bluuebunny/crossref_metadata_2025_split huggingface dataset:
Investigation of the Power Generation Performance of a Stack by Reverse Electrodialysis and Its Influencing Factors
Authors: Li Mei , Wang Yiwei , Guo Jiabin , Li Xiaoliang , Guo Pengcheng 
Published: August 2021

Abstract
This paper presents an experimental study on the performance of a reverse electrodialysis (RED) stack for SELEMION, ASTOM, and FUJI membranes with the cell pair number from 3 to 15 and flowrate from 5 to 60 L/h over a wide solution concentration range from 1 to 120 g/L. Direct current and alternate current measurements are employed to identify quantitatively the contribution of ohmic and non-ohmic resistances to the stack total resistance and then, the power output is predicted theoretically. The results show that the ohmic resistance dominates in the stack total resistance and accounts for about 90%. The factors such as the membrane type, cell pair, solution concentration, and flowrate have a considerable impact on the power generation process of RED. Especially, simultaneously increasing the high concentration (HC) and low concentration (LC) solution concentrations is more conducive to suppressing the concentration polarization when compared with increasing HC solution concentration alone. Although the concentration polarization maintains declining with the increase in flowrate, the flowrate should not be too large in order to harvest the highest power output by reason of serious tangential flow at higher flowrates. The optimal performance of RED stack is obtained when SELEMION membranes are used with cell pairs of 5, HC–LC solution concentration of 120-4 g/L and feed flowrate of 20 L/h.
A Longitudinal Analysis Examining the Associations of Tummy Time With Active Playtime, Screen Time, and Sleep Time
Authors: Buchanan Limin , Xu Huilan , Hewitt Lyndel , Taki Sarah , Wen Li Ming 
Published: August 2021

Background: Evidence links tummy time (ie, the time spent in awake prone positioning that is encouraged and supervised by an adult) to infants’ health outcomes such as gross motor and total development. However, the associations between tummy time and other movement and sleep behaviors as the child develops remain unknown. The aim of this study was to examine whether early introduction and practice of tummy time within the first 6 months of age were associated with active and outdoor playtime, screen time, and nocturnal sleep time of children when they were 12 and 24 months old. Methods: A longitudinal analysis was conducted using data extracted from an Australian trial. Using telephone surveys with mothers, demographic data were collected from third trimester of pregnancy and tummy time data were collected at 6 months of age. Data on playtime, screen time, and nocturnal sleep duration as dependent variables were collected at 12 and 24 months of age. Multiple logistic regression models were built to investigate the associations. Results: Children who started tummy time within 4 weeks of age were more likely to have >10 hours sleep at night at 12 months (adjusted odds ratio 1.54, 95% confidence interval, 1.08–2.19). They were more likely to have >3 hours per day of outdoor play and have <1 hour per day of screen time at 24 months. Children who practiced tummy time every day were more likely to have >2 hours per day of active play at 12 months and have <1 hour per day of screen time at 24 months. Conclusions: Starting tummy time earlier and frequently was associated with more favorable movement and sleep of young children at 12 and 24 months of age.
Medication adherence in cardiovascular medicine
Authors: Simon Steven T , Kini Vinay , Levy Andrew E , Ho P Michael 
Published: August 2021

AbstractCardiovascular disease is the leading cause of death globally. While pharmacological advancements have improved the morbidity and mortality associated with cardiovascular disease, non-adherence to prescribed treatment remains a significant barrier to improved patient outcomes. A variety of strategies to improve medication adherence have been tested in clinical trials, and include the following categories: improving patient education, implementing medication reminders, testing cognitive behavioral interventions, reducing medication costs, utilizing healthcare team members, and streamlining medication dosing regimens. In this review, we describe specific trials within each of these categories and highlight the impact of each on medication adherence. We also examine ongoing trials and future lines of inquiry for improving medication adherence in patients with cardiovascular diseases.
Evaluation of an intervention targeted with predictive analytics to prevent readmissions in an integrated health system: observational study
Authors: Marafino Ben J , Escobar Gabriel J , Baiocchi Michael T , Liu Vincent X , Plimier Colleen C , Schuler Alejandro 
Published: August 2021

Abstract

Objectives
To determine the associations between a care coordination intervention (the Transitions Program) targeted to patients after hospital discharge and 30 day readmission and mortality in a large, integrated healthcare system.

