bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence of Clostridioides difficile infection in peripartum women: a retrospective cohort study
Authors: Saha Srishti , Pardi Ryan , Theiler Regan N. , Pardi Darrell S. , Khanna Sahil 
Published: July 2020

Background: The incidence of Clostridioides difficile infection (CDI) is increasing in the general population. Data on the epidemiology of CDI in peripartum women – a highly vulnerable patient population – is scarce. The objective of this study was to report the incidence of CDI in peripartum women. Methods: A single-center retrospective cohort study was conducted in peripartum women from 1997 to 2017. Peripartum CDI was defined as definite CDI (watery diarrhea for >24 h with positive stool assay) during pregnancy, or within 6 weeks postpartum. Incidence was reported per 100,000 pregnancies and time trends in incidence were analyzed using Poisson regression. Analyses were done separately for time trends before and after 2007, when CDI testing strategy changed to polymerase chain reaction. Results: From 1997 to 2017, 80 patients with peripartum CDI (47 during pregnancy, 33 postpartum) out of 125,683 pregnancies (0.064%) were identified. Incidence of CDI increased 3.4 fold (95% confidence interval 1.5–7.4, p = 0.005) over the 21 year period. Time trends were evident after ( p = 0.054), but not before 2007 ( p = 0.97). Conclusion: Incidence of CDI in peripartum women increased over the 21 year study period. The rise in incidence is concerning, and calls for heightened surveillance for CDI in this highly vulnerable population.
Barriers associated with mandatory influenza vaccination policies for healthcare workers: an integrative review
Authors: Short Erica , Zimmerman Peta-Anne , van de Mortel Thea 
Published: July 2020

Background: Uptake of influenza vaccination reduces staff absenteeism as well as mortality of patients and healthcare workers (HCWs); however, adherence of HCWs to annual influenza vaccination is poor and some healthcare facilities are now considering mandatory influenza vaccination policies. Aim: The purpose of this study was to identify the perceived and reported barriers to the implementation of a mandatory influenza vaccination policy for HCWs. Methods: An integrative review of the literature was conducted. Databases including CINAHL, Cochrane Library, Medline and PubMed were searched using key terms. The quality of papers was assessed utilising the Standard Quality Assessment Criteria for Evaluating Primary Research papers for a Variety of Fields which consisted of 10 questions with a possible total score of 20. PRISMA guidelines were used to report the search outcomes. Results: A total of 68 papers were identified from the database search. Seven papers were relevant, following screening. The quality scores of these were in the range of 15–20. A number of barriers are reported to prevent the effective implementation of mandatory influenza vaccination policies including ethical and legal considerations, logistics, healthcare burden, leadership and management, and human factors such as HCWs’ perspectives. Conclusions: By comprehensively identifying these, barriers can be addressed to allow effective implementation of such policies in healthcare facilities to ensure improved outcomes. The results of the review indicated the need for further research to ensure that barriers are addressed cohesively.
Collaborative Care in Primary Care: The Influence of Practice Interior Architecture on Informal Face-to-Face Communication—An Observational Study
Authors: Morgan Sonya , Pullon Susan , McKinlay Eileen , Garrett Susan , Kennedy Jonathan , Watson Bruce 
Published: July 2020

