bluuebunny/crossref_metadata_2025_split huggingface dataset:
A comparison of intensive vs. light-touch quality improvement interventions for maternal health in Uttar Pradesh, India
Authors: Montagu Dominic , Giessler Katie , Nakphong Michelle Kao , Green Cathy , Roy Kali Prosad , Sahu Ananta Basudev , Sharma Kovid , Sudhinarset May 
Published: December 2020

Abstract
Background
Poor patient experiences during delivery leads to delayed presentation at facilities and contributes to poor maternal health outcomes. Person-centered maternity care (PCMC) is a key component of quality. Improving PCMC requires changing the process of care which can be complex and necessitate significant external input, making replication and scale difficult. This study compares the effectiveness two Quality Improvement (QI) intervention phases, one Intensive, one Light-Touch.

Methods
We use a matched case-control design to compare two phases of a QI Intervention targeting PCMC, with three facilities in each. The Intensive phase was introduced into three government facilities where teams were supported to identify, design, and test potential improvements over 12 months. The Light-Touch phase was subsequently introduced in three other government facilities and changes were tracked over six months. We compared the two groups using multivariate linear regression and difference-in-difference models to assess changes in PCMC outcome

Results
Both Intensive and Light-Touch arms demonstrated large improvements in PCMC. On a scale from 0 to 100, Intensive facilities increased in PCMC scores from 85.02 to 97.13, while Light-Touch facilities increased from 63.42 to 87.47. For both there was a ‘halo’ effect, with a similar improvement recorded for the specific improvement activities focused on, as w ell as aspects of PCMC not directly addressed.

Conclusions
This study demonstrates that a short, inexpensive, light-touch and directive intervention can change staff practices and significantly improve the experiences of women during childbirth. It also shows that improvements in a few areas of provider-patient interaction have a ‘halo’ effect, changing many other aspects of patient-provider interaction at the same time.

Trial registration
QI Phase 1 - NCT04208867. Retrospectively registered. December 19th, 2019.
QI Phase 2 –NCT04208841. Retrospectively registered. December 23, 2019.
Cisplatin and carboplatin result in similar gonadotoxicity in immature human testis with implications for fertility preservation in childhood cancer
Authors: Tharmalingam Melissa D. , Matilionyte Gabriele , Wallace William H. B. , Stukenborg Jan-Bernd , Jahnukainen Kirsi , Oliver Elizabeth , Goriely Anne , Lane Sheila , Guo Jingtao , Cairns Bradley , Jorgensen Anne , Allen Caroline M. , Lopes Federica , Anderson Richard A. , Spears Norah , Mitchell Rod T. 
Published: December 2020

AbstractBackgroundClinical studies indicate chemotherapy agents used in childhood cancer treatment regimens may impact future fertility. However, effects of individual agents on prepubertal human testis, necessary to identify later risk, have not been determined. The study aimed to investigate the impact of cisplatin, commonly used in childhood cancer, on immature (foetal and prepubertal) human testicular tissues. Comparison was made with carboplatin, which is used as an alternative to cisplatin in order to reduce toxicity in healthy tissues.MethodsWe developed an organotypic culture system combined with xenografting to determine the effect of clinically-relevant exposure to platinum-based chemotherapeutics on human testis. Human foetal and prepubertal testicular tissues were cultured and exposed to cisplatin, carboplatin or vehicle for 24 h, followed by 24–240 h in culture or long-term xenografting. Survival, proliferation and apoptosis of prepubertal germ stem cell populations (gonocytes and spermatogonia), critical for sperm production in adulthood, were quantified.ResultsCisplatin exposure resulted in a significant reduction in the total number of germ cells (− 44%,p < 0.0001) in human foetal testis, which involved an initial loss of gonocytes followed by a significant reduction in spermatogonia. This coincided with a reduction (− 70%,p < 0.05) in germ cell proliferation. Cisplatin exposure resulted in similar effects on total germ cell number (including spermatogonial stem cells) in prepubertal human testicular tissues, demonstrating direct relevance to childhood cancer patients. Xenografting of cisplatin-exposed human foetal testicular tissue demonstrated that germ cell loss (− 42%,p < 0.01) persisted at 12 weeks. Comparison between exposures to human-relevant concentrations of cisplatin and carboplatin revealed a very similar degree of germ cell loss at 240 h post-exposure.ConclusionsThis is the first demonstration of direct effects of chemotherapy exposure on germ cell populations in human foetal and prepubertal testis, demonstrating platinum-induced loss of all germ cell populations, and similar effects of cisplatin or carboplatin. Furthermore, these experimental approaches can be used to determine the effects of established and novel cancer therapies on the developing testis that will inform fertility counselling and development of strategies to preserve fertility in children with cancer.
Outcomes of extensive hemilaminectomy with durotomy on dogs with presumptive progressive myelomalacia: a retrospective study on 34 cases
Authors: Hirano Ryuji , Asahina Ryota , Hirano Taiyo , Hyakkoku Ayuko , Miura Rino , Kunihiro Takuya , Nakamoto Yuya 
Published: December 2020

