bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of the implementation of a fast-track on emergency department length of stay and quality of care indicators in the Champagne-Ardenne region: a before–after study
Authors: Chrusciel Jan , Fontaine Xavier , Devillard Arnaud , Cordonnier Aurélien , Kanagaratnam Lukshe , Laplanche David , Sanchez Stéphane 
Published: June 2019

ObjectivesWe aimed to evaluate the effect of the implementation of a fast-track on emergency department (ED) length of stay (LOS) and quality of care indicators.DesignAdjusted before–after analysis.SettingA large hospital in the Champagne-Ardenne region, France.ParticipantsPatients admitted to the ED between 13 January 2015 and 13 January 2017.InterventionImplementation of a fast-track for patients with small injuries or benign medical conditions (13 January 2016).Primary and secondary outcome measuresProportion of patients with LOS ≥4 hours and proportion of access block situations (when patients cannot access an appropriate hospital bed within 8 hours). 7-day readmissions and 30-day readmissions.ResultsThe ED of the intervention hospital registered 53 768 stays in 2016 and 57 965 in 2017 (+7.8%). In the intervention hospital, the median LOS was 215 min before the intervention and 186 min after the intervention. The exponentiated before–after estimator for ED LOS ≥4 hours was 0.79; 95% CI 0.77 to 0.81. The exponentiated before–after estimator for access block was 1.19; 95% CI 1.13 to 1.25. There was an increase in the proportion of 30 day readmissions in the intervention hospital (from 11.4% to 12.3%). After the intervention, the proportion of patients leaving without being seen by a physician decreased from 10.0% to 5.4%.ConclusionsThe implementation of a fast-track was associated with a decrease in stays lasting ≥4 hours without a decrease in access block. Further studies are needed to evaluate the causes of variability in ED LOS and their connections to quality of care indicators.
Registry of Older South Australians (ROSA): framework and plan
Authors: Inacio Maria C , Bray Sarah Catherine Elizabeth , Whitehead Craig , Corlis Megan , Visvanathan Renuka , Evans Keith , Griffith Elizabeth C , Wesselingh Steve L 
Published: June 2019

IntroductionAustralia’s ageing population puts significant demands on the aged care and healthcare sectors. To monitor the provision of aged care and healthcare services to older people, each government body has an individual data collection system. Together these systems can be the basis for creating the evidence necessary to support future allocation of resources for our ageing community. The Registry of Older South Australians (ROSA) is a cross-sector multidisciplinary (ie, aged care and healthcare) platform built to address the challenges of monitoring people in aged care settings. This protocol describes the ROSA’s framework and plans.Methods and analysisA registry to capture 16 000 South Australians/year undergoing an aged care eligibility assessment was designed. ROSA will contain information captured by the Commonwealth and South Australian state Health Authority, linked by two data integrating authorities, and housed on a secured data platform. ROSA will contain information on the sociodemographic, health, function, psychological, social, home and safety assessment and concerns characteristics, aged care services, general health services, and mortality of people receiving aged care services. Registered participants will be prospectively monitored until their death and yearly updates of their aged care and healthcare services information will be added to the registry.Ethics and disseminationROSA will longitudinally monitor the services provided to a population that puts costly demands on the state healthcare and aged care systems, identify unwanted variation, and underpin future research. ROSA’s expected outputs include an annual report, a research agenda that focuses on high burden conditions and potentially economically impactful questions, educational materials, and risk profiling tools. ROSA was approved by the South Australian Department for Health and Ageing HREC (HREC/17/SAH/125) and the Australian Institute of Health and Welfare HREC (EO2018/2/429).
The impact of maternal health care utilisation on routine immunisation coverage of children in Nigeria: a cross-sectional study
Authors: Anichukwu Onyekachi Ibenelo , Asamoah Benedict Oppong 
Published: June 2019