Background: Quality patient care in primary care settings, especially for patients with complex long-term health needs, is improved by interprofessional collaborative practice. Effective collaboration is achieved in large part by frequent informal face-to-face “on-the-fly” communication between team members. Research undertaken in hospitals shows that interior architecture influences informal communication and collaboration between staff. However, little is known about how the interior architecture of primary care practices might facilitate or hinder informal communication and collaboration among primary care staff. Objectives: This research explores the influence of primary care practice interior architecture on face-to-face on-the-fly communication for collaborative care. Methods: An observational study was undertaken to compare face-to-face informal interactions between staff in three primary care practices of differing interior architecture. Data collected from practices included: direct observations floor plans, photographs, interviews, and surveys. Results: Most primary care staff engaged in frequent, brief face-to-face interactions, which appeared to be key to the delivery of effective collaboration. Features of primary care practice designs that were associated with increased frequency of staff interaction included shared spaces, staff proximity/visibility, and the presence of convenient circulatory and transitional spaces where staff were able to easily engage in timely on-the-fly communication with colleagues. Conclusions: The interior architecture of primary care practices has an important impact on staff collaboration. Although more research is needed to investigate further details in more practices, close attention should nevertheless be paid to maximizing opportunities for brief face-to-face communication in well-designed shared spaces in primary care practices.
Impact of Post-Surgical Therapies on Endoscopic and External Dacryocystorhinostomy: Systematic Review and Meta-Analysis
Authors: Vinciguerra Alessandro , Nonis Alessandro , Resti Antonio Giordano , Bussi Mario , Trimarchi Matteo 
Published: July 2020

Background Epiphora is a common ophthalmologic sign that is most commonly caused by distal acquired lacrimal obstruction. Recent data have demonstrated that external dacryocystorhinostomy (EXT-DCR) and endoscopic endonasal dacryocystorhinostomy (END-DCR) can be considered the treatments of choice. However, different post-surgical medical therapies are available and are currently used to improve surgical outcomes, although no direct comparison has been performed. Objective To analyse the influence of post-surgical medical treatments on END-DCR and EXT-DCR outcomes. Methods A structured search was conducted using the U.S. National Library of Medicine (PubMed), EMBASE, SCOPUS, and Cochrane databases with a final search performed in May 2020. The research identified papers published later than 2000 with at least 50 single clinician procedures performed in EXT-DCR and END-DCR. Articles that studied acute infections, revision cases, mixed cohort studies of acquired and congenital obstruction, and tumour were excluded. The influence of systemic antibiotic/steroids, local application of mitomycin C, nasal/ocular antibiotic, nasal/ocular steroids and nasal decongestants was analysed. Results In total, 11,445 papers were selected, 2,741 of which were reviewed after screening, and 18 included after full text review (0.6% of the initial articles reviewed) which involved 3,590 procedures. Considering the low number of publications on EXT-DCR, statistical analysis of post-surgical therapy was not feasible. In END-DCR, the analyses were performed only for nasal steroids (p = 0.58), oral antibiotics (p = 0.45) and nasal decongestant (p = 0.27), which demonstrated no meaningful influence. Given the variable association between adjunctive medical therapies, pharmacologic molecular heterogeneity and modality/concentration of application, these results should be considered critically. Additionally, no differences were seen for application of silicone stenting, whereas, no statistical analysis was performed for mitomycin C. Conclusions Given the high success rate of EXT-DCR and END-DCR and the heterogeneity of literature data, the effective influence of post-surgical medical therapy is difficult to identify. Future large prospective randomized studies could help in detecting the optimal adjunctive therapy for these surgeries.
Lower serum 25-hydroxyvitamin D levels are associated with impaired glomerular filtration rate in type 2 diabetes patients
Authors: Dall’Agnol Angélica , Brondani Letícia de Almeida , Cancelier Vítor da Agostim , Camargo Eduardo Guimarães , Silveiro Sandra Pinho 
Published: July 2020

