bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differences in Growth of HIV-exposed Uninfected Infants in Ethiopia According to Timing of In-utero Antiretroviral Therapy Exposure
Authors: Ejigu Yohannes , Magnus Jeanette H. , Sundby Johanne , Magnus Maria Christine 
Published: June 2020

Background:
There are concerns about the adverse effect of in-utero exposure to antiretroviral therapy (ART) on the growth of HIV exposed-uninfected (HEU) infants. We compared growth of HEU-infants according to the timing and type of ART exposure.

Methods:
A retrospective cohort study was conducted by abstracting clinical data from HIV-infected mothers and HEU-infants in Addis Ababa, Ethiopia between February 2013 and October 2016. Mixed-effects linear models were used to compare changes in weight and length and cox proportional hazard models were used to evaluate stunting (length-for-age z score <−2.0) and underweight (weight-for-age z score <−2.0).

Results:
A total of 624 HEU-infants were included in the analyses. Infants exposed to ART from conception had a lower rate of change in length [β = −0.54, 95% confidence interval (CI): −1.00 to −0.08] the first 3 months of life, as compared with infants exposed from late pregnancy. Risk of stunting was 51.9 per 100 person-years and risk of underweight was 26.7 per 100 person-years. Exposure to ART from conception was associated with a higher rate of stunting as compared with exposure from late pregnancy (adjusted hazard ratio = 1.95, 95% CI: 1.27–2.99). Infants born to mothers with advanced disease had a higher incidence of underweight compared with infants born to mothers with early-stage disease adjusted hazard ratio = 1.99, 95% CI: 1.32–3.03).

Conclusions:
In HEU-infants, exposure to ART from conception was associated with decrease growth during early infancy and higher incidence of stunting compared with treatment exposure later in pregnancy. Close monitoring of HEU-infants’ growth and prompt nutritional intervention is essential.
Properties of the Early Symptom Measurement of Post-Stroke Depression: Concurrent Criterion Validity and Cutoff Scores
Authors: LI Jufang , OAKLEY Linda Denise , BROWN Roger L. , LI Yun , LUO Yong 
Published: June 2020

ABSTRACT

Background
Early-stage post-stroke depression (PSD) increases the risk of stroke-related disability and mortality in the first year of recovery. Presently available screening measures were developed to assess major depression, and none used a PSD screening criterion that was systematically developed and tested in populations of patients with acute stroke.

Purpose
The purpose of this study was to evaluate the concurrent criterion validity and cutoff scoring of the Early Symptom Measurement of Post-Stroke Depression (ESM-PSD) instrument in hospitalized patients with acute stroke.

Methods
Purposive recruitment of newly admitted patients yielded a qualified sample of 139 nonaphasic participants who were 7–30 days post mild-to-moderate stroke confirmed by computed tomography and magnetic resonance images. Participants responded to the ESM-PSD and Hamilton Rating Scale for Depression-24 (HAMD-24).

Results
The mean number of post-stroke days was 11.99 (SD = 7.68). Cronbach’s alpha estimates of internal consistency were ESM-PSD = .90 and HAMD-24 = .76. ESM-PSD measurement sensitivity and specificity were superior. The following three ESM-PSD cutoff scores, determined by the receiver operating characteristic curve, were used to assess clinically relevant early-symptom levels: no PSD < 14.5, low PSD = 14.5–25.5, moderate PSD = 25.5–45.5, high PSD ≥ 45.5.

Conclusion/Implications for Practice
ESM-PSD cutoff scores show the expected correspondence with mild–moderate–severe HAMD-24 symptoms, which was evidenced by the high area under the receiver operating characteristic curve. Planned follow-up research will assess the efficacy of using ESM-PSD scores to detect increased risk of major depression onset in patients with acute stroke.
The Effects of Shared Decision Making on Different Renal Replacement Therapy Decisions in Patients With Chronic Kidney Disease
Authors: HO Ya-Fang , CHEN Yu-Chi , HUANG Chiu-Chin , HU Wen-Yu , LIN Kuan-Chia , LI I-Chuan 
Published: June 2020

ABSTRACT

Background
The prevalence and incidence of end-stage renal disease (ESRD) in Taiwan are the highest of any country in the world. The different renal replacement therapies that are adopted by patients with ESRD significantly affect their social roles and daily life. However, because of the complexities of different renal replacement therapies, patients may be unsure of which to choose.

