bluuebunny/crossref_metadata_2025_split huggingface dataset:
Strengthening the quality and scope of paediatric primary care in South Africa: Evaluating contextual impacts of the introduction of the Practical Approach to Care Kit for children (PACK Child)
Authors: Murdoch Jamie , Curran Robyn , Cornick Ruth , Picken Sandy , Bachmann Max , Bateman Eric , Simelane Makhosazana Lungile , Fairall Lara 
Published: December 2019

Abstract
Background: Despite significant reductions in mortality, preventable and treatable conditions remain leading causes of death and illness in children aged under five in South Africa. The PACK Child intervention, comprising a clinical decision support tool (guide), training strategy and health systems strengthening components, was developed to expand on WHO’s Integrated Management of Childhood Illness programme, and in 2017-2018 was piloted in 10 primary healthcare facilities in the Western Cape Province. Here we report findings from an investigation into the contextual features of South African primary care that shaped how clinicians delivered the PACK Child intervention within clinical consultations. Methods: Process evaluation using semi-structured interviews, focus groups, observation, audio-recorded consultations and documentary analysis. Linguistic ethnographic analysis of relationship between primary care contextual features and clinician-caregiver interactions.Results: Primary healthcare facilities demonstrated dominance of a risk minimisation approach upheld by provincial documentation, providing curative episodic care to children presenting with acute symptoms, and preventive care including immunisations, feeding and growth monitoring, all in children 5 years or younger. Children with chronic illnesses such as asthma rarely received routine care. These contextual features constrained the ability of clinicians to use the PACK Child intervention to facilitate diagnosis of long-term conditions, elicit and manage psychosocial issues, and navigate use of the guide alongside provincial documentation. Conclusion: Our findings provide evidence that PACK Child is catalysing a transition to an approach that strikes a balance between risk minimisation on the day of an acute presentation and a larger remit of care for the child over time. However, to optimise success of the intervention requires reviewing priorities for paediatric care which will facilitate enhanced skills, knowledge and deployment of clinical staff to better address acute illnesses and long-term health conditions of children of all ages, as well as complex psychosocial issues surrounding the child.
Estrogen receptor α phosphorylated at Ser216 confers inflammatory function to mouse microglia
Authors: Shindo Sawako , Chen Shih-Heng , Gotoh Saki , Yokobori Kosuke , Hu Hao , Ray Manas , Moore Rick , Nagata Kiyoshi , Martinez Jennifer , Hong Jau-Shyong , Negishi Masahiko 
Published: December 2019

Abstract
Background Estrogen has been suggested to regulate anti-inflammatory signaling in brain microglia through estrogen receptor α (ERα), the only resident immune cells of the brain. The mechanism of how ERα regulates is not well understood. Previously, ERα is phosphorylated at Ser216 in mouse neutrophils, regulating their infiltration into the uterus. Therefore, ERα has now been examined as to its phosphorylation in microglia to regulate their inflammatory functions.MethodsAn antibody against an anti-phospho-S216 peptide of ERα (αP-S216) was used for double immunofluorescence staining to detect to ERα in cultured microglia. A knock-in (KI) mouse line bearing the phosphorylation-blocked ERα mutation S216A (ERα KI) was generated to examine whether this phosphorylation regulate immune functions of microglia.ResultsPhosphorylated ERα at Ser216 was present in microglia but not astrocytes. Staining with an anti-Iba-1 antibody showed that microglia activation was augmented in substantial nigra of ERα KI brains. Lipopolysaccharide (LPS) treatments aggravated microglia activation in ERα KI brains, pro-inflammatory cytokines were increased while anti-inflammatory cytokines were decreased at mRNA and protein levels in whole brain extracts. These increases and decreases of cytokine proteins were also observed in LPS-treated microglia cultured from brains of ERα KI neonates. FACS analysis revealed that ERα KI mutation increased number of IL-6 producing microglia and apoptosis. ERα KI mice decreased motor connection ability in Rotarod tests.ConclusionsBlocking of Ser216 phosphorylation aggravated microglia activation and inflammation of mouse brain, thus confirming that phosphorylated ERα exerts anti-inflammatory functions. ERα KI mice enable us to further investigate the mechanism by which phosphorylated ERα regulates brain immunity and inflammation.
The relationship between nutritional habits and sleep quality in adolescents of Yazd, Iran
Authors: Mozaffari-Khosravi Hassan , Karandish Majid , Hadianfard Ali Mohammad , Azhdari Maryam , Sheikhi Leila , Shams-Rad Shamim , tabatabaie mahtab , Mirzavandi Farhang , Babaie Siavash 
Published: December 2019

