bluuebunny/crossref_metadata_2025_split huggingface dataset:
I’ve got to be independent’: views of older people on recovery following road traffic injury in New South Wales, Australia
Authors: Brown Katherine , Cameron Ian D. , Keay Lisa , Nguyen Ha , Dillon Lisa , Jagnoor Jagnoor , Ivers Rebecca 
Published: August 2020

Abstract
Background
Mild to moderate road traffic injury (RTI) in people of working age is associated with limited recovery. Less is known about RTI recovery in older age. This study explored the perspectives and factors associated with recovery and health-related quality of life following mild to moderate RTI in older age in New South Wales, Australia.

Methods
A qualitative study using content analysis was undertaken. Participants aged 65 or more years were purposively selected from a larger inception cohort study of health outcomes following mild to moderate RTI conducted in New South Wales, Australia. Semi-structured interviews were undertaken at approximately 12 or 24 months post-injury. Content analysis was used to code and analyse the data, with methodological rigour obtained by double-coding and discussing findings to reach consensus. Results were reported using the consolidated criteria for reporting qualitative research (COREQ).

Results
Nineteen participants were invited to participate in the study of which 12 completed interviews. Data saturation was reached at the twelfth interview. Recovery experiences were diverse. Five main themes were identified: recovery is regaining independence; injury and disability in older age; the burden of non-obvious disability; the importance of support; and positive personal approaches.
Key facilitators of recovery were: regaining independence; support from family and friends; and positive personal approaches. Key barriers were: threats to independence; passive coping behaviours; non-obvious disabilities (chronic pain, psychological impacts); and reluctance to raise ongoing issues with General Practitioners. Threats to independence, especially not driving and self-care, appeared to have a more profound effect on recovery than physical functioning.

Conclusion
Older people view injury as a threat to independent functioning. This is somewhat different to what younger people report. Regaining independence is key to older people’s recovery and health-related quality of life following RTI, and should be a key consideration for health professionals, services and supports working with this unique cohort. Greater efforts to help older people regain their independence following RTI are needed and can be facilitated by health professionals and appropriate service provision.

Trial registration
Australia New Zealand clinical trial registry identification number ACTRN12613000889752.
Lack of benefit from low dose computed tomography in screening for lung cancer - comment on paper by Huang K-L et al.
Authors: Benjamin Don 
Published: August 2020

AbstractThe article by Huang K-L et al. Effects of low-dose computed tomography (LDCT) screening on lung cancer contains a conclusion that is not consistent with the data presented. With reference to the National Lung Screening Trial (NLST) there are several flaws in the methodology overlooked. Also there is no significant reduction in deaths from all causes following the screening. Therefore any claim that the LDCT screening is superior to usual care is invalid.
Optimized culture conditions for bacterial cellulose production by Acetobacter senegalensis MA1
Authors: Aswini K. , Gopal N. O. , Uthandi Sivakumar 
Published: August 2020

Abstract
Background
Cellulose, the most versatile biomolecule on earth, is available in large quantities from plants. However, cellulose in plants is accompanied by other polymers like hemicellulose, lignin, and pectin. On the other hand, pure cellulose can be produced by some microorganisms, with the most active producer being Acetobacter xylinum. A. senengalensis is a gram-negative, obligate aerobic, motile coccus, isolated from Mango fruits in Senegal, capable of utilizing a variety of sugars and produce cellulose. Besides, the production is also influenced by other culture conditions. Previously, we isolated and identified A. senengalensis MA1, and characterized the bacterial cellulose (BC) produced.

