bluuebunny/crossref_metadata_2025_split huggingface dataset:
Total flavones of Dracocephalum moldavica L. protect astrocytes against H2O2-induced apoptosis through a mitochondria-dependent pathway
Authors: Zheng Rui-Fang , Du Yan-Wen , Zeng Cheng , Wang Hui-Fang , Xing Jian-Guo , Xu Ming 
Published: March 2020

Abstract
Background
The active components of Dracocephalum moldavica L. (TFDM) can inhibit myocardial ischemia by inhibiting oxidative stress. However, the effects of TFDM on astrocytes have not been investigated in vitro. The current study aimed to explore whether TFDM protects astrocytes against H2O2-induced apoptosis through a mitochondria-dependent pathway.

Methods
The human glioma cell line U87 was used to investigate the ability of TFDM to protect astrocytes against H2O2-induced apoptosis. The cell counting kit-8 assay and flow cytometry were used to detect cell viability, apoptosis, MMP, Ca2+ influx and reactive oxygen species (ROS). Lactate dehydrogenase (LDH) and malonic dialdehyde (MDA) levels were measured by ELISA. In addition, protein and mRNA expression changes were detected by Western blotting and qRT-PCR.

Results
TFDM (0.78~200 μg/ml) had limited cytotoxic effects on the viability of U87 cells. Compared with the model group (treated with H2O2 only), cells treated with medium- and high-dose TFDM exhibited reduced MDA concentrations (P < 0.05) and ROS production (P < 0.05) and decreased MMP (P < 0.05) and reduced apoptosis (P < 0.05). The percentage of annexin V-FITC-stained cells was markedly suppressed by TFDM, confirming its anti-apoptotic properties. WB results showed that protein expression of Bcl-2-associated X protein (BAX), Caspase-3, Caspase-9, Caspase-12, and B-cell leukemia/lymphoma 2 (Bcl2) was reduced in the TFDM group compared with that in the model group (P < 0.05) and that expression of these proteins was normalized by TFDM treatment in a dose-dependent manner. According to RT-qPCR results, TFDM pretreatment resulted in reduced mRNA expression of BAX, Caspase-9, Caspase-12, p38MAPK, and CaMKII and increased mRNA expression of mTOR compared with the model group.

Conclusions
The current study revealed the protective effects of TFDM on U87 cells under oxidative stress conditions through the inhibition of a mitochondria-dependent pathway that is associated with the CaMKII/P38MAPK/ERK1/2 and PI3K/AKT/mTOR pathways.
Antibacterial activity of Centaurea pumilio L. root and aerial part extracts against some multidrug resistant bacteria
Authors: Naeim Huda , El-Hawiet Amr , Abdel Rahman Raoufa A. , Hussein Ahmed , El Demellawy Maha A. , Embaby Amira M. 
Published: March 2020

Abstract
Background
In the context of searching for potent, safe, natural antimicrobial agents to combate the global antimicrobial resistance (AMR) phenomenon, the current study evaluates for the first time ever, the broad-spectrum antimicrobial activity of essential oil (EO) and extracts from the rare wild plant Centaurea pumilio L.. It has tremendous ethnomedicinal values; its dried root is used as a fattening agent, a treatment for bad breath and diabetes, and screened for schistosomicidal activity.

Methods
C. pumilio EO was extracted by hydrodistillation using a Clevenger apparatus. Chemical constituents of aerial part were extracted using a sequential solvent/solvent procedure employing four solvents with increasing polarities in the following order: petroleum ether, chloroform, ethyl acetate, and n-butanol. The chemical constituents were identified by GC-MS. Fifty-two microbial strains were used; twenty-six multidrug resistant (MDR), sixteen clinical, and ten reference strains. The identification of the microbial strains was performed by MALDI-TOF-MS. The antimicrobial activity of the EO and the aerial part and the root extracts was assessed through disc diffusion assay. A minimum inhibitory concentration (MIC) of the EO and extracts was determined using the broth micro-dilution method.

Results
The growth of reference and clinical strains was inhibited by EO, methanol, chloroform, and ethyl acetate aerial part extracts and chloroform root extract. The MDR strains growth, however, was inhibited only by EO and chloroform aerial part extract. GC-MS identified for the first time eighteen constituents from aerial part EO and chloroform extract each. EO showed antimicrobial activity against the reference, clinical, and MDR strains with MIC values of 31.25–125, 31.25–125, and 62.50–250 μg/mL, respectively. Methanol aerial part extract exhibited high antimicrobial activities with MIC values of 62.50–250 μg/mL against reference and clinical strains. Chloroform root extract displayed strong antimicrobial activity against reference and clinical strains recording MIC values of 62.50–250 μg/mL and 62.50–125 μg/mL, respectively. The chloroform aerial part extract demonstrated potent antimicrobial activity against the reference, clinical, and MDR strains with 31.25, 31.25, and 15.62 μg/mL MIC values, respectively.

