bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient experience of different regional models of urgent and emergency care: a cross-sectional survey study
Authors: Foley Conor , Droog Elsa , Boyce Maria , Healy Orla , Browne John 
Published: March 2017

ObjectivesTo compare user experiences of 8 regional urgent and emergency care systems in the Republic of Ireland, and explore potential avenues for improvement.DesignA cross-sectional survey.SettingSeveral distinct models of urgent and emergency care operate in Ireland, as system reconfiguration has been implemented in some regions but not others. The Urgent Care System Questionnaire was used to explore service users' experiences with urgent and emergency care. Linear regression and logistic regression were used to detect regional variation in each of the 3 domains and overall ratings of care.ParticipantsA nationally representative sample (N=8002) of the general population was contacted by telephone, yielding 1205 participants who self-identified as having used urgent and emergency care services in the previous 3 months.Main outcome measuresPatient experience was assessed across 3 domains:entry into the system,progress through the systemandpatient convenience of the system. Participants were also asked to provide an overall rating of the care they received.ResultsService users in Dublin North East gave lower ratings on theentry into the systemscale than those in Dublin South (adjusted mean difference=−0.18; 95% CI −0.35 to −0.10; p=0.038). For overall ratings of care, service users in the Mid-West were less likely than those in Dublin North East to give an excellent rating (adjusted OR 0.57; 95% CI 0.35 to 0.92; p=0.022). Survey items relating to communication, and consideration of patients' needs were comparatively poorly rated. The use of public emergency departments and out-of-hours general practice care was associated with poorer patient experiences.ConclusionsNo consistent relationship was found between the type of urgent and emergency care model in different regions and patient experience. Scale-level data may not offer a useful metric for exploring the impact of system-level service change.
Interventions to improve the self-management support health professionals provide for people with progressive neurological conditions: protocol for a realist synthesis
Authors: Davies Freya , Wood Fiona , Bullock Alison , Wallace Carolyn , Edwards Adrian 
Published: March 2017

IntroductionSupporting self-management among people with long-term conditions is recognised as an important component of healthcare. Progressive neurological conditions (PNCs), for example, Parkinson's disease and multiple sclerosis are associated with problems such as fatigue and cognitive impairment which may make self-management more challenging. Health professionals may need to develop specific skills in order to provide effective self-management support for these patients. The review aims to develop explanatory theories about how health professional-targeted interventions to improve self-management support provision for people with PNCs operate in different circumstances.Methods and analysisA realist synthesis of the evidence is proposed. There are 2 priority questions for the review to address. These relate to the role of a shared concept of self-management support within the healthcare team, and the need to tailor the support provided to the requirements of people with PNCs. Key stakeholders will be involved throughout the process. The initial search strategy uses terms relating to (1) self-management, (2) health professionals and (3) PNCs. Searching, data extraction and synthesis will occur in parallel. Studies will be prioritised for inclusion based on anticipated contribution to generating explanatory theories. Key informant interviews are planned to direct supplementary searches and help further refine the theories developed. Results will be expressed in the form of context–mechanism–outcome configurations.Ethics and disseminationPublication guidelines on realist synthesis will be followed. The results will be published in a peer-reviewed journal and made available to organisations involved in the provision of health professional training.
From first symptoms to diagnosis of amyotrophic lateral sclerosis: perspectives of an Irish informal caregiver cohort—a thematic analysis
Authors: Galvin Miriam , Gaffney Rebecca , Corr Bernie , Mays Iain , Hardiman Orla 
Published: March 2017

ObjectivesInformal caregivers play an integral part in the management of amyotrophic lateral sclerosis (ALS). The objective of this study was to explore the journey from first problem symptoms to diagnosis from the perspective of informal caregivers providing care to people with ALS.DesignAs part of a semistructured interview, information was collected on a range of caregiver demographic details, and from an open-ended question their experiences of the time of symptom onset to diagnosis. We carried out descriptive statistical analysis and thematic analysis of qualitative data.Setting and participantsHome interviews with informal caregivers (n=74) of people with ALS attending the National ALS/Motor Neuron Disease Clinic at Beaumont Hospital, Dublin, Ireland.ResultsThis was a largely female and spousal cohort of caregivers, living with the patient for whom they provided informal care. The majority of patients were men and were spinal onset. Caregivers described the time from first symptoms to diagnosis. Using a primarily inductive approach, the coding was data driven and the codes and themes derived from the content of these descriptions. Two main themes were identified (1) problem signs and symptoms (A) noticing and (B) reaction; (2) interaction with the health services.ConclusionsExploring the perspectives of caregivers from first problem symptoms to diagnosis provides valuable insights into the development of the condition, impediments to its recognition, help-seeking behaviours and interactions with healthcare services. The journey from early symptoms to diagnosis is important for future decision-making, affects readiness for caregiving and could negatively impact on caregiver health and well-being. The early acknowledgement by healthcare professionals of stressors along the journey to diagnosis, and appreciation of their possible impact on caregivers is important. The separate needs of caregivers should be assessed on a regular basis.
High BMI in late adolescence predicts future severe liver disease and hepatocellular carcinoma: a national, population-based cohort study in 1.2 million men
Authors: Hagström Hannes , Tynelius Per , Rasmussen Finn 
Published: March 2017

