bluuebunny/crossref_metadata_2025_split huggingface dataset:
South African individual retirement savings: An analysis of the social factors
Authors: Willows Gizelle Demarie 
Published: August 2019

AbstractThis study's primary aim is to determine whether members of a South African tertiary institution's retirement fund are en route to have sufficient retirement savings. Secondly, the results are analysed between different social factors namely: age, gender, race, education level, marital status, and cost of employment. Survey data and information received directly from the retirement fund were used as inputs in a customised model. This method was unique to this study, that is, it was able to consider broader circumstances other than the member's retirement savings within the fund only. Among the sample of 753 respondents, one‐third of respondents will have insufficient retirement savings and <10% will have enough. Single, younger and male respondents are most likely to have sufficient retirement savings and this is suggested to be as a result of advantageous annuity rates upon retirement. Black/African respondents were least likely to have sufficient retirement savings. Notwithstanding the racial population divide following apartheid, societal and cultural explanations speak to a culture of increased spending coupled with high financial dependency relationships. Thus, the findings provide rich information which necessitates policies which address leakage from retirement savings, appropriate defaults, and the availability of innovative and affordable savings vehicles.
First report of using low‐titer cold‐stored type O whole blood in massive postpartum hemorrhage
Authors: Bahr Timothy M. , DuPont Tara L. , Morris David S. , Pierson Spencer E. , Esplin Michael Sean , Brown Samuel M. , O'Brien Elizabeth A. , Ilstrup Sarah J. , Christensen Robert D. 
Published: August 2019

BACKGROUNDIn cases of massive hemorrhage in the US military, improved outcomes have been reported with the use of warm, fresh whole blood transfusions. Cold‐stored low‐titer type O whole blood (LTOWB) has become the preferred product for resuscitation of severe bleeding in deployed surgical units. Reports of LTOWB use in civilian trauma are becoming more frequent.CASE REPORTWe report our experience with emergency transfusion of LTOWB for a woman with massive postpartum hemorrhage. The patient had two previous cesarean section deliveries at term without complications. With her third elective cesarean section at term, blood loss during surgery was not excessive, but 3 to 4 hours later she had an estimated blood loss of 3600 mL. Despite measures to control the hemorrhage, she rapidly became hypotensive and tachycardic, and our massive transfusion protocol (MTP) was activated. The transfusion service had very recently incorporated LTOWB into Trauma Pack 1 of the MTP. She received two LTOWB units, after which her hemorrhaging ceased, blood pressure normalized, and she became alert. One hour later she received one unit of fresh frozen plasma and one unit of red blood cells (RBCs). The following morning she received one unit of crossmatched RBCs, for a hematocrit of 20.7%. She was discharged home on Day 4, and she remains healthy.CONCLUSIONSThis is the first report of which we are aware of massive postpartum hemorrhage treated using LTOWB. Our positive experience leads us to speculate that this approach could have a role in massive obstetric hemorrhage.
Ceratohyoidectomy in standing sedated horses
Authors: Racine Julien , O'Brien Thomas , Bladon Bruce M. , Cruz Antonio M. , Stoffel Michael H. , Haenssgen Kati , Rodgerson Dwayne H. , Livesey Michael A. , Koch Christoph 
Published: August 2019

