bluuebunny/crossref_metadata_2025_split huggingface dataset:
The spatial-temporal association between mrteorological factors and bacillary dysentery
Authors: Zhang Xiangxue , Wang Li , Xu Chengdong , Gu Xinchen , Zhou Yuke , Xiao Gexin , Qiao Jiajun 
Published: December 2019

Abstract
BackgroundBacillary dysentery remains a worldwide public health problem, which has been found to have spatial–temporal heterogeneity, however most studies have only focused on the disease from either a time or space perspective, the spatial–temporal association between them has been still unclear. MethodIn this study, the Bayesian space–time hierarchy model was used to identify the spatial-temporal patterns of this disease in Shandong province, China. And then GeoDetector was used to quantify the determinant power of meteorological factors and their interactive effect among different regions in Shandong. ResultsThe results indicated that, temporally, the incidence peaked in summer. Geographically, the hot spots were distributed discretely among three regions, among which the effect of meteorological factors on this disease exist significant discrepancy. The most important two dominant factors of eastern coastal region were wind speed and average temperature, with determinant powers of 28% and 25%, respectively. The first two dominant factors of western inland region were average temperature and precipitation, with determinant powers of 47% and 32%, respectively. The first two dominant factors of middle region were average temperature and wind speed, with determinant powers of 66% and 48%, respectively. ConclusionsThese findings suggest that in a hot and humid environment would boost the transmission of bacillary dysentery, which can be served as a suggestion and basis for the surveillance and will be helpful for this disease control and implementing disease-prevention policies.
Afebrile Bacteremia in Adult Emergency Department Patients with Liver Cirrhosis：Clinical Characteristics and Outcomes
Authors: Chen Hung-Yu , Hsu Yin-Chou 
Published: December 2019

Abstract
Background: Cirrhotic patients with bacteremia are at an increased risk of organ failure and mortality. In addition, they can develop serious infection without fever because of their impaired immune response. Our study aimed to investigate the clinical characteristics, and outcomes in afebrile bacteremic patients with liver cirrhosis. Methods: A single-center, retrospective cohort study was performed on adult patients who visited the emergency department from January 2015 to December 2018. All patients with bacteremia and a diagnosis of liver cirrhosis were enrolled and classified as either afebrile or febrile. We compared the clinical characteristics, laboratory results, microbiological data and outcomes between the two groups. Results：In total, 113 bacteremic patient with liver cirrhosis (afebrile: 60 patients and, febrile: 53) were included in the study. Compared with the febrile group, patients in the afebrile group showed a significantly higher rate of inappropriate antimicrobial agent administration (43.3% vs. 18.9%, p= 0.01). They were also at an increased risk of 30-day mortality (40% vs. 18.9%, p= 0.02), intensive care unit transfer (38.3% vs. 20.8%, p=0.04) and endotracheal intubation (28.3% vs. 11.3%, p=0.03). Conclusions：In bacteremic patients with liver cirrhosis, a significantly higher rate of inappropriate antimicrobial agent administration, higher risk of intensive care unit transfer, endotracheal intubation and 30-day mortality were observed in the afebrile group than in the febrile group. Clinicians should perform prudent evaluation in cirrhotic patients and carefully monitor for possible sings of serious infection even in the absence of fever.
Pre-attentive processing of Alzheimer's disease: an event-related potential study
Authors: Na Eunchan , Lee Kanghee , Kim Eun Ji , Bae Jong Bin , Suh Seung Wan , Byun Seonjeong , Han Ji Won , Kim Ki Woong 
Published: December 2019

