bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlations between care users’ and the healthcare inspectorate’s ratings of the quality of care in long-term care homes
Authors: Palimetaki Flora , Woutersen Karlijn , Pot Anne Margriet 
Published: March 2023

ObjectivesIncreasing emphasis is being placed on person-centredness as a quality requirement for long-term care (LTC). Although healthcare inspectorates value the importance of care users’ experiences, they struggle to address these experiences in regulatory practice. The aim of this study is to explore the correlations between care users’ and the healthcare inspectorate’s ratings of the quality of LTC in The Netherlands.DesignThe correlations between care users’ ratings from a public Dutch online patient rating site and the Dutch Health and Youth Care Inspectorate’s ratings of the quality of care were examined using Spearman rank correlations. The inspectorate’s ratings cover three themes: ‘attention to person-centred care’, ‘working towards sufficient and competent care staff’ and ‘focusing on quality and safety’.SettingRatings of the quality of care were obtained for 200 LTC homes in The Netherlands between January 2017 and March 2019. These LTC homes had 6 to 350 residents (M=89; SD=57) and belonged to organisations with 1–40 LTC homes in total (M=6; SD=6).ParticipantsPublicly available anonymous ratings of the perceived quality of care by care users were extracted from the Dutch patient rating website ‘www.zorgkaartnederland.nl’. Care users’ ratings were available for the 2 years prior to an assessment by the inspectorate for 200 LTC homes.ResultsWe found a weak, significant correlation between the mean care users’ ratings and the inspectorate’s aggregated scores for the theme ‘person-centred care’ (r=0.26, N=200, padj<0.01); no other correlations were significant.ConclusionsThis study showed only a weak correlation between care users’ ratings and ratings of the Dutch Inspectorate of the quality of ‘person-centred care’ in LTC homes. Therefore, it may be fruitful to intensify or innovate approaches to involve care users’ experiences in regulation to do them justice.
Process improvement using telemedicine consultation to prevent unnecessary interfacility transfers for low-severity blunt head trauma
Authors: Miles Gayla , Shank Christopher , Quinlan Ann , Cavender Jennifer 
Published: March 2023

ObjectiveMild traumatic brain injuries (MTBI) associated with intracranial haemorrhage are commonly transferred to tertiary care centres. Recent studies have shown that transfers for low-severity traumatic brain injuries may be unnecessary. Trauma systems can be overwhelmed by low acuity patients justifying standardisation of MTBI transfers. We sought to evaluate the impact of telemedicine services on mitigating unnecessary transfers for those presenting with low-severity blunt head trauma after sustaining a ground level fall (GLF).MethodA process improvement plan was developed by a task force of transfer centre (TC) administrators, emergency department physicians (EDP), trauma surgeons and neurosurgeons (NS) to facilitate the requesting EDP and the NS on-call to converse directly to mitigate unnecessary transfers. Consecutive retrospective chart review was performed on neurosurgical transfer requests between 1 January 2021 and 31 January 2022. A comparison of transfers preintervention and postintervention (1 January 2021 to 12 September 2021)/(13 September 2021 to 31 January 2022) was performed.ResultsThe TC received 1091 neurological-based transfer requests during the study period (preintervention group: 406 neurosurgical requests; postintervention group: 353 neurosurgical requests). After consultation with the NS on-call, the number of MTBI patients remaining at their respective ED’s with no neurological degradation more than doubled from 15 in the preintervention group to 37 in the postintervention group.ConclusionTC-mediated telemedicine conversations between the NS and the referring EDP can prevent unnecessary transfers for stable MTBI patients sustaining a GLF if needed. Outlying EDPs should be educated on this process to increase efficacy.
Quality improvement project to reduce unplanned extubations in a paediatric intensive care unit
Authors: Ferreira Joyce Caroline Dinelli , Nascimento Milena Siciliano , Brandi Simone , do Prado Cristiane , Cintra Cintia de Cassia , Almeida João Fernando , Malheiro Daniel Tavares , Capone Antonio 
Published: March 2023

