bluuebunny/crossref_metadata_2025_split huggingface dataset:
Understanding health professional role integration in complex adaptive systems: A multiple-case study of Physician Assistants in Ontario, Canada
Authors: Burrows Kristen , Abelson Julia , Miller Patricia , Levine Mitch , Vanstone Meredith 
Published: March 2020

Abstract
Background To meet the complex needs of healthcare delivery, the Ministry of Health and Long Term Care (MOHLTC) introduced Physician Assistants (PAs) into the Ontario health care system in 2006 to help increase access to care, decrease wait times, and improve continuity of care. Integration of new health professional roles is often stymied by role resistance and funding barriers. The characterization of healthcare organizations as complex adaptive systems (CAS) may offer insight into the relationships and interactions that optimize and restrict successful PA integration. The aim of this study is to explore the integration of PAs across multiple settings and to understand the PA role within complex adaptive systems. Methods An exploratory, multiple-case study was used to examine PA role integration in four settings: family medicine, emergency medicine, general surgery, and inpatient medicine. Interviews were conducted with 46 healthcare providers and administrators across 13 hospitals and 6 clinics in Ontario, Canada. Analysis was conducted in three phases: inductive thematic analysis within each of the four cases; a cross-case thematic analysis; and a broader exploration of cross-case patterns pertaining to specific complexity theory principles of interest. Results Support for PA contributions across various health care settings, the importance of role awareness, supervisory relationship attributes, and role vulnerability (in relation to sustainability and funding) are interconnected and dynamic in hospital and community settings. Findings represent the experiences of PAs and other healthcare providers, and demonstrate how the PA’s willingness to work and ability to build relationships within existing health systems allows for the establishment of interprofessional, collaborative, and person-centered care. As a self-organizing agent in complex adaptive systems (i.e. health organizations), PA role exploration revealed patterns of team behavior, non-linear interconnections, open relationships, dynamic systems, and the legacy of role implementation as defined by complexity theory. Conclusions By exploring the role of PAs across multiple sites, the complexity theory lens concurrently fosters an awareness of emerging patterns, relationships and non-linear interactions within the defined context of the Ontario healthcare system. By establishing collaborative, interprofessional care models in community and hospital settings, PAs are making a significant contribution to Ontario healthcare settings.
Influence of benzene exposure, fat content, and their interactions on erythroid-related hematologic parameters in petrochemical workers: a cross-sectional study
Authors: Zhang Xue , Deng Qifei , He Zhini , Li Jie , Ma Xiaoju , Zhang Zhaorui , Wu Dehua , Xing Xiumei , Peng Jing , Guo Hongyu , Huang Ming , Chen Liping , Dang Shanfeng , Zhu Yanqun , Zhang Zhengbao , Yang Boyi , Wang Hailan , Chen Wen , Xiao Yongmei 
Published: March 2020

Abstract
Background: Ubiquitously distributed benzene is a known hematotoxin. Increasing evidence has suggested that erythroid-related hematologic parameters may be sensitive to benzene exposure. Fat content, which is also closely associated with erythroid-related hematologic parameters, may affect the distribution and/or metabolism of benzene, and eventually benzene-induced toxicity.
Methods: To explore the influence of benzene exposure, fat content, and their interactions on erythroid-related hematologic parameters, we recruited 1669 petrochemical workers and measured their urinary S-phenylmercapturic acid (SPMA) concentration and erythroid-related hematological parameters. Indices for fat content included body fat percentage (BF%), plasma total cholesterol (TC) and triglycerides (TG) , and occurrence of fatty liver.
Results: The dose-response curve revealed U-shaped nonlinear relationships of SPMA with hematocrit (HCT) and mean corpuscular hemoglobin concentration (MCHC) ( P -overall <0.001, and P -nonlinear < 0.015), as well as positive linear associations and r-shaped nonlinear relationships of continuous fat content indices with erythroid-related hematological parameters ( P -overall ≤ 0.005). We also observed modification effects of fat content on the associations between benzene exposure and erythroid-related hematological parameters, with workers of lower or higher BF% and TG more sensitive to benzene-induced elevation of MCHC ( P interaction =0.021) and benzene-induced decrease of HCT ( P interaction = 0.050), respectively. We also found that some erythroid-related hematologic parameters differed between subgroups of workers with different SPMA levels and fat content combination.
Conclusions: Our study suggested that benzene exposure, fat content, and their interactions may affect erythroid-related hematological parameters in petrochemical workers in a complex manner that are worthy of further investigation.
Predicting the potential distribution of the parasitic Cuscuta chinensis under global warming
Authors: Ren Zichun , Zagorchev Lyuben , Ma Junxia , Yan Ming , Li Junmin 
Published: March 2020

