bluuebunny/crossref_metadata_2025_split huggingface dataset:
Combined extracorporeal shock wave lithotripsy and endoscopic treatment for pain in chronic pancreatitis (SCHOKE Trial): study protocol for a randomized sham-controlled trial
Authors: Olesen Søren Schou , Drewes Asbjørn M. , Maragoni Rajesh Goud , Tandan Manu , Lakhtakia Sundeep , Ramchandani Mohan , Rao G V , Reddy D Nageshwar , Talukdar Rupjyoti 
Published: November 2019

Abstract
Background: Pain is the primary symptom of chronic pancreatitis (CP) and remains a considerable therapeutic challenge. In patients with obstruction of the pancreatic duct, including stones and strictures, endoscopic treatment with or without preceding extracorporeal shock wave lithotripsy (ESWL) have been used for pancreatic duct decompression. The rationale for these procedures is based on the assumption that obstruction of the pancreatic duct leads to ductal hypertension and pain. However, clinical pain symptoms correlate poorly with pancreatic duct morphology and the evidence for pancreatic duct decompression as an effective treatment for pain is based on case-series and comparison between different procedures, while no randomised prospective sham-controlled trials are currently available. The SCHOKE trial is a randomized sham-controlled trial designed to determine if pancreatic duct decompression is an effective treatment for pain in patients with CP. Methods: The SCHOKE trial is a randomized, single-blinded, parallel-group, sham-controlled trial designed to evaluate the effect of combined ESWL and endoscopic treatment for pain in patients with CP. In total, 106 adult patients with painful CP and pancreatic duct obstruction will be randomized to combined ESWL and subsequent endoscopic treatment or corresponding sham procedures. The primary outcome is pain relief during the 3 months post-randomization period as documented in a pain diary. Secondary outcomes include quality of life and functional scores, patient’s global impression of change, change in use of analgesics, frequency of hospitalization and complications. Standard follow-up is at 3 and 6 months after randomization. In an experimental sub-study, quantitative sensory testing obtained before and after intervention will be used to obtain information on central pain processing and to develop models for prediction of treatment outcome.Discussion: The SCHOKE trial investigates if pancreatic duct decompression, obtained by combined ESWL and endoscopic treatment, is effective for pain treatment in patients with CP.Trial registration: ClinicalTrials.gov, NCT03966781. Registered on 25th May 2019.
The effect of tumor necrosis on postoperative survival of patients with solitary small hepatocellular carcinoma
Authors: Ling Yi-hong , Chen Jie-wei , Wen Shi-hong , Huang Chao-yun , Li Peng , Lu Liang-he , Mei Jie , Li Shao-hua , Wei Wei , Cai Muyan , Guo Rong-ping 
Published: November 2019

Abstract
Background: Small hepatocellular carcinoma (sHCC) is a special subtype of HCC with the maximum tumor diameter ≤ 3 cm and favorable long-term outcomes. Surgical resection or radiofrequency ablation offer the greatest chance for cure; however, many patients still undergo tumor recurrence after primary treatment. So far, there is no clinical applicable method to assess biological aggressiveness in solitary sHCC.Methods: In the present study, we retrospectively evaluated tumor necrosis of 335 patients with solitary sHCC treated with hepatectomy between December 1998 and 2010 from Sun Yat-sen University Cancer Center.Results: In the current study, the presence of tumor necrosis was observed in 157 of 335 (46.9%). Further correlation analysis showed that the presence of tumor necrosis in sHCC was significantly correlated with tumor size and vascular invasion (P = 0.026, 0.003, respectively). The presence of tumor necrosis was associated closely with poorer cancer-specific overall survival (OS) and recurrence-free survival (RFS) as evidenced by univariate (P < 0.001; hazard ratio, 2.821; 95% CI, 1.643-4.842) and multivariate analysis (P = 0.005; hazard ratio, 2.208; 95% CI, 1.272-3.833). More importantly, the combined model by tumor necrosis, vascular invasion and tumor size can significantly stratify the risk for RFS and OS and improve the ability to discriminate sHCC patients’ outcomes (P < 0.0001 for both).Conclusions: Our findings provide evidence that tumor necrosis has the potential to be a parameter for cancer aggressiveness in solitary sHCC. The combined prognostic model may be a useful tool for identifying solitary sHCC patients with worse outcomes.
First-year drug therapy of new-onset rheumatoid and undifferentiated arthritis: A nationwide register-based study.
Authors: Muilu Paula , Rantalaiho Vappu , Kautiainen Hannu , Virta Lauri , Eriksson Johan , Puolakka Kari 
Published: November 2019

