bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Visual Performance between Refractive and Diffractive Multifocal Intraocular Lenses
Authors: Ye Lingying , Chen Tianyu , Hu Zhixiang , Yang Qiuwen , Su Qiudong , Li Jin 
Published: March 2020

Abstract
BACKGROUND: To compare the visual performance of asymmetric refractive multifocal intraocular lenses (MIOLs) with all optic zone diffractive MIOLs. METHODS: A prospective study. Patients underwent phacoemulsification were divided into two groups according to the type of MIOLs: 25 patients were implanted with asymmetric refractive MIOLs and 25 patients with all optic zone diffractive MIOLs. Visual acuity, refraction, defocus curves, objective optical quality and the questionnaire of life quality were measured 3 months after surgery. RESULTS: There was no significant difference between two groups in uncorrected distance visual acuity、uncorrected near visual acuity、best corrected distance visual acuity or distance corrected near visual acuity. However, the uncorrected intermediate visual acuity was 0.24±0.10 in refractive group and 0.31±0.13 in diffractive group (P<0.05); the distance corrected intermediate visual acuity was 0.22±0.09 in refractive group and 0.31±0.14 in diffractive group (P<0.05). Defocus curves showed two peaks of maximum vision in both groups. However, the curve between two peaks of refractive group was smoother than diffractive group. The Modulated transfer function cut-off frequency was （22.74±12.29）c/d in refractive group and（30.50±10.04）c/d in diffractive group (P<0.05); the OQAS values 100% (OV100%) were 0.75±0.41 in refractive group and 1.02±0.34 in diffractive group（P<0.05），OV20% were 0.52±0.34 in refractive group and 0.71±0.25 in diffractive group （P<0.05）.There was no significant difference between two groups at overall satisfaction, independence spectacles ratio or visual interference phenomenon. CONCLUSIONS: Both MIOLs achieve good visual acuity at distance and near. The asymmetric refractive MIOLs show better intermediate visual acuity, and the all optic zone diffractive MIOLs appear to have better objective visual quality.
In search of universal health coverage – highlighting the accessibility of health care to students with disabilities in Ghana: a qualitative study
Authors: Abodey Eric , Vanderpuye Irene , Mensah Isaac , Badu Eric 
Published: March 2020

Abstract
Background: Accessibility of health care to students with disabilities is a global concern. This is no less important in Ghana, however, to date, no study has been undertaken regarding access to health care to students with disabilities. This study, therefore, aims to explore the accessibility of health care to students with disabilities, in the quest of achieving universal health coverage in Ghana.
Methods: Qualitative methods, involving in-depth interviews were employed to collect data from 54 participants (29 students with disabilities, 17 health workers and 8 school mothers), selected through purposive sampling. Thematic analysis was used to analyze the data.
Results: The study identified three themes – accessibility, adequacy, and affordability. The study findings highlighted that universal health coverage for students with disabilities has not been achieved due to barriers in accessing health care. The barriers faced by students with disabilities were unfriendly physical environments, structures, equipment, limited support services and poor health insurance policy to finance health care.
Conclusion: The study concludes that the government should prioritize disability-related issues in health policy formulation, implementation and monitoring. The current provisions and requirements in the disability act should be prioritized, enforced and monitored to ensure adequate inclusion of disability issues in health services. Further, the current exemption policy under the National Health Insurance Scheme should be revised to adequately address the needs of people with disabilities.
Experience of Nurse Educators on the Implementation of the Competency-Based Curriculum for Nursing and Midwifery Programmes in Tanzania: A mixed method study.
Authors: Mmari Vumilia Bettuel , Lilian Mselle Teddy , Stephen Kibusi Mathew , Osaki Kalafunja Mlang'a 
Published: March 2020

