bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving transitions of care: a resident-driven approach to address delays in patient care during the direct admission process
Authors: Goolsarran Nirvani , Huang Li , Ottaviano Lorenzo 
Published: September 2017

BackgroundThe direct admission process is a complex system that can be aggravated by inherent gaps in communication leading to inefficient continuity of care and patient safety issues. Bypassing the emergency room, triage is often associated with long periods of unmonitored observation and significant delays in patient assessment. We identified significant communication gaps, delays in placement of admission orders and patient assessment during the direct admission process at our institution. To address this issue, we created and implemented a standardised direct admission flow diagram that consists of a step-by- step direct admission process, which includes a communication device and a triage power plan in the Electronic Medical Record.MethodsWe used the Plan-Do-Study-Act (PDSA) model for Quality improvement to address communication gaps in the direct admission process Baseline measurement confirmed two critical gaps in communication: 1) communication to the Medical Admitting Resident (MAR), the central source of communication of all medicine admissions, and 2) delays in placement of orders and assessment of the patient.ResultsTwo months after implementation of a standardised process that addressed the two major gaps in communication, we found that communication to the MAR increased from 16% (7/42) to 100% (15/15). Additionally, the average time for order placement and assessment of patient decreased from 153 minutes to 53 minutes (n=15).ConclusionIn order to improve the safety of direct admissions, the entire process must be carefully analysed and potential delays in patient assessment should be minimised. A standardised flow diagram that identified and targeted specific communication gaps can minimise delays in patient care.
On two conjectures on the subspace inclusion 6 graph of a vector space
Authors: Wong Dein , Wang Xinlei , Xia Chunguang 
Published: September 2017

The subspace inclusion graph on a vector space [Formula: see text], denoted by [Formula: see text], is a graph whose vertex set consists of nontrivial proper subspaces of [Formula: see text] and two vertices are adjacent if one is properly contained in another. In a recent paper, Das posed the following four conjectures on the subspace inclusion graph [Formula: see text]: If [Formula: see text] is a [Formula: see text]-dimensional vector space over a finite field [Formula: see text] with [Formula: see text] elements, then: (1) The domination number of [Formula: see text] is [Formula: see text]. (2) [Formula: see text] is distance regular. (3) [Formula: see text] is Hamiltonian. (4) [Formula: see text] is a Cayley graph. In the present paper, we prove the first two conjectures: If [Formula: see text] is a [Formula: see text]-dimensional vector space over a finite field [Formula: see text] with [Formula: see text] elements, then: (1) The domination number of [Formula: see text] is [Formula: see text]. (2) [Formula: see text] is distance regular.
Sex‐Specific Association of Obstructive Sleep Apnea With Retinal Microvascular Signs: The Multi‐Ethnic Study of Atherosclerosis
Authors: Lin Gen‐Min , Redline Susan , Klein Ronald , Colangelo Laura A. , Cotch Mary Frances , Wong Tien Y. , Klein Barbara E. K. , Patel Sanjay R. , Shea Steven J. , Liu Kiang 
Published: September 2017

Background

Obstructive sleep apnea (
OSA
) is a common condition affecting more men than women. The relationship of
OSA
with microvascular disease is unclear, complicated by possible sex difference. Assessment of the relationship of
OSA
with retinal microvascular signs in men and women may provide insights into such a relationship.

Methods and Results

We examined the sex‐specific cross‐sectional association of
OSA
severity with retinal vascular calibers in 1808 participants, and with specific retinopathy signs in 1831 participants from a sample of 2060 participants aged 54 to 93 years who underwent successful polysomnography in the Multi‐Ethnic Study of Atherosclerosis, 2010–2012.
OSA
severity was defined by the apnea–hypopnea index (events/h) as none (<5), mild (5–14.9), moderate (15–29.9), and severe (≥30). As compared to no
OSA
, moderate/severe
OSA
in men was associated with retinal arteriolar narrowing (odds ratio [
OR
] and 95% CI for the narrowest quartile: 1.65 [1.00–2.71]) and retinal venular widening (1.80 [1.07–3.04] for the widest quartile), but not in women (odds ratio: 1.10 [0.67–1.81] and 0.91 [0.58–1.43], respectively) after adjusting for age, race/ethnicity, body mass index, pack‐years of cigarette smoking, alcohol intake, hypertension duration, diabetes mellitus duration, HbA1c levels, lipid profile, micro‐/macroalbuminuria, estimated glomerular filtration rate, β‐blockers use, antihypertensive therapy, and lipid‐lowering therapy. In contrast, severe
OSA
was associated with retinal microaneurysms in women, but not in men (odds ratio: 3.22 [1.16–8.97] and 0.59 [0.27–1.30], respectively).

