bluuebunny/crossref_metadata_2025 huggingface dataset:
The heterogeneous health state profiles of high-risk healthcare utilizers and their longitudinal hospital readmission and mortality patterns
Authors: Ng Shawn Choon Wee , Kwan Yu Heng , Yan Shi , Tan Chuen Seng , Low Lian Leng
Published: December 2019

Background: High-risk patients are most vulnerable during transitions of care. Due to the high burden of resource allocation for such patients, we propose that segmentation of this heterogeneous population into distinct subgroups will enable improved healthcare resource planning. In this study, we segmented a high-risk population with the aim to identify and characterize a patient subgroup with the highest 30-day and 90-day hospital readmission and mortality.
Methods: We extracted data from our transitional care program (TCP), a Hospital-to-Home program launched by the Singapore Ministry of Health, from June to November 2018. Latent class analysis (LCA) was used to determine the optimal number and characteristics of latent subgroups, assessed based on model fit and clinical interpretability. Regression analysis was performed to assess the association of class membership on 30- and 90-day all-cause readmission and mortality.
Results: Among 752 patients, a 3-class best fit model was selected: Class 1 “Frail, cognitively impaired and physically dependent”, Class 2 “Pre-frail, but largely physically independent” and Class 3 “Physically independent”. The 3 classes have distinct demographics, medical and socioeconomic characteristics (p<0.05), 30- and 90-day readmission (p<0.05) and mortality (p<0.01). Class 1 patients have the highest age-adjusted 90-day readmission (OR=2.04, 95%CI: 1.21-3.46, p= 0.008), 30- (OR=6.92, 95%CI: 1.76-27.21, p=0.006) and 90-day mortality (OR=11.51, 95%CI: 4.57-29.02, p<0.001).
Conclusions: We identified a subgroup with the highest readmission and mortality risk amongst high-risk patients. We also found a lack of interventions in our TCP that specifically addresses increased frailty and poor cognition, which are prominent features in this subgroup. These findings will help to inform future program modifications and strengthen existing transitional healthcare structures currently utilized in this patient cohort.
Neonatal Survival and Determinants of Mortality in Aroresa District, Southern Ethiopia: a Prospective cohort study
Authors: Limaso Alaka Adiso , Dangisso Mesay Hailu , Hibstu Desalegn Tsegaw
Published: December 2019

Background: The first day, week and month of life are the most critical period for the survival of children. In Ethiopia, despite a significant reduction in under-five mortality during the last fifteen years, neonatal mortality remains a public health problem accounting for 47% of under-five mortality. Understanding neonatal survival and risk factors for neonatal mortality could help devising tailored interventions. The aim of this study was to determine the neonatal survival and risk factors for neonatal mortality in Aroresa district, Southern Ethiopia.
Methods: A community based prospective follow up study was conducted among a cohort of term pregnant mothers and neonates delivered from January 1/2018 to March 30/2018. A total of 586 term pregnant mothers were selected with a multistage sampling technique and 584 neonates were followed-up for a total of 28 days, with 12 twin pairs. Data were coded, entered cleaned and analyzed using SPSS version 22. Kaplan–Meier survival curve was used to show pattern of neonatal death in 28 days. Independent and adjusted relationships of different predictors with neonates’ survival were assessed with Cox regression model. The risk of mortality was explored and presented with hazard ratio and 95% confidence interval and P-value less than 0.05 were considered as significant.
Result: The overall neonatal mortality was 41 per 1000 live births. Hazards of neonatal mortality was high for neonates with complications (AHR=3.643; 95% CI, 1.36-9.77), male neonates (AHR=2.71; 95% CI, 1.03-7.09), mother’s perception of baby’s size (AHR=3.46; 95% CI, 1.119-10.704), neonates who had initiated exclusive breast feeding (EBF) after one hour (AHR=3.572; 95% CI, 1.255-10.165) and mothers who had no postnatal care (AHR=3.07; 95% CI, 1.16-8.12).
Conclusion: Neonatal mortality in the study area was 4.1% which was high and immediate action should be taken towards achieving the Sustainable Development Goals. To improve neonatal survival, high impact interventions such as promotion of maternal service utilization, essential newborn care and early initiation of exclusive breast feeding were recommended.
The Effect of TRX vs. Aquatic Exercises on Self-Reported Knee Instability and Affected Factors in Women with Knee Osteoarthritis: A Randomized Controlled Trial
Authors: Asar Shirin , Gandomi Farzaneh , Mozafari Mahsa , Sohaili Freshteh
Published: December 2019

