bluuebunny/crossref_metadata_2025_split huggingface dataset:
Data quality of the routine health management information system at the primary healthcare facility and district levels in Tanzania
Authors: RUMISHA SUSAN F. , LYIMO EMANUEL P. , MREMI IRENE R. , TUNGU PATRICK K. , MWINGIRA VICTOR S. , MBATA DORIS , MALEKIA SIA E. , JOACHIM CATHERINE , Mboera Leonard 
Published: December 2020

Abstract
Background: Effective planning for disease prevention and control requires accurate, adequately-analysed, interpreted and communicated data. In recent years, efforts have been put in strengthening health management information systems (HMIS) in Sub-Saharan Africa to improve data accessibility to decision-makers. This study assessed the quality of routine HMIS data at primary healthcare facility (HF) and district levels in Tanzania.Methods: This cross-sectional study involved reviews of documents, information systems and databases, and collection of primary data from facility-level registers, tally sheets and monthly summary reports. Thirty-four indicators from Outpatient, Inpatient, Antenatal care, Family Planning, Post-natal care, Labour and Delivery, and Provider-Initiated Testing and Counselling service areas were assessed. Indicator records were tracked and compared across the process of data collection, compilation and submission to the district office. Copies of monthly report forms submitted by facilities to the district were also reviewed. The availability and utilization of HMIS tools were assessed, while completeness and data accuracy levels were quantified for each phase of the reporting system.Results: A total of 115 HFs (including hospitals, health centres, dispensaries) in 11 districts were involved. Registers (availability rate=91.1%; interquartile range (IQR):66.7%-100%) and report forms (86.9%; IQR:62.2%-100%) were the most utilized tools. There was a limited use of tally-sheets (77.8%; IQR:35.6%-100%). Tools availability at the dispensary was 91.1%, health centre 82.2% and hospital 77.8%, and was low in urban districts. The availability rate at the district level was 65% (IQR:48%-75%). Wrongly filled or empty cells in registers and poor adherence to the coding procedures were observed. Reports were highly over-represented in comparison to registers’ records, with large differences observed at the HF phase of the reporting system. The OPD and IPD areas indicated the highest levels of mismatch between data source and district office. Indicators with large number of clients, multiple variables, disease categorization, or those linked with dispensing medicine performed poorly. Conclusion: There are high variations in the tool utilisation and data accuracy at facility and district levels. The routine HMIS is weak and data at district level inaccurately reflects what is available at the source. These results highlight the need to design tailored and inter-service strategies for improving data quality.
Clinical significance of D-dimer level in refractory Mycoplasma pneumoniae pneumonia
Authors: Huang Xia , Li Dan , Liu Feng , Zhao Deyu , Zhu Yifan , Tang Heng 
Published: December 2020

Abstract
Background: The levels of serum D-dimer (D-D) in children with Mycoplasma pneumoniae pneumonia (MPP) were assessed to explore the clinical significance of D-D levels in refractory MPP (RMPP).Method: A total of 430 patients with MPP were enrolled between January 2015 and December 2015 and divided into a general MPP (GMPP) group (n=306) and a RMPP group (n=124). Clinical data, D-D level, white blood cell (WBC) count, proportion of neutrophils (N%), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), alanine transaminase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) were compared between the two groups. Multivariate logistic regression was performed to identify independent predictors of RMPP.Results: (1) Hospitalization time, preadmission fever duration, total fever duration, WBC, N %, CRP, LDH, ESR, ALT, AST, and D-D were significantly higher in the RMPP group than those in the GMPP group (all P<0.05). (2) Correlation analysis showed that D-D was positively correlated with WBC, CRP, ESR, and LDH, and could be used to jointly evaluate the severity of the disease. (3) Multivariate logistic regression analysis identified preadmission fever duration, CRP, LDH and DD as independent risk factors for RMPP (all P<0. 05). D-D had the highest predictive power for RMPP (P<0.01). The D-D level also had a good ability to predict pleural effusion and liver injury (all P<0.01). Conclusion: Serum D-D levels were significantly increased in patients with RMPP, indicating that excessive inflammatory response and vascular endothelial injury with prolonged duration existed in this patient population. Increased levels of serum D-D may be used as an early predictor of RMPP and the occurrence of complications. Our findings provide a theoretical basis for the early diagnosis of RMPP, early intervention and excessive inflammatory response in the pathogenesis of mycoplasma.
The effects of family physician–contracted service on health-related quality of life and equity in health in China
Authors: Lai Sha , Lu Li , Zhou Zhongliang , Shen Chi , Yang Xiaowei , Zhao Yaxin , Zhang Xiaolong 
Published: December 2020