ObjectiveTo examine the impact of maternal healthcare (MHC) utilisation on routine immunisation coverage of children in Nigeria.DesignIndividual level cross-sectional study using bivariate and multivariable logistic regression analyses to examine the association between MHC utilisation and routine immunisation coverage of children.SettingNigeria Demographic and Health Survey 2013.Participants5506 women aged 15–49 years with children aged 12–23 months born in the 5 years preceding the survey.Primary outcome measuresFully immunised children and not fully immunised children.ResultsThe percentage of children fully immunised with basic routine childhood vaccines by the age of 12 months was 25.8%. Antenatal care (ANC) attendance irrespective of the number of visits (adjusted OR (AOR)1–3 visits2.4, 95% CI 1.79 to 3.27; AOR4–7 visits3.2, 95% CI 2.52 to 4.13; AOR≥ 8 visits3.5, 95% CI 2.64 to 4.50), skilled birth attendance (SBA) (AOR 1.9, 95% CI 1.65 to 2.35); and maternal postnatal care (PNC) (AOR 1.7, 95% CI 1.46 to 2.06) had positive effects on the child being fully immunised after adjusting for covariates (except for each other, ie, ANC, SBA and PNC). Further analyses (adjusting stepwise for each MHC service) showed a mediation effect that led to the effect of PNC not being significant.ConclusionsThe percentage of fully immunised children in Nigeria was very low. ANC attendance, SBA and maternal PNC attendance had positive impact on the child being fully immunised. The findings suggest that strategies aimed at maximising MHC utilisation in Nigeria could be effective in achieving the national coverage target of at least 80% for routine immunisation of children.
How do we evaluate the cost of nosocomial infection? The ECONI protocol: an incidence study with nested case-control evaluating cost and quality of life
Authors: Stewart Sally , Robertson Chris , Manoukian Sarkis , Haahr Lynne , Mason Helen , McFarland Agi , Dancer Stephanie , Cook Brian , Graves Nicholas , Reilly Jacqui 
Published: June 2019

IntroductionHealthcare-associated or nosocomial infection (HAI) is distressing to patients and costly for the National Health Service (NHS). With increasing pressure to demonstrate cost-effectiveness of interventions to control HAI and notwithstanding the risk from antimicrobial-resistant infections, there is a need to understand the incidence rates of HAI and costs incurred by the health system and for patients themselves.Methods and analysisThe Evaluation of Cost of Nosocomial Infection study (ECONI) is an observational incidence survey with record linkage and a nested case-control study that will include postdischarge longitudinal follow-up and qualitative interviews. ECONI will be conducted in one large teaching hospital and one district general hospital in NHS Scotland. The case mix of these hospitals reflects the majority of overnight admissions within Scotland. An incidence survey will record all HAI cases using standard case definitions. Subsequent linkage to routine data sets will provide information on an admission cohort which will be grouped into HAI and non-HAI cases. The case-control study will recruit eligible patients who develop HAI and twice that number without HAI as controls. Patients will be asked to complete five questionnaires: the first during their stay, and four others during the year following discharge from their recruitment admission (1, 3, 6 and 12 months). Multiple data collection methods will include clinical case note review; patient-reported outcome; linkage to electronic health records and qualitative interviews. Outcomes collected encompass infection types; morbidity and mortality; length of stay; quality of life; healthcare utilisation; repeat admissions and postdischarge prescribing.Ethics and disseminationThe study has received a favourable ethical opinion from the Scotland A Research Ethics Committee (reference 16/SS/0199). All publications arising from this study will be published in open-access peer-reviewed journal. Lay-person summaries will be published on the ECONI website.Trial registration numberNCT03253640; Pre-results.
Outcomes following feeding gastrostomy (FG) insertion in patients with learning disability: a retrospective cohort study using the health improvement network (THIN) database
Authors: Harvey Philip R , Thomas Tom , Chandan Joht Singh , Bhala Neeraj , Nirantharakumar Krishnarajah , Trudgill Nigel J 
Published: June 2019

