bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ambulance staff and end-of-life hospital admissions: A qualitative interview study
Authors: Hoare Sarah , Kelly Michael P , Prothero Larissa , Barclay Stephen 
Published: June 2018

Background: Hospital admissions for end-of-life patients, particularly those who die shortly after being admitted, are recognised to be an international policy problem. How patients come to be transferred to hospital for care, and the central role of decisions made by ambulance staff in facilitating transfer, are under-explored. Aim: To understand the role of ambulance staff in the admission to hospital of patients close to the end of life. Design: Qualitative interviews, using particular patient cases as a basis for discussion, analysed thematically. Participants/setting: Ambulance staff ( n = 6) and other healthcare staff (total staff n = 30), involved in the transfer of patients (the case-patients) aged more than 65 years to a large English hospital who died within 3 days of admission with either cancer, chronic obstructive pulmonary disease or dementia. Results: Ambulance interviewees were broadly positive about enabling people to die at home, provided they could be sure that they would not benefit from treatment available in hospital. Barriers for non-conveyance included difficulties arranging care particularly out-of-hours, limited available patient information and service emphasis on emergency care. Conclusion: Ambulance interviewees fulfilled an important role in the admission of end-of-life patients to hospital, frequently having to decide whether to leave a patient at home or to instigate transfer to hospital. Their difficulty in facilitating non-hospital care at the end of life challenges the negative view of near end-of-life hospital admissions as failures. Hospital provision was sought for dying patients in need of care which was inaccessible in the community.
How are physicians delivering palliative care? A population-based retrospective cohort study describing the mix of generalist and specialist palliative care models in the last year of life
Authors: Brown Catherine RL , Hsu Amy T , Kendall Claire , Marshall Denise , Pereira Jose , Prentice Michelle , Rice Jill , Seow Hsien-Yeang , Smith Glenys A , Ying Irene , Tanuseputro Peter 
Published: June 2018

Background: To enable coordinated palliative care delivery, all clinicians should have basic palliative care skill sets (‘generalist palliative care’). Specialists should have skills for managing complex and difficult cases (‘specialist palliative care’) and co-exist to support generalists through consultation care and transfer of care. Little information exists about the actual mixes of generalist and specialist palliative care. Aim: To describe the models of physician-based palliative care services delivered to patients in the last 12 months of life. Design: This is a population-based retrospective cohort study using linked health care administrative data. Setting/participants: Physicians providing palliative care services to a decedent cohort in Ontario, Canada. The decedent cohort consisted of all adults (18+ years) who died in Ontario, Canada between April 2011 and March 2015 ( n = 361,951). Results: We describe four major models of palliative care services: (1) 53.0% of decedents received no physician-based palliative care, (2) 21.2% received only generalist palliative care, (3) 14.7% received consultation palliative care (i.e. care from both specialists and generalists), and (4) 11.1% received only specialist palliative care. Among physicians providing palliative care ( n = 11,006), 95.3% had a generalist palliative care focus and 4.7% a specialist focus; 74.2% were trained as family physicians. Conclusion: We examined how often a coordinated palliative care model is delivered to a large decedent cohort and identified that few actually received consultation care. The majority of care, in both the palliative care generalist and specialist models, was delivered by family physicians. Further research should evaluate how different models of care impact patient outcomes and costs.
Implementation of a Nurse-Driven Protocol for Catheter Removal to Decrease Catheter-Associated Urinary Tract Infection Rate in a Surgical Trauma ICU
Authors: Tyson Anna F. , Campbell Eileen F. , Spangler Lacey R. , Ross Samuel W. , Reinke Caroline E. , Passaretti Catherine L. , Sing Ronald F. 
Published: June 2018

