bluuebunny/crossref_metadata_2025_split huggingface dataset:
A general practice provider federation in a mixed health economy in England: a case study investigation
Authors: Mitchell Jill 
Published: June 2018

BackgroundThere is an emerging debate that general practice in its current format is out-dated and there is a requirement to move to a federated model of provision where groups of Practices come together. The emergence of federations has developed over the past 5 years but the factors that influence how federations develop and the impact of this new model is an under researched area.AimThe study explored the rationale around why a group of independent GP practices opted to pursue an alternative business venture and the benefits that this strategy offered.MethodA single organisational case study of a federation in the North of England was conducted between 2011–2016. Mixed methods data collection included individual and group semi-structured interviews and quantitative surveys.ResultsFederations promote collaborative working, relying on strategic coherence of multiple individual GP practices through a shared vision and common purpose. Findings revealed many complexities in implementing a common strategy across multiple independent businesses. The ability of the federation to gain legitimacy was two dimensional – externally and internally. The venture had mixed successes, but their approach to quality improvement proved innovative and demonstrated outcomes on a population basis. The study identified significant pressures that practices were experiencing and the need to seek alternative ways of working but there was no shared vision or inclination to relinquish individual practice autonomy.ConclusionOrganisational development support is critical to reform General Practice. Whether central funding through the GP Five Year Forward View will achieve the scale of change required is yet to be evidenced.
Effects and costs of predictive risk stratification in primary care: randomised stepped wedge trial
Authors: Russell Ian , Bailey-Jones Kerry , Burge-Jones Deborah , Dale Jeremy , Diethart Bernadette , Fitzsimmons Deborah , Heaven Martin , Hutchings Hayley , John Gareth , Kingston Mark-Rhys , Lewis Leo , Phillips Ceri , Warm Daniel , Watkins Alan , Snooks Helen ,   On behalf of the PRiSMATIC (Predictive Risk Stratification Modelling: A Trial In Cymru) team
Published: June 2018

BackgroundThe ageing UK population needs safe approaches to reduce emergency hospital admissions. Predictive risk stratification modelling (PRiSM) estimates risk that individuals will suffer emergency admission to hospital within 12 months and selects patients for preventative community care to avoid admissions.AimTo evaluate the introduction of (PRiSM) into primary care.MethodFunded by NIHR, we used randomised stepped wedge design to estimate (cost) effectiveness of introducing PRiSM software into 32 participating practices in urban South Wales, supported by practice-based training, clinical support through two local ‘GP champions’, and technical support through telephone help-desk. Outcome measures included: emergency hospital admissions (primary), other hospital activity, and GP activity, all estimated from routine data; patient-reported SF-12 health-related quality of life scores; and NHS costs.ResultsAcross 230,000 participants, PRiSM implementation increased: emergency hospital admission rates by 1.1% (95% confidence interval [CI] = 1.0% to 1.3%); Emergency Department attendance rates by 3.0% (95%CI = 2.8% to 3.2%); outpatient visit rates by 5.5% (95%CI = 5.1% to 5.8%); GP activity by 1.1% (95% CI = 0.7% to 1.4%); and NHS costs per patient by £76 (95%CI = £46 to £106). Questionnaires completed by 1400 randomly sampled participants showed that: PRISM improved SF-12 physical scores by 1.5 points (95%CI = 0.8 to 2.2); but not SF-12 mental scores (95%CI = −1.5 points to +0.3). The direct cost of introducing PRiSM was £0.11/patient/year.ConclusionThe introduction of PRiSM increased emergency hospital admissions and other NHS activity without clear evidence of benefit.
Cancer patients and primary care prescribed medications: offering insights into symptoms, polypharmacy and multimorbidity
Authors: Wong Kwok F , Charman Jackie , Round Thomas , Henson Katherine E 
Published: June 2018