Abstract
Background: While identifying Alzheimer’s Disease (AD) in its early stages is crucial, traditional neuropsychological tests tend to lack sensitivity and specificity for its diagnosis. Based on the early visual attention deficits of adults with AD, which are apparent before cognitive deficits emerge, this study aimed to investigate visual attentional characteristics of adults with AD, from pre-attentive to attentive processing, using a visual oddball task and event-related potentials (ERPs).Methods: Cognitively normal elderly controls (NC, n=27) and patients with probable AD (AD, n=10) were recruited. Participants performed a three-stimulus visual oddball task and were asked to press a designated button in response to the target stimuli. The amplitudes of 4 ERPs were analyzed. Visual mismatch-negativity (vMMN) was analyzed around the parieto-occipital and temporo-occipital regions. P3a was analyzed around the fronto-central regions, whereas P3b was analyzed around the centro-parietal regions.Results: Late vMMN amplitudes of the AD group were significantly smaller than those of the NC group, while early vMMN amplitudes were comparable. Compared to the NC group, P3a amplitudes of the AD group were significantly smaller for the infrequent deviant stimuli but the amplitudes for the standard stimuli were comparable. Lastly, the AD group had significantly smaller P3b amplitudes than the NC group.Conclusion: Our findings imply that AD patients exhibit pre-attentive visual processing deficits, known to affect later higher-order brain functions. In a clinical setting, the visual oddball paradigm could be used to provide helpful diagnostic information since pre-attentive ERPs can be induced by passive exposure to infrequent stimuli.
LINEAR CHOLESKY DECOMPOSITION OF COVARIANCE MATRICES IN MIXED MODELS WITH CORRELATED RANDOM EFFECTS
Authors: Rabe Anasu , Shangodoyin D. K. , Thaga K. 
Published: December 2019

Abstract
Modelling the covariance matrix in linear mixed models provides an additional advantage in making inference about subject-specific effects, particularly in the analysis of repeated measurement data, where time-ordering of the responses induces significant correlation. Some difficulties encountered in these modelling procedures include high dimensionality and statistical interpretability of parameters, positive definiteness constraint and violation of model assumptions. One key assumption in linear mixed models is that random errors and random effects are independent, and its violation leads to biased and inefficient parameter estimates. To minimize these drawbacks, we developed a procedure that accounts for correlations induced by violation of this key assumption. In recent literature, variants of Cholesky decomposition were employed to circumvent the positive definiteness constraint, with parsimony achieved by joint modelling of mean and covariance parameters using covariates. In this article, we developed a linear Cholesky decomposition of the random effects covariance matrix, providing a framework for inference that accounts for correlations induced by covariate(s) shared by both fixed and random effects design matrices, a circumstance leading to lack of independence between random errors and random effects. The proposed decomposition is particularly useful in parameter estimation using the maximum likelihood and restricted/residual maximum likelihood procedures.
Effects of Perinatal Cardamom Exposure on Social Behavior, Anxiety, Locomotor Activity, Blood Biochemical Parameters and Brain Acetylcholinesterase of Mice Offspring
Authors: Abu-Taweel Gasem M. 
Published: December 2019

Background:
Cardamom is the flavouring spices mainly cultivated all over the world. Apart
from being used as the spice, it has many medicinal values. Therefore, the present study aimed to investigate
the potential use of cardamom and its effects on the ability of learning, developmental, and
various biochemical factors of Swiss-Webster mice offspring at different stages.

Methods:
In this method, Swiss-Webster mice offspring at different stages were used for the analysis of
biochemical factors. After the administration of cardamom orally, the pups were subjected to various tests
for determining social and defense behaviors of males and females, anxiety behavior; locomotor and neuromuscular
activities, haemotological parameters, and hormonal factors of males and females.

Results:
The present findings indicate that the cardamom induced reduction in the social and defense
behaviors of males and females, respectively, and also anxiety behavior. Interestingly, locomotor and
neuromuscular activities decreased significantly.

Discussion:
In addition, the packed cell volume, red blood count, hemoglobin content, AChE in forebrain,
the testosterone in males and progesterone in females were observed to increase significantly,
whereas the blood platelets and total white blood count decreased non-significantly. Through perinatal
exposure, cardamom can pass through the placenta or/and lactation and reaches the fetus. Care must be
taken when using cardamom and especially during pregnancy and lactation.