AbstractBackgroundProgressive myelomalacia (PMM) is a fatal complication of progressive ascending and descending necrosis of the spinal cord after acute spinal cord injury. A recent study suggested that extensive hemilaminectomy with durotomy (EHLD) at the intramedullary T2-hyperintense region which performed immediately after magnetic resonance imaging (MRI) improved the survival rate in dogs with presumptive PMM. The objective of this retrospective study was to evaluate the effects of EHLD on halting the progression of PMM in dogs presumptively diagnosed with PMM which had the interval between MRI and surgery.ResultsThirty-four dogs with presumptive PMM which had undergone EHLD with the delay following MRI examination (range, 0 to 3 days) were included. The cranial side of EHLD was set depending on the delay time after MRI, MRI findings, neurological examination and intraoperative macroscopic appearance. Two weeks after surgery, the perioperative survival rate was 97% (33/34). During follow-up with a median time period of 82.5 weeks (range, 0-290 weeks), the postoperative survival rate was 91% (31/34). At the end of the follow-up period, 31 out of 34 dogs were alive without severe postoperative complications while the remaining 2 dogs died from causes not directly attributable to the surgery. There was no improvement in the pelvic limb function of all dogs.ConclusionsEHLD appears to be effective in halting the progression of presumptive PMM and preventing morbidity even in dogs which had the interval between MRI and EHLD. Our algorithm of determining the range of EHLD may enable to set the appropriate ranges of EHLD in the cases which develop signs consistent with PMM after MRI examination.
Proceedings from the CIHLMU Symposium 2020 on “eHealth: Trends and innovations”
Authors: Noreña Ivan , Shah Nairuti , Ndenkeh Jackson , Hernandez Cecilia , Sitoe Nadia , Sillah Abdou , Shin Anna , Han Wai Wai , Devaera Yoga , Mosoba Maureen , Moonga Given , Hendl Tereza , Wernick Alina , Kiberu Vincent Micheal , Menke Melissa , Guggenbuehl Noller Jessica Michelle , Pritsch Michael 
Published: December 2020

AbstractElectronic Health (eHealth) is the use of information and communication technologies for health and plays a significant role in improving public health. The rapid expansion and development of eHealth initiatives allow researchers and healthcare providers to connect more effectively with patients. The aim of the CIHLMU Symposium 2020 was to discuss the current challenges facing the field, opportunities in eHealth implementation, to share the experiences from different healthcare systems, and to discuss future trends addressing the use of digital platforms in health. The symposium on eHealth explored how the health and technology sector must increase efforts to reduce the obstacles facing public and private investment, the efficacy in preventing diseases and improving patient quality of life, and the ethical and legal frameworks that influence the proper development of the different platforms and initiatives related to the field. This symposium furthered the sharing of knowledge, networking, and patient/user and practitioner experiences in low- and middle-income countries (LMIC) in both public and private sectors.
Single-step dynamic dewatering of microalgae from dilute suspensions using flocculant assisted filtration
Authors: Musa Mutah , Ward Andrew , Ayoko Godwin A. , Rösch Christine , Brown Richard , Rainey Thomas J. 
Published: December 2020

Abstract
Background
Dewatering constitutes a major challenge to the production of microalgae, accounting for 20–30% of the product cost. This presents a setback for the applicability of microalgae in the development of several sustainable products. This study presents an investigation into the dynamic dewatering of microalgae in a combined flocculation-filtration process. The effect of process conditions on the performance of 12 flocculants and their mixtures was assessed.

