bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stakeholder views of podiatry services in the UK for people living with arthritis: a qualitative study
Authors: Dando Charlotte , Bacon Dawn , Borthwick Alan , Bowen Catherine 
Published: September 2020

AbstractBackgroundThe aim of this study was to explore the views of stakeholders in podiatry services, patients, commissioners and general practitioners (GP), to further understand experiences of referral, access and provision of treatment in the National Health Service (NHS) for foot problems for patients living with arthritis.MethodTo explore in‐depth individual views and experiences of stakeholders in podiatry services, 19 patients who had arthritis (osteoarthritis and/or rheumatoid arthritis) participated in one of four focus groups. In addition, seven commissioners and/or GPs took part in semi structured interviews. A purposive sampling strategy was adopted for all focus groups and semi structured interviews. To account for geographical variations, the focus groups and semi structured interviews were conducted across two predetermined regions of the United Kingdom (UK), Yorkshire and Hampshire. Data was rendered anonymous and transcribed verbatim. Thematic analysis was employed to identify key meanings and report patterns within the data.ResultsFive key themes derived from the focus groups and interviews suggest a variety of factors influencing referral, access and provision of treatment for foot problems within the UK. 1. Systems working together (navigation of different care pathways, access and referral opportunities for people with OA or RA, education around foot health services for people with OA or RA); 2.Finance (financial variations, different care systems, wasting resources); 3. Understanding what podiatry services have to offer (podiatrists are leaders in foot health services, service requirements in relation to training standards and health needs); 4. Person factors of foot pain (arthritis is invisible, affects quality of life, physical and mental wellbeing); 5. Facilitators of foot care (NICE guidelines, stakeholder events, supporting self‐management strategies).ConclusionThe findings indicate that patients, commissioners and GPs have very similar experiences of referral, access and provision of treatment for foot problems, for patients living with arthritis. Essentially, commissioners and GPs interviewed called for a transformational approach in current systems to include newer models of care that meet the footcare needs of individual patient circumstances. Patients interviewed called for better signposting and information about the different services available to help them manage their foot health needs. To address this, we have formulated a signposting pack for all stakeholders to help them facilitate access to appropriate clinicians ‘at the right time, in the right place’ to manage foot health problems.
Ascending aorta pseudoaneurysm simulating mediastinal lymphoma in computed tomography, a possible diagnostic error: a case report
Authors: Chiocchi Marcello , Spiritigliozzi Luigi , Di Tosto Federica , Benelli Leonardo , D’Errico Francesca , Presicce Matteo , Pugliese Luca , Ricci Francesca , De Stasio Vincenzo , Di Donna Carlo , Pasqualetto Monia , Colella Dionisio Ferdinando , Floris Roberto 
Published: September 2020

AbstractBackgroundAn ascending aortic pseudoaneurysm is a severe and rare complication following cardiothoracic surgery. This case report demonstrates its possible misinterpretation and the consequent importance of multidisciplinary evaluation.Case presentationWe present a case of an 18-year-old Caucasian man with Marfan syndrome who developed an ascending aortic pseudoaneurysm about 1 year after undergoing cardiac surgery with the Bentall procedure. Computed tomographic examination of the thoracic aorta and positron emission tomography–computed tomography initially suggested a lymphomatous pathology. However, these imaging results were in contrast to the transesophageal echocardiogram and the laboratory data that showed negative results for hematological pathology. A second computed tomographic scan redirected the diagnosis toward a pseudoaneurysm.ConclusionThis case demonstrates the utility of close communication and interdisciplinary consultation between cardiovascular radiologists and the cardiac surgery team, which are mandatory in order to maximize their diagnostic skills in identifying postoperative complications.
Calvarial bone grafts to augment the alveolar process in partially dentate patients: a prospective case series
Authors: Yousif Ahmed , Raghoebar Gerry M. , Putters Thomas F. , Vissink Arjan , Schortinghuis Jurjen 
Published: September 2020

Abstract
Background
Calvarial bone grafts as a pre-implant augmentation procedure are mostly used to reconstruct the edentulous maxilla, although calvarial grafts could also be used in the partially dentate patients needing extensive bone grafting.

