bluuebunny/crossref_metadata_2025_split huggingface dataset:
‘I know those people will be approachable and not mistreat us’: a qualitative study of inspectors and private drug sellers’ views on peer supervision in rural Uganda
Authors: Bagonza Arthur , Peterson Stefan , Mårtensson Andreas , Mutto Milton , Awor Phllis , Kitutu Freddy Eric , Gibson Linda , Wamani Henry 
Published: October 2020

Abstract
BackgroundPeer supervision improves health care delivery by health workers. However, in rural Uganda, self-supervision is what is prescribed for licensed private drug sellers by statutory guidelines. Evidence shows that self-supervision encourages inappropriate treatment of children less than five years of age by private drug sellers. This study constructed a model for an appropriate peer supervisor to augment the self-supervision currently practiced by drug sellers at district level in rural Uganda.MethodsIn this qualitative study, six Key informant interviews were held with inspectors while ten focus group discussions were conducted with one hundred and thirty drug sellers. Data analysis was informed by the Kathy Charmaz constructive approach to grounded theory. Atlas ti.7 software package was used for data management.Results A model with four dimensions defining an appropriate peer supervisor was developed. The dimensions included; incentives, clearly defined roles, mediation and role model peer supervisor. While all dimensions were regarded as being important, all participants interviewed agreed that incentives for peer supervisors were the most crucial. Overall, an appropriate peer supervisor was described as being exemplary to other drug sellers, operated within a defined framework, well facilitated to do their role and a good go-between drug sellers and government inspectors. Conclusion Four central contributions advance literature by the model developed by our study. First, the model fills a supervision gap for rural private drug sellers. Second, it highlights the need for terms of reference for peer supervisors. Third, it describes who an appropriate peer supervisor should be. Lastly, it elucidates the kind of resources needed for peer supervision.
Sudden death in the young adult: An autopsy-based series
Authors: Saadi Said , Jomaa Sami Ben , Hadj Mariem Bel , Oualha Dorra , Salem Nidhal Haj 
Published: October 2020

Abstract
Background: We aim to study the profile, and pathological characteristics of sudden death in young in purpose of recommendations for prevention. Methods: We performed a retrospective cohort study using autopsy data from the Department of Forensic Medicine of Monastir (Tunisia). A review of all autopsies performed for 28 years was done. In each case, clinical information, and circumstances of death were obtained. A complete forensic autopsy and histological, and toxicological investigations were performed. We have included all sudden death in persons aged between 18 years and 35 years.Results: We collected 137 cases of sudden death during the studied period. The mean age of the studied population was 26.47 years. Almost 72% deaths were classified as cardiac death, and was due to ischemic heart disease in 32.32%. Sudden death was attributed to a pleuropulmonary cause in 7.4%, an abdominal cause in 6%, and from a neurological origin in 4.5%. The cause of sudden death in this group was not established by 9.5%.Conclusion: There are several potential causes of sudden unexplained death such as structural abnormalities, ion channel abnormalities. Unexplained deaths, presumed to result from sudden primary arrhythmogenic causes, occur in a young adult with structurally normal hearts. That underlying disease-causing genetic defects may be involved has clinical implications for family members. Our findings suggest that prevention of sudden death among young adults under the age of 35 years should also focus on evaluation for causes not associated with structural heart disease.
The Clinical Relevance of Luteal Phase Progesterone Support in True Natural Cycle Cryopreserved Blastocyst Stage Embryo Transfers: A Retrospective Cohort Study
Authors: Waldman Ian , Racowsky Catherine , Disler Emily , Thomas Ann , Andrea Lanes , Hornstein Mark 
Published: October 2020

