bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring the role of regulation and the care of older people with depression living in long-term care? A systematic scoping review protocol
Authors: Crick Michelle , Angus Douglas E , Backman Chantal 
Published: July 2018

IntroductionThis systematic scoping review will explore the role of regulation on the care of older people living with depression in long-term care. Depression presents a significant burden to older people living in long-term care. Regulation in the long-term care sector has increased, but there are still concerns about quality of care in the sector.Methods and analysisUsing Arksey and O’Malley’s scoping review methodology as a guide, our scoping review will search several databases: Embase; MEDLINE (using the OVID platform); Psych info; Ageline; and CINAHL, alongside the grey literature. An expert librarian has assisted the research team, using the Peer Review of Electronic Search Strategies, to assess the search strategy. The research team has formulated search strategies and two reviewers will independently screen studies for final study selection. We will summarise extracted data in tabular format; use a narrative format to describe their relevance; and finally, identify knowledge gaps and topics for future research.Ethics and disseminationThis scoping review will outline the scope of the existing literature related to the influence of regulation on the care of older people living with depression in long-term care. The scoping review findings will be disseminated through publication in a peer-reviewed journal. The findings will be useful to policy-makers, managers and clinicians working in the long-term care sector.
Costs and effects of on-demand treatment of hereditary angioedema in Italy: a prospective cohort study of 167 patients
Authors: Federici Carlo , Perego Francesca , Borsoi Ludovica , Crosta Valentina , Zanichelli Andrea , Gidaro Antonio , Tarricone Rosanna , Cicardi Marco 
Published: July 2018

ObjectivesTo explore treatment behaviours in a cohort of Italian patients with hereditary angioedema due to complement C1-inhibitor deficiency (C1-INH-HAE), and to estimate how effects and costs of treating attacks in routine practice differed across available on-demand treatments.DesignCost analyses and survival analyses using attack-level data collected prospectively for 1 year.SettingNational reference centre for C1-INH-HAE.Participants167 patients with proved diagnosis of C1-INH-HAE, who reported data on angioedema attacks, including severity, localisation and duration, treatment received, and use of other healthcare services.InterventionsAttacks were treated with either icatibant, plasma-derived C1-INH (pdC1-INH) or just supportive care.Main outcome measuresTreatment efficacy in reducing attack duration and the direct costs of acute attacks.ResultsOverall, 133 of 167 patients (79.6%) reported 1508 attacks during the study period, with mean incidence of 11 attacks per patient per year. Only 78.9% of attacks were treated in contrast to current guidelines. Both icatibant and pdC1-INH significantly reduced attack duration compared with no treatment (median times from onset 7, 10 and 47 hours, respectively), but remission rates with icatibant were 31% faster compared with pdC1-INH (HR 1.31, 95% CI 1.14 to 1.51). However, observed treatment behaviours suggest patterns of suboptimal dosing for pdC1-INH. The average cost per attack was €1183 (SD €789) resulting in €1.58 million healthcare costs during the observation period (€11 912 per patient per year). Icatibant was 54% more expensive than pdC1-INH, whereas age, sex and prophylactic treatment were not associated to higher or lower costs.ConclusionsBoth icatibant and pdC1-INH significantly reduced attack duration compared with no treatment, however, icatibant was more effective but also more expensive. Treatment behaviours and suboptimal dosing of pdC1-INH may account for the differences, but further research is needed to define their role.
Patient safety issues and concerns in Bhutan’s healthcare system: a qualitative exploratory descriptive study
Authors: Pelzang Rinchen , Hutchinson Alison M 
Published: July 2018

