bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can combined online and face‐to‐face continuing medical education improve the clinical knowledge and skills of family doctors in Vietnam? A cluster randomised controlled trial
Authors: Thai Thuy T. N. , Nguyen Kien T. , Pham Tam T. , Nguyen Phuong M. , Derese Anselme 
Published: January 2020

AbstractObjectivesTo assess the effectiveness of a combined online and face‐to‐face continuing medical education (CME) programme, for improvement in clinical knowledge and skills of family doctors, in comparison with a control group; and to explore the self‐reported satisfaction, competencies and confidence of those in the intervention group.MethodsWe used a cluster randomised controlled trial, with pre‐ and post‐testing, and a feedback survey at the end of the 18‐month CME programme. The measurements consisted of a multiple‐choice test, an objective structured clinical examination test and an anonymously self‐administered questionnaire.ResultsThere were 58 family doctors from four provinces in the intervention group and 32 doctors from three provinces in control group, both in the Mekong Delta region in Vietnam. The mean age of participants was 47.8 years, and the female/male ratio was 1/2.9. After training, the intervention group had significantly higher scores on overall knowledge (mean difference = 1.4, 95% CI 1.0–1.86, P < 0.001; Cohen's d 1.36, Pearson's r 0.53), in four of the five education modules: peptic disorders, diabetes, hypertension and bone–muscle–joint diseases (Pearson's r 0.56, 0.56, 0.34 and 0.4, respectively), and in problem‐solving skills (Pearson's r 0.27). Self‐reports showed a positive learning attitude, strong interest and improved confidence and competency among doctors in the intervention group.ConclusionsA combined online and face‐to‐face CME programme proved applicable and effective for improving the clinical knowledge and problem‐solving skills of family doctors in Vietnam.
Heating quinoa shoots results in yield loss by inhibiting fruit production and delaying maturity
Authors: Tovar Jose C. , Quillatupa Carlos , Callen Steven T. , Castillo S. Elizabeth , Pearson Paige , Shamin Anastasia , Schuhl Haley , Fahlgren Noah , Gehan Malia A. 
Published: January 2020

SummaryIncreasing global temperatures and a growing world population create the need to develop crop varieties that provide higher yields in warmer climates. There is growing interest in expanding quinoa cultivation, because of the ability of quinoa to produce nutritious grain in poor soils, with little water and at high salinity. The main limitation to expanding quinoa cultivation, however, is the susceptibility of quinoa to temperatures above approximately 32°C. This study investigates the phenotypes, genes and mechanisms that may affect quinoa seed yield at high temperatures. Using a differential heating system where only roots or only shoots were heated, quinoa yield losses were attributed to shoot heating. Plants with heated shoots lost 60–85% yield as compared with control plants. Yield losses were the result of lower fruit production, which lowered the number of seeds produced per plant. Furthermore, plants with heated shoots had delayed maturity and greater non‐reproductive shoot biomass, whereas plants with both heated roots and heated shoots produced higher yields from the panicles that had escaped the heat, compared with the control. This suggests that quinoa uses a type of avoidance strategy to survive heat. Gene expression analysis identified transcription factors differentially expressed in plants with heated shoots and low yield that had been previously associated with flower development and flower opening. Interestingly, in plants with heated shoots, flowers stayed closed during the day while the control flowers were open. Although a closed flower may protect the floral structures, this could also cause yield losses by limiting pollen dispersal, which is necessary to produce fruit in the mostly female flowers of quinoa.
The United Kingdom and the stability of the Euro area: From Maastricht to Brexit
Authors: Campos Nauro F , Macchiarelli Corrado 
Published: January 2020

AbstractThe two key events expected to mark the year 2019 were the 20th anniversary of the euro and Brexit. This paper examines the role of the United Kingdom on the stability of the euro area. We study stability from the perspective of synchronisation of economic activity in a core and periphery framework. We show the UK, since 1990, has become significantly more integrated with the EU economy. The UK moved from the periphery before 1990 to the core afterwards. We also find that the level of synchronisation of the UK economy has had the highest variability over time among all countries.
Reviewer Acknowledgements
Authors: Smith Robert 
Published: January 2020

