bluuebunny/crossref_metadata_2025_split huggingface dataset:
Investment case for two-year post university speciality training in family medicine in Tajikistan: how much is needed for continuing and scaling up the improved education of family doctors?
Authors: Kempers Jari , Bohle Leah F. , Topa Alexandra , Ross Greta , Kasymova Zukhra , Yarbaeva Shakhlo , Rotaru Cristina , Prytherch Helen 
Published: December 2020

Abstract
Background
A new two-year Post University Specialty Training (PUST) programme in family medicine was introduced to improve the quality of postgraduate speciality medical education in Tajikistan. Postgraduate education of family doctors (FDs) needs to be urgently scaled up, as 38% of FD positions in Tajikistan remained unfilled in 2018. Moreover, the international financial support for the PUST programme is ending. This investment case assesses the minimum funding needed for the continuation and scale-up of PUST and establishes the rationale for the investment in the light of a recent evaluation.

Methods
The costs of the programme were calculated for 2018 and a scale-up forecast made for the period 2019–2023. The impact of the scale-up on the shortage of FDs was assessed. An evaluation using a Multiple Choice Questionnaire and Objective Structured Clinical Examination (OSCE) assessed and compared theoretical knowledge, clinical skills and competencies of PUST trained and conventionally trained FDs.

Results
The annual costs of the programme were US$ 228,000 in 2018. The total investment needed for scaling up PUST from 31 new FDs in 2018 to 100 FD graduates each year by 2023 was US$ 802,000.However, when the retirement of FDs and population growth are considered, the scale-up will result only in maintaining the current level of FDs working and not solve the country’s FD shortage. The PUST FDs demonstrated significantly better clinical skills than the conventionally trained interns, scoring 60 and 45% of OSCE points, respectively. Theoretical knowledge showed a similar trend; PUST FDs answered 44% and interns 38% of the questions correctly.

Conclusions
The two-year PUST programme has clearly demonstrated it produces better skilled family doctors than the conventional one-year internship, albeit some enduring quality concerns do still prevail. The discontinuation of international support for PUST would be a major setback and risks potentially losing the benefits of the programme for family medicine and also other specialities. To guarantee the supply of adequately trained FDs and address the FD shortage, the PUST should be continued and scaled up. Therefore, it is essential that international support is extended and a gradual transition to sustainable national financing gets underway.
The TRIFLOW study: a randomised, cross-over study evaluating the effects of extrafine beclometasone/formoterol/glycopyrronium on gas trapping in COPD
Authors: Dean James , Panainte Catalina , Khan Naimat , Singh Dave 
Published: December 2020

Abstract
Background
The effects of triple therapy on gas trapping in COPD are not fully understood. We evaluated the effects of the long acting bronchodilator components of the extrafine single inhaler triple therapy beclometasone dipropionate/formoterol/glycopyrronium (BDP/F/G) pMDI on gas trapping.

Methods
This open-label, randomised, single centre, 2-way cross-over study recruited 23 COPD patients taking inhaled corticosteroid combination treatments and with residual volume (RV) > 120% predicted at screening. Inhaled BDP was taken during run-in and washout periods. Baseline lung function (spirometry, lung volumes, oscillometry) was measured over 12 h prior to randomisation to BDP/F/G or BDP/F for 5 days followed by washout and crossover. Lung function was measured prior to dosing on day 1 and for 12 h post-dose on day 5.

Results
Co-primary endpoint analysis: BDP/F/G had a greater effect than BDP/F on FEV1 area under the curve over 12 h (AUC0–12) (mean difference 104 mls, p = 0.0071) and RV AUC0–12 (mean difference − 163 mls, p = 0.0028). Oscillometry measurements showed a greater effect of BDP/F/G on the difference between resistance at 5 and 20 Hz (R5–R20) AUC0–12, which measures small airway resistance (mean difference − 0.045 kPa/L/s, p = 0.0002). Comparison of BDP/F with the baseline measurements (BDP alone) showed that F increased FEV1 AUC0–12 (mean difference 227 mls) and improved RV AUC0–12 (mean difference − 558 mls) and R5–R20 AUC0–12 (mean difference − 0.117 kPa/L/s), all p < 0.0001.

