bluuebunny/crossref_metadata_2025_split huggingface dataset:
Aloe vera for Prevention of Acute Radiation Proctitis in Colorectal Cancer: A Preliminary Randomized, Placebo-Controlled Clinical Trial
Authors: Salehifar Ebrahim , sahebnasagh adeleh , saghafi fatemeh , alipour abbas , Ghasemi Arash , Akbari Jafar , Safdari Mohammadreza , Ghaleno Hassan Rezai 
Published: April 2020

Abstract
Background Acute radiation proctitis (ARP) is a common complication of radiation therapy (RT). This adverse effect in severe cases ultimately results in interruption of RT and poor outcome. Aloe vera contains multiple antioxidant and anti-inflammatory compounds This study was aimed to evaluate the preventive effects of Aloe vera in ARP in colorectal cancer.Method: twenty eligible colorectal cancer patients, who received radiation, were randomized to receive Aloe vera 3% ointment or placebo for six weeks. At each weekly visit, ARP symptoms were evaluated by Radiation Therapy Oncology Group (RTOG) and clinical presentation criteria. The lifestyle impact of the symptoms, depression and anxiety for assessment of psychosocial status of patients, and quantitative CRP were evaluated as secondary endpoints.Results there was a significant improvement in the symptom index for diarrhea and total RTOG scores and quantitative CRP levels (between-subject differences or group effect) (p < 0.05) in Aloe group. The overall time trend (within-subject differences or time effect) was statistically significant for rectal bleeding, rectal pain, total clinical scores, proctitis, cystitis, and total RTOG (P < 0.05) in Aloe vera group. The median lifestyle score improved significantly with Aloe vera. Intervention patients had a lower probability of presenting anxiety in their overall HAD scale during RT.Conclusion The use of topical formulation of Aloe vera 3% diminished the severity of ARP in colorectal cancer patients. Trial registration: Current Controlled Trials IRCT201606042027N6, registrations date: 2016-04-09.
Changes in D-Dimer after initiation of antiretroviral therapy in adults living with HIV in Kenya
Authors: Teasdale Chloe A , Hernandez Cecilia , Zerbe Allison , Chege Duncan , Hawken Mark , El-Sadr Wafaa M 
Published: April 2020

Abstract
Background
Increased coagulation biomarkers are associated with poor outcomes among people living with HIV(PLHIV). There are few data available from African cohorts demonstrating the effect of antiretroviral therapy (ART) on coagulation biomarkers.
Methods
From March 2014 to October 2014, ART-naïve PLHIV initiating non-nucleoside reverse transcriptase inhibitor-based ART were recruited from seven clinics in western Kenya and followed for up to 12 months. Demographics, clinical history and blood specimens were collected. Logistic regression models adjusted for intrasite clustering examined associations between viral load and D-Dimer at baseline. Mixed linear effects models were used to estimate mean change from baseline to six months overall, and by baseline viral load, sex and TB status at enrollment. Mean change in D-dimer at six months is reported on the log10 scale and as percentage change from baseline.
Results
Among 611 PLHIV enrolled, 66% were female, median age was 34 years (interquartile range (IQR) 29–43 years), 31 (5%) participants had tuberculosis and median viral load was 113,500 copies/mL (IQR: 23,600 − 399,000). At baseline, 311 (50.9%) PLHIV had elevated D-dimer (> 500 ng/mL) and median D-dimer was 516.4 ng/mL (IQR: 302.7-926.6) (log baseline D-dimer: 2.7, IQR: 2.5-3.0). Higher baseline D-dimer was significantly associated with higher viral load (p < 0.0001), female sex (p = 0.02) and tuberculosis (p=-0.02). After six months on ART, 518 (84.8%) PLHIV had achieved viral load < 1,000 copies/mL and median D-dimer was 390.0 (IQR: 236.6-656.9) (log D-dimer: 2.6, IQR: 2.4–2.8). Mean change in log D-dimer from baseline to six months was − 0.12 (95%CI -0.15, − 0.09) (p < 0.0001) indicating at 31.3% decline (95%CI -40.0, -23.0) in D-dimer levels over the first six months on ART. D-dimer decline after ART initiation was significantly greater among PLHIV with tuberculosis at treatment initiation
Effect of the Pumping-injection flow rate on Heat Transfer Characteristic of Borehole Heat Exchangers for Coupling Ground-Source Heat Pump System
Authors: Ma Jiuchen , Jiang Qian , Zhang QuLi , Xie Yacheng , Wang Yahui , Yi Feiyu 
Published: April 2020

