bluuebunny/crossref_metadata_2025_split huggingface dataset:
Simulation via Instant Messaging-Birmingham Advance (SIMBA) model helped improve clinicians’ confidence to manage cases in diabetes and endocrinology
Authors: Melson Eka , Davitadze Meri , Aftab Manal , Ng Cai Ying , Ooi Emma , Blaggan Parisha , Chen Wentin , Hanania Thia , Thomas Lucretia , Zhou Dengyi , Chandan Joht Singh , Senthil Latha , Arlt Wiebke , Sankar Sailesh , Ayuk John , Karamat Muhammad Ali , Kempegowda Punith 
Published: March 2020

Abstract
Introduction: Simulation-based learning (SBL) has been increasingly used in both undergraduate and postgraduate medical training curricula. The aim of Simulation via Instant Messaging-Birmingham Advance (SIMBA) is to create a simple virtual learning environment to improve trainees’ self-reported confidence in diabetes and Endocrinology. Methods: This study was done as part of the continuous professional development for Health Education England West Midlands specialty trainees in diabetes and Endocrinology. Standardized transcripts of anonymized real-life endocrinology (endocrine session) and diabetes cases (diabetes session) were used in the simulation model. Trainees interacted with moderators through WhatsApp® in this model. All cases were then discussed in detail by a consultant endocrinologist with reference to local, national and international guidelines. Trainee acceptance rate and improvement in their self-reported confidence levels post-simulation were assessed.Results: 70.8% (n=17/24) and 75% (n=18/24) strongly agreed the simulation session accommodated their personal learning style and the session was engaging. 66.7% (n=16/24) strongly felt that the simulation was worth their time. In endocrine session, there was a significant improvement in trainees’ confidence in the management of craniopharyngioma (p=0.0179) and acromegaly (p=0.0025). There was a trend towards improved confidence levels to manage Cushing’s disease and macroprolactinoma. In diabetes session, there was a significant improvement in trainees’ confidence to interpret continuous glucose monitor readings (p = 0.01). There was a trend towards improvement for managing monogenic diabetes, hypoglycaemic unawareness and interpreting Libre readings. Overall, there was a significant improvement in trainees’ confidence in managing cases that were discussed post-simulation. Conclusion: SIMBA is an effective learning model to improve trainees’ confidence to manage various diabetes and endocrine case scenarios. More sessions with a variety of other specialty case scenarios is needed to further assess SIMBA’s effectiveness and application in other areas of medical training.
Effects of Kinesio Tape on kinesiophobia, balance and functional performance of athletes with post anterior cruciate ligament reconstruction: A Pilot Trial
Authors: Gholami Milad , Kamali Fahimeh , Mirzaei Maryam , Motealleh Alireza , Shamsi MohammadBagher 
Published: March 2020

Abstract
Background : This study aimed to investigate the effects of Kinesio Taping on Kinesiophobia (fear of re-injury), balance and functional performance in athletes after anterior cruciate ligament reconstruction.
Methods: This randomized, placebo-controlled clinical trial was performed on 20 athletes with anterior cruciate ligament reconstruction (mean age 32.35 ± 6.25 years) at the time of return to sport. The participants were selected using purposive sampling approach and they were randomly assigned to kinesio tape group (n=10) or placebo kinesio tape group (n=10).
While subjects under taped, the following outcomes were measured at baseline, ten minutes after the intervention, and two days later. Kinesiophobia, balance, strength, functional / agility performance was assessed by Tampa Scale, Y balance test (YBT), single leg hops and 10-yard extremity functional test, respectively. Data were analyzed using the repeated measure analysis of variance (RMANOVA) in the SPSS v.23.
Results: Two days after Kinesio taping, the difference between the scores obtained in the first and the second measurements for all variables in the kinesio tape group was not significantly different rather than placebo kinesio tape group (all P> 0.05). The difference between scores of the third and the first measurements of all variables was also not significantly different in the kinesio tape group compared to the placebo kinesio tape group (all P> 0.05).
In the kinesio tape and placebo kinesio tape groups, RMANOVA indicated that the differences in all variables scores were significant over time (P < 0.001), Sidak post-hoc test indicated that the differences between the first and the second measurements, as well as between the first and the third measurements were significant (P < 0.001).
Conclusion: This study gives no support for any beneficial effect of kinesio taping on reduction of kinesiophobi or improvement of balance score and functional performance in athletes with post anterior cruciate ligament reconstruction.
Trial registration: This study was registered in the Iranian Clinical Trial Center with the code IRCT20190130042556N1, https://www.irct.ir/trial/37312, registered 12 February 2019.
Psychosocial barriers and enablers of exclusive breastfeeding: lived experiences of mothers in low-income townships, North West Province, South Africa
Authors: Witten Chantell Beverley , Claasen Nicole , Kruger Herculina S , Coutsoudis Anna , Grobler Herman 
Published: March 2020

