bluuebunny/crossref_metadata_2025_split huggingface dataset:
Design thinking during a health emergency: building a national data collection and reporting system
Authors: Durski Kara N. , Singaravelu Shalini , Naidoo Dhamari , Djingarey Mamoudou Harouna , Fall Ibrahima Soce , Yahaya Ali Ahmed , Aylward Bruce , Osterholm Michael , Formenty Pierre 
Published: December 2020

Abstract
Background
Design thinking allows challenging problems to be redefined in order to identify alternative user-center strategies and solutions. To address the many challenges associated with collecting and reporting data during the 2014 Ebola outbreak in Guinea, Liberia and Sierra Leone, we used a design thinking approach to build the Global Ebola Laboratory Data collection and reporting system.

Main text
We used the five-stage Design Thinking model proposed by Hasso-Plattner Institute of Design at Stanford in Guinea, Liberia and Sierra Leone. This approach offers a flexible model which focuses on empathizing, defining, ideating, prototyping, and testing. A strong focus of the methodology includes end-users’ feedback from the beginning to the end of the process. This is an iterative methodology that continues to adapt according to the needs of the system. The stages do not need to be sequential and can be run in parallel, out of order, and repeated as necessary. Design thinking was used to develop a data collection and reporting system, which contains all laboratory data from the three countries during one of the most complicated multi-country outbreaks to date. The data collection and reporting system was used to orient the response interventions at the district, national, and international levels within the three countries including generating situation reports, monitoring the epidemiological and operational situations, providing forecasts of the epidemic, and supporting Ebola-related research and the Ebola National Survivors programs within each country.

Conclusions
Our study demonstrates the numerous benefits that arise when using a design thinking methodology during an outbreak to solve acute challenges within the national health information system and the authors recommend it’s use during future complex outbreaks.
Effects of tree species and topography on soil and microbial biomass stoichiometry in Funiu Mountain, China
Authors: Tian Yaowu , Qiao Dong , Xu Shaojun , Wang Ning 
Published: December 2020

Abstract
Background
Soil and microbial biomass stoichiometry plays an important role in understanding nutrient cycling in terrestrial ecosystems. However, studies on soil and microbial biomass stoichiometry in forests are rare. This study investigated the effect of tree species and topographic factors on the ecological stoichiometry of soil and soil microbial biomass.

Methods
Three types of forest stands (Quercus variabilis, Larix principis-ruprechtii, and Cotinus coggygria Scop.) in the Beiru River basin of Funiu Mountain were analyzed in September 2018. Six slope positions (sunny bottom slope, sunny middle slope, sunny top slope, shady bottom slope, shady middle slope, and shady top slope) were selected, and the total number of sampling plots was 108. The stoichiometric indices of soil and microbial biomass were determined.

Results
At a depth of 0–10 cm, the soil organic C contents in different stands followed the order of C. coggygria (27.7 ± 5.2 g/kg) > Q. variabilis (24.5 ± 4.9 g/kg) > L. principis-ruprechtii (20.8 ± 4.3 g/kg) (P < 0.05). The soil organic C contents at depths of 0–10 cm with different slope aspects and at different slope positions also showed significant differences (P < 0.05). The highest MBC content was observed at the slope bottom (1002 ± 157 mg/kg), whereas the lowest was observed at the slope top (641 ± 98.3 mg/kg). Redundancy analysis showed that the contribution of tree species to these differences was 57.1%, whereas that of topographical factors was 36.2%.

Conclusions
Tree species more significantly affected soil nutrients and microbial biomass C, N and P than did topographic factors.
Symptomatic pelvic hematoma following hysterectomy: risk factors, bacterial pathogens and clinical outcome
Authors: Chill Henry H. , Amsalem Itshak , Karavani Gilad , Amit Sharon , Benshushan Abraham , Shveiky David 
Published: December 2020

Abstract
Background
Pelvic hematoma is a common finding following hysterectomy which at times may become infected causing substantial morbidity. The aim of this study was to describe the incidence, clinical manifestation and identify risk factors for infected pelvic hematoma. We also attempted to identify specific bacterial pathogens which may cause this phenomenon.