Abstract
A coupling ground source heat pump system (CGSHP) is established in areas where groundwater is shallow but the seepage velocity is weak, which sets up pumping and injection wells on both sides of borehole heat exchangers (BHEs). A convection-dispersion analytical model of excess temperature in aquifer that considers groundwater forced seepage and axial effects and thermal dispersion effects is proposed. A controllable forced seepage sandbox is built by equation analysis method and similarity criteria. Through indoor test and the proposed analytical model, the correctness and accuracy of the numerical simulation software FEFLOW7.1 is verified. The influence of different pumping-injection flow rate on the heat transfer characteristic of BHEs is studied by numerical simulation. The results show that the average heat efficiency coefficient of BHEs increases and the heat influence range of downstream BHEs expands with the increasing of pumping-injection flow rate. The relation curve between Pe and the increment of heat transfer rate per unit depth of BHEs (Δ`q) is distributed as Gaussian function. The pumping-injection flow rate that makes Darcy velocity reaches 0.6 × 10− 6~1.4 × 10− 6 m∙s− 1 in the aquifer is the best reference range for CGSHP system,so 400 ~ 600 m3∙d− 1 is taken as the best pumping-injection flow rate in this paper.
Pilot trial on the efficacy and safety of pantethine in children with pantothenate kinase-associated neurodegeneration: A single-arm, open-label study.
Authors: Chang Xuting , Zhang Jie , Jiang Yuwu , Yao Bufan , Wang Jingmin , Wu Ye 
Published: April 2020

Abstract
Objective This study aimed to explore the efficacy and safety of pantethine in children with pantothenate kinase-associated neurodegeneration (PKAN).Methods A single-arm, open-label study was conducted. All subjects received pantethine during the 24-week period of treatment. The primary endpoints were change of the Unified Parkinson’s Disease Rating Scale (UPDRS) I–III and Fahn–Marsden (FM) score from baseline to week 24 after treatment.Results Fifteen children with PKAN were enrolled, and all patients completed the study. After 24 weeks of treatment with pantethine at 60 mg/kg per day, there was no difference in either UPDRS I–III (t = 0.516, P = 0.614) or FM score (t = 0.353, P = 0.729) between the baseline and W24. Whereas the rates of increase in UPDRS I-III (Z = 2.614, p = 0.009) and FM scores (Z = 2.643, p = 0.008) were slowed. Four patients (26.7%) were evaluated as “slightly improved” by doctors through blinded video assessment. Patients with lower baseline UPDRS I–III or FM scores were more likely to be improved. The living quality of family members improved after pantethine treatment, evaluated by PedsQL TM 2.0 FIM scores, whereas the living quality of the patients was unchanged at W24, evaluated by PedsQL TM 4.0 and PedsQL TM 3.0 NMM. Serum level of CoA was comparable between baseline and W24. There was no drug related adverse event during the study.Conclusions Pantethine could not significantly improve motor function in children with PKAN after 24 weeks treatment, but it could probably delay the progression of motor dysfunction in our study. 26.7% of patients showed slightly improved. Pantethine was well-tolerated at 60 mg/kg per day.
Menopause Is a Natural Stage of Aging: A Qualitative Study
Authors: Ilankoon Ilankoon Mudiyanselage Prasanthi Sumudrika , Samarasinghe Kerstin , Elgán Carina 
Published: April 2020

