bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cerebral arterial air embolism secondary to iatrogenic left atrial-esophageal fistula: a case report
Authors: Zhang Ping , Bian Yi 
Published: January 2020

Abstract
Background
Cerebral arterial air embolism is a life-threatening complication that can result in neurologic deficits or death. Sometimes it is iatrogenic, presented as a complication of invasive medical procedures. Here we describe a case of cerebral arterial air embolism secondary to iatrogenic left atrial-esophageal fistula, of which the diagnosis might be covered up by the complicated pathophysiologic changes.

Case presentation
A 68-year-old man presented with unconsciousness hours after aphasia and right hemiplegia, accompanied with hematemesis and fever. He had a history of atrial fibrillation, treated by radiofrequency catheter ablation 1 month ago. Brain CT displayed massive air embolism in left hemisphere, as well as right parietal lobe. Chest CT demonstrated a focus of air in the left atrium, which highly suggested an atrial-esophageal fistula. The patient received high flow (6 L/min) oxygen therapy. Intravenous antibiotics including imipenem and vancomycin were administered together with crystalloid rehydration. Supportive therapies were given including intubation, mechanical ventilation and vasopressor use. Because of the patient’s unstable condition and poor prognosis, surgical repair was considered but not pursued. The patient presented a very fast deterioration of cardiac function and circulatory failure, and finally died from cardiac arrest.

Conclusions
Clinicians must have a high index of suspicion for atrial-esophageal fistula for patients presenting with chest discomfort, new onset of stroke, upper gastrointestinal bleeding, and development of sepsis as long as 50 days after the ablation for atrial fibrillation. Urgent CT can ultimately establish the diagnosis in most cases.
A suicide prevention strategy for youth presenting to the emergency department with suicide related behaviour: protocol for a randomized controlled trial
Authors: Korczak Daphne J. , Finkelstein Yaron , Barwick Melanie , Chaim Gloria , Cleverley Kristin , Henderson Joanna , Monga Suneeta , Moretti Myla E. , Willan Andrew , Szatmari Peter 
Published: January 2020

Abstract
Background
Suicide is a leading cause of death among adolescents in North America. Youth who present to the Emergency Department (ED) with acute suicidality are at increased risk for eventual death by suicide, thereby presenting an opportunity for secondary prevention of suicide. The current study evaluates the effectiveness of a standardized individual and family-based suicidal behaviour risk reduction intervention targeting adolescents at high-risk for suicide.

Methods
A randomized controlled trial (RCT) will be conducted to evaluate the effectiveness of a manualized youth- and family- based suicide prevention strategy (SPS) as compared with case navigation (NAV) among adolescents aged 12 to 18 years of age who present to the ED with acute suicidal ideation (SI) or suicide risk behaviours (SRB). We will recruit 128 participants and compare psychiatric symptoms including SI/SRB, family communication, and functional impairment at baseline and follow-ups (post-intervention [6 weeks], 24 weeks). The primary outcome is change in suicidal ideation measured with the Suicide Ideation Questionnaire- Junior. SRBs are measured with the Suicide Behaviour Questionnaire. Secondary outcomes are change in depressive and anxious symptoms measured with semi-structured psychiatric interview and Screen for Child Anxiety Related Disorders; acute mental health crises measured by urgent medical (including ED) visits; family communication measured with Conflict Behaviour Questionnaire, functional impairment measured by Columbia Impairment Scale; cost effectiveness, and fidelity of implementation measured by audio recording and fidelity checklist.

Discussion
Results of this study will inform a larger multi-centre RCT that will include both community and academic hospitals in urban and rural settings. Study results will be shared at international psychiatry and emergency medicine meetings, in local rounds, and via publication in academic journals and clinician-oriented newsletters. If effective, the intervention may provide a brief, scalable, and transportable treatment program that may be implemented in a variety of settings, including those in which access to children’s mental health care services is challenging.

