bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do we need to go further to train healthcare providers in the targeted regions for malaria elimination in Myanmar? A mixed-methods study
Authors: Hein Zar Ni Min , Maung Thae Maung , Aung Poe Poe , Mon Nwe Oo , Han Wai Wai , Oo Tin , Linn Nay Yi Yi , Thi Aung , Wai Khin Thet 
Published: February 2020

Abstract
Background
The National Malaria Control Programme (NMCP) in Myanmar trained health staff at the township level starting in mid-2016 in order to achieve the Plasmodium falciparum malaria elimination target by 2020. This study aimed to evaluate the knowledge and perception of Basic Health Staff (BHS) and Vector-borne Diseases Control (VBDC) teams exposed to a short training course on malaria elimination in six targeted townships which included two conflict-affected townships between 2016 and 2017.

Methods
This was a cross-sectional mixed-methods study using quantitative and qualitative data extracted from one survey database conducted between October 2018 and March 2019. Modified Poisson regression analysis was performed to ascertain the determinants of low knowledge scores after the training programme.

Results
Altogether, 544 trained frontline health workers involved in malaria elimination at the time of the survey were recruited and 56% (302/544) were stationed at sub-Rural Health Centers. More than half of the respondents had correct knowledge of malaria case categories although relapse and recrudescent cases (39% and 37% respectively) were less well known. Over two-thirds of respondents could mention those eligible for malaria testing. Less than 30% knew the foci classification. The overall knowledge scores ranged from 10 to 31. The significant predictors of low level of knowledge [the cut-off point was set at the median value of 21 (IQR 12–30)] in multivariate analysis were the younger age group (18–29 years) and health staff who had attended malaria elimination training in 2017, [(APR = 1.6, 95% CI 1.2–2.2)]; and (APR = 1.5, 95%CI 1.2–1.8)]. Qualitative data from 10 key informants identified perceived challenges in conflict-affected areas as well as in areas of high population mobility with further implications for case surveillance. In addition, the low level of education of community members was noted as one of the barriers that hampered public readiness in the elimination scenario.

Conclusion
A significant impact on knowledge improvement after the training programme was not visible especially for correct notification of malaria cases and treatment according to National Malaria Elimination Guidelines. Regular monitoring and continuing guidance by the higher level management is critical to support the field staff.
Early environmental factors and somatic comorbidity in schizophrenia and nonschizophrenic psychoses: A 50-year follow-up of the Northern Finland Birth Cohort 1966
Authors: Korpela Hanna , Miettunen Jouko , Rautio Nina , Isohanni Matti , Järvelin Marjo-Riitta , Jääskeläinen Erika , Auvinen Juha , Keinänen-Kiukaanniemi Sirkka , Nordström Tanja , Seppälä Jussi 
Published: February 2020

Abstract

Background.
We studied the cumulative incidence of physical illnesses, and the effect of early environmental factors (EEFs) on somatic comorbidity in schizophrenia, in nonschizophrenic psychosis and among nonpsychotic controls from birth up to the age of 50 years.

Methods.
The sample included 10,933 members of the Northern Finland Birth Cohort 1966, of whom, 227 had schizophrenia and 205 had nonschizophrenic psychosis. Diagnoses concerning physical illnesses were based on nationwide registers followed up to the end of 2016 and classified into 13 illness categories. Maternal education and age, family type at birth and paternal socioeconomic status were studied as EEFs of somatic illnesses.

Results.
When adjusted by gender and education, individuals and especially women with nonschizophrenic psychosis had higher risk of morbidity in almost all somatic illness categories compared to controls, and in some categories, compared to individuals with schizophrenia. The statistically significant adjusted hazard ratios varied from 1.27 to 2.42 in nonschizophrenic psychosis. Regarding EEFs, single-parent family as the family type at birth was a risk factor for a higher somatic score among men with schizophrenia and women with nonschizophrenic psychosis. Maternal age over 35 years was associated with lower somatic score among women with nonschizophrenic psychosis.