Background: 25-Hydroxyvitamin D [25(OH)D] deficiency has been implicated as a possible risk factor for the onset and progression of diabetes kidney disease (DKD). The aim of this study was to evaluate the interaction between levels of 25(OH)D and DKD in type 2 diabetes mellitus (DM) patients. Methods: Cross-sectional design, outpatient type 2 DM. Glomerular filtration rate (GFR) was measured by 51Cr-EDTA and estimated by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), urinary albumin excretion (UAE) by immunoturbidimetry, and 25(OH)D by chemiluminescence. Receiver operating characteristic (ROC) curve analysis and generalized linear model (Poisson robust regression estimator) were used to assess the interaction between 25(OH)D levels and renal function. Results: A total of 114 type 2 DM patients aged 60 ± 10 years, 49 males (43%), DM duration 22 ± 10 years, with GFR > 60 ml/min/1.73 m2 were evaluated. Patients with GFRs 60–90 ( n = 50) had significantly lower 25(OH)D levels than individuals with GFRs > 90 ml/min/1.73 m2 ( n = 64), respectively 40 ± 20 versus 48 ± 20 nmol/l, p = 0.027. This difference was more pronounced for older individuals (39 ± 20 versus 54 ± 23 nmol/l, respectively), and Poisson robust regression disclosed that lower 25(OH)D [Poisson regression (PR) = 0.989, confidence interval (CI): 0.978–0.999, p = 0.034], and advanced age (PR = 1.050, CI: 1.007–1.096, p = 0.023) were significantly associated with the lower GFR category, adjusted for seasons. ROC curve analysis showed that the cutoff point of 25(OH)D of 41 nmol/l was associated with lower GFR [area under the curve (AUC) = 0.694, p = 0.009]. CKD-EPI estimated GFR (eGFR) was not associated with 25(OH)D in any analysis. There was no difference in 25(OH)D levels between patients with elevated UAE as compared with normoalbuminuric ones (44 ± 21 versus 46 ± 19 nmol/l, p = 0.587). Conclusion: Lower levels of 25(OH)D are associated with decreased GFR in patients with type 2 DM, especially in older patients, with no evidence of interaction with UAE levels.
Plant-derived oleanolic acid ameliorates markers of subclinical inflammation and innate immunity activation in diet-induced pre-diabetic rats
Authors: Gamede Mlindeli , Mabuza Lindokuhle , Ngubane Phikelelani , Khathi Andile 
Published: July 2020

Aims: Sub-clinical inflammation during pre-diabetes is one of the predisposing factors that facilitates the progression of pre-diabetes to type 2 diabetes. The administration of oleanolic acid (OA) with or without dietary intervention ameliorates the metabolic and cardiovascular complications in diet-induced pre-diabetes animal models of pre-diabetes. This study aimed to investigate whether OA can also suppress immune activation and ameliorate pro-inflammatory markers. Methods: Pre-diabetes was induced by feeding Sprague Dawley rats a high-fat high carbohydrate diet for 20 weeks. The pre-diabetic rats were then treated with OA (80 mg/kg) or metformin (500 mg/kg) in the presence or absence of dietary interventions for a period of 12 weeks. At the end of the treatment period, the animals were euthanised and whole blood was used for platelet and immune cell count while plasma was used for fibrinogen, cluster differentiation 40 ligand and pro-inflammatory cytokine evaluation. Results: The results of this study revealed that OA, with or without dietary intervention, improved lipid metabolism by restoring high-density lipoprotein (HDL) and low-density lipoproteins (LDLs) as well as reducing platelets and immune cell counts. Furthermore, OA also decreased plasma proinflammatory cytokines, including tumour necrosis factor-α and -1β. Markers of immune activation such as C-reactive protein, fibrinogen, and CD40L were also decreased upon administration of OA with or without dietary intervention. Conclusion: The findings of this study suggest that OA may provide an alternative to prevent the progression of pre-diabetes to overt diabetes. This was evident by the reduction of differential white blood cell count and proinflammatory cytokines that exercebate insulin resistance. However, more studies are needed to elucidate the molecular mechanisms and to improve efficacy.
DDCI‐01, a novel long acting phospdiesterase‐5 inhibitor, attenuated monocrotaline‐induced pulmonary hypertension in rats
Authors: Li Ailing , Zhu Zhongkai , He Yangke , Dong Qian , Tang Dianyong , Chen Zhongzhu , Huang Wei 
Published: July 2020

