bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rating early child development outcome measurement tools for routine health programme use
Authors: Boggs Dorothy , Milner Kate M , Chandna Jaya , Black Maureen , Cavallera Vanessa , Dua Tarun , Fink Guenther , KC Ashish , Grantham-McGregor Sally , Hamadani Jena , Hughes Rob , Manji Karim , McCoy Dana Charles , Tann Cally , Lawn Joy E 
Published: March 2019

BackgroundIdentification of children at risk of developmental delay and/or impairment requires valid measurement of early child development (ECD). We systematically assess ECD measurement tools for accuracy and feasibility for use in routine services in low-income and middle-income countries (LMIC).MethodsBuilding on World Bank and peer-reviewed literature reviews, we identified available ECD measurement tools for children aged 0–3 years used in ≥1 LMIC and matrixed these according towhen(child age) andwhat(ECD domains) they measure at population or individual level. Tools measuring <2 years and covering ≥3 developmental domains, including cognition, were rated for accuracy and feasibility criteria using a rating approach derived from Grading of Recommendations, Assessment, Development and Evaluations.Results61 tools were initially identified, 8% (n=5) population-level and 92% (n=56) individual-level screening or ability tests. Of these, 27 tools covering ≥3 domains beginning <2 years of age were selected for rating accuracy and feasibility. Recently developed population-level tools (n=2) rated highly overall, particularly in reliability, cultural adaptability, administration time and geographical uptake. Individual-level tool (n=25) ratings were variable, generally highest for reliability and lowest for accessibility, training, clinical relevance and geographical uptake.Conclusions and implicationsAlthough multiple measurement tools exist, few are designed for multidomain ECD measurement in young children, especially in LMIC. No available tools rated strongly acrossallaccuracy and feasibility criteria with accessibility, training requirements, clinical relevance and geographical uptake being poor for most tools. Further research is recommended to explore this gap in fit-for-purpose tools to monitor ECD in routine LMIC health services.
Evolving quality improvement support strategies to improve Plan–Do–Study–Act cycle fidelity: a retrospective mixed-methods study
Authors: McNicholas Chris , Lennox Laura , Woodcock Thomas , Bell Derek , Reed Julie E 
Published: March 2019

BackgroundAlthough widely recommended as an effective approach to quality improvement (QI), the Plan–Do–Study–Act (PDSA) cycle method can be challenging to use, and low fidelity of published accounts of the method has been reported. There is little evidence on the fidelity of PDSA cycles used by front-line teams, nor how to support and improve the method’s use. Data collected from 39 front-line improvement teams provided an opportunity to retrospectively investigate PDSA cycle use and how strategies were modified to help improve this over time.MethodsThe fidelity of 421 PDSA cycles was reviewed using a predefined framework and statistical analysis examined whether fidelity changed over three annual rounds of projects. The experiences of project teams and QI support staff were investigated through document analysis and interviews.ResultsAlthough modest, statistically significant improvements in PDSA fidelity occurred; however, overall fidelity remained low. Challenges to achieving greater fidelity reflected problems with understanding the PDSA methodology, intention to use and application in practice. These problems were exacerbated by assumptions made in the original QI training and support strategies: that PDSA was easy to understand; that teams would be motivated and willing to use PDSA; and that PDSA is easy to apply. QI strategies that evolved to overcome these challenges included project selection process, redesign of training, increased hands-on support and investment in training QI support staff.ConclusionThis study identifies support strategies that may help improve PDSA cycle fidelity. It provides an approach to assess minimum standards of fidelity which can be replicated elsewhere. The findings suggest achieving high PDSA fidelity requires a gradual and negotiated process to explore different perspectives and encourage new ways of working.
Temporal trends in cognitive function of older US adults associated with population changes in demographic and cardiovascular profiles
Authors: Bancks Michael , Alonso Alvaro , Allen Norrina , Yaffe Kristine , Carnethon Mercedes 
Published: March 2019

