bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retention and outcomes for clients attending a methadone clinic in a resource-constrained setting: a mixed methods prospective cohort study in Imphal, Northeast India
Authors: Kermode Michelle , Choudhurimayum Robedi Sharma , Rajkumar Lenin Singh , Haregu Tilahun , Armstrong Greg 
Published: September 2020

Abstract
Background
Opioid substitution therapy (OST) with buprenorphine has been widely available in India since 2007, but the introduction of methadone occurred much later in 2012, and availability remains limited. Illicit injecting drug use is a long-standing public health problem in Manipur, a state in Northeast India characterised by major resource constraints and political unrest. We investigated retention and outcomes for clients attending a methadone-based OST program in Manipur with the aim of strengthening the evidence base for development of relevant policies and programs.

Methods
All clients enrolling in the methadone clinic over a 1 year period were invited to be part of a prospective cohort study, which followed up and surveyed both retained and defaulting clients for 12 months post-enrollment to assess retention as well as social, behavioural and mental health outcomes. Additionally, we conducted semi-structured qualitative interviews to supplement quantitative information and identify factors contributing to retention and drop-out.

Results
Of the 74 clients enrolled, 21 had dropped out and three had died (all defaulters) by 12 months post-enrollment, leaving 67.6% still in the program. Using an intention-to-treat analysis, meaningful and statistically significant gains were observed for all social, behavioural and mental health variables. Between baseline and 12 months there were reductions in needle sharing, drug use, property crime, anxiety, depression and suicidal thoughts; and improvements in physical health, mental health, quality of family relationships, employment and hopefulness. Factors contributing to retention and drop-out were identified, including the centrality of family, and general lack of awareness of and misunderstanding about methadone.

Conclusion
Even in parts of India where resources are constrained, methadone is an effective treatment for opioid dependence. Scaling up the availability of methadone elsewhere in Manipur and in other areas of India experiencing problematic opioid dependence is indicated.
Flipping the paradigm: a qualitative exploration of research translation centres in the United Kingdom and Australia
Authors: Robinson Tracy , Skouteris Helen , Burns Prue , Melder Angela , Bailey Cate , Croft Charlotte , Spyridonidis Dmitrios , Teede Helena 
Published: September 2020

Abstract
Background
Over the past decade, Research Translation Centres (RTCs) have been established in many countries. These centres (sometimes referred to as Academic Health Science Centres) are designed to bring universities and healthcare providers together in order to accelerate the generation and translation of new evidence that is responsive to health service and community priorities. This has the potential to effectively ‘flip’ the traditional research and education paradigms because it requires active participation and continuous engagement with stakeholders (especially service users, the community and frontline clinicians). Although investment and expectations of RTCs are high, the literature confirms a need to better understand the processes that RTCs use to mobilise knowledge, build workforce capacity, and co-produce research with patients and the public to ensure population impact and drive healthcare improvement.

Methods
Semi-structured interviews were conducted with selected leaders and members from select RTCs in England and Australia. Convenience sampling was utilised to identify RTCs, based on their geography, accessibility and availability. Purposive sampling and a snowballing approach were employed to recruit individual participants for interviews, which were conducted face to face or via videoconferencing. Interviews were recorded, transcribed verbatim and analysed using a reflexive and inductive approach. This involved two researchers comparing codes and interrogating themes that were analysed inductively against the study aims and through meetings with the research team.

Results
A total of 41 participants, 22 from England and 19 from Australia were interviewed. Five major themes emerged, including (1) dissonant metrics, (2) different models of leadership, (3) public and patient involvement and research co-production, (4) workforce development and (5) barriers to collaboration.

Conclusions
Participants identified the need for performance measures that capture community impact. Better aligned success metrics, enhanced leadership, strategies to partner with patients and the public, enhanced workforce development and strategies to enhance collaboration were all identified as crucial for RTCs to succeed.
Cost-utility analysis of cardiovascular outpatient rehabilitation care and spa treatment care for patients with heart disease
Authors: Gajdoš Ondřej , Kamenský Vojtěch , Doskočilová Kristýna , Caithamlová Martina , Kubátová Ivana 
Published: September 2020

Abstract
Background
Cardiovascular diseases have the highest mortality rates and the costs for treatment are very high so far. Cardiovascular rehabilitation helps to reduce the risk of relapses or deterioration of cardiovascular diseases, however, the number of patients that participate is insufficient, especially in later stages of the rehabilitation process. The aim of the study is to evaluate cost-effectiveness of cardiovascular rehabilitation care using cost-utility analysis.