Conclusions

The associations of
OSA
severity with retinal microvascular signs may differ by sex. Whether these findings were related to sex differences in
OSA
exposure needs further investigation.
Characteristics of Wintertime Daily Precipitation over the Australian Snowy Mountains
Authors: Sarmadi Fahimeh , Huang Yi , Siems Steven T. , Manton Michael J. 
Published: September 2017

Abstract
The relationship between orographic precipitation, low-level thermodynamic stability, and the synoptic meteorology is explored for the Snowy Mountains of southeast Australia. A 21-yr dataset (May–October, 1995–2015) of upper-air soundings from an upwind site is used to define synoptic indicators and the low-level stability. A K-means clustering algorithm was employed to classify the daily meteorology into four synoptic classes. The initial classification, based only on six synoptic indicators, distinctly defines both the surface precipitation and the low-level stability by class. Consistent with theory, the wet classes are found to have weak low-level stability, and the dry classes have strong low-level stability. By including low-level stability as an additional input variable to the clustering method, statistically significant correlations were found between the precipitation and the low-level stability within each of the four classes. An examination of the joint PDF reveals a highly nonlinear relationship; heavy rain was associated with very weak low-level stability, and conversely, strong low-level stability was associated with very little precipitation. Building on these historical relationships, model output statistics (MOS) from a moderate resolution (12-km spatial resolution) operational forecast were used to develop stepwise regression models designed to improve the 24-h forecast of precipitation over the Snowy Mountains. A single regression model for all days was found to reduce the RMSE by 7% and the bias by 75%. A class-based regression model was found to reduce the overall RMSE by 30% and the bias by 85%.
Implementing evidence-based smoking cessation treatment in psychosocial care units (CAPS) in Brazil
Authors: Castaldelli-Maia João Mauricio , da Silva Nilson R , Campos Marta RD , Moura Helena F , Zabert Gustavo , Champagne Beatriz M , Kemper Katherine E , Hays J Taylor 
Published: September 2017

Background: The prevalence of smoking among mental health and addiction (MHA) patients is 3 times higher than it is in the general population, yet this patient population has received little help to combat smoking. Considering this, psychosocial care centers (CAPS – Centros de Atenção Psicossocial) are strategic locations for integrating tobacco dependence treatment (TDT) into existing treatment activities. Methods: Our team provided an 8-hour training package to the staff of CAPS that have not been providing specialized TDT for smokers. Our curriculum included the following topics focused on the implementation of treatment for MHA smokers: management, epidemiology, medications, psychotherapy, and smoking/mental health assessment instruments. Results: Our team trained the staff of 17 CAPS units within 10 cities – which included more than 186 health professionals. There were many barriers encountered as we provided this training. A summary of problems we faced were as follows: resistance to incorporating TDT in addiction/mental health-care units, resistance to the implementation of cognitive-behavioral therapy (CBT) (psychodynamic therapy and harm reduction were preferred) and treatment for smoking is already implemented in primary care network; resistance to the use of medication in addiction treatment (a preference for psychotherapy and psychosocial approach). Conclusion: We learned a number of important lessons as we worked to improve the delivery of TDT to MHA patients in Brazil: provide clinicians an opportunity to explore how they feel/think about providing TDT to their clients at the very outset of the training, rather than focusing on a specific type of behavioral therapy for TDT (such as CBT), which some may find objectionable; use more generic descriptions of behavioral therapy such as ‘supportive counseling’; include training professionals who are open to other forms of behavioral therapy in addition to psychoanalysis and discuss the important impact that MHA units can have in improving the quality of life for their patients who smoke.
Assessing the impact of headaches and the outcomes of treatment: A systematic review of patient-reported outcome measures (PROMs)
Authors: Haywood Kirstie L , Mars Tom S , Potter Rachel , Patel Shilpa , Matharu Manjit , Underwood Martin 
Published: September 2017

