bluuebunny/crossref_metadata_2025_split huggingface dataset:
Counterfeit medicines in Peru: a retrospective review (1997–2014)
Authors: Medina Edwin , Bel Elvira , Suñé Josep María 
Published: April 2016

ObjectiveTo consolidate and assess information on counterfeit medicines subject to pharmaceutical alerts issued by the Peruvian Medicines Regulatory Authority over 18 years (1997–2014) of health monitoring and enforcement.DesignA retrospective review of drug alerts.SettingA search of the website of the General Directorate of Medicines, Supplies and Drugs (DIGEMID) of the Ministry of Health of Peru for drug alerts issued between 1997 and 2014.Eligibility criteriaDrug alerts related to counterfeit medicines.ResultsA total of 669 DIGEMID alerts were issued during the study period, 354 (52.91%) of which cover 1738 cases of counterfeit medicines (many alerts deal with several cases at a time). 1010 cases (58.11%) involved pharmaceutical establishments and 349 (20.08%) involved non-pharmaceutical commercial outlets. In 126 cases (7.25%), counterfeit medicines were seized in an unauthorised trade (without any marketing authorisation); in 253 cases (14.56%) the type of establishment or business associated with the seized product was not identified.ConclusionsCounterfeit medicines are a serious public health problem in Peru. A review of the data cannot determine whether counterfeit medicines in Peru increased during the study period, or if monitoring by different government health agencies highlighted the magnitude of the problem by providing more evidence. The problem is clearly structural, since the majority of cases (58.11% of the total) were detected in legitimate supply chains. Most counterfeit medicines involve staple pharmaceutical products and common dosage forms. Considerable work remains to be done to control the serious problem of counterfeit medicines in Peru.
Quality of relationships as predictors of outcomes in people with dementia: a systematic review protocol
Authors: Edwards Hannah B , Savović Jelena , Whiting Penny , Leach Verity , Richards Alison , Cullum Sarah , Cheston Richard 
Published: April 2016

IntroductionSerious adverse outcomes for people with dementia include institutionalisation, hospitalisation, death, development of behavioural and psychiatric symptoms, and reduced quality of life. The quality of the relationship between the person with dementia and their informal/family carer is thought to affect the risk of these outcomes. However, little is known about which aspects of relationship quality are important, or how they affect outcomes for people with dementia.Methods and analysisThis will be a systematic review of the literature. Electronic databases MEDLINE, EMBASE, Web of Science, PsycInfo, the Cochrane Database, ALOIS and OpenGrey will be searched from inception. 2 independent reviewers will screen results for eligibility with standardised criteria. Data will be extracted for relevant studies, and information on the associations between relationship quality and dementia outcomes will be synthesised. Meta-analysis will be performed if possible to calculate pooled effect sizes. Narrative synthesis will be performed if study heterogeneity rules out meta-analysis.Ethics and disseminationEthical review is not necessary as this review summarises data from previous studies. Results will be disseminated via peer-reviewed publication. Results will also be disseminated to a patient and public involvement group and an expert panel for their views on the findings and implications for future work.Trial registration numberCRD42015020518.
Patient attitudes about the clinical use of placebo: qualitative perspectives from a telephone survey
Authors: Ortiz Robin , Chandros Hull Sara , Colloca Luana 
Published: April 2016

ObjectivesTo examine qualitative responses regarding the use of placebo treatments in medical care in a sample of US patients.Survey studies suggest a deliberate clinical use of placebos by physicians, and prior research has found that although most US patients find placebo use acceptable, the rationale for these beliefs is largely unknown.SettingMembers of the Outpatient Clinic at the Kaiser Permanente Northern California interviewed research participants who had been seen for a chronic health problem at least once in the prior 6 months.Participants853 women (61%) and men, white (58%) and non-white participants aged 18–75 years.Primary and secondary outcomesQualitative responses on perceptions of placebo use from one-time telephone surveys were analysed for common themes and associations with demographic variables.ResultsPrior results indicated that a majority of respondents felt it acceptable for doctors to recommend placebo treatments. Our study found that a lack of harm (n=291, 46.1%) and potential benefit (n=250, 39.6%) were the most common themes to justify acceptability of placebo use. Responses citing potential benefit were associated with higher education (r=0.787; p<0.024). Of the minority of respondents who judged it never acceptable for doctors to recommend placebo treatments, the most often referenced rationale was obligation of the doctor to do more (n=102, 48.3%). Additional themes emerged around the issue of whether a doctor was transparent about placebo use, including honesty, patient's right to know and power of the mind. Older age was associated with likelihood to cite overall physician, as opposed to treatment, related themes (r=0.753; p<0.002).ConclusionsParticipants seem to appreciate and understand the lack of harm and potential benefit associated with placebo treatments, while valuing the role of the physician and the patient in its implementation.
Glycosylated haemoglobin for screening and diagnosis of gestational diabetes mellitus
Authors: Khalafallah Alhossain , Phuah Eileen , Al-Barazan Abdul Majeed , Nikakis Irena , Radford Andrea , Clarkson Wade , Trevett Clinton , Brain Terry , Gebski Val , Corbould Anne 
Published: April 2016