Trial registration
ClinicalTrials.gov: NCT03488602, retrospectively registered April 4, 2018.
The importance of sex as a risk factor for hospital readmissions due to pulmonary diseases
Authors: Buja Alessandra , De Polo Anna , De Battisti Elisa , Sperotto Milena , Baldovin Tatjana , Cocchio Silvia , Furlan Patrizia , Saia Mario , Scapellato Maria Luisa , Viel Guido , Baldo Vincenzo , Bertoncello Chiara , Ebell Mark 
Published: January 2020

Abstract
Background
Pulmonary diseases are a common and costly cause of 30-day readmissions. Few studies have focused on the difference in risk for rehospitalization between men and women in older patients. In this study we analyzed the association between sex and the risk of readmission in a cohort of patients admitted to the hospital for chronic obstructive pulmonary disease (COPD) exacerbation and other major pulmonary diseases.

Methods
This was a retrospective cohort study based on administrative data collected in the Veneto Region in 2016. We included 14,869 hospital admissions among residents aged ≥65 years for diagnosis related groups (DRGs) of the most common disorders of the respiratory system: bronchitis and asthma, pneumonia, pulmonary edema, respiratory failure, and COPD. Multilevel logistic regressions were performed to test the association between 30-day hospital readmission and sex, adjusting for confounding factors.

Results
For bronchitis and asthma, male patients had significantly higher odds of 30-day readmission than female patients (adjusted odds ratio (aOR), 2.07; 95% confidence interval (CI), 1.11–3.87). The odds of readmission for men were also significantly higher for pneumonia (aOR, 1.40; 95% CI, 1.13–1.72), for pulmonary edema and respiratory failure (aOR, 1.28; 95% CI, 1.05–1.55), and for COPD (aOR, 1.34; 95% CI, 1.00–1.81).

Conclusions
This study found that male sex is a major risk factors for readmission in patients aged more than 65 years with a primary pulmonary diagnosis. More studies are needed to understand the underlying determinants of this phenomena and to provide targets for future interventions.
Assessment of knowledge, attitude and practice towards rabies and associated factors among household heads in Mekelle city, Ethiopia
Authors: Hagos Weldegerima Gebremedhin , Muchie Kindie Fentahun , Gebru Goyitom Gebremdehn , Mezgebe Gebreamlak Gebremariam , Reda Kebede Ambaye , Dachew Berihun Assefa 
Published: January 2020

Abstract
Background
Rabies has a worldwide distribution in continental regions of Africa, Asia and the Latin America. Globally, the case fatality rate is 100% once a clinical sign is developed. Poor public awareness towards rabies is one of the major obstacles in any prevention and control scheme of the diseases. The study aimed to assess knowledge, attitude and practice (KAP) about rabies and associated factors among household heads in Mekelle city, Northern Ethiopia, 2016.

Methods
A community based cross-sectional study was conducted from October to November 2016 with a total of 633 study participants. Data were collected using a pretested structured questionnaire and entered to EPI-Info 3.5.4 and coded, cleaned and analyzed using SPSS version 20 software. Bi variable and multivariable analysis was done to identify factors associated with knowledge, attitude and practice about rabies. Variables having p < 0.05 was considered as statistically significant at 95%CI.

Results
Of 633 study participants, 357 (56.4%) were females and 239 (37.8%) were 18–35 years old. Among the study participants, 56.1% (95%CI = 52.2, 59.9), 56.2% (95%CI = 52.4, 60.1) and 61.3% (95%CI = 57.5, 65.1) had good level of knowledge, attitude and practice on the prevention and control of rabies respectively. Being female (AOR = 1.50, 95%CI = 1.05, 2.13), dog owner (AOR = 1.68, 95%CI = 1.17, 2.41) and participants who had training on rabies (AOR = 2.22, 95%CI = 1.53, 3.21) were found to have good knowledge. Married participants (AOR = 2.19, 95%CI = 1.16, 4.16), participants who owned dog (AOR = 2.64, 95%CI = 1.80, 3.86) and those encountered dog bite (AOR = 2.24, 95%CI = 1.23, 4.10) were found to have positive attitude towards rabies. Similarly, dog ownership (AOR = 11.85, 95%CI = 7.16, 19.6) was found to be associated with good practice.

