bluuebunny/crossref_metadata_2025_split huggingface dataset:
Overseeing oversight: governance of quality and safety by hospital boards in the English NHS
Authors: Mannion Russell , Davies Huw , Freeman Tim , Millar Ross , Jacobs Rowena , Kasteridis Panos 
Published: December 2014

Objectives To contribute towards an understanding of hospital board composition and to explore board oversight of patient safety and health care quality in the English NHS. Methods We reviewed the theory related to hospital board governance and undertook two national surveys about board management in NHS acute and specialist hospital trusts in England. The first survey was issued to 150 trusts in 2011/2012 and was completed online via a dedicated web tool. A total 145 replies were received (97% response rate). The second online survey was undertaken in 2012/2013 and targeted individual board members, using a previously validated standard instrument on board members’ attitudes and competencies (the Board Self-Assessment Questionnaire). A total of 334 responses were received from 165 executive and 169 non-executive board members, providing at least one response from 95 of the 144 NHS trusts then in existence (66% response rate). Results Over 90% of the English NHS trust boards had 10–15 members. We found no significant difference in board size between trusts of different types (e.g. Foundation Trusts versus non-Foundation Trusts and Teaching Hospital Trusts versus non-Teaching Hospital Trusts). Clinical representation on boards was limited: around 62% had three or fewer members with clinical backgrounds. For about two-thirds of the trusts (63%), board members with a clinical background comprised less than 30% of the members. Boards were using a wide range and mix of quantitative performance metrics and soft intelligence (e.g. walk-arounds, patient stories) to monitor their organisations with regard to patient safety. The Board Self-Assessment Questionnaire data showed generally high or very high levels of agreement with desirable statements of practice in each of its six dimensions. Aggregate levels of agreement within each dimension ranged from 73% (for the dimension addressing interpersonal issues) to 85% (on the political). Conclusions English NHS boards largely hold a wide range of attitudes and behaviours that might be expected to benefit patient safety and quality. However, there is significant scope for improvement as regards formal training for board members on quality and safety, routine morbidity reporting at boards and attention to the interpersonal dynamics within boards. Directors with clinical backgrounds remain a minority on most boards despite policies to increase their representation. A better understanding of board composition, actions and attitudes should help refine policy recommendations around boards.
A qualitative study of systemic influences on paramedic decision making: care transitions and patient safety
Authors: O’Hara Rachel , Johnson Maxine , Siriwardena A Niroshan , Weyman Andrew , Turner Janette , Shaw Deborah , Mortimer Peter , Newman Chris , Hirst Enid , Storey Matthew , Mason Suzanne , Quinn Tom , Shewan Jane 
Published: December 2014

Objectives Paramedics routinely make critical decisions about the most appropriate care to deliver in a complex system characterized by significant variation in patient case-mix, care pathways and linked service providers. There has been little research carried out in the ambulance service to identify areas of risk associated with decisions about patient care. The aim of this study was to explore systemic influences on decision making by paramedics relating to care transitions to identify potential risk factors. Methods An exploratory multi-method qualitative study was conducted in three English National Health Service (NHS) Ambulance Service Trusts, focusing on decision making by paramedic and specialist paramedic staff. Researchers observed 57 staff across 34 shifts. Ten staff completed digital diaries and three focus groups were conducted with 21 staff. Results Nine types of decision were identified, ranging from emergency department conveyance and specialist emergency pathways to non-conveyance. Seven overarching systemic influences and risk factors potentially influencing decision making were identified: demand; performance priorities; access to care options; risk tolerance; training and development; communication and feedback and resources. Conclusions Use of multiple methods provided a consistent picture of key systemic influences and potential risk factors. The study highlighted the increased complexity of paramedic decisions and multi-level system influences that may exacerbate risk. The findings have implications at the level of individual NHS Ambulance Service Trusts (e.g. ensuring an appropriately skilled workforce to manage diverse patient needs and reduce emergency department conveyance) and at the wider prehospital emergency care system level (e.g. ensuring access to appropriate patient care options as alternatives to the emergency department).
Managing competing organizational priorities in clinical handover across organizational boundaries
Authors: Sujan Mark A , Chessum Peter , Rudd Michelle , Fitton Laurence , Inada-Kim Matthew , Cooke Matthew W , Spurgeon Peter 
Published: December 2014