Methods
In 7 consecutive partially dentate patients needing bone grafting because of a large bony defect as a result of trauma (n = 1), oligodontia (n = 1), failed previous bone augmentation (n = 1), or atrophy (n = 4), the alveolar process was reconstructed with calvarial bone as a pre-implant procedure.

Results
A total of 30 implants was placed either immediate at the time of bone grafting (13 implants) or after a healing time of 4 months when immediate placement was not possible (17 implants). One wound dehiscence occurred that needed secondary intervention. During follow-up (40 ± 14 months), one implant was lost due to peri-implantitis with an infected osteosynthesis screw. Marginal peri-implant bone loss was 0.65 ± 0.47 mm during this period.

Conclusion
Calvarial bone is a sound extra-oral donor site when aiming for reconstruction of a large bony defect of the alveolar process of partially dentate patients.
Successful treatment of recurrent volvulus in the afferent limb of the pouch following proctocolectomy for ulcerative colitis: a case report
Authors: Itabashi Michio , Bamba Yoshiko , Aihara Hisako , Tani Kimitaka , Nakagawa Ryousuke , Koshino Kurodo , Ohki Takeshi , Ogawa Shinpei , Inoue Yuji , Yamamoto Masakazu 
Published: September 2020

Abstract
Background
Pouch volvulus after proctocolectomy for ulcerative colitis is a very rare postoperative complication. The common site of pouch volvulus has been reported to be the ileal pouch–anal anastomosis and the middle part of the pouch, but no reports on pouch volvulus in the afferent limb of the pouch have been observed. Here, we report the case of a patient with afferent limb volvulus who underwent afferent limbpexy, but required reoperation 7 months later.

Case presentation
A 38-year-old man with refractory ulcerative colitis had undergone open proctocolectomy 10 years ago at another hospital. He had been aware of lower abdominal pain and bowel movement difficulty for 2 years. After repeated bowel obstruction, he was referred to our hospital for surgery. Based on the radiographic findings, we diagnosed a pouch volvulus and performed an operation. Laparoscopically, counterclockwise rotation of the afferent limb of the pouch was recognized. Moreover, the ileal mesentery was adhered and fixed to the presacral space 20 cm from the oral side of the pouch. The antimesenteric side of the afferent limb was fixed using interrupted stiches on the left peritoneal wall of the pelvis. He was discharged uneventfully 18 days after surgery, and defecation improved immediately. However, he was readmitted 7 months after surgery with the same abdominal pain and defecation difficulty. A similar finding was found and diagnosed as recurrent volvulus. Therefore, we performed a laparoscopic surgery. The same volvulus as in the previous surgery was confirmed. The site fixed during the previous surgery showed scars, but the afferent limb was free. The dilated ileum that contained the volvulus was excised only on the oral side of the pouch and an intraluminal anastomosis was performed on the anterior wall of the pouch. He had a good postoperative course and was discharged.

Conclusion
Proper diagnosis of volvulus based on the characteristic imaging findings is important. In principle, bilateral row fixation of the rotated ileum is the basic procedure for volvulus. However, fixation with this technique is sometimes difficult. Therefore, this procedure is one of the useful options for the fixation of difficult or recurrent cases.
Population structure and regeneration of Himalayan endemic Larix species in three high-altitude valleys in Nepal Himalaya
Authors: Dhamala Man Kumar , Aryal Prakash Chandra , Suwal Madan Krishna , Bhatta Sijar , Bhuju Dinesh Raj 
Published: September 2020