BackgroundRecent estimates suggest that dementia incidence is decreasing in the US possibly due to better management of cardiovascular disease (CVD) risk factors, but these studies lack repeated cross-sectional assessment among a representative US sample. Our objective was to assess temporal trends in cognitive performance in relation to CVD risk factors among older National Health and Nutrition Examination Survey (NHANES) participants.MethodsWe used repeated cross-sectional assessment of 5711 participants ≥60 years of age from four NHANES cycles: 1999–2000, 2001–2002, 2011–2012 and 2013–2014. Cognitive function was assessed during each cycle with the Digit Symbol Substitution Test (DSST). We estimated mean DSST score at each cycle and annual trend in DSST before and after adjustment for age, sex, race/ethnicity, education, smoking status, blood pressure, glucose status and body mass index.ResultsDSST scores was significantly higher for 2011–2012 (difference: 6.7, 95% CI 4.4 to 9.0) and 2013–2014 (difference: 6.2, 95% CI 4.0 to 8.5), but not 2001–2002 (difference: 2.3, 95% CI −0.01 to 4.6) as compared with 1999–2000 before adjustment. We observed a linear trend for higher annual DSST score before adjustment (DSST/year: 0.44, 95% CI 0.31 to 0.57) and after adjustment for age, sex, race/ethnicity, educational attainment and CVD risk factors (DSST/year: 0.17, 95% CI 0.08 to 0.26). Educational attainment was most strongly associated with the attenuation in the trend in cognitive function (77% of trend attenuation and 20% of variance in DSST).ConclusionCognitive function is improving over time for US adults aged ≥60 years. These improvements are strongly associated with greater educational attainment and irrespective of the changing US demographic and cardiovascular health profiles.
Impact of Saharan dust episodes on preterm births in Guadeloupe (French West Indies)
Authors: Viel Jean-Francois , Mallet Yoann , Raghoumandan Christina , Quénel Philippe , Kadhel Philippe , Rouget Florence , Multigner Luc 
Published: March 2019

ObjectivesLarge amounts of mineral dust are transported from their African sources in the Saharan-Sahel region to the Caribbean Sea, generating peak exposures to particulate matter ≤10 µm (PM10). This study aimed to investigate the impact of Saharan dust episodes on preterm births in the Guadeloupe archipelago.MethodsThe study population consisted of 909 pregnant women who were enrolled in the TIMOUN mother-child cohort between 2004 and 2007. Desert dust episodes were assessed from PM10 concentrations recorded at the unique background air quality monitoring station located in Pointe-à-Pitre. For each woman, the daily PM10 concentrations were averaged over the entire pregnancy, and the proportion of days with intense dust episodes (≥55 µg PM10/m3) during pregnancy was calculated. Weighted logistic regression models adjusting for known individual sociomedical risk factors were used to estimate ORs and 95% CIs for preterm birth.ResultsDuring pregnancy, the mean PM10 concentrations ranged from 13.17 to 34.92 µg/m3, whereas the proportion of intense dust events ranged from 0.00% to 19.41%. Increased adjusted ORs were found for both the mean PM10 concentrations and the proportion of intense dust events (OR 1.40, 95% CI 1.08 to 1.81, and OR 1.54, 95% CI 1.21 to 1.98 per SD change, respectively). Restriction to spontaneous preterm births produced similar ORs but with wider 95% CIs.ConclusionConsidering the personal and social burden of this adverse pregnancy outcome, this finding is of importance for both healthcare workers and policy makers to provide necessary preventive measures.
The critical weed-free period in glyphosate-resistant soybean in Ontario is similar to previous estimates using glyphosate-susceptible soybean
Authors: Soltani Nader , Nurse Robert E. , Jhala Amit J. , Sikkema Peter H. 
Published: March 2019

A study consisting of 13 field experiments was conducted during 2014–2016 in southwestern Ontario and southcentral Nebraska (Clay Center) to determine the effect of late-emerging weeds on the yield of glyphosate-resistant soybean. Soybean was maintained weed-free with glyphosate (900 g ae ha−1) up to the VC (cotyledon), V1 (first trifoliate), V2 (second trifoliate), V3 (third trifoliate), V4 (fourth trifoliate), and R1 (beginning of flowering) growth stages, after which weeds were allowed to naturally infest the soybean plots. The total weed density was reduced to 24%, 63%, 67%, 72%, 76%, and 92% in Environment 1 (Exeter, Harrow, and Ridgetown) when soybean was maintained weed-free up to the VC, V1, V2, V3, V4, and R1 soybean growth stages, respectively. The total weed biomass was reduced by 33%, 82%, 95%, 97%, 97%, and 100% in Environment 1 (Exeter, Harrow, and Ridgetown) and 28%, 100%, 100%, 100%, 100%, and 100% in Environment 2 (Clay Center) when soybean was maintained weed-free up to the VC, V1, V2, V3, V4, and R1 stages, respectively. The critical weed-free periods for a 2.5%, 5%, and 10% yield loss in soybean were the V1–V2, VC–V1, and VC–V1 soybean stages in Environment 1 (Exeter, Harrow, and Ridgetown) and V2–V3, V2–V3, and V1–V2 soybean stages in Environment 2 (Clay Center), respectively. For the weed species evaluated, there was a minimal reduction in weed biomass (5% or less) when soybean was maintained weed-free beyond the V3 soybean growth stage. These results shows that soybean must be maintained weed-free up to the V3 growth stage to minimize yield loss due to weed interference.
Short-term nitrogen dynamics in a soil amended with anaerobic digestate
Authors: Sharifi Mehdi , Baker Scott , Hojabri Leila , Hajiaghaei-Kamrani Monireh 
Published: March 2019

