bluuebunny/crossref_metadata_2025_split huggingface dataset:
Audit Feedback Interventions to Address High-Risk Prescriptions in Long-Term Care Homes: A Costing Study and Return on Investment Analysis
Authors: Thavorn Kednapa , Kumar Srishti , Reis Catherine , Lam Jonathan , Dobell Gail , Mulhall Cara , Grimshaw Jeremy M. , Ivers Noah 
Published: March 2020

Abstract
Background: Audit and feedback is a common implementation strategy, but little literature describes its costs. ‘MyPractice’ is an audit and feedback initiative produced by Ontario Health, the provincial agency tasked with supporting quality of care. This study sought to estimate the costs of ‘MyPractice’ and assess whether the financial benefit of ‘MyPractice’ offsets those costs. Methods: We conducted a costing study from the perspective of the government of Ontario, which funds both Ontario Health and necessary healthcare costs for people living in long-term care (LTC) homes in the province. Total cost of ‘MyPractice’ was calculated as the sum of the costs of producing and disseminating the reports (covering three report releases) which were obtained from Ontario Health staff interviews and document reviews. Return on investment (ROI) was calculated as the ratio of net cost-savings and the intervention cost. Net cost-savings were estimated as the reduction in the costs of antipsychotics incurred by LTC home residents attributable to ‘MyPractice’ reports. Results: Total intervention costs were C$223,691 (C$838 per physician and C$74,564 per release). Costs incurred during the development phase accounted for 74% of the total cost (C$166,117), while implementation costs for three report releases were responsible for 26% of the total costs (C$57,575). The ROI for every C$1 spent on the ‘MyPractice’ intervention was 1.22 (95% CI: 0.82, 1.61) for three report releases. Conclusion: ‘My Practice’ report offers a good return on investment and the value for money increases if physicians sign up and view the reports.
Lung MRI to predict lack of response to treatment in interstitial lung disease: initial observations on SSFSE/PROPELLER T2 mismatch
Authors: Paula Wagner Diniz de , Rodrigues Marcelo Palmeira , Ferreira Nathali Mireise Costa , Passini Viviane Vieira , Silva César Augusto Melo e 
Published: March 2020

Abstract
BackgroundHigh-resolution chest computed tomography (HRCT) signs of interstitial lung disease (ILD) are varied, some corresponding to irreparable parenchymal destruction and fibrosis, others representing potentially reversible changes, such as fine reticulation and ground-glass opacities (GGO). GGO frequently correspond to sites of active inflammation that may be responsive to steroids or immunosuppressive agents, but they might also represent intralobular interstitial fibrosis not resolved by current HRCT technique. Our aim was to investigate the ability of lung MRI to predict treatment response in individuals with ILD presenting with predominant GGO.MethodsIn this prospective cohort, 15 participants (4 male and 11 female) aged 38–84 years, presenting with ILD manifested as predominant GGO and referred for a new treatment regimen with a systemic glucocorticoid and/or an immunosuppressive agent, underwent 1.5 T lung MRI with breath-hold (SSFSE) and respiratory-gated (PROPELLER) T2-weighted pulse sequences, and with dynamic contrast-enhanced fat-suppressed T1-weighted pulse sequence (LAVA). Relative signal intensity on T2-weighted images and relative enhancement of lung lesions were compared to functional response in a dichotomous fashion (response versus non-response) with t test for independent samples. SSFSE/PROPELLER T2 mismatch was compared to response with Fisher’s exact test. Inter-rater agreement was evaluated with Cohen’s kappa coefficient. The primary endpoint for response was a greater than 10% increase in forced vital capacity in 10 weeks.ResultsResponders (4/15, 27%) and non-responders (11/15, 73%) showed similar relative signal intensity on T2-weighted images and relative enhancement measurements. SSFSE/PROPELLER T2 mismatch was able to discriminate responders from non-responders in 12 of 15 participants (80% accuracy, p = 0.026) for readers 1 and 2, and in 13 of 15 participants (87% accuracy, p = 0.011) for reader 3, with inter-rater agreement of 87% between readers 1 and 2 (Cohen’s kappa coefficient of 0.732) and 93% between readers 1/2 and 3 (Cohen’s kappa coefficient of 0.865).ConclusionsSSFSE-PROPELLER T2 mismatch was predictive of lack of response to treatment in this small group of ILD patients presenting with predominant GGO at HRCT.Key PointSSFSE/PROPELLER T2 mismatch may help predict lack of response to anti-inflammatory/immunosuppressive treatment in interstitial lung disease, with high accuracy and high inter-rater agreement.
Twinning partnership helps to accelerate the performance of district health systems towards achieving Universal Health Coverage
Authors: Argaw Mesele Damte , Desta Binyam Fekadu , Kibret Mengistu Asnake , Abebe Melkamu Getu , Heyi Wubishet Kebede , Mamo Elias , Gebru Tesfaye , Gela Chala , Tefera Bekele Belayhun , Bele Temesgen Ayehu 
Published: March 2020

