bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of healthcare delivery in the early management of bacterial meningitis in UK young infants: an observational study
Authors: Okike Ifeanyichukwu O , Ladhani Shamez N , Anthony Mark , Ninis Nelly , Heath Paul T 
Published: August 2017

ObjectiveTo define early presenting features of bacterial meningitis in young infants in England and to review the adequacy of individual case management as compared with relevant national guidelines and an expert panel review.DesignRetrospective medical case note review and parental recall using standardised questionnaires.SettingEngland and Wales.ParticipantsInfants aged <90 days with bacterial meningitis diagnosed between July 2010 and July 2013.ResultsOf the 97 cases recruited across England and Wales, 66 (68%) were admitted from home and 31 (32%) were in hospital prior to disease onset. Almost all symptoms reported by parents appeared at the onset of the illness, with very few new symptoms appearing subsequently. Overall, 20/66 (30%) infants were assessed to have received inappropriate prehospital management. The median time from onset of first symptoms to first help was 5 hours (IQR: 2–12) and from triage to receipt of first antibiotic dose was 2.0 hours (IQR: 1.0–3.3), significantly shorter in infants with fever or seizures at presentation compared with those without (1.7 (IQR: 1.0–3.0) vs 4.2 (IQR: 1.8–6.3) hours, p=0.02). Overall, 26 (39%) infants had a poor outcome in terms of death or neurological complication; seizures at presentation was the only significant independent risk factor (OR, 7.9; 95% CI 2.3 to 207.0). For cases in hospital already, the median time from onset to first dose of antibiotics was 2.6 (IQR: 1.3–9.8) hours, and 12/31 (39%) of infants had serious neurological sequelae at hospital discharge. Hearing test was not performed in 23% and when performed delayed by ≥4 weeks in 41%.ConclusionsIn young infants, the non-specific features associated with bacterial meningitis appear to show no progression from onset to admission, whereas there were small but significant differences in the proportion of infants with more specific symptoms at hospital admission compared with at the onset of the illness, highlighting the difficulties in early recognition by parents and healthcare professionals alike. A substantial proportion of infants received inappropriate prehospital and posthospital management. We propose a targeted campaign for education and harmonisation of practice with evidence-based management algorithms.
Evaluation of the McGrath MAC and Macintosh laryngoscope for tracheal intubation in 2000 patients undergoing general anaesthesia: the randomised multicentre EMMA trial study protocol
Authors: Kriege Marc , Alflen Christian , Tzanova Irene , Schmidtmann Irene , Piepho Tim , Noppens Ruediger R 
Published: August 2017

IntroductionThe direct laryngoscopy technique using a Macintosh blade is the first choice globally for most anaesthetists. In case of an unanticipated difficult airway, the complication rate increases with the number of intubation attempts. Recently, McGrath MAC (McGrath) video laryngoscopy has become a widely accepted method for securing an airway by tracheal intubation because it allows the visualisation of the glottis without a direct line of sight. Several studies and case reports have highlighted the benefit of the video laryngoscope in the visualisation of the glottis and found it to be superior in difficult intubation situations. The aim of this study was to compare the first-pass intubation success rate using the (McGrath) video laryngoscope compared with conventional direct laryngoscopy in surgical patients.Methods and analysisThe EMMA trial is a multicentre, open-label, patient-blinded, randomised controlled trial. Consecutive patients requiring tracheal intubation are randomly allocated to either the McGrath video laryngoscope or direct laryngoscopy using the Macintosh laryngoscope. The expected rate of successful first-pass intubation is 95% in the McGrath group and 90% in the Macintosh group. Each group must include a total of 1000 patients to achieve 96% power for detecting a difference at the 5% significance level. Successful intubation with the first attempt is the primary endpoint. The secondary endpoints are the time to intubation, attempts for successful intubation, the necessity of alternatives, visualisation of the glottis using the Cormack & Lehane score and percentage of glottic opening score and definite complications.Ethics and disseminationThe project was approved by the local ethics committee of the Medical Association of the Rhineland Palatine state and Westphalia-Lippe. The results of this study will be made available in the form of manuscripts for publication and presentations at national and international meetings.Trial registration numberClinicalTrials.gov NCT 02611986; pre-results.
eLearning for health system leadership and management capacity building: a protocol for a systematic review
Authors: Tudor Car Lorainne , Atun Rifat 
Published: August 2017