The co-product of anaerobic digestion, digestate, is nitrogen (N) rich; however, the forms and accessibility of this N by the crops have not been fully explored. This study aimed to determine the mineralization parameters of digestate N and to assess its availability for annual ryegrass (Lolium multiflorum Lam.). Four digestate rates of 0 (control), 38, 75, and 150 mg N kg−1 soil (equal to 0, 90, 180, and 360 kg total N ha−1) were applied to a silty clay loam soil in a completely randomized block design with four replications in a greenhouse study. A 100 d aerobic incubation experiment was also conducted with 0 and 150 mg digestate N kg−1 rates at 25 °C. Digestate feedstock included cattle manure (28%), hay (15%), and silage corn (Zea mays L.; 57%). Total plant biomass and N uptake increased linearly with digestate application rate with average apparent N recovery of 37%. Potentially mineralizable N (N0) and mineralizable N rate constant (k) were not significantly different in digestate and control treatments; however, a flush of digestate organic N (30 mg N kg−1) released right after mixing the digestate with soil. Evidences of N immobilization with digestate application were observed in greenhouse study. Majority of plant-available digestate N was in form of NH4+-N; therefore, NH4+-N can be used for estimation of available digestate N for crops. Results need to be validated for specific feedstock and soil properties under field conditions. Further research is needed to assess how long-term build-up of digestate organic N may impact the N availability for crops.
O PROBLEMA DO MONISMO EM ESPINOSA
Authors: Rusmando Luis Marcelo 
Published: March 2019

A partir da exegese do próprio texto espinosano, objetivamos pôr em evidência a dificuldade que este gera acerca da conciliação entre o uno e o múltiplo ou diverso, isto é, entre a substância divina e seus atributos. Partiremos do raciocínio pelo qual, na Ética, Espinosa demonstra o monismo de sua filosofia, ou a existência de Deus, enquanto única substância, para logo criticar um dos seus pressupostos, a saber, a existência de Deus, enquanto substância que consiste de infinitos atributos. A nossa exegese, assim, concentrar-se-á nos argumentos e princípios que a Espinosa lhe permitem demonstrar ou justificar que a uma substância podem ser atribuídos mais de um atributo, e, destarte, que a uma substância absolutamente infinita devam ser atribuídos infinitos atributos. O problema que pretendemos evidenciar decorre do fato de que, de acordo com a exegese que propomos, os argumentos e princípios em questão parecem não cumprir com seu desígnio, nos deixando a dificuldade de compreender de que maneira, ao certo, Espinosa pode superar a autonomia dos atributos, posta por sua perseidade, de tal sorte a que eles, em lugar de serem concebidos como substâncias autônomas, devam ser ditos atributos de uma mesma e única substância. Longe de propormos uma solução para tal dificuldade, ou bem de analisar alguma das soluções que tem sido apresentadas pela tradição de comentadores, pretendemos expôr o problema, à luz daquilo que Espinosa expõe em sua obra-prima, a fim de que tal exposição possa servir de alavanca para a análise da difícil relação que a filosofia espinosana estabelece entre a substância divina e seus atributos, incluindo o exame do que seja, ao certo, um atributo divino.
Lesion Index Titration Using Contact-Force Technology Enables Safe and Effective Radiofrequency Lesion Creation at the Root of the Aorta and Pulmonary Artery
Authors: Alfonso-Almazán José Manuel , Quintanilla Jorge G. , García-Torrent María Jesús , Laguna-Castro Santiago , Rodríguez-Bobada Cruz , González Pablo , González-Ferrer Juan José , Salinas Pablo , Cañadas-Godoy Victoria , Moreno Javier , Borrego-Bernabé Luis , Pérez-Castellano Nicasio , Jalife José , Perez-Villacastín Julián , Filgueiras-Rama David 
Published: March 2019

Background:
Ablation of some myocardial substrates requires catheter-based radiofrequency delivery at the root of a great artery. We studied the safety and efficacy parameters associated with catheter-based radiofrequency delivery at the root of the aorta and pulmonary artery.

