bluuebunny/crossref_metadata_2025_split huggingface dataset:
Online patient simulation training to improve clinical reasoning: A feasibility randomised controlled trial
Authors: Plackett Ruth , Kassianos Angelos P , Kambouri Maria , Kay Natasha , Mylan Sophie , Hopwood Jenny , Schartau Patricia , Gray Shani , Timmis Jessica , Bennett Sarah , Valerio Chris , Rodrigues Veena , Player Emily , Hamilton Willie , Raine Rosalind , Duffy Stephen , Sheringham Jessica 
Published: April 2020

Abstract
Background: Online patient simulations (OPS) are a novel method for teaching clinical reasoning skills to students and could contribute to reducing diagnostic errors. However, little is known about how best to implement and evaluate OPS in medical curricula. The aim of this study was to assess the feasibility, acceptability and potential effects of eCREST — the electronic Clinical Reasoning Educational Simulation Tool.Methods: A feasibility randomised controlled trial was conducted with final year undergraduate students from three UK medical schools in academic year 2016/2017 (cohort one) and 2017/2018 (cohort two). Student volunteers were recruited in cohort one via email and on teaching days, and in cohort two eCREST was also integrated into a relevant module in the curriculum. The intervention group received three patient cases and the control group received teaching as usual; allocation ratio was 1:1. Researchers were blind to allocation. Clinical reasoning skills were measured using a survey after one week and a patient case after one month.Results: Across schools, 264 students participated (18.2% of all eligible). Cohort two had greater uptake (183/833, 22%) than cohort one (81/621, 13%). After one week, 99/137 (72%) of the intervention and 86/127 (68%) of the control group remained in the study. eCREST improved students’ ability to gather essential information from patients over controls (OR =1.4; 95% CI 1.1-1.7, n =148). Of the intervention group, most (84/98, 82%) agreed eCREST helped them to learn clinical reasoning skills.Conclusions: eCREST was highly acceptable and improved data gathering skills that could reduce diagnostic errors. Uptake was low but improved when integrated into course delivery. A summative trial is needed to estimate effectiveness.
Long term prognostic implication of newly detected abnormal glucose tolerance among patients with stable cardiovascular disease: a population-based study
Authors: Kabootari Maryam , Asgari Samaneh , Ghavam Seyedeh Maryam , Azizi Fereidoun , Hadaegh Farzad 
Published: April 2020

Abstract
Background: To assess the association between fasting plasma glucose (FPG) and 2-h post challenge plasma glucose (2h-PCPG) as continuous or categorical variables with risk of recurrent cardiovascular disease (CVD) and incident diabetes among subjects with history of previous CVD. Methods: In a prospective population-based cohort, a total of 335 Iranians aged ≥30 years, with history of CVD and free of known diabetes were included. Prediabetes was defined as impaired fasting glucose (IFG) according to the criteria of the American Diabetes Association (ADA) [IFG-ADA; FPG: 5.6-6.9 mmol/L], the World Health Organization (WHO) expert group (IFG-WHO; FPG: 6.1-6.9 mmol/L) and impaired glucose tolerance [IGT: 2h-PCPG: 7.8-11.0 mmol/L]. Cox’s proportional hazard models adjusted for traditional risk factors were used to estimate the hazard ratio (HR) with 95% confidence interval (CI) of different glucose intolerance for outcomes of interest. Results: During a median follow-up of 15.8 (IQR, 10.7-16.5) years, 178 CVD (hard event including death, myocardial infarction and stroke=69) events occurred. Regarding FPG, only IFG-ADA was associated with significant higher risk of hard CVD in the fully adjusted model (HR, 1.73, 95% CI: 1.04-2.89). Moreover, newly diagnosed diabetes (FPG≥7 mmol/L) was an independent risk of CVD (2.11: 1.22-3.66). Focusing on 2h-PCPG, subjects with newly diagnosed diabetes (2h-PCPG ≥ 11.1 mmol/L) had moderately increased risk of hard coronary heart disease (2.02:0.91-4.47, P=0.08). The multivariate HRs (95% CI) associated with 1 SD increase in FPG and 2h-PCPG was 1.16 (1.01–1.33) and 1.19 (1.02–1.38) for CVD, respectively. Among population free of diabetes at baseline (n=270), IFG-ADA, IFG-WHO and IGT were significantly associated with incident diabetes in multivariate analysis (all HRs > 4, P< 0.001); significant associations were also found for FPG and 2h-PCPG as continuous variables (all HRs for 1-SD increase > 2, all P < 0.001). Conclusions: Among subjects with stable CVD, both FPG and 2h-PCPG as continuous variables was associated with higher risk of recurrent CVD. However, only IFG-ADA was independent predictor of hard CVD events. Also, newly diagnosed diabetes, using FPG criteria, was associated with a significant risk of CVD. IFG-ADA, IFG-WHO and IGT were all significant predictors of incident diabetes.
A Multilevel Mixed Effects Analysis of Informal Carers Health in Australia: The role of Community Participation, Social Support and Trust at Small Area level.
Authors: Mohanty Itismita , Niyonsenga Theo , Cochrane Tom , Rickwood Debra 
Published: April 2020