Objectives Handover across care boundaries poses additional challenges due to the different professional, organizational and cultural backgrounds of the participants involved. This paper provides a qualitative account of how practitioners in emergency care attempt to align their different individual and organizational priorities and backgrounds when handing over patients across care boundaries (ambulance service to emergency department (ED), and ED to acute medicine). Methods A total of 270 clinical handovers were observed in three emergency care pathways involving five participating NHS organizations (two ambulance services and three hospitals). Half-day process mapping sessions were conducted for each pathway. Semi-structured interviews were carried out with 39 participants and analysed thematically. Results The management of patient flow and the fulfilment of time-related performance targets can create conflicting priorities for practitioners during handover. Practitioners involved in handover manage such competing organizational priorities through additional coordination effort and dynamic trade-offs. Practitioners perceive greater collaboration across departments and organizations, and mutual awareness of each other’s goals and constraints as possible ways towards more sustainable improvement. Conclusion Sustainable improvement in handover across boundaries in emergency care might require commitment by leaders from all parts of the local health economy to work as partners to establish a culture of integrated, patient-centred care.
The Role of Magnetic Resonance Imaging in Management of Patients With Nonlobar Hypertensive Intracerebral Hemorrhage
Authors: Adeli Amir , Behrouz Réza 
Published: December 2014

Background and Purpose: Despite the increased use and availability of magnetic resonance imaging (MRI), its role in hypertensive intracerebral hemorrhage (ICH) remains uncertain. In this retrospective study, we assessed the utility of MRI in diagnosis and management of patients with hypertensive ICH. Methods: We retrospectively reviewed the charts of patients with ICH presenting to our hospital over an 18-month period. We included patients who presented with hypertensive ICH in typical locations and excluded lobar hemorrhages. We further isolated cases that had undergone MRI. Collected data included mean age, gender, location of hematoma, neuroradiologist’s interpretative report of the MRI, and management steps taken in response to the results of the MRI. Logistic regression was used to determine whether the overall yield of MRI in these patients was significant. Results: We found 222 patients with ICH in our database. Forty-eight patients met our inclusion criteria, of which 24 had brain MRI done as a part of their hospital workup. Brain MRI obtained in 2 (8%) of the 24 patients revealed abnormalities that led to a change in management. The diagnostic yield of MRI and the management decisions that followed were both insignificant. Conclusions: The diagnostic yield of brain MRI in patients with nonlobar hypertensive ICH is low and does not result in significant changes in management.
Aripiprazole versus quetiapine in treatment-resistant obsessive–compulsive disorder: a double-blind clinical trial
Authors: Shoja Shafti Saeed , Kaviani Hamid 
Published: December 2014

Introduction: Around 40–60% of the patients with obsessive–compulsive disorder (OCD) remain unimproved by serotonin reuptake inhibitors (SRIs). Goal of this study was to compare the efficiency and safety of aripiprazole versus quetiapine, in patients with OCD, who did not respond effectively to fluvoxamine. Method: A total of 44 female inpatients with OCD, who did not respond successfully to fluvoxamine at maximum dose (300 mg/day) and duration (12 weeks), were assigned randomly, in a double-blind trial, to receive aripiprazole ( n = 22) or quetiapine ( n = 22), in addition to their SRI, for 12 weeks. Treatment response was assessed by the Yale–Brown Obsessive–Compulsive Scale (YBOCS), as primary outcome measure, and Clinical Global Impressions-Severity Scale (CGI-S), as a secondary outcome measure. Results: A total of 27.27% of the cases in the aripiprazole group ( n = 6) and 54.54% of them in the quetiapine cluster ( n = 12) responded moderately to the aforesaid augmentation. The mean ± SD baseline YBOCS score of 33.27 ± 3.90 dropped to a mean of 30.72 ± 4.67 ( p = 0.06) in the aripiprazole group, and from 31.18 ± 4.93 to 27.97 ± 3.71 ( p = 0.01) in the quetiapine group, at the end of the evaluation. There was no significant change with respect to CGI-S in either of the aforesaid groups. Conclusion: This study shows that treatment-resistant OCD patients may benefit more from addition of quetiapine in comparison with aripiprazole, to their ongoing SRI therapy.
Consent information leaflets – readable or unreadable?
Authors: Graham Caroline , Reynard John M , Turney Benjamin W 
Published: December 2014

