bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term impact of undergraduate community-based clinical training on community healthcare practice in Japan: a cross-sectional study
Authors: Yahata Shinsuke , Takeshima Taro , Kenzaka Tsuneaki , Okayama Masanobu 
Published: October 2020

Abstract
Background
Community-based medical education (CBME) has been evolving globally. However, the long-term impacts of CBME programs on career intention are ambiguous. Therefore, this study aimed to reveal the long-term impact of community-based clinical training (CBCT) such as CBME programs in Japan on current community healthcare (CH) practice.

Methods
This cross-sectional study targeted physicians who had graduated from Kobe University School of Medicine between 1998 and 2004 and had over 15 years’ experience after graduation. Self-administered questionnaires were mailed to participants between September and November 2019. Of the 793 potential subjects, 325 questionnaires were undeliverable. A total of 468 questionnaires substantially sent to the subjects. The exposure was the undergraduate CBCT defined as clinical training about CH in a community. The primary outcome was the provision of current CH practice. The secondary outcome was rural retention. The odds ratios (ORs) and confidence intervals (CIs) were calculated, and the confounders (age, gender, and attitude toward CH at admission; primary outcome, and age, gender, attitude toward rural healthcare at admission, own and spouse’s hometown, and emphasis on child education; secondary outcomes) were adjusted using multivariate logistic regression analysis.

Results
A total of 195 (41.7%) questionnaires were analyzed. The mean (standard deviation [SD]) age of study participants was 43.8 (3.5) years and 76.4% were men. A total of 48 physicians (24.6%) experienced CBCT, of which the mean (SD) training period was 26.3 (27.3) days. As many as 148 (76.3%) physicians provided CH at the time of the study, and 12 (6.5%) worked in rural areas. There was no notable impact of undergraduate CBCT on current CH practice (OR, 1.24; 95% CI, 0.53–3.08; adjusted OR [aOR], 1.00; 95% CI, 0.43–2.30) and rural retention (OR, 0.59; 95% CI, 0.06–2.94; aOR, 0.59; 95% CI, 0.11–3.04).

Conclusions
It may be insufficient to use conventional CBCT in Japan to develop CH professionals effectively. Japanese CBME programs should be standardized through a review of their content and quality. They should continue to be evaluated for their medium- to long-term effects.
Implementing pelvic floor muscle training for women with pelvic organ prolapse: a realist evaluation of different delivery models
Authors: Abhyankar Purva , Wilkinson Joyce , Berry Karen , Wane Sarah , Uny Isabelle , Aitchison Patricia , Duncan Edward , Calveley Eileen , Mason Helen , Guerrero Karen , Tincello Douglas , McClurg Doreen , Elders Andrew , Hagen Suzanne , Maxwell Margaret 
Published: October 2020

Abstract
Background
Pelvic Floor Muscle Training (PFMT) has been shown to be effective for pelvic organ prolapse in women, but its implementation in routine practice is challenging due to lack of adequate specialist staff. It is important to know if PFMT can be delivered by different staff skill mixes, what barriers and facilitators operate in different contexts, what strategies enable successful implementation and what are the underlying mechanisms of their action. PROPEL intervention was designed to maximise the delivery of effective PFMT in the UK NHS using different staff skill mixes. We conducted a realist evaluation (RE) of this implementation to understand what works, for whom, in what circumstances and why.

Methods
Informed by the Realist and RE-AIM frameworks, the study used a longitudinal, qualitative, multiple case study design. The study took place in five, purposively selected, diverse NHS sites across the UK and proceeded in three phases to identify, test and refine a theory of change. Data collection took place at 4 time points over an 18 month implementation period using focus groups and semi-structured interviews with a range of stakeholders including service leads/managers, senior practitioners, newly trained staff and women receiving care in the new service models. Data were analysed using thematic framework approach adapted to identify Context, Mechanism and Outcome (CMO) configurations of the RE.

Results
A heightened awareness of the service need among staff and management was a mechanism for change, particularly in areas where there was a shortage of skilled staff. In contrast, the most established specialist physiotherapist-delivered PFMT service activated feelings of role protection and compromised quality, which restricted the reach of PFMT through alternative models. Staff with some level of prior knowledge in women’s health and adequate organisational support were more comfortable and confident in new role. Implementation was seamless when PFMT delivery was incorporated in newly trained staff’s role and core work.

