bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inter-rater Reliability in Clinical Assessments: Do Examiner Pairings Influence Candidate Ratings?
Authors: Faherty Aileen , Finn Yvonne , Counihan Tim , Kropmans Thomas 
Published: October 2019

Abstract
BackgroundThe reliability of clinical assessments is known to vary considerably with inter-rater reliability a key contributor. Many of the mechanisms that contribute to inter-rater reliability however remain largely unexplained and unclear. While research in other fields suggests personality of raters can impact ratings, studies looking at personality factors in clinical assessments are few. Many schools use the approach of pairing examiners in clinical assessments and asking them to come to an agreed score. Little is known however, about what occurs when these paired examiners interact to generate a score. Could personality factors have an impact?

Methods:

A fully-crossed design was employed with each participant examiner observing and scoring. A quasi-experimental research design used candidate’s observed scores in a mock clinical assessment as the dependent variable. The independent variables were examiner numbers, demographics and personality with data collected by questionnaire. A purposeful sample of doctors who examine in the Final Medical examination at our institution was recruited.

Results:

Variability between scores given by examiner pairs (N=6) was less than the variability with individual examiners (N=12). 75% of examiners (N=9) scored below average for neuroticism and 75% also scored high or very high for extroversion. The higher an examiner’s personality score for extroversion, the lower the amount of change in his/her score when paired up with a co-examiner; reflecting possibly a more dominant role in the process of reaching a consensus score.

Conclusions:

While the variability between scores given by examiner pairs (N=6) was less than the variability with individual examiners (N=12), the reliability statistics for both assessments were comparable. However, using paired examiners resulted in a more accurate and robust score than simply averaging two independent examiners scores. The higher an examiner’s personality score for extroversion, the lower the amount of change in his/her score when paired up with a co-examiner; reflecting possibly a more dominant role in the process of reaching a consensus score. These findings could have implications for the organisation and administration of clinical assessments. Further studies with larger numbers of participants might establish if personality testing before choosing examiner pairs should be adopted.
Nutrition knowledge and Attitude in Medical Students of Tabriz University of Medical Sciences in 2017-2018
Authors: Dolatkhah Neda , Aghamohammadi Dawood , Khalili Azizeh Farshbaf , Hajifaraji Majid , Hashemian Maryam , Esmaeili Sepideh 
Published: October 2019

Abstract
Objectives : In this cross-sectional study among 220 medical students we aimed to determine the nutritional knowledge and attitude of medical students through clinical training courses (externship and internship) of Tabriz University of Medical Sciences, Iran. A nutritional knowledge questionnaire included 51 questions was used to determine the correct, perceived and accuracy of knowledge of the participant in different aspects of nutrition sciences. Nutritional knowledge was calculated as percentage of correct responses. The nutrition attitude questionnaire included 30 questions. Both questionnaires were confirmed in terms of the validity and reliability for assessing nutritional knowledge and attitude in this sample of Iranian medical students.
Results: The mean score of correct knowledge was not significantly different among externs and interns (68.20±7.50% and 67.87±6.04% respectively, p=0.729). Results showed that most of the participants (49.61% of externs and 57.14% of inters) had a poor nutritional knowledge, significantly varied by age (p=0.035). The mean attitude index of the subjects was not significantly different among externs and interns (106.37±13.66 and 108.16±13.35 out of 145 respectively, p=0.337). Most students (92.7%) had a very appropriate attitude toward nutrition, significantly varied by sex (p=0.010). These findings indicate that there are multiple deficiencies in nutrition knowledge of medical students.
Graft failure of IgA nephropathy in renal allografts following living donor transplantation: predictive factor analysis of 102 biopsies
Authors: Zhang Jin , Chen Guo-dong , Qiu Jiang , Liu Guo-chang , Chen Li-zhong , Fu Kai , Wu Zi-xuan 
Published: October 2019

