Gilenya Registry.MethodsAn observational, retrospective/prospective, multicenter case registry, including all patients with relapsing-remitting MS (RRMS) starting treatment with fingolimod in 43 centers in Spain. Analyses were performed in the overall population and in subgroups according to prior disease-modifying therapy (DMT): glatiramer acetate/interferon beta-1 (BRACE), natalizumab, other treatment, or naïve.ResultsSix hundred and sixty-six evaluable patients were included (91.1% previously treated with at least one DMT). The mean annualized relapse rate (ARR) prior to fingolimod was 1.12, and the mean EDSS at fingolimod initiation was 3.03. Fingolimod reduced the ARR by 71.4%, 75%, 75.5%, and 80.3%, after 1, 2, 3 and 4 years, respectively (p<0.001). This significant reduction in the ARR continued to be observed in all subgroups. After 4 years, the EDSS showed a minimal deterioration, with the EDSS scores from year 1 to year 4 remaining mostly stable. The percentage of patients without T1 Gd+ lesions progressively increased from 45.6% during the year prior to fingolimod initiation to 88.2% at year 4. The proportion of patients free from new/enlarged T2 lesions after 4 years of fingolimod treatment was 80.3%. This trend in both radiological measures was also observed in the subgroups. Adverse events (AEs) were experienced by up to 41.6% of patients (most commonly: lymphopenia [12.5%] and urinary tract infection [3.7%]). Most AEs were mild in severity, 3.6% of patients had serious AEs.ConclusionsThe patient profile was similar to other observational studies. The results obtained from the long-term use of fingolimod showed that it was effective, regardless of prior DMT, and it had adequate safety results, with a positive benefit-risk balance.
Who keeps on working? The importance of resilience for labour market participation
Authors: Berthung Espen , Gutacker Nils , Friborg Oddgeir , Abelsen Birgit , Olsen Jan Abel 
Published: October 2021

Background
It is widely recognized that individuals’ health and educational attainments, commonly referred to as their human capital, are important determinants for their labour market participation (LMP). What is less recognised is the influence of individuals’ latent resilience traits on their ability to sustain LMP after experiencing an adversity such as a health shock.

Aim
We investigate the extent to which resilience is independently associated with LMP and moderates the effect of health shocks on LMP.

Method
We analysed data from two consecutive waves of a Norwegian prospective cohort study. We followed 3,840 adults who, at baseline, were healthy and worked full time. Binary logistic regression models were applied to explain their employment status eight years later, controlling for age, sex, educational attainment, health status at baseline, as well as the occurrences of three types of health shocks (cardiovascular diseases, cancer, psychological problems). Individuals’ resilience, measured by the Resilience Scale for Adults (RSA), entered as an independent variable and as an interaction with the indicators of health shocks. In separate models, we explore the role of two further indicators of resilience; locus of control, and health optimism.

Results
As expected, health shocks reduce the probability to keep on working full-time. While both the RSA and the two related indicators all suggest that resilience increases the probability to keep on working, we did not find evidence that resilience moderates the association between health shocks and LMP.

Conclusion
Higher levels of resilience is associated with full-time work as individuals age.
Safety and efficacy of very low carbohydrate diet in patients with diabetic kidney disease—A randomized controlled trial
Authors: Zainordin Nur Aisyah , Eddy Warman Nur’ Aini , Mohamad Aimi Fadilah , Abu Yazid Fatin Aqilah , Ismail Nazrul Hadi , Chen Xin Wee , Koshy Marymol , Abdul Rahman Thuhairah Hasrah , Mohd Ismail Nafeeza , Abdul Ghani Rohana 
Published: October 2021