Aims To critically appraise, compare and synthesise the quality and acceptability of multi-item patient reported outcome measures for adults with chronic or episodic headache. Methods Systematic literature searches of major databases (1980–2016) to identify published evidence of PROM measurement and practical properties. Data on study quality (COSMIN), measurement and practical properties per measure were extracted and assessed against accepted standards to inform an evidence synthesis. Results From 10,903 reviewed abstracts, 103 articles were assessed in full; 46 provided evidence for 23 PROMs: Eleven specific to the health-related impact of migraine (n = 5) or headache (n = 6); six assessed migraine-specific treatment response/satisfaction; six were generic measures. Evidence for measurement validity and score interpretation was strongest for two measures of impact, Migraine-Specific Quality of Life Questionnaire (MSQ v2.1) and Headache Impact Test 6-item (HIT-6), and one of treatment response, the Patient Perception of Migraine Questionnaire (PPMQ-R). Evidence of reliability was limited, but acceptable for the HIT-6. Responsiveness was rarely evaluated. Evidence for the remaining measures was limited. Patient involvement was limited and poorly reported. Conclusion While evidence is limited, three measures have acceptable evidence of reliability and validity: HIT-6, MSQ v2.1 and PPMQ-R. Only the HIT-6 has acceptable evidence supporting its completion by all “headache” populations.
Analgesic effects of gabapentin and buprenorphine in cats undergoing ovariohysterectomy using two pain-scoring systems: a randomized clinical trial
Authors: Steagall Paulo V , Benito Javier , Monteiro Beatriz P , Doodnaught Graeme M , Beauchamp Guy , Evangelista Marina C 
Published: September 2017

Objectives The aim of the study was to evaluate the analgesic efficacy of gabapentin–buprenorphine in comparison with meloxicam–buprenorphine or buprenorphine alone, and the correlation between two pain-scoring systems in cats. Methods Fifty-two adult cats were included in a randomized, controlled, blinded study. Anesthetic protocol included acepromazine–buprenorphine–propofol–isoflurane. The gabapentin–buprenorphine group (GBG, n = 19) received gabapentin capsules (50 mg PO) and buprenorphine (0.02 mg/kg IM). The meloxicam–buprenorphine group (MBG, n = 15) received meloxicam (0.2 mg/kg SC), buprenorphine and placebo capsules (PO). The buprenorphine group (BG, n = 18) received buprenorphine and placebo capsules (PO). Gabapentin (GBG) and placebo (MBG and BG) capsules were administered 12 h and 1 h before surgery. Postoperative pain was evaluated up to 8 h after ovariohysterectomy using a multidimensional composite pain scale (MCPS) and the Glasgow pain scale (rCMPS-F). A dynamic interactive visual analog scale (DIVAS) was used to evaluate sedation. Rescue analgesia included buprenorphine and/or meloxicam if the MCPS ⩾6. A repeated measures linear model was used for statistical analysis ( P <0.05). Spearman’s rank correlation between the MCPS and rCMPS-F was evaluated. Results The prevalence of rescue analgesia with a MCPS was not different ( P = 0.08; GBG, n = 5 [26%]; MBG, n = 2 [13%]; BG, n = 9 [50%]), but it would have been significantly higher in the BG (n = 14 [78%]) than GBG ( P = 0.003; n = 5 [26%]) and MBG ( P = 0.005; n = 4 [27%]) if intervention was based on the rCMPS-F. DIVAS and MCPS/rCMPS-F scores were not different among treatments. A strong correlation was observed between scoring systems ( P <0.0001). Conclusions and relevance Analgesia was not significantly different among treatments using an MCPS. Despite a strong correlation between scoring systems, GBG/MBG would have been superior to the BG with the rCMPS-F demonstrating a potential type II error with an MCPS due to small sample size.
Clinical profile of patients with paraneoplastic neuromyelitis optica spectrum disorder and aquaporin-4 antibodies
Authors: Sepúlveda Maria , Sola-Valls Nuria , Escudero Domingo , Rojc Bojan , Barón Manuel , Hernández-Echebarría Luis , Gómez Begoña , Dalmau Josep , Saiz Albert , Graus Francesc 
Published: September 2017

