bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cuff Leak Test and Airway Obstruction in Mechanically Ventilated ICU Patients (COMIC): a pilot randomised controlled trial protocol
Authors: Lewis Kimberley , Culgin Sarah , Jaeschke Roman , Perri Dan , Marchildon Corry , Hassall Kelly , Piraino Thomas , Thabane Lehana , Almubarak Yousef , Alshahrani Mohammed S , Rochwerg Bram , Baw Bandar , Szczeklik Wojciech , Karachi Tim , Alhazzani Waleed 
Published: July 2019

IntroductionEndotracheal intubation and invasive mechanical ventilation are lifesaving interventions that are commonly performed in the intensive care unit (ICU). Laryngeal oedema is a known complication of intubation that may cause airway obstruction in a patient on extubation. To date, the only test available to predict this complication is the cuff leak test (CLT); however, its diagnostic accuracy and utility remains uncertain. Herein, we report the protocol for the CuffLeak and AirwayObstruction in MechanicallyVentilated ICU Patients (COMIC) pilottrial.Methods and analysisThis will be a multicentred, pragmatic, pilot randomised controlled trial (RCT). We will enrol 100 mechanically ventilated patients in the ICU who are deemed ready for extubation. We will exclude patients at a high risk of laryngeal oedema. All enrolled patients will have a CLT done before extubation. In the intervention arm, the results of the CLT will be communicated to the bedside physician, and decision to extubate will be left to the treating team. In the control arm, respiratory therapist will not communicate the results of the CLT to the treating physician, and the patient will be extubated regardless of the CLT result. Randomisation will be done in a 1:1 allocation ratio, stratified by size of the endotracheal tube and duration of invasive mechanical ventilation.Although we will examine all clinical outcomes relevant for the future COMIC RCT, the primary outcomes of the COMIC pilottrial will be feasibility outcomes including: consent rate, recruitment rate and protocol adherence. Clinical outcomes include postextubation stridor, reintubation, emergency surgical airway, ICU mortality, in hospital mortality, duration of mechanical ventilation and ICU length of stay in days.Ethics and disseminationThe Hamilton Integrated Research Ethics Board, Imam Abdulrahman Bin Faisal University Institutional Review Board and Bioethical Commission of the Jagiellonian University approved this study. The trial results will be disseminated via publication in peer-reviewed journals.Trial registration numberNCT03372707.
Generating evidence for planning eye care service delivery in an urban underprivileged population setting in Pune, Western India
Authors: Kulkarni Sucheta , Kondalkar Shridevi , Mactaggart Islay , Shamanna B R , Lodhi Azher , Mendke Rohit , Kharat Jitesh , Kapse Rajesh , Dole Kuldeep , Deshpande Madan 
Published: July 2019

PurposeTo estimate prevalence of blindness, diabetic retinopathy and causes of blindness through rapid assessment of avoidable blindness (RAAB) survey in Pune, India to develop an evidence base for planning urban eye care services.Methods‘Rapid assessment of avoidable blindness and diabetic retinopathy’ methodology was used. Compact segment sampling was used in each of the 60 selected electoral wards identified through cluster selection module of the RAAB software using probability proportionate to size method. Persons >50 years of age were enumerated from selected segments to achieve cumulative target of 60/day by two teams. Participants underwent presenting and pinhole visual acuity (VA) testing in each eye. A torch light examination and direct ophthalmoscopy established cause of visual impairment/blindness if present. Data were entered into and analysed using RAAB software.ResultsThe response rate was 89.5% (3221/3600), and 55.3% were women. Results of only RAAB module are presented in this paper. Age-standardised and sex-standardised prevalence of blindness was 1.3% (95% CI 0.9 to 1.8). Cataract was the most common cause of blindness (45.7%) followed by overall posterior segment disorders (39.1%). Cataract surgical outcome was good (VA>6/18) or very good (VA>6/12) in 805/1190 (67.6%) cases. Cataract surgical coverage was 96.7%. ‘Need not felt’ (36.6%) and ‘cost’ (31.7%) were the most common barriers for cataract surgery.ConclusionPrevalence of blindness is showing declining trend in urban India. Cataract remains a major cause of blindness followed by posterior segment disorders. Social marketing, and referral linkages between community and service providers were planned after this survey.
Influence of doctor-patient conversations on behaviours of patients presenting to primary care with new or persistent symptoms: a video observation study
Authors: Amelung Dorothee , Whitaker Katriina L , Lennard Debby , Ogden Margaret , Sheringham Jessica , Zhou Yin , Walter Fiona M , Singh Hardeep , Vincent Charles , Black Georgia 
Published: July 2019