Abstract
Background

Despite national efforts to promote exclusive breastfeeding (EBF), South Africa’s EBF rate is only 32%. The aim of this study was to examine the rate of EBF discontinuation and the lived experiences of breastfeeding mothers at postnatal time points 3-14 days, 4-8 weeks, 10-14 weeks and 20-24 weeks.

Methods

This community-based mixed-methods study collected data within a prospective cohort study on socio-demographics, the Edinburgh Postnatal Depression Scale (EPDS) and the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) at 6-8 weeks with infant feeding data collected at 4-8, 10-14 and 20-24 weeks from 159 mothers living in low income areas. Six focus groups with 32 mothers with infants aged 6-24 weeks were conducted. Descriptive statistics was used for the quantitative data and thematic analysis for qualitative data.

Results

The majority of mothers were unmarried (84.9%), living with family (69.2%) and unemployed (74.2%). EBF decreased from 34% at 4-8 weeks to 9.7% at 20-24 weeks. Mixed feeding with infant formula increased from 17.0% to 50.1% and food feeding from 3.1% to 54.2%. While there were no statistically significant associations between EBF and any of the quantitative socio-demographic variables, in the qualitative data, codes associated with barriers were more than enablers. The themes were Mothers’ attributes (wellbeing, experiences and relationships) with the code mother’s stress the strongest barrier, Mother’s knowledge, attitudes and practices of breastfeeding with the code conventional medicines the strongest barrier , Family environment with the code home setting the strongest barrier, Social environment with public spaces and places a barrier and in Baby cues the code baby stomach ailments the barrier. Within these same themes mother’s positive emotions , benefits of breastfeeding , support in the home , access to information and services from health professionals and baby’s health were strong enabling factors.

Conclusions

Low EBF, high mixed feeding and a high EPDS score were explained by the barriers identified in the qualitative data. The data suggests that mothers from low-income households would be better supported through interventions that address food insecurity; family relationships and those that build confidence in mothers and resilience in confronting difficult and hostile breastfeeding environments.
Comparison of Trunk Muscle Activities during Pressure Feedback Monitoring among Individuals With and Without Chronic Low Back Pain
Authors: Wang Chu Huai , Li Xin , Lo Wai Leung Ambrose , Lu Song Wei , Liu Howe , Lin Ke Yu , Lai Jian Yang , Li Le 
Published: March 2020