Abstract
Background: The climate is the dominant factor that affects the distribution of plants. Cuscuta chinensis is a stem holoparasitic plant, which develops a haustorium and sucks nutrients from host plants. The potential distribution of C . chinensis has not been predicted to date. This study used Maxent modeling to predict the potential global distribution of C. chinensis , based on the following six main bioclimatic variables: annual mean temperature, isothermality, temperature seasonality, precipitation seasonality, precipitation of the warmest quarter, and precipitation of the coldest quarter. Results: The optimal annual average temperature and isothermality of C. chinensis ranged from 4 to 37°C and less than 45, respectively, while the optimal temperature seasonality and precipitation seasonality ranged from 4000 to 25000 and from 50 to 130, respectively. The optimal precipitation of the warmest season ranged from 300 to 1000 mm and from 2500 to 3500 mm, while that of the coldest season was less than 20000 mm. In Asia, C. chinensis is mainly distributed at latitudes ranging from 20° N to 50° N. During three specific historical periods (last glacial maximum, mid-Holocene, and 1960–1990) the habitats suitable for C. chinensis were concentrated in the central, northern, southern, and eastern parts of China. From the last glacial maximum to the mid-Holocene, the total area with suitability of 0.5-1 increased by 0.0875 million km 2 ; however, from the mid-Holocene to 1960–1990, the total area with suitability of 0.5-1 decreased by 0.0759 million km 2 . The simulation results of habitat suitability in the two representative concentration pathways (RCP) 2.6 (i.e., the low greenhouse gas emissions pathway) and 8.5 (i.e., the high greenhouse gas emissions pathway) indicate that the habitat suitability of C. chinensis decreased in response to the warming climate. Compared with RCP2.6, areas with averaged suitability and high suitability for survival (RCP8.5) decreased by 0.18 million km 2 . Conclusion: Suitable habitats of C. chinensis are situated in central, northern, southern, and eastern China. The habitat suitability of C. chinensis decreased in response to the warming climate. These results provide a reference for the management and control of C. chinensis .
Disease Features Associated with a low Disease Impact in Patients with Psoriatic Arthritis: Results of a Cross-Sectional Multicenter Study
Authors: Queiro Rubén , Cañete Juan D , Montoro María , Gómez Susana , Cábez Ana 
Published: March 2020

Abstract
Background Patient reported outcomes measures, such as those provided by the the Psoriatic Arthritis Impact of Disease ( PsAID) questionnaire, have been found to be a reliable indicator of change during treatment, predictive of long-term outcomes, and the impact of psoriatic arthritis (PsA) on patients’ lives. The objective of the study was to describe demographic and clinical characteristics of PsA patients with a low disease impact and to analyze predictive factors for that state. Methods Post-hoc analysis of a cross-sectional multicenter study that included 223 consecutive patients. The Psoriatic Arthritis Impact of Disease (PsAID) questionnaire was used to estimate disease impact. Patients with a PsAID < 4 were considered in low disease impact. Minimal Disease Activity (MDA) response and the Health Assessment Questionnaire (HAQ) were also assessed. The degree of agreement between the different outcomes was addressed by Cohen´s kappa index. Results One hundred and twenty-two (54.7%) patients reached a PsAID <4. Among them, 52.0% and 68.0% presented articular or skin remission, respectively. Almost 75% of patients were in MDA state and 85.2% presented a low disability state according to the HAQ. A moderate concordance between HAQ ≤ 0.5 and PsAID <4 (k=0.53), fair between MDA and PsAID <4 (k=0.36), and moderate between DAPSA remission and PsAID <4 (k= 0.46), was observed. Multivariate logistic regression analysis showed that patients with distal interphalangeal joint (DIP) disease (OR 0.40, 95%CI: 0.20-0.79, p=0.009), family history of PsA (OR 0.25, 95%CI: 0.09-0.72, p=0.010), and higher C-reactive protein (OR 0.92, 95%CI: 0.85-0.99, p=0.036) were significantly less likely to reach a PsAID < 4. Conclusions There is certain discrepancy between disease activity measures and a low impact of disease in PsA. Clinical features (DIP joint involvement), biologic activity, and genetic factors (familial history), seem to be associated with lower odds of reaching a low disease impact.
Status and influential factors of vitamin D among children aged 0 to 6 years in a Chinese population
Authors: Zhang Heng , Li Zhijuan , Wei Yarong , Fu Jinyan , Feng Yaling , Chen Daozhen , Xu De-xiang 
Published: March 2020

