bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validation of an automated delirium prediction model (DElirium MOdel (DEMO)): an observational study
Authors: Mestres Gonzalvo Carlota , de Wit Hugo A J M , van Oijen Brigit P C , Deben Debbie S , Hurkens Kim P G M , Mulder Wubbo J , Janknegt Rob , Schols Jos M G A , Verhey Frans R , Winkens Bjorn , van der Kuy Paul-Hugo M 
Published: November 2017

ObjectivesDelirium is an underdiagnosed, severe and costly disorder, and 30%–40% of cases can be prevented. A fully automated model to predict delirium (DEMO) in older people has been developed, and the objective of this study is to validate the model in a hospital setting.SettingSecondary care, one hospital with two locations.DesignObservational study.ParticipantsThe study included 450 randomly selected patients over 60 years of age admitted to Zuyderland Medical Centre. Patients who presented with delirium on admission were excluded.Primary outcome measuresDevelopment of delirium through chart review.ResultsA total of 383 patients were included in this study. The analysis was performed for delirium within 1, 3 and 5 days after a DEMO score was obtained. Sensitivity was 87.1% (95% CI 0.756 to 0.939), 84.2% (95% CI 0.732 to 0.915) and 82.7% (95% CI 0.734 to 0.893) for 1, 3 and 5 days, respectively, after obtaining the DEMO score. Specificity was 77.9% (95% CI 0.729 to 0.882), 81.5% (95% CI 0.766 to 0.856) and 84.5% (95% CI 0.797 to 0.884) for 1, 3 and 5 days, respectively, after obtaining the DEMO score.ConclusionDEMO is a satisfactory prediction model but needs further prospective validation with in-person delirium confirmation. In the future, DEMO will be applied in clinical practice so that physicians will be aware of when a patient is at an increased risk of developing delirium, which will facilitate earlier recognition and diagnosis, and thus will allow the implementation of prevention measures.
Emergency obstetric care provision in Southern Ethiopia: a facility-based survey
Authors: Windsma Mitchell , Vermeiden Tienke , Braat Floris , Tsegaye Andualem Mengistu , Gaym Asheber , van den Akker Thomas , Stekelenburg Jelle 
Published: November 2017

ObjectivesTo assess the provision of basic emergency obstetric and newborn care (BEmONC), knowledge of high-risk pregnancies and referral capacity at health centres in Southern Ethiopia.DesignA facility-based survey, using an abbreviated version of the Averting Maternal Death and Disability needs assessment tool for emergency obstetric and newborn care. Modules included infrastructure, staffing, number of deliveries, maternal and perinatal mortality, BEmONC signal functions, referral capacity and knowledge of risk factors in pregnancy.SettingPrimary healthcare centres providing delivery services in the Eastern Gurage Zone, a predominantly rural area in Southern Ethiopia.ParticipantsAll 20 health centres in the study area were selected for the assessment. One was excluded, as no delivery services had been provided in the 12 months prior to the study.ResultsThree out of 19 health centres met the government’s staffing norm. In the 12 months prior to the survey, 10 004 (X−=527±301) deliveries were attended to at the health centres, but none had provided all seven BEmONC signal functions in the three months prior to the survey (X−=3.7±1.2). Eight maternal and 32 perinatal deaths occurred. Most health centres had performed administration of parenteral uterotonics (17/89.5%), manual removal of placenta (17/89.5%) and neonatal resuscitation (17/89.5%), while few had performed assisted vaginal delivery (3/15.8%) or administration of parenteral anticonvulsants (1/5.3%). Reasons mentioned for non-performance were lack of patients with appropriate indications, lack of training and supply problems. Health workers mentioned on average 3.9±1.4 of 11 risk factors for adverse pregnancy outcomes. Five ambulances were available in the zone.ConclusionBEmONC provision is not guaranteed to women giving birth in health centres in Southern Ethiopia. Since the government aims to increase facility deliveries, investments in capacity at health centres are urgently needed.
Contribution of the voluntary sector to mental health crisis care in England: protocol for a multimethod study
Authors: Newbigging Karen , Mohan John , Rees James , Harlock Jenny , Davis Alex 
Published: November 2017

