bluuebunny/crossref_metadata_2025_split huggingface dataset:
Understanding health professional role integration in complex adaptive systems A multiple-case study of Physician Assistants in Ontario, Canada
Authors: Burrows Kristen , Abelson Julia , Miller Patricia , Levine Mitch , Vanstone Meredith 
Published: January 2020

Abstract
Background

To meet the complex needs of healthcare delivery, the Ministry of Health and Long Term Care (MOHLTC) introduced Physician Assistants (PAs) into the Ontario health care system in 2006 to help increase access to care, decrease wait times, and improve continuity of care. Integration of new health professional roles is often stymied by role resistance and funding barriers. The characterization of healthcare organizations as complex adaptive systems (CAS) may offer insight into the relationships and interactions that optimize and restrict successful PA integration. The aim of this study is to explore the integration of PAs across multiple settings and to understand the PA role within complex adaptive systems.

Methods

An exploratory, multiple-case study was used to examine PA role integration in four settings: family medicine, emergency, general surgery, and inpatient medicine. Interviews were conducted with 46 healthcare providers and administrators across 13 hospitals and 6 family medicine clinics in Ontario, Canada. Analysis was conducted in three phases: inductive thematic analysis within each of the four cases; a cross-case thematic analysis; and a broader exploration of cross-case patterns pertaining to specific complexity theory principles of interest.

Results

Support for PA contributions across various health care settings, the importance of role awareness, supervisory relationship attributes, and role vulnerability (in relation to sustainability and funding) are interconnected and dynamic in hospital and community settings. Findings represent the experiences of PAs and other healthcare providers, and demonstrate how the PA’s willingness to work and ability to build relationships within existing health systems allows for the establishment of interprofessional, collaborative, and person-centered care. As a self-organizing agent in complex adaptive systems (i.e. health organizations), PA role exploration revealed patterns of team behavior, non-linear interconnections, open relationships, dynamic systems, and the legacy of role implementation as defined by complexity theory.

Conclusions

By exploring the role of PAs across multiple sites, the complexity theory lens concurrently fosters an awareness of emerging patterns, relationships and non-linear interactions within the defined context of the Ontario healthcare system. By establishing collaborative, interprofessional care models in community and hospital settings, PAs are making a significant contribution to Ontario healthcare settings.
Birth order is associated with caries development in young children: a register-based cohort study
Authors: Julihn Annika , Soares Fernanda Cunha , Hammarfjord Ulrika , Hjern Anders , Dahllöf Göran 
Published: January 2020

Abstract
Background: Birth order has been shown to affect the health of the child; less is known, however, about how birth order affects caries development in children. Thus, the present study investigated the association between birth order and dental caries development in young children. Methods: This retrospective registry-based cohort study included all children born in 2000–2003 who were residing in Stockholm County, Sweden, at age 3 years (n = 83,147). The study followed the cohort until subjects reached 7 years of age. Children with registry data on dental examinations and sociodemographic characteristics at ages 3- and 7 years constituted the final study cohort (n = 65,259). The outcome variable was “caries increment from age 3- to 7 years” (Δdeft > 0) and the key exposure, “birth order”, was divided into five groups. A forward stepwise logistic binary regression was done for the multivariate analysis with adjustments for sociodemographic factors. Results: At age 3 years, 94% had no fillings or manifest caries lesions. During the study period, 22.5% (n = 14,711) developed dental caries. The final logistic regression analysis found a statistically significant positive association between birth order and caries increment. Further, excess risk increased with higher birth order; with the mother’s first-born child as reference, risk for the second-born child was OR 1.17, 95% CI=1.12–1.23; for the third-born child, OR 1.47, 95% CI=1.38–1.56; for the fourth-born child, OR 1.69, 95% CI=1.52–1.88; and for the fifth-born or higher birth-order child, OR 1.84, 95% CI=1.58–2.14. Conclusions: These findings show that birth order influences caries development in siblings, suggesting that birth order can be regarded as a predictor for caries development in young children. This factor may be helpful in assessing caries risk in preschool children and should be considered in caries prevention work in young children with older siblings.
Coronary heart disease mortality is decreasing in Argentina and Colombia, but keeps increasing in Mexico: a time trend study
Authors: Arroyo-Quiroz Carmen , Barrientos-Gutierrez Tonatiuh , O'Flaherty Martin , Guzman-Castillo Maria , Mejia Lina Sofia Palacio , Saldarriaga Elkin de Jesus Osorio , Rodriguez Andrea Yanira Rodriguez 
Published: January 2020

