bluuebunny/crossref_metadata_2025_split huggingface dataset:
Utilization of the Ghana National Health Insurance Scheme and its association with patient perceptions on healthcare quality
Authors: Haw Nel Jason L 
Published: August 2018

Abstract

Objective
To determine the association between the utilization of the Ghana National Health Insurance Scheme (NHIS) and patient perceptions of quality of care.

Methods
Ghana Demographic and Health Survey (GDHS) 2014 had 19 questions on perceptions of quality of care received during the last reported health visit (n = 4332). These questions were summarized into an overall 100-point perception score using item response theory (IRT). Patients were divided into three utilization categories: those paying with their NHIS card fully, those paying with their card and out-of-pocket (OOP), and those paying fully OOP. A multiple linear regression model was used to measure the association between NHIS utilization and overall perception.

Results
In general, NHIS utilization was negatively associated with overall perception, and the difference across utilization categories was higher among private facility users than public facility users. Among private facilities, those who paid fully with NHIS reported five points lower than those who paid fully OOP (P = 0.005). Among public facilities, the difference is only 1.7 (P = 0.4342).

Conclusion
NHIS utilization was a negative predictor for patient perceptions, but the differences are more nuanced according to type of facility. Future GDHS rounds should continue measuring perceptions in aid of policy to improve service delivery under the NHIS.
eAssessment: development of an electronic version of the Objective Structured Assessment of Debriefing tool to streamline evaluation of video recorded debriefings
Authors: Zamjahn John B , Baroni de Carvalho Raquel , Bronson Megan H , Garbee Deborah D , Paige John T 
Published: August 2018

Abstract

Objective
The Objective Structured Assessment of Debriefing (OSAD) is an evidence-based, 8-item tool that uses a behaviorally anchored rating scale in paper-based form to evaluate the quality of debriefing in medical education. The objective of this project was twofold: 1) to create an easy-to-use electronic format of the OSAD (eOSAD) in order to streamline data entry; and 2) to pilot its use on videoed debriefings.

Materials and Methods
The eOSAD was developed in collaboration with the LSU Health New Orleans Epidemiology Data Center using SurveyGizmo (Widgix Software, LLC, Boulder, CO, USA) software. The eOSAD was then piloted by 2 trained evaluators who rated 37 videos of faculty teams conducting pre-briefing and debriefing after a high-fidelity trauma simulation. Inter-rater reliability was assessed, and evaluators’ qualitative feedback was obtained.

Results
Inter-rater reliability was good [prebrief, intraclass correlation coefficient, ICC = 0.955 (95% CI, 0.912–0.977), P &lt; .001; debrief, ICC = 0.853 (95% CI, 0.713–0.924), P &lt; .001]. Qualitative feedback from evaluators found that the eOSAD was easy to complete, simple to read and add comments, and reliably stored data that were readily retrievable, enabling the smooth dissemination of information collected.

Discussion
The eOSAD features a secure login, sharable internet access link for distant evaluators, and the immediate exporting of data into a secure database for future analysis. It provided convenience for end-users, produced reliable assessments among independent evaluators, and eliminated multiple sources of possible data corruption.

Conclusion
The eOSAD tool format advances the post debriefing evaluation of videoed inter-professional team training in high-fidelity simulation.
Divergence and the Price of Uncertainty*
Authors: Schneider Paul , Trojani Fabio 
Published: August 2018

Abstract
Realized divergence measures the distinct realized moments associated with time-varying uncertainty. It is tradeable with divergence swaps engineered from delta-hedged option portfolios. Implied divergence decomposes the price of uncertainty into distinct implied moments, in a way that is consistent with established notions of a deviation from put-call symmetry in option markets. Empirically, market implied divergence and divergence risk premia vary substantially, in the time series, cross-sectionally and as a function of the investment horizon. Such variations can help to make the potential shortcomings of a model more directly visible.
Morphology of prestellar cores in pressure-confined filaments
Authors: Heigl S , Gritschneder M , Burkert A 
Published: August 2018

