bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety on the ground: using critical incident technique to explore the factors influencing medical registrars’ provision of safe care
Authors: Ralston Katherine , Smith Samantha Eve , Kerins Joanne , Clark-Stewart Saskia , Tallentire Victoria 
Published: February 2024

BackgroundAvoidable patient harm in hospitals is common, and doctors in training can provide underused but crucial insights into the influencers of patient safety as those working ‘on the ground’ within the system. This study aimed to explore the factors that influence safe care from the perspective of medical registrars, to identify targets for safety-related improvements.MethodsThis study used enhanced critical incident technique (CIT), a qualitative methodology that results in a focused understanding of significant factors influencing an activity, to identify practical solutions. We interviewed 12 out of 17 consenting medical registrars in Scotland, asking them to recount their observations during clinical experiences where something happened that positively or negatively impacted on patient safety. Data were analysed manually using a modified content analysis with credibility checks as per enhanced CIT, with data exhaustiveness reached after six registrars.ResultsA total of 221 critical incidents impacting patient safety were identified. These were inductively placed into 24 categories within 4 overarching categories:Individual skills, encompassing individual behavioural and technical skills;Collaboration, regarding how communication, trust, support and flexibility shape interprofessional collaboration;Organisation, concerning organisational systems and staffing andTraining environment, relating to culture, civility, having a voice and learning at work. Practical targets for safety-related interventions were identified, such as clear policies for patient care ownership or educational interventions to foster civility.ConclusionsThis study provides a rigorous and focused understanding of the factors influencing patient safety in hospitals, using the ‘insider’ perspective of the medical registrar. Safety goes beyond the individual and is reliant on safe system design, interprofessional collaboration and a culture of support, learning and respect. Organisations should also promote flexibility within clinical practice when patient needs do not conform to standardised care pathways. We suggest targeted interventions within educational and organisational priorities to improve safety in hospitals.
Why do patients with DR-TB do not complete their treatment? Findings of a qualitative study from Pakistan
Authors: Abubakar Muhammad , Ullah Matti , Shaheen Muhammad Aamir , Abdullah Orva 
Published: February 2024

BackgroundOne of the major reasons for unsuccessful treatment outcomes among patients with drug-resistant tuberculosis (DR-TB) is the high rate of loss to follow-up (LTFU). However, in Pakistan, no qualitative study has been conducted to explore the perceptions of LTFU patients with regard to DR-TB treatment, the problems they face and the reasons for LTFU in detail.MethodsThis was a qualitative study that involved semistructured, indepth, face-to-face interviews of 39 LTFU patients with DR-TB. All interviews were carried out in Pakistan’s national language ‘Urdu’ using an interview guide in two phases: the first phase was from December 2020 to February 2021 among patients with extensively drug-resistant tuberculosis and the second phase from July 2021 to September 2021 among patients with multidrug-resistant tuberculosis.ResultsThe inductive thematic analysis of audio-recorded interviews generated the following four key themes, which were the major reasons reported by the participants of the current study to have led to LTFU: (1) patient-related factors, such as lack of awareness about the total duration of DR-TB treatment, fatigue from previous multiple failed episodes, lack of belief in treatment efficacy and perception of DR-TB as a non-curable disease; (2) medication-related factors, such as use of injectables, high pill burden, longer duration and adverse events; (3) socioeconomic factors, such as gender discrimination, poor socioeconomic conditions, non-supportive family members, social isolation and unemployment; and (4) service provider-related factors, such as distant treatment centres, non-availability of a qualified person, lack of adequate counselling and poor attitude of healthcare professionals.ConclusionIn the current study, patients’ perceptions about DR-TB treatment, socioeconomic condition, medication and service provider-related factors emerged as barriers to the successful completion of DR-TB treatment. Increasing patients’ awareness about the duration of DR-TB treatment, interacting sessions with successfully treated patients, availability of rapid drug susceptibility testing facilities at treatment centres, decentralising treatment and using the recently recommended all-oral regimen may further decrease the rate of LTFU.
Window of opportunity in psoriatic arthritis: the earlier the better?
Authors: Snoeck Henkemans Selinde V J , de Jong Pascal H P , Luime Jolanda J , Kok Marc R , Tchetverikov Ilja , Korswagen Lindy-Anne , van der Kooij Sjoerd M , van Oosterhout Maikel , Baudoin Paul , Bijsterbosch Jessica , van der Kaap Jos H , van der Helm-van Mil Annette H M , Vis Marijn 
Published: February 2024

