bluuebunny/crossref_metadata_2025_split huggingface dataset:
What are parents' perspectives on psychological empowerment in the MMR vaccination decision? A focus group study
Authors: Fadda Marta , Galimberti Elisa , Carraro Valter , Schulz Peter J 
Published: April 2016

ObjectivesMost developed countries do not have compulsory immunisation requirements, but instead issue recommendations. Although parents are expected to make an informed, autonomous (ie, empowered) decision regarding their children's vaccinations, there is no evidence about how parents' interpret this demand nor on the latitude of their decision-making. The goal of this study is to gain insights from parents residing in a low measles-mumps-rubella (MMR) uptake area on what constitutes feelings of empowerment in the decision they have to make on their child's MMR vaccination.DesignA qualitative study employing focus group interviews.Setting11 vaccination centres and hospitals in the Province of Trento, Italy.Participants24 mothers and 4 fathers of children for whom the MMR vaccination decision was still pending participated in 6 focus groups.ResultsAutonomy and competence were salient themes in relation to empowerment, and were further connected with beliefs regarding legal responsibility and ethics of freedom concerning the decision, parents' relationship with the paediatrician (trust), feelings of relevance of the decision and related stress, and seeking, avoidance, or fear of vaccination-related information. Competence was interpreted as medical knowledge and information-seeking skills, but it was also related to the extent parents perceived the paediatrician to be competent.ConclusionsSince parents' interpretation of empowerment goes beyond mere perceptions of being informed and autonomous and differs across individuals, it is important that this construct be correctly interpreted and implemented by best practice, for instance by explicitly adopting a relational conception of autonomy. Knowing whether parents want to make an empowered decision and what their information and autonomy needs are might help health professionals adapt their communication about immunisation, and promote parental perception of making an informed, autonomous decision.
Weekly miscarriage rates in a community-based prospective cohort study in rural western Kenya
Authors: Dellicour Stephanie , Aol George , Ouma Peter , Yan Nicole , Bigogo Godfrey , Hamel Mary J , Burton Deron C , Oneko Martina , Breiman Robert F , Slutsker Laurence , Feikin Daniel , Kariuki Simon , Odhiambo Frank , Calip Gregory , Stergachis Andreas , Laserson Kayla F , ter Kuile Feiko O , Desai Meghna 
Published: April 2016

ObjectiveInformation on adverse pregnancy outcomes is important to monitor the impact of public health interventions. Miscarriage is a challenging end point to ascertain and there is scarce information on its rate in low-income countries. The objective was to estimate the background rate and cumulative probability of miscarriage in rural western Kenya.DesignThis was a population-based prospective cohort.Participants and settingWomen of childbearing age were followed prospectively to identify pregnancies and ascertain their outcomes in Siaya County, western Kenya. The cohort study was carried out in 33 adjacent villages under health and demographic surveillance.Outcome measureMiscarriage.ResultsBetween 2011 and 2013, among 5536 women of childbearing age, 1453 pregnancies were detected and 1134 were included in the analysis. The cumulative probability was 18.9%. The weekly miscarriage rate declined steadily with increasing gestation until approximately 20 weeks. Known risk factors for miscarriage such as maternal age, gravidity, occupation, household wealth and HIV infection were confirmed.ConclusionsThis is the first report of weekly miscarriage rates in a rural African setting in the context of high HIV and malaria prevalence. Future studies should consider the involvement of community health workers to identify the pregnancy cohort of early gestation for better data on the actual number of pregnancies and the assessment of miscarriage.
Follow-up study of the regional quota system of Japanese medical schools and prefecture scholarship programmes: a study protocol
Authors: Matsumoto Masatoshi , Takeuchi Keisuke , Tanaka Junko , Tazuma Susumu , Inoue Kazuo , Owaki Tetsuhiro , Iguchi Seitaro , Maeda Takahiro 
Published: April 2016

