bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of serious games and impact of design elements on engagement and educational outcomes in healthcare professionals and students: a systematic review and meta-analysis protocol
Authors: Maheu-Cadotte Marc-André , Cossette Sylvie , Dubé Véronique , Fontaine Guillaume , Mailhot Tanya , Lavoie Patrick , Cournoyer Alexis , Balli Fabio , Mathieu-Dupuis Gabrielle 
Published: March 2018

IntroductionSerious games (SGs) are interactive and entertaining digital software with an educational purpose. They engage the learner by proposing challenges and through various design elements (DEs; eg, points, difficulty adaptation, story). Recent reviews suggest the effectiveness of SGs in healthcare professionals’ and students’ education is mixed. This could be explained by the variability in their DEs, which has been shown to be highly variable across studies. The aim of this systematic review is to identify, appraise and synthesise the best available evidence regarding the effectiveness of SGs and the impact of DEs on engagement and educational outcomes of healthcare professionals and students.Methods and analysisA systematic search of the literature will be conducted using a combination of medical subject headings terms and keywords in Cumulative Index of Nursing and Allied Health, Embase, Education Resources Information Center, PsycInFO, PubMed and Web of Science. Studies assessing SGs on engagement and educational outcomes will be included. Two independent reviewers will conduct the screening as well as the data extraction process. The risk of bias of included studies will also be assessed by two reviewers using the Effective Practice and Organisation of Care criteria. Data regarding DEs in SGs will first be synthesised qualitatively. A meta-analysis will then be performed, if the data allow it. Finally, the quality of the evidence regarding the effectiveness of SGs on each outcome will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.Ethics and disseminationAs this systematic review only uses already collected data, no Institutional Review Board approval is required. Its results will be submitted in a peer-reviewed journal by the end of 2018.PROSPERO registration numberCRD42017077424.
Forgone care among middle aged and elderly with chronic diseases in China: evidence from the China Health and Retirement Longitudinal Study Baseline Survey
Authors: Li Xiangjun , Chen Mingsheng , Wang Zhonghua , Si Lei 
Published: March 2018

ObjectiveIn general, published studies analyse healthcare utilisation, rather than foregone care, among different population groups. The assessment of forgone care as an aspect of healthcare system performance is important because it indicates the gap between perceived need and actual utilisation of healthcare services. This study focused on a specific vulnerable group, middle-aged and elderly people with chronic diseases, and evaluated the prevalence of foregone care and associated factors among this population in China.MethodsData were obtained from a nationally representative household survey of middle-aged and elderly individuals (≥45 years), the China Health and Retirement Longitudinal Study, which was conducted by the National School of Development of Peking University in 2013. Descriptive statistics were used to analyse sample characteristics and the prevalence of foregone care. Andersen’s healthcare utilisation and binary logistic models were used to evaluate the determinants of foregone care among middle-aged and elderly individuals with chronic diseases.ResultsThe prevalence of foregone outpatient and inpatient care among middle-aged and elderly people was 10.21% and 6.84%, respectively, whereas the prevalence of foregone care for physical examinations was relatively high (57.88%). Predisposing factors, including age, marital status, employment, education and family size, significantly affected foregone care in this population. Regarding enabling factors, individuals in the highest income group reported less foregone inpatient care or physical examinations compared with those in the lowest income group. Social healthcare insurance could significantly reduce foregone care in outpatient and inpatient situations; however, these schemes (except for urban employee medical insurance) did not appear to have a significant impact on foregone care involving physical examinations.ConclusionIn China, policy-makers may need to further adjust healthcare policies, such as health insurance schemes, and improve the hierarchical medical system, to promote reduction in foregone care and effective utilisation of health services.
Protocol for a 1-year prospective, longitudinal cohort study of patients undergoing Roux-en-Y gastric bypass and sleeve gastrectomy: the BARI-LIFESTYLE observational study
Authors: Jassil Friedrich C , Carnemolla Alisia , Kingett Helen , Paton Bruce , O’Keeffe Aidan G , Doyle Jacqueline , Morris Stephen , Lewis Neville , Kirk Amy , Pucci Andrea , Chaiyasoot Kusuma , Batterham Rachel L 
Published: March 2018

