bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of care utilisation and medical institutional death among older adults by home care facility type: a retrospective cohort study in Fukuoka, Japan
Authors: Kim Sung-A , Babazono Akira , Jamal Aziz , Li Yunfei , Liu Ning 
Published: April 2021

ObjectivesWe compared the care services use and medical institutional deaths among older adults across four home care facility types.DesignThis was a retrospective cohort study.SettingWe used administrative claims data from April 2014 to March 2017.ParticipantsWe included 18 347 residents of Fukuoka Prefecture, Japan, who received home care during the period, and aged ≥75 years with certified care needs of at least level 3. Participants were categorised based on home care facility use (ie, general clinics, Home Care Support Clinics/Hospitals (HCSCs), enhanced HCSCs with beds and enhanced HCSCs without beds).Primary and secondary outcome measuresWe used generalised linear models (GLMs) to estimate care utilisation and the incidence of medical institutional death, as well as the potential influence of sex, age, care needs level and Charlson comorbidity index as risk factors.ResultsThe results of GLMs showed the inpatient days were 54.3, 69.9, 64.7 and 75.0 for users of enhanced HCSCs with beds, enhanced HCSCs without beds, HCSCs and general clinics, respectively. Correspondingly, the numbers of home care days were 63.8, 51.0, 57.8 and 29.0. Our multivariable logistic regression model estimated medical institutional death rate among participants who died during the study period (n=9919) was 2.32 times higher (p<0.001) for general clinic users than enhanced HCSCs with beds users (relative risks=1.69, p<0.001).ConclusionsParticipants who used enhanced HCSCs with beds had a relatively low inpatient utilisation, medical institutional deaths, and a high utilisation of home care and home-based end-of-life care. Findings suggest enhanced HCSCs with beds could reduce hospitalisation days and medical institutional deaths. Our study warrants further investigations of home care as part of community-based integrated care.
Contributions of treatment centre and patient characteristics to patient-reported experience of haemodialysis: a national cross-sectional study
Authors: Hawkins Janine , Smeeton Nigel , Busby Amanda , Wellsted David , Rider Beth , Jones Julia , Steenkamp Retha , Stannard Catherine , Gair Rachel , van der Veer Sabine N , Corps Claire , Farrington Ken 
Published: April 2021

ObjectivesTo examine the relative importance of patient and centre level factors in determining self-reported experience of care in patients with advanced kidney disease treated by maintenance haemodialysis (HD).DesignAnalysis of data from a cross sectional national survey; the UK Renal Registry (UKRR) national Kidney patient-reported experience measure (PREM) survey (2018). Centre-level data were obtained from the UKRR report (2018).SettingNational survey of patients with advanced kidney disease receiving treatment with maintenance HD in UK renal centres in 2018.ParticipantsThe Kidney PREM was distributed to all UK renal centres by the UKRR in May 2018. Each centre invited patients receiving outpatient treatment for kidney disease to complete the PREM. These included patients with chronic kidney disease, those receiving dialysis—both HD and peritoneal dialysis, and those with a functioning kidney transplant. There were no formal inclusion/exclusion criteria.Main outcome measuresThe Kidney PREM has 38 questions in 13 subscales. Responses were captured using a 7-point Likert scale (never1,always7). The primary outcome of interest was the mean PREM score calculated across all questions. Multilevel modelling was used to determine the proportion of variation of the mean PREM score across centres due to patient-related and centre-related factors.ResultsThere were records for 8253 HD patients (61% men, 77% white) from 69 renal centres (9–710 patients per centre). There was significant variation in mean PREM score across centres (5.35–6.53). In the multivariable analysis there was some variation in relation to both patient- and centre-level factors but these contributed little to explaining the overall variation. However, multilevel modelling showed that the overwhelming proportion of the explained variance (45%) was explained by variation between centres (40%), only a small proportion of which is identified by measured factors. Only 5% of the variation was related to patient-level factors.ConclusionsCentre rather than patient characteristics determine the experience of care of patients receiving HD. Further work is required to define the characteristics of the treating centre which determine patient experience.
NHS Health Check programme: a protocol for a realist review
Authors: Duddy Claire , Wong Geoff , Gadsby E W , Krska Janet , Hibberd Vivienne 
Published: April 2021