AbstractBackgroundThe Himalayan forests are of great importance to sustain the nature and community resource demands. These forests are facing pressures both from anthropogenic activities and ongoing global climatic changes. Poor natural regeneration has been considered a major problem in mountainous forests. To understand the population structure and regeneration status ofLarix(Larix griffithianaandLarix himalaica), we conducted systematic vegetation surveys in three high-altitude valleys namely Ghunsa (Kanchenjunga Conservation Area, KCA), Langtang (Langtang National Park, LNP), and Tsum (Manaslu Conservation Area, MCA) in Nepal Himalaya. The average values of diameter at breast height (DBH), height, and sapling height were compared for three sites and two species using Kruskal-Wallis test. Population structure was assessed in terms of proportion of seedlings, saplings, and trees. Regeneration was analyzed using graphical representation of frequencies of seedlings, saplings, and trees in histograms.ResultsThe results showed that the population structure ofLarixin terms of the proportion of seedling, sapling, and tree varied greatly in the three study areas. KCA had the highest record of seedling, sapling, and tree compared to other two sites. Seedlings were the least among three forms and many plots were without seedlings. We found no seedling in MCA study plots. The plot level average DBH variation among sites was significant (Kruskal-Wallisχ2= 7.813, df = 2,p= 0.02) as was between species (Kruskal-Wallisχ2= 5.9829, df = 1,p= 0.014). Similarly, the variation in average tree height was significant (Kruskal-Wallisχ2= 134.23, df = 2,p< 0.001) among sites as well as between species (Kruskal-Wallisχ2= 128.01, df = 1,p< 0.001). All the sites showed reverse J-shaped curve but more pronounced for KCA and MCA. In comparing the two species,Larix griffithianahas clear reverse J-shaped diameter distribution but notLarix himalaica.ConclusionThe varied responses ofLarixmanifested through regeneration status from spatially distinct areas show that regeneration limitations might be more pronounced in the future. In all the three studied valleys, regeneration ofLarixis found to be problematic and specifically forLarix griffithianain MCA andLarix himalaicain LNP. To address the issues of disturbances, especially serious in LNP, management interventions are recommended to sustain the unique Himalayan endemic conifer.
Primitive techno-economic study of bio-diesel and bio-active compound production from microalgae
Authors: Abdo Sayeda M. , El Diwani Guzine I. , El-Khatib Kamel M. , Abo El-Enin Sanaa A. , El-Galad Mohammed I. , Basily Haidy S. , Ali Gamila H. 
Published: September 2020

Abstract
Background
Microalgae cells can be identified as a potential source for new and renewable energy. The economic investigation for biodiesel and bio-active compound production from the microalgae community (Bloom), which are collected from the high rate algal pond (HRAP) constructed to treat municipal wastewater at Zenin wastewater treatment plant, Giza, was the main target of study.

Results
The microscopical examination showed that Scenedesmus obliquus is the dominant species. The total carotenoids were extracted using jojoba oil and determined by high-performance liquid chromatography (HPLC) to reach 81.44 μg/g. The biodiesel production through acid transesterification reaction recorded 70.6% of fatty acid methyl ester content with high cetane number (44) and low acid value. Such results prove that the obtained biodiesel has better ignition quality. The total phenolic and flavonoid compounds have been derived from the remaining biomass to give 5.36 ± 0.03 and 1.50 ± 0.19 mg/g respectively. Finally, total proteins and carbohydrates content in algal cells were recorded 54.3 and 1.5 mg/g successively

Conclusion
The preliminary economic evaluation showed that the production of biodiesel and carotenoids from the microalgae growing in municipal wastewater can be considered, as a techno-economic feasible process.
Screening of the SHOX/PAR1 region using MLPA and miRNA expression profiling in a group of Egyptian children with non-syndromic short stature
Authors: Eid Ola M. , Eid Maha M. , Abdelrahman Amany H. , Abdel kader Rania M. A. , Farid Marwa , Mahrous Rana , Mekkawy Mona K. , Kamel Alaa K. , Mazen Inas , El-Bassyouni Hala T. 
Published: September 2020

Abstract
Background
Short stature is defined as a body height below the third percentile, based on chronological age, or 2 standard deviations (SD) below the national height standard. The prevalence of short stature is around 2% of children worldwide. Several gene deficiencies have been associated with the etiology of short stature. The SHOX is an important candidate gene for short stature, as its haploinsufficiency underlies syndromic and non-syndromic short stature. Partial and complete duplications of SHOX have been reported in patients with short stature. Proper genetic diagnosis of these children allows for appropriate therapeutic approaches to be administered. Since copy number variation (CNV) is a possible mechanism of interhuman variability and pathogenic disease, the multiplex ligation-dependent probe amplification technique (MLPA) can be used as an initial screening technique. Cartilage tissue expresses specific microRNAs (miRNAs), which play an essential role in the regulation of chondrocyte proliferation and differentiation during growth plate development. We aimed to assess the SHOX/PAR1 region using CNV profiling for non-syndromic short stature in Egyptian children with and without growth hormone deficiency using the MLPA technique and expression profiling of miR-1, miR-15a, and miR-140 using quantitative real-time polymerase chain reaction (qRT-PCR) in a group of Egyptian children with non-syndromic short stature.