Conclusion
Roll-out of PFMT delivery through different staff skill mixes is possible when it is undertaken by clinicians with an interest in women’s health, and carefully implemented ensuring adequate levels of training and ongoing support from specialists, multi-disciplinary teams and management.
Meperidine pharmacokinetics and effects on physiologic parameters and thermal threshold following intravenous administration of three doses to horses
Authors: Hamamoto-Hardman Briana D. , Steffey Eugene P. , McKemie Daniel S. , Kass Philip H. , Knych Heather K. 
Published: October 2020

AbstractBackgroundMeperidine is a synthetic opioid that belongs to the phenylpiperidine class and is a weak mu receptor agonist. In horses there are a limited number of published studies describing the analgesic effects of systemically administered meperidine in horses. The objective of this study was to describe the pharmacokinetics, behavioral and physiologic effects and effect on thermal threshold of three doses of intravenously administered meperidine to horses. Eight University owned horses (four mares and four geldings, aged 3–8 years were studied using a randomized balanced 4-way cross-over design. Horses received a single intravenous dose of saline, 0.25, 0.5 and 1.0 mg/kg meperidine. Blood was collected before administration and at various time points until 96 hours post administration. Plasma and urine samples were analyzed for meperidine and normeperidine by liquid chromatography-mass spectrometry and plasma pharmacokinetics determined. Behavioral and physiologic data (continuous heart rate, step counts, packed cell volume, total plasma protein and gastrointestinal sounds) were collected at baseline through 6 hours post administration. The effect of meperidine administration on thermal nociception was determined and thermal excursion calculated.ResultsMeperidine was rapidly converted to the metabolite normeperidine. The volume of distribution at steady state and systemic clearance (mean ± SD) ranged from 0.829 ± 0.138–1.58 ± 0.280 L/kg and 18.0 ± 1.4–22.8 ± 3.60 mL/min/kg, respectively for 0.5–1.0 mg/kg doses. Adverse effects included increased dose-dependent central nervous excitation, heart rate and cutaneous reactions. Significant effects on thermal nociception were short lived (up to 45 minutes at 0.5 mg/kg and 15 minutes at 1.0 mg/kg).ConclusionsResults of the current study do not support routine clinical use of IV meperidine at a dose of 1 mg/kg to horses. Administration of 0.5 mg/kg may provide short-term analgesia, however, the associated inconsistent and/or short-term adverse effects suggest that its use as a sole agent at this dose, at best, must be cautiously considered.
Immunogenicity evaluation of recombinant Lactobacillus casei W56 expressing bovine viral diarrhea virus E2 protein in conjunction with cholera toxin B subunit as an adjuvant
Authors: Jia Shuo , Huang Xinning , Li Hua , Zheng Dianzhong , Wang Li , Qiao Xinyuan , Jiang Yanping , Cui Wen , Tang Lijie , Li Yijing , Xu Yigang 
Published: October 2020

Abstract
Background
Bovine viral diarrhea virus (BVDV) is one of the main causes of infectious diseases in cattle and causes large financial losses to the cattle industry worldwide. In this study, Lactobacillus casei strain W56 (Lc W56) was used as antigen deliver carrier to construct a recombinant Lactobacillus vaccine pPG-E2-ctxB/Lc W56 constitutively expressing BVDV E2 protein fused with cholera toxin B subunit (ctxB) as an adjuvant, and its immunogenicity against BVDV infection in mice model by oral route was explored.

Results
Our results suggested that pPG-E2-ctxB/Lc W56 can effectively activate dendritic cells (DCs) in the Peyer’s patches, up-regulate the expression of Bcl-6, and promote T-follicular helper (Tfh) cells differentiation, as well as enhance B lymphocyte proliferation and promote them differentiate into specific IgA-secreting plasma cells, secreting anti-E2 mucosal sIgA antibody with BVDV-neutralizing activity. Moreover, significant levels (p < 0.01) of BVDV-neutralizing antigen-specific serum antibodies were induced in the pPG-E2-ctxB/LC W56 group post-vaccination. The recombinant Lactobacillus vaccine can induce cellular immune responses, and significant levels (p < 0.01) of Th1-associated cytokines (IL-2, IL-12, and IFN-γ), Th2-associated cytokines (IL-4, IL-10) and Th17-associated cytokine (IL-17) were determined in the serum of vaccinated mice. Significantly, the recombinant Lactobacillus vaccine provides immune protection against BVDV infection, which can be cleared effectively by the vaccine post-challenge in orally vaccinated animals.