Purpose
The aim of this study was to explore the effectiveness of a shared decision-making (SDM) program regarding different renal replacement therapies for patients with chronic kidney disease.

Methods
A quasi-experimental design was conducted at two similar regional hospitals in Miaoli County, Taiwan. One hospital hosted the intervention group, and the other hospital hosted the control group. The 31 participants in the intervention group took part in a SDM program. The 36 control group participants took part in the pre-ESRD care program. Data collection included demographic and disease characteristics, decisional conflict scale, and decision self-efficacy scale. Results were analyzed using independent t test, Fisher’s exact test, generalized estimating equation, and paired t tests.

Results
The study results revealed that the intervention group experienced a significant increase in decision self-efficacy and a significant decrease in decisional conflict at 1 month after receiving the SDM intervention in comparison to before and immediately after receiving the intervention. Moreover, the intervention group had higher decision self-efficacy and lower decisional conflict than the control group.

Conclusions/Implications for Practice
The SDM program may be an effective intervention for complex decision-making processes, such as the process involved in making renal replacement treatment decisions. The SDM program group intervention improved decisional conflict and decision self-efficacy. Thus, to improve patients’ decision-making processes, the application of an SDM program focused on the personal values and opinions of patients with ESRD will be necessary. Physicians and case managers of patients with ESRD should act in complementary and cooperative roles in SDM programs.
Association Between Residential Neighborhood Social Conditions and Health Care Utilization and Costs
Authors: Zhang Yongkang , Ancker Jessica S. , Hall Jaclyn , Khullar Dhruv , Wu Yiyuan , Kaushal Rainu 
Published: June 2020

Background:
Social factors are important drivers of health. However, it is unclear to what extent neighborhood social conditions are associated with total and preventable health care utilization and costs.

Objectives:
To examine the association of neighborhood social conditions with total annual and potentially preventable Medicare costs.

Research Design and Subjects:
Retrospective cohort study. Medicare claims data from 2013 to 2014 linked with neighborhood social conditions at the US census block group level of 2013 for 93,429 Medicare fee-for-service and dually eligible patients.

Measures:
Neighborhood social conditions were measured by Area Deprivation Index at the census block group level, categorized into quintiles. Outcomes included total annual and potentially preventable utilization and costs.

Results:
After adjustment for demographics and comorbidities, patients with the least disadvantaged social conditions had higher total annual Medicare costs [$427; 95% confidence interval (CI), $200–$655] and similar potentially preventable costs (−$23; 95% CI, −$56 to $10) as compared with patients with the intermediate level social conditions. Patients with the most disadvantaged social conditions had similar total Medicare costs (−$22; 95% CI, −$342 to $298) but higher potentially preventable costs ($53; 95% CI, $1–$104) than patients with the intermediate level social conditions.

Conclusions:
Disadvantaged neighborhood conditions are associated with lower total annual Medicare costs but higher potentially preventable costs after controlling for demographic, medical, and other patient characteristics. Socioeconomic barriers may limit access and use of primary care and disease management services, resulting in a higher proportion of their health care costs going to potentially preventable care.
The How Matters
Authors: Lee Yuna S.H. , King Marissa D. , Anderson Daren , Cleary Paul D. , Nembhard Ingrid M. 
Published: June 2020

Background:
Investigating primary care provider (PCP)-team communication can provide insight into how colleagues work together to become high-functioning teams more able to address an increasingly complex set of tasks associated with chronic disease management.

Objective:
To assess how PCP communication with their care team relates to patients’ health.

Research Design:
Longitudinal study of how 3 aspects of PCP-care team communication—participation, time spent listening, and uninterrupted speaking length—relate to disease management of patients with hypertension or diabetes, and the effect of these team communication behaviors on PCP-patient communication as a pathway by which this relationship might exist. We used multilevel regression models.

Subjects:
Twenty-seven PCPs and 98 team members, and 18,067 patients with hypertension and 8354 patients with diabetes affiliated with a federally qualified health center with 12 practice sites.

