bluuebunny/crossref_metadata_2025_split huggingface dataset:
Leadership perspective on the implementation of guidelines on healthcare-associated infections
Authors: Hegarty Josephine , Murphy Siobhan , Creedon Sile , Wills Teresa , Savage Eileen , Barry Fiona , Smiddy Maura , Coffey Alice , Burton Aileen , O'Brien Deirdre , Horgan Sinead , Nibhuachalla Cliodhna , Brennan Cathal , Agreli Heloise , Drennan Jonathan 
Published: April 2019

BackgroundLeadership is a key component for infection prevention and control and plays an important role in the implementation of guidelines on healthcare-associated infections. A body of literature exists on healthcare workers’ perspectives on implementing these types of guidelines; however, there is a paucity of data on the leadership perspectives on implementation. This study aims to contribute to the evidence base of leadership perspectives.ObjectiveTo explore the implementation of National Clinical Guidelines pertaining to methicillin-resistantStaphylococcus aureusandClostridium difficilefrom the leadership angle.SettingHealthcare organisations.ParticipantsClinical and non-clinical leaders.DesignThis research used a mixed-methods approach comprising qualitative individual interviews (n=16) and quantitative surveys (n=51) underpinned by the integrated Promoting Action on Research Implementation in Health Services framework.ResultsLeaders recognise the value and innovation of guidelines to support clinical practice. However, they describe barriers to implementation that prevent the full uptake of guidelines, for example, guidelines may present an ideological approach to care which differs from the contextual reality of clinical practice where resources and time are not always available.ConclusionThis research highlighted that guidelines are complex interventions in complex organisations, perhaps leadership could help overcome the challenges posed by this complexity. Leadership may allow a systematic approach to all aspects of implementation despite the variety of challenges faced at different stages of implementation and sustainability of uptake of guidelines over time.
Visual imagery and visual perception induce similar changes in occipital slow waves of sleep
Authors: Bernardi Giulio , Betta Monica , Cataldi Jacinthe , Leo Andrea , Haba-Rubio José , Heinzer Raphaël , Cirelli Chiara , Tononi Giulio , Pietrini Pietro , Ricciardi Emiliano , Siclari Francesca 
Published: April 2019

Previous studies have shown that regional slow-wave activity (SWA) during non-rapid eye movement (NREM) sleep is modulated by prior experience and learning. Although this effect has been convincingly demonstrated for the sensorimotor domain, attempts to extend these findings to the visual system have provided mixed results. In this study we asked whether depriving subjects of external visual stimuli during daytime would lead to regional changes in slow waves during sleep and whether the degree of “internal visual stimulation” (spontaneous imagery) would influence such changes. In two 8-h sessions spaced 1 wk apart, 12 healthy volunteers either were blindfolded while listening to audiobooks or watched movies (control condition), after which their sleep was recorded with high-density EEG. We found that during NREM sleep, the number of small, local slow waves in the occipital cortex decreased after listening with blindfolding relative to movie watching in a way that depended on the degree of visual imagery subjects reported during blindfolding: subjects with low visual imagery showed a significant reduction of occipital sleep slow waves, whereas those who reported a high degree of visual imagery did not. We also found a positive relationship between the reliance on visual imagery during blindfolding and audiobook listening and the degree of correlation in sleep SWA between visual areas and language-related areas. These preliminary results demonstrate that short-term alterations in visual experience may trigger slow-wave changes in cortical visual areas. Furthermore, they suggest that plasticity-related EEG changes during sleep may reflect externally induced (“bottom up”) visual experiences, as well as internally generated (“top down”) processes.NEW & NOTEWORTHY Previous work has shown that slow-wave activity, a marker of sleep depth, is linked to neural plasticity in the sensorimotor cortex. We show that after short-term visual deprivation, subjects who reported little visual imagery had a reduced incidence of occipital slow waves. This effect was absent in subjects who reported strong spontaneous visual imagery. These findings suggest that visual imagery may “substitute” for visual perception and induce similar changes in non-rapid eye movement slow waves.
Rapid adaptation to Coriolis force perturbations of voluntary body sway
Authors: Bakshi Avijit , DiZio Paul , Lackner James R. 
Published: April 2019