Objective: The objective of this article is to assess the readability of leaflets about urological procedures provided by the British Association of Urological Surgeons (BAUS) to evaluate their suitability for providing information. Methods: Information leaflets were assessed using three measures of readability: Flesch Reading Ease, Flesch-Kincaid and Simple Measure of Gobbledygook (SMOG) grade formulae. The scores were compared with national literacy statistics. Results: Relatively good readability was demonstrated using the Flesch Reading Ease (53.4–60.1) and Flesch-Kincaid Grade Level (6.5–7.6) methods. However, the average SMOG index (14.0–15.0) for each category suggests that the majority of the leaflets are written above the reading level of an 18-year-old. Using national literacy statistics, at least 43% of the population will have significant difficultly understanding the majority of these leaflets. Conclusions: The results suggest that comprehension of the leaflets provided by the BAUS is likely to be poor. These leaflets may be used as an adjunct to discussion but it is essential to ensure that all the information necessary to make an informed decision has been conveyed in a way that can be understood by the patient.
Knowledge, attitudes and perceptions towards menopause among highly educated Asian women in their midlife
Authors: Memon Fouzia R , Jonker Leon , Qazi Roshan A 
Published: December 2014

Objective To determine knowledge levels, and attitudes and perceptions towards, menopause among highly educated Asian women in their midlife. Study design A cross-sectional survey. Setting Five teaching institutions in Hyderabad, Pakistan. Population In total, 200 out of 225 (89% response rate) teachers, lecturers and professors, aged 40–59 years, were surveyed in 2013 using a self-administered questionnaire. Results The mean age of responders was 48 years. Premenopausal and perimenopausal women attributed for 58%, whereas 42% were postmenopausal. All women had a masters degree; 15% had a PhD degree. Forty-six percent of responders thought they had sufficient knowledge about the menopause and 87% had positive perceptions about it, with 76% feeling life was easier and calmer as a result of it. Reported negative perceptions included 30% of women experiencing feelings of grumpiness, irritability, altered work capability and loss of femininity. Health professionals were an information resource. of 60% of cases, only 5% of participants knew about hormone replacement therapy and none knew about available alternative therapies. Conclusion Despite the fact that the majority of women felt well informed and exhibited a positive attitude towards menopause, a strong urge for more knowledge was expressed. Public health care systems should mobilize resources and take measures to improve women’s awareness and knowledge about menopause-related changes through a variety of educational tools and media, including the Internet. A recommendation would be for physicians to provide more information about menopausal symptoms and also therapies to alleviate these symptoms, regardless of the patient’s socioeconomic background.
Reproductive issues in sickle cell disease
Authors: Smith-Whitley Kim 
Published: December 2014

Abstract
As medical advances improve survival, reduce disease-related morbidity, and improve quality of life, reproductive issues will take higher priority in the sickle cell disease (SCD) community. A wide variety of topics are addressed in this chapter, including fertility, gonadal failure, erectile dysfunction, and menstrual issues in SCD. Etiologies of impaired male fertility are multifactorial and include hypogonadism, erectile dysfunction, sperm abnormalities, and complications of medical therapies. Much less is known about the prevalence and etiology of infertility in women with SCD. Other reproductive issues in women included in this review are pain and the menstrual cycle, contraception, and preconception counseling. Finally, long-term therapies for SCD and their impact on fertility are presented. Transfusional iron overload and gonadal failure are addressed, followed by options for fertility preservation after stem cell transplantation. Focus is placed on hydroxyurea therapy given its benefits and increasing use in SCD. The impact of this agent on spermatogenesis, azoospermia, and the developing fetus is discussed.
A genome-wide association study of susceptibility to acute lymphoblastic leukemia in adolescents and young adults
Authors: Perez-Andreu Virginia , Roberts Kathryn G. , Xu Heng , Smith Colton , Zhang Hui , Yang Wenjian , Harvey Richard C. , Payne-Turner Debbie , Devidas Meenakshi , Cheng I-Ming , Carroll William L. , Heerema Nyla A. , Carroll Andrew J. , Raetz Elizabeth A. , Gastier-Foster Julie M. , Marcucci Guido , Bloomfield Clara D. , Mrózek Krzysztof , Kohlschmidt Jessica , Stock Wendy , Kornblau Steven M. , Konopleva Marina , Paietta Elisabeth , Rowe Jacob M. , Luger Selina M. , Tallman Martin S. , Dean Michael , Burchard Esteban G. , Torgerson Dara G. , Yue Feng , Wang Yanli , Pui Ching-Hon , Jeha Sima , Relling Mary V. , Evans William E. , Gerhard Daniela S. , Loh Mignon L. , Willman Cheryl L. , Hunger Stephen P. , Mullighan Charles G. , Yang Jun J. 
Published: December 2014