ObjectivesThe oral glucose tolerance test (OGTT) is a cumbersome test that is time consuming, labour intensive and often poorly tolerated by pregnant women. To date, glycosylated haemoglobin (HbA1c) is the most accepted measure of chronic glycaemia outside of pregnancy. HbA1c is an uncomplicated test, less time consuming, does not require any specific patient preparation and is considered straightforward compared with the OGTT. Therefore, we prospectively tested the utility of the HbA1c when used as a screening tool in pregnancy for gestational diabetes mellitus (GDM).SettingsPrimary health care. Single tertiary referral centre, Tasmania, Australia.ParticipantsA direct comparison between HbA1c levels and the OGTT results in pregnant women, tested concurrently at the 24–28 gestational week, was undertaken. A full profile of 480 pregnant women during the period from September 2012 to July 2014 was completed. Median and mean age of participants was 29 years (range 18–47 years).InterventionsA simultaneous prospective assessment of HbA1c versus standard OGTT in a cohort of consecutive pregnant women presenting to our institute was performed.ResultsThe number of women who had GDM according to OGTT criteria was 57, representing 11.9% of the evaluated 480 pregnant women. Using a cut-off value for HbA1c at 5.1% (32 mmol/mol) for detecting GDM showed sensitivity of 61% and specificity of 68% with negative predictive value (NPV) of 93%, versus sensitivity of 27% and specificity of 95% with NPV of 91% when using HbA1c cut-off value of 5.4% (36 mmol/mol).ConclusionsOur results suggest that pregnant women with an HbA1c of≥5.4% (36 mmol/mol) should proceed with an OGTT. This may result in a significant reduction in the burden of testing on both patients and testing facility staff and resources. Further investigations are required to integrate and optimise the HbA1c as a single, non-fasting, screening tool for GDM.Trial registration numberACTRN12611000739910.
Improving feedback on junior doctors’ prescribing errors: mixed-methods evaluation of a quality improvement project
Authors: Reynolds Matthew , Jheeta Seetal , Benn Jonathan , Sanghera Inderjit , Jacklin Ann , Ingle Digby , Franklin Bryony Dean 
Published: April 2016

BackgroundPrescribing errors occur in up to 15% of UK inpatient medication orders. However, junior doctors report insufficient feedback on errors. A barrier preventing feedback is that individual prescribers often cannot be clearly identified on prescribing documentation.AimTo reduce prescribing errors in a UK hospital by improving feedback on prescribing errors.InterventionsWe developed three linked interventions using plan–do–study–act cycles: (1) name stamps for junior doctors who were encouraged to stamp or write their name clearly when prescribing; (2) principles of effective feedback to support pharmacists to provide feedback to doctors on individual prescribing errors and (3) fortnightly prescribing advice emails that addressed a common and/or serious error.Implementation and evaluationInterventions were introduced at one hospital site in August 2013 with a second acting as control. Process measures included the percentage of inpatient medication orders for which junior doctors stated their name. Outcome measures were junior doctors' and pharmacists' perceptions of current feedback provision (evaluated using quantitative pre-questionnaires and post-questionnaires and qualitative focus groups) and the prevalence of erroneous medication orders written by junior doctors between August and December 2013.ResultsThe percentage of medication orders for which junior doctors stated their name increased from about 10% to 50%. Questionnaire responses revealed a significant improvement in pharmacists' perceptions but no significant change for doctors. Focus group findings suggested increased doctor engagement with safe prescribing. Interrupted time series analysis showed no difference in weekly prescribing error rates between baseline and intervention periods, compared with the control site.ConclusionFindings suggest improved experiences around feedback. However, attempts to produce a measurable reduction in prescribing errors are likely to need a multifaceted approach of which feedback should form part.
‘Down-triage’ for children with abnormal vital signs: evaluation of a new triage practice at a paediatric emergency department in Japan
Authors: Takahashi Takuto , Inoue Nobuaki , Shimizu Naoki , Terakawa Toshiro , Goldman Ran D 
Published: April 2016