Methods
The study evaluate the Cardio ambulance Late Phase, Late Phase of The Spa treatment and for comparison also Early Phase of The Spa treatment in Konstantin Spa. The research was conducted in outpatient facility and spa facility. For QALY, a prospective questionnaire survey was conducted in patients with cardiovascular disease using generic EQ-5D-5L questionnaires. The costs were calculated from the perspective of the health care payer. The cost-utility analysis was carried out at the end of the study and results are presented in incremental cost-utility ratio.

Results
The average cost per patient in outpatient facility is CZK 12,459. The average amount for an overall early phase of spa treatment per patient is CZK 35,161. The average amount for an overall late phase spa treatment per patient is CZK 30,503. QALY obtained from Index Value was 0.092 (Konstantin Spa Early Phase), 0.054 (Konstantin Spa Late Phase), 0.26 (Cardio ambulance Late Phase). For Konstantin Spa Late Phase, the ICUR value was 644,436 and for Konstantin Spa Early Phase was 343,981 (comparator is the Cardio ambulance Late Phase). Konstantin Spa Early Phase compared to Konstantin Spa Late Phase had an ICUR value of 122,592.

Conclusions
The results of this study suggest that the spa treatment in later stage of the cardiovascular rehabilitation process is cost effective with use of cost effectiveness threshold three times the Gross Domestic Product (GDP) per capita.
Dose response of a novel exogenous ketone supplement on physiological, perceptual and performance parameters
Authors: Prins Philip J. , D’Agostino Dominic P. , Rogers Christopher Q. , Ault Dana L. , Welton Gary L. , Jones Dalton W. , Henson Samuel R. , Rothfuss Tyler J. , Aiken Kylie G. , Hose Jantzen L. , England Emilia L. , Atwell Adam D. , Buxton Jeffrey D. , Koutnik Andrew P. 
Published: September 2020

Abstract
Background
Interest into the health, disease, and performance impact of exogenous ketone bodies has rapidly expanded due to their multifaceted physiological and signaling properties but limiting our understanding is the isolated analyses of individual types and dose/dosing protocols.

Methods
Thirteen recreational male distance runners (24.8 ± 9.6 years, 72.5 ± 8.3 kg, VO2max 60.1 ± 5.4 ml/kg/min) participated in this randomized, double-blind, crossover design study. The first two sessions consisted of a 5-km running time trial familiarization and a VO2max test. During subsequent trials, subjects were randomly assigned to one (KS1: 22.1 g) or two (KS2: 44.2 g) doses of beta-hydroxybutyrate (βHB) and medium chain triglycerides (MCTs) or flavor matched placebo (PLA). Blood R-βHB, glucose, and lactate concentrations were measured at baseline (0-min), post-supplement (30 and 60 min), post-exercise (+ 0 min, + 15 min). Time, heart rate (HR), rating of perceived exertion (RPE), affect, respiratory exchange ratio, oxygen consumption (VO2), carbon dioxide production, and ventilation were measured during exercise. Cognitive performance was evaluated prior to and post-exercise.

Results
KS significantly increased R-βHB, with more potent and prolonged elevations in KS2, illustrating an administrative and dosing effect. R-βHB was significantly decreased in KS1 compared to KS2 illustrating a dosing and exercise interaction effect. Blood glucose elevated post-exercise but was unchanged across groups. Blood lactate significantly increased post-exercise but was augmented by KS administration. Gaseous exchange, respiration, HR, affect, RPE, and exercise performance was unaltered with KS administration. However, clear responders and none-responders were indicated. KS2 significantly augmented cognitive function in pre-exercise conditions, while exercise increased cognitive performance for KS1 and PLA to pre-exercise KS2 levels.

Conclusion
Novel βHB + MCT formulation had a dosing effect on R-βHB and cognitive performance, an administrative response on blood lactate, while not influencing gaseous exchange, respiration, HR, affect, RPE, and exercise performance.
The microvascular extracellular matrix in brains with Alzheimer’s disease neuropathologic change (ADNC) and cerebral amyloid angiopathy (CAA)
Authors: Damodarasamy Mamatha , Vernon Robert B. , Pathan Jasmine L. , Keene C. Dirk , Day Anthony J. , Banks William A. , Reed May J. 
Published: September 2020

Abstract
Background
The microvasculature (MV) of brains with Alzheimer’s disease neuropathologic change (ADNC) and cerebral amyloid angiopathy (CAA), in the absence of concurrent pathologies (e.g., infarctions, Lewy bodies), is incompletely understood.

