bluuebunny/crossref_metadata_2025_split huggingface dataset:
Be good to thy neighbours: A spatial analysis of foreign direct investment and economic growth in sub‐Saharan Africa
Authors: Chih Yao‐Yu , Kishan Ruby P. , Ojede Andrew 
Published: July 2021

AbstractThis paper employs a spatial dependency framework to examine intermediary roles played by trade, institutional quality and natural resource endowment in determining direct and indirect (spillover) effects of inbound foreign direct investment (FDI) on economic growth. We develop a number of spatial mechanisms to assess how these intermediary factors limit and/or enhance the effect of FDI on economic growth. In particular, we test whether different levels of resource rents, severity of civil conflict and openness to international trade are statistically different in attenuating direct and indirect (spillover) effects of inbound FDI on growth. Last, we conduct a test of asymmetry to investigate whether the effect of FDI on growth is statistically different from zero in three democratic (autocratic) regimes, that is, low democratic (high autocratic), moderate democratic–autocratic and high democratic (low autocratic) societies. A number of insightful contributions to the economic growth‐FDI literature can be extracted from our analyses. First, results indicate that inbound FDIs on their own have positive and significant effect on economic growth. However, the positive FDI effect on growth is significantly dampened by the negative intermediary role of civil conflict. Second, we find that, the more opened sub‐Saharan African economies are to international trade, the greater is the impact of FDI on growth. However, trade among African countries as a share of their economies plays insignificant intermediation role on direct and indirect effects of FDI on growth. Third, we find that an increase in resource rents as a share of the economy significantly reduces direct and spillover effects of inbound FDI on economic growth. Last, our analysis indicates that both low democratic (high autocratic) and high democratic (low autocratic) regimes do accelerate the positive impact of FDI on growth. However, results indicate a slow‐down effect of FDI on growth under moderate democratic–autocratic regimes. This particular finding suggests that the intermediary role of democracy in determining the effect of FDI on economic growth is non‐linear. A number of policy implications can be extrapolated from our analysis. Most importantly, trade policies, which boost integration of sub‐Saharan African countries and open up the continent to the rest of the world, are likely to play major intermediation roles in accelerating the positive effect of FDI on growth.
The influence of a fast‐track service on case flow and client satisfaction in a high‐volume veterinary emergency department
Authors: Weltman Joel G. , Prittie Jennifer E. 
Published: July 2021

AbstractObjectiveTo assess the benefit of a fast‐track service in the emergency department of a large, high‐volume veterinary hospital.DesignProspective, observational, clinical study.SettingEmergency department of an urban, tertiary referral veterinary hospital.AnimalsAll animals presented to the emergency department between April 1 and April 30 in 2017 and 2018 were eligible for inclusion. Only patients seen on days in 2017 corresponding to those days of 2018 during which the fast‐track service was available were studied.Measurement and Main ResultsTriage case logs were collected and reviewed for April 2017 (prefast‐track) and 2018 (fast‐track). The fast‐track service was launched as a pilot program in April 2018 to provide expedited care to low acuity patients presented to the emergency department. The median number of daily emergency department cases did not differ between 2017 (45, range 26‐64) and 2018 (47, range 38‐64; P = 0.3). The median time from presentation until first discussion with a doctor for low acuity cases was lower in April 2017 (29 min, range 1‐163) than in April 2018 (24 min, range 1‐100; P < 0.001). This reduction in wait time was observed despite a 40% increase in low acuity case presentations in 2018. Wait times for high acuity patients did not differ between study periods. The number of cases that left without being seen was higher in April 2017 compared to April 2018 (77 and 45 cases, respectively P < 0.001).ConclusionsImplementation of a fast‐track service reduced wait time for low acuity cases without adversely impacting wait times for sicker patients and led to a reduction in clients leaving without being seen. By introducing the fast‐track service in a large volume veterinary hospital, limited resources can be distributed to improve speed of care, case flow, and client satisfaction in the emergency department.
Multiple melt source origin of the Line Islands (Pacific Ocean)
Authors: Pockalny Robert , Barth Ginger , Eakins Barry , Kelley Katherine A. , Wertman Christina 
Published: July 2021