Conclusion
This study showed that more than half of the respondents had good knowledge, attitude and practice about the prevention and control of rabies.
Implementation of pharmaceutical care for older adults in the brazilian public health system: a case study and realistic evaluation
Authors: Silva Barbara Barros , Fegadolli Claudia 
Published: January 2020

Abstract
Background
Pharmaceutical care services have been recognized as the most highly regarded professional pharmacy practice model that allows the identification, intervention, and resolution of drug related problems. This practice provides significant clinical outcomes and can reduce direct and indirect costs for health systems. However, its implementation can be complex and challenging, needing study experiences that aims at overcoming obstacles, especially in free and universal healthcare systems. The objective of this study is to evaluate the implementation of Ambulatory Care Pharmacy services for older adults at Paulista Institute of Geriatrics and Gerontology (IPGG), which is recognized in the city of São Paulo for offering pharmaceutical care services for over 10 years continuously. This initiative and process is independent of external academic interventions or educational institutions. It is hoped that the results may also contribute to advancing the implementation of pharmaceutical care service in similar health systems.

Design
This is a case study using multiple sources of data. Qualitative and quantitative data were collected from institutional documents, by participant observation and interviews. Initial themes were identified by content analysis and analyzed under the context-mechanism-outcome configurations (CMO Configurations) in realistic evaluation.

Setting
Geriatrics and Gerontology Institute of São Paulo (known as IPGG).

Participants
Eleven health professionals and three pharmaceutical care service users.

Results
Three CMO configurations were identified and accepted: “Scenario Construction mediated by educational processes”, “Contribution to complex needs resolution”, and “Organizational Visibility”. The CMO (Context-Mechanism-Outcomes) configuration “Logistic activities discourage clinical pharmaceutical services implantation” was denied due to the influence of accepted CMOs.

Conclusions
Educational processes which value transdisciplinary knowledge exchanges provide resources required to overcome important obstacles present during pharmaceutical care implementation. Thus, providing and seeking knowledge to build and offer context-consistent clinical health services as well as fulfilling organizational environment requirements can be the key to implement pharmaceutical care service.
A pilot study on molecular diagnosis of Hapalotrema mistroides (Digenea: Spirorchiidae) infection in blood samples of live loggerhead turtles Caretta caretta
Authors: Marchiori Erica , Dotto Giorgia , Tessarin Cinzia , Santoro Mario , Affuso Andrea , Tarricone Luciano , Di Renzo Ludovica , Freggi Daniela , Spoto Vincenzoleo , Marcer Federica 
Published: January 2020

Abstract
Background
Parasites of the family Spirorchiidae cause disease and mortality in marine and freshwater turtles; two species, Hapalotrema mistroides and Neospirorchis sp., are reported in the resident population of loggerhead turtles of the Mediterranean Sea, with the first being the most widespread. In vivo diagnosis of spirorchidiasis can represent a challenge in guaranteeing prompt control and treatment of the disease and is currently limited to copromicroscopy.
The aim of this study was the development of a real time PCR assay with TaqMan probe for the detection of H. mistroides infection in the blood of live loggerhead turtles, Caretta caretta, hospitalized in rehabilitation centres. Its potential use for in vivo diagnosis is explored.

Results
The developed real time PCR successfully detected H. mistroides DNA from both positive controls and experimental blood samples of live loggerhead sea turtles, showing good specificity, sensitivity and good reaction efficiency. Two out of three turtles which had demonstrated positivity at copromicroscopy also tested positive to this blood assay; DNA of H. mistroides was detected within the blood of one sea turtle, which tested negative for copromicroscopy.

