bluuebunny/crossref_metadata_2025_split huggingface dataset:
Meibomian Gland Dysfunction (MGD), as Diagnosed by Non-Contact Infrared Meibography, in Dogs with Ocular Surface Disorders (OSD): A Retrospective Study.
Authors: Vinas Marta , Maggio Federica , D’Anna Nunzio , Rabozzi Roberto , Peruccio Claudio 
Published: November 2019

Abstract
Background:Meibomian gland dysfunction (MGD) is one of the possible conditions underlying ocular surface disorders (OSD). Prevalence of MGD in dogs affected by OSD has not yet been reported. We aimed to evaluate the prevalence of MGD among OSD canine patients, which had been assessed by non-contact infrared meibography and interferometry, and to identify MGD associated factors that might guide its diagnosis. Medical records of canine patients examined for OSD between 2016 and 2019 were reviewed. The frequency of MGD was evaluated within different categories (skull conformation, gender, eye and STT-1). The putative MGD risk factors and frequency of MGD within grades of interferometry were evaluated in a regression analysis model and reported as odd ratios (ORs).
Results:One hundred fifty eyes from 81 dogs with OSD were included with median age 75 months (range 3-192) and female representation with 52%. MGD was present in 70% of the examined eyes. MGD risk was higher in males ORadj= 3.015 (95% CI: 1.395 - 6.514) (P= 0.005) and older patients ORadj= 1.207 (95% CI: 1.081 - 1.348) (P= 0.001). No significant differences were found between left and right eyes (P= 0.66) or between the two types of skull conformation (P= 0.477) and MGD presence. MGD was associated to the lowest lipid layer (LL) thickness, as assessed by interferometry (grade 0) OR= 16.00 (95% CI: 2.104 - 121.68) (P< 0.001). STT values were not significantly associated with the presence of MGD (P > 0.05).
Conclusions:MGD is a common underlying pathology in OSD. Being male and higher age are risk factors for MGD. An interferometry grade 0 may guide OSD diagnosis towards MGD.
Patterns of physical activity and health-related quality of life amongst patients with multimorbidity in a multi-ethnic Asian population
Authors: Subramaniam Mythily , Zhang Yunjue , Lau Jue Hua , Vaingankar Janhavi Ajit , Abdin Edimansyah , Chong Siow Ann , Lee Eng Sing 
Published: November 2019

Abstract
Background: The co-occurrence of two or more chronic medical conditions in an individual is defined as multimorbidity. Lifestyle factors, including poor dietary patterns, physical inactivity, tobacco use, and excessive alcohol consumption are key modifiable risk factors that play a role in the development of chronic medical conditions and potentially multimorbidity. The current study aimed to examine the levels of physical activity among those with multimorbidity and its association with socio-demographic factors, clinical parameters, and health-related quality of life (HRQoL) among community-dwelling adults attending a primary care clinic in Singapore. Methods: This cross-sectional study was conducted among patients with multimorbidity between August 2014 and June 2016. Physical activity was measured using the International Physical Activity Questionnaire (IPAQ) Short Form. Health related quality of life (HRQoL) was measured using the EuroQol-5 Dimension (EQ-5D-3L). Data on clinical parameters like hemoglobin A1c (HbA1C), low-density lipoprotein cholesterol (LDL-C), and blood pressure were collected from patient records. Multivariable logistic regression analysis and linear regression were performed to determine the association between IPAQ and clinical health outcomes, as well as HRQoL measures, respectively. Results: In all, 932 respondents with multimorbidity were recruited for the study. Of them, 500 (53.8%) had low physical activity, 325 (35.0%) had moderate physical activity, while 104 (11.2%) had high physical activity. Respondents who were insufficiently active had significantly higher odds of being overweight/ obese (OR: 1.5, 95% confidence interval [CI]: 1.1- 1.9, p = 0.01) as compared to those were sufficient physical active. The multiple linear regression model revealed that insufficient activity level was negatively associated with EQ-5D index scores (β = -0.05, p < 0.001) and the visual acuity scale (β = -4.4, p < 0.001) measuring HRQoL as compared to sufficient activity levels in respondents with multimorbidity. Conclusions: The low levels of physical activity among patients with multimorbidity, and its association with overweight status and poorer HRQoL emphasizes the importance of increasing physical activity in this population. Family physicians treating patients with chronic diseases need to continue encouraging and helping individuals to initiate and maintain appropriate physical activity levels.
Comparison of sciatic nerve block quality achieved using the anterior and posterior approaches: A randomised trial
Authors: Yektaş Abdulkadir , Balkan Bedih 
Published: November 2019