Design
Observational study.

Setting
21 hospitals operated by Kaiser Permanente Northern California.

Participants
1 539 285 eligible index hospital admissions corresponding to 739 040 unique patients from June 2010 to December 2018. 411 507 patients were discharged post-implementation of the Transitions Program; 80 424 (19.5%) of these patients were at medium or high predicted risk and were assigned to receive the intervention after discharge.

Intervention
Patients admitted to hospital were automatically assigned to be followed by the Transitions Program in the 30 days post-discharge if their predicted risk of 30 day readmission or mortality was greater than 25% on the basis of electronic health record data.

Main outcome measures
Non-elective hospital readmissions and all cause mortality in the 30 days after hospital discharge.

Results
Difference-in-differences estimates indicated that the intervention was associated with significantly reduced odds of 30 day non-elective readmission (adjusted odds ratio 0.91, 95% confidence interval 0.89 to 0.93; absolute risk reduction 95% confidence interval −2.5%, −3.1% to −2.0%) but not with the odds of 30 day post-discharge mortality (1.00, 0.95 to 1.04). Based on the regression discontinuity estimate, the association with readmission was of similar magnitude (absolute risk reduction −2.7%, −3.2% to −2.2%) among patients at medium risk near the risk threshold used for enrollment. However, the regression discontinuity estimate of the association with post-discharge mortality (−0.7% −1.4% to −0.0%) was significant and suggested benefit in this subgroup of patients.

Conclusions
In an integrated health system, the implementation of a comprehensive readmissions prevention intervention was associated with a reduction in 30 day readmission rates. Moreover, there was no association with 30 day post-discharge mortality, except among medium risk patients, where some evidence for benefit was found. Altogether, the study provides evidence to suggest the effectiveness of readmission prevention interventions in community settings, but further research might be required to confirm the findings beyond this setting.
Breast feeding and infant development in a cohort with sibling pair analysis: the Japan Environment and Children’s Study
Authors: Sanefuji Masafumi , Senju Ayako , Shimono Masayuki , Ogawa Masanobu , Sonoda Yuri , Torio Michiko , Ichimiya Yuko , Suga Reiko , Sakai Yasunari , Honjo Satoshi , Kusuhara Koichi , Ohga Shouichi 
Published: August 2021

ObjectivesTo investigate the association between breast feeding and infant development during the first year of life using sibling comparison.DesignNationwide prospective birth cohort study with sibling pair analysis.Setting15 regional centres that participated in the Japan Environment and Children’s Study.ParticipantsThis study included 77 119 children (singleton, term birth and no malformation/severe diseases) whose mothers were registered between January 2011 and March 2014, including 3521 duos or trios of siblings.Primary outcome measuresThe primary outcome was developmental delay at 6 and 12 months of age, assessed using the Japanese translation of the Ages and Stages Questionnaires, third edition. Multivariable regression analyses adjusted for confounders were performed to estimate the risk ratios of delay associated with any or exclusive breast feeding. Pairs of siblings discordant for statuses were selected, and conditional regression analyses were conducted with a matched cohort design.ResultsDevelopmental delay was identified in 6162 (8.4%) and 10 442 (14.6%) children at 6 and 12 months of age, respectively. Any breast feeding continued until 6 months or 12 months old was associated with reduced developmental delay at 12 months of age (adjusted risk ratio (95% CI): 0.81 (0.77 to 0.85) and 0.81 (0.78 to 0.84), respectively). Furthermore, exclusive breast feeding until 3 months was associated with reduced developmental delay at 12 months of age (adjusted risk ratio, 0.86 (95% CI 0.83 to 0.90)). In sibling pair analysis, the association between any breast feeding until 12 months and reduced developmental delay at 12 months of age persisted (adjusted risk ratio, 0.64 (95% CI 0.43 to 0.93)).ConclusionsThe present study demonstrated the association of continuous breast feeding with reduced developmental delay at 1 year of age using sibling pair analysis, in which unmeasured confounding factors are still present but less included. This may provide an argument to promote breastfeeding continuation.
What do doctors understand by spiritual health? A survey of UK general practitioners
Authors: Whitehead Orla , Jagger Carol , Hanratty Barbara 
Published: August 2021