Conclusions.
Persons with nonschizophrenic psychoses have higher incidence of somatic diseases compared to people with schizophrenia and nonpsychotic controls, and this should be noted in clinical work. EEFs have mostly weak association with somatic comorbidity in our study.
Frailty in Older Adults With Multiple Myeloma: A Study of US Veterans
Authors: Patel Bindiya G. , Luo Suhong , Wildes Tanya M. , Sanfilippo Kristen M. 
Published: February 2020

PURPOSE Age-associated cumulative decline across physiologic systems results in a diminished resistance to stressors, including cancer and its treatment, creating a vulnerable state known as frailty. Frailty is associated with increased risk of adverse outcomes in patients with cancer. Identification of frailty in administrative data can allow for assessment of prognosis and facilitate control for confounding variables. The purpose of this study was to assess frailty from claims-based data using the accumulation of deficits approach in veterans with multiple myeloma (MM). METHODS From the Veterans Administration Central Cancer Registry, we identified patients who were diagnosed with MM between 1999 and 2014. Using the accumulation of deficits approach, we calculated a Frailty Index (FI) using 31 health-associated deficits and categorized scores into five groups: nonfrail (FI, 0 to 0.1), prefrail (FI, 0.11 to 0.20), mild frailty (FI, 0.21 to 0.30), moderate frailty (FI, 0.31 to 0.40), and severe frailty (FI, > 0.4). We used Cox proportional hazards regression analysis to assess association between FI score and mortality while adjusting for potential confounders. RESULTS We calculated an FI for 3,807 veterans age 65 years or older. Among the cohort, 28.7% were classified as nonfrail, 41.3% prefrail, 21.6% mildly frail, 6.6% moderately frail, and 1.7% severely frail. Frailty was strongly associated with mortality independent of age, race, MM treatment, body mass index, or statin use. Higher FI score was associated with higher mortality with hazard ratios of 1.33 (95% CI, 1.21 to 1.47), 1.97 (95% CI, 1.70 to 2.20), 2.86 (95% CI, 2.45 to 3.34), and 3.22 (95% CI, 2.46 to 4.22) for prefrail, mildly frail, moderately frail, and severely frail, respectively. CONCLUSION Frailty status is a significant predictor of mortality in older veterans with MM. Assessment of frailty status using the readily available electronic medical records data in administrative data allows for assessment of prognosis.
Predicting Acute Graft-Versus-Host Disease Using Machine Learning and Longitudinal Vital Sign Data From Electronic Health Records
Authors: Tang Shengpu , Chappell Grant T. , Mazzoli Amanda , Tewari Muneesh , Choi Sung Won , Wiens Jenna 
Published: February 2020

PURPOSE Acute graft-versus-host disease (aGVHD) remains a significant complication of allogeneic hematopoietic cell transplantation (HCT) and limits its broader application. The ability to predict grade II to IV aGVHD could potentially mitigate morbidity and mortality. To date, researchers have focused on using snapshots of a patient (eg, biomarkers at a single time point) to predict aGVHD onset. We hypothesized that longitudinal data collected and stored in electronic health records (EHRs) could distinguish patients at high risk of developing aGVHD from those at low risk. PATIENTS AND METHODS The study included a cohort of 324 patients undergoing allogeneic HCT at the University of Michigan C.S. Mott Children’s Hospital during 2014 to 2017. Using EHR data, specifically vital sign measurements collected within the first 10 days of transplantation, we built a predictive model using penalized logistic regression for identifying patients at risk for grade II to IV aGVHD. We compared the proposed model with a baseline model trained only on patient and donor characteristics collected at the time of transplantation and performed an analysis of the importance of different input features. RESULTS The proposed model outperformed the baseline model, with an area under the receiver operating characteristic curve of 0.659 versus 0.512 ( P = .019). The feature importance analysis showed that the learned model relied most on temperature and systolic blood pressure, and temporal trends (eg, increasing or decreasing) were more important than the average values. CONCLUSION Leveraging readily available clinical data from EHRs, we developed a machine-learning model for aGVHD prediction in patients undergoing HCT. Continuous monitoring of vital signs, such as temperature, could potentially help clinicians more accurately identify patients at high risk for aGVHD.
Growth Rates of Genetically Defined Renal Tumors: Implications for Active Surveillance and Intervention
Authors: Ball Mark W. , An Julie Y. , Gomella Patrick T. , Gautam Rabindra , Ricketts Christopher J. , Vocke Cathy D. , Schmidt Laura S. , Merino Maria J. , Srinivasan Ramaprasad , Malayeri Ashkan A. , Metwalli Adam R. , Linehan W. Marston 
Published: February 2020

