bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of sacubitril–valsartan combination in patients with chronic heart failure and sleep apnoea syndrome: the ENTRESTO‐SAS study design
Authors: Jaffuel Dany , Molinari Nicolas , Berdague Philippe , Pathak Atul , Galinier Michel , Dupuis Marion , Ricci Jean‐Etienne , Mallet Jean‐Pierre , Bourdin Arnaud , Roubille François 
Published: February 2018

AbstractAimsSleep‐disordered breathing (SDB) is a highly prevalent co‐morbidity in patients with chronic heart failure (CHF) and can play a detrimental role in the pathophysiology course of CHF. However, the best way to manage SDB in CHF remains a matter of debate. Sacubitril–valsartan has been included in the 2016 European Society of Cardiology guidelines as an alternative to angiotensin‐converting enzyme inhibitors to further reduce the risk of progression of CHF, CHF hospitalization, and death in ambulatory patients. Sacubitril and valsartan are good candidates for correcting SDB of CHF patients because their known mechanisms of action are likely to counteract the pathophysiology of SDB in CHF.Methods and resultsThe ENTRESTO‐SAS trial is a 3‐month, multicentric, prospective, open‐label real‐life cohort study. Patients eligible for sacubitril–valsartan treatment (i.e. adults with left ventricular ejection fraction ≤35%, who remain symptomatic despite optimal treatment with an angiotensin‐converting enzyme inhibitor, a beta‐blocker, and a mineralocorticoid receptor antagonist) will be evaluated before and after 3 months of treatment (nocturnal ventilatory polygraphy, echocardiography, laboratory testing, and quality‐of‐life and SDB questionnaires). The primary outcome is the change in the Apnoea–Hypopnoea Index, before and after 3 months of treatment. One hundred twenty patients are required to detect a significant 20% improvement of the Apnoea–Hypopnoea Index with a power of 90% at an alpha risk of 5%.ConclusionsIn the context of the SERVE‐HF study, physicians are waiting for new trials and alternative therapies. We sought to assess in the ENTRESTO‐SAS trial whether sacubitril–valsartan could improve the outcome of SDB in CHF patients.
W/O Nano‐Emulsions with Olive Leaf Phenolics Improved Oxidative Stability of Sacha Inchi Oil
Authors: Liu Lingyi , Jin Zhou , Wang Min , Shen Wangyang , Zhu Zhenzhou , Wang Zhan , Liu Lianliang 
Published: February 2018

Natural phenolic compounds have been drawn a wide attention to replace the synthesis antioxidants due to the food safety issues, while, natural phenolic compounds are usually polyhydroxy derivatives which exhibit hydrophilic capacity, limiting their applications directly in lipid systems. In this work, olive leaf phenolics (OLP) are extracted by ultrasound from five cultivars and the optimal cultivar is chosen to prepare W/O nano‐emulsions of Sacha Inchi oil (SIO, containing more than 90% polyunsaturated fatty acids). The droplet size could reach 2.15 ± 0.13 nm and remaines stable without phase separation during 30‐day storage. Oxidative stabilities of SIO containing 0.02%, 0.05%, and 0.1% OLP (w/w) are evaluated by Rancimat test and accelerated storage test. The release of OLP by preparation of W/O nano‐emulsions is capable of controlling the oxidative progress of SIO, by prolonging the induction time, preventing the production of primary and secondary oxidative products and also the deterioration of polyunsaturated fatty acids and tocopherols.Practical Applications: Sacha Inchi oil (SIO) contains approximately 90% of polyunsaturated fatty acids (PUFAs) associated with poor oxidative stability. Olive leaf phenolics (OLP) are considered as a great and cheap source of natural phenolic compounds. This study aimes to select the optimum source of OLP from five cultivars and to prepare a W/O nano‐emulsion of OLP. By diluting the W/O nano‐emulsion of OLP into SIO, effect of different concentrations OLP on the oxidative stability of SIO is evaluated through thermal oxidative stability and storage oxidative stability in an accelerated storage test. Results indicate that the capacity of OLP to retard the SIO oxidation depends on the incorporated concentration, which means that it is doable to adopt OLP, an abundant and cheap material, to improve the stability of edible oil with high PUFAs in the industry.Olive leaf phenolics are extracted and detected to prepare an efficient and stable W/O nano‐emulsion; By diluting W/O nano‐emulsion into Sacha Inchi oil, oxidative stability of the high content PUFAs oil is improved.
Application of Temperature Modulated Optical Refractometry for the Characterization of the Crystallization Behavior of Palm Oil
Authors: Häupler Michaela , Savitri Ratna Ayu , Hutschenreuter Valeska , Flöter Eckhard 
Published: February 2018