Objective
To analyze microvascular density, diameter and extracellular matrix (ECM) content in association with ADNC and CAA.

Methods
We examined samples of cerebral cortex and isolated brain microvasculature (MV) from subjects with the National Institute on Aging-Alzheimer's Association (NIA-AA) designations of not-, intermediate-, or high ADNC and from subjects with no CAA and moderate-severe CAA. Cases for all groups were selected with no major (territorial) strokes, ≤ 1 microinfarct in screening sections, and no Lewy body pathology. MV density and diameter were measured from cortical brain sections. Levels of basement membrane (BM) ECM components, the protein product of TNF-stimulated gene-6 (TSG-6), and the ubiquitous glycosaminoglycan hyaluronan (HA) were assayed by western blots or HA ELISA of MV lysates.

Results
We found no significant changes in MV density or diameter among any of the groups. Levels of BM laminin and collagen IV (col IV) were lower in MV isolated from the high ADNC vs. not-ADNC groups. In contrast, BM laminin was significantly higher in MV from the moderate-severe CAA vs. the no CAA groups. TSG-6 and HA content were higher in the presence of both high ADNC and CAA, whereas levels of BM fibronectin and perlecan were similar among all groups.

Conclusions
Cortical MV density and diameter are not appreciably altered by ADNC or CAA. TSG-6 and HA are increased in both ADNC and CAA, with laminin and col IV decreased in the BM of high ADNC, but laminin increased in moderate-severe CAA. These results show that changes in the ECM occur in AD and CAA, but independently of one another, and likely reflect on the regional functioning of the brain microvasculature.
Occupational exposure to carbon black nanoparticles increases inflammatory vascular disease risk: an implication of an ex vivo biosensor assay
Authors: Tang Jinglong , Cheng Wenting , Gao Jinling , Li Yanting , Yao Ruyong , Rothman Nathaniel , Lan Qing , Campen Matthew J. , Zheng Yuxin , Leng Shuguang 
Published: September 2020

Abstract
Background
Among manufactured or engineered nanoparticles, carbon black (CB) has largest production worldwide and is also an occupational respiratory hazard commonly seen in rubber industry. Few studies have assessed the risk for cardiovascular disease in carbon black exposed populations. An endothelial biosensor assay was used to quantify the capacity of sera from 82 carbon black packers (CBP) and 106 non-CBPs to induce endothelial cell activation ex vivo. The mediation effect of circulatory proinflammatory factors on the association between carbon black exposure and endothelial cell activation was assessed and further validated using in vitro intervention experiments.

Results
The average elemental carbon level inside carbon black bagging facilities was 657.0 μg/m3, which was 164-fold higher than that seen in reference areas (4.0 μg/m3). A global index was extracted from mRNA expression of seven candidate biosensor genes using principal component analysis and used to quantify the magnitude of endothelial cell activation. This global index was found to be significantly altered in CBPs compared to non-CBPs (P < 0.0001), however this difference did not vary by smoking status (P = 0.74). Individual gene analyses identified that de novo expression of key adhesion molecules (e.g., ICAM and VCAM) and chemotactic factors (e.g., CCL2, CCL5, and CXCL8) responsible for the recruitment of leukocytes was dramatically induced in CBPs with CXCL8 showing the highest fold of induction (relative quantification = 9.1, P < 0.0001). The combination of mediation analyses and in vitro functional validation confirmed TNF-α, IL-1β, and IL-6 as important circulatory factors mediating the effects of carbon black exposure on endothelial cell activation responses.

