bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quick and dirty? A systematic review of the use of rapid ethnographies in healthcare organisation and delivery
Authors: Vindrola-Padros Cecilia , Vindrola-Padros Bruno 
Published: September 2018

BackgroundThe ability to capture the complexities of healthcare practices and the quick turnaround of findings make rapid ethnographies appealing to the healthcare sector, where changing organisational climates and priorities require actionable findings at strategic time points. Despite methodological advancement, there continue to be challenges in the implementation of rapid ethnographies concerning sampling, the interpretation of findings and management of field research. The purpose of this review was to explore the benefits and challenges of using rapid ethnographies to inform healthcare organisation and delivery and identify areas that require improvement.MethodsThis was a systematic review of the literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We used the Mixed Methods Appraisal Tool to assess the quality of the articles. We developed the search strategy using the Population, Intervention, Comparison, Outcomes, Settingframework and searched for peer-reviewed articles in MEDLINE, CINAHL PLUS, Web of Science and ProQuest Central. We included articles that reported findings from rapid ethnographies in healthcare contexts or addressing issues related to health service use.Results26 articles were included in the review. We found an increase in the use of rapid ethnographies in the last 2‰years. We found variability in terminology and developed a typology to clarify conceptual differences. The studies generated findings that could be used to inform policy and practice. The main limitations of the studies were: the poor quality of reporting of study designs, mainly data analysis methods, and lack of reflexivity.ConclusionsRapid ethnographies have the potential to generate findings that can inform changes in healthcare practices in a timely manner, but greater attention needs to be paid to the reflexive interpretation of findings and the description of research methods.Trial registration numberCRD42017065874.
Anticholinergic drug use and cognitive performances in middle age: findings from the CONSTANCES cohort
Authors: Ziad Abdelkrim , Olekhnovitch Romain , Ruiz Fabrice , Berr Claudine , Bégaud Bernard , Goldberg Marcel , Zins Marie , Mura Thibault 
Published: September 2018

BackgroundPrevious studies have shown associations between the use of anticholinergics (AC) and cognitive performance in the elderly, considering AC as a homogeneous set of drugs. The present study aims to assess the relationship between exposure to AC drugs and cognitive performance in middle-aged adults according to AC potency and drug class.MethodsOur cross-sectional study used baseline data of 34 267 participants aged 45–70 from the Consultants des centres d’examen de santé de la sécurité sociale (CONSTANCES) cohort. The cumulative exposure to AC was measured using national reimbursement databases over the 3-year period preceding assessment of cognitive performance. Eight classes of AC drugs were differentiated. Episodic verbal memory, language abilities and executive functions were evaluated by validated neuropsychological tests. Analyses were controlled on lifestyle and health status variables.ResultsThis study showed a negative association between overall cumulative AC exposure and cognitive performances after adjustment. The use of drugs with possible AC effect according to the Anticholinergic Cognitive Burden scale (ACB-1 score) was only associated with executive functions. Analyses of AC exposure across drug classes showed a negative association between the use of AC antipsychotics and all cognitive functions assessed. Heterogeneous associations were found for the use of AC anxiolytics, AC opioids and AC drugs targeting the gastrointestinal tract or metabolism. We did not find significant associations between the use of antihistamines, antidepressants, cardiovascular system or other AC medications and cognitive function.ConclusionAssociation between AC drugs and cognitive performance was highly heterogeneous across drug classes; this heterogeneity will have to be considered by future studies.
Development of clinically apparent synovitis: a longitudinal study at the joint level during progression to inflammatory arthritis
Authors: ten Brinck Robin M , van Steenbergen Hanna W , van der Helm-van Mil Annette H M 
Published: September 2018