Results
The mechanism of flocculation via the electrostatic path was dominated by charge neutralization and subsequently followed bridging in a ‘sweep flocculation’ process. Cationic polyacrylamide (CPAM) based flocculants recorded the highest biomass retention with PAM1 and PAM2 attaining 99 and 98% retention with flocculant dosages of 10 and 15 mg/L respectively. Polyvinylamine (PVAM) was also found to improve system stability across the pH range 4–10. Alum was observed to be only effective in charge neutralization, bringing the system close to its isoelectric point (IEP). Chemometric analysis using the multi-criteria decision methods, PROMETHEE and GAIA, was applied to provide a sequential performance ranking based on the net outranking flow (ф) from 207 observations. A graphical exploration of the flocculant performance pattern, grouping the observations into clusters in relation to the decision axis ($$\pi$$
π
), which indicated the weighted resultant of most favorable performance for all criteria was explored.

Conclusion
CPAM based flocculants and their mixtures demonstrated superior performance due to their viscoelastic behaviour under turbulence. The use of PVAM or alum in mixtures with CPAM reduced the required doses of both flocculants, which will provide beneficial financial impact for largescale microalgae dewatering in a flocculant assisted dynamic filtration process. Chemometric analysis based on the physico-chemical properties of the system provides a time saving assessment of performance across several criteria. The study findings provide an important foundation for flocculant assisted dynamic filtration processes.
Deaths of despair: cause-specific mortality and socioeconomic inequalities in cause-specific mortality among young men in Scotland
Authors: Allik Mirjam , Brown Denise , Dundas Ruth , Leyland Alastair H. 
Published: December 2020

AbstractBackgroundIncreasing mortality among men from drugs, alcohol and suicides is a growing public health concern in many countries. Collectively known as “deaths of despair”, they are seen to stem from unprecedented economic pressures and a breakdown in social support structures.MethodsWe use high-quality population wide Scottish data to calculate directly age-standardized mortality rates for men aged 15–44 between 1980 and 2018 for 15 leading causes of mortality. Absolute and relative inequalities in mortality by cause are calculated using small-area deprivation and the slope and relative indices of inequality (SII and RIIL) for the years 2001–2018.ResultsSince 1980 there have been only small reductions in mortality among men aged 15–44 in Scotland. In that period drug-related deaths have increased from 1.2 (95% CI 0.7–1.4) to 44.9 (95% CI 42.5–47.4) deaths per 100,000 and are now the leading cause of mortality. Between 2001 and 2018 there have been small reductions in absolute but not in relative inequalities in all-cause mortality. However, absolute inequalities in mortality from drugs have doubled from SII = 66.6 (95% CI 61.5–70.9) in 2001–2003 to SII = 120.0 (95% CI 113.3–126.8) in 2016–2018. Drugs are the main contributor to inequalities in mortality, and together with alcohol harm and suicides make up 65% of absolute inequalities in mortality.ConclusionsContrary to the substantial reductions in mortality across all ages in the past decades, deaths among young men are increasing from preventable causes. Attempts to reduce external causes of mortality have focused on a single cause of death and not been effective in reducing mortality or inequalities in mortality from external causes in the long-run. To reduce deaths of despair, action should be taken to address social determinants of health and reduce socioeconomic inequalities.
A comprehensive scheme for the objective upper body assessments of subjects with cerebellar ataxia
Authors: Tran Ha , Nguyen Khoa D. , Pathirana Pubudu N. , Horne Malcolm K. , Power Laura , Szmulewicz David J. 
Published: December 2020

