bluuebunny/crossref_metadata_2025_split huggingface dataset:
Time-varying Discrimination Accuracy of Longitudinal Biomarkers for the Prediction of Mortality Compared to Assessment at Fixed Time Point in Severe Burns Patients
Authors: Yoon Jaechul , Kym Dohern , Hur Jun , Won Jae Hee , Yim Haejun , Cho Yong Suk , Chun Wook 
Published: July 2020

Abstract
Background: The distribution of biomarkers over time is considered as an indicator of disease progression and helps in the early detection of disease, thereby reducing disease-related mortality. The ability of biomarkers to predict outcomes has been evaluated using conventional cross-sectional methods. In this study, we investigated the prognostic performance of longitudinal biomarkers over time.Methods: Patients aged >18 years who were admitted to the burn intensive care unit within 24 h of a burn incident were enrolled. Information regarding longitudinal biomarkers, such as white blood cell; platelet count; lactate, creatinine, and total bilirubin levels; and prothrombin time (PT), were retrieved from a clinical database warehouse. Time-dependent receiver operating characteristic curves using cumulative/dynamic and incident/dynamic (ID) approaches were used to evaluate time-varying prognostic performance.Results: In total, 2259 patients were included in this retrospective study and divided into survival and non-survival groups. By determining the area under the curve using the ID approach, platelets showed the highest c-index [0.930 (0.919–0.941)] across all time points. On the other hand, the c-index of PT and creatinine levels was 0.862 (0.843–0.881) and 0.828 (0.809–0.848), respectively.Conclusions: Platelet count is the best prognostic marker. PT and creatinine levels also show good overall diagnostic ability. Although lactate is a strong predictor, it shows relatively poor prognostic performance in burns patients.
Sex differences in family planning knowledge, attitudes, and use in Uganda
Authors: Nuwasiima Afra , Watsemba Agnes , Eyapu Allan , Kaddu Peter , Loiseau Justin 
Published: July 2020

Abstract
Background
Literature is satiated with studies focusing on knowledge, attitude, and practices of family planning (FP) among the female population, conversely, the gaps in sex-disaggregated data on FP continue to exist. This study sought to report sex differences existing in FP knowledge, attitude, and use in Uganda.
Methods
This study uses data from a household survey that covered 16 districts in Uganda. Multi-stage cluster randomized sampling was employed for participant selection. Bivariate analysis for categorical data was conducted. Multilevel logistic regression model was applied to model the effects of socio-demographic characteristics on the uptake and unmet need of FP services.
Results
Data from 4,352 respondents in the ratios of 70% female and 30% of males were analyzed. The mean age was 28.7 SD (8.5) and was not significantly different between males and females. More male respondents had secondary or higher level of education (44%) than females (36%). Low percent (16%) of females reported having no child compared to 38% in males. Knowledge of at least one modern FP method was high, but small significant differences were revealed between males (96%) and females (98%). Significant differences were further seen in specific FP methods. A small proportion agreed that community health workers (CHWs) were always available to offer FP services and no sex variations were observed. The proportion of married females using a modern FP method was 39% compared to 45% for married males. Condom use as a dual protection method potentially overstated FP use among males by 16%. Significant differences were revealed in total unmet need between males (19%) and females (24%). Males, young adults, the more educated and those in marriage or active relationship were more likely to use modern FP services.
Conclusions
Our study found significant sex differences in knowledge, attitudes and use of FP services. Initiatives to create demand for FP services for both males and females should study sex differences in FP knowledge, attitudes, and methods choice. Findings also revealed low involvement of CHWs in delivery of FP services to both males and females. More research is needed on how CHWs can be leveraged to reach both males and females with appropriate FP services and follow up to improve uptake and retention
A Novel Approach to Minimally Invasive Hysterectomy Without the Use of a Uterine Manipulator; Kamran’s TLH.
Authors: Gendia Ahmed , Waseem Kamran M. , Donlon Noel E 
Published: July 2020