Abstract
Background Family physician–contracted service (FPCs) has been recently implemented in Chinese primary care settings. This study was aimed at measuring the effects of FPCs on residents’ health-related quality of life (HRQoL) and equity in health among the Chinese population.Methods The study data was drawn from the 2018 household health survey (Shaanxi Province, China) using multistage, stratified cluster random sampling. We measured HRQoL using EQ-5D-3L based on the Chinese-specific time trade-off values set. Coarsened exact matching (CEM) technique was used to control for confounding factors between residents with and without a contracted family physician. The concentration index (C) was calculated to measure equity in health.Results Individuals with a contracted family physician had significantly higher HRQoL than those without, after data matching (0.9355 vs. 0.8995; P <0.001). Additionally, the inequity in HRQoL among respondents with a contracted family physician was significantly lower than those without a contracted family physician (Cs of EQ-5D utility score: 0.0084 vs. 0.0263; p<0.001). Conclusions This study highlights the positive effects of FPCs on HRQoL and socioeconomic-related equity in HRQoL. Future efforts should prioritize the economically and educationally disadvantaged groups, the expansion of service coverage, and the competency of family physician teams to further enhance health outcome and equity in health.
Mild Hyponatremia Is Associated with Low Skeletal Muscle Mass, Physical Function Impairment, and Depressive Mood in the Elderly
Authors: Fujisawa Chisato , Umegaki Hiroyuki , Sugimoto Taiki , Samizo Satoshi , Huang Chi Hsien , Fujisawa Haruki , Sugimura Yoshihisa , Kuzuya Masafumi , Toba Kenji , Sakurai Takashi 
Published: December 2020

Abstract
Background: Mild hyponatremia (serum sodium 130-135 mEq/L) is a common electrolyte disorder in the elderly. However, its association with both sarcopenia and cognitive function remains to be clarified. Therefore, here we investigated the association of mild hyponatremia with skeletal muscle mass, physical function, and cognitive function in the elderly. Methods: We enrolled 75 participants with mild hyponatremia and 2907 with normonatremia (serum sodium, 136-145 mEq/L) aged ≥ 70 years who visited the Memory Disorder Outpatient Center of Japan’s National Center for Geriatrics and Gerontology. Skeletal muscle mass index (SMI), grip strength (GS), walking speed (WS), one-leg standing (OLS) test times, and neuropsychological test scores were determined. Results: One-way analysis of covariance showed that elderly participants with mild hyponatremia had lower SMI (7.1 ± 0.2, 7.2 ± 0.2 kg/m2, p = 0.04), weaker GS (19.1 ± 1.9 vs 21.4 ± 1.8 kg, p = 0.01), slower WS (0.9 ± 0.1 vs 1.1 ± 0.1 m/s, p = 0.001), and higher GDS- 15 score (6.4 ± 0.9 vs 5.2 ± 0.9, p = 0.002) than those with normonatremia. Multiple logistic regression analysis indicated that mild hyponatremia was independently associated with sarcopenia (odds ratio [OR]: 2.2, p = 0.02), slower WS (OR: 5.3, p = 0.04) and shorter OLS time (OR: 2.5, p = 0.02) as well as with severe depressive mood (OR: 2.6 p = 0.006) but not with SMI (OR: 1.6, p = 0.2) or GS (OR: 1.9, p = 0.09). Conclusions: Our results suggest that elderly people with even mild hyponatremia had physical function impairment and depressive mood.
Bloodstream infections caused by ST2 Acinetobacter baumannii : Risk factors, antibiotic regimens, and virulence over 6 years period in China
Authors: Yu Kaihang , Zeng Weiliang , Xu Ye , Liao Wenli , Xu Wenya , Zhou Tieli , Cao Jianming , Chen Lijiang 
Published: December 2020