IntroductionGiven the shortage of physicians, particularly in rural areas, the Japanese government has rapidly expanded the number of medical school students by addingchiikiwaku(regional quotas) since 2008. Quota entrants now account for 17% of all medical school entrants. Quota entrants are usually local high school graduates who receive a scholarship from the prefecture government. In exchange, they temporarily practise in that prefecture, including its rural areas, after graduation. Many prefectures also have scholarship programmes for non-quota students in exchange for postgraduate in-prefecture practice. The objective of this cohort study, conducted by the Japanese Council for Community-based Medical Education, is to evaluate the outcomes of the quota admission system and prefecture scholarship programmes nationwide.Methods and analysisThere are 3 groups of study participants: quota without scholarship, quota with scholarship and non-quota with scholarship. Under the support of government ministries and the Association of Japan Medical Colleges, and participation of all prefectures and medical schools, passing rate of the National Physician License Examination, scholarship buy-out rate, geographic distribution and specialties distribution of each group are analysed. Participants who voluntarily participated are followed by linking their baseline information to data in the government's biennial Physician Census. Results to date have shown that, despite medical schools' concerns about academic quality, the passing rate of the National Physician License Examination in each group was higher than that of all medical school graduates.Ethics and disseminationThe Ethics Committee for Epidemiological Research of Hiroshima University and the Research Ethics Committee of Nagasaki University Graduate School of Biomedical Sciences permitted this study. No individually identifiable results will be presented in conferences or published in journals. The aggregated results will be reported to concerned government ministries, associations, prefectures and medical schools as data for future policy planning.
Exercise and BMI z-score in overweight and obese children and adolescents: protocol for a systematic review and network meta-analysis of randomised trials
Authors: Kelley George A , Kelley Kristi S 
Published: April 2016

IntroductionWhile overweight and obesity in children and adolescents is a major global health problem, the effects of exercise on overweight and obesity in children and adolescents are not well established despite numerous studies on this topic. The purpose of this study is to use the network meta-analytic approach to determine the effects of exercise (aerobic, strength training or both) on body mass index (BMI) z-score in overweight and obese children and adolescents.Methods and analysisRandomised exercise intervention trials>4 weeks, published in any language between 1 January 1990 and 31 September 2015, and which include direct and/or indirect evidence, will be included. Studies will be retrieved by searching 6 electronic databases, cross-referencing and expert review. Dual abstraction of data will occur. The primary outcome will be changes in BMI z-score while the secondary outcome will be changes in body weight in kilograms (kg). Risk of bias will be assessed using the Cochrane risk of bias assessment instrument while confidence in the cumulative evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) instrument for network meta-analysis. Network meta-analysis will be performed using multivariate random-effects meta-regression models. The surface under the cumulative ranking curve will be used to provide a hierarchy of exercise treatments (aerobic, strength training or both).DisseminationThe results of this study will be presented at a professional conference and published in a peer-reviewed journal.Trial registration numberCRD42015026377.
Persistence of immunophenotypically aberrant CD34+ myeloid progenitors is frequent in bone marrow of patients with myelodysplastic syndromes and myelodysplastic/myeloproliferative neoplasms treated with hypomethylating agents
Authors: Huang Lanshan , Garcia-Manero Guillermo , Jabbour Elias , Goswami Maitrayee , Routbort Mark J , Medeiros L Jeffrey , Jorgensen Jeffrey L , Wang Sa A 
Published: April 2016