Abstract
Background: Hysterectomy remains one of the most common major gynaecological procedure, with total laparoscopic hysterectomy (TLH) now the established as the technique of choice over conventional open approaches. This approach depends on the use of a uterine manipulator to facilitate uterine retraction and colpotomy. This study describes a novel approach in performing total laparoscopic hysterectomy without the use of uterine manipulator or vaginal tubes and reports the intra- and post-operative outcome of this technique.Methods: A single centre retrospective analysis of patients who underwent TLH without uterine manipulator or vaginal tube “Kamran’s TLH” for benign conditions was performed from January 2017 to October 2019. Data collected included patients demographics, intraoperative finding and postoperative course.Results: A total of eighty six hysterectomies were performed utilizing the Kamran’s TLH (KTLH) approach. Mean age was 52.2 (±11) years old and BMI was 28.2(±7). TLH with bilateral salpingo-oophorectomy was performed in 63(73.3%) patients and TLH with preservation of ovaries in 23 (26.7%) patients. Mean operative time was 64.7(±27.9) minutes and estimated bloods loss was 46.2(±54.6) ml. No intraoperative complications were recorded and there was no conversion to open surgery. Only one patient required readmission and surgery for vaginal vault dehiscence during their postoperative course.Conclusion: Uterine manipulator is a key component in performing laparoscopic hysterectomy. However, our approach demonstrated that TLH can be safely performed without the use of any uterine or vaginal manipulation.
Gradual Lengthening of the Ulna for the Treatment of Forearm Deformities in Children with Hereditary Multiple Exostosis: A Retrospective Study
Authors: Zheng Chao , Han Huanli , Cao Yujiang 
Published: July 2020

Abstract
Objectives: Hereditary multiple exostosis (HME) often involves forearm deformities. The aim of this study was to present the clinical results of 37 children who underwent the surgical procedure of ulnar lengthening with two different types of single arm external fixators.Methods: We evaluated 37 children with forearm deformities caused by HME treated in our hospital from January 2008 to July 2019. The surgical procedures included resection of exostosis, osteotomy of the ulna, and gradual lengthening of the ulna with a single arm external fixator. According to the type of external fixator they received, the children were divided into two groups: group A received monorail fixators, and group B received multi-joint fixators. Radiographic and functional parameters were assessed. Complications were recorded.Results: All patients were followed up for an average of 4.6 years (3.0 to 6.5). In both group A and group B, the ulna shortening (US), radial articular angle (RAA), carpal slip (CS), elbow flexion, forearm pronation, supination, and Mayo Elbow Performance Score (MEPS) values improved significantly from preoperatively to postoperatively (p < 0.05). However, ulnar deviation was observed in 4 cases in group B and no cases in group A. According to logistic regression, the difference was only related to age (p<0.05) and the type of external fixator (p<0.05). Conclusions: Ulnar lengthening with unilateral external fixation is a safe and effective procedure for the treatment of HME. Regarding complications, deviation of the ulna axis was more likely to occur in older children with multi-joint external fixators.
Association of Ultra-processed Food Consumption With Cardiovascular Mortality in the US Population: Long-term Results From a Large Prospective Multicenter Study
Authors: Zhong Guo-Chao , Gu Hai-Tao , Peng Yang , Wang Kang , Wu You-Qi-Le , Hu Tian-Yang , Jing Feng-Chuang , Hao Fa-Bao 
Published: July 2020