Conclusions
In COPD patients with hyperinflation, the G and F components of extrafine BDP/F/G improved FEV1, RV and small airway function. These long acting bronchodilators target small airway function, thereby improving gas trapping and airflow.
Trial registration The study was retrospectively registered at ClinicalTrials.gov on 15th February 2019 (No.: NCT03842904, https://clinicaltrials.gov/ct2/show/NCT03842904).
Impact of a 2-year trial of nutritional ketosis on indices of cardiovascular disease risk in patients with type 2 diabetes
Authors: Athinarayanan Shaminie J. , Hallberg Sarah J. , McKenzie Amy L. , Lechner Katharina , King Sarah , McCarter James P. , Volek Jeff S. , Phinney Stephen D. , Krauss Ronald M. 
Published: December 2020

AbstractBackgroundWe have previously reported that in patients with type 2 diabetes (T2D) consumption of a very low carbohydrate diet capable of inducing nutritional ketosis over 2 years (continuous care intervention, CCI) resulted in improved body weight, glycemic control, and multiple risk factors for cardiovascular disease (CVD) with the exception of an increase in low density lipoprotein cholesterol (LDL-C). In the present study, we report the impact of this intervention on markers of risk for atherosclerotic cardiovascular disease (CVD), with a focus on lipoprotein subfraction particle concentrations as well as carotid-artery intima-media thickness (CIMT).MethodsAnalyses were performed in patients with T2D who completed 2 years of this study (CCI; n = 194; usual care (UC): n = 68). Lipoprotein subfraction particle concentrations were measured by ion mobility at baseline, 1, and 2 years and CIMT was measured at baseline and 2 years. Principal component analysis (PCA) was used to assess changes in independent clusters of lipoprotein particles.ResultsAt 2 years, CCI resulted in a 23% decrease of small LDL IIIb and a 29% increase of large LDL I with no change in total LDL particle concentration or ApoB. The change in proportion of smaller and larger LDL was reflected by reversal of the small LDL subclass phenotype B in a high proportion of CCI participants (48.1%) and a shift in the principal component (PC) representing the atherogenic lipoprotein phenotype characteristic of T2D from a major to a secondary component of the total variance. The increase in LDL-C in the CCI group was mainly attributed to larger cholesterol-enriched LDL particles. CIMT showed no change in either the CCI or UC group.ConclusionConsumption of a very low carbohydrate diet with nutritional ketosis for 2 years in patients with type 2 diabetes lowered levels of small LDL particles that are commonly increased in diabetic dyslipidemia and are a marker for heightened CVD risk. A corresponding increase in concentrations of larger LDL particles was responsible for higher levels of plasma LDL-C. The lack of increase in total LDL particles, ApoB, and in progression of CIMT, provide supporting evidence that this dietary intervention did not adversely affect risk of CVD.
Water treadmill training attenuates blood-spinal cord barrier disruption in rats by promoting angiogenesis and inhibiting matrix metalloproteinase-2/9 expression following spinal cord injury
Authors: Ying Xinwang , Xie Qingfeng , Li Shengcun , Yu Xiaolan , Zhou Kecheng , Yue Jingjing , Chen Xiaolong , Tu Wenzhan , Yang Guanhu , Jiang Songhe 
Published: December 2020

Abstract
Background
The permeability of the blood-spinal cord barrier (BSCB) is mainly determined by junction complexes between adjacent endothelial cells (ECs), including tight junctions (TJs) and adherens junctions (AJs), which can be severely damaged after spinal cord injury (SCI). Exercise training is a recognized method for the treatment of SCI. The destruction of the BSCB mediated by matrix metalloproteinases (MMPs) leads to inflammation, neurotoxin production, and neuronal apoptosis. The failure of new blood vessels to effectively regenerate is also an important cause of delayed recovery after SCI. For the first time, we introduced water treadmill training (TT) to help SCI rats successfully exercise and measured the effects of TT in promoting recovery after SCI and the possible mechanisms involved.

Methods
Sprague-Dawley (200–250 g) rats were randomly divided into the following three groups: sham operated, SCI, and SCI + TT. Animals were sacrificed at 7 or 14 days post-surgery. The degree of neurological deficit, tissue morphology and BSCB permeability were assessed by the Basso-Beattie-Bresnahan (BBB) motor function scale and appropriate staining protocols, and apoptosis, protein expression and vascular EC ultrastructure were assessed by TUNEL staining, Western blotting, immunofluorescence and transmission electron microscopy (TEM).