Abstract
Background : Vitamin D insufficiency and deficiency in childhood are common. However, the status and influential factors of vitamin D during different ages are not clear. This study aimed to survey vitamin D concentrations in children aged 0 to 6 years and explore its influential factors. Methods: A total of 6953 children were recruited in Wuxi City of East China from January to December in 2016. Enzyme-linked immunosorbent assay was used to determine the serum concentrations of 25-hydroxyvitamin D [25(OH)D]. Results: The median vitamin D concentrations in the infant group (0-1 years of age) was 69.40 nmol/L, which were higher than that in both the toddlerhood group (1-3 years of age; 62.30 nmol/L) and the preschool group (3-6 years of age; 50.85 nmol/L). In addition, the median vitamin D concentrations were 71.70 nmol/L in summer, which was higher than that in spring (64.25 nmol/L), autumn (62.95 nmol/L) and winter (64.10 nmol/L). However, no difference was observed between genders ( P = 0.974). Furthermore, the prevalence of vitamin D deficiency (<50 nmol/L) was 48.1% in the preschool group (3-6 years of age), which was higher than the 21.2% vitamin D deficiency in the toddlerhood group (1-3 years of age) and the 17.9% vitamin D deficiency in the infant group (0-1 years of age). Interestingly, a nonlinear association between 25(OH)D and air temperature was observed. Conclusions: A high prevalence of vitamin D deficiency was common in a Chinese population of children 0-6 years old, especially in the preschool-aged children. Therefore, we suggested that we should pay more attention to vitamin D supplementation in Chinese young children.
Development of the Japanese Version of the Other as Shamer Scale using Item Response Theory
Authors: Hiramatsu Yoichi , Asano Kenichi , Kotera Yasuhiro , Sensui Toshihiko , Endo Ayumu , Shimizu Eiji , Basran Jaskaran , Goss Ken 
Published: March 2020

Abstract
Objective; ResultsExternal shame is reflective of a person’s anxiety that he or she might be rejected by others. The Other As Shamer Scale (OAS) is a scale for assessing external shame. The Japanese version of OAS was developed, and its reliability and validity were examined using Item Response Theory (IRT).
Results; A questionnaire survey was conducted with university students (N=199). Exploratory factor analysis of the results indicated a significantly high factor loading on the first factor, which was identical to the original version of the scale, as well as high internal consistency. Moreover, results confirmed that each item had adequate discrimination and information levels, suggesting that external shame could be discriminated with high accuracy with a wide range between relatively low and relatively high external shame groups. These results suggested that this scale could be used for screening external shame as a stress factor and for assessing intervention effects.
Fertility intentions and the way they change following birth- a prospective longitudinal study
Authors: Preis Heidi , Tovim Selen , Mor Pnina , Grisaru-Granovsky Sorina , Samueloff Arnon , Benyamini Yael 
Published: March 2020