Abstract
The Line Islands volcanic chain in the central Pacific Ocean exhibits many characteristics of a hotspot-generated seamount chain; however, the lack of a predictable age progression has stymied previous models for the origin of this feature. We combined plate-tectonic reconstructions with seamount age dates and available geochemistry to develop a new model that involves multiple melt regions and multiple melt delivery styles to explain the spatial and temporal history of the Line Islands system. Our model identifies a new melt source region (Larson melt region at ~17°S, ~125°W) that contributed to the formation of the Line Islands, as well as the Mid-Pacific Mountains and possibly the Pukapuka Ridge.
Developing a pulse oximetry home monitoring protocol for patients suspected with COVID-19 after emergency department discharge
Authors: Gootenberg David B , Kurtzman Nicholas , O’Mara Thomas , Ge Jennifer Y , Chiu David , Shapiro Nathan I , Mechanic Oren J , Dagan Alon 
Published: July 2021

ObjectivesPatients with COVID-19 can present to the emergency department (ED) without immediate indication for admission, but with concern for decompensation. Clinical experience has demonstrated that critical illness may present later in the disease course and hypoxia is often the first indication of disease progression. The objectives of this study are to (a) assess feasibility and describe a protocol for ED-based outpatient pulse-oximetry monitoring with structured follow-up and (b) determine rates of ED return, hospitalisation and hypoxia among participants.MethodsProspective observational study of patients presenting to a single academic ED in Boston with suspected COVID-19. Eligible patients were adults being discharged from the ED with presumed COVID-19. Exclusion criteria included resting oxygen saturation <92%, ambulatory oxygen saturation <90%, heart rate >110 beats per minute or inability to use the device. Study personnel made scripted phone calls on postdischarge days 1, 3 and 7 to review the pulse-oximetry readings and to evaluate for decompensation. Return visit and admission information were collected via medical record and 28-day follow-up calls.Results81 patients were enrolled of which 10 (12%) developed hypoxia after their initial discharge from the ED. Overall, 23 (28%) of the 81 patients returned to the ED at least once and 10 of those who returned (43%) were admitted. We successfully contacted 76/81 (94%) of subjects via phone at least once for follow-up assessment.DiscussionPatients are eager and willing to participate in home monitoring systems and are comfortable with using technology, which will allow providers and health systems to extend our hospitals capabilities for tracking patient populations in times of crisis.ConclusionsIt is feasible to implement an outpatient pulse-oximetry monitoring protocol to monitor patients discharged from the ED with confirmed or suspected COVID-19.
2 Perioperative medicines management for trauma inpatients – a quality improvement project
Authors: Adams Megan 
Published: July 2021

IntroductionIt was observed anecdotally that several trauma patients were not receiving routine oral meds due to being ‘Nil-by-mouth’. Our aim was to improve perioperative administration of regular medication for patients admitted with fractured neck of femur (NOF #) on the day of surgery.MethodsData was collected from drug charts of those admitted to the Queen Alexandra Hospital, Portsmouth with NOF # in 2019. Good practice was mostly observed, however areas for improvement were identified in anticoagulation, cardiac and diabetic medication. In addition, the pre-op guidelines and drug trolley posters were not always available and were out of date. Change was implemented by updating the NOF # guidelines using up-to-date guidance.The ‘Nil by Mouth’ drug trolley posters were re-designed and were re-distributed to every drug trolley on the orthopaedic wards and the nursing teams were informed of the changes.ResultsFollowing re-audit, improvement was made in the following areas. Anticoagulation administration now had a 100% compliance. Rate-limiters administration had improved, as had the administration of antihypertensives (CCB). Parkinson’s medication, inhalers and alcohol withdrawal medication had continued to be consistently given. The reasons for omitting medication was documented. No improvement was made in the following areas: Gastric protection, oral analgesia, anti-anginals and more data was required to assess glycaemic management.ConclusionsOptimisation of these high-risk patients requires a multi-faceted approach but by improving basic aspects of care such as peri-operative medication, it is hoped that overall mortality and morbidity are reduced. Further education on this topic may be required to continue improvement.ReferencesUKCPA. 2019. The Handbook of Perioperative Medicines. [online] Available at: https://www.ukcpa-periophandbook.co.uk/[Accessed 10 February 2020].Escardio.org. 2014. ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. [online] Available at: https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/ESC-ESA-Guidelines-on-non-cardiac-surgery-cardiovascular-assessment-and-management [Accessed 8 February 2020].
4 Optimisation of shared learning between critical care teams during the early stages of the COVID-19 pandemic
Authors: O’Brien Mark 
Published: July 2021