Journal of Education and Training Studies (JETS) would like to acknowledge the following reviewers for their assistance with peer review of manuscripts for this issue. Many authors, regardless of whether JETS publishes their work, appreciate the helpful feedback provided by the reviewers. Their comments and suggestions were of great help to the authors in improving the quality of their papers. Each of the reviewers listed below returned at least one review for this issue.Reviewers for Volume 8, Number 2 John Cowan, Edinburgh Napier University, UKMehmet Galip Zorba, Akdeniz University, TurkeyMelike Özüdoğru, Manisa Celal Bayar University, TurkeyNiveen M. Zayed, MENA College of Management, JordanSandro Sehic, Oneida BOCES, USASenem Seda Şahenk Erkan, Marmara University, TurkeyThada Jantakoon, Rajabhat Maha Sarakham University, Thailand Robert SmithEditorial AssistantOn behalf of,The Editorial Board of Journal of Education and Training StudiesRedfame Publishing9450 SW Gemini Dr. #99416Beaverton, OR 97008, USAURL: http://jets.redfame.com
Risk of herpes zoster after exposure to varicella to explore the exogenous boosting hypothesis: self controlled case series study using UK electronic healthcare data
Authors: Forbes Harriet , Douglas Ian , Finn Adam , Breuer Judith , Bhaskaran Krishnan , Smeeth Liam , Packer Simon , Langan Sinéad M , Mansfield Kathryn E , Marlow Robin , Whitaker Heather , Warren-Gash Charlotte 
Published: January 2020

Abstract

Objective
To assess the magnitude and duration of any hypothesised protective effect of household exposure to a child with varicella on the relative incidence of herpes zoster in adults.

Design
Self controlled case series.

Setting
UK general practices contributing to Clinical Practice Research Datalink.

Participants
9604 adults (≥18 years) with a diagnosis of herpes zoster (in primary care or hospital records) between 1997 and 2018, who during their observation period lived with a child (<18 years) with a diagnosis of varicella.

Main outcome measures
Relative incidence of herpes zoster in the 20 years after exposure to a child with varicella in the household compared with baseline time (all other time, excluding the 60 days before exposure).

Results
6584 of the 9604 adults with herpes zoster (68.6%) were women. Median age of exposure to a child with varicella was 38.3 years (interquartile range 32.3-48.8 years) and median observation period was 14.7 (11.1-17.7) years. 4116 adults developed zoster in the baseline period, 433 in the 60 days before exposure and 5055 in the risk period. After adjustment for age, calendar time, and season, strong evidence suggested that in the two years after household exposure to a child with varicella, adults were 33% less likely to develop zoster (incidence ratio 0.67, 95% confidence interval 0.62 to 0.73) compared with baseline time. In the 10-20 years after exposure, adults were 27% less likely to develop herpes zoster (0.73, 0.62 to 0.87) compared with baseline time. A stronger boosting effect was observed among men than among women after exposure to varicella.

Conclusions
The relative incidence of zoster was lower in the periods after exposure to a household contact with varicella, with modest but long lasting protective effects observed. This study suggests that exogenous boosting provides some protection from the risk of herpes zoster, but not complete immunity, as assumed by previous cost effectiveness estimates of varicella immunisation.
Namaste care in the home setting: developing initial realist explanatory theories and uncovering unintended outcomes
Authors: Dalkin Sonia Michelle , Lhussier Monique , Kendall Nicola , Atkinson Joanne , Tolman Sharron 
Published: January 2020

