bluuebunny/crossref_metadata_2025_split huggingface dataset:
Processes and outcomes of diabetes mellitus care by different types of team primary care models
Authors: Guo Fangjian , Lin Yu-Li , Raji Mukaila , Leonard Bruce , Chou Lin-Na , Kuo Yong-Fang 
Published: November 2020

Background
Team care improves processes and outcomes of care, especially for patients with complex medical conditions that require coordination of care. This study aimed to compare the processes and outcomes of care provided to older patients with diabetes by primary care teams comprised of only primary care physicians (PCPs) versus team care that included nurse practitioners (NPs) or physician assistants (PAs).

Methods
We studied 3,524 primary care practices identified via social network analysis and 306,741 patients ≥66 years old diagnosed with diabetes in or before 2015 in Medicare data. Guideline-recommended diabetes care included eye examination, hemoglobin A1c test, and nephropathy monitoring. High-risk medications were based on recommendations from the American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Preventable hospitalizations were defined as hospitalizations for a potentially preventable condition.

Results
Compared with patients in the PCP only teams, patients in the team care practices with NPs or PAs received more guideline-recommended diabetes care (annual eye exam: adjusted odds ratio (aOR): 1.04 (95% CI: 1.00–1.08), 1.08 (95% CI: 1.03–1.13), and 1.10 (95% CI: 1.05–1.15), and HbA1C test: aOR: 1.11 (95% CI: 1.04–1.18), 1.11 (95% CI: 1.02–1.20), and 1.15 (95% CI: 1.06–1.25) for PCP/NP, PCP/NP/PA, and PCP/PA teams). Patients in the PCP/NP and the PCP/PA teams had a slightly higher likelihood of being prescribed high-risk medications (aOR: 1.03 (95% CI: 1.00–1.07), and 1.06 (95% CI: 1.02–1.11), respectively). The likelihood of preventable hospitalizations was similar among patients cared for by various types of practices.

Conclusion
The team care practices with NPs or PAs were associated with better adherence to clinical practice guideline recommendations for diabetes compared to PCP only practices. Both practices had similar outcomes. Further efforts are needed to explore new and cost-effective team-based care delivery models that improve process, outcomes, and continuity of care, as well as patient care experiences.
Impact of changing the surgical team for wound closure on surgical site infection: A matched case-control study
Authors: Salm Lilian , Chapalley Dimitri , Perrodin Stéphanie Fabienne , Tschan Franziska , Candinas Daniel , Beldi Guido 
Published: November 2020

Background
Wound closure is performed at the end of the procedure, when the attention of the surgical team may decrease due to tiredness. The aim of this study was to assess the influence of changing the surgical team for wound closure on the rate of surgical site infection (SSI).

Methods
A two-armed observational monocentric matched case-control study was performed in a time series design. During the baseline period, closure of the abdominal wall was performed by the main surgical team. The intervention consisted of closure of the abdominal wall and skin by an independent surgical team. Matching was based on gender, BMI, length of surgery, type of surgery, elective versus emergency surgery and ASA score. The primary outcome was SSI rate 30 days after surgery.

Results
A total of 72 patients in the intervention group were matched with 72 patients in the baseline group. The SSI rate after 30 days in the intervention group was 10% (n = 7) and in the baseline group 21% (n = 15) (p = 0.064). Redo-Surgery as result of infection (e.g. opening the wound, drainage or reoperation) was significantly higher in the baseline group (19.4% vs 2.7%; p = 0.014). Mortality, length of stay, rehospitalisation and complication rates 30 days after surgery did not differ significantly.

Conclusion
Changing the surgical team for wound closure did not reduce the overall rate of SSI, but the rate of redo-surgery as a result of SSI. Despite being potentially beneficial, organizational factors are a main limiting factor of changing the surgical team for the wound closure.

