bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Workflow Simulation for the Design and Assessment of Operating Room Setups in Orthopedic Surgery
Authors: Neumann Juliane , Angrick Christine , Höhn Celina , Zajonz Dirk , Ghanem Mohamed , Roth Andreas , Neumuth Thomas 
Published: November 2019

Abstract
Background: The design and internal layout of modern operating rooms are influencing the team’s collaboration and communication, ergonomics, as well as intraoperative hygiene substantially. Nevertheless, there is no objective method for the assessment and design of the personnel and table positions for different surgical disciplines and intervention types available. The aim of this work is to establish an improved OR setup for common procedures in arthroplasty. Methods: With the help of computer simulation techniques, a method for the objective design and assessment of enhanced OR setups was developed. In this work, new OR setups were designed, analyzed in a computer simulation environment and evaluated in the actual intraoperative setting. Results: The implementation of improved OR setups reduces the instrument handover time between the surgeon and the scrub nurse, the travel paths of the OR team as well as shortens the procedure duration. Additionally, the ergonomics of the OR staff were improved. Conclusion: The developed simulation method was intraoperatively evaluated and proved its benefit for the design and optimization of OR setups for different surgical intervention types. As a clinical result, enhanced setups for total knee arthroplasty and total hip arthroplasty surgeries were established in daily clinical routine and the OR efficiency was improved.
Characterizing the ribosomal tandem repeat and its utility as a DNA barcode in lichen-forming fungi
Authors: Bradshaw Michael , Grewe Felix , Thomas Anne , Harrison Cody H. , Lindgren Hanna , Muggia Lucia , Clair Larry L. St. , Lumbsch H. Thorsten , Leavitt Steve 
Published: November 2019

Abstract
Regions within the nuclear ribosomal operon are a major tool for inferring evolutionary relationships and investigating diversity in fungi. In spite of the prevalent use of ribosomal markers in fungal research, central features of nuclear ribosomal DNA (nrDNA) evolution are poorly characterized for fungi in general, including lichenized fungi. The internal transcribed spacer (ITS) region of the nrDNA has been adopted as the primary DNA barcode identification marker for fungi. However, little is known about intragenomic variation in the nrDNA in symbiotic fungi. In order to better understand evolution of nrDNA and the utility of the ITS region for barcode identification of lichen-forming fungal species, we generated nearly complete nuclear ribosomal operon sequences from nine species in the Rhizoplaca melanophthalma species complex using short reads from high-throughput sequencing. Results: We estimated copy numbers for the nrDNA operon, ranging from nine to 48 copies for members of thiscomplex, and found low levels of intragenomic variation in the standard barcode region (ITS). Monophyly of currently described species in this complex was supported in phylogenetic inferences based on the ITS, 28S, IGS, and some intronic regions; however, a phylogenetic inference based on the 18S provided much lower resolution. Phylogenetic analysis of concatenated ITS and intergenic spacer sequence data generated from 496 specimens collected worldwide revealed previously unrecognized lineages in the nrDNA phylogeny. Conclusions: The results from our study support the general assumption that the ITS region of the nrDNA is an effective barcoding marker for fungi. For the R. melanophthalma group, the limited amount of potential intragenomic variability in the ITS region did not correspond to fixed diagnostic nucleotide position characters separating taxa within this species complex. Previously unrecognized lineages inferred from ITS sequence data may represent undescribed species-level lineages or reflect uncharacterized aspects of nrDNA evolution in the R. melanophthalma species complex.
Reliability of residents’ assessments of their postgraduate medical education learning environment: an observational study
Authors: Brand Paul L P , Rosingh H Jeroen , Meijssen Maarten A C , Nijholt Ingrid M , Dünnwald Saskia , Prins Jelle , Schönrock-Adema Johanna 
Published: November 2019