BackgroundMost cancers are diagnosed following contact with primary care. Patients diagnosed with cancer often see their doctor multiple times with potentially relevant symptoms before being referred to see a specialist, suggesting missed opportunities during doctor-patient conversations.ObjectiveTo understand doctor-patient communication around the significance of persistent or new presenting problems and its potential impact on timely cancer diagnosis.Research designQualitative thematic analysis based on video recordings of doctor-patient consultations in primary care and follow-up interviews with patients and doctors. 80 video observations, 20 patient interviews and 7 doctor interviews across 7 general practices in England.ResultsWe found that timeliness of diagnosis may be adversely affected if doctors and patients do not come to an agreement about the presenting problem’s significance. ‘Disagreements’ may involve misaligned cognitive factors such as differences in medical knowledge between doctor and patient or misaligned emotional factors such as patients’ unexpressed fear of diagnostic procedures. Interviews suggested that conversations where the difference in views is either not recognised or stays unresolved may lead to unhelpful patient behaviour after the consultation (eg, non-attendance at specialist appointments), creating potential for diagnostic delay and patient harm.ConclusionsOur findings highlight how doctor-patient consultations can impact timely diagnosis when patients present with persistent or new problems. Misalignments were common and could go unnoticed, leaving gaps for potential to cause patient harm. These findings have implications for timely diagnosis of cancer and other serious disease because they highlight the complexity and fluidity of the consultation and the subsequent impact on the diagnostic process.
‘The (second) year of first aid’: a 15-month follow-up after a 3-day first aid programme
Authors: Bánfai Bálint , Pandur Attila , Schiszler Bence , Pek Emese , Radnai Balazs , Csonka Henrietta , Betlehem József 
Published: July 2019

AimFirst aid education in early childhood can be an effective method to increase the number of trained bystanders. Our aim was to evaluate the long-term effects of a 3-day first aid programme for all primary school-age groups (7–14 years old).MethodsThis study was a 15-month follow-up of our previous investigation. Five-hundred and twenty-four primary school children were involved in this study. Measurements were made on the following topics: adult basic life support, using an automated external defibrillator (AED), handling an unconscious patient, managing bleeding and calling the ambulance. Data collection was made with a self-made questionnaire and skill test.ResultsKnowledge and skills were significantly higher after 15 months than before training (p<0.01). However, these results were significantly worse than immediately and 4 months after training (p<0.01). Based on the questionnaire, more than three-quarters knew the emergency phone number 15 months after training. Approximately two-thirds of the children could use the correct hand position in cardiopulmonary resuscitation, the correct compression-ventilation ratio and an AED, and half of them could perform correct recovery position at 15 months. Correct assessment of breathing was similar in a situation game than before training. Self-efficacy improved significantly after training (p<0.01) and remained improved after 4 and 15 months when compared with before training (p<0.01).ConclusionParticipants could remember some aspects of first aid long term. However, knowledge and skills had declined after 15 months, so refresher training would be recommended. Self-efficacy towards first aid improved after training and remained high after 15 months.
Socioeconomic inequality in recent adverse all-cause mortality trends in Scotland
Authors: Fenton Lynda , Wyper Grant MA , McCartney Gerry , Minton Jon 
Published: July 2019