Trial registration
Clinicaltrial.gov NCT04503642.
Effect of long-chain polyunsaturated fatty acids in infant formula on long-term cognitive function in childhood: A systematic review and meta-analysis of randomised controlled trials
Authors: Verfuerden Maximiliane L. , Dib Sarah , Jerrim John , Fewtrell Mary , Gilbert Ruth E. 
Published: November 2020

Lack of preformed long-chain polyunsaturated fatty acids (LCPUFA) in infant formula has been hypothesised as contributing to cognitive differences between breast-fed and formula-fed infants. Previous systematic reviews found no cognitive differences between infants fed formula with LCPUFA and those fed formula without, but focused on early developmental measures, such as Bayley Scales of Infant Development, which are poorly differentiating and not predictive of cognitive ability in childhood. This systematic review examined the effect of randomising infants to formula supplemented with LCUFA vs unsupplemented formula on cognitive function ≥ age 2.5 years. We searched Medline, Embase the Cochrane Central Register of Controlled Trials without date limit, following a pre-published protocol according to PRISMA guidelines. We conducted random effects meta-analyses in RevMan v5.4 and followed GRADE and Cochrane Guidelines to evaluate strength of evidence and potential for bias. We included 8 trial cohorts which randomised participants between 1993 and 2004 and analyse 6 previously unpublished outcomes provided by various trialists. Age at the last available cognitive test ranged from 3.3 to 16 years. The pooled mean difference in Wechsler Preschool and Primary Scale of Intelligence-Revised from four trials in term-born children showed no benefit of LCPUFA: -0.04 points (95% confidence interval -5.94 to 5.85, 95% prediction interval -14.17 to 14.25). The pooled mean difference in Wechsler Abbreviated Scale of Intelligence score from two trials in preterm-born children also showed no benefit of LCPUFA: -7.71 (95% CI -24.63 to 9.22, 95% PI -97.80 to 82.38). Overall quality of evidence was low, due to substantial heterogeneity, low rates of follow-up, and indications of selective publication. The long-term effect of LCPUFA supplementation in term and preterm-born infants on cognition is highly uncertain and includes potential for large benefit as well as large harm. Based on our findings, LCPUFA supplementation of infant formula is not recommended until further robust evidence excludes long-term harm.Study registrationPROSPERO registration numbers CRD42018105196 and CRD42018088868.
A simple and clinically applicable model to predict liver-related morbidity after hepatic resection for hepatocellular carcinoma
Authors: Choi Jonggi , Kim So-Hyun , Han Seungbong , Lee Danbi , Shim Ju Hyun , Lim Young-Suk , Lee Han Chu , Chung Young-Hwa , Lee Yung Sang , Lee Sung-Gyu , Kim Ki-Hun , Kim Kang Mo 
Published: November 2020

Background & aimHepatic resection is a treatment option for patients with hepatocellular carcinoma (HCC). However, factors associated with candidacy for resection and predictive of liver-related morbidity after resection for HCC remain unclear. This study aimed to assess candidacy for liver resection in patients with HCC and to design a model predictive of liver-related morbidity after resection.MethodsA retrospective analysis of 1,565 patients who underwent liver resection for HCC between January 2016 and December 2017 was performed. The primary outcome was liver-related morbidity, including post-hepatectomy biochemical dysfunction (PHBD), ascites, hepatic encephalopathy, rescue liver transplantation, and death from any cause within 90 days. PHBD was defined as international normalized ratio (INR) > 1.5 or hyperbilirubinemia (> 2.9 mg/dL) on postoperative day ≥ 5.ResultsThe 1,565 patients included 1,258 (80.4%) males and 307 (19.6%) females with a mean age of 58.3 years. Of these patients, 646 (41.3%) and 919 (58.7%) patients underwent major and minor liver resection, respectively. Liver-related morbidity was observed in 133 (8.5%) patients, including 77 and 56 patients who underwent major and minor resection, respectively. A total of 83 (5.3%) patients developed PHBD. Multivariate analysis identified cut-off values of the platelet count, serum albumin concentration, and ICG R15 value for predicting liver-related morbidity after resection. A model predicting postoperative liver-related morbidity was developed, which included seven factors: male sex, age ≥ 55 years, ICG R15 value ≥ 15%, major resection, platelet count < 150,000/mm3, serum albumin concentration < 3.5 g/dL, and INR > 1.1.ConclusionHepatic resection for HCC was safe with 90-day liver-related morbidity and mortality rates of 8.5% and 0.8%, respectively. The developed point-based scoring system with seven factors could allow the prediction of the risk of liver-related morbidity after resection for HCC.
Is older age associated with COVID-19 mortality in the absence of other risk factors? General population cohort study of 470,034 participants
Authors: Ho Frederick K. , Petermann-Rocha Fanny , Gray Stuart R. , Jani Bhautesh D. , Katikireddi S. Vittal , Niedzwiedz Claire L. , Foster Hamish , Hastie Claire E. , Mackay Daniel F. , Gill Jason M. R. , O'Donnell Catherine , Welsh Paul , Mair Frances , Sattar Naveed , Celis-Morales Carlos A. , Pell Jill P. 
Published: November 2020

Introduction
Older people have been reported to be at higher risk of COVID-19 mortality. This study explored the factors mediating this association and whether older age was associated with increased mortality risk in the absence of other risk factors.