Results
Our experiments showed that TT reduced permeability of the BSCB and decreased structural tissue damage. TT significantly improved functional recovery when compared with that in the SCI group; TJ and AJ proteins expression increased significantly after TT, and training reduced apoptosis induced by SCI. TT could promote angiogenesis, and MMP-2 and MMP-9 expression was significantly inhibited by TT.

Conclusions
The results of this study indicate that TT promotes functional recovery for the following reasons: TT (1) protects residual BSCB structure from further damage, (2) promotes vascular regeneration, and (3) inhibits MMP-2/9 expression to mitigate BSCB damage.
Differences in force-time parameters and electromyographic characteristics of two high-velocity, low-amplitude spinal manipulations following one another in quick succession
Authors: Gorrell Lindsay M. , Conway Philip J. , Herzog Walter 
Published: December 2020

Abstract
Background
Spinal manipulative therapy is an effective treatment for neck pain. However, the mechanisms underlying its clinical efficacy are not fully understood. Previous studies have not systematically compared force-time parameters and electromyographic responses associated with spinal manipulation. In this study, force-time parameters and electromyographic characteristics associated with multiple manual high-velocity, low-amplitude cervical and upper thoracic spinal manipulations were investigated. The purpose of this analysis was to compare the force-time parameters and electromyographic characteristics between two spinal manipulations delivered following one another in quick succession if the first thrust was not associated with an audible cavitation.

Methods
Nine asymptomatic and eighteen symptomatic participants received six Diversified-style spinal manipulations to the cervical and upper thoracic spines during data collected February 2018 to September 2019. Peak force, rate of force application and thrust duration were measured using a pressure pad. Bipolar surface electrodes were used to measure the electromyographic responses and reflex delay times in sixteen neck, back and limb outlet muscles bilaterally. Differences in force-time parameters and electromyographic data were analyzed between the first and second thrust.

Results
Fifty-two spinal manipulations were included in this analysis. Peak force was greater (p < 0.001) and rate of force application faster (p < 0.001) in the second thrust. Furthermore, peak electromyographic responses were higher following the second thrust in asymptomatic (p < 0.001) and symptomatic (p < 0.001) subjects. Also, electromyographic delays were shorter in the symptomatic compared to the asymptomatic participants for the second thrust (p = 0.039). There were no adverse patient events.

Conclusion
When a second manipulation was delivered because there was not audible cavitation during the first thrust, the second thrust was associated with greater treatment forces and faster thrust rates. Peak electromyographic responses were greater following the second thrust.
Radiology artificial intelligence, a systematic evaluation of methods (RAISE): a systematic review protocol
Authors: Kelly Brendan , Judge Conor , Bollard Stephanie M. , Clifford Simon M. , Healy Gerard M. , Yeom Kristen W. , Lawlor Aonghus , Killeen Ronan P. 
Published: December 2020

Abstract
Introduction
There has been a recent explosion of research into the field of artificial intelligence as applied to clinical radiology with the advent of highly accurate computer vision technology. These studies, however, vary significantly in design and quality. While recent guidelines have been established to advise on ethics, data management and the potential directions of future research, systematic reviews of the entire field are lacking. We aim to investigate the use of artificial intelligence as applied to radiology, to identify the clinical questions being asked, which methodological approaches are applied to these questions and trends in use over time.

Methods and analysis
We will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and by the Cochrane Collaboration Handbook. We will perform a literature search through MEDLINE (Pubmed), and EMBASE, a detailed data extraction of trial characteristics and a narrative synthesis of the data. There will be no language restrictions. We will take a task-centred approach rather than focusing on modality or clinical subspecialty. Sub-group analysis will be performed by segmentation tasks, identification tasks, classification tasks, pegression/prediction tasks as well as a sub-analysis for paediatric patients.