Abstract
Background: More than 67% of all embryos transferred in the United States involve frozen-thawed embryos. Progesterone supplementation is necessary in medicated cycles in order to luteinize the endometrium and prepare it for implantation, but little data is available if this is necessary in true natural cycles. We evaluated the use of luteal phase progesterone supplementation for cryopreserved/warmed blastocyst transfers in natural cycles not using an ovulatory trigger.Methods: Retrospective cohort study in a single academic medical center. We studied the use of luteal phase progesterone supplementation in patients undergoing true natural cycle cryopreserved blastocyst embryo transfers. Our primary outcome measure was ongoing pregnancy rate, with other pregnancy outcomes being evaluated (i.e. implantation rate, miscarriage rate, ectopic rate, and multifetal gestation). Categorical data were analyzed utilizing Fisher’s exact test and non-parametric data were analyzed using the Wilcoxon rank sum test. Results: 229 patients were included in the analysis with 149 receiving luteal phase progesterone supplementation and 80 receiving no luteal phase support. Patient demographic and cycle characteristics, and embryo quality were similar between the two groups. No difference was seen in ongoing pregnancy rate (49.0% vs. 47.5%, p=0.8738), clinical pregnancy rate (50.3% vs. 47.5%, p= 0.7483), positive HCG rate (62.4% vs. 57.5%, p=0.5965), miscarriage/abortion rate (5.4% vs. 2.5%, p=0.2622), ectopic pregnancy rate (0% vs. 1.3%, p=0.3493), or multifetal gestations (7.4% vs. 3.8%, p=0.3166).Conclusion(s): The addition of luteal phase progesterone support in true natural cycle cryopreserved blastocyst embryo transfers did not improve pregnancy outcomes and therefore the routine use in practice cannot be recommended based on this study, but the utilization should not be discouraged without further studies. Capsule: Progesterone supplementation as luteal phase support in true natural cycle cryopreserved blastocyst transfers does not improve ongoing pregnancies.
Hair cortisol-a method to detect chronic cortisol levels in patients with Prader-Willi syndrome
Authors: Shukur Hasanain Hamid , de Rijke Yolanda B , Rossum Elisabeth FC van , Hussain-Alkhateeb Laith , Höybye Charlotte 
Published: October 2020

Abstract
Background: Prader-Willi syndrome (PWS) is a multisymptomatic, rare, genetic, neurodevelopmental disorder in adults mainly characterized by hyperphagia, cognitive dysfunction, behavioral problems and risk of morbid obesity. Although endocrine insufficiencies are common, hypocortisolism is rare and knowledge on long-term cortisol concentrations is lacking. The aim of this study was to evaluate long-term cortisol levels in PWS by measurements of hair cortisol. Methods: Twenty-nine adults with PWS, 15 men and 14 women, median age 29 years, median BMI 27 kg/m2, were included. Scalp hair samples were analyzed for cortisol content using liquid-chromatography tandem-mass spectrometry. In addition, a questionnaire on auxology, medication and stress were included. For comparison, 105 age- and sex-matched participants from the population-based Lifelines Cohort study were included as controls. The mean hair cortisol between the groups were compared and associations between BMI and stress were assessed by a generalized linear regression model. Results: In the PWS group large variations in hair cortisol was seen. Mean hair cortisol was 12.8±25.4 pg/mg compared to 3.8±7.3 pg/mg in controls (p=0.001). The linear regression model similarly showed higher cortisol levels in patients with PWS, which remained consistent after adjusting for BMI and stress (p=0.023). Furthermore, hair cortisol increased with BMI (p=0.012) and reported stress (p=0.014). Conclusion: Long-term cortisol concentrations were higher in patients with PWS compared to controls and increased with BMI and stress, suggesting an adequate cortisol response to chronic stress. Hair cortisol demonstrate promising applications in the context of PWS treatment and disease management.
Mechanism of Multi-loop Edgewise Archwire technique in correcting Class II anterior open bites with temporomandibular disorders – a retrospective cephalometric study in Chinese patients&nbsp;
Authors: Liu Huanye , Suh Heeyeon , Jung Young-Eun , Xu Kaiyuan , Zhang Dan , Oh Heesoo 
Published: October 2020