Conclusions
Present data unravel the C. pumilio pharmacological magnitude to discover eco-friendly potent antimicrobial agents to fight AMR phenomenon.
Assessment of third-year medical students’ comfort and preparedness for navigating challenging clinical scenarios with patients, peers, and supervisors
Authors: Kahkoska Anna R. , DeSelm Tracy M. , Young Laura A. 
Published: March 2020

Abstract
Background
Medical training focuses heavily on clinical skills but lacks in training for navigating challenging clinical scenarios especially with regard to diversity issues. Our objective was to assess third-year medical students’ preparedness to navigate such scenarios.

Methods
A 24-item survey was administered electronically to third-year medical students describing a range of specific interactions with patients, peers, and “upper-levels” or superiors including residents and attendings, spanning subjects including gender, race/ethnicity, politics, age, sexual orientation/identity, disability, and religion. Students rated their level of comfort via a 5-point Likert scale ranging from 1 (“Very Uncomfortable”) to 5 (“Very Comfortable”). Basic demographics were collected and data were summarized for trends.

Results
Data were analyzed from 120 students (67% response rate, 54.2% female, 60.8% non-Hispanic white). Students reported lower comfort with peer and superiors compared to patient interactions (p < 0.0001). Students reported the highest comfort with sexual orientation/identity- and religion-related interactions (median (IQR): 3.3 (1.3) and 3.4 (10.0), respectively) and the lowest comfort with gender-, race/ethnicity-, and disability- related interactions (median (IQR): 2.3 (1.3), 2.0 (1.0), 2.5 (1.5), respectively). Males reported significantly higher median comfort levels for scenarios with upper-level, gender, and religion related interactions. Males were more likely to be completely comfortable versus females across the 24 scenarios, although multiple male response patterns showed evidence of a bimodal distribution.

Conclusions
Third-year medical students report generally inadequate comfort with navigating complex clinical scenarios, particularly with peers and supervisors and relating to gender-, race/ethnicity-, and disability-specific conflicts. There are differences across gender with regards to median comfort and distribution of scores suggesting that there is a subgroup of males report high/very high comfort with challenging clinical scenarios. Students may benefit from enhanced training modules and personalized toolkits for navigating these scenarios.
The design and development of technology platforms in a developing country healthcare context from an ecosystem perspective
Authors: Herman Hilde , Grobbelaar Sara S. , Pistorius Calie 
Published: March 2020

Abstract
Background
Research on the development and functioning of technology platforms specifically for health applications in sub-Saharan Africa (SSA), is limited. The healthcare sector has also been resistant to platform adoption due to characteristics such as sensitive data and high cost of failure. A framework for the design, development and implementation of technology platforms in the South African health context could therefore contribute to the gap in research as well as provide a practical tool that platform owners could use to potentially increase the adoption of platforms in this context.

Methods
The research design for this study was based on the Grounded Theory Conceptual Framework Analysis process. The process focused on mapping and investigating data sources, categorising and integrating concepts, synthesising these concepts into a framework and iteratively evaluating the framework. The first stage of the evaluation process was a preliminary evaluation exploring an existing Health platform in South Africa (MomConnect). The second evaluation stage included local and international interviews with nine experts to identify any missing concepts in the framework. Stage three included a case study and case study interviews which led to the formulation of the final framework and management tool.

Results
The developed and evaluated framework comprised three components, namely the pre-use component, which includes considerations the platform owner should be aware of prior to using the framework. The framework comprises of two dimensions, 1) an ecosystem dimension to guide the platform owner to consider different ecosystem actors before embarking on designing a platform 2) a platform development dimension that include typical platform development components and presents an interpretation of the viewpoints included in the ecosystem levels.

Conclusions
The final framework can be used by platform owners as a management tool. A unique contribution of this study is that the framework draws from two platform perspectives, namely the engineering and the economic perspectives to provide a holistic understanding of platforms. Finally, a contribution of this article is the tailoring of the framework for the South African health context.
Let’s CHAT (community health approaches to) dementia in Aboriginal and Torres Strait Islander communities: protocol for a stepped wedge cluster randomised controlled trial
Authors: Bradley Kate , Smith Robyn , Hughson Jo-anne , Atkinson David , Bessarab Dawn , Flicker Leon , Radford Kylie , Smith Kate , Strivens Edward , Thompson Sandra , Blackberry Irene , LoGiudice Dina 
Published: March 2020

Abstract
Background
Documented rates of dementia and cognitive impairment not dementia (CIND) in older Aboriginal and Torres Strait Islander Peoples is 3–5 times higher than the rest of the population, and current evidence suggests this condition is under-diagnosed and under-managed in a clinical primary care setting. This study aims to implement and evaluate a culturally responsive best practice model of care to optimise the detection and management of people with cognitive impairment and/or dementia, and to improve the quality of life of carers and older Aboriginal and Torres Islander Peoples with cognitive impairment.