Results
The maximum cellulose production by A. senengalensis MA1 was pre-optimized for different parameters like carbon, nitrogen, precursor, polymer additive, pH, temperature, inoculum concentration, and incubation time. Further, the pre-optimized parameters were pooled, and the best combination was analyzed by using Central Composite Design (CCD) of Response Surface Methodology (RSM). Maximum BC production was achieved with glycerol, yeast extract, and PEG 6000 as the best carbon and nitrogen sources, and polymer additive, respectively, at 4.5 pH and an incubation temperature of 33.5 °C. Around 20% of inoculum concentration gave a high yield after 30 days of inoculation. The interactions between culture conditions optimized by CCD included alterations in the composition of the HS medium with 50 mL L− 1 of glycerol, 7.50 g L− 1 of yeast extract at pH 6.0 by incubating at a temperature of 33.5 °C along with 7.76 g L− 1 of PEG 6000. This gave a BC yield of wet weight as 469.83 g L− 1.

Conclusion
The optimized conditions of growth medium resulted in enhanced production of bacterial cellulose by A. senegalensis MA1, which is around 20 times higher than that produced using an unoptimized HS medium. Further, the cellulose produced can be used in food and pharmaceuticals, for producing high-quality paper, wound dressing material, and nanocomposite films for food packaging.
Does moxonidine reduce Achilles tendon or musculoskeletal pain in women with polycystic ovarian syndrome? A secondary analysis of a randomised controlled trial
Authors: Jewson Jacob , Lambert Elisabeth , Sari Carolina , Jona Eveline , Shorakae Soulmaz , Lambert Gavin , Gaida Jamie 
Published: August 2020

AbstractBackgroundSympathetic activity and insulin resistance have recently been linked with chronic tendon and musculoskeletal pain. Polycystic ovarian syndrome is linked with insulin resistance and increased sympathetic drive and was therefore an appropriate condition to study the effects of modulating sympathetic activity on Achilles tendon and musculoskeletal symptoms.MethodsA secondary analysis of a double-blinded, randomised controlled trial on women with polycystic ovarian syndrome was conducted. Participants received 12 weeks of moxonidine (n = 14) or placebo (n = 18). Musculoskeletal symptom and Victorian Institute of Sport Assessment – Achilles (VISA-A) questionnaires were distributed, and ultrasound tissue characterisation quantified tendon structure at 0 and 12 weeks. 2-way ANOVA was used for multiple comparisons.ResultsThere was no difference in mean change in musculoskeletal symptoms (− 0.6 ± 1.7 vs − 0.4 ± 1.8,p = 0.69) or VISA-A (moxonidine − 0.2 ± 8.8 vs placebo + 4.2 ± 14.6,p = 0.24) attributable to the intervention. There was no difference in any measures of Achilles structure. Moxonidine did not reduce sympathetic drive when compared to placebo.ConclusionsThis was the first study to investigate the effects of blocking sympathetic drive on musculoskeletal and Achilles tendon symptoms in a metabolically diverse population. While the study was limited by small sample size and lack of sympathetic modulation, moxonidine did not change tendon pain/structure or musculoskeletal symptoms.Trial registrationClinicalTrials.gov,NCT01504321. Registered 5 January 2012.
A behavioural intervention for young adults with dental caries, using acceptance and commitment therapy (ACT): treatment manual and case illustration
Authors: Werner Helene , Young Celia , Hakeberg Magnus , Wide Ulla 
Published: August 2020

Abstract
Background
There is a need for effective behavioural interventions in dentistry. This paper presents an innovative behavioural intervention for young adults with dental caries, in an interdisciplinary collaboration between dental personnel and licensed psychologist in general dental care. The intervention has been evaluated in an RCT, with positive effects on oral health behaviour.

Method
The intervention, Acceptance and Commitment Therapy (ACT), a recent form of cognitive behaviour therapy (CBT), was adapted to young adult patients (18–25 years of age) with high dental caries activity.

Results
The intervention included two individual sessions, provided by a clinical psychologist at general dental clinics. The rationale for selecting ACT as the theory base is presented, together with the treatment manual and a case illustration.

Conclusions
ACT may be a promising alternative for behavioural interventions in dentistry for patients with oral diseases, specifically dental caries. Interprofessional collaboration between psychologists and dental personnel opens up for new possibilities to help and treat patients with various health issues in public dental care.