BackgroundGains in life expectancies have stalled in Scotland, as in several other countries, since around 2012. The relationship between stalling mortality improvements and socioeconomic inequalities in health is unclear.MethodsWe calculate the difference, as percentage change, in all-cause, all-age, age-standardised mortality rates (ASMR) between 2006 and 2011 (period 1) and between 2012 and 2017 (period 2), for Scotland overall, by sex, and by Scottish Index of Multiple Deprivation (SIMD) quintile. Linear regression is used to summarise the relationship between SIMD quintile and mortality rate change in each period.ResultsBetween 2006 and 2011, the overall ASMR fell by 10.6% (138/100 000), by 10.1% in women, and 11.8% in men, but between 2012 and 2017 the overall ASMR fell by only 2.6% (30/100 000), by 3.5% in women, and by 2.0% in men. Within the most deprived quintile, the overall ASMR fell by 8.6% (143/100 000) from 2006 to 2011 (7.2% in women; 9.8% in men), but rose by 1.5% (21/100 000) from 2012 to 2017 (0.7% in women; 2.1% in men).The socioeconomic gradient in ASMR improvement more than quadrupled, from 0.4% per quintile in period 1, to 1.7% per quintile in period 2.ConclusionFrom 2012 to 2017, socioeconomic gradients in mortality improvement in Scotland were markedly steeper than over the preceding 6 years. As a result, there has not only been a slowdown in overall reductions in mortality, but a widening of socioeconomic mortality inequalities.
Relative position of the supra-acetabular bone to the crestal plane: a radiological analysis
Authors: Dehn George , Hammer N , Wyatt M C , Soltani S J , Kieser D C 
Published: July 2019

IntroductionDisplaced unstable pelvic injuries are life threatening and require rapid reduction and stabilisation, typically achieved with an external fixator. Recently, the benefits of supra-acetabular pins have been proven; however, these are usually inserted under fluoroscopic guidance. In austere environments andin extremis, this facility is limited and fixation using anatomical landmarks is required. Thus, the aim of this study is to determine the relative position of the supra-acetabular bone to the crestal plane and examine its consistency in military-aged European personnel.MethodsA radiological review of 50 randomised pelvic CT scans in European patients aged 18–30 years from a Level 1 trauma centre was performed. The CT scans were analysed using 3D rendering software. The relative position of the supra-acetabular bone to the crestal plane was determined.ResultsThe supra-acetabular bone relative to the crestal plane was approximately 28° caudal and 24° medial to the crestal plane. The mean minimum distance from the pin’s entry point to the sciatic notch was approximately 73 mm. There were no differences noted between genders or hemipelvic side.ConclusionsThe supra-acetabular bone maintains a consistent relative position to the crestal plane. Thus, with the surgeon’s thumb on the anterior superior iliac spine (ASIS) and index finger on the iliac tubercle, defining the crestal plane, a supra-acetabular pin can be inserted into the anterior inferior iliac spine, which lies 3 cm inferior and 2 cm medial to the ASIS, and advanced along the supra-acetabular bone by angling the pin 30° caudal and 25° medial to the crestal plane.
Impact of a telephone-first consultation system in general practice
Authors: Miller Diane , Loftus Angela M , O'Boyle Peter J , McCloskey Martin , O'Kelly John , Mace Donna , McKeon Neil , Ewan Sian-Lee , Moore Laura , Abbott Aine , Cunning Shane , McCarron Mark O , Paget Anthony M 
Published: July 2019

AbstractPurpose of the studyIncreasing pressure on general practice prompts innovative change in service organisation. This study sought to evaluate the impact of introducing a telephone-first consultation system in a socioeconomically deprived population.Study designAn interrupted time series of preplanned outcomes for 2 years before and 1 year postintroduction of a telephone-first system was used to measure the volume and type of general practitioner (GP) consultations and the number of patients consulted per year. Emergency department (ED) and GP out-of-hours attendances, the number of outpatient referrals, and the number of requests for laboratory tests were measured as secondary outcomes.ResultsThe telephone-first system was associated with a 20% increase in total GP consultations (telephone and face-to-face, effect estimate at 12 months, p=0.001). Face-to-face consultations decreased by 39% (p&lt;0.001), while telephone consultations increased by 131% (p&lt;0.001). The volume of individual patient requests for a GP consultation and the number of treatment room nurse consultations did not change. Secondary outcome measures showed no change in hospital outpatient referrals, number of requests for laboratory tests, and ED or GP out-of-hours attendances.ConclusionsA telephone-first system in a deprived urban general practice can decrease delays to GP–patient contacts. The number of patients seeking a medical intervention did not differ irrespective of the consultation system used. The telephone-first system did not affect GP out-of-hours, laboratory investigations or secondary care contacts.
Development of a prognostic tool exploring female adolescent risk for HIV prevention and PrEP in rural South Africa, a generalised epidemic setting
Authors: Ayton Sarah Gabrielle , Pavlicova Martina , Tamir Hod , Abdool Karim Quarraisha 
Published: July 2019