ObjectivesTo investigate what healthcare professionals perceived and experienced as key patient safety concerns in Bhutan’s healthcare system.DesignQualitative exploratory descriptive inquiry.SettingsThree different levels of hospitals, a training institute and the Ministry of Health, Bhutan.ParticipantsIn total, 140 healthcare professionals and managers.MethodsNarrative data were collected via conversational in-depth interviews and Nominal Group Meetings. All data were subsequently analysed using thematic analysis strategies.ResultsThe data revealed that medication errors, healthcare-associated infections, diagnostic errors, surgical errors and postoperative complications, laboratory/blood testing errors, falls, patient identification and communication errors were perceived as common patient safety concerns. Human and system factors were identified as contributing to these concerns. Instituting clinical governance, developing and improving the physical infrastructure of hospitals, providing necessary human resources, ensuring staff receive patient safety education and promoting ‘good’ communication and information systems were, in turn, all identified as processes and strategies critical to improving patient safety in the Bhutanese healthcare system.ConclusionPatient safety concerns described by participants in this study were commensurate with those identified in other low and middle-income countries. In order to redress these concerns, the findings of this study suggest that in the Bhutanese context patient safety needs to be conceptualised and prioritised.
Responsive and Equitable Health Systems—Partnership on Non-Communicable Diseases (RESPOND) study: a mixed-methods, longitudinal, observational study on treatment seeking for hypertension in Malaysia and the Philippines
Authors: Palafox Benjamin , Seguin Maureen L , McKee Martin , Dans Antonio L , Yusoff Khalid , Candari Christine J , Idris Khairuddin , Ismail Johan Rizwal , Krauss Steven Eric , Lasco Gideon , Majid Fadhlina A , Palileo-Villanueva Lia M , Razak Azlina A , Renedo Alicia , Balabanova Dina 
Published: July 2018

IntroductionHypertension is a leading contributor to the global burden of disease. While safe and effective treatment exists, blood pressure control is poor in many countries, often reflecting barriers at the levels of health systems and services as well as at the broader level of patients’ sociocultural contexts. This study examines how these interact to facilitate or hinder hypertension control, taking into account characteristics of service provision components and social contexts.Methods and analysisThe study, set in Malaysia and the Philippines, builds on two systematic reviews of barriers to effective hypertension management. People with hypertension (pre-existing and newly diagnosed) will be identified in poor households in 24–30 communities per country. Quantitative and qualitative methods will be used to examine their experiences of and pathways into seeking and obtaining care. These include two waves of household surveys of 20–25 participants per community 12–18 months apart, microcosting exercises to assess the cost of illness (including costs due to health seeking activities and inability to work (5 per community)), preliminary and follow-up in-depth interviews and digital diaries with hypertensive adults over the course of a year (40 per country, employing an innovative mobile phone technology), focus group discussions with study participants and structured assessments of health facilities (including formal and informal providers).Ethics and disseminationEthical approval has been granted by the Observational Research Ethics Committee at the London School of Hygiene and Tropical Medicine and the Research Ethics Boards at the Universiti Putra Malaysia and the University of the Philippines Manila. The project team will disseminate findings and engage with a wide range of stakeholders to promote uptake and impact. Alongside publications in high-impact journals, dissemination activities include a comprehensive stakeholder analysis, engagement with traditional and social media and ‘digital stories’ coproduced with research participants.
Novel aspiration catheter design for acute stroke thrombectomy
Authors: Long Troy D , Kallmes David F , Hanel Ricardo , Shigematsu Tomoyoshi , Halaszyn Alexander Michael , Wolter Julia , Berenstein Alejandro 
Published: July 2018

BackgroundNavigable, large diameter aspiration catheters demonstrate markedly improved recanalization rates over smaller lumen devices in suction embolectomy. We evaluated the performance of a novel aspiration catheter system designed to maximize lumen size, and compare it to other commercially available aspiration catheters.MethodsThe 6F R4Q aspiration catheter system comprises a proximal pusher wire of 117 cm length connected to a distal catheter of 25 cm length. When placed through standard guide catheters and into the cerebral circulation, the proximal catheter makes a tight seal between its outer surface and the guide catheter’s inner surface. During aspiration, in vitro flow rates and tip suction force under gentle retraction were compared among 10 commercially available aspiration catheters and the R4Q system.ResultsThe R4Q 6F, 5F, 4F, and 3F catheters achieved flow rates at least 21.9%, 24.7%, 61.9%, and 244.7% greater than the other catheters tested respectively and the R4Q 6F produced a 140.2% higher tip force than a catheter of similar size. Fluid flow rate in the R4Q 6F increased on retraction into the guide catheter, delivering a 58.2% increase from fully extended to fully retracted.ConclusionThe R4Q design demonstrates a substantial increase in aspirated flow rate and suction force due to an increased effective diameter than standard tubular catheter designs tested. The prominent increase in the aspiration parameters measured in vitro supports the potential for improved clinical results during stroke thrombectomy procedures.
ADAPT technique with ACE68 and ACE64 reperfusion catheters in ischemic stroke treatment: results from the PROMISE study
Authors: Schramm Peter , Navia Pedro , Papa Rosario , Zamarro Joaquin , Tomasello Alejandro , Weber Werner , Fiehler Jens , Michel Patrik , Pereira Vitor M , Krings Timo , Gralla Jan , Santalucia Paola , Pierot Laurent , Lo T H 
Published: July 2018