Abstract
Background
Ultra-processed foods have now become dominant in the global food system. Whether their consumption is associated with cardiovascular mortality remains controversial. Moreover, data on ultra-processed foods and cardiovascular outcomes are scarce in the US population. We aimed to examine the association of ultra-processed food consumption with cardiovascular mortality in a US population.
Methods
A population-based cohort of 91891 participants was identified from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Dietary data were collected through a validated 137-item food frequency questionnaire. Ultra-processed foods were defined by the NOVA classification. Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for cardiovascular mortality. Restricted cubic spline regression was used to test nonlinearity. Subgroup analyses were conducted to identify the potential effect modifiers.
Results
After an average follow-up of 13.5 years (1236049.2 person-years), 5490 cardiovascular deaths were documented, including 3985 heart disease deaths and 1126 cerebrovascular deaths. In the fully adjusted model, participants in the highest vs. the lowest quintiles of ultra-processed food consumption had higher risks of death from cardiovascular disease (HRquintile 5 vs. 1, 1.52; 95% CI, 1.39–1.67) and heart disease (HRquintile 5 vs. 1, 1.70; 95% CI, 1.52–1.89) but not cerebrovascular disease (HRquintile 5 vs. 1, 1.00; 95% CI, 0.80–1.23). A nonlinear dose–response pattern was observed for overall cardiovascular and heart disease mortality (all Pnonlinearity<0.05), with a threshold effect observed at ultra-processed food consumption of 2.5 servings/day and 2.4 servings/day, respectively; below the thresholds, no significant associations were observed for these two outcomes. Subgroup analyses showed that the increased risks of mortality from ultra-processed foods were significantly higher in women than in men (all Pinteraction<0.05).
Conclusions
High consumption of ultra-processed foods is associated with increased risks of overall cardiovascular and heart disease mortality. These harmful associations may be more pronounced in women. Our findings are needed to be confirmed in other populations and settings.
Two Cases of Continued Progression of Chronic Ocular Graft-Versus-host Disease Without Concurrent Systemic Comorbidities Treated by Amniotic Membrane Transplantation.
Authors: Ikarashi Hideto , Aketa Naohiko , Shimizu Eisuke , Takano Yoji , Fujishima Hiroshi , Kawakita Tetsuya , Uchino Yuichi , Matsumoto Yukihiro , Ogawa Junko , Tsubota Kazuo , Ogawa Yoko 
Published: July 2020

Abstract
BackgroundChronic ocular graft-versus-host disease (oGVHD) is an ocular comorbidity of graft-versus-host disease (GVHD) that usually occurs concurrently with systemic manifestations. Failure to detect and treat oGVHD in its early stages may lead to progression of ocular signs and symptoms leading to oGVHD that is refractory to conventional treatment. Case presentationWe report the clinical course of a 19-year-old male and a 59-year-old female with severe and progressive chronic oGVHD without concurrent systemic signs of chronic graft-versus-host disease (cGVHD). Although their systemic conditions had been stable, both suffered from severe oGVHD and were referred to our clinic. Both cases exhibited marked improvement in conjunctival inflammation and fibrotic changes after amniotic membrane transplantation (AMT). Both cases underwent keratoplasty eventually to stabilize ocular surface conditions and to improve visual function.Conclusions We reported the clinical outcomes of 2 cases of chronic oGVHD without concurrent systemic comorbidities that were treated with AMT. The clinician should be aware that cGVHD may persist in target organs even in the absence of concurrent systemic comorbidities following seemingly successful systemic treatment. A multidisciplinary team approach is essential in the early detection and therapeutic intervention for chronic oGVHD.
A Profession in Danger: Stakeholders’ Perspectives on Supporting The Pharmacy Profession in Lebanon
Authors: Hijazi Mohamad Ali , Bou-Karroum Karen , Kassas Sara , Alameddine Mohamad 
Published: July 2020

Abstract
Background: Lebanon boosts one of the highest pharmacist to population ratios globally (20.3/10,000). Yet, workforce analyses elicited serious concerns with the distribution, practice environments and regulation of Lebanese pharmacists. Recent workforce data shows that the profession has been majorly destabilized with hundreds of pharmacists closing their pharmacies or losing their employment. Proper planning for the future of the pharmacy profession in Lebanon necessitate a deeper understanding of the current challenges and the necessary policy and practice recommendations. The aim of this study is to examine stakeholders’ perspectives on the current pharmacist workforce challenges and the necessary measures to support the profession.Methods: The research team carried out a series of semi-structured interviews with twenty-one key stakeholders within the pharmacy profession in Lebanon. We categorized stakeholders according to their experience as policy makers, practitioners, academicians, and media experts. The interview guide included questions about workforce trends, labor market challenges and recommendations for improvement. Interviews were transcribed and analyzed thematically.Results: Four major themes emerged from this study: the oversupply of pharmacists in Lebanon, the demand supply imbalance, poor regulation of the pharmacy practice, and the difficult practice environment. There was a consensus among interviewees that the oversupply of pharmacists is due to the poor workforce planning and weak regulatory framework, combined with the easy integration of foreign-trained pharmacists into the labor market. The lack of coordination between the educational and practice sectors is further widening the demand-supply gap. Interviewees further revealed that the regulatory policies on pharmacy practice were outdated and/or weakly enforced which increases the risk of unethical practices and erodes the image of pharmacists in the society. With respect to the practice environment, there is an ongoing struggle by Lebanese pharmacists to maintain profitability and exercise their full scope of practice.Conclusion: The poor pharmacy workforce planning and regulation is significantly weakening the pharmacy profession in Lebanon. A concerted effort between the various stakeholders is necessary to enhance workforce planning, regulate supply, optimize the integration of pharmacists into work sectors of need, and to enhance the financial and professional wellbeing of pharmacists in Lebanon.
Evaluation of a Multidisciplinary Lipid Clinic to Improve the Care of Individuals With Severe Lipid Conditions: A Re-aim Framework Analysis
Authors: Jones Laney K , McMinn Megan , Kann David , Lesko Michael , Sturm Amy C , Walters Nicole , Chen Nan , Fry Kerrianne , Brownson Ross C , Gidding Samuel S , Williams Marc S , Rahm Alanna Kulchak 
Published: July 2020