IntroductionSubclinical inflammation, detected by MRI, in patients with arthralgia is predictive for development of inflammatory arthritis (IA). However, within patients that develop IA, the course of inflammation at the joint level during this transition is unknown. This longitudinal study assessed progression of inflammation at the joint level.Methods350 joints (unilateral metacarpophalangeals (MCPs), wrist, metatarsophalangeal (MTP) joints) of 35 patients presenting with clinically suspect arthralgia (CSA) that progressed to IA were studied at presentation with CSA and subsequently when clinical synovitis was first identified at joint examination (median time interval 17 weeks). At both time points, subclinical inflammation (bone marrow oedema, synovitis, tenosynovitis) was evaluated with MRI and joint examination was performed.ResultsAt presentation with CSA, 71 joints showed subclinical inflammation. During progression to IA, 20% of these joints had resolution of inflammation, 60% had persistent inflammation and 20% progressed to clinical synovitis. Of all joints that had developed clinical synovitis (n = 45), no prior subclinical inflammation was detected in 69%. Similar results were observed for anticitrullinated protein antibodies (ACPA)-positive and ACPA-negative patients.ConclusionsThis longitudinal study demonstrated moderate correlations between joints with subclinical inflammation and joints that developed clinical synovitis. These data imply that IA development is a more systemic rather than a locally outgrowing process.
Chinese Stroke Center Alliance: a national effort to improve healthcare quality for acute stroke and transient ischaemic attack: rationale, design and preliminary findings
Authors: Wang Yongjun , Li Zixiao , Wang Yilong , Zhao Xingquan , Liu Liping , Yang Xin , Wang Caiyun , Gu Hongqiu , Zhang Fuying , Wang Chunjuan , Xian Ying , Wang David Z , Dong Qiang , Xu Anding , Zhao Jizong 
Published: September 2018

BackgroundIn June 2015, the Chinese Stroke Association (CSA) initiated the Chinese Stroke Center Alliance (CSCA) to establish the national hospital-based stroke care quality assessment and improvement platform. This article outlines its objectives, operational structure, patient population, quality improvement (QI) intervention tools, data elements, data collection methodology and current patient and hospital data.MethodsThe CSCA is a national, hospital-based, multicentre, voluntary, multifaceted intervention and continuous QI initiative. This multifaceted intervention includes stroke centre development, written care protocols, workshops and a monitoring/feedback system of evidence-based performance measures. The data coordinating centre of the CSCA resides at the China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital.ResultsAs of July 2017, 1576 hospitals in China have contributed detailed clinical information to serve as a benchmark for the stroke care quality of 433 264 patients with acute stroke/transient ischaemic attacks (TIA), including 352 572 (81.38%) acute ischaemic stroke, 30 362 (7.01%) TIA, 42 080 (9.71%) spontaneous intracranial haemorrhage, 5505 (1.27%) subarachnoid haemorrhage and 2745 (0.63%) not specified stroke.ConclusionThe CSCA programme is designed to establish a continuous national stroke registry and help healthcare providers develop stroke centres and treat patients in a consistent manner in accordance with accepted national guidelines and, ultimately, improve patient outcomes. It supports the CSA mission to reduce stroke burden in China.
Assessment of the intermediate care unit triage system
Authors: Plate Joost D J , Peelen Linda M , Leenen Luke P H , Houwert R Marijn , Hietbrink Falco 
Published: September 2018

BackgroundAn important critique with respect to the utilization of intermediate care units (IMCU) is that they potentially admit patients who would otherwise be cared for on the regular ward. This would lead to an undesired waste of critical care resources. This article aims to (1) describe the caseload at the IMCU and (2) to assess the triage system at the IMCU to determine potentially unnecessary admissions.MethodsThis cohort study included all admissions at the mixed-surgical IMCU from 2001 to 2015. The Therapeutic Intervention Scoring System-28 (TISS-28) was prospectively collected for all admissions to describe the caseload at the IMCU and to identify medical criteria for admission. These were combined with logistical criteria to assess the IMCU triage system.ResultsA total of 8816 admissions were included in the study. The average TISS-28 was 20.19 (95% CI 18.05 to 22.33), corresponding with 3.57 (95% CI 3.19 to 3.94) hours of direct patient-related work per patient per nursing shift. Over time, this increased by an average of 0.27 points/year (p<0.001). Of all admissions, 6539 (74.2%) were medically considered to be justly admitted, and 7093 (80.4%) were logistically considered to be justly admitted. With these criteria combined, a total of 8324 (94.4%) were correctly admitted.DiscussionMost admissions to the IMCU are medically and/or logistically necessary, as the majority of admitted patients demand a higher level of nursing care than available on the general ward. Continuous triage is thereby essential. These findings support further utilization of the IMCU in our current healthcare system and has important implications for IMCU-related management decisions.Level of evidenceLevel VI.
Morning report decreases length of stay in trauma patients
Authors: Wolfe John D , Gardner James R , Beck William C , Taylor John R , Bhavaraju Avi , Davis Ben , Kimbrough Mary Katherine , Robertson Ronald D , Karim Saleema A , Sexton Kevin W 
Published: September 2018