IntroductionThe End-of-Life Namaste Care Program for People with Dementia, challenges the misconception that people with dementia are a ‘shell’; it provides a holistic approach using the five senses, which can provide positive ways of communicating and emotional responses. It is proposed Namaste Care can improve communication and the relationships families and friends have with the person with dementia. Previously used in care homes, this study is the first to explore the pioneering use of Namaste Care in people’s own homes.ObjectiveTo develop initial programme theories detailing if, how and under which circumstances Namaste Care works when implemented at home.DesignA qualitative realist approach following the RAMESES II guidelines was employed to understand not only whether Namaste Care has positive outcomes, but also how these are generated, for whom they happen and in which circumstances.SettingA hospice in the North East of England, operating in the community, through volunteers.ParticipantsProgramme theories were developed from three focus groups with volunteers implementing Namaste Care (n=8; n=8; n=11) and eight interviews with family carers (n=8).ResultsFour refined explanatory theories are presented: increasing engagement, respite for family carers, importance of matched volunteers and increasing social interaction. It was identified that while Namaste Care achieved some of the same goals in the home setting as it does in the care home setting, it could also function in a different way that promoted socialisation.ConclusionsNamaste Care provides holistic and personalised care to people with both moderate and advanced dementia, improving engagement and reducing social isolation. In the present study carers often chose to use Namaste Care sessions as respite. This was often linked to their frustration of the unavoidable dominance of task-focussed care in daily life. Individualised Namaste Care activities thus led to positive outcomes for both those with dementia and their carers.
Circular pOlyethylene drape in preVEntion of suRgical site infection (COVER trial): study protocol for a randomised controlled trial
Authors: Yoo Ri Na , Kim Hyung Jin , Lee Jae Im , Kang Won-Kyung , Kye Bong-Hyeon , Kim Chang Woo , Bae Sung Uk , Nam Soomin , Kang Byung Mo 
Published: January 2020

IntroductionSurgical site infection (SSI) after abdominal surgery remains a significant cause of morbidity and is associated with an increased socioeconomic burden and a reduced quality of life. Circular wound protectors have been expected to reduce the risk of SSI, but previous studies reported conflicting results on their protective effects. The purpose of this study was to evaluate the efficacy of circular wound protectors in reducing SSI in open abdominal surgery.Methods and analysisThe circular pOlyethylen drape in preVEntion of suRgical site infection (COVER) trial investigates whether the application of a dual-ring circular plastic wound protector reduces the rate of SSI in patients undergoing elective or emergent open abdominal surgery related to the gastrointestinal tract, regardless of the type of wound classified by the Centers for Disease Control. The COVER trial is a multicentre, randomised controlled clinical trial with two parallel arms—one using a dual-ring wound protector with circular polyethylene drape and the other using conventional surgical dressing gauze. The primary outcome will measure the rate of SSI within 30 days after surgery in two groups. Statistical analysis of the primary end point will be based on the intention-to-treat population. The sample size was determined to achieve a study power of 80% with 95% two-sided confidence limits. Considering a dropout rate of up to 5%, a total of 458 patients, 229 patients in each group, will be enrolled in this study.Ethics and disseminationThe trial protocol and informed consent document have been reviewed and approved by the institutional review board at each participating centre. Written informed consent will be obtained from each study participant. The clinical outcomes of this trial will be submitted to an international peer-reviewed journal and presented at international conferences.Trial registration numberNCT 03170843.
Brain Damage With Heart Failure
Authors: Mueller Karsten , Thiel Friederike , Beutner Frank , Teren Andrej , Frisch Stefan , Ballarini Tommaso , Möller Harald E. , Ihle Kristin , Thiery Joachim , Schuler Gerhard , Villringer Arno , Schroeter Matthias L. 
Published: January 2020

Rationale:
Heart failure (HF) following heart damage leads to a decreased blood flow due to a reduced pump efficiency of the heart muscle. A consequence can be insufficient oxygen supply to the organism including the brain. While HF clearly shows neurological symptoms, such as fatigue, nausea, and dizziness, the implications for brain structure are not well understood. Few studies show regional gray matter decrease related to HF; however, the underlying mechanisms leading to the observed brain changes remain unclear.