Abstract
Background. Even in anonymous evaluations of a postgraduate medical education (PGME) program, residents may be reluctant to provide an honest evaluation of their PGME program, because they fear embarrassment or repercussions from their supervisors if their anonymity as a respondent is endangered. This study was set up to test the hypothesis that current residents in a PGME program provide more positive evaluations of their PGME program than residents having completed it. We therefore compared PGME learning environment evaluations of current residents in the program to leaving residents having completed it. Methods. This observational study used data gathered routinely in the quality cycle of PGME programs at two Dutch teaching hospitals to test our hypothesis. At both hospitals, all current PGME residents are requested to complete the Scan of Postgraduate Education Environment Domains (SPEED) annually. Residents leaving the hospital after completion of the PGME program are also asked to complete the SPEED after an exit interview with the hospital’s independent residency coordinator. All SPEED evaluations are collected and analysed anonymously. We compared the residents’ grades (on a continuous scale ranging from 0 (poor) to 10 (excellent)) on the three SPEED domains (content, atmosphere, and organization of the program) and their mean (overall department grade) between current and leaving residents. Results. Mean (SD) overall SPEED department grades were 8.00 (0.52) for 287 current residents in 39 PGME programs and 8.07 (0.48) for 170 leaving residents in 39 programs. Neither the overall SPEED department grades (t test, p=0.53, 95% CI for difference -0.16 to 0.31) nor the department SPEED domain grades (MANOVA, F(3, 62)=0.79, p=0.51) were significantly different between current and leaving residents. Conclusions. Residents leaving the program did not provide more critical evaluations of their PGME learning environment than current residents in the program. This suggests that current residents’ evaluations of their postgraduate learning environment were not affected by social desirability bias or fear of repercussions from faculty.
Oral health of children and adolescents with or without attention deficit hyperactivity disorder (ADHD) living in residential care in rural Rhineland-Palatinate, Germany
Authors: Ehlers Vicky , Callaway Angelika , Wantzen Sophia , Patyna Michael , Deschner James , Azrak Birgül 
Published: November 2019

Abstract
Background: Attention deficit hyperactivity disorder (ADHD) is defined as childhood neurobehavioural disorder. Due to short attention span, oral hygiene and dental treatment of such individuals can be challenging. Aim of this study was to evaluate the oral health of children and adolescents with and without ADHD living in residential care in rural Rhineland-Palatinate, Germany. Methods: Included in the study were 79 participants (male/female:58/21, age 9-15 years) living in residential care: 34 participants with ADHD and 45 participants without ADHD (control). Oral examination included the following parameters decayed, missing, filled teeth in the primary dentition (dmft), decayed, missing, filled surfaces/teeth in the secondary dentition (DMFS/DMFT), approximal plaque index (API), bruxism and orthodontic treatment. Additionally, oral hygiene, last dental visit and treatment performed, and dietary habits were assessed by questionnaire. Results: There were no significant differences in dmft, API, bruxism and oral hygiene habits between groups. However, participants with ADHD tended to have higher DMFS/DMFT values than the control group. Ongoing orthodontic treatment was found more often in the control group. The ADHD group tended to consume acidic/sugary beverages and sweet snacks more often than the controls. Different treatments (control visit/prophylaxis, dental therapy, orthodontic treatment) were performed at the last dental visit in the two groups. Conclusions: Within the limitations of this study , oral health was similar in children and adolescents with or without ADHD from the same residential care setting. Parents/guardians need instructions for better supervision of oral hygiene and dietary habits to improve the poor oral health of children with or without ADHD.
Molecular Cloning and Chartacterization DNA Polymerase I from thermophilic Geobacillus SBS 4S strain
Authors: aslam farheen , Bajwa Saima Iftikhar 
Published: November 2019