Abstract
Background: Mortality rates due to coronary heart disease (CHD) have decreased in most countries, but increased in low and middle-income countries. Few studies have analyzed the trends of coronary heart disease mortality in Latin America, specifically the trends in young-adults and the effect of correcting these comparisons for nonspecific causes of death (garbage codes). Objective: To describe and compare standardized, age-specific, and garbage-code corrected mortality trends for coronary heart disease from 1985 to 2015 in Argentina, Colombia, and Mexico. Methods: Deaths from coronary heart disease were grouped by country, year of registration, sex, and 10-year age bands to calculate age-adjusted and age and sex-specific rates for adults aged ≥25. We corrected for garbage-codes using the methodology proposed by the Global Burden of Disease. Finally, we fitted Joinpoint regression models. Results: In 1985, age-standardized mortality rates per 100,000 population were 136.6 in Argentina, 160.6 in Colombia, and 87.51 in Mexico; by 2015 rates decreased 51% in Argentina and 6.5% in Colombia, yet increased by 61% in Mexico, where an upward trend in mortality was observed in young adults. Garbage-code corrections produced increases in mortality rates, particularly in Argentina with approximately 80 additional deaths per 100,000, 14 in Colombia and 13 in Mexico. Conclusions: Latin American countries are at different stages of the cardiovascular disease epidemic. Garbage code correction produce large changes in the mortality rates in Argentina, yet smaller in Mexico and Colombia, suggesting garbage code corrections may be needed for specific countries. While coronary heart disease (CHD) mortality is falling in Argentina, modest falls in Colombia and substantial increases in Mexico highlight the need for the region to propose and implement population-wide prevention policies.
1-1-8 one-step sevoflurane wash-in scheme for low-flow anesthesia: simple, rapid, and predictable induction
Authors: Tribuddharat Sirirat , Sathitkarnmanee Thepakorn , Vattanasiriporn Naruemon , Thananun Maneerat , Nonlhaopol Duangthida , Somdee Wilawan 
Published: January 2020

Abstract
Background Sevoflurane is suitable for low-flow anesthesia (LFA). LFA needs a wash-in phase. The reported sevoflurane wash-in schemes lack simplicity, target coverage, and applicability. We proposed a one-step 1-1-8 wash-in scheme for sevoflurane LFA to be used with both N 2 O and Air. The objective of our study was to identify time for achieving each level of alveolar concentration of sevoflurane (F A S) from 1% to 3.5% in both contexts. Methods We recruited 199 adults requiring general anesthesia with endotracheal intubation and controlled ventilation—102 in group N 2 O and 97 in group Air. After induction and intubation, a wash-in was started using a fresh gas flow of O 2 :N 2 O or O 2 :Air at 1:1 L·min -1 plus sevoflurane 8%. The ventilation was controlled to maintain end-tidal CO 2 of 30-35 mmHg. Results The rising patterns of F A S and inspired concentration of sevoflurane (F I S) are similar, running parallel between the groups. The F A S/F I S ratio increased from 0.46 to 0.72 within 260 sec in group N 2 O and from 0.42 to 0.69 within 286 sec in group Air. The respective time to achieve an F A S of 1%, 1.5%, 2%, 2.5%, 3%, and 3.5% was 1, 1.5, 2, 3, 3.5, and 4.5 min in group N 2 O and 1, 1.5, 2, 3, 4, and 5 min in group Air. The heart rate and blood pressure of both groups significantly increased initially then gradually decreased as F A S increased. Conclusions The 1-1-8 wash-in scheme for sevoflurane LFA has many advantages, including simplicity, coverage, swiftness, safety, economy, and that it can be used with both N 2 O and Air. A respective F A S of 1%, 1.5%, 2%, 2.5%, 3%, and 3.5% when used with N 2 O and Air can be expected at 1, 1.5, 2, 3, 3.5, and 4.5 min and 1, 1.5, 2, 3, 4, and 5 min.
Identification and characterization of circRNAs in the skin during wool follicle development in Aohan fine wool sheep
Authors: Zhao Ranran , Liu Nan , Han Fuhui , Li Hegang , Liu Jifeng , Li Lanlan , Wang Guoyi , He Jianning 
Published: January 2020