IntroductionTimely access to the right kind of support for people experiencing a mental health crisis can be problematic. The voluntary sector (VS) plays a key role in providing support and enabling access, but there is a knowledge gap concerning its contribution and interface with public services in mental health crisis care. This study aims to address this.Methods and analysisThe study has three empirical elements: (1) a national survey of voluntary sector organisations (VSOs) in England and national stakeholder interviews to develop a typology of organisations and interventions provided by VSOs; (2) detailed mapping of VS services in two regions through interviews and extending the national survey; (3) four case studies, identified from the regional mapping, of VS mental health crisis services and their interface with National Health Service (NHS) and local authority services, at both a system and individual level. Data collection will involve interviews with commissioners; VSO and NHS or local authority providers; and focus groups with people who have experience of VSO crisis support, both service users and carers; and mapping the crisis trajectory of 10 service users in each study site through narrative interviews with service users and informal carers to understand the experience of VSO crisis care and its impact.Ethics and disseminationThe University of Birmingham Humanities and Social Sciences Ethical Review Committee granted ethical approval (reference ERN_16–1183) for the national and regional elements of the study. Ethical review by the Health Research Authority will be required for the case study research once the sites have been identified from the first two elements of the study. A range of methods including a policy seminar, publication in academic journals and a tool kit for commissioners and practitioners will be produced to maximise the impact of the findings on policy and practice.
‘Difficult Conversations’: evaluation of multiprofessional training
Authors: Brighton Lisa Jane , Selman Lucy Ellen , Gough Nicholas , Nadicksbernd JJ , Bristowe Katherine , Millington-Sanders Catherine , Koffman Jonathan 
Published: November 2017

ObjectivesEvidence-based communication skills training for health and social care professionals is essential to improve the care of seriously ill patients and their families. We aimed to evaluate the self-reported impact of ‘Difficult Conversations’, a multidisciplinary half-day interactive workshop, and gain feedback to inform future development and evaluation.MethodsService evaluation using questionnaire data collected before and immediately after workshops from February 2015 to August 2016 regarding participant self-assessed confidence, knowledge and skills. Qualitative free-text comments provided feedback about the workshop and were subjected to content analysis.ResultsOf 886 workshop participants, 655 completed baseline questionnaires and 714 postworkshop questionnaires; 550 were matched pairs. Participants were qualified or trainee general practitioners (34%), community nurses and care coordinators (32%), social care professionals (7%), care home staff (6%), advanced practice/specialist nurses (5%), care workers (5%) and allied health professionals (3%). All groups demonstrated significant increases in mean self-assessed confidence (2.46, 95% CI 2.41 to 2.51; to 3.20, 95% CI 3.17 to 3.24; P<0.001), knowledge (2.22, 95% CI 2.17 to 2.27; to 3.18, 95% CI 3.14 to 3.22; P<0.001) and skills (2.37, 95% CI 2.32 to 2.42; to 3.09, 95% CI 3.05 to 3.12; P<0.001). Qualitative findings showed participants valued role play, the communication framework acronym and opportunities for discussion. They commended workshop facilitators’ skills, the safe atmosphere and interprofessional learning. Suggested improvements included more prepared role play and greater coverage of the taught topics.Conclusions‘Difficult Conversations’ workshops were associated with improvements in participants’ self-assessed confidence, knowledge, and skills. Our findings identify workshop characteristics that are acceptable to multidisciplinary trainees. Further testing is warranted to determine effectiveness and accurately identify workshop components leading to change.
Prevalence and risk factor for injury in sub-Saharan Africa: a multicountry study
Authors: Diamond Megan B , Dalal Shona , Adebamowo Clement , Guwatudde David , Laurence Carien , Ajayi Ikeoluwapo O , Bajunirwe Francis , Njelekela Marina A , Chiwanga Faraja , Adami Hans-Olov , Nankya-Mutyoba Joan , Kalyesubula Robert , Reid Todd G , Hemenway David , Holmes Michelle D 
Published: November 2017

