bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient‐Centered Insights: Using Health Care Complaints to Reveal Hot Spots and Blind Spots in Quality and Safety
Authors: GILLESPIE ALEX , READER TOM W. 
Published: September 2018

Policy Points:Health care complaints contain valuable data on quality and safety; however, there is no reliable method of analysis to unlock their potential.We demonstrate a method to analyze health care complaints that provides reliable insights on hot spots (where harm and near misses occur) and blind spots (before admissions, after discharge, systemic and low‐level problems, and errors of omission).Systematic analysis of health care complaints can improve quality and safety by providing patient‐centered insights that localize issues and shed light on difficult‐to‐monitor problems.ContextThe use of health care complaints to improve quality and safety has been limited by a lack of reliable analysis tools and uncertainty about the insights that can be obtained. The Healthcare Complaints Analysis Tool, which we developed, was used to analyze a benchmark national data set, conceptualize a systematic analysis, and identify the added value of complaint data.MethodsWe analyzed 1,110 health care complaints from across England. “Hot spots” were identified by mapping reported harm and near misses onto stages of care and underlying problems. “Blind spots” concerning difficult‐to‐monitor aspects of care were analyzed by examining access and discharge problems, systemic problems, and errors of omission.FindingsThe tool showed moderate to excellent reliability. There were 1.87 problems per complaint (32% clinical, 32% relationships, and 34% management). Twenty‐three percent of problems entailed major or catastrophic harm, with significant regional variation (17%‐31%). Hot spots of serious harm were safety problems during examination, quality problems on the ward, and institutional problems during admission and discharge. Near misses occurred at all stages of care, with patients and family members often being involved in error detection and recovery. Complaints shed light on 3 blind spots: (1) problems arising when entering and exiting the health care system; (2) systemic failures pertaining to multiple distributed and often low‐level problems; and (3) errors of omission, especially failure to acknowledge and listen to patients raising concerns.ConclusionsThe analysis of health care complaints reveals valuable and uniquely patient‐centered insights on quality and safety. Hot spots of harm and near misses provide an alternative data source on adverse events and critical incidents. Analysis of entry‐exit, systemic, and omission problems provides insight on blind spots that may otherwise be difficult to monitor. Benchmark data and analysis scripts are downloadable as supplementary files.
POLICE CULTURE AND OFFICER BEHAVIOR: APPLICATION OF A MULTILEVEL FRAMEWORK
Authors: INGRAM JASON R. , TERRILL WILLIAM , PAOLINE EUGENE A. 
Published: September 2018

AbstractAlthough recent advancements have been made in the understanding and studying of police culture, several significant gaps remain, including deficiencies in theoretical development and the lack of research on culture's influence on police practice. In the current study, we apply a multilevel theoretical framework to the examination of officers’ cultural attitudes and behavior to help bridge these gaps. In doing so, police culture is treated as a collective feature of patrol groups as opposed to as an individual‐level attribute. Furthermore, we extend previous work by introducing the concept of culture strength as a moderator of the culture–behavior relationship. After drawing on survey and behavioral data from a national multimethod project, we then test this framework with two empirical examples from each of the primary work environments (i.e., street and organization) in which police culture originates and operates. The findings reveal that workgroup culture is associated with officers’ behaviors, representing a collective effect, and that the relationship between culture and behavior may not always be linear. The results provide support for incorporating a multilevel approach to the study of police culture and officer behavior.
neogen: A tool to predict genetic effective population size (Ne) for species with generational overlap and to assist empirical Ne study design
Authors: Blower Dean C. , Riginos Cynthia , Ovenden Jennifer R. 
Published: September 2018

