bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of total bilirubin and indirect bilirubin content with metabolic syndrome among Kazakhs in Xinjiang
Authors: Hao Hao , Guo Heng , Ma Ru-lin , Yan Yi-zhong , Hu Yun-hua , Ma Jiao-long , Zhang Xiang-hui , Wang Xin-ping , Wang Kui , Mu La-ti , Song Yan-peng , Zhang Jing-yu , He Jia , Guo Shu-xia 
Published: July 2020

Abstract
Background
Some studies have shown that a high level of bilirubin is a protective factor against metabolic syndrome (MS), while a high level of transaminase is a risk factor for MS. However, the existing results are inconsistent and few cohort studies have been published.

Methods
Using an ambispective cohort study, 565 Kazakhs from Xinjiang, China were selected as the study subjects. The baseline serum bilirubin and transaminase levels of the subjects were divided into quartiles and the relationship between these values and the incidence of MS was analyzed. The definition of MS was based on the Joint Interim Statement (JIS) diagnostic criteria.

Results
The average follow-up time for the subjects was 5.72 years. The cumulative incidence of MS was 36.11% (204 of the 565 subjects), and the incidence density was 63.10/1000 person-years. Multivariate Cox regression analysis showed that the levels of total bilirubin (TBIL) and indirect bilirubin (IBIL) were negatively correlated with the occurrence of MS, Compared to the lowest quartile level (Q1), the hazard ratios of MS the TBIL levels at the Q2-Q4 quartiles were: 0.47 (0.31–0.71), 0.53 (0.35–0.79), and 0.48 (0.32–0.72), respectively, while IBIL levels at the Q2-Q4 quartiles showed an MS hazard ratio of 0.48 (0.32–0.72), 0.54(0.36–0.81), and 0.52 (0.35–0.77), respectively, all at a 95% confidence level. However, no relationship was found between transaminase levels and the incidence of MS.

Conclusion
Serum TBIL and IBIL levels were negatively correlated with the incidence of MS in a Kazakh population in China.
Importance of the big-five in the future medical specialty preference
Authors: Milić Jakov , Škrlec Ivana , Milić Vranješ Iva , Jakab Jelena , Plužarić Vera , Heffer Marija 
Published: July 2020

AbstractBackgroundThe most crucial decision in the physician’s career after graduation is undoubtedly the choice of specialization. It is conditioned by many factors such as intellectual challenges, clinical experience, economic and social influences. The aim of this study was to determine whether personality traits affect the choice of medical specialty at the University of Osijek, Croatia.MethodsThis cross-sectional study included a total of 407 medical students. To assess the personality traits, the IPIP Big-Five questionnaire was used.ResultsThere were no differences in four of the five personality traits of the Big-Five questionnaire when comparing the groups based on their specialty preference: extroversion, agreeableness, conscientiousness, and emotional stability. A significant difference was found for openness to experience (intellect/imagination) trait, where students who preferred psychiatry specialties achieved the highest score, and those who chose public health specialties scored the lowest. We observed no significant effect between gender and specialty preference based on personality traits.ConclusionsWe could not attribute the differences in personality traits to specialty preference. Medical students with higher scores on agreeableness and openness (intellect/imagination) scales were more inclined to psychiatric specialties, and more conscientiousness students preferred the anesthesiology and emergency medicine specialties. Even if variations in personality traits do not exist across different specialties, many other factors influence specialty preference.
Nursing competence in municipal in-patient acute care in Norway: a cross-sectional study
Authors: Vatnøy Torunn Kitty , Sundlisæter Skinner Marianne , Karlsen Tor-Ivar , Dale Bjørg 
Published: July 2020

Abstract
Background
The primary health care services are becoming increasingly complex, which presents challenges for the municipal nursing services. In Norway, municipal in-patient acute care (MipAC) has been introduced in all municipalities, and the competence at the services has been questioned. Few studies have examined the nursing services in the units. This study aims to get an overview of the nursing competence in those units across geographical regions, and different groups of organisation and localisation.

