bluuebunny/crossref_metadata_2025_split huggingface dataset:
Study protocol for the randomized controlled EVA (early vascular adjustments) trial: tailored treatment of mild hypertension in pregnancy to prevent severe hypertension and preeclampsia
Authors: Mulder Eva , Ghossein-Doha Chahinda , Appelman Evine , van Kuijk Sander , Smits Luc , van der Zanden Rogier , van Drongelen Joris , Spaanderman Marc 
Published: December 2020

Abstract
Background
In contrast to severe gestational hypertension, it is questioned whether antihypertensive medication for mild to moderate gestational hypertension prevents adverse maternal and offspring outcomes. Hypertensive drugs halve the risk of severe hypertension, but do not seem to prevent progression to preeclampsia or reduce the risk of complications in offspring. In fact, beta-blockers, a first line therapy option, are suspected to impair foetal growth. Disappointing effects of antihypertensive medication can be anticipated when the pharmacological mode of action does not match the underlying haemodynamic imbalance. Hypertension may result from 1) high cardiac output, low vascular resistance state, in which beta blockade is expected to be most effective, or 2) low cardiac output, high vascular resistance state where dihydropyridine calcium channel blockers or central-acting alpha agonists might be the best corrective medication. In the latter, beta-blockade might be maternally ineffective and even contribute to impaired foetal growth by keeping cardiac output low. We propose a randomized controlled trial to determine whether correcting the haemodynamic imbalance in women with mild to moderate hypertension reduces the development of severe hypertension and/or preeclampsia more than non-pharmacological treatment does, without alleged negative effects on foetal growth.

Methods
Women diagnosed with mild to moderate hypertension without proteinuria or signs of other organ damage before 37 weeks of pregnancy are invited to participate in this randomized controlled trial. Women randomized to the intervention group will be prescribed tailored antihypertensive medication, using a simple diagnostic and treatment algorithm based on the mean arterial pressure/heart rate ratio, which serves as an easy-to-determine proxy for maternal circulatory state. Women randomized to the control group will receive non-pharmacological standard care according to national and international guidelines. In total, 208 women will be randomized in a 1:1 ratio. The primary outcome is progression to severe hypertension and preeclampsia and the secondary outcomes are adverse maternal and neonatal outcomes.

Discussion
This trial will provide evidence of whether tailoring treatment of mild to moderate gestational hypertension to the individual haemodynamic profile prevents maternal disease progression.

Trial registration
NCT02531490, registered on 24 August 2015.
Facilitators and challenges in delivering a peer-support physical activity intervention for older adults: a qualitative study with multiple stakeholders
Authors: Crozier Anthony , Porcellato Lorna , Buckley Benjamin J. R. , Watson Paula M. 
Published: December 2020

Abstract
Background
Involving peer volunteers in intervention delivery can provide social support and improve adherence. Whilst such interventions have the potential to reduce physical activity (PA) intervention costs, little is known about the process of delivering them in practice. This qualitative study explored the facilitators and challenges of delivering a peer-support PA intervention for older adults, with a view to making recommendations for the delivery of future interventions.

Methods
Data were collected via (7) semi-structured interviews and a focus group with stakeholders involved in a peer-support PA intervention for older adults in a large city in the North-West of England. Participants included local authority staff (n = 3), peer volunteers (n = 2) and service users (n = 7). Audio data were transcribed verbatim and thematically coded to identify perceived facilitators and challenges.

Results
Facilitators to delivery included social interaction, community referral pathways, suitable facilities, peer volunteers and high-quality instructors. Challenges surrounded inconsistent practice, staff capacity, safety and accountability, and awareness raising.