Trial registration
TRN ISRCTN15009620www.isrctn.com, retrospectively registered 14/03/2018.
Impact of fashion braces on oral health related quality of life: a web-based cross-sectional study
Authors: Hakami Zaki , Chung Hye Soo , Moafa Seham , Nasser Hadia , Sowadi Hajar , Saheb Safeena , Bokhari Ahmed M. , Anderson Nina K. 
Published: August 2020

Abstract
Background
Orthodontic braces have become symbols of wealth and fashion accessories in some parts of the world. However, there is a scarcity of information about the effects of fashion braces on various aspects of quality of life. Therefore, our aim was to investigate the effects of fashion braces on oral health related quality of life (OHRQoL).

Methods
A cross-sectional study was carried out with data collection from a Google form questionnaire distributed in Saudi Arabia via various forms of social media over a period of 4 months. OHRQoL was assessed using the validated Arabic version of the Oral Health Impact Profile-14 (OHIP-14) questionnaire. The fashion braces group included respondents who had braces installed for fashion purposes only. Therapeutic braces group included subjects who were wearing braces to treat any malocclusion problems. Control group included subjects who did not have any kind of braces. People who had previously completed orthodontic treatments were excluded from the study. The negative impacts were divided into seven domains and a total OHIP score was calculated. Statistical analyses and data illustration were performed with SPSS v25 (IBM, NY).

Results
A total of 1141 people voluntarily participated in the study. More than 60% of the participants were in the control group while 33.7% had conventional braces for therapeutic reasons and 3.4% had fashion braces. Sociodemographic distributions varied among the groups, with the majority of the fashion braces group having education below the university level and family incomes less than average. There were significant group differences in OHIP domains. Physical pain was the most frequently reported complaint by all subjects and was the highest in the therapeutic braces group. People with therapeutic braces reported significantly higher functional limitation and physical disability than the controls. Fashion braces group reported significantly lower psychological discomfort and disability, social disability and handicap compared to control groups.

Conclusions
The illustrated effects of fashion braces on OHRQoL suggest the need to study the role of social media and educate the public on the use of braces to minimize the negative effects experienced by individuals.
Benefits of combined quantitative and qualitative evaluation of learning experience in a gerodontology course for dental students
Authors: Lamprecht Ragna , Guse Jennifer , Schimmel Martin , Müller Frauke , Heydecke Guido , Reissmann Daniel R. 
Published: August 2020

Abstract
Objectives
The oral health status of long-term care (LTC) facility residents is often poor, and acceptance of dental services by the elderly is irregular and mostly problem-driven. The perceived knowledge gap due to insufficient under- or postgraduate education and training in gerodontology might present a barrier for dentists to provide domiciliary care. This study aimed to develop a high-quality student course in gerodontology.

Methods
A total of 52 undergraduate dental students (age: 23.4 ± 2.1 yrs., 81% female) participated in a novel one-year gerodontology course and were included in this prospective study. The course was organized over two semesters, comprising two consecutive modules (one theoretical and one practical). The evaluation after the first semester applied a 16-item questionnaire with an ordinal 6-point response scale ranging from “not satisfied at all” (0) to “very satisfied” (5) for quantitative evaluation, and free-text comments as the qualitative part. These qualitative findings were used for validating the satisfaction questionnaire by triangulation, and to identify potential issues for improving the course. Satisfaction scores of the second evaluation after 1 year were used to assess potential effects of course modifications by comparing the participant satisfaction scores between both evaluations.

Results
Satisfaction scores of 3.6 ± 0.7 after the first semester indicated students’ initial satisfaction. The lowest satisfaction was observed for timeframe (2.6 ± 1.3) and interdisciplinary education (3.0 ± 1.4). The qualitative evaluation confirmed not only the ratings but also provided potential explanations, which were addressed by modifying the course accordingly. The effect of the modifications on participant evaluation was reflected by substantially improved satisfaction scores at the second assessment in 14 of 16 items, with a significant increase in overall satisfaction from 3.6 ± 0.7 to 4.0 ± 0.4 (p = 0.008).