BackgroundIn the UK, doctors’ regulatory and professional bodies require general practitioners (GPs) to consider discussing spiritual health as part of the consultation. However, spiritual health is not defined in guidance, and it is unknown what individual doctors understand by the term.Research questionWhat do GPs understand by the term ‘spiritual health’?AimTo explore how GPs understand and define spiritual health.Design and settingSurvey of GPs in England 9 April 2019–21 May 2019.MethodA mixed-methods online survey asked practising GPs in England qualitative free text questions—‘What does the term ‘Spiritual Health’ mean to you?’ and ‘Any comments?’ after five vignettes about discussing spiritual health with patients. These were subject to thematic analysis using a priori themes from the literature on GP definitions of spiritual health, and on attitudes towards the topic.Participants177 practising GPs in England.Results177 GPs responded to the survey. Understanding of spiritual health fitted into three themes: self-actualisation and meaning, transcendence and relationships beyond the self, and expressions of spirituality. A full range of views were expressed, from a minority who challenged their role in spiritual health, through to others enthusiastic about its place in healthcare.ConclusionSpirituality and religiosity are understood by English GPs to be distinct concepts. A consensus definition of spiritual health incorporating the themes identified by working doctors, may be helpful to support GPs to follow the recommended guidance in their practice.
Detection of intracranial hypertension in children using optical coherence tomography: a systematic review
Authors: Rufai Sohaib R , Hisaund Michael , Jeelani Noor ul Owase , McLean Rebecca J 
Published: August 2021

ObjectivesTo evaluate the diagnostic capability of optical coherence tomography (OCT) in children aged under 18 years old with intracranial hypertension (IH).DesignSystematic review.MethodsWe conducted a systematic review using the following platforms to search the keywords ‘optical coherence tomography’ and ‘intracranial hypertension’ from inception to 2 April 2020: Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, PubMed and Web of Science, without language restrictions. Our search returned 2729 records, screened by two independent screeners. Studies were graded according to the Oxford Centre for Evidence-Based Medicine and National Institutes of Health Quality Assessment Tool for observational studies.ResultsTwenty-one studies were included. Conditions included craniosynostosis (n=354 patients), idiopathic IH (IIH; n=102), space-occupying lesion (SOL; n=42) and other pathology (n=29). OCT measures included optic nerve parameters, rim parameters (notably retinal nerve fibre layer thickness) and retinal parameters. Levels of evidence included 2b (n=13 studies), 3b (n=4) and 4 (n=4). Quality of 10 studies was fair and 11 poor. There was inconsistency in OCT parameters and reference measures studied, although OCT did demonstrate good diagnostic capability for IH in craniosynostosis, IIH and SOL.ConclusionsThis systematic review identified various studies involving OCT to assist diagnosis and management of IH in children with craniosynostosis, IIH, SOL and other pathology, in conjunction with established clinical measures of intracranial pressure. However, no level 1 evidence was identified. Validating prospective studies are, therefore, required to determine optimal OCT parameters in this role and to develop formal clinical guidelines.PROSPERO registration numberCRD42019154254.
Multicentre observational study on practice of ventilation in brain injured patients: the VENTIBRAIN study protocol
Authors: Robba Chiara , Citerio Giuseppe , Taccone Fabio S , Galimberti Stefania , Rebora Paola , Vargiolu Alessia , Pelosi Paolo 
Published: August 2021