Methods/design
The prospective study will use a stepped-wedge cluster randomised controlled trial design working with 12 Aboriginal Community Controlled Health Services (ACCHSs) across four states of Australia. Utilising a co-design approach, health system adaptations will be implemented including (i) development of a best practice guide for cognitive impairment and dementia in Aboriginal and Torres Strait Islander communities (ii) education programs for health professionals supported by local champions and (iii) development of decision support systems for local medical software. In addition, the study will utilise a knowledge translation framework, the Integrated Promoting Action on Research Implementation in Health Services (iPARIHS) Framework, to promote long-term sustainable practice change. Process evaluation will also be undertaken to measure the quality, fidelity and contextual influences on the outcomes of the implementation.
The primary outcome measures will be rates of documentation of dementia and CIND, and evidence of improved management of dementia and CIND among older Indigenous peoples attending Aboriginal and Torres Strait Islander primary care services through health system changes. The secondary outcomes will be improvements to the quality of life of older Indigenous peoples with dementia and CIND, as well as that of their carers and families.

Discussion
The Let’s CHAT Dementia project will co-design, implement and evaluate a culturally responsive best practice model of care embedded within current Indigenous primary health care. The best practice model of care has the potential to optimise the timely detection (especially in the early stages) and improve the ongoing management of people with dementia or cognitive impairment.

Trial registration
ACTRN12618001485224. Date of registration: 04 of September 2019
Promoting children’s health when a parent has a mental health problem: a mixed methods study of the experiences and views of health visitors and their co-workers
Authors: Condon Louise , Driscoll Timothy , Merrell Joy , Storey Mel , Thomas Amanda , Mansel Beryl , Snelgrove Sherrill 
Published: March 2020

Abstract
Background
Unrecognised and untreated parental mental illness is a major adverse childhood experience with potentially life-long consequences for health and wellbeing. In the United Kingdom (UK) health visitors provide a universal health promotion service to children aged 0–5 years, which includes safeguarding. This preventive work is highly relevant to policy aims of improving outcomes for children living with adverse childhood experiences, but is currently under researched. The aim of this study was to explore how health visitors promote young children’s wellbeing when a parent has a mental health problem, and to co-produce strategies to improve child health outcomes.

Methods
A mixed methods study was conducted, consisting of a cross-sectional survey and consensus workshops in Wales, UK. In phase 1 health visitors (n = 174) responded to an online questionnaire designed to explore the nature and scope of their preventive work with families experiencing mental ill health. For phase 2 providers of health and other support services (n = 38) took part in Nominal Group Technique workshops to co-produce strategies for better joint working to protect the wellbeing of children living with parental ill health.

Results
We identified that health visitors routinely provide support to families where parents have a range of mental health problems, including severe mental illness. Most practice is focused on mothers with depression, and fewer respondents were confident about working with fathers. Unmet training needs were identified in relation to adult mental illness, particularly the impact upon children. Solutions to working more effectively with professional and voluntary agencies included raising awareness of professional roles and responsibilities, timely two-way communication, taking a strengths-based approach and maintaining a focus on the child.

Conclusions
This study provided evidence on the range of parental mental ill health encountered by health visitors and the strategies they use to protect children’s wellbeing. Increasing the effectiveness of joint working is key to improving outcomes for babies and young children, including greater use of voluntary sector services. This study has implications for those who commission and provide health and welfare services for children, and adult mental health services.
Understanding the conditions that influence the roles of midwives in Ontario, Canada’s health system: an embedded single-case study
Authors: Mattison Cristina A. , Lavis John N. , Hutton Eileen K. , Dion Michelle L. , Wilson Michael G. 
Published: March 2020