Conclusion
A combined quantitative and qualitative evaluation is a successful method for developing, evaluating, and improving a gerodontology course for dental students with high student satisfaction.
Theory and practice of integrative clinical ethics support: a joint experience within gender affirmative care
Authors: Hartman Laura , Inguaggiato Giulia , Widdershoven Guy , Wensing-Kruger Annelijn , Molewijk Bert 
Published: August 2020

Abstract
Background
Clinical ethics support (CES) aims to support health care professionals in dealing with ethical issues in clinical practice. Although the prevalence of CES is increasing, it does meet challenges and pressing questions regarding implementation and organization. In this paper we present a specific way of organizing CES, which we have called integrative CES, and argue that this approach meets some of the challenges regarding implementation and organization.

Methods
This integrative approach was developed in an iterative process, combining actual experiences in a case study in which we offered CES to a team that provides transgender health care and reflecting on the theoretical underpinnings of our work stemming from pragmatism, hermeneutics and organizational and educational sciences.

Results
In this paper we describe five key characteristics of an integrative approach to CES; 1. Positioning CES more within care practices, 2. Involving new perspectives, 3. Creating co-ownership of CES, 4. Paying attention to follow up, and 5. Developing innovative CES activities through an emerging design.

Conclusions
In the discussion we compare this approach to the integrated approach to CES developed in the US and the hub and spokes strategy developed in Canada. Furthermore, we reflect on how an integrative approach to CES can help to handle some of the challenges of current CES.
Closing the gap in implementation of HIV clinical guidelines in a low resource setting using electronic medical records
Authors: Allorant Adrien , Parrish Canada , Desforges Gracia , Robin Ermane , Honore Jean Guy , Puttkammer Nancy 
Published: August 2020

Abstract
Background
Universal health coverage promises equity in access to and quality of health services. However, there is variability in the quality of the care (QoC) delivered at health facilities in low and middle-income countries (LMICs). Detecting gaps in implementation of clinical guidelines is key to prioritizing the efforts to improve quality of care. The aim of this study was to present statistical methods that maximize the use of existing electronic medical records (EMR) to monitor compliance with evidence-based care guidelines in LMICs.

Methods
We used iSanté, Haiti’s largest EMR to assess adherence to treatment guidelines and retention on treatment of HIV patients across Haitian HIV care facilities. We selected three processes of care – (1) implementation of a ‘test and start’ approach to antiretroviral therapy (ART), (2) implementation of HIV viral load testing, and (3) uptake of multi-month scripting for ART, and three continuity of care indicators – (4) timely ART pick-up, (5) 6-month ART retention of pregnant women and (6) 6-month ART retention of non-pregnant adults. We estimated these six indicators using a model-based approach to account for their volatility and measurement error. We added a case-mix adjustment for continuity of care indicators to account for the effect of factors other than medical care (biological, socio-economic). We combined the six indicators in a composite measure of appropriate care based on adherence to treatment guidelines.

Results
We analyzed data from 65,472 patients seen in 89 health facilities between June 2016 and March 2018. Adoption of treatment guidelines differed greatly between facilities; several facilities displayed 100% compliance failure, suggesting implementation issues. Risk-adjusted continuity of care indicators showed less variability, although several facilities had patient retention rates that deviated significantly from the national average. Based on the composite measure, we identified two facilities with consistently poor performance and two star performers.

Conclusions
Our work demonstrates the potential of EMRs to detect gaps in appropriate care processes, and thereby to guide quality improvement efforts. Closing quality gaps will be pivotal in achieving equitable access to quality care in LMICs.
The need for a telemedicine strategy for Botswana? A scoping review and situational assessment
Authors: Ncube B. , Mars M. , Scott R. E. 
Published: August 2020

Abstract
Background
Health, healthcare, and healthcare system problems within the developing world are well recognised. eHealth, the use of Information and Communications Technologies (ICT) for health, is frequently suggested as one means by which to ameliorate such problems. However, to identify and implement the most appropriate ehealth solutions requires development of a thoughtful and broadly evidence-informed strategy. Most published strategies focus on health informatics solutions, neglecting the potential for other aspects of ehealth (telehealth, telemedicine, elearning, and ecommerce). This study examined the setting in Botswana to determine the need for a telemedicine-specific strategy.