Methods
We conducted a retrospective cohort study at a tertiary university teaching hospital. Included were all women who underwent hysterectomy and were diagnosed with a pelvic hematoma following surgery from 2013 to 2018. In an attempt to assess possible risk factors for infected pelvic hematoma women with asymptomatic pelvic hematoma were compared to women with an infected pelvic hematoma.

Results
During the study period 648 women underwent hysterectomy at our medical center. Pelvic hematoma was diagnosed by imaging in 50 women (7.7%) including 41 women who underwent vaginal hysterectomy and 9 women who underwent abdominal hysterectomy. In 14 (2.2%) cases the hematoma became infected resulting in need for readmission and further treatment. Women who underwent vaginal surgery were more likely to return with infected pelvic hematoma compared to women who underwent open abdominal or laparoscopic surgery (4.5% vs. 1.1%, p < 0.05). In 8 women bacterial growth from hematoma culture was noted. Enterococcus faecalis, was the most abundant pathogen to be isolated in this sub-group.

Conclusion
Vaginal route of hysterectomy is a risk factor for infected pelvic hematoma following hysterectomy. Most of these infections were caused by anaerobic bacteria which may not be sufficiently covered by current antibiotic prophylactic regimens.
Effects on applying micro-film case-based learning model in pediatrics education
Authors: Pan Yuan , Chen Xiuqi , Wei Qiuwen , Zhao Jinmin , Chen Xun 
Published: December 2020

Abstract
Background
In view of the harsh reality Chinese paediatricians face, the challenge of paediatric education is about instilling not only knowledge and clinical skills but also resilience and beliefs. The aim of the study is to explore a more effective method than the traditional lecture-based learning (LBL) model for optimizing educational outcomes by establishing an innovative, comprehensive, case-based learning (CBL) model combined with the micro-film technique (MF + CBL). This approach has four important components: interests (attraction), knowledge application, competency, and scenario coping skills.

Methods
Experimental research was conducted via a controlled parallel group study. The total sample of 104 senior-year students (Chinese) majoring in clinical medicine was randomly divided into two groups. The experimental group was exposed to the MF + CBL model and the control group to the LBL model. Overall, the results were assessed after an 8-week course via a student self-assessment questionnaire, a satisfaction survey and the final examination.

Results
The experimental group generally performed better than the control group on the student self-assessment (P<0.05), satisfaction survey (P<0.05), and final examination (80.02 ± 3.77 vs 73.65 ± 3.69, P = 0.000). The open question at the end of the questionnaire revealed that a small number of students did not favour the MF + CBL model due to its time- and energy-consuming features.

Conclusions
Compared with LBL, the MF + CBL model was an innovative teaching method that promoted more comprehensive quality development. It represents an alternative model for optimizing the capacity of future paediatric doctors.
Understanding the role of nurse practitioners, physician assistants and other nursing staff in HIV pre-exposure prophylaxis care in the United States: a systematic review and meta-analysis
Authors: Zhang Chen , Mitchell Warton , Xue Ying , LeBlanc Natalie , Liu Yu 
Published: December 2020

Abstract
Background
Although pre-exposure prophylaxis (PrEP) was approved for primary HIV prevention by the Federal Drug Administration in 2012, PrEP utilization has been suboptimal. A body of literature and programs has emerged to examine the role of nurse practitioners (NPs), physician assistants and nursing staff in PrEP care. This review aims to understand the current status of non-physician health providers in PrEP care implementation in the United States.

Methods
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance, we conducted a comprehensive literature search using multiple databases to identify peer-reviewed articles that examined the role of non-physician health providers in the implementation of PrEP. Four major databases of studies using observational study design, randomized control trials and mixed-method study design were screened from November 2019 to January 2020 were searched. Two independent reviewers examined eligibility and conducted data extraction. We employed random-effects model aims to capture variances of estimates across studies.

Results
A total of 26 studies with 15,789 health professionals, including NPs (18, 95% CI = 14,24%), physician assistants (6, 95% CI = 2, 10%), nursing staff (26, 95% CI = 18–34%), and physicians (62,95% CI = 45, 75%), were included in the analysis. The odds of prescribing PrEP to patients among NPs were 40% (OR = 1.40, 95% CI = 1.02,1.92) higher than that among physicians, while the likelihood of being willing to prescribe PrEP was similar. On the other hand, the odds of being aware of PrEP (OR = 0.63, 95% CI = 0.46, 0.87) was 37% less in nursing professionals than that among physicians.