Pulmonary arterial hypertension is a progressive, malignant heart disease, characterized by pulmonary arteriole remodeling and increased pulmonary vascular resistance, which eventually leads to right heart failure. This study sought to evaluate the effects of a novel long‐acting phospdiesterase‐5 inhibitor, namely DDCI‐01, as an early intervention for monocrotaline‐induced pulmonary hypertensive rats. To establish this model, 50 mg/kg of monocrotaline was intraperitoneally injected into rats. At Day 7 after monocrotaline injection, two doses of DDCI‐01 (3 or 9 mg/kg/day) or tadalafil (at 3 or 9 mg/kg/day) were intragastrically administered. The rats were anesthetized with pentobarbital for hemodynamic and echocardiographic measurements, at Day 21 after monocrotaline injection. Compared to the monocrotaline group, DDCI‐01 at 3 and 9 mg/kg/day (P) reduced the mean pulmonary arterial pressure (mPAP), right ventricular systolic pressure, right ventricular transverse diameter, pulmonary arterial medial wall thickness (WT%), and right ventricle hypertrophy. However, no significant difference in the indices mentioned as above was found between DDCI‐01 (3 mg/kg/day) and tadalafil (3 mg/kg/day). In addition, DDCI‐01 at 9 mg/kg/day resulted in lower mPAP and WT%, as well as higher cyclic guanosine monophosphate levels in the lung and plasma compared with the same dose of tadalafil (9 mg/kg/day) (all P < 0.05). These findings suggested that DDCI‐01 improved monocrotaline‐induced pulmonary hypertension in rats, and a dose of DDCI‐01 of 9 mg/kg/day might be more effective than the same dose of tadalafil in monocrotaline‐induced pulmonary hypertension in rats.
De-schooling Well-being: Toward a Learning-Oriented Definition
Authors: Rincón-Gallardo Santiago 
Published: July 2020

Purpose: (1) Critique conventional schooling as detrimental to student well-being and learning. (2) Articulate an alternative that is more conducive to learning and well-being in classrooms, schools, and educational systems. Design/Approach/Methods: I review the historical functions of compulsory schooling, the main critiques to conventional schooling developed over the past century, emerging knowledge on the neuroscience of learning and well-being, and cases of large-scale pedagogical transformation from the Global South. Findings: I argue that conventional schooling is detrimental to well-being, that deep learning is a precursor of well-being, and that compulsory schooling is not designed to cultivate it. Well-being has to be de-schooled so that students thrive in schools: The grammar of schooling has to be replaced with the language of learning. This requires deep and widespread cultural change, and some movements of pedagogical renewal from the Global South offer important lessons on how to accomplish this. Originality/Value: Expanding the scope of existing debates about student well-being by questioning the assumption that compulsory schooling is inherently good and pointing out that unless the default culture of schooling is replaced with cultures of robust learning, student well-being efforts will simply reproduce the very problems they seek to solve.
Education for the Whole Person in a Modern East Asian Context: “Caring-About the World” as a Form of Self-Love
Authors: Kwak Duck-Joo 
Published: July 2020

Purpose: The essay attempts to explore a possibility to conceive the idea of education for the whole person as a way of recovering the old spirit of liberal education or Bildung, yet in a new language. Design/Approach/Methods: The essay largely consists of two parts. The first part touches upon and diagnoses the current problems with educational culture in modern Korea where youths suffer their divided soul, by employing Rousseau’s notions of two different kinds of self-love, amour-de-soi and amour-propre. The second part addresses how the pursuit of the whole person as being wholehearted can be a healthy form of self-love mediated by love of the world or other persons. Findings: The idea of education for the whole person may turn out to be an unfeasible ideal, in the modern condition. Yet, being a whole person as wholehearted can be taken as a regulative ideal that guides our practice in teaching and learning, stimulating us to make an effort to be so despite our knowledge that it is out of reach. Originality/Value: The essay shows how the idea of education for the whole person can be newly interpreted in modern East Asian context, which can resonate with current problems with education culture in the West as well as around the globe for the age of measurement.
Exercise Counseling by Primary Care Physicians in Jordan—A Preliminary Study
Authors: Beni Yonis Othman , Saadeh Rami , Chamseddin Zaher , Alananzeh Hussam 
Published: July 2020