BackgroundUnplanned extubations are recurrent adverse events in mechanically ventilated children and have been the focus of quality and safety improvement in paediatric intensive care units (ICUs).Local problemTo reduce the rate of unplanned extubation in the paediatric ICU by 66% (from 2.02 to 0.7).MethodsThis is a quality improvement project that was conducted in a paediatric ICU of a private hospital at the quaternary level. All hospitalised patients who used invasive mechanical ventilation between October 2018 and August 2019 were included.InterventionsThe project was based on the Improvement Model methodology of the Institute for Healthcare Improvement to implement change strategies. The main ideas of change were innovation in the endotracheal tube fixation model, evaluation of the endotracheal tube positioning, good practices of physical restraint, sedation monitoring, family education and engagement and checklist for prevention of unplanned extubation, with Plan–Do–Study–Act, the tool chosen to test and implement ideas for change.ResultsThe actions reduced the unplanned extubation rate to zero in our institution and sustained this result for a period of 2 years, totalling 743 days without any event. An estimate was made comparing cases with unplanned extubation and controls without the occurrence of this adverse event, which resulted in savings of R$955 096.65 (US$179 540.41) during the 2 years after the implementation of the improvement actions.ConclusionThe improvement project conducted in the 11-month period reduced the unplanned extubation rate to zero in our institution and sustained this result for a period of 743 days. Adherence to the new fixation model and the creation of a new restrictor model, which enabled the implementation of good practices of physical restraint were the ideas of change that had the greatest impact in achieving this result.
POSTOPED: improving surveillance of postoperative delirium in a Scottish tertiary hospital
Authors: Brown Keiran Anthony , McCulloch Alison 
Published: March 2023

Delirium is the most common postoperative complication among patients over the age of 65 years. It is associated with increased morbidity and is a significant financial cost to healthcare systems.We aimed to improve the detection of delirium on the surgical wards of a tertiary surgical centre. This would take the form of completion of 4AT assessments (the 4 AT test for delirium, on admission and 1 day postoperatively). Prior to this project, the 4AT was in use in the surgical admission clerking paperwork for over 65 s, however, 4AT assessments were not routinely performed as part of day 1 postoperative assessment. By introducing routine postoperative assessment and reinforcing the importance of admission assessment, we hoped to allow for objective comparisons to be made about patients cognitive state and thereafter improve delirium identification.After a baseline snapshot data collection period, we conducted five (Plan, Do, Study, Act) cycles following which repeat snapshot data were collected. Improvement strategies included ‘tea-trolley’ teaching sessions, adhesive 4AT pro-forma, targeted accompaniment of specialty ward rounds with reminders to complete 4AT assessments and working with nursing staff to promote awareness of delirium among permanent non-rotating healthcare professionals.For the admission 4ATs, completion improved from a baseline of 74.1%–90.5% in cycle 5. Completion of postoperative 4AT assessments rose from 14.8% at baseline to 47.6% in cycle 5.We were able to improve the use of a delirium screening tool, (the 4AT) among the postoperative elderly population in this centre via the use of regular teaching sessions, targeted interventions on ward rounds as well working with non-rotating staff. Further improvements could be made by widening access to delirium champion programmes and including delirium as an outcome measure of national surgical audits such as the National Emergency Laparotomy Audit.
Screening and diagnosis of neonatal hypoglycaemia in at-risk late preterm and term infants following AAP recommendations: a single centre retrospective study
Authors: Anderson Enni Jacqueline B , Narasimhan Sudha Rani , Huang Angela , Jegatheesan Priya 
Published: March 2023

BackgroundThere is a lack of consensus regarding the definition and treatment threshold for neonatal hypoglycaemia. The American Academy of Pediatrics (AAP) has a published clinical report making recommendations on practice guidelines. There is limited literature discussing the impact of these guidelines. In this study, we evaluated the screening and diagnosis of neonatal hypoglycaemia following the AAP guidelines.MethodsInfants born ≥35 weeks gestational age and admitted to the well–baby nursery between January and December 2017 were included in this study. Our hypoglycaemia policy was based on the AAP clinical report for hypoglycaemia management in newborns. Chart review was done to obtain infant hypoglycaemia risk factors and blood glucose values in the first 24 hours. Data analysis was conducted using Stata V.14.2 (StataCorp).ResultsOf 2873 infants born and admitted to the well–baby nursery, 32% had at least one hypoglycaemia risk factor and 96% of them were screened for hypoglycaemia. Screened infants were more likely to be born at a lower gestational age, via C-section, and to a multiparous older mother. Screened infants and hypoglycaemic infants had lower exclusive breastfeeding rates compared with those who were not screened or not hypoglycaemic, respectively. Sixteen per cent of screened infants were diagnosed with hypoglycaemia; 0.8% of at-risk screened infants and 5% of hypoglycaemic infants were admitted to the NICU for treatment of hypoglycaemia. Thirty-one per cent of preterm infants, 15% of large for gestational age infants, 13% of small for gestational age infants and 15% of infants of diabetic mothers were hypoglycaemic. Hypoglycaemic infants were more likely to be born preterm and via C-section.ConclusionUsing the AAP time-based definitional blood glucose cut-off values, our incidence of hypoglycaemia found in those who were screened for risk factors was lower compared with other studies. Future long-term follow-up studies will be important.
Lightning in Brunei: a follow-up of a single strike affecting 29 serving personnel of the Royal Gurkha Rifles
Authors: Makin Seth , Austin I 
Published: March 2023