IntroductionHealth leadership and management capacity are essential for health system strengthening and for attaining universal health coverage by optimising the existing human, technological and financial resources. However, in health systems, health leadership and management training is not widely available. The use of information technology for education (ie, eLearning) could help address this training gap by enabling flexible, efficient and scalable health leadership and management training. We present a protocol for a systematic review on the effectiveness of eLearning for health leadership and management capacity building in improving health system outcomes.Methodology and analysisWe will follow the Cochrane Collaboration methodology. We will search for experimental studies focused on the use of any type of eLearning modality for health management and leadership capacity building in all types of health workforce cadres. The primary outcomes of interest will be health outcomes, financial risk protection and user satisfaction. In addition, secondary outcomes of interest include the attainment of health system objectives of improved equity, efficiency, effectiveness and responsiveness. We will search relevant databases of published and grey literature as well as clinical trials registries from 1990 onwards without language restrictions. Two review authors will screen references, extract data and perform risk of bias assessment independently. Contingent on the heterogeneity of the collated literature, we will perform either a meta-analysis or a narrative synthesis of the collated data.Ethics and disseminationThe systematic review will aim to inform policy makers, investors, health professionals, technologists and educators about the existing evidence, potential gaps in literature and the impact of eLearning for health leadership and management capacity building on health system outcomes. We will disseminate the review findings by publishing it as a peer-reviewed journal manuscript and conference abstracts.Trial registration numberPROSPERO CRD42017056998
Better evidence for earlier assessment and surgical intervention for refractory epilepsy (The BEST study): a mixed methods study protocol
Authors: Rapport Frances , Shih Patti , Mitchell Rebecca , Nikpour Armin , Bleasel Andrew , Herkes Geoffrey , Vagholkar Sanjyot , Mumford Virginia 
Published: August 2017

IntroductionOne-third of patients with refractory epilepsy may be candidates for resective surgery, which can lead to positive clinical outcomes if efficiently managed. In Australia, there is currently between a 6-month and 2-year delay for patients who are candidates for respective epilepsy surgery from the point of referral for surgical assessment to the eventual surgical intervention. This is a major challenge for implementation of effective treatment for individuals who could potentially benefit from surgery. This study examines implications of delays following the point of eligibility for surgery, in the assessment and treatment of patients, and the factors causing treatment delays.Methods and analysisMixed methods design: Observations of qualitative consultations, patient and healthcare professional interviews, and health-related quality of life assessments for a group of 10 patients and six healthcare professionals (group 1); quantitative retrospective medical records’ reviews examining longitudinal outcomes for 50 patients assessed for, or undergoing, resective surgery between 2014 and 2016 (group 2); retrospective epidemiological study of all individuals hospitalised with a diagnosis of epilepsy in New South Wales (NSW) in the last 5 years (2012–2016; approximately 11 000 hospitalisations per year, total 55 000), examining health services’ use and treatment for individuals with epilepsy, including refractory surgery outcomes (group 3).Ethics and disseminationEthical approval has been granted by the North Sydney Local Health District Human Research Ethics Committee (HREC/17/HAWKE/22) and the NSW Population & Health Services Research Ethics Committee (HREC/16/CIPHS/1). Results will be disseminated through publications, reports and conference presentations to patients and families, health professionals and researchers.
Shoe cushioning, body mass and running biomechanics as risk factors for running injury: a study protocol for a randomised controlled trial
Authors: Malisoux Laurent , Delattre Nicolas , Urhausen Axel , Theisen Daniel 
Published: August 2017

IntroductionRepetitive loading of the musculoskeletal system is suggested to be involved in the underlying mechanism of the majority of running-related injuries (RRIs). Accordingly, heavier runners are assumed to be at a higher risk of RRI. The cushioning system of modern running shoes is expected to protect runners again high impact forces, and therefore, RRI. However, the role of shoe cushioning in injury prevention remains unclear. The main aim of this study is to investigate the influence of shoe cushioning and body mass on RRI risk, while exploring simultaneously the association between running technique and RRI risk.Methods and analysisThis double-blinded randomised controlled trial will involve about 800 healthy leisure-time runners. They will randomly receive one of two running shoe models that will differ in their cushioning properties (ie, stiffness) by ~35%. The participants will perform a running test on an instrumented treadmill at their preferred running speed at baseline. Then they will be followed up prospectively over a 6-month period, during which they will self-report all their sports activities as well as any injury in an internet-based database TIPPS (Training and Injury Prevention Platform for Sports). Cox regression analyses will be used to compare injury risk between the study groups and to investigate the association among training, biomechanical and anatomical risk factors, and injury risk.Ethics and disseminationThe study was approved by the National Ethics Committee for Research (Ref: 201701/02 v1.1). Outcomes will be disseminated through publications in peer-reviewed journals, presentations at international conferences, as well as articles in popular magazines and on specialised websites.Trial registration numberNCT03115437, Pre-results.
STRAP Promotes Stemness of Human Colorectal Cancer via Epigenetic Regulation of the NOTCH Pathway
Authors: Jin Lin , Vu Trung , Yuan Guandou , Datta Pran K. 
Published: August 2017