Abstract
Backgroud: In this retrospective cohort study, we wanted to evaluate the drug therapies used for early rheumatoid (RA) and undifferentiated (UA) arthritis patients. Methods: From a nationwide register maintained by the Social Insurance Institution, information on sex, date of birth, and date of special medicine reimbursement decision for all new Finnish RA and UA patients between 2011-14 were collected, and their DMARD purchases during the first year after the diagnosis were analyzed. Results: A total of 7338 patients with early RA (67.3% female, 68.1% seropositive) and 2433 with early UA (67.8% female) were identified. DMARDs were initiated during the first month after the diagnosis to 92.0 % of the patients with seropositive RA, 90.3% with seronegative RA and to 87.7% with UA (p<0.001). Respectively, 72.1%, 63.4%, and 42.9% of the patients (p<0.001) used methotrexate; 49.8%, 35.9%, and 16.0% (p<0.001) as part of a DMARD combination during the first month. By the end of the first year after the diagnosis, self-injected biologics were initiated to 2.6%, 5.3% and 3.1% (p<0.001) of them. Only 1.4%, 2.6% and 3.0% (p<0.001) of the patients were not receiving any DMARDs. During the first year, 83.4% of the seropositive RA patients had purchased methotrexate, 50.4% sulfasalazine, 72.1% hydroxychloroquine, and 72.6% prednisolone. Conclusions: Currently, combination therapy including methotrexate is a common treatment strategy for early seropositive RA in Finland. Despite an easy access to biologics, these drugs are seldom needed during the first year after diagnosis.
The incidence of depression and anxiety in patients with ankylosing spondylitis: A systematic review and meta-analysis
Authors: Park Jamie YE , Howren Alyssa M , Zusman Enav Z , Esdaile John M , De Vera Mary A 
Published: November 2019

Abstract
Background: As awareness for the importance of mental health continues to expand in rheumatology, it is important to understand the epidemiology of psychiatric complications in ankylosing spondylitis (AS) with the ultimate goal of future prevention and improved quality of care. This study aims to review evidence on the incidence and determinants of depression and/or anxiety among patients with AS. Methods: We searched Medline, Embase, Cochrane Database of Systematic Reviews, CINAHL Complete, and PsycINFO for full-length observational studies that involved a sample or population of patients with AS and assessed depression and/or anxiety. Primary outcomes extracted were: 1) risk estimates for depression and/or anxiety (e.g., relative risk [RR]); and 2) determinants or factors identified as independent predictors of depression and/or anxiety using multivariable regression approaches and corresponding estimates (e.g., odds ratios [OR]). Where relevant, we pooled estimates using random effects models. Results: Out of 783 titles from our search strategy, we reviewed 39 manuscripts. Four studies assessed the incidence of depression and meta-analyzing reported estimates from three of these studies yielded a pooled RR of 1.51 (95% CI 1.28 to 1.79). Differences in risk of depression among men and women with AS were inconclusive, suggesting need for further study. The incidence of anxiety was comparatively less studied with only one included study reporting a hazard ratio of 1.85 (95% CI 1.37 to 2.49). Education level was a key determinant, with lower levels associated with higher odds of depression (OR 6.65; 9% CI 1.36 to 32.51) and anxiety (OR 9.31; 9% CI 1.39 to 62.19) among AS patients. Conclusions: Our systematic review and meta-analysis shows an increased risk of depression and anxiety among patients with AS. These findings suggest the importance of monitoring and care for psychiatric conditions in AS.
Stigma and discrimination: A barrier to the utilisation of a nutritional program in HIV care services in Ethiopia
Authors: Tesfay Fisaha , Javanparast Sara , Mwanri Lillian , Ziersch Anna 
Published: November 2019