IntroductionThere is limited data on the effects of low carbohydrate diets on renal outcomes particularly in patients with underlying diabetic kidney disease. Therefore, this study determined the safety and effects of very low carbohydrate (VLCBD) in addition to low protein diet (LPD) on renal outcomes, anthropometric, metabolic and inflammatory parameters in patients with T2DM and underlying mild to moderate kidney disease (DKD).Materials and methodsThis was an investigator-initiated, single-center, randomized, controlled, clinical trial in patients with T2DM and DKD, comparing 12-weeks of low carbohydrate diet (<20g daily intake) versus standard low protein (0.8g/kg/day) and low salt diet. Patients in the VLCBD group underwent 2-weekly monitoring including their 3-day food diaries. In addition, Dual-energy x-ray absorptiometry (DEXA) was performed to estimate body fat percentages.ResultsThe study population (n = 30) had a median age of 57 years old and a BMI of 30.68kg/m2. Both groups showed similar total calorie intake, i.e. 739.33 (IQR288.48) vs 789.92 (IQR522.4) kcal, by the end of the study. The VLCBD group showed significantly lower daily carbohydrate intake 27 (IQR25) g vs 89.33 (IQR77.4) g, p<0.001, significantly higher protein intake per day 44.08 (IQR21.98) g vs 29.63 (IQR16.35) g, p<0.05 and no difference in in daily fat intake. Both groups showed no worsening of serum creatinine at study end, with consistent declines in HbA1c (1.3(1.1) vs 0.7(1.25) %) and fasting blood glucose (1.5(3.37) vs 1.3(5.7) mmol/L). The VLCBD group showed significant reductions in total daily insulin dose (39(22) vs 0 IU, p<0.001), increased LDL-C and HDL-C, decline in IL-6 levels; with contrasting results in the control group. This was associated with significant weight reduction (-4.0(3.9) vs 0.2(4.2) kg, p = <0.001) and improvements in body fat percentages. WC was significantly reduced in the VLCBD group, even after adjustments to age, HbA1c, weight and creatinine changes. Both dietary interventions were well received with no reported adverse events.ConclusionThis study demonstrated that dietary intervention of very low carbohydrate diet in patients with underlying diabetic kidney disease was safe and associated with significant improvements in glycemic control, anthropometric measurements including weight, abdominal adiposity and IL-6. Renal outcomes remained unchanged. These findings would strengthen the importance of this dietary intervention as part of the management of patients with diabetic kidney disease.
Spore morphology of Taenitis, Syngramma, and Austrogramme species (Pteridoideae, Pteridaceae) from South-Eastern Asia and Oceania. II
Authors: Vaganov Alexey V. , Gureyeva Irina I. , Shmakov Alexander I. , Kuznetsov Alexander A. , Romanets Roman S. 
Published: October 2021

This paper continues consideration of the spores of three paleotropical fern genera – Taenitis, Syngramma, and Austrogramme (Pteridoideae, Pteridaceae) from South-Eastern Asia and Oceania. At the second stage, we carried out a comparative scanning electron microscopy study of spores of three species of Austrogramme, four species of Syngramma, and six species of Taenitis and added information about previously studied spores of seven species of these genera. Spores of all examined species are trilete, tetrahedral or tetrahedral-globose with convex to hemispherical distal side and plane, convex or conical proximal side. The spores of Austrogramme species are the smallest, simplest in ornamentation and similar to each other. Sculpture of the proximal and distal sides are microverrucate, the surface of the spores is covered by granular deposits. Spores of most Syngrammaspecies are very similar to spores of Austrogramme species in shape and surface sculpture: their distal and proximal surfaces are microverrucate, whereas the spores of S. borneensis and S. cartilagidens have the low-tuberculate sculpture. Spores of Taenitis species are very different from the spores of Austrogramme and Syngramma. Seven of nine studied species have spores with well-expressed cingulum (T. blechnoides, T. cordata, T. diversifolia, T. interrupta, T. luzonica, T. obtusa, and T. requiniana), three species (T. cordata, T. hookeri, and T. pinnata) have spores with prominent laesural ridges. The spores have well-expressed ornamentation – tuberculate, baculate, rugate, tuberculate-rugate. The most conspicuous character of the ornamentation of spore surfaces is the presence of rodlets associated with sculpture elements. The densest rodlets are characteristic of Taenitis diversifolia, T. luzonica, T. obtusa, and T. requiniana. Spore size (equatorial diameter) ranges on average between 22 μm and 37 μm in Austrogramme, between 27 μm and 41 μm in Syngramma, and between 26 and 51 μm in Taenitis species.
Phytocoenotical behaviour of boreal plant species in broadleaved-forest zone communities
Authors: Kucherov Ilja B. , Zverev Andrey A. 
Published: October 2021