Abstract
Background: Bloodstream infection (BSI) caused by multidrug-resistant Acinetobacter baumannii (MDR-AB) has been increasingly observed among hospitalized patients. The following study analyzed the epidemiology and microbiological characteristics of MDR-AB, as well as the clinical features, antimicrobial treatments, and outcomes in patients over a six years period in ChinaMethods: This retrospective study was conducted in a large tertiary hospital in China between January 2013 and December 2018. The clinical and microbiological data of all consecutive hospitalized patients with MDR-AB induced bloodstream infection were included and analyzed. Results: A total of 108 BSI episodes were analyzed. All MDR isolates belonged to ST2, a sequence type that has spread all over the world. Overall, ST2 strains showed strong biofilm formation ability, high serum resistance, and high pathogenicity. As for the clinical characteristics of the patient, 30-day mortality was 69.4% (75/108). The three main risk factors included mechanical ventilation, intensive care unit (ICU) stay, and thrombocytopenia; three protective factors included a change of antimicrobial regimen within 48 h after positive blood culture, use of the antibacterial agent combination, and more inpatient days. The most effective antibacterial regimen was the combination of cefoperazone/sulbactam and tigecycline.Conclusions: BSI caused by ST2 A.baumannii represents a difficult challenge for physicians, considering the high mortality associated with this infection. The combination of cefoperazone/sulbactam and tigecycline may be an effective treatment option.
Development and Validation of a Model for Individualized Prediction of Cervical Insufficiency Risks in Patients undergoing IVF/ICSI Treatment
Authors: Wu Yaoqiu , Liang Xiaoyan , Cai Meihong , Gao Linzhi , Lan Jie , Yang Xing 
Published: December 2020

Abstract
Background: Women who conceived with in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) are more likely to experience adverse pregnancy outcomes than women who conceived naturally. Cervical insufficiency (CI) is one of the important causes of miscarriage and premature birth, however there is no published data available focusing on the potential risk factors predicting CI occurrence in women who received IVF/ICSI treatment. This study aimed to identify the risk factors that could be integrated into a predictive model for CI, which could provide further personalized and clinically specific information related to the incidence of CI after IVF/ICSI treatment.Patients and methods: This retrospective study included 4710 patients who conceived after IVF/ICSI treatment from Jan 2011 to Dec 2018 at a public university hospital. The patients were randomly divided into development (n = 3108) and validation (n = 1602) samples for the building and testing of the nomogram, respectively. Multivariate logistic regression was developed on the basis of pre-pregnancy clinical covariates assessed for their association with CI occurrence.Results: A total of 109 patients (2.31%) experienced CI among all the enrolled patients. Body mass index (BMI), basal serum testosterone (T), gravidity and uterine length were associated with CI occurrence. The statistical nomogram was built based on BMI, serum T, gravidity and uterine length, with an area under the curve (AUC) of 0.84 (95% confidence interval: 0.76 - 0.90) for the developing cohort. The AUC for the validation cohort was 0.71 (95% confidence interval: 0.69 - 0.83), showing a satisfactory goodness-of-fit and discrimination ability in this nomogram.Conclusion: The user-friendly nomogram which graphically represents the risk factors and a pre-pregnancy predicted tool for the incidence of CI in patients undergoing IVF/ICSI treatment, provides a useful guide for medical staff on individualized decisions making, where preventive measures could be carried out during the IVF/ICSI procedure and subsequent pregnancy.
Achieving equitable uptake of handwashing and sanitation by addressing both supply and demand-based constraints: Findings from a randomized controlled trial in rural Bangladesh
Authors: Parvez Sarker Masud , Rahman Musarrat Jabeen , Azad Rashidul , Rahman Mahbubur , Unicomb Leanne , Ashraf Sania , Mondol Momenul Haque , Jahan Farjana , Winch Peter J. , Luby Stephen P. 
Published: December 2020