Methods
In UK Biobank, a population cohort study, baseline data were linked to COVID-19 deaths. Poisson regression was used to study the association between current age and COVID-19 mortality.

Results
Among eligible participants, 438 (0.09%) died of COVID-19. Current age was associated exponentially with COVID-19 mortality. Overall, participants aged ≥75 years were at 13-fold (95% CI 9.13–17.85) mortality risk compared with those <65 years. Low forced expiratory volume in 1 second, high systolic blood pressure, low handgrip strength, and multiple long-term conditions were significant mediators, and collectively explained 39.3% of their excess risk. The associations between these risk factors and COVID-19 mortality were stronger among older participants. Participants aged ≥75 without additional risk factors were at 4-fold risk (95% CI 1.57–9.96, P = 0.004) compared with all participants aged <65 years.

Conclusions
Higher COVID-19 mortality among older adults was partially explained by other risk factors. ‘Healthy’ older adults were at much lower risk. Nonetheless, older age was an independent risk factor for COVID-19 mortality.
Comparison of bispectral index-guided and fixed-gas concentration techniques in desflurane and remifentanil anesthesia: A randomized controlled trial
Authors: Yang Seong Mi , Jung Yoo Sun , Jung Chul-Woo , Kim Won Ho , Yoon Soo Bin , Lee Hyung-Chul 
Published: November 2020

Anesthesia with desflurane and remifentanil can be maintained with either fixed or titrated desflurane concentration. We hypothesized that the fixed-gas concentration (FG) method would reduce the number of anesthetic titrations without hypnotic and hemodynamic instability compared to the bispectral index (BIS)-guided (BG) method. Forty-eight patients were randomly allocated to the FG or BG groups. In the FG group, desflurane vaporizer setting was fixed at 1 age-corrected minimum alveolar concentration (MAC). In the BG group, desflurane was titrated to target a BIS level at 50. Remifentanil was titrated to maintain a systolic arterial pressure (SAP) of 120 mmHg in both groups. Our primary endpoint was the hypnotic stability measured by the wobble of BIS in performance analysis, and the secondary endpoints included the wobble of SAP, mean BIS value during surgery, and the number of anesthetic titrations. The BIS in the FG group showed significantly less wobble (3.9 ± 1.1% vs 5.5 ± 1.5%, P <0.001) but lower value (33 ± 6 vs 46 ± 7, P <0.001) than BG group. The wobble of SAP showed no difference between groups [median (inter-quartile range), 5.0 (4.1–7.5)% vs 5.2 (4.2–8.3)%, P = 0.557]. The numbers of anesthetic titrations in the FG group were significantly lower than the BG group (0 ± 0 vs 8 ± 5, P<0.001 for desflurane, 13 ± 13 vs 22 ± 17, P = 0.047 for remifentanil). Less wobble in BIS and reduced anesthetic titration without hemodynamic instability during the FG technique may be practical in balanced anesthesia using desflurane and remifentanil anesthesia.
Clinical trial: This study was registered at ClinicalTrials.gov (NCT02283866).
Tiered healthcare in South Africa exposes deficiencies in management and more patients with infectious etiology of primary adrenal insufficiency
Authors: Mofokeng Thabiso Rafaki Petrus , Ndlovu Kwazi Celani Zwakele , Beshyah Salem A. , Ross Ian L. 
Published: November 2020

