bluuebunny/crossref_metadata_2025_split huggingface dataset:
Modern contraceptive methods knowledge and practice among blind and deaf women in Ethiopia. A cross-sectional survey
Authors: Yimer Awol Seid , Modiba Lebitsi Maud 
Published: November 2019

Abstract
Background
Evidences from various parts of the world reveal that women with disabilities are facing widespread barriers in accessing public services. Service providers and program managers do not grasp the relevance of their work and interventions in addressing the sexual and reproductive health needs of women with disabilities. The present study therefore aimed to assess family planning knowledge and practice among women with sensory disabilities.

Methods
A mixed method approach using quantitative and qualitative methods was employed to collect the data. The study included 326 blind and deaf women using respondent driven sampling technique and 29 purposely selected key informants. We carried out the study from August 2016–April 2017. The quantitative data were analyzed using SPSS and the qualitative analysis was done using Open code software version 4.02 and triangulated with the quantitative findings.

Results
The findings showed that nearly two third of the respondents of were sexually active. The majority (97.2%) of study respondents had heard about FP methods, however the level of comprehensive knowledge on modern contraceptive methods was 32.5%. The prevalence of unwanted pregnancy was 67.0% and abortion was 44%.
Almost half of sexually active respondents ever used modern contraceptive methods, yet the contraceptive prevalence at the time of survey was 31.1%. Implants were the most commonly used (51%) contraceptive method among current users.

Conclusions
The use of modern contraceptive methods among women with sensory disabilities was low. Thus, the government and concerned organizations need to address the attitudinal, social, and physical barriers women with sensory disabilities are facing while seeking, accessing to and using family planning services.
1α, 25-dihydroxy Vitamin D3 containing fractions of Catharanthus roseus leaf aqueous extract inhibit preadipocyte differentiation and induce lipolysis in 3T3-L1 cells
Authors: Borah Anuj Kumar , Singh Archana , Yasmin Rafika , Doley Robin , Mattaparthi Venkata Satish Kumar , Saha Sougata 
Published: November 2019

AbstractBackgroundTo investigate the potential ofCatharanthus roseusleaf aqueous crude extract (CRACE) as a regulator of adipocyte development and function.Methods3T3-L1 adipogenesis model was used to investigate the effect of CRACE on adipogenesis. 3T3-L1 preadipocytes (for adipogenic differentiation) and mature 3T3-L1 adipocytes (for adipocyte function) were treated with non-toxic doses of CRACE. The outcomes were corroborated by intracellular lipid accumulation, expression of pro-and anti-adipogenic effector molecules. To investigate CRACE mediated lipolysis, cAMP accumulation, glycerol release and phosphorylation of key effector molecules were tested in treated mature adipocytes. Finally, the extract was fractionated to identify the active molecule/s in the extract.ResultsCRACE significantly reduced adipocyte differentiation by modulating PPARγ expression. At early stage CRACE directly targeted Lipin1 expression and consequently impacted KLF7, subsequently expression of GATA2, CEBPα, SREBP1c were targeted, with PPARγ expression, particularly curtailed. While CRACE significantly reduced several lipogenic genes like FAS and GPD1 in mature adipocytes, concomitantly, it greatly increased lipolysis resulting in decreased lipid accumulation in mature adipocytes. The increase in lipolysis was due to decreased Akt activation, increased cAMP level, and PKA activity. The fractionation of CRACE allowed identification of two fractions with potent anti-adipogenic activity. Both the fractions contained 1α, 25-dihydroxy Vitamin D3 as major component.Conclusions1α, 25-dihydroxy Vitamin D3 containing CRACE can be developed into an effective anti-obesity formulation that decreases adipogenesis and increases lipid catabolism.
A self-report of the Healer’s art by junior doctors: does the course have a lasting influence on personal experience of humanism, self-nurturing skills and medical counterculture?
Authors: Jaiswal Chanakya , Anderson Katrina , Haesler Emily 
Published: November 2019

Abstract
Background
Healer’s Art (HA) is a voluntary course offered during medical school. The course aims to address the growing loss of meaning and commitment experienced by doctors through the exploration of compassion, empathy and awe in medicine, and early exposure to a supportive community of practice. This project aimed to evaluate the potential influence of HA on junior doctor graduates.

Methods
Junior doctors who had undertaken HA during their medical studies were interviewed. A thematic analysis was performed on the results of these semi-structured interviews.

