bluuebunny/crossref_metadata_2025_split huggingface dataset:
Examining Health Care Providers’ and Middle-level Managers’ Readiness for Change:A Qualitative Study
Authors: Austin Tujuanna , Chreim Samia , Grudniewicz Agnes 
Published: December 2019

Abstract
Background: Readiness is a critical precursor of successful change; it denotes whether those involved in the change are motivated and empowered to participate in the change. Research on readiness tends to focus on frontline providers or individuals in non-managerial positions and offers limited attention to individuals in middle management positions who are expected to lead frontline providers in change implementation. Yet middle-level managers are also recipients of changes that are planned and decreed by those in higher positions. This study sought to examine both frontline provider and middle manager readiness for change in the context of primary care program integration.
Methods: Using a qualitative case study approach, we examined how frontline providers and middle managers experienced six readiness factors: discrepancy, appropriateness, valence, efficacy, fairness and trust in management. Data were collected through documents, meeting observation and semi-structured interviews with frontline providers and middle managers involved in the change.
Results: The findings highlighted similarities and differences in readiness experiences of frontline providers and middle managers. Across both types of participants, we found that the notion of valence should be expanded to consider individuals’ evaluation of benefits to patients and the health system; efficacy applies to both content and process of change; fairness and trust in management findings require further exploration to determine their appropriateness to be incorporated in models of readiness for change; and trust in management (or lack of trust) has a cascading influence across the levels in the organization.
Conclusions: Our study makes a contribution by nuancing and extending conceptualizations of individual readiness factors, and by highlighting the central role of middle manager readiness for change. Implications of the study include the need to consider readiness factors prior to the implementation of change and the importance of fostering readiness throughout all levels of the organization.
Evolution of cis- and trans-regulatory divergence in the chicken genome between two contrasting breeds analyzed using three tissue types at one-day-old
Authors: Wang Qiong , Jia Yaxiong , Wang Yuan , Jiang Zhihua , Zhou Xiang , Zhang Zebin , Nie Changsheng , Li Junying , Yang Ning , Qu Lujiang 
Published: December 2019

Abstract
Background: Gene expression variation is a key underlying factor influencing phenotypic variation, and can occur via cis- or trans-regulation. To understand the role of cis- and trans-regulatory variation on population divergence in chicken, we developed reciprocal crosses of two chicken breeds, White Leghorn and Cornish Game, which exhibit major differences in body size and reproductive traits, and used them to determine the degree of cis versus trans variation in the brain, liver, and muscle tissue of male and female 1-day-old specimens.Results: We provided an overview of how transcriptomes are regulated in hybrid progenies of two contrasting breeds based on allele specific expression analysis. Compared with cis-regulatory divergence, trans-acting genes were more extensive in the chicken genome. In addition, considerable compensatory cis- and trans-regulatory changes exist in the chicken genome. Most importantly, stronger purifying selection was observed on genes regulated by trans-variations than in genes regulated by the cis elements.Conclusions: We present a pipeline to explore allele-specific expression in hybrid progenies of inbred lines without a specific reference genome. Our research is the first study to describe the regulatory divergence between two contrasting breeds. The results suggest that artificial selection associated with domestication in chicken could have acted more on trans-regulatory divergence than on cis-regulatory divergence.
Day centres for older people: attender characteristics, access routes and outcomes of regular attendance. Finding of exploratory mixed methods case study research.
Authors: Orellana Katharine , Manthorpe Jill , Tinker Anthea 
Published: December 2019