Abstract
Background: The twinning partnership is a formal and substantive collaboration between two districts to improve their performance in providing primary healthcare services. The ‘win-win’ twinning partnership pairs relatively high and low performing districts. The purpose of this formative evaluation is to use the empirically derived systems model as an analytical framework to systematically document the inputs, throughputs and outputs of the twinning partnership strategy.Methods: This evaluation employed a case study research design and was conducted from October 2018 to September 2019, in Amhara, Oromia, Southern, Nations, Nationalities and Peoples’ (SNNP) and Tigray Regions. Qualitative data was collected using interviewer-guided semi-structured interview tools. The data were transcribed verbatim, translated into English and analyzed through the theoretical framework called Bergen Model of Collaborative Functioning (BMCF). Quantitative data were extracted from Routine Health Management Information System. Results were presented using average, percentages and graphs.Result: The result of this case study revealed that scanning the mission of the twinning partnership and focusing on a shared vision coupled with mobilizing internal and external resources were the fundamental input element for successful twinning partnership at the district level. In addition, the context of pursuing Universal Health Coverage (UHC) through achieving transformed districts can be enhanced through deploying skilled and knowledgeable leadership, defining clear roles and responsibilities for all stakeholders, forming agreed detailed action plans and effective communication that leads to additive results and synergy. The twinning partnership implementing districts benefit from the formal relationship and accelerate their performances towards meeting criteria of transformed districts in Ethiopia. At the baseline measurement stage, only two out of eight districts achieved a medium performance status; at mid-term, two districts achieved high performance status and during the end-line results out of eight twinning targeted districts, three districts fulfilled the transformation criteria, three districts were categorized as medium performers and the remaining two districts fell into the low performing districts category.Conclusions: The implemented twinning partnership helped to accelerate the health system’s performance in achieving the district transformation criteria. Therefore, scaling up the implementation of the twinning partnership strategy is recommended.
GLP-1-induced AMPK activation inhibits PARP-1 and promotes LXR-mediated ABCA1 expression to protect pancreatic β-cells against cholesterol-induced toxicity through cholesterol efflux
Authors: Li Rao , Sun Xulong , Li Pengzhou , Li Weizheng , Zhao Lei , Zhu Liyong , Zhu Shaihong 
Published: March 2020

Abstract
Background: T2DM (Type 2 diabetes) is a complex, chronic disease characterized as insulin resistance and islet β-cell dysfunction. Bariatric surgeries, mainly Roux-en-Y gastric bypass (RYGB) surgery and laparoscopic sleeve gastrectomy (LSG), have become an important method for treating obesity and T2DM, and GLP-1 increase after bariatric surgery has been regarded as a central event in bariatric surgery-induced remission of T2DM.Methods: The cell viability was examined using 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide (MTT). Cell apoptosis was determined by Flow cytometry. The cellular contents of cholesterol in INS-1 cells were measured using cholesterol assay kits. The BODIPY-cholesterol assay was performed to monitor the cholesterol efflux.Results: High concentration cholesterol-induced lipotoxicity was observed in INS-1 cells, including inhibited cell viability, enhanced cell apoptosis, and inhibited cholesterol efflux from INS-1 cells; in the meantime, ABCA1 protein level was decreased by cholesterol stimulation. Cholesterol-induced toxicity and ABCA1 downregulation was attenuated by GLP-1 agonist EX-4. GLP-1 induced AMPK phosphorylation during the protection against cholesterol-induced toxicity. Under cholesterol stimulation, GLP-1-induced AMPK activation inhibited PARP-1 activity, therefore attenuating cholesterol-induced toxicity in INS-1 cells. In INS-1 cells, PARP-1 directly interacted with LXR, leading to the poly(ADP-ribosyl)ation of LXRα and downregulation of LXR-mediated ABCA1 expression. In STZ-induced T2DM model in rats, RYGB surgery or EX-4 treatment improved the glucose metabolism and lipid metabolism in rats through GLP-1 inhibition of PARP-1 activity. According to clinical data, GLP-1 was significantly increased after LSG surgery on T2DM patients, and the increase in GLP-1 was closely related to the improvement of islet function.Conclusions: GLP-1 inhibits PARP-1 to protect islet β cell function against cholesterol-induced toxicity in vitro and in vivo through enhancing cholesterol efflux. GLP-1-induced AMPK and LXR-mediated ABCA1 expression are involved in GLP-1 protective effects.
Clinical and cost effectiveness of staff training in the delivery of positive behaviour support (PBS) for adults with intellectual disabilities, autism spectrum disorder and challenging behaviour - randomised trial
Authors: Strydom André , Bosco Alessandro , Vickerstaff Victoria , Hunter Rachael , Hassiotis Angela 
Published: March 2020

