bluuebunny/crossref_metadata_2025_split huggingface dataset:
Establishment of a communication environment supporting low-health literacy in the Hungarian community pharmacies: the introduction of a methodological recommendation: a before–after study
Authors: Szilvay András , Somogyi Orsolya , Meskó Attiláné , Szűcs-Polonkai Kata , Zelkó Romána , Hankó Balázs 
Published: December 2020

ObjectivesThe research aimed to support the effectiveness and necessity of the communication training and methodology introduced in the postgraduate pharmacy training and community pharmacy practice in Hungary.DesignTwo cross-sectional questionnaire surveys before and after the introduction of a methodological recommendation.Setting69 Hungarian community pharmacies.ParticipantsThe study included 333 pharmacists and pharmacy technicians from community pharmacies, 890 and 847 patients (over 18 who bought their prescribed medication) at the beginning and the end of the project, respectively.InterventionsA 3-day postgraduate health literacy-focused communication training followed by the ‘Train the trainer’ teaching method at pharmacies, then the introduction of the learnt methodology using uniform information materials and a communication checklist.Primary and secondary outcome measuresPrimary: total score of the staff and patient questionnaires and the change in score due to the intervention, total and for each question. Secondary: the differences between sexes, age groups, marital statuses, educational attainments and types of settlement.ResultsThe mean score of the preintervention patient group was 64.07% which increased to 72.72% by the end of the project (p<0.001). For staff, the mean score of the initial questionnaires was 74.47%, and that of the final questionnaires was 85.21% (p<0.001). According to both groups, professionals made the most progress in encouraging patients to ask questions.ConclusionsIt can be stated that the presented methodology can be used to develop the communication skills of a large number of professionals in a short time, using a small number of instructors, so it is worthwhile to introduce this methodology as part of compulsory postgraduate training.
Prevalence and determinants of incomplete or not at all vaccination among children aged 12–36 months in Dabat and Gondar districts, northwest of Ethiopia: findings from the primary health care project
Authors: Atnafu Asmamaw , Andargie Gashaw , Yitayal Mezgebu , Ayele Tadesse Awoke , Alemu Kassahun , Demissie Getu Debalkie , Wolde Haileab Fekadu , Dellie Endalkachew , Azale Telake , Geremew Bisrat Misganaw , Kebede Adane , Teshome Destaw Fetene , Gebremedhin Tsegaye , Derso Terefe 
Published: December 2020

ObjectiveEthiopia is one of the Africa’s signatory countries for implementation of the primary healthcare strategy including immunisation. In Ethiopia, however, 16% of child death is due to vaccine-preventable disease. Thus, this study aimed to assess the prevalence and determinants of incomplete or not at all vaccination among children aged 12–36 months in Dabat and Gondar districts, Northwest Ethiopia.Study designThe study is community-based cross-sectional study.Study settingDabat and Gondar Zuria districts, Northwest Ethiopia.ParticipantsMothers/caregivers with children aged 12–36 months were enrolled in the study. Participants were randomly selected through systematic sampling and a total of 603 participants were included in the analysis.MethodsA binary logistic regression analysis was done. In the multivariable logistic regression analysis, a p value of <0.05 and adjusted OR (AOR) with 95% CI were used to identify statistically associated factors with incomplete or not at all vaccination.OutcomesIncomplete or not at all vaccination.ResultsThe prevalence of incomplete or not at all vaccinated children was 23.10% (95% CI 16.50 to 29.70). The multivariable analysis revealed that the odds of incomplete or not at all vaccination were higher among mothers who had no antenatal care (ANC) visit (AOR: 1.81, 95% CI 1.21 to 4.03) and no postnatal care (PNC) visit (AOR=1.52, 95% CI 1.05 to 2.25).ConclusionsIn the study area, nearly one-fourth of children are incompletely or not at all vaccinated. Our finding suggests that ANC and PNC visits are key determinants of incomplete or not at all vaccination. Thus, in low-resource settings like Ethiopia, the health system approaches to improved ANC and PNC services should be intensified with more effective advice on child immunisation to reduce vaccine preventable disease.
Needlestick and sharps injuries in an Indonesian tertiary teaching hospital from 2014 to 2017: a cohort study
Authors: Yunihastuti Evy , Ratih Dewi Mira , Aisyah Matdoan Rifkiah , Hidayah Ainum Jhariah , Widhani Alvina , Sulaiman Andri Sanityoso , Karjadi Teguh Harjono , Soejono Czeresna Heriawan 
Published: December 2020

