bluuebunny/crossref_metadata_2025_split huggingface dataset:
Continuity of care for orthopaedic patients in a district general hospital
Authors: Kulloo Praneta 
Published: March 2014

AbstractContinuity of care has been defined as a patient repeatedly consulting the same doctor and forming a therapeutic relationship. There is evidence that not only do patients value continuity of the care they receive but also that provider continuity is related to lower overall total healthcare costs and better healthcare outcomes. A retrospective audit was undertaken in James Paget Hospital, a district general hospital in East Anglia, England, to assess continuity of care from the preoperative clinic to surgery and subsequent postoperative follow-up in the orthopaedic department. Overall continuity of care by individual surgeon was 23% and by orthopaedic team (consultant and middle grade staff) 43% in the first audit cycle of 106 patients in 2008. In the second cycle in 2010, this improved to 24% and 56%, respectively, in a sample of 156 patients. Moreover, the continuity of care for trauma patients improved from 10% to 75%. Interventions which resulted in the improvement were change of on-call rota and the implementation of measures so that, following surgery, patients were allocated to the operating surgeon’s clinic postoperatively. This completed audit cycle highlights the importance of continuity of care of patients and how efficient management led to a more patient centred delivery of healthcare.
Disaster management in low- and middle-income countries: scoping review of the evidence base
Authors: Lee Andrew Chee Keng , Booth Andrew , Challen Kirsty , Gardois Paolo , Goodacre Steve 
Published: March 2014

IntroductionGlobally, there has been an increase in the prevalence and scale of disasters with low- and middle-income countries (LMICs) tending to be more affected. Consequently, disaster risk reduction has been advocated as a global priority. However, the evidence base for disaster management in these settings is unclear.MethodsThis study is a scoping review of the evidence base for disaster management in LMIC. Potentially relevant articles between 1990 and 2011 were searched for, assessed for relevance and subsequently categorised using a thematic coding framework based on the US Integrated Emergency Management System model.ResultsOut of 1545 articles identified, only 178 were from LMIC settings. Most were of less robust design such as event reports and commentaries, and 66% pertained to natural disasters. There was a paucity of articles on disaster mitigation or recovery, and more were written on disaster response and preparedness issues.DiscussionConsiderably more articles were published from high-income country settings that may reflect a publication bias. Current grey literature on disaster management tends not to be peer reviewed, is not well organised and not easy to access. The paucity of peer-reviewed publications compromises evidence review initiatives that seek to provide an evidence-base for disaster management in LMIC. As such, there is an urgent need for greater research and publication of findings on disaster management issues from these settings.
Association of Body Mass Index With Increased Cost of Care and Length of Stay for Emergency Department Patients With Chest Pain and Dyspnea
Authors: Peitz Geoffrey W. , Troyer Jennifer , Jones Alan E. , Shapiro Nathan I. , Nelson R. Darrell , Hernandez Jackeline , Kline Jeffrey A. 
Published: March 2014

Background—
High body mass index (BMI) increases the probability of indeterminate findings on diagnostic studies, length of stay, and cost of care for hospitalized patients. No study has examined the economic and operational impact of BMI in patients with chest complaints presenting to the emergency department (ED). The objective was to measure the association of BMI with the main outcomes of cost of care, length of stay (including time in the ED and time in the wards if admitted), and radiation exposure in patients presenting to the ED with chest pain and dyspnea.

Methods and Results—

This was a prospective, 4-center, outcomes study. Patients were adults with dyspnea and chest pain, nondiagnostic electrocardiograms, and no obvious diagnosis. Patients were followed for the main outcomes for 90 days. Outcomes that were stratified by BMI in 5 categories, underweight, normal weight, overweight, obese, and morbidly obese, were compared using the Kruskall–Wallis rank test, and the independent predictive value of BMI was tested with multivariate regressions. Compared with medical costs for normal weight patients, costs were 22% higher for overweight patients (
P
=0.077), 28% higher for obese patients (
P
=0.020), and 41% higher for morbidly obese patients (
P
=0.015). Morbidly obese patients without computerized tomographic scanning stayed in the hospital 34% longer than normal weight patients (
P
=0.073), and morbidly obese patients with computerized tomographic scanning stayed in the hospital 44% longer than normal weight patients (
P
=0.083). BMI was not a significant predictor of radiation exposure. Morbidly obese patients had the highest proportion (87%) of no significant cardiopulmonary diagnosis for 90 days after computerized tomographic pulmonary angiography.