Key PointsIn this first ALL GWAS in AYAs, we determined that inherited GATA3 variants strongly influence ALL susceptibility in this age group. These findings revealed similarities and differences in the genetic basis of ALL susceptibility between young children and AYAs.
Temperature-induced reversible self-assembly of diphenylalanine peptide and the structural transition from organogel to crystalline nanowires
Authors: Huang Renliang , Wang Yuefei , Qi Wei , Su Rongxin , He Zhimin 
Published: December 2014

Abstract
Controlling the self-assembly of diphenylalanine peptide (FF) into various nanoarchitectures has received great amounts of attention in recent years. Here, we report the temperature-induced reversible self-assembly of diphenylalanine peptide to microtubes, nanowires, or organogel in different solvents. We also find that the organogel in isopropanol transforms into crystalline flakes or nanowires when the temperature increases. The reversible self-assembly in polar solvents may be mainly controlled by electronic and aromatic interactions between the FF molecules themselves, which is associated with the dissociation equilibrium and significantly influenced by temperature. We found that the organogel in the isopropanol solvent made a unique transition to crystalline structures, a process that is driven by temperature and may be kinetically controlled. During the heating-cooling process, FF preferentially self-assembles to metastable nanofibers and organogel. They further transform to thermodynamically stable crystal structures via molecular rearrangement after introducing an external energy, such as the increasing temperature used in this study. The strategy demonstrated in this study provides an efficient way to controllably fabricate smart, temperature-responsive peptide nanomaterials and enriches the understanding of the growth mechanism of diphenylalanine peptide nanostructures.
Haplotypes of P2RX7 Gene Polymorphisms are Associated with both Cold Pain Sensitivity and Analgesic Effect of Fentanyl
Authors: Ide Soichiro , Nishizawa Daisuke , Fukuda Ken-Ichi , Kasai Shinya , Hasegawa Junko , Hayashida Masakazu , Minami Masabumi , Ikeda Kazutaka 
Published: December 2014

Background: The P2X7 receptor is a member of the P2X**** family of adenosine 5′-triphosphate-gated cation channels. Several recent studies have demonstrated that this receptor is involved in mechanisms related to pain and inflammation. However, unknown is whether polymorphisms of the P2RX7 gene that encodes the human P2X7 receptor influence pain sensitivity and analgesic effects of opioids. The P2RX7 gene is known to be highly polymorphic. Thus, the present study examined associations between fentanyl sensitivity and polymorphisms in the P2RX7 gene in 355 Japanese patients who underwent painful orofacial cosmetic surgery. Results: We first conducted linkage disequilibrium (LD) analyses for 55 reported single-nucleotide polymorphisms (SNPs) in the region within and around the P2RX7 gene using genomic samples from 100 patients. In our samples, 42 SNPs were polymorphic, and a total of five LD blocks with six Tag SNPs (rs2708092, rs1180012, rs1718125, rs208293, rs1718136, and rs7132846) were observed. Thus, we further analyzed associations between genotypes/haplotypes of these Tag SNPs and clinical data using a total of 355 samples. In the genotype-based association study, only the rs1718125 G > A SNP tended to be associated with higher pain scores on a visual analog scale 24 h after surgery (VAS24). The haplotype-based association study showed that subjects with homozygous haplotype No.3 (GTAAAC; estimated frequency: 15.0%) exhibited significantly higher cold pain sensitivity and lower analgesic effects of fentanyl for acute cold pain in the cold pressor test. Conversely, subjects who carried haplotype No.1 (ACGGAC; estimated frequency: 24.5%) tended to exhibit lower cold pain sensitivity and higher analgesic effects of fentanyl. Furthermore, subjects with homozygous haplotype No.2 (GCGGAC; estimated frequency: 22.9%) exhibited significantly lower VAS24 scores. Conclusions: Cold pain sensitivity and analgesic effects of fentanyl were related to the SNP and haplotypes of the P2RX7 gene. The patients with the rs1718125 G>A SNP tended to show higher VAS24 scores. Moreover, the combination of polymorphisms from the 5′-flanking region to exon 5 recessively affected cold pain sensitivity and analgesic effects of opioids for acute cold pain. The present findings shed light on the involvement of P2RX7 gene polymorphisms in naive cold pain sensitivity and analgesic effects of fentanyl.
Aspect angle sensitivity of pump-induced optical emissions at EISCAT
Authors: Kosch Michael J , Bryers Carl , Rietveld Michael T , Yeoman Timothy K , Ogawa Yasunobu 
Published: December 2014