Conclusions
The genetically engineered Lactobacillus vaccine constructed in this study is immunogenic in mice and can induce mucosal, humoral, and cellular immune responses, providing effective anti-BVDV immune protection. It thus represents a promising strategy for vaccine development against BVDV.
Malaria parasites in macaques in Thailand: stump-tailed macaques (Macaca arctoides) are new natural hosts for Plasmodium knowlesi, Plasmodium inui, Plasmodium coatneyi and Plasmodium fieldi
Authors: Fungfuang Wirasak , Udom Chanya , Tongthainan Daraka , Kadir Khamisah Abdul , Singh Balbir 
Published: October 2020

Abstract
Background
Certain species of macaques are natural hosts of Plasmodium knowlesi and Plasmodium cynomolgi, which can both cause malaria in humans, and Plasmodium inui, which can be experimentally transmitted to humans. A significant number of zoonotic malaria cases have been reported in humans throughout Southeast Asia, including Thailand. There have been only two studies undertaken in Thailand to identify malaria parasites in non-human primates in 6 provinces. The objective of this study was to determine the prevalence of P. knowlesi, P. cynomolgi, P. inui, Plasmodium coatneyi and Plasmodium fieldi in non-human primates from 4 new locations in Thailand.

Methods
A total of 93 blood samples from Macaca fascicularis, Macaca leonina and Macaca arctoides were collected from four locations in Thailand: 32 were captive M. fascicularis from Chachoengsao Province (CHA), 4 were wild M. fascicularis from Ranong Province (RAN), 32 were wild M. arctoides from Prachuap Kiri Khan Province (PRA), and 25 were wild M. leonina from Nakornratchasima Province (NAK). DNA was extracted from these samples and analysed by nested PCR assays to detect Plasmodium, and subsequently to detect P. knowlesi, P. coatneyi, P. cynomolgi, P. inui and P. fieldi.

Results
Twenty-seven of the 93 (29%) samples were Plasmodium-positive by nested PCR assays. Among wild macaques, all 4 M. fascicularis at RAN were infected with malaria parasites followed by 50% of 32 M. arctoides at PRA and 20% of 25 M. leonina at NAK. Only 2 (6.3%) of the 32 captive M. fascicularis at CHA were malaria-positive. All 5 species of Plasmodium were detected and 16 (59.3%) of the 27 macaques had single infections, 9 had double and 2 had triple infections. The composition of Plasmodium species in macaques at each sampling site was different. Macaca arctoides from PRA were infected with P. knowlesi, P. coatneyi, P. cynomolgi, P. inui and P. fieldi.

Conclusions
The prevalence and species of Plasmodium varied among the wild and captive macaques, and between macaques at 4 sampling sites in Thailand. Macaca arctoides is a new natural host for P. knowlesi, P. inui, P. coatneyi and P. fieldi.
Management of the patient with allergic and immunological disorders in the pandemic COVID-19 era
Authors: Patella Vincenzo , Delfino Gabriele , Florio Giovanni , Spadaro Giuseppe , Chieco Bianchi Fulvia , Senna Gianerico , Di Gioacchino Mario 
Published: October 2020

AbstractThe pandemic COVID-19 abruptly exploded, taking most health professionals around the world unprepared. Italy, the first European country to be hit violently, was forced to activate the lockdown in mid-February 2020. At the time of the spread, a high number of victims were quickly registered, especially in the regions of Northern Italy which have a high rate of highly-polluting production activities. The need to hospitalize the large number of patients with severe forms of COVID-19 led the National Health System to move a large number of specialists from their disciplines to the emergency hospital departments for the treatment of COVID-19. Furthermore, the lockdown itself has limited the possibility for general practitioners and pediatricians to be able to make outpatient visits and/or home care for patients with chronic diseases. Among them, the patient with atopic diseases, such as asthma, rhinitis and atopic dermatitis, is worthy of particular attention as she/he is immersed in a studded negative scenario with the onset of spring, a factor that should not be underestimated for those who suffer from pollen allergy. The Italian Society of Asthma Allergology and Clinical Immunology, to quickly deal with the lack of references and specialist medical procedures, has produced a series of indications for immunologic patient care that are reported in this paper, and can be used as guidelines by specialists of our discipline.
Prognostic utility of lipoprotein(a) combined with fibrinogen in patients with stable coronary artery disease: a prospective, large cohort study
Authors: Zhang Yan , Jin Jing-Lu , Cao Ye-Xuan , Liu Hui-Hui , Zhang Hui-Wen , Guo Yuan-Lin , Wu Na-Qiong , Gao Ying , Hua Qi , Li Yan-Fang , Xu Rui-Xia , Cui Chuan-Jue , Liu Geng , Dong Qian , Sun Jing , Li Jian-Jun 
Published: October 2020