Abstract
Background: Supply driven programs that are not closely connected to community demand and demand-driven programs that fail to ensure supply both risk worsening inequity. Understanding patterns of uptake of behaviors among the poorest under ideal experimental conditions, such as those of an efficacy trial, can help identify strategies that could be strengthened in routine programmatic conditions for more equitable uptake. WASH Benefits Bangladesh was a randomized controlled efficacy trial that provided free-of cost WASH hardware along with behavior change promotion. The current paper aimed to determine the impact of the removal of supply and demand constraints on the uptake of handwashing and sanitation behaviors across wealth and education levels.Methods: The current analysis selected 4 indicators from the WASH Benefits trial— presence of water and soap in household handwashing stations, observed mother’s hand cleanliness, observed visible feces on latrine slab or floor and reported last child defecation in potty or toilet. A baseline assessment was conducted immediately after enrolment and endline assessment was conducted approximately 2 years later. We compared change in uptake of these indicators including wealth quintiles (Q) between intervention and control groups from baseline to endline.Results: For hand cleanliness, the poorest mothers improved more [Q1 difference in difference, DID: 16% (7, 25%)] than the wealthiest mothers [Q5 DID: 7% (-4, 17%)]. The poorest households had largest improvements for observed presence of water and soap in handwashing station [Q1 DID: 82% (75, 90%)] compared to the wealthiest households [Q5 DID: 39% (30, 50%)]. Similarly, poorer household demonstrated greater reductions in visible feces on latrine slab or floor [Q1DID, -25% (-35, -15) Q2: -34% (-44, -23%)] than the wealthiest household [Q5 DID: -1% (-11, 8%). For reported last child defecation in potty or toilet, the poorest mothers showed greater improvement [Q1-4 DID: 50-54% (44, 60%)] than the wealthier mothers [Q5 DID: 39% (31, 46%). Conclusion: By simultaneously addressing supply and demand-constraints among the poorest, we observed substantial overall improvements in equity. Within scaled-up programs, a separate targeted strategy that relaxes constraints for the poorest can improve the equity of a program. Trial registration: WASH Benefits Bangladesh: ClinicalTrials.gov, identifier: NCT01590095. Date of registration: April 30, 2012 ‘Retrospectively registered’URL: https://clinicaltrials.gov/ct2/show/NCT01590095
Differential Production and Secretion of Potentially Toxigenic Extracellular Proteins from Hypervirulent Aeromonas hydrophila Under Biofilm and Planktonic Culture
Authors: Barger Priscilla C. , Liles Mark R , Beck Benjamin H , Newton Joseph C 
Published: December 2020

Abstract
Background: Hypervirulent Aeromonas hydrophila (vAh) is an emerging pathogen in freshwater aquaculture that results in the loss of over 3 million pounds of marketable channel catfish, Ictalurus punctatus, and channel catfish hybrids (I. punctatus, ♀ x blue catfish, I. furcatus, ♂) each year from freshwater catfish production systems in Alabama, U.S.A. vAh isolates are clonal in nature and are genetically unique from, and significantly more virulent than, traditional A. hydrophila isolates from fish. Even with the increased virulence, natural infections cannot be reproduced in aquaria challenges making it difficult to determine modes of infection and the pathophysiology behind the devastating mortalities that are commonly observed. Despite the intimate connection between environmental adaptation and plastic response, the role of environmental adaption on vAh pathogenicity and virulence has not been previously explored. In this study, secreted proteins of vAh cultured as free-living planktonic cells and within a biofilm were compared to elucidate the role of biofilm growth on virulence. Results: Functional proteolytic assays found significantly increased degradative activity in biofilm secretomes; in contrast, planktonic secretomes had significantly increased hemolytic activity, suggesting higher toxigenic potential. Intramuscular injection challenges in a channel catfish model showed that in vitro degradative activity translated into in vivo tissue destruction. Identification of secreted proteins by HPLC-MS/MS revealed the presence of many putative virulence proteins under both growth conditions. Biofilm grown vAh produced higher levels of proteolytic enzymes and adhesins, whereas planktonically grown cells secreted higher levels of toxins, porins, and fimbrial proteins. Conclusions: This study is the first comparison of the secreted proteomes of vAh when grown in two distinct ecological niches. These data on the adaptive physiological response of vAh based on growth condition increase our understanding of how environmental niche partitioning could affect vAh pathogenicity and virulence. Increased secretion of colonization factors and degradative enzymes during biofilm growth and residency may increase bacterial attachment and host invasiveness, while increased secretion of hemolysins, porins, and other potential toxins under planktonic growth (or after host invasion) could result in increased host mortality. The results of this research underscore the need to use culture methods that more closely mimic natural ecological habitat growth to improve our understanding of vAh pathogenesis.
A ATUALIDADE DO LIBERALISMO POLÍTICO DE BOBBIO NA ÉPOCA DO LIBERALISMO ECONÔMICO E DO POPULISMO AUTORITÁRIO
Authors: Tosi Giuseppe 
Published: December 2020