IntroductionRoux-en-Y gastric bypass and sleeve gastrectomy are the two most common bariatric surgery performed in the UK that result in comparable weight loss and remission of obesity-associated comorbidities. However, there is a paucity of studies examining the impact of these procedures on body composition, physical activity levels, sedentary behaviour, physical function and strength, dietary intake, health-related quality of life and costs.Methods and analysisThe BARI-LIFESTYLE observational study is a 1-year prospective, longitudinal cohort study within a real-world routine clinical care setting aiming to recruit 100 patients with severe obesity undergoing either primary Roux-en-Y gastric bypass or sleeve gastrectomy from two bariatric centres in London, UK. Participants will be followed up four times during the study period; presurgery baseline (T0) and at 3 (T1), 6 (T2) and 12 months (T3) postsurgery. In addition to the standard follow-up investigations, assessments including dual-energy X-ray absorptiometry scan, bioelectric impedance analysis, 6 min walk test, sit-to-stand test and handgrip test will be undertaken together with completion of questionnaires. Physical activity levels and sedentary behaviour will be assessed using accelerometer, and dietary intake will be recorded using a 3-day food diary. Outcome measures will include body weight, body fat mass, lean muscle mass, bone mineral density, physical activity levels, sedentary behaviour, physical function and strength, dietary intake, health-related quality of life, remission of comorbidities, healthcare resource utilisation and costs.Ethics and disseminationThis study has been reviewed and given a favourable ethical opinion by London-Dulwich Research Ethics Committee (17/LO/0950). The results will be presented to stakeholder groups locally, nationally and internationally and published in peer-reviewed medical journals. The lay-person summary of the findings will be published on the Centre for Obesity Research, University College London website (http://www.ucl.ac.uk/obesity).
Does a prostate cancer diagnosis affect management of pre-existing diabetes? Results from PCBaSe Sweden: a nationwide cohort study
Authors: Crawley Danielle , Garmo Hans , Rudman Sarah , Stattin Pär , Zethelius Björn , Armes Jo , Holmberg Lars , Adolfsson Jan , Van Hemelrijck Mieke 
Published: March 2018

ObjectivesBoth prostate cancer (PCa) and type 2 diabetes mellitus (T2DM) are increasingly prevalent conditions, which frequently coexist in men. Here, we set out to specifically examine the impact of a PCa diagnosis and its treatment on T2DM treatment.SettingThis study uses observational data from Prostate Cancer database Sweden Traject.ParticipantsThe study was undertaken in a cohort of 16 778 men with T2DM, of whom 962 were diagnosed with PCa during mean follow-up of 2.5 years.Primary and secondary outcome measuresWe investigated the association between PCa diagnosis and escalation in T2DM treatment in this cohort. A treatment escalation was defined as a new or change in anti-T2DM prescription, as recorded in the prescribed drug register (ie, change from diet to metformin or sulphonylurea or insulin). We also investigated how PCa diagnosis was associated with two treatment escalations. Multivariate Cox proportional hazards regression with age as a time scale was used while adjusting for educational level and initial T2DM treatment.ResultsWe found no association between PCa diagnosis and risk of a single treatment escalation (HR 0.99, 95% CI 0.87 to 1.13). However, PCa diagnosis was associated with an increased risk of receiving two consecutive T2DM treatment escalations (HR 1.75, 95% CI 1.38 to 2.22). This increase was strongest for men on gonadotropin-releasing hormone (GnRH) agonists (HR 3.08, 95% CI 2.14 to 4.40). The corresponding HR for men with PCa not on hormonal treatment was 1.40 (95% CI 1.03 to 1.92) and for men with PCa on antiandrogens 0.91 (95% CI 0.29 to 2.82).ConclusionsMen with T2DM who are diagnosed with PCa, particularly those treated with GnRH agonists, were more likely to have two consecutive escalations in T2DM treatment. This suggests a need for closer monitoring of men with both PCa and T2DM, as coexistence of PCa and its subsequent treatments could potentially worsen T2DM control.
Expert practice patterns and opinions on corneal cross-linking for infectious keratitis
Authors: Hsia Yen C , Moe Caitlin A , Lietman Thomas M , Keenan Jeremy D , Rose-Nussbaumer Jennifer 
Published: March 2018