BackgroundModern acute care surgery (ACS) programs depend on consistent patient hand-offs to facilitate care, as most programs have transitioned to shift-based coverage. We sought to determine the impact of implementing a morning report (MR) model on patient outcomes in the trauma service of a tertiary care center.MethodsThe University of Arkansas for Medical Sciences (UAMS) Division of ACS implemented MR in October 2015, which consists of the trauma day team, the emergency general surgery day team, and a combined night float team. This study queried the UAMS Trauma Registry and the Arkansas Clinical Data Repository for all patients meeting the National Trauma Data Bank inclusion criteria from January 1, 2011 to April 30, 2018. Bivariate frequency statistics and generalized linear model were run using STATA V.14.2ResultsA total of 11 253 patients (pre-MR, n=6556; post-MR, n=4697) were analyzed in this study. The generalized linear model indicates that implementation of MR resulted in a significant decrease in length of stay (LOS) in trauma patients.DiscussionThis study describes an approach to improving patient outcomes in a trauma surgery service of a tertiary care center. The data show how an MR session can allow for patients to get out of the hospital faster; however, broader implications of these sessions have yet to be studied. Further work is needed to describe the decisions being made that allow for a decreased LOS, what dynamics exist between the attendings and the residents in these sessions, and if these sessions can show some of the same benefits in other surgical services.Level of evidenceLevel 4, Care Management.
Defining severe traumatic brain injury readmission rates and reasons in a rural state
Authors: Gardner James , Sexton Kevin W , Taylor John , Beck William , Kimbrough Mary Katherine , Davis Ben , Bhavaraju Avi , Karim Saleema , Porter Austin 
Published: September 2018

BackgroundReadmissions after a traumatic brain injury (TBI) have significant impact on long-term patient outcomes through interruption of rehabilitation. This study examined readmissions in a rural population, hypothesizing that readmitted patients after TBI will be older and have more comorbidities than those not readmitted.MethodsDischarge data on all patients 15 years and older who were admitted to an Arkansas-based hospital for TBI were obtained from the Arkansas Hospital Discharge Data System from 2010 to 2014. This data set includes diagnoses (principal discharge diagnosis, up to 3 external cause of injury codes, 18 diagnosis codes using the International Classification of Disease, 9th Edition, Clinical Modifications), age, gender, and inpatient costs. Hospital Cost and Utilization Project Clinical Classification and Chronic Condition Indicator were used to identify chronic disease and body systems affected in principal diagnosis.ResultsOf the 3114 cases of significant head trauma, more than two-thirds were attributed to fall injuries, with motor vehicle crashes accounting for 20% of the remainder. The mean length of stay was 6.5 days. 691 of these patients were admitted to an Arkansas hospital in the following year, totaling 1368 readmissions. Of the readmissions, 16.4% of patients were admitted for altered mental status, 12.9% with shortness of breath (SOB), and 9.4% with chest pain. Mental disorders (psychosis, dementia, and depression) and organic nervous symptoms (Alzheimer’s disease, encephalopathy, and epilepsy) were the primary source of readmissions. More than one-third of the patients were admitted in the following year for chronic diseases such as heart failure (8.6%), psychosis (5.2%), and cerebral artery occlusion (4.1%).DiscussionThis study showed that there is a significant rate of readmissions in the year after a diagnosis of TBI. Complications with existing chronic diseases are among the most reported reasons for admission in this time period, demonstrating the effect severe head trauma has on long-term treatment.Level of evidenceLevel IV, Retrospective epidemiological study.
Relative sensitivity of explicit reaiming and implicit motor adaptation
Authors: Hutter Sarah A. , Taylor Jordan A. 
Published: September 2018