IntroductionMechanical ventilatory is a crucial element of acute brain injured patients’ management. The ventilatory goals to ensure lung protection during acute respiratory failure may not be adequate in case of concomitant brain injury. Therefore, there are limited data from which physicians can draw conclusions regarding optimal ventilator management in this setting.Methods and analysisThis is an international multicentre prospective observational cohort study. The aim of the ‘multicentre observational study on practice of ventilation in brain injured patients’—the VENTIBRAIN study—is to describe the current practice of ventilator settings and mechanical ventilation in acute brain injured patients. Secondary objectives include the description of ventilator settings among different countries, and their association with outcomes. Inclusion criteria will be adult patients admitted to the intensive care unit (ICU) with a diagnosis of traumatic brain injury or cerebrovascular diseases (intracranial haemorrhage, subarachnoid haemorrhage, ischaemic stroke), requiring intubation and mechanical ventilation and admission to the ICU. Exclusion criteria will be the following: patients aged <18 years; pregnant patients; patients not intubated or not mechanically ventilated or receiving only non-invasive ventilation. Data related to clinical examination, neuromonitoring if available, ventilator settings and arterial blood gases will be recorded at admission and daily for the first 7 days and then at day 10 and 14. The Glasgow Outcome Scale Extended on mortality and neurological outcome will be collected at discharge from ICU, hospital and at 6 months follow-up.Ethics and disseminationThe study has been approved by the Ethic committee of Brianza at the Azienda Socio Sanitaria Territoriale-Monza. Data will be disseminated to the scientific community by abstracts submitted to the European Society of Intensive Care Medicine annual conference and by original articles submitted to peer-reviewed journals.Trial registration numberNCT04459884.
Single-centre, open-label, randomised, trial to compare rapid molecular point-of-care streptococcal testing to standard laboratory-based testing for the management of streptococcal pharyngitis in children: study protocol
Authors: Pernica Jeffrey M , Smaill Fiona , Kam April J , Bartholomew Amy , Doan Quynh , Smieja Marek , Khan Sarah , Sung Melani , Thabane Lehana , Goldfarb David M 
Published: August 2021

IntroductionStreptococcal pharyngitis, which commonly occurs in children, should be treated with antibiotics. Clinical prediction rules to differentiate streptococcal pharyngitis from viral infection are not recommended in children. Rapid point-of-care (POC) antigen tests have limited sensitivity and so are not often used in Canadian paediatric emergency departments (EDs). Standard paediatric practice is to rely on laboratory-based testing, which often results in a delay before the results can be communicated to the patient; this may impede appropriate prescribing, decrease caregiver satisfaction and delay recovery. The objective of this study is to determine whether a novel rapid molecular POC assay for streptococcal pharyngitis leads to more appropriate antibiotic use in children seeking care in a paediatric ED than standard laboratory-based testing.Methods and analysisA randomised, superiority, open-label, trial with two parallel groups. Children presenting to a tertiary paediatric ED at least 3 years of age who have a throat swab ordered for diagnosis of streptococcal pharyngitis will be eligible; those who have taken antibiotics within 72 hours prior to presentation and those with additional active infections will be excluded. The primary study outcome will be appropriate antibiotic treatment at 3–5 days postenrolment. Secondary outcomes include time to symptom resolution, caregiver satisfaction, caregiver/child absenteeism, number of subsequent healthcare visits, clinician satisfaction and incremental cost-effectiveness of POC testing. A total of 352 participants will be needed.Ethics and disseminationAll study documentation has been approved by the Hamilton Integrated Research Ethics board and informed consent will be obtained from all participants. Data from this trial will be presented at major conferences and published in peer-reviewed publications to facilitate collaborations with networks of clinicians experienced in the dissemination of clinical guidelines.Trial registration numberNCT04247243.
Efficacy of therapeutic fasting and plant-based diet in patients with rheumatoid arthritis (NutriFast): study protocol for a randomised controlled clinical trial
Authors: Hartmann Anika M , Dell"Oro Melanie , Kessler Christian S , Schumann Dania , Steckhan Nico , Jeitler Michael , Fischer Jan Moritz , Spoo Michaela , Kriegel Martin A , Schneider Jochen G , Häupl Thomas , Kandil Farid I , Michalsen Andreas , Koppold-Liebscher Daniela A 
Published: August 2021