Abstract
Background: Pressure biofeedback unit (PBU) is a widely used non-invasive device for the monitoring of transverse abdominals (TA) and multifidus (MF) muscles in patients with low back pain (LBP). There is little research that compared trunk muscle activities with pressure feedback during trunk muscle contraction in a seated position. The aim this study was to compare muscle activities between deep local trunk muscles (TA and MF) and different target pressures (50, 60 and 70mmHg) of PBU in individuals with and without cLBP. Methods: Twenty-two patients with chronic LBP (cLBP) and 24 age matched healthy individuals were recruited. Electromyography (EMG) signals were recorded from the TA and MF muscles while the TA and MF were contracted to achieve PBU pressure value of 50, 60 and 70mmHg in random order. The average EMG amplitude (AEMG) of 3 replicate trials was used in the analysis after normalization to %MVIC. %MVIC is defined as the mean of the three AEMG divided by the AEMG of MVIC. Two-way ANOVA was performed to assess the effects of groups (Healthy and cLBP) and the three different target pressures of PBU. Spearman’s correlation analysis was performed in the cLBP group to determine potential correlations between EMG activity, NPRS and ODI. Results: The %MVIC of the TA and MF in the cLBP group were statistically higher than the control group at each pressure value (P＜0.05). The slope of the %MVIC-pressure of the cLBP subjects was significantly steeper than the healthy subjects (TA: P=0.01, MF: P＜0.001). During maximal voluntary isometric contraction (MVIC) of TA and MF, compared with pain-free group, cLBP subjects showed a decrease in EMG amplitudes (P≤0.001). The MVIC of MF was negatively correlated with Numerical Pain Rating Scale (r = -0.48, P=0.024) and Oswestry Disability Index (r = -0.59, P=0.004). Conclusions: The study demonstrated the feasibility of using PBU to assess muscle contraction that corresponds with changes of muscle activity as measured by EMG. Clinicians may be able to confer PBU measurements with EMG recordings to estimate the level of muscle activities during MF and TA contraction exercise in patients with cLBP.
Pre-operative hemoglobin level and use of sedative-hypnotics are independent risk factors for post-operative delirium following total knee arthroplasty
Authors: Kijima Eiji , Kayama Tomohiro , Saito Mitsuru , Kurosaka Daisaburo , Ikeda Ryo , Hayashi Hiroteru , Kubota Daisuke , Hyakutake Takashi , Marumo Keishi 
Published: March 2020

Abstract
Background: Delirium is a well-known complication following surgery, especially with the increasing age of patients undergoing surgery. The increasing demands resulting from a prolonged healthy life expectancy has resulted in more arthroplasties despite their age and existing comorbidities. The purpose of this study is to explore the various risk factors that may contribute to delirium in unilateral and bilateral total knee arthroplasties in the elderly population. Methods: 170 patients who underwent unilateral or bilateral total knee arthroplasties were analyzed retrospectively for delirium. Age, sex, comorbidities, use of sedative-hypnotics, peri-operative blood loss, pre- and post-operative laboratory blood test results were investigated and analyzed. Results: The incidence of post-operative delirium was 6.5% (11 out of 170 patients) with a mean age of 79.5 (± 6.9) years, compared to 73.0 (± 9.0) years in the non-delirium group. Higher age, use of sedative-hypnotics, low pre-operative Hb and Ht, low post-operative Hb, Ht and BUN were observed in the delirium group. Multivariate logistic regression analysis identified that the use of sedative-hypnotics and pre-operative Hb level were independent risk factors for post-operative delirium after TKA. The odds ratios for the use of sedative-hypnotics and pre-operative Hb level were 4.6 and 0.53, respectively. Receiver operating characteristic curve analysis showed that pre-operative Hb of less than 11.1 g/dL was a predictor for the development of delirium, with a sensitivity of 54.6% and a specificity of 91.6%. Conclusion: Patients with a pre-operative Hb level of <11.1 g/dL or those using sedative-hypnotics are associated with post-operative delirium. Peri-operative management and preventative measures are therefore needed to reduce the risks of post-operative delirium in such patients.
Evaluation of efficacy and recurrence for anti-vascular endothelial growth factor therapy in idiopathic choroidal neovascularization
Authors: Wu Qianru , Chen Xiaoyong , Feng Kang , Liu Yuling , Zhang Chun , Zhao Lin 
Published: March 2020

Abstract
Background

This study aimed to evaluate the visual and morphological outcomes of intravitreal anti-VEGF therapy and the recurrence for idiopathic choroidal neovascularization (ICNV).

Methods

This retrospective study included 35 patients (35 eyes) with ICNV from July 2012 to October 2017. All patients received 1 intravitreal anti-VEGF injection followed by pro re nata injections until there was no sign of ICNV activity. This was defined as the first follow-up period. To evaluate ICNV recurrence, we continued to follow-up 27 of the 35 patients for at least 2 years after the initial diagnosis, and the longest follow-up period was 5 years. Additional injection was performed when ICNV recurred. Best corrected visual acuity (BCVA) and central retinal thickness (CRT) were recorded and morphological improvement in optical coherence tomography (OCT) was assessed. Parameters that affect prognosis and recurrence were analysed.

