bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characterization of Visceral leishmaniasis Outbreak, Marsabit County, Kenya, 2014
Authors: Kanyina Evalyne Jaquelyne Wambui 
Published: January 2020

Abstract

Background: Visceral leishmaniasis (VL) is caused by protozoa of the Leishmania donovani complex. Annually, an estimated 500,000 cases of VL are reported globally posing a public health challenge. The objectives of our study were to confirm and determine the magnitude of VL outbreak, characterize the outbreak clinically and epidemiologically and evaluate the county preparedness and response in Marsabit County, Kenya.
Methods: A retrospective review of laboratory registers and patients’ clinical notes was done at Marsabit County Hospital. Cases were persons with confirmed VL diagnosis either by microscopy, serology or molecular technique coming from Marsabit County from May to October 2014. Cases were interviewed using structured questionnaire to collect clinical and epidemiologic information. Blood samples were collected from cases for laboratory confirmation.
Results: A total of 136 cases were confirmed of which 77% (105) were male with a median age of 17 (IQR: 22) years and 9.6% (13) case fatality rate. All cases were admitted at Marsabit County Referral Hospital, Kenya. Medical records of 133 cases were retrieved. Of the 133 cases, 102 (77%) presented with fever, 43 (32%) with splenomegaly, 26 (20%) with hepatomegaly and 96 (72%) were managed with Sodium stibogluconate (SSG) monotherapy. Thirty four cases (26%) received Full haemogram (FHG) test and none had more than one Liver Function Tests (LFTs) in a span of six months. No VL case management training had been conducted nor VL treatment guidelines distributed among health care workers (HCWs) in the last one year.
Conclusions: VL cases were confirmed. Inadequate case monitoring and management was evident. VL case management sensitization training was conducted. The County health department should put in place one health VL surveillance and facilitate periodic case management trainings.
Total words: 275
Key words: Visceral leishmaniasis (VL), Kala-azar, VL case management, Marsabit County, Kenya
Pharmacists’ knowledge attitude and practice regarding the dispensing of antibiotics without prescription in Tanzania: an explorative cross-sectional study
Authors: Poyongo Baraka P , Sangeda Raphael Zozimus 
Published: January 2020

Abstract

Background:
Inappropriate use of antibiotics has been reported to contribute to the emergence and increase of antimicrobial resistance (AMR) in the world. Enforcing the dispensing of antibiotics with prescription is a way to promote the rational use of antibiotics and preventing the development and spread of AMR. The pharmacist has the responsibility to supervise the dispensing of antibiotics in pharmacies and ensure its rational use. This study assessed pharmacists’ knowledge, attitude and practice regarding the dispensing of antibiotics without prescription in Tanzania.
Methods:
An online semi-structured questionnaire was designed, tested and shared with licensed pharmacists in Tanzania through an invitation link sent in their official WhatsApp groups. An SMS alternative was used contact list from the Pharmacy Council to administer the questionnaire to pharmacists not subscribed to WhatsApp. Study data were collected and managed using REDCap electronic data capture tools hosted at Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. Data were then downloaded and exported into Statistical Package for Social Sciences (SPSS) version 20 for data analysis; Chi-square test was used to test association for categorical data, where a p-value of less than 0.05 was considered statistically significant.
Results :
More than 75% of pharmacists had excellent knowledge about the legal requirements for dispensing antibiotics and of the AMR challenge. Of the interviewed pharmacists, seventy-four percent admitted to dispensing antibiotics without prescription in their daily practice. Notably, 85.7% of pharmacists with high education were more likely to dispense without prescription compared to 69.9% among bachelor holders (p-value = 0.028). The main reasons for administering antibiotics without prescription were the profitability nature of pharmacy business, a failure of the patient to get a prescription and a lack of stringent regulatory authorities. Penicillins, macrolides and fluoroquinolones were the classes of antibiotics mostly dispensed without a prescription.
Conclusion :
Even though pharmacists seem knowledgeable about AMR, they still dispense antibiotics without prescription in Tanzania. The regulatory authorities should make regular inspections in pharmacies to detect this malpractice. The community should be trained on the importance of taking laboratory tests before getting medications for their sickness by a qualified medical practitioner.
The multimodal strategy in Surgical Site Infections control and prevention in orthopaedic patients – a 10-year retrospective observational study at a Polish hospital
Authors: Kołpa Małgorzata , Słowik Róża , Wałaszek Marta , Wolak Zdzisław , Rozanska Anna , Wojkowska-Mach Jadwiga 
Published: January 2020