Conclusion:
The administration of cardamom enhances the ability of social, developmental, and various
biochemical factors of Swiss-Webster mice offspring at different stages.
Predicting the Potential Patients' Intention to Select Healthcare Service Providers: Application of Structural Equation Modeling Based on the Theory of Planned Behavior
Authors: Bastani Peivand , Javanbakht Mahnaz , Ravangard Ramin 
Published: December 2019

Background:
Today, patients are more sensitive in selecting healthcare services than the past, and are more engaged in their healthcare process. Also, the characteristics of each health service provider are likely to affect the patients' behavior or intention to behave in selecting service providers.

Objective:
To predict the intention of employees working at Shiraz University of Medical Sciences (SUMS), as potential patients, to select health service providers.

Methods:
This cross-sectional applied study was carried out among 330 employees of various SUMS' sub-centers in 2016 using structural equation modeling (SEM). A standard questionnaire designed based on the theory of planned behavior (TPB) was used for collecting the required data. The collected data were analyzed by Warp-PLS 5.0 software.

Results:
The results of the model fitness in the public, private and charity sectors showed that these models were well fitted and the greatest associations were between the attitude towards the behavior and intention, the perceived behavioral control and intention, and also between the perceived behavioral control and intention in the studied sectors.

Conclusion:

It seems that the positive attitude of the employees leads to their increased intention of selecting the public sector. In this regard, the University was recommended to take action to build trust among its employees and to create an atmosphere of empathy and respect in order to facilitate employees' use of services.
Obstetrics Outcome after a Nutritional Health Education Program for Pregnant Females at Zagazig University Hospitals; An Interventional Study
Authors: Soliman Al-Zahraa Mohammad , Hassan Al-Said , Fahmy Howaida Henry , Abdelsalam Amira E. , Salem Mostafa Abdo Ahmed 
Published: December 2019

Background:
Nutrition during pregnancy is an important element for the pregnant women and their developing fetus, they must take enough calories and nutrients to provide the essential requirements for both themselves and their fetus and to prevent complications of abnormal weight gain in pregnancy.

Objectives:
To determine the effect of the nutritional health education program on changing knowledge, attitude, and practice towards a healthy lifestyle during pregnancy, obtaining optimal weight gain and consequently its effect on maternal and fetal outcomes.

Subjects and Methods:
An interventional study (pre-post test), in Zagazig university antenatal care outpatient clinic was conducted.

Subjects' Criteria:
135 pregnant females in the first trimester aged 18-35 years who did not have any chronic medical disorder with Body Mass Index between 18.5 and 24.9 kg/m2 were enrolled.

Methods:
Data collection was done using a semi-structured questionnaire about females’ socio-demographic characteristics, obstetric, family and clinical history. Health education sessions were applied to the pregnant females and their knowledge, attitude, and practice about healthy nutrition were assessed before and after the intervention. Ultrasound was performed, maternal and fetal outcomes were detected.

Results:
This study was conducted on 135 pregnant females from whom 9 cases had excluded at the time of delivery due to the detection of ultrasound abnormalities and 16 women were dropped out during the follow-up period. After the nutritional education program, the proportions of adequate knowledge, attitude, and practice were increased from (28.2% to 77.3%), (8.2% to 75.5%) and (32.7% to 77.3%) respectively (p-value <0.001). There was a statistically significant higher cesarean section, Intra and post-partum complications (85.7%vs 42.9%p<0.001), (71.4% vs17.2% p<0.001) and (25.7%vs7.1% p=0.008) [Odds (95% C.I); 8 (6.7-11.3), 12.1(11.7-13.9) and 4.5(1.2-8.7)], higher neonatal weight and neonatal blood glucose (p<0.001& 0.009) in over-weight versus optimal weight gain groups respectively.

