bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Dynamics of Self‐Governance Capacity: The Dutch Rural Civic Initiative ‘Project Ulrum 2034’
Authors: Ubels Hiska , Bock Bettina B. , Haartsen Tialda 
Published: June 2019

AbstractIn this article, we use Kooiman’s theory of governance in combination with key‐conditions of community self‐steering identified in recent studies to examine how the self‐steering capacity developed of a community initiative aiming at improving the liveability of a small Dutch village. Using non‐participatory observations and qualitative analysis, we obtained in‐depth insights into how this initiative, ‘Project Ulrum 2034’ managed to build local autonomy from 2010 to 2018. We found that government support was crucial for many of its successes. Also, tensions came to light between 1. local autonomy, and its dependence on professional support, and; 2. broader community engagement, and accountability related to the public funding obtained leading to the formalisation of its organisation and the centralisation of tasks. We discovered that self‐steering capacities fluctuate in time, are dynamic and develop in a non‐linear way. The voluntary engagement was above all temporary, except for some activities when of direct interest to those involved. The continuity of community self‐governance was fragile, due to its dependency on external funding and voluntary engagement.
Comparing the Effects of Single‐ and Multiple‐Component Therapies for Insomnia on Sleep Outcomes
Authors: Sidani Souraya , Epstein Dana R. , Fox Mary , Collins Laura 
Published: June 2019

AbstractBackgroundSingle‐ and multiple‐component therapies are recommended in professional guidelines for managing chronic insomnia. Systematic reviews point to insufficient evidence of the comparative effectiveness of these therapies, which is required for treatment decision making.PurposeTo compare the effectiveness of three single‐component and one multiple‐component therapies on short‐term sleep outcomes.MethodsThe data were obtained from 517 persons with chronic insomnia, enrolled in a partially randomized preference trial. They were allocated to the single‐component therapies: sleep education and hygiene (SEH), stimulus control therapy (SCT), and sleep restriction therapy (SRT), or the multiple‐component therapy (MCT). The outcomes, perceived insomnia severity and sleep parameters, were assessed with established measures at pre and posttest. Repeated measure analysis of variance was used to compare the outcomes across therapy groups over time. The clinical relevance of the therapies’ effects was evaluated by examining the effect size and remission rate.ResultsThe four therapies differed in their effectiveness in reducing perceived insomnia severity and improving sleep outcomes. SEH was least effective. SCT, SRT, and MCT were moderately effective. SCT and SRT demonstrated slightly higher remission rates than MCT for perceived insomnia severity and some sleep parameters.Linking Evidence to ActionSCT and SRT are viable single‐component therapies that produce clinical benefits. Single‐component insomnia treatment may be more convenient to implement in the primary care setting due to the reduced number of treatment recommendations compared to MCT.
Fructose co‐ingestion to increase carbohydrate availability in athletes
Authors: Fuchs Cas J. , Gonzalez Javier T. , van Loon Luc J. C. 
Published: June 2019

AbstractCarbohydrate availability is important to maximize endurance performance during prolonged bouts of moderate‐ to high‐intensity exercise as well as for acute post‐exercise recovery. The primary form of carbohydrates that are typically ingested during and after exercise are glucose (polymers). However, intestinal glucose absorption can be limited by the capacity of the intestinal glucose transport system (SGLT1). Intestinal fructose uptake is not regulated by the same transport system, as it largely depends on GLUT5 as opposed to SGLT1 transporters. Combining the intake of glucose plus fructose can further increase total exogenous carbohydrate availability and, as such, allow higher exogenous carbohydrate oxidation rates. Ingesting a mixture of both glucose and fructose can improve endurance exercise performance compared to equivalent amounts of glucose (polymers) only. Fructose co‐ingestion can also accelerate post‐exercise (liver) glycogen repletion rates, which may be relevant when rapid (<24 h) recovery is required. Furthermore, fructose co‐ingestion can lower gastrointestinal distress when relatively large amounts of carbohydrate (>1.2 g/kg/h) are ingested during post‐exercise recovery. In conclusion, combined ingestion of fructose with glucose may be preferred over the ingestion of glucose (polymers) only to help trained athletes maximize endurance performance during prolonged moderate‐ to high‐intensity exercise sessions and accelerate post‐exercise (liver) glycogen repletion.
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Rotor–Stator Interactions in a 2.5-Stage Axial Compressor—Part II: Impact of Aerodynamic Modeling on Forced Response
Authors: Sanders Christoph , Terstegen Marius , Jeschke Peter , Schoenenborn Harald , Heners Jan Philipp 
Published: June 2019