Abstract
We investigate the aspect angle sensitivity of the pump-induced artificial optical emissions in the ionosphere over the European Incoherent Scatter Scientific Association (EISCAT) high-frequency transmitter facility at Ramfjord, Norway, as a function of the pump beam launch angle relative to the magnetic field line direction. The highest intensity optical emissions occur when the pump beam pointing direction is in the magnetic zenith (approximately 12° S of local zenith). For pump beam directions further north from field aligned, the optical emission intensity decreases for the same pump power. In addition, the primary photon-emitting region becomes displaced towards the magnetic zenith relative to the pump beam and for larger aspect angles, the brightest emissions were found to be outside the −3-dB pump beam width. The Cooperative UK Twin-Located Auroral Sounding System (CUTLASS) coherent scatter high-frequency (HF) radar detected a quasi-constant level of backscatter power from the pumped ionosphere, indicating that saturated striations were formed for all pump beam directions. This indicates that the presence of upper-hybrid resonance is not sufficient to explain the angular sensitivity of the optical emissions.
Bang for the Buck: Gain-Loss Ratio as a Driver of Judgment and Choice
Authors: de Langhe Bart , Puntoni Stefano 
Published: December 2014

Prominent decision-making theories propose that individuals (should) evaluate alternatives by combining gains and losses in an additive way. Instead, we suggest that individuals seek to maximize the rate of exchange between positive and negative outcomes and thus combine gains and losses in a multiplicative way. Sensitivity to gain-loss ratio provides an alternative account for several existing findings and implies a number of novel predictions. It implies greater sensitivity to losses and risk aversion when expected value is positive, but greater sensitivity to gains and risk seeking when expected value is negative. It also implies more extreme preferences when expected value is positive than when expected value is negative. These predictions are independent of decreasing marginal sensitivity, loss aversion, and probability weighting—three key properties of prospect theory. Five new experiments and reanalyses of two recently published studies support these predictions. This paper was accepted by Yuval Rottenstreich, judgment and decision making.
Reflexivity in research: Promoting rigour, reliability and validity in qualitative research
Authors: Darawsheh Wesam 
Published: December 2014

Background The value of qualitative research is increasingly acknowledged in health studies, as well as the demand for employing rigorous strategies. Although the literature recognises that reflexivity is a valuable and rigorous strategy, few studies unravel the practical employment of reflexivity as a strategy for ensuring rigour and quality in qualitative research. Aim To present a practical example of how reflexivity can be employed as a strategy for ensuring rigour by reviewing 13 narratives from the author's reflexive diary on qualitative research. Methods Content analysis and narrative analysis were used to approach and analyse data. Findings Analysis of the posited qualitative research study found five main outcomes of the influence of reflexivity as a strategy to establish criteria of rigour. Conclusions Further research is needed to show how reflexivity can be employed as a strategy in qualitative research to: i) establish criteria of rigour; ii) monitor the researcher's subjectivity in generating credible findings.