Methods
A cross-sectional study was conducted, and an ad hoc questionnaire was distributed to first-line leaders in all the MipAC units in Norway. Data were collected in the period between 6 March 2019 to 6 June 2019. Measures to get an overview of the nursing competence were ratio of registered nurses (RNs) in staff, count of shifts with only one RN on duty and count of RNs with master’s degrees/specialisation. Descriptive comparative statistics were used.

Results
Of all 226 first-line leaders invited to participate, 207 (91.6%) responded to the questionnaire. Overall a considerable variance across the sample was revealed. The median ratio of RNs in staff was 56 (IQR = 40–70), the count of shifts with only one RN on duty median 28 (IQR = 5–49), and the count of RNs with a master’s degree or specialisation median 3 (IQR = 0–5). The regions of Northern and Central Norway, MipACs located in nursing home and MipACs organised at long-term care units, showed significantly lower nursing competence in staff compared to the remaining institution and organisations.

Conclusion
This study generates knowledge that can inform planning, priorities and interventions that may be initiated at all organisational and political levels concerning the MipAC services. An overall conclusion is that advanced nursing competence is lacking. The study also highlights the most urgent direction for improvements regarding nursing competence in the services. It seemed to be MipACs in Northern and Central Norway, and those located at nursing homes organised together with long-term care units, that needed improvements the most.
Measuring productivity of healthcare services under environmental constraints: evidence from China
Authors: Yu Jinna , Liu Zhen , Zhang Tingting , Hatab Assem Abu , Lan Jing 
Published: July 2020

Abstract
Background
Despite the growing literature on the efficiency and productivity of the Chinese healthcare system, less attention has been given to examining the undesirable outputs linked to healthcare services, including environmental pollution. Taking the atmospheric environmental pollution resulting from the incineration of medical waste as an undesirable output of the healthcare system, this study analyzed the growth and decomposition of Total Factor Productivity (TFP) of healthcare services across 31 Chinese provinces during the period 2005–2016.

Methods
The Meta-frontier undesirable super-efficiency slack-based measure (SBM) model and the Global Malmquist-Luenberger (GML) Index were employed to analyze the growth and decomposition of TFP using the Max DEA software.

Results
The results revealed that the years 2009 and 2015 marked significant changes in TFP of healthcare services in Chinese provinces. During the study period, the rate of technological change (TC) slowly declined, whereas the rate of efficiency change (EC) steadily increased. With the national average being the benchmark, the results indicated that: the TFP of 17 provinces and cities exceeded the average, the EC of 16 provinces and cities exceeded the average, the TC of 9 provinces and cities exceeded the average, and the value in the Technology Gap Ratio (TGR) changes of 13 provinces and cities were above the national average.

Conclusions
(1) The TFP of the healthcare services across China continued to decline slowly during the study period. (2) The effect of technical catch-up in the eastern, central, and western regions of China was significant across the three regions, whereas the effect of technical innovation was negative. (3) The TFP varied considerably among the Chinese provinces. These findings suggest that, under existing environmental constraints, relevant government departments should improve technical innovation in the supply of healthcare services and medical waste treatment, increase technical efficiency in the factor of healthcare production, strengthen regional health planning, and balance the development of regional healthcare.
The use of UK primary care databases in health technology assessments carried out by the National Institute for health and care excellence (NICE)
Authors: Leahy Thomas P. , Ramagopalan Sreeram , Sammon Cormac 
Published: July 2020

Abstract
Background
Real world evidence (RWE) is becoming more frequently used in technology appraisals (TAs). This study sought to explore the use and acceptance of evidence from primary care databases, a key source of RWE in the UK, in National Institute for Health and Care Excellence (NICE) technology assessments and to provide recommendations regarding their use in future submissions.

Methods
A keyword search was conducted relating to the main primary care databases in the UK on the NICE website. All NICE TAs identified through this search were screened, assessed for duplication and information on the data source and the way the data was used in the submission were extracted. Comments by the evidence review group (ERG) and the appraisal committee were also extracted and reviewed. All data extraction was performed by two independent reviewers and all decisions were reached by consensus with an additional third reviewer.