Abstract
Background: This study investigated the self-assessed mental and general health outcomes of informal carers in Australia. It evaluated the influence of carers’ personal social capital- a logically linked sequence of their social behaviour such as community participation, social support and trust in others- on their health outcomes while controlling for socio-demographic, physical activity level and other economic confounders. More importantly, the study estimated the magnitude of small local area (SA1) level variation along with individual level variation in informal carers’ health outcomes.Methods: The study used a multilevel mixed effects cross-sectional study using data from the Household Income and Labour Dynamics of Australia survey, wave 14 (2014). It included Australians aged 15 years and older that are surveyed in the year 2014. The sample consisted of 12,767 individuals and 5004 small local areas (SA1) in Australia. The outcome measures included- mental health, general health and physical functioning, domains of the Short Form 36 Questionnaire, a widely used multi-dimensional measure of health-related quality of life.Results: Informal carers suffered from poor mental (Beta = -0.587, p=0.003) and general health (Beta = -0.670, p=0.001) outcomes compared to non-carers in Australia. The health outcome measures exhibited significant variation across small areas (SA1s) in Australia, with 12-13% variation in general and mental health. However, within small local areas, differences at the individual level, accounted for most of the variation in health. Moreover, levels of community participation, personal social connection and trust, as perceived by individuals in the communities, had a positive influence on both mental and general health of carers and non-carers, and even more beneficial for carers compared to non-carers.Conclusion: It seems the positive influence of social capital for carers, helps them in coping with the negative impact of their caregiving on health outcomes. Findings suggested that some targeted community support programs for carers to build on their personal social cohesion and trust in their community could help in improving their poor health profiles. Moreover, improved informal carers’ health may help the health system in better managing their resources.
Clinical analysis and predictive factors associated with improved visual acuity of infectious endophthalmitis
Authors: Gao Zhao , Zhang Yunda , Gao Xiaohong , Zhang Ximei , Ma Tao , Li Gaiyun , Wang Jingjing , Yan Hua 
Published: April 2020