Methods
A situational assessment of ehealth activities in Botswana was performed through a scoping review of the scientific and grey literature using specified search terms to July 2018; an interview with an official from the major mhealth stakeholder; and benchtop review of policies and other relevant Government documents including the country’s current draft eHealth Strategy.

Results
Thirty-nine papers were reviewed. Various ehealth technologies have been applied within Botswana. These include Skype for educational activities, instant messaging (WhatsApp for telepathology; SMS for transmission of laboratory test results, patient appointment reminders, and invoicing and bill payment), and robotics for dermatopathology. In addition health informatics technologies have been used for surveillance, monitoring, and access to information by healthcare workers. The number of distinct health information systems has been reduced from 37 to 12, and 9 discrete EMRs remain active within the public health institutions. Many infrastructural issues were identified. A critical assessment of the current draft ehealth strategy document for Botswana showed limitations. Many telemedicine services have been introduced over the years (addressing cervical cancer screening, teledermatology, teleradiology, oral medicine and eye screening), but only one project was confirmed to be active and being scaled up with the intervention of the Government.

Conclusions
Botswana’s draft ‘ehealth’ strategy will not, in and of itself, nurture innovative growth in the application of telemedicine initiatives, which currently are fragmented and stalled. This lack of focus is preventing telemedicine’s recognised potential from being leveraged. A specific Telemedicine Strategy, aligned with and supportive of the pre-existing ehealth strategy, would provide the necessary focus, stimulus, and guidance.
The impact of revised diagnostic criteria on hospital trends in gestational diabetes mellitus rates in a high income country
Authors: McMahon Léan E. , O’Malley Eimer G. , Reynolds Ciara M. E. , Turner Michael J. 
Published: August 2020

Abstract
Objective
In 2010, national guidelines were published in Ireland recommending more sensitive criteria for the diagnosis of Gestational Diabetes Mellitus (GDM). The criteria were based on the 2008 Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) Study and were endorsed subsequently by the World Health Organization (WHO). Screening nationally is selective based on risk factors. We examined the impact of the new criteria on hospital trends nationally for GDM over the 10 years 2008–17.

Research design and methods
Data from three national databases, the Hospital Inpatient Enquiry System (HIPE), National Perinatal Reporting System (NPRS) and the Irish Maternity Indicator System (IMIS), were analyzed using descriptive statistics, analysis of variance, and Poisson loglinear modelling.

Results
The overall incidence of GDM nationally increased almost five-fold from 3.1% in 2008 to 14.8% in 2017 (p ≤ 0.001). The incidence varied widely across maternity units. In 2008, the incidence varied from 0.4 to 5.9% and in 2017 it varied from 1.9 to 29.4%. There were increased obstetric interventions among women with GDM over the decade, specifically women with GDM having increased cesarean sections (CS) and induction of labor (IOL) (p ≤ 0.001). These trends were significant in large and mid-sized maternity hospitals (p ≤ 0.001). The increase in GDM diagnosis could not be explained by an increase in maternal age nationally over the decade. The data did not include information on other risk factors such as obesity. The increased incidence in GDM diagnosis was accompanied by a decrease in high birthweight ≥ 4.5 kg nationally.

Conclusions
We found adoption of the new criteria for diagnosis of GDM resulted in a major increase in the incidence of GDM rates. Inter-hospital variations increased over the decade, which may be explained by variations in the implementation of the new national guidelines in different maternity units. It is likely to escalate further as compliance with national guidelines improves at all maternity hospitals, with implications for provision and configuration of maternity services. We observed trends that may indicate improvements for women and their offspring, but more research is required to understand patterns of guideline implementation across hospitals and to demonstrate how increased GDM diagnosis will improve clinical outcomes.