ObjectiveTo assess the current opinion and practice patterns from cornea experts regarding the benefit of corneal cross-linking (CXL) for infectious keratitis (IK).Methods and analysisAn international survey was distributed to corneal specialists via an internet survey. The survey data collected were analysed with descriptive statistics.ResultsA survey was sent to 190 recipients, and 29 (15%) respondents completed the survey with an average of 7 years’ experience using CXL. A majority of respondents (66%) used CXL to treat IK due to bacterial, fungal, protozoan or unknown aetiology. Main indications to use CXL as adjuvant therapy were worsening infiltrate diameter or depth despite therapy (74%), followed by antibiotic resistance (68%), corneal thinning (53%), poor compliance with medication (26%) and other reasons (21%). Most respondents felt CXL would be at least moderately helpful as an adjuvant therapy for bacterial (96%) or fungal (75%) keratitis; about half (46%) thought it would be helpful for acanthamoeba keratitis. As sole therapy, fewer respondents believed CXL would be at least moderately helpful to treat bacterial (75%), fungal (58%) and acanthamoeba (43%) keratitis.ConclusionThe survey offered insights into current expert practices and opinions of using CXL as therapy for IK. The results of this survey serve to guide in the design of future clinical studies.
Tracking workflow during high-stakes resuscitation: the application of a novel clinician movement tracing tool during in situ trauma simulation
Authors: Petrosoniak Andrew , Almeida Rodrigo , Pozzobon Laura Danielle , Hicks Christopher , Fan Mark , White Kari , McGowan Melissa , Trbovich Patricia 
Published: March 2018

IntroductionClinician movement and workflow analysis provides an opportunity to identify inefficiencies during trauma resuscitation care. Inefficient workflows may represent latent safety threats (LSTs), defined as unrecognised system-based elements that can negatively impact patients. In situ simulation (ISS) can be used to model resuscitation workflows without direct impact on patients. We report the pilot application of a novel, tracing tool to track clinician movement during high-fidelity ISS trauma sessions.MethodsTwelve unannounced ISSs were conducted. An open source, Windows-based video overlay tracing tool was developed to generate a visual representation of participant movement during ISS. This tracing tool used a manual mouse tracking algorithm to produce point-by-point location information of a selected participant in a video. The tracing tool was applied to video recordings of clinicians performing a cricothyroidotomy during ISS trauma scenarios. A comparative workflow and movement analysis was completed, which included distance travelled and space utilisation. This data was visually represented with time-lapsed movement videos and heat maps.ResultsA fourfold difference in the relative distance travelled was observed between participants who performed a cricothyroidotomy during an ISS trauma resuscitation. Variation in each participant’s movement was attributable to three factors: (1) team role assignment and task allocation; (2) knowledge of clinical space: equipment location and path to equipment retrieval; and (3) equipment bundling. This tool facilitated LST identification related to cricothyroidotomy performance.ConclusionThis novel tracing tool effectively generated a visual representation of participants’ workflows and quantified movement during ISS video review. An improved understanding of human movement during ISS trauma resuscitations provides a unique opportunity to augment simulation debriefing, conduct human factor analysis of system elements (eg, tools/technology, physical environment/layout) and foster change management towards efficient workflows.
Social marketing to address attitudes and behaviours related to preventable injuries in British Columbia, Canada
Authors: Smith Jennifer , Zheng Xin , Lafreniere Kevin , Pike Ian 
Published: March 2018

BackgroundSocial marketing is a tool used in the domain of public health for prevention and public education. Because injury prevention is a priority public health issue in British Columbia, Canada, a 3-year consultation was undertaken to understand public attitudes towards preventable injuries and mount a province-wide social marketing campaign aimed at adults aged 25–55 years.MethodsPublic response to the campaign was assessed through an online survey administered to a regionally representative sample of adults within the target age group between 1 and 4 times per year on an ongoing basis since campaign launch. A linear regression model was applied to a subset of this data (n=5186 respondents) to test the association between exposure to thePreventablecampaign and scores on perceived preventability of injuries as well as conscious forethought applied to injury-related behaviours.ResultsCampaign exposure was significant in both models (preventability: β=0.27, 95% CI 0.20 to 0.35; conscious thought: β=0.24, 95% CI 0.13 to 0.35), as was parental status (preventability: β=0.12, 95% CI 0.03 to 0.21; conscious thought: β=0.18, 95% CI 0.06 to 0.30). Exposure to the more recent campaign slogan was predictive of 0.47 higher score on conscious thought (95% CI 0.27 to 0.66).DiscussionThis study provides some evidence that thePreventableapproach is having positive effect on attitudes and behaviours related to preventable injuries in the target population. Future work will seek to compare these data to other jurisdictions as thePreventablesocial marketing campaign expands to other parts of Canada.
Emilia-Romagna Study on Pregnancy and Exposure to Antiepileptic drugs (ESPEA): a population-based study on prescription patterns, pregnancy outcomes and fetal health
Authors: Mostacci Barbara , Bisulli Francesca , Poluzzi Elisabetta , Cocchi Guido , Piccinni Carlo , Curti Alessandra , Simonazzi Giuliana , Astolfi Gianni , Rizzo Nicola , Zenesini Corrado , D’Alessandro Roberto , Tinuper Paolo 
Published: March 2018