BackgroundNational Cancer Registration and Analysis Service (NCRAS) are responsible for registering data on all cases of cancer. For the first time individual patient level prescribing data is available, offering potential unique insights into treatment and co-morbidity.AimTo investigate the patterns of polypharmacy in cancer patients compared to non-cancer patients.MethodPrimary care prescriptions data (electronic and FP10) is currently available from April to July 2015 inclusive. Unique prescription items were summarised for each registered cancer patient; with an initial focus on opioids. These summaries were broken down by age of the patient at prescription for the most common cancers (invasive breast, colorectal, lung and prostate). Non-cancer patients were used as a comparisonResultsOverall 1,680,764 cancer patients were dispensed prescriptions during the period. On average, patients diagnosed with breast, colorectal, prostate and lung cancers received 7, 8, 8 and 10 unique drugs, respectively, throughout the 4 months. In all cases 2 of these unique drugs were opioids. In comparison, patients not diagnosed with cancer received 4 unique drugs on average: of which 2 were unique opioid drugs. Cancer patients aged 0–39, 40–69 and 70+, at prescription date, received 4, 6 and 8 unique prescriptions respectively compared to 3, 5 and 7, for non-cancer patients.ConclusionThis provides insight into primary care polypharmacy for all cancer patients in England. Analysis is underway to assess the cumulative dosage of unique drugs that patients receive, and the potential use of the data as a marker of polypharmacy/co-morbidity with larger patient level datasets.
A systematic review to explore the impact of anxiety on quality of life and treatment outcomes in rheumatoid arthritis
Authors: Machin Annabelle , Haththotuwa Randula , Babatunde Opeyemi , Scott Ian , Corp Nadia , Chew-Graham Carolyn , Hider Samantha 
Published: June 2018

BackgroundRheumatoid arthritis (RA) is the commonest inflammatory arthritis. Comorbid anxiety and depression are common, but under-recognised and under-treated. Depression in RA has been linked to reduced quality of life and treatment response and increased mortality. Past research into co-morbid mood problems in RA has mainly focused on the prevalence and impact of depression.AimTo complete a systematic review to explore the impact of anxiety on QOL and treatment outcomes in RA.MethodThe systematic review has been registered on PROSPERO. Databases (Web of Science, PsycINFO, CINAHL, Embase and Medline) have been systematically searched for relevant studies. Titles and abstracts have been independently screened by two reviewers. Data extraction and quality appraisal of studies will be carried out using a customized and piloted data extraction tool and the Newcastle-Ottawa Scale. Disagreements will be resolved through discussion or by a third reviewer. A narrative synthesis framework will be used to develop a theory of how anxiety impacts on QOL and treatment response and a meta-analysis performed.ResultsThe search has identified 6404 articles. After title screening, 284 abstracts have been reviewed and 48 full texts are being reviewed for inclusion. Full text review is ongoing, and results of the analysis will be presented.ConclusionHighlighting the impact of anxiety on outcomes in RA may suggest areas for future implementation studies to improve patient outcomes, potentially reducing associated morbidity and mortality.
The mediating role of medical professionalism on financial self-interest GPs
Authors: McCaffrey David , O’Riordan Chris , Kelliher Felicity 
Published: June 2018

BackgroundWhile no normative definition exists, medical professionalism emphasises a set of values, behaviours and relationships that underpin public trust in a physician. The empirical setting for this study is the Irish health care system where GPs receive income through a unique mix of private fee income and state funded capitation. GPs’ income per patient has fallen by 33% under state schemes between 2008 and 2013 due to changes in health policy and national fiscal constraints.AimThis paper examines how general practitioners conceptualise and operationalise medical professionalism and financial self-interest in the Irish healthcare system.MethodTo address this research aim, a historical documentary analysis (2009–2016) of national and medical newspapers was used to investigate GPs’ expressions of medical professionalism and financial self-interest.ResultsThe vagueness of language in differing definitions of medical professionalism may lead to a GP having a fluid interpretation depending on the situation. While general practitioners expressed core humanistic values, such as empathy and compassion, the expression of altruistic values were limited when practitioners indicated there was constraint on the financial resources of a practice.ConclusionCentral to the analysis of a medical practitioner’s treatment of patients and receipt of fee income is the tension between medical professionalism and financial self-interest. Developing an understanding of this tension has implications for those undertaking healthcare policy initiatives and the recruitment and retention of general practitioners in primary care.
PREP — The Preoperative Risk Education Package: an online educational resource for primary care clinicians to encourage community based prehabilitation prior to major surgery
Authors: Durrand James , McHardy F , Land E , Llewellyn Z , Norman C , Goh T , Fenton S , Danjoux G 
Published: June 2018