Studying adaptation to Coriolis perturbations of arm movements has advanced our understanding of motor control and learning. We have now applied this paradigm to two-dimensional postural sway. We measured how subjects ( n = 8) standing at the center of a fully enclosed rotating room who made voluntary anterior-posterior swaying movements adapted to the Coriolis perturbations generated by their sway. Subjects underwent four voluntary sway trials prerotation, 20 per-rotation at 10 rpm counterclockwise, and 10 postrotation. Each trial lasted 20 s, and subjects were permitted normal vision. Their voluntary sway during rotation generated Coriolis forces that initially induced rightward deviations of their forward sway paths and leftward deviations of their backward sway. Sagittal plane sway was gradually restored over per-rotation trials, and a mirror image aftereffect occurred in postrotation trials. Dual force plate data analysis showed that subjects learned to counter the Coriolis accelerations during rotation by executing a bimodal torque pattern that was asymmetric across legs and contingent on forward vs. backward movement. The experience-dependent acquisition and washout of this compensation indicate that an internal, feedforward model underlies the leg-asymmetric bimodal torque compensation, contingent on forward vs. backward movement. The learned torque asymmetry we observed for forward vs. backward sway is not consistent with parallel two-leg models of postural control. NEW & NOTEWORTHY This paper describes adaptation to Coriolis force perturbations of voluntary sway in a rotating environment. During counterclockwise rotation, sway paths are deviated clockwise, but full restoration of fore-aft sway is regained in minutes. Negative aftereffects are briefly present postrotation. Current parallel leg models of postural control cannot account for these findings, which show that postural control, like arm movement control, can adapt rapidly and completely to the Coriolis forces generated in artificial gravity environments.
Noninvasive Vagus Nerve Stimulation Prevents Ruptures and Improves Outcomes in a Model of Intracranial Aneurysm in Mice
Authors: Suzuki Tomoaki , Takizawa Tsubasa , Kamio Yoshinobu , Qin Tao , Hashimoto Tomoki , Fujii Yukihiko , Murayama Yuichi , Patel Aman B. , Ayata Cenk 
Published: April 2019

Background and Purpose—
Inflammation is a critical determinant of aneurysmal wall destabilization, growth, and rupture risk. Targeting inflammation may suppress aneurysm rupture. Vagus nerve stimulation (VNS) has been shown to suppress inflammation both systemically and in the central nervous system. Therefore, we tested the effect of a novel noninvasive transcutaneous VNS approach on aneurysm rupture and outcome in a mouse model of intracranial aneurysm formation with wall inflammation.

Methods—
Aneurysms were induced by a single stereotaxic injection of elastase into the cerebrospinal fluid at the skull base, combined with systemic deoxycorticosterone-salt hypertension, without or with high-salt diet, for mild or severe outcomes, respectively. Cervical VNS (two 2-minute stimulations 5 minutes apart) was delivered once a day starting from the day after elastase injection for the duration of follow-up. Transcutaneous stimulation of the femoral nerve (FNS) served as control. Multiple aneurysms developed in the circle of Willis and its major branches, resulting in spontaneous ruptures and subarachnoid hemorrhage, neurological deficits, and mortality.

Results—
In the milder model, VNS significantly reduced aneurysm rupture rate compared with FNS (29% versus 80%, respectively). Subarachnoid hemorrhage grades were also lower in the VNS group. In the more severe model, both VNS and FNS arms developed very high rupture rates (77% and 85%, respectively). However, VNS significantly improved the survival rate compared with FNS after rupture (median survival 13 versus 6 days, respectively), without diminishing the subarachnoid hemorrhage grades. Chronic daily VNS reduced MMP-9 (matrix metalloproteinase-9) expression compared with FNS, providing a potential mechanism of action. As an important control, chronic daily VNS did not alter systemic arterial blood pressure compared with FNS.