Conclusions
This study describes a specific and rapid molecular assay to detect H. mistroides infection from live sea turtles and highlights for the first time the presence of DNA of this species in turtle blood samples. Since this assay is able to detect low amounts of the parasitic free DNA in blood samples, its application could be helpful for in vivo diagnosis of H. mistroides infection as well as for epidemiological purposes.
Gender difference in suicidal ideation and related factors among rural elderly: a cross-sectional study in Shandong, China
Authors: Lu Lu , Xu Lingzhong , Luan Xiaorong , Sun Long , Li Jiajia , Qin Wenzhe , Zhang Jiao , Jing Xiang , Wang Yali , Xia Yu , Li Yaozu , Jiao An’an 
Published: January 2020

AbstractBackgroundSuicide is a global public health problem which has significant negative influence on individuals, families and the society. The aim of this study is to investigate the prevalence of suicidal ideation and related factors among elderly people in rural China, and further examine the gender differences of suicidal ideation.MethodsData were collected from the 2017 Survey of the Shandong Elderly Family Health Service, which was conducted by Shandong University. A total of 5514 elderly aged 60 and above from rural Shandong were included in this study. Binary logistic regression model was performed to examine the gender difference towards suicidal ideation, and to identify the influencing factors of suicidal ideation by gender among elderly.Results7.7% rural elderly reported suicidal ideation in the past 12 months in Shandong, China. The prevalence of suicidal ideation among females was significantly higher than that among males (P < 0.001). Education level, debts, stress of daily life, loneliness and psychological distress were significantly related to suicidal ideation in both males and females. Besides, negative life events and life satisfaction were found to be significantly associated with suicidal ideation in females but not in males.ConclusionsThere was a significant gender difference towards suicidal ideation among rural elderly in Shandong, China. So, gender difference should be considered when medical practitioners and public health workers seek to prevent and manage suicidal ideation among rural elderly, which will be important to develop strategies for coping with risk factors for suicidal ideation among males and females. In other words, more attention should be paid to females who had encountered negative life event or with lower life satisfaction.
Relationship between the timing of the first postpartum ovulation and antral follicle counts in Holstein cows
Authors: Furukawa Eri , Masaki Tomoyuki , Sakaguchi Kenichiro , Bo Min , Yanagawa Yojiro , Ueda Koichiro , Nagano Masashi 
Published: January 2020

Abstract
Background
The timing of the first postpartum ovulation is an important factor affecting the timing of estrous resumption in dairy cows. The first postpartum ovulation is delayed in cows producing large amounts of milk with an intensive negative energy balance. The antral follicle count (AFC) and serum anti-Müllerian hormone concentrations are known to be indicators of the ovarian reserve, which is the number and quality of follicles left in a pair of ovaries and known as an indicator of female fertility. Cows with higher AFC have been proven to show higher pregnancy rate and shorter calving to conception intervals; however, the relationship between the timing of the first postpartum ovulation and ovarian reserve remains unclear. Therefore, this study examined the relationships between postpartum follicular dynamics, the ovarian cycle, nutritional status, and ovarian reserve.

Methods
Transrectal ultrasonography was conducted from calving to 70–120 days in milk (DIM) in 26 cows to monitor AFC, follicular dynamics and the ovarian cycle. Body weight (BW) and milk yield were used as indicators of nutritional status.

Results
The first postpartum ovulation was significantly later in cows with low AFC (< 25) than in those with high AFC (≥25), while changes in BW from calving to the nadir and milk production were similar in both groups. The present results also suggested that cows with low AFC and a delayed first postpartum ovulation had a shorter first ovarian cycle after the first postpartum ovulation. The mean DIM of the first postpartum artificial insemination (AI) and days open (days from calving to AI with which pregnancy was achieved) were similar in high and low AFC groups.

Conclusions
The first postpartum ovulation was significantly earlier in cows with high AFC than in those with low AFC. The assumed reason for this result was higher sensitivity to luteinizing hormone and larger androstenedione and estradiol production in follicles in high AFC cows. Therefore, cows with high AFC may be more fertile than those with low AFC while their milk production increase and BW decrease; it means they are in negative energy balance.
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DENDRO: genetic heterogeneity profiling and subclone detection by single-cell RNA sequencing
Authors: Zhou Zilu , Xu Bihui , Minn Andy , Zhang Nancy R. 
Published: January 2020