AimsHypomethylating agents (HMAs) exhibit clinical efficacy in patients with myelodysplastic syndromes (MDS) and myelodysplastic/myeloproliferative neoplasms (MDS/MPN). This study was performed to assess residual disease status by flow cytometry immunophenotyping (FCI) methods in patients with MDS or MDS/MPN treated with HMAs, and correlate the findings with clinical response.MethodsCD34+ myeloid precursors were assessed in 85 patients with MDS and MDS/MPN treated with HMAs using FCI methods. Morphological, cytogenetic and molecular assessments were performed to evaluate the responses.ResultsAfter a median six cycles (3–19) of HMAs, 40 (47%) patients showed haematological improvement, 26 (63%) showed bone marrow (BM) and 20 (39%) cytogenetic response. However, CD34+ myeloid progenitors showed persistent immunophenotypic aberrancies in 72 (85%) patients, indeterminate in four (5%) and negative in nine (10%). Compared with pretreatment BM in a given patient, FCI abnormalities were reduced in 15 (20%) patients, similar in 37 (48%), increased in 15 (20%) and showed antigenic shift in nine (12%). Patients who achieved immunophenotypic improvement had a superior progression-free survival (p=0.031). In the subgroup of patients who underwent haematopoietic stem cell transplant (HSCT), 16/19 (84%) patients who had a pre-HSCT positive FCI study became normal.ConclusionsThese findings show the difficulty in eradicating neoplastic myeloid precursors by HMA therapy, thereby resulting in ultimate treatment failure in most patients. Achieving immunophenotypic improvement helps to identify patients who may benefit from continuous HMA treatment. HSCT provides a potential cure for these patients by replenishing BM with normal haematopoietic stem cells.
Neighbourhood food, physical activity, and educational environments and black/white disparities in obesity: a complex systems simulation analysis
Authors: Orr Mark G , Kaplan George A , Galea Sandro 
Published: April 2016

BackgroundMultiple approaches that can contribute to reducing obesity have been proposed. These policies may share overlapping pathways, and may have unanticipated consequences, creating considerable complexity. Aiming to illuminate the use of agent-based models to explore the consequences of key policies, this paper simulates the effects of increasing neighbourhood availability of good food stores, physical activity infrastructure and higher school quality on the reduction of black/white disparities in body mass index (BMI) in the USA.MethodsWe used an agent-based model, with parameters derived from the empirical literature, which included individual and neighbourhood characteristics over the life course as determinants of behaviours thought to impact BMI. We systematically varied the strength of the 3 policy interventions, examining the impact of 125 different policy scenarios on black/white BMI disparities.ResultsIn the absence of any of these policies, black/white BMI disparities generally increased over time. However, we found that some combinations of these policies resulted in reductions in BMI, yielding decreases in the black/white BMI disparity as large as a 90%.ConclusionsWithin the structure of relationships captured in this simulation model, there is support for the further use of agent-based simulation models to explore upstream policies as plausible candidates for the reduction of black/white disparities in BMI. These results highlight the potential insights into important public health problems, such as obesity, that can come from uniting the systems science approach with policy analysis.
Late Cretaceous (Campanian) leaf and palynoflora from southern Skåne, Sweden
Authors: Halamski Adam T. , Kvaček Jiří , Vajda Vivi 
Published: April 2016

Abstract

A Late Cretaceous (Campanian) leaf megaflora from the Vomb Trough in southern Skåne, Sweden, has been investigated on the basis of collections held at the Swedish Museum of Natural History. The main plant-bearing locality is Köpinge, but single specimens originate from Högestad, Ingelstorp, Rödmölla, Svenstorps mölla and Tosterup. The fossil flora is dominated by the angiosperm (eudicot)
Debeya
(
Dewalquea
)
haldemiana
(Debey
ex
de Saporta & Marion) Halamski. Other dicots are cf.
Dryophyllum
sp.,
Ettingshausenia
sp.,
Rarytkinia
? sp.,
Dicotylophyllum friesii
(Nilsson) comb. nov. and
Salicites wahlbergii
(Nilsson) Hisinger. Conifers are represented by cf.
Aachenia
sp. (cone scales),
Pagiophyllum
sp. and
Cyparissidium
sp. (leaves). Single poorly preserved specimens of ferns and monocots have also been identified. The terrestrial palynomorphs (the focus herein) clearly link to the megaflora, although with different relative abundances. The fern spore
Cyathidites
dominates along with the conifer pollen
Perinopollenites elatoides
and
Classopollis
. Angiosperm pollen comprise up to 15% of the assemblage, represented by monocolpate, tricolpate and periporate pollen and the extinct Normapolles group. The spores in the kerogen residue show a thermal alteration index (TAI) of 2+.