Abstract
BACKGROUND Social prescribing is encouraged to promote well-being, reduce isolation and loneliness. Traditional, generalist day centres for older people could be suggested by social prescribing, but little is known about their clientele or their outcomes. As part of a larger study of the role, outcomes and commissioning of generalist English day centres for older people, the characteristics of attenders at four day centres, their reasons for attendance and outcomes were explored. METHODS This mixed-methods study used qualitative interviews and standardised tools within an embedded multiple-case study design. Semi-structured interviews with older day centre attenders (n=23, 62% of eligible attenders) of four day centres in south-east England, recruited purposively to reflect organisational differences, were analysed. RESULTS Participants reported non-elective withdrawal from socialisation following health or mobility decline, or losses. Apart from living arrangements and marital status, attenders’ profiles differed between centres. Access had been mostly facilitated by others. Day centre attendance enhanced quality of life for this group of socially isolated people with mobility restrictions and at risk of declining independence and wellbeing. The positive impact on attenders' social participation and involvement and on meaningful occupation was significant (p-value <0.001, 99% CI), with an average ASCOT gain score of 0.18. Ten outcome themes were identified. CONCLUSIONS Outcomes of day centre attendance are those targeted by social care and health policy. Centres were communities that ‘enabled’ and offset loss or isolation, thus supporting ageing in place through wellbeing and contributed something unique to their attenders’ lives. By monitoring attenders’ health and wellbeing and providing practical support, information and facilitating access to other services, centres offered added value. Attendance needs to be set in the context of other social engagement and care provision which may not overlap or duplicate centre support. Professionals may wish to explore the benefits of social prescriptions to day centres but should map local centres’ provision, engage with their organisers, and seek information on attenders, who may differ from those in this study.
The Prognostic Significance of Different Bleeding Classifications in Off-pump Coronary Artery Bypass Grafting
Authors: Xi Ziwei , Gao Yanan , Yan Zhenxian , Zhou Yujie , Liu Wei 
Published: December 2019

Abstract
Background: Perioperative bleeding during cardiac surgery are known to make patients susceptible to adverse outcomes and several bleeding classifications have been developed to stratify the severity of bleeding events. Further validation of different classifications was needed. The aim of present study was to validate and explore the prognostic value of different bleeding classifications in patients undergoing off-pump coronary artery bypass grafting (OPCAB).
Methods: Data on baseline and operative characteristics of 3,988 patients who underwent OPCAB in Beijing Anzhen Hospital from February 2008 to December 2014 were available. The primary endpoint was a composite of in-hospital death and nonfatal postoperative myocardial infarction (MI). The secondary endpoint was postoperative acute kidney injury (AKI). We explored the association of major bleeding defined by the European registry of Coronary Artery Bypass Grafting (E-CABG), Universal Definition of Perioperative Bleeding (UDPB), Bleeding Academic Research Consortium (BARC) classification and Study of Platelet Inhibition and Patient Outcomes (PLATO) with primary endpoints by multivariable logistic regression analysis and investigated their significance of adverse event prediction using goodness-of-fit tests of -2 log likelihood.
Results: In-hospital mortality was 1.23% (n=49) and postoperative MI was observed in 4.76% (n=190) of patients, AKI in 24.69% (n=985). The incidence of the primary outcome was 5.99% (n=239). Multivariable logistic regression analysis showed that BARC type 4 (OR=2.64, 95% CI: 1.66–4.19, P<0.001), UDPB class 4 (OR=3.52, 95% CI: 2.05–6.02, P<0.001) and E-CABG class 2-3 (class 2: OR=2.24, 95% CI: 1.36–3.70, P=0.001; class 3: OR=12.65, 95% CI: 2.74–18.43, P=0.002) bleeding but not PLATO bleeding were associated with an increased risk of in-hospital death and postoperative MI. Major bleeding defined by all the four classifications mentioned above was an independent risk factor of AKI after surgery. Inclusion of major bleeding defined by these four classifications improved the predictive performance of the multivariable model with baseline characteristics.
Conclusions: Bleeding assessed by BARC, E-CABG and UDPB classifications were significantly associated with poorer immediate outcomes. These classifications seemed to be valuable tool in the assessment of prognostic effect of perioperative bleeding.
Ethnic disparity in pneumonia-specific mortality among children under 5 years of age in Sichuan Province of Western China from 2010 to 2017
Authors: Luo Min , Zhao Ziling , He Linkun , Su Bingzhong , Liu Weixin , Zhang Gang 
Published: December 2019