Abstract
Background: In Tanzania, the competency-based curriculum was introduced in 2008. Despite the government’s efforts to ensure its effective implementation, there has been a public concern on graduate nurses’ and midwives’ competencies in providing quality nursing care in the country. This concern has influenced people to question the process of the implementation of competency-based curriculum for nursing and midwifery programmes. This study describes experiences of the nurse educators in implementing the competency-based curriculum for nursing and midwifery programmes in Tanzania. Methods: Cross section study design using convergent parallel mixed methods approach was used to describe the experience of nurse educators implementing competency-based curriculum. To enhance the validity of the findings, 240 nurse educators, out of 264, answered a questionnaire while the remaining 24 were interviewed. Results: The study found out that nurse educators had difficulties implementing the competency-based curriculum. Nighty-seven percent of participants used lecture discussions, 53% simulation and were not using participatory methods of teaching and learning because of time constraints (25%) and lack of special skills (13%). Qualitative findings revealed inability of the participants to understand concepts and interpret the competency based curriculum. Conclusion: The Nursing and Midwifery CBET curriculum was not implemented as it was intended. Nurse educators lacked understanding of the competency-based curriculum. Further, they reported that they were unable to apply various participatory methods of teaching and learning because of lack of time, equipment and larger number of students. There is need to put in place sustainable strategies for continuous professional development, provision of adequate teaching and learning resources and mentorship. Keywords: Competency-based curriculum, nurse educators’ experience, nursing and midwifery training programmes.
Lesion distribution characteristics of deep infiltrating endometriosis with ovarian endometrioma: An observational clinical study
Authors: Kwok Hungling , Jiang Hongye , Li Tian , Yang Huan , Fei Hui , Cheng Li , Yao Shuzhong , Chen Shu-Qin 
Published: March 2020

Abstract
Background: To investigate the characteristics of deep infiltrating endometriosis (DIE) lesion distribution when associated with ovarian endometrioma (OEM). Methods: The present study analyzed retrospective data obtained by the First Affiliated Hospital of Sun Yat-sen University, between June 2008 to June 2016. A total of 304 patients underwent laparoscopic surgery for complete removal of endometriosis by one experienced surgeon, and histological confirmation of OEM associated with DIE was conducted for each patient. Clinical data were recorded for each patient from medical, operative and pathological reports. Patients were then divided into two groups according to unilateral or bilateral OEM. Patients with unilateral OEM were subsequently divided into two subgroups according to OEM location (left- or right-hand side) and the diameter of the OEM (≤50 and >50 mm). The distribution characteristics of DIE lesions were then compared between the groups. Results: DIE lesions were widely distributed, 30 anatomical sites were involved. Patients with associated unilateral OEM (n=184 patients) had a significantly increased number of DIE lesions when compared with patients with bilateral OEM (n=120 patients; 2.76±1.52 vs. 2.33±1.34; P=0.006). Compared with bilateral OEM with DIE, there was a higher rate of intestinal (39.1% vs. 18.3%; P<0.01) and vaginal (17.4% vs. 6.7%; P<0.01) infiltration by DIE lesions in unilateral OEM with DIE. The mean number of DIE lesions was not significantly correlated with the location or size of the OEM (2.83±1.56 vs. 2.74±1.53; P=0.678; and 2.65±1.42 vs. 2.80±1.43; P=0.518, respectively). There was no significant difference between the groups with OEM ≤50 mm and >50 mm. Conclusion: Lesion distribution characteristics in women diagnosed with histologically proven OEM associated with DIE were frequently multifocal and severe. Key Words: ovarian endometrioma, deep infiltrating endometriosis, lesion distribution characteristics
Applicability of the Five Case Model to African eHealth investment decisions
Authors: Broomhead Sean C , Mars Maurice , Scott Richard E. , Jones Tom 
Published: March 2020

Abstract
Background: eHealth programmes in African countries face fierce competition for scarce resources. Such initiatives should not proceed without adequate appraisal of their probable impacts, thereby acknowledging their opportunity costs and the need for appraisals to promote optimal use of available resources. However, since there is no broadly accepted eHealth impact appraisal framework available to provide guidance, and local expertise is limited, African health ministries have difficulty completing such appraisals. The Five Case Model, used in several countries outside Africa, has the potential to function as a decision-making tool in African eHealth environments and serve as a key component of an eHealth impact model for Africa. Methods: This study identifies internationally recognised metrics and readily accessible data sources to assess the applicability of the model’s five cases to African countries. Results: Ten metrics are identified that align with the Five Case Model’s five cases, including nine component metrics and one summary metric that aggregates the nine. The metrics cover the eHealth environment, human capital and governance, technology development, and finance and economics. Fifty-four African countries are scored for each metric. Visualisation of the metric scores using spider charts reveals profiles of the countries’ relative performance and provides an eHealth Investment Readiness Assessment Tool. Conclusion: The utility of these comparisons to strengthen eHealth investment planning suggests that the five cases are applicable to African countries’ eHealth investment decisions. The potential for the Five Case Model to have a role in an eHealth impact appraisal framework for Africa should be validated through field testing.
Effect of Residual Extractable Lignin on Acetone-Butanol-Ethanol Production in SHF and SSF Processes
Authors: Li Jing , Zhang Yu , Shi Suan , Tu Maobing 
Published: March 2020