PURPOSE Published series of growth rates of renal tumors on active surveillance largely consist of tumors without pathologic or genetic data. Growth kinetics of genetically defined renal tumors are not well known. Here, we evaluate the growth of genetically defined renal tumors and their association with patient clinical and genetic characteristics. PATIENTS AND METHODS We evaluated patients with an inherited kidney cancer susceptibility syndrome as a result of a pathologic germline alteration of VHL, MET, FLCN, or BAP1 with at least 1 solid renal mass managed with active surveillance at our institution. Tumor growth rates (GR) were calculated and patients were stratified by genetic alteration and other clinical and genetic factors to analyze differences in growth rates using linear regression and comparative statistics. RESULTS A total of 292 patients with 435 genetically defined tumors were identified, including 286 VHL-deficient, 91 FLCN-deficient, 52 MET-activated, and 6 BAP1-deficient tumors. There were significant differences in GRs when stratified by genetic alteration. BAP1-deficient tumors had the fastest median GR (0.6 cm/y; interquartile range [IQR], 0.57-0.68 cm/y), followed by VHL-deficient tumors (GR, 0.37 cm/y; IQR, 0.25-0.57 cm/y), FLCN-deficient tumors (GR, 0.10 cm/y; IQR, 0.04-0.24 cm/y), and tumors with MET activation (GR, 0.15 cm/y; IQR, 0.053-0.32 cm/y; P < .001). Tumors from the same patient had similar GRs. Younger age was independently associated with higher GR ( P = .005). CONCLUSION In a cohort of genetically defined tumors, tumor growth rates varied in a clinically and statistically different manner according to genetic subtype. Rapid growth of BAP1-deficient tumors indicates that these patients should be managed with caution. The faster growth of tumors in younger patients may support more frequent imaging, whereas the slower growth of other tumors may support extended surveillance beyond annual imaging in some instances.
Infrastructural Challenges Lead to Delay of Curative Radiotherapy in Nigeria
Authors: Leng Jim , Ntekim Atara I. , Ibraheem Abiola , Anakwenze Chidinma P. , Golden Daniel W. , Olopade Olufunmilayo I. 
Published: February 2020

PURPOSE In low- and middle-income countries, there has been an exponential increase in cancer incidence. According to the International Atomic Energy Agency, the biggest gap in radiotherapy availability and need is in Nigeria, where each machine serves an estimated 25.7 million people. This study aimed to characterize the barriers to radiotherapy and to identify areas for intervention. METHODS This was a cross-sectional study conducted at the University College Hospital in Ibadan, Nigeria, from June 2017 to August 2017. Demographic, sociocultural, and infrastructural factors relating to radiotherapy were collected through a questionnaire (N = 186). Ordinal logistic regression was used to identify the factors leading to delays in referral and delays in treatment initiation. RESULTS Patients traveled from 20 of Nigeria’s 36 states. The median age was 50 years (range, 19-79 years). The most common cancers treated were breast (37.5%), cervical (16.3%), head and neck (11.9%), and prostate (10.9%). In ordinal logistic regression, sociocultural factors, including the inability to pay (odds ratio [OR], 1.99; P = .034), a bad hospital experience (OR, 7.05; P = .001), and travel time (OR, 1.36; P = .001), increased the odds of referral delay to radiotherapy. In contrast, there was no significant relationship between time to treatment initiation and sociocultural factors including age, education, and inability to pay. Infrastructural barriers, including machine breakdown (OR, 2.92; P = .001), worker strikes (OR, 2.64; P = .001), and power outages (OR, 2.81; P = .022), increased the odds of treatment delay. CONCLUSION Although delays caused by patient factors are reported extensively, patients overcame these barriers in the hopes of curative treatment. However, staff and equipment malfunctions prevented patients from receiving timely radiotherapy. Policies aimed at addressing machine maintenance, health care worker satisfaction, and the aging power grid in Nigeria must be implemented in the future to strengthen the health care system to care for patients with cancer.
Enslavement and the Temporality of Childhood
Authors: Chinn Sarah E. 
Published: February 2020