ObjectiveAssessment of abnormal vital signs in triage is a challenge in the paediatric emergency department (PED), since vital signs may reflect anxiety, fever or pain rather than the clinical deterioration of the child. We aimed to evaluate the efficacy of subjective ‘down-triage’ (change of the initially determined acuity levels) of Japanese Triage and Acuity Scale (JTAS).MethodsThis is a retrospective cohort study of patients in PED up to 15 years of age at a tertiary paediatric medical centre in Japan during a 1-year period. At the end of every JTAS triage process, PED nurses were allowed to ‘down-triage’ acuity levels of well-appearing patients with abnormal HR or RR, which were presumably attributable to fever, crying or being upset. We compared predictive performance of the triage system before and after ‘down-triage’ using admission rate as the primary outcome.ResultsAmong 37 961 PED visits during the study period, we analysed 37 219 records. A total of 17 089 patients (45.9%) were ‘down-triaged’ after their initial triage allocation upon arrival. Admission rates after ‘down-triage’ (83%, 33%, 7%, 1% and 3% for levels 1–5, respectively), compared with those of unmodified initial level (16%, 11%, 6%, 2% and 6% for levels 1–5, respectively), had a better apparent relevance with the anticipated admission rates of Canadian Triage and Acuity Scale.ConclusionsModification of JTAS through ‘down-triage’ by experienced staff improves prediction of disposition in a PED. Further research is needed to determine an objective protocol for ‘down-triage’ to ensure safe practice in a PED.
Study protocol for the Flooring for Injury Prevention (FLIP) Study: a randomised controlled trial in long-term care
Authors: Lachance Chantelle C , Feldman Fabio , Laing Andrew C , Leung Pet Ming , Robinovitch Stephen N , Mackey Dawn C 
Published: April 2016

BackgroundA promising strategy for reducing the incidence and severity of fall-related injuries in long-term care (LTC) is to decrease the ground surface stiffness, and the subsequent forces applied to the body parts at impact, through installation of compliant flooring that does not substantially affect balance or mobility. Definitive evidence of the effects of compliant flooring on fall-related injuries in LTC is lacking. The Flooring for Injury Prevention (FLIP) Study is designed to address this gap.MethodsThe FLIP Study is a 4-year, parallel-group, 2-arm, randomised controlled superiority trial of flooring in 150 resident rooms at a LTC site. The primary objective is to determine whether compliant flooring reduces serious fall-related injuries relative to control flooring. Intervention (2.54 cm SmartCells compliant; 74 rooms) and control (2.54 cm plywood; 76 rooms) floorings were installed over the top of existing concrete floors and covered with identical 2.00 mm vinyl. The primary outcome is serious fall-related injury, defined as any impact-related injury due to a fall in a study room that results in Emergency Department visit or hospital admission. Secondary outcomes include minor fall-related injury, any fall-related injury, falls, number of fallers, fractures, and healthcare utilisation and costs for serious fall-related injuries. Randomisation of study rooms, and residents in rooms, was stratified by residential unit, and flooring assignments were concealed. Outcome ascertainment began September 2013.DiscussionResults from the FLIP Study will provide evidence about the effects of compliant flooring on fall-related injuries in LTC and will guide development of safer environments for vulnerable older adults.Trial registration numberNCT01618786.
Mobile internet service for self-management of physical activity in people with rheumatoid arthritis: evaluation of a test version
Authors: Revenäs Åsa , Opava Christina H , Ahlén Henrik , Brusewitz Maria , Pettersson Susanne , Åsenlöf Pernilla 
Published: April 2016

