bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of a multifaceted intervention to improve antibiotic prescribing: a pragmatic cluster-randomised controlled trial
Authors:   on behalf of the GREPHEPI Group, Figueiras Adolfo , López-Vázquez Paula , Gonzalez-Gonzalez Cristian , Vázquez-Lago Juan Manuel , Piñeiro-Lamas María , López-Durán Ana , Sánchez Coro , Herdeiro María Teresa , Zapata-Cachafeiro Maruxa 
Published: December 2020

Abstract
Objectives
This study sought to assess the effectiveness and return on investment (ROI) of a multifaceted intervention aimed at improving antibiotic prescribing for acute respiratory infections in primary care.

Design
Large-sized, two-arm, open-label, pragmatic, cluster-randomised controlled trial.

Setting
All primary care physicians working for the Spanish National Health Service (NHS) in Galicia (region in north-west Spain).

Participants
The seven spatial clusters were distributed by unequal randomisation (3:4) of the intervention and control groups. A total of 1217 physicians (1.30 million patients) were recruited from intervention clusters and 1393 physicians (1.46 million patients) from control clusters.

Interventions
One-hour educational outreach visits tailored to training needs identified in a previous study; an online course integrated in practice accreditation; and a clinical decision support system.

Main outcome measures
Changes in the ESAC (European Surveillance of Antimicrobial Consumption) quality indicators for outpatient antibiotic use. We used generalised linear mixed and conducted a ROI analysis to ascertain the overall cost savings.

Results
Median follow-up was 19 months. The adjusted effect on overall antibiotic prescribing attributable to the intervention was − 4.2% (95% CI: − 5.3% to − 3.2%), with this being more pronounced for penicillins − 6.5 (95% CI: − 7.9% to − 5.2%) and for the ratio of consumption of broad- to narrow-spectrum penicillins, cephalosporins, and macrolides − 9.0% (95% CI: − 14.0 to − 4.1%). The cost of the intervention was €87 per physician. Direct savings per physician attributable to the reduction in antibiotic prescriptions was €311 for the NHS and €573 for patient contributions, with an ROI of €2.57 and €5.59 respectively.

Conclusions
Interventions designed on the basis of gaps in physicians’ knowledge of and attitudes to misprescription can improve antibiotic prescribing and yield important direct cost savings.
Trial registration: Current Controlled Trials ISRCTN24158380. Registered 5 February 2009.
A preliminary study on designing a cluster randomized control trial of two new mosquito nets to prevent malaria parasite infection
Authors: Minakawa Noboru , Kongere James O. , Sonye George O. , Lutiali Peter A. , Awuor Beatrice , Kawada Hitoshi , Isozumi Rie , Futami Kyoko 
Published: December 2020

Abstract
Background
Although long-lasting insecticidal nets (LLINs) are the most effective tool for preventing malaria parasite transmission, the nets have some limitations. For example, the increase of LLIN use has induced the rapid expansion of mosquito insecticide resistance. More than two persons often share one net, which increases the infection risk. To overcome these problems, two new mosquito nets were developed, one incorporating piperonyl butoxide and another covering ceilings and open eaves. We designed a cluster randomized controlled trial (cRCT) to evaluate these nets based on the information provided in the present preliminary study.

Results
Nearly 75% of the anopheline population in the study area in western Kenya was Anopheles gambiae s. l., and the remaining was Anopheles funestus s. l. More female anophelines were recorded in the western part of the study area. The number of anophelines increased with rainfall. We planned to have 80% power to detect a 50% reduction in female anophelines between the control group and each intervention group. The between-cluster coefficient of variance was 0.192. As the number of clusters was limited to 4 due to the size of the study area, the estimated cluster size was 7 spray catches with an alpha of 0.05. Of 1619 children tested, 626 (48%) were Plasmodium falciparum positive using a rapid diagnostic test (RDT). The prevalence was higher in the northwestern part of the study area. The number of children who slept under bed nets was 929 (71%). The P. falciparum RDT-positive prevalence (RDTpfPR) of net users was 45%, and that of non-users was 55% (OR 0.73; 95% CI 0.56, 0.95). Using 45% RDTpfPR of net users, we expected each intervention to reduce prevalence by 50%. The intracluster correlation coefficient was 0.053. With 80% power and an alpha of 0.05, the estimated cluster size was 116 children. Based on the distribution of children, we modified the boundaries of the clusters and established 300-m buffer zones along the boundaries to minimize a spillover effect.