Abstract
Background: An anterior open bite is considered challenging to treat because of its multifactorial etiology. Condylar resorption, which is one of the temporomandibular disorders (TMD) symptoms, has been identified as an etiologic factor of anterior open bites. It is essential to find an effective and efficient method to correct open bites while reducing the risk of exacerbating TMD during orthodontic treatment.Objectives: To evaluate the effect of the multi-loop edgewise archwire (MEAW) technique in correcting anterior open bite in patients with TMD. Materials and Methods: In this retrospective study, 20 patients with anterior open bites and TMD were included. 19 cephalometric measurements and 2 open bite indices were evaluated. A paired t-test was used to assess changes between pre- and post-treatments. Results: There were statistically significant changes after the treatment using the MEAW technique. The cephalometric measurements, including vertical positions of the incisors and molars, changed significantly. The maxillary and mandibular regional superimpositions for a subgroup of non-extraction patients showed slight intrusion of the upper molars (-0.6±1.0mm, p=0.04) and slight extrusion of the lower molars (1.0±1.1mm, p<0.01). Open bite correction was achieved predominantly through retraction and extrusion of the upper and lower incisors. Conclusions: The MEAW technique can be an effective method in correcting anterior open bites in Class II patients with TMD. Anterior open bites were corrected mainly by extrusion and retraction of the anterior teeth. The vertical dimension was maintained for the upper molars, but the mandibular molars were extruded. During treatment, the patients who had TMD did not show evident recurrence or worsening of their TMD conditions, indicating that orthodontic treatment can be performed when required.
Role of demographic variables in investigating occupational stress of disaster and emergency medical management center 115
Authors: lebni Javad Yoosefi , Abbas Jaffar , Gheshlaghi Parvin Abdi , Toghroli Razie , Garosi Vahid Hatami , Kalhori Reza Pourmirza , Salahshoor Mohammad Reza , Kianipour Neda , ziapour arash 
Published: October 2020

Abstract
Background: The Emergency Medical Services (EMS) Center is a community-centric that coordinates with the entire health care system. Employees are the most crucial asset of this medical center. This present study investigates the role of demographic variables associated with 115 disasters and the occupational stress of emergency medical management center personnel in 2019.Methods: This present descriptive study selected a statistical population based on 200 medical personnel associated with disaster and emergency medical management center 115 in Iran, according to inclusion chosen criteria. The review used a scale consisting of two parts, including demographic information and HSE standard questionnaire. The study selected respondents through Cochran's Sample Size Formula using stratified random sampling with a cross-sectional research design for data collection. The study has analyzed received data by using SPSS version 24 and performed the descriptive and inferential statistics (t-test and one-way ANOVA) at a significance level p<0.05.Results: The study results showed the mean score of total occupational stress 3.41±0.26. The results showed the highest (4.34±0.35) and the lowest stress levels (2.72±0.86) related to role dimensions. The study findings revealed a significant relationship between stress level and participants’ age, marital status, educational level, type of base, workplace, and the number of work hours per month. There was no relationship between the type of employment and work experience with stress levels. Conclusion: Emergency medical personnel experience a high level of occupational stress. Senior managers can use similar studies to implement measures to reduce the experience of employees' stress.
Systematic Development and Refinement of a Contextually Relevant Strategy for Undergraduate Medical Ethics Education: a qualitative study
Authors: Shamim Muhammad Shahid , Torda Adrienne , Baig Lubna , Zubairi Nadeem , Balasooriya Chinthaka 
Published: October 2020