AbstractObjectiveTo investigate the feasibility and complications associated with ceratohyoidectomy (CHE) in standing sedated horses unaffected (experimental horses) and standing sedated horses affected (clinical cases) with temporohyoid osteoarthropathy (THO).Study designCase series.AnimalsSix experimental horses and four clinical cases.MethodsStanding CHE was performed in six experimental horses euthanized 30 minutes (n = 3) and 7 days (n = 3) postoperatively. The four clinical cases were presented because of central facial nerve paralysis (n = 3), vestibular ataxia (n = 3), auricular hemorrhage (n = 2), quidding (n = 1), and oesophageal impaction (n = 1). Evolution was assessed by clinical examination during hospitalization and later by telephone interviews for the clinical cases.ResultsThe procedure was successfully performed in all horses. Experimental horses did not show any short‐term postoperative complications. Hemorrhage was experienced intraoperatively in one of the clinical cases and was successfully managed with placement of hemostatic forceps. Vestibular ataxia and other symptoms of THO improved within days, but facial nerve paralysis did not improve until 9 days to 6 months after surgery. Follow‐up ranged from 9 to 24 months. All clinical cases returned to performance, and client satisfaction was excellent.ConclusionCeratohyoidectomy was consistently feasible in standing sedated horses. The method did not result in postoperative complications and led to resolution of clinical signs associated with THO.Clinical significanceStanding CHE should be considered in horses affected with THO, especially when horses present with marked vestibular deficits and ataxia, to reduce risks associated with recovery from general anesthesia.
Transformative learning opportunities for students and educators during interprofessional healthcare practice experiences in higher education: Viewed through the lens of Threshold Concepts Theory
Authors: Morgan Cecile Jane , Bowmar Alexander , McNaughton Susan , Flood Brenda , O'Brien Daniel 
Published: August 2019

Introduction: The transformative nature of collaborative interprofessional learning experiences, for both students and educators, signals the importance of learning opportunities that transcend professional or disciplinary boundaries. Specifically, real-time clinical practice experiences where students and educators from a number of health professions learn with, from and about eachother, while working with patients, enables authentic interprofessional learning opportunities.Methods: This paper reports the qualitative interpretive findings from a mixed methods study on the learning experiences of students and educators from several undergraduate health and allied health programmes engaged in collaborative interprofessional practice in a university context. Interpretive thematic analysis of student and educator focus group transcripts revealed a number of transformational learning thresholds that students and educators transitioned through, over time. Findings: Transformative learning occurred through cumulative collaborative learning experiences. Interprofessional thresholds were identified as: broadening perspectives on health practice; navigating collaborative roles through interprofessional practice (IPP); interprofessional team practice through active learning/learning by doing; integrative professional practice for actioning holistic, patient-centred healthcare. Conclusion: Threshold Concepts Theory (TCT) provided both an interpretive lens for viewing the experiential learning processes that occurred during the student-led interprofessional programme and a theoretical perspective into the transformative nature of knowledge and skills acquisition and integration during interprofessional learning opportunities.
Script concordance test examinations: Student perception and study approaches
Authors: Bacchi Stephen , Tan Ian , Chim Ivana , Dabarno Matthew , Lubarsky Stuart , Duggan Paul 
Published: August 2019

Introduction: Script concordance test questions (SCTs) are a style of question that has been developed based upon the script theory of information storage and retrieval. SCTs use script theory to examine a clinical reasoning construct purported to be different from that assessed by multiple-choice questions (MCQs). Evidence regarding the construct validity of SCT is somewhat limited, but generally supportive. Methods: This project involved a content-matched MCQ and SCT practice examination delivered to senior medical students (n = 211) from a single institution with an accompanying survey regarding educational consequences of SCT and MCQ examinations. Results:Students’ responses differed significantly between how they would prepare for an MCQ examination as compared to an SCT examination. These differences were present in a number of areas, including greater focus on textbooks and use of websites for MCQ examination preparation (p < 0.001). Students reported that for an SCT examination they would benefit most from in-person teaching from local consultants involved in the process of SCT generation. Students felt that they would also benefit from further instruction regarding key elements of SCT technique, and from opportunities to provide written explanations of their reasoning during the exam. Conclusions:The results suggest that SCTs have educational consequences different from MCQs. Further research into the educational consequences of SCTs, and how these consequences may differ from that of other methods of assessment, is warranted.
Establishing and sustaining a new interprofessional allied health student placement
Authors: Foley Wendy , Fagan Amy , Liddle Karen 
Published: August 2019