Methods:
Thirty-six pigs underwent in-vivo catheter-based ablation under continuous contact-force and lesion index (power, contact-force, and time) monitoring during 60-s radiofrequency delivery with an open-irrigated tip catheter. Twenty-eight animals were allocated to groups receiving 40 W (n=9), 50 W (n=10), or 60 W (n=9) radiofrequency energy, and acute (n=22) and chronic (n=6) arterial wall damage was quantified by multiphoton microscopy in ex vivo samples. Adjacent myocardial lesions were quantified in parallel samples. The remaining 8 pigs were used to validate safety and efficacy parameters.

Results:

Acute collagen and elastin alterations were significantly associated with radiofrequency power, although chronic assessment revealed vascular wall recovery in lesions without steam pop. The main parameters associated with steam pops were median peak temperature >42°C and impedance falls >23 ohms. Unlike other parameters, lesion index values of 9.1 units (interquartile range, 8.7–9.8) were associated with the presence of adjacent myocardial lesions in both univariate (
P
=0.03) and multivariate analyses (
P
=0.049; odds ratio, 1.99; 95% CI, 1.02–3.98). In the validation group, lesion index values using 40 W over a range of contact-forces correlated with the size of radiofrequency lesions (R
2
=0.57;
P
=0.03), with no angiographic or histopathologic signs of coronary artery damage.

Conclusions:
Lesion index values obtained during 40 W radiofrequency applications reliably monitor safe and effective lesion creation at the root of the great arteries.
Telemedicine in Prehospital Acute Stroke Care
Authors: Geisler Frederik , Kunz Alexander , Winter Benjamin , Rozanski Michal , Waldschmidt Carolin , Weber Joachim E. , Wendt Matthias , Zieschang Katja , Ebinger Martin , Audebert Heinrich J. ,   the Stroke Emergency Mobile (STEMO) Consortium
Published: March 2019

Background

Mobile stroke units (
MSU
s), equipped with an integrated computed tomography scanner, can shorten time to thrombolytic treatment and may improve outcome in patients with acute ischemic stroke. Original (German)
MSU
s are staffed by neurologists trained as emergency physicians, but patient assessment and treatment decisions by a remote neurologist may offer an alternative to neurologists aboard
MSU
.

Methods and Results

Remote neurologists examined and assessed emergency patients treated aboard the
MSU
in Berlin, Germany. Audiovisual quality was rated by the remote neurologist from 1 (excellent) to 6 (insufficient), and duration of video examinations was assessed. We analyzed interrater reliability of diagnoses, scores on the National Institutes of Health Stroke Scale and treatment decisions (intravenous thrombolysis) between the
MSU
neurologist and the remote neurologist. We included 90 of 103 emergency assessments (13 patients were excluded because of either failed connection, technical problems, clinical worsening during teleconsultation, or missing data in documentation) in this study. The remote neurologist rated audiovisual quality with a median grade for audio quality of 3 (satisfactory) and for video quality of 2 (good). Mean time for completion of teleconsultations was about 19±5 minutes. The interrater reliabilities between the onboard and remote neurologist were high for diagnoses (Cohen's κ=0.86),
National Institutes of Health Stroke Scale
sum scores (intraclass correlation coefficient, 0.87) and treatment decisions (16 treatment decisions agreed versus 2 disagreed; Cohen's κ=0.93).

Conclusions
Remote assessment and treatment decisions of emergency patients are technically feasible with satisfactory audiovisual quality. Agreement on diagnoses, neurological examinations, and treatment decisions between onboard and remote neurologists was high.
Spotty Calcium on Cervicocerebral Computed Tomography Angiography Associates With Increased Risk of Ischemic Stroke
Authors: Zhang Fan , Yang Li , Gan Lu , Fan Zhaoyang , Zhou Bill , Deng Zixin , Dey Damini , Berman Daniel S. , Li Debiao , Xie Yibin 
Published: March 2019

Background and Purpose—
Cervicocerebral vascular calcification on computed tomography angiography is a known sign of advanced atherosclerosis. However, the clinical significance of calcification pattern remains unclear. In this study, we aimed to investigate the potential association between spotty calcium and acute ischemic stroke.