Results
A total of 52 NICE TAs were identified, 47 used the General Practice Research Database /Clinical Practice Research Datalink (GPRD/CPRD) database, 10 used The Health Improvement Network (THIN) database and 3 used the QResearch databases. Data from primary care databases were used to support arguments regarding clinical need and current treatment in 33 NICE TAs while 36 were used to inform input parameters for economic models. The databases were sometimes used for more than one purpose. The data from the three data sources were generally well received by the ERGs/committees. Criticisms of the data typically occurred where the results had been repurposed from a published study or had not been applied appropriately.

Conclusions
The potential of UK primary care databases in NICE submissions is increasingly being realised, particularly in informing the parameters of economic models. Purpose conducted studies are less likely to receive criticism from ERGs/committees, particularly when providing clinical input into cost effectiveness models.
Examining correlations between opioid dispensing and opioid-related hospitalizations in Canada, 2007–2016
Authors: Jones Wayne , Kurdyak Paul , Fischer Benedikt 
Published: July 2020

Abstract
Background
High levels of opioid-related mortality, as well as morbidity, contribute to the excessive opioid-related disease burden in North America, induced by high availability of opioids. While correlations between opioid dispensing levels and mortality outcomes are well-established, fewer evidence exists on correlations with morbidity (e.g., hospitalizations).

Methods
We examined possible overtime correlations between medical opioid dispensing and opioid-related hospitalizations in Canada, by province, 2007–2016. For dispensing, we examined annual volumes of medical opioid dispensing derived from a representative, stratified sample of retail pharmacies across Canada. Raw dispensing information for ‘strong opioids’ was converted into Defined Daily Doses per 1000 population per day (DDD/1000/day). Opioid-related hospitalization rates referred to opioid poisoning-related admissions by province, for fiscal years 2007–08 to 2016–17, drawn from the national Hospital Morbidity Database. We assessed possible correlations between opioid dispensing and hospitalizations by province using the Pearson product moment correlation; correlation values (r) and confidence intervals were reported.

Results
Significant correlations for overtime correlations between population-levels of opioid dispensing and opioid-related hospitalizations were observed for three provinces: Quebec (r = 0.87, CI: 0.49–0.97; p = 0.002); New Brunswick (r = 0.85;CI: 0.43–0.97; p = 0.004) and Nova Scotia (r = 0.78; CI:0.25–0.95; p = 0.012), with an additional province, Saskatchewan, (r = 0.073; CI:-0.07–0.91;p = 0.073) featuring borderline significance.

Conclusions
The correlations observed further add to evidence on opioid dispensing levels as a systemic driver of population-level harms. Notably, correlations were not identified principally in provinces with reported high contribution levels (> 50%) of illicit opioids to mortality, which are not captured by dispensing data and so may have distorted or concealed potential correlation effects due to contamination.
The influence of electronic health record use on collaboration among medical specialties
Authors: Vos Janita F. J. , Boonstra Albert , Kooistra Arjen , Seelen Marc , van Offenbeek Marjolein 
Published: July 2020

