bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Robust Predictive Resource Planning under Demand Uncertainty to Improve Waiting Times in Outpatient Clinics
Authors: Munavalli Jyoti R. , Rao Shyam Vasudeva , Srinivasan Aravind , Manjunath Usha , van Merode G. G. 
Published: October 2017

Background and context: Resource planning is performed ahead of time within outpatient clinics (OPC). Due to local control of operations (department-centric decision-making) and limited resources, OPCs cannot handle high variability and uncertainty in demand. There is always a difference between planning and reality, and this leads to operational problems such as excessive waiting times. The OPCs often react to the situation when problems are encountered and reaction times play an important role in determining patient waiting times. Objectives: To propose a predictive resource planning that incorporates variability in the short term with the OPC-wide perspective, not department-centric. Methodology: The process and patient data were collected from the OPC under study by observation, interviews and from the records of the hospital management information system. A resource planning model (RPM) was developed that matched resources according to demand in short term. A mathematical model with outputs resource plan for a day was formulated utilizing Takt time (the average time a patient needs to move out of the OPC system) management that is used in Toyota Production System (TPS), to allocate resources to all the departments. Using a Discrete Event Simulation Model, the effects of predictive resource planning with different reaction times on waiting times and cycle times were analyzed. The resource plans were implemented in the OPC of Aravind Eye Hospital, Madurai, Tamil Nadu, India, that has high patient volumes and random patient arrivals. Results and discussion: The simulation and implementation results indicate that predictive resource planning is robust and improves waiting times, and cycle times in OPCs. Study findings confirm that the predictive planning model reduces the average waiting time by 43.4 per cent during simulation and by 41.1 per cent during its implementation. The reduction in standard deviations in waiting times indicate reduction of unregulated waiting times. The OPC scheduled 28 resources throughout the day, whereas with predictive resource planning, the number of resources varied between a minimum of 12 to a maximum around 30–34 resources. Conclusions: The OPCs currently match demands to their supply, while matching resources to varying demand in short term; throughout the OPC (all departments) improves patient flow, and minimizes waiting time and cycle time. Previously, Takt time management (TTM) has applied to systems with even and stable demand; in this study, it has been applied to stochastic demand. Implications: This planning model helps the management to identify resource requirements: types of resources and number of resources, for the future demand growth and expansion. It can probably be extended to general hospitals by considering their demand forecast, precedence constraints and workflow complexities.
‘Trust me, I’m a doctor’: a qualitative study of the role of paternalism and older people in decision-making when they have lost their capacity
Authors: Cole Joanne , Kiriaev Oleg , Malpas Phillipa , Cheung Gary 
Published: October 2017

Objective: The objective of this study was to explore whether older people want their doctors to make treatment decisions on their behalf when they no longer have capacity to do so, and their reasons for these preferences. Method: A convenience sample of older people from two retirement villages were interviewed and asked to respond to a hypothetical vignette. Their responses were analysed using qualitative thematic methodology. Results: Thirty-seven people (56.8% female; mean age = 83.9 years; mean Mini Mental State Examination = 26.5) participated; 73.0% indicated that they would want their doctor to make treatment decisions on their behalf. Three key themes emerged: 1) trust in the doctor–patient relationship; 2) doctor-derived factors: knowledge and expertise, professionalism, role and responsibility; 3) patient-derived factors: vulnerability, dependence and reliance, compromised autonomy. Conclusion: Our findings suggest that the paternalistic model within medical care can be an expectation of some older patients and if taking a paternalistic approach we should not underestimate the trust and power that is imparted to us.
Open Defaecation and Its Effects on the Bacteriological Quality of Drinking Water Sources in Isiolo County, Kenya
Authors: Okullo Joab Odhiambo , Moturi Wilkister Nyaora , Ogendi George Morara 
Published: October 2017