Conclusions—
BMI was associated with increases in cost of care and length of hospital stay for patients with chest pain and dyspnea. These results emphasize a need for specific protocols to manage morbidly obese patients presenting to the ED with chest pain and dyspnea.

Clinical Trial Registration—

http://www.clinicaltrials.gov
. Unique identifier: NCT01059500.
Sources of Hospital-Level Variation in Major Bleeding Among Patients With Non–ST-Segment Elevation Myocardial Infarction
Authors: Xian Ying , Chen Anita Y. , Thomas Laine , Roe Matthew T. , Subherwal Sumeet , Cannon Christopher P. , Pollack Charles V. , Fonarow Gregg C. , Kosiborod Mikhail , Peterson Eric D. , Alexander Karen P. 
Published: March 2014

Background—
Major bleeding has received increasing attention as a target for quality improvement in care of patients with acute myocardial infarction. However, little is known about variation in bleeding across hospitals and whether variation is attributable to quality of hospital care, treatments, or case mix.

Methods and Results—
We characterized hospital variation in major bleeding events (an absolute hemoglobin drop ≥4 g/dL, intracranial hemorrhage, retroperitoneal bleed, or transfusion) among 99 200 patients with non–ST-segment elevation myocardial infarction in the National Cardiovascular Data Registry (NCDR) Acute Coronary Treatment and Intervention Outcomes Network Registry–Get With the Guidelines (ACTIOM Registry-GWTG) between January 2007 and June 2010. A total of 9566 (9.6%) patients experienced a major bleeding event during hospitalization. The median of the estimated distribution of major bleeding rates across hospitals was 9.4% (interquartile range, 7.5%–11.7%), with some hospitals having bleeding rates >2.3 times higher than others (10th–90th percentile, 6.1%–14.2%). Multivariable hierarchical models revealed that differences in case mix explained 19.2% of the hospital variation in bleeding complications, where anticoagulation and antiplatelet strategies explained an incremental 9.9% and 6.8%, respectively. Together, 32.3% of hospital variation in major bleeding rates was attributable to differences in patient case mix and identifiable differences in treatment strategies in patients with non–ST-segment elevation myocardial infarction.

Conclusions—
In-hospital major bleeding rates varied widely across hospitals. Although patient factors and treatments explained less than one third of hospital-level variation, ≈70% of bleeding variation remains after adjustment. A better understanding of causes for substantial hospital-level bleeding variations is needed to help target high-risk patients or practices and to optimize care.
Type A Aortic Dissection in Marfan Syndrome
Authors: Rylski Bartosz , Bavaria Joseph E. , Beyersdorf Friedhelm , Branchetti Emanuela , Desai Nimesh D. , Milewski Rita K. , Szeto Wilson Y. , Vallabhajosyula Prashanth , Siepe Matthias , Kari Fabian A. 
Published: March 2014

Background—
Data on outcomes after Stanford type A aortic dissection in patients with Marfan syndrome are limited. We investigated the primary surgery and long-term results in patients with Marfan syndrome who suffered aortic dissection.

Methods and Results—
Among 1324 consecutive patients with aortic dissection type A, 74 with Marfan syndrome (58% men; median age, 37 years [first and third quartiles, 29 and 48 years]) underwent surgical repair (85% acute dissections; 68% DeBakey I; 55% composite valved graft, 30% supracoronary ascending replacement, 15% valve-sparing aortic root replacement; 12% total arch replacement; 3% in-hospital mortality) at 2 tertiary centers in the United States and Europe over the past 25 years. The rate of aortic reintervention with resternotomy was 24% (18 of 74) and of descending aorta (thoracic+abdominal) intervention was 30% (22 of 74) at a median follow-up of 8.4 years (first and third quartiles, 2.2 and 12.7 years). Freedom from need for aortic root reoperation in patients who underwent primarily a composite valved graft or valve-sparing aortic root replacement procedure was 95±3%, 88±5%, and 79±5% and in patients who underwent supracoronary ascending replacement was 83±9%, 60±13%, 20±16% at 5, 10, and 20 years. Secondary aortic arch surgery was necessary only in patients with initial hemi-arch replacement.