Background: Knee Instability (KI) is described as a sense of knee buckling, shifting, or giving way during the weight bearing activities. High prevalence (60-80%) has been reported for KI amongst the patients with knee osteoarthritis (KOA). In this line, the present study targeted the effect of two interventions on self-reported KI and affected factors. Methods: In this single blind, randomized, and controlled trial, 36 patients with radiographic grading (Kellgren–Lawrence > II) of KOA were selected. Patients were divided into three groups namely, aquatic (n=12), Total Resistance exercises (TRX) (n=12) and control (n=12) by random. Then both 8-week TRX and aquatic exercises were carried out by experimental groups. The following measure were taken before and after interventions: Pain by visual analog scale (VAS), balance by Berg Balance Scale (BBS), quadriceps strength by dynamometer, knee flexion range of motion (ROM) by inclinometer, knee stiffness with Western Ontario and McMaster Universities Osteoarthritis (WOMAC), and self-reported KI with Felson's questionnaire. Results: The results demonstrated that KI, VAS, BBS improved over time both in TRX and aquatic groups significantly (p<0.05), but WOMAC(stiffness), knee flexion ROM, and quadriceps strength were significantly improved over time only for TRX (p<0.05). Post hoc test, also, showed that there were significant differences between interventions and control groups (p<0.05) for the VAS, KI, BBS, but for WOMAC(stiffness), a significant difference was observed only between TRX and control groups (p=0.05). Conclusions: Although TRX and aquatic interventions had a similar effect on the patients’ balance, pain and KI, TRX had more effect on WOMAC(stiffness), quadriceps strength, and knee flexion ROM than aquatic exercises.
Educational roles as a continuum of mentoring’s role in medicine – A systematic review and thematic analysis of educational studies from 2000 to 2018
Authors: Krishna Lalit , Renganathan Yaazhini , Tay Kuang Teck , Tan Benjamin Jia Xing , Chong Jia Yan , Ching Ann Hui , Prakash Kishore , Quek Nicholas Wei Sheng , Peh Rachel Huidi , Chin Annelissa Mien Chew , Taylor David C M , Mason Stephen , Kanesvaran Ravindran , Toh Ying Pin
Published: December 2019

Background: Recent studies have gone to great lengths to differentiate mentoring from teaching, tutoring, role modelling, coaching and supervision in efforts to better understand mentoring processes. This review seeks to evaluate the notion that teaching, tutoring, role modelling, coaching and supervision may in fact all be part of the mentoring process. To evaluate this theory, this review scrutinizes current literature on teaching, tutoring, role modelling, coaching and supervision to evaluate their commonalities with prevailing concepts of novice mentoring.

Methods: A three staged approach is adopted to evaluate this premise. Stage one involves four systematic reviews on one-to-one learning interactions in teaching, tutoring, role modelling, coaching and supervision within Internal Medicine, published between 1st January 2000 and 31st December 2018. Braun and Clarke’s (2006) approach to thematic analysis was used to identify key elements within these approaches and facilitate comparisons between them.
Stage two provides an updated view of one-to-one mentoring between a senior physician and a medical student or junior doctor to contextualise the discussion.
Stage three infuses mentoring into the findings delineated in stage one.

Results: 17499 citations were reviewed, 235 full-text articles were reviewed, and 104 articles were thematically analysed. Four themes were identified – characteristics, processes, nature of relationship, and problems faced in each of the four educational roles.

Conclusions: Role modelling, teaching and tutoring, coaching and supervision lie within a mentoring spectrum of increasingly structured interactions, assisted by assessments, feedback and personalised support that culminate with a mentoring approach. Still requiring validation, these findings necessitate a reconceptualization of mentoring and changes to mentor training programs and how mentoring is assessed and supported.
Communication mediums used by patients and health professionals during access and provision of healthcare in low resource settings: A cross-sectional study
Authors: Dongyele Mathias , Ansong Daniel , Adjei Francis Osei , Xamuzu Evans , Mensah Nicholas Karikari , Owusu Alfred Kwame , Dankwa Bright Atta , Newton Sam Kofi , Odoom Samuel Frimpong , Bonney Joseph , Adjei Duncan , Amusu Anne , Akowuah Emmanuel Kofi , Lartey Kelvin
Published: December 2019

Background: The issue with communication mediums during service provision and for making enquiries to a hospital on the type of services available, availability of physicians and beds at the receiving hospitals, and a reminder system remains a challenge for patients and providers of the health service in sub-Sharan Africa. This present study sought to review the existing healthcare communication mediums from the perspectives of patients and health professionals at the Komfo Anokye Teaching Hospital, Kumasi Ghana. Method: A descriptive cross-sectional design was employed with a multilevel sampling method to select a total of 651 participants consisting of 304 patients, 303 health workers and 44 hospital directorate managers for the study. A well-structured survey questionnaire was used to collect data from respondents. Results: Most hospital staff (66.4%) used a blend of social media and direct means (face-to-face medium) to communicate among themselves whereas 89.8% only communicates with management through meetings sections. Predominantly, 97.4% of the staff communicated by direct means (face-to-face medium) with patients. Almost all management members of the hospital communicated with the general public using letters and official memos. Conclusions: There is evidence of combination of both traditional mediums (face-to-face) and the technological mediums (social media) for communications by health providers and health consumers. However, there is a dissatisfaction with delayed information flow and poor feedbacks with the use of the traditional mediums. Therefore, a digital mobile application communication system is recommended to offer efficient communication within and outside the Ghanaian health facilities. Keywords: Communication, hospital, patients, healthcare.
Psychological interventions for managing postpartum psychosis: A qualitative analysis of women’s and family members’ experiences and preferences
Authors: Forde Rebecca , Peters Sarah , Wittkowski Anja
Published: December 2019