Results
Ten junior doctors who had undertaken the HA course participated in interviews. All interviewees described the HA as a positive and enlightening experience in their medical education. The thematic analysis identified four major themes: developing empathy in the doctor-patient journey, self-care and self-awareness, the creation of a supportive community, and coping with the challenging medical culture.

Conclusions
HA provides experiential learning that enables participants to explore humanistic medicine. Self-selected junior doctors recall the course as a positive experience, and perceive themselves to be continuing to employ the techniques from HA in the healthcare setting. The concepts taught in the HA course appear to have a lasting personal impact on some junior doctors, who identify the course as influencing their self-reported positive patient-doctor relationships and supportive relationships with medical peers.
Developing a standardised approach to the aggregation of inpatient episodes into person-based spells in all specialties and psychiatric specialties
Authors: Rees Sarah , Akbari Ashley , Collins Huw , Lee Sze Chim , Marchant Amanda , Rees Arfon , Thayer Daniel , Wang Ting , Wood Sophie , John Ann 
Published: November 2019

Abstract
Background
Electronic health record (EHR) data are available for research in all UK nations and cross-nation comparative studies are becoming more common. All UK inpatient EHRs are based around episodes, but episode-based analysis may not sufficiently capture the patient journey. There is no UK-wide method for aggregating episodes into standardised person-based spells. This study identifies two data quality issues affecting the creation of person-based spells, and tests four methods to create these spells, for implementation across all UK nations.

Methods
Welsh inpatient EHRs from 2013 to 2017 were analysed. Phase one described two data quality issues; transfers of care and episode sequencing. Phase two compared four methods for creating person spells. Measures were mean length of stay (LOS, expressed in days) and number of episodes per person spell for each method.

Results
3.5% of total admissions were transfers-in and 3.1% of total discharges were transfers-out. 68.7% of total transfers-in and 48.7% of psychiatric transfers-in had an identifiable preceding transfer-out, and 78.2% of total transfers-out and 59.0% of psychiatric transfers-out had an identifiable subsequent transfer-in. 0.2% of total episodes and 4.0% of psychiatric episodes overlapped with at least one other episode of any specialty.
Method one (no evidence of transfer required; overlapping episodes grouped together) resulted in the longest mean LOS (4.0 days for all specialties; 48.5 days for psychiatric specialties) and the fewest single episode person spells (82.4% of all specialties; 69.7% for psychiatric specialties). Method three (evidence of transfer required; overlapping episodes separated) resulted in the shortest mean LOS (3.7 days for all specialties; 45.8 days for psychiatric specialties) and the most single episode person spells; (86.9% for all specialties; 86.3% for psychiatric specialties).

Conclusions
Transfers-in appear better recorded than transfers-out. Transfer coding is incomplete, particularly for psychiatric specialties. The proportion of episodes that overlap is small but psychiatric episodes are disproportionately affected.
The most successful method for grouping episodes into person spells aggregated overlapping episodes and required no evidence of transfer from admission source/method or discharge destination codes. The least successful method treated overlapping episodes as distinct and required transfer coding. The impact of all four methods was greater for psychiatric specialties.
Standards as applied in reality: a case study on the translation of standards in eHealth evaluation practice
Authors: Jurkeviciute Monika 
Published: November 2019

Abstract
Background
Application of standards is a way to increase quality in an evaluation study. However, standards are used insufficiently in eHealth evaluation, affecting the generalization of the knowledge generated.
This study aimed to explore how standards are used in a practical setting of an eHealth evaluation, and to identify the factors that can hinder their use.

Methods
The data were collected in a multi-national and interdisciplinary eHealth evaluation study targeted at the elderly people suffering from mild cognitive impairment and mild dementia. The study was carried out in four countries and funded by the European Union. The collected data included meeting minutes (n = 8) and e-mail correspondence (n = 261) between partners. The chronological sequence of events related to the use of standards was established. Subsequently, the hindering factors related to the use of standards were identified from the sequence.

Results
The use of four standards was described, reflecting a variety of related processes or barriers that emerge during eHealth evaluation. The processes differed based on the type of the standard. Specifically, evaluation frameworks were found to be conceptual standards and they were easy to agree upon, while standardized metrics were more tangible and their use triggered negotiations. Further, the following factors hindered the use of standards in eHealth evaluations: (1) inadequacy of a standard to address a target population or a disease, (2) insufficient resources to use a standard, (3) lack of experience in using a standard, and (4) lack of validation of a standard in a particular location.