AbstractBackgroundOne of the main objectives of Electronic Health Records (EHRs) is to enhance collaboration among healthcare professionals. However, our knowledge of how EHRs actually affect collaborative practices is limited. This study examines how an EHR facilitates and constrains collaboration in five outpatient clinics.MethodsWe conducted an embedded case study at five outpatient clinics of a Dutch hospital that had implemented an organization-wide EHR. Data were collected through interviews with representatives of medical specialties, administration, nursing, and management. Documents were analyzed to contextualize these data. We examined the following collaborative affordances of EHRs: (1) portability, (2) co-located access, (3) shared overviews, (4) mutual awareness, (5) messaging, and (6) orchestrating.ResultsOur findings demonstrate how an EHR will both facilitate and constrain collaboration among specialties and disciplines. Affordances that were inscribed in the system for collaboration purposes were not fully actualized in the hospital because:(a) The EHR helps health professionals coordinate patient care on an informed basis at any time and in any place but only allows asynchronous patient record use.(b) The comprehensive patient file affords joint clinical decision-making based on shared data, but specialty- and discipline-specific user-interfaces constrain mutual understanding of that data. Moreover, not all relevant information can be easily shared across specialties and outside the hospital.(c) The reduced necessity for face-to-face communication saves time but is experienced as hindering collective responsibility for a smooth workflow.(d) The EHR affords registration at the source and registration of activities through orders, but the heightened administrative burden for physicians and the strict authorization rules on inputting data constrain the flexible, multidisciplinary collaboration.(e) While the EHR affords a complete overview, information overload occurs due to the parallel generation of individually owned notes and the high frequency of asynchronous communication through messages of varying clinical priority.ConclusionsFor the optimal actualization of EHRs’ collaborative affordances in hospitals, coordinated use of these affordances by health professionals is a prerequisite. Such coordinated use requires organizational, technical, and behavioral adaptations. Suggestions for hospital-wide policies to enhance trust in both the EHR and in its coordinated use for effective collaboration are offered.
Sequence analysis and pathogenicity of Avian Orthoavulavirus 1 strains isolated from poultry flocks during 2015–2019
Authors: Abd El-Hamid Hatem S. , Shafi Manal E. , Albaqami Najah M. , Ellakany Hany F. , Abdelaziz Naglaa M. , Abdelaziz Mohamed N. , Abd El-Hack Mohamed E. , Taha Ayman E. , Alanazi Khalid M. , Elbestawy Ahmed R. 
Published: July 2020

Abstract
Background
Newcastle disease (ND) causes severe economic losses in poultry industry worldwide. Egyptian poultry industry suffered from severe economic losses since the isolation of Velogenic Newcastle disease virus (vNDV) genotype VIId in 2011 and up till now despite the use of different vaccination programs. So, this study aimed to isolate and characterize the vNDV from a total of 120 poultry flocks from ten provinces in the Egyptian Delta region with a history of respiratory manifestation, high mortalities or a decrease in egg production between 2015 and 2019. Seventy-three samples’ allantoic fluid (73/120, 60.8%) were positive for hemagglutination with chicken RBCs. These samples were submitted to molecular examination using qRT-PCR specific primers for AOAV-1, highly pathogenic avian influenza (HPAI-H5), low pathogenic avian influenza (LPAI-H9) and infectious bronchitis virus (IBV).

Results
Fifty samples (50/120: 41.6%) were confirmed positive for AOAV-1, based on genetic analysis of matrix and fusion protein. The co-infection rate of other respiratory viral diseases examined was 1.6, 14.1, and 4.1%, for HPAI-H5, LPAI-H9, and IBV, respectively. Biologically, the intracerebral pathogenicity index of ten selected AOAV-1 isolates ranged from 1.70 to 1.98, which indicated the velogenic nature of these isolates. All the sixteen sequenced isolates were AOAV-1 genotype VII.1.1. The full F gene sequence of six examined AOAV-1 VII.1.1 isolates contained the seven neutralizing epitopes, and the glycosylation motif of six-potential sites for N linked glycosylation at residues 85, 191, 366, 447, 471, and 541.

Conclusion
It could be concluded that the high prevalence of AOAV-1 genotype VII.1.1 in the Egyptian chicken flocks despite the intensive vaccination with live and killed ND vaccines, as all the 16 isolates tested were belonged to this genotype. Homologous vaccination is badly needed to control and reduce the spread of AOAV-1 genotype VII.1.1infection in Egyptian poultry flocks.
Precision radiotherapy for non-small cell lung cancer
Authors: Yang Wen-Chi , Hsu Feng-Ming , Yang Pan-Chyr 
Published: July 2020

AbstractPrecision medicine is becoming the standard of care in anti-cancer treatment. The personalized precision management of cancer patients highly relies on the improvement of new technology in next generation sequencing and high-throughput big data processing for biological and radiographic information.Systemic precision cancer therapy has been developed for years. However, the role of precision medicine in radiotherapy has not yet been fully implemented. Emerging evidence has shown that precision radiotherapy for cancer patients is possible with recent advances in new radiotherapy technologies, panomics, radiomics and dosiomics.This review focused on the role of precision radiotherapy in non-small cell lung cancer and demonstrated the current landscape.
Continuously available ratio of SpO2/FiO2 serves as a noninvasive prognostic marker for intensive care patients with COVID-19
Authors: Lu Xiaofan , Jiang Liyun , Chen Taige , Wang Yang , Zhang Bing , Hong Yizhou , Wang Jun , Yan Fangrong 
Published: July 2020

Abstract
Rationale
Oxygen saturation to fraction of inspired oxygen ratio (SpO2/FiO2) has been described as potential predictor of poor outcome for COVID-19, without considering its time-varying behavior though.