Abstract
Background In Ethiopia, stigmatizing attitudes towards people living with HIV have reduced over time. This is mainly due to improved HIV knowledge and the expansion of access to HIV care and support services. However, HIV stigma and discrimination remain a key challenge, and have negative impacts on access to and utilisation of HIV services including nutritional programs. A small number of studies have examined the experience of stigma related to nutritional programs provided to people living with HIV, but this is limited. This study explored HIV status disclosure and experience of stigma among people living with HIV enrolled in a nutritional program in HIV care setting in Ethiopia and impacts on program utilisation.Methods and participants As part of a larger study, qualitative in-depth interviews were conducted with 20 adults living with HIV, 15 caregivers of children living with HIV and 13 program staff in the nutritional program in three hospitals in the Tigray region of Northern Ethiopia. Framework analysis was employed to analyse the data and NVivo 11 was used to assist data analysis.Results The study found varying levels of positive HIV status disclosure, depending on who the target of disclosure was. Disclosing to family members was reported to be less problematic by most participants. Despite reported benefits of the nutritional in terms of improving their weight and overall health status, adults and caregivers of children living with HIV revealed experience of stigma and discrimination and fear of discovery of positive HIV status due to: a) nutritional support (Plumpynut/sup) to HIV by the community; b) increased frequency of visits to HIV services.Conclusion There is evidence that enrolment in the nutritional program is associated with increased concern about stigma and discrimination, which in turn negatively affected the utilisation of the nutritional program and HIV service more broadly. Nutritional programs in HIV care should include strategies which take these concerns into account by mainstreaming stigma prevention and mitigation activities. Further research should be done to identify innovative ways of social inclusion to mitigate stigma and improve utilisation.
Time Dependent Hazard Ratio Estimation Using Instrumental Variables Without Conditioning on an Omitted Covariate
Authors: MacKenzie Todd , Martinez-Camblor Pablo , O'Malley James 
Published: November 2019

Abstract
Estimation that employs instrumental variables (IV) can reduce or eliminate bias due to confounding. In observational studies instruments result from natural experiments such as the effect of clinician preference or geographic distance on treatment selection. In randomized studies the randomization indicator is an instrument, especially if the study is blinded, e.g. no placebo effect. Estimation via instruments is a highly developed field for linear models but the use of instruments in time-to-event analysis is far from established. Various IV-based estimators of the hazard ratio (HR) from Cox's regression models have been proposed. We extend IV based estimation of Cox's models beyond proportionality of hazards, and address estimation of a log-linear time dependent hazard ratio and a piecewise constant HR. We estimate the marginal time-dependent hazard ratio unlike other approaches that estimate the hazard ratio conditional on the omitted covariates. Due to the non-collapsibility of the Cox's models these two estimands are not identical. We report the results of simulations that includes the use of copulas to generate potential times-to-event that have a given marginal structural time dependent hazard ratio but are dependent on omitted covariates. We demonstrate the method to estimate the time dependent hazard ratio for two vascular interventions.
Prevalence and causes of visual impairment and blindness in three ecological regions of Nepal
Authors: Shrestha Mohan Krishna , Sun Sunjuri Zhi Yu , Limbu Ben , Poudel Manish , Khanal Shankar Prasad , Pradhan Bandana , Shrestha Mangala 
Published: November 2019

Abstract
Background: Visual impairment and blindness are significant public health issues worldwide. This study aimed to estimate the prevalence and causes of moderate to severe visual impairment (MSVI) and blindness in people aged 15 years and above across three ecological regions of Nepal.
Methods: A comparative cross-sectional study was conducted in one district in each of the three ecological regions of Nepal. Intensive training was provided to health workers on how to conduct door-to-door enumeration, visual acuity testing and referral when indicated for comprehensive ocular examination by technicians and ophthalmologists to diagnose and treat ocular morbidities. Collected data were analyzed using Statistical Package for Social Science (SPSS) v19.0 and Stata v10.0 software.
Results: Altogether 5234 participants were enrolled in the study (participation rate 96.4%). The overall prevalence of MSVI was 9.5% (95% CI = 8.7 - 10.3) which was 4.7% in the Mountain district, 11.2% in the Hill district and 21.2% in the Tarai district. In those aged 15-49 years MSVI prevalence was 1.5% and in those aged ≥50 it was 25.1%. The overall prevalence of blindness was 0.9% (95% CI=0.6-1.2), and the prevalence of blindness in the 15-49 and ≥50 age groups was 0.2% and 2.3% respectively. Most cases of visual impairment and blindness (95.5%) were due to cataract and uncorrected refractive error. Overall, cataract was the leading cause of visual impairment and blindness (53.5%), followed by uncorrected refractive error (39.5%).
Conclusion: The prevalence of visual impairment and blindness varied significantly with age, ethnicity and locality. The correction of refractive error and cataract surgery would reduce nine in ten cases of moderate to severe visual impairment and blindness.