IntroductionInjury-related morbidity is a neglected health concern in many low-income and middle-income countries. Most injury data in Africa have been collected from hospital-based studies, and few studies have occurred across multiple countries. Using data from a novel cohort, we examined the prevalence and incidence of serious injuries and associated risk factors across five sites in sub-Saharan Africa (SSA).MethodsA common baseline and follow-up survey was administered to participants. The study population included 1316 persons at baseline and 904 persons at follow-up. Frequencies were calculated, and logistic regression models were used to assess risk factors for injury.ResultsA total of 233 (17.7%) persons reported a serious injury at baseline and 60 (6.6%) reported a serious injury 6 months later at follow-up. Sixty-nine per cent of participants responded to the follow-up questionnaire. At baseline and follow-up, the most common cause of serious injury at urban sites was transport related, followed by poison/overdose. In rural Uganda, sharp instruments injuries were most common, followed by transport-related injuries. Living at an urban site was associated with an increased odds for serious injury compared with those at the rural site (OR: 1.83, 95% CI 1.15 to 2.90). Participants who consumed above a moderate amount of alcohol were at a higher risk of serious injury compared with those who did not consume alcohol (OR: 1.86, 95% CI 1.02 to 3.41). High level of education was an important risk factor for injury.ConclusionAt baseline and follow-up, common causes of serious injury were transport related, sharp instrument and poison/overdose. Alcohol consumption, urban location and education are important risk factors for injury. It is feasible to collect longitudinal injury data using a standardised questionnaire across multiples sites in SSA. Longitudinal data collection should be leveraged to obtain robust data on risk factors for injury in SSA.
In Vitro Evaluation of Human Hand Tendon Ingrowth into A Synthetic Scaffold
Authors: Abdullah Shalimar , Mohtar Fadzlina , Abdul Shukor Nordashima , Sapuan Jamari 
Published: November 2017

Background: Synthetic scaffold has been used for tissue approximation and reconstructing damaged and torn ligaments. This study explores the ability of tendon ingrowth into a synthetic scaffold in vitro, evaluate growth characteristics, morphology and deposition of collagen matrix into a synthetic scaffold. Methods: Upper limb tendons were harvested with consent from patients with crush injuries and non-replantable amputations. These tendons (both extensor and flexor) measuring 1 cm are sutured to either side of a 0.5 cm synthetic tendon strip and cultured in growth medium. At 2, 4, 6 and 8 weeks, samples were fixed into paraffin blocks, cut and stained with haematoxylin-eosin (H&E) and Masson’s trichrome. Results: Minimal tendon ingrowth were seen in the first 2 weeks of incubation. However at 4 weeks, the cell ingrowth were seen migrating towards the junction between the tendon and the synthetic scaffold. This ingrowth continued to expand at 6 weeks and up to 8 weeks. At this point, the demarcation between human tendon and synthetic scaffold was indistinct. Conclusions: We conclude that tendon ingrowth composed of collagen matrix were able to proliferate into a synthetic scaffold in vitro.
Tuberculosis of the Elbow Region in Pediatric Age Group – Experiences from a Single Centre
Authors: Agarwal Anil , Rastogi Anuj 
Published: November 2017

Background: Clinical series of tuberculosis of elbow region in children are few. The purpose of our study was to retrospectively review the presentation, healing response and functional results of 30 children.Methods: The pretreatment disease presentation was studied from patient’s case records. Serial radiographs of the patients were studied to see remineralization and healing of radiological lesions. For elbow’s functional evaluation, pain, range of motion and recurrence were observed at final follow up.Results: The mean patient age was 8.2 years. The mean duration of symptoms before presentation was 47 days. A discharging sinus was present in 6 patients. Multifocal presentation was found in 7 patients. The lesion was most commonly localized in proximal ulna or lower humerus. The classical ‘ice cream scoop’ appearance of proximal ulnar metaphysis was noted in 5 elbows. Most elbows were in Martini stage 2 (70%) at the time of presentation. All patients were treated non-operatively. Average follow up after completion of antitubercular therapy was 18.97 months. The resolution of regional osteopenia, sclerosis of lytic lesions, reappearance of bony trabeculae and decrease in size of cavities was the usual sequence of radiological healing. End average elbow flexion arc deteriorated with increasing Martini stage. ‘Ice cream scoop lesions’ resulted in a worse functional outcome with formation of an irregular proximal ulnar articular surface.Conclusions: Restriction of elbow range of motion, early discharging sinus formation and radiological ‘ice cream scoop’ appearance indicated a tubercular pathology. Late presentation with advanced disease, total joint involvement, and ‘ice cream scoop appearance’ resulted in decreased elbow flexion arc.
Prevalence of Absence of Palmaris Longus and Its Association with Gender, Hand Dominance and Absence of FDS Tendon to Little Finger Among Malay Population
Authors: Yong Mei Wen , Yusof Nabihah , Rampal Lekhraj , Arumugam Manohar 
Published: November 2017