IntroductionIn anticipation of an uplift in critical care acuity due to COVID-19, staffing at JHG (SE) ICU was reconfigured into six discreet teams. At that time, there was no dedicated mechanism for shared learning and development of SOPs to occur in a horizontal fashion across teams. The aim of this project was to develop a tool that would enable the expanding knowledge base of each individual team to be captured, refined and rapidly disseminated to the rest of the department.MethodsA ‘Virtual Whiteboard’ was created consisting of an electronic feedback form accessible via smartphone. Individual team feedback was collated and then reviewed by a designated consultant. Subsequent modification of SOPs was disseminated across all teams via group email.ResultsThe Virtual White Board proved of particular use in the first few weeks of the new COVID-19 rota. Specific changes which occurred as a consequence of the project included improved efficiency in the use of personal protective equipment, increased clinical support to nursing staff from trainees and the development of new SOPs relating to more timely completion of death certificates.ConclusionsThe Virtual Whiteboard contributed to the ability of JHG (SE) Critical Care Unit to adapt rapidly and cohesively in the context of a fast-changing clinical environment.
Variation in COVID-19 characteristics, treatment and outcomes in Michigan: an observational study in 32 hospitals
Authors: Chopra Vineet , Flanders Scott A , Vaughn Valerie , Petty Lindsay , Gandhi Tejal , McSparron Jakob Israel , Malani Anurag , O'Malley Megan , Kim Tae , McLaughlin Elizabeth , Prescott Hallie 
Published: July 2021

ObjectiveTo describe patient characteristics, symptoms, patterns of care and outcomes for patients hospitalised with COVID-19 in Michigan.DesignMulticentre retrospective cohort study.Setting32 acute care hospitals in the state of Michigan.ParticipantsPatients discharged (16 March–11 May 2020) with suspected or confirmed COVID-19 were identified. Trained abstractors collected demographic information on all patients and detailed clinical data on a subset of COVID-19-positive patients.Primary outcome measurementsPatient characteristics, treatment and outcomes including cardiopulmonary resuscitation, mortality and venous thromboembolism within and across hospitals.ResultsDemographic-only data from 1593 COVID-19-positive and 1259 persons under investigation discharges were collected. Among 1024 cases with detailed data, the median age was 63 years; median body mass index was 30.6; and 51.4% were black. Cough, fever and shortness of breath were the top symptoms. 37.2% reported a known COVID-19 contact; 7.0% were healthcare workers; and 16.1% presented from congregated living facilities.During hospitalisation, 232 (22.7%) patients were treated in an intensive care unit (ICU); 558 (54.9%) in a ‘cohorted’ unit; 161 (15.7%) received mechanical ventilation; and 90 (8.8%) received high-flow nasal cannula. ICU patients more often received hydroxychloroquine (66% vs 46%), corticosteroids (34% vs 18%) and antibiotic therapy (92% vs 71%) than general ward patients (p<0.05 for all). Overall, 219 (21.4%) patients died, with in-hospital mortality ranging from 7.9% to 45.7% across hospitals. 73% received at least one COVID-19-specific treatment, ranging from 32% to 96% across sites.Across 14 hospitals, the proportion of patients admitted directly to an ICU ranged from 0% to 43.8%; mechanical ventilation on admission from 0% to 12.8%; mortality from 7.9% to 45.7%. Use of at least one COVID-19-specific therapy varied from 32% to 96.3% across sites.ConclusionsDuring the early days of the Michigan outbreak of COVID-19, patient characteristics, treatment and outcomes varied widely within and across hospitals.
Effect of faecal calprotectin testing on referrals for children with chronic gastrointestinal symptoms in primary care: study protocol for a cluster randomised controlled trial
Authors: Ansems Sophie , Berger Marjolein , van Rheenen Patrick Ferry , Vermeulen Karin , Beugel Gina , Couwenberg Maria , Holtman Gea 
Published: July 2021