Abstract
Background: The co-administration of sciatic and femoral nerve blocks can provide anaesthesia and analgesia in patients undergoing lower extremity surgeries. Several approaches to achieve sciatic nerve block have been described, including anterior and posterior approaches.
Methods: In total, 58 study patients were randomly assigned to receive either anterior (group A, n=29) or posterior (group P, n=29) sciatic nerve block. Thereafter, the following parameters were determined: sensory and motor block start and end times, time to first fentanyl requirement after blockade but before the start of the operation, time to first fentanyl requirement after the start of the operation, mean fentanyl dose administered after blockade but before the start of the operation, mean fentanyl dose after the start of the operation, time to first diclofenac sodium dose, and total dose of diclofenac sodium required. The trial was retrospectively registered on 11 July 2018.
Results: The time to initiation of sensory block was significantly shorter in group P than in group A (7.70±2.05 min and 12.88±4.87 min, respectively; p=0.01). Group P also had a significantly shorter time to first fentanyl requirement after block but before the start of the operation (00.00±00.00 min for group P and 4.05±7.47 min for group A; p<0.01), significantly higher mean fentanyl dose per patient after block but before the start of the operation (44.03±23.78 µg for group P and 31.20±27.79 µg for group A), significantly longer time to first fentanyl requirement after the start of the operation (16.24±7.13 min for group P and 00.00±00.00 min for group A; p=0.01), and significantly lower mean fentanyl dose per patient after the start of the operation (11.51±2.87 µg for group P and 147.75±22.30 µg for group A). Patient satisfaction (p<0.01), anaesthesia quality (p=0.006), and surgical quality (p=0.047) were significantly higher in group P.
Conclusions: Anterior and posterior approaches can be used to achieve sciatic nerve block in patients undergoing surgery for malleolar fractures. However, better anaesthesia and pain control results can be obtained if analgesia is administered preoperatively in patients with a posterior approach block and after the start of the operation in patients with an anterior approach block.
Prevalence of objectively measured movement asymmetry in yearling Standardbred trotters
Authors: Kallerud Anne Selven , Fjordbakk Cathrine T. , Hendrickson Eli H. S. , Persson-Sjodin Emma , Hammarberg Marie , Rhodin Marie , Hernlund Elin 
Published: November 2019

Abstract
Background Objective measurement of movement asymmetry is gaining in popularity, especially as an adjunct to traditional lameness evaluation. Earlier research has highlighted the need for more knowledge regarding the clinical significance of measured movement asymmetry, and the influence of biological variation. Evaluating the locomotor system of the Standardbred trotter can be challenging, and studies using objective technology on this breed are few. The aim of this study was to quantify the prevalence and magnitude of objectively measured movement asymmetry in young, presumed sound Standardbred trotters, by performing objective movement analysis during in-hand trot and while driven on a track. Our hypothesis was that asymmetry scores would be higher when evaluating horses in-hand versus while driving on a track.Results Of 103 horses included in the study, 77 were measured both in-hand and on the track, 24 were measured only in-hand, and two were measured only on the track. Previously set symmetry thresholds for the measurement system were used, during both in-hand and track trials. The majority of horses (91, 88.3%) did not have any trials below threshold. Front and/or hind limb parameters were above the symmetry thresholds during in-hand trials for 94 (93.1%) horses, and during track trials for 74 (93.7%) horses. For the total 180 in-hand and track trials, 166 (92.2%) trials were above threshold. Asymmetry magnitude ranged from mild to severe, with the majority of horses showing mild asymmetry. A minority of horses (19.7%) switched side of asymmetry for one or more parameters between in-hand and track trials. Trial standard deviations were overall high, mainly due to horse behavior, and this variability should be considered when interpreting the results. There was no significant effect on asymmetry of measuring horses in-hand versus driven.Conclusions A high proportion of presumed sound Standardbred yearlings showed movement asymmetries above previously determined thresholds. The biological and clinical relevance of the study findings may be aided by examining how this asymmetry evolves over time and with training. This is important in order to ensure the welfare of the Standardbred trotter.
Indicators of missing Electronic Medical Record (EMR) discharge summaries: A retrospective study on data from a large Canadian cohort
Authors: Wiebe Natalie , Xu Yuan , Shaheen Abdel Aziz , Eastwood Catherine , Boussat Bastien , Quan Hude 
Published: November 2019