AbstractMolecular genetic estimates of population effective size (Ne) lose accuracy and precision when insufficient numbers of samples or loci are used. Ideally, researchers would like to forecast the necessary power when planning their project. neogen (genetic Ne for Overlapping Generations) enables estimates of precision and accuracy in advance of empirical investigation and allows exploration of the power available in different user‐specified age‐structured sampling schemes. neogen provides a population simulation and genetic power analysis framework that simulates the demographics, genetic composition, and Ne, from species‐specific life history, mortality, population size, and genetic priors. neogen guides the user to establish a tractable sampling regime and to determine the numbers of samples and microsatellite or SNP loci required for accurate and precise genetic Ne estimates when sampling a natural population. neogen is useful at multiple stages of a study's life cycle: when budgeting, as sampling and locus development progresses, and for corroboration when empirical Ne estimates are available. The underlying model is applicable to a wide variety of iteroparous species with overlapping generations (e.g., mammals, birds, reptiles, long‐lived fishes). In this paper, we describe the neogen model, detail the workflow for the point‐and‐click software, and explain the graphical results. We demonstrate the use of neogen with empirical Australian east coast zebra shark (Stegostoma fasciatum) data. For researchers wishing to make accurate and precise genetic Ne estimates for overlapping generations species, neogen facilitates planning for sample and locus acquisition, and with existing empirical genetic Ne estimates neogen can corroborate population demographic and life history properties.
Characteristics and prescribing practices of clinicians recently waivered to prescribe buprenorphine for the treatment of opioid use disorder
Authors: Jones Christopher M. , McCance‐Katz Elinore F. 
Published: September 2018

AbstractBackground and AimsExpanding access to medication‐assisted treatment with buprenorphine is a cornerstone of the opioid crisis response, yet buprenorphine remains underutilized. Research has identified multiple barriers to prescribing buprenorphine. This study aimed to examine clinician characteristics, prescribing practices and barriers and incentives to prescribing buprenorphine among clinicians with a federal Drug Addiction Treatment Act of 2000 (DATA) waiver to prescribe buprenorphine for opioid use disorder treatment.DesignElectronic survey of 4225 clinicians conducted between March and April 2018.SettingUnited States.ParticipantsClinicians obtaining an initial federal DATA waiver or an increase in authorized patient limit to prescribe buprenorphine for opioid use disorder treatment in 2017.MeasurementsDescriptive statistics and multivariable logistic regression examined clinician characteristics, prescribing practices and primary barriers and incentives to prescribing buprenorphine or prescribing at or near the authorized patient limit.FindingsAmong respondents, 75.5% had prescribed buprenorphine since obtaining a DATA waiver; the mean (standard deviation) number of patients treated in the past month was 26.6 (40.3), and 13.1% of providers were prescribing at or near their patient limit in the past month. Lack of patient demand, cited by 19.4% of clinicians, was the most common primary barrier to prescribing buprenorphine or prescribing to the authorized patient limit, followed by time constraints in practice (14.6%) and insurance reimbursement, prior authorization or other insurance requirements (13.2%). Increased patient demand (22.2%), institutional support for buprenorphine treatment (12.5%) and increased reimbursement (12.2%) were the most endorsed primary incentives for buprenorphine prescribing. Multivariable logistic regression models identified multiple clinician characteristics associated with buprenorphine prescribing and prescribing at or near the authorized patient limit.ConclusionsUS clinicians recently waivered to prescribe buprenorphine for opioid use disorder treatment appear to prescribe well below their patient limit, and many do not prescribe at all.
Estimating the benefits of public plant breeding: beyond profits
Authors: Shew Aaron Michael , Durand‐Morat Alvaro , Nalley Lawton Lanier , Moldenhauer Karen Ann‐Kuenzel 
Published: September 2018