Conclusions—
VNS can reduce aneurysm rupture rates and improve the outcome from ruptured aneurysms.
Disentangling the Changes in the Indian Ocean Dipole–Related SST and Rainfall Variability under Global Warming in CMIP5 Models
Authors: Huang Ping , Zheng Xiao-Tong , Ying Jun 
Published: April 2019

AbstractThis study disentangles the changes in Indian Ocean (IO) dipole (IOD)-related SST and rainfall variability under global warming projected by the RCP8.5 runs in 29 CMIP5 models. The IOD rainfall changes consist of the thermodynamic component due to the surface moisture increase and the dynamic component due to the changes in IOD-related circulation. The IOD circulation changes are dominated by the IOD SST changes, which were further clarified using the amplitude and structural decomposition. The amplitudes of IOD SST and circulation are both decreased at rates of around 7.2% and 13.7% °C−1, respectively. The structural changes in IOD SST and circulation show a pattern with increases from the eastern to the western coast of the equatorial IO, similar to the pattern of so-called extreme IOD events in previous studies. Disentangling previous mechanisms and projections, we conclude that the increased atmospheric stability suppresses the amplitudes in IOD SST and circulation, whereas the positive IOD (pIOD)-like mean-state SST changes, leading to greater warming in the west than the east, mainly alter the structure of IOD SST and circulation. Both the amplitude and structural changes in the IOD SST and circulation are robust among the CMIP5 models, but their distinct patterns and out-of-step changes lead to an uncertain projection of IOD changes defined by the dipole mode index or EOF analysis in previous studies. Furthermore, the structural changes, dominated by the pIOD-like mean-state SST changes, are significantly correlated with the historical IOD amplitude among the models. Considering the commonly overestimated IOD amplitude as an emergent constraint, the structural changes in IOD SST and circulation should not be as robust as the original multimodel projection.
Climate Change–Related Heat Stress and Subjective Well-Being in Australia
Authors: Zander Kerstin K. , Moss Simon , Garnett Stephen T. 
Published: April 2019

AbstractThere is mounting evidence that climate change impacts compromise people’s well-being. Many regions of Australia have experienced record hot temperatures and more frequent and longer heat waves with substantial consequences for people, economies, and ecosystems. Using data from an Australia-wide online survey with 1101 respondents, we investigated the relationship between self-reported measures of heat stress and different dimensions of subjective well-being. After controlling for socioeconomic factors known to affect well-being, we found that heat stress was linked to people’s certainty about and planning for their future but not to their life satisfaction, happiness, social state, capabilities, or purpose in life. This result indicates that, while heat is not associated with present well-being, many people worry about the effect that increased heat will have on their future well-being. People who were uncertain about their future were also more likely than those who did not feel uncertain to think that heat compromised their productivity. People who agreed that they were competent and capable in their activities rated their heat stress–related productivity loss lower than those who disagreed. The findings are relevant for future studies using life-satisfaction approaches to assess consequences of climate change impacts and to studies in “happiness economics.” We recommend that future research on the impact of climate change on well-being go beyond simply life satisfaction and happiness and test multiple dimensions of well-being.
12 years active surveillance for pediatric pleural empyema in a Mexican hospital: effectiveness of pneumococcal 13-valent conjugate vaccine, and early emergence of methicillin-resistant Staphylococcus aureus
Authors: Chacon-Cruz Enrique , Rivas-Landeros Rosa Maria , Volker-Soberanes Maria Luisa , Lopatynsky-Reyes Erika Zoe , Becka Chandra , Alvelais-Palacios Jorge Arturo 
Published: April 2019