ObjectivesTo assess the prevalence of antiepileptic drug (AED) exposure in pregnant women and the comparative risk of terminations of pregnancy (TOPs), spontaneous abortions, stillbirths, major birth defects (MBDs), neonatal distress and small for gestational age (SGA) infants following intrauterine AED exposure in the Emilia Romagna region, Italy (4 459 246 inhabitants on 31 December 2011).MethodsWe identified all deliveries and hospitalised abortions in Emilia Romagna in the period 2009–2011 from the certificate of delivery assistance registry (Certificato di Assistenza al Parto— CedAP) and the hospital discharge card registry, exposure to AEDs from the reimbursed drug prescription registries, MBDs from the regional registry of congenital malformations, and Apgar scores and cases of SGA from the CedAP. Records from different registries were linked.ResultsWe identified 145 243 pregnancies: 111 284 deliveries, 16 408 spontaneous abortions and 17 551 TOPs. Six hundred and eleven pregnancies (0.42%; 95% Cl 0.39 to 0.46) were exposed to AEDs. In the AED-exposed group 21% of pregnancies ended in TOPs vs 12% in the non-exposed women (OR: 2.24; 95% CI 1.41 to 3.56). Rates of spontaneous abortions, stillbirths, neonatal distress and SGA were comparable. Three hundred and fifty-three babies (0.31%; 95% CI 0.28 to 0.35) were exposed to AEDs during the first trimester. MBD rates were 2.3% in the exposed vs 2.0% in the non-exposed pregnancies (OR: 1.12, 95% CI 0.55 to 2.55).ConclusionThe Emilia Romagna prevalence of AED exposure in pregnancy was 0.42%, comparable with previous European studies. Rates of spontaneous abortions, stillbirths, neonatal distress, SGA and MBDs following AED exposure were not significantly increased. The rate of TOPs was significantly higher in the AED-exposed women.
Endovascular therapy versus thrombolysis in patients with large vessel occlusions within the anterior circulation aged ≥80 years
Authors: Kastrup Andreas , Brunner Freimuth , Hildebrandt Helmut , Roth Christian , Winterhalter Michael , Papanagiotou Panagiotis 
Published: March 2018

Background and purposeIn patients with large vessel occlusions, endovascular treatment (ET) has been shown to be superior to intravenous thrombolysis (IVT) in recent trials. However, the effectiveness of ET in elderly patients is uncertain.MethodsUsing our stroke database, we compared the rates of good outcome (modified Rankin scale (mRS) ≤2), excellent outcome (mRS 0–1), poor outcome (mRS 5–6) at discharge, in-hospital death, infarct size, and symptomatic intracranial hemorrhage (SICH) in patients aged ≥80 years with distal intracranial carotid artery, M1 and M2 occlusions during two time periods.ResultsFrom January 2008 to October 2012, 217 patients were treated with IVT and, from November 2012 to October 2017, 209 patients received ET with stent retrievers (with or without IVT). Significantly more patients in the ET group than in the IVT group had a good outcome (25% vs 16%, P<0.05), as well as an excellent outcome (12% vs 4%, P<0.01). Significantly fewer patients in the ET group than in the IVT group died (14% vs 22%, P<0.05) or had a poor outcome (35% vs 52%, P<001). The SICH rates were lower after ET than after IVT (1% vs 6%, P<0.01), and the infarct sizes were smaller after ET than after IVT.ConclusionsCompared with IVT, the routine use of ET significantly improved the early clinical and radiological outcome in patients with anterior circulation large vessel occlusions aged ≥80 years. Nevertheless, poor outcome rates were high so the role of ET needs to be defined further in this population.
A System-Level Correction SAR ADC with Noise-Tolerant Technique
Authors: Xu Daiguo , Xu Kaikai , Xu Shiliu , Liu Lu , Liu Tao 
Published: March 2018