ObjectiveWe wished to determine the prevalence, etiology, presentation, and available management strategies for primary adrenal insufficiency (PAI) in South Africa (SA), hypothesizing a prevalence greater than the described 3.1 per million. There is great inequity in healthcare allocation, as two parallel healthcare systems exist, potentially modifying PAI patients’ clinical profiles, private being better resourced than public healthcare.MethodsAn online survey of physicians’ experience relating to PAI.ResultsThe physicians were managing 811 patients, equal to a prevalence of 14.2 per million. Likely causes of PAI in public/ academic vs private settings included: AIDS-related [304 (44.8%) vs 5 (3.8%);p<0.001], tuberculosis [288 (42.5%) vs 8 (6.0%);p<0.001], autoimmune disease [50 (7.4%) vs 88 (66.2%);p<0.001], malignancy [27 (4.0%) vs 7 (5.3%);p= 0.500], genetic including adrenoleukodystrophy (ALD) [5 (0.7%) vs 16 (12.0%);p<0.001], respectively. Overall, more patients presented with nausea [101 (74.3%) and vomiting 89 (65.9%), than diarrhoea 76 (58.9%);p= 0.008 and 126 (15.5%) in adrenal crisis. Features suggestive of a crisis were hypoglycaemia [40 (78.4%) vs 42 (48.8%);p= 0.001], shock [36 (67.9%) vs 31(36.9%);p<0.001], and loss of consciousness [25 (52.1%) vs 27 (32.9%);p= 0.031]. Greater unavailability of antibody testing in the public vs. the private sector [32 (66.7%) vs 30 (32.1%);p= 0.001], [serum-ACTH 25 (52.1%) vs 16 (19.5%);p<0.001] and glucocorticoids were [26 (54.2%) vs 33 (40.2%);p= 0.015]. Many patients, 389(66.7%) were not using identification, indicating that they need steroids in an emergency.ConclusionA survey of South African physicians suggests a higher prevalence than previously reported. Patients presented with typical symptoms, and 15.5% presented in adrenal crisis. Significant disparities in the availability of physicians’ expertise, diagnostic resources, and management options were noted in the public versus private settings. Greater awareness among health practitioners to timeously diagnose PAI is required to prevent a life-threatening outcome.
On the δ-Pinching Function of the Sectional Curvature of a Compact Connected Lie Group G with a Bi-Invariant Riemannian Metric and a Vectorial Torsion Connection
Authors: Rodionov E.D. , Khromova O.P. 
Published: November 2020

One of the important problems of Riemannian geometry is the problem of establishing connections between curvature and the topology of a Riemannian manifold, and, in particular, the influence of the sign of sectional curvature on the topological structure of a Riemannian manifold. Of particular importance in these studies is the question of the influence of d-pinching of Riemannian metrics of positive sectional curvature on the geometric and topological structure of the Riemannian manifold. This question is most studied for the homogeneous Riemannian case. In this direction, the classification of homogeneous Riemannian manifolds of positive sectional curvature, obtained by M. Berger, N. Wallach, L. Bergeri, as well as a number of results on d- pinching of homogeneous Riemannian metrics of positive sectional curvature, is well known.
In this paper, we investigate Riemannian manifolds with metric connection being a connection with vectorial torsion. The Levi-Civita connection falls into this class of connections. Although the curvature tensor of these connections does not possess the symmetries of the Levi-Civita connection curvature tensor, it seems possible to determine sectional curvature. This paper studies the d-pinch function of the sectional curvature of a compact connected Lie group G with a biinvariant Riemannian metric and a connection with vectorial torsion. It is proved that it takes the values d(||V ||)∈(0,1].
IMPACT OF FOSSIL POWER PLANTS ON AIR QUALITY
Authors: Lawrence B. 
Published: November 2020

South Africa has abundant supply of coal, about half being used in generation of electricity. Use of low grade high ash coal results in about 25% leaving boilers as PFA but ESP's lowers quantity emitted to air considerably.
Lower sulphur coal increases ash resistivity, inhibiting precipitator effectiveness. Various solutions tested by Eskom through the 80's include electrical improvements and ash modification. S03 injection equipment is effective at two Eskom stations in reducing dust emission to acceptable levels. General perception of poor dust emission is a stack that has visible emission. This could be a subjective view without real basis.
Gas emissions include vast volumes of SOX and NOx, with no steps taken to attenuate. Then is obviously a difference between high level and pound level phenomena. It was previously assumed that emission of pollutants via tall stacks above inversion layers into the jet-stream would avoid pollution problems. This does not appear in practice to have resulted, as low level haze appears to be increasing and impact of high level gas emission is now being investigated. Installation of gas removal plant may help the air quality, but may be unaffordable.
Greater demands for wealth and jobs results in greater industrialisation, with accompanying pollution products. Also, provision of living wages and housing scheme benefits has seen development of whole new black residential areas where coal is not burned, giving clean air living areas for these people and their neighbours.
ENVIRONMENTAL LEAD EXPOSURE : ARE WE AT RISK?
Authors: Von Schirnding Y.E.R. 
Published: November 2020