AbstractBackgroundDespite the significant variability in the role and integration of midwifery across provincial and territorial health systems, there has been limited scholarly inquiry into whether, how and under what conditions midwifery has been assigned roles and integrated into Canada’s health systems.MethodsWe use Yin’s (2014) embedded single-case study design, which allows for an in-depth exploration to qualitatively assess how, since the regulation of midwives in 1994, the Ontario health system has assigned roles to and integrated midwives as a service delivery option. Kingdon’s agenda setting and 3i + E theoretical frameworks are used to analyze two recent key policy directions (decision to fund freestanding midwifery-led birth centres and the Patients First primary care reform) that presented opportunities for the integration of midwives into the health system. Data were collected from key informant interviews and documents.ResultsNineteen key informant interviews were conducted, and 50 documents were reviewed in addition to field notes taken during the interviews. Our findings suggest that while midwifery was created as a self-regulated profession in 1994, health-system transformation initiatives have restricted the profession’s integration into Ontario’s health system. The policy legacies of how past decisions influence the decisions possible today have the most explanatory power to understand why midwives have had limited integration into interprofessional maternity care. The most important policy legacies to emerge from the analyses were related to payment mechanisms. In the medical model, payment mechanisms privilege physician-provided and hospital-based services, while payment mechanisms in the midwifery model have imposed unintended restrictions on the profession’s ability to practice in interprofessional environments.ConclusionsThis is the first study to explain why midwives have not been fully integrated into the Ontario health system, as well as the limitations placed on their roles and scope of practice. The study also builds a theoretical understanding of the integration process of healthcare professions within health systems and how policy legacies shape service delivery options.
Implementing a research-based innovation to generate intra-familial involvement in type 2 diabetes self-management for use in diverse municipal settings: a qualitative study of barriers and facilitators
Authors: Helms Andersen Tue , Grabowski Dan 
Published: March 2020

Abstract
Background
Involving family members in disease management is vital to people with type 2 diabetes. New innovations that support family members’ involvement can help both the person with type 2 diabetes and the relatives to create the supportive environment they need. The objective of the present study is to examine what facilitates and obstructs implementation of an innovation that supports intra-familial involvement in life with type 2 diabetes.

Methods
Of the 48 healthcare professionals trained in facilitating the innovation in municipal patient education courses, single, semi-structured interviews were conducted with 13 of them. The interviews were focused specifically on the implementation process. All interviews were transcribed verbatim and analyzed using radical hermeneutics.

Results
The analysis revealed three distinct themes affecting implementation of the innovation. 1) Focusing on creating family involvement in patient education for people with type 2 diabetes was relevant and important to the healthcare professionals. 2) The dynamics of group-based patient education sessions changed when family members were involved, which affects healthcare professionals’ group facilitation methods. 3) Implementing new methods in patient education requires great commitment and support from the organization and management.

Conclusion
Implementation of an innovation to involve families and close relatives in patient education in Danish municipalities is feasible, but highly dependent on the commitment of healthcare professionals and managers as well as their openness to new ways of facilitating group processes.
Exploring the capacity of the Somaliland healthcare system to manage female genital mutilation / cutting-related complications and prevent the medicalization of the practice: a cross-sectional study
Authors: Yussuf Mohamed , Matanda Dennis J. , Powell Richard A. 
Published: March 2020

Abstract
Background
Female genital mutilation/cutting (FGM/C) negatively impacts the wellbeing of girls and women throughout their lifecycle. In Somalia, FGM/C prevalence is nearly universal (98%) among females aged 15–49 years, with infibulation prevalence at 77%. Whilst there is need to engage healthcare workers in the prevention and management of FGM/C, minimal information exists indicating healthcare systems’ capacity to fulfil this role. This study explored factors impacting the capacity of the Somaliland healthcare system to prevent the medicalization, and manage the complications of, FGM/C.

Methods
A cross-sectional qualitative study using semi-structured key informant interviews, conducted in the Somali language, was undertaken in the Maroodi Jeex and Awdal regions of Somaliland, in rural and urban Borama and Hargeisa districts in December 2016. A total of 20 interviews were conducted with healthcare workers comprised of medical doctors, nurses, midwives and system administrators. Transcribed and translated interview data were analysed using the template analysis approach.

Results
Healthcare workers reported understanding the adverse impact of FGM/C on the health of girls and women. However, they faced multiple contextual challenges in their preventative and management roles at the individual level, e.g., they lacked specific formal training on the prevention and management of FGM/C complications and its medicalization; institutional level, e.g., many facilities lacked funding and equipment for effective FGM/C management; and policy level, e.g., no national policies exist on the management of FGM/C complications and against its medicalization.

Conclusion
Healthcare systems in urban and rural Somaliland have limited capacity to prevent, diagnose and manage FGM/C. There is a need to strengthen healthcare workers’ skill deficits through training and address gaps in the health system by incorporating the care of girls and women with FGM-related complications into primary healthcare services through multi-sectoral collaboration and coordination, establishing clinical guidelines for FGM/C management, providing related equipment, and enacting policies to prevent the medicalization of the practice.