Results

The mean follow-up period was 168.0 ± 34.82 weeks. Mean BCVA improved from 56.20 ± 14.13 letters at baseline to 73.31 ± 12.57 letters (P＜0.01); Mean CRT decreased from 353.6 ± 98.70 μm at baseline to 273.1 ± 53.56 μm (P < 0.001) at the end of the first follow-up period. Better baseline BCVA indicated a better morphological improvement(P = 0.026) in OCT: the lesion had completely subsided with recovery of the foveal contour. Those with high baseline BCVA (more than 60 letters) showed significant resolution of CNV lesions (P = 0.036). ICNV recurred in six patients (22.2%), 1 of whom experienced 2 recurrences. The mean timing of recurrence was 90.83± 49.02 weeks after diagnosis. There was no significant correlation between ICNV recurrence and the morphological improvement (P = 0.633). The final BCVA in patients with recurrence did not differ from that in patients without recurrence (P=0.065).

Conclusions

Intravitreal anti-VEGF therapy on a pro re nata basis was effective for treating ICNV. High baseline BCVA indicated a better prognosis. Re-treatment with anti-VEGF could effectively lead to resolution of recurrent ICNV. Disease recurrence had no significant effect on final visual prognosis and had no correlation with the morphological improvement during treatment, suggesting that follow-up for subsequent monitoring should be performed in all ICNV patients.
Surgical treatment strategies for extra-pelvic intravenous leiomyomatosis
Authors: Li Hua , Xu Jing , Lin Qiaowei , Zhang Yong , Zhao Yun , Tong Hanxing , Tu Ruiqin , Xu Demin , Wang Chunsheng , Lu Weiqi 
Published: March 2020

Abstract
Background

Extra-pelvic intravenous leiomyomatosis (IVL) extending into inferior vena cava (IVC) or heart (i.e. intracardiac leiomyomatosis, ICL) is an extremely rare benign disease. No consensus has been reached on the optimal surgical strategy. The aim of this study is to introduce four types of one-stage surgical strategies including less invasive options and a guideline to select patient-specific strategy for this disease.

Methods

Twenty-four patients of extra-pelvic IVLs receiving one-stage resections at the Zhongshan Hospital from July 2011 to November 2019 were reviewed retrospectively. Base on the initial experiences of the indiscriminate choices of tumor thrombectomies through sterno-laparotomy under cardiopulmonary bypass (CPB) in 6 ICLs, an anatomy-based guideline for four types of surgical strategies was developed and applied for the next 18 patients.

Results

Under the direction of guideline, tumor thrombectomies through single laparotomy were applied without CPB in 2 ICLs and 4 IVLs confined in IVC, or with CPB in 7 ICLs. Guideline-directed double-incisions with CPB were applied in only 5 ICLs, including 1 receiving mini-thoracotomy and 4 receiving sternotomy because of tumor adherences with right atriums in 2 and with pulmonary arteries in 2. All 24 patients accomplished one-stage panhysterectomy, bilateral adnexectomy and complete resections of intracaval and intracardiac tumors. For residual pelvic intravenous tumors in 19 patients, 17 received macroscopically complete resections while the other 2 failed because of high risk of hemorrhage. Intraoperative blood losses, operation time and hospitalization expense in the single-laparotomy non-CPB group were significantly lesser than the other groups. In CPB groups, inpatient stay and hospitalization expense in the single-incision group were significantly lesser than the double-incisions group. All patients were alive and free of recurrences during a mean follow-up of 35.4±27.2 months (range, 1–100 months). The pelvic tumor residues in 2 patients remained unchanged for 51 and 52 months since operation, respectively.