Introduction: Early removal of urinary catheters is an effective strategy for catheter-associated urinary tract infection (CAUTI) prevention. We hypothesized that a nurse-directed catheter removal protocol would result in decreased catheter utilization and CAUTI rates in a surgical trauma intensive care unit (STICU). Methods: We performed a retrospective, cohort study following implementation of a multimodal CAUTI prevention bundle in the STICU of a large tertiary care center. Data from a 19-month historical control were compared to data from a 15-month intervention period. Pre- and postintervention indwelling catheter utilization and CAUTI rates were compared. Results: Catheter utilization decreased significantly with implementation of the nurse-driven protocol from 0.78 in the preintervention period to 0.70 in the postintervention period ( P < .05). As a result of the bundle, the CAUTI rate declined significantly, from 5.1 to 2.0 infections per 1000 catheter-days in the pre- vs postimplementation period (Incident Rate Ratio [IRR]: 0.38, 95% confidence interval: 0.21-0.65). Conclusions: Implementation of a nurse-driven protocol for early urinary catheter removal as part of a multimodal CAUTI intervention strategy can result in measurable decreases in both catheter utilization and CAUTI rates.
Facilitators and barriers to research participation: perspectives of Latinos with type 2 diabetes
Authors: Hildebrand Janett A , Billimek John , Olshansky Ellen F , Sorkin Dara H , Lee Jung-Ah , Evangelista Lorraine S 
Published: June 2018

Background: Latinos constitute 17% of the US population and are one of the largest ethnic groups; however, only 7.6% participate in research studies. There is a disproportionately high number of Latinos living with type 2 diabetes mellitus and are at increased risk for cardiovascular events. Research to elicit facilitators and barriers for participation in research and effective recruitment strategies is limited. Aims: This article reports the qualitative findings of a mixed-methods study examining perceived facilitators and barriers for research participation, and explores decision-making processes and ascertains ethnic values that influenced their decisions among Spanish-speaking Latinos with type 2 diabetes mellitus. Methods: Semi-structured interviews were conducted with 25 participants (mean age 50.8 ± 9.4 years, 76% women and 28% employed). Participants were asked to elaborate on perceived facilitators and barriers to research participation. All interviews were conducted in Spanish. Transcribed interviews were analyzed through conventional content analysis. Results: Three themes emerged from transcribed interviews: (a) lowering barriers to access health-related expertise; (b) language concordance; and (c) trusting relationships. Perceived barriers to research participation included work schedule, childcare, transportation and ethnic beliefs. Conclusion: Strategies to support learning, language concordance and establishing trusting relationships among Spanish-speaking Latinos may be key to increasing Latinos in research studies.
Acute Myocardial Infarction Experience Among Mexican American Women
Authors: Bowles John R. , McEwen Marylyn M. , Rosenfeld Anne G. 
Published: June 2018

Introduction: Health disparities in cardiovascular disease risk factors affect a burgeoning segment of the U.S. population—Mexican American (MA) women. MAs experience disparities in the prevalence of heart disease risk factors. However, there are no studies describing acute myocardial infarction (AMI) symptoms unique to this Hispanic subgroup. The aim of the study was to describe MA women’s AMI symptom experience. Methods: A qualitative descriptive design guided the study. Data were collected in semistructured interviews with eight MA women who reported having an AMI within the past 18 months. Data were analyzed using qualitative content analysis. Results: The overall theme was “The nature of my AMI experience.” This theme, composed of four categories, described their prodromal and AMI symptom experience: my perception of AMI, having a heart attack, AMI symptoms, and actions taken. No participants recognized prodromal or symptoms of AMI. Asphyxiatia (asphyxiating) and menos fuerza (less strength) were commonly described symptoms. Conclusion: Participants attributed both prodromal and AMI symptoms to noncardiac causes, self-managed symptoms, and delay in seeking health care. Findings suggest that community engagement through culturally tailored family-focused heart health education for MA women and their family members may improve recognition of prodromal symptoms.
Prognostic value of hypoxia-inducible factor-1 alpha in nasopharyngeal carcinoma: a meta-analysis
Authors: Xie Wenji , Liu Lihui , He Haixia , Yang Kaixuan 
Published: June 2018