Abstract
Background:
Healthcare systems worldwide have adopted the electronic medical record (EMR). EMRs are an efficient method of interprofessional communication, and can improve data availability for secondary research purposes. The discharge summary (DS) is a crucial document for both interprofessional communication, and coding of data for research purposes. We aimed to assess the completeness of our EMRs by assessing the presence of a DS in the EMR. Additionally, we evaluated the presence of indicators for a missing DS.
Method:
A retrospective chart review was conducted on 3,011 inpatient charts from 3 hospitals in Calgary, Alberta Canada. 893 charts were missing an electronic DS. A 10% sample was drawn to assess for presence of a paper DS. A list of variables was compiled to assess for association between patient and hospital characteristics, patient comorbidities, and the absence of an electronic DS. A Chi-square test, Fisher’s test and logistic regression were conducted to assess for associations.
Results:
The univariate analyses showed that age, being a surgical patient, a Charlson Comorbidity Index (CCI) of </1, as well as patients with myocardial infarctions, congestive heart failure, cerebrovascular disease, dementia, chronic pulmonary disease, diabetes, and renal disease were associated with a missing DS. The multivariate logistic regression showed that those that were middle aged, surgical patients, or with fewer comorbidities were more likely to have a missing DS. Within the 10% sample, approximately 50% of all patients were from a surgical department, all of which were missing both electronic and paper discharge summaries.
Conclusion:
Our study is the first to describe indicators associated with missing electronic discharge summaries. There is a modern day propensity for adoption of the EMR across healthcare systems worldwide. The EMR, especially the DS, is used for the improvement of interprofessional communication, patient outcomes, and data quality. Therefore, the implications of an incomplete EMR are widespread. Our findings will caution future researchers using EMR data about the potential for incomplete data, particularly for patients who are surgical, middle aged, and have fewer comorbidities. Additionally, our study highlights the need for further investigation into the lack of discharge summaries in surgical units.
Implementation and adoption of a health insurance support tool in the electronic health record: A mixed methods analysis within a randomized trial
Authors: Hatch Brigit , Tillotson Carrie , Huguet Nathalie , Marino Miguel , Baron Andrea , Nelson Joan , Sumic Aleksandra , Cohen Deborah , DeVoe Jennifer 
Published: November 2019

Abstract
Background: In addition to delivering vital health care to millions of patients in the United States, community health centers (CHCs) provide needed health insurance outreach and enrollment support to their communities. We developed a health insurance enrollment tracking tool integrated within the electronic health record (EHR) and conducted a hybrid implementation-effectiveness trial in a CHC-based research network to assess tool adoption using two implementation strategies.
Methods: CHCs were recruited from the OCHIN practice-based research network. Seven health center systems (23 CHC clinic sites) were recruited and randomized to receive basic educational materials alone (Arm 1), or these materials plus facilitation (Arm 2) during the 18-month study period, September 2016-April 2018. Facilitation consisted of monthly contacts with clinic staff and utilized audit and feedback and guided improvement cycles. We measured total and monthly tool utilization from the EHR. We conducted structured interviews of CHC staff to assess factors associated with tool utilization. Qualitative data were analyzed using an immersion-crystallization approach with barriers and facilitators identified using the Consolidated Framework for Implementation Research.
Results: The majority of CHCs in both study arms adopted the enrollment tool. The rate of tool utilization was, on average, higher in Arm 2 compared to Arm 1 (20.0% versus 4.7%, p <0.01). However, by the end of the study period, the rate of tool utilization was similar in both arms; and observed between-arm differences in tool utilization were largely driven by a single, large health center in Arm 2. Perceived relative advantage of the tool was the key factor identified by clinic staff as driving tool utilization. Implementation climate and leadership engagement were also associated with tool utilization.
Conclusions: Using basic education materials and low-intensity facilitation, CHCs quickly adopted an EHR-based tool to support critical outreach and enrollment activities aimed at improving access to health insurance in their communities. Though facilitation carried some benefit, a CHC’s perceived relative advantage of the tool was the primary driver of decisions to implement the tool.
Trial Registration: ClinicalTrials.gov: NCT02355262, Posted February 4, 2015
Impact of First Metatarsal Shortening on Forefoot Loading Pattern: A Finite Element Model Study
Authors: Geng Xiang , Shi Jiaqi , Chen Wenming , Ma Xin , Wang Xu , Zhang Chao , Chen Li 
Published: November 2019