Conclusions

For various extra-pelvic IVLs, the 4 types of surgical strategies including less invasive options are feasible, providing these are selected by a guideline base on the tumor extension and morphology. The proposed guideline is believed to accommodate more patients receiving less invasive surgery without compromising the curative effect.
Competitive exclusion and metabolic dependency among microorganisms structure the cellulose economy of agricultural soil
Authors: Wilhelm Roland C , Pepe-Ranney Charles , Weisenhorn Pamela , Lipton Mary , Buckley Daniel H. 
Published: March 2020

Abstract
Background
Microorganisms that degrade cellulose utilize extracellular processes that yield free intermediates which promote interactions with non-cellulolytic organisms. We hypothesized that these interactions determine the ecological and physiological traits governing the fate of cellulosic carbon (C) in soil. We employed metagenomic-SIP and metaproteomics to characterize the attributes of cellulolytic and non-cellulolytic microbes accessing 13C from cellulose. We hypothesized that cellulolytic taxa would exhibit competitive traits to limit access, while non-cellulolytic taxa would display metabolic dependency, such as signatures of adaptive gene loss. We tested this hypothesis by evaluating genomic traits indicative of competitive exclusion or metabolic dependency, such as antibiotic production, growth rate, surface attachment, biomass degrading potential and auxotrophy.
Results
The most 13C-enriched taxa were cellulolytic Cellvibrio (Gammaproteobacteria) and Chaetomium (Ascomycota), which exhibited a strategy of self-sufficiency (prototrophy), rapid growth, and competitive exclusion via antibiotic production. These ruderal taxa were common indicators of soil disturbance in agroecosystems, such as tillage and fertilization. Auxotrophy was more prevalent in cellulolytic Actinobacteria than in cellulolytic Proteobacteria, demonstrating differences in dependency among cellulose degraders. Non-cellulolytic taxa that accessed 13C from cellulose (Planctomycetales, Verrucomicrobia and Vampirovibrionales) were highly dependent, as indicated by patterns of auxotrophy and 13C-labeling (i.e. partial labelling or labeling at later-stages). Major 13C-labeled cellulolytic microbes (e.g. Sorangium, Actinomycetales, Rhizobiales and Caulobacteraceae) possessed adaptations for surface colonization (e.g. gliding motility, hyphae, attachment structures) signifying the importance of surface ecology in decomposition.
Conclusions
Our results demonstrate that access to cellulose was accompanied by ecological trade-offs characterized by differing degrees of metabolic dependency and competitive exclusion. These trade-offs influence microbial growth dynamics on particulate organic carbon and reveal that the fate of carbon is governed by a complex economy within the microbial community. We propose three ecological groups for microbes participating in this economy: (i) independent primary degraders, (ii) integrated primary degraders and (iii) mutualists, opportunists and parasites.
Knowledge, attitudes, and practices of primary health care physicians regarding the pre-travel counselling of patients with type 2 diabetes in Riyadh, Saudi Arabia
Authors: Alduraibi Rabia , Almigbal Turky H , Alrasheed Abdullah A , Batais Mohammed Ali 
Published: March 2020

Abstract
Background: Travel has become an integral part of Saudi life. People with diabetes face many challenges while travelling that can have detrimental effects on glycaemic control. However, no previous studies have investigated pre-travel counselling in Saudi Arabia. This study aims to assess the knowledge, attitudes and practices of primary health care (PHC) physicians regarding pre-travel counselling for patients with type 2 diabetes.Methods: This cross-sectional study was conducted in PHC centres under the Ministry of Health in Riyadh, Saudi Arabia, during the period 2018-2019. A cluster multistage random sampling technique was used to recruit physicians. The data were collected through a self-administered questionnaire.Results: Three hundred and eighty-five primary health care physicians were recruited. This study showed that more than half (57.9%) of PHC physicians had poor knowledge scores. Additionally, the following characteristics were significantly associated with poor knowledge: being younger in age, being male, being Saudi, being a general practitioner, and having limited (0-5 years) experience. A total of 183 (47.5%) subjects showed disagreement attitudes towards the importance of pre-travel counselling among patients with diabetes. Furthermore, these disagreement attitudes were significantly associated with being older and having more years of experience. The majority (62.6%) of the physicians had poor practice scores. Poor practices were detected among physicians who were younger, male, and Saudi and who had a general practitioner specialty and degree.Conclusions: It could be concluded that a gap was detected in the knowledge and practices of primary health care physicians regarding pre-travel counselling for people with type 2 diabetes. Therefore, it is necessary to create easily accessible travel medicine education programmes for Saudi PHC providers to improve the management of travellers with diabetes.Trial registrationNot applicable