Abstract
Background To investigate predictive factors related to graft failure of IgA nephropathy(IgAN) in renal allografts following living donor transplantation. Methods We identified a series of 102 biopsies diagnosed as IgAN in renal allografts following living donor transplantation from July 2004 to January 2017 at our center, and assess the predict value of the Lee's classification and the 2009 Oxford classification in IgAN in renal allografts, clinical, ultrasonic and pathological characteristics at biopsy and the outcomes were retrospectively analyzed. Results The 5-year graft cumulative survival rate after transplantation was 91.4%. The 4-year graft cumulative survival rate after biopsy diagnosis of IgAN in renal allografts was 59.6%. The mean time ± SD to disease was 4.7 ± 3.5 years. The color doppler ultrasound and blood flow imagine showed the echo enhancement, the reduced blood flow distribution, the reduced peak systolic velocity of main renal artery, and the increased resistance index of arcuate renal artery were valuable in evaluating the graft dysfunction. The Cox multivariate analysis revealed that the 24-h urinary protein level (HR 1.6 for 1-g increase, 95%CI 1.2-2.0), estimated glomerular filtration rate (eGFR) (HR 1.0 for 1-mL/min/1.73m^2 decline, 95%CI 1.0-1.1), and mesangial C1q deposition (HR 3.0, 95%CI 1.2-7.4) at biopsy were independent predictive factors of graft failure of IgAN in renal allografts. Conclusions IgAN in renal allografts occurred frequently within 5 years after transplantation. The risk of graft failure should be taken seriously in patients who exhibit heavy proteinuria and/or a declined eGFR as the initial symptoms; a high lesion grade (grade IV-V of Lee’s classification) and/or mesangial C1q deposition may also indicated a poor outcome.
First referral to an Integrated Onco-Palliative Care program: a retrospective analysis of its timing
Authors: Barth Claire , Colombet Isabelle , Montheil Vincent , Huillard Olivier , Boudou-Rouquette Pascaline , Tlemsani Camille , Alexandre Jérôme , Goldwasser François , Vinant Pascale 
Published: October 2019

Abstract
Background : Palliative care (PC) referral is recommended early in the course of advanced cancer. This study aims to describe, in an integrated onco-palliative care program (IOPC), patient’s profile when first referred to this program, timing of this referral and its impact on the trajectory of care at end-of-life.
Patients and Methods : The IOPC combined the weekly onco-palliative meeting (OPM) dedicated to patients with incurable cancer, and/or the clinical evaluation by the PC team. Oncologists can refer to the multidisciplinary board of the OPM the patients for whom goals and organization of care need to be discussed. We analyzed all patients first referred at OPM in 2011-2013. We defined the index of precocity (IP), as the ratio of the time from first referral to death by the time from diagnosis of incurability to death, ranging from 0 (late referral) to 1 (early referral).
Results: Of the 416 patients included, 57% presented with lung, urothelial cancers, or sarcoma. At first referral to IOPC, 76% were receiving antitumoral treatment, 63% were outpatients, 56% had a performance status ≤2 and 46% had a serum albumin level >35g/l. The median [1 st -3 rd quartile] IP was 0.39 [0.16-0.72], ranging between 0.53 [0.20-0.79] (earliest, for lung cancer) to 0.16 [0.07-0.56] (latest, for prostate cancer). Among 367 decedents, 42 (13%) received antitumoral treatment within 14 days before death, and 157 (43%) died in PC units.
Conclusions : The IOPC is an effective organization to enable early integration of PC and decrease aggressiveness of care near the end-of life. The IP is a useful tool to model the trajectory of care while taking into account each cancer types and therapeutic advances.
Challenges and opportunities in the continuity of care for hypertension: a mixed-methods study embedded in the Tajikistan Health Services Improvement Project
Authors: Chukwuma Adanna , Gong Estelle , Latypova Mutriba , Fraser-Hurt Nicole 
Published: October 2019

Abstract
Background: Hypertension, a significant risk factor for ischemic heart disease and other chronic conditions, is the third-highest cause of death and disability in Tajikistan. Thus, ensuring the early detection and appropriate management of hypertension is a core element of strategies to improve population health in Tajikistan. For a strategy to be successful, it should be informed by the causes of gaps in service delivery and feasible solutions to these challenges. The objective of this study was to undertake a systematic assessment of hypertension case detection and retention in care within Tajikistan’s primary health care system, and to identify challenges and appropriate solutions.