It has become increasingly clear that learning in visuomotor rotation tasks, which induce an angular mismatch between movements of the hand and visual feedback, largely results from the combined effort of two distinct processes: implicit motor adaptation and explicit reaiming. However, it remains unclear how these two processes work together to produce trial-by-trial learning. Previous work has found that implicit motor adaptation operates automatically, regardless of task relevance, and saturates for large errors. In contrast, little is known about the automaticity of explicit reaiming and its sensitivity to error magnitude. Here we sought to characterize the automaticity and sensitivity function of these two processes to determine how they work together to facilitate performance in a visuomotor rotation task. We found that implicit adaptation scales relative to the visual error but only for small perturbations—replicating prior work. In contrast, explicit reaiming scales linearly for all tested perturbation sizes. Furthermore, the consistency of the perturbation appears to diminish both implicit adaptation and explicit reaiming, but to different degrees. Whereas implicit adaptation always displayed a response to the error, explicit reaiming was only engaged when errors displayed a minimal degree of consistency. This comports with the idea that implicit adaptation is obligatory and less flexible, whereas explicit reaiming is volitional and flexible. NEW & NOTEWORTHY This paper provides the first psychometric sensitivity function for explicit reaiming. Additionally, we show that the sensitivities of both implicit adaptation and explicit reaiming are influenced by consistency of errors. The pattern of results across two experiments further supports the idea that implicit adaptation is largely inflexible, whereas explicit reaiming is flexible and can be suppressed when unnecessary.
Vestibular and corticospinal control of human body orientation in the gravitational field
Authors: Zhang Lei , Feldman Anatol G. , Levin Mindy F. 
Published: September 2018

Body orientation with respect to the direction of gravity changes when we lean forward from upright standing. We tested the hypothesis that during upright standing, the nervous system specifies the referent body orientation that defines spatial thresholds for activation of multiple muscles across the body. To intentionally lean the body forward, the system is postulated to transfer balance and stability to the leaned position by monotonically tilting the referent orientation, thus increasing the activation thresholds of ankle extensors and decreasing their activity. Consequently, the unbalanced gravitational torque would start to lean the body forward. With restretching, ankle extensors would be reactivated and generate increasing electromyographic (EMG) activity until the enhanced gravitational torque would be balanced at a new posture. As predicted, vestibular influences on motoneurons of ankle extensors evaluated by galvanic vestibular stimulation were smaller in the leaned compared with the upright position, despite higher tonic EMG activity. Defacilitation of vestibular influences was also observed during forward leaning when the EMG levels in the upright and leaned position were equalized by compensating the gravitational torque with a load. The vestibular system is involved in the active control of body orientation without directly specifying the motor outcome. Corticospinal influences originating from the primary motor cortex evaluated by transcranial magnetic stimulation remained similar at the two body postures. Thus, in contrast to the vestibular system, the corticospinal system maintains a similar descending facilitation of motoneurons of leg muscles at different body orientations. The study advances the understanding of how body orientation is controlled.NEW & NOTEWORTHY The brain changes the referent body orientation with respect to gravity to lean the body forward. Physiologically, this is achieved by shifts in spatial thresholds for activation of ankle muscles, which involves the vestibular system. Results advance the understanding of how the brain controls body orientation in the gravitational field. The study also extends previous evidence of empirical control of motor function, i.e., without the reliance on model-based computations and direct specification of motor outcome.
Stromal Fibroblasts Mediate Anti–PD-1 Resistance via MMP-9 and Dictate TGFβ Inhibitor Sequencing in Melanoma
Authors: Zhao Fei , Evans Kathy , Xiao Christine , DeVito Nicholas , Theivanthiran Balamayooran , Holtzhausen Alisha , Siska Peter J. , Blobe Gerard C. , Hanks Brent A. 
Published: September 2018