Conclusion:
The intervention was effective in increasing pregnant females’ knowledge, attitude, and practice towards healthy nutrition during pregnancy, obtaining optimal weight gain and improving maternal and fetal outcomes.
Web-Based Intervention Effects on Mild Cognitive Impairment Based on Apolipoprotein E Genotype: Quasi-Experimental Study
Authors: Tsolaki Anthoula C , Tsolaki Magda , Pandria Niki , Lazarou Eftychia , Gkatzima Olymbia , Zilidou Vasiliki , Karagianni Maria , Iakovidou-Kritsi Zafiroula , Kimiskidis Vasilios K , Bamidis Panagiotis D 
Published: December 2019

BackgroundApolipoprotein E (APOE) ε4 allele is a major genetic risk factor for Alzheimer disease and mild cognitive impairment (MCI). Computer-based training programs can improve cognitive performance in elderly populations. However, the effects of computer-based interventions on MCI APOE ε4 carriers have never been studied before.ObjectiveThe effects of different web-based interventions and the APOE isoform-specific differences in training outcomes are investigated.MethodsUsing a quasi-experimental study design, 202 participants with MCI aged 60 years and older took part in three different intervention programs (physical and cognitive [Long-Lasting Memories, or LLM], cognitive [Active Control, or AC], or physical intervention [Physical Training Control, or PTC]) via an innovative information and communication technologies exergaming platform. Participants in each interventional group were subdivided into APOE ε4 carriers and non–APOE ε4 carriers. All participants underwent an extensive neuropsychological evaluation before and after the training, blood tests, and brain imaging.ResultsAll interventions resulted in multiple statistically significant cognitive benefits after the intervention. Verbal learning (California Verbal Learning Test: immediate recall test score—LLM: P=.04; AC: P<.001), working memory (digit span forward and backward test scores—AC: P=.03; PTC: P=.02 and P=.006, respectively), and long-term memory (California Verbal Learning Test: delayed recall test score—LLM: P=.02; AC: P=.002; and PTC: P=.02) were improved. There was no statistically significant difference among the intervention effects. APOE ε4 presence moderates intervention effects as the LLM intervention improved only their task-switching processing speed (Trail Making Test, Part B: P=.03) and the PTC intervention improved only the working memory (digit span backward: P=.03). No significant performance alteration was noted for the APOE ε4+ cognitive AC training group.ConclusionsNone of the applied interventions could be identified as the optimal one; it is suggested, however, that combined cognitive and physical training and physical training via exergaming may be more effective for the high-risk MCI ΑPOE ε4+ subgroup.
Engaging African American Youth in the Development of a Serious Mobile Game for Sexual Health Education: Mixed Methods Study
Authors: Patchen Loral , Ellis Lindsey , Ma Tony Xuyen , Ott Corilyn , Chang Katie HK , Araya Brook , Atreyapurapu Sravanthi , Alyusuf Amal , Gaines Lanzi Robin 
Published: December 2019

Background
Although teen pregnancy rates decreased dramatically in the United States over the past decade, the rates of sexually transmitted infections (STIs) among adolescents and young adults increased. STI rates disproportionately affect African American youth and young adults. Innovative, accessible, and culturally relevant sexual health interventions are urgently needed.

Objective
This study aimed to identify the optimal modality for a game-based sexual health intervention; develop the educational, entertainment, and technological aspects of the serious game; and demonstrate its usability and acceptance by the target population.

Methods
This project was grounded in formative data collection with community-based participatory research principles and practices combined with a user-centered design and development approach. Sexually Active Adolescent–Focused Education (SAAFE) was developed using input and feedback from African American youths aged 15 to 21 years who participated in a youth advisory board and focus group discussions to inform the co-design and cocreation of the serious game. The process was highly iterative with multiple sessions for user input following design changes. It proceeded in 3 stages. Social cognitive theory and problem-solving theory were leveraged to provide evidence-based, trauma-informed education through a serious game. Usability testing assessed the quality of user experience with the prototype.

Results
Across all 3 stages, a total of 86 self-identified African American males and females aged 15 to 21 years from the District of Columbia and Birmingham, Alabama, participated. Participants requested a dating simulation game. They wanted SAAFE to be customizable, realistic, entertaining, educational, modern, and experiential, linking consequences to their gameplay decisions. Usability testing resulted in an initial System Usability Survey score of 77.7, placing the game in the 82nd percentile and above average for usability.