Ethics and dissemination
Ethical approval will not be required for this study, as data will be obtained from publicly available clinical trials. We will disseminate our results in a peer-reviewed publication.
Registration number PROSPERO: CRD42020154790
Trends of interventional radiology procedures during the COVID-19 pandemic: the first 27 weeks in the eye of the storm
Authors: How Guo Yuan , Pua Uei 
Published: December 2020

AbstractObjectivesWhile the Novel Coronavirus (COVID-19) pandemic looks to persist, institutions promote delaying procedures. Understanding trends and demands of interventional radiology (IR) procedures in the infected and COVID-free populations are needed in long-term planning. We detail IR procedure trends in the first 27 weeks of the pandemic and compare with the pre-pandemic era.MethodsIn this IRB approved retrospective electronic case review, all IR patients in our institution from 1 January to 9 July 2020, the same period in 2019 pre-pandemic and the Severe Acute Respiratory Syndrome (SARS-CoV) outbreak were included. IR procedures were classified using Interventional Radiology—Procedure Acuity Scale (IR-PAS) and category of IR procedures. Along with descriptive frequencies, the Mann–WhitneyUtest and Chi-square test of independence were performed.ResultsDuring the pandemic, 3655 IR procedures were performed compared to 3851 procedures pre-pandemic. No statistically significant difference in weekly IR caseloads across IR-PAS tiers between both periods (p = .088) and category of procedure (p = .054) were noted. General intervention procedures remained the largest proportion and musculoskeletal procedures the minority, in both periods. More general intervention radiology and oncology procedures were performed during the COVID-19 pandemic compared to the SARS-CoV outbreak. Thirty-four (0.93%) IR procedures were performed on 30 COVID-19 patients. There was no IR procedure-related COVID-19 cross-transmission.ConclusionsDemand for IR procedures among COVID-free patients remains high, and IR procedures involving COVID-19 represents a fraction of the IR caseload. A sustainable model in providing timely IR services to COVID-free patients needs to be considered.
A note on general solutions to a hyperbolic-cotangent class of systems of difference equations
Authors: Stević Stevo 
Published: December 2020

AbstractRecently there has been some interest in difference equations and systems whose forms resemble some trigonometric formulas. One of the classes of such systems is the so-called hyperbolic-cotangent class of systems of difference equations. The corresponding two-dimensional class has two delays denoted bykandl. So far the class has been studied for the case$k\ne l$k≠l, and it was shown that it is practically solvable when$\max \{k,l\}\le 2$max{k,l}≤2. In this note we show practical solvability of the system in the case$k=l$k=l, not only for small values ofkandl, but for all$k=l\in {\mathbb {N}}$k=l∈N, which is the first result of such generality.
A new liquid phase microextraction method-based reverse micelle for analysis of dexketoprofen in human plasma by HPLC-DAD
Authors: Yuvali Dönay , Yilmaz Erkan , Narin İbrahim 
Published: December 2020

AbstractA new liquid phase microextraction method was developed by used reverse micelle-based coacervates as microextraction agents for the separation of dexketoprofen (DKT) from human plasma before its determination by high-performance liquid chromatography with photodiode-array detection (HPLC-DAD). The change in the concentration of dexketoprofen in the plasma of the male and female patients was successfully monitored by using this method. The proposed method involves the use of reverse micelles of decanoic acid (DA) are dispersed in tetrahydrofuran (THF) and aqueous system. After addition of the DA and THF to the aqueous sample phase, the formation of micelles of nano and molecular size was observed in an ultrasonic bath. The solution was centrifuged, and the DKT extracted into the DA phase was analyzed by HPLC-DAD. Some analytical parameters that important in the developed procedure were examined in detail. The limit of detection (LOD), the limit of quantification (LOQ), the intraday, and inter day relative standard deviation (RSD, %) of the developed method in the plasma sample were found to be 12.8 ng mL−1, 38.8 ng mL−1, 1.7 and 3.9%, respectively. Additional/recovery studies were performed in plasma samples with proposed method, and quantitative recoveries were obtained in the range of 97–100%. The developed microextraction method was applied to human plasma that taken from volunteer patients for the determination of DKT.
Graphical abstract
Assessing site-safeguard effectiveness and habitat preferences of Bar-headed Geese (Anser indicus) at their stopover sites within the Qinghai-Tibet Plateau using GPS/GSM telemetry
Authors: Zhang Junjian , Xie Yanbo , Li Laixing , Batbayar Nyambayar , Deng Xueqin , Damba Iderbat , Meng Fanjuan , Cao Lei , Fox Anthony David 
Published: December 2020

Abstract
Background
The Bar-headed Goose (Anser indicus) breeds across the high plains and plateau of Central Asia and winters in the Qinghai-Tibet Plateau (QTP), the Yunnan-Guizhou Plateau and the Indian sub-continent. Of the two recognized discrete flyways of the Bar-headed Goose, the Eastern Tibetan Flyway (ETF) is the larger, comprising at least six migration routes. However, we remain ignorant about their migratory connectivity, habitat use and effectiveness of site-safeguard mechanisms set in place for the species.