Background and purposeThe recent randomized trials demonstrated the benefit of mechanical thrombectomy in stroke therapy. However, treatment using different strategies is an ongoing area of investigation. The PROMISE study analyzed the safety and effectiveness of the Penumbra System with the ACE68 and ACE64 reperfusion catheters in aspiration thrombectomy of stroke, using A Direct Aspiration First Pass Technique (ADAPT).MethodsPROMISE was a prospective study which enrolled 204 patients with intracranial anterior circulation large vessel occlusion (LVO) ischemic stroke in 20 centers from February 2016 to May 2017. Initial treatment was with the ACE68/ACE64 catheters within 6 hours of symptom onset. Imaging and safety review was performed by an independent Core Laboratory and a Clinical Events Committee. The primary angiographic outcome was revascularization to mTICI 2b-3 at immediate post-procedure and the primary clinical outcome was 90-day modified Rankin Scale (mRS) score ≤2. Safety assessment included device- and procedure-related serious adverse events (SAEs), symptomatic intracranial hemorrhage (sICH), mortality, and embolization of new territory (ENT).ResultsEnrolled patients had a median age of 74 (IQR 65–80) years and a median admission NIHSS of 16 (IQR 11–20). The post-procedure mTICI 2b-3 revascularization rate was 93.1% and the 90-day mRS 0–2 rate was 61%. Device- and procedure-related SAEs at 24 hours occurred in 1.5% and 3.4%, respectively, 90-day mortality was 7.5%, sICH occurred in 2.9% while ENT occurred in 1.5%.ConclusionsFor frontline therapy of LVO stroke, the ACE68/ACE64 catheters for aspiration thrombectomy were found to be safe and showed similar efficacy to randomized trials using other revascularization techniques.Clinical Trial RegistrationNCT02678169; Pre-results.
Diagnostic performance of PCR assays for the diagnosis of neurosyphilis: a systematic review
Authors: Marks Michael , Lawrence David , Kositz Christian , Mabey David 
Published: July 2018

IntroductionSyphilis continues to be a major public health problem and the recent resurgence in syphilis in high-income settings has seen an accompanying increase in cases of neurosyphilis. While the introduction of PCR has had a significant impact on the diagnosis of early syphilis, cerebrospinal fluid (CSF) serological assays remain the most commonly used tests to diagnosis neurosyphilis. We reviewed data on the performance of CSF-PCR for the diagnosis of neurosyphilis.MethodsWe searched Pubmed, Medline, EMBASE and the grey literature for references on PCR in neurosyphilis. We calculated the sensitivity and specificity of PCR compared with reference testing for the diagnosis of neurosyphilis.ResultsWe identified 66 articles of which seven met the study inclusion criteria. The sensitivity of PCR for definite neurosyphilis varied between 40% and 70% and specificity between 60% and 100% across the studies. The most commonly used PCR assay targeted Tp47 which had an overall sensitivity of 68% and a specificity of 91.9%.DiscussionThe sensitivity of PCR was low compared with CSF-serological assays but the challenges of evaluating a diagnostic test in the absence of a clear gold standard make definitive interpretation challenging. Most studies were small and not adequately powered highlighting the need for multicentre, multicountry trials to provide adequate statistical power in evaluations of new tests the diagnosis of neurosyphilis.
Phenotypic ASCOD characterisations of ischaemic stroke in the young at an urban tertiary care centre
Authors: Liu Angela , Pirastehfar Mohsen , Yu Daohai , Linares Guillermo 
Published: July 2018