Conclusions
Although the limited number and scope of existing studies constrained the generalizability of our findings, the pattern of PrEP care implementation among non-physician health providers was described. To achieve wider PrEP care implementation in the U.S., increasing awareness of PrEP among all health providers including both physicians and non-physicians is a key step.
In defence of a single body of clinical and public health, medical ethics
Authors: Unger Jean-Pierre , Morales Ingrid , De Paepe Pierre , Roland Michel 
Published: December 2020

AbstractBackgroundSince some form of dual clinical/public health practice is desirable, this paper explains why their ethics should be combined to influence medical practice and explores a way to achieve that.Main textIn our attempt to merge clinical and public health ethics, we empirically compared the individual and collective health consequences of two illustrative lists of medical and public health ethical tenets and discussed their reciprocal relevance to praxis.The studied codes share four principles, namely, 1. respect for individual/collective rights and the patient’s autonomy; 2. cultural respect and treatment that upholds the patient’s dignity; 3. honestly informed consent; and 4. confidentiality of information. However, they also shed light on the strengths and deficiencies of each other’s tenets. Designing a combined clinical and public health code requiresfleshing out three similar principles, namely, beneficence, medical and public health engagement in favour of health equality, and community and individual participation; andadopting three stand-alone principles, namely, professional excellence, non-maleficence, and scientific excellence.Finally, we suggest that eco-biopsychosocial and patient-centred care delivery and dual clinical/public health practice should become a doctor’s moral obligation.We propose to call ethics based on non-maleficence, beneficence, autonomy, and justice – the values upon which, according to Pellegrino and Thomasma, the others are grounded and that physicians and ethicists use to resolve ethical dilemmas – “neo-Hippocratic”. The neo- prefix is justified by the adjunct of a distributive dimension (justice) to traditional Hippocratic ethics.ConclusionEthical codes ought to be constantly updated. The above values do not escape the rule. We have formulated them to feed discussions in health services and medical associations. Not only are these values fragmentary and in progress, but they have no universal ambition: they are applicable to the dilemmas of modern Western medicine only, not Ayurvedic or Shamanic medicine, because each professional culture has its own philosophical rationale.Efforts to combine clinical and public health ethics whilst resolving medical dilemmas can reasonably be expected to call upon the physician’s professional identity because they are intellectual challenges to be associated with case management.
Risk of mortality associated with concomitant antidepressant and benzodiazepine therapy among patients with depression: a population-based cohort study
Authors: Jeong Han Eol , Jeon Ha-Lim , Oh In-Sun , Kim Woo Jung , Shin Ju-Young 
Published: December 2020

Abstract
Background
With antidepressants (ADs) having minimal therapeutic effects during the initial weeks of treatment, benzodiazepines (BZDs) are concomitantly used to alleviate depressive symptoms of insomnia or anxiety. However, with mortality risks associated with this concomitant use yet to be examined, it remains unclear as to whether this concomitant therapy offers any benefits in treating depression.

Methods
We conducted a population-based cohort study using South Korea’s nationwide healthcare database from 2002 to 2017. Of 2.6 million patients with depression, we identified 612,729 patients with incident depression and newly prescribed ADs or BZDs, by excluding those with a record of diagnosis or prescription within the 2 years prior to their incident diagnosis. We classified our study cohort into two discrete groups depending on the type of AD treatment received within 6 months of incident diagnosis—AD monotherapy and AD plus BZD (AD+BZD) therapy. We matched our study cohort in a 1:1 ratio using propensity scores to balance baseline characteristics and obtain comparability among groups. The primary outcome was all-cause mortality, and patients were followed until the earliest of outcome occurrence or end of the study period. We conducted multivariable Cox proportional hazards regression analysis to estimate adjusted hazards ratios (HRs) with 95% confidence intervals (CIs) for the risk of mortality associated with AD+BZD therapy versus AD monotherapy.