The flora probably represents mainly a coastal lowland
Debeya
/conifer forest, and is similar to approximately coeval assemblages from analogous palaeo-communities described from eastern Poland, western Ukraine and Westphalia.
Germline Analysis from Tumor–Germline Sequencing Dyads to Identify Clinically Actionable Secondary Findings
Authors: Seifert Bryce A. , O'Daniel Julianne M. , Amin Krunal , Marchuk Daniel S. , Patel Nirali M. , Parker Joel S. , Hoyle Alan P. , Mose Lisle E. , Marron Andrew , Hayward Michele C. , Bizon Christopher , Wilhelmsen Kirk C. , Evans James P. , Earp H. Shelton , Sharpless Norman E. , Hayes D. Neil , Berg Jonathan S. 
Published: April 2016

Abstract
Purpose: To evaluate germline variants in hereditary cancer susceptibility genes among unselected cancer patients undergoing tumor–germline sequencing.
Experimental Design: Germline sequence data from 439 individuals undergoing tumor–germline dyad sequencing through the LCCC1108/UNCseq™ (NCT01457196) study were analyzed for genetic variants in 36 hereditary cancer susceptibility genes. These variants were analyzed as an exploratory research study to determine whether pathogenic variants exist within the germline of patients undergoing tumor–germline sequencing. Patients were unselected with respect to indicators of hereditary cancer predisposition.
Results: Variants indicative of hereditary cancer predisposition were identified in 19 (4.3%) patients. For about half (10/19), these findings represent new diagnostic information with potentially important implications for the patient and their family. The others were previously identified through clinical genetic evaluation secondary to suspicion of a hereditary cancer predisposition. Genes with pathogenic variants included ATM, BRCA1, BRCA2, CDKN2A, and CHEK2. In contrast, a substantial proportion of patients (178, 40.5%) had Variants of Uncertain Significance (VUS), 24 of which had VUS in genes pertinent to the presenting cancer. Another 143 had VUS in other hereditary cancer genes, and 11 had VUS in both pertinent and nonpertinent genes.
Conclusions: Germline analysis in tumor–germline sequencing dyads will occasionally reveal significant germline findings that were clinically occult, which could be beneficial for patients and their families. However, given the low yield for unexpected germline variation and the large proportion of patients with VUS results, analysis and return of germline results should adhere to guidelines for secondary findings rather than diagnostic hereditary cancer testing. Clin Cancer Res; 22(16); 4087–94. ©2016 AACR.
See related commentary by Mandelker, p. 3987
Biochemical and Bioimaging Evidence of Cholesterol in Acquired Cholesteatoma
Authors: Thorsted Bjarne , Bloksgaard Maria , Groza Alexandra , Schousboe Lars Peter , Færgeman Nils J. , Sørensen Jens A. , Svane-Knudsen Viggo , Brewer Jonathan R. 
Published: April 2016

Objectives: To quantify the barrier sterols and image the lipid structures in the matrix of acquired cholesteatoma and compare the distribution with that found in stratum corneum from normal skin, with the goal to resolve their potential influence on cholesteatoma growth. Methods: High-performance thin-layer chromatography (HPTLC) was used to achieve a quantitative biochemical determination of the sterols. The intercellular lipids were visualized by Coherent Anti-Stokes Raman scattering (CARS) microscopy, which enables label-free imaging of the lipids in intact tissue samples. Results: The results show that the total lipid content of the cholesteatoma matrix is similar to that of stratum corneum from skin and that the cholesteatoma matrix unquestionably contains cholesterol. The cholesterol content in the cholesteatoma matrix is increased by over 30% (w/w dry weight) compared to the control. The cholesterol sulfate content is below 1% of the total lipids in both the cholesteatoma and the control. Cholesterol ester was reduced by over 30% when compared to the control. Conclusions: The content of cholesterol in the cholesteatoma matrix is significantly different from that in stratum corneum from skin, and we confirm that the main structure of the cholesteatoma resembles very thick stratum corneum.
Clinically useful predictors for premature mortality among psychiatric patients visiting a psychiatric emergency room
Authors: Aagaard Jørgen , Buus Niels , Wernlund Andreas Glahn , Foldager Leslie , Merinder Lars 
Published: April 2016

