bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bottled water brands are contaminated with multidrug resistant bacteria which are associated with companies handling procedures in Nairobi, Kenya
Authors: Adam Mohamed Safia , Nyerere Andrew , Sang Willie Kipkemboi , Ngayo Musa 
Published: November 2020

Background: The demand for water has necessitated the proliferation of bottled water companies in Kenya. This study evaluated if retailed bottled water in Nairobi Kenya complies with both local and international reference criteria. Methods: A total of 42 different water brands (25 approved by Kenya Revenue Authority (KRA) and 17 banned brands) were analyzed for both physicochemical and bacteriological quality. Spread plate method was used to obtain the total plate count of bacteria, while the membrane filter method was used to obtain total coliform count (TCC) and fecal coliform count (FCC). Structured interviews were used to gather company-related information. Results: Overall, 16% of KRA-approved and 35.3% of banned bottled water were contaminated with heterotrophic bacteria. Of the approved water brands, 4% were positive for total coliforms, compared with 17% of the banned brands. Similarly, 4% and 17% approved and banned water brands were positive for fecal coliforms, respectively. Escherichia coli (19.1%), Pseudomonas spp. (9.5%) and Klebsiella spp. (4.8%) were the most common bacterial types isolated from all water brands, most of which exhibited multidrug resistance. In multivariable analysis, water companies that cleaned pipework and bottles using chlorine-based disinfectants (OR 0.08, 95% CI 0.01 to 0.8), those that had food safety programs (OR 0.1, 95% CI 0.019 to 0.9), had standard operating procedures (SOP) for water sourcing (OR 0.1, 95% CI 0.012 to 0.9) and SOP for contamination protection (OR 0.1, 95% CI 0.02 to 0.9) remained independently associated with bottled water brands exceeding WHO TCC limits. Conclusions: A number of bottled water brands were contaminated with one or more types of indicator bacteria, some of which were multidrug resistant. Water bottling companies’ processes contribute to contamination; rigorous regulation and monitoring will improve on water quality and safety.
Rare health conditions 40: Gaucher's disease, Pompe disease, Ellis-Van Creveld syndrome, and Duchenne muscular dystrophy
Authors: Barber Chris 
Published: November 2020

The purpose of this series is to briefly highlight a range of rare health conditions. Rare health conditions are those that affect no more and usually less than 1 person in every 2000 and many HCAs and nurses will encounter some of these conditions given the high number of these conditions. This 40th article will briefly explore four of these conditions.
Tunable multilayer-graphene-based broadband metamaterial selective absorber
Authors: Jiang Xinpeng , Zhang Zhaojian , Chen Dingbo , Wen Kui , Yang Junbo 
Published: November 2020

We propose a tunable multilayer-graphene-based broadband metamaterial selective absorber using the finite-difference time domain. The simulation results reveal that the absorption spectra of the proposed metamaterial with the nano-cylinder and 30-layer graphene show high absorption (88.3%) in the range of 250–2300 nm, which covers the entire solar spectrum. Moreover, the graphene-based metamaterial has a low thermal emittance of 3.3% in the mid-infrared range (4–13 µm), which can greatly reduce the heat loss. The proposed metamaterial has a tunable cutoff wavelength, which can be tuned by controlling the Fermi level of graphene. In addition, our structure is an angle-insensitive absorber, and the device has the potential to be widely used in solar cell and thermal detectors.
Body mass index and risk of dying from a bloodstream infection: A Mendelian randomization study
Authors: Rogne Tormod , Solligård Erik , Burgess Stephen , Brumpton Ben M. , Paulsen Julie , Prescott Hallie C. , Mohus Randi M. , Gustad Lise T. , Mehl Arne , Åsvold Bjørn O. , DeWan Andrew T. , Damås Jan K. 
Published: November 2020

Background
In observational studies of the general population, higher body mass index (BMI) has been associated with increased incidence of and mortality from bloodstream infection (BSI) and sepsis. On the other hand, higher BMI has been observed to be apparently protective among patients with infection and sepsis. We aimed to evaluate the causal association of BMI with risk of and mortality from BSI.