Abstract
Background Delivery of medical ethics education is complex due to various reasons, compounded by the context-dependent nature of the content. The scarcity of relevant resources in the contexts of some developing countries adds a further layer of difficulty to ethics education in these contexts. We used a consultative approach with students, teachers and external experts to develop a practical approach to medical ethics education. This study aimed to develop and refine a contextually relevant approach to ethics education in the region of Saudi Arabia.Methods The study utilised an explorative qualitative methodology to seek views of students and faculty of Rabigh Faculty of Medicine, Saudi Arabia, and international experts in the field of ethics and education to review and enhance a new ethics learning strategy which included a workbook-based tool. Three focus groups with 12 students, in-depth interviews with four faculty members and qualitative feedback from eleven external experts enabled the study participants to objectively critique the WBEL and provide feedback to enhance its quality. Thematic content analysis of the data was done to draw inferences which were used to refine the educational strategy. Results The analysis generated twenty-one sub-themes within four main themes: design features, content, teaching methods and assessment. These findings helped to design the educational strategy to improve its effectiveness in the given context.Conclusion The study drew on the views of students, faculty and external experts to systematically develop a novel approach to ethics education for countries like Saudi Arabia. It also demonstrated the use of the consultative approach for informing a culturally relevant educational strategy in the Middle East context.
Patterns of white matter degeneration in remote brain areas from the basal ganglion lesion of ischemic stroke patients with motor impairment
Authors: Cao Xuejin , Wang Zan , Chen Xiaohui , Liu Yanli , Wang Wei , Abdoulaye Idriss Ali , Yang Xi , Zhang Shiyao , Guo Xiaoying , Wu Shanshan , Guo Yijing 
Published: October 2020

Abstract
Background: Diffusion tensor imaging (DTI) studies have revealed distinct white matter characteristics of the brain following diseases. Beyond the lesion-symptom mapping, recent studies have demonstrated extensive structural and functional alterations of remote areas to local lesions caused by stroke in the brain. Here, we further investigated the structural changes from a global level using DTI data through multivariate pattern analysis (MVPA) and network-based statistic (NBS). Methods: Ten ischemic stroke patients with basal ganglia lesions and motor dysfunctions and eleven demographically matched adults as controls underwent brain Magnetic Resonance Imaging scans. DTI data were processed to obtain fractional anisotropy (FA) maps and MVPA was used to explore brain regions that play an important role in classification based on FA maps. The white matter (WM) structural network was constructed by the deterministic fiber tracking approach according to the Automated Anatomical Labeling (AAL) atlas. NBS was used to explore differences in structural networks between groups.Results: MVPA applied to FA images correctly identified stroke patients with a statistically significant accuracy of 100% (P≤0.001). Compared with the controls, the study patients showed FA reductions in the perilesional basal ganglia and brainstem, with a few showing reductions in bilateral frontal lobes. Using NBS, we found a significant decrease in FA-weighted WM subnetwork in stroke patients. Conclusions: We identified some patterns of WM degeneration affecting brain areas remote to the ischemic lesion, revealing the abnormal organization of WM network in stroke patients, which may be helpful for the understanding of the neural mechanisms of stroke sequela.
Efficacy of contrast-enhanced ultrasonography and shear-wave elastography in conjunction with BI-RADS classification for diagnosis of small breast nodules
Authors: Shen Yan , He Jie , Liu Miao , Hu Jiaojiao , Wan Yonglin , Zhang Tingting , Ding Jun , Dong Jiangnan , Fu Xiaohong 
Published: October 2020