Conclusions—
Emergency surgery for type A dissection in patients with Marfan syndrome is associated with low in-hospital mortality. Failure to extend the primary surgery to aortic root or arch repair leads to a highly complex clinical course. Aortic root replacement or repair is highly recommended because supracoronary ascending replacement is associated with a high need (>40%) for root reintervention.
Long‐term Cardiovascular Outcomes in Patients With Chronic Kidney Disease Undergoing Coronary Artery Bypass Graft Surgery for Acute Coronary Syndromes
Authors: Holzmann Martin , Jernberg Tomas , Szummer Karolina , Sartipy Ulrik 
Published: March 2014

Background

Patients with chronic kidney disease have an increased risk of death after myocardial infarction, coronary artery bypass graft surgery (
CABG
), and percutaneous coronary intervention. We sought to describe the association between chronic kidney disease and long‐term cardiovascular outcomes and death in patients who underwent
CABG
for acute coronary syndromes.

Methods and Results

All patients (N=12 956) from the Swedish Web System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) registry who underwent CABG for acute coronary syndromes in Sweden between 2000 and 2008 with complete information on preoperative serum creatinine values were included. Estimated glomerular filtration rates (
eGFRs
) were obtained, and hazard ratios with 95% CIs were calculated for the composite end point of myocardial infarction, heart failure, stroke, or death in relation to
eGFR
. During a mean follow‐up of 3.5 years, there were in total 2844 (22%) cardiovascular events and 1340 (10%) deaths. In patients with
eGFR
>60 mL/min per 1.73 m
2
, 45 to 60 mL/min per 1.73 m
2
, and 15 to 45 mL/min per 1.73 m
2
, there were 2896 (28%), 882 (43%), and 407 (61%) cardiovascular events or deaths, respectively. Hazard ratios with 95% CIs for death or any cardiovascular event in patients with
eGFR
45 to 60 mL/min per 1.73 m
2
, and 15 to 45 mL/min per 1.73 m
2
were 1.07 (0.98 to 1.15) and 1.36 (1.22 to 1.53) respectively, after multivariable adjustment. The corresponding figures for any cardiovascular event were 1.08 (0.98 to 1.19), and 1.24 (1.08 to 1.43).

Conclusions

Severe, but not moderate, renal dysfunction was independently associated with an increased risk of long‐term cardiovascular events and death in patients undergoing
CABG
for acute coronary syndromes.
Martinus Dacus and Boethius Dacus on the Signification of Terms and the Truth-Value of Assertions
Authors: Mora-Márquez Ana María 
Published: March 2014

Abstract
The article intends to show: a) that the modist Martin of Dacia sides with the traditional reading of the first chapter of Aristotle’s De interpretatione that we find in masters of arts from the first half of the thirteenth century; and b) that the modist Boethius of Dacia is one of the first thirteenth-century scholars to depart from this reading. In fact, Boethius presents us with an account of propositional verification where the terms’ signification is not operational and where the immediate truth-maker of statements like ‘homo est animal’ is an external state of affairs. In Martin’s case, to the contrary, the terms’ signification is operational in his account of propositional verification and the immediate truth-bearer of such statements is a mental composition or division.
Was the Early Wyclif a Determinist? Concerning an Unnoticed Level within His Taxonomy of Being
Authors: Campi Luigi 
Published: March 2014