Background: In a minority of patients with neuromyelitis optica spectrum disorder (NMOSD) and aquaporin-4 antibodies (AQP4-IgG), the disease has a paraneoplastic origin. It is unknown whether these patients have distinctive clinical features. Objective: To report the clinical features of a series of patients with paraneoplastic NMOSD and AQP4-IgG and to review previously reported cases. Methods: Retrospective analysis of clinical records of 156 patients with NMOSD and AQP4-IgG and review of previously reported patients with paraneoplastic NMOSD and AQP4-IgG. Paraneoplastic patients were defined as those with cancer identified within 2 years of the diagnosis of NMOSD. Results: Five (3.2%) of 156 patients had paraneoplastic NMOSD, and 12 previously reported patients were identified. The most common tumors were adenocarcinoma of the lung (five patients) and breast (five). Compared with the 151 non-paraneoplastic NMOSD patients, the 17 (5 current cases and 12 previously reported) were older at symptom onset (median age = 55 (range: 17–87) vs 40 (range: 10–77) years; p = 0.006), more frequently male (29.4% vs 6.6%; p = 0.009), and presented with severe nausea and vomiting (41.2% vs 6.6%; p < 0.001). The frequency of longitudinal extensive transverse myelitis (LETM) as heralding symptom was similar in both groups, but patients with paraneoplastic NMOSD were older than those with non-paraneoplastic NMOSD (median age: 63 (range: 48–73) vs 43 (range: 14–74) years; p = 0.001). Conclusion: Patients, predominantly male, with NMOSD and AQP4-IgG should be investigated for an underlying cancer if they present with nausea and vomiting, or LETM after 45 years of age.
Surgical Interventions for Organ and Limb Ischemia Associated With Primary and Secondary Antiphospholipid Antibody Syndrome With Arterial Involvement
Authors: Hinojosa Carlos A. , Anaya-Ayala Javier E. , Bermudez-Serrato Karla , García-Alva Ramón , Laparra-Escareno Hugo , Torres-Machorro Adriana , Lizola Rene 
Published: September 2017

Objective: The association of antiphospholipid antibody syndrome (APS) and hypercoagulability is well known. Arterial compromise leading to ischemia of organs and/or limbs in patients with APS is uncommon, frequently unrecognized, and rarely described. We evaluated our institutional experience. Methods: Retrospective review was conducted. From August 2007 to September 2016, 807 patients with diagnosis of APS were managed in our Institution. Patients with primary and secondary APS who required interventions were examined. Demographics, comorbidities, manifestations, procedures, complications, and other factors affecting outcomes were recorded. Results: Fourteen patients (mean age 35 years old, standard deviation ±14) were evaluated and treated by our service. Six (43%) of them had primary APS and 8 (57%) had secondary APS; 11 (79%) were female. Two (14%) experienced distal aorta and iliac arteries involvement, 3 (21%) visceral vessels disease, 2 (14%) in upper and 7 (50%) in the lower extremity vasculatures. Thirteen (93%) patients underwent direct open revascularization and 1 with hand ischemia (Raynaud disease) underwent sympathectomy. During the mean follow-up period of 48 months, reinterventions included a revision of the proximal anastomosis of an aortobifemoral bypass graft, 1 (7%) abdominal exploration for bleeding, 1 (7%) graft thrombectomy, and 4 (29%) amputations (2 below the knee, 1 above the knee, and 1 transmetatarsal). One (7%) death occurred secondary to sepsis in a patient who had acute mesenteric ischemia. Significant differences in clinical manifestations and outcomes were not observed among patients with primary and secondary APS. All patients remained on systemic anticoagulation. Conclusion: APS is a prothrombotic disorder that may lead to arterial involvement with less frequency than the venous circulation but has significant morbidity and limb loss rate. Arterial reconstruction seems feasible in an attempt to salvage organs and limbs; however, research is necessary to establish the optimal anticoagulation regime and long-term management following surgical interventions.
Fibrinolytic for treatment of intraventricular hemorrhage: A meta-analysis and systematic review
Authors: Baker Alexandra Delaney , Rivera Perla Krissia Margarita , Yu Zhiyuan , Dlugash Rachel , Avadhani Radhika , Mould William Andrew , Ziai Wendy , Thompson Richard E , Staykov Dimitre , Hanley Daniel F 
Published: September 2017