Meeting the increasing demand for allied health (AH) clinical placements is challenging (McBride, Fitzgerald, Morrison, & Hulcombe, 2015), as is providing experience for AH students in authentic interprofessional practice (Copley et al., 2007). Furthermore, limited opportunities exist to develop AH students’ skills in working effectively with Indigenous clients (Hill, Nelson, Copley, Quinlan, & White, 2017), due to the low number of health professionals practising in Indigenous communities (Nelson, Shannon, & Carson, 2013; Whitford, Taylor, & Thomas, 2013). The need for paediatric AH services for developmentally-vulnerable children in the Inala Indigenous community was identified in 2014 by the Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care’s (CoE) visiting paediatrician. Children in the region are developmentally vulnerable in all domains, particularly in language and communication, where the average percentage of vulnerable children is twice that in the Queensland population and more than double the national figures (Commonwealth of Australia, 2015). In 2014, the demand for the local mainstream public child development service exceeded capacity, leading to lengthy waiting lists. With few nearby private AH practices offering paediatric services, many Inala paediatric patients were unable to access comprehensive AH assessments and care. At the time, no paediatric AH clinical services or training opportunities existed within the CoE.
Videos in the medical student objective structured clinical examination: A systematic review
Authors: Pham Huy-Dat , Pistorius Eduard Bernard , Bacchi Stephen , Jersmann Hubertus 
Published: August 2019

Introduction: The use of video in objective structured clinical examinations (OSCEs) may serve as a means of facilitating assessment, as a component of the exam itself or utilised as a tool in other ways. The aim of this review was to summarise the evidence currently supporting the uses of video in relation to the OSCE process. Methods: A systematic search of Pubmed, Medline, EMBASE, Scopus and PsychInfo was conducted on 12 April 2017 using the subject heading “(OSCE OR objective structured clinical examination) AND (video OR recording)”. To be deemed eligible, the paper had to be a primary research paper, involve the analysis of OSCEs conducted for medical students and involve the use of video technology. Results: Thirty-six articles met eligibility criteria. Twenty-four investigated the use of video within OSCEs as a means of facilitating the exam, nine detailed cases where video was integrated as a part of an OSCE and three utilised videos in some other way. Of those that investigated the use of video as a means of facilitation, only one compared the use of video to traditional in-room examiners. Other articles in this category demonstrated good inter-rater reliability between different assessors marking via video. Conclusion: There is currently limited evidence regarding the usefulness and educational benefit of introducing video into the assessment of clinical skills, and minimal research evaluating the use of video compared to traditional live examiners as a means of facilitating the assessment of students currently exists. Preliminary results demonstrated reasonably high inter-rater reliability. This should be a topic of future research.
Global warming leads to Early Triassic nutrient stress across northern Pangea
Authors: Grasby Stephen E. , Knies Jochen , Beauchamp Benoit , Bond David P.G. , Wignall Paul , Sun Yadong 
Published: August 2019

Abstract
The largest extinction in Earth history, in the latest Permian, was followed throughout most of the Early Triassic by a prolonged period of ecologic recovery. What factors delayed biotic recovery are still under debate and partly revolve around impacts of global warming on primary marine productivity. We examined N isotope records from the Festningen section on Spitsbergen, Arctic Norway, to examine changes in nutrient availability through the Early to Middle Triassic along the northern margin of Pangea. Our results show progressive decline in N availability throughout the Griesbachian, leading to severe nutrient limitations through the remainder of the Early Triassic, until returning to a highly productive continental margin in Middle Triassic time. These results are consistent with other studies from northern and western Pangea and thus show regional nutrient limitations occurred in what should have been the main zone of marine primary productivity. Such nutrient limitation likely stressed primary production and consequently contributed to prolonged marine recovery. We suggest this was driven by high ocean temperatures depressing the marine nutricline.
Balance of benefits and harms of different blood pressure targets in people with multiple chronic conditions: a quantitative benefit-harm assessment
Authors: Aschmann Hélène E , Boyd Cynthia M , Robbins Craig W , Mularski Richard A , Chan Wiley V , Sheehan Orla C , Wilson Renée F , Bennett Wendy L , Bayliss Elizabeth A , Yu Tsung , Leff Bruce , Armacost Karen , Glover Carol , Maslow Katie , Mintz Suzanne , Puhan Milo A 
Published: August 2019