Abstract
Background: To describe the clinical characteristics and analyze the predictive factors associated with improved visual acuity of 359 patients with infectious endophthalmitis. Methods: This study retrospectively analyzed 359 eyes of 359 patients with infectious endophthalmitis from January 2014 to December 2018. The findings summarized some epidemiological characteristics of these patients, including age, sex, occupation, patient visit time, etiology, causative organisms, therapy and best-corrected visual acuity (BCVA). Multivariate logistic regression was performed to predict the relative factors of improved visual acuity (VA). Results: Overall, 283(78.83%) patients were male.The mean age was 48.0 ± 18.27 years. Ocular truma, especially the open globe injuries (246, 68.5%) was the most common etiology of infectious endophthalmitis in this study. The etiologies of infectious endophthalmitis were open globe injuries (68.5%), intraocular surgery (22.6%), cornea ulcer-associated causes (6.7%), and endogenous causes (2.2%). In the etiology classification and visual acuity improvement group, the statistically significant difference in factors such as age, sex, patient visit time, pre-therapy VA,etc. The average Logarithm of the Minimum Angle of Resolution (logMAR) BCVA on pre-therapy was 2.28 ± 0.60, and it had significantly improved to 1.67 ± 0.83 on post-therapy (P<0.05). Logistic regression analysis showed that visit time>7 day (P=0.034, OR=0.522, 95%CI: 0.286-0.953),pre-therapy VA≦logMAR 2.3(P=0.032 ,OR=1.809, 95%CI：1.052-3.110 ), etiology of PS (vs. PT; P=0.023, OR=2.100, 95%CI:1.109-3.974) and etiology of CA(vs. PT; P=0.005, OR=0.202, 95%CI:0.066-0.621) were significantly associated with improved VA after adjusting for possible confounding factors. Conclusion: Among the patients with infectious endophthalmitis, middle-aged males, especially farmers and workers, accounted for a large proportion. Open globe injuries was the main cause and gram-positive bacteria was the major causative organisms. The final visual outcomes seem to vary according to the type of endophthalmitis, but early treatment and good initial visual acuity are important factors for visual acuity improvement.
Characterization and transcriptome analysis of a dominant genic male sterile cotton mutant
Authors: Cheng Xinqi , Zhang Xinyu , Xue Fei , Zhu Shouhong , Li Yanjun , Zhu Qianhao , Liu Feng , Sun Jie 
Published: April 2020

Abstract
Background : Male sterility is an efficient trait for hybrid seed production and germplasm innovation. Until now, most studies on male sterility were on cytoplasmic and recessive genic sterility, with few on dominant genic male sterility, especially in cotton, due to lack of such mutant.Results : We discovered a natural male sterile (MS) Sea Island cotton ( G. barbadense ) mutant, Genetic analysis showed the mutation was caused by a dominant mutation in a single nuclear gene. Comparative cytological observation of anther sections from MS and WT uncovered cellular differences in anther at and after the tetrad stage of pollen mother cells (PMC). In the MS anthers, the outer wall of pollen grains was free of spinules, the tapetum was vacuolated and showed delayed degradation, consequently, no functional pollen grains. Comparison of transcriptomes from meiosis, tetrad, mononuclear and binuclear pollen, and pollen maturation stages identified 13,783 non-redundant differentially expressed genes (DEGs) between MS and WT. Based on the number of DEGs, analyses of enriched GO terms and KEGG pathways, it was evident that significant transcriptomic changes occurred at and after the tetrad stage, consistent with cytological observation, and that the major differences were on metabolism of starch, sucrose, ascorbate, aldarate, alanine, aspartate and glutamate, and biosynthesis of cutin, suberine and wax. WGCNA analysis identified five modules containing 920 genes highly related to anther development, especially the greenyellow module with 54 genes that was highly associated with PMC meiosis and tetrad formation. A NAC transcription factor ( Gh_D11G2469 ) was identified as a hub gene for this module, which warrants further functional characterization.Conclusions : We demonstrated that the MS trait was controlled by a single dominant nuclear gene and caused by delayed tapetum degradation at the tetrad stage. Comparative transcriptome analysis and gene network construction identified DEGs, enriched GO terms and metabolic pathways, and hub genes potentially associated with anther development and the MS trait, which will contribute to important ideas and basis of the experimental data related to the molecular mechanism of DGMS and the innovation of cotton germplasm resources.
Association between intestinal microbiota composition and tail-biting in pigs
Authors: Rabhi Nassima , Thibodeau Alexandre , Côté Jean-Charles , Devillers Nicolas , Laplante Benoit , Fravalo Philippe , Larivière-Gauthier Guillaume , Thériault William P. , Faucitano Luigi , Beauchamp Guy , Quessy Sylvain 
Published: April 2020