ObjectiveA high body mass index (BMI) is associated with an increased risk for severe liver disease. It is unclear if this risk differs across BMI categories, and if the association is partially attributed to development of type 2 diabetes mellitus (T2DM).DesignWe used register data from more than 1.2 million Swedish men enlisted for conscription between 1969 and 1996. Data regarding new events of severe liver disease and T2DM during follow-up were obtained by record-linkage of population-based registers. We used Cox regression to estimate adjusted HRs for future inpatient care and mortality in severe liver disease and incidence of hepatocellular carcinoma (HCC) across BMI categories, using BMI of 18.5–22.5 kg/m2 as reference.ResultsDuring a follow-up of more than 34 million person-years, 5281 cases of severe liver disease including 251 cases of HCC were identified. An association with severe liver disease was found for overweight (HR 1.49, 95% CI 1.35 to 1.64) and for obese men (HR 2.17, 95% CI 1.82 to 2.59). Development of T2DM further increased the risk for severe liver disease across all BMI categories, for instance, men with obesity and T2DM had a higher risk of severe liver disease (HR 3.28, 95% CI 2.27 to 4.74) than men with obesity free of T2DM (HR 1.72, 95% CI 1.72 to 2.54).ConclusionsA high BMI in late adolescent men was associated with an increased risk of future severe liver disease, including HCC. Development of T2DM during follow-up was associated with a further increased risk of severe liver disease, independent of baseline BMI.
Optimizing General-Purpose CPUs for Energy-Efficient Mobile Web Computing
Authors: Zhu Yuhao , Reddi Vijay Janapa 
Published: March 2017

Mobile applications are increasingly being built using web technologies as a common substrate to achieve portability and to improve developer productivity. Unfortunately, web applications often incur large performance overhead, directly affecting the user quality-of-service (QoS) experience. Traditional techniques in improving mobile processor performance have mostly been adopting desktop-like design techniques such as increasing single-core microarchitecture complexity and aggressively integrating more cores. However, such a desktop-oriented strategy is likely coming to an end due to the stringent energy and thermal constraints that mobile devices impose. Therefore, we must pivot away from traditional mobile processor design techniques in order to provide sustainable performance improvement while maintaining energy efficiency.
In this article, we propose to combine hardware customization and specialization techniques to improve the performance and energy efficiency of mobile web applications. We first perform design-space exploration (DSE) and identify opportunities in customizing existing general-purpose mobile processors, that is, tuning microarchitecture parameters. The thorough DSE also lets us discover sources of energy inefficiency in customized general-purpose architectures. To mitigate these inefficiencies, we propose, synthesize, and evaluate two new domain-specific specializations, called the Style Resolution Unit and the Browser Engine Cache. Our optimizations boost performance and energy efficiency at the same time while maintaining general-purpose programmability. As emerging mobile workloads increasingly rely more on web technologies, the type of optimizations we propose will become important in the future and are likely to have a long-lasting and widespread impact.
DRIHM(2US): An e-Science Environment for Hydrometeorological Research on High-Impact Weather Events
Authors: Parodi Antonio , Kranzlmüller Dieter , Clematis Andrea , Danovaro Emanuele , Galizia Antonella , Garrote Luis , Llasat Maria Carmen , Caumont Olivier , Richard Evelyne , Harpham Quillon , Siccardi Franco , Ferraris Luca , Rebora Nicola , Delogu Fabio , Fiori Elisabetta , Molini Luca , Foufoula-Georgiou Efi , D’Agostino Daniele 
Published: March 2017