ObjectivesLife-long adherence to health-enhancing physical activity (PA) is a major challenge for people with rheumatoid arthritis (RA). Our aim was to evaluate the utilisation of and experiences with a RA-specific, mobile internet PA support service, ‘tRAppen’, developed through a co-design process.Methods28 participants with RA formed 3 web communities and tested tRAppen for 6 weeks. A mixed-method design was used to combine different types of data. Log data and questionnaire data were analysed quantitatively, while data from telephone interviews were analysed with a directed content analysis.Results25 of the 28 participants used tRAppen. Log data indicated that a majority of them registered their PA, sent likes and posted comments to peers, set personal goals and made exercise plans. tRAppen was rated as easy and fun to use, and fairly informative and supportive for PA, and was highly recommended for people with RA. The interview analysis resulted in the following 6 categories describing the utilisation of and experiences with tRAppen: (1) experiences in general, (2) feasibility of features, (3) value as support for PA, (4) enjoyment, (5) ideas for improvements and (6) additional factors.ConclusionstRAppen is the first co-designed mobile internet service developed specifically for the self-management of PA in people with RA. The results are promising and indicate that tRAppen may be useful for supporting a physically active lifestyle in a subpopulation at certain risk of poor health. It will now be revised, launched and continuously updated in an iterative process involving its future users.
Electron paramagnetic resonance in Cu-doped ZnO
Authors: Buchheit R. , Acosta-Humánez F. , Almanza O. 
Published: April 2016

In this work, ZnO and Cu-doped ZnO nanoparticles [Formula: see text], [Formula: see text], with a calcination temperature of 500[Formula: see text]C were synthesized using the sol–gel method. The particles were analyzed using atomic absorption spectroscopy (AAS), X-ray diffraction (XRD) and electron paramagnetic resonance (EPR) at X-band, measurement in a temperature range from 90 K to room temperature. AAS confirmed a good correspondence between the experimental doping concentration and the theoretical value. XRD reveals the presence of ZnO phase in hexagonal wurtzite structure and a nanoparticle size for the samples synthesized. EPR spectroscopy shows the presence of point defects in both samples with [Formula: see text]-values of [Formula: see text] for shallow donors and [Formula: see text] for ionized vacancies. It is important when these materials are required have been used as catalysts, as suggested that it is not necessary prepare them at higher temperature. A simulation of the Cu EPR signal using an anisotropic spin Hamiltonian was performed and showed good coincidence with the experimental spectra. It was shown that Cu[Formula: see text] ions enter interstitial octahedral sites of orthorhombic symmetry in the wurtzite crystal structure. Temperature dependence of the EPR linewidth and signal intensity shows a paramagnetic behavior of the sample in the measurement range. A Néel temperature [Formula: see text] K was determined.
Examining and Reducing the Influence of Sampling Errors on Feedback-Driven Optimizations
Authors: Zhou Mingzhou , Wu Bo , Shen Xipeng , Gao Yaoqing , Yiu Graham 
Published: April 2016

Feedback-driven optimization (FDO) is an important component in mainstream compilers. By allowing the compiler to reoptimize the program based on some profiles of the program's dynamic behaviors, it often enhances the quality of the generated code substantially. A barrier for using FDO is that it often requires many training runs to collect enough profiles to amortize the sensitivity of program optimizations to program input changes. Various sampling techniques have been explored to alleviate this time-consuming process. However, the lowered profile accuracy caused by sampling often hurts the benefits of FDO.
This article gives the first systematic study in how sampling rates affect the accuracy of collected profiles and how the accuracy correlates with the usefulness of the profile for modern FDO. Studying basic block and edge profiles for FDO in two mature compilers reveals several counterintuitive observations, one of which is that profiling accuracy does not strongly correlate with the benefits of the FDO. A detailed analysis identifies three types of sampling-caused errors that critically impair the quality of the profiles for FDO. It then introduces a simple way to rectify profiles based on the findings. Experiments demonstrate that the simple rectification fixes most of those critical errors in sampled profiles and significantly enhances the effectiveness of FDO.
Protecting Software through Obfuscation
Authors: Schrittwieser Sebastian , Katzenbeisser Stefan , Kinder Johannes , Merzdovnik Georg , Weippl Edgar 
Published: April 2016