Background: Previous publications have proved the effectiveness of the 13-valent pneumococcal conjugate vaccine (PCV13) on pneumococcal pleural empyema (PnPE) in children, with little emergence of other pathogens. We searched the literature to establish whether PCV13 reduces PnPE, and to identify other pathogens causing pleural empyemas (PEs). Material and methods: From October 2005 to January 2018 (12.3 years) we performed active surveillance for all cases of PE at the General Hospital of Tijuana, Mexico. Isolates from pleural fluid (PF) were identified by conventional culture, and since 2014, polymerase chain reaction (PCR) was added for all culture-negative PFs. Streptococcus pneumoniae serotypes were detected by either Quellung reaction (Statens Serum Institute®) or PCR. Clinical, imagenological, laboratorial and microbiological evaluation was performed on each patient. Statistical analysis was purely descriptive. Results: A total of 64 PEs were identified (5.28/year). Median age was 51 months (1–191), hospitalization days 18 (4–35). Decortication was performed in 42%, and two children died (3.2%). Bacterial identification was obtained from 51 (80%). S. pneumoniae was the leading cause (29 = 56.8%), followed by Staphylococcus aureus (14 = 27.4%), Streptococcus pyogenes (3–5 = 9%) and others (5 = 9.8%). PCV13 was initiated in May 2012, and its impact on serotype-specific PnPE was 81% (much fewer than serotype 3) and for all PnPE 56.1%; however, for all PE −2.1% due to an increase of PE caused by S. aureus for all but one methicillin-resistant S. aureus (MRSA). Conclusions: Following 12.3 years of active surveillance, PCV13 has shown impact on both serotype-specific and all PnPEs; however, an increase of PEs by MRSA has emerged. Continuous surveillance is crucial to establish whether this epidemiological finding is transitory or not.
Staff Perspectives Toward Challenges in a Newly Established Cancer Center in Tanzania: A Qualitative Study
Authors: Alwash Zainab , Henke Oliver , Serventi Furaha , Kantelhardt Eva Johanna 
Published: April 2019

PURPOSE Cancer is a growing public health concern in low-income countries (LICs). From 14 million new patient cases identified worldwide each year, 8 million are diagnosed in LICs. The fatality rate is 75% in LICs compared with 46% in high-income countries. Causes are low literacy levels, lack of awareness and knowledge about cancer, and limited education of health care professionals that leads to late detection and diagnosis. In Tanzania, cancer incidence will double to 60,000 in 2030. The referral hospital of Northern Tanzania established a new cancer unit in December 2016 to meet these needs. However, there is limited knowledge about perceptions of health care professionals toward cancer care in LICs. This study aims to understand attitudes and perspectives of those professionals and the treatment-related challenges in a newly established center to assist future efforts in this field. METHODS A qualitative method approach using in-depth interviews was chosen to achieve inductive conceptualization. Analysis of data was performed according to qualitative content analysis. RESULTS Eleven interviews were conducted. Five main categories were found: training and education of staff, availability of financial support, challenges in management, interests in future developments, and job satisfaction. Subcategories elaborated in more detail within the main categories. CONCLUSION Limitations in staffing, training, and education were major concerns. The importance of sustainable funding and the needed cooperation of the government with international aid were identified as key points. The involvement of different stakeholders requires guidance by health care management. Health care professionals expressed their satisfaction with the possibilities of treating cancer and the rewarding feedback from patients. Misconceptions and poor knowledge by patients were mentioned as reasons for delayed health-seeking behavior. Screening and awareness programs were seen as useful interventions.
Perception of the risk of medicinal marijuana in postgraduate medical residents
Authors: Castillo-Guzmán Sandra , Palacios Ríos Dionicio , Nava Obregón Teresa Adriana , Becerril Gaitàn Daniela Alejandra , Juangorena García Keren  Daniela , Domínguez  Romero Danya Carolina , Reyes Rodríguez Misael Jerónimo 
Published: April 2019

Background: Drugs can often cause adverse reactions, and the perception of the risk of prescription drugs could influence prescription behaviour. Methods: This was a prospective cross-sectional study of the perception of postgraduate physicians in training of the risk of using medical marijuana, comparing it with their perception of paracetamol and sedatives. A visual analogue scale with ranges from 0 (no risk) to 10 (totally risky) was used. Results: A total of 197 postgraduate students were evaluated; 48 women and 149 men took part, with a mean age 27.8 years. Among the different specialties, there was a difference with regard to the perception of medical marijuana and paracetamol and all perceived a greater risk with sedatives. There was no evidence of a risk perception of marijuana in relation to factors such as alcohol consumption and smoking. Conclusions: There is a difference in the perception of risk of medical marijuana and paracetamol with this perception being greater with sedatives. Regarding specialties, the perception of risk was greater for medical marijuana in general surgery than in urology.
Gestational age at delivery of twins and perinatal outcomes: a cohort study in Aberdeen, Scotland.
Authors: Murray Sarah R. , Bhattacharya Sohinee , Stock Sarah J. , Pell Jill P. , Norman Jane E. 
Published: April 2019