AbstractFrom 1970 to 2012, about 9,000 high-impact weather events were reported globally, causing the loss of 1.94 million lives and damage of $2.4 trillion (U.S. dollars). The scientific community is called to action to improve the predictive ability of such events and communicate forecasts and associated risks both to affected populations and to those making decisions. At the heart of this challenge lies the ability to have easy access to hydrometeorological data and models and to facilitate the necessary collaboration between meteorologists, hydrologists, and computer science experts to achieve accelerated scientific advances. Two European Union (EU)-funded projects, Distributed Research Infrastructure for Hydro-Meteorology (DRIHM) and DRIHM to United States of America (DRIHM2US), sought to help address this challenge by developing a prototype e-science environment providing advanced end-to-end services (models, datasets, and postprocessing tools), with the aim of paving the way to a step change in how scientists can approach studying these events, with a special focus on flood events in complex topographic areas. This paper describes the motivation and philosophy behind this prototype e-science environment together with certain key components, focusing on hydrometeorological aspects that are then illustrated through actionable research for a critical flash flood event that occurred in October 2014 in Liguria, Italy.
Ekman Transport in Balanced Currents with Curvature
Authors: Wenegrat Jacob O. , Thomas Leif N. 
Published: March 2017

AbstractEkman transport, the horizontal mass transport associated with a wind stress applied on the ocean surface, is modified by the vorticity of ocean currents, leading to what has been termed the nonlinear Ekman transport. This article extends earlier work on this topic by deriving solutions for the nonlinear Ekman transport valid in currents with curvature, such as a meandering jet or circular vortex, and for flows with the Rossby number approaching unity. Tilting of the horizontal vorticity of the Ekman flow by the balanced currents modifies the ocean response to surface forcing, such that, to leading order, winds parallel to the flow drive an Ekman transport that depends only on the shear vorticity component of the vertical relative vorticity, whereas across-flow winds drive transport dependent on the curvature vorticity. Curvature in the balanced flow field thus leads to an Ekman transport that differs from previous formulations derived under the assumption of straight flows. Notably, the theory also predicts a component of the transport aligned with the surface wind stress, contrary to classic Ekman theory. In the case of the circular vortex, the solutions given here can be used to calculate the vertical velocity to a higher order of accuracy than previous solutions, extending possible applications of the theory to strong balanced flows. The existence of oscillations, and the potential for resonance and instability, in the Ekman flow at a curved jet are also demonstrated.
Comparing Polar Lows in Atmospheric Reanalyses: Arctic System Reanalysis versus ERA-Interim
Authors: Smirnova Julia , Golubkin Pavel 
Published: March 2017

Abstract
Representation of polar lows in the new high-resolution Arctic System Reanalysis (ASR) was for the first time assessed and compared to that in the ERA-Interim. Substantial improvements were found in the 850-hPa relative vorticity and near-surface wind speed information. The latter was found to be in close agreement with satellite-derived estimates. Representation of polar lows from a widely used selective list in ERA-Interim and ASR was estimated as 48% and 89%, respectively. The proportion of polar lows represented in ASR is substantially higher than reported for other reanalyses in previous studies. Verifications were found to be sensitive to the polar low reference list used, and to the definition of a polar low. As found, when a more complete polar low list from a recent satellite-derived climatology was used, the proportion of represented events decreased to 26% and 66% for ERA-Interim and ASR, respectively. Variations in polar low representation in reanalyses were also observed in different regions, with the highest proportion resolved in the Norwegian Sea. Strong dependence between polar low sizes and their representation in ERA-Interim was found. In the case of ASR, polar low representation remains constant in the size range of 200–500 km and slightly decreases only for the smallest systems with diameters less than 200 km. Usage of the strict threshold of 43 K for the atmospheric static stability criterion was found to exclude a considerable number of otherwise well-represented polar lows.
Comorbidity, Polytherapy, and Drug Interactions in a Neurological Context: An Example of a Multidisciplinary Approach to Promote the Rational Use of Drugs
Authors: Busa Giulia , Burlina Alessandro , Damuzzo Vera , Chiumente Marco , Palozzo Angelo C. 
Published: March 2017