Abstract
Background: Postpartum psychosis is a rare, yet severe disorder, in which early identification and immediate intervention are crucial. Despite recommendations for psychological input, little is known about the types of psychological intervention reported to be helpful. The aim of this study was to explore the experiences, needs and preferences for psychological intervention from the perspective of women with postpartum psychosis and from the perspective of family members.
Methods: Thirteen women and eight family members, including partners were interviewed. The data from these semi-structured interviews were audio-recorded, transcribed and inductively analysed using thematic analysis.
Results: Twelve subthemes were identified and then organised around three main themes: 1) Seeking safety and containment, 2) Recognising and responding to the psychological impact and 3) Planning for the future. These themes highlight the temporal element of recovery from postpartum psychosis, because women’s psychological needs and preferences changed over time. Emphasis was initially placed on ensuring safety, followed by a need to connect, process and adjust to their experiences. Additional needs were reported by women and family when planning for the future, including managing the fear of relapse and help to reach a decision about future pregnancies.
Conclusion: The results illustrate a range of areas in which psychological intervention could be delivered to facilitate and enhance recovery. Further research is needed to develop meaningful and effective psychological interventions and to investigate the most appropriate timing for this to be offered.
Brain SegNet: 3D Local Refinement Network for Brain Lesion Segmentation
Authors: Luo Weijian , Hu Xiaojun , Hu Jiliang , Guo Sheng , Huang Weilin , Scott Matthew R. , Wiest Roland , Dahlweid Michael , Reyes Mauricio
Published: December 2019

MR images (MRIs) accurate segmentation of brain lesions is important for improving cancer diagnosis, surgical planning, and prediction of outcome. However, manual and accurate segmentation of brain lesions from 3D MRIs is highlyexpensive, time-consuming, and prone to user biases. We present an efficient yet conceptually simple brain segmentation network (referred as Brain SegNet), which is a 3D residual framework for automatic voxel-wise segmentation of brain lesion. Our model is able to directly predict dense voxel segmentation of brain tumor or ischemic stroke regions in 3D brain MRIs. The proposed 3D segmentation network can run at about 0.5s per MRIs - about 50 times faster than previous approaches [1,2]. Our model is evaluated on the BRATS 2015 benchmark for brain tumor segmentation, where it obtains state-of-the-art results, by surpassing recently published results reported in [1,2]. We further applied the proposed Brain SegNet for ischemic stroke lesion outcome prediction, with impressive results achieved on the Ischemic Stroke Lesion Segmentation (ISLES) 2017 database.
Treatment of C-section diverticula with hysteroscopic resection in women without childbearing intention: a retrospective cohort study
Authors: Shi Hui , He Jingyan , Gao Yunhe , Qin Shuang , Fan Jiaying , Xiao Qing , Li Kuanrong , Liang Huiying
Published: December 2019

Background: Diverticulum, one of the long-term sequelae of cesarean section, can cause abnormal uterine bleeding, dysmenorrhea and chronic pelvic pain. Hysteroscopic resection of diverticula is thought to reduce abnormal uterine bleeding and chronic pelvic pain. In this study, we aim to describe the improvement after hysteroscopic resection of cesarean section diverticula (CSD) in women without childbearing intention, and to explore the variables associated with poor prognosis. Methods: A retrospective cohort study of women aged 25-48 with CSD diagnosis by transvaginal ultrasonography (TVS) and hysteroscopy that were enrolled at Guangzhou Women and Children’s Medical Center between June 2017 and December 2018. A total of 124 women met the inclusion criteria and all patients had undergone hysteroscopic resection and accepted a follow-up interview at the 3rd and 6th months postoperatively to record symptom improvement. Result: The mean of intraoperative blood loss and operative time of hysteroscopic resection were (12.94±12.63) ml and (33.63±6.87) min in 124 patients. Overall observed improvement rates of CSD symptom were 47.2% and 65.6% in the first 3 and 6 months, respectively. Multivariable logistic regression models revealed that timing of surgery <14 days was a good prognostic factor associated with both 3-month improvement (OR, 16.59; 95% CI, 2.62-104.90; P=0.003) and 6-month improvement (OR, 15.51; 95%CI, 1.63-148.00; P=0.02); Patients with numbers of cesarean section(CS) ≥2 had a lower rate of improvement after 6 months of CSD repair surgery compared with patients who underwent one CS(OR, 8.29; 95%CI, 1.05-65.75; P=0.04). Conclusions: A hysteroscopic repair might be an appropriate method for CSD in women who no childbearing intentions. The timing of surgery and the number of CS seems to be factors influencing the postoperative improvement of CSD. Keywords: Cesarean section diverticulum; Cohort study; Hysteroscopic; Prognostic factor
Time to Change’s social marketing campaign for a new target population: results from 2017-2019.
Authors: González-Sanguino Clara , Potts Laura C , Milenova Maria , Henderson Claire
Published: December 2019