Abstract
BackgroundLifestyle and its relationship to aspects of sleep quality have been reported in many studies. An unhealthy lifestyle is associated with less sleep duration and sleep patterns. Breakfast skipping is as an important part of unhealthy lifestyle. Poor sleep quality and skipping breakfast are common in adolescents. The aim of this study was to investigate the relationship between nutritional habits (breakfast and midmorning snack) and sleep quality in Yazd adolescents.MethodsThis study was conducted among 569 students aged 12–16 years. They were selected by multistage random-cluster sampling method. Information such as demographic characteristics, anthropometric measurements, students' nutritional habits, physical activity and sleep quality were collected from all adolescents. All data were assessed by interview, 7-day food record, short form of the International Physical Activity, and Questionnaire and Pittsburgh Sleep Quality Index. The data were analyzed by SPSS software (version 22).ResultsThe prevalence of breakfast skipping and semi-skipping (57.2%), overweight and obesity (37.8%), and insufficient sleep duration (38.9%) were high. The sleep score was significantly better in boys (p = 0.02). Sleep quality score of 63.7 % of the students was poor, but a significant relationship was not illustrated between sleep quality with breakfast frequency, abnormal weight, breakfast time, morning snack intake. A significant relationship was found between poor sleep quality with late bedtime and low physical activity (p <0.0001), late dinner (p <0.004), and female gender (p <0.02).ConclusionsThis cross-sectional study supported the association between having dinner soon and no late bedtime with good sleep quality. But no significant difference was shown between sleep quality with weight and breakfast habits. This study suggested paying more attention to nutritional and sleeping status in this age group by employing skilled nutritionists and mental health professional in high schools.
Statistical approaches to computing sample size in cluster randomized trials: a simulation study
Authors: Ranjan Ashutosh , Song Guangzi , Coffey Christopher S , McClure Leslie A 
Published: December 2019

Abstract
Background: Cluster randomized trials, which randomize groups of individuals to an intervention, are common in health services research when one wants to evaluate improvement in a subject's outcome by intervening at an organizational level. For many such trials sample size calculation is performed under the assumption of equal cluster size. Many trials that set out to recruit equal clusters end up with unequal clusters for various reasons. This leads to a misalignment between the method used for sample size calculation and the data analysis, which may affect trial power. Various weighted analysis methods for analyzing cluster means have been suggested to overcome the problem introduced by unbalanced clusters; however, the performance of such methods has not been evaluated extensively.Methods: We examine the use of the general linear model for analysis of clustered randomized trials assuming equal cluster sizes during the planning stage but ending up with unequal clusters. We demonstrate the performance of three approaches using different weights for analyzing the cluster means: (1) the standard analysis of cluster means, (2) weighting by cluster size, and (3) minimum variance weights. Several distributions are used to generate cluster sizes to cover a wide range of patterns of imbalance. The variability in cluster size is measured by the coefficient of variation (CV). By means of a simulation study, we assess the impact of using each of the three analysis methods with respect to type I error and power of the study and how it is affected by the variability in cluster size. Results: Analyses that assumes equal clusters provide a reasonable approximation when cluster sizes vary minimally (CV < 0.30). In an analysis weighted by cluster size type I errors were inflated, and that worsened as the variation in cluster size increases. However, a minimum variance weighted analysis best maintains target power and level of significance under all degrees of imbalance considered. Conclusion: The unweighted analysis works well as an approximate method when the variation in cluster size is minimal. However, using minimum variance weights performs much better across the full range of variation in cluster size and is recommended.
Ankle Joint Pressure Change in Varus Malalignment of Tibia
Authors: Zhu Yuan , Li Xingchen , Xu Xiangyang 
Published: December 2019