AbstractBackgroundCerebellar ataxia refers to the disturbance in movement resulting from cerebellar dysfunction. It manifests as inaccurate movements with delayed onset and overshoot, especially when movements are repetitive or rhythmic. Identification of ataxia is integral to the diagnosis and assessment of severity, and is important in monitoring progression and improvement. Ataxia is identified and assessed by clinicians observing subjects perform standardised movement tasks that emphasise ataxic movements. Our aim in this paper was to use data recorded from motion sensors worn while subjects performed these tasks, in order to make an objective assessment of ataxia that accurately modelled the clinical assessment.MethodsInertial measurement units and a Kinect© system were used to record motion data while control and ataxic subjects performed four instrumented version of upper extremities tests, i.e. finger chase test (FCT), finger tapping test (FTT), finger to nose test (FNT) and dysdiadochokinesia test (DDKT). Kinematic features were extracted from this data and correlated with clinical ratings of severity of ataxia using the Scale for the Assessment and Rating of Ataxia (SARA). These features were refined using Feed Backward feature Elimination (the best performing method of four). Using several different learning models, including Linear Discrimination, Quadratic Discrimination Analysis, Support Vector Machine and K-Nearest Neighbour these extracted features were used to accurately discriminate between ataxics and control subjects. Leave-One-Out cross validation estimated the generalised performance of the diagnostic model as well as the severity predicting regression model.ResultsThe selected model accurately ($$96.4\%$$96.4%) predicted the clinical scores for ataxia and correlated well with clinical scores of the severity of ataxia ($$rho = 0.8$$rho=0.8,$$p < 0.001$$p<0.001). The severity estimation was also considered in a 4-level scale to provide a rating that is familiar to the current clinically-used rating of upper limb impairments. The combination of FCT and FTT performed as well as all four test combined in predicting the presence and severity of ataxia.ConclusionIndividual bedside tests can be emulated using features derived from sensors worn while bedside tests of cerebellar ataxia were being performed. Each test emphasises different aspects of stability, timing, accuracy and rhythmicity of movements. Using the current models it is possible to model the clinician in identifying ataxia and assessing severity but also to identify those test which provide the optimum set of data.Trial registrationHuman Research and Ethics Committee, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia (HREC Reference Number: 11/994H/16).
Postoperative analgesic effect of acupotomy combined with patient-controlled analgesia in patients undergoing video-assisted thoracoscopic surgery: a study protocol for a randomized controlled trial
Authors: Jiang Cai , Li Yinyan , Li Xiaomei , Guo Jinhua , Guo Miaomiao , Yu Shengxian , Lin Zhonghua 
Published: December 2020

AbstractBackgroundPostoperative acute pain is a common issue following thoracic surgery. Acupotomy is a common and safe intervention method for pain treatment in clinical practice. In previous preliminary experiments, we found that acupotomy has a good clinical effect and good safety in the treatment of pain after thoracoscopic surgery. However, due to a lack of a rigorous design and an adequate sample size, its efficacy still requires further confirmation. The purpose of this study will be to explore the efficacy and safety of acupotomy combined with patient-controlled analgesia (PCA) for the treatment of pain after video-assisted thoracic surgery (VATS).MethodsThe study will be a single-centre, parallel group, randomized controlled trial.Seventy patients with significant pain after thoracoscopic surgery with a visual analogue scale (VAS) score ≥ 7 will be included and randomly distributed into two groups: G1, the acupotomy combined with PCA group; and G2, the conventional PCA group. The primary outcome measure is pain scores at rest and coughing evaluated with the VAS by a blinded observer in the postanaesthesia care unit (PACU) and postoperatively at 1, 2, 4, 8, 12, 24, 48, and 72 h. The secondary outcome measures are postoperative requirements for rescue analgesia, the cumulative amount of self-administered analgesics, the level of sedation (LOS), the Bruggemann comfort scale (BCS), and the functional activity score (FAS) concerning adverse effects and patient satisfaction.DiscussionThis trial has the potential to identify an innovative and effective analgesic method for postoperative pain management for VATS. The findings may advocate for the inclusion of the treatment of comorbid pain after thoracoscopy in current pain management practice guidelines.Trial registrationChinese Clinical Trial RegistryChiCTR1900027191. Registered on 4 November 2019
Diagnosis at gut point: rapid identification of pneumoperitoneum via point-of-care ultrasound
Authors: Taylor Matthew A. , Merritt Christopher H. , Riddle Philip J. , DeGennaro Carter J. , Barron Keith R. 
Published: December 2020