Results
Of the fifty cases included in this study, different CNVs were detected in ten children (20%), in/outside the SHOX region. Moreover, in children with short stature, the expression level of miRNA-140 was significantly different from that of healthy controls.

Conclusions
This is one of the first studies that have assessed CNVs in the SHOX/PAR1 region in a group of Egyptian children with short stature. MLPA analysis of SHOX/PAR1 identified different CNVs in children with non-syndromic short stature, suggesting that the MLPA should be used as an initial screening technique in short children, as proper genetic diagnosis of these children leads to implementation of the appropriate therapeutic approach. Alterations in the levels of miRNA-140 in children with short stature suggest that changes in the expression levels of this miRNA are associated with the pathogenesis of short stature.
Improving adherence to guideline recommendations in dementia care through establishing a quality improvement collaborative of agents of change: an interrupted time series study
Authors: Laver Kate , Cations Monica , Radisic Gorjana , de la Perrelle Lenore , Woodman Richard , Fitzgerald Janna Anneke , Kurrle Susan , Cameron Ian D. , Whitehead Craig , Thompson Jane , Kaambwa Billingsley , Hayes Kate , Crotty Maria 
Published: September 2020

Abstract
Background
Non-pharmacological interventions including physical activity programmes, occupational therapy and caregiver education programmes have been shown to lead to better outcomes for people with dementia and their care partners. Yet, there are gaps between what is recommended in guidelines and what happens in practice. The aim of this study was to bring together clinicians working in dementia care and establish a quality improvement collaborative. The aim of the quality improvement collaborative was to increase self-reported guideline adherence to three guideline recommendations.

Methods
Interrupted time series. We recruited health professionals from community, hospital and aged care settings across Australia to join the collaborative. Members of the collaborative participated in a start-up meeting, completed an online learning course with clinical and quality improvement content, formed a quality improvement plan which was reviewed by a team of experts, received feedback following an audit of their current practice and were able to share experiences with their peers. The primary outcome was self-reported adherence to their guideline recommendation of interest which was measured using checklists. Data were collected monthly over a period of 18 months, and the study used an interrupted time series design and multilevel Poisson regression analysis to evaluate changes in self-reported adherence.

Results
A total of 45 health professionals (78% therapists) from different sites joined the collaborative and 28 completed all requirements. Data from 1717 checklists were included in the analyses. Over the duration of the project, there was a significant increase in clinician self-reported adherence to guideline recommendations with a 42.1% immediate increase in adherence (incidence rate ratio = 1.42; 95% confidence interval = 1.08–1.87; p = 0.012).

Conclusion
Health professionals working with people with dementia are interested in and willing to join a quality improvement collaborative with the goal of improving non-pharmacological aspects of care. Participation in the collaborative improved the quality of care for people with dementia as measured through self-reported adherence to guideline recommendations. Although there are challenges in implementation of guideline recommendations within dementia care, the quality improvement collaborative method was considered successful. A strength was that it equipped and empowered clinicians to lead improvement activities and allowed for heterogeneity in terms of service and setting.

Trial registration
ACTRN12618000268246
Effect of an Artificial Intelligence Clinical Decision Support System on Treatment Decisions for Complex Breast Cancer
Authors: Xu Fengrui , Sepúlveda Martín-J. , Jiang Zefei , Wang Haibo , Li Jianbin , Liu Zhenzhen , Yin Yongmei , Roebuck M. Christopher , Shortliffe Edward H. , Yan Min , Song Yuhua , Geng Cuizhi , Tang Jinhai , Purcell Jackson Gretchen , Preininger Anita M. , Rhee Kyu 
Published: September 2020