Purpose: A high number of adverse drug reactions (ADRs), mainly caused by drug–drug interactions (DDIs), occur in neurological wards and few data are available about incidence and prevalence of DDIs in this context. This study investigated—(1) the prevalence of drug–drug and drug–disease interactions in patients admitted to a neurological unit in Italy, (2) the risk factors for DDIs, and (3) the diseases and the drug classes mostly involved in drug–drug and drug–disease interactions. Methods: For 2 months, we performed a retrospective, observational study in the neurological unit of St Bassiano Hospital, enrolling 79 patients who received a drug prescription at discharge. Results: About half of the patients were discharged with 5 or more prescribed drugs, and 72% of patients showed potential, clinically relevant DDIs. Linear correlations were observed between age and number of prescribed drugs ( P < .01) and between age and number of interactions ( P < .01). The number of prescribed drugs was associated with the number of detected DDIs ( P < .01). The application of drug interaction alerts and the use of medication inappropriateness criteria (ie, Beers criteria) were not satisfactory in choosing the best therapy for each patient. Therefore, multidisciplinary discussions of each clinical case was required. Conclusion: The study demonstrated that the neurological patient, especially if elderly, has a high risk of DDI and ADRs and that many of these can be avoided by case discussion in multidisciplinary team meetings, in which the presence of a dedicated clinical pharmacist is crucial.
Cognitive impairment in pediatric-onset multiple sclerosis is detected by the Brief International Cognitive Assessment for Multiple Sclerosis and computerized cognitive testing
Authors: Charvet Leigh E , Shaw Michael , Frontario Ariana , Langdon Dawn , Krupp Lauren B 
Published: March 2017

Background: Cognitive impairment is a common and troubling feature of pediatric-onset multiple sclerosis (POMS). Brief cognitive assessment in the outpatient setting can identify and longitudinally monitor cognitive involvement so that early intervention is possible. Objectives: The goal of this study was to measure the sensitivity of two cognitive assessment approaches that are brief, repeatable, and suitable for clinical practice and for multicenter investigation. Methods: Participants with POMS ( n = 69) were consecutively evaluated as part of outpatient neurologic visits and compared to healthy control participants (HC, n = 66) using the Brief International Cognitive Assessment for MS (BICAMS) approach and timed information processing measures from Cogstate, a computer-based assessment. Results: There was strong agreement in the detection rate of impairment between both assessments, with 26% for the BICAMS and 27% for Cogstate. Two of the Cogstate tasks were the most sensitive individual measures. Conclusion: Both the BICAMS and Cogstate timed processing measures offer practical, sensitive, and standardized approaches for cognitive screening assessment in POMS.
Supporting Simple Activity Engagement in Persons With Moderate to Severe Alzheimer’s Disease Through a Technology-Aided Program
Authors: Lancioni Giulio E. , Singh Nirbhay N. , O’Reilly Mark F. , Sigafoos Jeff , D’Amico Fiora , Pinto Katia , Chiapparino Claudia 
Published: March 2017

Objectives:These 2 studies assessed a technology-aided program to support mild physical exercise or simple occupational activity in participants with moderate to severe Alzheimer’s disease.Methods:Study 1 included 11 participants who were to perform a leg-raising response. Study 2 included 10 participants who were to sort objects into different containers. The program ensured that they received positive stimulation contingent on the responses and reminders/prompts after periods of nonresponding. Each study was carried out according to a nonconcurrent multiple baseline design across participants.Results:The program was successful in supporting mild physical exercise and activity with objects in the 2 groups of participants, respectively. The participants also showed signs of positive involvement (eg, smiles and verbalizations) during the sessions. Moreover, staff personnel rated the program and its impact positively.Conclusion:The program may be considered a practical resource for supporting positive engagement in persons with moderate to severe Alzheimer’s disease.
A quasi-experimental intervention to assess the effectiveness of a physician-delivered tobacco cessation intervention in India: A detailed study protocol
Authors: Panda Rajmohan , Mahapatra Sandeep , Gaurav Kumar , Pati Sanghamitra , Mathur Manu Raj 
Published: March 2017

Introduction: Tobacco cessation is the most important, cost-effective preventive maintenance that clinicians can offer study participants who use tobacco. There is lack of preparedness among primary care physicians in delivering cessation interventions. There are also limited studies which record the effectiveness of cessation interventions in the Indian context. This study is designed to evaluate the effectiveness of brief and intensive tobacco cessation interventions delivered by trained primary care providers in two states of India. Methods and Analysis: A quasi-experimental study design has been adopted for the study with around 20 primary care practices, selected from four districts of two states in India (Odisha and Rajasthan). Brief (3A) and Intensive tobacco (5A) cessation intervention services will be provided to two groups of tobacco users, respectively. Both groups will be followed up for 6 months to determine the effectiveness of the cessation interventions. The cost-effectiveness of the services will also be documented at the end of the study. The entire study will be completed in 24 months, of which the final 6 months will be reserved for study participant follow-up and quit rate evaluation. When comparing the two groups, differences between proportions will be assessed by chi-square test and differences between means with t-test. The conventional significance level of 0.05 will be used in all analyses in order to reject the null hypothesis of no difference between groups. We will use difference-in-differences methods to assess the impact of the interventions on physicians’ behavior to deliver tobacco cessation in their clinical practice. Conclusion: The study is in participant recruitment phase.