Background: Over the past 5 years, many studies have reported the prognostic value of hypoxia-inducible factor-1 alpha (HIF-1α) in nasopharyngeal carcinoma. However, the results have not reached a consensus until now. Therefore, we performed this meta-analysis to investigate the influence of HIF-1α expression on the prognosis and clinical characteristics in nasopharyngeal carcinoma. Methods: We searched PubMed, the Cochrane Library, Embase (via Ovid interface), Web of Science, and China National Knowledge Infrastructure electronic databases from their establishment to 6 December 2017. We calculated the hazard ratio (HR) and the odds ratio (OR) to assess the prognostic and clinicopathological values of HIF-1α, respectively. Q test and I2 statistic were applied to evaluate heterogeneity. We also conducted publication bias and sensitivity analyses. Results: A total of 18 studies with 1476 patients were included in our meta-analysis. We found HIF-1α expression was associated with poor overall survival (HR=1.77; 95% confidence interval (CI) 1.35, 2.32; P<0.001), poor progression-free survival (HR=1.72; 95% CI 1.22, 2.44; P=0.002), a higher rate of lymph node metastasis (OR=3.81; 95% CI 2.60, 5.58, P<0.001), and more advanced tumor stage (OR=2.98; 95% CI 1.79, 4.97; P<0.001). Conclusions: Our study demonstrated that HIF-1α could be an appropriate prognostic biomarker for nasopharyngeal carcinoma patients.
Measurement of Normative Foveal Avascular Zone Parameters in Healthy Adults Using Optical Coherence Tomography Angiography
Authors: Alshareef Rayan A. , Al-khersan Hasenin , Darwich Rami , Jabeen Ayesha , Jabeen Asiya , Kim David Ta , Chhablani Jay 
Published: June 2018

Background and Objective: The purpose of this study was to quantify the geometric dimension of the foveal avascular zone (FAZ) area and its index measurement of morphology as a circle (acircularity index) in healthy participants according to age and sex, using optical coherence tomography angiography (OCTA). Study Design/Materials and Method: This is a cross-sectional descriptive study conducted at LV Prasad Eye Institute, India. Written informed consent was obtained from all participants before the study. Deep range imaging-optical coherence tomography (DRI-OCT; Topcon) was performed on right eyes of all participants in this study. The OCTA scans were analyzed and processed; FAZ dimensions and the acircularity index were calculated for both superficial retinal capillary plexus (SCP) and deep retinal capillary plexus (DCP). Results: A total of 88 normal right eyes from 88 participants were included (48 males, 40 females; mean 42 ± 13 years of age). Mean FAZ area for SCP and DCP was 3.37 ± 1.28 mm2 and 2.31 ± 1.12 mm2, respectively. Mean acircularity index for SCP and DCP was 1.76 ± 1.58 and 1.60 ± 0.90, respectively. In the SCP, male sex was correlated with lower FAZ values; however, there was no correlation with age or refractive error. For the DCP, male sex and increasing age correlated with lower FAZ values, but there was no correlation with refractive error. Foveal avascular zone areas decreased 0.0225 mm2 per year in the DCP. The acircularity index of both the SCP and DCP was not correlated with sex, age, or refractive error. Conclusions: Male sex and increasing age were correlated with lower FAZ values in the DCP, while only male sex was correlated with lower FAZ values in the SCP. There was no correlation between sex, age, or refractive error with the acircularity index for both the SCP and DCP.
Aged murine hematopoietic stem cells drive aging-associated immune remodeling
Authors: Leins Hanna , Mulaw Medhanie , Eiwen Karina , Sakk Vadim , Liang Ying , Denkinger Michael , Geiger Hartmut , Schirmbeck Reinhold 
Published: June 2018

Key Points
Phenotypic and functional changes in T and B cells of old mice are primarily driven by aging of HSCs. CASIN-treated aged HSCs reconstitute an immune system with a function similar to that in young animals.
Big data: what it can and cannot achieve
Authors: Schofield Peter , Das-Munshi Jayati 
Published: June 2018

SUMMARYThis article looks at the use of large datasets of health records, typically linked with other data sources, in mental health research. The most comprehensive examples of this kind of ‘big data’ are typically found in Scandinavian countries, although there are also many useful sources in the UK. There are a number of promising methodological innovations from studies using big data in UK mental health research, including: hybrid study designs, data linkage and enhanced study recruitment. It is, however, important to be aware of the limitations of research using big data, particularly the various pitfalls in analysis. We therefore caution against abandoning traditional research designs, and argue that other data sources are equally valuable and, ideally, research should incorporate data from a range of sources.LEARNING OBJECTIVES•Be aware of major big data resources relevant to mental health research•Be aware of key advantages and innovative study designs using these data sources•Understand the inherent limitations to studies reliant on big data aloneDECLARATION OF INTERESTNone.
Meaningful patient engagement
Authors: Gerada Clare 
Published: June 2018