Background and purposeStroke in young individuals is a serious public health burden. This study aimed to characterise the various phenotypes of ischaemic stroke in a young urban population (≤50 years old) using the ASCOD classification system, which assigns a score to five stroke categories: atherosclerosis, small vessel disease (SVD), cardioembolism, other and dissection. Within each category, a numerical score represents the degree of causality attributed to the stroke.MethodsThis retrospective study cohort was composed of patients from an urban tertiary care academic centre. Cases were selected by searching Get With the Guidelines database for adults ≤50 years old with ischaemic stroke. The study sample included 175 ischaemic strokes in 157 patients, with 16 subjects re-infarcting. Using retrospective chart review, each stroke was scored according to the ASCOD classification system. Multivariable logistic regression analyses were performed to explore each ASCOD category’s association with causal risk factors.ResultsOf possible causal mechanisms, defined as receiving a grade 1 or 2, a cardiovascular aetiology was most prevalent (25.7%), followed by SVD (22.3%), and closely by atherosclerosis (21.1%). Of general phenotypes, defined as receiving a grade 1 or 2 or 3, atherosclerosis was the most prevalent (51.4%), followed by SVD (47.4%), cardioembolism (42.3%) and other (35.4%). 31.6% of all strokes were of unclear aetiology. Subjects between 45 and 50 years old were more likely to develop a cardioembolic or SVD stroke when compared with subjects <45 years old.ConclusionThis study took a novel approach to ASCOD phenotyping, allowing several observations: (1) In patients with advanced atherosclerosis receiving the score A1, the vast majority had systemic atherosclerosis in multiple vascular territories; (2) the cardiac score C2(6), defined as a radiographic pattern highly suggestive of a central embolic source, may overestimate the prevalence of true cardiac disease; (3) incidental laboratory findings may detect some underlying pathology, but causality to the stroke is unlikely.
Environmental exposures and systemic hypertension are risk factors for decline in lung function
Authors: Miele Catherine H , Grigsby Matthew R , Siddharthan Trishul , Gilman Robert H , Miranda J Jaime , Bernabe-Ortiz Antonio , Wise Robert A , Checkley William 
Published: July 2018

BackgroundChronic lung disease is a leading contributor to the global disease burden; however, beyond tobacco smoke, we do not fully understand what risk factors contribute to lung function decline in low-income and middle-income countries.MethodsWe collected sociodemographic and clinical data in a randomly selected, age-stratified, sex-stratified and site-stratified population-based sample of 3048 adults aged ≥35 years from four resource-poor settings in Peru. We assessed baseline and annual pre-bronchodilator and post-bronchodilator lung function over 3 years. We used linear mixed-effects models to assess biological, socioeconomic and environmental risk factors associated with accelerated lung function decline.ResultsMean±SD enrolment age was 55.4±12.5 years, 49.2% were male and mean follow-up time was 2.36 (SD 0.61) years. Mean annual pre-bronchodilator FEV1 decline was 30.3 mL/year (95% CI 28.6 to 32.0) and pre-bronchodilator FVC decline was 32.2 mL/year (30.0 to 34.4). Using multivariable linear mixed-effects regression, we found that urban living, high-altitude dwelling and having hypertension accounted for 25.9% (95% CI 15.7% to 36.1%), 21.3% (11.1% to 31.5%) and 15.7% (3.7% to 26.9%) of the overall mean annual decline in pre-bronchodilator FEV1/height2, respectively. Corresponding estimates for pre-bronchodilator FVC/height2 were 42.1% (95% CI% 29.8% to 54.4%), 36.0% (23.7% to 48.2%) and 15.8% (2.6% to 28.9%) of the overall mean annual decline, respectively.ConclusionUrbanisation, living at high altitude and hypertension were associated with accelerated lung function decline in a population with low daily smoking prevalence.
Size metrics, longevity, and growth rates in Umbellula encrinus (Cnidaria: Pennatulacea) from the eastern Canadian Arctic.
Authors: de Moura Neves Bárbara , Edinger Evan , Hayes Vonda Wareham , Devine Brynn , Wheeland Laura , Layne Graham 
Published: July 2018