Abstract
Background: Identification of malignancy in small breast nodules can be difficult using conventional methods, especially in patients with dense breast tissue. Advanced imaging techniques, including contrast-enhanced ultrasound (CEUS) and shear-wave elastography (SWE), could be used in conjunction with the Breast Imaging Reporting and Data System (BI-RADS) classification to characterize these nodules more effectively. This retrospective study aimed to evaluate the use of CEUS and SWE for the differentiation of benign from malignant small (≤ 2 cm) breast nodules.Methods: We reviewed the medical records and imaging data of 302 patients who underwent evaluation for 305 small breast nodules from November 2015 to December 2019. The BI-RADS classification values of the nodules and the results of CEUS and SWE were retrospectively analyzed; the diagnostic efficacy of these techniques was evaluated by comparison of the pathology results. Receiver operating characteristic (ROC) curves were analyzed based on the CEUS patterns and shear-wave velocity values of the nodules. The sensitivity, specificity, positive and negative predictive values, accuracies of BI-RADS, CEUS, SWE, and a combination of all three methods for identifying benign and malignant small breast nodules were investigated.Results: CEUS was effective at diagnosing malignant nodules when at least two out of nine suspicious features were present. ROC analysis revealed that the best cut-off value for SWE was at 3.7 m/s. For the diagnosis of benign breast nodules, the BI-RADS classification was reduced by one level when both, CEUS and SWE were used, and remained unchanged when either one, CEUS or SWE was used; the highest and lowest levels were of category 5 and 3, respectively. Furthermore, when using the combined method, 75.8% (91/120) of small breast nodules with a BI-RADS category 4A classification avoided the need for coarse needle biopsies.Conclusions: CEUS and SWE can be used as auxiliary methods for clarifying BI-RADS classification of the breast nodules, and a combination of these techniques may provide more diagnostic efficacy for identifying malignancy in small breast nodules.Trial registration: Retrospectively registered.
Cost-utility analysis of pralatrexate for relapsed or refractory peripheral T-cell lymphoma based on a case-matched historical control study along with single arm clinical trial
Authors: Park Seonyoung , Kim Ah-Young , Cho Hyeonseok , Baik Deborah , Lee Hankil , Cho Sunghwa , Kang Hye-young 
Published: October 2020

Abstract
Background: Patients with relapsed or refractory peripheral T-cell lymphoma (R/R PTCL) treated with pralatrexate have previously shown superior overall survival (OS) compared to those who underwent conventional chemotherapy (CC, 15.4 vs. 4.07 months). We conducted an economic evaluation of pralatrexate from a societal perspective in Korea based on data from the PROPEL phase II study. Methods: Using a Markov model with a weekly cycle, we simulated the experience of patients with R/R PTCL receiving pralatrexate or CC for 15 years. The model consists of five health states; initial treatment, treatment pause, subsequent treatment, stem cell transplantation (SCT) success, and death. Comparative effectiveness was based on PROPEL phase II single-arm study and its matched historical control analysis. Costs included drug, drug administration, monitoring, adverse event management, and SCT costs. Results: The incremental cost-effectiveness ratio of the base case was $39,153 per quality-adjusted life-year (QALY) gained. The results of one-way sensitivity analysis ranged from $33,949 to $51,846 per QALY gained, which remained within an implicit willingness-to-pay (WTP) threshold of anticancer drugs in Korea. Conclusions: Pralatrexate is a cost-effective intervention with improved OS and incremental costs within the WTP limit. Pralatrexate could function as a new therapeutic option for patients suffering from life-threatening R/R PTCL.
COSMIN Risk of Bias tool to assess the quality of studies on reliability or measurement error of outcome measurement instruments: a Delphi study.
Authors: Mokkink Lidwine B. , Boers Maarten , Vleuten CPM van der , Bouter LM , Alonso Jordi , Patrick Donald L , de Vet HCW , Terwee CB 
Published: October 2020

Abstract
Background: Scores on an outcome measurement instrument depend on the type and settings of the instrument used, how instructions are given to patients, how professionals administer and score the instrument, etc. The impact of all these sources of variation on scores can be assessed in studies on reliability and measurement error, if properly designed and analyzed. The aim of this study was to develop standards to assess the quality of studies on reliability and measurement error of clinician-reported outcome measurement instruments, performance-based outcome measurement instrument, and laboratory values. Methods: We conducted a 3-round Delphi study involving 52 panelists. Results: Consensus was reached on how a comprehensive research question can be deduced from the design of a reliability study to determine how the results of a study inform us about the quality of the outcome measurement instrument at issue. Consensus was reached on components of outcome measurement instruments, i.e. the potential sources of variation. Next, we reached consensus on standards on design requirements (n=5), standards on preferred statistical methods for reliability (n=3) and measurement error (n=2), and their ratings on a four-point scale. There was one term for a component and one rating of one standard on which no consensus was reached, and therefore required a decision by the steering committee. Conclusion: We developed a tool that enables researchers with and without thorough knowledge on measurement properties to assess the quality of a study on reliability and measurement error of outcome measurement instruments.