Methods: Our mixed-methods study drew on the cascade of care framework to examine patient progression through the recommended stages of hypertension care. We triangulated data from household surveys and facility registries within Tajikistan’s Health Services Improvement Project (HSIP) to describe the cascade. Focus group discussions with local HSIP stakeholders identified the barriers to and facilitators for care. Drawing on global empirical evidence on effective interventions and stakeholder judgments on the feasibility of implementation, we developed recommendations to improve hypertension service delivery that were informed by our quantitative and qualitative findings.

Results: We review the results for the case detection stage of the cascade of care, which had the most significant gaps. Of the half a million people with hypertension in Khatlon and Sogd Oblasts (administrative regions), about 10 percent have been diagnosed in Khatlon and only 5 percent in Sogd. Barriers to case detection include misinformation about hypertension, ambiguous protocols, and limited delivery capacity. Solutions identified to these challenges were mobilizing faith-based organizations, scaling up screening through health caravans, task-shifting to increase provider supply, and introducing job aids for providers.

Conclusions: Translating findings on discontinuities in care for hypertension and other chronic diseases to actionable policy insights can be facilitated by collaboration with local stakeholders, triangulation of data sources, and identifying the intersection between the feasible and the effective in defining solutions to service delivery challenges.
Prevalence and Risk Factors for Microalbuminuria in Children with Sickle Cell Disease at King Abdulaziz University Hospital: A Retrospective Cross-sectional Study
Authors: Alzahrani Yahya A , Algarni Malak Ali , Alnashri Maryam Mohammed , AlSayyad Hanan Mohammad , Aljahdali Khadijah Mohammed , Alead Joud Emad , Alhjrsy Yara Ali , Alzahrani Fatma Salih , Safder Osama 
Published: October 2019

Abstract
Objectives

Previous studies have not addressed microalbuminuria in pediatric patients with sickle cell disease (SCD) in Jeddah, Saudi Arabia. This study aimed to determine the prevalence of microalbuminuria and identify associated risk factors in children with SCD at King Abdulaziz University Hospital.Results

Overall, 42.5% of the patients enrolled were Saudi Arabian and 51% were male. The patients’ mean age was 12.4 years, and the highest percentage (40%) was in the age group of 15–18 years. The prevalence of microalbuminuria was 9.6%, and hematuria was present in 8% of cases. The percentage of patients with hematuria was significantly higher in the microalbuminuria group (22.6%) than in the non-microalbuminuria group (6.5%; P=.007). The percentage of patients with acute chest syndrome was also higher in the microalbuminuria group (26%) than in the non-microalbuminuria group (8%; P=0.005). The percentage of patients with gallbladder stones was higher in the microalbuminuria group (13%) than in the non-microalbuminuria group (2.4%; P=.014). However, the mean number of blood transfusions was higher in the non-microalbuminuria group than in the microalbuminuria group (P=.002). Sickle cell nephropathy manifests as microalbuminuria, begins at an early age, occurs in all types of SCD, and is associated with disease severity.
Diversity and bioactivities of fungal endophytes from Distylium chinense, a rare waterlogging tolerant plant endemic to the Three Gorges Reservoir
Authors: Duan Xiaoxiang , Xu Fangfang , Qin Dan , Gao Tiancong , Shen Weiyun , Zuo Shihao , Yu Baohong , Xu Jieru , Peng Yajun , Dong Jinyan 
Published: October 2019

Abstract
Background

The present study involves diversity and biological activities of the endophytic fungal community from Distylium chinense , a rare waterlogging tolerant plant endemic to the Three Gorges Reservoir. This study has been conducted hypothesizing that the microbial communities in the TGR area would contribute to the host plant tolerating a range of abiotic stress such as summer flooding, infertility, drought, salinity and soil erosion etc., and they may produce new metabolites, which may possess plentiful bioactive property, especially antioxidant activity. Therefore in the current study, the antioxidant, antimicrobial and anticancer activities of 154 endophytes recovered from D. chinense have been investigated. Furthermore, the active metabolites of the most broad-spectrum bioactive strain have also been studied.Results