Abstract
Background: Tail-biting (TB) is a serious behavioral disorder in pigs. It is defined as a pig chewing the tail of another pig. It is an important challenge in swine production as it impacts the animal welfare, its health and the economics and safety of the pork meat supply chain. Some treatments have been proposed but have not proven optimal. Nutrition, feed type and composition, appears to be an important factor in TB behavior, perhaps by modulating the intestinal microbiota (IM). In humans, IM is increasingly recognized as a modulator of behavior. Our aim was to assess an association between TB behavior and IM in pigs through comparisons of IM in groups of biter or bitten pigs to the IM in a non-biter and non-bitten negative control group, and through comparisons of IM between the biter and bitten groups. Each group, composed of 12 pigs, was formed at the beginning of the growing/finishing phase based on a target behavior analysis centered on TB behavior for the biter group and a score of damages caused to the tail for the bitten group. Fecal and blood samples were collected from each pig during a TB episode, at time 0, t0, and after a TB episode, four weeks later, at time 1, t1. Serum cortisol level was determined by ELISA and used as an indicator of stress. The pig’s fecal microbiota was analyzed from DNA extracted from freshly collected fecal matter using amplicon sequencing of the V4 hypervariable region of the 16S rRNA gene. Results: Serum cortisol levels were significantly higher in either the biter or bitten pig groups compared to the negative control group ( p =0.02 and p =0.01, respectively). Interestingly, no significant difference was revealed between the biter and bitten groups. The microbiota alpha-diversity was not significantly different between all groups, biter, bitten and negative control. Analyses of beta-diversity, however, revealed a significant difference between either the biter or the bitten group in comparison to the negative control group in terms of structure and composition of the microbiota. Lactobacillus were significantly more abundant in the negative control group compared to the two other groups ( p =0.001). No significant difference was revealed between the biter and bitten groups. Quantitative real-time PCR (qPCR) confirmed that lactobacilli were more abundant in the negative control group. Conclusions: This study demonstrates that TB behavior is associated to the IM composition in pigs.
Availability, Price and Affordability of WHO Priority Maternal and Child Health Medicine in Public Health Facilities of Dessie, North-East Ethiopia
Authors: Hailu Abel Demerew , Mohammed Solomon Ahmed 
Published: April 2020

Abstract
Background: Access to health care is a fundamental human right and the provision of affordable, high quality and appropriate medicines for Maternal and child health is a vital component of a well-functioning health system. The study assessed the availability, price and affordability of WHO priority maternal and child medicines in public health facilities, Dessie, North – East Ethiopia.Methods: Retrospective cross-sectional study design was conducted in Dessie town from November 2018 to February 2019. A standard checklist adapted from Logistics Indicator Assessment Tool and WHO/HAI was used to collect data on the availability, affordability, and price of 45 priority life-saving medicines from eight public health centers and two public hospitals. Descriptive statistics (percent and median) were computed for availability and prices. Affordability was reported in terms of the daily wage of the lowest-paid unskilled government worker.Results: Twenty-two medicines were not completely managed. The overall availability of WHO priority maternal and child medicines was 34.02%. The mean numbers of stock outs was 3.9 and mean number of 128.9 days. The mean average point availability was 33.5 % and 7 medicines stock out on the days of assessment. From WHO priority maternal and child medicines, 4 (40%) of the products were unaffordable and 5 (55.5%) had higher price compared to international prices. Ceftriaxone 1gm, ceftriaxone 500mg and hydralazine 20mg injection requires wages of 6.58, 8.01, and 5.02 to cover specific maternal health problems respectively. Median price ratio of priority lifesaving maternal and child medicines in public health facility ranged from 0.65 to 3.19. Conclusions: The average mean period and point mean availability was very low. The availed products were encountered with high number of stock outs and unaffordable. Strict control of inventory is recommended to have steady supply of these essential medicines and improve quality of health service. Keywords: Availability, Affordability, Price, Medicines and Maternal and child.
Adaptation and preliminary psychometric properties of three self-stigma outcome measures for people living with dementia
Authors: Bhatt Jemini , Stoner Charlotte R , Scior Katrina , Charlesworth Georgina 
Published: April 2020