Methods
We tracked 30 ETF Bar-headed Geese from Chinese and Mongolian breeding areas to their wintering grounds using GPS/GSM transmitters, to determine their migration routes and stopover staging patterns within the QTP, overlaying these upon GIS layers of protected area status and habitat type, to model their habitat selection.

Results
In total, 14 tagged Bar-headed Geese provided information on their entire autumn migration and 4 geese on their entire spring migration. Qinghai Lake marked birds overwintered in the QTP (n = 2), geese tagged in Mongolia wintered either in the QTP (n = 3) or in India/Bangladesh (n = 9), representing three of the migration routes within the ETF. In total, tagged birds staged at 79 different stopover sites within QTP in autumn and 23 in spring, of which 65% (autumn) and 59% (spring) of all fixes fell within the boundaries of either National Nature Reserves (NNRs) or Important Birds Areas (IBAs) in the QTP. Bar-headed Geese predominantly occurred on four land-cover types: grassland (mostly by day), water bodies (at night), wetlands and bare substrates (salt flats, dry lake/river substrates and plough) with little change in proportion. Generalized linear mixed models comparing presence with pseudo-absence data suggested geese strongly selected for wetlands as staging habitat, avoiding bare substrates in spring.

Conclusions
Based on our limited observations of these tagged geese, this study is the first to show that the current designated National Nature Reserves in place in the staging areas within the QTP appear adequate to protect this increasing population. In addition, Hala Lake in Qinghai Province and adjacent areas used as initial QTP staging during autumn migration (currently outside of designated as NNRs/IBAs) are recommended for protection, based on their use by tagged birds from this study. Habitat modelling confirmed the importance of natural wetlands as feeding areas and safe areas of open water as roosting places.
Breast metastasis from pelvic high-grade serous adenocarcinoma: a report of two cases
Authors: Harada Yurina , Kubo Makoto , Kai Masaya , Yamada Mai , Zaguirre Karen , Ohgami Tatsuhiro , Yahata Hideaki , Ohishi Yoshihiro , Yamamoto Hidetaka , Oda Yoshinao , Nakamura Masafumi 
Published: December 2020

Abstract
Background
Metastatic tumors to the breast reportedly account for 0.5% to 2.0% of all malignant breast diseases. Such metastatic tumors must be differentiated from primary breast cancer. Additionally, few reports have described metastases of gynecological cancers to the breast. We herein report two cases of metastasis of pelvic high-grade serous adenocarcinoma to the breast.

Case presentation
The first patient was a 57-year-old woman with a transverse colon obstruction. Colostomy was performed, but the cause of the obstruction was unknown. We found scattered white nodules disseminated throughout the abdominal cavity and intestinal surface. Follow-up contrast-enhanced computed tomography (CT) showed an enhanced nodule outside the right mammary gland. Core needle biopsy (CNB) of the right breast mass was conducted, and immunohistochemical staining of the mass suggested a high-grade serous carcinoma of female genital tract origin. We diagnosed the patient’s condition as breast and lymph node metastasis of a high-grade serous carcinoma of the female genital tract. After chemotherapy for stage IVB peritoneal cancer, tumor reduction surgery was performed. The second patient was a 71-year-old woman with a medical history of low anterior resection for rectal cancer at age 49, partial right thyroidectomy for follicular thyroid cancer at age 53, and left lower lung metastasis at age 57. Periodic follow-up CT showed peritoneal dissemination, cancerous peritonitis, and pericardial effusion, and the patient was considered to have a cancer of unknown primary origin. Contrast-enhanced CT showed an enhanced nodule in the left mammary gland with many enhanced nodules and peritoneal thickening in the abdominal cavity. CNB of the left breast mass was conducted, and immunohistochemical staining of the mass suggested a high-grade serous carcinoma of female genital tract origin. After chemotherapy for stage IVB peritoneal cancer, tumor reduction surgery was performed.

Conclusions
We experienced two rare cases of intramammary metastasis of high-grade serous carcinoma of female genital tract origin. CNB was useful for confirming the histological diagnosis of these cancers that had originated from other organs. A correct diagnosis of such breast tumors is important to ensure quick and appropriate treatment.