Abstract
INTRODUCTION Surgical site infections (SSIs) are among the most common healthcare-associated infections. They are associated with longer post-operative hospital stays, additional surgical procedures, treatment in intensive care units and higher mortality. MATERIAL AND METHODS Surgical site infections (SSIs) were detected in patients hospitalized in a 40-bed orthopaedics ward via continuous surveillance in 2009–2018. The total number of study patients was 15,678. The results were divided into two 5-year periods before and after the introduction of the SSI prevention plan. The study was conducted as part of a national Healthcare-Associated Infections Surveillance Programme, following the methodology recommended by the HAI-Net, European Centre for Disease Prevention and Control Program (ECDC). RESULTS 168 SSIs were detected in total, including 163 deep SSIs (SSI-D). The total SSI incidence rate was 1.1%, but in hip prosthesis: 1.2%, in knee prosthesis: 1.3%, for open reduction of fracture (FX): 1.3%, for close reduction of fracture (CR): 1.5%, and 0.8% for other procedures. 64% of SSI-D cases required rehospitalisation. A significantly reduction in incidence was found only after fracture reductions: FX and CR, respectively 2.1% vs. 0.7% (OR 3.1 95%CI 1.4-6.6, p<0.01) and 2.1 vs. 0.8% (OR 2.4 95%CI 1.0-5.9, p<0.05). SSI-Ds were usually caused by Gram-positive cocci, specially Staphylococcus aureus , 74 (45.7%); Enterobacteriaceae bacillis accounted for 14.1% and Gram-negative non-fermenting rods for 8.5%. CONCLUSIONS The implementated SSI prevention plan demonstrated a significant decrease from 2.1% to 0.7% in SSI-D incidence only in fracture reductions, without changes in epidemiology SSI incidence rates in other procedures. Depending on the epidemiological situation in the ward, it is worthwhile to surveillance of SSIs associated to different types of orthopaedic surgery to assess the risks and take preventive measures.
Identification of E2 with improved secretion and immunogenicity against CSFV in piglets
Authors: Xu Huiling , Wang Yanli , Han Guangwei , Fang Weihuan , he fang 
Published: January 2020

Abstract
Background: Outbreaks of Classical swine fever virus (CSFV) cause significant economic losses in the swine industry. Vaccination is the major method to prevent and control the disease. As live attenuated vaccines fail to elicit differentiable immunity between infected and vaccinated animals, subunit vaccine was considered as an alternative candidate to prevent and eradicate CSFV. Subunit vaccines present advantages in DIVA immunogenicity and safety. The technology was limited due to the low yield and the high cost with multiple and large doses. The native E2 signal peptide has not been well defined before. Here, the aim of this study is to develop a cost-effective and efficacious E2 vaccine candidate against CSFV with signal peptide and E2 sequence selection.
Results: A novel CSFV E2 sequence (E2ZJ) was identified from an epidemic strain of Zhejiang for outstanding secretion in baculovirus and enhanced immunogenicity. E2 secretion induced with the selected signal peptide, SPZJ (SP23), increase at least 50% as compared to any other signal peptides tested. Besides, unique antigenic features were identified in E2ZJ. E2ZJ elicited CSFV antibodies at the earlier stage than other E2 types tested in mice. Moreover, higher level of neutralization antibodies against both genotypes 1 and 2 CSFV with E2ZJ was detected than other E2s with the same dosage. Further, in piglets, E2ZJ successfully elicited neutralizing immunity. A single dose of 5 μg of E2ZJ was sufficient to induce protective antibodies against CSFV in piglets and provided 100% protection against lethal virus challenge.
Conclusions: Our studies provide evidence that E2ZJ guided by a novel E2 signal peptide (SPZJ) was efficiently secreted and presented significantly improved immunogenicity than conventional E2 vaccines. Moreover, a single dose of 5 μg E2ZJ is efficacious against CSFV in piglets.
Keywords: Classical swine fever virus; novel signal peptide; SPZJ-E2ZJ; subunit vaccine; protective immunity
Multivariate Network Meta-Analysis Incorporating Class Effects
Authors: Owen Rhiannon Kate , Bujkiewicz Sylwia , Tincello Douglas G , Abrams Keith R 
Published: January 2020