Background. Since 2009 Time to Change has included among its strategies a social marketing campaign to tackle the stigma surrounding mental health problems. At the start of its third phase (2016-2021) the target group of the campaign was kept as people aged between mid-twenties and mid-forties but changed to middle-low income groups and the content was focused on men.
Methods. Participants (n = 3700) were recruited through an online market research panel, before and after each burst of the campaign. They completed an online questionnaire evaluating knowledge [Mental Health Knowledge Schedule (MAKS)]; attitudes [Community Attitudes toward Mental Illness (CAMI)]; and desire for social distance [Intended Behaviour subscale of the Reported and Intended Behaviour Scale (RIBS)]. Socio-demographic data and awareness of the campaign were also collected.
Results. For each of the 3 bursts, significant pre-post awareness differences were found (OR=2.83, CI=1.90 to 4.20, p<0.001; OR=1.72, CI=1.22 to 2.42, p=0.002; OR=1.41, CI=1.01 to 1.97, p=0.043),
and awareness at the end of the third burst was 33%. Demographic factors associated with awareness for one or more bursts included having children, familiarity with mental illness, male sex, being Black, Asian or other ethnic minorities and living in London or the East Midlands regions. An improvement across bursts in the “living with” subscale item of the RIBS, and in the “recover” and “advice to a friend” MAKS items were found. Familiarity with mental illness had the strongest association with all outcome measures, while the awareness of the campaign was also related with higher scores in MAKS and RIBS.
Conclusions. These interim results suggest that the campaign is reaching and having an impact on its target audience. While over the course of Time to Change we have found no evidence that demographic differences in stigma have widened, and indeed those by age group and region of England have narrowed, those for socioeconomic status, ethnicity and sex have so far remained unchanged. By targeting a lower socioeconomic group and creating relatively greater awareness among men and in Black and ethnic minority groups, the campaign is showing the potential to address these persistent differences in stigma.
Effects of alternate-day fasting on body weight and dyslipidaemia in patients with non-alcoholic fatty liver disease: a randomised controlled trial
Authors: Cai Hua , Qin Yue-Lan , Shi Ze-Ya , Chen Jin-Hui , Zeng Min-Jie , Zhou Wei , Chen Ru-Qun , Chen Zhi-Yuan
Published: December 2019

Background: Alternate-day fasting (ADF) is a novel diet therapy that may achieve reduction in body weight and improvement of dyslipidaemia, but the impact of this diet on patients with non-alcoholic fatty liver disease (NAFLD) remains unknown. The aim of this study was to evaluate the effects of ADF on the body weight and lipid profile of individuals with NAFLD.

Methods: NAFLD patients (n=271) were randomised to the ADF group, time-restricted feeding (TRF) group, or the control group and subjected to the respective diet for 12 weeks. Anthropometric measurements (body weight, fat mass/fat-free mass) were performed, and plasma lipids were analysed enzymatically.

Results: Within 4 weeks, the body weight decreased significantly (P<0.001) in the ADF group by 4.56±0.41 kg (6.1 ± 0.5%) and the TRF group by 3.62±0.65 kg (4.83±0.9%) compared to the control group, and it decreased even more after 12 weeks in both groups (ADF: -4.04±0.54 kg, 5.4±0.7%; TRF: -3.25±0.67 kg, 4.3±0.9%). Fat mass was significantly reduced by ADF (-3.49±0.37 kg; 11±1.2%) and TRF (-2.91±0.41 kg; 9.6±1.3%), with ADF leading to a further reduction in fat mass after 12 weeks (-3.48±0.38 kg; 11±1.2%). Total cholesterol was significantly decreased at both time points in the ADF group (-0.91±0.07 mmol/L; 18.5±1.5%) compared to the control and TRF groups. Both ADF (-0.64±0.06 mmol/L; 25±1.9%) and TRF (0.58±0.07 mmol/L; 20±1.7%) achieved a significant reduction in serum triglycerides (P<0.001) after 12 weeks. Changes in fat free mass, HDL, LDL, fasting insulin, glucose, liver stiffness, and systolic or diastolic blood pressure did not differ between the groups.

Conclusions: ADF appears to be an effective diet therapy for individuals with NAFLD that can achieve weight loss and improvement of dyslipidaemia within a relatively short period of time (4 to 12 weeks). Potential preventive effects of ADF on cardiovascular disease need to be confirmed by future investigations.

Trial registration: ChiCTR1900024411, this trial was retrospectively registered on July 10, 2019
Long-term effects of group exercise intervention on maximal step-up height in female primary care patients with cardio-metabolic risk factors
Authors: Nyberg Lillemor Amanda , Sundberg Carl Johan , Wändell Per , Kowalski Jan , Hellenius Mai-Lis
Published: December 2019

Background: Low physical performance is a predictor of morbidity and mortality. This study looks at long-term effects of an exercise intervention on maximal step-up height (MSH) in individuals with low physical function. Furthermore, we studied correlates to changes in MSH. Methods: Female patients (n = 101), mean (SD) age of 52 (11) years, were recruited for a 3-month group exercise intervention including 2-3 sessions/week of mixed aerobic fitness and strength training. MSH, weight, body mass index (BMI), waist circumference, maximal oxygen consumption (VO 2 -max), self-reported health (SF-36) and physical activity (PA) were measured at baseline (T0), after 3 months (T1) and after 14-30 (mean 22) months (T2). Relationships between changes in MSH (cm) and age, baseline MSH, time to follow-up, changes in anthropometric measurements, VO 2 -max, SF-36 and PA were studied with regression analyses. Results: MSH, significantly, increased from T0 to T1, 27.2 (5.7) to 29.0 (5.5) cm and decreased to 25.2 (5.5) cm at T2. Time to follow-up (B = -0.42, p < 0.001) and change in BMI (B = -0.29, p = 0.012) correlated significantly to changes in MSH. Waist circumference, VO 2 -max, PF and exercise/physical activity levels were significantly improved at T2, while BMI did not change. In a univariate logistic regression model, maintenance of MSH correlated to the extent of mixed training (OR 3.33, 95% CI 1.25-8.89). In a multivariate logistic regression model adjusted for important factors the correlation was not significant. However, MSH was significantly higher in individuals participating in 2-3 session per week compared to one session. Conclusions: A 3-month group exercise intervention increased MSH, improved fitness, decreased risk in female patients with elevated cardio-metabolic risk. After an average of 22 months MSH was reduced while positive effects remained for waist circumference, VO 2 -max, physical function and physical activity. However, regular group exercise 2-3 times per week with mixed aerobic fitness and strength training was associated with maintenance of MSH in a subgroup of patients. We suggest that such an intervention including regular support from healthcare professionals is a successful approach for maintaining improved leg-muscle strength among primary care patients.
Optimization of the antibiotic management of diabetic foot infections - Protocol for two randomized controlled trials
Authors: Waibel Felix WA , Berli Martin , Catanzaro Sabrina , Sairanen Kati , Schöni Madlaina , Böni Thomas , Burkhard Jan , Holy Dominique , Huber Tanja , Bertram Maik , Laeubli Karin , Frustaci Dario , Rosskopf Andrea , Botter Sander , Uçkay Ilker
Published: December 2019