Abstract
Background Menopause is a biopsychosocial phenomenon encompassing the transition in a woman’s life from being fertile to becoming infertile. Although menopause may result in extremely unpleasant physical symptoms such as recurrent urinary tract infections, hot flushes and night sweats there is evidence of a low rate of reported menopausal symptoms among women in Asian cultures. Women’s experiences, views, and responses to menopause affect how women handle their menopausal symptoms varies between different societies and cultures. Consequently, also influencing women’s daily life and well-being.Methods We explore and describe menopausal experiences among women in Sri Lanka using a qualitative exploratory research approach. Individual interviews with a purposive sample of 20 women were conducted, and data analysis was done using conventional content analysis. This study aligns with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.Results The results consist of one overriding theme, “Menopause is a natural stage of aging” and two categories “Entering a new stage” and “Remaining valuable.” The overriding theme, “Menopause is a natural stage of aging” elucidate that menopausal changes was perceived as a natural change in life, with health problems that are normal and these problems was handled with various self-care practices. The category “Entering a new stage” describes the women’s feelings of fear of being pregnant when the menstruation ceases and feelings of relief when realizing not being fertile anymore. It also involved becoming aware of and dealing with menopause related health risks. The category “Remaining valuable” describes women’s experiences of being competent and able to find their own remedies to ease the menopausal symptoms and by interacting with significant others, shifting focus to other people also was a way to deal with problems related to menopause.Conclusion Sri Lankan women manage menopausal problem on their own. Educational interventions with regard to menopausal issues and alternatives to ease menopausal symptoms need to be tailored according to the prevailing sociocultural context. By implementing community-based health centers led by nurses and/or midwives providing information about additional hormonal therapy and thereafter facilitate follow-up and evaluation would simplify Sri Lankan women’s transition into menopause.
Qualitative research on the psychological experience of female patients undergoing in vitro fertilization and embryo transfer
Authors: Zhou Feijing , Du Kun , Dong Yuezhi 
Published: April 2020

Abstract
Background: Infertility and fertility treatment exacerbate the intensity of stress that couples experience and negatively affects the patients’ quality of life. Stress is a crucial factor in reproductive health and is likely to be one of the psychological factors affecting ART success. The qualitative research method permitted an understanding of the patients’ experience during the diagnosis of and treatment for IVF and identified the sources of psychological stress. This understanding could urge medical workers, families, and society at large to provide targeted help to these patients.Methods: A qualitative research was conducted in the reproductive medicine center of our hospital. Women who received IVF treatment were randomly selected.Results: In total, 16 interviews were conducted with female patients undergoing IVF-ET between May and October 2019. The psychological experience of female patients undergoing IVF–ET can be summarized into four themes: (1) negative emotions due to infertility; (2) suffering under stress; (3) eager to obtain family and social support; (4) desire for medical knowledge related to infertility.Conclusion: Medical staff should fully understand the emotional state of the patient during the process of infertility treatment and careful attention should be paid to the patients’ psychological needs. According to the individual differences between the patients, we should provide positive factors of social support. Furthermore, corresponding health guidance and psychological support to reduce the psychological stress of patients and thus improve their chances of getting pregnant should be provided.
The influence of social media on recruitment to surgical trials.
Authors: Bisset Carly Nichola , Carter Ben , Law Jennifer , Hewitt Jonathan , Parmar Kat , Moug Susan Joan 
Published: April 2020