PURPOSE To examine the impact of a clinical decision support system (CDSS) on breast cancer treatment decisions and adherence to National Comprehensive Cancer Center (NCCN) guidelines. PATIENTS AND METHODS A cross-sectional observational study was conducted involving 1,977 patients at high risk for recurrent or metastatic breast cancer from the Chinese Society of Clinical Oncology. Ten oncologists provided blinded treatment recommendations for an average of 198 patients before and after viewing therapeutic options offered by the CDSS. Univariable and bivariable analyses of treatment changes were performed, and multivariable logistic regressions were estimated to examine the effects of physician experience (years), patient age, and receptor subtype/TNM stage. RESULTS Treatment decisions changed in 105 (5%) of 1,977 patients and were concentrated in those with hormone receptor (HR)–positive disease or stage IV disease in the first-line therapy setting (73% and 58%, respectively). Logistic regressions showed that decision changes were more likely in those with HR-positive cancer (odds ratio [OR], 1.58; P < .05) and less likely in those with stage IIA (OR, 0.29; P < .05) or IIIA cancer (OR, 0.08; P < .01). Reasons cited for changes included consideration of the CDSS therapeutic options (63% of patients), patient factors highlighted by the tool (23%), and the decision logic of the tool (13%). Patient age and oncologist experience were not associated with decision changes. Adherence to NCCN treatment guidelines increased slightly after using the CDSS (0.5%; P = .003). CONCLUSION Use of an artificial intelligence–based CDSS had a significant impact on treatment decisions and NCCN guideline adherence in HR-positive breast cancers. Although cases of stage IV disease in the first-line therapy setting were also more likely to be changed, the effect was not statistically significant ( P = .22). Additional research on decision impact, patient-physician communication, learning, and clinical outcomes is needed to establish the overall value of the technology.
Use of Wearable Activity Tracker in Patients With Cancer Undergoing Chemotherapy: Toward Evaluating Risk of Unplanned Health Care Encounters
Authors: Nilanon Tanachat , Nocera Luciano P. , Martin Alexander S. , Kolatkar Anand , May Marcella , Hasnain Zaki , Ueno Naoto T. , Yennu Sriram , Alexander Angela , Mejia Aaron E. , Boles Roger Wilson , Li Ming , Lee Jerry S. H. , Hanlon Sean E. , Cozzens Philips Frankie A. , Quinn David I. , Newton Paul K. , Broderick Joan , Shahabi Cyrus , Kuhn Peter , Nieva Jorge J. 
Published: September 2020

PURPOSE Unplanned health care encounters (UHEs) such as emergency room visits can occur commonly during cancer chemotherapy treatments. Patients at an increased risk of UHEs are typically identified by clinicians using performance status (PS) assessments based on a descriptive scale, such as the Eastern Cooperative Oncology Group (ECOG) scale. Such assessments can be bias prone, resulting in PS score disagreements between assessors. We therefore propose to evaluate PS using physical activity measurements (eg, energy expenditure) from wearable activity trackers. Specifically, we examined the feasibility of using a wristband (band) and a smartphone app for PS assessments. METHODS We conducted an observational study on a cohort of patients with solid tumor receiving highly emetogenic chemotherapy. Patients were instructed to wear the band for a 60-day activity-tracking period. During clinic visits, we obtained ECOG scores assessed by physicians, coordinators, and patients themselves. UHEs occurring during the activity-tracking period plus a 90-day follow-up period were later compiled. We defined our primary outcome as the percentage of patients adherent to band-wear ≥ 80% of 10 am to 8 pm for ≥ 80% of the activity-tracking period. In an exploratory analysis, we computed hourly metabolic equivalent of task (MET) and counted 10 am to 8 pm hours with > 1.5 METs as nonsedentary physical activity hours. RESULTS Forty-one patients completed the study (56.1% female; 61.0% age 40-60 years); 68% were adherent to band-wear. ECOG score disagreement between assessors ranged from 35.3% to 50.0%. In our exploratory analysis, lower average METs and nonsedentary hours, but not higher ECOG scores, were associated with higher 150-day UHEs. CONCLUSION The use of a wearable activity tracker is generally feasible in a similar population of patients with cancer. A larger randomized controlled trial should be conducted to confirm the association between lower nonsedentary hours and higher UHEs.