Conclusions
Peer volunteers can provide an additional support mechanism alongside qualified instructors for increasing social interaction within PA interventions. For optimal intervention delivery, consideration needs to be given to equipment and space, safety and accountability and consistency of practice.
The dysregulation of the hypothalamic–pituitary–adrenal axis in diet-induced prediabetic male Sprague Dawley rats
Authors: Mosili Palesa , Mkhize Bongeka Cassandra , Ngubane Phikelelani , Sibiya Ntethelelo , Khathi Andile 
Published: December 2020

Abstract
Background
Altered function of the hypothalamic–pituitary–adrenal (HPA) axis in type 2 diabetic patients, a condition preceded by pre-diabetes, has been shown to increase the risk of depression as well as cause downstream effects resulting in upregulation of gluconeogenesis and dyslipidemia. In addition, stress, either psychological from managing diabetes or lifestyle related, further activates the HPA axis causing an exaggerated stress response. This study investigated the activity of the HPA axis in selected markers of glucose handling, and the stress response relative to components of the HPA axis in a diet-induced pre-diabetic rat model.

Methods
Sprague Dawley Rats were randomly divided into non-pre-diabetic group (NPD) and pre-diabetic group (PD) (n = 6, per group) over a 20-week induction period and a further 12-week experimental period to get 32 weeks. At the end of the 20 and 32-week periods, glucose handling using the Homeostasis Model Assessment indices, adrenocorticotropic (ACTH) and corticosterone (CORT) concentrations were measured. Stress was induced and the forced swim test were performed in the 12-week experimental week. At the end of 32 weeks glucocorticoid and mineralocorticoid hippocampal receptors were also measured.

Results
Impaired glucose handling in the PD group as well as increase in corticosterone was observed at the end of both 20 and 32-week periods by comparison to NPD groups. No changes were observed in ACTH concentration at week 20 while, at week 32, a decrease in plasma ACTH concentration was observed in the PD group by comparison to the NPD group. The stressed-induced animals were stressed using the forced swim test: the behaviour observed showed an increase in immobility time in the PD stressed group by comparison to the NPD group. This was followed by the observation of a decrease in ACTH and CORT concentration in the PD stressed group by comparison to the NPD stressed group. Mineralocorticoid and glucocorticoid receptors gene expression were elevated in the stressed PD group relative to the stressed NPD group.

Conclusion
These observations, together, suggest that diet-induced pre-diabetes is associated with impaired HPA axis activity and deteriorating response to stress.
Factors associated with antiretroviral treatment failure among people living with HIV on antiretroviral therapy in resource-poor settings: a systematic review and metaanalysis
Authors: Lailulo Yishak , Kitenge Marcel , Jaffer Shahista , Aluko Omololu , Nyasulu Peter Suwirakwenda 
Published: December 2020

AbstractBackgroundDespite the increase in the number of people accessing antiretroviral therapy (ART), there is limited data regarding treatment failure and its related factors among HIV-positive individuals enrolled in HIV care in resource-poor settings. This review aimed to identify factors associated with antiretroviral treatment failure among individuals living with HIV on ART in resource-poor settings.MethodsWe conducted a comprehensive search on MEDLINE (PubMed), Excerpta Medica Database (EMBASE), Cochrane Central Register of Controlled Trials (CENTRAL), World Health Organization’s (WHO’s) library database, and Latin American and Caribbean Health Sciences Literature (LILACS). We included observational studies (cohort, case-control, and cross-sectional studies) where adolescents and adults living with HIV were on antiretroviral treatment regardless of the ART regimen. The primary outcomes of interest were immunological, virological, and clinical failure. Some of the secondary outcomes were mm3opportunistic infections, WHO clinical stage, and socio-demographic factors. We screened titles, abstracts, and the full texts of relevant articles in duplicate. Disagreements were resolved by consensus. We analyzed the data by doing a meta-analysis to pool the results for each outcome of interest.ResultsAntiretroviral failure was nearly 6 times higher among patients who had poor adherence to treatment as compared to patients with a good treatment adherence (OR = 5.90, 95% CI 3.50, 9.94, moderate strength of evidence). The likelihood of the treatment failure was almost 5 times higher among patients with CD4 < 200 cells/mm3compared to those with CD4 ≥ 200 CD4 cells/mm3(OR = 4.82, 95% CI 2.44, 9.52, low strength of evidence). This result shows that poor adherence and CD4 count below < 200 cells/mm3are significantly associated with treatment failure among HIV-positive patients on ART in a resource-limited setting.ConclusionThis review highlights that low CD4 counts and poor adherence to ART were associated to ART treatment failure. There is a need for healthcare workers and HIV program implementers to focus on patients who have these characteristics in order to prevent ART treatment failure.Systematic review registrationThe systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number: 2019 CRD42019136538.
The influence of acute exercise on bone biomarkers: protocol for a systematic review with meta-analysis
Authors: Dolan E. , Dumas A. , Keane K. M. , Bestetti G. , Freitas L. H. M. , Gualano B. , Kohrt W. , Kelley G. A. , Pereira R. M. R. , Sale C. , Swinton P. 
Published: December 2020