BackgroundPrehabilitation prior to major surgery mandates cross-sector working. Utilising the preoperative window from referral requires clinician engagement. Awareness of perioperative risk factors is crucial. A national survey uncovered gaps in knowledge and understanding.AimCreate an open-access, online educational resource for primary care clinicians.MethodOur multidisciplinary team developed a focused CPD resource targeting lifestyle factors and chronic health conditions influencing perioperative risk (www.prepwell.co.uk).ResultsPREP highlights seven risk factors influencing perioperative risk: Smoking, alcohol, inactivity, anaemia, cognitive impairment, frailty and low BMI. A case study frames each factor alongside perioperative impact and prehabilitation strategies.ConclusionPREP is the first educational resource of its type. Early evaluation through local clinicians, the RCGP and RCOA has resulted in very positive feedback. We are working with Royal College representatives to gain formal endorsement and facilitate wider scale rollout, a major step towards raised clinician awareness and enhanced collaboration for improved perioperative outcomes.
Exploring the experience of a ‘diagnosis’ of pre-diabetes and factors influencing uptake of a lifestyle intervention programme in areas of socio-economic deprivation
Authors: Hodges Victoria , Hobbis Chloe , Twohig Helen , Mitchell Caroline 
Published: June 2018

BackgroundPeople living in socio-economically deprived areas are at higher risk of developing diabetes and have worse health outcomes when they do. A Diabetes Prevention Programme (DPP) is being rolled out across England with eligibility linked to a HbA1c screening test to ‘diagnose’ pre-diabetes (42–47 mmol/mol). The DPP is a lifestyle intervention offering a 9-month individualised programme aiming to reduce progression to diabetes, through optimization of diet and physical activity to achieve weight loss. Previous studies suggest that patients from lower socioeconomic groups are less likely to engage with and benefit from lifestyle interventions. The DPP may increase health inequalities unless barriers to engagement are considered.AimTo explore patients’ understanding of and reactions to a ‘diagnosis’ of pre-diabetes and to identify the barriers and facilitators to uptake of a lifestyle intervention programme in a socio-economically deprived, pre-diabetic population.MethodA literature review will inform development of a topic guide. A purposive sample of ‘pre-diabetic’ patients who have been offered referral to the DPP and are registered at practices within the Yorkshire and Humber ‘Deep End’ Research Cluster will be invited to participate in a semi-structured interview study. Data will be systematically analysed to identify emerging concepts and themes. Interviews will continue until data saturation is reached. A thematic framework will be developed, justified by and linked to the interview data.ResultsHealth literacy, relationship with healthcare provider and level of activation all influence how the diagnosis is received and the decision to engage with the programme. Practical barriers to engaging with the programme exist but are secondary to other factors.ConclusionA ‘diagnosis of ‘pre-diabetes’ provokes healthy lifestyle change without causing anxiety. Healthcare professionals have considerable influence in determining whether a patient engages with the DPP.
REVISIT, the next stage: developing plans for wider application of a retrospective review of prescribing of GPs in training
Authors: Knox Richard , Salema Ndeshi , Gookey Gill , Marsden Kate , Bell Brian , Mehta Raj , Roders Sarah , McCartney Karen , Avery Tony 
Published: June 2018

