bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality of maternal and neonatal health care: A cross sectional survey in the for-profit private sector facilities in urban Bangladesh
Authors: Begum Tahmina , Nababan Herfina , Adams Alayne , Ahmed Anisuddin , Rahman Aminur , Anwar Iqbal 
Published: February 2020

Abstract
Background For-profit private sector is increasingly contributing in maternal and neonatal health (MNH) in many low and middle income countries including Bangladesh. However, they operate beyond any regulatory frame-work that raises concerns about quality, cost and equity. In view of maximizing the contribution of ever-growing private sector in achieving the national public health goals, this study explores the quality of MNH care in the for-profit private hospitals in urban Bangladesh. Method The study was conducted in Sylhet City Corporation area during June to August 2015 where all 34 for-profit private hospitals providing Comprehensive Emergency Obstetric and Neonatal care services were included. A facility survey (N=34) using structured checklist; and a review of inpatient medical records (n=1343) was undertaken to explore the structure, process and outcome dimensions of quality of MNH care. Finally results were presented according to size of the facility. ResultsOut of 34 health facilities, labour room, neonatal care unit and breast feeding corner were absent in 13, 27 and 31 facilities respectively. The median number of full time obstetricians, anesthetists and pediatricians were <1; and unregistered nurses (9) were more than registered nurses (3). Hospital copy for discharge certificates were available in 10 facilities. The recommended waste segregations and disposals using three separate colour coded bins were present in six surveyed facilities for in house but not at all for outhouse waste management. Out of 1343 delivery cases reviewed; 67% were conducted after 2 pm and 81% of all deliveries were conducted by caesarean section. Supporting clinical findings such as partograph use (<1%) and vaginal examination findings (21%) to validate Caesarean indication, were also missing. Conclusions Skilled human resource shortage was prominent and reflected as low use of evidence based clinical practices. Tendency of delivery being conducted after office time of public hospital implies dual practice of consultants which can jeopardize quality both in public and private health facilities. Poor record keeping was a medico-legal concern and improper waste management can increase hospital acquired infection rate. The observed poor quality of care under this study need immediate policy attention to safeguard individual health and national health system.
Concordance of mother-child (6-23 month) dietary diversity and its associated factors in Kucha district, Gamo Gofa Zone, Southern Ethiopia: a community- based cross- sectional study
Authors: Guja Tesfaye , Melaku Yeabsira , Andarge Eshetu 
Published: February 2020

Abstract
Background Meeting minimum standards of dietary quality in mothers and children is a challenge in many developing countries including Ethiopia. Emerging evidence suggests that maternal and child dietary diversity is associated but little is known about the associated factors of concordance of mother-child dietary diversity in Ethiopia and none is documented in the study area. This study examines the concordance between mother- child (6-23 months) dyads dietary diversity and the associated factors in Kucha district, Gamo Gofa zone, Southern Ethiopia. Methods A community based cross-sectional study was conducted among 791 mother- child (6-23 months) pairs from 11 selected kebeles in March 6 to April 13, 2017. Multi-stage cluster sampling technique was used to select the study subjects. The sampling frame was obtained from family folder of health posts in each kebele. The mother-child pairs were selected by simple random sampling method. The 7 food groups of World Health Organization (WHO) for children and the 10 food groups of FANTA/FAO, 2016 for mothers were used to analyze the dietary diversity. Cohen’s kappa statistics was calculated to see the strength of concordance. Multivariable logistic regression model was fitted to determine factors affecting mother-child dietary diversity concordance. Result A good concordance was noted between mother- child dietary diversity scores (Kappa = 0.43). Only 56 (7.1%) of mothers were negative deviants and 133 (16.8%) of mothers were positive deviants in dietary diversity consumption. Rural residence (AOR =3.49; 95% CI: 1.90-6.41), mothers having no formal education (AOR= 1.8; 95% CI: 1.08-3.05, mothers who did not own milking cow (AOR= 1.7; 95% CI: 1.10-2.56),children with low diversity diversity(AOR= 8.23; 95% CI: 5.17-13.08) and mothers with low dietary diversity (AOR= 0.46; 95% CI: 0.29-0.74) were found to be factors associated with mother-child dietary diversity concordance. An increase in the percentage of children reaching the minimum dietary diversity was greater with successive increase in maternal dietary diversity. Conclusion Despite, interesting similarity between mothers and children dietary consumption, more than three quarter of concordants didn’t achieve the recommended dietary diversity score (were low concordants). Interventions targeting on rural women’s access to high school education, home based milking cow rearing and promote nutrition sensitive agriculture to meet the dietary requirements of mothers and children in a sustainable manner and public health efforts to improve child nutrition may be strengthened by promoting maternal dietary diversity due to its potential effect on the entire family.
Geographical disparities and determinants of childhood diarrheal illness in Ethiopia: Further Analysis of 2016 Ethiopian Demographic and Health Survey
Authors: Atnafu Asmamaw , Sisay Malede Mequanent , Demissie Getu Debalkie , Tessema Zemenu Tadesse 
Published: February 2020