Abstract
The main objective of this study is the validation of numerical forced response predictions through experimental blade vibration measurements for higher order modes of a blade-integrated disk (blisk). To this end, a linearized and a nonlinear frequency domain CFD methods are used, as well as a tip timing measurement system. The focus is on the blade excitation by downstream vanes, in particular, because this study shows that the correct prediction of acoustic modes is of key importance in this case. The analysis of these modes is presented, both experimentally and numerically, in Part I of this publication. The grid independence study for the aerodynamic work on the blade surface conducted in this part shows a possible prediction uncertainty of more than 100% when a coarse grid is chosen. For the validation of the numerical setup, a study was performed using different turbulence and transition models. The results are compared to the measured performance map, to a 2D field traverse conducted with a pneumatic probe, and to data gained by unsteady pressure sensors mounted in the casing of the compressor. Flow features relevant for the prediction of blade stresses are best represented using the SST turbulence model in combination with the γ–ReΘ transition model. Nonlinear simulations with this setup are able to predict the blade stresses due to downstream excitation with an average difference of 23% compared to tip timing measurements. Single row linearized CFD methods have shown to be incapable of making a correct stress prediction when acoustic modes form a major part of the exciting mechanisms. In summary, this two-part publication proves the importance of acoustic rotor–stator interactions for blade vibrational stresses excited by downstream vanes in a state-of-the-art high-pressure compressor.
Maternal Immunization and Antenatal Care Situation Analysis (MIACSA) study protocol: a multiregional, cross-sectional analysis of maternal immunization delivery strategies to reduce maternal and neonatal morbidity and mortality
Authors: Roos Nathalie , Lambach Philipp , Mantel Carsten , Mason Elizabeth , Muñoz Flor M , Giles Michelle , Moran Allisyn , Hombach Joachim , Diaz Theresa 
Published: June 2019

IntroductionMaternal immunization (MI) with tetanus toxoid containing vaccine, is a safe and cost-effective way of preventing neonatal tetanus. Given the prospect of introducing new maternal vaccines in the near future, it is essential to identify and understand current policies, practices and unmet needs for introducing and/or scaling up MI in low-income and middle-income countries (LMICs).Methods and analysisThe Maternal Immunization and Antenatal Care Situation Analysis (MIACSA) is a mixed methods, cross-sectional study that will collect data in four phases: (1) a review of global databases for selected health indicators in 136 LMICs; (2) a structured online survey directed at Maternal, Newborn and Child Health and Expanded Programme on Immunization focal points in all 136 LMICs; (3) semistructured telephone interviews of 30 selected LMICs and (4) 10 week-long country visits, including key informant interviews, health facility visits and focus group discussions. The principal analyses will assess correlations between the various aspects of MI delivery strategies and proxy measures of health systems performance related to vaccine-preventable disease control. The primary outcome will be a typology of existing MI delivery models, and secondary outcomes will include country profiles of child and maternal health indicators, and a MI gaps and needs analysis.Ethics and disseminationThe protocol was approved by the WHO Ethics Review Committee (ERC.0002908). The results will be made available in a project report and submitted for publication in peer-reviewed journals that will be shared broadly among global health decision-makers, researchers, product developers and country-level stakeholders.
Introducing a sector-wide pooled fund in a fragile context: mixed-methods evaluation of the health transition fund in Zimbabwe
Authors: D’Aquino Luigi , Pyone Thidar , Nigussie Assaye , Salama Peter , Gwinji Gerald , van den Broek Nynke 
Published: June 2019