BackgroundThe GMC PRACtICe study identified prescribing errors in general practice occurring at a rate of 5%. GPs in training (GP AiTs) were highlighted as a group who may benefit from further help to reduce their prescribing errors. A recent pilot study explored the effect of reviewing 100 sequential prescriptions issued by ten GPs AiTs. The error rate in this small cohort (the REVISIT study) was found to be nearly double that reported in the PRACtICe study (9%). Three-month follow-up interviews with GP AiTs and their trainers provided useful insight into prescribing behaviour and rationale for behaviour change.AimShould the revisit intervention be rolled out or is further development required?MethodInterviews with 30 stakeholders or stakeholder organisations were performed during which results from the REVISIT study were presented, and plans for development explored. Stakeholders included organisations involved with training and regulating GPs and pharmacists, as well as other interested parties such as GP AiTs and members of the public. Interviews were recorded, transcribed and analysed for emergent themes.ResultsThere was broad support for further development of the REVISIT programme, with several stakeholders expressing surprise that this intervention is not already everyday practice. Caution was expressed about the way in which such an intervention could be viewed by participants: a supportive, developmental approach was preferred. Stakeholders also discussed the stage of training that such an intervention should occur within, and postulated other groups of prescribers who may benefit from similar interventions.ConclusionFindings from the REVISIT study confirmed that GP AiTs benefited from personalised prescribing review. By conducing systematic stakeholder interviews we aim to elucidate whether a larger intervention study is required, or whether the REVISIT process can be implemented universally or in a targeted format.
Chlorine Isotope Ratios in M Giants
Authors: Maas Z. G. , Pilachowski C. A. 
Published: June 2018

Abstract
We have measured the chlorine isotope ratio in six M giant stars using HCl 1-0 P8 features at 3.7 microns with R ∼ 50000 spectra from Phoenix on Gemini South. The average Cl isotope ratio for our sample of stars is 2.66 ± 0.58 and the range of measured Cl isotope ratios is 1.76 < 35Cl/37Cl < 3.42. The solar system meteoric Cl isotope ratio of 3.13 is consistent with the range seen in the six stars. We suspect the large variations in Cl isotope ratio are intrinsic to the stars in our sample given the uncertainties. Our average isotopic ratio is higher than the value of 1.80 for the solar neighborhood at solar metallicity predicted by galactic chemical evolution models. Finally, the stellar isotope ratios in our sample are similar to those measured in the interstellar medium.
The Redshift Completeness of Local Galaxy Catalogs
Authors: Kulkarni S. R. , Perley D. A. , Miller A. A. 
Published: June 2018

Abstract
There is considerable interest in understanding the demographics of galaxies within the local universe (defined, for our purposes, as the volume within a radius of 200 Mpc or z ≤ 0.05). In this pilot paper, using supernovae (SNe) as signposts to galaxies, we investigate the redshift completeness of catalogs of nearby galaxies. In particular, type Ia SNe are bright and are good tracers of the bulk of the galaxy population, as they arise in both old and young stellar populations. Our input sample consists of SNe with redshift ≤0.05, discovered by the flux-limited ASAS-SN survey. We define the redshift completeness fraction (RCF) as the number of SN host galaxies with known redshift prior to SN discovery, determined, in this case, via the NASA Extragalactic Database, divided by the total number of newly discovered SNe. Using SNe Ia, we find

% (90% confidence interval) for z < 0.03. We examine the distribution of host galaxies with and without cataloged redshifts as a function of absolute magnitude and redshift, and, unsurprisingly, find that higher-z and fainter hosts are less likely to have a known redshift prior to the detection of the SN. However, surprisingly, some

galaxies are also missing. We conclude with thoughts on the future improvement of RCF measurements that will be made possible from large SN samples resulting from ongoing and especially upcoming time-domain surveys.
High-cadence Multi-color Observations of the Dwarf Nova KSP-OT-201503a by the KMTNet Supernova Program
Authors: Brown Shannon , Moon Dae-Sik , Ni Yuan Qi , Drout Maria , Antoniadis John , Afsariardchi Niloufar , Cha Sang-Mok , Lee Yongseok 
Published: June 2018