Abstract
Background Social media is changing the way surgeons communicate worldwide with a key role in disseminating trial results. However, it is unclear if social media could be used in recruitment to surgical trials. This study aimed to investigate the influence of Twitter in promoting surgical recruitment in The Emergency Laparotomy and Frailty (ELF) Study. Methods The ELF Study was a UK prospective, observational cohort that aimed to assess the influence of frailty on 90-day mortality in older adults undergoing emergency surgery. A power calculation required 500 patients to be recruited in 12 weeks to detect a 10% change in mortality associated with frailty. A Twitter handle was designed (@ELFStudy) with eye-catching logos to encourage enrolment and inform the public and clinicians involved in the study. Twitter Analytics and an online analytics tool (Twitonomy; Digonomy Pty Ltd) were used to analyse trends in user engagement. Results After 90 days of data collection, a total of 49 sites from Scotland, England and Wales recruited 952 consecutive patients undergoing emergency laparotomy. Target recruitment (n=500) was achieved by week 11. A total of 591 tweets were published by @ELFStudy since its conception, making 218,136 impressions at time of writing. The number of impressions prior to March 20 th 2017 (study commencement date) was 23,335 (343.2 per tweet), compared to the recruitment period with 114,314 impressions (256.3 per tweet), ending on June 20 th 2017. Each additional tweet was associated with an increase in recruitment of 1.66 (95%CI 1.36 to 1.97; p<0.001). Conclusion The ELF Study over-recruited by nearly 100%, reaching over 200,000 people across the U.K. Branding enhanced tweet aesthetics and helped increase tweet engagement to stimulate discussion and healthy competition amongst clinicians to aid trial recruitment. Other studies may draw from the social media experiences of the ELF Study to optimise collaboration amongst researchers. Trial Registration This study is registered online at www.clinicaltrials.gov (registration number NCT02952430) and has been approved by the National Health Service Research Ethics Committee.
A qualitative study exploring the benefits and challenges of implementing client centered care in a substance dependence rehabilitation service
Authors: Davis Esther Louise , Kelly Peter J. , Deane Frank P. , Buckingham Mark , Breeze Danielle , Degan Tayla 
Published: April 2020

Abstract
Background Client centered care is strongly advocated as key to improving the quality of health care. However, there is a notable absence of research about the acceptability and feasibility of a client centered approach in substance dependence treatment settings. The aim of this study was to explore client and staff perspectives of a new client centered model of care implemented at Kedesh Rehabilitation Services, a residential substance dependence treatment service.Methods Participants were client and staff at Kedesh between April 2018 and April 2019. Clients were invited to take part in a focus group and staff in individual interviews. Questions elicited client and staff experience of client centered care at Kedesh, including advantages and disadvantages. Staff were also asked to describe how they would define the client centered model. Thematic analysis was conducted on transcriptions of audio recordings.Results Four focus groups were conducted amongst 18 clients and 8 individual interviews amongst staff. Staff identified the defining features of client centered care as that which is flexible, comprehensive, open-minded and inclusive. Clients and staff shared predominantly positive views on the client centered model, with an emphasis on the satisfaction in providing and receiving what felt like more authentic and comprehensive care. Shared themes emerged for clients and staff on the challenge of striking a balance between flexibility and structure, and managing comprehensive and individualized care within existing knowledge, skills and resources.Conclusions Client centered care encourages health care organisations and providers to strive for a more holistic and empowering standard of care. Results support the acceptability of client centered care in residential substance dependence treatment settings for both clients and staff. Future research is needed to develop knowledge in interpreting, implementing, and assessing client centered care in the treatment of substance dependence.
What methods are used to promote patient and family involvement in healthcare regulation? A case study across four countries
Authors: Wiig Siri , Rutz Suzanne , Boyd Alan , Churruca Kate , Kleefstra Sophia , Haraldseid-Driftland Cecilie , Braithwaite Jeffrey , O'Hara Jane , de Bovenkamp Hester van 
Published: April 2020

Abstract
Background In healthcare regulation, the subject of patient and family involvement figures increasingly prominently on the agenda. However, the literature on involving patient and families in regulation is still in its infancy. A systematic analysis of how patient and family involvement in regulation is accomplished across different health systems is lacking. We provide such an overview by mapping and classifying methods of patient and family involvement in regulatory practice in four countries; Norway, England, the Netherlands, and Australia. We thus provide a knowledge base that enables discussions about possible types of involvement, and advantages and difficulties of involvement encountered in practice.Methods The research design was a multiple case study of patient and family involvement in regulation in four countries. The authors collected 1) academic literature if available and 2) documents of regulators that describe user involvement. Based on the data collected, the authors from each country completed a pre-agreed template to describe the involvement methods. The following information was extracted and included if available: 1) Method of involvement, 2) Type of regulatory activity, 3) Purpose of involvement, 4) Who is involved and 5) Lessons learnt.Results Our mapping of involvement methods showed a range of methods being used in regulation, which we classified into four categories: individual proactive, individual reactive, collective proactive, and collective reactive methods. Reported advantages include: increased quality of regulation, increased legitimacy, perceived justice for those affected, and empowerment. Difficulties were also reported concerning: how to incorporate the input of users in decisions, the fact that not all users want to be involved, time and costs required, organizational procedures standing in the way of involvement, and dealing with emotions.Conclusions Our mapping of user involvement methods found a broad variety of involvement methods. These can serve as inspiration to regulators in healthcare. The paper shows that making involvement in regulation successful is a challenging and complex task. The fact that regulators are experimenting with different methods can be valued positively in this regard.
Availability of Essential Commodities and Related Bottlenecks for Community Health System: Systematic Literature Review
Authors: Pradhan Ami , Bogue Erin , Schreiber Benjamin , Dini Hannah Sarah , Hurkchand Hitesh , Briggs Jane , Ballard Madeleine 
Published: April 2020