Abstract
Thermostable DNA polymerases are extensively used in biotechnology and life science applications. DNA Polymerase I was isolated from a hyperthermophile bacteria Geobacillus SBS 4S. Primers were designed using the template sequence of DNA Polymerase I gene of Geobacillus kaustophilus HTA26 strain. Nco 1 and Hind III sites were introduced on the forward and reverse primers respectively. Polymerase I gene of 2.6 Kb was cloned in pTZ57/ RT vector. Cloned gene of Polymerase I was restricted with Nco 1 and Bam H1, and ligated to pET 22b vector. Nco 1 site was used to insert twenty two N-terminal aminoacids (pelB) leader sequence at the start of the gene, which lead the recombinant protein in the periplasmic space, which increases the half life of recombinant protein. pelB fused with DNA Polymerase I produces soluble protein, which was detected after sonication. Sequencing shows that DNA polymerase I consists of 2499 bp with encodes for 832 amino acids, showed 99 % similarity with Geobacillus Kaustophillus .

The expression of pelB fused DNA Polymerase I was optimized at different concentrations of IPTG and lactose. Highest expression was observed with 0.5mM IPTG and 20mM lactose. After Harvesting and sonication of BL21 codon plus cells, Polymerase I was produced in the soluble fraction. The supernatant containing the protein of interest, was separated after centrifugation at 10,000 rpm for 20 min. The protein was purified by ammonium sulphate precipitation and cation exchange column. The activity of purified DNA Polymerase I was checked by PCR reaction.
Effects of cognitive behavioral therapy on anxiety and depression in patients with chronic obstructive pulmonary disease:A Meta-analysis and Systematic Review
Authors: Zhang Xuemei , Yi Changchun , Tian Wuguo , Lu Dongbing , Yang Xiumu 
Published: November 2019

Abstract
Symptoms such as depression and anxiety are common psychiatric symptoms in patients with chronic obstructive pulmonary disease (COPD). Cognitive-behavioral therapy (CBT) is still controversial in the treatment of anxiety and depression in patients with COPD. We conducted a meta-analysis and systematic review to evaluate the effect of CBT on anxiety and depression in patients with COPD, with a view to providing some guidance for clinical application.Materials and Methods Computer search Web of Science, EMbase, PubMed, Cochrane Library, search time limit from the establishment of the library to August 2019.Collect the randomized controlled trial (RCT) for this topic. Two investigators independently screened the literature according to inclusion and exclusion criteria, extracted the data, and assessed the risk of bias in the included studies. Meta analysis using RevMan5.3 software.Results A total of 10 studies were included in a total of 1278 patients. Meta-analysis shows that cognitive behavioral therapy can improve depression and anxiety in patients with COPD. Subgroup analysis showed that intervention time ≥ 8 weeks had significant differences in improving anxiety, while intervention time <8weeks had significant differences in improving depression.Conclusion Cognitive-behavioral therapy can improve depression in COPD patients in a short period of time, and it takes longer to improve anxiety. Therefore, clinical practice can choose the appropriate intervention time according to the patient's psychological condition.
Preventing Peterson’s space Hernia Using a Bio Synthetic Mesh
Authors: Skidmore Adam Peter , Aarts Edo O 
Published: November 2019

Abstract
Introduction Up to 30% of all Bariatric procedures performed worldwide still are Roux-en-Y Gastric Bypasses (RYGB). Internal hernia’s occur when small bowel herniates into the intermesenteric spaces created when the roux limb is mobilised for anastomosis to the gastric pouch. To prevent internal hernia’s to occur many surgeons nowadays close the mesenteric defects during primary RYGB. Using a non-resorbable double layered suture, this risk can be significantly reduced from 8.9 to 2.5% in the first three postoperative years. However the technique of closure seems to be related to these reduced internal hernia risks outcomes while for example closure with staples does reduce the amount of internal hernia’s but in a much lesser extent. Setting Two large private hospitals specialized in bariatric surgeryMethods All patients receiving a RYGB for (morbid) obesity between 2014 and 2018 were included in this retrospective study. In the first year Peterson’s space was closed using glue, the years hereafter it was closed using a double layered non absorbable suture combined with a piece of glued BIO Mesh.Results The first group of glued RYGB patients showed 15% of patients with an internal hernia through Peterson’s space compared to 0% of patients (p<0.001) who had a combined sutured and BIO Mesh Closure of their Peterson’s space defect. Although an ideal technique for Peterson’s space, it led to 1% of entero-enterostomy kinking due to firm adhesions.Conclusion Closing this defect with clips or sutures partially reduces the chances on herniation, but not completely. Gluing this defect is not beneficial, but placing a BIO Mesh in Peterson’s space is a promising new technique to induce local adhesions. It is at least safe, effective and led to a complete reduction of Peterson’s internal herniations. In the future, a randomized controlled trial comparing this technique to a double layered, non-absorbable suture would give more insights in which is the optimal closure technique.
Observational study for laryngeal mask anesthesia combined with nerve block in internal fixation for rib fractures
Authors: Cao Jun , Zhang Junfeng , Gao Xiaoyun , Zhang Xiaoli , Li Jing 
Published: November 2019