Abstract
Introduction: Women's fertility intentions, their desired number of children and desired inter-pregnancy interval (IPI) are related to micro (personal) and macro (socio-cultural) level factors. We investigated factors that contribute to changes in women's fertility intentions in Israel, a developed country with high birth rates.
Methods: Pregnant women (N=1163), recruited from prenatal clinics and hospitals in two major metropolitan areas, completed self-report questionnaires prenatally (≥24 weeks gestation) and postpartum (two months after childbirth). Women reported their socio-demographic background and obstetric history prenatally, their desired number of children and IPI at both time-points, and their objective and subjective birth experiences postpartum. Results: The findings indicated that background characteristics were related to prenatal fertility intentions. The strongest contributor to prenatal fertility intentions was degree of religiosity- the more religious women were, the more children they desired and the shorter their desired IPI. Women's postpartum fertility intentions were mostly consistent with their prenatal reports. In regression models, only being very-religious, more educated, and previously giving birth were protective against a decrease in desired number of children from before birth to after birth. Greater birth satisfaction and giving birth for the first time were protective of changing desired IPI.
Conclusion: Having a negative birth experience could adversely affect women's fertility intentions, but in a pronatalist and medicalized birth culture, social pressures may decrease the effects of birth experiences on fertility intentions.
Keywords: Fertility Intentions; Birth Experience; Religiosity; Interpregnancy Interval; Mode of Delivery.
An 8 week open-label interventional multicenter study to evaluate the lung clearance index as endpoint for clinical trials in cystic fibrosis patients ≥8 years of age, chronically infected with Pseudomonas aeruginosa
Authors: Sutharsan Sivagurunathan , Naehrig Susanne , Mellies Uwe , Sieder Christian , Zeigler joerg 
Published: March 2020

Abstract
Background Forced expiratory volume in 1 second (FEV 1 ) is the only parameter currently recognized as a surrogate endpoint in cystic fibrosis (CF) trials. However, FEV 1 is relatively insensitive to changes in the small airways of patients with milder lung disease. This pilot study aimed to evaluate the lung clearance index (LCI) as a marker for use in efficacy trials with inhaled antibiotics in CF. Methods This open-label, single-arm study enrolled CF patients with Pseudomonas aeruginosa infection, who were treated with tobramycin (28-day on/off regime). FEV 1 , LCI and bacterial load in sputum (CFU) were assessed at baseline, after 1, 4 and 8 weeks of treatment. Results All patients (n=17) showed elevated LCI of >11 despite 3 patients having normal FEV 1 (>90% predicted) at baseline. Overall, LCI improved in 8 (47%) patients and FEV 1 in 9 (53%) patients. At week 4, LCI improved by 0.88, FEV 1 increased by 0.52%, and P. aeruginosa reduced by 30481.3 CFU/mL. These changes were however statistically non-significant. Six adverse events occurred in 5/17 (29.4%) patients, most of which were mild-to-moderate in severity. Conclusions Due to the low evaluable sample size, no specific trend was observed related to the changes between LCI, FEV1 and CFU. Based on the individual data from this study and from recently published literature, LCI has been shown to be a more sensitive parameter than FEV1 for lung function. LCI can hypothesized to be an appropriate endpoint for efficacy trials in CF patients if the heterogeneity in lung function is limited by enrolling younger patients or patients with more milder lung disease and thus, limiting the ventilation inhomogeneities. Trial registration : The study is registered with ClinicalTrials.gov, identifier: NCT02248922
iNOS is not responsible for RyR1 S-nitrosylation in mdx mice with truncated dystrophin.
Authors: Nogami Ken'ichiro , Maruyama Yusuke , Elhussieny Ahmed , Sakai-Takemura Fusako , Tanihata Jun , Kira Jun-ichi , Miyagoe-Suzuki Yuko , Takeda Shin'ichi 
Published: March 2020

Abstract
Background: Previous research indicated that nitric oxide synthase (NOS) is the key molecule for S-nitrosylation of ryanodine receptor 1 (RyR1) in DMD model mice ( mdx mice) and that both neuronal NOS (nNOS) and inducible NOS (iNOS) might contribute to the reaction because nNOS is mislocalized in the cytoplasm and iNOS expression is higher in mdx mice. We investigated the effect of iNOS on RyR1 S-nitrosylation in mdx mice and whether transgenic expression of truncated dystrophin reduced iNOS expression in mdx mice or not. Methods: Three- to 4-month-old C57BL/6J, mdx , and transgenic mdx mice expressing exon 45-55-deleted human dystrophin (Tg/ mdx mice) were used. We also generated two double mutant mice, mdx iNOS KO and Tg/ mdx iNOS KO to reveal the iNOS contribution to RyR1 S-nitrosylation. nNOS and iNOS expression levels in skeletal muscle of these mice were assessed by immunohistochemistry (IHC), qRT-PCR, and Western blotting. Total NOS activity was measured by a citrulline assay. A biotin-switch method was used for detection of RyR1 S-nitrosylation. Statistical differences were assessed by one-way ANOVA with Tukey-Kramer post-hoc analysis. Results: mdx and mdx iNOS KO mice showed the same level of RyR1 S-nitrosylation. Total NOS activity was not changed in mdx iNOS KO mice compared with mdx mice. iNOS expression was undetectable in Tg/ mdx mice expressing exon 45-55-deleted human dystrophin, but the level of RyR1 S-nitrosylation was the same in mdx and Tg/ mdx mice. Conclusion: Similar levels of RyR1 S-nitrosylation and total NOS activity in mdx and mdx iNOS KO demonstrated that the proportion of iNOS in total NOS activity was low, even in mdx mice. Exon 45-55-deleted dystrophin reduced the expression level of iNOS, but it did not correct the RyR1 S-nitrosylation. These results indicate that iNOS was not involved in RyR1 S-nitrosylation in mdx and Tg /mdx muscles.
Strain-resolved Dynamics of the Lung Microbiome in Patients with Cystic Fibrosis
Authors: Dmitrijeva Marija , Kahlert Christian , Feigelman Rounak , Kleiner Rebekka , Nolte Oliver , Albrich Werner , Baty Florent , Von Mering Christian 
Published: March 2020