ObjectivesTo investigate whether there is a window of opportunity for psoriatic arthritis (PsA) patients and to assess which patient characteristics are associated with a longer diagnostic delay.MethodsAll newly diagnosed, disease-modifying antirheumatic drug-naïve PsA patients who participated in the Dutch southwest Early PsA cohoRt and had ≥3 years of follow-up were studied. First, total delay was calculated as the time period between symptom onset and PsA diagnosis made by a rheumatologist and then split into patient and physician delays. The total delay was categorised into short (<12 weeks), intermediate (12 weeks to 1 year) or long (>1 year). These groups were compared on clinical (Minimal Disease Activity (MDA) and Disease Activity index for PSoriatic Arthritis (DAPSA) remission) and patient-reported outcomes during 3 years follow-up.Results708 PsA patients were studied of whom 136 (19%), 237 (33%) and 335 (47%) had a short, intermediate and long total delay, respectively. Patient delay was 1.0 month and physician delay was 4.5 months. Patients with a short delay were more likely to achieve MDA (OR 2.55, p=0.003) and DAPSA remission (OR 2.35,p=0.004) compared with PsA patients with a long delay. Patient-reported outcomes showed numerical but non-significant differences between the short and long delay groups. Female patients and those presenting with enthesitis, chronic back pain or normal C-reactive protein (CRP) had a longer delay.ConclusionsIn PsA, referral and diagnosis within 1 year is associated with better clinical outcomes, suggesting the presence of a window of opportunity. The most gain in referral could be obtained in physician delay and in females, patients with enthesitis, chronic back pain or normal CRP.
Digital simulation of convex mixtures of Markovian and non-Markovian single qubit Pauli channels on NISQ devices
Authors: David I. J. , Sinayskiy I. , Petruccione F. 
Published: February 2024

AbstractQuantum algorithms for simulating quantum systems provide a clear and provable advantage over classical algorithms in fault-tolerant settings. There is also interest in quantum algorithms and their implementation in Noisy Intermediate Scale Quantum (NISQ) settings. In these settings, various noise sources and errors must be accounted for when executing any experiments. Recently, NISQ devices have been verified as versatile testbeds for simulating open quantum systems and have been used to simulate simple quantum channels. Our goal is to solve the more complicated problem of simulating convex mixtures of single qubit Pauli channels on NISQ devices. We consider two specific cases: mixtures of Markovian channels that result in a non-Markovian channel (M + M = nM) and mixtures of non-Markovian channels that result in a Markovian channel (nM + nM = M). For the first case, we consider mixtures of Markovian single qubit Pauli channels; for the second case, we consider mixtures of Non-Markovian single qubit depolarising channels, which is a special case of the single qubit Pauli channel. We show that efficient circuits, which account for the topology of currently available devices and current levels of decoherence, can be constructed by heuristic approaches that reduce the number of CNOT gates used in our circuit. We also present a strategy for regularising the process matrix so that the process tomography yields a completely positive and trace-preserving (CPTP) channel.Key points

This work simulates the convex mixtures of single qubit Markovian and non-Markovian quantum channels on NISQ devices provided by the IMBQE.

The circuits used to implement the channels take into account the topolgy of the quantum device used as well as the number of CNOT gates used.

We present a strategy for regularising the process matrix to ensure the quantum process tomography yields a CPTP channel. Something that is not correctly implemented in Qiskit.