AbstractIn this study, we estimate increases in producer revenue, total exports, and welfare effects from the genetic gains of the rice breeding program at the University of Arkansas System (UofA) Division of Agriculture from 1983 to 2016. Rice producers are paid based on both the quantity and quality of rice. Therefore, we implement a cluster‐specific fixed‐effects model based on location and year to identify the contributions of the UofA breeding program for both paddy yields (quantity) and head rice yields (quality attribute) over time. Additionally, the estimated increased yield was imputed into the RiceFlow trade model to estimate price and export effects. Including spillover benefits from UofA varieties, we find that on average U.S. rice producers gain 30.9 million USD annually. The expansion of U.S. long grain rice exports facilitated by the UofA is estimated to be 53,000 milled metric tons annually, which is enough to lower rice prices by over 1% in low‐income countries such as Haiti, Panama, and Nicaragua. Overall, the public breeding program at the UofA contributes to (1) positive genetic gains, (2) additional revenue in the Mid‐South, and (3) increased trade between the U.S. and rice‐consuming countries.
Pilot study shows right ventricular diastolic function impairment in young children with obstructive respiratory disease
Authors: Manti S , Parisi G F , Giacchi V , Sciacca P , Tardino L , Cuppari C , Salpietro C , Chikermane A , Leonardi S 
Published: September 2018

AbstractAimThis study determined cardiovascular impairment in young children with obstructive respiratory disease who were assessed using the opening interrupter technique (RINT).MethodsThis pilot study enrolled 41 children who had been referred to pulmonology and allergology specialists at the University of Catania, Italy, from March to July 2017: 23 (mean age 4.13 ± 0.62 years) had chronic coughs and wheezing and 18 controls (mean age 4.27 ± 0.66 years) had obstructive chest disease, but were otherwise healthy. Airway resistance was evaluated using RINT and cardiac function by studying the ejection fraction, pulmonary artery systolic pressure (PASP), tricuspid annular plane systolic excursion and tricuspid flow propagation velocity (TFPV).ResultsThe RINT and PASP values were significantly higher in the patient group when compared to the controls, but the TFPV values were lower. A direct and significant Spearman's correlation coefficient (r) between RINT and PASP values was observed (r = 0.81). We found a significant inverse correlation between RINT and TFPV (r = −0.83), as well as TFPV and PASP (r = −0.78).ConclusionThis study showed that children with obstructive respiratory diseases had a major risk of cardiovascular impairment. Impaired diastolic function of the right ventricle occurred very early when airway resistance was abnormally increased.
Review article: an analysis of safety profiles of treatments for diarrhoea‐predominant irritable bowel syndrome
Authors: Lacy Brian E. 
Published: September 2018

SummaryBackgroundIrritable bowel syndrome (IBS) is multifactorial in nature, and a wide range of therapies is available to manage symptoms of this common disorder.AimTo provide an overview of the safety of interventions that may be used to manage patients with diarrhoea‐predominant IBS (IBS‐D).MethodsMedline and Embase database searches (through 02 May 2018) to identify clinical studies that evaluated treatment safety and/or efficacy in adults with IBS‐D.ResultsIBS‐D treatments include dietary modification, probiotics, serotonin receptor antagonists, opioid receptor agonists and antagonists, nonsystemic antibiotics, bile acid sequestrants, antidepressants, and complementary and alternative therapies. These treatments vary in administration frequency (eg, daily; short‐course therapy) and target various pathophysiologic factors. Safety profiles vary considerably by treatment among IBS‐D therapies. The number needed to harm (defined as the number of patients treated to encounter an adverse event) was lowest (worse) for antidepressants (8.5) and highest (best) for probiotics (35), and the number needed to harm (defined as the number of patients who discontinued due to an adverse event) was lowest for tricyclic antidepressants (9) and highest for rifaximin (8971). Notable safety concerns with IBS‐D treatments include pancreatitis with eluxadoline, ischaemic colitis and serious complications of constipation with alosetron, and cardiac adverse events with loperamide and tricyclic antidepressants. Treatment decisions need to account for medication risks and adverse events for each patient.ConclusionsMultiple treatment options are now available for patients with IBS‐D. However, the safety profiles of these agents vary widely by number needed to harm value. Providers should consider both safety and efficacy of a specific intervention when determining how best to manage patients’ IBS‐D symptoms.
Vegetation on mesic loamy and sandy soils along a 1700‐km maritime Eurasia Arctic Transect
Authors: Walker Donald A. , Epstein Howard E. , Šibík Jozef , Bhatt Uma , Romanovsky Vladimir E. , Breen Amy L. , Chasníková Silvia , Daanen Ronald , Druckenmiller Lisa A. , Ermokhina Ksenia , Forbes Bruce C. , Frost Gerald V. , Geml Jozsef , Kaärlejarvi Elina , Khitun Olga , Khomutov Artem , Kumpula Timo , Kuss Patrick , Matyshak Georgy , Moskalenko Natalya , Orekhov Pavel , Peirce Jana , Raynolds Martha K. , Timling Ina 
Published: September 2018