Results
The propensity score-matched cohort had 519,780 patients with 259,890 patients in each group, where all baseline characteristics were well-balanced between the two groups. Compared to AD monotherapy, AD+BZD therapy was associated with an increased risk of all-cause mortality (adjusted HR, 1.04; 95% CI, 1.02 to 1.06).

Conclusions
Concomitantly initiating BZDs with ADs was associated with a moderately increased risk of mortality. Clinicians should therefore exercise caution when deciding to co-prescribe BZDs with ADs in treating depression, as associated risks were observed.
Geometric accuracy of an acrylonitrile butadiene styrene canine tibia model fabricated using fused deposition modelling and the effects of hydrogen peroxide gas plasma sterilisation
Authors: Hsu Chi-Pin , Lin Chen-Si , Fan Chun-Hao , Chiang Nai-Yuan , Tsai Ching-Wen , Chang Chun-Ming , Liu I-Li 
Published: December 2020

Abstract
Background
Three-dimensional (3D) printing techniques have been used to produce anatomical models and surgical guiding instruments in orthopaedic surgery. The geometric accuracy of the 3D printed replica may affect surgical planning. This study assessed the geometric accuracy of an acrylonitrile butadiene styrene (ABS) canine tibia model printed using fused deposition modelling (FDM) and evaluated its morphological change after hydrogen peroxide (H2O2) gas plasma sterilisation. The tibias of six canine cadavers underwent computed tomography for 3D reconstruction. Tibia models were fabricated from ABS on a 3D printer through FDM. Reverse-engineering technology was used to compare morphological errors (root mean square; RMS) between the 3D-FDM models and virtual models segmented from original tibia images (3D-CT) and between the models sterilised with H2O2 gas plasma (3D-GAS) and 3D-FDM models on tibia surface and in cross-sections at: 5, 15, 25, 50, 75, 85, and 95% of the tibia length.

Results
The RMS mean ± standard deviation and average positive and negative deviation values for all specimens in EFDM-CT (3D-FDM vs. 3D-CT) were significantly higher than those in EGAS-FDM (3D-GAS vs. 3D-FDM; P < 0.0001). Mean RMS values for EFDM-CT at 5% bone length (proximal tibia) were significantly higher than those at the other six cross-sections (P < 0.0001). Mean RMS differences for EGAS-FDM at all seven cross-sections were nonsignificant.

Conclusions
The tibia models fabricated on an FDM printer had high geometric accuracy with a low RMS value. The surface deviation in EFDM-CT indicated that larger errors occurred during manufacturing than during sterilisation. Therefore, the model may be used for surgical rehearsal and further clinically relevant applications in bone surgery.

Graphical abstract
Extended spectrum β lactamase-producing Enterobacteriaceae shedding by race horses in Ontario, Canada
Authors: Shnaiderman-Torban Anat , Navon-Venezia Shiri , Paitan Yossi , Archer Holly , Abu Ahmad Wiessam , Bonder Darryl , Hanael Erez , Nissan Israel , Zizelski Valenci Gal , Weese Scott J. , Steinman Amir 
Published: December 2020

Abstract
Background
We aimed to investigate the prevalence, molecular epidemiology and prevalence factors for Extended Spectrum β-Lactamase-producing Enterobacteriaceae (ESBL-E) shedding by race horses. A cross-sectional study was performed involving fecal samples collected from 169 Thoroughbred horses that were housed at a large racing facility in Ontario, Canada. Samples were enriched, plated on selective plates, sub-cultured to obtain pure cultures and ESBL production was confirmed. Bacterial species were identified and antibiotic susceptibility profiles were assessed. E. coli sequence types (ST) and ESBL genes were determined using multilocus sequence type (MLST) and sequencing. Whole genome sequencing was performed to isolates harboring CTX-M-1 gene. Medical records were reviewed and associations were investigated.