Background: Few studies address the appropriate duration of antibiotic therapy for diabetic foot infections (DFI); with or without amputation. We will perform two randomized clinical trials (RCT) to reduce the antibiotic use and associated adverse events in DFI.
Methods: We hypothesize that shorter durations of post-debridement systemic antibiotic therapy are non-inferior (10% margin, 80% power, ɑ 5%) to existing (long) durations and we will perform two unblinded RCTs with a total of 400 DFI episodes (randomization 1:1) from 2019 to 2022. The primary outcome for both RCT is “remission of infection” after a minimal follow-up of two months. The secondary outcomes for both RCT are the incidence of adverse events and the overall treatment costs. The First RCT will allocate the total therapeutic amputations in two arms of 50 patients each: 1 vs. 3 weeks of antibiotic therapy for residual osteomyelitis (positive microbiological samples of the residual bone stump); or 1 vs. 4 days for remaining soft tissue infection. The Second RCT will randomize the conservative approach (only surgical debridement without in toto amputation) in two arms with 50 patients each: 10 vs. 20 days of antibiotic therapy for soft tissue infections; and 3 vs. 6 weeks for osteomyelitis. All participants will have professional wound debridement, adequate off-loading, angiology evaluation, and a concomitant surgical, re-educational, podiatric, internist and infectiology care. During the surgeries, we will collect tissues for BioBanking and future laboratory studies.
Discussion: Both parellel RCTs will repond to frequent questions regarding the duration of antibiotic use in the both major subsets of DFIs, to assure the quality of care, and to avoid unnecessary excesses in terms of surgery and antibiotic use.
Trial registration: ClinicalTrial.gov NCT04081792. Registered on 4th September 2019.
Protocol version: 2 (15th July 2019)
Fear-avoidance beliefs are associated with exercise adherence: Secondary analysis of a randomised controlled trial (RCT) among female healthcare workers with recurrent low back pain
Authors: Taulaniemi Annika , Kankaanpää Markku , Rinne Marjo , Tokola Kari , Parkkari Jari , Suni Jaana Helena
Published: December 2019

Background Exercise is recommended for the treatment and management of low back pain (LBP) and the prevention of chronicity. Exercise adherence has proved to be only modest in intervention studies among people with musculoskeletal pain. Fear-avoidance beliefs (FABs) are known to affect exercise adherence.The purpose was twofold: to examine which bio-psycho-social factors contributed to exercise adherence during a 6-month neuromuscular exercise intervention among female healthcare workers with recurrent LBP, and to investigate how exercising affects FABs at 6 and 12 months’ follow-up.Methods In original RCT study, 219 healthcare workers aged 30–55 years with mild-to-moderate re-current non-specific LBP were allocated into: 1) exercise, 2) counselling, 3) combined exercise and counselling, and 4) control groups. In the present secondary analysis, groups 1 and 3 (exercise only and exercise+counselling) were merged to be exercisers and groups 2 and 4 were merged to be non-exercisers. Baseline variables of the exercise compliers (≥24 times over 24 weeks; n=58) were compared to those of the non-compliers (<1 time/week, 0–23 times; n=52). The effects of the exercise programme on FABs were analysed by a generalised linear mixed model according to the intention-to-treat principle (exercisers; n= 110 vs non-exercisers; n=109) at three measurement points (baseline, 6, and 12 months). A per-protocol analysis compared the more exercised to the less exercised and non-exercisers.Results A low education level (p=0.026), shift work (p=0.023), low aerobic (p=0.048) and musculoskeletal (p=0.043) fitness level, and high FABs related to physical activity (p=0.019) at the baseline contributed to lower exercise adherence. The exercise programme reduced levels of both physical activity- and work-related FABs, and there was a dose response: FABs reduced more in persons with better exercise adherence.Conclusion Healthcare workers who had lower education and fitness levels, worked shifts, and had high physical activity-related FABs had a lower adherence to the 6-month neuromuscular exercise programme. Exercising with good adherence reduced levels of FABs, which are known to be linked with prolonged LBP. In exercise interventions, motivational strategies should be targeted at persons with low education and fitness levels and high FABs in order to achieve better exercise adherence.
Dual-energy Spectral CT Quantitative Parameters for the Differentiation of Glioma Recurrence from Treatment-Related Changes: A Preliminary Study
Authors: Lv Yanchun , Zhou Jian , Lv Xiaofei , Tian Li , He Haoqiang , Liu Zhigang , Wu Yi , Han Lujun , Sun Meili , Yang Yadi , Guo Chengcheng , Li Cong , Zhang Rong , Xie Chuanmiao , Chen Yinsheng , Chen Zhong-ping
Published: December 2019