AbstractQuestionsHow do plant communities on zonal loamy vs. sandy soils vary across the full maritime Arctic bioclimate gradient? How are plant communities of these areas related to existing vegetation units of the European Vegetation Classification? What are the main environmental factors controlling transitions of vegetation along the bioclimate gradient?Location1700‐km Eurasia Arctic Transect (EAT), Yamal Peninsula and Franz Josef Land (FJL), Russia.MethodsThe Braun‐Blanquet approach was used to sample mesic loamy and sandy plots on 14 total study sites at six locations, one in each of the five Arctic bioclimate subzones and the forest–tundra transition. Trends in soil factors, cover of plant growth forms (PGFs) and species diversity were examined along the summer warmth index (SWI) gradient and on loamy and sandy soils. Classification and ordination were used to group the plots and to test relationships between vegetation and environmental factors.ResultsClear, mostly non‐linear, trends occurred for soil factors, vegetation structure and species diversity along the climate gradient. Cluster analysis revealed seven groups with clear relationships to subzone and soil texture. Clusters at the ends of the bioclimate gradient (forest–tundra and polar desert) had many highly diagnostic taxa, whereas clusters from the Yamal Peninsula had only a few. Axis 1 of a DCA was strongly correlated with latitude and summer warmth; Axis 2 was strongly correlated with soil moisture, percentage sand and landscape age.ConclusionsSummer temperature and soil texture have clear effects on tundra canopy structure and species composition, with consequences for ecosystem properties. Each layer of the plant canopy has a distinct region of peak abundance along the bioclimate gradient. The major vegetation types are weakly aligned with described classes of the European Vegetation Checklist, indicating a continuous floristic gradient rather than distinct subzone regions. The study provides ground‐based vegetation data for satellite‐based interpretations of the western maritime Eurasian Arctic, and the first vegetation data from Hayes Island, Franz Josef Land, which is strongly separated geographically and floristically from the rest of the gradient and most susceptible to on‐going climate change.
The influence of heart failure on the pharmacokinetics of cardiovascular and non‐cardiovascular drugs: a critical appraisal of the evidence
Authors: Mangoni Arduino A. , Jarmuzewska Elzbieta A. 
Published: September 2018

AbstractPrescribing in heart failure (HF), a common disease state that predominantly affects the older population, is often a challenging task because of the dynamic nature of the condition, requiring frequent monitoring and medication review, the presence of various comorbidities, and the frailty phenotype of many patients. The significant alterations in various organs and tissues occurring in HF, particularly the reduced cardiac output with peripheral hypoperfusion and the structural and functional changes of the gastrointestinal tract, liver and kidney, might affect the pharmacokinetics of several drugs. This review critically appraises the results of published studies investigating the pharmacokinetics of currently marketed cardiovascular and selected non‐cardiovascular drugs in HF patients and control groups, identifies gaps in the current knowledge, and suggests avenues for future research in this complex patient population.
Impact of hydration status on haemodynamics, effects of acute blood pressure‐lowering treatment, and prognosis after stroke
Authors: Billington Charlotte K. , Appleton Jason P. , Berge Eivind , Sprigg Nikola , Glover Mark , Bath Philip M. W. 
Published: September 2018