Abstract
Background

Lignin played an important role in biochemical conversion of biomass to biofuels. A significant amount of lignin is precipitated on the surface of pretreated substrates after organosolv pretreatment. The effect of this residual lignin on enzymatic hydrolysis has been well understood, however, their effect on subsequent ABE fermentation is still unknown.

Results

To determine the effect of residual extractable lignin on Acetone-Butanol-Ethanol (ABE) fermentation in separate hydrolysis and fermentation (SHF) and simultaneous saccharification and fermentation (SSF) processes, we compared ABE production from ethanol washed and unwashed substrates. The ethanol organosolv pretreated loblolly pine (OPLP) was used as the substrate. It was observed that butanol production from OPLP-UW (unwashed) and OPLP-W(washed) reached 8.16 and 1.69 g/L, respectively in SHF. The results showed that ABE production in SHF from OPLP-UW prevents an “acid crash” as comparing the OPLP-W. In SSF process, the “acid crash” occurred for both OPLP-W and OPLP-UW. The inhibitory extractable lignin intensified the “acid crash” for OPLP-UW and resulted in less ABE production than OPLP-W. The addition of detoxified prehydrolysates in SSF processes shortened the fermentation time and could potentially prevent the “acid crash”.

Conclusions

The results suggested that the residual extractable lignin in high sugar concentration could help ABE production by lowering the metabolic rate and preventing “acid crash” in SHF processes. However, it became unfavorable in SSF due to its inhibition of both enzymatic hydrolysis and ABE fermentation with low initial sugar concentration. It is essential to remove extractable lignin of substrates for ABE production in SSF processes. Also, a higher initial sugar concentration is needed to prevent the “acid crash” in SSF processes.
A cross-sectional study on spouse and parent differences in caregiving experiences of people living with schizophrenia in rural China
Authors: Yu Yu , Li Tong-xin , Li Yi-lu , Qiu Dan , Xi Shi-jun , Xiao Shuiyuan , Tebes Jacob 
Published: March 2020

Abstract
Background: Conflicting evidence exists on whether parent or spouse caregivers experience better outcomes when caring for family members with schizophrenia. The current study aims to examine relative caregiving experiences and impacts of spouse and parent caregivers for people living with schizophrenia (PLS) in China.
Methods: A cross-sectional study was conducted in a sample of 264 community-dwelling primary family caregivers of PLS. Face-to-face interviews were conducted to collect information on family caregiving activities; objective and subjective burden; caregiver psychological distress, such as depression and anxiety; positive caregiving impact, such as caregiving rewarding feelings; and family functioning for spouse and parent caregivers.
Results: Both types of caregivers report engaging in similar caregiving activities and report comparable levels of objective burden. However, parent caregivers report significantly higher subjective burden than spouse caregivers ( b =7.94, 95% CI :2.08, 13.80, P <0.01), which is also reflected in significantly higher depression ( b =3.88, 95% CI :1.35, 6.41, P <0.01) and anxiety ( b =2.53, 95% CI : 0.22, 4.84, P <0.05), and lower family functioning ( b =-1.71, 95% CI : -2.73, -0.49, P <0.01). Despite these differences, both groups of caregivers report comparable rewarding feelings about caregiving.
Conclusions: Our findings have implications for family caregivers globally, but especially for countries that adhere to Confusion cultural values, and provide guidance for future family intervention programs. Such programs may do well to incorporate cultural values and beliefs in understanding caregiving and kinship family dynamics so as support family caregivers, and in particular, the specific vulnerabilities of parent caregivers.