ObjectivesTo measure the rates of lower respiratory tract infection (LRTI) and mortality following feeding gastrostomy (FG) placement in patients with learning disability (LD). Following this to compare these rates between those having LRTI prior to FG placement and those with no recent LRTI.DesignRetrospective cohort study.Setting and participantsThe study population included patients with LD undergoing FG placement in the ‘The Health Improvement Network’ database. Patients with LRTI in the year prior (LYP) to their FG placement were compared with patients without a history of LRTI in the year prior (non-LYP) to FG placement. FG placement and LD were identified using Read codes previously developed by an expert panel.Main outcome measuresIncidence rate ratio (IRR) of developing LRTI and mortality following FG, comparing patients with LRTI in the year prior to FG placement to patients without a history of LRTI.Results214 patients with LD had a FG inserted including 743.4 person years follow-up. 53.7% were males and the median age was 27.6 (IQR 19.6 to 38.6) years. 27.1% were in the LYP patients. 18.7% had a LRTI in the year following FG, with an estimated incidence rate of 254 per 1000-person years. Over the study period the incidence rate of LRTI in LYP patients was 369 per 1000-person years, in non-LYP patients this was 91 per 1000-person years (adjusted IRR 4.21 (95% CI 2.68 to 6.63) p<0.001). 27.1% of patients died during study follow-up. Incidence rate of death was 80 and 45 per 1000-person year for LYP and non-LYP patients, respectively (adjusted IRR 1.80 (1.00 to 3.23) p=0.05).ConclusionIn LD patients, no clinically meaningful reduction in LRTI incidence was observed following FG placement. Mortality and LRTI were higher in patients with at least one LRTI in the year preceding FG placement, compared with those without a preceding LRTI.
A prospective study of consecutive emergency medical admissions to compare a novel automated computer-aided mortality risk score and clinical judgement of patient mortality risk
Authors: Faisal Muhammad , Khatoon Binish , Scally Andy , Richardson Donald , Irwin Sally , Davidson Rachel , Heseltine David , Corlett Alison , Ali Javed , Hampson Rebecca , Kesavan Sandeep , McGonigal Gerry , Goodman Karen , Harkness Michael , Mohammed Mohammed 
Published: June 2019

ObjectivesTo compare the performance of a validated automatic computer-aided risk of mortality (CARM) score versus medical judgement in predicting the risk of in-hospital mortality for patients following emergency medical admission.DesignA prospective study.SettingConsecutive emergency medical admissions in York hospital.ParticipantsElderly medical admissions in one ward were assigned a risk of death at the first post-take ward round by consultant staff over a 2-week period. The consultant medical staff used the same variables to assign a risk of death to the patient as the CARM (age, sex, National Early Warning Score and blood test results) but also had access to the clinical history, examination findings and any immediately available investigations such as ECGs. The performance of the CARM versus consultant medical judgement was compared using the c-statistic and the positive predictive value (PPV).ResultsThe in-hospital mortality was 31.8% (130/409). For patients with complete blood test results, the c-statistic for CARM was 0.75 (95% CI: 0.69 to 0.81) versus 0.72 (95% CI: 0.66 to 0.78) for medical judgements (p=0.28). For patients with at least one missing blood test result, the c-statistics were similar (medical judgements 0.70 (95% CI: 0.60 to 0.81) vs CARM 0.70 (95% CI: 0.59 to 0.80)). At a 10% mortality risk, the PPV for CARM was higher than medical judgements in patients with complete blood test results, 62.0% (95% CI: 51.2 to 71.9) versus 49.2% (95% CI: 39.8 to 58.5) but not when blood test results were missing, 50.0% (95% CI: 24.7 to 75.3) versus 53.3% (95% CI: 34.3 to 71.7).ConclusionsCARM is comparable with medical judgements in discriminating in-hospital mortality following emergency admission to an elderly care ward. CARM may have a promising role in supporting medical judgements in determining the patient’s risk of death in hospital. Further evaluation of CARM in routine practice is required.
Effects of heat stroke on surface ECG: a study on clinical outcomes
Authors: Paul Amal , Alex Reginald , Jacob John Roshan , Yadav Bijesh 
Published: June 2019

AimsClassic heat stroke is associated with high in-hospital mortality and morbidity. The relation between the ECG findings in heat stroke and the clinical outcomes of these patients has not been studied. The aim of this study was to describe the electrocardiographic features in patients with classic heat stroke and to determine if there is any correlation of ECG findings with in-hospital outcomes.MethodsWe performed a retrospective study on 50 patients with classic heat stroke during summer months of 2016–2018. All 12-lead electrocardiographic recordings obtained from these patients were subjected to in-depth analysis. Statistical analysis was done to determine the correlation of electrocardiographic findings with in-hospital outcomes.Results37 patients were in sinus rhythm, while supraventricular arrhythmias including atrial fibrillation (n=6), ectopic atrial tachycardia (n=4) and atrial flutter (n=2) were observed in the rest. There was a high prevalence of QTc prolongation, low voltage P waves, conduction defects like incomplete right bundle branch block and repolarisation abnormalities. The ratio of QRS voltage in the limb leads to that in precordial leads was ≤0.5 in nearly three-fourths of the patients. Among the observed electrocardiographic features, low P-wave voltage (<0.01 mV) in lead II was found to have statistically significant correlation with adverse in-hospital outcome (OR 8.93, p=0.04), after adjustment for clinical covariates.ConclusionThere was high incidence of atrial arrhythmias in patients with classic heat stroke. A low P-wave voltage (<0.01 mV) in lead II was predictive of adverse in-hospital outcome in this cohort of patients.
Content-Aware Trust Propagation Toward Online Review Spam Detection
Authors: Xue Hao , Wang Qiaozhi , Luo Bo , Seo Hyunjin , Li Fengjun 
Published: June 2019