Measures:
Primary data on communication collected using sociometric sensors worn by PCPs and team members, patient-PCP communication data collected with surveys, and patient health, PCP and patient characteristics extracted from electronic records.

Results:
PCPs participated in 75% of care team conversations, spent 56% of conversation time listening, and had an average uninterrupted speaking length of 2.42 seconds. PCP participation, listening, and length of uninterrupted speaking time were associated with significantly higher odds that their patients had controlled hypertension and diabetes and improvements in disease control over time. PCP-patient communication mediates this relationship.

Conclusions:
PCP-team communication is associated with patient health management. How team members speak with one another may be as important as the content of their communication.
Prognostic value of metabolic tumor volume and total lesion glycolysis in breast cancer: a meta-analysis
Authors: Pak Kyoungjune , Seok Ju Won , Kim Hyun Yul , Nguyen Tuong Linh , Kim Keunyoung , Kim Seong Jang , Kim In-Joo , Hopper John 
Published: June 2020

Objectives
PET using 18F-fluorodeoxyglucose (FDG) has proven to be valuable in staging and monitoring of treatment response in breast cancer. We aimed to assess the prognostic value of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in patients with breast cancer.

Methods
A systematic search of MEDLINE and EMBASE was performed using the keywords of breast cancer, PET, and volume. Inclusion criteria were 18F-FDG PET used as an initial imaging tool; studies limited to patients with breast cancer who had not undergone any treatment before PET scans; and studies reporting survival data. Event-free survival (EFS) and overall survival (OS) were considered markers of outcome.

Results
Nine studies comprising 975 patients were included in this study. The pooled hazard ratio (HR) for adverse events was 33.73 (P < 0.00001; I2 = 0%) with MTV from primary tumor and 2.89 (P < 0.00001; I2 = 45%) with TLG from primary tumor, meaning that primary tumors with high volumetric parameters were associated with progression or recurrence. However, the combined HRs for EFS of MTV, and TLG, and those for OS of MTV from whole-body tumor were NS. The pooled HR for OS of TLG from whole-body tumor was 2.95 (P = 0.18; I2 = 71%).

Conclusion
Volumetric parameters from 18F-FDG PET are significant prognostic factors for outcome in patients with breast cancer. Patients with a high MTV or TLG from primary tumor have a higher risk of adverse events. Patients with a high TLG from whole-body tumor have a higher risk of deaths.
Challenges in the Early Infant HIV Diagnosis and Treatment Cascade
Authors: Mofenson Lynne M. , Cohn Jennifer , Sacks Emma 
Published: June 2020

Abstract:
The first step in improving morbidity and mortality among children living with HIV is the timely and early identification of HIV infection, which must be followed by rapid engagement in care and provision of antiretroviral therapy. However, in 2018, only 59% of HIV-exposed infants received an infant nucleic acid diagnostic test by age 2 months and only 54% of children living with HIV received treatment. Because infant diagnosis requires molecular techniques to detect viral nucleic acid, programs for early diagnosis of infection in infants are more complex than those in adults and often require coordination and management of multiple health facilities as well as logistic, financial, and human resource challenges. This article will discuss challenges at each step in the early infant diagnosis cascade and innovations that may help overcome these challenges.
“We Need it the Same Day”: A Qualitative Study of Caregivers and Community Members' Perspectives Toward the Use of Point-of-Care Early Infant Diagnosis
Authors: Katirayi Leila , Ochuka Bernard , Mafaune Haurovi , Chadambuka Addmore , Baffour Theresa , Sacks Emma 
Published: June 2020

Background:
Only half of the infants tested for HIV ever receive results, leading to low uptake of treatment and increased mortality and morbidity rates. Point-of-care (POC) nucleic acid diagnostic machines allow for the possibility of same-day results. In Kenya and Zimbabwe, as part of an evaluation comparing standard of care with POC testing for early infant diagnosis, a qualitative substudy was undertaken to understand the acceptability of POC among caregivers of HIV-exposed infants and community members.

Setting:
Kenya and Zimbabwe.

Methods:
In Kenya, 74 interviews were conducted with caregivers, and 6 focus group discussions were conducted with male and female community members and elders. In Zimbabwe, we conducted 85 interviews and 8 focus group discussions. Data were collected in 2 rounds: 1 before the introduction of POC platforms and 1 after the platforms had been in use for at least 3 months. Interviews were conducted in local languages, and content analysis and constant comparison were used to identify key themes.