Abstract
To evaluate the safety and effectiveness of laryngeal mask(LMA) anesthesia combined with nerve block in rib fractures internal fixation, twenty patients with unilateral isolated rib fractures were observed during the anesthesia prospectively.Methods Thoracic paravertebral block(TPB) and/or erector spinae plane block(ESPB) were carried out before LMA anesthesia. The vital signs(HR, BP, SpO 2 ) and parameters of breath were recorded during the operation. The arterial blood gas analysis and chest radiograph were performed preoperatively and on the next day after operation. Patient-controlled analgesia contained with 500mg of tramadol and 16mg of lornoxicam was routinely used after the operation, and 50mg of flurbiprofen was infused intravenously Bisindie in the ward. Postoperative nausea and vomiting(PONV) within 48 hours after surgery and NRS pain score at 6(T1), 12(T2), 24(T3) hours after surgery were assessed as well.Results Thirteen males and seven females(mean age 54 years) were enrolled in this trial. 6(30%) had a flail chest, 9(45%) had Haemothorax, 2(10%) had a pulmonary contusion. The vital signs and spontaneous breathing were kept stable. End-tidal carbon dioxide concentration(EtCO 2 ) was acceptable(no more than 63 mmHg in all cases). PaO 2 of post-operation was significantly increased than that of pre-operation(P<0.001), PaCO 2 of pre-operation and post-operation had no significant difference. NRS at T3 was significantly lower than that at T1 and T2(p < 0.001), while the score at T2 was slightly lower than that at T1 (p < 0.005). Furthermore, no one suffered from PONV.Conclusions We demonstrated that laryngeal mask anesthesia combined with nerve block was feasible in the internal fixation for rib fractures.
Patterns of access to reproductive health services in Ghana and Nigeria: results of a cluster analysis
Authors: Ogundele Oluwasegun Jko , Pavlova Milena , Groot Wim 
Published: November 2019

Abstract
Background To understand differences in access to reproductive healthcare services, the use of family planning and maternal care by women in Ghana and Nigeria is examined.Methods We used population-level data from the Ghana and Nigeria Demographic Health Surveys of 2014 and 2013 in two-step cluster analysis followed by multinomial logistic regression analysis.Results The initial two-step cluster analyses on family planning identify three groups of women in Ghana and Nigeria: women with high, medium and poor access to family planning services. The subsequent two-step cluster analyses identify five distinct groups: higher, high, medium, low and poor access to maternal health services in Ghana and Nigeria. The multinomial logistic regression shows that education and occupation are associated with access to family planning and maternal health services. Women without education often have poor access to reproductive health services in both countries. In Nigeria, household wealth is strongly associated with access to maternal health services but household wealth does not explain access in Ghana. Not having insurance in Ghana is associated with low access to family planning service, while this is not the case in Nigeria.Conclusions These differences confirm the importance of a focused context-specific approach towards reproductive health services, particularly to reduce inequality in access resulting from socioeconomic status.
Relationship between probable sarcopenia and nutritional disorders as evaluated using the Geriatric Nutritional Risk Index and serum phosphorus concentration in maintenance dialysis patients: A cross-sectional study
Authors: KONO Kenichi , MORIYAMA Yoshihumi , HARA Ayaka , YABE Hiroki , NISHIDA Yusuke , YAMADA Tetsuya 
Published: November 2019