ObjectiveNeedlestick and sharps injuries among healthcare workers (HCWs) pose significant occupational health problems. We aim to provide incidence and other epidemiological aspects of needlestick and sharp injuries (NSSIs) among HCWs in a tertiary teaching hospital in Indonesia, to inform the evaluation of NSSIs prevention programme.MethodsA cohort study was conducted at Cipto Mangunkusumo Hospital in Jakarta. We analysed data of the sharps injury programme at the hospital between January 2014 and December 2017. Incidence of NSSIs was calculated per 1000 person-years (1000-PY).ResultsOver the 4-year period, a total of 286 NSSIs were reported. The mean NSSIs incidence rate for 4 years was 13.3/1000-PY, peaking in 2015 (15.5/1000-PY) then decreasing afterward. Most NSSIs were experienced by nurses (42.7%), but the highest incidence was among midwives (18.9/1000-PY), followed by nurses, medical students and medical doctors (15.2/1000-PY, 12.6/1000-PY and 11.8/1000-PY, respectively). The devices causing the highest proportion of NSSIs were hollow-bore needles (66.8%), followed by suture needles (14.3%) and solid needles (10.8%). 9.4% of NSSIs were related to insulin pen injection. Of all the incidents, 31.3% occurred during surgical procedures, 25.9% during blood collections, 14.3% during administering injection of drugs and 13.3% during waste cleaning.ConclusionIn conclusion, this study showed varied incidences of NSSI among different occupations, with the highest among midwives and nurses. Many unsafe work practices still continue, which is of utmost concern. We suggest opportunities for prevention including training and cultivating safer workplace practices.
Which factors should be included in triage? An online survey of the attitudes of the UK general public to pandemic triage dilemmas
Authors: Wilkinson Dominic , Zohny Hazem , Kappes Andreas , Sinnott-Armstrong Walter , Savulescu Julian 
Published: December 2020

ObjectiveAs cases of COVID-19 infections surge, concerns have renewed about intensive care units (ICUs) being overwhelmed and the need for specific triage protocols over winter. This study aimed to help inform triage guidance by exploring the views of lay people about factors to include in triage decisions.Design, setting and participantsOnline survey between 29th of May and 22nd of June 2020 based on hypothetical triage dilemmas. Participants recruited from existing market research panels, representative of the UK general population. Scenarios were presented in which a single ventilator is available, and two patients require ICU admission and ventilation. Patients differed in one of: chance of survival, life expectancy, age, expected length of treatment, disability and degree of frailty. Respondents were given the option of choosing one patient to treat or tossing a coin to decide.ResultsSeven hundred and sixty-three participated. A majority of respondents prioritised patients who would have a higher chance of survival (72%–93%), longer life expectancy (78%–83%), required shorter duration of treatment (88%–94%), were younger (71%–79%) or had a lesser degree of frailty (60%–69%, all p<0.001). Where there was a small difference between two patients, a larger proportion elected to toss a coin to decide which patient to treat. A majority (58%–86%) were prepared to withdraw treatment from a patient in intensive care who had a lower chance of survival than another patient currently presenting with COVID-19. Respondents also indicated a willingness to give higher priority to healthcare workers and to patients with young children.ConclusionMembers of the UK general public potentially support a broadly utilitarian approach to ICU triage in the face of overwhelming need. Survey respondents endorsed the relevance of patient factors currently included in triage guidance, but also factors not currently included. They supported the permissibility of reallocating treatment in a pandemic.
Occupation and risk of severe COVID-19: prospective cohort study of 120 075 UK Biobank participants
Authors: Mutambudzi Miriam , Niedzwiedz Claire , Macdonald Ewan Beaton , Leyland Alastair , Mair Frances , Anderson Jana , Celis-Morales Carlos , Cleland John , Forbes John , Gill Jason , Hastie Claire , Ho Frederick , Jani Bhautesh , Mackay Daniel F , Nicholl Barbara , O'Donnell Catherine , Sattar Naveed , Welsh Paul , Pell Jill P , Katikireddi Srinivasa Vittal , Demou Evangelia 
Published: December 2020