Conclusions
The cRCT study design is feasible. As the number of clusters is limited, we will apply a two-stage procedure with the baseline data to evaluate each intervention.
Community’s misconception about COVID-19 and its associated factors among Gondar town residents, Northwest Ethiopia
Authors: Mekonnen Habtamu Sewunet , Azagew Abere Woretaw , Wubneh Chalachew Adugna , Belay Getaneh Mulualem , Assimamaw Nega Tezera , Agegnehu Chilot Desta , Azale Telake , Azene Zelalem Nigussie , Merid Mehari Woldemariam , Muluneh Atalay Goshu , Geberu Demiss Mulatu , Kassa Getahun Molla , Yenit Melaku Kindie , Tilahun Sewbesew Yitayih , Gelaye Kassahun Alemu , Tamiru Animut Tagele , Rade Bayew Kelkay , Taye Eden Bishaw , Taddese Asefa Adimasu , Andualem Zewudu , Dagne Henok , Gashaye Kiros Terefe , Kabito Gebisa Guyasa , Mekonnen Tesfaye Hambisa , Wami Sintayehu Daba , Azanaw Jember , Adane Tsegaye , Alemayehu Mekuriaw 
Published: December 2020

Abstract
Background
Despite the implementation of various strategies such as the declaration of COVID-19 emergency state, staying at home, lockdown, and massive protective equipment distribution, still COVID-19 is increasing alarmingly. Therefore, the study aimed to assess the community’s perception of COVID-19 and its associated factors in Gondar town, Northwest Ethiopia.

Methods
A community-based cross-sectional study was employed among 635 Gondar administrative town residents, from April 20 to April 27, 2020. Study participants were selected using a cluster sampling technique. Data were collected using an interviewer-administered structured questionnaire. Epi-Data version 4.6 and STATA 14 were used for data entry and analysis, respectively. Logistic regressions (bivariable and multivariable) were performed to identify statistically significant variables at p < 0.05.

Results
Of the 635 study participants, 623 have completed the study with a 98.1% response rate. The mean age of participants was 36.32 years (SD ± 13.24). The overall magnitude of the community’s misconception about COVID-19 stood at 56.9% (349). Age and religion showed a negative association with misconceptions. To be specific, being in the age group of 27–33 (AOR = 0.52, 95% CI 0.32, 0.86) and being a Muslim (AOR 0.51, 95% CI 0.34, 0.78) were negatively associated with the misconception of COVID-19, whereas occupation and awareness showed positive associations with the misconception. To be specific, having an unemployed occupational status (AOR = 1.79, 95% CI 1.14, 2.82) and being unaware of the number of cases of COVID-19 (AOR 1.66, 95% CI 1.05, 2.62) were positively associated with the community’s misconception on COVID-19.

Conclusion
The magnitude of the community’s misconception about COVID-19 among Gondar town residents was high. Age, religion, unemployment, and unawareness about the number of COVID-19 cases were significant factors of misconception about COVID-19. Thus, stakeholders ought to build community perceptions about COVID 19. To resolve misinformation about COVID-19, accurate and relevant information should be provided to the community using appropriate communication media.
Innovations in Diabetes Care for a Better “New Normal” Beyond COVID-19
Authors: Agarwal Shivani , Griffith Michelle L , Murphy Elizabeth J , Greenlee Carol , Boord Jeffrey , Gabbay Robert A 
Published: December 2020

Abstract
The coronavirus disease pandemic has created opportunities for innovation in diabetes care that were not possible before. From the lens of this “new normal” state, we have an opportunity to rapidly implement, test, and iterate models of diabetes care to achieve the quadruple aim of improving medical outcomes, patient experience, provider satisfaction, and reducing costs. In this perspective, we discuss several innovative diabetes models of care which promote collaborative care models and improve access to high-quality specialty diabetes care. We discuss ongoing threats to diabetes care innovation, and offer practical solutions to foster evolution and sustain current strides made during the pandemic.
Διερεύνηση των παραγόντων που επιδρούν στην πρόθεση συμπεριφοράς για μείωση του οικολογικού αποτυπώματος στο πλαίσιο της εκπαίδευσης για την αειφορία σε βιοσυστήματα
Authors: Γιαννακόπουλος Ευάγγελος 
Published: December 2020