BackgroundPrevious studies have shown beneficial effects of therapeutic fasting and plant-based dietary interventions on disease activity in patients with rheumatoid arthritis (RA) for a duration of up to 1 year. To date, the effects of such interventions on the gut microbiome and on modern diagnostic markers in patients with RA have not been studied. This trial aims to investigate the clinical effects of therapeutic fasting and a plant-based diet in patients with RA, additionally considering current immunological diagnostic tools and microbiome analyses.Methods/designThis trial is an open-label, single-centre, randomised, controlled, parallel-group clinical trial. We will randomly assign 84 patients with RA under a stable standard therapy to either (1) therapeutic fasting followed by a plant-based dietary intervention or (2) to a conventional nutritional counselling focusing on an anti-inflammatory dietary pattern according to the recommendations of the Deutsche Gesellschaft für Ernährung (German society for nutrition). Primary outcome parameter is the group difference from baseline to 12 weeks on the Health Assessment Questionnaire (HAQ). Other secondary outcomes include established clinical criteria for disease activity and treatment response in RA (Disease Activity Score 28, Simple Disease Activity Index, ACR-Response Criteria), changes in self-reported health and physical functional ability, mood, stress, quality of life, dietary behaviour via 3-day food records and a modified Food Frequency Questionnaire, body composition, changes in the gut microbiome, metabolomics and cytometric parameters. Outcomes will be assessed at baseline and day 7, after 6 weeks, 12 weeks and after 6 months.Ethics and disseminationEthical approval to process and analyse data, and to publish the results was obtained through the institutional review board of Charité-Universitätsmedizin Berlin. Results of this trial will be disseminated through peer-reviewed publications and scientific presentations.Trial registration numberNCT03856190.
Sexually transmitted infections and prior antibiotic use as important causes for negative urine cultures among adults presenting with urinary tract infection symptoms to primary care clinics in Zimbabwe: a cross-sectional study
Authors: Olaru Ioana D , Chisenga Mutsawashe , Yeung Shunmay , Mabey David , Marks Michael , Chonzi Prosper , Masunda Kudzai PE , Machiha Anna , Ferrand Rashida A , Kranzer Katharina 
Published: August 2021

ObjectiveUrinary tract infections (UTIs) are common in primary care. The yield of urine cultures in patients with UTI symptoms can be considerably different between high-income and low-income settings. This study aimed to explore possible causes of negative urine cultures in patients presenting with symptoms of UTI to primary health clinics in Harare.DesignCross-sectional study.SettingNine primary health clinics in Harare, Zimbabwe.ParticipantsAdults presenting with symptoms of UTIs between March and July 2020.Primary outcome measuresUrine samples underwent dipstick testing, microscopy, culture, and testing for sexually transmitted infections (STIs) using GeneXpert and for the presence of antibiotic residues using an antibiotic bioassay. The primary outcomes were the number and proportion of participants with evidence of STIs, prior antibiotic exposure, leucocyturia and UTIs.ResultsThe study included 425 participants with a median age of 37.3 years, of whom 275 (64.7%) were women. Leucocyturia was detected in 130 (30.6%, 95% CI 26.2% to 35.2%) participants, and 96 (22.6%, 95% CI 18.7% to 26.9%) had a positive urine culture for a uropathogen.Chlamydia trachomatis,Neisseria gonorrhoeaeandTrichomonas vaginaliswere detected in 43/425 (10.1%, 95% CI 7.4% to 13.4%), 37/425 (8.7%, 95% CI 6.2% to 11.8%) and 14/175 (8.0%, 95% CI 4.4% to 13.1%) participants, respectively. Overall, 89 (20.9%, 95% CI 17.2% to 25.1%) participants reported either having taken prior antibiotics or having had a positive urine bioassay. In 170 (40.0%, 95% CI 35.3% to 44.8%) participants, all of the tests that were performed were negative.ConclusionsThis study found a high prevalence of STIs and evidence of prior antimicrobial use as possible explanations for the low proportion of positive urine cultures.