AbstractUndifferentiated abdominal pain is a common presentation often requiring immediate medical or surgical intervention. Providing an accurate diagnosis involves a detailed patient history and thorough physical exam. Point of care ultrasound is gaining acceptance as a rapid diagnostic tool that can be used to accurately detect life-threatening conditions while potentially avoiding unnecessary radiation exposure and facilitating rapid treatment. Detection of pneumoperitoneum with point-of-care ultrasound is a simple procedure that relies heavily on the experience of the investigating practitioner. Standard technique involves placing a high-frequency linear-array transducer in the right upper quadrant, where abdominal free air is most likely to accumulate. Detection of the ‘gut point’, which is the transition of abdominal wall sliding to lack thereof in a single image, is the pathognomonic finding of pneumoperitoneum. If visualization is difficult, moving the patient to the left lateral decubitus position or using the scissors technique can provide additional image views. This representative case report and review highlights the use of abdominal POCUS for the diagnosis of pneumoperitoneum. Ultrasound should continue to be explored by clinicians to narrow the differential diagnosis of acute abdominal pain.
Evaluation of a novel handheld point-of-care ultrasound device in an African emergency department
Authors: Burleson Samuel L. , Swanson Jonathan F. , Shufflebarger Erin F. , Wallace Douglas W. , Heimann Matthew A. , Crosby James C. , Pigott David C. , Gullett John P. , Thompson Maxwell A. , Greene Christopher J. 
Published: December 2020

Abstract
Background
Many point-of-care ultrasound devices are now “pocket-sized” or handheld, allowing easy transport during travel and facilitating use in crowded spaces or in austere low-resource settings. Concerns remain about their durability, image quality, and clinical utility in those environments.

Method
Five emergency physicians with training in point-of-care ultrasound employed the Butterfly iQ, a novel handheld ultrasound device, in routine clinical care in a busy, high-acuity African emergency department over a period of 10 weeks. We retrospectively evaluated the performance of the Butterfly iQ from the perspectives of both the clinicians using the device and expert ultrasound faculty reviewing the images.

Results
We found advantages of the Butterfly iQ in a high-acuity African emergency department include its use of a single probe for multiple functions, small size, ease of transport, relatively low cost, and good image quality in most functions. Disadvantages include large probe footprint, lower, though still adequate, cardiac imaging quality, frequent overheating, and reliance on internet-based cloud storage, but these were surmountable. We also report a wide variety of patient presentations, pathology, and procedures to which the device was used.

Conclusion
We conclude the Butterfly iQ is an effective, though imperfect, point-of-care ultrasound device in a low-resource emergency setting. We will continue to employ the device in clinical emergency care and teaching in this setting.
Sex differences in the knee orthopaedic injury patterns among recreational alpine skiers
Authors: Shi Huijuan , Jiang Yanfang , Ren Shuang , Hu Xiaoqing , Huang Hongshi , Ao Yingfang 
Published: December 2020

Abstract
Background
Although studies have reported the sex differences in injury patterns among recreational skiers, the findings are still conflicting. This study aims to analyse the sex differences of orthopaedic knee injuries that occurred during alpine skiing.

Methods
A total of 306 recreational alpine skiers (125 females and 181 males) who sustained knee surgeries between June 2016 and December 2018 participated in this study. Age, height, weight, and physical activity level of the patients were recorded. The orthopaedic knee injury patterns were analysed based on the diagnosis given by the physicians.

Results
Male skiers (17.13%) had a higher proportion of multiple knee ligament injuries than females (6.40%). The combined anterior cruciate ligament (ACL) and medial collateral ligament injury were the most common injury types in both females and males, with ACL injury being more prevalent for females (79.20%) than that in males (56.35%). The proportion of female skiers (17.6%) with vigorous-intensity activity level was significantly lower than that of males (30.9%). Female skiers had lower body height, body weight, and body mass index than male skiers (P <  0.001).

Conclusions
ACL injury is the most common orthopaedic injury among both female and male knee-injured recreational skiers. The proportion of females with an ACL injury is higher than that of males, but the proportion of multiple knee ligament injuries is lower than that of males. More male recreational skiers have vigorous-intensity activity level habits in daily life than females.