AbstractThis article explores how thinking about the time of childhood through the lens of US slavery forces us to rethink both phenomena. According to many of the people who lived through it, enslaved childhood was a shifting, episodic phenomenon that had multiple points of definition. Throughout the nineteenth century, as their adult selves looked back on their early years, formerly enslaved people adopted a number of different strategies to understand and narrate how they came to be who they were and what their formative experiences meant in terms of the trajectory of their lives. They wrote within a literary culture that was itself partially responsible for creating (and certainly was instrumental in promoting and perpetuating) the temporal understanding of childhood as unidirectional, progressive, and only tangentially connected to material reality. But they also described quite different temporal patterns for slave childhood. These patterns are the focus of my analysis here: how African American narrators negotiated their vexed relationship to childhood as both never- and always-children in order to challenge the growing consensus on how childhood could and should be staged in literary texts. My primary sources are narratives by formerly enslaved people, written, as most slave narratives were, primarily but not exclusively for white readers.
TouchingThe Scarlet Letter : What Disability History Can Teach Us about Literature
Authors: Altschuler Sari 
Published: February 2020

AbstractThis essay demonstrates the value of disability history for literary and cultural studies. It develops historical cripistemology as a method through which to examine the historical experiences and epistemologies, rather than representations, of disability in particular times and places and emphasizes the vast and varied entanglements of those experiences and epistemologies with mainstream US culture. To do so, “Touching The Scarlet Letter” turns to perhaps the most canonical American novel to show how returning disability history to a text—here Nathaniel Hawthorne’s connections to and interest in blind education as well as the extensive cultural influence of the Perkins Institution and Massachusetts School for the Blind in the 1840s and 1850s—can reframe fundamental aspects of our analyses, such as how we understand reading and interpretation. In so doing, this essay argues for and begins to uncover a hidden disability history of US literature and culture.
How Would Low-Income Communities Prioritize Medicaid Spending?
Authors: Myers C. Daniel , Kieffer Edith C. , Fendrick A. Mark , Kim Hyungjin Myra , Calhoun Karen , Szymecko Lisa , LaHahnn Lynnette , Ledón Charo , Danis Marion , Rowe Zachary , Goold Susan Dorr 
Published: February 2020

AbstractContext: Medicaid plays a critical role in low-income, minority, and medically underserved communities, particularly in states that have expanded Medicaid under the Affordable Care Act. Yet, the voices of underresourced communities are often unheard in decisions about how to allocate Medicaid's scarce resources, and traditional methods of public engagement are poorly suited to gathering such input. We argue that deliberative public engagement can be a useful tool for involving communities in setting Medicaid priorities.Method: We engaged 209 residents of low-income, medically underserved Michigan communities in discussions about Medicaid spending priorities using an exercise in informed deliberation: CHAT (CHoosing All Together). Participants learned about Medicaid, deliberated in small groups, and set priorities both individually and collectively.Findings: Participants prioritized broad eligibility consistent with the ACA expansion, accepted some cost sharing, and prioritized spending in areas—including mental health—that are historically underfunded. Participants allocated less funding beyond benefit coverage, such as spending on healthy communities. Participants perceived the deliberative process as fair and informative, and they supported using it in the policy-making process.Conclusion: The choices of participants from low-income, medically underserved communities reflect a unique set of priorities and suggest that engaging low-income communities more deeply in Medicaid policy making might result in different prioritization decisions.
An Azide-Tethered Cremophor® ELP Surfactant Allowing Facile Post-Surface Functionalization of Nanoemulsions
Authors: Saito Airi , Yamamoto Shinkuro , Ochi Rika , Inoue Keiji , Hadano Shingo , Watanabe Shigeru , Nakayama Taku , Niko Yosuke 
Published: February 2020