With the increasing popularity of online review systems, a large volume of user-generated content becomes available to help people make reasonable judgments about the quality of services and products from unknown providers. However, these platforms are frequently abused since fraudulent information can be freely inserted by potentially malicious users without validation. Consequently, online review systems become targets of individual and professional spammers, who insert deceptive reviews by manipulating the rating and/or the content of the reviews.
In this work, we propose a review spamming detection scheme based on the deviation between the aspect-specific opinions extracted from individual reviews and the aggregated opinions on the corresponding aspects. In particular, we model the influence on the trustworthiness of the user due to his opinion deviations from the majority in the form of a deviation-based penalty, and integrate this penalty into a three-layer trust propagation framework to iteratively compute the trust scores for users, reviews, and review targets, respectively. The trust scores are effective indicators of spammers, since they reflect the overall deviation of a user from the aggregated aspect-specific opinions across all targets and all aspects. Experiments on the dataset collected from Yelp.com show that the proposed detection scheme based on aspect-specific content-aware trust propagation is able to measure users’ trustworthiness based on opinions expressed in reviews.
Reduced exercise ventilatory efficiency in adults with cystic fibrosis and normal to moderately impaired lung function
Authors: Di Paolo Marcello , Teopompi Elisabetta , Savi Daniela , Crisafulli Ernesto , Longo Chiara , Tzani Panagiota , Longo Francesco , Ielpo Antonella , Pisi Giovanna , Cimino Giuseppe , Simmonds Nicholas J. , Neder J. Alberto , Chetta Alfredo , Palange Paolo 
Published: June 2019

Despite being a hallmark and an independent prognostic factor in several cardiopulmonary diseases, ventilatory efficiency—i.e., minute ventilation/carbon dioxide output relationship (V̇e/V̇co2)—has never been systematically explored in cystic fibrosis (CF). To provide a comprehensive frame of reference regarding measures of ventilatory efficiency in CF adults with normal to moderately impaired lung function and to confirm the hypothesis that V̇e/V̇co2is a sensitive marker of early lung disease. CF patients were divided into three groups, according to their spirometry: normal (G1), mild impairment (G2), and moderate impairment (G3) in lung function. All participants underwent incremental cardiopulmonary exercise testing on a cycle ergometer. Lowest V̇e/V̇co2ratio (nadir) and the slope and the intercept of the linear region of the V̇e/V̇co2relationship were contrasted in a two-center retrospective analysis, involving 72 CF patients and 36 healthy controls (HC). Compared with HC, CF patients had significantly higher V̇e/V̇co2nadir, slope, and intercept ( P < 0.001, P < 0.001, and P = 0.049, respectively). Subgroup analysis revealed significant differences in nadir ( P = 0.001) and slope ( P = 0.012) values even between HC and G1. Dynamic hyperinflation related negatively with slope ( P = 0.045) and positively with intercept ( P = 0.001), while no impact on nadir was observed. Ventilatory inefficiency is a clear feature of adults with CF, even among patients with normal spirometry. V̇e/V̇co2nadir seems to be the most reliable metric to describe ventilatory efficiency in CF adults. Further prospective studies are needed to clarify whether V̇e/V̇co2could represent a useful marker in the evaluation of early lung disease in CF.NEW & NOTEWORTHY This is the first study to investigate ventilatory efficiency in a cohort of adult cystic fibrosis (CF) patients with nonsevere lung disease. The finding of impaired ventilatory efficiency in patients with normal lung function confirms the higher sensitivity of exercise testing in detecting early lung disease compared with spirometry. Dynamic hyperinflation plays a significant role in determining the behavior of V̇e/V̇co2slope and intercept values with increasing lung function impairment. Apparently free from interference from mechanical constraints, V̇e/V̇co2nadir seems the most reliable parameter to evaluate ventilatory efficiency in CF adults.
Differential activation of the calpain system involved in individualized adaptation of different fast-twitch muscles in hibernating Daurian ground squirrels
Authors: Ma Xiufeng , Chang Hui , Wang Zhe , Xu Shenhui , Peng Xin , Zhang Jie , Yan Xia , Lei Tingyun , Wang Huiping , Gao Yunfang 
Published: June 2019