This paper discusses the new evidence linking lead at low levels of environmental exposure to adverse effects on aspects of children's neurobehavioural development. Risk factors for environmental exposure an discussed, with particular reference to the role of atmospheric lead. Epidemiological aspects of childhood lead exposure in South Africa ate outlined, with consideration given to the need for appropriate intervention strategies.
Lead has received an inordinate amount of attention in the scientific and medical literature worldwide over recent years. Pan of the reason for this is that lead, as an environmental pollutant, is somewhat unique. It has been used over thousands of years in hundreds of products and as a result is one of the most widely dispersed pollutants in the environment. It also has a particularly long residence time in the environment and has accumulated in significant amounts which have given rise to concern regarding the health impact on human populations.
Risk perceptions of dust and its impacts among communities living in a mining area of the Witwatersrand, South Africa
Authors: Wright C.Y. , Matooane M. , Oosthuizen M.A. , Phala N. 
Published: November 2020

Mining is a major economic activity in many developing countries. In South Africa, gold mining has played a significant role in the development and sustenance of the country's economy, with both positive and negative consequences. In gold mining areas, tailings dams and mine dumps are significant sources of ambient dust, known to be a nuisance, and health risk, to communities living near them and who must find appropriate coping mechanisms to protect themselves. A qualitative study based on five focus groups with sixty-two participants of different ages and sex was carried out in the Witwatersrand mining district of South Africa. All focus groups agreed that they had noticed dust in the air where they live, stating that the dust came largely from mine dumps but also from other sources. They agreed that the dust causes, among others, health problems, and both short-term and long-term coping mechanisms for protecting themselves against excess dust were mentioned yet considered inadequate, i.e. closing windows and doors, watering their yards, paving their yards and planting trees. Little support from government, mines and other organisations was identified as an important perceived barrier to resolving the dust problem. Means for communication of communities' perceptions of the impacts, risks and possible mitigation / adaption measures associated with dust need to be created and supported in a formal risk management plan.
Aerosol particle morphology of residential coal combustion smoke
Authors: Makonese T. , Forbes P. , Mudau L. , Annegarn H.J. 
Published: November 2020

A study carried out at the University of Pretoria characterised aerosol particle morphology of residential coal combustion smoke. The general approach in this study was on individual particle conglomerations because the radiative, environmental, and health effects of particles may depend on specific properties of individual particles rather than on the averaged bulk composition properties. A novel, miniature denuder system, developed and tested at the University of Pretoria, was used to capture particle emissions from the coal fires. The denuder consists of two silicone rubber traps (for gas phase semi-volatile organic compound monitoring) in series separated by a quartz fibre filter (for particle collection). The denuders were positioned 1 m away from the fire and were connected to pumps that sampled ~5 litres of air over a 10 min sampling interval. A JSM 5800LV Scanning Electron Microscope with a Thermo Scientific EDS was used to analyse the structure and morphology of different aerosol samples from the quartz fibre filters. Eight samples from the different fire lighting methods were selected for SEM analysis. The punched samples were sputter coated with gold for ~15 minutes using a K550 Emitech Sputter Coater. Results show that apart from the fine and ultra-fine particles, coal smoke from domestic burning also contains aerosols greater than 5 μm in diameter. Consequently, we describe the potential for generation of ‘giant’ carbonaceous soot conglomerates with outer diameters of 5 to 100 μm. However, the exact mechanism for formation of such large soot conglomerates remains to be determined. We also describe the presence of spherules and solid ‘melted toffee’ irregular surfaces. Circumstantial evidence is used to postulate and discuss the possible modes of formation in terms of condensation, and partial melting. This work provides a description of the modes of formation and transformation of conglomerates originating from low temperature (<8000C) coal combustion.
Design considerations for a continuous emission measurement system for pressure type bag houses
Authors: Roberts P. , Els L. , Kornelius G. 
Published: November 2020

Measurement of the outlet particulate concentration on pressure-type bag filters, whether intermittent or continuous, has been avoided in South Africa as cumbersome and possibly inaccurate. A system based on the requirements of the US EPA’s method 5D was however recently designed and installed on three pressure-type reverse air filters serving ferro-chrome electric arc furnaces in order to allow comparison with the legal emission concentration limits for this type of furnace. This paper reports on the design considerations and design process of this system.