Background: Palmaris Longus is being widely used in reconstructive, plastic and cosmetic surgeries due to its long tendon. It is the most readily available source for tendon grafting. The objective of this study was to determine the prevalence of absence of Palmaris Longus and its association with gender, hand dominance and absence of FDS (flexor digitorum superficialis) tendon to little finger among Malay population.Methods: An analytical cross sectional study design was used and a self-administered proforma was distributed for data collection. 1239 Malay secondary school children in Putrajaya were tested for absence of Palmaris Longus using Schaffer’s test. 4 additional tests namely Thompson’s test, Mishra’s test I, Mishra’s test II and Pushpakumar’s ‘two-finger sign’ method were used to confirm its absence in respondents with negative Schaffer’s test. Function of Flexor Digitorum Superficialis tendon to little finger was determined by flexing PIP of little finger while hyperextend the other fingers.Results: The prevalence of absence of Palmaris Longus was 11.7%. Left side absence of Palmaris Longus was much common. There was a significant association between absence of Palmaris Longus with gender in which female had higher prevalence of absence of Palmaris Longus than male.Conclusions: In conclusion, the prevalence of absence of Palmaris Longus in Malay population was lower than Indian but higher than Chinese population. Females had higher prevalence of absence of Palmaris Longus and no association can be found with hand dominance and absence of Flexor Digitorum Superficialis tendon to little finger.
Does Mutated K-RAS Oncogene Attenuate the Effect of Sulindac in Colon Cancer Chemoprevention?
Authors: Rice Photini F.S. , Ehrichs Kevin G. , Jones Mykella S. , Chen Hwudarw , Hsu Chiu-Hsieh , Abril Edward R. , Nagle Raymond B. , Besselsen David G. , Barton Jennifer K. , Ignatenko Natalia A. 
Published: November 2017

Abstract
The NSAID sulindac has been successfully used alone or in combination with other agents to suppress colon tumorigenesis in patients with genetic predisposition and also showed its efficacy in prevention of sporadic colon adenomas. At the same time, some experimental and clinical reports suggest that a mutant K-RAS oncogene may negate sulindac antitumor efficacy. To directly assess sulindac activity at suppressing premalignant lesions carrying K-RAS mutation, we utilized a novel mouse model with an inducible colon-specific expression of the mutant K-ras oncogene (K-rasG12D). Tumor development and treatment effects were monitored by minimally invasive endoscopic Optical coherence tomography. Expression of the mutant K-ras allele accelerated azoxymethane (AOM)-induced colon carcinogenesis in C57BL/6 mice, a strain otherwise resistant to this carcinogen. Sulindac completely prevented AOM-induced tumor formation in K-ras wild-type (K-ras wt) animals. In K-rasG12D–mutant mice, a 38% reduction in tumor number, an 83% reduction in tumor volume (P ≤ 0.01) and an increase in the number of adenoma-free mice (P = 0.04) were observed. The partial response of K-RasG12D animals to sulindac treatment was evident by the decrease in mucosal thickness (P &lt; 0.01) and delay in progression of the precancerous aberrant crypt foci to adenomas. Molecular analyses showed significant induction in cyclooxygenase 2 (COX-2), cleaved caspase-3 (CC3), and Ki-67 expression by AOM, but not sulindac treatment, in all genotypes. Our data underscore the importance of screening for K-RAS mutations in individuals with colon polyps to provide more personalized interventions targeting mutant K-RAS signaling pathways. Cancer Prev Res; 11(1); 16–26. ©2017 AACR.
Natureza, espaço e paisagem como construção humana
Authors: Bartalini Vania 
Published: November 2017