Abstract
Background: Network meta-analysis synthesises data from a number of clinical trials in order to assess the comparative efficacy of multiple healthcare interventions in similar patient populations. In situations where clinical trial data are heterogeneously reported i.e. data are missing for one or more outcomes of interest, synthesising such data can lead to disconnected networks of evidence, increased uncertainty, and potentially biased estimates which can have severe implications for decision-making. To overcome this issue, strength can be borrowed between outcomes of interest in multivariate network meta-analyses. Furthermore, in situations where there are relatively few trials informing each treatment comparison, there is a potential issue with the sparsity of data in the treatment networks, which can lead to substantial parameter uncertainty. A multivariate network meta-analysis approach can be further extended to borrow strength between interventions of the same class using hierarchical models. Methods: We extend the trivariate network meta-analysis model to incorporate the exchangeability between treatment effects belonging to the same class of intervention to increase precision in treatment effect estimates. We further incorporate a missing data framework to estimate uncertainty in trials that fail to report measures of variability in order to maximise the use of all available information for healthcare decision-making. The methods are applied to a motivating dataset in overactive bladder syndrome. The outcomes of interest were mean change from baseline in incontinence, voiding and urgency episodes. All models were tted using Bayesian Markov Chain Monte Carlo (MCMC) methods in WinBUGS. Results: All models (univariate, multivariate, and multivariate models incorporating class effects) produced similar point estimates for all treatment effects. Incorporating class effects in multivariate models often increased precision in treatment effect estimates. Conclusions: Multivariate network meta-analysis incorporating class effects allowed for the comparison of all interventions across all outcome measures to ameliorate the potential impact of outcome reporting bias, and further borrowed strength between interventions belonging to the same class of treatment to increase the precision in treatment effect estimates for healthcare policy and decision-making. Keywords: multivariate; network meta-analysis; mixed treatment comparisons; meta-analysis; class effect
Broadening Risk Profile in Familial Colorectal Cancer Type X; increased risk for five cancer types in the national Danish cohort
Authors: Therkildsen Christina , Rasmussen Maria , Smith-Hansen Lars , Kallemose Thomas , Lindberg Lars Joachim , Nilbert Mef 
Published: January 2020

Abstract
Background Familial colorectal cancer type X (FCCTX) is a phenotypically defined subset of hereditary colorectal cancer with unknown and potentially heterogeneous genetic aetiology. Though FCCTX has been characterized as a colorectal cancer-specific syndrome, we aimed to estimate the risk for extra-colorectal cancer in the Danish FCCTX cohort. Methods Through the national hereditary non-polyposis colorectal cancer (HNPCC) register, 213 families fulfilling the Amsterdam I criteria and showing retained mismatch repair (MMR) function were identified. In here, sex and age-specific incidence rate ratios (IRR) were calculated for 30 extra-colorectal cancer types in comparison with the general Danish population. Results In total, 494 extra-colorectal cancers developed with significantly increased risks for the urinary tract, breasts, stomach, pancreas, and eye. The age spans, during which increased risks were observed, were 30-49 years for gastric cancer, 30-69 years for female breast cancer, 50-69 years for ocular melanoma and above age 70 for pancreatic cancer and urothelial cancer. Conclusions These risk estimates suggest an increased risk of several extra-colorectal cancer types, which calls for awareness during genetic counselling and follow-up. The cancers that occur at increased risk may indicate unidentified disease-predisposing genetic variants in this phenotypically defined subset of hereditary colorectal cancer.
Initial Surgical versus Non-Surgical treatments for advanced hypopharyngeal cancer: a meta-analysis with trial sequential analysis
Authors: Cui Jie , Wang Liping , Piao Jinsong , Huang Haiyan , Chen Weiquan , Chen Zhen , Yang Hong , Tan Xiaojun , Li Jiansheng , Liu Genglong 
Published: January 2020