Abstract
Although anti–PD-1 therapy has improved clinical outcomes for select patients with advanced cancer, many patients exhibit either primary or adaptive resistance to checkpoint inhibitor immunotherapy. The role of the tumor stroma in the development of these mechanisms of resistance to checkpoint inhibitors remains unclear. We demonstrated that pharmacologic inhibition of the TGFβ signaling pathway synergistically enhanced the efficacy of anti–CTLA-4 immunotherapy but failed to augment anti–PD-1/PD-L1 responses in an autochthonous model of BRAFV600E melanoma. Additional mechanistic studies revealed that TGFβ pathway inhibition promoted the proliferative expansion of stromal fibroblasts, thereby facilitating MMP-9–dependent cleavage of PD-L1 surface expression, leading to anti–PD-1 resistance in this model. Further work demonstrated that melanomas escaping anti–PD-1 therapy exhibited a mesenchymal phenotype associated with enhanced TGFβ signaling activity. Delayed TGFβ inhibitor therapy, following anti–PD-1 escape, better served to control further disease progression and was superior to a continuous combination of anti–PD-1 and TGFβ inhibition. This work illustrates that formulating immunotherapy combination regimens to enhance the efficacy of checkpoint blockade requires an in-depth understanding of the impact of these agents on the tumor microenvironment. These data indicated that stromal fibroblast MMP-9 may desensitize tumors to anti–PD-1 and suggests that TGFβ inhibition may generate greater immunologic efficacy when administered following the development of acquired anti–PD-1 resistance.
See related Spotlight on p. 1444
Structural Investigation into Poly-p-phenylenebenzobisoxazole Fibres
Authors: Sharma L. , Mizoo O. , Pezzotti G. 
Published: September 2018

Poly-p-phenylenebenzobisoxazole, Zylon™, is a fibre with numerous applications in the aerospace and sports (sail cloth, ski poles and tennis racquets) industries and was developed by the Toyobo Company in Japan. It is a lightweight material having higher tensile modulus and strength than graphite. From Raman nanostress mappings, using high resolution Raman piezospectroscopy, HRRP and electron microscopy, we have attempted to determine the structural changes occurring in two poly-p-phenylenebenzobisoxazole fibres prepared under different processing conditions. Fibre A was coagulated in aqueous phosphoric acid and fibre B was produced by heat treating fibre A at 650 °C under 0.7 GPa tension. We reveal the ordered and disordered morphology relating this to (probable) liquid crystal formation.
Solution Rheology of Poly(vinyl alcohol)/Silica Hybrid Nanocomposites
Authors: Bandyopadhyay Abhijit , De Sarkar Mousumi , Bhowmick Anil K. 
Published: September 2018

The solution behavior of polymer/silica hybrid nanocomposites was investigated using a Brookfield viscometer. The nanocomposites were prepared using the sol-gel technique with tetraethoxysilane (TEOS) as the precursor for silica. The sol-gel reaction was carried out in the pH range of 1.0-2.0, which was maintained by the addition of concentrated HCl. Poly (vinyl alcohol) (PVA)/silica nanocomposites demonstrated a bigger rise in solution viscosity after continuous measurement for five days than either- acrylic rubber (ACM)/silica or epoxidised natural rubber (ENR)/silica nanocomposites. Detailed investigation of the PVA/silica system indicated that it exhibited Newtonian behaviour when the solutions contained (5 or 7.5 wt% of PVA,) even when increasing the TEOS concentration to 50 wt%, although at one particular TEOS concentration (10 wt%), the nanocomposite was pseudoplastic when the concentration of PVA was increased to 10 wt%. The reinforcement factor [Formula: see text] for those PVA/silica hybrid nanocomposites containing 5 wt% of PVA deviated strongly from the Guth-Smallwood prediction. Instead they obeyed a relationship of the type ηmax = η0(1 + aϕb), where a = 4.45 and b = 0.38, calculated for this system. The viscosity decreased with increasing temperature for both PVA and the representative nanocomposite with 30 wt% TEOS (PVA30), although the activation energy for flow of the nanocomposite did not vary to a great extent.