Despite the value of physical activity and exercise to patients, little is known about the perception and practices of Jordanian primary care physicians (PCPs) regarding counseling patients about exercise. This study was aimed at assessing counseling about exercise by PCPs in Jordan. A cross-sectional study targeting a random sample of physicians from family medicine, internal medicine and general practice in academic, public, and private sectors. Chi-square test of independence was used to assess the association of perceptions and practices of physicians regarding exercise counseling with their specialty. Logistic regression models were used to examine the association of demographic information with selected items of perception and practice. A total of 218 physicians participated in the study. They were mainly males (67%), family medicine physicians (42.2%), and had a mean age of 33.7 (±9.87) years. Most physicians believed that less than half of patients will start exercising (91.3%) or will continue exercising if they were repeatedly counseled at follow-up visits (85.4%). Family medicine physicians counseled more patients, more frequently, and their desire to counsel more patients was significantly higher than other physicians ( P = .002). The Perceptions and practices of Jordanian PCPs toward exercise counseling for their patients were found positive; however the desire to counsel more patients was low. Lack of patients’ motivation to practice exercise, time constraint and limited resources were the most frequently reported barriers to counseling. Further investigation on how to overcome such barriers is recommended.
Spontaneous hemoperitoneum in pregnancy due to endometriosis
Authors: Kim Tesia G , Sudhof Leanna S , Liu Fong W , Shainker Scott A 
Published: July 2020

Background: Hemoperitoneum in pregnancy requires urgent evaluation. While spontaneous intraperitoneal bleeding is rare, ectopic endometrial tissue is a frequent cause of this event. Case: A 38-year-old woman with a history of endometriosis presented at 26 weeks gestation with 1 week of vague abdominal pain. Vital signs were within normal limits, and physical exam was notable for left-sided abdominal tenderness. Imaging demonstrated simple free fluid in her pelvis, concern for a uterine fundal defect and an adjacent hematoma. Exploratory laparotomy revealed hemoperitoneum secondary to highly vascularized stage 4 endometriosis. After classical cesarean delivery, a supracervical hysterectomy with bilateral oophorectomy was performed due to ongoing global pelvic hemorrhage. Conclusion: Consider endometriosis as a cause of spontaneous hemoperitoneum in pregnancy. Obstetricians should be prepared for significant maternal morbidity when encountering such pathology.
Retina Injury After Dexamethasone Injection Into a Vitrectomized Eye
Authors: Elliott Michael S. , Montezuma Sandra R. 
Published: July 2020

Purpose: This work reports a case of retinal and vitreous hemorrhage after a dexamethasone (Ozurdex, Allergan) intravitreal implant injection to treat clinically significant macular edema (ME) in a patient with moderate nonproliferative diabetic retinopathy. Methods: A 61-year-old woman who had a vitrectomy 3 years prior in the right eye underwent intravitreal dexamethasone implant injection in the right eye. Immediately after the injection, the patient noted numerous floaters, with visual acuity decline from 20/30 before injection, to counting fingers at 3 feet after injection. Dilated examination revealed the dexamethasone implant resting against the retina, just inferior to the inferior arcade. On 360° fundus examination, the retina was found to be flat and attached. Optical coherence tomography of the macula demonstrated that the dexamethasone implant was preretinal, possibly having lifted the internal limiting membrane. Results: Thirty minutes after the injection, the patient reported that her vision was starting to clear. The patient was informed about what had transpired and warned about signs and symptoms of retinal detachment. She canceled her 1-week follow-up appointment because her vision returned to baseline. By 4 weeks post injection, her vision was 20/20 without macular edema. Conclusions: This case represents the first reported instance in which retinal impact by an Ozurdex implant was observed without treatment and vision recovered to baseline.