Abstract
Background There is no consensus whether either initial surgical or non-surgical treatments should be the standard treatment pattern to advanced hypopharyngeal cancer. The aim of the meta-analysis was systematically and quantitatively to compare the relative efficacy between initial surgical and non-surgical therapies in patients with advanced-stage hypopharyngeal carcinoma.Methods A comprehensive search was performed in PubMed, the ISI Web of Knowledge, the Cochrane Library, and Embase databases from inception through to April 10, 2019.Citation screening, data abstraction and quality assessment were performed in duplicate. Meta-analysis with trial sequential analysis (TSA) were used to assess the primary and secondary outcomes. In addition, we used the Grading of Recommendations Assessment Development and Evaluation (GRADE) to evaluate the certainty of the body of evidence.Results A total of 17 trials was appraised with 2539 patients that were in compliance with inclusion and exclusion criterion. Pooled analyses indicated patients receiving primary surgical and non-surgical therapy did not significantly differ in overall survival (OS) (relative risk [RR] = 1.04, 95% confidence interval [CI] = 0.94 to 1.15), with TSA inconclusive. Additionally, patients treated with primary surgical experienced an increased disease free survival (DFS) probability compared with non-surgical treatment (RR 1.20, 95% CI=1.05 to1.37), while TSA is inconclusive. Notably, non-surgical management did have a beneficial efficacy on larynx preservation (RR 0.48, 95% CI=0.33 to 0.70), and TSA also provided conclusive evidence. GRADE indicated the level of evidence was low or very low for primary or secondary outcomes.Conclusion The results of our meta-analysis indicated compared to surgical treatments, non-surgical therapy for patients with advanced hypopharyngeal carcinoma appear to equivalent efficacy, and it offers an opportunity to preserve laryngeal function. Due to inconclusive evidence by TSA, further investigation with larger randomized clinical trials (RCTs) using modern approaches should be undertaken to verify the results of this meta-analysis.
Non-communicable diseases are key to further narrow gender gap in life expectancy in Shanghai, China
Authors: Chen Hanyi , Zhou Yi , Sun Lianghong , Chen Yichen , Qu Xiaobin , Chen Hua , Rajbhandari-Thapa Janani , Xiao Shaotan 
Published: January 2020

Abstract
Background To address change in gender gap of life expectancy (GGLE) in Shanghai from 1973 to 2018, and to identify the major causes of death and age groups associated with the change overtime. Methods Retrospective demographic analysis with application of Joinpoint regression to evaluate the temporal trend in GGLE and using life table technique and decomposition method to express changes in GGLE. Results Trend of GGLE in Shanghai experienced two phases ie., a decrease from 8.4 to 4.2 years in the descent phase (1973-1999) and a fluctuation between 4.0 and 4.9 years in the plateau phase (1999-2018). The reduced age-specific mortality rates tended to concentrate to a narrower age range, from age 0-9 and above 30 years in the descent phase to age above 55 years in the plateau phase. Gastroesophageal and liver cancer, communicable, chronic respiratory and digestive diseases were once the major contributors to narrow GGLE in the descent phase. While importance should be attached to a widening effect on GGLE by lung cancer, cardiovascular diseases, other neoplasms like colorectal and pancreatic cancer and diabetes in recent plateau phase. Conclusions Non-communicable diseases (NCDs) have made GGLE enter a plateau phase from a descent phase in Shanghai China. Public efforts to reduce excess mortalities for male NCDs, cancers, cardiovascular diseases, chronic respiratory diseases and diabetes in particular and health policies focused on the middle-aged and elderly population might further narrow GGLE and ensure improvement in health and health equity in Shanghai China.
Alveolar MMP28 is Associated With Clinical Outcomes and Measures of Lung Injury in Acute Respiratory Distress Syndrome
Authors: Morrell Eric , Mikacenic Carmen , Gong Ke-Qin , Kosamo Susanna , Stapleton Renee D. , Wurfel Mark M. , Manicone Anne M. 
Published: January 2020