Background information: The post-2015 Sustainable Development Goals for sanitation call for universal access to adequate and equitable sanitation and an end to open defaecation by 2030. In Isiolo County, a semi-arid region lying in the northern part of Kenya, poor sanitation and water shortage remain a major problem facing the rural communities. Objective: The overall aim of the study was to assess the relationship between sanitation practices and the bacteriological quality of drinking water sources. The study also assessed the risk factors contributing to open defaecation in the rural environments of the study area. Methods: A cross-sectional study of 150 households was conducted to assess the faecal disposal practices in open defaecation free (ODF) and open defaecation not free (ODNF) areas. Sanitary surveys and bacteriological analyses were conducted for selected community water sources to identify faecal pollution sources, contamination pathways, and contributory factors. Analysis of data was performed using SPSS (descriptive and inferential statistics at α = .05 level of significance). Results: Open defaecation habit was reported in 51% of the study households in ODNF villages and in 17% households in ODF villages. Higher mean colony counts were recorded for water samples from ODNF areas 2.0, 7.8, 5.3, and 7.0 (×103) colony-forming units (CFUs)/100 mL compared with those of ODF 1.8, 6.4, 3.5, and 6.1 (×103) areas for Escherichia coli, faecal streptococci, Salmonella typhi, and total coliform, respectively. Correlation tests revealed a significant relationship between sanitary surveys and contamination of water sources ( P = .002). Conclusions: The water sources exhibited high levels of contamination with microbial pathogens attributed to poor sanitation. Practising safe faecal disposal in particular is recommended as this will considerably reverse the situation and thus lead to improved human health.
Remote consulting with telemonitoring of continuous positive airway pressure usage data for the routine review of people with obstructive sleep apnoea hypopnoea syndrome: A systematic review
Authors: Murphie Phyllis , Little Stuart , McKinstry Brian , Pinnock Hilary 
Published: October 2017

Introduction Telehealth has the potential to offer more convenient care and reduce travel. We aimed to systematically review studies that assessed the effectiveness of teleconsultation plus telemonitoring in the review of people with obstructive sleep apnoea hypopnoea syndrome receiving continuous positive airway pressure therapy versus face-to-face care. Methods Following Cochrane methodology, we searched 10 electronic databases (November 2015), trial registries, and reference lists of included studies, for trials testing interventions that combined remote consultations with telemonitoring of usage/continuous positive airway pressure data. Outcomes measures were: proportion reviewed, continuous positive airway pressure adherence, symptom control, and satisfaction/acceptability and cost effectiveness. Results From 362 potentially relevant papers, we identified five randomised controlled trials ( n = 269 patients): four from North America and one from Spain. Risk of bias was moderate in one, and moderate/high in four trials. Two trials reported number/duration of reviews with inconsistent results. The teleconsultation/telemonitoring improved continuous positive airway pressure adherence in two trials ( n = 19; n = 75); two ( n = 114 and n = 75) reported no between-groups differences. Two studies, both at moderate/high risk of bias, showed no between-group difference in the Epworth Sleepiness Score. Satisfaction was generally reported positively in all five trials; one trial reported that the teleconsultation/telemonitoring patients were ‘more likely to continue’ with continuous positive airway pressure therapy treatment. One study reported teleconsultation/telemonitoring as cost effective. Discussion The evidence for teleconsultation/telemonitoring in continuous positive airway pressure users is limited; however, no safety concerns have been raised. Adequately powered, well-designed trials are needed to establish whether real-time telemonitoring and remote teleconsultation is a clinically and cost effective option for people using continuous positive airway pressure therapy.
Reflections on the Concept of Authentic Leadership: From an Indigenous Scholar/Leader Perspective
Authors: Faircloth Susan C. 
Published: October 2017

The ProblemThis article draws on the author’s experiences as an American Indian administrator and faculty member in a public university. The dilemma presented here revolves around her struggle to reconcile her identity as an Indigenous person with the values, beliefs, and priorities of an academic institution solidly rooted in Western structures and traditions.The SolutionThe author draws on this dilemma as she reflects on the concept of authentic leadership as a practicable goal for Indigenous leaders within the academy. In doing so, she cites the need for a nuanced conception of authentic leadership that takes into account the complex identities of Indigenous peoples.The StakeholdersThe dilemma presented here can be used by human resource development scholars and practitioners as a tool for examining and understanding the ways in which the concept of authentic leadership both conflicts and resonates with the personal and professional values of Indigenous scholars/leaders within academic environments.
Viewing Authentic Leadership Through a Bourdieusian Lens: Understanding Gender and Leadership as Social Action
Authors: Fox-Kirk Wendy 
Published: October 2017