Methods and findings
We used a population-based cohort in Norway followed from 1995 to 2017 (the Trøndelag Health Study [HUNT]), and carried out linear and nonlinear Mendelian randomization analyses. Among 55,908 participants, the mean age at enrollment was 48.3 years, 26,324 (47.1%) were men, and mean BMI was 26.3 kg/m2. During a median 21 years of follow-up, 2,547 (4.6%) participants experienced a BSI, and 451 (0.8%) died from BSI. Compared with a genetically predicted BMI of 25 kg/m2, a genetically predicted BMI of 30 kg/m2 was associated with a hazard ratio for BSI incidence of 1.78 (95% CI: 1.40 to 2.27; p < 0.001) and for BSI mortality of 2.56 (95% CI: 1.31 to 4.99; p = 0.006) in the general population, and a hazard ratio for BSI mortality of 2.34 (95% CI: 1.11 to 4.94; p = 0.025) in an inverse-probability-weighted analysis of patients with BSI. Limitations of this study include a risk of pleiotropic effects that may affect causal inference, and that only participants of European ancestry were considered.

Conclusions
Supportive of a causal relationship, genetically predicted BMI was positively associated with BSI incidence and mortality in this cohort. Our findings contradict the “obesity paradox,” where previous traditional epidemiological studies have found increased BMI to be apparently protective in terms of mortality for patients with BSI or sepsis.
Oncologic outcomes after resection of para-aortic lymph node metastasis in left-sided colon and rectal cancer
Authors: Sakamoto Junichi , Ozawa Heita , Nakanishi Hiroki , Fujita Shin 
Published: November 2020

Aim
The optimal surgical management strategy for para-aortic lymph node (PALN) metastasis has not attracted as much attention as surgery for liver or lung metastasis. The purpose of this retrospective study was to evaluate the oncologic outcomes after synchronous resection of PALN metastasis in left-sided colon and rectal cancer.

Methods
Between January 1986 and August 2016, 29 patients with pathologically positive PALN metastases who underwent curative resection at our hospital were retrospectively reviewed. We examined clinicopathological characteristics, long-term oncologic outcomes, and factors related to favorable prognosis in these patients.

Results
The 3-year overall survival and recurrence-free survival (RFS) rates were 50.5% and 17.2%, respectively. In total, 6 (20.7%) patients experienced no recurrence in the 3 years after surgery, while postoperative complications were seen in 9 (31.0%) patients. The 3-year RFS rate was significantly better in the pM1a group than in the pM1b/pM1c group (26.3% and 0.0%, respectively, p = 0.032).

Conclusion
PALN dissection for patients without other organ metastases in left-sided colon or rectal cancer is a good indication as it is for liver and lung metastasis.
A profession in danger: Stakeholders’ perspectives on supporting the pharmacy profession in Lebanon
Authors: Alameddine Mohamad , Bou-Karroum Karen , Kassas Sara , Hijazi Mohamad Ali 
Published: November 2020

Background
Lebanon boosts one of the highest pharmacists to population ratios globally (20.3/10,000). Yet, workforce analysis elicited serious concerns with the distribution, practice environments and regulation of Lebanese pharmacists. Recent workforce data shows that the profession has been majorly destabilized with hundreds of pharmacists closing their pharmacies or losing their employment. Proper planning for the future of the pharmacy profession in Lebanon necessitates a deeper understanding of the current challenges and the necessary policy and practice recommendations. The aim of this study is to examine stakeholders’ perspectives on the current pharmacist workforce challenges and the necessary measures to support the profession.

Methods
The research team carried out a series of semi-structured interviews with twenty-one key stakeholders within the pharmacy profession in Lebanon. We categorized stakeholders according to their experience as policy makers, practitioners, academicians, and media experts. The interview guide included questions about workforce trends, labor market challenges and recommendations for improvement. Interviews were transcribed and analyzed thematically.

Results
Four major themes emerged from this study: the oversupply of pharmacists in Lebanon, the demand supply imbalance, poor regulation of the pharmacy practice, and the difficult practice environment. There was a consensus among interviewees that the oversupply of pharmacists is due to the poor workforce planning and weak regulatory framework, combined with the easy integration of foreign-trained pharmacists into the labor market. The lack of coordination between the educational and practice sectors is further widening the demand-supply gap. Interviewees further revealed that the regulatory policies on pharmacy practice were outdated and/or weakly enforced which increases the risk of unethical practices and erodes the image of pharmacists in the society. With respect to the practice environment, there is an ongoing struggle by Lebanese pharmacists to maintain profitability and exercise their full scope of practice.