Tendo como ponto de partida as bases fenomenológicas, nas quais paisagem é compreendida como fruto da relação Homem/lugar/mundo, busca-se abordar as ideias de natureza, espaço e paisagem, sob a ótica do que se convencionou chamar de “experenciador”. Diante do complexo panorama contemporâneo, em que as categorias acima citadas sofrem revisões e ampliações conceituais sistemáticas, pretende-se discutir natureza, espaço e paisagem como construções humanas, historicamente determinadas. O tema é conduzido através da reflexão sobre a tessitura e sentido que se dá a partir da experiência direta, por meio da qual paisagem pode ser lida como “mediação” entre natureza e humano.
Neurohormonal Blockade and Circulating Cardiovascular Biomarkers During Anthracycline Therapy in Breast Cancer Patients: Results From the PRADA (Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy) Study
Authors: Gulati Geeta , Heck Siri L. , Røsjø Helge , Ree Anne H. , Hoffmann Pavel , Hagve Tor‐Arne , Norseth Jon , Gravdehaug Berit , Steine Kjetil , Geisler Jürgen , Omland Torbjørn 
Published: November 2017

Background
Anthracyclines are associated with cardiotoxic effects. Cardiovascular biomarkers may reflect myocardial injury, dysfunction, inflammation, and fibrosis and may precede and predict the development of left ventricular impairment. The aim of this study was to assess: (1) longitudinal change in circulating cardiovascular biomarkers, (2) the effect of metoprolol succinate and candesartan cilexetil on the biomarker response, and (3) the associations between on‐treatment changes in biomarker concentrations and subsequent left ventricular dysfunction in patients with early breast cancer receiving anthracyclines.

Methods and Results

This report encompasses 121 women included in the 2×2 factorial, placebo‐controlled, double‐blind PRADA (Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy) trial with metoprolol and candesartan given concomitantly with anticancer therapy containing the anthracycline, epirubicin (total cumulative dose, 240–400 mg/m
2
). Cardiovascular magnetic resonance, echocardiography images, and circulating levels of biomarkers were obtained before and after anthracycline treatment. Cardiac troponins I and T, B‐type natriuretic peptide, N‐terminal pro‐B‐type natriuretic peptide, C‐reactive protein, and galectin‐3 increased during anthracycline therapy (all
P
<0.05). The troponin response was attenuated by metoprolol (
P
<0.05), but not candesartan. There was no association between change in biomarker concentrations and change in cardiac function during anthracycline therapy.

Conclusions
Treatment with contemporary anthracycline doses for early breast cancer is associated with increase in circulating cardiovascular biomarkers. This increase is, however, not associated with early decline in ventricular function. Beta‐blockade may attenuate early myocardial injury, but whether this attenuation translates into reduced risk of developing ventricular dysfunction in the long term remains unclear.

Clinical Trial Registration

URL
:
http://www.clinicaltrial.gov
. Unique identifier:
NCT
01434134.
Le devenir de la famille paysanne de la réforme agraire dans le Saïss au Maroc sous une perspective de genre
Authors: Bossenbroek Lisa 
Published: November 2017

RésuméL’État marocain décida en 2006 de privatiser les terres des coopératives de la réforme agraire créée au début des années 1970. Cette dynamique foncière s’inscrit dans des processus plus larges de changements agraires, qui se manifeste entre autre par la vente des terres, l’introduction de nouvelles cultures à forte valeur ajoutée, l’utilisation de nouvelles technologies (forage et goutte-à-goutte) et des transformations dans les relations de travail. Ces changements auront une influence sur le développement de l’agriculture familiale et les relations de genres. À la base d’un travail ethnographique et historique portant sur une coopérative dans la plaine du Saïss, nous suggérons d’ouvrir la « boite noire » de l’agriculture familiale pour illustrer les dynamiques de genre qui marquent aujourd’hui l’impact des changements agraires. À travers ce regard nous illustrons dans un premier temps comment, pendant la période de la coopérative la terre, l’exploitation et la famille paysanne étaient intimement liées. Les activités et l’organisation autour de la terre forment les identités des hommes et des femmes paysans. Aujourd’hui, nous illustrons au travers de différentes trajectoires de familles paysannes comment ce modèle est en mutation. Les dynamiques agraires offrent de nouvelles opportunités à certains jeunes hommes et agriculteurs « modernes ». Cependant, différentes femmes paysannes ne trouvent plus de fierté dans le travail agricole et essaient de développer de nouvelles identités féminines rurales, ce qui n’est pas facile. Ainsi, nous verrons que le devenir de l’agriculture paysanne dépendra fortement de cette nouvelle génération de jeunes agriculteurs et agricultrices et de leurs aspirations à moderniser leur devenir.