Abstract
Background: Childhood diarrheal illness is the second leading cause of child mortality in Sub Saharan Africa, including Ethiopia. Studies hypothesized that there are regional variations. Thus, the study aimed to examine the spatial variations and to identify the determinants of childhood diarrhea in Ethiopia. Methods: Data from the 2016 Ethiopia Demographic and Health Survey (EDHS) was analyzed. This nationwide survey involved 10,337 children below 5 years old. The survey was carried out using a two-stage stratified sampling design. Moran’s I and LISA were used to detect the spatial clustering of diarrhea cases and to test for clustering in the data. Descriptive statistics followed by a mixed-effect logistic regression was used to identify the factors associated with the prevalence of diarrhea. Results: Overall, 11.87% of children were experienced childhood diarrheal illness. The study reveals high-risk areas were Southern and central Ethiopia, while eastern and west were indicated as low-risk regions. Younger children were more likely to suffer from childhood diarrhea than their older counterparts: age 6 to 12, 12 to 23, and 24 to 35 months were (AOR = 2.66, (95% CI 2.01, 3.52)), (AOR = 2.45, (95% CI 1.89, 3.17)), and (AOR = 1.53, (95% CI 1.17, 2.01)), respectively. Children living in Tigray (AOR= 1.69 (95% CI, 1.01, 2.83)), Amhara (AOR = 1.80, (95% CI, 1.06, 3.06), SNNPR (AOR = 2.04, 95% CI 1.22, 3.42), and Gambela (AOR = 2.05, (95% CI 1.22, 3.42)), faced greater risk than Addis Ababa city. The odds of getting diarrhea is decreased by 24% among households having ≥3 under-five children as compared to households having only one under-five child (AOR = 0.76 (95% CI: 0.61, 0.94)). The odds of children getting diarrheal illness among working mothers increase by 19% as compared to not working (AOR = 1.19 (95% CI 1.03, 1.38)). Conclusions: childhood diarrheal illness is highly prevalent among under-five children, particularly in SNNP, Gambella, Oromia, and Benishangul Gumuz regions. Capacity building programs with best experience sharing and better household environment may prove effective in reducing the incidence of childhood diarrhea in Ethiopia. Keywords: Spatial statistics, Ethiopia, under-five children, Diarrhea, Generalized Mixed Model
Correlation between Agricultural Biodiversity, Dietary Diversity, Household Food Security and Associated Factors of Wasting among 6-59 Months old Children in Ambassel Woreda, North East Ethiopia
Authors: Tadesse Sisay Eshete , Mekonnen Tefera Chane , Feleke Yitbarek Wasihun , Mesfine Metadel Adane , Bekele Nigus Cherie , Ali Hafiza 
Published: February 2020