Results
Adult horses (n = 169), originating from 16 different barns, were sampled. ESBL-E shedding rate was 12% (n = 21/169, 95% CI 8–18%); 22 ESBL-E isolates were molecularly studied (one horse had two isolates). The main species was E. coli (91%) and the major ESBL gene was CTX-M-1 (54.5%). Ten different E. coli STs were identified. Sixty-four percent of total isolates were defined as multi-drug resistant. ESBL-E shedding horses originated from 8/16 different barns; whereas 48% (10/21) of them originated from one specific barn. Overall, antibiotic treatment in the previous month was found as a prevalence factor for ESBL-E shedding (p = 0.016, prevalence OR = 27.72, 95% CI 1.845–416.555).

Conclusions
Our findings demonstrate the potential diverse reservoir of ESBL-E in Thoroughbred race horses. Multi-drug resistant bacteria should be further investigated to improve antibiotic treatment regimens and equine welfare.
Strategic supplementation of Flemingia silage to enhance rumen fermentation efficiency, microbial protein synthesis and methane mitigation in beef cattle
Authors: Viennasay Bounnaxay , Wanapat Metha 
Published: December 2020

Abstract
Background
Good quality protein as an on-farm feed resource has been in great demand to support the productivity of ruminants. A digestion trial using beef cattle crossbreds was conducted to assess the four dietary treatments of Flemingia macrophylla silage (FMS) supplementation at 0, 0.2, 0.4 and 0.6 kg dry matter (DM)/day in a 4 × 4 Latin square design. Feed DM intakes were measured during the 14 days and sample of feeds, feces, urine, as well as rumen fluid and blood were collected during the 7 days while the animals were on metabolism crates.

Results
Based on this experiment strategic supplementation of FMS increased (P < 0.05) nutrients digestibility (organic matter, crude protein, and acid detergent fiber) enhanced rumen total volatile fatty acid production especially propionic acid (C3), C2:C3 ratio while, remarkably promoted the microbial protein synthesis (MPS) by increasing N-balance and retention of purine derivatives.

Conclusions
Under this experiment, the results revealed the potential use of FMS as a good-quality feed to improve nutrients digestibility, rumen fermentation, microbial protein synthesis, and to mitigate methane production. FMS supplementation at 0.6 kg DM/day exhibited the best result.
Engineering Lactococcus lactis as a multi-stress tolerant biosynthetic chassis by deleting the prophage-related fragment
Authors: Qiao Wanjin , Qiao Yu , Liu Fulu , Zhang Yating , Li Ran , Wu Zhenzhou , Xu Haijin , Saris Per Erik Joakim , Qiao Mingqiang 
Published: December 2020

Abstract
Background
In bioengineering, growth of microorganisms is limited because of environmental and industrial stresses during fermentation. This study aimed to construct a nisin-producing chassis Lactococcus lactis strain with genome-streamlined, low metabolic burden, and multi-stress tolerance characteristics.

Results
The Cre-loxP recombination system was applied to reduce the genome and obtain the target chassis strain. A prophage-related fragment (PRF; 19,739 bp) in the L. lactis N8 genome was deleted, and the mutant strain L. lactis N8-1 was chosen for multi-stress tolerance studies. Nisin immunity of L. lactis N8-1 was increased to 6500 IU/mL, which was 44.44% higher than that of the wild-type L. lactis N8 (4500 IU/mL). The survival rates of L. lactis N8-1 treated with lysozyme for 2 h and lactic acid for 1 h were 1000- and 10,000-fold higher than that of the wild-type strain, respectively. At 39 ℃, the L. lactis N8-1 could still maintain its growth, whereas the growth of the wild-type strain dramatically dropped. Scanning electron microscopy showed that the cell wall integrity of L. lactis N8-1 was well maintained after lysozyme treatment. Tandem mass tags labeled quantitative proteomics revealed that 33 and 9 proteins were significantly upregulated and downregulated, respectively, in L. lactis N8-1. These differential proteins were involved in carbohydrate and energy transport/metabolism, biosynthesis of cell wall and cell surface proteins.

Conclusions
PRF deletion was proven to be an efficient strategy to achieve multi-stress tolerance and nisin immunity in L. lactis, thereby providing a new perspective for industrially obtaining engineered strains with multi-stress tolerance and expanding the application of lactic acid bacteria in biotechnology and synthetic biology. Besides, the importance of PRF, which can confer vital phenotypes to bacteria, was established.