Abstract
Background: A diagnosis of dementia presents individuals with both social and psychological challenges but research on self-stigma in dementia has been largely confined to qualitative approaches due to a lack of robust outcome measures that assess change. The Stigma Impact Scale is the most commonly used measure of self-stigma in dementia but its suitability as a tool to assess change in a diverse UK population is unclear. Thus, the aim of this study was to identify, adapt and evaluate the acceptability and psychometric properties of self-stigma measures for people with dementia for use as measures of change.

Method: A four-stage approach was used to identify, adapt and test self-stigma measures in a UK population who had received a diagnosis of dementia: 1) psychometric outcome measures were extracted based on the evidence base of an anti-stigma intervention that guided the current work, 2) identified measures were assessed for psychometric quality according to Terwee criteria, 3) modifications were made for culture (UK) and condition (dementia rather than mental health) through stakeholder consultations (researchers in fields of dementia and stigma; experts by experience in living with, or caring for persons with dementia), and 4) modified measures were pilot tested in a small sample of people living with dementia (N=40) for acceptability, and preliminary psychometric properties (internal consistency, test-retest, concurrent and convergent validity).

Results: Seven measures were identified but most were of low quality (Terwee range: 0-4). Three measures were considered and modifiable by stakeholders. Pilot testing indicated data were normally distributed. Almost all measures demonstrated acceptable internal consistency (except the Stigma Stress Scale total and internalized shame subscale), test retest reliability, concurrent validity and convergent validity, with some exceptions.

Conclusion: The Secrecy subscale, Stigma Impact Scale and Stigma Stress Scale were acceptable for use in a UK population of people living with dementia. However, further psychometric analysis is required before such measures can be implemented in psychosocial research.
Short-Term Projection of COVID 19 Cases in Kenya using an Exponential Model
Authors: Kirichu Samuel Kiruri 
Published: April 2020

Abstract
Introduction: The COVID-19 disease has spread to over 200 countries and territories since the first case was recorded in Wuhan, China in December 2019. In Kenya, the first case of COVID-19 was recorded on 13th March 2020, since then over one hundred cases have been confirmed, and three deaths recorded as of 2nd April 2020. With the rapid changing situation, timely and reliable data is required for monitoring, planning and rapid decision making with an aim of reversing the already deteriorating situation (economic, health, learning among others) in the country. Methods: The study used the exponential model to project the expected daily cumulative cases in Kenya within the first 40 days. The study opted to do a short time prediction owing to the fact that the scenario is rapidly changing. Data used in the analysis was obtained from the daily updates by the Kenya Ministry of Health, and analysis was done using Stata Version 15 and MS Excel 2010. Results: The Case Fatality Rate on day 21 was estimated as 2.7% (95% CI 0.01 – 7.80), with varying daily estimates as expected. The model estimated that the 1,000 confirmed cases will be reached by 14th April 2020 while the 4,000 cases will be reached by 21st April 2020. The results indicate that it will take 33 days for Kenya to reach the 1,000 confirmed cases and 40 days to reach the 4,000 casesConclusion: Massive screening and contact tracing of all individuals who entered the country within 28 days prior to the mandatory screening should be planned and implemented immediately with an aim of increasing the chances of getting active cases, and possible transmission through such contacts. Continuous modeling of data is needed in order to cater for other factors which were not considered in this study such as the impact of mandatory quarantine, night curfews and suspension of international flights