ObjectivesAdolescent females in sub-Saharan Africa bear a disproportionate burden of new HIV infections but have been excluded from prognostic research, such as developed risk calculators. This study examines whether validated risk calculators, which calculate HIV risk among sub-Saharan African women, can be modified to assess HIV risk among adolescent girls. The performance of selected risk variables from validated calculators and the literature was evaluated among adolescent females using modern advanced statistical tools.MethodsRisk variables for the updated tool were selected from the CAPRISA 007 (CAP007) trial (2010–2012) questionnaires. An initially HIV-seronegative cohort of rural South African female high school students (n=1049) aged 14–25 years was selected. The number and characteristics of latent factors, or dimensions, underlying selected variables were assessed using exploratory factor analysis (EFA). The updated tool’s effectiveness identifying trends in adolescent risk were assessed with latent class analysis (LCA).ResultsEFA identified two key latent factors: sexual behaviour and socioeconomic risk factors. Latent sexual behaviour risk influenced contraception use (0.883), perceived HIV risk (0.691) and pregnancy (−0.384). Latent socioeconomic risk influenced low HIV knowledge (0.371), financial dependence (0.532), prior HIV testing (−0.379) and alcohol use (−0.332). Using LCA, three underlying categories of adolescent females were identified: those with no, low and high risk of HIV (1.10%, 2.26% and 2.91% 1-year seroconversion rates, respectively). Herpes simplex virus serotype-2, condom contraception, alcohol use, pregnancy and age were significantly associated with higher risk class membership, while non-condom contraception was associated with lower risk class membership.ConclusionsAdolescent females are at unequal risk of acquiring HIV. Findings suggest the updated tool captures two main facets of adolescent characteristics and may identify differential risk. This work supports further investigation to inform development of targeted differentiated interventions and efficient prognostic tools for adolescents in high-risk settings.
Effect of flavour manipulation on low and high-frequency waterpipe users’ puff topography, toxicant exposures and subjective experiences
Authors: Maziak Wasim , Ben Taleb Ziyad , Ebrahimi Kalan Mohammad , Ward-Peterson Melissa , Bursac Zoran , Osibogun Olatokunbo , Eissenberg Thomas 
Published: July 2019

BackgroundFlavoured tobacco is one of the major factors behind the popularity of waterpipe (WP) smoking in the USA and internationally. The current study examined the impact of flavour manipulation on satisfaction, puff topography and toxicant exposure among high-frequency and low-frequency WP users.MethodThis cross-over study was conducted among 144 current (past month) WP smokers reporting WP smoking less than once a week (low-frequency users; n=69) or at least once a week (high-frequency users; n=75) in the past 6 months. Participants attended two counterbalanced 45 min ad libitum smoking sessions that differed by flavour (preferred flavoured vs unflavoured tobacco), preceded by ≥12 hours of tobacco use abstinence. Outcome measures included puff topography, expired carbon monoxide (eCO), plasma nicotine and subjective measures.ResultsBoth high-frequency and low-frequency WP users reported an enhanced smoking experience and greater interest in future use after smoking the flavoured compared with unflavoured tobacco (p<0.05 for all). High-frequency users, however, were more keen on smoking the flavoured tobacco in the future, had higher puffing parameters in general compared with low-frequency users (p<0.05 for all) and had no differences in eCO and plasma nicotine concentrations between the flavoured and unflavoured tobacco conditions (p>0.05 for all). On the other hand, low-frequency users had significantly greater eCO and plasma nicotine concentrations following smoking the unflavoured compared with flavoured tobacco condition (p<0.05 for all).ConclusionsOur results indicate that removing flavours will likely negatively affect WP satisfaction and future use and that such an effect will be more pronounced among high-frequency compared with low-frequency WP smokers.
First report of dermatophilosis in wild European red squirrels (Sciurus vulgaris)
Authors: Holmes Paul , Everest David J , Spiro Simon , Wessels Mark , Shuttleworth Craig 
Published: July 2019