Abstract
Backgrounds There has long been a consensus that shortening of the first metatarsal during hallux valgus reconstruction could lead to postoperative transfer metatarsalgia. However, appropriate shortening is sometimes beneficial for correcting severe deformities or relieving stiff joints. This study is to investigate, from the biomechanical perspective, whether and how much shortening of the first metatarsal could be allowed.
Methods A finite element model of the human foot simulating the push-off phase of the gait was established. Progressive shortening of the first metatarsal from 2 to 8 mm at an increment of 2 mm were sequentially applied to the model, and the corresponding changes in forefoot loading pattern during push-off phase, especially the loading ratio at the central rays, was calculated. The effect of depressing the first metatarsal head was also investigated.
Results With increasing shortening level of the first metatarsal, the plantar pressure of the first ray decreased, while that of the lateral rays continued to rise. When the shortening reaches 6 mm, the load ratio of the central rays exceeds a critical threshold of 55%, which was considered risky; but it could still be manipulated to normal if the distal end of the first metatarsal displaced to the plantar side by 3 mm.
Conclusions During the first metatarsal osteotomy, a maximum of 6 mm shortening length is considered to be within the safe range. Whenever a higher level of shortening is necessary, pushing down the distal metatarsal segment could be a compensatory procedure to maintain normal plantar force distributions.
Transcriptome sequencing of Saccharina japonica sporophytes during whole developmental periods reveals regulatory networks underlying alginate and mannitol biosynthesis
Authors: Author) Zhanru Shao(Former Corresponding , Zhang Pengyan , Lu Chang , Li Shaoxuan , Chen Zhihang , Wang Xiuliang , Author) Delin Duan(New Corresponding 
Published: November 2019

Abstract
Background: Alginate is an important cell wall component and mannitol is a soluble storage carbon substance in the brown seaweed Saccharina japonica. Their contents vary with kelp developmental periods and harvesting time. Alginate and mannitol regulatory networks and molecular mechanisms are largely unknown. Results: With WGCNA and trend analysis of 20,940 known genes and 4,264 new genes produced from transcriptome sequencing of 30 kelp samples from different stages and tissues, we deduced that ribosomal proteins, light harvesting complex proteins and “imm upregulated 3” gene family are closely associated with the meristematic growth and kelp maturity. Moreover, 134 and 6 genes directly involved in the alginate and mannitol metabolism were identified, respectively. Mannose-6-phosphate isomerase (MPI2), phosphomannomutase (PMM1), GDP-mannose 6-dehydrogenase (GMD3) and mannuronate C5-epimerase (MC5E70 and MC5E122) are closely related with the high content of alginate in the distal blade. Mannitol accumulation in the basal blade might be ascribed to high expression of mannitol-1-phosphate dehydrogenase (M1PDH1) and mannitol-1-phosphatase (M1Pase) (in biosynthesis direction) and low expression of mannitol-2-dehydrogenase (M2DH) and Fructokinase (FK) (in degradation direction). Oxidative phosphorylation and photosynthesis provide ATP and NADH for mannitol metabolism whereas glycosylated cycle and tricarboxylic acid (TCA) cycle produce GTP for alginate biosynthesis. RNA/protein synthesis and transportation might affect alginate complex polymerization and secretion processes. Cryptochrome (CRY-DASH), xanthophyll cycle, photosynthesis and carbon fixation influence the production of intermediate metabolite of fructose-6-phosphate, contributing to high content of mannitol in the basal blade. Conclusions: The network of co-responsive DNA synthesis, repair and proteolysis are presumed to be involved in alginate polymerization and secretion, while upstream light-responsive reactions are important for mannitol accumulation in meristem of kelp. Our transcriptome analysis provides new insights into the transcriptional regulatory networks underlying the biosynthesis of alginate and mannitol during S. japonica developments. Keywords: Alginate, Mannitol, Transcriptome, Regulatory networks, Growth, Development, Saccharina japonica
Transcriptome dynamics underlying flower color in marigold (Tagetes erecta L.)
Authors: Zhang Huali , Zhang Shiya , Zhang Hua , Chen Xi , Liang Fang , Qin Heland , Zhang Yue , Cong Richen , Xin Haibo , Zhang Zhao 
Published: November 2019