Abstract
Background: Although Positive Behaviour Support (PBS) is a widely used intervention for ameliorating challenging behaviour (CB), evidence for its use in adults with intellectual disability (ID) and comorbid autism (ASD) is lacking. We report a planned subsidiary analysis of adults with both ASD and ID who participated in a randomised trial of PBS delivered by health professionals.Methods: The study was a multicentre, cluster randomised trial conducted in 23 community ID services in England, participants were randomly allocated to either the delivery of PBS (n=11 clusters) or to treatment as usual (TAU; n=12). One-hundred and thirteen participants (46% of all participants in the trial) had a diagnosis of ID, autism spectrum disorder and CB (ASD+); (47 allocated to the intervention arm, and 66 to the control). CB (primary outcome) was measured with the Aberrant Behaviour Checklist total score (ABC-CT). Secondary outcomes included mental health status, psychotropic medication use, health and social care costs and quality adjusted life years (QALYs) over 12 months.Results: There were no statistically significant differences in ABC-CT between ASD+ groups randomised to the two arms over 12 months (adjusted mean difference = -2.10, 95% CI: -11.3 7.13, p =0.655) or other measures. The mean incremental cost of the intervention per participant was £628 (95% CI -£1004 to £2013). There was a difference of 0.039 (95% CI -0.028 to 0.103) for QALYs and a cost per QALY gained of £16,080.Conclusions: Results suggest lack of clinical effectiveness for PBS delivered by specialist ID clinical teams. Further evidence is needed from larger trials, and development of improved interventions.Trial registrationClinicalTrials.gov: NCT01680276
Functional analysis of haplotypes and promoter activity at the 5' region of the DRD2 gene and associations with schizophrenia.
Authors: Zhang Xicen , Ding Mei , Liu Yi , Liu Yongping , Xing Jiaxin , Xuan Jinfeng , Xia Xi , Yao Jun , Wang Baojie 
Published: March 2020

Abstract
Background: In previous studies, we researched the association of the DRD2 gene promoter region SNP loci rs7116768, rs1047479195, rs1799732, rs1799978 and schizophrenia using Sanger sequencing. rs7116768 and rs1799978 were found to be slightly associated with schizophrenia. This study investigated the effects of haplotypes consisted of the four SNPs on protein expression level in vitro and identified the functional sequence in the 5’ regulatory region of DRD2 gene which has a potential link with schizophrenia.Methods: Recombinant plasmids with haplotypes, SNPs and 13 recombinant vectors containing deletion fragments from the DRD2 gene 5' regulatory region were transfected into HEK293 and SK-N-SH cell lines. Relative luciferase activity of the haplotypes, SNPs and different sequences was compared using a dual luciferase reporter assay system.Results: Haplotype H4(G-C-InsC-G) could significantly increase the gene expression in SK-N-SH cell lines. Allele C of rs7116768, allele A of rs1047479195 and allele del C of rs1799732 could up-regulate the gene expression. There were 5~7 functional regions in the promoter region of DRD2 gene that could affect the level of gene expression.Conclusion: We cannot rule out the possibility that different haplotypes may influence DRD2 gene expression in vivo. We observed that allele C of rs7116768, allele A of rs1047479195 and allele del C of rs1799732 could up-regulate gene expression. The truncation results confirmed the existence of functional regions in the promoter region of DRD2 gene that could affect the level of gene expression.
Psychometric of Iranian version of Mental Health Literacy Scale(MHLS)
Authors: Nejatian Mahboobeh , Tehrani Hadi , Momenian Hanieh , Jafari Alireza 
Published: March 2020