Η παρούσα μελέτη διερευνά τους παράγοντες που επιδρούν στην πρόθεση για διαμόρφωση συμπεριφοράς (Behavioral Intention) με στόχο την μείωση του οικολογικού αποτυπώματος (Ecological Footprint) σε βιοσυστήματα (biosystems). Εκατόν τριάντα τέσσερα άτομα από την περιοχή Μεσολογγίου, περιοχή που γειτνιάζει με βιότοπο προστατευμένο από συνθήκη Natura 2000, απάντησαν σε ερωτηματολόγιο το οποίο δομήθηκε με βάση την θεωρία της Προσχεδιασμένης Συμπεριφοράς (Theory of Planned Behavior-TPB). Τα δεδομένα αναλύθηκαν με δείκτες περιγραφικής στατιστικής προκειμένου να εξεταστούν οι μεταβλητές που διαμορφώνουν την πρόθεση της συμπεριφοράς του ατόμου για Αειφορία (Αειφόρο Σχολείο). Το μοντέλο βρέθηκε να είναι στατιστικά σημαντικό (p<0.05), ενώ το 61.90% της διακύμανσης της πρόθεσης συμπεριφοράς ερμηνεύτηκε με βάση τις ανεξάρτητες μεταβλητές του μοντέλου. Τα αποτελέσματα δείχνουν ότι το μοντέλο της TPB αποτελεί ένα σημαντικό εργαλείο πρόθεσης συμπεριφοράς και ευαισθητοποίησης μιας τοπικής κοινότητας προς την αειφόρο ανάπτυξη αναδεικνύοντας την ανακύκλωση στην πηγή, μέσω της κομποστοποίησης, ως μια αειφορική δράση που μπορεί να οδηγήσει στην μείωση του οικολογικού αποτυπώματος στον τοπικό οικοσύστημα.
Long-range density patterns in a six-beam optical lattice from polarization interference
Authors: Alfaro Castro Wilber , Connolly Patrick , Roach Timothy 
Published: December 2020

We report a correlation between periodic patterns of cold-atom density and field polarization that gives new insight into a nearly 30 year old question about the role of optical phases in laser cooling. The laser field of three intersecting pairs of counter-propagating

σ
+

−

σ
−

beams is widely used for cooling of atoms in magneto-optical traps and optical molasses. This six-beam optical lattice differs from four-beam lattices in having two “excess” phase constants of the optical standing waves. These relative time phases are independent degrees of freedom that affect key lattice properties, such as the polarization of the potential wells and the sub-Doppler cooling process. In this work, we create one-dimensional and two-dimensional spatial gradients of the optical phases in a six-beam lattice by slightly tilting the retro-reflected beams. This tilt imparts a long-range periodicity (

∼

m
m

) to the lattice polarization, creating a superlattice in which atoms are seen to diffuse into a periodic density distribution over several milliseconds. We find that high density is correlated with low field ellipticity; atoms move preferentially into regions where the field is linearly polarized. Such a non-uniform density may be important in cold collision experiments and may have applications in the preparation of atoms for atomic clocks and quantum computation.
Epidemic risk of arboviral diseases: Determining the habitats, spatial-temporal distribution, and abundance of immature Aedes aegypti in the Urban and Rural areas of Zanzibar, Tanzania
Authors: Saleh Fatma , Kitau Jovin , Konradsen Flemming , Kampango Ayubo , Abassi Rahibu , Schiøler Karin Linda 
Published: December 2020

Background
In Zanzibar, little is known about the arboviral disease vector Aedes aegypti in terms of abundance, spatio-temporal distribution of its larval habitats or factors associated with its proliferation. Effective control of the vector requires knowledge on ecology and habitat characteristics and is currently the only available option for reducing the risk of arboviral epidemics in the island nation of Zanzibar.

Methodology
We conducted entomological surveys in households and surrounding compounds from February to May 2018 in the urban (Mwembemakumbi and Chumbuni) and rural (Chuini and Kama) Shehias (lowest government administrative unit) situated in the Urban-West region of Unguja island, Zanzibar. Larvae and pupae were collected, transported to the insectary, reared to adult, and identified to species level. Characteristics and types of water containers were also recorded on site. Generalized linear mixed models with binomial and negative binomial distributions were applied to determine factors associated with presence of Ae. aegypti immatures (i.e. both larvae and pupae) or pupae, alone and significant predictors of the abundance of immature Ae. aegypti or pupae, respectively.

Results
The survey provided evidence of widespread presence and abundance of Ae. aegypti mosquitoes in both urban and rural settings of Unguja Island. Interestingly, rural setting had higher numbers of infested containers, all immatures, and pupae than urban setting. Likewise, higher House and Breteau indices were recorded in rural compared to the urban setting. There was no statistically significant difference in Stegomyia indices between seasons across settings. Plastics, metal containers and car tires were identified as the most productive habitats which collectively produced over 90% of all Ae. aegypti pupae. Water storage, sun exposure, vegetation, and organic matter were significant predictors of the abundance of immature Ae. aegypti.