Results:
Reduced time to receive test results lowered caregiver anxiety about the child's HIV status and allowed families to put children on treatment earlier. Printed POC results were seen by some as more trustworthy than conventional handwritten results, believing this reduced the chance of human error; a few distrusted HIV results were generated too quickly. Community awareness of POC was lower among caregivers of HIV-exposed infants.

Conclusion:
Caregivers are generally very accepting of receiving POC HIV test results; however, additional sensitization among influential community members about the benefits of POC testing is needed.
Effectiveness of Maternal Transmission Risk Stratification in Identification of Infants for HIV Birth Testing: Lessons From Zimbabwe
Authors: Mafaune Haurovi W. , Sacks Emma , Chadambuka Addmore , Musarandega Reuben , Tachiwenyika Emmanuel , Simmonds Francis M. , Nyamundaya Tichaona , Cohn Jennifer , Mahomva Agnes , Mushavi Angela 
Published: June 2020

Background:
In 2017, Zimbabwe adopted a modified version of the World Health Organization 2016 recommendation on HIV birth testing by offering HIV testing at birth only to infants at “high risk” of HIV transmission. There is limited evidence on the effectiveness of this approach. Our study assessed the sensitivity and specificity of birth testing “high risk” infants only.

Methods:
We conducted a cross-sectional study at 10 health facilities from November 2018 to July 2019. A nucleic acid test for HIV was performed on all HIV-exposed infants identified within 48 hours of life, irrespective of risk status. Univariate and bivariate analyses were used to estimate the performance of the risk screening tool.

Results:
HIV nucleic acid test was successfully performed on 1970 infants (95%), of whom 266 (13.5%) were classified as high-risk infants. HIV prevalence for all infants tested was 1.5% (95% CI: 1% to 2%), whereas prevalence among high-risk infants and low-risk infants was 6.8% (95% CI: 3.7% to 9.8%) and 0.6% (95% CI: 0.3% to 1%) respectively. Sensitivity and specificity of the maternal risk screening tool was at 62.1% (95% CI: 44.4% to 79.7%) and 87.2% (95% CI: 85.7% to 88.7%), respectively; positive and negative predictive values were 6.8% (95% CI: 3.7% to 9.8%) and 99.4% (95% CI: 99.0% to 99.7%) respectively.

Conclusions:
Despite high negative predictive value, sensitivity was relatively low, with potential of missing 2 in every 5 HIV infected infants. Given the potential benefits of early ART initiation for all exposed infants, where feasible, universal testing for HIV-exposed infants at birth may be preferred to reduce missing infected infants.
The Carbon Footprint of Surgical Operations
Authors: Rizan Chantelle , Steinbach Ingeborg , Nicholson Rosamond , Lillywhite Rob , Reed Malcolm , Bhutta Mahmood F. 
Published: June 2020

Summary of background data and objectives:Operating theatres are typically the most resource-intensive area of a hospital, 3–6 times more energy-intensive than the rest of the hospital and a major contributor of waste. The primary objective of this systematic review was to evaluate existing literature calculating the carbon footprint of surgical operations, determining opportunities for improving the environmental impact of surgery.Methods:A systematic review was conducted in accordance with PRISMA guidelines. The Cochrane Database, Embase, Ovid MEDLINE, and PubMed were searched and inclusion criteria applied. The study endpoints were extracted and compared, with the risk of bias determined.Results:A total of 4604 records were identified, and 8 were eligible for inclusion. This review found that the carbon footprint of a single operation ranged 6–814 kg carbon dioxide equivalents. The studies found that major carbon hotspots within the examined operating theatres were electricity use, and procurement of consumables. It was possible to reduce the carbon footprint of surgery through improving energy-efficiency of theatres, using reusable or reprocessed surgical devices and streamlining processes. There were significant methodological limitations within included studies.Conclusions:Future research should focus on optimizing the carbon footprint of operating theatres through streamlining operations, expanding assessments to other surgical contexts, and determining ways to reduce the footprint through targeting carbon hotspots.
A Multicenter Randomized Controlled Trial Comparing Safety, Efficacy, and Cost-effectiveness of the Surgisis Anal Fistula Plug Versus Surgeon's Preference for Transsphincteric Fistula-in-Ano
Authors: Jayne David G. , Scholefield John , Tolan Damian , Gray Richard , Senapati Asha , Hulme Claire T. , Sutton Andrew J. , Handley Kelly , Hewitt Catherine A. , Kaur Manjinder , Magill Laura 
Published: June 2020

Objective:
To undertake a randomized comparison of the Biodesign Surgisis anal fistula plug against surgeon's preference in treating cryptoglandular transsphincteric fistula-in-ano.