Abstract
Nanoemulsions (NEs) comprising Labrafac WC® as an inner oil and Cremophor® ELP as an outer surfactant are promising organic nanoparticles for biomedical applications due to their characteristics, such as a low toxicity, good structural robustness, and a high capacity to encapsulate hydrophobic contrasting agents or drugs. However, NEs present a limited ability to undertake surface functionalization, resulting in uncontrollable cellular uptake or the poor targeting of specific biomolecules and cells. To address this drawback, we herein developed the Cremophor® ELP-derivative (Crem-N3), which possesses multiple azides. Remarkably, the surfaces of NEs formulated from Crem-N3 were easily modified with dibenzocyclooctyne derivatives through a copper-free azide–alkyne cycloaddition reaction known as a bioorthogonal click reaction. Förster resonance energy transfer analysis revealed that these surface-modified NEs possess the desired dispersibility and integrity. Furthermore, NEs that were functionalized with a cell-penetrating peptide, namely octaalginine (R8), were rapidly internalized into cancer cells, unlike NEs containing no R8. Based on our results, we believe that NEs composed of Crem-N3 as a co-surfactant are advanced NEs that allow flexible functionalization in response to targeted applications, such as vivo diagnostic applications that require a probe with minimum toxicity and specificity toward biological substances.
DISCRETE ISOMETRIC EXERCISE FOR THE INDIVIDUAL WITH TIME AND FACILITY CONSTRAINTS
Authors: Anastasio Albert Thomas 
Published: February 2020

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• Recent research indicates that isometric exercise appears to be safe and has a myriad of potential health benefits.
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Efficacy of Liraglutide in clinical practice: Single centre experience
Authors: Rashid Muhammad Owais , Jabeen Sumerah , Khoja Adeel , Islam Najmul 
Published: February 2020

Background and Objective: GLP-one receptor agonists are amongst the unique antidiabetes medications that have significant metabolic and cardiovascular benefits in addition to glucose lowering effect. To best of our knowledge, there is no published data on efficacy of liraglutide use among Pakistani population.Our objective was to ascertain the efficacy of liraglutide use among type two diabetes patients.
Methods: This retrospective study was conducted at the Endocrinology Clinics of Aga Khan University Hospital (AKUH) Karachi, Pakistan during the period from July 01, 2016 to 30th June, 2017. Liraglutide was prescribed to 68 obese type two diabetes patients with uncontrolled diabetes taking more than one oral medication ± insulin. Starting dose of Liraglutide was 0.6 mg, which was increased to 1.2 mg after 1-2 weeks with further increment to 1.8 mg/day based on tolerance and individual patient preference. Dose of other diabetes medications was adjusted according to clinical judgment whereas Dipeptidyl peptidase-4 (DPP-4) inhibitors were discontinued.
Results: Mean age of cohort was 55 years (SD=10.94 years) with median body mass index of 36.45 kg/m2 and majority (57.35%) were on a dose of 1.2 mg of Liraglutide per day. Median HbA1c reduced to 7.50% and 7.40% at three months and six months respectively vs 8.45% at baseline. Mean reduction in weight after three month was two kilograms and at six months, it was 1.38 kilograms respectively.
Conclusion: Liraglutide as add on therapy demonstrated favourable HbA1c and weight reduction in obese uncontrolled type two Diabetes Pakistani subjects.
doi: https://doi.org/10.12669/pjms.36.3.358
How to cite this:Rashid MO, Jabeen S, Khoja A, Islam N. Efficacy of Liraglutide in clinical practice: Single centre experience. Pak J Med Sci. 2020;36(3):432-437. doi: https://doi.org/10.12669/pjms.36.3.358
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Η Ηθική αιτιολόγηση στην Επιχειρηματολογία
Authors: ΠΑΠΑΔΟΠΟΥΛΟΥ ΒΑΣΙΛΙΚΗ ΓΡΗΓΟΡΙΟΣ , ΜΟΝΙΑΣ ΝΙΚΟΛΑΟΣ ΔΗΜΗΤΡΙΟΣ 
Published: February 2020

Στο πλαίσιο διδακτορικής διατριβής για την ανάπτυξη επιχειρηματολογικού γραπτού λόγου σε μαθητές της Στ΄Δημοτικού με την αξιοποίηση ηλεκτρονικών συνεργατικών περιβαλλόντων μάθησης, εξετάζουμε την εξέλιξη της ηθικής αιτιολόγησης στο λόγο των μαθητών. Κατατάξαμε την αιτιολόγηση στο λόγο των μαθητών πριν και μετά την παρέμβαση που εφαρμόσαμε. Από την συγκριτική εξέταση προκύπτει εξέλιξη στο λόγο των μαθητών ως προς τα στάδια ηθικής ανάπτυξης κατά Kohlberg. Η έρευνά μας αφορά την ηθική αιτιολόγηση και σε καμιά περίπτωση την ηθικότητα του ατόμου και την ηθική του συμπεριφορά