IntroductionAid effectiveness and improving its impact is a central policy matter for donors and international organisations. Pooled funding is a mechanism, whereby donors provide financial contributions towards a common set of broad objectives by channelling finance through one instrument. The results of pooled funds as an aid mechanism are mixed, and there is limited data on both methodology for, and results of, assessment of effectiveness of pooled funding.MethodsThis study adapted a conceptual framework incorporating the Paris Principles of Aid Effectiveness and qualitative methods to assess the performance of the Health Transition Fund (HTF) Zimbabwe. 30 key informant interviews, and 20 focus group discussions were conducted with informants drawn from village to national level. Descriptive secondary data analysis of Demographic Health Surveys, Health Management Information Systems (HMIS) and policy reports complemented the study.ResultsThe HTF combined the most optimal option to channel external aid to the health sector in Zimbabwe during a period of socioeconomic and political crisis. It produced results quickly and at scale and enhanced coordination and ownership at the national and subnational level. Flexibility in using the funds was a strong feature of the HTF. However, the initiative compromised on the investment in local capacity and systems, since the primary focus was on restoring essential services within a nearly collapsed healthcare system, rather than building long-term capacity. Significant changes in maternal and newborn health outcomes were observed during the HTF implementation in Zimbabwe.ConclusionA framework which can be used to assess pooled funds was adapted and applied. Future assessments could use this or another framework to provide new evidence regarding effectiveness of pool donor funds although the frameworks should be properly tested and adapted in different contexts.
Unintended discontinuation of medication following hospitalisation: a retrospective cohort study
Authors: Redmond Patrick , McDowell Ronald , Grimes Tamasine C , Boland Fiona , McDonnell Ronan , Hughes Carmel , Fahey Tom 
Published: June 2019

ObjectivesWhether unintended discontinuation of common, evidence-based, long-term medication occurs after hospitalisation; what factors are associated with unintended discontinuation; and whether the presence of documentation of medication at hospital discharge is associated with continuity of medication in general practice.DesignRetrospective cohort study between 2012 and 2015.SettingElectronic records and hospital supplied discharge notifications in 44 Irish general practices.Participants20 488 patients aged 65 years or more prescribed long-term medication for chronic conditions.Primary and secondary outcomesDiscontinuity of four evidence-based medication drug classes: antithrombotic, lipid-lowering, thyroid replacement drugs and respiratory inhalers in hospitalised versus non-hospitalised patients; patient and health system factors associated with discontinuity; impact of the presence of medication in the hospital discharge summary on continuity of medication in a patient’s general practitioner (GP) prescribing record at 6 months follow-up.ResultsIn patients admitted to hospital, medication discontinuity ranged from 6%–11% in the 6 months posthospitalisation. Discontinuity of medication is significantly lower for hospitalised patients taking respiratory inhalers (adjusted OR (AOR) 0.63, 95% CI (0.49 to 0.80), p<0.001) and thyroid medications (AOR 0.62, 95% CI (0.40 to 0.96), p=0.03). There is no association between discontinuity of medication and hospitalisation for antithrombotics (AOR 0.95, 95% CI (0.81 to 1.11), p=0.49) or lipid lowering medications (AOR 0.92, 95% CI (0.78 to 1.08), p=0.29). Older patients and those who paid to see their GP were more likely to experience increased odds of discontinuity in all four medicine groups. Less than half (39% to 47.4%) of patients had medication listed on their hospital discharge summary. Presence of medication on hospital discharge summary is significantly associated with continuity of medication in the GP prescribing record for lipid lowering medications (AOR 1.64, 95% CI (1.15 to 2.36), p=0.01) and respiratory inhalers (AOR 2.97, 95% CI (1.68 to 5.25), p<0.01).ConclusionDiscontinuity of evidence-based long-term medication is common. Increasing age and private medical care are independently associated with a higher risk of medication discontinuity. Hospitalisation is not associated with discontinuity but less than half of hospitalised patients have medication recorded on their hospital discharge summary.
Evaluation protocol of the implementation of a learning healthcare system in clinical practice: the Connected Health Cities programme in the north of England
Authors: Steels Stephanie , van Staa Tjeerd 
Published: June 2019