A total of 154 fungal endophytes were isolated from roots and stems. They were categorized into 30 morphotypes based on cultural characteristics and were affiliated with 27 different taxa. Among these, the most abundant fungal orders included Diaporthales (34.4%) and Botryosphaeriales (30.5%), which were predominantly represented by the species Phomopsis sp. (24.7%) and Neofusicoccum parvum (23.4%). Fermentation extracts were evaluated, screening for antioxidant, antimicrobial and anticancer activities. Among the 154 isolates tested, 99 (64.3%) displayed significant antioxidant activity, 153 (99.4%) exhibited inclusive antimicrobial activity against at least one tested microorganism and 27 (17.5%) showed exclusive anticancer activity against one or more cancer cell lines. Specifically, the crude extract of Irpex lacteus DR10-1 exhibited note-worthy bioactivities. Further chemical investigation on DR10-1 strain resulted in the isolation and identification of two known bioactive metabolites, indole-3-carboxylic acid ( 1 ) and indole-3-carboxaldehyde ( 2 ), indicating their potential roles in plant growth promotion and human medicinal value.Conclusion

These results indicated that diverse endophytic fungal population inhabits D. chinense . One of the fungal isolate DR10-1 ( Irpex lacteus ) exhibited significant antioxidant, antimicrobial and anticancer potential. Further, its active secondary metabolites 1 and 2 also showed antioxidant, antimicrobial and anticancer potential.
Microbiological and cytological characterization of coelomic fluid from three captive endangered amphibian Gastrotheca species with edema syndrome: Preliminary analysis.
Authors: Oleas-Paz Anahí , Santamaría-Naranjo Ana Cecilia , Rojas-Carrillo Maira , Merino-Viteri Andrés , Genoy-Puerto Alexander 
Published: October 2019

Abstract
Objective: Edema syndrome is highly prevalent but under researched in captive frogs around the world. The objective of the present study was to characterize at a basic microbiological and cytological level the edema fluid of 20 individuals of the genus Gastrotheca to determine the presence of possible anaerobic and aerobic bacteria.
Results: Fourteen types of bacteria were identified in the edema fluid, twelve of them at the species level ( Pasteurella haemolytica , Hafnia alvei , Enterobacter agglomerans , Aeromonas hydrophila , Pseudomonas fluorescens , Burkholderia pseudomallei , Salmonella arizonae , Enterobacter gergoviae , Enterobacter sakazakii , Yersinia enterocolitica , Klebsiella oxytoca, and Klebsiella ozaenae ) and two at the genus level ( Enterococcus spp. and Streptococcus spp.). The most frequently identified cells were lymphocytes (37.7% in females and 46.4% in males), erythrocytes (23.5% in females and 17.5% in males) and neutrophils (4.2% in females and 2.8% in males). Finally, no relationship was found between the data obtained and the sex of the individuals studied.
Screening And Quantification Of Anti-Quorum Sensing And Antibiofilm Activities Of Phyllosphere Bacteria Against Biofilm Forming Bacteria
Authors: THEODORA NADINE AMABEL , DOMINIKA VANIA , Waturangi Diana Elizabeth 
Published: October 2019

Abstract
Objective

The objectives of this research were to screen anti-quorum sensing activity of phyllosphere bacteria and quantify their antibiofilm activity against biofilm forming bacteria ( Bacillus cereus, Staphylococcus aureus, Enterococcus faecalis, Salmonella typhimurium, Vibrio cholerae, Pseudomonas aeruginosa). Results

We found 11 phyllosphere bacteria isolates with potential anti-quorum sensing activity. Most of the crude extracts from phyllosphere bacteria isolates had anti-quorum sensing activity against Chromobacterium violaceum at certain concentration (20 and 10 mg/mL), but not crude extract from isolate JB 7F. Crude extracts showed various antibiofilm activities against all tested pathogenic bacteria.
Robot-Assisted Bronchoscopy for Pulmonary Lesion Diagnosis: Results from the Initial Multicenter Experience
Authors: Chaddha Udit , Kovacs Stephen P. , Hogarth Douglas Kyle , Manley Christopher , Cumbo-Nacheli Gustavo , Bhavani Sivasubramanium V. , Kumar Rohit , Shende Manisha , III John P. Egan , Murgu Septimiu 
Published: October 2019