Objective:
To study the relationship between impaired heart function, hampered blood circulation, and structural brain change in a case-control study.

Methods and Results:
Within a group of 80 patients of the Leipzig Heart Center, we investigated a potential correlation between HF biomarkers and the brain’s gray matter density (GMD) obtained by magnetic resonance imaging. We observed a significant positive correlation between cardiac ejection fraction and GMD across the whole frontal and parietal medial cortex reflecting the consequence of HF onto the brain’s gray matter. Moreover, we also obtained a relationship between GMD and the NT-proBNP (N-terminal prohormone of brain natriuretic peptide)—a biomarker that is used for screening, diagnosis, and prognosis of HF. Here, we found a significant negative correlation between NT-proBNP and GMD in the medial and posterior cingulate cortex but also in precuneus and hippocampus, which are key regions implicated in structural brain changes in dementia.

Conclusions:
We obtained significant correlations between brain structure and markers of heart failure including ejection fraction and NT-proBNP. A diminished GMD was found with decreased ejection fraction and increased NT-proBNP in wide brain regions including the whole frontomedian cortex as well as hippocampus and precuneus. Our observations might reflect structural brain damage in areas that are related to cognition; however, whether these structural changes facilitate the development of cognitive alterations has to be proven by further longitudinal studies.
<p><strong>The identity of <em>Clematis dongchuanensis</em></strong><em> </em><strong>(Ranunculaceae) from northeastern Yunnan, China</strong></p>
Authors: YUAN QIONG , YANG QIN-ER 
Published: January 2020

We demonstrate that Clematis dongchuanensis (Ranunculaceae), described from Dongchuan in northeastern Yunnan, China and considered to be related to C. repens in having simple leaves, erect sepals and pubescent filaments and anthers, is identical with C. connata var. trullifera, a taxon with pinnate leaves of 5−7 (9) leaflets. The simple leaves described in C. dongchuanensis are actually leaflets of a pinnate leaf in C. connata var. trullifera. We therefore place C. dongchuanensis in synonymy with C. connata var. trullifera. Lectotypification is proposed for C. connata var. trullifera and for C. coriigera, a synonym of C. connata var. trullifera.
Designer benzodiazepines’ pharmacological effects and potencies: How to find the information
Authors: El Balkhi Souleiman , Monchaud Caroline , Herault Frédéric , Géniaux Hélène , Saint-Marcoux Franck 
Published: January 2020

Background: Scientific data on the psychopharmacological effects of new psychoactive substances (NPSs) are scarce. Web fora contain a wealth of information posted by users as trip reports (TRs), but the reliability of the reports remains questionable because of the nature of the used molecule and the potential for dose inaccuracies. We focused on the TRs of designer benzodiazepine (DBZD) users since their psychopharmacological effects are similar to prescription benzodiazepines (BZDs). Moreover, the impact of functional groups on the BZD rings with regards to the potency has been fairly/quite studied, allowing structural analysis. Methods: DBZDs offering more than 15 TRs with at least two accounts on experienced effects were included. Data were analyzed with the empirical phenomenological psychological method. Reported effects were analyzed and the pharmacological potencies of DBZDs were compared by calculating a ‘potency score’. Results: In total, 197 TRs for clonazolam, deschloroetizolam, diclazepam, etizolam, flubromazepam, flubromazolam, meclonazepam, metizolam, nifoxipam and pyrazolam were analyzed. Effects similar to prescription BZDs were reported for all the selected DBZDs. Pyrazolam was reported to be the most anxiolytic DBZD, flubromazolam the most hypnotic, etizolam the most euphoric and flubromazolam and clonazolam as the most amnesic DBZDs. Diclazepam and pyrazolam were not reported to induce euphoria. Flubromazepam, flubromazolam, clonazolam and meclonazepam were the most potent and deschloroetizolam, nifoxipam, metizolam and pyrazolam the least potent. The chemical structure of the different DBZDs and the functional groups on the BZD rings confirmed this ranking, except for nifoxipam. Conclusions: When information on NPSs obtained from Internet fora are abundant, it could be considered as an appreciable data source.
A Novel Emergency Telepsychiatry Program in a Canadian Urban Setting: Identifying and Addressing Perceived Barriers for Successful Implementation: Un nouveau programme de télépsychiatrie d’urgence en milieu urbain canadien: Identifier et aborder les obstacles perçus d’une mise en œuvre réussie
Authors: Hensel Jennifer , Graham Reid , Isaak Corinne , Ahmed Naweed , Sareen Jitender , Bolton James 
Published: January 2020