Methods
Prognostic value of SpO2/FiO2 was evaluated by jointly modeling the longitudinal responses of SpO2/FiO2 and time-to-event data retrieved from 280 severe and critically ill (intensive care) patients with COVID-19.

Results
A sharply decrease of SpO2/FiO2 from the first to second measurement for non-survivors was observed, and a strong association between square root SpO2/FiO2 and mortality risk was demonstrated, with a unit decrease in the marker corresponding to 1.82-fold increase in mortality risk (95% CI: 1.56–2.13).

Conclusions
The current study suggested that SpO2/FiO2 could serve as a non-invasive prognostic marker to facilitate early adjustment for treatment, thus improving overall survival.
Quantifying flight aptitude variation in wild Anopheles gambiae in order to identify long-distance migrants
Authors: Faiman Roy , Yaro Alpha S. , Diallo Moussa , Dao Adama , Djibril Samake , Sanogo Zana L. , Sullivan Margery , Krishna Asha , Krajacich Benjamin J. , Lehmann Tovi 
Published: July 2020

AbstractBackgroundIn the West African Sahel, mosquito reproduction is halted during the 5–7 month-long dry season, due to the absence of surface waters required for larval development. However, recent studies have suggested that bothAnopheles gambiaesensu stricto (s.s.) andAnopheles arabiensisrepopulate this region via migration from distant locations where larval sites are perennial.Anopheles coluzziiengages in more regional migration, presumably within the Sahel, following shifting resources correlating with the ever-changing patterns of Sahelian rainfall. Understanding mosquito migration is key to controlling malaria—a disease that continues to claim more than 400,000 lives annually, especially those of African children. Using tethered flight data of wild mosquitoes, the distribution of flight parameters were evaluated as indicators of long-range migrantsversusappetitive flyers, and the species specific seasonal differences and gonotrophic states compared between two flight activity modalities. Morphometrical differences were evaluated in the wings of mosquitoes exhibiting high flight activity (HFA) vs. low flight activity (LFA).MethodsA novel tethered-flight assay was used to characterize flight in the three primary malaria vectors-An. arabiensis, An. coluzziiandAn. gambiae s.s. The flights of tethered wild mosquitoes were audio-recorded from 21:00 h to 05:00 h in the following morning and three flight aptitude indices were examined: total flight duration, longest flight bout, and the number of flight bouts during the assay.ResultsThe distributions of all flight indices were strongly skewed to the right, indicating that the population consisted of a majority of low-flight activity (LFA) mosquitoes and a minority of high-flight activity (HFA) mosquitoes. The median total flight was 586 s and the maximum value was 16,110 s (~ 4.5 h). In accordance with recent results, flight aptitude peaked in the wet season, and was higher in gravid females than in non-blood-fed females. Flight aptitude was also found to be higher inAn. coluzziicompared toAn. arabiensis, with intermediate values inAn. gambiae s.s., but displaying no statistical difference. Evaluating differences in wing size and shape between LFA individuals and HFA ones, the wing size of HFAAn. coluzziiwas larger than that of LFAs during the wet season—its length was wider than predicted by allometry alone, indicating a change in wing shape. No statistically significant differences were found in the wing size/shape ofAn. gambiae s.s.orAn. arabiensis.ConclusionsThe partial agreement between the tethered flight results and recent results based on aerial sampling of these species suggest a degree of discrimination between appetitive flyers and long-distance migrants although identifying HFAs as long-distance migrants is not recommended without further investigation.