IntroductionChildren with chronic gastrointestinal symptoms are frequently seen in primary care, yet general practitioners (GPs) often experience challenges distinguishing functional gastrointestinal disorders (FGID) from organic disorders. We, therefore, aim to evaluate whether a test strategy that includes point-of-care testing (POCT) for faecal calprotectin (FCal) can reduce the referral rate to paediatric specialist care among children with chronic gastrointestinal symptoms. The study findings will contribute to improving the recommendations on FCal use among children in primary care.Methods and analysisIn this pragmatic cluster randomised controlled trial, we will randomise general practices into intervention and control groups. The intervention group will use FCal-POCT when indicated, after completing online training about its indication, interpretation and follow-up as well as communicating an FGID diagnosis. The control group will test and treat according to Dutch GP guidelines, which advise against FCal testing in children. GPs will include children aged 4–18 years presenting to primary care with chronic diarrhoea and/or recurrent abdominal pain. The primary outcome will be the referral rate for children with chronic gastrointestinal symptoms within 6 months after the initial assessment. Secondary outcomes will be evaluated by questionnaires completed at baseline and at 3- and 6-month follow-up. These outcomes will include parental satisfaction and concerns, gastrointestinal symptoms, impact of symptoms on daily function, quality of life, proportion of children with paediatrician-diagnosed FGID referred to secondary care, health service use and healthcare costs. A sample size calculation indicates that we need to recruit 158 GP practices to recruit 406 children.Ethics and disseminationThe Medical Research Ethics Committee (MREC) of the University Medical Center Groningen (The Netherlands) approved this study (MREC number: 201900309). The study results will be made available to patients, GPs, paediatricians and laboratories via peer-reviewed publications and in presentations at (inter)national conferences.Trial registration numberThe Netherlands Trial Register: NL7690 (Pre-results)
Illness severity and risk of mental morbidities among patients recovering from COVID-19: a cross-sectional study in the Icelandic population
Authors: Saevarsdóttir Karen Sól , Hilmarsdóttir Hildur Ýr , Magnúsdóttir Ingibjörg , Hauksdóttir Arna , Thordardottir Edda Bjork , Gudjónsdóttir Ásdís Braga , Tomasson Gunnar , Rúnarsdóttir Harpa , Jónsdóttir Harpa Lind , Gudmundsdóttir Berglind , Pétursdóttir Gudrún , Petersen Pétur Henry , Kristinsson Sigurdur Yngvi , Love Thorvardur Jon , Hansdóttir Sif , Hardardóttir Hrönn , Gudmundsson Gunnar , Eythorsson Elias , Gudmundsdóttir Dóra Gudrún , Sigbjörnsdóttir Hildur , Haraldsdóttir Sigrídur , Möller Alma Dagbjört , Palsson Runolfur , Jakobsdóttir Jóhanna , Aspelund Thor , Valdimarsdottir Unnur 
Published: July 2021

ObjectiveTo test if patients recovering from COVID-19 are at increased risk of mental morbidities and to what extent such risk is exacerbated by illness severity.DesignPopulation-based cross-sectional study.SettingIceland.ParticipantsA total of 22 861 individuals were recruited through invitations to existing nationwide cohorts and a social media campaign from 24 April to 22 July 2020, of which 373 were patients recovering from COVID-19.Main outcome measuresSymptoms of depression (Patient Health Questionnaire), anxiety (General Anxiety Disorder Scale) and posttraumatic stress disorder (PTSD; modified Primary Care PTSD Screen for DSM-5) above screening thresholds. Adjusting for multiple covariates and comorbidities, multivariable Poisson regression was used to assess the association between COVID-19 severity and mental morbidities.ResultsCompared with individuals without a diagnosis of COVID-19, patients recovering from COVID-19 had increased risk of depression (22.1% vs 16.2%; adjusted relative risk (aRR) 1.48, 95% CI 1.20 to 1.82) and PTSD (19.5% vs 15.6%; aRR 1.38, 95% CI 1.09 to 1.75) but not anxiety (13.1% vs 11.3%; aRR 1.24, 95% CI 0.93 to 1.64). Elevated relative risks were limited to patients recovering from COVID-19 that were 40 years or older and were particularly high among individuals with university education. Among patients recovering from COVID-19, symptoms of depression were particularly common among those in the highest, compared with the lowest tertile of influenza-like symptom burden (47.1% vs 5.8%; aRR 6.42, 95% CI 2.77 to 14.87), among patients confined to bed for 7 days or longer compared with those never confined to bed (33.3% vs 10.9%; aRR 3.67, 95% CI 1.97 to 6.86) and among patients hospitalised for COVID-19 compared with those never admitted to hospital (48.1% vs 19.9%; aRR 2.72, 95% CI 1.67 to 4.44).ConclusionsSevere disease course is associated with increased risk of depression and PTSD among patients recovering from COVID-19.
Experiences of supported isolation in returning travellers during the early COVID-19 response: a qualitative interview study
Authors: Carter Holly , Weston Dale , Greenberg Neil , Oliver Isabel , Robin Charlotte , Rubin G James , Wessely Simon , Gauntlett Louis , Amlot Richard 
Published: July 2021