Objectives: To report on the perceived barriers surrounding the use of telepsychiatry for emergency assessments and our approach to overcoming those barriers to achieve successful implementation of a program to increase access to emergency psychiatric assessment in a Canadian urban setting. Methods: We conducted a survey of emergency care staff to inform the implementation of an emergency telepsychiatry program in the urban setting of Winnipeg, Manitoba, where hospitals have variable on-site emergency psychiatric coverage. We analyzed survey responses for perceived barriers we would need to address in implementation. We employed implementation strategies for each barrier and scaled the program to three sites over the first year. Data from the first year were collected including number of telepsychiatry assessments, reasons for referral, wait time, and percentage of patient transfers avoided. Results: Survey respondents ( N = 111) had little prior exposure to telepsychiatry, but the majority were open to its use for emergency psychiatric assessments in the region. We identified three categories of perceived barriers: clinical, logistical/technical, and readiness barriers. Implementation planning addressed each barrier, and a hub-and-spoke program was launched. After the first year, the program had one hub serving three spokes, and 243 emergency telepsychiatry assessments had been completed. After 12 months, we were avoiding 65% of patient transfers. Conclusions: By conducting a user survey to identify perceived barriers, and addressing these during implementation, we successfully scaled our emergency telepsychiatry program across our region. Our report of this experience may benefit others attempting to implement a similar program.
Is the R coefficient of interest in cluster randomized trials with a binary outcome?
Authors: Yepnang Ariane M Mbekwe , Caille Agnès , Eldridge Sandra M , Giraudeau Bruno 
Published: January 2020

In cluster randomized trials, the intraclass correlation coefficient (ICC) is classically used to measure clustering. When the outcome is binary, the ICC is known to be associated with the prevalence of the outcome. This association challenges its interpretation and can be problematic for sample size calculation. To overcome these situations, Crespi et al. extended a coefficient named R, initially proposed by Rosner for ophthalmologic data, to cluster randomized trials. Crespi et al. asserted that R may be less influenced by the outcome prevalence than is the ICC, although the authors provided only empirical data to support their assertion. They also asserted that “the traditional ICC approach to sample size determination tends to overpower studies under many scenarios, calling for more clusters than truly required”, although they did not consider empirical power. The aim of this study was to investigate whether R could indeed be considered independent of the outcome prevalence. We also considered whether sample size calculation should be better based on the R coefficient or the ICC. Considering the particular case of 2 individuals per cluster, we theoretically demonstrated that R is not symmetrical around the 0.5 prevalence value. This in itself demonstrates the dependence of R on prevalence. We also conducted a simulation study to explore the case of both fixed and variable cluster sizes greater than 2. This simulation study demonstrated that R decreases when prevalence increases from 0 to 1. Both the analytical and simulation results demonstrate that R depends on the outcome prevalence. In terms of sample size calculation, we showed that an approach based on the ICC is preferable to an approach based on the R coefficient because with the former, the empirical power is closer to the nominal one. Hence, the R coefficient does not outperform the ICC for binary outcomes because it does not offer any advantage over the ICC.