Abstract
Background
Elevated lipoprotein(a) [Lp(a)] and fibrinogen (Fib) are both associated with coronary artery disease (CAD). The atherogenicity of Lp(a) can be partly due to the potentially antifibrinolytic categories. We hypothesize that patients with higher Lp(a) and Fib may have worse outcomes.

Methods
In this prospective study, we consecutively enrolled 8,417 Chinese patients with stable CAD from March 2011 to March 2017. All subjects were divided into 9 groups according to Lp(a) (Lp(a)-Low, Lp(a)-Medium, Lp(a)-High) and Fib levels (Fib-Low, Fib-Medium, Fib-High) and followed up for CVEs, including nonfatal acute myocardial infarction, stroke, and cardiovascular mortality. Kaplan–Meier, Cox regression and C-statistic analyses were performed.

Results
During a median of 37.1 months’ follow-up, 395 (4.7%) CVEs occurred. The occurrence of CVEs increased by Lp(a) (3.5 vs. 5.3 vs. 5.6%, p = 0.001) and Fib (4.0 vs. 4.4 vs. 6.1%, p < 0.001) categories. When further classified into 9 groups by Lp(a) and Fib levels, the CVEs were highest in the 9th (Lp(a)-High and Fib-High) compared with the 1st (Lp(a)-Low and Fib-Low) group (7.2 vs. 3.3%, p < 0.001). The highest risk of subsequent CVEs was found in the 9th group (HRadjusted 2.656, 95% CI 1.628–4.333, p < 0.001), which was more significant than Lp(a)-High (HRadjusted 1.786, 95% CI 1.315–2.426, p < 0.001) or Fib-High (HRadjusted 1.558, 95% CI 1.162–2.089, p = 0.003) group. Moreover, adding the combined Lp(a) and Fib increased the C-statistic by 0.013.

Conclusion
Combining Fib and Lp(a) enhance the prognostic value for incident CVEs beyond Lp(a) or Fib alone.
Renegotiating situativity: transformations of local herbal knowledge in a Western Alpine valley during the past 40 years
Authors: Fontefrancesco Michele F. , Pieroni Andrea 
Published: October 2020

Abstract
Background
Mountain environments are fragile socio-ecological systems and the conservation of their biological and cultural diversities— seen as co-evolving, strongly intertwined entities—represents a crucial issue for fostering their sustainability. Very few ethnobiological studies have assessed in the mountainous regions of Europe how local botanical knowledge, which represents a vital portion of the local environmental knowledge (LEK), changes over time, although this may be quintessential for a better understanding of the factors influencing how knowledge and practices are shaped, eroded, or even re-created.

Methods
In the current study, we compared the gathering and use of local medicinal plants in the Upper Sangone Valley, Western Italian Alps, Piedmont (NW Italy) as described in a field study conducted in the mid-seventies and published in 1977 and those arising from field research that we conducted in the spring of 2015 and 2018, during which time ethnobotanical and ethnomycological information concerning both folk medicinal and wild food uses was obtained via 47 in-depth open and semi-structured interviews with community members.

Results
In total, one hundred thirty folk taxa represent the past and present medicinal and wild food plant/mushroom heritage of the Sangone Valley: 26 herbal taxa were recorded 40 years ago only; 68 herbal and wild food taxa have been recorded in the current study only; and 36 herbal taxa have been continuously used during the last 40 years. There were no remarkable quantitative differences between the two diachronic medico-ethnobotanical datasets, but the qualitative differences were substantial. The gathering and use of some medicinal plants growing in meadows, forests and higher mountain environments (i.e. Arctostaphylos, Filipendula, Hepatica, Larix, Laserptium, Picea, Polygonatum, Primula, Tussilago and Veronica spp.) disappeared, whereas the collection of plant genera growing in more anthropogenic environments or possibly promoted via popular books and media has been newly introduced (i.e. Aloysia, Apium, Brassica, Crataegus, Epilobium, Fumaria, Geranium, Juniperus, Melissa, Rubus, Rumex, Sedum, Silybum, Taraxacum and Vaccinium spp.).