We examined the lateral gastrocnemius (LG), plantaris (PL), and extensor digitorum longus (EDL) muscles to determine whether differential activation of the calpain system is related to the degree of atrophy in these fast-twitch skeletal muscles during hibernation in Daurian ground squirrels ( Spermophilus dauricus). Results from morphological indices showed various degrees of atrophy in the order LG > PL > EDL. Furthermore, all three muscles underwent fast-to-slow fiber-type conversion in hibernation. In regard to the calpain system in the LG muscle, cytosolic Ca2+ increased significantly in hibernation, followed by recovery in posthibernation. Furthermore, calpastatin expression significantly decreased, and calpain 1 and 2 expression significantly increased, which may be responsible for the increased degradation of desmin during hibernation compared with that during summer activity. In the EDL muscle, Ca2+ overload was observed during interbout arousal, and calpastatin showed an increase during hibernation and interbout arousal, which could explain the increased levels of troponin T during both periods compared with levels during summer activity. These findings suggest that cytosolic Ca2+ overload and subsequent calpain 1 and 2 activation may be an important mechanism of LG muscle atrophy during hibernation. Cytosolic Ca2+ homeostasis and high expression of calpain inhibitor calpastatin during hibernation may also be an important mechanism for the EDL muscle to maintain muscle mass. Thus, the differential activation of the calpain system and selective degradation of downstream substrates may be involved in muscle atrophy of different fast-twitch muscles during hibernation. NEW & NOTEWORTHY We found that the extent of both muscle atrophy and calpain system activation differed in fast-twitch lateral gastrocnemius (LG), plantaris (PL), and extensor digitorum longus (EDL) skeletal muscles in hibernating Daurian ground squirrels, but similar hierarchies in the order of LG > PL > EDL. The differential activation of the calpain system and selective degradation of downstream substrates may be involved in muscle atrophy in different fast-twitch muscles during hibernation.
An improved method to evaluate heart rate variability based on time-variant cardiorespiratory relation
Authors: Liu Binbin , Yan Saisai , Wang Xiaoni , Xie Lin , Tong Jie , Zhao Fadong , Di Xiaohui , Yan Xiangguo , Zhang Jianbao 
Published: June 2019

Frequency domain analysis of heart rate variability (HRV) is a noninvasive method to evaluate the autonomic nervous system (ANS), but the traditional parameters of HRV, i.e., the power spectra of the high-frequency (HF) and low-frequency bands (LF), cannot estimate the activity of the parasympathetic (PNS) and sympathetic nervous systems (SNS) well. The aim of our study was to provide a corrected method to better distinguish the contributions of the PNS and SNS in the HRV spectrum. Respiration has a gating effect on cardiac vagal efferent activity, which induces respiration-locked heart rate (HR) changes because of the fast effect of the PNS. So the respiration-related heart rate (HRr) is closely related to PNS activity. In this study, HR was decomposed into HRr and the respiration-unrelated component (HRru) based on empirical mode decomposition (EMD) and the relationship between HR and respiration. Time-frequency analysis of HRr and HRru was defined as HFr and LFru, respectively, with specific adaptive bands for every signal. Two experimental data sets, representing SNS and PNS activation, respectively, were used for efficiency analysis of our method. Our results show that the corrected HRV predicted ANS activity well. HFr could be an index of PNS activity, LFru mainly reflected SNS activity, and LFru/HFr could be more accurate in representing the sympathovagal balance. NEW & NOTEWORTHY This study includes the time-varying relationship between respiration and heart rate in the analysis of heart rate variability. Correction for low-frequency and high-frequency components based on respiration significantly improved evaluation of the sympathetic and parasympathetic nervous systems.