Conclusion
The poor pharmacy workforce planning and regulation is significantly weakening the pharmacy profession in Lebanon. A concerted effort between the various stakeholders is necessary to enhance workforce planning, regulate supply, optimize the integration of pharmacists into work sectors of need, and improve the financial and professional wellbeing of pharmacists in Lebanon.
Providing person-centered care for patients with complex healthcare needs: A qualitative study
Authors: Peters Vincent J. T. , Meijboom Bert R. , Bunt Jan Erik H. , Bok Levinus A. , van Steenbergen Marianne W. , de Winter J. Peter , de Vries Esther 
Published: November 2020

BackgroundPeople with chronic conditions have complex healthcare needs that lead to challenges for adequate healthcare provision. Current healthcare services do not always respond adequately to their needs. A modular perspective, in particular providing visualization of the modular service architecture, is promising for improving the responsiveness of healthcare services to the complex healthcare needs of people with chronic conditions. The modular service architecture provides a comprehensive representation of the components and modules of healthcare provision. In this study, we explore this further in a qualitative multiple case study on healthcare provision for children with Down syndrome in the Netherlands.MethodsData collection for four cases involved 53 semi-structured interviews with healthcare professionals and 21 semi-structured interviews with patients (the parents of children with Down syndrome as proxy). In addition, we gathered data by means of practice observations and analysis of relevant documents. The interviews were audio-recorded, transcribed verbatim and analyzed utilizing the Miles and Huberman approach.ResultsOur study shows that the perspectives on healthcare provision of professionals and patients differ substantially. The visualization of the modular service architecture that was based on the healthcare professionals’ perspective provided a complete representation of (para)medical outcomes relevant to the professionals’ own discipline. In contrast, the modular service architecture based on the patients’ perspective, which we define as a person-centered modular service architecture, provided a representation of the healthcare service that was primarily based on functional outcomes and the overall wellbeing of the patients.ConclusionOur study shows that visualization of the modular service architecture can be a useful tool to better address the complex needs and requirements of people with a chronic condition. We suggest that a person-centered modular service architecture that focuses on functional outcomes and overall wellbeing, enables increased responsiveness of healthcare services to people with complex healthcare needs and provision of truly person-centered care.
The expression of TNF-Î±, IL-1Î², and IL-10 in the diabetes mellitus condition induced by the combination of spirulina and chitosan
Authors: Hendrijantini Nike , Sitalaksmi Ratri Maya , Ari Muhammad Dimas Aditya , Hidayat Tiffany Josephine , Putri Prisca Agustina Nurcahyan , Sukandar Daniel 
Published: November 2020

Background: Rapid wound healing is needed after tooth extraction treatment so that prosthodontics treatment can be done immediately. However, systemic diseases, such as diabetes mellitus, can inhibit the wound healing process. The state of hyperglycemia in people with diabetes mellitus can interfere with the function of macrophages and neutrophils. This condition can cause an imbalance in the cytokines IL-1Î², TNF-Î± and IL-10 that are produced by macrophages and thus will affect the wound healing process. Spirulina and chitosan are two natural substances that have been proven to have anti-inflammatory properties. This study was aimed to determine whether the combination of 12% spirulina and 20% chitosan can accelerate wound healing through its intervention in cytokines IL-1Î², TNF-Î± and IL-10.Method: The samples used were 36 Wistar rats suffering from diabetes mellitus and divided into control groups induced by CMC Na base gel and treatment groups induced by the combination of 12% spirulina and 20% chitosan in the socket. These 2 groups were further divided into groups terminated on one day, three days and seven days post-extraction.Results: The amount of IL-1Î² and TNF-Î± in the treatment groups is lower than that of the control group. Meanwhile, the treatment group of IL-10 showed an increase in IL-10 levels.Â Conclusion: The combination of 12% spirulina and 20% chitosan can accelerate wound healing. They are decreasing the amount of pro-inflammatory cytokines IL-1Î² and TNF-Î± as well as increasing the number of anti-inflammatory cytokines IL-10.
Caco-2 cells monolayer as an in-vitro model for probiotic strain translocation
Authors: Fatmawati Ni Nengah Dwi , Goto Kazuyoshi , Mayura I Putu Bayu , Nocianitri Komang Ayu , Ramona Yan , Sakaguchi Masakiyo , Matsushita Osamu , Sujaya I Nengah 
Published: November 2020