The ProblemMany leadership development activities in modern organizations focus on the individual, either finding an individual with the secret sauce, named leadership potential, or training the individual in so-called effective leadership competencies. For women, this focus often leads to a ‘fix the women’ approach. Avolio and Gardner’s Authentic Leadership (AL) theory with its overemphasis on the individual and narrow definitions of what it means to be ‘authentic’ reinforces the concept of the ‘ideal leader’ as the hero who will rid organizations of unethical practice. The theory’s lack of attention to the role of context leads to errors in our understanding of gender and leadership, and perpetuates discrimination.The SolutionBourdieu’s Social Theory is used to explore AL theory with a view to illuminating the role of power and privilege inherent in this concept.The StakeholdersStakeholders are leadership development practitioners and HR specialists who are interested in reducing inequalities in organizational practices.
Disease-modifying and symptomatic treatment of amyotrophic lateral sclerosis
Authors: Dorst Johannes , Ludolph Albert C. , Huebers Annemarie 
Published: October 2017

In this review, we summarize the most important recent developments in the treatment of amyotrophic lateral sclerosis (ALS). In terms of disease-modifying treatment options, several drugs such as dexpramipexole, pioglitazone, lithium, and many others have been tested in large multicenter trials, albeit with disappointing results. Therefore, riluzole remains the only directly disease-modifying drug. In addition, we discuss antisense oligonucleotides (ASOs) as a new and potentially causal treatment option. Progress in symptomatic treatments has been more important. Nutrition and ventilation are now an important focus of ALS therapy. Several studies have firmly established that noninvasive ventilation improves patients’ quality of life and prolongs survival. On the other hand, there is still no consensus regarding best nutritional management, but big multicenter trials addressing this issue are currently ongoing. Evidence regarding secondary symptoms like spasticity, muscle cramps or sialorrhea remains generally scarce, but some new insights will also be discussed. Growing evidence suggests that multidisciplinary care in specialized clinics improves survival.
Gait speed has comparable prognostic capability to six-minute walk distance in older patients with cardiovascular disease
Authors: Kamiya Kentaro , Hamazaki Nobuaki , Matsue Yuya , Mezzani Alessandro , Corrà Ugo , Matsuzawa Ryota , Nozaki Kohei , Tanaka Shinya , Maekawa Emi , Noda Chiharu , Yamaoka-Tojo Minako , Matsunaga Atsuhiko , Masuda Takashi , Ako Junya 
Published: October 2017

Background Although gait speed and six-minute walk distance are used to assess functional capacity in older patients with cardiovascular disease, their prognostic capabilities have not been directly compared. Methods The study population was identified from the Kitasato University Cardiac Rehabilitation Database and consisted of 1474 patients ≥60 years old with a mean age of 72.2 ± 7.1 years that underwent evaluation of both usual gait speed and six-minute walk distance in routine geriatric assessment between 1 June 2008–30 September 2015. Both gait speed and six-minute walk distance were determined on the same day at hospital discharge. Results Mean gait speed and six-minute walk distance in the whole population were 1.04 m/s and 381 m, respectively, and were strongly positively correlated ( r = 0.80, p < 0.001). A total of 180 deaths occurred during a follow-up of 2.3 ± 1.9 years. After adjusting for confounding factors, both gait speed (adjusted hazard ratio per 0.1 m/s increase: 0.87, 95% confidence interval: 0.81–0.93, p < 0.001) and six-minute walk distance (adjusted hazard ratio per 10-metre increase: 0.96, 95% confidence interval: 0.94–0.97, p < 0.001) were independent predictors of all-cause mortality. There was no significant difference in prognostic capability between gait speed and six-minute walk distance (c-index: 0.64 (95% confidence interval: 0.60–0.69) and 0.66 (95% confidence interval: 0.61–0.70), respectively, p = 0.357). Conclusions Gait speed and six-minute walk distance showed similar prognostic predictive ability for all-cause mortality in older cardiovascular disease patients, indicating the potential utility of gait speed as a simple risk stratification tool in older cardiovascular disease patients.
Chronic post-amputation pain: peri-operative management – Review
Authors: Srivastava Devjit 
Published: October 2017