ObjectivesTo investigate severe COVID-19 risk by occupational group.MethodsBaseline UK Biobank data (2006–10) for England were linked to SARS-CoV-2 test results from Public Health England (16 March to 26 July 2020). Included participants were employed or self-employed at baseline, alive and aged <65 years in 2020. Poisson regression models were adjusted sequentially for baseline demographic, socioeconomic, work-related, health, and lifestyle-related risk factors to assess risk ratios (RRs) for testing positive in hospital or death due to COVID-19 by three occupational classification schemes (including Standard Occupation Classification (SOC) 2000).ResultsOf 120 075 participants, 271 had severe COVID-19. Relative to non-essential workers, healthcare workers (RR 7.43, 95% CI 5.52 to 10.00), social and education workers (RR 1.84, 95% CI 1.21 to 2.82) and other essential workers (RR 1.60, 95% CI 1.05 to 2.45) had a higher risk of severe COVID-19. Using more detailed groupings, medical support staff (RR 8.70, 95% CI 4.87 to 15.55), social care (RR 2.46, 95% CI 1.47 to 4.14) and transport workers (RR 2.20, 95% CI 1.21 to 4.00) had the highest risk within the broader groups. Compared with white non-essential workers, non-white non-essential workers had a higher risk (RR 3.27, 95% CI 1.90 to 5.62) and non-white essential workers had the highest risk (RR 8.34, 95% CI 5.17 to 13.47). Using SOC 2000 major groups, associate professional and technical occupations, personal service occupations and plant and machine operatives had a higher risk, compared with managers and senior officials.ConclusionsEssential workers have a higher risk of severe COVID-19. These findings underscore the need for national and organisational policies and practices that protect and support workers with an elevated risk of severe COVID-19.
CO2combining power and outcomes in patients with acute ischaemic stroke or transient ischaemic attack
Authors: Wang Anxin , Tian Xue , Gu Hongqiu , Zuo Yingting , Meng Xia , Lv Wei , Li Hao , Wang Yongjun 
Published: December 2020

Background and purposeThe clinical significance of carbon dioxide combining power (CO2CP) in ischaemic cerebrovascular disease is not well established, and the role of CO2CP in the prognosis of acute ischaemic stroke (AIS) or transient ischaemic attack (TIA) has not been reported. The objective of the study was to investigate the associations between CO2CP and clinical outcomes in patients with AIS or TIA.MethodsData were derived from the China National Stroke Registry III. Patients were classified into five groups by quintiles of CO2CP levels and three groups according to the normal range of CO2CP (23–29 mmol/L). Multivariable Cox and logistic regressions were adopted to explore the associations of CO2CP levels with all-cause death and poor functional outcomes (modified Rankin Scale (mRS) 3–6/2–6) at 3 months and 1 year.ResultsAmong 9531 patients included in the study, the median (IQR) CO2CP was 24.9 (23.0–27.0) mmol/L. After adjustment for potential confounders, patients in the first CO2CP quintile (21.1–23.3 mmol/L) had higher risk of all-cause death and poor functional outcomes (mRS score of 3–6/2–6) (HR or OR with 95% CI 2.37 (1.32 to 4.25), 1.49 (1.20 to 1.83) and 1.21 (1.03 to 1.42), respectively) compared with those in the fourth quintile. Similar results were found for outcomes at 1 year. Furthermore, all associations were also significant when CO2CP was <23 mmol/L compared with CO2CP of 23–29 mmol/L.ConclusionsDecreased CO2CP was associated with high risk of all-cause death and poor functional outcomes in patients with AIS or TIA.
Frailty subtypes and recovery in older survivors of acute respiratory failure: a pilot study
Authors: Baldwin Matthew R , Pollack Lauren R , Friedman Richard A , Norris Simone P , Javaid Azka , O'Donnell Max R , Cummings Matthew J , Needham Dale M , Colantuoni Elizabeth , Maurer Mathew S , Lederer David J 
Published: December 2020