Abstract
Background
Bone is a plastic tissue that is responsive to its physical environment. As a result, exercise interventions represent a potential means to influence the bone. However, little is currently known about how various exercise and participant characteristics interact to influence bone metabolism. Acute, controlled, interventions provide an in vivo model through which the acute bone response to exercise can be investigated, typically by monitoring circulating bone biomarkers. Currently, substantial heterogeneity in factors such as study design, quality, exercise, and participant characteristics render it difficult to synthesize and evaluate the available evidence. Using a systematic review and meta-analytic approach, the aim of this investigation is to quantify the effect of an acute exercise bout on circulating bone biomarkers as well as examine the potential factors that may moderate this response, e.g., variation in participant, exercise, and sampling characteristics.

Methods
This protocol was designed in accordance with the PRISMA-P guidelines. Seven databases (MEDLINE, Embase, Sport Discus, Cochrane CENTRAL, PEDro, LILACS, and Ibec) will be systematically searched and supplemented by a secondary screening of the reference lists of all included articles. The PICOS (Population, Intervention, Comparator, Outcomes and Study Design) approach was used to guide the determination of the eligibility criteria. Participants of any age, sex, training, or health status will be considered for inclusion. We will select studies that have measured the bone biomarker response before and after an acute exercise session. All biomarkers considered to represent the bone metabolism will be considered for inclusion, and sensitivity analyses will be conducted using reference biomarkers for the measurement of bone resorption and formation (namely β-CTX-1 and P1NP). Multi-level, meta-regression models within a Bayesian framework will be used to explore the main effect of acute exercise on bone biomarkers as well as potential moderating factors. The risk of bias for each individual study will be evaluated using a modified version of the Downs and Black checklist while certainty in resultant outcomes will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Discussion
A better understanding of the bone metabolic response to an acute bout of exercise has the potential to advance our understanding of the mechanisms through which this stimulus impacts bone metabolism, including factors that may moderate this response. Additionally, we will identify current gaps in the evidence base and provide recommendations to inform future research.

Systematic review registration
This protocol was prospectively registered in the Open Science Framework Registry (https://osf.io/6f8dz)
A brief review of the biological potential of indole derivatives
Authors: Kumar Sunil , Ritika  
Published: December 2020

AbstractBackgroundVarious bioactive aromatic compounds containing the indole nucleus showed clinical and biological applications. Indole scaffold has been found in many of the important synthetic drug molecules which gave a valuable idea for treatment and binds with high affinity to the multiple receptors helpful in developing new useful derivatives.Main textIndole derivatives possess various biological activities, i.e., antiviral, anti-inflammatory, anticancer, anti-HIV, antioxidant, antimicrobial, antitubercular, antidiabetic, antimalarial, anticholinesterase activities, etc. which created interest among researchers to synthesize a variety of indole derivatives.ConclusionFrom the literature, it is revealed that indole derivatives have diverse biological activities and also have an immeasurable potential to be explored for newer therapeutic possibilities.
Simulated annealing velocity analysis: Automating the picking process
Authors: Velis Danilo 
Published: December 2020