The phase behavior of fats is mainly determined using DSC. Here, the application of temperature modulated optical refractometry (TMOR) is examined to monitor the phase transitions of palm oil with different degrees of saturation.Studying the phase behavior by both methods revealed systematic differences. At identical scan rates, TMOR yielded up to 2 °C higher crystallization temperatures and identified consistently lower temperatures for melting phenomena. Because the prism serves as heating surface and defines the sample volume considered for the measurement a more direct heat transfer with TMOR is assumed. The sample depth above the prism relevant for the determination is only one micron. Hence, a direct heat transfer is ensured and thermal lag is practically eliminated causing the above‐mentioned differences.Because the TMOR signal is averaged over a defined prism surface area data for inhomogeneous samples can be generated. Although actual values for thermal expansion coefficients appear meaningless the combination of the TMOR signals allows to accurately determine the relevant phase transitions. The identification of different polymorphic forms and levels of solids in palm oil will be studied prospectively building on the promising results reported to identify if TMOR can become a valuable extension of the fat technologists' toolbox.Practical Applications: The new temperature modulated optical refractometry can extend the mainly used differential scanning calorimetry. It works highly accurate at small scan rates (<5 °C min−1) in comparison to the DSC. The new method can provide a deeper insight into samples during heating and cooling due to additional temperature undulation as well as the possibility to perform quasi‐isothermal measurements.It is possible to investigate the crystallization and melting behavior of fats with the new temperature modulated optical refractometry (TMOR). An undulated temperature is applied and the time‐delayed answer of the refractive index is measured. Subsequently, the real and imaginary part of the thermal expansion coefficient α are calculated based on the refractive index of the sample and the occurring phase shift. A plot of the real and imaginary part against the temperature leads to peaks at the phase transition temperatures and a resulting thermogram for the sample.
A pilot evaluation of a novel First Episode and Rapid Early Intervention service for Eating Disorders (FREED)
Authors: McClelland Jessica , Hodsoll John , Brown Amy , Lang Katie , Boysen Elena , Flynn Michaela , Mountford Victoria A. , Glennon Danielle , Schmidt Ulrike 
Published: February 2018

AbstractThis pilot study assesses the impact of FREED (First Episode Rapid Early Intervention for Eating Disorders [ED]), a novel transdiagnostic service for emerging adults with recent ED onset, on clinical outcomes. Data were collected from 56 patients and 19 carers for 12 months following enrolment. FREED patients showed significant improvements in ED and other symptoms across time. Carers also showed psychological improvements. For FREED anorexia nervosa (AN) patients, body mass index (BMI) at initial clinical assessment was similar to that of comparable patients (audit cohort) seen in our service before (16.4 vs 16.1 kg/m2). By start of treatment, because of their shorter wait, FREED‐AN had gained weight whereas audit patients had lost (16.7 vs 15.8 kg/m2). This difference continued throughout treatment, and at 12 months, nearly 60% FREED‐AN patients returned to a BMI of 18.5 or greater. FREED shows promise as a service model for emerging adults with EDs.
A roadmap to advance dementia research in prevention, diagnosis, intervention, and care by 2025
Authors: Pickett James , Bird Cathy , Ballard Clive , Banerjee Sube , Brayne Carol , Cowan Katherine , Clare Linda , Comas‐Herrera Adelina , Corner Lynne , Daley Stephanie , Knapp Martin , Lafortune Louise , Livingston Gill , Manthorpe Jill , Marchant Natalie , Moriarty Jo , Robinson Louise , van Lynden Clare , Windle Gill , Woods Bob , Gray Katherine , Walton Clare 
Published: February 2018