Abstract
Background: To reveal the ethnic disparity in the pneumonia-specific mortality rates of children under the age of five years(PU5MRs) and provide suggestions regarding priority interventions to reduce preventable under-five-years-of-age deaths. Methods: Data were obtained from the Direct Report System of Maternal and Child Health in Sichuan. The Cochran-Armitage trend test was used to assess the time trend. The Cochran-Mantel-Haenszel test and Chi-square test were used to examine the differences in the PU5MRs among different groups. Results: The PU5MRs in the minority and nonminority counties decreased by 53.7% and 42.3% from 2010 to 2017, respectively. The PU5MRs of the minority counties were 4.81 times higher than those of the nonminority counties in 2017. The proportion of pneumonia deaths to total deaths in Sichuan Province increased from 11.7% in 2010 to 15.5% in 2017. The pneumonia-specific mortality rates of children in the categories of 0-28 days, 29days-11 months, and 12-59 months were reduced by 55.1%, 38.8%, and 65.5%, respectively, in the minority counties and by 35.5%, 43.1%, and 43.7%, respectively, in the nonminority counties. Conclusions: PU5MRs declined in Sichuan, especially in the minority counties, while ethnic disparity still exists. Although the PU5MRs decreased more for the minority counties as a fraction of all mortality the absolute number of such deaths were higher, and therefore more children in these counties continue to die from pneumonia than from the non-minority counties. Priority should be given to strategies for preventing and controlling child pneumonia, especially for postneonates, in the minority counties.
Investigating Associated Factors with Glomerular Filtration Rate : Structural Equation Modeling
Authors: Jamshidi Parastoo , Najafi Farid , Mostafaee Shayan , Shakiba Ebrahem , pasdar yahya , Hamzeh Behrooz , Moradinazar Mahdi 
Published: December 2019

Abstract
Background: glomerular filtration rate (GFR) is a valid indicator for kidney function. Different factors can affect GFR. The purpose of this study is to assess direct and indirect effects of GFR-related factors using structural equation modeling.Patients and methods:We analyzed data from baseline phase of Ravansar Non-Communicable Disease cohort study. Data on socio-behavioral, nutritional, cardiovascular, and metabolic risk factors were entered in a conceptual model in order to test direct and indirect effects of factors related to GFR,separately in male and female, using the structural equation modeling.Results: Of 8927 individuals participated in this study, 4212 subjects were male (47.20%) and 4715 subjects were female (52.80%). The obtained mean and standard deviation of GFR was 76.05 (±14.31) per 1.73 . GFR for 0.2%, 11.3%, 73.0% and 15.50% of people were <30, , and , respectively. Hypertension and aging in both gender and atherogenic factor in male directly, and in female directly and indirectly had a lower effect on GFR. Blood urea nitrogen and smoking in male and female, directly or indirectly through other variables, were associated with a lower GFR. In female, diabetes had a lower direct and indirect effect on GFR. Obesity in female was directly associated with uper and indirectly associated with lower GFR.Conclusion: According to our results, aging, hypertension, diabetes, obesity and high lipid profile, and BUN had a decreasing direct and indirect effects on GFR. Although low GFR might have different reasons and it is not a consistent sign of CKD, our findings, are in line with other reports, provide more detailed informations about important risk factors of low GFR. Public awareness about such factors can improve public practice of positive health behaviours.
Identifying risk factors of anemia among women of reproductive age in Rwanda - a cross-sectional study using secondary data from the Rwanda Demographic and Health Survey 2014/2015
Authors: Hakizimana Dieudonne , Nisingizwe Marie Paul , Logan Jenae , Wong Rex 
Published: December 2019

Abstract
Background Anemia among Women of Reproductive Age (WRA) continues to be among the major public health problems in many developing countries, including Rwanda, where it increased in prevalence between the 2015 and 2010 Rwanda Demographic and Health Survey (RDHS) reports. A thorough understanding of its risk factors is necessary to design better interventions. However, to the best of our knowledge, no study has been conducted in Rwanda on a nationally representative sample to assess factors associated with anemia among WRA. Accordingly, this study was conducted to address such gap. Methods A quantitative, cross-sectional study was conducted using data from the RDHS 2014-2015 report. The study population consisted of 6680 WRA who were tested for anemia during the survey. Anemia was defined as having a hemoglobin level equal to or below 10.9 g/dl for a pregnant woman, and hemoglobin level equal to or below 11.9 g/dl for a non-pregnant woman. Pearson’s chi-squared test and multiple logistic regression were conducted for bivariate and multivariable analysis, respectively. Results The prevalence of anemia among WRA was 19.2% (95% CI: 18.0 - 20.5). Four factors were found to be associated with lower odds of anemia, including being obese (OR: 0.61, 95% CI: 0.40 - 0.91), being in the rich category (OR: 0.74, 95% CI: 0.63 - 0.87), sleeping under a mosquito net (OR: 0.85, 95% CI: 0.74 - 0.98), and using hormonal contraceptives (OR: 0.61, 95% CI: 0.50 - 0.73). Five factors were associated with higher odds of anemia, including being underweight (OR: 1.39, 95% CI: 1.09 - 1.78), using an intrauterine device (OR: 1.98, 95% CI: 1.05 - 3.75), being separated or widowed (OR: 1.35, 95% CI: 1.09 - 1.67), and living in the Southern province (OR: 1.45, 95% CI: 1.11 - 1.89) or in the Eastern province (OR: 1.41, 95% CI: 1.06 - 1.88). Conclusion Anemia continues to pose public health challenges; novel public health interventions should consider geographic variations in anemia risk, seek to improve women’s economic statuses, and strengthen iron supplementation especially for Intrauterine device users. Additionally, given the association between anemia and malaria, interventions to prevent malaria should be enhanced.
Prevalence, risk factors, phenotypic and molecular characteristics for methicillin-resistant Staphylococcus aureus carriage in community-based drug users in Guangzhou, China
Authors: Wang Yingying , Lin Jialing , Zhou Junli , Han Zhigang , Yao Zhenjiang 
Published: December 2019