SUMMARYHolding a medical degree does not magically protect the individual from ever becoming unwell or needing medical help. However, for various reasons, most of which relate to personal, professional and institutional stigma, doctors are often denied the care they so readily provide to their own patients. The author has been running a ‘sick doctor’ service for 10 years and this article describes, from the practitioner-patient perspective, the barriers to care and what can be done to improve doctors' access to services.LEARNING OBJECTIVES•Appreciate the external and internal risk factors for mental illness in doctors•Understand why doctors do not attend for care when mentally unwell•Acknowledge how mentally ill doctors are exposed to stigma and how this can be overcomeDECLARATION OF INTERESTC.G. is a partner of the Hurley Group who won the contract for PHP in 2008 and is employed by and leads the NHS Practitioner Health Programme.
Simultaneous Optimization of Container Ship Sailing Speed and Container Routing with Transit Time Restrictions
Authors: Karsten Christian Vad , Ropke Stefan , Pisinger David 
Published: June 2018

We introduce a decision support tool for liner shipping companies to optimally determine the sailing speed and needed fleet for a global network. We incorporate cargo routing decisions with tight transit time restrictions on each container such that we get a realistic picture of the utilization of the network. Furthermore, we show that it is possible to extend the model to include optimal time scheduling decisions such that the time associated with transshipments is also reflected accurately. To solve the speed optimization problem, we propose an exact algorithm based on Benders decomposition and column generation that exploits the separability of the problem. Computational results show that the method is applicable to liner shipping networks of realistic size and that it is important to incorporate cargo routing decisions when optimizing speed. The online appendix is available at https://doi.org/10.1287/trsc.2018.0818 .
A Contribuição dos Recursos de Coesão para o Leitor Durante o Processo de Construção da Representação Textual
Authors: Simões Antonia Barros Gibson , Lima Henrique Miguel De , Silva Silva Danielli Cristina De  Lima , Vasconcelos Rita de Cássia Freire de Melo 
Published: June 2018

Partindo do pressuposto de que, a partir de fragmentos do texto, o usuário da língua aplica estratégias para compreendê-lo (DIJK e KINTSCH, 1983), notamos que os conectivos podem influenciar na construção representacional do texto. A representação textual, construída durante a leitura (processamento) do texto, precisa ser coerente, neste sentido, os conectivos, existindo em função coerência textual, manifestam, explicitamente, como o leitor deverá relacionar os conteúdos dispostos em um texto, por isso devem ser relevantes para o leitor durante o processo de estabelecimento da coerência textual. A fim de refletirmos sobre a contribuição dos recursos de coesão durante a compreensão do texto, propomos, no presente trabalho, um diálogo entre os textos Strategies of Discourse Comprehension (DIJK e KINTSCH,1983) e The Semantics and Pragmatics of Functional Coherence in Discourse. (DIJK, 1980)- no que concerne à necessidade de construção representacional do texto- e a pesquisa psicolinguística sobre processamento textual, mais especificamente o processamento de conectivos, proposta e reportada por Sanders e Noordman e Vonk (1996). Por meio dos resultados encontrados pelos autores (NOORDMAN e VONK, 1996) percebemos contribuições- significativas estatisticamente- dos recursos de coesão, do tipo conectivos, durante o processamento textual que atestariam a relevância destes itens linguísticos na construção da representação mental do texto.
Early Abrogation of Gelatinase Activity Extends the Time Window for tPA Thrombolysis after Embolic Focal Cerebral Ischemia in Mice
Authors: Chen Shanyan , Chen Zhenzhou , Cui Jiankun , McCrary Myah L. , Song Hailong , Mobashery Shahriar , Chang Mayland , Gu Zezong 
Published: June 2018