Abstract
Background: The risk rate for the incidence of any mental disorder is 50%, and the prevalence of mental disorders is increasing. This study aimed to evaluate the psychometric of the Iranian Version of Mental Health Literacy Scale(MHLS).Methods: This cross-sectional study was conducted with a multi-stage sampling method with the participation of 1363 individuals in the general population. The formal, content and construct validity were used for validation of MHLS. Cronbach’s alpha coefficient was used for the reliability of MHLS. Confirmatory factor analysis(CFA) was performed using AMOS software Version 24.Results: After performing the CFA, the final version of the MHLS included a total of 29 items, which consisted knowledge of where to seek information (4 item), Ability to recognize disorders (8 item), knowledge of self-treatment (2 item), knowledge of risk factors and causes (2 item), Attitudes that promote recognition or appropriate help-seeking behavior (10 item), and knowledge of professional help available (3 item). In the CFA test, the six items were deleted.Conclusion: Due to the lack of appropriate tools for measuring health literacy in the Iranian population, the 29-item MHLS with six subscales is a valid and reliable tool for measuring mental health literacy in the population.
The introduction of mindfulness groups to a Psychiatric Rehabilitation in-patient setting: a feasibility study
Authors: Millar Audrey , Tip Liesbeth , Lennon Ruth , Macinnes Marlene , Michalska Beata , Lawrie Stephen , Schwannauer Matthias 
Published: March 2020

Abstract
Background Patients within Psychiatric Rehabilitation services have multiple, complex and enduring difficulties, and are frequently described as ‘treatment resistant’. This group have diagnoses of major mental health conditions, most commonly schizophrenia, often alongside a history of complex trauma, co-morbid alcohol/ substance misuse, and cognitive impairment. There is no known effective medical treatment other than Clozapine in this patient group, however, there is preliminary evidence that mindfulness can help individuals with psychosis by improving their ability to cope with stressful internal experiences. This study aimed to determine if mindfulness practice groups are an acceptable therapeutic intervention in an in-patient rehabilitation setting. The study also aimed to monitor the well-being of those who participated. Methods Mindfulness practice groups were offered three times weekly on a 15-bedded rehabilitation ward in a psychiatric hospital over five months, and weekly in a second ward over an 18 month period. The sessions were delivered by Clinical Psychologists in accordance with adaptations for a psychosis population. Attendance data were gathered on both wards and additional measures of well-being were collected on one ward. Qualitative interviews were conducted with a sample of patients, group facilitators, and staff, to provide supplementary information about the acceptability of the intervention. Results In both wards around two thirds (65%, 67%) of in-patients attended at least one group and smaller proportion (around a third) went on to attend regularly. There was no discernible impact on well-being using the Warwick-Edinburgh well-being scale. Qualitative interviews suggested a number of benefits to individuals attending as well as the potential for groups to enhance the therapeutic culture within wards. Conclusions Clinical guidelines suggest that all patients with a diagnosis of psychosis should have access to psychological therapies, but delivering psychological therapy within an in-patient rehabilitation setting can be challenging. This preliminary feasibility study suggests that mindfulness practice groups are an acceptable intervention, and that further research to look at the effectiveness of mindfulness for symptoms of treatment-resistant psychosis is both possible and merited.
A Systematic Study on the Reliability and Validity of the Japanese Smartphone Addiction Scale among the Youth in Japan
Authors: Otsuka Yuichiro , Kaneita Yoshitaka , Itani Osamu , Matsumoto Yuuki 
Published: March 2020

Abstract
Background: Few studies in Japan have investigated smartphone addiction utilizing an international scale. This study aimed to evaluate the reliability and validity of the Japanese version of the Smartphone Addiction Scale (SAS) in Japanese youths and to examine the factors underlying smartphone overuse. Methods: We conducted a questionnaire survey in 2018 with participants from one high school (n=1,050) and one vocational school (n=83; age range, 15-24 years; median age, 17 years) in Japan. Data from 1,037 (male: 60.8%, n=631) questionnaires were analyzed. Results: Factor analysis showed six factors with factor loading ranging from 0.42 to 0.72 for the Japanese version of the SAS. Cronbach’s alpha was 0.94 for the 33 items in this scale. The scale showed good reliability for test-retest scores ( intraclass correlation coefficient 3,1 =0.92). Multiple linear regression analyses showed that the factors related to smartphone overuse were female gender, long smartphone usage duration, poor mental health, contact with virtual friends, and being a smartphone zombie. Contact with family and real friends were not associated with smartphone overuse. Conclusions: Although smartphone overuse differs depending on one’s cultural and social background, the Japanese version of the SAS is as good as the other language versions. Thus, this scale was shown to be reliable and valid in the Japanese youth.
Changes over time in prevalence rates of past-year cannabis use by men and women with a psychotic disorder.
Authors: Waterreus Anna , Prinzio Patsy Di , Badcock Johanna C. , Martin-Iverson Mathew T. , Morgan Vera A. 
Published: March 2020