Abstract
Background: Varus malalignment of tibia could alter ankle biomechanics, might lead to degenerative changes of the ankle joint. However, previous studies failed to report the detailed changes of ankle biomechanics in varus malalignment of tibia. The aim of this biomechanical study was to evaluate ankle joint pressure change in response to the gradual progression of varus malalignment of tibia. Methods 8 fresh-frozen human cadaver legs were tested in this study. Varus malalignment of tibia and a total of 600N compressive force was simulated using a custom made fixture. Intra-articular sensors(TeckScan)were inserted in the ankle joint to collected ankle joint pressure data. The testing sequence was 0°, 2°,4°,6°,8°,10°,12°,14°,16°,18°,20° of tibial varus. Results As the tibial varus progressed, the center of force(COF) shifted laterally both for medial and lateral aspect of the ankle joint. For medial aspect of ankle joint, the lateral shift reached its maximum at 6º[2.76(1.46)mm, p=0.001] and 8º[2.76(1.62)mm, p=0.002], while for lateral aspect of ankle joint, the lateral shift reached its maximum at 12º[2.11(1.19)mm, p=0.002], thereafter, the COF shifted medially as the tibial varus progressed. The lateral joint pressure ratio was 0.481(0.125) at 0º and 0.548(0.108) at 10º and 0.517(0.101) at 20º. Significant differences were found between 0º and 10º(p=0.002), 10º and 20º (p=0.002)of tibial varus. Conclusions For mild tibial varus deformities, there was a lateral shift of COF and lateral stress concentration within the ankle joint, while as the deformity progressed, COF shifted medially and lateral stress concentration decreased. Keywords: ankle biomechanics, tibial varus, joint pressure measurement
The impact of cesarean section on neonatal outcomes at a university based tertiary hospital in Jordan
Authors: khasawneh wasim , Yusef Dawood , Alsulaiman Jomana W 
Published: December 2019

Abstract
Background Despite the WHO recommendation for cesarean section rates not to exceed 15% to minimize negative consequences in the mothers and neonates, there continues to be a steady rise in its rate globally. As a result, short-term and long-term maternal and neonatal complications are rising. The objective of this study is to determine the rate and assess neonatal outcomes of cesarean section at King Abdullah University Hospital (KAUH) in Jordan.Methods A retrospective chart review of all mothers and neonates delivered by cesarean section during the period January 2016 to July 2017 at KAUH tertiary academic center.Results 2595 Cesarean deliveries were performed over 18 months representing a rate of 50.5% of all deliveries. 60% were scheduled procedures. 72% were performed at full term gestation. The most common indication was previously scarred uterus followed by fetal distress. Rate of admission to the neonatal ICU was 30% (800/2595). After multilogistic conditional regression analysis, the factors associated with increased risk of neonatal ICU admission include grandmultiparity (Adjusted OR 1.46), gestational diabetes (Adjusted OR 1.92), maternal employment (Adjusted OR 1.84), prolonged rupture of membranes (Adjusted OR 5), fetal distress (Adjusted OR 1.84), prematurity (Adjusted OR 43.78), low birth weight (Adjusted OR 42), high order multiple gestation (Adjusted OR 9.58) and low 5-minute APGAR score (Adjusted OR 10). One out of six babies born at early term (37-38.6 weeks) were admitted for a median length of stay of 4 days (IQR 2, 8), the most common diagnosis was transient tachypnea of newborns and respiratory distress syndrome.Conclusion CS deliveries account for more than half the number of deliveries at our institution and one third of the delivered babies get admitted to the NICU. Together with the resulting maternal and neonatal consequences, this carries a major burden on the newborns, health care facilities and involved families. Local strategies and policies should be established and implemented to improve the outcome of births.
Under Nutrition and associated factors among lactating mothers in Southern Ethiopia: Institution Based Cross-sectional study
Authors: Kejela Gemechu , Gebremeskel Feleke , Hassen Hadiya , Shewangizaw Misgun , Desalegn Markos 
Published: December 2019