ABSTRACT
Observations of prestellar cores in star-forming filaments show two distinct morphologies. While molecular line measurements often show broad cores, submillimetre continuum observations predominantly display pinched cores compared to the bulk of the filament gas. In order to explain how different morphologies arise, we use the gravitational instability model where prestellar cores form by growing density perturbations. The radial extent at each position is set by the local line mass. We show that the ratio of core radius to filament radius is determined by the initial line mass of the filament. Additionally, the core morphology is independent of perturbation length-scale and inclination, which makes it an ideal diagnostic for observations. Filaments with a line mass of less than half its critical value should form broad cores, whereas filaments with more than half its critical line-mass value should form pinched cores. For filaments embedded in a constant background pressure, the dominant perturbation growth times significantly differ for low and high line-mass filaments. Therefore, we predict that only one population of cores is present if all filaments within a region begin with similar initial perturbations.
Microsurgical Anatomy of the Jugular Process as an Anatomical Landmark to Access the Jugular Foramen: A Cadaveric and Radiological Study
Authors: Komune Noritaka , Matsuo Satoshi , Miki Koichi , Matsushima Ken , Akagi Yojiro , Kurogi Ryota , Iihara Koji , Matsushima Toshio , Inoue Tooru , Nakagawa Takashi 
Published: August 2018

Abstract

BACKGROUND
The jugular process forms the posteroinferior surface of the jugular foramen and is an important structure for surgical approaches to the foramen. However, its morphological features have not been well described in modern texts.

OBJECTIVE
To elucidate the microsurgical anatomy of the jugular process and examine its morphological features.

METHODS
Five adult cadaveric specimens were dissected in a cadaveric study, and computed tomography data from 31 heads (62 sides) were examined using OsiriX (Pixmeo SARL, Bernex, Switzerland) to elucidate the morphological features of the jugular process.

RESULTS
The cadaveric study showed that it has a close relationship with the sigmoid sinus, jugular bulb, rectus capitis lateralis, lateral atlanto-occipital ligament, and lateral and posterior condylar veins. The radiographic study showed that 9/62 sigmoid sinuses protruded inferiorly into the jugular process and that in 5/62 sides, this process was pneumatized. At the entry of the jugular foramen, if the temporal bone has a bulb-type jugular bulb, and if surgery concerns the right side of the head, the superior surface of the jugular process is more likely to be steep.

CONCLUSION
The jugular process forms the posteroinferior border of the jugular foramen. Resection of the jugular process is a critical step for opening the jugular foramen from the posterior and lateral aspects. Understanding the morphological features of the jugular process, and preoperative and radiographical examination of this process thus help skull base surgeons to access the jugular foramen.
Electoral Rules and Legislators’ Productivity
Authors: Akirav Osnat 
Published: August 2018

AbstractOver the years, there have been a variety of changes to candidate selection methods for the Israeli Knesset. As a result, there have been changes in the way the Knesset functions. This study investigates whether these changes have made legislators more productive. To explore this issue, we used Akirav’s (2016) legislative productivity scale with data from the 14th, 16th and 19th Knesset (Israel’s parliament) terms to test several hypotheses. We found that in Israel, the candidate selection process affects legislators’ productivity, with the 19th Knesset proving the most productive. Nevertheless, in Israel, legislators’ productivity does not affect the likelihood of them being reelected.
Epidemiology of ICU-acquired pneumonia
Authors: Ferrer Miquel , Torres Antoni 
Published: August 2018

Purpose of review
Review of the epidemiology of ICU-acquired pneumonia, including both ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia (HAP) in nonventilated ICU patients, with critical review of the most recent literature in this setting.

Recent findings
The incidence of ICU-acquired pneumonia, mainly VAP has decrease significantly in recent years possibly due to the generalized implementation of preventive bundles. However, the exact incidence of VAP is difficult to establish due to the diagnostic limitations and the methods employed to report rates. Incidence rates greatly vary based on the studied populations. Data in the literature strongly support the relevance of intubation, not ventilatory support, in the development of HAP in ICU patients, but also that the incidence of HAP in nonintubated patients is not negligible. Despite the fact of a high crude mortality associated with the development of VAP, the overall attributable mortality of this complication was estimated in 13%, with higher mortality rates in surgical patients and those with mid-range severity scores at admission. Mortality is consistently greatest in patients with HAP who require intubation, slightly less in VAP, and least for nonventilated HAP. The economic burden of ICU acquired pneumonia, particularly VAP, is important. The increased costs are mainly related to the longer periods of ventilatory assistance and ICU and hospital stays required by these patients. However, the different impact of VAP on economic burden among countries is largely dependent on the different costs associated with heath care.