AimsAlthough high blood pressure (BP) is common in acute stroke and associated with poor outcome, the Efficacy of Nitric Oxide in Stroke (ENOS) trial showed no beneficial effect of antihypertensive treatment in this situation. Antihypertensive agents have accentuated effects in dehydrated patients. We assessed the impact of dehydration on haemodynamics, the effects of antihypertensive treatment, and prognosis in the ENOS trial.MethodsENOS randomized 4011 patients with acute stroke and raised systolic BP to a glyceryl trinitrate (GTN) patch or no GTN patch, and to continue or to stop existing antihypertensive treatment within 48 h of onset. The primary outcome was functional outcome (modified Rankin Scale, mRS) at day 90. Blood markers of dehydration at baseline were collected at two sites (n = 310) and their relationship with haemodynamics and outcome was assessed.ResultsThere were no significant associations between dehydration markers and fall in blood pressure from baseline to day 1, and no significant interaction with allocated treatment. Overall, increasing urea was associated with an unfavourable shift in mRS [odds ratio 3.43, 95% confidence interval (CI) 1.42, 8.32; P = 0.006] and increased risk of death at day 90 (hazard ratio 4.55, 95% CI 1.51, 13.66; P = 0.007).ConclusionsBlood pressure‐lowering treatment was safe in dehydrated patients, with no precipitous changes in BP, thus supporting its use in acute stroke prior to blood markers of dehydration becoming available. Increased baseline urea was associated with poor prognosis after stroke.
Cosmetic dentistry: A socioethical evaluation
Authors: Holden Alexander C. L. 
Published: September 2018

AbstractCosmetic dentistry is a divisive discipline. Within discourses that raise questions of the purpose of the dental profession, cosmetic dentistry is frequently criticised on the basis of it being classified as a non‐therapeutic intervention. This article re‐evaluates this assertion through examination of ethics of care of the self, healthcare definitions and the social purpose of dentistry, finding the traditional position to be wanting in its conclusions. The slide of dentistry from a healthcare vocation towards being a predominantly business‐focused interaction between clinician and consumer conflicts with traditional notions of dentistry as a profession. Whilst it is undeniable that cosmetic dental treatment particularly lends itself to the commercial paradigm, this is not exclusive to this area of professional practice. The cultural basis of dental appearance and the potential of the dental profession to exert coercive pressure upon the public to undergo treatment that is based upon social norms is discussed. This essay concludes that cosmetic dentistry is undeniably part of the professional purpose of 21st Century dentistry. However, the caveat that may be placed upon this, is that this status is conditional upon the professional conduct of dental practitioners remaining resilient to commercial practices not compatible with professional obligations.
Supporting young children as digital citizens: The importance of shared understandings of technology to support integration in play‐based learning
Authors: Bittner Kelly , Highfield Kate , Hadley Fay 
Published: September 2018

AbstractThe ubiquity of technology in contemporary society positions it as a significant cultural tool in children’s lives. Definitions, conceptualisations and understandings of the relevance of technology are diverse which can hinder integration of technology in early learning settings. This paper presents findings from a doctoral research project that investigated Australian educator beliefs and practices in relation to technology integration within play‐based curriculums for children aged three to five years. The key findings presented relate to creating connections and shared conceptualisations of technology between educators, families and directors of early learning services. Shared understandings of the sociocultural relevance of diverse technological tools were found to facilitate technology integration in the curriculum. Rogoff’s (1995) three planes of analysis were utilised to identify and understand the interplay between the personal, interpersonal and community levels of sociocultural activity. A significant implication is identification of the need for professional discussion, professional learning and critical reflection opportunities to extend educator understandings of technology as socially, culturally, and pedagogically relevant for young children. Sharing this knowledge in collaborative partnerships between educators, families and management can support children’s development as digital citizens.