Conclusions
Inflammatory mediators in sera from CBPs may bridge carbon black exposure and endothelial cell activation response assessed ex vivo. CBPs may have elevated risk for cardiovascular diseases when comorbidity exists. Our study may serve as a benchmark for understanding health effects of engineered carbon based nanoparticles with environmental and occupational health relevance.
The prevalence of sleep disturbances among physicians and nurses facing the COVID-19 patients: a systematic review and meta-analysis
Authors: Salari Nader , Khazaie Habibolah , Hosseinian-Far Amin , Ghasemi Hooman , Mohammadi Masoud , Shohaimi Shamarina , Daneshkhah Alireza , Khaledi-Paveh Behnam , Hosseinian-Far Melika 
Published: September 2020

Abstract
Background
In all epidemics, healthcare staff are at the centre of risks and damages caused by pathogens. Today, nurses and physicians are faced with unprecedented work pressures in the face of the COVID-19 pandemic, resulting in several psychological disorders such as stress, anxiety and sleep disturbances. The aim of this study is to investigate the prevalence of sleep disturbances in hospital nurses and physicians facing the COVID-19 patients.

Method
A systematic review and metanalysis was conducted in accordance with the PRISMA criteria. The PubMed, Scopus, Science direct, Web of science, CINHAL, Medline, and Google Scholar databases were searched with no lower time-limt and until 24 June 2020. The heterogeneity of the studies was measured using I2 test and the publication bias was assessed by the Egger’s test at the significance level of 0.05.

Results
The I2 test was used to evaluate the heterogeneity of the selected studies, based on the results of I2 test, the prevalence of sleep disturbances in nurses and physicians is I2: 97.4% and I2: 97.3% respectively. After following the systematic review processes, 7 cross-sectional studies were selected for meta-analysis. Six studies with the sample size of 3745 nurses were examined in and the prevalence of sleep disturbances was approximated to be 34.8% (95% CI: 24.8-46.4%). The prevalence of sleep disturbances in physicians was also measured in 5 studies with the sample size of 2123 physicians. According to the results, the prevalence of sleep disturbances in physicians caring for the COVID-19 patients was reported to be 41.6% (95% CI: 27.7-57%).

Conclusion
Healthcare workers, as the front line of the fight against COVID-19, are more vulnerable to the harmful effects of this disease than other groups in society. Increasing workplace stress increases sleep disturbances in the medical staff, especially nurses and physicians. In other words, increased stress due to the exposure to COVID-19 increases the prevalence of sleep disturbances in nurses and physicians. Therefore, it is important for health policymakers to provide solutions and interventions to reduce the workplace stress and pressures on medical staff.
Expanding the reach: ethnobotanical knowledge and technological intensification in beekeeping among the Ogiek of the Mau Forest, Kenya
Authors: Zocchi Dauro Mattia , Volpato Gabriele , Chalo Duncan , Mutiso Patrick , Fontefrancesco Michele Filippo 
Published: September 2020

Abstract
Background
Initiatives for beekeeping intensification across the tropics can foster production and income, but the changes triggered by the introduction of modern beehives might permeate traditional knowledge and practices in multiple ways, and as such should be investigated and understood. We conducted an ethnobotanical study in the Eastern part of the Mau Forest among Ogiek beekeepers who customarily practice forest beekeeping and who are involved in a project aimed at the modernization of their beekeeping activities. We aimed to document the beekeeping-associated ethnobotanical knowledge, exploring the relationships and complementarity between modern and traditional knowledge and practices.

Methods
Field research was carried out through semi-structured interviews with 30 Ogiek beekeepers and 10 additional stakeholders. We collected ethnobotanical data about plants used for beekeeping purposes, and ethnographic information on traditional and modern beekeeping systems.

Results
We report 66 plant species, distributed across 36 botanical families representing 58 genera, important as melliferous, for the construction and placing of hives, attracting bees, and harvesting and storing honey. Dombeya torrida (J.F.Gmel.) Bamps, Juniperus procera Hochst. ex Endl., and Podocarpus latifolius (Thunb.) R.Br. ex Mirb. are the species with the most mentions and the highest number of uses. Our study reveals that the Ogiek possess a detailed knowledge of the forest’s flora, its importance and uses and that this knowledge underpins beekeeping practices. Under the influence of external actors, the Ogiek have progressively adopted modern versus traditional log hives and moved beekeeping out of the forest into open areas of pastures and crop fields. Beekeepers are also experimenting with combinations of practices borrowed from modern and traditional beekeeping systems, particularly in the field of hive construction and in the criteria to set up apiaries.