Summary
VAP has significant impact on mortality mainly in surgical patients and those with mid-range severity scores at admission. The economic burden on ICU-acquired pneumonia depends mainly on the increased length of stay of these patients.
Self-Reported Management of IV Fluids and Fluid Accumulation in Children With Acute Respiratory Failure*
Authors: Hassinger Amanda B. , Valentine Stacey L. 
Published: August 2018

Objectives:
Observational studies have shown that fluid overload is independently associated with increased morbidity in critically ill children, especially with respiratory pathology. It is unknown if recent evidence has influenced clinical practice. We sought to describe current IV fluid management in pediatric acute respiratory distress syndrome.

Design:
Multinational, cross-sectional electronic survey.

Setting:
Pediatric Acute Lung Injury and Sepsis Investigators Network.

Subjects:
Pediatric intensivists.

Interventions:
None.

Measurements and Main Results:
One-hundred fifty-four respondents (43% response rate) had a median 10 years of experience (Q1–Q3, 4–17.8), in ICUs with a median 24 beds (18–36), where 86% provided extracorporeal membrane oxygenation. For maintenance IV fluid, 96% used the “4-2-1” rule to determine rate, and 59% used dextrose with normal saline for content. For fluid resuscitation, 77% use normal saline in 10 milliliters per kilogram aliquots (42%) or as fluid challenges (37%). Less than 20% of respondents reported resuscitating with 20 mL/kg boluses. Documented intake over output is the favored vital sign to assess (75% vs 57%) and guide fluid management (97% vs 14%) over central venous pressure. The majority of respondents chose 10% fluid overload as the threshold to act in children with pediatric acute respiratory distress syndrome. The majority (77%) agreed that fluid accumulation contributes to worse outcomes in pediatric acute respiratory distress syndrome and should be treated. Ninety-one percent reported conservative fluid management in pediatric acute respiratory distress syndrome is likely to be beneficial or protective.

Conclusions:
Pediatric intensivists agree that acting on 10% fluid overload in children with pediatric acute respiratory distress syndrome is important. Decisions are being made largely using intake and output documentation, not central venous pressure. These findings are important for future pediatric acute respiratory distress syndrome interventional trials.
Comparing Percutaneous to Open Access for Extracorporeal Membrane Oxygenation in Pediatric Respiratory Failure
Authors: Cairo Sarah B. , Arbuthnot Mary , Boomer Laura , Dingeldein Michael W. , Feliz Alexander , Gadepalli Samir , Newton Christopher R. , Puligandla Pramod , Ricca Robert , Rycus Peter , Vogel Adam M. , Yu Guan , Chen Ziqiang , Rothstein David H. 
Published: August 2018

Objectives:
Evaluate trends in method of access (percutaneous cannulation vs open cannulation) for pediatric extracorporeal membrane oxygenation and determine the effects of cannulation method on morbidity and mortality.

Design:
Retrospective cohort study.

Setting and Subjects:
The Extracorporeal Life Support Organization’s registry was queried for pediatric patients on extracorporeal membrane oxygenation for respiratory failure from 2007 to 2015.

Inverventions:
None.

Measurements and Main Results:
Of 3,501 patients identified, 77.2% underwent open cannulation, with the frequency of open cannulation decreasing over the study period from approximately 80% to 70% (p < 0.001). Percutaneous cannulation patients were more commonly male (24.2% vs 21.5%; p = 0.01), older (average 7.6 vs 4.5 yr; p < 0.001), and heavier (average 33.0 vs 20.2 kg; p < 0.001). Subset analysis of patients on venovenous extracorporeal membrane oxygenation revealed higher rates of mechanical complications due to blood clots (28.9% vs 22.6%; p = 0.003) or cannula problems (18.9% vs 12.7%; p < 0.001), cannula site bleeding (25.3% vs 20.2%; p = 0.01) and increased rates of cannula site repair in the open cannulation cohort. Limb related complications were not significantly different on subset analysis for venovenous extracorporeal membrane oxygenation patients stratified by access site. Logistic regression analysis revealed that method of access was not associated with a difference in mortality.