Abstract
NOTCH signaling exerts essential roles in normal and malignant intestinal physiology and the homeostasis of cancer stem-like cells (CSC), but the basis for this latter role remains obscure. The signaling scaffold protein STRAP is upregulated in several cancers, where it promotes tumorigenicity and metastasis. Here we report a novel oncogenic function for STRAP in maintaining CSC subpopulations in a heterogeneous mixture by antagonizing formation of the chromatin modifier PRC2 and by epigenetically activating NOTCH signals in human colorectal cancer. Silencing STRAP sensitized colorectal cancer cells to chemotherapeutic drugs in vitro and in vivo. STRAP depletion also contributed to a reduced stem-like phenotype of colorectal cancer cells, as indicated by reduced expression of the CSC signature and NOTCH signaling regulators in vitro and by diminished tumorigenesis in vivo. Genes encoding some upstream activators of NOTCH were highly enriched for H3K27me3, which forms repressive chromatin domains upon STRAP silencing. Mechanistically, STRAP competitively disrupted association of the PRC2 subunits EZH2 and SUZ12, thereby inhibiting PRC2 assembly. Restoring the NOTCH pathway by lentiviral expression of NICD1 or HES1 in STRAP-depleted tumor cells reversed the CSC phenotype. In 90 colorectal cancer clinical specimens, a significant positive correlation was documented between the expression of STRAP and HES1. Overall, our findings illuminated a novel STRAP–NOTCH1–HES1 molecular axis as a CSC regulator in colorectal cancer, with potential implications to improve treatment of this disease. Cancer Res; 77(20); 5464–78. ©2017 AACR.
The Intermodel Diversity of East Asia’s Summer Rainfall among CMIP5 Models
Authors: Qu Xia 
Published: August 2017

Based on the results of 46 phase 5 of the Coupled Model Intercomparison Project (CMIP5) models and empirical orthogonal function analysis, it was found that the leading diversity mode of East Asian summer rainfall across the models features a dipole structure. This structure is characterized by intensified rainfall over southern China and the area south of Japan and by weakened rainfall over northern China and explains more than 1/3 of the total intermodel variance. The uncertainty in meridional position of intertropical convergence zone (ITCZ) over the tropical North Pacific, caused by rainfall parameterization and air–sea interactions, is responsible for the mode. In models with a southward shifted ITCZ, the heating associated with inadequate rainfall (7°–18°N) over the tropical northwest Pacific excites wave activities that propagate northward and converge south of Japan in the midtroposphere. In the midtroposphere, a positive (negative) vorticity departure resides north (south) of the center of rainfall diversity. Correspondingly, the westerlies departure resides over the anomaly centers. The westerlies induce warm horizontal advection departure, leading to ascendance and rainfall variability. In addition, the rainfall diversity south of Japan induces changes in rainfall over northern China; this, in turn, promotes rainfall over the area south of Japan. Anomalous positive latent heating associated with the rainfall south of Japan induces anomalous northerlies and northeasterlies over northern China. This phenomenon depresses rainfall in northern China through bringing in dry air and weakening evaporation. This rainfall excites an upper-troposphere vorticity departure to the west, exciting wave activity propagating southeastward and downward. In the midtroposphere, the waves converge south of Japan and reinforce the westerlies and the rainfall diversity there.
Impact of Rainfall Assimilation on High-Resolution Hydrometeorological Forecasts over Liguria, Italy
Authors: Davolio Silvio , Silvestro Francesco , Gastaldo Thomas 
Published: August 2017

Abstract
The autumn of 2014 was characterized by a number of severe weather episodes over Liguria (northern Italy) associated with floods and remarkable damage. This period is selected as a test bed to evaluate the performance of a rainfall assimilation scheme based on the nudging of humidity profiles and applied to a convection-permitting meteorological model at high resolution. The impact of the scheme is assessed in terms of quantitative precipitation forecast (QPF) applying an object-oriented verification methodology that evaluates the structure, amplitude, and location (SAL) of the precipitation field, but also in terms of hydrological discharge prediction. To attain this aim, the meteorological model is coupled with the operational hydrological forecasting chain of the Ligurian Hydrometeorological Functional Centre, and the whole system is implemented taking operational requirements into account. The impact of rainfall data assimilation is large during the assimilation period and still relevant in the following 3 h of the free forecasts, but hardly lasts more than 6 h. However, this can improve the hydrological predictions. Moreover, the impact of the assimilation is dependent on the environment characteristics, being more effective when nonequilibrium convection dominates, and thus an accurate prediction of the local triggering for the development of the precipitation system is required.
Radiance Preprocessing for Assimilation in the Hourly Updating Rapid Refresh Mesoscale Model: A Study Using AIRS Data
Authors: Lin Haidao , Weygandt Stephen S. , Lim Agnes H. N. , Hu Ming , Brown John M. , Benjamin Stanley G. 
Published: August 2017