ObjectiveNational and global dementia plans have focused on the research ambition to develop a cure or disease‐modifying therapy by 2025, with the initial focus on investment in drug discovery approaches. We set out to develop complementary research ambitions in the areas of prevention, diagnosis, intervention, and care and strategies for achieving them.MethodsAlzheimer's Society facilitated a taskforce of leading UK clinicians and researchers in dementia, UK funders of dementia research, people with dementia, and carer representatives to develop, using iterative consensus methodology, goals and recommendations to advance dementia research.ResultsThe taskforce developed 5 goals and 30 recommendations. The goals focused on preventing future cases of dementia through risk reduction, maximising the benefit of a dementia diagnosis, improving quality of life, enabling the dementia workforce to improve practice, and optimising the quality and inclusivity of health and social care systems. Recommendations addressed gaps in knowledge and limitations in research methodology or infrastructure that would facilitate research in prioritised areas. A 10‐point action plan provides strategies for delivering the proposed research agenda.ConclusionsBy creating complementary goals for research that mirror the need to find effective treatments, we provide a framework that enables a focus for new investment and initiatives. This will support a broader and more holistic approach to research on dementia, addressing prevention, surveillance of population changes in risk and expression of dementia, the diagnostic process, diagnosis itself, interventions, social support, and care for people with dementia and their families.
Can Rationing through Inconvenience Be Ethical?
Authors: Eyal Nir , Romain Paul L. , Robertson Christopher 
Published: February 2018

AbstractIn this article, we provide a comprehensive analysis and a normative assessment of rationing through inconvenience as a form of rationing. By “rationing through inconvenience” in the health sphere, we refer to a nonfinancial burden (the inconvenience) that is either intended to cause or has the effect of causing patients or clinicians to choose an option for health‐related consumption that is preferred by the health system for its fairness, efficiency, or other distributive desiderata beyond assisting the immediate patient. We argue that under certain conditions, rationing through inconvenience may turn out to serve as a legitimate and, compared to direct rationing, even a preferable tool for rationing; we propose a research agenda to identify more precisely when that might be the case and when, alternatively, rationing through inconvenience remains ethically undesirable. After defining and illustrating rationing through inconvenience, we turn to its moral advantages and disadvantages over other rationing methods.We take it as a starting assumption that rationing, understood as scarce‐resource prioritization, is inevitable and, in a society that has goals beyond optimizing health care for individual patients—such as improving societal health care, education, or overall welfare—prudent and fair.
Rationing Care through Collaboration and Shared Values
Authors: Sabin James E. 
Published: February 2018

AbstractAlthough “rationing” continues to be a dirty word for the public in health policy discourse, Nir Eyal and colleagues handle the concept exactly right in their article in this issue of the Hastings Center Report. They correctly characterize rationing as an ethical requirement, not a moral abomination. They identify the key health policy question as how rationing can best be done, not whether it should be done at all. They make a cogent defense of what they call “rationing through inconvenience” as a justifiable allocational technique. And they wisely call for research on the effectiveness and fairness of this approach and other methods of rationing. I fully agree with their approach to rationing and with their argument that the process they provocatively label “rationing through inconvenience” should not be rejected out of hand. But I believe they have underestimated two ways in which the practical impacts of rationing through inconvenience limit its potential usefulness: the asymmetry of its effect on patients and physicians and the way in which it reduces the capacity of health systems to learn from experience.
The Different Moral Bases of Patient and Surrogate Decision‐Making
Authors: Brudney Daniel 
Published: February 2018