Conclusions:
The proportion of pediatric patients undergoing percutaneous extracorporeal membrane oxygenation cannulation is increasing. Mechanical and physiologic complications occur with both methods of cannulation, but percutaneous cannulation appears safe in this cohort. Further analysis is needed to evaluate long-term outcomes with this technique.
Advancing Randomized Controlled Trials in Pediatric Critical Care: The Perspectives of Trialists
Authors: Duffett Mark , Swinton Marilyn , Brouwers Melissa , Meade Maureen , Cook Deborah J. 
Published: August 2018

Objectives:
Clinical research is a complex scientific and social enterprise. Our objective was to identify strategies that pediatric critical care trialists consider acceptable, feasible, and effective to improve the design and conduct randomized controlled trials in pediatric critical care.

Design:
Qualitative descriptive study using semistructured individual interviews.

Subjects:
We interviewed 26 pediatric critical care researchers from seven countries who have published a randomized controlled trial (2005–2015). We used purposive sampling to achieve diversity regarding researcher characteristics and randomized controlled trial characteristics.

Interventions:
None.

Measurements and Main Results:
Most participants (24 [92%]) were from high-income countries, eight (31%) had published more than one randomized controlled trial, 17 (65%) had published a multicenter randomized controlled trial, and eight (31%) had published a multinational randomized controlled trial. An important theme was “building communities”—groups of individuals with similar interests, shared experiences, and common values, bound by professional and personal relationships. Participants described a sense of community as a source of motivation and encouragement and as a means to larger, more rigorous trials, increasing researcher and clinician engagement and maintaining enthusiasm. Strategies to build communities stressed in-person interactions (both professional and social), capable leadership, and trust. Another important theme was “getting started.” Participants highlighted the importance of formal research training and high-quality experiential learning through collaboration on other’s projects, guided by effective mentorship. Also important was “working within the system”—ensuring academic credit for a range of contributions, not only for the principal investigator role. The longitudinal notion of “building on success” was also underscored as a cross-cutting theme.

Conclusions:
Coordinated, deliberate actions to build community and ensure key training and practical experiences for new investigators may strengthen the research enterprise in pediatric critical care. These strategies, potentially in combination with other novel approaches, may vitalize clinical research in this field.
Circadian Rhythm Disruption and Sepsis in Severe Trauma Patients
Authors: Coiffard Benjamin , Diallo Aissatou B. , Culver Aurélien , Mezouar Soraya , Hammad Emmanuelle , Vigne Coralie , Nicolino-Brunet Corine , Dignat-George Françoise , Baumstarck Karine , Boucekine Mohamed , Leone Marc , Mege Jean-Louis 
Published: August 2018

ABSTRACT

Background:
Circadian rhythms are important regulators of immune functions. Admission to an intensive care unit may impact molecular clock activity and host response. Our objective was to assess and compare the immune circadian rhythms in trauma patients who develop and in those who do not develop sepsis.

Methods:
Blood samples were collected from severe trauma patients within 4 days after admission, with collections taking place every 4 h over a 24-h period. Cortisol and cytokines were measured with immunoassays. Whole-blood expression of 3 clock genes (Bmal1, Per2, and Per3) was studied by reverse transcription quantitative polymerase chain reaction. Neutrophils, monocytes, and lymphocytes were analyzed by flow cytometry. Patients with and without sepsis were compared with the cosinor mixed model to estimate mesors, amplitudes, and acrophases.

Results:
Thirty-eight patients were enrolled in the study, and 13 developed at least 1 septic episode. The septic patients had higher levels of cortisol than the nonseptic patients (mesor at 489 nmol/L vs. 405 nmol/L, P < 0.05) and delayed acrophases (22 h vs. 15 h, P < 0.05). They also had lower lymphocyte counts (mesor at 785 vs. 1,012 cells/μL, P < 0.05), higher neutrophil counts (mesor at 7,648 vs. 7,001 cells/μL, P < 0.05), and monocyte counts (mesor at 579 vs. 473 cells/μL, P < 0.05) than the nonseptic patients. Although no amplitude difference was identified, the acrophases were significantly different between the 2 groups for lymphocytes, interleukin 10 and tumor necrosis factor.