Conclusions
Widespread presence and abundance of Ae. aegypti were found in rural and urban areas of Unguja, the main island of Zanzibar. Information on productive habitats and predictors of colonization of water containers are important for the development of a routine Aedes surveillance system and targeted control interventions in Zanzibar and similar settings.
The meaning of home questionnaire revisited: Psychometric analyses among people with Parkinson’s disease reveals new dimensions
Authors: Andersson Nilla , Nilsson Maria H. , Slaug Björn , Oswald Frank , Iwarsson Susanne 
Published: December 2020

BackgroundResearch addressing perceptions of housing in people with Parkinson’s disease (PD) is rare, and existing instruments capturing perceived aspects of housing are rarely used. Perceived housing comprises of several domains and is associated with health in general older populations. One such domain is meaning of home, captured by the Meaning of Home Questionnaire (MOH). The aim of this study was to evaluate psychometric properties of the MOH among people with PD.Materials and methodsThe MOH was administrated to 245 participants with PD (mean age = 69.9 years; mean PD duration = 9.7 years). The instrument consisted of four sub-scales with 28 items, each with 11 response options (strongly disagree = 0; strongly agree = 10). We evaluated data quality, structural validity (factor analysis), construct validity (i.e., testing correlations with relevant constructs according to pre-defined hypotheses), corrected item total correlations, floor and ceiling effects and internal consistency.ResultsThe data quality was high (0–1.2% missing data). The exploratory factor analysis suggested removal of five items and revealed three new factors; “My home is my castle”, “My home is my prison” and “My home is my social hub”. The 23-item MOH showed statistically significant correlations with life satisfaction, usability and ADL dependence, while not correlated with number of environmental barriers. These findings were largely as hypothesised, thus supporting construct validity (both convergent and discriminant). The corrected item total correlations were >0.3 for all items and the internal consistency was >0.70 for all sub-scales. No floor or ceiling effects were reported except for the sub-scale “My home is my castle” (ceiling effect = 15.6%).ConclusionsThe 23-item MOH version with three new sub-scales is sufficiently reliable and valid for use in PD populations. This paves the way for further research of meaning of home among people with PD, using the 23-item MOH version.
The route to diagnosis of sarcoma patients: Results from an interview study in the Netherlands and the United Kingdom
Authors: Soomers Vicky L. M. N. , van der Graaf Winette T. A. , Zaidi Shane , Kaal Suzanne E. J. , Hayes Andrew J. , Schreuder Bart H. W. B. , Jones Robin L. , Desar Ingrid M. E. , Husson Olga 
Published: December 2020

Introduction
Sarcomas are rare tumours. Early diagnosis is challenging, but important for local control and potentially survival and quality of life(QoL). We investigated (1)the route to diagnosis (RtD) experienced by sarcoma patients, including factors contributing to the length of the RtD from patients’ perspective; (2)the impact of the RtD on QoL and care satisfaction; and (3)differences in aims 1–2 between English and Dutch patients.

Methods
Fifteen sarcoma patients from The Royal Marsden Hospital, United Kingdom, and Radboud University Medical Centre, The Netherlands, were interviewed, exploring RtD experiences. Interviews were analysed according to qualitative content analysis.

Results
The main themes were: patient interval, diagnostic interval, reflection on the RtD and recommendations for improvement. Patient interval was long if symptoms were attributed as benign, did not interfere with daily life or were expected to cease. An incorrect working diagnosis, ineffective process of additional investigations, long referral times and lack of a lead clinician lengthened the diagnostic interval. Long waiting times, false reassurance and inadequate information provision led to dissatisfaction and a high emotional burden. Factors for improvement included increasing awareness of patients and healthcare providers, empowering patients, and having a lead clinician.

Conclusion
The RtD of sarcoma patients is complex. Increasing awareness of patients and healthcare providers may contribute to shorten the RtD.
Neutrophil-to-lymphocyte ratio predicts early mortality in females with metastatic triple-negative breast cancer
Authors: de la Cruz-Ku Gabriel , Chambergo-Michilot Diego , Torres-Roman J. Smith , Rebaza Pamela , Pinto Joseph , Araujo Jhajaira , Morante Zaida , Enriquez Daniel , Flores Claudio , Luque Renato , Saavedra Antonella , Lujan Maria , Gomez Henry , Valcarcel Bryan 
Published: December 2020

Background
The aim of this study was to determine the utility of the neutrophil-to-lymphocyte ratio (NLR) as a biomarker for predicting early-mortality (<2 years) among females with metastatic triple-negative breast cancer (mTNBC).