Background: Differentiating glioma recurrence from treatment-related changes can be challenging on conventional imaging. We evaluated the use of dual-energy spectral computed tomographic (CT) quantitative parameters for this differentiation.
Methods: Twenty-eight patients were examined by dual-energy spectral imaging CT. The slope of the spectral Hounsfield unit curve (λHU), effective atomic number (Zeff), normalized effective atomic number (Zeff-N), iodine concentration (IC), and normalized iodine concentration (ICN) in the post-treatment enhanced areas were calculated. Pathological results or clinicoradiologic follow-up of ≥2 months were used for final diagnosis. Nonparametric and t-tests were used to compare quantitative parameters between glioma recurrence and treatment-related changes. Positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated; sensitivity and specificity were calculated using receiver operating characteristic (ROC) curves. ROC curves were generated using predictive probabilities to evaluate the diagnostic value.
Results: There were no significant differences in quantitative parameters based on examination of pre-contrast λHU, Zeff, Zeff-N, IC, ICN and venous phase ICN (P>0.05). Venous phase λHU, Zeff, Zeff-N, and IC in glioma recurrence were higher than in treatment-related changes (P<0.001). The optimal venous phase threshold was 1.03, 7.75, 1.04, and 2.85 mg/cm3, achieving 66.7%, 91.7%, 83.3%, and 91.7% sensitivity; 100.0%, 77.8%, 88.9%, and 77.8% specificity; 100.0%, 73.3%, 83.3%, and 73.3% PPV; 81.8%, 93.3%, 88.9%, and 93.3% NPV; and 86.7%, 83.3%, 86.7%, and 83.3% accuracy, respectively. The areas under the curve (AUC) were 0.912, 0.912, 0.931, and 0.910 in glioma recurrence and treatment-related changes, respectively.
Conclusions: Dual-energy spectral CT imaging may provide quantitative values to aid in differentiation of glioma recurrence from treatment-related changes.
Cyniclomyces guttulatus is an opportunistic pathogen in rabbits with coccidiosis
Authors: Shi Tuanyuan , Sun Hongchao , Fu Yuan , Hao Lili , Zhou Yongxue , Liu Yan , Bao Guolian , Suo Xun
Published: December 2019

Background: Cyniclomyces guttulatus is a common inhabitant of the gastrointestinal tract in rabbits, and large numbers are often present in feces of diarrheic rabbits. However, its relation with rabbit diarrhea has not been clearly identified. Relationship between C. guttulatus and the rabbit are identified in this paper.Methods: YPG (pH 1.5) medium and 96-well culture plate were used to isolate C. guttulatus from rabbit. Automatic microbial growth curve analyser and optical density scanner were used to optimized culture conditions of the C. guttulatus strain in the YPG medium. Microscope observation, PCR and gene sequencing were used to identify the C. guttulatus strain. Animal inoculation with the C. guttulatus strain or co-inoculation with E. intestinalis were used identify relationship between C. guttulatus and the rabbit. Results: A C. guttulatus Zhejiang strain was isolated from a rabbit with diarrhea and the culture conditions in YPG medium were optimized. The sequenced 18S and 26S ribosomal DNA fragments were 1559bp and 632bp, respectively, and showed 99.8% homology with the 18S ribosomal sequence of the NRRL Y-17561 isolate from the dog and 100% homology with the 26S ribosomal sequence of the DPA-CGR1 and CGDPA-GP1 isolates from the rabbit and guinea pig. Our isolate was not pathogenic to healthy SPF rabbits. Instead, rabbits inoculated with the yeast had a slightly better body weight gain and higher food intake. Rabbits co-inoculated with C. guttulatus and the coccidian, E. intestinalis developed more severe coccidiosis as shown by clinical signs, and decreased body weight gain, diarrhea and death, associated with significantly higher fecal output of C. guttulatus vegetative cells but lower coccidian oocysts output than the rabbits inoculated with C. guttulatus or E. intestinalis alone. We also surveyed the prevalence of C. guttulatus in rabbits and found a positive rate of 83% in Zhejiang province. Conclusions: Our results indicate that C. guttulatus alone is not pathogenic to healthy rabbits and seems a probiotic microorganism in rabbits, but could become an opportunistic pathogen when the digestive tract is damaged by other pathogens such as coccidia.
Semi-supervised Method for Image Texture Classification of Pituitary Tumors via CycleGAN and Optimized Feature Extraction
Authors: ZHU Hong , FANG Qianhao , HUANG Yihe , XU Kai
Published: December 2019

Background: Accurately determining the softness level of pituitary tumors preoperatively by using their image textures can provide a basis for surgical options and prognosis. Existing methods for this problem require manual intervention, which could hinder the efficiency and accuracy considerably.Methods: we present an automatic method for diagnosing the texture of pituitary tumors using unbalanced sequence image data. Firstly, for the small sample problem in our pituitary tumor MRI image dataset where T1 and T2 sequence data are unbalanced (due to data missing) and under-sampled, our method uses a CycleGAN model for domain conversion to obtain fully sampled MRI spatial sequence. Then, it uses a DenseNet-ResNet based Autoencoder framework to optimize the feature extraction process for pituitary tumor image data. Finally, to take advantage of sequence data, it uses a CRNN model to classify pituitary tumors based on their predicted softness levels.Results: Experiments show that our method is the best in terms of efficiency and accuracy(91.78%) compared to other methods.Conclusions: We propose a semi-supervised method for grading pituitary tumor texture. This method can accurately determine the softness level of pituitary tumors, which provides convenience for surgical selection and prognosis, and improves the diagnostic efficiency of pituitary tumors.
The use of olanzapine as an antiemetic in palliative medicine: a systematic review of the literature
Authors: Saudemont Gaëtan , Prod'Homme Chloé , Silva Arlette Da , Villet Stephanie , Reich Michel , Penel Nicolas , Gamblin Vincent
Published: December 2019