IntroductionOn 25 August 2020, 29 British Forces Brunei (BFB) service personnel were hospitalised after being struck by lightning during a company-level training exercise in the Brunei jungle. This paper observes both the initial injury pattern of the personnel and their occupational health status at the 22-month point.MethodAll 29 of the personnel affected by the lightning strike on 25 August 2020 were followed up until the 22-month point, allowing observation of injury patterns and management as well as the long-term outcomes. They were all members of two Royal Gurkha Rifles and received local hospital care and British Defence Healthcare input. Initial data were collected for mandatory reporting processes, and cases were followed up as a routine part of the Unit Health processes.ResultsOf the 29 identified as having lightning-related injuries, 28 returned to Medically Fully Deployable status. Acoustic trauma was the most common injury which was treated in several cases by oral steroids with some receiving intratympanic steroids. Multiple personnel suffered transient or short-lasting sensory changes and pain. 1756 service personnel days were covered by restrictions.ConclusionThe pattern of the lightning-related injuries was different to that which would be expected from previous reports. This is likely due to the unique nature of each lightning strike, combined with the ample unit support, the fit and resilient cohort and the rapid initiation of treatment, especially with regard to hearing.Brunei is at high risk of lightning strikes, planning for them is now standard for BFB. Despite lightning strikes having the potential to cause mortality and mass casualty events, this case study shows that such events do not necessarily result in severe long-term injury or mortality.
Association between high deductible health plan coverage and age at pediatric umbilical hernia repair
Authors: Doty Morgan E , Gil Lindsay A , Cooper Jennifer N 
Published: March 2023

BackgroundHigh deductible health plans (HDHPs) are associated with the avoidance of both necessary and unnecessary healthcare. Umbilical hernia repair (UHR) is a procedure that is frequently unnecessarily performed in young children, contrary to best practice guidelines. We hypothesized that children with HDHPs, as compared with other types of commercial health plans, are less likely to undergo UHR before 4 years of age but are also more likely to have UHR delayed beyond 5 years of age.MethodsChildren aged 0–18 years old residing in metropolitan statistical areas (MSAs) who underwent UHR in 2012–2019 were identified in the IBM Marketscan Commercial Claims and Encounters Database. A quasi-experimental study design using MSA/year-level HDHP prevalence among children as an instrumental variable was employed to account for selection bias in HDHP enrollment. Two-stage least squares regression modeling was used to evaluate the association between HDHP coverage and age at UHR.ResultsA total of 8601 children were included (median age 5 years, IQR 3–7). Univariable analysis revealed no differences between the HDHP and non-HDHP groups in the likelihood of UHR being performed before 4 years of age (27.7% vs 28.7%, p=0.37) or after 5 years of age (39.8% vs 38.9%, p=0.52). Geographical region, metropolitan area size, and year were associated with HDHP enrollment. Instrumental variable analysis demonstrated no association between HDHP coverage and undergoing UHR at <4 years of age (p=0.76) or >5 years of age (p=0.87).ConclusionsHDHP coverage is not associated with age at pediatric UHR. Future studies should investigate other means by which UHRs in young children can be avoided.
The Range of State Complexities of Languages Resulting from the Cascade Product — The Unary Case
Authors: Holzer Markus , Rauch Christian 
Published: March 2023