We have developed an automated method for velocity picking that allows us to estimate appropriate velocity functions for the normal moveout correction of common-depth-point (CDP) gathers, valid for either hyperbolic or nonhyperbolic trajectories. In the hyperbolic velocity analysis case, the process involves the simultaneous search (picking) of a certain number of time-velocity pairs in which the semblance, or any other coherence measure, is high. In the nonhyperbolic velocity analysis case, a third parameter, usually associated with the layering and/or the anisotropy, is added to the searching process. Our technique relies on a simple but effective search of a piecewise linear curve defined by a certain number of nodes in a 2D or 3D space that follows the semblance maxima. The search is carried out efficiently using a constrained very fast simulated annealing algorithm. The constraints consist of static and dynamic bounding restrictions, which are viewed as a means to incorporate prior information about the picking process. This allows us to avoid those maxima that correspond to multiples, spurious events, and other meaningless events. Results using synthetic and field data indicate that our technique permits automatically obtaining accurate and consistent velocity picks that lead to flattened events, in agreement with the manual picks. As an algorithm, the method is very flexible for accommodating additional constraints (e.g., preselected events) and depends on a limited number of parameters. These parameters are easily tuned according to data requirements, available prior information, and the user’s needs. The computational costs are relatively low, ranging from a fraction of a second to, at most, 1–2 s per CDP gather, using a standard PC with a single processor.
Rare health conditions 41: Childhood interstitial lung disease or ChILD, Neuroblastoma and Ehlers-Danlos syndromes
Authors: Barber Chris 
Published: December 2020

The purpose of this series is to highlight a range of rare health conditions. Rare health conditions are those that affect no more and usually less than 1 person in every 2000 and many healthcare assistants and nurses will encounter some of these conditions, given the high number of them. This 41st article will explore three of these conditions: childhood interstitial lung disease or ChILD, neuroblastoma and Ehlers-Danlos syndromes.
The public health role of maternity support workers
Authors: Lindsay Pat , Linay Denise 
Published: December 2020

Most of the work of midwives and obstetricians is directed at improving pregnancy outcomes. Part of this work is built on the public health strategy developed by the national health services around the UK. Pregnancy and early parenthood are times when expectant and new parents are receptive to public health information. Midwives and maternity support workers work together to convey public health messages. The positive outcomes of this work include reductions in rates of stillbirth, preterm birth and low-birthweight babies. Other outcomes are increased parental satisfaction, stronger family bonds and better family health. Specialist and consultant midwives' views on the role of maternity support workers in public health are included in this paper.
Understanding the nursing process
Authors: Stonehouse David 
Published: December 2020

Support staff work closely with their patients and members of the multidisciplinary team to deliver high-quality care. Often this care will have been planned by a nurse using ‘the nursing process’. It is therefore important for the support worker to understand how the patient has been assessed and that the care they are providing has been planned. Within this article, the author will be discussing the nursing process, explaining the different stages and how these are used to deliver quality care. Relevant sections of the Code of Conduct for Healthcare Support Workers and Adult Social Care Workers in England ( Skills for Care and Skills for Health, 2013 ) will be highlighted. Support workers have a clear and important role in making sure the nursing process is successful and patients receive the best quality care.
Dynamic interference of the high harmonics from photoisomerizing 1,3-cyclohexadiene
Authors: Kaneshima Keisuke , Ninota Yuki , Sekikawa Taro 
Published: December 2020

The ionization potential difference between photoexcited and ground-state molecules results in a phase difference between their high harmonics, which causes high harmonic interference. The interference enables us to reveal how ionization potential of the photoexcited molecules evolves along the electronic relaxation path from the Franck–Condon state to the electronic ground state. We observe the ultrafast electron dynamics of a photoisomerizing molecule, 1,3-cyclohexadiene, via high harmonic interference. The experimental observations reveal that the electronic relaxation of 1,3-cyclohexadiene takes 200 fs, and the photoisomerization to 1, 3, 5-hexatriene takes an additional 450 fs.
Clinician perspectives on inpatient cystatin C utilization: A qualitative case study at Mayo Clinic
Authors: Markos James Roland , Schaepe Karen S. , Teaford Hilary R. , Rule Andrew D. , Kashani Kianoush B. , Lieske John C. , Barreto Erin F. 
Published: December 2020