Abstract
Background: Staphylococcus aureus ( S. aureus ) and methicillin-resistant Staphylococcus aureus (MRSA) remained the predominant cause of infections in drug users. The cross-sectional study aimed to elucidate the prevalence, risk factors, phenotypic and molecular characteristics of S. aureus and MRSA carriage among community-based drug users. Methods: Eligible drug users were asked to complete questionnaires and collect nasal swabs during May and December 2017 in Guangzhou, China. Swabs were processed for identification of S. aureus and MRSA. Antimicrobial susceptibility test and polymerase chain reaction assays were used to detect phenotypic and molecular characteristics for identified isolates. Univariate and multivariate logistic regression analyses were used to assess risk factors for S. aureus and MRSA carriage. Results: Overall, the prevalence of S. aureus and MRSA carriage in 353 drug users were 15.01% and 6.79%, respectively. Cohabitation was a risk factor for S. aureus (adjusted OR=8.80, 95% CI: 1.89-40.99) and MRSA (adjusted OR=14.30, 95% CI: 2.67-76.46) carriage. The proportions of multidrug resistance were respectively 72.41% and 89.47% for S. aureus and MRSA isolates and were simultaneously resistant to penicillin, erythromycin and clindamycin. The results of clonal complexes and sequence types for S. aureus and MRSA isolates were diverse. The proportions of virulence genes were high for MRSA isolates. Conclusion: The prevalence of S. aureus nasal carriage was lower while the prevalence of MRSA nasal carriage was moderate. Phenotypic and molecular characteristics of MRSA isolates revealed serious antibiotic resistance, indicating the cross-circulation of MRSA isolates, and imply high opportunity of virulence-related diseases. Decolonization might be considered for drug users with MRSA carriage, especially for those with risk factors.
Microscopic and submicroscopic Plasmodium infections in indigenous and non-indigenous communities in Colombia.
Authors: Montiel Jehidys , Zuluaga Lina M. , Aguirre Daniel C. , Segura Cesar , Tobon-Castaño Alberto , Vasquez Ana M 
Published: December 2019

Abstract
Background The indigenous population is considered a highly susceptible group to malaria becouse they usually live in areas with high Anopheles exposure and poverty, and have low access to health services. There is a great diversity of indigenous communities in Colombia living in malaria-endemic areas; however, the burden of infection in these populations has not extensively studied. This study aimed to determine the prevalence of Plasmodium infections in indigenous and non-indigenous communities in two malaria-endemic areas in Colombia.Methods A Community-based cross-sectional survey was conducted in seven villages of Turbo and El Bagre municipalities; three of these villages were indigenous communities. All inhabitants of all ages that were willing to participate were included. Sociodemographic and clinical data were recorded as well as household information. The parasitological diagnosis was performed by microscopy and nested PCR. The prevalence of microscopy and submicroscopic infection was estimated. An adjusted GEE model was used to explore risk factors associated with the infection.Results Among 713 participants, 60.1% were from indigenous communities. Plasmodium spp. was detected in 30 subjects (4.2%, CI 95% 2.9-5.9); from those, 29 were in the indigenous population, 47% of infections were afebrile, and most of them submicroscopic (10/14). Microscopic and submicroscopic prevalence was 2.5% (CI 95% 1.6-3.9) and 1.7% (CI 95% 0.9-2.9) respectively. In El Bagre, all infections occurred in indigenous participants (3.9%, CI 95% 2.2-7.1), and 81% were submicroscopic. By contrast, in Turbo, the highest prevalence occurred in indigenous people (11.5%; CI 95%: 7.3-17.5), but 88.8% were microscopic. Living in an indigenous population increased the incidence rate of infection compared with a non-indigenous population (IRR 19.4; CI 95% 2.3-166.7).Conclusion There is a high proportion of Plasmodium infection in indigenous communities. A substantial proportion of asymptomatic and submicroscopic carriers were detected. The identification of these infections, not only in indigenous but also in the non-indigenous population, as well as their associated factors, could help to implement specific malaria strategies for each context.
Determining spa-type of methicillin-resistant Staphylococcus aureus (MRSA) via High-Resolution Melting (HRM) analysis, Shiraz, Iran
Authors: Hashemizadeh Zahra , Bazargani Abdollah , Mohebi Samane , Kalantar-Neyestanaki Davood , Hadi Nahal 
Published: December 2019