BackgroundIdentifying subtypes of acute respiratory failure survivors may facilitate patient selection for post-intensive care unit (ICU) follow-up clinics and trials.MethodsWe conducted a single-centre prospective cohort study of 185 acute respiratory failure survivors, aged
≥
65 years. We applied latent class modelling to identify frailty subtypes using frailty phenotype and cognitive impairment measurements made during the week before hospital discharge. We used Fine-Gray competing risks survival regression to test associations between frailty subtypes and recovery, defined as returning to a basic Activities of Daily Living disability count less than or equal to the pre-hospitalisation count within 6 months. We characterised subtypes by pre-ICU frailty (Clinical Frailty Scale score
≥
5), the post-ICU frailty phenotype, and serum inflammatory cytokines, hormones and exosome proteomics during the week before hospital discharge.ResultsWe identified five frailty subtypes. The recovery rate decreased 49% across each subtype independent of age, sex, pre-existing disability, comorbidity and Acute Physiology and Chronic Health Evaluation II score (recovery rate ratio: 0.51, 95% CI 0.41 to 0.63). Post-ICU frailty phenotype prevalence increased across subtypes, but pre-ICU frailty prevalence did not. In the subtype with the slowest recovery, all had cognitive impairment. The three subtypes with the slowest recovery had higher interleukin-6 levels (p=0.03) and a higher prevalence of
≥
2 deficiencies in insulin growth factor-1, dehydroepiandrostersone-sulfate, or free-testosterone (p=0.02). Exosome proteomics revealed impaired innate immunity in subtypes with slower recovery.ConclusionsFrailty subtypes varied by prehospitalisation frailty and cognitive impairment at hospital discharge. Subtypes with the slowest recovery were similarly characterised by greater systemic inflammation and more anabolic hormone deficiencies at hospital discharge.
CD4+T cells in ageing-associated interstitial lung abnormalities show evidence of pro-inflammatory phenotypic and functional profile
Authors: Machahua Carlos , Buendia-Roldan Ivette , Ocaña-Guzman Ranferi , Molina-Molina María , Pardo Annie , Chavez-Galan Leslie , Selman Moises 
Published: December 2020

BackgroundInterstitial lung abnormalities (ILA) occur in around 10% of subjects over 60 years, and are associated with a higher rate of all-cause mortality. The pathogenic mechanisms are unclear, and the putative contribution of alterations in the immune response has not been explored. Normal ageing is associated with immune deficiencies, including Naïve T-cell decrease and greater expression of the proliferative-limiting, co-inhibitory receptor killer-cell lectin-like receptor G1 (KLRG1).ObjectiveTo evaluate the frequency and activation state of different T-cell subpopulations in ILA subjects.MethodsPeripheral blood mononuclear cells were obtained from 15 individuals with ILA, 21 age-matched controls and 28 healthy young subjects. T-cells phenotype was characterised by flow cytometry, and proliferation and activation by stimulation with anti-CD3/anti-CD28 or phorbol myristate acetate/ionomycin; KLRG1 isoforms were evaluated by western blot and cytokines were quantified by ELISA and Multiplex.ResultsA significant increase of Naïve CD4+T cells together with a decrease of central and effector memory CD4+T cells was observed in ILA compared with age-matched controls. CD4+T cells from ILA subjects exhibited greater basal proliferation, which raised after anti-CD3/anti-CD28 stimulation. Additionally, a significant increase in the levels of interleukin-6 and interferon gamma was observed in isolated CD4+T cells and plasma of ILA subjects. They also displayed fewer KLRG1+/CD4+T cells with an increase of circulating E-cadherin, the ligand of KLRG1+. No changes were observed with CD8+T cell subsets.ConclusionCD4+T cells from ILA subjects are highly proliferative and show an excessive functional activity, likely related to the loss of KLRG1 expression, which may contribute to an inflammatory state and the development of ILA.
Quality of dying and death in patients with interstitial lung disease compared with lung cancer: an observational study
Authors: Koyauchi Takafumi , Suzuki Yuzo , Sato Kazuki , Hozumi Hironao , Karayama Masato , Furuhashi Kazuki , Fujisawa Tomoyuki , Enomoto Noriyuki , Nakamura Yutaro , Inui Naoki , Yokomura Koshi , Imokawa Shiro , Nakamura Hidenori , Morita Tatsuya , Suda Takafumi 
Published: December 2020