Abstract
Background The Robotic Endoscopic System (Auris Health, Inc., Redwood City, CA) has the potential to overcome several limitations of contemporary guided-bronchoscopic technologies for the diagnosis of lung lesions. Our objective is to report on the initial post-marketing feasibility, safety and diagnostic yield of this technology.Methods We retrospectively reviewed data on consecutive cases in which robot-assisted bronchoscopy was used to sample lung lesions at four centers in the US (academic and community) from June 15th, 2018 to December 15th, 2018.Results One hundred and sixty-seven lesions in 165 patients were included in the analysis, with an average follow-up of 185 ± 55 days. The average size of target lesions was 25.0 ± 15.0 mm. Seventy-one percent were located in the peripheral third of the lung. Pneumothorax and airway bleeding occurred in 3.6% and 2.4% cases, respectively. Navigation was successful in 88.6% of cases. Tissue samples were successfully obtained in 98.8%. The diagnostic yield estimates ranged from 69.1% to 77% assuming the cases of biopsy-proven inflammation without any follow-up information (N=13) were false-negatives and true-negatives, respectively. The yield was 81.5%, 71.7% and 26.9% for concentric, eccentric and absent r-EBUS views, respectively. Diagnostic yield was not affected by lesion size, density, lobar location or centrality.Conclusions RAB implementation in community and academic centers is safe and feasible, with an initial diagnostic yield of 69.1-77% in patients with lung lesions that require diagnostic bronchoscopy. Comparative trials with the existing bronchoscopic technologies are needed to determine cost-effectiveness of this technology.
Spiral artery blood flow during pregnancy: a systematic review and meta-analysis.
Authors: Schiffer Veronique , Evers Laura , de Haas Sander , Ghossein Chahinda , Al-Nasiry Salwan , Spaanderman Marc 
Published: October 2019

Abstract
Background : Downstream remodeling of the SpA decreases utero-placental resistance drastically, allowing sustained and increased blood flow to the placenta at all circumstances. We systematically evaluated available reports to visualize adaptation of spiral arteries throughout pregnancy by ultra-sonographic measurements and evaluated when this process is completed. Methods : A systematic review and meta-analysis of spiral artery flow (pulsatility index (PI), resistance index (RI) and peak systolic velocity (PSV)) was performed. English articles were obtained from Pubmed, EMBASE and Cochrane Library and included articles were assessed on quality and risk of bias. Weighted means of Doppler indices were calculated using a random-effects model. Results : In healthy pregnancies, PI and RI decreased from 0.75 (95% CI: 0.67-0.83) and 0.49 (95% CI: 0.46-0.53) in the first trimester to 0.52 (95% CI: 0.48-0.56, p=0.003) and 0.40 (95% CI: 0.38-0.42, p=0.080) in the second trimester and to 0.49 (95% CI: 0.44-0.53, p=0.510) and 0.36 (95% CI: 0.35-0.37, p=0.307) in the third trimester, respectively. In parallel, PSV altered from 0.24 m/s (95% CI: 0.17-0.31 m/s) to 0.28 m/s (95% CI: 0.22-0.34 m/s, p=0.377) and to 0.25 m/s (95% CI: 0.21-0.28 m/s, p=0.919) in the three trimesters. In absence of second and third trimester Doppler data in complicated gestation, only a difference in PI was observed between complicated and healthy pregnancies during the first trimester (1.49 vs 0.76, p<0.001). Although individual studies have identified differences in PI between SpA located in the central part of the placental bed versus those located at its periphery, this meta-analysis could not confirm this (p=0.349) . Conclusions : This review and meta-analysis concludes that an observed decrease of SpA PI and RI from the first towards the second trimester parallels the physiological trophoblast invasion converting SpA during early gestation, a process completed in the midst of the second trimester. Higher PI and RI were found in SpA of complicated pregnancies compared to healthy pregnancies, possibly reflecting suboptimal utero-placental circulation. Longitudinal studies examining comprehensively the predictive value of spiral artery Doppler for complicated pregnancies are yet to be carried out.