IntroductionThe ‘learning healthcare system’ (LHS) has been proposed to deliver better outcomes for patients and communities by analysing routinely captured health information and feeding back results to clinical staff. This approach is being piloted in the Connected Health Cities (CHC) programme in four regions in the north of England. This article describes the protocol of the evaluation of this programme.Methods and analysisIn designing this evaluation, we had to take a pragmatic approach to ensure the feasibility of completing the work within 1 year. Furthermore, we have designed the evaluation in such a way as to be able to capture differences in how each of the CHC regions uses a variety of methods to create their own LHS. A mixed methods approach has been adopted for this evaluation due the scale and complexities of the pilot study. A documentary review will identify how CHC pilot study deliverables were operationalised. To gain a broad understanding of CHC staff experiences, an online survey will be offered to all staff to complete. Semi-structured interviews with key programme staff will be used to gain a deeper understanding of key achievements, as well as how challenges have been overcome or managed. Our data analysis will triangulate the documentary review, survey and interview data. A thematic analysis using our logic model as a framework will also be used to assess progress against the CHC programme deliverables and to identify recommendations to support future programme decision-making.Ethics and disseminationEthical approval was granted by The University of Manchester Ethics Committee on 24 May 2018. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media, the internet and various stakeholder/patient and public engagement activities.
Magnitude and modifiers of the weekend effect in hospital admissions: a systematic review and meta-analysis
Authors: Chen Yen-Fu , Armoiry Xavier , Higenbottam Caroline , Cowley Nicholas , Basra Ranjna , Watson Samuel Ian , Tarrant Carolyn , Boyal Amunpreet , Sutton Elizabeth , Wu Chia-Wei , Aldridge Cassie P , Gosling Amy , Lilford Richard , Bion Julian 
Published: June 2019

ObjectiveTo examine the magnitude of the weekend effect, defined as differences in patient outcomes between weekend and weekday hospital admissions, and factors influencing it.DesignA systematic review incorporating Bayesian meta-analyses and meta-regression.Data sourcesWe searched seven databases including MEDLINE and EMBASE from January 2000 to April 2015, and updated the MEDLINE search up to November 2017. Eligibility criteria: primary research studies published in peer-reviewed journals of unselected admissions (not focusing on specific conditions) investigating the weekend effect on mortality, adverse events, length of hospital stay (LoS) or patient satisfaction.ResultsFor the systematic review, we included 68 studies (70 articles) covering over 640 million admissions. Of these, two-thirds were conducted in the UK (n=24) or USA (n=22). The pooled odds ratio (OR) for weekend mortality effect across admission types was 1.16 (95% credible interval 1.10 to 1.23). The weekend effect appeared greater for elective (1.70, 1.08 to 2.52) than emergency (1.11, 1.06 to 1.16) or maternity (1.06, 0.89 to 1.29) admissions. Further examination of the literature shows that these estimates are influenced by methodological, clinical and service factors: at weekends, fewer patients are admitted to hospital, those who are admitted are more severely ill and there are differences in care pathways before and after admission. Evidence regarding the weekend effect on adverse events and LoS is weak and inconsistent, and that on patient satisfaction is sparse. The overall quality of evidence for inferring weekend/weekday difference in hospital care quality from the observed weekend effect was rated as ‘very low’ based on the Grading of Recommendations, Assessment, Development and Evaluations framework.ConclusionsThe weekend effect is unlikely to have a single cause, or to be a reliable indicator of care quality at weekends. Further work should focus on underlying mechanisms and examine care processes in both hospital and community.Prospero registration numberCRD42016036487
Staying Quit After Release (SQuARe) trial protocol: a randomised controlled trial of a multicomponent intervention to maintain smoking abstinence after release from smoke-free prisons in Victoria, Australia
Authors: Young Jesse T , Puljević Cheneal , Love Alexander D , Janca Emilia K , Segan Catherine J , Baird Donita , Whiffen Rachel , Pappos Stan , Bell Emma , Kinner Stuart A 
Published: June 2019