Abstract
Background Worldwide there are up to 300,000 known plant species. But, only 2% are consumed by human. Under nutrition among under five children is still a public health problem. There is an information gap on the importance of agricultural biodiversity in relation to dietary intake and nutritional status. Objective to assess the correlation between agricultural bio-diversity, dietary diversity, household food insecurity and associated factors of wasting among 6-59 months old children. Method A community based cross-sectional study was employed among 367 systematically selected children aged 6-59 months from January to April 2018. The sample size was determined by Epi Info 7.2.5.1. Data were collected by open data kit. Height and weight were measured using height measuring board and SECA Germany. Data entry and analysis was done using Epi Data version 3.1 and STATA version 14. Descriptive statistics was computed and reported using frequency and percentage. Anthropometric measurements were analyzed using WHO Anthro 2005 software. Linear regression and correlation were done. A p-value of < 0.05 and 95% confidence intervals were used to see the statistical significance. Result The prevalence of wasting was 7.3%(95% C.I; 4.6, 10.0). Dietary diversity score is found to be correlated with height for weight Z score (r=-0.11, p-value=0.04) of children. Mother who are unable to read and write (B=-.126, 95% CI: -1.02, -.034) and dietary diversity score (B=.143, 95% CI: .14, 1.86) were factors associated with wasting. Conclusion and Recommendation Wasting is higher than the national target of Ethiopia. Educational status of mother and DDS were factors associated with wasting among children aged 6-59 months. Prevention of nutritional problem should include reducing illiteracy rate among mother/care-givers and promote diversified intake of diet among 6-59 months old.
The correlation between vitamin D and maternal/infant outcomes, inflammatory response in pregnant women
Authors: Wei Yarong , Jiang Xinye , Qiu Ting , Fu Jinyan , Zhang Heng , Chen Daozhen 
Published: February 2020

Abstract
Purposes To analyze the effects of vitamin D deficiency in pregnant women on common adverse pregnancy outcomes and small for gestational age (SGA) and to detect the expression of inflammatory factors in pregnant women to provide a theoretical basis for the treatment of vitamin D deficiency in pregnant women. Methods Serum samples from pregnant women from January 2015 to December 2015 were collected to measure the 25-(OH)D level. The effects of maternal age, pregnancy, season, parity and temperature on vitamin D levels in pregnant women were recorded. Then, the relationship between vitamin D levels and gestational diabetes mellitus, gestational hypertension, premature rupture of membranes, cesarean section, premature delivery and spontaneous abortion, and neonatal gestational age were analyzed. The expression of IL-6 and TNF-α in serum was detected by RT-PCR and western blot. Results The incidence of vitamin D deficiency, insufficiency and sufficiency in pregnant women in this region was 83.28%, 15.36% and 1.36%, respectively. Age, pregnancy, sampling season and parity were the influencing factors on vitamin D level, and multivariate logistic regression analysis showed that summer, autumn and temperature were protective factors for adequate vitamin D in pregnant women (P <0.05). Vitamin D levels in pregnant women were associated with preterm birth, spontaneous abortion and SGA. The incidences of preterm birth, spontaneous abortion and SGA were higher in the vitamin D deficiency group (P<0.05). ConclusionThe serum vitamin D level of pregnant women in this area is low and is affected by multiple factors such as age, pregnancy, season, parity and temperature. Low vitamin D levels can increase the risk of premature birth, spontaneous abortion and SGA in pregnant women, and its low expression is common. As it also leads to inflammation, increasing the level of vitamin D in the serum of pregnant women can effectively reduce the occurrence of related diseases.
Evaluation of simplified fluid intake and output recording schemes for the self-management in patients with heart failure: a randomized controlled trial
Authors: Lin Na , Chen Xiaohuan , Huang Xiufang , Liu Donghui , Wu Zhiyong , Guo Yansong , Li Hong 
Published: February 2020

Abstract
Background Fluid management plays a pivotal role for heart failure (HF) patients. Medical fluid intake and output recording scheme by health care professional is complicated, which is not easily conducive to carry out by HF patients for self-management at home. This study aimed to optimize the professional fluid records for the self-management of HF patients and evaluate the effectiveness of this simplified recording scheme of fluid intake and output. Methods A randomized, non-blinded, non-inferiority trial with allocation concealment was conducted. Participants meeting the diagnostic criteria for HF were randomly assigned to professional recording group (PRG) and simplified recording group (SRG) according to the random allocation sequence generated by online tool. Days from admission to clinical stability (primary outcome), clinical congestion score (CCS), Minnesota Living with Heart Failure Questionnaire (MLHFQ) and frequency of electrolyte disturbances (secondary outcomes) were collected. The outcomes judges were blinded to group assignment.Results A total of 140 HF patients were enrolled and randomly divided into PRG (n=70) and SRG (n=70). Ultimately, 129 HF patients (PRG, n=65, and SRG, n=64) completed these experiments. Compared to PRG patients, SRG patients also improved their HF symptoms (including shortness of breath and fluid retention), and did not show the prolonged hospitalization time after similar intravenous diuretic treatment. Additionally, the parameters of clinical stability, CCS, MLHFQ, electrolyte disturbances and body weight in SRG patients were not inferior to that of PRG patients ( P >0.05). Conclusions This simplified fluid intake and output recording scheme was safe, efficient and non-inferior to the professional mode, which might effectively enhance their feasibility of self-management, and improve their quality of life in HF patients.
Do checklist-induced behavioral changes improve self-confidence in fundoscopic examination?: A mixed-methods study
Authors: Yokokawa Daiki , Shikino Kiyoshi , Ikegami Akiko , Tsukamoto Tomoko , Noda Kazutaka , Uehara Takanori , Ohira Yoshiyuki , Ikusaka Masatomi 
Published: February 2020