Conclusions
Standardization initiatives in eHealth evaluation provide a blueprint for evaluation, but their practical application is problematic. The practical circumstances of an evaluation study can cause deviations in the standards, thus producing heterogeneity in the evaluation methodologies.
Evaluation of the primary care for chronic diseases in the high coverage context of the Family Health Strategy
Authors: Alves Kelly Cristina Gomes , Guimarães Rafael Alves , de Souza Marta Rovery , de Morais Neto Otaliba Libânio 
Published: November 2019

Abstract
Background
This cross-sectional study evaluated the adequacy of the Family Health Strategy for the primary care model for chronic noncommunicable diseases and the changes that occurred between the two cycles of external evaluations of the National Program for Improving Access and Quality of Primary Care, which took place in 2012 and 2014, in the higher coverage context of the Family Health Strategy of Brazil, in the state of Tocantins, Brazil.

Methods
The data source contained information on the infrastructure of the 233 Primary Health Units and on the work process of 266 health teams. The Principal Component Analysis for Categorical Data technique and the McNemar chi-squared statistical test for comparing paired samples were used, and a significance level of 5% with a 95% Confidence Interval was used.

Results
The analysis identified a low proportion of dispensing of medications for the treatment of chronic disease in both cycles. There was a significant increase in seasonal influenza vaccination, in the number of sterilization, procedure, dressings and inhalation rooms. There was a small but significant reduction in the materials for cervical cancer screening, although they are available in almost 90.0% of the PHUs. More than 70.0% of the health teams carried out additional health education activities, encouraged physical activity, registered schoolchildren with health needs for monitoring, evaluated user satisfaction and user referral.

Conclusions
The findings of this study highlighted the improvement of the structure of the Primary Health Units, but identified a low provision of medicines to treat chronic diseases. The health promotion was performed as the main work process tool of family health teams, but it was little focused on intersectoral actions and on actions with the population in the area or on the empowerment of users through self-management support for chronic diseases. Furthermore, it is critical that the Family Health Strategy in Tocantins be organized and focused on the care of chronic diseases to improve and adapt itself to a primary chronic care model.
A realist evaluation to identify contexts and mechanisms that enabled and hindered implementation and had an effect on sustainability of a lean intervention in pediatric healthcare
Authors: Flynn Rachel , Rotter Thomas , Hartfield Dawn , Newton Amanda S. , Scott Shannon D. 
Published: November 2019

AbstractBackgroundIn 2012, the Saskatchewan Ministry for Health mandated a system-wide Lean transformation. Research has been conducted on the implementation processes of this system-wide Lean implementation. However, no research has been done on the sustainability of these Lean efforts. We conducted a realist evaluation on the sustainability of Lean in pediatric healthcare. We used the context (C) + mechanism (M) = outcome (O) configurations (CMOcs) heuristic to explain under what contexts, for whom, how and why Lean efforts are sustained or not sustained in pediatric healthcare.MethodsWe employed a case study research design. Guided by a realist evaluation framework, we conducted qualitative realist interviews with various stakeholder groups across four pediatric hospital units ‘cases’ at one acute hospital. Interview data was analyzed using an integrated approach of CMOc categorization coding, CMOc connecting and pattern matching.ResultsWe conducted thirty-two interviews across the four cases. Five CMOcs emerged from our realist interview data. These configurations illustrated a ‘ripple-effect’ from implementation outcomes to contexts for sustainability. Sense-making and staff engagement were prominent mechanisms to the sustainment of Lean efforts. Failure to trigger these mechanisms resulted in resistance. The implementation approach used influenced mechanisms and outcomes for sustainability, more so than Lean itself. Specifically, the language, messaging and training approaches used triggered mechanisms of innovation fatigue, poor ‘sense-making’ and a lack of engagement for frontline staff. The mandated, top-down, externally led nature of implementation and lack of customization to context served as potential pitfalls. Overall, there was variation between leadership and frontline staff’s perceptions on how embedded Lean was in their contexts, and the degree to which participants supported Lean sustainability.ConclusionsThis research illuminates important contextual factors and mechanisms to the process of Lean sustainment that can be applicable to those implementing systems changes. Future work is needed to continue to develop the science on the sustainability of interventions for healthcare improvement.
Working well: strategies to strengthen the workforce of the Indigenous primary healthcare sector
Authors: Jongen Crystal , McCalman Janya , Campbell Sandy , Fagan Ruth 
Published: November 2019