Conclusion:
We demonstrated that all trauma patients had impaired circadian rhythms of cortisol, cytokines, leukocytes, and clock genes. Early circadian disruption was associated with the occurrence of sepsis and might be a marker of sepsis severity.
Half of Postoperative Deaths After Hepatectomy may be Preventable
Authors: Khaoudy Iman , Farges Olivier , Boleslawski Emmanuel , Vibert Eric , Soubrane Olivier , Adham Mustapha , Mabrut Jean Yves , Christophe Laurent , Bachellier Philippe , Scatton Olivier , Le Treut Yves-Patrice , Regimbeau Jean Marc 
Published: August 2018

Objective:
To perform a retrospective root-cause analysis of the causes of postoperative mortality after hepatectomy.

Background:
Mortality after liver resection has not decreased over the past decade.

Methods:
The study population was a prospective cohort of hepatectomies performed at hepatic, pancreatic, and biliary (HPB) centers between October 2012 and December 2014. Of the 1906 included patients, 90 (5%) died within 90 days of surgery. Perioperative data were retrieved from the original medical records. The root-cause analysis was performed independently by a senior HBP-surgeon and a surgical HBP-fellow. The objectives were to record the cause of death and then assess whether (1) the attending surgeon had identified the cause of death and what was it?, (2) the intra- and postoperative management had been appropriate, (3) the patient had been managed according to international guidelines, and (4) death was preventable. A typical root cause of death was defined.

Results:
The cause of death was identified by the index surgeon and by the root-cause analysis in 84% and 88% of cases, respectively. Intra- and postoperative management procedures were inadequate in 33% and 23% of the cases, respectively. Guidelines were not followed in 57% of cases. Overall, 47% of the deaths were preventable. The typical root cause of death was insufficient evaluation of the tumor stage or tumor progression in a patient with malignant disease resulting in a more invasive procedure than expected.

Conclusion:
Measures to ensure compliance with guidelines and (in the event of unexpected operative findings) better within-team communication should be implemented systematically.
Left-liver Adult-to-Adult Living Donor Liver Transplantation
Authors: Sánchez-Cabús Santiago , Cherqui Daniel , Rashidian Niki , Pittau Gabriella , Elkrief Laure , Vanlander Aude , Toso Christian , Fondevila Constantino , Cunha Antonio Sa , Berney Thierry , Castaing Denis , de Hemptinne Bernard , Fuster Josep , Rogiers Xavier , Adam René , Majno Pietro , García-Valdecasas Juan Carlos , Troisi Roberto I. 
Published: August 2018

Objective:
To evaluate the European experience after Adult-to-adult living donor liver transplantation using the left liver (LL-aLDLT).

Summary Background Data:
LL-aLDLT decreases donor risk but provides a smaller graft that increases recipient risk as compared with right liver (RL-aLDLT). However, there is little knowledge of results obtained after LL-aLDLT in Europe.

Methods:
This is a European multicenter retrospective study which aims to analyze donor and recipient outcomes after 46 LL-aLDLT.

Results:
Seventy-six percent of the grafts were harvested by minimally invasive approach. Mean donor hospital stay was 7.5 ± 3.5 days. Donor liver function was minimally impaired, with 36 donors (78.3%) without any 90-day complication, and 4 (8.7%) presenting major complications. One, 3, and 5-year recipient survival was 90.9%, 82.7%, and 82.7%, respectively. However, graft survival was of 59.4%, 56.9%, and 56.9% at 1, 3, and 5 years respectively, due to a 26.1% urgent liver retransplantation (ReLT) rate, mainly due to SFSS (n = 5) and hepatic artery thrombosis (HAT, n = 5). Risk factor analysis for ReLT and HAT showed an association with a graft to body weight ratio (GBWR) <0.6% (P = 0.01 and P = 0.024, respectively) while SFSS was associated with a recipient MELD ≥14 (P = 0.019). A combination of donor age <45 years, MELD <14 and actual GBWR >0.6% was associated with a lower ReLT rate (0% vs. 33%, P = 0.044).

Conclusions:
Our analysis showed low donor morbidity and preserved liver function. Recipient outcomes, however, were hampered by a high ReLT rate. A strict selection of both donor and recipients is the key to minimize graft loss.