Abstract
Objectives: Molecular typing methods are useful for rapid detection and control of a disease. Recently, the use of High-resolution melting (HRM) for spa typing of MRSA isolates were reported. This technique is rapid, inexpensive and simple for genotyping and mutation screening in DNA sequence. The aim of this study was to evaluate the ability of HRM-PCR to analysis spa genes amongst MRSA isolates.Results: A total of 50 MRSA isolates were collected from two teaching hospitals in Shiraz, Iran. The isolates were confirmed as MRSA by susceptibility to Cefoxitin and detection of mecA gene using PCR. we used High-resolution melting (HRM) analysis and PCR-sequencing method for spa typing of MRSA isolates. In total, 15 different spa types were discriminate by HRM and sequencing method. The melting temperature of the 15 spa types, using HRM genotyping were between 82.16° C and 85.66° C. The rate of GC% content was 39.4-46.3. According to the results, spa typing of 50 clinical isolates via PCR-sequencing and HRM methods were 100% similar. Consequently, HRM method can easily identify and rapidly differentiate alleles of spa genes. This method is faster, less laborious and more suitable for high sample at lower cost and risk of contamination.
Microglia depletion prior to lipopolysaccharide and paraquat treatment differentially modulates behavioral and neuronal outcomes in wild type and G2019S LRRK2 knock-in mice.
Authors: Dwyer Zach , Rudyk Chris , Situt Divya , Beauchamp Sheryl , Abdali Jawaria , Dinesh Anu , Legancher Nathalie , Sun Hongyu , Schlossmacher Michael , Hayley Shawn 
Published: December 2019

Abstract
Background: Substantial data have implicated microglial-driven neuroinflammation in Parkinson’s disease (PD) and environmental toxicants have been long expected as triggers of such inflammatory processes. Of course, these environmental insults act in the context of genetic vulnerability factors and in this regard, leucine rich repeat kinase 2 (LRRK2), may play a prominent role.Methods: We used a double hit, lipopolysaccharide (LPS; endotoxin) followed by paraquat (pesticide toxicant) model of PD in mice with the most common LRRK2 mutation G2019S, knockin mice and wild type littermates. In order to assess the contribution of microglia, we depleted these cells (through 14 days of the CSF-1 antagonist, PLX-3397) prior to LPS and paraquat exposure.Results: We found that the G2019S mice displayed the greatest signs of behavioral pathology, but that the PLX-3397 induced microglial depletion at the time of LPS exposure diminished toxicity and weight loss and blunted the reduction in home-cage activity with subsequent paraquat exposure. However, neither the PLX-3397 pre-treatment nor the G2019S mutation affected the LPS + paraquat induced loss of substantia nigra pars compacta (SNc) dopamine neurons or elevation of circulating immune (IL-6) or stress (corticosterone) factors. Intriguingly, microglial morphological ratings were basally enhanced in G2019S mice and the PLX-3397 pre-treatment reversed this effect. Moreover, PLX-3397 pre-treatment selectively elevated soluble a-synuclein and SIRT3 levels, while reducing SNc caspase-1 and 3, along with CX3CR1. Hence, the re-populated “new” microglia following cessation of PLX-3397 clearly had an altered phenotype or were immature at the time of sacrifice (i.e. after 11 days).Conclusions: Collectively, these findings suggest that G2019S knock-in and PLX-3397 microglial depletion at the time of LPS exposure affects behavioral, but not neurodegenerative responses to subsequent environmental toxin exposure.