Abstract
Background Fundoscopic exams are conducted during outpatient consultations to assess intracranial disease and complications from chronic diseases. Low level of confidence in these skills which physicians have is one of the causes that Implementation frequency is low. We quantitatively verified increases in exam implementation for patients suggested for fundoscopic exams, as well as improvements in physicians' confidence in the procedures, by introducing a checklist. We also conducted a qualitative analysis in order to clarify the process by which they gain confidence in examination procedures. Methods This study is a before-after study, within an embedded-experimental mixed methods design. Phase 1 spans April to May 2016, April to May 2017, and October to November 2017. Phase 2 spans the two months following each phase 1 period. We sampled 15 physicians in department of general medicine at a university hospital assigned to initial consultation. The introduction of a checklist that verifies whether the fundoscopic exam was implemented. Measures are implementation ratio of the fundoscopic exam to the total number of indication cases, and Visual Analog Scale (VAS) values ​​for the confidence in procedure are measured between the two phases. To analyze, we obtained qualitative data from interviews and used the Modified Grounded Theory Approach. Results We observed significant increases in the implementation ratio (19.2% (29/151 cases) vs. 64.8% (105/162 cases), p<0.001), and in the VAS value for the confidence (1.89mm vs 4.68 mm (p<0.001)) between the two phases. Analysis of the interviews produced five themes from the initial 632 codes, 31 concepts (with <>), and 8 categories. To increase the implementation, it is necessary to reduce the and < Forgetting>, which is preventing by the checklist. The <Lack of successful experiences in detecting abnormalities> leads to a <Lack of confidence>. Repeated executions result in <Successful experiences and confidence building>.Conclusions The intervention increased the implementation ratio, thereby increasing successful experiences and confidence among physicians. The growth of confidence boosted motivations to implement fundoscopic exams.
A pilot exploratory study of the potentials of deep learning methods in cancer image segmentation and classification
Authors: Yi Eric , Liu Yanling 
Published: February 2020

Abstract
Background Tumor classification and feature quantification from H&E histology images are critical tasks for cancer diagnosis, cancer research, and treatment. However, both tasks involve tedious and time-consuming manual examination of histology images. We explored the usage of deep learning methods in segmentation and classification of histology images of cancer tissue for their potential in computer-aided tumor diagnosis and other clinical and research applications. Specifically, we evaluated performance of selected deep learning methods in stroma and glandular objects segmentation in tumor image data and tumor images classification. We automated these tasks to help facilitate downstream tumor image analysis, reduce the labor load of pathologists, and provide them with a second opinion on their analysis. Methods We modified a patch-based U-Net model and trained it to perform stroma detection and segmentation in cancer tissue. Then the semantic segmentation capabilities of the U-Net model were compared with that of a DeepLabV3+ model. We explored the possible use of transfer learning to train a patch-based model to classify cancer tissue images as carcinoma and sarcoma and to further classify them as carcinoma subtypes. Results In spite of the limited dataset available for the pilot study, we found that the DeepLabV3+ model performed biomedical image segmentation more effectively than U-Net when k-fold cross-validation was utilized, but U-Net still showed promise as an effective and efficient model when we used a customized validation approach. We believe that the DeepLabV3+ model can perform segmentation with even more accuracy if computation resource constraints are removed or if more data is used to augment the result. In terms of tumor classification, our selected models also consistently achieve test accuracies above 80%, with a model trained using transfer learning with VGG-16 network as the feature extractors, or convolutional base performing best. For multi-class tumor subtype classification, we also observed promising test accuracies from our models, and a customized post-processing method provided even higher prediction accuracy on test set images and this method can be further investigated. Conclusions This pilot exploratory study provided strong evidence for the powerful potentials of deep learning models for segmentation and classification of tumor image data.
Does baseline corticosterone influence inter-annual apparent survival of the Thorn-tailed Rayadito?
Authors: Quirici Verónica , Botero-Delgadillo Esteban , González-Gómez Paulina , Espíndola-Hernández Pamela , Zambrano Brayan , Cuevas Elfego , Wingfield John C. , Vásquez Rodrigo A. 
Published: February 2020