Abstract
This study describes the initial application of radiance bias correction and channel selection in the hourly updated Rapid Refresh model. For this initial application, data from the Atmospheric Infrared Sounder (AIRS) are used; this dataset gives atmospheric temperature and water vapor information at higher vertical resolution and accuracy than previously launched low-spectral resolution satellite systems. In this preliminary study, data from AIRS are shown to add skill to short-range weather forecasts over a relatively data-rich area. Two 1-month retrospective runs were conducted to evaluate the impact of assimilating clear-sky AIRS radiance data on 1–12-h forecasts using a research version of the National Oceanic and Atmospheric Administration (NOAA) Rapid Refresh (RAP) regional mesoscale model already assimilating conventional and other radiance [AMSU-A, Microwave Humidity Sounder (MHS), HIRS-4] data. Prior to performing the assimilation, a channel selection and bias-correction spinup procedure was conducted that was appropriate for the RAP configuration. RAP forecasts initialized from analyses with and without AIRS data were verified against radiosonde, surface atmosphere, precipitation, and satellite radiance observations. Results show that the impact from AIRS radiance data on short-range forecast skill in the RAP system is small but positive and statistically significant at the 95% confidence level. The RAP-specific channel selection and bias correction procedures described in this study were the basis for similar applications to other radiance datasets now assimilated in version 3 of RAP implemented at NOAA’s National Centers for Environmental Prediction (NCEP) in August 2016.
Preoperative Counseling in Salvage Total Laryngectomy: Content Analysis of Electronic Medical Records
Authors: Raol Nikhila , Lilley Elizabeth , Cooper Zara , Dowdall Jayme , Morris Megan A. 
Published: August 2017

ObjectiveTo study preoperative counseling in patients undergoing salvage total laryngectomy (STL).Study DesignCase series with chart review.SettingTertiary care academic hospital.Subjects and MethodsWe reviewed charts of patients ≥18 years undergoing STL between 2005 and 2015. Fifty‐eight patients were identified. Notes written within 2 months prior to surgery by head and neck surgical oncologists, radiation oncologists, medical oncologists, speech‐language pathologists, social workers, and nurse practitioners were extracted and coded into 4 categories. Coded content was then analyzed using a simple tally within content areas.ResultsNonphysicians documented patient values and priorities, exclusive of treatment desires, more frequently. These topics included apprehension about family obligations, fear about communication, questions regarding quality of life, and anxiety regarding job continuation. Physician notes documented priorities regarding preferences for surgical treatment. No patients were seen by palliative care preoperatively, and only 14% (n = 8) patients had documentation of an end‐of‐life discussion.ConclusionsPreoperative counseling for STL patients that included nonphysicians had a higher frequency of discussion of patients’ priorities. This suggests including these types of providers may lead to more patient‐centered care. A prospective study evaluating patient and physician perceptions of preoperative counseling can better identify where discrepancies exists and help conceptualize a framework for preoperative counseling in STL patients and other patients undergoing high‐risk surgery.
Reporting interventions in trials evaluating cognitive rehabilitation in people with multiple sclerosis: a systematic review
Authors: Mhizha-Murira Jacqueline R , Drummond Avril , Klein Olga A , dasNair Roshan 
Published: August 2017

Objective: To determine the quantity and quality of description of cognitive rehabilitation for cognitive deficits in people with multiple sclerosis, using a variety of published checklists, and suggest ways of improving the reporting of these interventions. Data sources: A total of 10 electronic databases were searched, including MEDLINE, EMBASE, CINAHL and PsycINFO, from inception to May 2017. Grey literature databases, trial registers, reference lists and author citations were also searched. Review methods: Papers were included if participants were people with multiple sclerosis aged 18 years and over and if the effectiveness of cognitive rehabilitation in improving functional ability for memory, attention or executive dysfunction, with or without a control group, was being evaluated. Results: A total of 54 studies were included in this review. The reporting of a number of key aspects of cognitive rehabilitation was poor. This was particularly in relation to content of interventions (reported completely in 26 of the 54 studies), intervention procedures (reported completely in 16 of the 54 studies), delivery mode (reported completely in 24 of the 54 studies) and intervention mechanism of action (reported completely in 21 of the 54 studies). Conclusion: The quality of reporting of cognitive rehabilitation for memory, attention and executive function for multiple sclerosis, across a range of study designs, is poor. Existing reporting checklists do not adequately cover aspects relevant to cognitive rehabilitation, such as the approaches used to address cognitive deficits. Future checklists could consider these aspects we have identified in this review.