Background: Twin pregnancy is associated with a threefold increase in perinatal death compared to singletons. The objective of this study was to determine the risk of perinatal death in twins by week of gestation and to quantify the effect of known risk factors. Methods: A cohort analysis was performed using data from the Aberdeen Maternity and Neonatal Databank (AMND). The exposure was gestational age at delivery and the primary outcome was perinatal death. Adjusted hazard ratios (aHRs) for perinatal death according to gestational age at delivery were determined by multivariate Cox proportional hazards regression modelling with robust standard errors to account for clustering in the twin infants. Confounders and risk factors quantified and adjusted for in the model included maternal age, smoking, parity, marital status and year of birth. Kaplan-Meier time to event analysis was used to determine the differences in survival according to chorionicity and assisted reproduction technologies (ART) conception status. Results: The population comprised of 7,420 twin babies born between 1950 and 2013 in the Grampian area of Northern Scotland. There were 272 stillbirths in the cohort (3.67%) and 273 neonatal deaths (3.68%). Compared to delivery at 37-38 weeks, delivery at or beyond 39 weeks was associated with a significant increase in perinatal death (aHR 2.00 [95% CI 1.45-2.78]). Monochorionic twins had a 2-fold increase in perinatal death compared to dichorionic twins (aHR 2.15, 95% CI 1.60-2.90). Twins conceived by ART did not have a greater risk of perinatal death compared to those naturally conceived (aHR 1.21, 95% CI 0.87-1.68) Conclusion: This study suggests that delivery of twins at 37-38 weeks is associated with the lowest risk of perinatal death.
To Lead Change - To Work and Study with Creativity and Structure - A Course Design for Deeper Learning Outcomes within a Course in Quality Technology
Authors: Oxenswardh Anette , Forsberg Per-Arne 
Published: April 2019

Purpose: In this paper a new course design as a case study is presented. The course was given at bachelor level at Uppsala university, campus Gotland, within the division of quality technology. The purpose of the case is to give students an opportunity to practice acquired theoretical knowledge by offering them the opportunity to create an organization of their dreams, working in small groups.Methodology/Approach: This paper builds upon a case study approach, combining a literature review, document studies over the performed course and evaluations over the course.Findings: The case study shows that course design can be an important inspiration and a bridge between theory and practice for the students. Course design seems to support students’ learning processes according to evaluations of the course. Course design offers benefits of the collective learning, especially for distance students. It increases independence, understanding of one’s mission and accountability for it. Students are given the opportunity to practice the theoretical knowledge in their education in a creative and inspiring way. Still, there are further demands and challenges left of improvement in the course design.Research Limitation/implication: The research limitation is that this study consists of only one course in Quality Technology.Originality/Value of paper: This study contributes to the discussion about learning at university level through a case study.
Maternal and paternal expectations of antenatal education across the transition to parenthood
Authors: Jones Catriona , Wadephul Franziska , Jomeen Julie 
Published: April 2019

Background Understanding parents' expectations of the knowledge and skills that they will acquire during antenatal classes provides an opportunity to tailor classes more closely to their needs. Aims To explore whether a programme of antenatal classes met parents' expectations across the transition to parenthood. Methods This study used research evaluation data to explore parents' expectations from antenatal classes as they transitioned from pregnancy to the postnatal period. Findings Findings indicated that expectant mothers and fathers had different learning needs at different times, and that while expectant mothers were clear about what they want to know from classes, fathers entered classes with unspecific learning needs. These became slightly more focused as pregnancy progresses, but generally speaking, remained fairly vague. Conclusion Understanding parents expectations of antenatal classes, and exploring the value of classes among attendees has the potential to result in improved attendance, reduced dropout rates and overall greater satisfaction.
A Marxist Correspondence
Authors: Mayer Tom 
Published: April 2019

Paul A. Baran (1910–1964) and Paul M. Sweezy (1910–2004) were two of the most creative and influential Marxist economists of the last century. The Age of Monopoly Capital collects hundreds of letters between Baran and Sweezy, written between 1949 and Baran's death in 1964. The correspondence contains numerous interesting, important, and unanticipated ideas. Nuggets of wisdom about economic theory, socialist history, dialectical method, academic politics, and many other topics are scattered throughout.
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