Abstract
Background: Aohan fine wool sheep (AFWS) is a historically bred fine wool sheep, cultivated in China. The wool has excellent quality and good textile performance. Investigating the molecular mechanisms that regulate wool growth is important to improve wool quality and yield. Circular RNAs (circRNAs) are non-coding RNAs that are widely expressed, and can act as a competitive endogenous RNAs (ceRNAs) to bind to miRNAs. Although circRNAs have been studied in many fields, research on their activity in sheep wool follicles is limited. To understand the regulation of circRNAs in the growth of fine wool in sheep, we used RNA-seq to identify circRNAs in sheep shoulder skin samples at three developmental stages: embryonic day 90 (E90d), embryonic day 120 (E120d), and at birth (Birth).

Results: We identified 8,753 circRNAs and found that 918 were differentially-expressed. We then analyzed the classification and characteristic of the circRNAs in sheep shoulder skin. Using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG), we identified the source genes of circRNAs, which were mainly enriched in cellular component organization, regulation of primary metabolic processes, tight junctions, and the cGMP-PKG and AMPK signaling pathways. In addition, we predict interactions between 17 circRNAs and eight miRNAs, using miRanda software. Based on the significant pathways, we speculate that circ_0005720, circ_0001754, circ_0008036, circ_0004032, circ_0005174, circ_0005519, circ_0007826 might play an important role in regulating wool follicle growth in AFWS. Seven circRNAs were randomly selected, and have validated the results of the RNA-seq by qRT-PCR.

Conclusion: Our results provide more information about circRNAs in regulating wool follicle development in AFWS, and establish a solid foundation for future research.
Health Assets and Frailty: Positive Psychosocial Resources and Health Status in Older Adult, a Prospective Cohort Study
Authors: Gregorevic Kate , Hubbard Ruth E , Peel Nancye M , Lau Wei Tong , Wu Jethro , Crammond Bradley , Lim Wen Kwang 
Published: January 2020

Abstract
Background: Although frailty is predictive of poorer outcomes for hospitalised older adults, it does not account for all variation in outcomes. Health assets are protective factors associated with wellbeing that may moderate frailty associated mortality and functional decline
Objective: To determine whether frail older adults with a higher number of health assets have improved outcomes
Design: Prospective cohort study
Methods: Adults aged 70 and older with an unplanned admission to hospital were included. Recruitment took place on general medical, orthogeriatric and subacute wards of two hospitals in Australia. The Health Assets Index (HAI), frailty, functional status and covariates were measured at the time of recruitment. Outcomes were mortality at 30 days and functional decline at the time of discharge.
Results: There were 298 participants, with an average age of 84.7 and 66% were women. 80.1% were frail. The mean score on the HAI was 10.86 with a range of 5.5-15. 56.4% of participants had functional decline on discharge from hospital with 30 day mortality of 5.7%. There was an inverse relationship between frailty and health assets. Neither frailty or a higher number of health assets alone predicted outcomes. In a post-hoc analysis to account for interaction, a higher number of health assets was protective against mortality for the least frail. This relationship was reversed at higher levels of frailty.
Conclusions: A higher number of Health Assets correlated with a lower level of frailty. Although Health Assets alone did not predict mortality, this relationship may be moderated by frailty.
Identification of miRNA-mRNA associations in hepatocellular carcinoma using hierarchical integrative model
Authors: Varghese Rency S. , Zhou Yuan , Barefoot Megan , Chen Yifan , Poto Cristina Di , Balla Abdalla Kara , Oliver Everett , Sherif Zaki A. , Kumar Deepak , Kroemer Alexander H. , Tadesse Mahlet G. , Ressom Habtom 
Published: January 2020