Methods—
This study included patients with first-time nonlacunar ischemic stroke (N=50) confirmed by brain magnetic resonance imaging or nonenhanced head computed tomography, as well as control subjects with asymptomatic carotid atherosclerosis (N=50) confirmed by carotid ultrasonography. Subjects in both groups underwent contrast-enhanced cervicocerebral computed tomography angiography within a week after the initial imaging examination. Spotty calcification was evaluated at 11 arterial segments commonly affected by atherosclerosis along the carotid and vertebrobasilar circulation. Statistical analysis was performed comparing the frequency and spatial pattern of spotty calcification between the 2 groups.

Results—

Spotty calcification in the Stroke group was markedly more prevalent than that in the Control group (total SC count: 8.74±4.96 versus 1.84±1.82,
P
<0.001). The odds ratio (95% CI) for stroke was 2.49 (1.55–4.00) for spotty calcification at bilateral carotid bifurcation, 1.52 (1.13–2.04) at carotid siphon, and 1.98 (1.45–2.69) at all evaluated locations. A total number of 3 spotty calcifications were determined as the optimal cutoff threshold for increased risk of stroke. Spotty calcium showed significantly greater area under the receiver operating characteristics curve than total calcium volume irrespective of size (0.88 versus 0.77). Within the Stroke group, ipsilateral lateral side showed significantly more spotty calcium than the contralateral side (5.18±3.05 versus 3.56±2.67,
P
<0.001).

Conclusions—
Nonlacunar ischemia stroke was associated with markedly increased incidence of spotty calcification with a distinct spatial pattern on cervicocerebral computed tomography compared with subclinical atherosclerosis, suggesting the potential role of spotty calcification for improving the risk stratification for ischemic stroke.
Obesity Paradox in Intracerebral Hemorrhage
Authors: Persaud Steven R. , Lieber Adam C. , Donath Elie , Stingone Jeanette A. , Dangayach Neha S. , Zhang Xiangnan , Mocco J , Kellner Christopher P. 
Published: March 2019

Background and Purpose—
Although obesity is an established risk factor for cardiovascular disease and stroke, studies have shown evidence of an obesity paradox—a protective effect of obesity in patients who already have these disease states. Data on the obesity paradox in intracerebral hemorrhage is limited.

Methods—
Clinical data for adult intracerebral hemorrhage patients were extracted from the National Inpatient Sample between 2007 and 2014. Multivariable logistic regression analyzed the association of body habitus with in-hospital mortality, discharge disposition, length of stay, tracheostomy or gastrostomy placement, and ventriculoperitoneal shunt placement.

Results—

There were 99 212 patients who were eligible. Patients with both obesity (OR=0.69; 95% CI=0.62–0.76;
P
<0.001) and morbid obesity (OR=0.85; 95% CI=0.74–0.97;
P
=0.02) were associated with decreased odds of in-hospital mortality. Morbid obesity was significantly associated with increased odds of a tracheostomy or gastrostomy placement (OR=1.42; 1.20–1.69;
P
<0.001) and decreased odds of a routine discharge disposition (OR=0.84; 0.74–0.97;
P
=0.014).

Conclusions—
Obesity and morbid obesity appear to protect against mortality in intracerebral hemorrhage.
Brain Morphometry Methods for Feature Extraction in Random Subspace Ensemble
Neural Network Classification of First-Episode Schizophrenia
Authors: Vyškovský Roman , Schwarz Daniel , Kašpárek Tomáš 
Published: March 2019

Abstract
Machine learning (ML) is a growing field that provides tools for automatic pattern recognition. The neuroimaging community currently tries to take advantage of ML in order to develop an auxiliary diagnostic tool for schizophrenia diagnostics. In this letter, we present a classification framework based on features extracted from magnetic resonance imaging (MRI) data using two automatic whole-brain morphometry methods: voxel-based (VBM) and deformation-based morphometry (DBM). The framework employs a random subspace ensemble-based artificial neural network classifier—in particular, a multilayer perceptron (MLP). The framework was tested on data from first-episode schizophrenia patients and healthy controls. The experiments differed in terms of feature extraction methods, using VBM, DBM, and a combination of both morphometry methods. Thus, features of different types were available for model adaptation. As we expected, the combination of features increased the MLP classification accuracy up to 73.12%—an improvement of 5% versus MLP-based only on VBM or DBM features. To further verify the findings, other comparisons using support vector machines in place of MLPs were made within the framework. However, it cannot be concluded that any classifier was better than another.