Introduction
Serum creatinine (SCr) testing has been the mainstay of kidney function assessment for decades despite known limitations. Cystatin C (CysC) is an alternative biomarker that is generally less affected than SCr by pertinent non-renal factors in hospitalized patients, such as muscle mass. Despite its potential advantages, the adoption of CysC for inpatient care is not widespread. At one hospital with CysC testing, we demonstrated a significant rise in non-protocolized use over the last decade. This study uses qualitative methods to provide the first report of how clinicians understand, approach, and apply CysC testing in inpatient care.

Methods
Fifteen clinicians from various disciplines were interviewed about their experience with inpatient CysC testing. The semi-structured interviews were audio-recorded, transcribed verbatim, and analyzed thematically using a phenomenological approach.

Results
Knowledge and confidence with CysC varied greatly. Clinicians reported first learning about the test from colleagues on consulting services or multidisciplinary teams. The majority believed CysC to provide a more accurate measure of kidney function than SCr. Common scenarios for CysC ordering included medication dosing, evaluation of acute kidney injury, and a thorough evaluation of kidney function in patients with risk factors for an altered SCr. Facilitators for ordering CysC included the availability of rapid results turnaround and the automated calculation of glomerular filtration rate based on the biomarker. Barriers to use included a lack of education about CysC, and the absence of an institutional protocol for use.

Discussion
Clinicians at our site decided independent of institutional guidance whether and when CysC added value to patient care. While the majority of study participants indicated advantages to rapid turnaround CysC testing, its use depended not just on the features of the specific case but on clinician familiarity and personal preference. Findings from this research can guide the implementation and expansion of CysC testing.
Influenza vaccination hesitancy in five countries of South America. Confidence, complacency and convenience as determinants of immunization rates
Authors: González-Block Miguel Ángel , Gutiérrez-Calderón Emilio , Pelcastre-Villafuerte Blanca Estela , Arroyo-Laguna Juan , Comes Yamila , Crocco Pedro , Fachel-Leal Andréa , Noboa Laura , Riva-Knauth Daniela , Rodríguez-Zea Berenice , Ruoti Mónica , Sarti Elsa , Puentes-Rosas Esteban 
Published: December 2020

Introduction
Influenza morbidity and mortality are significant in the countries of South America, yet influenza vaccination is as low as 56.7% among pregnant women, reaching 76.7% of adults with chronic diseases. This article measures the relative values for the vaccination hesitancy indicators of confidence, complacency and convenience by risk-groups in urban areas of five countries of South America with contrasting vaccination rates, analyzing their association with sociodemographic variables and self-reported immunization status.

Methods
An exit survey was applied to 640 individuals per country in Brazil, Chile, Paraguay, Peru and Uruguay, distributed equally across risk groups of older adults, adults with risk factors, children ≤6 and pregnant women. Indicators were constructed for vaccine confidence, complacency and convenience. Analysis of variance and multiple logistic analysis was undertaken.

Results
Adults with risk factors are somewhat more confident of the influenza vaccine yet also more complacent. Convenience is higher for mothers of minors. Children and older adults report higher levels of vaccination. The 3Cs are more different across countries than across risk groups, with values for Chile higher for confidence and those for Uruguay the lowest. Complacency is lower in Brazil and higher in Uruguay. Results suggest that confidence and complacency affect vaccination rates across risk groups and countries.

Conclusions
Influenza vaccine confidence, complacency and convenience have to be bolstered to improve effective coverage across all risk groups in the urban areas of the countries studied. The role played by country contextual and national vaccination programs has to be further researched in relation to effective coverage of influenza vaccine.