Abstract
Background . Individuals with complex dyslipidemia, or those with medication intolerance, are often difficult to manage in primary care. They require the additional attention, expertise, and compliance counseling that occurs in multidisciplinary lipid clinics (MDLCs). We conducted a program evaluation of the first year of a newly implemented MDLC utilizing the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to provide empirical data not only on program effectiveness, but also on components important to local sustainability and future generalizability. Methods . The purpose of the MDLC is to increase uptake of guideline-based care for lipid conditions. Established in 2019, the MDLC provides care via a centralized clinic location within the healthcare system. Primary care providers and cardiologists were invited to refer individuals with lipid conditions. Using a pre/post study design, we evaluated implementation outcomes from the MDLC using the RE-AIM framework. Results . In 2019, 420 referrals were received, and 83 patients were seen in the MDLC (reach). In the lipid subgroups, we found improved diagnosis of condition, increase in prescribing of more aggressive lipid-lowering therapies, high rates of medication prior authorization approvals, and significant reductions in lipid levels (effectiveness). Of the 796 active primary care and cardiology providers in 2019, only 18% (146/796) referred patients to the MDLC (adoption). At the patient-level, 50% (41/82) of patients had at least one follow-up visit with the MDLC, with 12% (10/82) having two or more follow-up visits in 2019 (implementation). At the provider-level, an average of 35 patient referrals per month were made from primary care providers or cardiologists (SD 12) (implementation). During monthly meetings of the operational team, the decision to transition from in-person follow-up to telehealth appointments was implemented to increase capacity and sustain the clinic (maintenance). Conclusions . We found improved diagnosis and risk stratification, increase in guideline-recommended treatments prescribed and clinically significant lowering of lipid levels. Attention to factors including multiple points of contact, duration of visits, extraneous comorbidities and social support could aid in better understanding the success of patient outcomes.
Hypertension Care Cascade at a Large Urban HIV Clinic in Uganda: A Mixed Methods Study Using the Capability, Opportunity, Motivation for Behavior Change (COM-B) Model
Authors: Muddu Martin , Ssinabulya Isaac , Kigozi Simon P. , Ssennyonjo Rebecca , Ayebare Florence , Katwesigye Rodgers , Mbuliro Mary , Kimera Isaac , Longenecker Chris T. , Kamya Moses R. , Schwartz Jeremy I. , Katahoire Anne R. , Semitala Fred C. 
Published: July 2020