Software obfuscation has always been a controversially discussed research area. While theoretical results indicate that provably secure obfuscation in general is impossible, its widespread application in malware and commercial software shows that it is nevertheless popular in practice. Still, it remains largely unexplored to what extent today’s software obfuscations keep up with state-of-the-art code analysis and where we stand in the arms race between software developers and code analysts. The main goal of this survey is to analyze the effectiveness of different classes of software obfuscation against the continuously improving deobfuscation techniques and off-the-shelf code analysis tools.
The answer very much depends on the goals of the analyst and the available resources. On the one hand, many forms of lightweight static analysis have difficulties with even basic obfuscation schemes, which explains the unbroken popularity of obfuscation among malware writers. On the other hand, more expensive analysis techniques, in particular when used interactively by a human analyst, can easily defeat many obfuscations. As a result, software obfuscation for the purpose of intellectual property protection remains highly challenging.
Altered Expression and Splicing of ESRP1 in Malignant Melanoma Correlates with Epithelial–Mesenchymal Status and Tumor-Associated Immune Cytolytic Activity
Authors: Yao Jun , Caballero Otavia L. , Huang Ying , Lin Calvin , Rimoldi Donata , Behren Andreas , Cebon Jonathan S. , Hung Mien-Chie , Weinstein John N. , Strausberg Robert L. , Zhao Qi 
Published: April 2016

Abstract
Melanoma is one of the major cancer types for which new immune-based cancer treatments have achieved promising results. However, anti–PD-1 and anti–CTLA-4 therapies are effective only in some patients. Hence, predictive molecular markers for the development of clinical strategies targeting immune checkpoints are needed. Using The Cancer Genome Atlas (TCGA) RNAseq data, we found that expression of ESRP1, encoding a master splicing regulator in the epithelial–mesenchymal transition (EMT), was inversely correlated with tumor-associated immune cytolytic activity. That association holds up across multiple TCGA tumor types, suggesting a link between tumor EMT status and infiltrating lymphocyte activity. In melanoma, ESRP1 mainly exists in a melanocyte-specific truncated form transcribed from exon 13. This was validated by analyzing CCLE cell line data, public CAGE data, and RT-PCR in primary cultured melanoma cell lines. Based on ESRP1 expression, we divided TCGA melanoma cases into ESRP1-low, -truncated, and –full-length groups. ESRP1-truncated tumors comprise approximately two thirds of melanoma samples and reside in an apparent transitional state between epithelial and mesenchymal phenotypes. ESRP1 full-length tumors express epithelial markers and constitute about 5% of melanoma samples. In contrast, ESRP1-low tumors express mesenchymal markers and are high in immune cytolytic activity as well as PD-L2 and CTLA-4 expression. Those tumors are associated with better patient survival. Results from our study suggest a path toward the use of ESRP1 and other EMT markers as informative biomarkers for immunotherapy. Cancer Immunol Res; 4(6); 552–61. ©2016 AACR.
Planeamento Turístico e Impactos Percecionados na Ilha da Boa Vista, Cabo Verde
Authors: Bernardo Edgar 
Published: April 2016

Em busca de um modelo de desenvolvimento sustentável que potencie as suas características morfológicas e climáticas, Cabo Verde viu no turismo massificado a resposta para as suas precariedades. De entre as ilhas escolhidas para a aplicação deste plano encontra-se a Boa Vista, um espaço que historicamente tem sido sinónimo de periferia nacional e de produção primária de subsistência. Nas duas últimas décadas este espaço tem sido um palco privilegiado pelos vários Governos para a aplicação da planificação turística centralizada. Uma planificação assente no turismo balnear massificado em serviço de turistas europeus. Este trabalho apresenta as perceções da comunidade residente da ilha quanto aos impactos positivos e negativos promovidos por esta aposta. Estas perceções foram recolhidas através da aplicação de entrevistas semi-dirigidas e procuram contribuir para determinar se o turismo, planeado desde o centro, tem contribuído para solucionar as precariedades e carências da Boa Vista, e os o objetivos de Cabo Verde. De entre os resultados salienta-se o volume de impactos positivos do tipo económico e entre os negativos os sociais.