AbstractAcute ischemic stroke (AIS) is caused by clotting in the cerebral arteries, leading to brain oxygen deprivation and cerebral infarction. Recombinant human tissue plasminogen activator (tPA) is currently the only Food and Drug Administration-approved drug for ischemic stroke. However, tPA has to be administered within 4.5 h from the disease onset and delayed treatment of tPA can increase the risk of neurovascular impairment, including neuronal cell death, blood-brain barrier (BBB) disruption, and hemorrhagic transformation. A key contributing factor for tPA-induced neurovascular impairment is activation of matrix metalloproteinase-9 (MMP-9). We used a clinically-relevant mouse embolic model of focal-cerebral ischemia by insertion of a single embolus of blood clot to block the right middle cerebral artery. We showed that administration of the potent and highly selective gelatinase inhibitor SB-3CT extends the time window for administration of tPA, attenuating infarct volume, mitigating BBB disruption, and antagonizing the increase in cerebral hemorrhage induced by tPA treatment. We demonstrated that SB-3CT attenuates tPA-induced expression of vascular MMP-9, prevents gelatinase-mediated cleavage of extracellular laminin, rescues endothelial cells, and reduces caveolae-mediated transcytosis of endothelial cells. These results suggest that abrogation of MMP-9 activity mitigates the detrimental effects of tPA treatment, thus the combination treatment holds great promise for extending the therapeutic window for tPA thrombolysis, which opens the opportunity for clinical recourse to a greater number of patients.
Accuracy of Genomic Prediction for Foliar Terpene Traits in Eucalyptus polybractea
Authors: Kainer David , Stone Eric A , Padovan Amanda , Foley William J , Külheim Carsten 
Published: June 2018

Abstract
Unlike agricultural crops, most forest species have not had millennia of improvement through phenotypic selection, but can contribute energy and material resources and possibly help alleviate climate change. Yield gains similar to those achieved in agricultural crops over millennia could be made in forestry species with the use of genomic methods in a much shorter time frame. Here we compare various methods of genomic prediction for eight traits related to foliar terpene yield in Eucalyptus polybractea, a tree grown predominantly for the production of Eucalyptus oil. The genomic markers used in this study are derived from shallow whole genome sequencing of a population of 480 trees. We compare the traditional pedigree-based additive best linear unbiased predictors (ABLUP), genomic BLUP (GBLUP), BayesB genomic prediction model, and a form of GBLUP based on weighting markers according to their influence on traits (BLUP|GA). Predictive ability is assessed under varying marker densities of 10,000, 100,000 and 500,000 SNPs. Our results show that BayesB and BLUP|GA perform best across the eight traits. Predictive ability was higher for individual terpene traits, such as foliar α-pinene and 1,8-cineole concentration (0.59 and 0.73, respectively), than aggregate traits such as total foliar oil concentration (0.38). This is likely a function of the trait architecture and markers used. BLUP|GA was the best model for the two biomass related traits, height and 1 year change in height (0.25 and 0.19, respectively). Predictive ability increased with marker density for most traits, but with diminishing returns. The results of this study are a solid foundation for yield improvement of essential oil producing eucalypts. New markets such as biopolymers and terpene-derived biofuels could benefit from rapid yield increases in undomesticated oil-producing species.
Paklitaxeltartalmú kemoterápiás kombináció metasztatikus cervixtumor első vonali és reindukciós palliatív kezelésében
Authors: Kullmann Tamás , Sipőcz István , Agyemang-Prempeh Kofi , Barna Orsolya , Pintér Tamás 
Published: June 2018

Abstract: Introduction: The paclitaxel-carboplatin doublet is an alternative choice in the first line treatment of metastatic or recurrent cervical cancer according to international guidelines. Method: The history of seven patients treated with paclitaxel-platinum in the last three years in the Petz Aladár Hospital is reported. A case report, supporting the efficacy of the combination in emergency and in reintroduced settings is presented as well. Results: The average progression-free survival was 10 months. All patients were alive at the time of the submission of the article. Conclusion: The results confirm the efficacy of the paclitaxel-carboplatin AUC 5 and the paclitaxel-cisplatin combinations in the treatment of metastatic cervical cancer. Orv Hetil. 2018; 159(24): 974–977.