IntroductionThe NHS Health Check aims to identify individuals at increased risk of cardiovascular diseases (CVDs) among the adult population in England. The Health Check includes calculation of CVD risk and discussion of pharmacological and lifestyle approaches to manage risk, including referral to lifestyle support services. The programme is commissioned by Local Authorities (LAs) and is delivered by a range of different providers in different settings. There is significant variation in activity, with uptake ranging from 25% to 85% in different areas, and clear evidence of variation in implementation and delivery practice.Methods and analysisWe aim to understand how the NHS Health Check programme works in different settings, for different groups, so that we can recommend improvements to maximise intended outcomes. To do so, we will undertake a realist review and a survey of LA public health teams. Our review will follow Pawson’s five iterative stages: (1) locate existing theories, (2) search for evidence, (3) article selection, (4) extract and organise data and (5) synthesise evidence and draw conclusions. Our review will include documents describing local implementation alongside published research studies. We will recruit a stakeholder group (including Public Health England, commissioners and providers of Health Checks, plus members of the public and patients) to advise us throughout. Our survey will be sent to all 152 LAs in England to gather detailed information on programme delivery (including COVID-19-related changes) and available referral services. This will enable us to map delivery across England and relate these data to programme outcomes.Ethics and disseminationEthical approval is not required for this review. For the survey, we have received approval from the University of Kent Research Ethics Committee. Our findings will be used to develop recommendations on tailoring, implementation and design strategies to improve delivery of the NHS Health Check in different settings, for different groups.PROSPERO registration numberCRD42020163822.
Income-related differences in out-of-hours primary care telephone triage using national registration data
Authors: Jansen Tessa , Hek Karin , Schellevis François G , Kunst Anton E , Verheij Robert A 
Published: April 2021

BackgroundTelephone triage is used to facilitate efficient and adequate acute care allocation, for instance in out-of-hours primary care services (OPCSs). Remote assessment of health problems is challenging and could be impeded by a patient’s ambiguous formulation of his or her healthcare need. Socioeconomically vulnerable patients may experience more difficulty in expressing their healthcare need. We aimed to assess whether income differences exist in the patient’s presented symptoms, assessed urgency and allocation of follow-up care in OPCS.MethodData were derived from Nivel Primary Care Database encompassing electronic health record data of 1.3 million patients from 28 OPCSs in 2017 in the Netherlands. These were linked to sociodemographic population registry data. Multilevel logistic regression analyses (contacts clustered in patients), adjusted for patient characteristics (eg, age, sex), were conducted to study associations of symptoms, urgency assessment and follow-up care with patients’ income (standardised for household size as socioeconomic status (SES) indicator).ResultsThe most frequently presented symptoms deduced during triage slightly differed across SES groups, with a larger relative share of trauma in the high-income groups. No SES differences were observed in urgency assessment. After triage, low income was associated with a higher probability of receiving telephone advice and home visits, and fewer consultations at the OPCS.ConclusionsSES differences in the patient’s presented symptom and in follow-up in OPCS suggest that the underlying health status and the ability to express care needs affect the telephone triage process . Further research should focus on opportunities to better tailor the telephone triage process to socioeconomically vulnerable patients.
Strengthening emergency care knowledge and skills in Uganda and Tanzania with the WHO-ICRC Basic Emergency Care Course
Authors: Kivlehan Sean M , Dixon Julia , Kalanzi Joseph , Sawe Hendry R , Chien Emily , Robert Jordan , Wallis Lee , Reynolds Teri A 
Published: April 2021

BackgroundThere is a pressing need for emergency care (EC) training in low-resource settings. We assessed the feasibility and acceptability of training frontline healthcare providers in emergency care with the World Health Organization (WHO)-International Committee of the Red Cross (ICRC) Basic Emergency Care (BEC) Course using a training-of-trainers (ToT) model with local providers.MethodsQuasiexperimental pretest and post-test study of an educational intervention at four first-level district hospitals in Tanzania and Uganda conducted in March and April of 2017. A 2-day ToT course was held in both Tanzania and Uganda. These were immediately followed by a 5-day BEC Course, taught by the newly trained trainers, at two hospitals in each country. Both prior to and immediately following each training, participants took assessments on EC knowledge and rated their confidence level in using a variety of EC skills to treat patients. Qualitative feedback from participants was collected and summarised.ResultsFifty-nine participants completed the four BEC Courses. All participants were current healthcare workers at the selected hospitals. An additional 10 participants completed a ToT course. EC knowledge scores were significantly higher for participants immediately following the training compared with their scores just prior to the training when assessed across all study sites (Z=6.23, p<0.001). Across all study sites, mean EC confidence ratings increased by 0.74 points on a 4-point Likert scale (95% CI 0.63 to 0.84, p<0.001). Main qualitative feedback included: positive reception of the sessions, especially hands-on skills; request for additional BEC trainings; request for obstetric topics; and need for more allotted training time.ConclusionsImplementation of the WHO-ICRC BEC Course by locally trained providers was feasible, acceptable and well received at four sites in East Africa. Participation in the training course was associated with a significant increase in EC knowledge and confidence at all four study sites. The BEC is a low-cost intervention that can improve EC knowledge and skill confidence across provider cadres.
On the geometry of polytopes generated by heavy-tailed random vectors
Authors: Guédon Olivier , Krahmer Felix , Kümmerle Christian , Mendelson Shahar , Rauhut Holger 
Published: April 2021