Keywords: Schizophrenia; family caregivers; caregiver burden; caregiving, parent, spouse
What is the main problem in conservative management for complicated appendicitis? A systematic review
Authors: Zhang Chi , Ren Xuemeng , Gao Peng 
Published: March 2020

Abstract
Background: As a classification of appendicitis, complicated appendicitis has no standardized treatment for adults.Method: According to the related literature systematically searched on PubMed, Embase, Cochrane and Web of Science, we evaluated the efficacy of surgical treatment and conservative treatment for complicated appendicitis, especially focused on the outcomes about the length of stay, operation time, postoperative complications and unplanned additional intervention, in the literature. Result: A total of 14 studies were involved in the meta-analysis, including 845 patients in the immediate operation group (IO) and 756 patients in the conservative management group (CM). Compared with conservative treatment, the total hospitalization time was reduced by 1 day (WMD=-1.29, 95%CI [-2.42, -0.16], P=0.03<0.05). The incidence of unplanned additional intervention in patients undergoing emergency surgery is lower than that of conservative treatment (OR=0.18, 95%CI [0.11, 0.30], P<0.00001). Surgical patients are more likely to have complications such as wound infection (OR=2.41, 95%CI [1.08, 5.38], P=0.03<0.05) and intestinal obstruction (OR=4.14, 95%CI [2.21, 7.75], P<0.00001) than conservative patients. The incidence of abdominal abscess was lower than that of conservative treatment, and the difference was not statistically significant (OR=0.9, 95%CI [0.54, 1.47], P=0.66>0.05). Conclusion: Compared with conservative management patients, immediately operated patients have shorter hospitalization time and less unplanned intervention, which can significantly reduce the readmission opportunity of patients with complicated appendicitis and lighten the burden of follow-up and medical resource consumption.
Microbiota Core in Central Lung Cancer with Streptococcal Enrichment as a Possible Diagnostic Marker
Authors: Bello Salvador , Vengoechea José J. , Ponce-Alonso Manuel , Figueredo Ana L. , Mincholé Elisa , Rezusta Antonio , Gambó Paula , Pastor Juan M. , Galeano Javier , Campo Rosa del 
Published: March 2020

Abstract
Background: Dysbiosis has been scarcely explored in the respiratory tract with cancer. We aimed to define the bacterial and fungal microbiota of the bronchi in cancer versus a healthy state, also defining the microbiota core, and their correlation with that in saliva and feces; and to detect markers for the early diagnosis of central lung cancer. For this purpose, twenty-five patients with central lung cancer and sixteen healthy controls without antimicrobial intake during the previous month were recruited. Bacterial and fungi distribution was determined by massive sequencing in bronchial biopsies. Complex computational analysis was performed to define for the first time the lung microbiota core.Results: A greater abundance of Streptococcus, Rothia, Gemella and Lactobacillus distinguish the saliva of patients. Affected and contralateral bronchi of these patients have almost identical microbiota dominated by Streptococcus, whereas Pseudomonas was the major genera in controls. Oral and pulmonary ecosystems were significantly more similar in patients, probably due to microaspirations. Streptococcal bronchial abundance differentiates patients from controls by an ROC curve (90.9% sensitivity, 83.3% specificity, AUC=0.897). The mycobiome of controls (Candida) was significantly different from that of patients (Malassezia), with the cancer-affected bronchi similar to their saliva, but different from their contralateral bronchi. Conclusions: Central lung cancer is highly enriched with Streptococcus, and shows significantly differences in their composition from healthy subjects. Alterations are not restricted to the tumor tissue, and seem to be the consequence of microaspirations from the oral cavity. These findings could be useful in the screening and even diagnosis of this pathology.
Hypoxia-challenged MSC-derived exosomes deliver miR-210 to attenuate post-infarction cardiac apoptosis
Authors: Cheng Hao , Chang Shufu , Xu Rende , Chen Lu , Song Xiaoyue , Wu Jian , Qian Juying , Zou Yunzeng , Ma Jianying 
Published: March 2020