IntroductionSmoke-free policies have been introduced in prisons internationally. However, high rates of relapse to smoking after release from prison indicate that these policies typically result in short-term smoking cessation only. These high rates of relapse, combined with a lack of investment in relapse prevention, highlight a missed opportunity to improve the health of a population who smoke tobacco at two to six times the rate of the general population. This paper describes the rationale and design of a randomised controlled trial, testing the effectiveness of a caseworker-delivered intervention promoting smoking cessation among former smokers released from smoke-free prisons in Victoria, Australia.Methods and analysisThe multicomponent, brief intervention consists of behavioural counselling, provision of nicotine spray and referral to Quitline and primary care to promote use of government-subsidised smoking cessation pharmacotherapy. The intervention is embedded in routine service delivery and is administered at three time points: one prerelease and two postrelease from prison. Control group participants will receive usual care. Smoking abstinence will be assessed at 1 and 3 months postrelease, and confirmed with carbon monoxide breath testing. Linkage of participant records to survey and routinely collected administrative data will provide further information on postrelease use of health services and prescribed medication.Ethics and disseminationEthical approval has been obtained from the Corrections Victoria Research Committee, the Victorian Department of Justice Human Research Ethics Committee, the Department of Human Services External Request Evaluation Committee and the University of Melbourne Human Research Ethics Committee. Results will be submitted to major international health-focused journals. In case of success, findings will assist policymakers to implement urgently needed interventions promoting the maintenance of prison-initiated smoking abstinence after release, to reduce the health disparities experienced by this marginalised population.Trial registration numberACTRN12618000072213; Pre-results.
Efficacy and safety of cannabidiol followed by an open label add-on of tetrahydrocannabinol for the treatment of chronic pain in patients with rheumatoid arthritis or ankylosing spondylitis: protocol for a multicentre, randomised, placebo-controlled study
Authors: Hendricks Oliver , Andersen Tonny Elmose , Christiansen Afshin Ashouri , Primdahl Jette , Hauge Ellen Margrethe , Ellingsen Torkell , Horsted Tina Ingrid , Bachmann Anja Godske , Loft Anne Gitte , Bojesen Anders Bo , Østergaard Mikkel , Lund Hetland Merete , Krogh Niels Steen , Roessler Kirsten Kaya , Petersen Kim Hørslev 
Published: June 2019

IntroductionRheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic, systemic, inflammatory diseases, primarily in the musculoskeletal system. Pain and fatigue are key symptoms of RA and AS. Treatment presents a clinical challenge for several reasons, including the progressive nature of the diseases and the involvement of multiple pain mechanisms. Moreover, side effects of pain treatment pose an implicit risk. Currently, no well-controlled studies have investigated how medical cannabis affects pain and cognitive functions in RA and AS. The present study aims to evaluate the efficacy and safety of medical cannabis in the treatment of persistent pain in patients with RA and AS with low disease activity.Methods and analysisA double-blinded, randomised, placebo-controlled study of cannabidiol (CBD), followed by an open label add-on of tetrahydrocannabinol (THC) with collection of clinical data and biological materials in RA and AS patients treated in routine care. The oral treatment with CBD in the experimental group is compared with placebo in a control group for 12 weeks, followed by an observational 12-week period with an open label add-on of THC in the primary CBD non-responders. Disease characteristics, psychological parameters, demographics, comorbidities, lifestyle factors, blood samples and serious adverse events are collected at baseline, after 12 and 24 weeks of treatment, and at a follow-up visit at 36 weeks. Data will be analysed in accordance with a predefined statistical analysis plan.Ethics and disseminationThe Danish Ethics Committee (S-20170217), the Danish Medicines Agency (S-2018010018) and the Danish Data Protection Agency approved the protocol. The project is registered in the European Clinical Trials Database (EudraCT 2017-004226-15). All participants will give written informed consent to participate prior to any study-related procedures. The results will be presented at international conferences and published in peer-reviewed journals.