Abstract
Background: General population data show cannabis use by younger people is declining but increasing in older adults. Overall, the gap between men and women appears to be narrowing. Little has been documented about sex and age differences in patterns of cannabis use over time by people with a psychotic disorder. We examined rates of past-year cannabis use by sex and age to determine whether use by this population has changed over time. Methods: Data on cannabis use from Australian National Psychosis Surveys (1997, 2010) were analysed by sex and age and compared to National Drug Strategy Household Surveys (1998, 2010). Results: Prevalence of past-year cannabis use by people with psychotic illness dropped significantly from 38.2% to 33.7%. Both sexes showed a decline in use. The steeper decline in use by men aged 18-29 years (70.2% to 47.8%) contributed to a narrowing of the sex gap. Conversely, use by men aged 55-64 increased from 4.8% to 18.8%. General population data showed a similar pattern of change across sex and age groups. Conclusions: Despite declining rates of past-year cannabis use in people with a psychotic illness, rates remain more than double that of the general population. Traditionally, men were more likely to use cannabis than women, but convergence in rates in younger people shows this is changing. Furthermore, cannabis use is not restricted to young people. Increasing use of cannabis by older men will place additional demands on drug and alcohol services.
Efficacy of revefenacin, a long-acting muscarinic antagonist for nebulized therapy, in patients with markers of more severe COPD: a post hoc subgroup analysis
Authors: Donohue James F. , Kerwin Edward , Barnes Chris N. , Moran Edmund J. , Haumann Brett , Crater Glenn D. 
Published: March 2020

Abstract
Background: Revefenacin, a once-daily, long-acting muscarinic antagonist delivered via standard jet nebulizer, increased trough forced expiratory volume in 1 second (FEV 1 ) in patients with moderate to very severe chronic obstructive pulmonary disease (COPD) in prior phase 3 trials. We evaluated the efficacy of revefenacin in patients with markers of more severe COPD. Methods: A post hoc subgroup analysis of two replicate, randomized, phase 3 trials (revefenacin 175 µg [n = 395] and placebo [n = 417]) was conducted over 12 weeks. Endpoints included least squares change from baseline in trough FEV 1 , St. George’s Respiratory Questionnaire (SGRQ) responders, and transition dyspnea index (TDI) responders at Day 85. We included patient subgroups at high risk for COPD exacerbations and compared patients who received revefenacin 175 μg and placebo: severe and very severe airflow limitation (percent predicted FEV 1 30%–<50% and <30%), 2011 Global Initiative for Chronic Obstructive Lung Disease (GOLD) D, reversibility (≥12% in FEV 1 ) to short-acting bronchodilators, concurrent use of long-acting β agonists and/or inhaled corticosteroids, older age (>65 and >75 years), and comorbidity risk factors. Results: Revefenacin demonstrated significant improvements in FEV 1 versus placebo at Day 85 among the intention-to-treat (ITT) population and all subgroups. There was a greater number of SGRQ and TDI responders in the ITT population and the majority of subgroups analyzed among patients who received revefenacin versus placebo. For the SGRQ responders, the odds of response (odds ratio >2.0) were significantly greater in the revefenacin arm versus the placebo arm among the severe airflow obstruction, very severe airflow obstruction and 2011 GOLD D subgroups. For the TDI responders, the odds of response (odds ratio >2.0) were significantly greater among the severe airflow obstruction subgroup and patients aged >75 years. Conclusions: Revefenacin showed significantly greater improvements in FEV 1 versus placebo in the ITT population and all subgroups. There were a greater number of SGRQ and TDI responders in the ITT population, and in the majority of patient subgroups among patients who received revefenacin versus placebo. Revefenacin could be a therapeutic option among patients with markers of more severe COPD.