Conclusion
The findings show a renegotiation of the situativity that for centuries forged the embeddedness of local communities in their natural environments, probably heavily informed in the past by prevalent pastoralist and forest-centred activities and thus by a deeper knowledge of higher mountain and forest environments. The re-arrangement of a more domestic and more “globalized” herbal knowledge system was possibly inspired by new urban residents, who started to populate the valley at the end of the Seventies, when the original inhabitants abandoned their homes for the urban centres of the Piedmontese plain. The current study suggests that future directions of ethnobiological research should more carefully look at the adaptive capacity of LEK systems.
Incidence and risk factors for surgical site infection following elective foot and ankle surgery: a retrospective study
Authors: Meng Jinghong , Zhu Yanbin , Li Yansen , Sun Tao , Zhang Fengqi , Qin Shiji , Zhao Haitao 
Published: October 2020

Abstract
Background
This study aimed to investigate the incidence of surgical site infection (SSI) in elective foot and ankle surgeries and identify the associated risk factors.

Methods
This was designed as a retrospective study, including patients who underwent elective surgery of foot and ankle between July 2015 and June 2018. Data on demographics, comorbidities, and perioperative parameters were collected from the medical records, the laboratory report, the operation report, and the outpatient follow-up registration database. SSI was defined in accordance with the Center for Disease Control criteria. Univariate and multivariate logistic regression analyses were used to identify the independent risk factors for SSI.

Results
A total of 1201 patients undergoing 1259 elective foot/ankle surgeries were included, of whom 26 (2.1%) had an SSI, representing an incidence rate of 1.3% for superficial SSI and 0.8% for deep SSI, respectively. The results for organism culture showed Pseudomonas aeruginosa in 7 cases, methicillin-resistant Staphylococcus aureus (MRSA) in 6, methicillin-susceptible Staphylococcus aureus (MSSA) in 5, methicillin-resistant coagulase-negative Staphylococci (MRCNS) in 2, Escherichia coli in 2, and Proteus mirabilis in 1 case. Five factors were identified to be independently associated with SSI, including prolonged preoperative stay (OR, 1.21; 95% CI, 1.09 to 1.30), allograft or bone substitute (OR, 3.76; 95% CI, 1.51 to 5.30), elevated FBG level (OR, 1.17; 95% CI, 1.04 to 1.26), lower ALB level (OR, 2.33; 95% CI, 1.19 to 3.05), and abnormal NEUT count (OR, 1.72; 95% CI, 1.27 to 2.12).

Conclusions
SSI following elective foot and ankle surgeries is low, but relatively high in forefoot surgeries, requiring particular attention in clinical practice. Although most not modifiable, these identified factors aid in risk assessment of SSI and accordingly stratifying patients and therefore should be kept in mind.
Selenium and at-risk pregnancy: challenges and controversies
Authors: Duntas Leonidas H. 
Published: October 2020

AbstractSelenium (Se), an essential trace element, is inserted as selenocysteine into an array of functional proteins and forms the core of various enzymes that play a cardinal role in antioxidant defense mechanisms, in redox regulation, and in thyroid hormone metabolism. Variations in plasma Se are due to nutritional habits, geographic and ethnic differences, and probably to genetic polymorphisms, the latter still to be conclusively established. Se concentrations were reported to be low in women of reproductive age in the UK, decreasing further during pregnancy, this resulting in low plasma and placental antioxidant enzyme activities. Since low serum Se levels have been found in women with preeclampsia, it has been hypothesized that low maternal Se status during early gestation may be an indicator of preterm birth. Moreover, it is documented that Se administration during pregnancy tendentially reduced the markers of thyroid autoimmunity and the incidence of maternal hypothyroidism in the postpartum period. Importantly, low Se levels in pregnant women affect fetal growth and augment the risk of delivering a small-for-gestational age infant by reducing placental antioxidant defense, while low Se in the third trimester is thought to indicate increased demands by the placenta, an issue which requires further confirmation. There is evidently a need for double-blind, placebo-controlled studies to better determine the efficacy and safety of Se supplementation in pregnancy at high risk for complications, and for measurement of Se levels or of selenoprotein P, the most reliable parameter of Se status, particularly in selenopenic regions.