Summary Background Data:
The efficacy of the Biodesign Surgisis anal fistula plug in healing anal fistulae is uncertain.

Methods:
Participants were randomized to the fistula plug with surgeon's preference (advancement flap, cutting seton, fistulotomy, Ligation of the Intersphincteric Fistula Tract procedure). The primary outcome was faecal incontinence quality of life (FIQoL) at 12-months. Secondary outcomes were fistula healing, incontinence rates, and complication and reintervention rates.

Results:
Between May 2011 and March 2016, 304 participants were randomized to fistula plug or surgeon's preference. No differences were seen in FIQoL between the 2 groups at 12 months. Clinical fistula healing was reported in 66/122 (54%) of the fistula plug and 66/119 (55%) of the surgeon's preference groups at 12 months. Fecal incontinence rates improved marginally in both the groups. Complications and reinterventions were frequent, with significantly more complications in the fistula plug group at 6-weeks (49/142, 35% vs 25/137, 18%; P=0.002). The mean total costs were £2738 (s.d. £1151) for the fistula plug and £2308 (s.d. £1228) for the surgeon's preference group (mean difference +£430, P=0.0174). The average total quality adjusted life years (QALYs) gained was marginally higher in the fistula plug group. The fistula plug was 35% to 45% likely to be cost-effective across a willingness to pay threshold of £20,000 to £30,000 / QALY.

Conclusions:
The Biodesign Surgisis anal fistula plug is associated with similar FIQoL and healing rates to surgeon's preference at 12 months. Higher costs and highly uncertain gains in QALYs mean that the fistula plug may not be considered as a cost-effective treatment in the UK NHS.
Sphingomonas chungangi sp. nov., a bacterium isolated from garden soil sample
Authors: Akter Shahina , Huq Md. Amdadul 
Published: June 2020

A novel bacterial strain, designated MAH-6T, was isolated from a garden soil sample. Cells were Gram-stain-negative, aerobic, non-motile and rod-shaped. The colonies were light yellow, smooth, circular and 0.6–1.2 mm in diameter when grown on nutrient agar for 3 days. Strain MAH-6T grew at 15–35 °C, at pH 5.0–7.0 and with 0–0.5 % NaCl. Cell growth occurred on nutrient agar and Reasoner's 2A (R2A) agar. The strain was positive for both catalase and oxidase tests. Cells were able to hydrolyse starch, aesculin, Tween 20 and Tween 80. According to 16S rRNA gene sequence comparisons, the isolate was identified as a member of the genus

Sphingomonas

and was most closely related to

Sphingomonas polyaromaticivorans

B2-7T (98.2 % sequence similarity),

Sphingomonas oligoaromativorans

SY-6T (96.9 %) and

Sphingomonas morindae

NBD5T (96.6 %). The novel strain MAH-6T has a draft genome size of 4 370 740 bp (28 contigs), annotated with 4199 protein-coding genes, 46 tRNA and three rRNA genes. The genomic DNA G+C content of the strain was determined to be 66.2 mol% and the predominant isoprenoid quinone is Q-10. The major fatty acids were identified as summed feature 8 (comprising C18 : 1
ω7c and/or C18 : 1
ω6c), C14 : 0 2OH and C16 : 0. The main polar lipids were phosphatidylcholine, sphingoglycolipid, phosphatidylethanolamine, phosphatidylglycerol and diphosphatidylglycerol. Based on the results of phenotypic, genotypic, chemotaxonomic and DNA–DNA hybridization studies, strain MAH-6T represents a novel species, for which the name Sphingomonas chungangi sp. nov. is proposed, with MAH-6T as the type strain (=KACC 19292T=CGMCC1.13654T).