We investigate the state complexity of languages resulting from the cascade product of two minimal deterministic finite automata with [Formula: see text] and [Formula: see text] states, respectively. More precisely we study the magic number problem of the cascade product operation and show what range of complexities can be produced in case the left automaton is unary, that is, has only a singleton letter alphabet. Here we distinguish the cases when the involved automata are reset automata, permutation automata, permutation-reset automata, or do not have any restriction on their structure. It turns out that the picture on the obtained state complexities of the cascade product is diverse, and for all cases, except where the left automaton is a unary permutation(-reset) or a deterministic finite automaton without structural restrictions, and the right one is a reset automaton or a deterministic finite automaton without structural restrictions, we are able to identify state sizes that cannot be reached — these numbers are called “magic.”
The m6A Reader YTHDF2 Promotes Bladder Cancer Progression by Suppressing RIG-I–Mediated Immune Response
Authors: Zhang Lei , Li Yuqing , Zhou Lingli , Zhou Houhong , Ye Liefu , Ou Tong , Hong Huaishan , Zheng Shiwen , Zhou Ziyu , Wu Kang , Yan Zeqin , Thiery Jean Paul , Cui Jun , Wu Song 
Published: March 2023

Abstract

N6-Methyladenosine (m6A) is the most prevalent internal modification of mammalian mRNAs. Recent studies have shown that m6A methyltransferases METTL3 and METTL14 play important roles in urothelial bladder carcinoma (BLCA). To provide a more comprehensive understanding of the m6A regulatory landscape in bladder cancer, we investigated the role of YTHDF2, a crucial m6A reader, in BLCA. YTHDF2 was frequently upregulated at both the RNA and protein level in BLCA. Functionally, YTHDF2 promoted the proliferation and tumor growth of BLCA cells in vitro and in vivo, respectively. Integrative RNA sequencing and m6A sequencing analyses identified RIG-I as a downstream target of YTHDF2. Mechanistically, YTHDF2 bound to the coding sequence of DDX58 mRNA, which encodes RIG-I, and mediated its degradation in an m6A-dependent manner. Knockdown of RIG-I inhibited apoptosis and promoted the proliferation of BLCA cells. Depleting RIG-I was also able to reverse the effects of YTHDF2 deficiency. YTHDF2-deficient BLCA cells implanted orthotopically in recipient mice activated an innate immune response and promoted recruitment of CD8+ T lymphocytes into the tumor bed and the urothelium. Moreover, YTHDF2 deficiency enhanced the efficacy of Bacillus Calmette-Guérin immunotherapy treatment. This study reveals that YTHDF2 acts as an oncogene in BLCA. YTHDF2 inhibits RIG-I to facilitate immune evasion, supporting testing YTHDF2 inhibition in combination with immunotherapy.

Significance:
YTHDF2 regulates RIG-I–mediated innate immune signaling to support bladder cancer progression, highlighting the functional importance of m6A modifications in bladder cancer and uncovering therapeutic opportunities to improve patient outcomes.
Identification of a First-in-Class Small-Molecule Inhibitor of the EIF4E-RBM38 Complex That Enhances Wild-type TP53 Protein Translation for Tumor Growth Suppression
Authors: Lucchesi Christopher A. , Zhang Jin , Gao Mingchun , Shaw Jared , Chen Xinbin 
Published: March 2023

Abstract
EIF4E, an mRNA cap-binding protein, is necessary for cap-dependent translation. Overexpression of EIF4E is known to promote cancer development by preferentially translating a group of oncogenic mRNAs. Thus, 4EGI-1, a disruptor of EIF4E-EIF4G1 interaction, was developed to inhibit oncoprotein expression for cancer therapy. Interestingly, RBM38, an RNA-binding protein, interacts with EIF4E on TP53 mRNA, prevents EIF4E from binding to TP53 mRNA cap, and inhibits TP53 expression. Thus, Pep8, an eight amino acid peptide derived from RBM38, was developed to disrupt the EIF4E-RBM38 complex, leading to increased TP53 expression and decreased tumor cell growth. Herein, we have developed a first-in-class small-molecule compound 094, which interacts with EIF4E via the same pocket as does Pep8, dissociates RBM38 from EIF4E, and enhances TP53 translation in RBM38- and EIF4E-dependent manners. Structure-activity relationship studies identified that both the fluorobenzene and ethyl benzamide are necessary for compound 094 to interact with EIF4E. Furthermore, we showed that compound 094 is capable of suppressing three-dimensional tumor spheroid growth in RBM38- and TP53-dependent manners. In addition, we found that compound 094 cooperates with the chemotherapeutic agent doxorubicin and EIF4E inhibitor 4EGI-1 to suppress tumor cell growth. Collectively, we showed that two distinct approaches can be used together to target EIF4E for cancer therapy by enhancing wild-type TP53 expression (094) and by suppressing oncoprotein expression (4EGI-1).
Association of White Matter Disease With Functional Recovery and 90‐Day Outcome After EVT: Beyond Chronological Age
Authors: Benali Faysal , Fladt Joachim , Jaroenngarmsamer Tanaporn , Bala Fouzi , Singh Nishita , Alhabli Ibrahim , Ospel Johanna , Tymianski Michael , Hill Michael D. , Goyal Mayank , Ganesh Aravind ,   ESCAPE‐NA1 Investigators
Published: March 2023

Background
Patients with white matter disease (WMD) – a key marker of cerebral small vessel disease – may have less brain reserve to cope with ischemic injury. The relationship of WMD to functional recovery after endovascular thrombectomy is uncertain. We aim to explore the association between WMD and functional outcome, assessed at multiple time‐points postendovascular thrombectomy.