Background: Olanzapine is an atypical antipsychotic that has affinity for many central nervous system receptors. Its efficacy is supported by several studies in the prevention and treatment of chemotherapy-induced nausea and vomiting. No recommendations exist on the antiemetic use of olanzapine in the palliative care setting. The aim of this work is to complete the initial work of Fonte et al. published in 2015, to determine whether the literature supports the use of olanzapine as an antiemetic in palliative situations and, in practice, to propose a therapeutic schema adapted to the palliative setting. Methods: Systematic review of the literature according to the PRISMA criteria. We searched the PubMed, Cochrane, RefDoc, EMBase databases and the gray literature databases. The bibliographic search was conducted between November 2016 and August 2017. Results: Thirteen articles were included: 2 case studies, 3 case series, 3 retrospective studies, 2 prospective studies, 2 literature reviews. All studies concluded on the efficacy of olanzapine as an antiemetic in the palliative care setting. No serious adverse effects were reported. Based on the data from the literature review, we propose a therapeutic scheme adapted to the palliative care context. Conclusion: Action of olanzapine on many receptors and its tolerance profile make it an interesting antiemetic treatment in palliative medicine. But to date, studies are scarce and have a low statistical power. Further investigation is therefore needed to determine the benefit of this treatment in palliative care patients, compared to usual treatments.
Isolation, characterization and application of theophylline-degrading Aspergillus fungi
Authors: ZHOU Bin-Xing , Ma Cunqiang , Xia Tao , Li Xiaohong , Zheng Chengqin , Wu Tingting , Liu Xiaohui
Published: December 2019

Background: Caffeine, theobromine and theophylline are main purine alkaloid in tea. Theophylline is the downstream metabolite and stays a very low level in Camellia sinensis. In our previous study, Aspergillus sydowii could convert caffeine into theophylline in solid-state fermentation of tea through N-demethylation. In this study, tea-derived fungi caused theophylline degradation in the solid-state fermentation. The aim of this study was isolate theophylline-degrading fungi and to investigate their application in production of methylxanthines with theophylline as feedstock through microbial conversion. Results: Of seven tea-derived fungi collected and identified by ITS, β-tubulin and calmodulin gene sequences, Aspergillus ustus, Aspergillus tamarii, Aspergillus niger and Aspergillus sydowii associated with solid-state fermentation of pu-erh tea have shown ability to degrade theophylline. A. ustus and A. tamarii could degrade theophylline highly significantly (p < 0.01) in liquid culture. 1,3-Dimethyluric acid, 3-methylxanthine, 3-methyluric acid, xanthine and uric acid were detected consecutively by HPLC in A. ustus and A. tamarii respectively. The data from absolute quantification analysis suggest that 3-methylxanthine and xanthine were main degraded metabolites in A. ustus and A. tamarii respectively. 129.48 ± 5.81 mg/L of 3-methylxanthine and 159.11 ± 10.8 mg/L of xanthine were produced by A. ustus and A. tamarii respectively in 300 mg/L of theophylline liquid medium. Conclusions: For the first time, we confirmed that isolated Aspergillus ustus, Aspergillus tamarii degrade theophylline through N-demethylation and oxidation. We were able to biologically produce 3-methylxanthine and xanthine efficiently from theophylline through a new microbial synthesis platform with A. ustus and A. tamarii as appropriate starter strains.
The efficacy of a mobile phone application to improve adherence to treatment and self-management in people with chronic respiratory disease in Romanian population – a pilot study
Authors: Munteanu Laura Adela , Frandes Mirela , Timar Bogdan , Tudorache Emanuela , Fildan Ariadna Petronela , Oancea Cristian , Tofolean Doina Ecaterina
Published: December 2019

Background Many studies assessed the effect of mobile phone applications on self-management outcomes in patients with asthma but all of them presented different results. In this paper we examined the effect of a mobile phone application on self-management and disease control in Romanian population.Material and methods This study included 93 patients diagnosed with asthma that were recalled every three months for a year for assessment and treatment. Patients were divided into two groups. The first group included patients that received treatment and the second group received treatment and also used the smartphone application. Number of exacerbations and asthma control test (ACT) were recorded.Results ACT score was significantly higher for patients using also the mobile application than for the patients using the treatment alone, Mann-Whitney U test, p < 0.001. When considering the exacerbations rate, the patients not using the application presented an insignificant lower number of exacerbations than the group using the application, 40.74% vs. 58.97%, respectively, chi-square test, X 2 (1) = 3.105, p = 0.081. The number of exacerbations without hospitalization was significantly higher in case of the first group, when comparing to the second group, 46.3% vs 10.26%, X 2 (1) = 13.71, p < 0.001.Conclusion Our study indicates that smartphone applications are an effective way to improve asthma control and self-management when used continually in our population. We found significant positive effects in disease control and exacerbation frequency.
Sexual and Gender Minority Health Curricula in Health Care Professional Schools
Authors: Pratt-Chapman Mandi L.
Published: December 2019