BackgroundThere is limited knowledge regarding the quality of dying and death (QODD) and end-of-life interventions in patients with interstitial lung disease (ILD). Hence, differences in QODD and end-of-life interventions between patients with ILD and those with lung cancer (LC) remain poorly understood.MethodsThe primary aim of this study was to explore the differences in QODD and end-of-life interventions among patients dying with ILD versus those dying with LC. We performed a mail survey to quantify the QODD of a bereaved family’s perspective using the Good Death Inventory (GDI) score. Moreover, we examined the end-of-life interventions by medical chart review.ResultsOf 361 consecutive patients analysed for end-of-life interventions, 167 patients whose bereaved families completed questionnaires were analysed for QODD. Patients with ILD had lower GDI scores for QODD than those with LC (p=0.04), particularly in domains related to ‘physical and psychological distress relief’ and ‘prognosis awareness and participation in decision making’ (p=0.02, respectively). In end-of-life interventions, patients with ILD were less likely to receive specialised palliative care services (8.5% vs 54.3%; p<0.001) and opioids (58.2% vs 73.4%; p=0.003). Additionally, lower frequencies of participation of patients with ILD in end-of-life discussion were also observed (40.8% vs 62.4%; p=0.007).ConclusionPatients with ILD had lower QODD and poorer access to palliative care and decision making than those with LC. Additional efforts to improve QODD in patients with ILD, particularly in symptom relief and decision-making processes, are urgently warranted.
Unusual case of splenic haemangiosarcoma with suspected scrotal metastasis in a 13‐year‐old English Pointer
Authors: Park Clair S , Sawyere Dominique M 
Published: December 2020

Visceral haemangiosarcoma is an aggressive neoplasm, often associated with a high metastatic potential. The most common sites for metastases are the liver, lungs, peritoneum, muscle and lymph nodes. This report describes an unusual presentation of possible visceral haemangiosarcoma metastasis to the scrotum in 13‐year‐old intact male English Pointer. The patient presented with a two‐day history of inappetence. On physical examination, mid‐abdominal and scrotal masses could be palpated. Following staging, a splenectomy and scrotal ablation were performed. Histopathology confirmed splenic and scrotal haemangiosarcoma. Adjuvant chemotherapy was started 20 days postoperatively. A suggestion of progressive disease was suspected at two months postoperatively. The patient was lost to follow‐up following that visit. Metastasis of a splenic haemangiosarcoma to the scrotum is uncommon, and the possibility of the presence of two independent lesions cannot be excluded. This case illustrates the importance of a thorough physical examination and staging.
Feasibility Study of Super-Long Span Bridges Considering Aerostatic Instability by a Two-Stage Geometric Nonlinear Analysis
Authors: Tsay Jiunn-Yin 
Published: December 2020

To meet the need of constructing fixed cross strait links, super-long span bridge with a main span over 2 000[Formula: see text]m is considered as a candidate for their ability to cross deep and wide straits. To this end, some super-long span bridges with proper cable and girder systems were previously proposed and studied. The major design considerations are aimed at adopting new cable material, increasing the entire rigidity of the bridge, stabilizing the dynamic characteristics, strengthening the deck sections, etc. In this paper, a brief review of main cable and girder system is first given of the concepts previously proposed for the design of super-long span bridges. Then some typical examples are studied, focused on various issues related to the design of super-long span bridges, including composite cable, the unstressed length and tension force of the main cable, the stiffness and mass effects of the deck on critical wind speed, and the critical wind speed of various cable systems. The most challenges in super-long span bridges are to solve aerostatic and aerodynamic instability at required design wind speed. In this connection, the wind-induced aerostatic instability of super-long span bridges is studied by a two-stage geometric nonlinear analysis for dead loads and wind loads. The developed program adopted herein for geometric nonlinear analysis was verified and confirmed before. The proposed methods (i.e. composite cable, slotted girder, increasing deck stiffness and mass, cable layout, etc.) obtained for all the examples are in agreement with this study, which indicates applicability of the design approaches presented.
Generalized fine rings
Authors: Zhou Yiqiang 
Published: December 2020

As introduced by Cǎlugǎreanu and Lam in [G. Cǎlugǎreanu and T. Y. Lam, Fine rings: a new class of simple rings, J. Algebra Appl. 15(9) (2016) 1650173, 18 pp.], a fine ring is a ring whose every nonzero element is the sum of a unit and a nilpotent. As a natural generalization of fine rings, a ring is called a generalized fine ring if every element not in the Jacobson radical is the sum of a unit and a nilpotent. Here some known results on fine rings are extended to generalized fine rings. A notable result states that matrix rings over generalized fine rings are generalized fine, extending the important result in [G. Cǎlugǎreanu and T. Y. Lam, Fine rings: a new class of simple rings, J. Algebra Appl. 15(9) (2016) 1650173, 18 pp.] that matrix rings over fine rings are fine.