Abstract
BackgroundMyocardial infarction (MI) is a major cause of death worldwide. Although percutaneous coronary intervention and coronary artery bypass grafting can prolong life, cardiac damage persists. In particular, cardiomyocytes have no regenerative capacity. Mesenchymal stem cells (MSCs) are attractive candidates for the treatment of MI. The manner by which MSCs exert a beneficial effect upon injured cells is a source of continued study.MethodsAfter the isolation and identification of exosomes from MSCs, the expression of miR-210 was determined by Microarray Chip. Subsequently, gain- and loss-function approaches were conducted to detect the role of exosomes and exosomal-miR-210 in cell proliferation and apoptosis of cardiomyocytes, as well as the MI in vivo. Dual-Luciferase Report Gene System was used to demonstrate the target gene of miR-210. ResultsWe tested the hypothesis that MSC-derived exosomes transfer specific miRNA to protect cardiomyocytes from apoptotic cell death. Interestingly, direct cardiac injection of MSC exosomes reduced infarct size and improved heart function after coronary ligation. In vitro, the MSC exosomes enhanced cardiomyocyte survival to hypoxia. Confirmation of exosome uptake in myocytes was confirmed. Dual luciferase reporter assay implicated miR-210 as a mediator of the therapeutic effect and AIFM3 as a downstream target. Treatment with miR-210 overexpressing MSC exosomes improved myocyte protection to both in vitro and in vivo stress. Furthermore, the endogenous and exogenous miR-210 had the same therapeutic effects. ConclusionThese results demonstrated that the beneficial effects offered by MSC-exosomes transplantation after MI are at least partially because of excreted exosome containing mainly miR-210.
Effects of Electroencephalogram Guided Anesthesia on Postoperative Delirium: A Systematic Review and Meta-analysis
Authors: Ding Lin , Chen DongXu , Li Qian 
Published: March 2020

Abstract
Background: Postoperative delirium is a common complication characterized by confusion, inattentiveness and other mental symptoms. It is still unclear whether the use of electroencephalogram (EEG) monitoring during surgery can decrease the incidence of postoperative delirium. The purpose of this study was to evaluate the effectiveness of EEG guided anesthesia on postoperative delirium (POD) based on randomized controlled trials (RCTs). Methods: The electronic databases of Ovid MEDLINE, PubMed, EMBASE, Cochrane Library database, CNKI and other local databases were systematically searched for RCTs from their inception until October 2019. The odds ratios (ORs) and the mean differences (MDs) with a 95% confidence intervals (CIs) were calculated to evaluate the correlation between EEG and itemized categories and continuous variable, respectively. Results: Seven RCTs with 3859 patients were included in the final analysis. The summary OR indicated that patients receiving EEG monitoring had a lower incidence rate of postoperative delirium (OR: 0.65; 95% CI: 0.46- 0.92; P = 0.01). In addition, no significant difference was found between the EEG monitoring group and the routine care group with respects to the length of hospitalization (MD: -0.59; 95%CI: -1.26 to 0.07; P=0.08). Conclusions: The findings of this study indicated that intraoperative use of electroencephalogram monitoring could decrease the risk of postoperative delirium. But for high risk patients, we should take a multi-component strategy to prevent delirium. Further large-scale, randomized controlled trials should be conducted to verify the treatment effect of intraoperative use of electroencephalogram monitoring on patients.
What drives regional differences in Body Mass Index? Evidence from Spain
Authors: Paolo Antonio Di , Gil Joan , Raftopoulou Athina 
Published: March 2020

Abstract
Background: This paper contributes to the debate on the North-South health divide by disentangling the conditioning factors responsible for regional differences in BMI. Specifically, this paper analyses differences in BMI between northern and southern Spanish regions, a country characterized by important geographical disparities in BMI and other health outcomes, as well as by the decentralized structure of its National Health System (NHS). Method: First, we decompose the average North-South BMI gap into the contribution of explained and unexplained factors using the Oaxaca-Blinder decomposition. Second, we perform a distributional analysis by applying the Recentered Influence Function (RIF) Regression and the corresponding decomposition, to analyse BMI differentials along its unconditional distribution. Results and Conclusions: Our findings indicate that North to South differences in BMI are significant only for women and a large share (74%) of this gap is explained by differences in endowments (basically years of schooling) to the detriment of women living in the South. Moreover, the explained (unexplained) portion of the gap steadily increases (decreases) along the BMI distribution, suggesting that what really matters to deal with the obesity epidemic among overweight women is focusing attention on regional disparities in observed endowments, human capital being the main driver.