Conclusions
The study indicates a complementarity and an incipient hybridization of traditional and modern beekeeping, in a way that suggests that modern beehives are instrumental in expanding the reach of beekeeping into deforested and cultivated areas. The study also points to the existence of a rift in the effects of beekeeping intensification on the livelihoods of the Ogiek and on their relationship with the forest. We argue that this intensification might be improving the former but weakening the latter, carrying the associated risk of erosion of traditional forest-based ethnobotanical knowledge.
Comparison of unilateral and bilateral polymethylmethacrylate-augmented cannulated pedicle screw fixation for the management of lumbar spondylolisthesis with osteoporosis
Authors: Liu Yao-yao , Xiao Jun , Jin Huai-jian , Wang Zhong , Yin Xiang , Liu Ming-yong , Zhao Jian-hua , Liu Peng , Dai Fei 
Published: September 2020

Abstract
Background
Cannulated pedicle screw (CPS) augmented by polymethylmethacrylate (PMMA) can achieve satisfactory clinical efficacy in the treatment of lumbar spondylolisthesis with osteoporosis. However, accurate application of CPSs will help to avoid the difficulty of screw revision and reduce the incidence of PMMA-related complications. This study aimed to investigate the mid-term efficacy of CPS compared to unilateral and bilateral applications in this common lumbar degenerative disease.

Methods
May 2011 and May 2018, 50 patients with lumbar spondylolisthesis with osteoporosis who underwent posterior fixation and fusion using traditional pedicle screws or CPSs were included in the study. Patients were divided into two groups based on the application: the unilateral PMMA-augmented CPS group (UC, n = 29) and the bilateral PMMA-augmented CPS group (BC, n = 21). Operation time, blood loss, average hospitalization time, PMMA leakage, and other complications were recorded. The visual analog scale (VAS) and Oswestry disability index (ODI) scores were used to evaluate symptom recovery. Radiographic results were compared for intervertebral fusion and screw loosening.

Results
There were no significant differences in the baseline data of the two groups.
The VAS and ODI scores improved significantly after surgery (P < 0.05), with no significant differences between the groups (P > 0.05). The operation time and blood loss in the UC group were significantly lower than those in the BC group (P < 0.05). However, the loss of intervertebral disk height and Taillard index did not differ significantly between the groups. The rates of PMMA leakage in the UC and BC groups were 7.0% and 11.9%, respectively (P < 0.05). Bony fusion was achieved in all groups without screw loosening at the last follow-up. Only one patient experienced superficial infection in both groups, while cerebrospinal fluid leakage was observed in two patients in the BC group.

Conclusions
Unilateral application of PMMA-augmented CPS may provide adequate clinical safety and effectiveness in the surgical treatment of lumbar spondylolisthesis with osteoporosis.
Clinical variables responsible for early and late diagnosis of foreign body aspiration in pediatrics age group
Authors: Goyal Samarth , Jain Shubhika , Rai Guruprasad , Vishnu Rajkamal , Kamath Ganesh Sevagur , Bishnoi Arvind Kumar , Gaude Yogesh , Kumara Vijaya , Joshi Harshil , Reddy Revanth 
Published: September 2020

Abstract
Background
Incidence of foreign body aspiration has been noticed predominantly in age group ranging from 12 months-3 years. Foreign body in the trachea is a medical emergency as presentation is in respiratory distress. Obstruction of only one main or distal bronchus, leads to severe cough, choking sensation and breathlessness. Without early intervention, it can lead to collapse, consolidation and pneumonia of the affected lung.

Methods
We retrospectively analyzed 37 pediatric case records who presented from January 2014–December 2018 with foreign body aspiration. Our primary aim was to assess the parameters responsible for early and late diagnosis of foreign body aspiration. We concluded with a diagnostic algorithm for management of foreign body aspiration on the basis of this outcome.

Results
Around 32.5% came with a history of aspiration, 43% were referred from the primary centers with a suspicion for the same and the rest came to our tertiary care hospital directly. Those who presented within a week came with complaints of wet cough, wheeze and tachypnea. Furthermore, those who came in after a week had a dry cough and fever as their main complaint. Majority of ingested foreign bodies was a vegetative type (80%) as compared to the non –vegetative.

Conclusion
Unlike adults, foreign body aspiration in children is most commonly diagnosed on history, suspicion and clinical findings. Chest x ray has been the primary investigation of choice but in the majority of the cases it was normal with subtle changes. Early diagnosis is the key to avoid complication.