Key words: Epidemiology, Public health, visual, Optic and refraction
Short‐Term Effects of Cover Crops on Soil Microbial Characteristics and Biogeochemical Processes across Actively Managed Farms
Authors: Strickland Michael S. , Thomason Wade E. , Avera Bethany , Franklin Josh , Minick Kevan , Yamada Steffany , Badgley Brian D. 
Published: November 2019

Core Ideas
The effect of cover crops on soil microbes and biogeochemistry was examined.
Cover crops increase microbial biomass and bioavailable soil carbon.
Increasing cover crop biomass amplifies belowground effects.
Agricultural soils are largely degraded or under threat of degradation. Given a growing human population and the subsequent need to feed this population, agricultural practices must maintain productivity and soil quality. Cover cropping regimes are a management approach that aims to address these dual goals. Although the use of cover crops has been linked to many positive effects on soil quality and crop yields, few studies have examined their effects on soil microbial community structure and function under active farm management. We assessed soil characteristics and microbial community structure and function between agricultural field plots with and without cover crops. We expected microbes would respond in the short‐term to increasing cover crop biomass, with increases in microbial activity and a shift in C acquisition toward substrates indicative of root exudation. In the presence of cover crops, we found active microbial biomass and bioavailable‐C increased by 64 and 37%, respectively, indicating the potential for increased C sequestration. Soil NH4+ increased by 64%, whereas soil NO3‐ decreased by 30%, indicating a shift toward less mobile N forms and the potential of greater nutrient retention under cover cropping regimes. Additionally, increasing cover crop biomass was related to lower microbial biomass C/N ratios and to decreased utilization of recalcitrant C substrates. These results potentially suggest a shift toward greater microbial utilization of root‐derived compounds with increasing cover crop biomass. Together, these results indicate that, in the short‐term, the presence of cover crops may improve soil quality, as measured by indices of microbial activity, and soil C and nutrients.
Current Insights into Nonuniform Flow across Scales, Processes, and Applications
Authors: Abou Najm Majdi , Lassabatere Laurent , Stewart Ryan D. 
Published: November 2019

Core Ideas
Nonuniform flow has proven to be the rule rather than the exception in nearly all soils.
Computational and technological advancements are promising for nonuniform flow.
They allow improved visualization and characterization of structures across scales.
We need to translate apparent complexity of geosystems into reproducible outcomes.
Those outcomes must be of generalizable applicability in flow and transport research.
Isolation and identification of Acanthamoeba genotypes and Naegleria spp. from the water samples of public swimming pools in Qazvin, Iran
Authors: Paknejad Nastaran , Hajialilo Elham , Saraei Mehrzad , Javadi Amir 
Published: November 2019

AbstractFree-living amoeba (FLA), including Acanthamoeba and Naegleria are facultative parasites in humans. The amoeba have widespread distribution in various water sources. The aim of this study was isolation and molecular identification of Acanthamoeba and Naegleria isolated from swimming pools and also hot and cold tub waters in Qazvin province. The samples (166 water samples) were cultured to isolate and identify positive specimens. PCR (polymerase chain reaction) amplification, sequencing and phylogenetic analysis were conducted to confirm the isolated species and genotypes of amoeba. According to morphological characterizations, 18.6% of specimens were identified as FLA, which in 71% were Acanthamoeba by PCR method. Molecular analysis revealed that 36.3%, 18.1% and 4.5% of Acanthamoeba specimens were identified as T3, T4 and T11 Acanthamoeba genotypes, respectively. Protacanthamoeba bohemica (27.2%) and Acanthamoeba sp. (4.5%) were found among the specimens. The results of osmo-tolerance and thermo-tolerance assays demonstrated that 50% of T3 and 25% of T4 genotypes of Acanthamoeba were highly pathogenic parasites. The molecular approach showed the presence of Naegleria lovaniensis (9%) in hot tub water of swimming pools. This study demonstrated that the swimming pools and hot tub water in Qazvin province were contaminated with Acanthamoeba and Naegleria species.
Maternal urinary levels of trichloroacetic acid and association with adverse pregnancy outcomes
Authors: Mashau Funanani , Ncube Esper Jacobeth , Voyi Kuku 
Published: November 2019