AbstractMy topic is a problem with our practice of surrogate decision‐making in health care, namely, the problem of the surrogate who is not doing her job—the surrogate who cannot be reached or the surrogate who seems to refuse to understand or to be unable to understand the clinical situation. The analysis raises a question about the surrogate who simply disagrees with the medical team. One might think that such a surrogate is doing her job—the team just doesn't like how she is doing it. My analysis raises the question of whether (or perhaps when) she should be overridden. In approaching this problem, I focus not on the range of difficulties in practice but on the underlying moral conceptual issue. My concern will be to show that the moral values that underpin patient decision‐making are fundamentally different from those that underpin surrogate decision‐making. Identifying the distinctions will set parameters for any successful solution to the “Who should decide?” question. A patient has a specific kind of moral right to make her own medical decisions. A surrogate has no analogous moral right to decide for someone else. We want the surrogate to make the decision because we believe that she has a relevant epistemological advantage over anyone else on the scene. If and when she has no such advantage or if she refuses or is unable to use it, then there might not be sufficient reason to let her be the decision‐maker.
It's All Relative
Authors: Hulkower Adira , Flicker Lauren S. 
Published: February 2018

AbstractIn this issue of the Hastings Center Report, Daniel Brudney suggests that clinicians have an overly deferential attitude toward their patients’ surrogate decision‐makers that is rooted in a wrongful investment of moral authority. He maintains that surrogate decision‐makers have no moral right to decide for their loved ones and that their value in the decision‐making process is limited to their knowledge of their loved one's preferences. If operationalized, Brudney's framework would ease the way for clinicians to remove a surrogate who cannot provide information relevant to the patient's preferences and to resort to a paternalistic model of decision‐making. Brudney fails to consider that the value of the surrogate does not flow from the surrogate, but rather from the patient's moral claim to have decisions made for him or her by a loved one. This claim recognizes that surrogates have intrinsic value through their relationship to and knowledge of the patient. Bioethics consultation services can assist clinical teams in engaging with the human crowd that surrounds each patient and navigating conflicting values and goals. This relational approach embraces the “mire and blood” that is endemic to relationships and clinical encounters.
Market Language, Moral Language
Authors: Goold Susan Dorr 
Published: February 2018

AbstractThose who advocate higher out‐of‐pocket spending, especially high deductibles, to keep health care costs better controlled without losing quality use market language to talk about how people should think about health care. Consumers—that is, patients—should hunt for bargains. Clip coupons. Shop around. Patients need to have more “skin in the game.” Consumer‐patients will then choose more carefully and prudently and use less unnecessary health care. Unfailingly, “skin” refers to having money at stake. Usually, those arguing for high deductibles express dismay or frustration that patients do not face the full (“true”) cost of the health services they receive. Unfortunately, a lack of price transparency, the need to unbundle bundled groups of services to discover total price, and the challenge of validly and reliably measuring and disclosing quality make shopping for health care a challenge for even the savviest patient. Urgency, fear, and sickness that impairs peak cognitive function and other aspects of emotionally laden decision‐making, even when “shared” with a physician, add obstacles to coupon clipping and tire kicking. Who has more at stake in health decisions than patients? Whose flesh is literally, not just figuratively, at risk?
Developing a culturally appropriate branding for a social and emotional wellbeing intervention in an Aboriginal community
Authors: Donovan Robert J. , Murray Lesley , Hicks Jolleen , Nicholas Amberlee , Anwar‐McHenry Julia 
Published: February 2018