Abstract
Background In cystic fibrosis, dynamic and complex communities of microbial pathogens and commensals colonize the lung. Cultured isolates from lung sputum reveal high inter- and intraindividual variability in pathogen strains, sequence variants, and phenotypes; disease progression likely depends on the precise combination of infecting strains. Routine clinical protocols, however, provide limited overview of the colonizer populations. A more comprehensive and precise identification and characterization of infecting strains could therefore assist in making corresponding decisions on treatment. Results Here, we propose a minimally invasive and culture-independent way to monitor microbial lung content. We describe longitudinal tracking of four patients with cystic fibrosis over several months, including repeated sampling and bulk DNA sequencing of sputum. We find that the taxonomic identity of individual lineages can be easily established. Crucially, even superficially clonal pathogens can be subdivided into multiple sub-strains at the sequence level. By tracking individual allelic differences over time, an assembly-free clustering approach allows us to reconstruct multiple strain-specific genomes with clear structural differences. Conclusions We emphasize the advantages of metagenomics sequencing of longitudinal data for taxonomic identification of microbial colonizers in cystic fibrosis lungs. Our study is the first to track sub-strain pathogen dynamics using a culture-independent approach, with a perspective of high-resolution routine characterization of disease progression that may allow to more accurately monitor treatment outcomes and tailor treatment.
Incidence and Risk Factors of Postoperative Delirium Following Primary Elective Total Hip Arthroplasty: A Retrospective Nationwide Inpatient Sample Database Study
Authors: Yang Qinfeng , Wang Jian , Huang Xusheng , Xu Yichuan , Zhang Yang 
Published: March 2020

Abstract
Background Postoperative delirium is a common complication following major surgeries, leading to a variety of adverse effects. However, there is a paucity of literatures studying the incidence and risk factors of delirium after primary elective total hip arthroplasty (THA) using a large-scale national database. Methods A retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2009-2014. Patients who underwent primary elective THA were included. Patient demographics, comorbidities, length of hospital stay (LOS), total charges, in-hospital mortality, and major and minor perioperative complications were evaluated. Results A total of 388,424 primary elective THAs were obtained from the NIS database, and the general incidence of delirium after THA was 0.90%. Patients with delirium after THA presented more comorbidities, increased LOS, extra hospital charges, and higher in-hospital mortality rate (P<0.001). Delirium following THA was associated with major complications during hospitalization including acute renal failure and pneumonia. Risk factors of postoperative delirium included advanced age, alcohol or drug abuse, depression, neurological disorders, psychoses, fluid and electrolyte disorders, diabetes, weight loss, deficiency anemia, coagulopathy, hypertension, congestive heart failure, valvular disease, pulmonary circulation disorders, peripheral vascular disorders, and renal failure. Both female and obesity were detected to be protective factors. Conclusions The results of our study identified a relatively low incidence of delirium after primary elective THA. Postoperative delirium of THA was associated with increased comorbidities, LOS, total charges, in-hospital mortality, and major perioperative complications including acute renal failure and pneumonia. It is of benefit to study risk factors of postoperative delirium to moderate its consequences.