Abstract
The current study aimed to determine the association between trichloroacetic acid (TCAA) levels and adverse pregnancy outcomes among third-trimester pregnant women who were exposed to chlorinated drinking water. A total of 205 pregnant women who participated in the disinfection by-products exposure and adverse pregnancy outcome study in South Africa were randomly asked to participate in this study by providing their morning urine sample voids. Samples were analysed for urinary creatinine and TCAA. Furthermore, participants gave individual data using a structured questionnaire. The mean (median) concentration of creatinine-adjusted urinary TCAA was 2.34 (1.95) μg/g creatinine. Elevated levels of creatinine-adjusted TCAA concentrations showed an increased risk of premature birth, small for gestational age (SGA) and low birth weight. There was no significant statistical correlation observed between creatinine-adjusted TCAA concentrations and the total volume of cold water ingested among the study population. No statistically significant association was observed between creatinine-adjusted urinary TCAA and premature birth, SGA and low birth weight newborns among the study subjects. However, the urinary TCAA concentrations identified in this study suggest potential health risks towards women and foetus. Therefore, further studies are warranted to prevent further adverse pregnancy outcomes.
Multi-drug resistance traits of methicillin-resistant Staphylococcus aureus and other Staphylococcal species from clinical and environmental sources
Authors: Oladipo Adegboyega O. , Oladipo Oluwatosin G. , Bezuidenhout Cornelius C. 
Published: November 2019

Abstract
Multi-drug resistance traits of Staphylococcus species especially methicillin-resistant Staphylococcus aureus (MRSA) in the clinical settings are well established. Of environmental concern is hospital effluents discharging into wastewaters. This article investigated the prevalence and detection of antibiotic resistance genes in Staphylococcus species from clinical and environmental sources in Ile-Ife, Nigeria. Standard culture-based and molecular protocols were used. Seventy-six (27 clinical, 14 hospital effluent and 35 environmental) Staphylococcus isolates were recovered: 56.58% were coagulase-negative and 43.42% coagulase-positive (S. aureus). For the clinical isolates, 10, 6, 4, 4 and 1 were isolated from urine, skin, wounds, blood and pus, respectively. Isolates were resistant to methicillin and amoxycillin (91.7%), cloxacillin (88.0%), ciprofloxacin (84.0%), ofloxacin (83.3%), azithromycin (78.0%), ceftazidime (76.0%), gentamycin (75.0%), cefuroxime (75.0%) and erythromycin (72.0%). Nearly, all isolates (90.8%) had multiple antibiotic resistance (MAR) index &gt;0.2. Overall MAR indices for Staphylococcus species isolated from the clinical, hospital effluent and environmental wastewaters were relatively similar (0.482; 0.500; 0.435). mecA, nuc and luk-pvl genes were detected in S. aureus, while mecA was detected in S. arlettae, S. sciuri, S. cohnii, S. epidermidis and S. saprophyticus. This study informs on the potential contamination of environmental waters downstream from hospitals and possible impacts that this could have on human and animal health.
Physical entrapment of chitosan in fixed-down-flow column bed enhances triclosan removal from water
Authors: Matolia Jyoti , Shukla S. P. , Kumar Saurav , Kumar Kundan , Singh A. R. 
Published: November 2019

Abstract
Triclosan (TCS) is an emergent pollutant with wide-ranging deleterious effects on aquatic organisms and humans. There is a growing concern about the development of low-cost and efficient treatment systems for the removal of TCS from water. This report describes the performance of a prototype of a continuous flow, fixed bed column device with physically entrapped industrial by-product chitosan. The effects of initial TCS concentration, adsorbent dose in the column matrix, and flow rate were investigated with regard to removal efficiency (%), adsorption capacity and breakthrough time. To understand the thermodynamic properties of the adsorption process, three kinetic models – Thomas, Yoon–Nelson and Adams–Bohart – were applied to the experimental data for the prediction of characteristic parameters of the adsorption process. The Yoon–Nelson model showed the best agreement between the experimental and calculated values. The column showed a near saturation state (Ct/C0 = 0.92; C0 and Ct are the concentration of TCS before and after treatment.) at 90 mg L−1 TCS concentration after 60 minutes. In view of non-availability of a treatment process for the emergent pollutant TCS, the data of the present investigation will facilitate the development of novel prototypes of column bed reactors for the removal of TCS.