Abstract
Background To explore the relationship between sarcopenia and nutritional disorders, as evaluated using the Geriatric Nutritional Risk Index (GNRI) and serum phosphorus concentration (P). Methods: This cross-sectional study analyzed 909 Japanese maintenance hemodialysis patients from a multicenter hemodialysis unit. The nutritional indices (GNRI and P) and sarcopenia indices [grip strength and Short Physical Performance Battery (SPPB)] were evaluated in all patients. Multiple logistic regression analysis was performed with the sarcopenia indices as dependent variables and GNRI only, P only, and combined GNRI and P as independent variables adjusted for patient attributes. The odds ratio (OR) and 95% confidence interval (95% CI) for the reference value were calculated by setting the category reference value to GNRI ≥90 and P to 3.6-5.0 mg/dL. The main outcome measure was presence of probable sarcopenia. Results: Grip strength was associated with decreased GNRI only (OR: 2.27, 95% CI: 1.64-3.16) and decreased GNRI and P (OR: 3.77, 95% CI: 1.49-9.53). In addition, SPPB was associated with decreased GNRI only (OR: 1.78, 95% CI: 1.30-2.44) and decreased GNRI and P (OR: 8.82, 95% CI: 3.52-22.12). Conclusions: Nutritional disorders, in which both GNRI and P are decreased, are strongly related to sarcopenia compared with nutritional disorders in which only GNRI or only P is decreased.
Lack of Progression of Intraventricular Hemorrhage in Premature Infants: Implications for Head Ultrasound Screening
Authors: Rhein Lawrence , Daigneault Jaclyn , Dube Alexandra , White Heather , Shi Qiming , Gauguet Jean-Marc 
Published: November 2019

Abstract
Background: Premature infants are known to be at increased risk for intraventricular hemorrhage (IVH) in the first week of life. IVH may be “mild” (grade I or II) or “severe” (grade III or IV). A classification of mild is less frequently associated with later morbidity. Severe grade IVH may be associated with death or severe neurodevelopmental disability. Mild IVH is generally considered a static, non-progressive disease. Thus, infants that do not present with IVH or who present with mild IVH are unlikely to advance to severe IVH. Consequently, after initial imaging demonstrates a normal result, subsequent head ultrasounds (HUS) may be unnecessary.Methods: This is a retrospective, single-center study. We identified all preterm infants with birth gestational age </= 32 0/7 weeks admitted to the University of Massachusetts Memorial Medical Center Neonatal Intensive Care Unit between January 1, 2011 and December 31, 2016 who received a head ultrasound (HUS) during hospitalization. Each individual ultrasound was classified according to the attending radiologist’s documentation. Grades of IVH were defined per the Papile classification. Initial HUS was defined as HUS performed on day of life 3-10. Every subsequent HUS throughout hospitalization was read and recorded.Results: We identified 682 eligible preterm infants. Of these, 88 were excluded for lack of HUS data, 237 had initial HUS out of inclusion timing window (day of life 3-10), and 4 were excluded for other conditions associated with intraventricular hemorrhage, leaving 353 infants for analysis. Initial findings of severe IVH were relatively rare in this cohort. Of the 343 (97%) infants who had mild IVH (grade II or less) at time of initial screening, only 4 (1.2%) progressed to severe (grade III or IV). Each of these infants required mechanical ventilation for at least 40 days.Conclusions: Based on the results of this analysis, premature infants who have a normal (no IVH) HUS or mild IVH (grade I or II) on initial routine screening HUS without other risk factors may not require follow-up HUS. Infants with prolonged mechanical ventilation may require further screening despite reassuring initial HUS findings.