We study the geometry of centrally symmetric random polytopes, generated by [Formula: see text] independent copies of a random vector [Formula: see text] taking values in [Formula: see text]. We show that under minimal assumptions on [Formula: see text], for [Formula: see text] and with high probability, the polytope contains a deterministic set that is naturally associated with the random vector — namely, the polar of a certain floating body. This solves the long-standing question on whether such a random polytope contains a canonical body. Moreover, by identifying the floating bodies associated with various random vectors, we recover the estimates that were obtained previously, and thanks to the minimal assumptions on [Formula: see text], we derive estimates in cases that were out of reach, involving random polytopes generated by heavy-tailed random vectors (e.g., when [Formula: see text] is [Formula: see text]-stable or when [Formula: see text] has an unconditional structure). Finally, the structural results are used for the study of a fundamental question in compressive sensing — noise blind sparse recovery.
On pairs of quadratic forms in five variables
Authors: Mallesham Kummari 
Published: April 2021

In this paper, we obtain an upper bound for the number of integral solutions, of given height, of system of two quadratic forms in five variables. Our bound is an improvement over the bound given in [H. Iwaniec and R. Munshi, The circle method and pairs of quadratic forms, J. Théor. Nr. Bordx. 22 (2010) 403–419].
The Chinese Gazette in European Sources from the Late Qianlong Period: The Case of the Siku Quanshu
Authors: Standaert Nicolas 
Published: April 2021

Abstract
The publicly available government gazette (often called dibao 邸報) that was published in a variety of formats in imperial China has recently caught new academic interest both in China and in the West. While most of these studies focus on the Peking Gazette (jingbao 京報) in the (late) nineteenth century, information about the gazette for earlier times remains very scarce. To address this gap, the present study focuses on the gazette from the Qianlong period (1736–1795). It uses and describes both Chinese sources, specifically the tizou shijian 題奏事件, and European sources, especially the French translations of gazettes by Jean-Joseph-Marie Amiot (1718–1793). A case study of translated reports on the Siku quanshu 四庫全書 sent to Europe shows how the Chinese gazette became part of a remarkable and lively global information network.
Persistent Anomaly Changes in High-Resolution Climate Simulations
Authors: Lackmann Gary M. , Miller Rebecca L. , Robinson Walter A. , Michaelis Allison C. 
Published: April 2021

AbstractPersistent anomalies (PAs) are associated with a variety of impactful weather extremes, prompting research into how their characteristics will respond to climate change. Previous studies, however, have not provided conclusive results, owing to the complexity of the phenomenon and to difficulties in general circulation model (GCM) representations of PAs. Here, we diagnose PA activity in ten years of current and projected future output from global, high-resolution (15-km mesh) time-slice simulations performed with the Model for Prediction Across Scales-Atmosphere (MPAS-A). These time slices span a range of ENSO states. They include high-resolution representations of sea-surface temperatures and GCM-based sea ice for present and future climates. Future projections, based on the RCP8.5 scenario, exhibit strong Arctic amplification and tropical upper warming, providing a valuable experiment with which to assess the impact of climate change on PA frequency. The MPAS-A present-climate simulations reproduce the main centers of observed PA activity, but with an eastward shift in the North Pacific and reduced amplitude in the North Atlantic. The overall frequency of positive PAs in the future simulations is similar to that in the present-day simulations, while negative PAs become less frequent. Although some regional changes emerge, the small, generally negative changes in PA frequency and meridional circulation index indicate that climate change does not lead to increased persistence of midlatitude flow anomalies or increased waviness in these simulations.
Gait Adaptations to Physical Fatigue During the Negotiation of Variable and Unexpected Obstacles
Authors: Hinkel-Lipsker Jacob W. , Stoehr Nicole M. , Lachica Isaiah J. , Rogers Sean M. 
Published: April 2021