Methods
In this post hoc analysis, we analyzed noncontrast computed tomography‐imaging from the ESCAPE‐NA1 (Safety and Efficacy of Nerinetide [NA‐1] in Subjects Undergoing Endovascular Thrombectomy for Stroke) trial and assessed WMD by using the total Fazekas‐score (score range: 0–6). The primary outcome was repeated measurements of the modified Rankin scale (mRS) scores (i.e., day‐5/discharge, day‐30, and day‐90). Secondary outcome measures were the ordinal‐mRS at 90‐days, 90‐day‐mRS0–2, and 90‐day‐mortality. Mixed‐linear and binary/ordinal logistic regressions were performed, adjusting for age, sex, baseline National Institutes of Health Stroke Scale, cortical atrophy, chronic infarctions, stroke laterality, follow‐up infarct volume, and alteplase–nerinetide interaction. Sensitivity analyses were done including only those patients for whom magnetic resonance imaging was available.

Results

We included 1102 patients with noncontrast computed tomography (median age 71, interquartile range: 61–80; median National Institutes of Health Stroke Scale 17, interquartile range: 12–21). The median total Fazekas‐score was 1(interquartile range: 0–2). Out of 1202 patients, 566 had follow‐up magnetic resonance imaging. We observed heterogeneity in functional recovery with varying degrees of WMD‐burden (
P
<0.001). Patients with Fazekas=3–6 fared worse at every time‐point after endovascular thrombectomy, compared with patients with Fazekas=0–1. At 30‐days, the adjusted difference of the mean mRS=0.47; 95% CI, 0.22–0.72 and at 90‐days: adjusted difference=0.60 (95% CI, 0.36–0.85). Higher WMD‐burdens were also associated with worse 90‐day mRS (adjusted common odds ratio for Fazekas=3–6 versus 0–1: 1.42; 95% CI, 1.03–1.96). Similar results were found in magnetic resonance imaging‐only sensitivity analyses.

Conclusion
Patients with more WMD showed worse functional recovery after endovascular thrombectomy, compared with patients without WMD, even after adjusting for age and chronic disease markers like atrophy and chronic infarctions. These data may further help inform treatment expectations and recovery‐related planning, by using simple visual ratings on routinely acquired noncontrast computed tomography.
Astronomical Imagery in Two Epigrams Ascribed to Germanicus Caesar (Anthologia Palatina 9.17 and 9.18)
Authors: Lightfoot Jessica 
Published: March 2023

Abstract
The presence of astronomical imagery in two consecutive epigrams on the theme of pursued hares in book 9 of the Anthologia Palatina (9.17 and 9.18) both strengthens their ascription to Germanicus Caesar and suggests that his astronomical and literary interests extended beyond the youthful production of a Latin translation of Aratus’ Phaenomena. The meaning of these two epigrams can only be understood fully by paying attention to the interplay of astronomical imagery between them and by considering Germanicus’ innovative account of two constellations in his Aratea: the Dog and the Hare.
The Didactic Oracle
Authors: Frank Rebecca A. 
Published: March 2023

Abstract
Plutarch’s ‘Delphic dialogues’—De E apud Delphos, De Pythiae oraculis, and De defectu oraculorum—contain a series of conversations held at Delphi regarding different aspects of the god, the oracle, and the oracular sanctuary. In these dialogues Delphi stands as a touchstone for humans to access divine knowledge through the oracular responses, but also through its physical presence. I argue that through these dialogues Plutarch presents Delphi as an ideal location for philosophical inquiry because it is a sanctuary to a philosophical god whose presence permeates Delphic ritual and cult as well as the physical dedications. The Delphic oracle may no longer play a pivotal role in the political sphere, but Plutarch makes the case for a new role for the sanctuary as a philosophical center where individuals from different schools of thought may gather to share knowledge and work together in their search for deeper understanding.