A method is outlined for finding mixtures of non-Markovian depolarising channels that yield a Markovian depolarising channel. It is also shown that, one cannot convexly mix two Markovian depolarising channels that leads to a non-Markovian depolarising channel.
Percutaneous Left Ventricular Unloading During High-Risk Coronary Intervention: Rationale and Design of the CHIP-BCIS3 Randomized Controlled Trial
Authors: Ryan Matthew , Ezad Saad M. , Webb Ian , O’Kane Peter D. , Dodd Matthew , Evans Richard , Laidlaw Lynn , Khan Sohail Q. , Weerackody Roshan , Bagnall Alan , Panoulas Vasileios F. , Rahman Haseeb , Strange Julian W. , Fath-Ordoubadi Farzin , Hoole Stephen P. , Stables Rod H. , Curzen Nick , Clayton Tim , Perera Divaka ,   on behalf of the CHIP-BCIS3 Investigators
Published: February 2024

INTRODUCTION:
Percutaneous coronary intervention for complex coronary disease is associated with a high risk of cardiogenic shock. This can cause harm and limit the quality of revascularization achieved, especially when left ventricular function is impaired at the outset. Elective percutaneous left ventricular unloading is increasingly used to mitigate adverse events in patients undergoing high-risk percutaneous coronary intervention, but this strategy has fiscal and clinical costs and is not supported by robust evidence.

METHODS:
CHIP-BCIS3 (Controlled Trial of High-Risk Coronary Intervention With Percutaneous Left Ventricular Unloading) is a prospective, multicenter, open-label randomized controlled trial that aims to determine whether a strategy of elective percutaneous left ventricular unloading is superior to standard care (no planned mechanical circulatory support) in patients undergoing nonemergent high-risk percutaneous coronary intervention. Patients are eligible for recruitment if they have severe left ventricular systolic dysfunction, extensive coronary artery disease, and are due to undergo complex percutaneous coronary intervention (to the left main stem with calcium modification or to a chronic total occlusion with a retrograde approach). Cardiogenic shock and acute ST-segment–elevation myocardial infarction are exclusions. The primary outcome is a hierarchical composite of all-cause death, stroke, spontaneous myocardial infarction, cardiovascular hospitalization, and periprocedural myocardial infarction, analyzed using the win ratio. Secondary outcomes include completeness of revascularization, major bleeding, vascular complications, health economic analyses, and health-related quality of life. A sample size of 250 patients will have in excess of 80% power to detect a hazard ratio of 0.62 at a minimum of 12 months, assuming 150 patients experience an event across all follow-up.

CONCLUSIONS:
To date, 169 patients have been recruited from 21 National Health Service hospitals in the United Kingdom, with recruitment expected to complete in 2024.

REGISTRATION:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT05003817.
Association of Sex With Cardiovascular Outcomes in Heart Failure Patients With Obstructive or Central Sleep Apnea
Authors: Huang Boping , Huang Yan , Zhai Mei , Zhou Qiong , Ji Shiming , Liu Huihui , Zhuang Xiaofeng , Zhang Yuhui , Zhang Jian 
Published: February 2024

Background
This study investigated the association of sex with cardiovascular outcomes in a prospective cohort of patients with heart failure (HF) with obstructive sleep apnea or central sleep apnea.

Methods and Results

Patients were screened for sleep apnea on admission using multichannel cardiopulmonary monitoring from May 2015 to July 2018. The primary outcome was a composite of cardiovascular death or unplanned hospitalization for worsening HF. Ultimately, 453 patients with HF with obstructive sleep apnea or central sleep apnea were included; 71 (15.7%) and 382 (84.3%) were women and men, respectively. During a median follow‐up of 2.33 years, 248 (54.7%) patients experienced the primary outcome. In the overall population, after adjusting for potential confounders, women had an increased risk of the primary outcome (66.2% versus 52.6%; hazard ratio [HR], 1.47 [95% CI, 1.05–2.04];
P
=0.024) and HF rehospitalization (62.0% versus 46.6%; HR, 1.55 [95% CI, 1.10–2.19];
P
=0.013) compared with men but a comparable risk of cardiovascular death (21.1% versus 23.3%; HR, 0.78 [95% CI, 0.44–1.37];
P
=0.383). Likewise, in patients with HF with obstructive sleep apnea, women had a higher risk of the primary outcome (81.8% versus 46.3%, HR, 2.37 [95% CI, 1.28–4.38];
P
=0.006) and HF rehospitalization (81.8% versus 44.7%, HR, 2.46 [95% CI, 1.32–4.56],
P
=0.004). However, in patients with HF with central sleep apnea, there was no statistically significant difference between women and men.