Study design: Narrative review. Method: Eight bibliographic databases were searched for studies published in the (last five years up until Feb 2017). For the two database searches (Cochrane and DARE), the time frame was unlimited. The review involved keyword searches of the term ‘Amputation’ AND ‘chronic pain’. Studies selected were interrogated for any association between peri-operative factors and the occurrence of chronic post amputation pain (CPAP). Results: Heterogeneity of study populations and outcome measures prevented a systematic review and hence a narrative synthesis of results was undertaken. The presence of variation in two gene alleles (GCH1 and KCNS1) may be relevant for development of CPAP. There was little evidence to draw conclusions on the association between age, gender and CPAP. Pre-operative anxiety and depression influenced pain intensity post operatively and long-term post amputation pain (CPAP). The presence of pre-amputation pain is correlated to the development of acute and chronic post amputation pain while evidence for the association of post-operative pain with CPAP is modest. Regional anaesthesia and peri-neural catheters improve acute postoperative pain relief but evidence on their efficacy to prevent CPAP is limited. A suggested whole system pathway based on current evidence to optimize peri-operative amputation pain is described. Conclusion: The current evidence suggests that optimized peri-operative analgesia reduces the incidence of acute peri-operative pain but no firm conclusion can be drawn on reducing risk for CPAP.
Fecal immunochemical tests in combination with blood tests for colorectal cancer and advanced adenoma detection—systematic review
Authors: Niedermaier Tobias , Weigl Korbinian , Hoffmeister Michael , Brenner Hermann 
Published: October 2017

Background Colorectal cancer (CRC) is a common but largely preventable cancer. Although fecal immunochemical tests (FITs) detect the majority of CRCs, they miss some of the cancers and most advanced adenomas (AAs). The potential of blood tests in complementing FITs for the detection of CRC or AA has not yet been systematically investigated. Methods We conducted a systematic review of performance of FIT combined with an additional blood test for CRC and AA detection versus FIT alone. PubMed and Web of Science were searched until June 9, 2017. Results Some markers substantially increased sensitivity for CRC when combined with FIT, albeit typically at a major loss of specificity. For AA, no relevant increase in sensitivity could be achieved. Conclusion Combining FIT and blood tests might be a promising approach to enhance sensitivity of CRC screening, but comprehensive evaluation of promising marker combinations in screening populations is needed.
Acquisition of double mutation in gyrA caused high resistance to sitafloxacin in Helicobacter pylori after unsuccessful eradication with sitafloxacin-containing regimens
Authors: Mori Hideki , Suzuki Hidekazu , Matsuzaki Juntaro , Masaoka Tatsuhiro , Kanai Takanori 
Published: October 2017

Background and aim Although sitafloxacin (STFX)-containing regimens are effective rescue treatments for Helicobacter pylori infection, prevalence of fluoroquinolone resistance in H. pylori has increased rapidly worldwide. The change in resistance levels and gyrA mutations, a major cause of fluoroquinolone resistance, after unsuccessful STFX-containing treatment has not been investigated. Methods We conducted a retrospective, non-randomized study to compare the minimum inhibitory concentrations (MICs) of STFX and the location of gyrA mutations in H. pylori before and after unsuccessful eradication with STFX-containing regimens at Keio University Hospital between December 2011 and March 2015. Results A total of 266 patients treated with STFX-containing regimens for third-line H. pylori eradication were evaluated. Double mutations in gyrA were acquired by 20.8% of strains that exhibited seven-fold increased STFX MICs, compared to pre-treatment MICs. The STFX MICs did not increase, however, when the location of the gyrA mutations did not change after treatment. Double mutations in gyrA developed in 60.0% of the strains in which eradication failed, which exhibited a baseline mutation at position D91, and in 11.1% of strains with baseline mutations at position N87. Conclusion Acquisition of double mutations in gyrA evoked high-level resistance to STFX in H. pylori after unsuccessful eradication with STFX-containing regimens.
Effect of Metformin on Vascular Function in Children With Type 1 Diabetes: A 12-Month Randomized Controlled Trial
Authors: Anderson Jemma J A , Couper Jennifer J , Giles Lynne C , Leggett Catherine E , Gent Roger , Coppin Brian , Peña Alexia S 
Published: October 2017