Abstract
Background : The established role miRNA-mRNA regulation of gene expression has in oncogenesis highlights the importance of integrating miRNA with downstream mRNA targets. These findings call for investigations aimed at identifying disease-associated miRNA-mRNA pairs. Hierarchical integrative models (HIM) offer the opportunity to uncover the relationships between disease and the levels of different molecules measured in multiple omic studies.
Results: mRNA-seq and miRNA-seq data were acquired by analysis of tumor and normal liver tissues from 30 patients with hepatocellular carcinoma (HCC). We analyzed the data using HIM and identified 157 significant miRNA-mRNA pairs in HCC. The majority of these molecules have already been independently identified as being either diagnostic, prognostic, or therapeutic biomarker candidates for HCC. These pairs appear to be involved in processes contributing to the pathogenesis of HCC involving inflammation, regulation of cell cycle, apoptosis, and metabolism. For further evaluation of our method, we analyzed miRNA-seq and mRNA-seq data from TCGA network. While some of the miRNA-mRNA pairs we identified by analyzing both our and TCGA data are previously reported in the literature and overlap in regulation and function, new pairs have been identified that may contribute to the discovery of novel targets.
Conclusion: The results strongly support the hypothesis that miRNAs are important regulators of mRNAs in HCC. Furthermore, these results emphasize the biological relevance of studying miRNA-mRNA pairs.
Inhibition of adenosine A1 receptors abolished the nutritional ketosis-evoked delay in the onset of isoflurane-induced anesthesia in Wistar Albino Glaxo Rijswijk rats
Authors: Kovács Zsolt , Brunner Brigitta , D'Agostino Dominic P. , Ari Csilla 
Published: January 2020

Abstract
Background: It has been demonstrated that administration of exogenous ketone supplement ketone salt (KS) and ketone ester (KE) increased blood ketone level and delayed the onset of isoflurane-induced anesthesia in different rodent models, such as Wistar Albino Glaxo Rijswijk (WAG/Rij) rats. The modulatory effect of adenosinergic system may have a role in the ketone supplementation-evoked effects on isoflurane-generated anesthesia. Thus, we investigated whether adenosine receptor antagonists can modulate the effect of exogenous ketone supplements on the onset of akinesia induced by isoflurane.
Methods: To investigate the effect of exogenous ketone supplements on anesthetic induction we used ketone supplement KE, KS, KEKS (1:1 mix of KE and KS), KSMCT and KEMCT (1:1 mix of KS and KE with medium chain triglyceride/MCT oil, respectively) in WAG/Rij rats. Animals were fed with standard diet (SD), which was supplemented by oral gavage of different ketone supplements (2.5 g/kg/day) for 1 week. After 7 days, isoflurane (3%) was administered for 5 min and the time until onset of isoflurane-induced anesthesia (time until immobility; light phase of anesthesia: loss of consciousness without movement) was measured. Changes in levels of blood β-hydroxybutyrate (βHB), blood glucose and body weight of animals were also recorded. To investigate the putative effects of adenosine receptors on ketone supplements-evoked influence on isoflurane-induced anesthesia we used a specific adenosine A1 receptor antagonist DPCPX (intraperitoneally/i.p. 0.2 mg/kg) and a selective adenosine A2A receptor antagonist SCH 58261 (i.p. 0.5 mg/kg) alone as well as in combination with KEKS.
Results: Significant increases were demonstrated in both blood βHB levels and the number of seconds required before isoflurane-induced anesthesia (immobility) after the final treatment by all exogenous ketone supplements. Moreover, this effect of exogenous ketone supplements positively correlated with blood βHB levels. It was also demonstrated that DPCPX completely abolished the effect of KEKS on isoflurane-induced anesthesia (time until immobility), but not SCH 58261.
Conclusions: These findings strengthen our previous suggestion that exogenous ketone supplements may modulate the isoflurane-induced onset of anesthesia (immobility), likely through A1Rs.
Toric Intraocular Lens Implantation in Cataract Patients with Corneal Opacity.
Authors: Ra Ho , Hwang Ho Sik , Kim Hyun Seung , Kim Man Soo , Kim Eun Chul 
Published: January 2020

Abstract
Purpose: To evaluate the effect of toric intraocular lens implantation in cataract patient with corneal opacity and high astigmatism.