Abstract
Background: Persons Living with HIV (PLHIV) receiving antiretroviral therapy (ART) have a high prevalence of hypertension (HTN) and increased risk of mortality from cardiovascular diseases. HTN and HIV care integration is recommended in Uganda, though its implementation has lagged. In this study, we sought to analyze the HTN and HIV care cascades and explore barriers and facilitators of HTN/HIV integration within a large HIV clinic in urban Uganda.Methods: We conducted an explanatory sequential mixed methods study at Mulago ISS clinic in Kampala, Uganda. We determined proportions of patients in HTN and HIV care cascade steps of: Screened, Diagnosed, Initiated on treatment, Retained, and Controlled. Guided by the Capability, Opportunity, Motivation and Behavior (COM-B) model, we then conducted semi-structured interviews and focus group discussions with healthcare providers and hypertensive PLHIV (n=45). We coded the qualitative data deductively and analyzed the data thematically categorizing them as themes that influenced HTN care positively or negatively. These denoted barriers and facilitators, respectively.Results: Of 15,953 adult PLHIV, 99.1% were initiated on ART, 89.5% were retained in care and 98.0% achieved control (viral suppression) at one year. All 15,953 (100%) participants were screened for HTN, of whom 24.3% had HTN. HTN treatment initiation, one-year retention, and control were low at 1.0%, 15.4% and 5.0%, respectively. Barriers and facilitators of HTN/HIV integration appeared in all three COM-B domains. Barriers included low patient knowledge of HTN complications, less priority by patients for HTN treatment compared to ART, sub-optimal provider knowledge of HTN treatment, lack of HTN treatment protocols, inadequate supply of anti-hypertensive medicines and lack of HTN care performance targets. Facilitators included patients’ and providers’ interest in HTN/HIV integration, patients’ interest in PLHIV peers support, providers’ knowledge and skills for HTN screening, optimal ART adherence counseling, and availability of automated BP machines. Conclusion: The prevalence of HTN among PLHIV is high, but the HTN care cascade is sub-optimal in this successful HIV clinic. To close these gaps, models of integrated HTN/HIV care are urgently needed. These findings provide a basis for designing contextually appropriate interventions for HTN/HIV integration in Uganda and other low and middle-income countries.
Recovery of phosphorus from stored urine using continuous flow reactor in decentralised level operations
Authors: Ramesh Sakthivel S. , Azizurrahaman Md , Ganesh Prabhu V. , Chariar V. M. 
Published: July 2020

Abstract
Past studies have shown that phosphate recovery in the form of struvite is relatively a simple process, which can be achieved by adding a magnesium source in stored urine. However, struvite recovery process at a decentralised level becomes uneconomical due to high input cost of magnesium salts and operational cost. While use of cheaper alternative magnesium sources such as bittern, low-grade MgO and wood ash could lead to partial cost reduction, it is also important to reduce the overall operational costs to make struvite recovery process economically viable and sustainable. In this study, a continuous flow reactor was developed for low-cost struvite recovery from stored urine at decentralised community scale operations. Our study revealed that over 81.2% of phosphate present in urine can be recovered in the form of struvite. Comparison of results from stirred and unstirred experiments shows that higher recovery efficiency is obtained due to minimal loss of fines. Operation and financial assessment of the process shows that struvite recovery can be profitable due to continuous operation of the reactor requiring minimal process control and manpower requirement.
Bacterial community evolution along full-scale municipal wastewater treatment processes
Authors: Zhang Lei , Cheng Yanan , Qian Chang , Lu Wenxuan 
Published: July 2020

AbstractSewage pollution is a major threat to public health because sewage is always accompanied by pathogens. Generally, wastewater treatment plants (WWTP) receive and treat sewage to control pathogenic risks and improve environmental health. This study investigated the changes in the bacterial community over the course of treatment by a WWTP. Illumina MiSeq high-throughput sequencing was performed to characterize the bacterial communities in the WWTP. This study found that potential pathogens in the WWTP, especially the genera Arcobacter and Acinetobacter, were greatly reduced. In addition, high chemical oxygen demand levels provided excessive growth substrates for the genera Hyphomicrobium and Rhodoplanes, the abundance of which could exceed autotrophic bacteria, increasing the ammonium removal. According to the network analysis, the bacterial assemblage was not randomly arranged in the WWTP, and various defined processes led to higher intra-phylum (such as Proteobacteria) coexistence than expected. Moreover, the metabolic functions of bacterial communities significantly improved in the WWTP compared with the influent. Together, the data in this study emphasize the need to understand the bacterial community of WWTPs better. When analyzing the risks of WWTP drainage systems to the environment and human health, these data should be considered.