Phytocoenotic behaviour of 11 species of boreal vascular plants and mosses is analyzed within the broadleaved-forest zone in comparison with that in different subzones of the boreal-forest zone, based upon the set of 1417 relevés made in European Russia in 1996–2017. The significance of differences in species cover is estimated by means of the one-way ANOVA. The cover of species like Vaccinium myrtillus, V. vitis-idaea, andHylocomium splendens in broadleaved / spruce forests of zonal types is constantly decreasing southwards. On the contrary, the cover of Luzula pilosain Scots pine forests and Pleurozium schreberi and Dicranum polysetum in paludified Norway spruce forests is subject to southward increase. Finally, Oxalis acetosella and Equisetum sylvaticum demonstrate maximae of their cover in forests of zonal types in the southern-boreal and hemiboreal subzones. The dark-coniferous boreal forest “cortege” of species is breaking down into several different floristic elements in the broadleaved-forest zone. These are: “vaccinietal” species p. p. sensu Yu. D. Kleopov (like Vaccinium myrtillus), “quasi-boreal” species sensu V. B. Sochava (Oxalis acetosella, Maianthemum bifolium, Trientalis europaea), hygromesophytes with aged areas (Equisetum sylvaticum), associated species with European-Ancient-Mediterranean nemoral (Luzula pilosa) or East-Asian boreal-montane (Rubus saxatilis) origins. Phytocoenotical behaviour of species is not always different in the intrazonal and the zonal community types but is rather similar in many cases like those of Vaccinium vitis-idaea and Equisetum sylvaticum. The more distinct differences in species positions are found in the extrazonal communities. The statistically proved differences are lacking in phytocoenotical behaviour of Maianthemum bifolium and Trientalis europaea in different zones and subzones due to either florogenetical, or purely methodical reasons, the latter connected with low abundance but high constancy of these species. Disintegration of vegetation “corteges” and individualization of coenotic patterns of species previously growing together are usually observed at the climatically determined (zonal / subzonal or altitudinal) distribution limits.
A High-Pressure Shear Testing Approach to Measure Flow Stresses Near a Friction Stir Welding Tool
Authors: Prymak David , Miles Michael , Nelson Tracy , Michael Fredrick 
Published: October 2021

Abstract
A new approach for measuring flow stresses near a spinning friction stir welding (FSW) tool is evaluated on AA 6061-T6 plate. The test consists of plunging a cylindrical tool with a flat face into the plate at different rotational speeds, using a variety of constant vertical loads. A viscosity-based model of the shear layer created under the tool is employed to estimate local flow stresses. The flow stresses measured by this approach exhibited an inverse relationship with temperature and a positive dependence on the pressure imposed by the spinning flat-faced tool. Compared to hot compression and hot torsion results, estimated flow stress levels in high-pressure shear were lower by 20–68 %, for similar temperatures and strain rates, owing to grain refinement induced by continuous dynamic recrystallization. This high-pressure shear approach could be used to characterize material behavior near a rapidly spinning FSW tool, leading to improved process model predictions.
Development of validated UHPLC–PDA with ESI–MS-MS method for concurrent estimation of magnoflorine, berbamine, columbamine, jatrorrhizine, palmatine and berberine in Berberis aristata
Authors: Basera Ishita A. , Girme Aboli , Bhatt Vijay P. , Saste Ganesh , Pawar Sandeep , Hingorani Lal , Shah Mamta B. 
Published: October 2021

Abstract
A validated UHPLC-PDA with an ESI-MS/MS method has been developed for simultaneous estimation of six bioactive alkaloids (magnoflorine, berbamine, columbamine, jatrorrhizine, palmatine and berberine) in the different extracts of the roots of Berberis aristata DC (Family:Berberdiaceae). It is an important medicinal herb native to Northern Himalaya and commonly known as ‘daruharidra’, ‘daruhaldi’, ‘Indian barberry’ or ‘tree turmeric’. An insight into the research literature uncovered reports on isoquinoline alkaloids like magnoflorine, berbamine, columbamine, jatrorrhizine, palmatine, and berberine as major bioactives in B. aristata roots, possessing different pharmacological and therapeutic effects. In the present study, these aforementioned alkaloids were separated on Phenomenex Luna®, 5 µm-C8 analytical column. The HPLC-MS analysis was performed at a flow rate of 0.90 mL min−1. Each alkaloid that is resolved was characterized by precursor ions and fragment ions with electrospray ionization (ESI) source in both positive and negative ionization using scan mode. The limit of detections (LODs) were 0.087, 0.727, 0.035, 0.124, 0.782 and 0.794 μg mL−1 for magnoflorine, berbamine, columbamine, jatrorrhizine, palmatine and berberine, respectively. The proposed UHPLC-PDA method was fully validated according to international (ICH) guidelines and was found to be selective, sensitive and highly accurate for the concomitant estimation of the aforementioned symbolic bio-markers of B. aristata roots.