Objectives(1) To understand the experiences and perceptions of those who underwent supported isolation, particularly in relation to factors that were associated with improved compliance and well-being; (2) to inform recommendations for the management of similar supported isolation procedures.DesignWe carried out a qualitative study using semistructured interviews to capture participants’ experiences and perceptions of supported isolation. Data were analysed using the framework approach, a type of thematic analysis that is commonly used in research that has implications for policy.SettingTelephone interviews carried out within approximately 1 month of an individual leaving supported isolation.Participants26 people who underwent supported isolation at either Arrowe Park Hospital (n=18) or Kents Hill Park Conference Centre (n=8) after being repatriated from Wuhan in January to February 2020.ResultsSix key themes were identified: factors affecting compliance with supported isolation; risk perceptions around catching COVID-19; management of supported isolation; communication with those outside supported isolation; relationship with others in supported isolation; and feelings on leaving supported isolation. Participants were willing to undergo supported isolation because they understood that it would protect themselves and others. Positive treatment by staff was fundamental to participants’ willingness to comply with isolation procedures. Despite the high level of compliance, participants expressed some uncertainty about what the process would involve.ConclusionsAs hotel quarantine is introduced across the UK for international arrivals, our findings suggest that those in charge should: communicate effectively before, during and after quarantine, emphasising why quarantine is important and how it will protect others; avoid coercion if possible and focus on supporting and promoting voluntary compliance; facilitate shared social experiences for those in quarantine; and ensure all necessary supplies are provided. Doing so is likely to increase adherence and reduce any negative effects on well-being.
Multimorbidity in Latin America and the Caribbean: a systematic review and meta-analysis
Authors: Huaquía-Díaz Alessandra M , Chalán-Dávila Tarick S , Carrillo-Larco Rodrigo M , Bernabe-Ortiz Antonio 
Published: July 2021

ObjectiveTo estimate the pooled prevalence of multimorbidity (≥2 non-communicable diseases in the same individual) among adults of the general population of Latin American and the Caribbean (LAC).DesignSystematic review and meta-analysis.Data sourcesMEDLINE, Embase, Global Health, Scopus and LILACS up to 1 July 2020.Eligibility criteria for selecting studiesThe outcome was the prevalence of multimorbidity. Reports were selected whether they enrolled adult individuals (age ≥18 years) from the general population.Data extraction and synthesisReviewers extracted relevant data and assessed risk of bias independently. A random-effects meta-analysis was conducted to report pooled prevalence estimates of multimorbidity; pooled estimates by pre-specified subgroups (eg, national studies) were also pursued.ResultsFrom 5830 results, we selected 28 reports, mostly from Brazil and 16 were based on a nationally representative sample. From the 28 selected reports, 26 were further included in the meta-analysis revealing a pooled multimorbidity prevalence of 43% (95% CI: 35% to 51%; I2: 99.9%). When only reports with a nationally representative sample were combined, the pooled prevalence was 37% (95% CI: 27% to 47%; I2: 99.9%). When the ascertainment of multimorbidity was based on self-reports alone, the pooled prevalence was 40% (95% CI: 31% to 48%; I2: 99.9%); this raised to 52% (95% CI: 33% to 70%; I2: 99.9%) for reports including self-reported and objective diagnosis.ConclusionsOur results complement and advance those from global efforts by incorporating much more reports from LAC. We revealed a larger presence of multimorbidity in LAC than previously reported.PROSPERO registration numberCRD42020196177.