Conclusions
Initial results suggest that the SAAFE prototype is a promising intervention to engage African American youth in sexual health education using a role-playing game. If proven efficacious, the game has the potential to meet the need for sex education, counterbalance unhealthy portrayals of sex in popular media, and respond to the disparities in the STI epidemic.
Translating the Burden of Pollen Allergy Into Numbers: 10-Year Observational Study of Electronically Generated Symptom Data From the Patient’s Hayfever Diary in Austria and Germany
Authors: Bastl Katharina , Bastl Maximilian , Bergmann Karl-Christian , Berger Markus , Berger Uwe 
Published: December 2019

BackgroundPollen allergies affect a significant proportion of the population globally. At present, Web-based tools such as pollen diaries and mobile apps allow for easy and fast documentation of allergic symptoms via the internet.ObjectiveThis study aimed to characterize the users of the Patient’s Hayfever Diary (PHD), a Web-based platform and mobile app, to apply different symptom score calculations for comparison, and to evaluate the contribution of organs and medications to the total score for the first time.MethodsThe PHD users were filtered with regard to their location in Austria and Germany, significant positive correlation to the respective pollen type (birch/grass), and at least 15 entries in the respective season. Furthermore, 4 different symptom score calculation methods were applied to the datasets from 2009 until 2018, of which 2 were raw symptom scores and 2 were symptom load index (normalized) calculations. Pearson correlation coefficients were calculated pairwise for these 4 symptom score calculations.ResultsUsers were mostly male and belonged to the age groups of 21 to 40 years or ≥40 years. User numbers have increased in the last 5 years, especially when mobile apps were made available. The Pearson correlation coefficients showed a significant linear relationship above 0.9 among the 4 symptom score datasets and thus indicated no significant difference between the different methods of symptom score calculation. The nose contributed the most to the symptom score and determined about 40% of the score.ConclusionsThe exact method of calculation of the symptom score is not critical. All computation methods show the same behavior (increase/decrease during the season). Therefore, the symptom load index is a useful computation method in all fields exploring pollen allergy, and Web-based diaries are a globally applicable tool to monitor the effect of pollen on human health via electronically generated symptom data.
Effectiveness of Conversational Agents (Virtual Assistants) in Health Care: Protocol for a Systematic Review
Authors: de Cock Caroline , Milne-Ives Madison , van Velthoven Michelle Helena , Alturkistani Abrar , Lam Ching , Meinert Edward 
Published: December 2019

Background
Conversational agents (also known as chatbots) have evolved in recent decades to become multimodal, multifunctional platforms with potential to automate a diverse range of health-related activities supporting the general public, patients, and physicians. Multiple studies have reported the development of these agents, and recent systematic reviews have described the scope of use of conversational agents in health care. However, there is scarce research on the effectiveness of these systems; thus, their viability and applicability are unclear.

Objective
The objective of this systematic review is to assess the effectiveness of conversational agents in health care and to identify limitations, adverse events, and areas for future investigation of these agents.

Methods
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols will be used to structure this protocol. The focus of the systematic review is guided by a population, intervention, comparator, and outcome framework. A systematic search of the PubMed (Medline), EMBASE, CINAHL, and Web of Science databases will be conducted. Two authors will independently screen the titles and abstracts of the identified references and select studies according to the eligibility criteria. Any discrepancies will then be discussed and resolved. Two reviewers will independently extract and validate data from the included studies into a standardized form and conduct quality appraisal.

Results
As of January 2020, we have begun a preliminary literature search and piloting of the study selection process.

Conclusions
This systematic review aims to clarify the effectiveness, limitations, and future applications of conversational agents in health care. Our findings may be useful to inform the future development of conversational agents and promote the personalization of patient care.

International Registered Report Identifier (IRRID)
PRR1-10.2196/16934