Methods
We reviewed 118 medical records of females with mTNBC. The cut-off value for the NLR (<2.5 and ≥2.5) was determined with receiver operating characteristic curves (area under the curve: 0.73; 95% CI: 0.62–0.85). Survival curves were estimated using the Kaplan-Meier method and compared with the Log-rank test. Multivariate Cox regression was used to identify the risk of mortality at two years. Moreover, we performed sensitivity analyses with different cut-off values and a subgroup analysis in females that only received chemotherapy.

Results
The median follow-up was 24 months. Females with NLR ≥2.5 had a poor overall survival compared to females with NLR <2.5 (6% vs. 28%, p<0.001) at two years. This outcome remained when we stratified for females that only received chemotherapy (8% vs. 36%, p = 0.001). Multivariate analyses identified NLR ≥2.5 as a poor prognostic risk factor for mortality in the entire population (HR: 2.12, 95% CI: 1.32–3.39) and among females that received chemotherapy (HR: 2.68, 95% CI: 1.46–4.92).

Conclusion
The NLR is an accessible and reliable biomarker that predicts early mortality among females with mTNBC. Our results suggest that females with high NLR values have poor prognosis despite receiving standard chemotherapy. Health providers should evaluate the possibility to enroll these patients in novel immunotherapy trials.
Pain prevalence in hospitalized patients at a tertiary academic medical center: Exploring severe persistent pain
Authors: Wu Chieh-Liang , Hung Yin-Lurn , Wang Yan-Ru , Huang Hui-Mei , Chang Chia-Hui , Wu Chih-Cheng , Hung Chih-Jen , Yeh Te-Feng 
Published: December 2020

ObjectiveThe pain prevalence of inpatients is not a well-studied medical issue in Asia. We have aimed to evaluate pain prevalence and characterize those patients who have suffered from severe, persistent pain.MethodsWe investigated pain prevalence using a quota sampling from 19 general wards during the year 2018. Using a structured questionnaire, eight interviewers visited patients at an age ≥ 20 years, and who had been staying in general wards for ≥ 3 days. Those patients were excluded if they were unable to respond to the interview questions. If they reported pain during hospitalization, the maximum pain level and the duration of pain suffered in the past 24 hours were assessed. Care-related pain was also surveyed.ResultsA total of 1,034 patients (M/F, 537/497) completed the survey. Amongst them, 719 patients (69.5%) experienced pain, with moderate and severe pain levels being 27.3% and 43%, respectively. Surgery was considered as it related to pain, including significantly severe pain. The top 3 care-related pain causes were needle pain, wound dressing, and change in position/chest percussion. Change in position/chest percussion and rehabilitation were associated with severe, persistent pain.ConclusionsPain is common in approximately 70% of inpatients, with surgery being associated with severe pain. Mobilization and rehabilitation may lead to severe, persistent pain. The periodic study of pain prevalence is essential in order to provide precise pain management.
Discursos de resistência em cenários de crise democrática: o campo das artes
Authors: De Sá Israel , Braga Amanda , Ribeiro Jocenilson 
Published: December 2020

No sentido que aqui tomamos das práticas de resistência e naquilo que concerne especificamente ao campo das artes, resiste-se por meio de grandes produções musicais, literárias, cinematográficas, mas não só. Resiste-se, do mesmo modo e cotidianamente, pelas mais diversas formas de expressão que se dão na microesfera, com produções marginais que, se não circulam nos grandes centros, fazem frente, ainda assim, ao exercício do poder. São manifestações que resistem à imposição de políticas públicas que restringem direitos aos mais vulneráveis economicamente, às regulações e normalizações das sexualidades, às diferenciações e violências de gênero, raça, etnia, aos modos de regulação da vida impostos pela sociedade capitalista etc. Foi pensando nessa dinâmica (teórica, artística, política), e ainda pensando ser papel do analista de discursos compreender as práticas históricas de resistência e sua relação com o presente, que propusemos refletir sobre os discursos de resistência inscritos no campo das artes. Neste conjunto de oito textos que aqui apresentamos, o leitor terá a oportunidade de pensar a partir de diferentes perspectivas de análises e refletir com autores e autoras que conduzem a leitura no campo do cinema, da literatura, da música ou, ainda, do trabalho editorial, jornalístico e humorístico, inscrevendo-se também, com isto, em uma prática possível de enfrentamento. Passemos então à apresentação dos artigos.