Background Lesbian, gay, bisexual, transgender, queer, and intersex people—inclusively termed “sexual and gender minorities”—have unique health and health care needs that are not being met by most healthcare providers due to lack of training in health care professional schools. The purpose of this study was to examine implementation factors for advancing sexual and gender minority health professional student curricula in academic settings. Methods: Semi-structured interviews, structured by the Consolidated Framework for Implementation Research, were conducted with sixteen curricular champions to identify factors relevant to curricular adoption, integration, and sustainment. Themes were coded using a hybrid of deductive and inductive approaches. Results: Facilitators supporting implementation of sexual and gender minority health curricula included collaboration among multiple stakeholders, alignment of formal and hidden curricula, fostering an organizational culture that valued inclusion and diversity, engagement with external subject matter experts or faculty with content expertise, and thoughtful and inclusive planning. Conclusion: This study contributes to health care professional education research as well as to implementation science. Facilitators that were identified in this study can be used to increase the adoption, integration, and sustainment of sexual and gender minority health curricula in diverse academic settings.
An interprofessional education conference approach to antimicrobial education: a mixed methods evaluation
Authors: Guilding Clare , Hardisty Jessica , Randles Elsa , Statham Louise , Green Alan , Bhudia Roshni , Thandi Charan Singh , Teodorczuk Andrew , Scott Lesley , Matthan Joanna
Published: December 2019

Background: Arguably, Medical School curricula are deficient in learning opportunities related to the safe and effective use of medicines, in particular antimicrobials. Infection management is complex and multidisciplinary, and undergraduate learning opportunities should therefore reflect these principles. Aligned to the complexity of the subject matter, simulation and interprofessional based teaching are methods that can foster the collaborative skills required of future healthcare professionals. There have been calls to develop these methods in the teaching of safe prescribing and the management of infections; however, reports of such studies are limited. Methods: We developed an interprofessional education (IPE) conference for second year undergraduate medical and pharmacy students based in the North East of England. We considered contact theory in the design of three small-group interprofessional workshops, on the broad themes of antimicrobial stewardship, infection management and patient safety. A mixed methods approach assessed students’ attitudes towards IPE, barriers and facilitators of learning, and perceived learning gains. Qualitative data from workshop evaluation forms were analysed thematically, while quantitative data were analysed descriptively and differences between medical and pharmacy cohorts analysed using unpaired two-tailed t-tests. Results:226/352 students returned the workshop evaluation forms (66% of pharmacy students, 62% of medical students). 281/352 students responded to a series of Likert scale questions on the value of interprofessional working (88% of pharmacy students, 70% of medical students). Students reported acquisition of knowledge and skills, including concepts and procedures related to infection management and antimicrobial prescribing, and the development of problem-solving and critical evaluation skills. Students reflected on their attitude towards interprofessional collaboration. They reported a greater understanding of the roles of other healthcare professionals, reflected on the importance of effective communication in ensuring patient safety, and were more confident to work in interprofessional teams after the conference. Conclusions: A robust IPE event, theoretically underpinned by contact theory and developed collaboratively, achieved interprofessional learning at scale and helped develop healthcare professionals willing to collaborate across disciplines. The resources, and evaluation insights based on the 3P (presage, process, and product) model of learning and teaching, will be of value to other educators who seek to develop theoretically-sound IPE interventions.
Egyptians Social Acceptance and Consenting Options for Posthumous Organ Donation. A Cross Sectional Study
Authors: Metwally Ammal Mokhtar , Abdel-Latif Ghada A. , Eletreby Lobna , Aboulghate Ahmed , Mohsen Amira , Amer Hala A , Saleh Rehan M. , Elmosalami Dalia , Salama Hend I. , Hady Safaa I. Abd El , Alam Raefa R. , Mohamed Hanan A. , Badran Hanan M. , Eltokhy Hanan E. , Elhariri Hazem , Rabah Thanaa , Abdelrahman Mohamed , Ibrahim Nihad A , Chami Nada
Published: December 2019

Background: Organ donation has become one of the most effective ways in developing and developed countries to save lives and improve the quality of life for patients with end-stage organ failure. No previous studies investigated either the Egyptians’ perception or preferences about different consenting options for organ donation. This study aims to assess Egyptian personal preferences and public perception of norm on several consenting options for posthumous organ donation, and measure the awareness and acceptance of the public to Egyptian law articles regulating organ donation. Methodology: A cross sectional study was conducted along two years among 2743 participants. Participants were chosen from governmental and non-governmental facilities as well as from the general public. Each participant was required to complete the study questionnaire which included demographic characteristics, personal preferences and public norms of eleven consenting options arranged from 1 (most preferred) to 11 (least preferred), and awareness and acceptance of the seven articles of Egyptian laws concerning organ donation. Results: About 78% of the respondents expressed willingness to donate their organs after death while 22% were not willing to donate. Out of donation preferences, informed consent by donor only was a preferable choice, where about one third of respondents assigned to this option the highest ranking scores (31% as a personal preference and 31.6 % for the public norm). There was no difference between males and females or between personal preferences and perception of norms in consenting systems ranking. The awareness for the targeted Egyptian laws regarding organ donation after death was relatively low ranging from 56% to 23%. Conclusion: Informed consent by donor only was the preferable choice as personal preference and as norm. The choice of consenting options did not vary with gender, education or employment. Increasing the awareness of Egyptians on the articles of the law of organ donation is highly needed.