Após a queda do muro de Berlim, os intelectuais liberais manifestaram a cauta esperança de que o encerramento do período histórico da guerra fria abriria uma nova era de expansão do Estado Democrático de Direito no mundo. Esta esperança se realizou em parte (a terceira onda de Huntington), mas está hoje em crise tanto nos regimes democráticos consolidados como nos novos regimes políticos que saíram de regimes autoritários. Os países que não experimentaram historicamente a democracia liberal, como a China e a Rússia, são governados por regimes de liberalismo econômico e de autoritarismo político; as primaveras árabes, na maioria dos casos, não resultaram em regimes democráticos, mas em guerras civis e/ou ditaduras militares; e nos países de tradição democrática como a Europa e os Estados Unidos a ideologia política que mais cresce é o populismo de extrema direta. Bobbio viria com preocupação este movimento, porque era favorável a um liberalismo político, mas mantinha severas restrições ao liberalismo econômico, e era também um crítico do populismo, que considerava uma forma de democracia plebiscitária com rasgos autoritários. Diante deste contexto, queremos debater a atualidade do liberalismo bobbiano, na esperança de que não estamos assistindo aos “últimos capítulos” de uma longa e gloriosa tradição. Faremos isso analisando três diferentes tipos de liberalismo (político, econômico e social), e três diferentes tipos de democracia (elitista, plebiscitária e participativa), relacionando-as entre elas na procura da “melhor forma de governo”. Finalmente teceremos algumas breves considerações sobre a situação política brasileira à luz desses princípios.
Palavras-chave: Liberalismo político; liberalismo econômico; democracia; populismo; autoritarismo.
Automated Categorization of Systemic Disease and Duration From Electronic Medical Record System Data Using Finite-State Machine Modeling: Prospective Validation Study
Authors: Sai Prashanthi Gumpili , Deva Ayush , Vadapalli Ranganath , Das Anthony Vipin 
Published: December 2020

BackgroundOne of the major challenges in the health care sector is that approximately 80% of generated data remains unstructured and unused. Since it is difficult to handle unstructured data from electronic medical record systems, it tends to be neglected for analyses in most hospitals and medical centers. Therefore, there is a need to analyze unstructured big data in health care systems so that we can optimally utilize and unearth all unexploited information from it.ObjectiveIn this study, we aimed to extract a list of diseases and associated keywords along with the corresponding time durations from an indigenously developed electronic medical record system and describe the possibility of analytics from the acquired datasets.MethodsWe propose a novel, finite-state machine to sequentially detect and cluster disease names from patients’ medical history. We defined 3 states in the finite-state machine and transition matrix, which depend on the identified keyword. In addition, we also defined a state-change action matrix, which is essentially an action associated with each transition. The dataset used in this study was obtained from an indigenously developed electronic medical record system called eyeSmart that was implemented across a large, multitier ophthalmology network in India. The dataset included patients’ past medical history and contained records of 10,000 distinct patients.ResultsWe extracted disease names and associated keywords by using the finite-state machine with an accuracy of 95%, sensitivity of 94.9%, and positive predictive value of 100%. For the extraction of the duration of disease, the machine’s accuracy was 93%, sensitivity was 92.9%, and the positive predictive value was 100%.ConclusionsWe demonstrated that the finite-state machine we developed in this study can be used to accurately identify disease names, associated keywords, and time durations from a large cohort of patient records obtained using an electronic medical record system.
KEBIJAKAN PENGURANGAN RISIKO BENCANA COVID-19: PENGALAMAN SEKOLAH TUMBUH
Authors: Dharma Dwitya Sobat Ady 
Published: December 2020

Semua lembaga pendidikan, baik swasta maupun negeri, memiliki peran dan tanggung jawab untuk ikut tetap menyelenggarakan pendidikan yang berkualitas. Dalam konteks kebijakan, lembaga pendidikan harus mampu menghasilkan kebijakan-kebijakan strategis yang tidak hanya berpusat pada siswa, tapi juga mampu memfasilitasi warga sekolah agar tetap melaksanakan fungsinya dengan optimal. Studi ini memfokuskan pada kebijakan yang diambil pada pengurangan risiko bencana (PRB) COVID-19 di Sekolah Tumbuh Yogyakarta (SD Tumbuh 1, SD Tumbuh 2, SD Tumbuh 3, SD Tumbuh 4, SMP Tumbuh, dan SMA Tumbuh). Penelitian menggunakan metode kualitatif dengan pendekatan literatur dan empiris. Data didapat dari kebijakan tanggap darurat bencana COVID-19 yang dirumuskan oleh Kepala Sekolah, HRM, serta fenomena yang terjadi di sekolah. Data yang yang digunakan berupa surat-surat edaran sebagai produk kebijakan, dan aneka dokumen. Hasil penelitian menunjukkan bahwa kebijakan PRB di Sekolah Tumbuh menerapkan prinsip humanis yang mampu mengakomodasi kebutuhan warga sekolah (siswa, guru, dan staf). Penerapan kebijakan dilakukan dengan alur yang sistematis sehingga mudah dipahami oleh warga sekolah dan dibuat dengan mengedepankan musyawarah para pemimpin.