Methods: 31 eyes of 31 patients who underwent cataract surgery with toric intraocular lens implantation were included. All patients had corneal opacity with astigmatism. Preoperative total corneal astigmatism was determined considering posterior astigmatism using a rotating Scheimpflug camera (Pentacam®: Oculus, Wetzlar, Germany). At 2 months after toric intraocular lens implantation, we evaluated residual astigmatism, uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA).

Results: Postoperative UCVA and BCVA (0.30 ± 0.17, 0.22 ± 0.16LogMAR) statistically improved compared to preoperative UCVA and BCVA (1.2 ± 0.34, 1.1 ± 0.30LogMAR, respectively) (P<0.01). Postoperative residual refractive astigmatism (1.2 ± 0.35D) was statistically reduced compared to preoperative refractive astigmatism (2.4 ± 0.65D) (P<0.05). Preoperative and postoperative total corneal astigmatism values were not statistically different. All eyes achieved postoperative visual acuity as good as or better than preoperative one. The size of corneal opacity covering pupil had significant negative correlation with postoperative UCVA and BCVA (logMAR) (R=0.91 P<0.05 and R=0.92 P<0.05, respectively)

Conclusion: Toric intraocular lens implantation can improve UCVA, BCVA, and refractive astigmatism in cataract patient with corneal opacity. The size of corneal opacity covering pupil is the major prognostic factor for postoperative visual improvement. Therefore, toric intraocular lens implantation should be considered for cataract patients who have corneal opacity with high astigmatism.
Molecular characterization and transcriptional profiling suggested structural and functional divergence in ascorbate peroxidase (APX) and APX-related (APX-R) genes in Triticum aestivum L.
Authors: Tyagi Shivi , . Shumayla , Verma Praveen Chandra , Singh Kashmir , Upadhyay Santosh Kumar 
Published: January 2020

Abstract
The authors have withdrawn this preprint from Research Square
A systematic review of studies describing the influence of informal social support on psychological wellbeing in people bereaved by sudden or violent causes of death
Authors: Scott Hannah Rachel , Pitman Alexandra , Kozhuharova Petya , Lloyd-Evans Brynmor 
Published: January 2020

Abstract
Aims Whilst any type of bereavement can be traumatic, bereavement through violent or sudden causes is associated with more severe negative health and wellbeing outcomes compared to other types of loss. Social support has been found to have a positive impact on wellbeing after traumatic events in general. However, this association appears to be less consistently demonstrated in studies that focus on bereavement, and the literature in this area has not yet been systematically reviewed. This study aimed to review the international literature to examine systematically whether there is an association between informal social support from family and friends after bereavement through sudden and/or violent causes and post-bereavement wellbeing. Methods We conducted a systematic search for quantitative studies that tested for an association between social support and any outcome related to wellbeing after a sudden and/or violent loss. Included studies were assessed for risk of bias, and findings were reported using the approach of narrative synthesis. The review was pre-registered on Prospero (registration number CRD42018093704). Results We identified 16 papers that met inclusion criteria, all of which we assessed as having generally low or moderate risk of bias. 15 different wellbeing outcomes were measured across all studies. We found consistent evidence for an inverse association between social support and symptoms/presence of depression, predominantly consistent evidence for an inverse association between social support and symptoms/presence of post-traumatic stress disorder (PTSD), and conflicting evidence for an inverse association between social support and symptoms/presence of complicated grief. Conclusions Our systematic review identified evidence to suggest that social support after sudden or violent bereavement is associated with a reduced severity of depressive and PTSD symptoms. Further longitudinal research is needed to explore potential causality in this relationship, widening the focus from common mental disorders to include other mental illnesses, wellbeing outcomes, and suicide-related outcomes after bereavement. There is also a need for consensus on the conceptualisation and measurement of social support. Our findings imply that interventions to improve access to and quality of social support may reduce the burden of mental illness after bereavement, and may therefore be worth investing in.