ObjectiveRecent studies suggest that a systolic blood pressure (SBP) target of 120 mm Hg is appropriate for people with hypertension, but this is debated particularly in people with multiple chronic conditions (MCC). We aimed to quantitatively determine whether benefits of a lower SBP target justify increased risks of harm in people with MCC, considering patient-valued outcomes and their relative importance.DesignHighly stratified quantitative benefit-harm assessment based on various input data identified as the most valid and applicable from a systematic review of evidence and based on weights from a patient preference survey.SettingOutpatient care.ParticipantsHypertensive patients, grouped by age, gender, prior history of stroke, chronic heart failure, chronic kidney disease and type 2 diabetes mellitus.InterventionsSBP target of 120 versus 140 mm Hg for patients without history of stroke.Primary and secondary outcome measuresProbability that the benefits of a SBP target of 120 mm Hg outweigh the harms compared with 140 mm Hg over 5 years (primary) with thresholds >0.6 (120 mm Hg better), <0.4 (140 mm Hg better) and 0.4 to 0.6 (unclear), number of prevented clinical events (secondary), calculated with the Gail/National Cancer Institute approach.ResultsConsidering individual patient preferences had a substantial impact on the benefit-harm balance. With average preferences, 120 mm Hg was the better target compared with 140 mm Hg for many subgroups of patients without prior stroke, especially in patients over 75. For women below 65 with chronic kidney disease and without diabetes and prior stroke, 140 mm Hg was better. The analyses did not include mild adverse effects, and apply only to patients who tolerate antihypertensive treatment.ConclusionsFor most patients, a lower SBP target was beneficial, but this depended also on individual preferences, implying individual decision-making is important. Our modelling allows for individualised treatment targets based on patient preferences, age, gender and co-morbidities.
Outcome reporting from clinical trials of non-valvular atrial fibrillation treated with traditional Chinese medicine or Western medicine: a systematic review
Authors: Qiu Ruijin , Hu Jiayuan , Huang Ya , Han Songjie , Zhong Changming , Li Min , He Tianmai , Lin Yiyi , Guan Manke , Chen Jing , Shang Hongcai 
Published: August 2019

ObjectivesTo examine variation in outcomes, outcome measurement instruments (OMIs) and measurement times in clinical trials of non-valvular atrial fibrillation (NVAF) and to identify outcomes for prioritisation in developing a core outcome set (COS) in this field.DesignThis study was a systematic review.Data sourcesClinical trials published between January 2015 and March 2019 were obtained from PubMed, the Cochrane Library, Web of Science, Wanfang Database, the China National Knowledge Infrastructure and SinoMed.Eligibility criteriaRandomised controlled trials (RCTs) and observational studies were considered. Interventions included traditional Chinese medicine and Western medicine. The required treatment duration or follow-up time was ≥4 weeks. The required sample size was ≥30 and≥50 in each group in RCTs and observational studies, respectively. We excluded trials that aimed to investigate the outcome of complications of NVAF, to assess the mechanisms or pharmacokinetics, or for which full text could not be acquired.Data extraction and synthesisThe general information and outcomes, OMIs and measurement times were extracted. The methodological and outcome reporting quality were assessed. The results were analysed by descriptive analysis.ResultsA total of 218 articles were included from 25 255 articles. For clinical trials of antiarrhythmic therapy, 69 outcomes from 16 outcome domains were reported, and 28 (31.82%, 28/88) outcomes were reported only once; the most frequently reported outcome was ultrasonic cardiogram. Thirty-one outcomes (44.93%, 31/69) were provided definitions or OMIs; the outcome measurement times ranged from 1 to 20 with a median of 3. For clinical trials of anticoagulation therapy, 82 outcomes from 18 outcome domains were reported; 38 (29.23%, 38/130) outcomes were reported only once. The most frequently reported outcome was ischaemic stroke. Forty (48.78%, 40/82) outcomes were provided OMIs or definitions; and the outcome measurement times ranged from 1 to 27 with a median of 8.ConclusionOutcome reporting in NVAF is inconsistent. Thus, developing a COS that can be used in clinical trials is necessary.
Perspectives of non-attenders for cervical cancer screening in Norway: a qualitative focus group study
Authors: Aasbø Gunvor , Solbrække Kari Nyheim , Waller Jo , Tropé Ameli , Nygård Mari , Hansen Bo Terning 
Published: August 2019