Abstract
Background Maternal Nutrition contributes significantly to the long term health of mothers and their children. Despite this importance, globally, about 795 million people are undernourished and women and their children are the most vulnerable groups.Objective the main aim of this study was to assess under nutrition and associated factors among lactating mothers in Arba Minch zuria district, Southern Ethiopia.Methods institution based cross-sectional study was used. Data was collected using interview administered questionnaire from a total of 441 lactating mothers. To get the required respondents, first health centers in Arba Minch zuria district were selected by using lottery method and probability to population size was performed for each health center. Finally, eligible respondents were selected using systematic sampling method. The questionnaire was pretested and close supervision was undertaken during data collection to assure the quality of data. The collected data was entered using Epi data version 3.02 and exported to SPSS version 20.0 for analysis. Binary and multivariable logistic regression were conducted, and finally variables with p-value of <0.05 were considered as statistically significant predictors.Results Prevalence of under nutrition in this study was 26.1%. Under nutrition is higher among mothers who are unable to read and write (AOR[95%CI]= 3.931[1.700,9.091]), mothers who experienced more than five numbers of pregnancies (AOR[95%CI]= 2.453[1.051, 5.728]), those with more than four members of family size (AOR[95%CI]= 2.289[1.171, 4.472]), those who live in the household with no toilet (AOR [95%CI] = 6.407[3.556, 11.545]) and those who have less than 4 antenatal care visits (AOR[95%CI]= 2.053[1.185, 3.559]).Conclusions and Recommendations In this study, the magnitude of under nutrition among lactating women was high. So, nutrition based health information, education and communication is needed for mothers especially during pregnancy and lactation in the study area.
Association Between Cytomegalovirus Disease and Dementia: A Population-Based Cohort Study
Authors: Lee Kyoung Hwa , Kwon Da Eun , Han Kyung Do , La Yeonju , Han Sang Hoon 
Published: December 2019

Abstract
Background The association between human cytomegalovirus (CMV) and dementia remains controversial. Previous studies have suggested that CMV serostatus assessed by serum immunoglobulin G plays a role in neurodegeneration with cognitive impairment. We aimed to evaluate the association between CMV tissue-invasive diseases and vascular dementia (VD) and Alzheimer’s disease (AD).MethodsThe International Classification of Diseases (ICD) 10th revision codes from the National Health Insurance Database covering entire people in Republic of Korea were used to classify patients: case group (n = 687), age ≥40 years with CMV tissue-invasive end-organ disease and control group (n = 3,435), without CMV disease, matched by age and sex (ratio, 1:5). The case and control subjects selected during 2010–2014 with a washout period of the previous 4 years were followed-up until December 2016.ResultsThe multivariate regression model adjusted for age and sex showed a significantly higher incidence of dementia (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.5–3.1) in the case group. The risk of VD (OR, 3.3; 95% CI, 1.3–8.4) was higher than that of AD (OR, 1.7; 95% CI, 1.1–2.8) in the case group. In age subgroup analysis adjusted for sex, patients aged 40–59 years with CMV disease had a significantly higher risk of all kinds of dementia than those aged 60-79 and ≥80 years (OR, 12.6; 95% CI, 3.3–48.8 vs. OR, 2.1; 95% CI, 1.3–3.4 vs. OR, 1.4; 95% CI, 0.7–2.9; P=0.021).Conclusions CMV disease may be associated with the risk of VD.
The Lived Experiences of Parents of Iranian Young Women with Multiple Sclerosis
Authors: Panahi Marzieh , Tazakori Zahra , Karimollahi Mansoureh 
Published: December 2019