Abstract
This article takes issue with the most authoritative argument for the commonplace that John Wyclif was an extreme determinist: he denied distinctions between divine ideas and God’s metaphysical constituents and between ideas as principle of divine cognition of creatures (rationes) and as models for their production ad extra (exemplaria); since as a constituent of God’s essence every divine idea is absolutely necessary, and every idea is unfailingly a pattern for creation, therefore God cannot but create anything He can think of. This paper argues against the premise that Wyclif never distinguished rationes and exemplaria by examining significant excerpts from Wyclif’s edited and unedited academic writings in which the distinction is assumed or discussed. Wyclif maintains that there are more ideas in God than created essences ad extra, and that God’s absolute power covers more than His ordained power does. To stress that not every divine idea is automatically a model for creation, Wyclif sometimes includes in his standard taxonomy of being a hitherto unnoticed level, the esse intentionale, which is eternal and ad intra, like the esse intelligibile, but contingent, the kind of being in which something participates as the result of God’s free choice to bring it into existence ad extra at the due time.
Hylomorphism versus the Theory of Elements in Late Aristotelianism: Péter Pázmány and the Sixteenth-Century Exegesis of Meteorologica IV
Authors: Petrescu Lucian 
Published: March 2014

Abstract
This paper investigates Péter Pázmány’s theory of mixtures from his exegesis of Meteorologica IV, in the context of sixteenth-century scholarship on Aristotle’s Meteorologica. It aims to contribute to a discussion of Anneliese Maier’s thesis concerning the incompatibility between hylomorphism and the theory of elements in the Aristotelian tradition. It presents two problems: (1) the placement of Meteorologica IV in the Jesuit cursus on physics and (2) the conceptualization of putrefaction as a type of substantial mutation. Through an analysis of these issues, it shows (1) how sixteenth-century exegesis imposes the hylomorphic thesis onto the subject matter of meteorology and (2) how the hylomorphic theory of substantial change can be adapted in order to accommodate the theory of elements. The case being made is that Meteorologica is a privileged place where hylomorphism and the theory of elements meet and that the late Aristotelian theory of mixtures sought to accommodate both theories of material substance.
Significative Supposition and Ockham’s Rule
Authors: Crimi Milo 
Published: March 2014

Abstract
Paul Spade argues that there is a tension between Ockham’s descriptions of the various types of supposition at Summa Logicae (sl) I.64 and a rule he provides at sl I.65. In later papers, Spade proposes a solution: a term supposits significatively (i.e., personally) just in case it supposits for everything it signifies. I evaluate Spade’s proposal and explore some of its implications. I show that it successfully resolves the tension and that it suggests a way to more precisely describe material and simple supposition. I argue furthermore that Ockham is committed to the proposal by showing that uncontroversial features of his theory imply it. In doing so, I raise and refute three potential objections. Finally, I highlight and discuss a controversial result: self-signifying conventional terms can supposit materially. I argue that this result makes for a more satisfying theory.
The mental health of Korean transnational mothers: A scoping review
Authors: Kim Jaemin , Agic Branka , McKenzie Kwame 
Published: March 2014

Background: A recent migration trend from Korea is transnational family arrangement where mothers migrate with children to English-speaking countries, while the fathers stay in the home country. Mothers in these families may experience more challenges than other family members because they have to adjust to a new country, new parenting role and family separation. But little is known about their mental health. Aims: This article scopes the evidences in the literature on impact of transnational family arrangement and migration on the mental health of Korean transnational mothers. Method: A comprehensive search was undertaken in 16 databases and 17 studies were identified. Results: The evidence on the mental health of Korean transnational mothers was analyzed into two themes: (1) challenges and life difficulties, (2) psychological and emotional states. In relation to the life difficulties such as role changes, adaptation in the host country and lack of social support, the mothers reported anxiety, depression, increased psychological distress and feeling of isolation. Positive perceptions such as sense of empowerment and increased self-confidence were also reported. Conclusion: The evidence suggests that there may be a potential for vulnerability to mental health problems in Korean transnational mothers. More research is needed to assess their mental health and to identify the risk factors.
Confluence
Authors: Gilliam Angela M. 
Published: March 2014