AbstractAlthough scRNA-seq is now ubiquitously adopted in studies of intratumor heterogeneity, detection of somatic mutations and inference of clonal membership from scRNA-seq is currently unreliable. We propose DENDRO, an analysis method for scRNA-seq data that clusters single cells into genetically distinct subclones and reconstructs the phylogenetic tree relating the subclones. DENDRO utilizes transcribed point mutations and accounts for technical noise and expression stochasticity. We benchmark DENDRO and demonstrate its application on simulation data and real data from three cancer types. In particular, on a mouse melanoma model in response to immunotherapy, DENDRO delineates the role of neoantigens in treatment response.
A study protocol for a randomised trial of adjunct computerised memory specificity training (c-MeST) for major depression in youth: targeting cognitive mechanisms to enhance usual care outcomes in mental health settings
Authors: Hallford D. J. , Carmichael A. M. , Austin D. W. , Takano K. , Raes F. , Fuller-Tyszkiewicz M. 
Published: January 2020

Abstract
Background
Youth depression is highly prevalent and is related to impairments in academic, social and behavioural functioning. Evidence-based treatments are available, but many young people do not respond or sufficiently recover with first-line options, and a significant proportion experience relapse. Consequently, there is clear scope to enhance intervention in this critical period of early-onset depression. Memory specificity training (MeST) is a low-intensity intervention for depression that targets reduced specificity when recalling memories of the past, a common cognitive vulnerability in depression. This randomised controlled trial will assess the efficacy of adding a computerised version of MeST (c-MeST) to usual care for youth depression.

Methods/design
Young people aged 15–25 years with a major depressive episode (MDE) will be recruited and randomised to have immediate access to the seven session online c-MeST program in addition to usual care, or to usual care and wait-list for c-MeST. The primary outcomes will be diagnostic status of an MDE and self-reported depressive symptoms assessed at baseline, 1-, 3- and 6-month intervals. Autobiographical memory specificity and other variables thought to contribute to the maintenance of reduced memory specificity and depression will be assessed as mediators of change.

Discussion
Online provision of c-MeST provides a simple, low-intensity option for targeting a cognitive vulnerability that predicts the persistence of depressive symptoms. If found to be efficacious as an adjunct to usual care for depressed youth, it could be suitable for broader roll-out, as c-MeST is highly accessible and implementation requires only minimal resources due to the online and automated nature of intervention.

Trial registration
Australian New Zealand Clinical Trials Registry, ACTRN12619000234112p. Registered on the 18 February 2019. All items from the WHO Trial Registration Data Set can be found within the protocol.

Protocol version
1.0
Native parasite affecting an introduced host in aquaculture: cardiac henneguyosis in the red seabream Pagrus major Temminck & Schlegel (Perciformes: Sparidae) caused by Henneguya aegea n. sp. (Myxosporea: Myxobolidae)
Authors: Katharios Pantelis , Varvarigos Panos , Keklikoglou Kleoniki , Ruetten Maja , Sojan Jerry , Akter Morgina , Cascarano Maria Chiara , Tsertou Maria Ioanna , Kokkari Constantina 
Published: January 2020

AbstractBackgroundHenneguyaThélohan, 1892 (Myxobolidae) is one of the most species-rich genera of myxosporean parasites infecting fish. Although common in nature, there are few reports of these parasites causing important disease in aquaculture. In this paper, we describe a new species ofHenneguyainfectingPagrus major(Temminck & Schlegel), a fish host introduced to the Mediterranean Sea from Japan in the late 1980s.ResultsLarge plasmodia of the parasite were found in the bulbus arteriosus and in the ventricle of the infected fish. Spores were found mainly in the kidney and heart and were accompanied by melanized macrophages or vascular intimal proliferation mixed with a mild non-suppurative response, respectively. Comparisons of morphometric data for spore and polar capsule length and width, suggest a unique combination of features in the newly described species. Molecular analysis, based on18SrDNA sequence of the parasite, followed by phylogenetic analysis, indicated that the parasite described here is a novel species ofHenneguya, clustered with the marine congeneric species.ConclusionsHenneguya aegean. sp. infects in aquacultureP. major, a host introduced as eggs to the Mediterranean from Japan. Despite the high host specificity of the myxobolid parasites,H. aegean. sp. seems to be able to useP. majoras a host and propagate successfully, causing morbidity and mortality. This could result in spillback of the new species from high density cultured non-nativeP. majorto native fish hosts.