AbstractIssue addressedAn initial consultation process to implement a culturally appropriate social and emotional wellbeing campaign in an Aboriginal community indicated that the fundamental principles of the Act‐Belong‐Commit mental health promotion campaign were acceptable, but that a cultural adaptation of the branding should be sought.MethodsA competition was held inviting community members to design a brand logo for the campaign in their community. Local judges selected “winners” in various categories, and six of the submissions were selected for testing in the broader community via street intercept interviews. Respondents were asked which logo they liked best, their perceived meanings of the designs and the perceived appropriateness of the designs for a social and emotional wellbeing campaign.ResultsA convenience sample of N = 26 local Aboriginal people who lived and/or worked in Roebourne completed the questionnaire. There was a clear majority preference for logo “D,” which communicated appropriate meanings of pride and strength in standing together, and reflected the underlying strengths and capacities of Aboriginal people which this project seeks to harness and support.ConclusionsThe approach of using a logo competition to develop the campaign brand was highly successful and enabled further meaningful engagement with the community and other service providers in the town. The success of the competition process resulted from an emphasis on relationship building, listening to the local community and involving the community in decision‐making.So what? By conforming to established, but not always adhered to, recommendations for community consultation, successful and more enduring outcomes are likely.
A rapid cycle method for local adaptation of an obstetric emergencies training program
Authors: Ghag Kiren , Winter Cathy , Bahl Rachna , Lynch Mary , Bautista Nayda , Ilagan Rogelio , Draycott Timothy J. 
Published: February 2018

AbstractObjectiveTo describe the adaptation of an obstetric emergencies training program to align with local clinical practice.MethodsA feasibility study was conducted to investigate the potential implementation of the PRactical Obstetric Multi‐Professional Training (PROMPT) program at eight urban tertiary hospitals in the Philippines. Multi‐professional teams attended a 2‐day course on September 23 and 24, 2015, that comprised a demonstration PROMPT course (day 1) and a Train‐the‐Trainers session (day 2). During a facilitated adaptation session, each team reviewed the PROMPT algorithms for eclampsia, severe pre‐eclampsia, postpartum hemorrhage and sepsis. The teams marked steps concordant with local practice and identified differences with local practice. Suggested amendments were reviewed by the PROMPT project team, using clinical guidelines to support any adaptations.ResultsThe PROMPT algorithm for initial management of eclampsia was used as an exemplar. Five of the nine management steps were concordant with local practice: support; airway; breathing; circulation; and control seizures. Amendments were successfully implemented for the following steps: call for help; magnesium sulfate loading dose; and magnesium sulfate maintenance dose.ConclusionRapid and efficient adaptation of PROMPT training materials for use in the Philippines was possible using a facilitated and focused approach, utilizing the expertise of a representative mix of local healthcare professionals and evidence‐based guidelines.
INDUSTRIAL WATER FORECASTS
Authors: Stewart Robert H. , Metzger Ivan 
Published: February 2018

It is important for long‐term water‐resource planning to project many years into the future sometimes by as much as 50 years. Past predictions of industrial water demands have been disparate because all factors were not considered. The authors of the main article contend that there are four important factors to consider and that these factors are sufficient.A critique article by a panel of three experts appends the feature article. The panel concurs with the approach adopted in the feature article and explains that any discrepancies between results by the panel and ones by Stewart and Metzger are related only to the precision of the starting data.
Water Use, Consumption, and Outlook in the US in 1970‐Water‐Utility Manager Development
Authors: Langworthy Virgil W. 
Published: February 2018

Many managers feel that they are staying on top of new management practices. However, managers sometimes become too comfortable with old ways of doing things and really don't keep abreast of changing times. Does management know how to communicate with and develop the talents of the younger generation? Is management flexible enough to change and able enough to provide the right kind of leadership? Can potential managers be guided to their greatest potential? Modern times require that water‐utility managers use new and sometimes sophisticated techniques. Many of the practices learned by managers on their way to earning a degree years ago do not apply today. Special programs and institutes devoted to management can and will aid managers to accept changes and adapt new ideas to their individual needs. Through such programs, managers can be given a new insight into communications up and down the heirarchy; utility staffing; management systems; utility computer applications; manpower planning; and many other techniques and styles.*In the first article, the need for management programs is described. The second article discusses who the recipients of training and education should be. The third article investigates what subjects should be taught to managers. The fourth article evaluates one type of educational program. The last article describes various methods used to impart knowledge of management techniques.