Ever since the Cuban Revolution challenged the Monroe Doctrine by asserting a right to independence and mutuality between the United States and Cuba, no effort has been spared to gain control of the island. The National Endowment for Democracy, which has long pursued regime change in Cuba in the guise of democracy promotion, has recently “discovered” Cuban black people and manipulated the discourse of nonviolent civil disobedience to charge Cuba with racism. In 2009, an open letter from the esteemed Abdias do Nascimento and a document signed by 59 respected U.S.-based public figures of African descent became part of this effort. This process was enhanced in 2013 with visits to the United States by Afro-descendant Cuban dissidents and the increase of the reward for the capture of Assata Shakur, an exiled political activist currently living in Cuba. The original charge was countered by Cuban artists and writers and by U.S. Afro-descendants in support of Cuba’s history of mobilization against discrimination and racial prejudice. If there is one way in which Cubans are taking to heart what Fidel Castro once called “the monopoly of knowledge,” it is combining the full-throated struggle against racism with the objective to improve socialism at all levels of society. Desde que la revolución cubana desafió la doctrina Monroe al afirmar el derecho a la independencia y la reciprocidad entre Estados Unidos y Cuba no se han escatimado esfuerzos para tomar control de la isla. El National Endowment for Democracy, que durante mucho tiempo ha buscado un cambio de régimen en Cuba, recientemente ha “descubierto” a los cubanos negros y manipulado el discurso de la desobediencia civil no violenta para acusar a Cuba de racismo. En 2009, una carta abierta del estimado Abdias do Nascimento y un documento firmado por 59 respetadas personalidades de origen africano en los Estados Unidos se convirtió en parte de este esfuerzo. Este proceso se ha intensificado con visitas a los Estados Unidos de disidentes cubanos afrodescendientes y un aumento en la recompensa por la captura de Assata Shakur, una activista política exiliada que vive en Cuba. La imputación original ha sido debatida por escritores y artistas cubanos y por afrodescendientes estadounidenses que apoyan la lucha histórica cubana contra la discriminación y los prejuicios raciales. Si hay una forma en la que los cubanos están tomando en serio aquello que Fidel Castro llamó “el monopolio del conocimiento” es combinando la lucha contra el racismo con el objetivo de mejorar el socialismo a todos los niveles sociales.
Z‐palatopharyngoplasty Combined with Endoscopic Coblator Open Tongue Base Resection for Severe Obstructive Sleep Apnea/Hypopnea Syndrome
Authors: Lin Hsin‐Ching , Friedman Michael , Chang Hsueh‐Wen , Yalamanchali Sreeya 
Published: March 2014

ObjectivesTo investigate the safety and outcomes of Z‐palatopharyngoplasty (ZPPP) combined with endoscopic Coblator open tongue base resection (Eco‐TBR) for the treatment of severe obstructive sleep apnea/hypopnea syndrome (OSAHS).Study DesignReview of a prospective database.SettingAcademic tertiary medical center.MethodsThirty‐nine patients with severe OSAHS who had multilevel obstruction, failed continuous positive airway pressure therapy, and then underwent ZPPP plus Eco‐TBR were enrolled in this study. The subjective symptoms and objective polysomnography parameters were collected preoperatively and at a minimum of 12 weeks postoperatively. Statistical analysis was determined by the Wilcoxon signed rank test.ResultsThirty‐five patients, consisting of 3 female and 32 male patients (mean age, 42 years), had completed data for final analysis. None of the patients had perioperative or postoperative serious complications. The classical success rate was 62.9% (22/35). Three months postoperatively, the Epworth Sleepiness Scale decreased from 11.0 ± 4.2 to 8.7 ± 4.3 (P =. 0006). The mean apnea/hypopnea index decreased from 50.6 ± 16.6 to 26.5 ± 23.5 events/h, the lowest oxygen saturation (%) improved from 70.4 ± 9.9 to 80.1 ± 11.3, and the snoring visual analog scale (0‐10) as assessed by bed partner decreased from 9.86 ± 0.69 to 3.27 ± 1.96 (P <. 0001 for all variables).ConclusionThis study shows the significant benefits of ZPPP plus Eco‐TBR in patients with severe OSAHS.