Background: Caco-2 cells monolayer is one of invitro models to evaluate the translocation capacity of Lactobacillus spp probioticstrains. The translocation is influenced by mucosa permeability of enterocytes as shown by increasing transepithelial resistance (TER) and formation of tight junction proteins. The pore size of the supported permeable membrane used in in vitro assay was one of the crucial factors in performing bacterial translocation assay. Almost no study has been conducted using Caco-2 cells monolayer grown on 8-Î¼m pore size polycarbonate membrane for evaluating probiotics translocation. Therefore this study aimed to determine whether the Caco-2 cells monolayer model was suitable as an in vitro translocation model.Methods: Caco-2 cells monolayer was seeded onto 8-Î¼m collagen-coated polycarbonate membrane insert TranswellÂ®. Differentiation of Caco-2 cells was detected by measuring the TER, while the ZO-1 protein (the tight junction proteins) was detected by immunofluorescence. H2O2 was used as a tight junction disruptive agent. Data were analyzed using SPSS version 23 software to compare the mean of TER measurement between untreated and H2O2-treated Caco-2 cells monolayer.Results: The result showed that the TER of Caco-2 cells monolayer was gradually increasing until day 14, reaching more than 800 ohm.cm2. Furthermore, the ZO-1 protein was successfully detected, indicated the tight junction formation. Â TER value of H2O2-treated cells showed significantly lower than that of untreated cells (P<0.05), indicating a disturbance of cells monolayer integrity. Lactobacillus rhamnosus FBB81 was used for validating the translocation. There was no translocation observed; however, translocation was observed in H2O2-treated cells.Conclusion: Altogether suggests that Caco-2 cells grown on 8 Î¼m-pore size permeable filters could be considered as a suitable in vitro model for probiotics strains translocation.
Diabetes mellitus control among elderly patients at geriatric polyclinic of Karangasem District Hospital, Bali, Indonesia: a preliminary study
Authors: Dwipayanti Ni Made Ayu , Nariata I Wayan , Aryana I Gusti Putu Suka 
Published: November 2020

Background: The increasing number of elderly populations also increases the number of chronic degenerative diseases, including diabetes mellitus (DM). Therefore, diabetes control is needed to prevent various complications and improve the health quality of the elderly patient. This study aims to obtain preliminary information about diabetes control in elderly patients in the geriatric clinic of Karangasem District Hospital to provide appropriate management to improve diabetes control.Method: This research is a cross-sectional study and consecutive sampling of 46 DM patients who seek treatment at the geriatric clinic of Karangasem District Hospital in the period May-July 2019. Inclusion criteria were DM patients aged â‰¥60 years. We exclude diabetes person with acute infection and end-stage renal disease. The criteria for DM control used in this study is body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting plasma glucose (FPG), postprandial glucose (PPG), and HbA1c levels. Data were analyzed using SPSS version 25 for Windows and depicted descriptively. Results: Among 46 samples, there were 23 (50.0%) male and 23 (50.0%) female enrolled in this study. We find median of each, BMI was 23.2856 kg/m2, SBP 120 mmHg, DBP 70mmHg, 153.5 mg/dl for FPG, 238 mg/dl for PPG, and 7.8% for HbA1c. In this study, patients who met target of diabetes control is 34.8% for BMI, 53.8% for SBP, 76.9% for DBP, 43.5% for FPG, 17.4% PPG, and 28.3 % for HbA1c levels.Â Conclusion: In this study, it was found that DM control in elderly patients in our Hospital is not optimal on the parameters of BMI, SBP, DBP, FPG, PPG, and HbA1c levels. Better results were obtained in systolic and diastolic blood pressure control.
Correlation of neutrophils lymphocytes ratio with femur muscle damage due to acute limb ischemia in white Wistar rats
Authors: Habibie Yopie Afriandi , Purnomo Avisenna Gatot 
Published: November 2020