Conclusions
In hospitalized patients with HF, female sex was associated with an increased risk of the primary outcome and HF rehospitalization, especially in those with obstructive sleep apnea. Screening for sleep apnea should be emphasized to improve the prognosis.

Registration

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02664818.
General dynamics of the URT microbiome and microbial signs of recovery in COVID-19 patients
Authors: Ignatyeva O. , Gostev V. , Taraskina A. , Tsvetkova I. , Pavlova P. , Sulian O. , Ageevets V. , Likholetova D. , Chulkova P. , Nikitina E. , Matkava L. , Terekhov M. , Lisovaya D. , Kashtanova D. , Ivanov M. , Kalinogorskaya O. , Avdeeva A. , Zhirkov A. , Goleva O. , Zakharenko S. , Zhdanov K. , Strizheletsky V. , Gomon Y. , Kruglov A. , Ni O. , Noskova T. , Gorbova I. , Cherenkova G. , Shlyk I. , Afanasyev A. , Yudin V. , Makarov V. , Sidorenko S. , Yudin S. 
Published: February 2024

Abstract
COVID-19 is caused by an airborne virus, SARS-CoV-2. The upper respiratory tract (URT) is, therefore, the first system to endure the attack. Inhabited by an assemblage of microbial communities, a healthy URT wards off the invasion. However, once invaded, it becomes destabilised, which could be crucial to the establishment and progression of the infection. We examined 696 URT samples collected from 285 COVID-19 patients at three time-points throughout their hospital stay and 100 URT samples from 100 healthy controls. We used 16S ribosomal RNA sequencing to evaluate the abundance of various bacterial taxa, α-diversity, and β-diversity of the URT microbiome. Ordinary least squares regression was used to establish associations between the variables, with age, sex, and antibiotics as covariates. The URT microbiome in the COVID-19 patients was distinctively different from that of healthy controls. In COVID-19 patients, the abundance of 16 genera was significantly reduced. A total of 47 genera were specific to patients, whereas only 2 were unique to controls. The URT samples collected at admission differed more from the control than from the samples collected at later stages of treatment. The following four genera originally depleted in the patients grew significantly by the end of treatment: Fusobacterium, Haemophilus, Neisseria, and Stenotrophomonas. Our findings strongly suggest that SARS-CoV-2 caused significant changes in the URT microbiome, including the emergence of numerous atypical taxa. These findings may indicate increased instability of the URT microbiome in COVID-19 patients. In the course of the treatment, the microbial composition of the URT of COVID-19 patients tended toward that of controls. These microbial changes may be interpreted as markers of recovery.
Diplomacy Within the Security Framework in Turkey and Romania During the Interwar Period
Authors: Emek Berk , Barlas Dilek 
Published: February 2024

Abstract
This article aims to highlight shifting diplomatic positions in Turkey and Romania and their stances towards the League of Nations collective security network during the interwar period. It takes a comparative approach to demonstrate the diplomatic activity and strategic decision-making mechanism employed by two strategically important Balkan and Black Sea countries vis-à-vis the fragile international system from the 1920s onwards. The rising threat of revisionism and declining belief in the League’s sanctioning power gradually led these countries to set their differences in foreign policy aside and strengthened the idea of joint regional action in the 1930s. Supported by primary sources from different archives, this comparative study proposes a new outlook, by demonstrating the contribution made by the notions of external threat and common aggressor to changing foreign policy perspectives in both countries.
How Much Lightning Actually Strikes the United States?
Authors: Vagasky Chris , Holle Ronald L. , Murphy Martin J. , Cramer John A. , Said Ryan K. , Guthrie Mitchell , Hietanen Jesse 
Published: February 2024