Abstract
Background: This paper explores the extent of community-level stock-out of essential and program commodities for Maternal, Newborn and Child Health (MNCH) among Community Health Workers (CHWs) in Low- and Middle-Income Countries (LMICs), and identifies the underlying bottlenecks leading to such stock-outs. Methods: A systematic literature review was conducted of published and grey literature. 48 studies containing information on the number or percentage of CHWs or health facilities (HFs) stocked-out, or reasons for stock-outs at these levels, were included. In addition, interviews were conducted with domain experts from different organizations working on community health to identify primary reasons for stock-outs. The qualitative data regarding reasons for stock-outs were categorized under different themes, using a content analysis method. Results: 48.09% [CI 95%: 39.28 - 56.90] of the Community Health Workers and 54.76 % [CI 95%: 43.54 - 65.98] of the health facilities in SSA countries included in this study experienced stock-outs of essential commodities. A hypothesis test showed no significant difference in stock-out rates between CHWs and HFs. The most frequently cited reason for CHW stock-outs was a lack of financial resources, leading to inadequate national level stocks, affecting supply available at the last mile. Moreover, issues at HF and CHW levels in the following areas contributed to stock-outs: transportation, data and estimation of needs, human resources, and stock management and storage. These significant bottlenecks hinder the ability of CHWs to save lives. Conclusion: Stock-outs of health commodities impact almost half of CHWs, preventing effective service delivery. Many factors contribute to stock-outs, which occur at all levels of the health supply chain. A system strengthening approach is necessary to reduce CHW stock-outs. Sparse data, differing definitions of stock-outs, and inconsistent reporting metrics posed significant challenges to analyzing results from reviewed studies. Therefore, a set of standard metrics to measure the rate, period, and frequency of stock-outs in future studies is recommended.
Policymakers and institutional structures affecting health inequality in Ethiopia: a Qualitative Study
Authors: Abbe Kassa Mohammed , Dolamo Bethabile L 
Published: April 2020

Abstract
Background : Ethiopia generally provides a story of progress in child health, but unevenly distributed. The attitude, knowledge, political drives, interest groups and institutional dynamics in health equity policy setting and execution has not been explored in Ethiopia. Without addressing these issues, the right kind of policy choice and implementation cannot be attained. Methods : This study was conducted between 2015 and 2017 in Ethiopia. The study utilized a qualitative framework, grounded in social determinants for health and health policy. Semi-structured interviews; executed policy analysis; and reviewed the literature. In-depth interviews were conducted among twenty-one policymakers and reviewed 23 policy documents and over 350 literatures, Transcribed data, policy extracts and articles were synthesised and analysed by ATLAS.ti 7.1.4. Results: Ethiopia is in an early state of recognizing and intervening against health inequalities. The quality and level of knowledge is mixed and gets reduced as one goes to the rural areas. Consensus is slowly developing on the major underlying causes of inequality. The contents of health policy documents are neither comprehensive nor strongly supported by evidence. There are multiple interest groups with varying level of knowledge and power. Complex political and institutional relations affect policy making process negatively. Participants demonstrated denialism; blaming of victims; misconceptions; and one size fits all attitudes. Conclusions : Any future work for improving health equity needs to be build more on evidence and embrace more participatory processes to address all types of interest groups.