Abstract

Context
Children with type 1 diabetes have vascular dysfunction preceding atherosclerosis. Early interventions are needed to reduce cardiovascular disease.

Objective
To evaluate the effect of metformin on vascular function in children with type 1 diabetes.

Design
Twelve-month double-blind, randomized, placebo-controlled trial.

Setting
Tertiary pediatric diabetes clinic.

Participants
Ninety children (8 to 18 years of age), &gt;50th percentile body mass index (BMI), with type 1 diabetes.

Intervention
Metformin (up to 1 g twice a day) or placebo.

Main Outcome Measure
Vascular function measured by brachial artery ultrasound [flow-mediated dilatation/glyceryl trinitrate–mediated dilatation (GTN)].

Results
Ninety participants were enrolled [41 boys, 13.6 (2.5) years of age, 45 per group], 10 discontinued intervention, and 1 was lost to follow-up. On metformin, GTN improved, independent of glycosylated hemoglobin (HbA1c), by 3.3 percentage units [95% confidence interval (CI) 0.3, 6.3, P = 0.03] and insulin dose reduced by 0.2 U/kg/d (95% CI 0.1, 0.3, P = 0.001) during 12 months, with effects from 3 months. Metformin had a beneficial effect on HbA1c at 3 months (P = 0.001) and difference in adjusted HbA1c between groups during 12 months was 1.0%; 95% CI 0.4, 1.5 (10.9 mmol/mol; 95% CI 4.4, 16.4), P = 0.001. There were no effects on carotid/aortic intima media thickness, BMI, lipids, blood pressure, or other cardiovascular risk factors. Median (95% CI) adherence, evaluated by electronic monitoring, was 75.5% (65.7, 81.5), without group differences. More gastrointestinal side effects were reported on metformin (incidence rate ratio 1.65, 95% CI 1.08, 2.52, P = 0.02), with no difference in hypoglycemia or diabetic ketoacidosis.

Conclusions
Metformin improved vascular smooth muscle function and HbA1c, and lowered insulin dose in type 1 diabetes children. These benefits and good safety profile warrant further consideration of its use.
Improving agricultural knowledge management: The AgTrials experience
Authors: Hyman Glenn , Espinosa Herlin , Camargo Paola , Abreu David , Devare Medha , Arnaud Elizabeth , Porter Cheryl , Mwanzia Leroy , Sonder Kai , Traore Sibiry 
Published: October 2017

Background: Opportunities to use data and information to address challenges in international agricultural research and development are expanding rapidly. The use of agricultural trial and evaluation data has enormous potential to improve crops and management practices. However, for a number of reasons, this potential has yet to be realized. This paper reports on the experience of the AgTrials initiative, an effort to build an online database of agricultural trials applying principles of interoperability and open access. Methods: Our analysis evaluates what worked and what did not work in the development of the AgTrials information resource. We analyzed data on our users and their interaction with the platform. We also surveyed our users to gauge their perceptions of the utility of the online database. Results: The study revealed barriers to participation and impediments to interaction, opportunities for improving agricultural knowledge management and a large potential for the use of trial and evaluation data. Conclusions: Technical and logistical mechanisms for developing interoperable online databases are well advanced. More effort will be needed to advance organizational and institutional work for these types of databases to realize their potential.