Abstract
The number of cloud-to-ground (CG) flashes over the contiguous United States (CONUS) has been estimated to be from as small as 25 million per year to as many as 40 million. In addition, many CG flashes contact the ground in more than one place. To clarify these values, recent data from the National Lightning Detection Network (NLDN) have been examined since the network is performing well enough to make precise updates to the number of CG flashes and their associated ground contact points. The average number of CG flashes is calculated to be about 23.4 million per year over the CONUS, and the average number of ground contact points is calculated as 36.8 million per year. Knowledge of these two parameters is critical to lightning protection standards, as well as better understanding of the effects of lightning on forest fire initiation, geophysical interactions, human safety, and applications that benefit from knowing that a single flash may transfer charge to the ground in multiple, widely spaced locations. Sensitivity tests to assess the effects of misclassification of CG and in-cloud (IC) lightning are also made to place bounds on these estimates, and the likely uncertainty is a few percent.
Assessment of a goal-directed perfusion strategy through an oxygen delivery audit
Authors: Lahanas Andrew , Argerakis Paul W , Hayward Beatrice A , Grant Peter W 
Published: February 2024

Introduction Evidence supports the role of oxygen delivery (DO2) in ameliorating acute kidney injury (AKI). While instrumentation for continuous DO2 measurement exists, a simplified method has been reported for targeting a specific DO2 index (DO2i), commonly referred to as a goal-directed perfusion (GDP) strategy, by using a reference table and available data such as body surface area and continuous haematocrit values. This simplified approach can also be used for quality auditing via archived data. Methods This retrospective sequential audit was conducted to assess the impact of employing a GDP strategy within our institution by examining perfusion practices, DO2 levels and renal outcomes before and after implementation. A total of 246 patients undergoing elective primary coronary revascularisation were included: 125 patients in the pre-change group and 121 patients in the post-change group. A DO2i threshold above 280 mL/min/m2 was targeted in the post-GDP group. Results While both groups maintained a mean DO2 above the threshold, the post-GDP group exhibited a higher average DO2i (311 vs 291 mL/min/m2). The GDP strategy led to higher nadir DO2i (255 vs 225, p < .001) and was coupled with a reduction in the time below the 280 mL/min/m2 threshold (30 min vs 50 min, p < .001). The average cardiac index in the post-GDP group was higher (1.87 vs 1.65, p < .001) while also demonstrating a smaller creatinine rise of 6.8% compared to 13.5% in the control group ( p = .035). There was no difference in AKI or mortality rates between the groups. Conclusion The implementation of the GDP strategy demonstrated an enhancement in oxygen delivery during cardiopulmonary bypass, primarily attributable to elevated pump flow rates. A statistically significant decrease in serum creatinine levels was observed. The published reference table emerged as a simple yet effective tool in optimising our GDP strategy.
Follow-up of individualised physical activity on prescription and individualised advice in patients with hip or knee osteoarthritis: A randomised controlled trial
Authors: Bendrik Regina , Kallings Lena V , Bröms Kristina , Emtner Margareta 
Published: February 2024

Objective Compare the long-term effects of two different individualised physical activity interventions in hip or knee osteoarthritis patients. Design Randomised, assessor-blinded, controlled trial. Setting Primary care. Subjects Patients with clinically verified hip or knee osteoarthritis, <150 min/week with moderate or vigorous physical activity, aged 40–74. Intervention The advice group (n = 69) received a 1-h information and goalsetting session for individualised physical activity. The prescription group (n = 72) received information, goalsetting, individualised written prescription, self-monitoring, and four follow-ups. Main measures Physical activity, physical function, pain and quality of life at baseline, 6, 12 and 24 months. Results There were only minor differences in outcomes between the two groups. For self-reported physical activity, the advice group had improved from a mean of 102 (95% CI 74–130) minutes/week at baseline to 214 (95% CI 183–245) minutes/week at 24 months, while the prescription group had improved from 130 (95% CI 103–157) to 176 (95% CI 145–207) minutes/week (p = 0.01 between groups). Number of steps/day decreased by −514 (95% CI −567–462) steps from baseline to 24 months in the advice group, and the decrease in the prescription group was −852 (95% CI −900–804) steps (p = 0.415 between groups). Pain (HOOS/KOOS) in the advice group had improved by 7.9 points (95% CI 7.5–8.2) and in the prescription group by 14.7 points (95% CI 14.3–15.1) from baseline to 24 months (p = 0.024 between groups). Conclusions There is no evidence that individualised physical activity on prescription differs from individualised advice in improving long-term effects in patients with hip or knee osteoarthritis.