Objective The purpose of this study was to investigate how physical fatigue impacts one’s ability to negotiate unexpected and randomly located obstacles during locomotion. Background Physically demanding occupations place workers at risk of trips and falls—a major health and financial burden. How worker physical fatigue and fitness impacts their ability to navigate through unpredictable environments is not thoroughly explored in current literature. In this exploratory study, we further examine these relationships. Methods Twenty-one young, physically fit participants completed a series of obstacle negotiation trials in the dark, where an obstacle would suddenly be illuminated as they reached it. Participants then engaged in a fatigue protocol, before repeating a series of the same negotiation trials. Results When fatigued, participants exhibited a significant decrease in leading toe and trailing toe clearance, as well as a significant increase in leading heel clearance. Moreover, participants stepped closer to the obstacle with their both feet on the step prior to negotiation. Participants also walked at a faster velocity. Regression analyses revealed that participants’ VO2max and height were significant predictors of foot placement metrics. Conclusion Results indicate that physical fatigue negatively impacts crossing mechanics of young, healthy individuals, and that a higher level of VO2 capacity may reduce the occurrences of altered crossing behavior that coincide with physical fatigue. Application These results highlight the effect of fatigue on worker safety during performance of job-related duties and are of interest to professionals seeking to reduce the incidence of slips, trips, and falls in the workplace.
Diversity in Dermatology? An Assessment of Undergraduate Medical Education
Authors: Bellicoso Emily , Quick Sofia Oke , Ayoo Kennedy Otieno , Beach Renée A. , Joseph Marissa , Dahlke Erin 
Published: April 2021

Background A lack of representation of skin of color (SoC) in dermatology curricula is well-documented across North American medical schools and may present a barrier to equitable and comprehensive undergraduate medical education. Objectives This study aims to examine representation in dermatologic educational materials and appreciate a link between bias in dermatologic education and student diagnostic ability and self-rated confidence. Design The University of Toronto Dermatology Undergraduate Medical Education curriculum was examined for the percentage photographic representation of SoC. A survey of 10 multiple-choice questions was administered to first- and third-year medical students at the University of Toronto to assess diagnostic accuracy and self-rated confidence in diagnosis of 5 common skin lesions in Fitzpatrick skin phototypes (SPT) I-III (white skin) and VI-VI (SoC). Results The curriculum audit showed that <7% of all images of skin disease were in SoC. Diagnostic accuracy was fair for both first- (77.8% and 85.9%) and third-year (71.3% and 72.4%) cohorts in white skin and SoC, respectively. Students’ overall self-rated confidence was significantly greater in white skin when compared to SoC, in both first- (18.75/25 and 17.78/25, respectively) and third-year students (17.75/25 and 15.79/25, respectively) ( P = .0002). Conclusions This preliminary assessment identified a lack of confidence in diagnosing dermatologic conditions in SoC, a finding which may impact health outcomes of patients with SoC. This project is an important first step in diversifying curricular materials to provide comprehensive medical education.
Comparison Between Soccer and Basketball of Bone Bruise and Meniscal Injury Patterns in Anterior Cruciate Ligament Injuries
Authors: Shi Huijuan , Ding Li , Jiang Yanfang , Zhang Haocheng , Ren Shuang , Hu Xiaoqing , Liu Zhenlong , Huang Hongshi , Ao Yingfang 
Published: April 2021

Background: The varying effectiveness of anterior cruciate ligament (ACL) injury prevention programs between soccer and basketball may be due to differences in sport-specific injury mechanisms. Bone bruise patterns may provide information regarding injury mechanisms. Purpose: To compare bone bruise and meniscal injury patterns for ACL injuries sustained in soccer versus basketball. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Clinical notes, operative reports, and magnetic resonance imaging scans were reviewed for patients who sustained a noncontact ACL rupture while playing soccer or basketball between August 2016 and August 2018. The presence, location, and signal intensity of bone bruises on the tibia and femur were documented, and patterns were classified according to the location of the bone bruise in the lateral-medial direction. The meniscal and bone bruise injury patterns and the specific bone bruise locations were compared between the soccer and basketball groups. Results: Overall, 138 patients were included (56 with soccer-related and 82 with basketball-related ACL injury). No significant difference between the groups was observed in bone bruise patterns ( P = .743) or meniscal injury patterns ( P = .952). Bone bruise on the lateral side only of both the femur and the tibia was the most common pattern in both soccer (41.9%) and basketball (47.0%) groups; the most common meniscal injury type was an isolated lateral meniscal injury in both soccer (50.0%) and basketball (45.0%) groups. For patients with bone bruises on both the lateral and the medial sides of both the femur and the tibia (BF+BT), the bone bruise signal intensity on the lateral side of the femur ( P < .001) and tibia ( P = .009) was significantly higher than that on the medial side for both groups. The bone bruises on the lateral side of the femur ( P < .001) and tibia ( P = .002) were significantly more anterior than those on the medial side for patients with the BF+BT pattern. Conclusion: No significant differences in bone bruise location or meniscal injury type were detected when comparing ACL injuries sustained during soccer versus basketball. The study results suggest a similar biomechanical loading pattern for ACL injuries in these sports.