Abstract
Background: Marigold (Tagetes erecta L.) is an important ornamental plant with a wide variety of flower colors. Despite its economic value, few biochemical and molecular studies have explored the generation of flower color in this species.
Results: To study the mechanism underlying marigold petal color, we performed a metabolomics analysis and de novo cDNA sequencing on the inbred line ‘V-01’ and its petal color mutant ‘V-01M’ at four flower developmental stages. A total of 49,217 unigenes were identified from 24 cDNA libraries. Based on our transcriptomic and metabolomic analyses, we present an overview of carotenoid biosynthesis, degradation, and accumulation in marigold flowers. The carotenoid content of the yellow mutant ‘V-01M’ was higher than that of the orange inbred line ‘V-01’, and the abundances of the yellow compounds lutein, neoxanthin, violaxanthin, zeaxanthin, and antheraxanthin were significantly higher in the mutant. During flower development, the carotenoid biosynthesis genes were upregulated in both ‘V-01’ and ‘V-01M’, with no significant differences between the two lines. By contrast, the carotenoid degradation genes were dramatically downregulated in the yellow mutant ‘V-01M’.
Conclusions: We therefore speculate that the carotenoid degradation genes are the key factors regulating the carotenoid content of marigold flowers. Our research provides a large amount of transcriptomic data and insights into the marigold color metabolome.
Histopathological assessment of optic nerve invasion guided by radiological findings in enucleated globes with retinoblastoma.
Authors: Abusayf Mohammed , Alkatan Hind Manaa , Maktabi Azza MY , Elkhamary Sahar , Almesfer Saleh 
Published: November 2019

Abstract
Purpose: High-risk histopathological features in primary enucleated retinoblastoma globes affect the indication for neoadjuvant chemotherapy to avoid the increased risk of metastasis and to improve survival in such children. Optic nerve (ON) invasion is an important indicator of prognosis and we aim through this study to correlate the detected-ON invasion by imaging with the corresponding confirmed histopathological level of invasion. Methods: This is an approved retrospective study with collaborative agreement between the 2 centres. All enucleated globes with the diagnosis of retinoblastoma received in the histopathology department(s) from January 2015 to December 2016 (2 years) were collected for review by 2 pathologists and the charts were reviewed for basic demographic data. All patients underwent Magnetic resonance imaging (MRI) under sedation upon diagnosis and MRI reading was done by an experienced single neuroradiologist. Results: A total of 38 patients were included: 21 males and 17 females. 29 (77.3%) had unilateral involvement, 7 (18.4%) had bilateral involvement and 2 cases had trilateral disease. The overall mean age at diagnosis was 22.63 ±15.15 months. 28 cases (74%) had pathologically-proven ON invasion: prelaminar (31.6%), laminar (18.4%), and post-laminar (23.7%). Post-laminar ON invasion was identified in 8 cases (true positive), while another 8 were false positive. Only 1 case was missed on MRI (accuracy: 63.3%; sensitivity: 88.9%; specificity: 72.4%; Positive predictive value (PPV): 50%; Negative predictive value (NPV): 95.5%). Conclusions: MRI was found to be less sensitive in evaluating pre-laminar and laminar ON invasion (0.0 and 42.9%) compared to post-laminar invasion (88.9%) but had better specificity in detecting various levels of invasion (72.4 to 83.9%). Obtaining deeper histologic sections in some cases where there are mismatching ON level of invasion between MRI and histopathological examination is recommended to avoid misleading assessment of the high-risk histopathological features. There are no solid international protocols of how many sections should be obtained to evaluate the optic nerve invasion in these globes and this should be established for universal use especially in less developed countries where experienced pathologists might be lacking. Key words: Retinoblastoma; High-risk, Histopathology; Optic nerve invasion; Lamina cribrosa; Radiology; Magnetic resonance imaging; Chemotherapy.