ObjectiveThe attendance rate for cervical cancer screening in Norway is currently suboptimal at 69%, and an in-depth understanding of postponement of cervical cancer screening from the perspective of non-attenders is lacking. This study aims to generate knowledge about how non-attenders for cervical cancer screening reflect on booking a screening appointment.MethodsUsing the Norwegian cervical cancer screening registry, we identified and recruited women who were non-attenders to screening. Nine focus group interviews were carried out, with 41 women participating in the interviews.ResultsFour main themes were generated, which provide a comprehensive understanding of how women who are overdue for screening reflect on their hesitancy to book a screening appointment: ‘It’s easy to forget about it’, ‘Women have to arrange their own appointment’, ‘It has to be a ‘must’’ and ‘It’s a humiliating situation’.ConclusionThe degree to which women regard screening as important is affected by the nudging strategies employed in the screening programme and the facilitation of attendance provided by healthcare services. Dependence on one’s personal initiative to schedule a screening appointment and perception of a lack of responsibility on the part of healthcare services to attend screening may undermine informed and shared decision-making about screening attendance.
Soft clustering using real-world data for the identification of multimorbidity patterns in an elderly population: cross-sectional study in a Mediterranean population
Authors: Violán Concepción , Foguet-Boreu Quintí , Fernández-Bertolín Sergio , Guisado-Clavero Marina , Cabrera-Bean Margarita , Formiga Francesc , Valderas Jose Maria , Roso-Llorach Albert 
Published: August 2019

ObjectivesThe aim of this study was to identify, with soft clustering methods, multimorbidity patterns in the electronic health records of a population ≥65 years, and to analyse such patterns in accordance with the different prevalence cut-off points applied. Fuzzy cluster analysis allows individuals to be linked simultaneously to multiple clusters and is more consistent with clinical experience than other approaches frequently found in the literature.DesignA cross-sectional study was conducted based on data from electronic health records.Setting284 primary healthcare centres in Catalonia, Spain (2012).Participants916 619 eligible individuals were included (women: 57.7%).Primary and secondary outcome measuresWe extracted data on demographics, International Classification of Diseases version 10 chronic diagnoses, prescribed drugs and socioeconomic status for patients aged ≥65. Following principal component analysis of categorical and continuous variables for dimensionality reduction, machine learning techniques were applied for the identification of disease clusters in a fuzzy c-means analysis. Sensitivity analyses, with different prevalence cut-off points for chronic diseases, were also conducted. Solutions were evaluated from clinical consistency and significance criteria.ResultsMultimorbidity was present in 93.1%. Eight clusters were identified with a varying number of disease values:nervous and digestive; respiratory, circulatory and nervous; circulatory and digestive; mental, nervous and digestive, female dominant; mental, digestive and blood, female oldest-old dominant; nervous, musculoskeletal and circulatory, female dominant; genitourinary, mental and musculoskeletal, male dominant; andnon-specified, youngest-old dominant. Nuclear diseases were identified for each cluster independently of the prevalence cut-off point considered.ConclusionsMultimorbidity patterns were obtained using fuzzy c-means cluster analysis. They are clinically meaningful clusters which support the development of tailored approaches to multimorbidity management and further research.