Abstract
We report multicolor BVI monitoring and spectroscopic classification of the dwarf nova KSP-OT-201503a. The transient was detected by the Korean Microlensing Telescope Network (KMTNet) Supernova Program (KSP) in 2015 March, reached a peak apparent magnitude V ≃ 17.3 mag from a quiescent magnitude V ≃ 22.6 mag, and lasted for approximately 17 days. Our high-cadence sampling allows us to identify distinctive phases consisting of a rapid ascent, a main outburst composed of a flat plateau followed by a gradual dimming, and a quick decline. We observe the sharp transition between the ascent phase and main outburst phase, likely related to the deceleration of the heating front as it passes through the accretion disk. These features in the light curves indicate that the outburst is outside-in. Archival data reveal the outburst history of the source, showing at least three outbursts between 2011 and 2015. These are equally separated by approximately 25 months, though we find a recurrence time as short as 189 days is compatible with the archival data. An optical spectrum obtained 701 days from outburst peak shows prominent Balmer emission lines superimposed on a blue continuum, consistent with a cataclysmic variable in quiescence. The outburst properties of KSP-OT-201503a closely resemble those of U Gem-type dwarf novae usually associated with younger, longer-period systems above the period gap of 2–3 hr observed in cataclysmic variables. This suggests that the source may be a rare U Gem-type dwarf nova with a long recurrence time, though we are unable to rule out the possibility that KSP-OT-201503a lies below the period gap.
Modal Decomposition of TTV: Inferring Planet Masses and Eccentricities
Authors: Linial Itai , Gilbaum Shmuel , Sari Re’em 
Published: June 2018

Abstract
Transit timing variations (TTVs) are a powerful tool for characterizing the properties of transiting exoplanets. However, inferring planet properties from the observed timing variations is a challenging task, which is usually addressed by extensive numerical searches. We propose a new, computationally inexpensive method for inverting TTV signals in a planetary system of two transiting planets. To the lowest order in planetary masses and eccentricities, TTVs can be expressed as a linear combination of three functions, which we call the TTV modes. These functions depend only on the planets’ linear ephemerides, and can be either constructed analytically, or by performing three orbital integrations of the three-body system. Given a TTV signal, the underlying physical parameters are found by decomposing the data as a sum of the TTV modes. We demonstrate the use of this method by inferring the mass and eccentricity of six Kepler planets that were previously characterized in other studies. Finally we discuss the implications and future prospects of our new method.
Momentum-driven Winds from Radiatively Efficient Black Hole Accretion and Their Impact on Galaxies
Authors: Brennan Ryan , Choi Ena , Somerville Rachel S. , Hirschmann Michaela , Naab Thorsten , Ostriker Jeremiah P. 
Published: June 2018

Abstract
We explore the effect of momentum-driven winds representing radiation-pressure-driven outflows from accretion onto supermassive black holes in a set of numerical hydrodynamical simulations. We explore two matched sets of cosmological zoom-in runs of 24 halos with masses ∼1012.0–1013.4
M
⊙ run with two different feedback models. Our “NoAGN” model includes stellar feedback via UV heating, stellar winds and supernovae, photoelectric heating, and cosmic X-ray background heating from a metagalactic background. Our fiducial “MrAGN” model is identical except that it also includes a model for black hole seeding and accretion, as well as heating and momentum injection associated with the radiation from black hole accretion. Our MrAGN model launches galactic outflows, which result in both “ejective” feedback—the outflows themselves that drive gas out of galaxies—and “preventative” feedback, which suppresses the inflow of new and recycling gas. As much as 80% of outflowing galactic gas can be expelled, and accretion can be suppressed by as much as a factor of 30 in the MrAGN runs when compared with the NoAGN runs. The histories of NoAGN galaxies are recycling dominated, with ∼70% of material that leaves the galaxy eventually returning, and the majority of outflowing gas reaccretes on 1 Gyr timescales without AGN feedback. Outflowing gas in the MrAGN runs has a higher characteristic velocity (500–1000 km s−1 versus 100–300 km s−1 for outflowing NoAGN gas) and travels as far as a few megaparsecs. Only ∼10% of ejected material is reaccreted in the MrAGN galaxies.
Beta-blockers after myocardial infarction: Are they useful to all patients? And how long should be the beta-blocker therapy?
Authors: Pedretti Roberto F.E. 
Published: June 2018

Some observational studies raised questions about the need for Î²-blockers in all patients after a first heart attack. Surprisingly, in some clinical settings, a limited mortality reduction was found in those who received Î²-blockade.Some studies suggest that patients without heart failure may not need post-MI Î²-blockers. The lack of data from randomized controlled clinical trials has led to clinical uncertainty and conflicting recommendations.Â Therefore, there are multiple information to revaluate the value of Î²-blocker therapy after a heart attack in absence of heart failure or left ventricular dysfunction and the time for new trials of an old group of drugs has arrived.