Background: Acute limb ischemia (ALI) is a sudden decrease in limb perfusion that threatens limb viability and requires urgent evaluation and management. Assessment determines whether the limb is viable or irreversibly damaged. Neutrophil-lymphocyte ratio (NLR) is a useful marker for cardiovascular disease to delineate the prognosis. Endothelial dysfunctions related to atherosclerotic plaques are usually associated with states of neutrophilia together with lymphopenia processes.Methods: This study was a post-test only control group performed on Wistar strain white rats. Thirty rats were divided into 5 groups, Control group (K), treatment group one (P1) examined NLR and femoral muscle tissue after 3 hours of ALI, P2 after 4 hours of ALI, P3 after 5 hours of ALI and P4 after 6 hours of ALI. Muscle tissue was histologically examined.Â Results: The duration of ALI increases the NLR value in Wistar strain white rats, the NLR value examined 6 hours after the rats experienced ALI increased significantly compared with the NLR values examined in the control group, the group examined 3 hours, 4 hours and 5 hours after the rats had ALI (p = 0.004). Necrotic muscle tissue very strongly correlated with the duration of ALI (r = 0.860, p<0.001). NLR value is strongly correlated with muscle tissue damage (r = 0.634, p<0.001).Â Conclusion: The duration of ALI increases the NLR value in wistar strain white rats, NLR values increased significantly after 6 hours of ALI. Necrotic muscle tissue occurs after six hours of ALI. NLR value is strongly correlated with muscle tissue damage. Revascularization must be done within 6 hours to prevent permanent damage.Â Â
Factors influencing sperm retrieval rate by Microdissection Testicular Sperm Extraction (mTESE) in non-obstructive azoospermia cases: a literature review
Authors: Sabudi I Made Nugraha Gunamanta 
Published: November 2020

Background:Â Non-Obstructive Azoospermia (NOA) had dominating 60% of all azoospermia cases. Sperm Retrieval Techniques (SRT) continued with Intra-Cytoplasmic Sperm Injection (ICSI) are therapy modalities helping infertile azoospermia to be fertile. There are some options of SRT such as PESA, MESA, TESE, TESA and microdissection-TESE (mTESE) to collect sperm from azoospermia cases. This study aims to evaluate some factors influencing sperm retrieval rate by mTESE in non-obstructive azoospermia cases.Method:Â The data collection for eligible articles were conducted from 2011 to 2019. Different database and manual search methods were used to find the topic-related articles, particularly in some factors influencing the sperm retrieval rate of mTESE in NOA cases. A total of 21 relevant kinds of literature were studied regarding some factors that might be increasing or decreasing of sperm retrieval rate by mTESE procedure. However, four literature were elaborated further due to a similar approach to get the results.Results:Â A previous study from Saudi Arabia with 264 patients samples found significant different on testosterone level who had successful Sperm Retrieval Rate (SRR) 57.25%. SRR was related by several factors of testosterone, FSH, bilateral testis retrieval and seminiferous tubules diameter taken as the earliest study from India. Besides, taking bilateral testis sperm retrieval also had low SRR 14.4%, but serum FSH level was not influenced by increasing SRR. The previous study found a very weak correlation between FSH and SRR. A different study was conducted in Italy found that all NOA patient who undergone mTESE procedure found the Maturation Arrest (MA) has the significant higher success SRR until 67% after Sertoli Cell Only (SCO) syndrome and sclera-hyalinosis histology.Conclusion:Â SRR depends on some factors those influencing by hormonal baseline preoperative such as testosterone level and FSH serum level, technique and how mTESE done by the operator in mTESE procedure.
The relationship between age of menarche with striae among female students
Authors: Aryunisari Chyntia Giska , Putra Imam Budi , Jusuf Nelva K. 
Published: November 2020

Background:Â Striae are harmless skin disorders, but can cause cosmetic and psychological concerns. The role of estrogen in reducing adhesion between collagen fibers can cause striae in stretch area. Menarche that occurs during puberty play a role in the increment of estrogen levels. Adolescents who had experienced menarche tend to have higher estrogen levels.Methods:Â This was a cross-sectional study with total sampling method. 151 female students in Faculty of Medicine, Universitas Sumatera Utara were included and physical examination on the site of striae was done to confirm diagnosis. Age of menarche is classified as early (â‰¤11 y.o), normal (12-13 y.o) and late (â‰¥14 y.o). StudyÂ was conductedÂ after approval from the Ethics Committee Faculty of Medicine, Universitas Sumatera Utara.Results:Â Subjects in early menarche group were 84 (55.6%) subjects, normal were 56 (37.1%) subjects and late were 11 (7.3%) subjects. Median (11.0 y.o) and minimum-maximum age of menarche (9-16 y.o). Sites ofÂ striae were found mostly in thighs (66.9%), followed by buttocksÂ (11.8%), calvesÂ (7.4%), hips (6.6%), chest (3.7%), upper arms (2.2%) and breasts (1.4%). Subjects with early menarche were 84 subjects in which 78 with striae and 6 without striae. Subjects with normal and late menarche was 67 subjects with 35 having striae and 32 without striae. In this study, we found a significant correlation between age of menarche with striae (p <0.05).Conclusion:Â Early menarche can induce risk of striae in adolescents