Objective: The aim of this study was to examine changes in the distribution of causes of death and mortality rates among psychiatric patients visiting a psychiatric emergency room (PER), to determine clinically useful predictors for avoiding premature mortality among these patients and to discuss possible interventions. Method: The study was designed as a historical prospective record linkage study of patients with at least one visit to a Danish PER in 1995–2007. Five consecutive 3-year cohorts of individuals aged 20 to <80 years were identified. Data from the Danish Civil Registration System were linked to the Cause of Death Register and the Central Psychiatric Research Register, and logistic predictor analyses for premature death were performed. Results: The standardised mortality ratio (SMR) of all visitors compared to the general Danish population was approximately 5. Overall, patients with drug and/or alcohol use disorder experienced at least a twofold increase in SMR compared to patients without substance use disorder. In the case of patients with schizophrenia and a concurrent substance use disorder, the SMR increased considerably. During the period, substance use disorder was the strongest predictor of premature death among visitors to a PER (odds ratio (OR) = 1.8; 95% confidence interval (CI) = 1.5, 2.2). Conclusion: Persons visiting the PER had an increased SMR and substance use disorders were the strongest predictor of premature death within 3 years. However, death caused by substance use disorder is preventable, and PERs are ideal points of early intervention. Systematic screening for substance use disorder at the PER and/or crisis intervention teams may be effective intervention strategies.
The new European Union economic governance: what about accountability?
Authors: Naert Frank 
Published: April 2016

The euro crisis marked the start of the so-called ‘new European Union economic governance’. This new economic governance brings along different kinds of changes in the status of decision-making actors. Some of these changes involve power shifts, which can be categorised as either vertical or horizontal. Vertical power shifts transfer powers between different levels of government, usually from the national level to the European Union level. Horizontal power shifts transfer powers away from discretionary decision-making by governments to independent institutions. The new economic governance also implies a restriction in the discretionary decision-making power of governments by the imposition of policy rules. In this article, the accountability problems involved with these power shifts are analysed. It finds that, overall, the implementation process of the new economic governance has harmed accountability. Points for practitioners The key implication of this article is that the new governance arrangements made by the European Union to tackle the euro crisis are lacking in accountability and legitimacy. The moves towards more rules replacing policy discretion and towards entrusting policies to independent agencies rather than politically accountable governments are to the detriment of political accountability. Policy efficiency comes at a high price in terms of political acceptance as trust in the European Union is negatively influenced by the new governance system. Practitioners should keep this in mind when designing governance systems.
Transparency is in the eye of the beholder: the effects of identity and negative perceptions on ratings of transparency via surveys
Authors: Park Heungsik , Blenkinsopp John 
Published: April 2016

Surveys are a commonly used means of measuring transparency levels, but they are potentially vulnerable to perceptual biases. This study sought to examine perceptual differences by the respondents’ identities as general citizens or public employees, and the possible negative perceptions that one group may have of the other concerning responses to a survey-based measure of transparency. The survey was designed on the basis of existing literature, suggesting that transparency has up to six facets. Two samples were taken: from citizens who visited district offices to file civil applications during the survey period; and from public employees involved in processing these applications. A total of 472 surveys were used for analysis: 233 citizens and 239 public employees. The results indicated that the two groups had different understandings of transparency. Data from public employees produced a three-factor solution, which was labeled as Efficiency, Reliability, and Access. For citizens, a two-factor solution was a better fit, with the factors being described as Accessibility (a wider notion than Access) and Utility. The findings suggest that public employees adopt a somewhat technical view of transparency, whereas citizens have more practical concerns about it. Only citizens’ unfavorable perception of public employees had a negative influence on the level of transparency. This study contributes to the understanding of how public employees and citizens have qualitatively different perceptions of transparency. Points for practitioners To assess progress in governmental transparency, we must measure it, and surveys offer an accessible and potentially cost-effective approach. However, the survey responses of citizens and public employees show that they understand transparency in qualitatively different ways, with citizens’ perceptions of transparency also influenced by their perceptions of public employees. If governments are to increase public trust in policymaking and administration, they must focus on improving transparency as it is understood by the public rather than how it is understood by public servants.