Abstract
Background Excessive inflammation leading to increased alveolar-capillary barrier permeability remains the pathogenic model for acute respiratory distress syndrome (ARDS). Alveolar macrophage (AM) polarization has been shown to modify the activity of various matrix metalloproteinases (MMPs) that have downstream effects on key ARDS cytokines/chemokines, however the relationship between AMs, MMP28 (the newest member of the MMP family), and ARDS clinical outcomes is unknown.Methods We analyzed bronchoalveolar lavage fluid (BALF) and peripheral blood from subjects previously enrolled in a phase-II trial of omega-3 fatty acids for the treatment of ARDS ( n = 76). In a subset of these patients ( n = 25), we tested for assocations between AM- and peripheral blood monocyte (PBM)-specific MMP28 gene expression and clincal outcomes [ventilator-free days (VFDs), P a O 2 /F i O 2 ratio (P/F ratio), and sequential organ failure assessment score (SOFA)]. We tested for assocations between soluble BALF or plasma MMP28 concentrations and ARDS clinical outcomes and inflammatory mediator concentrations in the entire cohort.Results Increased AM MMP28 gene expression was significantly associated with worse VFDs and P/F ratio ( p < 0.05). Higher BALF MMP28 concentrations were associated with worse P/F, but not VFDs. Increased BALF MMP28 concentrations were associated with increased % neutrophils as well as BALF total protein, IL-6, IL-17A, and MCP-1 concentrations (all p < 0.05). Plasma MMP28 concentrations were not associated with any clinical outcome. Increased PBM MMP28 gene expression was associated with worse P/F ratio but not VFDs.Conclusions Higher AM MMP28 gene expression and BALF MMP28 concentrations are associated with poor clinical outcomes and with increased alveolar inflammatory mediators in patients with ARDS.
Evaluation of a PRImary-ORthopaedic (PRIOR) low back pain care model in Hong Kong: a pilot study
Authors: Choi Shirley Yue Kwan , Law Sheung Wai , Wong William WL , Lau Jamie , Ko Shaau Yiu , Lin Sibei , Hui Eric , Wong Samuel Yeung Shan , Sit Regina Wing Shan 
Published: January 2020

Abstract
Introduction: Low back pain (LBP) is a common and disabling condition with significant socioeconomic burden. A LBP care delivery model with collaborative input from primary care physicians, orthopaedic surgeons and allied health professionals has been implemented in one of the local tertiary hospital to streamline LBP care.Objective: To evaluate the preliminary effectiveness of the primary-orthopaedic (PRIOR) LBP care model.Methods: This was a 6-month quasi-experimental study with pre and post assessment. Participants (N=30) with chronic LBP were recruited and stratified by physiotherapists at the triage station located at Orthopaedic Special Outpatient Clinic. Eligible participants were referred to attend primary physicians with trained musculoskeletal skills for risk-matched treatment at Family Medicine Clinic. Patient-specific outcomes included the acceptance rate, Roland Morris Disability (RMD) scores, the self-pain efficacy scores (PSE) scores and the Euro-Qol-5D. The health service outcomes included the waiting time, discharge rate, adherence rate and healthcare resources utilization. Results: Of the 33 participants screened, 30 were eligible and enrolled for the study, the recruitment rate was 91% (X2=0.569, p=0.451). At 6 months, participants reported overall improvement of the RMD scores (β coefficient -4.3, 95% confidence interval CI -5.9 to – 2.7, P<0.001) and PSEQ scores (β coefficient 7.3, 95% CI 3.0-12.0, P=0.002). The waiting time of the FM clinic was 11.6 ±1.6 weeks, the overall discharge rate was 73%, and the adherence rate was 87%.Conclusions: The study suggested that the PRIOR LBP model could potentially improve the clinical outcomes of LBP patients and enhance the overall LBP health service delivery.