A system-level correction successive approximation register analog-to-digital converter (SAR ADC) with regulated comparator of noise-tolerant technique is proposed. First, a substrate voltage boost technique is provided to improve the linearity and speed of sampling switch. Secondly, the proposed SAR ADC provides a comparator of noise regulation without redundant comparison cycle. The proposed comparator would be regulated in high-speed large noise state in large input differential signals. In the condition of small input differential signals, the comparator would be adjusted to low-speed small noise state. Furthermore, a high-speed low-power technique is proposed to optimize the performance of dynamic comparator. Additionally, a fast SAR logic structure is provided to increase the conversion speed of SAR ADC. To demonstrate the proposed techniques, a design example of SAR ADC is fabricated in 65[Formula: see text]nm CMOS technology. The SAR ADC is able to tolerate about 1.1 LSB noise errors in post-simulation with the operation state regulated automatically. The core occupies an active area of only 0.025[Formula: see text]mm2 and consumes 1.5[Formula: see text]mW. Measurement results achieve SFDR [Formula: see text][Formula: see text]dB and SNDR [Formula: see text][Formula: see text]dB, resulting in the FOM of 21.6[Formula: see text]fJ per conversion step.
A 16.4 nW, Sub-1 V, Resistor-Less Voltage Reference with BJT Voltage Divider
Authors: Yang Qingshan , Han Peiqing , Mei Niansong , Zhang Zhaofeng 
Published: March 2018

A 16.4[Formula: see text]nW, sub-1[Formula: see text]V voltage reference for ultra-low power low voltage applications is proposed. This design reduces the operating voltage to 0.8[Formula: see text]V by a BJT voltage divider and decreases the silicon area considerably by eliminating resistors. The PTAT and CTAT are based on SCM structures and a scaled-down [Formula: see text], respectively, to improve the process insensitivity. This work is fabricated in 0.18[Formula: see text][Formula: see text]m CMOS process with a total area of 0.0033[Formula: see text]mm2. Measured results show that it works properly for supply voltage from 0.8[Formula: see text]V to 2[Formula: see text]V. The reference voltage is 467.2[Formula: see text]mV with standard deviation ([Formula: see text]) being 12.2 mV and measured TC at best is 38.7[Formula: see text]ppm/[Formula: see text]C ranging from [Formula: see text]C to 60[Formula: see text]C. The total power consumption is 16.4[Formula: see text]nW under the minimum supply voltage at 27[Formula: see text]C.
Glacio-marine iron formation deposition in a
c.
700 Ma glaciated margin: insights from the Chuos Formation, Namibia
Authors: Lechte Maxwell A. , Wallace Malcolm W. , Hoffmann Karl-Heinz 
Published: March 2018

Abstract

The Chuos Formation of Namibia is the sedimentary product of the Neoproterozoic Sturtian (
c.
720–660 Ma) glaciation and contains massive diamictites intercalated with finely laminated iron formation. Similar Sturtian glacially associated iron formations are found globally. The iron formations are laminated and generally very pure. The diamictites are massive, contain abundant clasts and can be highly ferruginous. These two lithofacies are repeatedly interbedded with no facies transition. The iron formations preserve the rare earth element geochemistry of their contemporaneous seawater and contain rare Ce and Eu anomalies. The geochemistry does not implicate a hydrothermal influence. The Chuos iron formation is interpreted to have been deposited in an ice-proximal glacio-marine setting in a sub-ice shelf environment. Oxygenated fluids, such as sea ice brines and glacial meltwater, are invoked as a mechanism to precipitate iron oxides due to mixing with ferruginous seawater. The iron formation accumulates under an ice shelf with little clastic input. Episodic movement of the grounding line reworks the sediments into ferruginous diamict. Glaciogenic debris flows are intercalated with the iron formations. Palaeobathymetric depressions and accompanying brine pools increased the preservation potential of these iron formations. This model explains the relationship between glaciation and iron formation in the Neoproterozoic.