Umbellula encrinus (Linnaeus, 1758) is a deep-water sea pen commonly found in the eastern Canadian Arctic. It can reach heights of >2 m, and it has often been caught as fishing bycatch. Here, we characterized abundance/density, size metrics, longevity, and growth rates of U. encrinus colonies from Baffin Bay (between Greenland and Canada). No prevalent size classes were identified at most locations, except for Jones Sound and Cape Dyer, where small-size colonies dominated. Average number of growth rings in the internal skeleton (axis) of the examined colonies ranged between 2 and 68, with a maximum of 75. A bomb-14C analysis yielded 14C curves comparable with those of other deep-water octocorals with annual ring formation. A trace element analysis of Mg/Ca, Sr/Ca, Ba/Ca, and Na/Ca yielded values oscillating along the axis radius, with the number of peaks and growth rings being comparable. Growth rates averaged 0.067 ± 0.015 mm year−1 (radial extension) and 4.5 ± 1.2 cm year−1 (linear extension), considering rings to be formed annually. Relationships between radial growth rates, depth, and surface salinity were weak but statistically significant. Umbellula encrinus is a long-lived species, vulnerable to various types of fishing gear, with a skeleton that stores biological and environmental information.
Magnetic interference testing method for an electric fixed-wing unmanned aircraft system (UAS)
Authors: Tuck L. , Samson C. , Laliberté J. , Wells M. , Bélanger F. 
Published: July 2018

One of the barriers preventing unmanned aircraft systems (UASs) from having a larger presence in the geophysical magnetic surveying industry is the magnetic interference generated by the UAS and its impact on the quality of the recorded data. Detailed characterization of interference effects is therefore needed before remedial solutions can be proposed. A method for characterizing magnetic interference is demonstrated for a 21 kg, 3.7 m wingspan, 6 kW electric fixed-wing UAS purposely built for magnetic surveying. It involves mapping the spatial variations of the total magnetic intensity resulting from the interference sources on the UAS. Dynamic tests showed that the motor should be engaged and the aircraft control surfaces levelled prior to mapping. Experimental results reveal that the two strongest sources of magnetic interference are the cables connecting the motor to the batteries, and the servos. Combining three factors to assess the level of magnetic interference — the total magnetic intensity, 4th difference and vertical magnetic gradient — an index overlay shows that the magnetic sensor(s) should be located at least 50 cm away from the wingtips or tail to ensure an interference level of <2 nT, a 4th difference of <0.05 nT, and a gradient of <10 nT/m.
Evolution of the Freshwater Coastal Current at the Southern Tip of Greenland
Authors: Lin Peigen , Pickart Robert S. , Torres Daniel J. , Pacini Astrid 
Published: July 2018

AbstractShipboard hydrographic and velocity measurements collected in summer 2014 are used to study the evolution of the freshwater coastal current in southern Greenland as it encounters Cape Farewell. The velocity structure reveals that the coastal current maintains its identity as it flows around the cape and bifurcates such that most of the flow is diverted to the outer west Greenland shelf, while a small portion remains on the inner shelf. Taking into account this inner branch, the volume transport of the coastal current is conserved, but the freshwater transport decreases on the west side of Cape Farewell. A significant amount of freshwater appears to be transported off the shelf where the outer branch flows adjacent to the shelfbreak circulation. It is argued that the offshore transposition of the coastal current is caused by the flow following the isobaths as they bend offshore because of the widening of the shelf on the west side of Cape Farewell. An analysis of the potential vorticity shows that the subsequent seaward flux of freshwater can be enhanced by instabilities of the current. This set of circumstances provides a pathway for the freshest water originating from the Arctic, as well as runoff from the Greenland ice sheet, to be fluxed into the interior Labrador Sea where it could influence convection in the basin.