The carcases of two wild red squirrels (Sciurus vulgaris) from Anglesey, North Wales, which had severe skin lesions, were presented to the Animal and Plant Health Agency. One was found dead in December 2017 and the second was found moribund in January 2018 but died 2 hours later. Both were examined at postmortem. The affected skin consisted of raised, firm, crusty lesions with pale subcutaneous necrotic tissue over the head particularly the face, eyelids and forehead. In addition, one had similar lesions on the scrotal and perineal area and along one hind leg extending to the foot. Postmortem examination, bacteriology and histopathology confirmed the presence of disease due to Dermatophilus congolensis with typical gross and pathological lesions. Squirrelpox virus was not detected. Here, we report the first description of dermatophilosis in European red squirrels, another important differential diagnosis of skin disease in a nationally declining population.
Colloquium 1 Commentary on Horan
Authors: Gardner Darren 
Published: July 2019

Abstract
This commentary examines several key points in David Horan’s paper “The Argu­mentative Unity of Plato’s Parmenides.” First, I discuss the general view of the paper, which engages with the first two hypotheses and in particular, the thought experiment passage in hypothesis 2 that is seen as a key to resolving the dilemma of participation. I consider the proposed view that hypothesis 1 takes up from its premise a strictly unitary, or non-multiple “one,” and hypothesis 2 takes up from its premise a one that admits of multiplicity, not a non-multiple “one.” I argue for an alternative reading whereby the premise of hypothesis 1 is not “if one is one” and hypothesis 2 is “if one is not one,” but rather that both hypotheses fall under the premise “if one is.”
Colloquium 4 Epicureans on Pity, Slavery, and Autonomy
Authors: Arenson Kelly E. 
Published: July 2019

Abstract
Diogenes Laertius reports that the Epicurean sage will pity slaves rather than punish them. This paper considers why a hedonistic egoist (such as an Epicurean) would feel pity for her subordinates, given that pity can cause psychological pain. I argue that Epicureans feel bad for those who lack the natural good of security, and that Epicureans’ concern for others is entirely consistent with their hedonistic egoism: they will endure the pain of pity in order to achieve the greater pleasure of social cohesion and to avoid the greater pain of social conflict. According to Epicureans, our feelings for fellow humans prevent us from becoming savages, unable to enter into trustworthy compacts to promote our safety.
Colloquium 4 Commentary on Arenson
Authors: Stark Susan A. 
Published: July 2019

Abstract
This commentary raises questions about the moral value of feeling pity. Whereas Professor Arenson asks whether an Epicurean hedonist can rightly feel pity given that feeling pity may be unpleasant, I ask whether feeling pity may be morally problematic for other reasons. In particular, I argue that feeling pity involves an endorsement of a morally problematic hierarchy between pitier and pitied. Because of this, I believe that we should draw a little-made distinction between compassion and pity and that individuals should cultivate compassion rather than pity. I suggest one possible way to draw the distinction between compassion and pity.
Colloquium 5 Aristotle on What to Praise and What to Prize: An Interpretation of Nicomachean Ethics I.12
Authors: Szaif Jan 
Published: July 2019

Abstract
This essay offers an analysis and interpretation of the rarely commented-on chapter I.12 of the Nicomachean Ethics. Aristotle’s goal in this chapter is to prove that human happiness belongs to the class of prized goods, also characterized as divine goods, whereas virtue ranks lower, being a merely praiseworthy good. It is not easy to see why this chapter is placed at the end of Aristotle’s general discussion of the highest human good in Book I or why he included it at all. My goal is to show that it does make a contribution to the architecture of the Nicomachean Ethics as a whole by helping to prepare the ground for one of the main argumentative strategies in the treatise X.6–8 on scientific contemplation as the key component of supreme happiness. To this end, I analyze each step of the argumentation in I.12, drawing also on relevant material from other Aristotelian texts, and then demonstrate the connection with some of the arguments in X.6–8.
Colloquium 5 Commentary on Szaif
Authors: King Colin Guthrie 
Published: July 2019

Abstract
In this response I consider the implications of Jan Szaif’s suggestion that there is a tight “conceptual affinity” between Books I and X of the Nicomachean Ethics (EN). I argue against one view which could claim such a thesis as an ally: the view which maintains that the Nicomachean Ethics is based upon the kind of conceptual cohesion supplied by a supposed metaphysical foundation for claims about happiness.