Abstract
Background: Many studies have attempted to link variation in corticosterone (Cort), the primary glucocorticoid (GC) in birds, with reproductive output, however the consequences of variation in Cort levels on survival probability have been relatively less explored. When considering baseline Cort and survival probability, two hypotheses have been proposed, the cort-fitness hypothesis and the cort-activity hypothesis. Notwithstanding a few exceptions, studies have generally however shown no relationship between levels of baseline Cort and the probability of survival. Methods: With the aim of increasing our understanding of the effect of baseline Cort on survival probability we utilized mark-recapture data from a long-term study (eight years of capture-mark-recapture) of the Thorn-tailed Rayadito ( Aphrastura spinicauda ), fitting different survival models with and without baseline Cort levels as covariates. Secondly, because the two populations in our study have different values of baseline Cort, we evaluated whether the association between baseline Cort and apparent inter-annual survival probability varied in relation to these two populations. Results: In the high latitude population (the population with lower baseline Cort levels), we observed a quadratic (inverted U-shape) relationship between baseline Cort levels and inter-annual survival probability; in the low latitude population, baseline Cort had no apparent effect on inter-annual survival probability. Conclusions: Because of the quadratic relationship, a relationship that only can be observed with long-term data, our approach emphasizes the importance of using a capture-recapture model. In addition, because the effect of baseline Cort on survival probability was found to be context-dependent, our work also highlights the importance of comparing different populations.
Preoperative anemia and postoperative thirty-day mortality in patients undergoing non-cardiac surgery: a secondary analysis based on a single-center retrospective study.
Authors: Luo Xueying , Liu Baoer , Zheng Sujing , Yang Liping , Li Ya , Hu Haofei , He Jinsong 
Published: February 2020

Abstract
Introduction There is controversial and limited evidence to clarify the specific relationship between anemia and perioperative mortality in surgical patients at different ages. We aimed to investigate the relationship between them in patients undergoing non-cardiac surgery of different ages. Methods The present study was a retrospective analysis of the electronic medical records of 90,785 patients who underwent general surgery at the Singapore General Hospital from January 1, 2012 to October 31, 2016. We reanalyzed these data including patient demographics, comorbidities, laboratory results, surgical priority and surgical risk. The main outcome measures included anemia and postoperative 30day mortality. Results The average age of the 86,748 participants enrolled was 52.73 ± 17.24 years old, of which approximately 54.05% were female. 62878 (72.48%)people in the study population had no anemia, 13006 (14.99%) had mild anemia, 10863 (12.52%) had moderate to severe anemia. Multivariate logistic regression analysis showed that anemia was independently associated with postoperative 30day mortality [Compared with none anemia, adjusted odds ratio of mild anemia:1.6404, (95% confidence interval [CI]: 1.2295-2.1886; P =0.000768); and adjusted OR of moderate or severe anemia: 2.6643 (95% [CI]: 2.0315- 3.4941) ;P<0.000001)]. There is no statistical difference among the effect sizes of anemia on 30day mortality, regardless of different age(P=0.2469), gender(p=0.8067), and race (0.4629). And the effect sizes of anemia at each stage on postoperative 30day mortality showed statistically significant increase in intra-transfusion, emergency surgery, high surgery risk(p for interaction is 0.0125,0.0001,0.0032,respectively) Discussion In patients undergoing non-cardiac surgery, anemia is an independent risk factor for perioperative 30day mortality, especially among emergency surgery, high-risk surgery and surgery with intraoperative blood transfusion.