Abstract
Background: Chronic illness in children causes more mental health risks for parents than other members of the family. Therefore, exploring the experiences of parents living with young women who have multiple sclerosis and presenting them to healthcare planners and managers can have a positive impact on community health. This study aimed to explore the experiences of parents of young women with multiple sclerosis in Iran. Methods: This research was a phenomenological study, and sampling was continued until data saturation, and 12 participants were chosen. The data were gathered using semi-structured interviews and analyzed using Colaizzi's method. Results: Open coding resulted in 450 codes, and after several stages of analysis and integration of similar codes, five main concepts, and 21 sub-concepts was produced. The main concepts included distress, trapping, adaptation barriers, response to illness, and reconciliation with the disease. Conclusion: This study showed the disease affects all dimensions of the parents' life and can lead to the experiences that are new to them and may lead to confusion. These findings can lead to more effective parental care for their daughters. It can also reduce the burden of disease on the family, the health system, and the community.
Significance of time from injury to surgery in the functional recovery of individuals with traumatic acute subdural hematoma
Authors: Chen Shih-Han , Sun Jui-Ming , Fang Wen-Kuei 
Published: December 2019

Abstract
Background: The time from injury to surgery (TIS) is critical in the functional recovery of individuals with traumatic acute subdural hematoma (TASDH). However, only few studies have confirmed such notion.Methods: The data of TASDH patients who were surgically treated in Chia-Yi Christian Hospital between January 2008 and December 2015 were collected. The significance of variables, including age, sex, traumatic mechanism, coma scale, midline shift on brain computed tomography (CT) scan, and TIS, in functional recovery was assessed using the student’s t -test, chi-square test, univariate and multivariate models, and receiver operating characteristic (ROC) curve.Results: A total of 37 patients achieved functional recovery (outcome scale score of 4 or 5) and 33 patients had poor recovery (outcome scale score of 1–3) after at least 1 year of follow-up. No significant difference was observed in terms of age, sex, coma scale score, traumatic mechanism, or midline shift on brain CT scan between the functional and poor recovery groups. TIS was found to be significantly shorter in the functional recovery group than in the poor recovery group (145.5±27.0 vs. 181.9±54.5, P-value=0.001). TIS and midline shift ≥10 mm were significant factors for functional outcomes in the multivariate regression models. The analysis of TIS with the ROC curve between these two groups showed that the threshold time for functional recovery in comatose patients and those with TASDH who were surgically treated was 2 hours and 57.5 minutes.Conclusions: TIS is crucial for the functional recovery of TASDH patients who underwent surgery.
Compliance with self-reporting quality assurance database entry in a tertiary academic anesthesiology practice
Authors: Tewfik George , Borad Neil 
Published: December 2019

Abstract
Background. Quality assurance (QA) programs are critical to ensuring patient safety in current anesthesiology practices. While challenging to adapt to daily practice, rates of case entry into other Anesthesiology quality assurance databases have ranged from 48% to 85.1%. The goal of this study was to investigate entry rates at our institution’s voluntary QA database and uncover patterns of reporting. Methods. From 2013 to 2017, a total of 61,492 surgeries were analyzed to determine the rates of voluntary reporting of all cases (with or without a reportable incident) in our QA database by comparing the number of total procedures billed in that time to the total number of cases input into the QA system. Results. The overall compliance rate of entry of cases into the QA database during the 5 year period analyzed was 65.51%. Cases in the Main OR had a higher 5 year rate of entry compared to cases in the Same Day Surgery center. Interestingly, during the 5 year period, July has consistently had the highest rate of case entry (72.54%) into the QA Database, perhaps due to the start of the new academic year for residents. More importantly, there was a decreasing trend of entry into the QA database over the 5 year period of study. From an initial rate of 84.37% in 2013, compliance rates have gradually declined to 78.88% in 2014, 67.30% in 2015, 54.18% in 2016, and 45.16% in 2017. Conclusion. The inherent disadvantages of a voluntary reporting system combined with the growing requirement for quality improvement measures in today’s healthcare system reflect the necessity for particular interventions at our institution aimed at increasing QA compliance rates.