Background Intraventricular hemorrhage is a significant cause of mortality and morbidity worldwide. Treating intraventricular hemorrhage with intraventricular fibrinolytic therapy via a catheter is becoming an increasingly utilized intervention. Aims This meta-analysis aimed to investigate the role of intraventricular fibrinolytic treatment in hypertensive intraventricular hemorrhage patients and evaluate the effect sizes for survival as well as level of function at differing time points. Summary of review PubMed, CNKI, VIP, and Wanfang were searched using the terms “IVH” and “IVH and ICH” for human studies with adult patients published between January 1950 and July 2016. Seventeen publications were selected. Data analysis showed lower rates of mortality in the treatment group at 30 days ( P < 0.001), 180 days ( P = 0.001), 365 days ( P = 0.40), and overall ( P < 0.001). Pooling modified Rankin Scale and Glasgow outcome scale data, the treatment group had more good functional outcomes at 30 days ( P = 0.38), 90 days ( P = 0.04), 180 days ( P = 0.31), 365 days ( P = 0.76), and overall ( P = 0.02). Good functional outcome was defined as modified Rankin Scale score of 0 to 3 or a Glasgow outcome scale score of 3 to 5. Conclusions Intraventricular fibrinolytic for treatment of hypertensive intraventricular hemorrhage reduces mortality and potentially leads to an increased number of good functional outcomes. Different functional outcome scales (modified Rankin Scale or Glasgow outcome scale) produce different effect sizes. Intraventricular fibrinolytic treatment may offer intraventricular hemorrhage patients a targeted therapy that produces meaningful mortality benefit and possible functional outcome benefits.
Involvement of the proximal radial ulnar joint in partial radial head fractures: a novel three-dimensional computed tomography scan evaluation method
Authors: Couture Anne , Hébert-Davies Jonah , Chapleau Julien , Laflamme G. Yves , Sandman Emilie , Rouleau Dominique M. 
Published: September 2017

Background Partial radial head fractures (PRHF) can involve the proximal radioulnar joint (PRUJ) or be restricted to the ‘safe zone’ (SZ) during forearm rotation. The objective of the present study was to develop an assessment method for PRUJ involvement in radial head fractures using axial computed tomography (CT) scans. Methods The area of the radial head in contact with the PRUJ zone was identified, and defined on 18 cadaveric elbows CT scans; the quantitative relationship between PRUJ zone and radial tuberosity was established. Then, four evaluators validated it on PRHF CT scan axial views, classifying the fractures as involving the PRUJ or not. Results Using the radial tuberosity as the 0° of a 360° circle, the SZ was within 108° to 212° clockwise for a right elbow and counter clockwise for the left elbow. Fifty-five consecutive (30 men, 25 women, mean age of 49 years) partial radial head fracture CT scans were classified: four in the SZ only, three in the PRUJ zone and 48 in both the PRUJ and SZ. The kappa for the inter- and intra-observer agreement was 0.517 and 0.881, respectively. Conclusions Ninety-three percent of partial radial head fractures will involve the PRUJ and the geometric model developed allows their classification, potentially helping surgeons decide on optimal treatment. Level of evidence Retrospective basic science study. Level III: anatomic study, imaging
SITAR: a system for independent task-oriented assessment and rehabilitation
Authors: Hussain Asif , Balasubramanian Sivakumar , Roach Nick , Klein Julius , Jarrassé Nathanael , Mace Michael , David Ann , Guy Sarah , Burdet Etienne 
Published: September 2017

Introduction Over recent years, task-oriented training has emerged as a dominant approach in neurorehabilitation. This article presents a novel, sensor-based system for independent task-oriented assessment and rehabilitation (SITAR) of the upper limb. Methods The SITAR is an ecosystem of interactive devices including a touch and force–sensitive tabletop and a set of intelligent objects enabling functional interaction. In contrast to most existing sensor-based systems, SITAR provides natural training of visuomotor coordination through collocated visual and haptic workspaces alongside multimodal feedback, facilitating learning and its transfer to real tasks. We illustrate the possibilities offered by the SITAR for sensorimotor assessment and therapy through pilot assessment and usability studies. Results The pilot data from the assessment study demonstrates how the system can be used to assess different aspects of upper limb reaching, pick-and-place and sensory tactile resolution tasks. The pilot usability study indicates that patients are able to train arm-reaching movements independently using the SITAR with minimal involvement of the therapist and that they were motivated to pursue the SITAR-based therapy. Conclusion SITAR is a versatile, non-robotic tool that can be used to implement a range of therapeutic exercises and assessments for different types of patients, which is particularly well-suited for task-oriented training.