Abstract
Background
The capacity of the Indigenous primary healthcare (PHC) sector to continue playing a crucial role in meeting the health needs of Aboriginal and Torres Strait Islander Australians is in large part reliant on the skills, motivation and experience of its workforce. While exhibiting many workforce strengths, the sector faces significant challenges in building and maintaining a strong and stable workforce. Drawing on data from one Aboriginal Community Controlled Health Service (ACCHS), this study reports what is working well and what could be improved to strengthen the Indigenous PHC sector workforce.

Methods
Using grounded theory methods, interviews with 17 ACCHS staff from a range of organisational positions were transcribed, coded and analysed. This paper focuses on the strategies identified that contribute towards strengthening the Indigenous PHC workforce.

Results
Four overarching strategies for Indigenous PHC workforce strengthening were identified. These were Strengthening Workforce Stability, Having Strong Leadership, Growing Capacity, and Working Well Together. A range of enabling factors at the macro, community, organisational and individual levels were also identified.

Conclusion
Indigenous PHC services are already implementing many important workforce-development strategies that are having a positive impact on the sector. There are also several persistent challenges which need to be addressed through action at organisational and structural levels. Approaches to workforce strengthening in Indigenous PHC should be tailored to local needs to ensure they address the unique workforce challenges experienced in different contexts.
O-serogroups, virulence genes, antimicrobial susceptibility, and MLST genotypes of Shiga toxin-producing Escherichia coli from swine and cattle in Central China
Authors: Peng Zhong , Liang Wan , Hu Zizhe , Li Xiaosong , Guo Rui , Hua Lin , Tang Xibiao , Tan Chen , Chen Huanchun , Wang Xiangru , Wu Bin 
Published: November 2019

Abstract
Background
Shiga toxin-producing Escherichia coli (STEC) is a leading cause of worldwide food-borne and waterborne infections. Despite an increase in the number of STEC outbreaks, there is a lack of data on prevalence of STEC at the farm level, distribution of serogroups, and virulence factors.

Results
In the present study, a total of 91 (6.16%) STEC strains were isolated from 1477 samples including pig intestines, pig feces, cattle feces, milk, and water from dairy farms. The isolation rates of STEC strains from pig intestines, pig feces, and cattle feces were 7.41% (32/432), 4.38% (21/480), and 9.57% (38/397), respectively. No STEC was isolated from the fresh milk and water samples. By O-serotyping methods, a total of 30 types of O-antigens were determined, and the main types were O100, O97, O91, O149, O26, O92, O102, O157, and O34. Detection of selected virulence genes (stx1, stx2, eae, ehxA, saa) revealed that over 94.51% (86/91) of the isolates carried more than two types of virulence associated genes, and approximately 71.43% (65/91) of the isolates carried both stx1 and stx2, simultaneously. Antimicrobial susceptibility tests showed that most of the STEC isolates were susceptible to ofloxacin and norfloxacin, but showed resistance to tetracycline, kanamycin, trimethoprim-sulfamethoxazole, streptomycin, amoxicillin, and ampicillin. MLST determined 13 categories of sequence types (STs), and ST297 (31.87%; 29/91) was the most dominant clone. This clone displayed a close relationship to virulent strains STEC ST678 (O104: H4). The prevalence of ST297 clones should receive more attentions.

Conclusions
Our preliminary data revealed that a heterogeneous group of STEC is present, but the non-O157 serogroups and some ST clones such as ST297 should receive more attentions.
Reinterpretation, reclassification, and its downstream effects: challenges for clinical laboratory geneticists
Authors: El Mecky Julia , Johansson Lennart , Plantinga Mirjam , Fenwick Angela , Lucassen Anneke , Dijkhuizen Trijnie , van der Hout Annemieke , Lyle Kate , van Langen Irene 
Published: November 2019

Abstract
Background
In recent years, the amount of genomic data produced in clinical genetics services has increased significantly due to the advent of next-generation sequencing. This influx of genomic information leads to continuous changes in knowledge on how genetic variants relate to hereditary disease. These changes can have important consequences for patients who have had genetic testing in the past, as new information may affect their clinical management. When and how patients should be recontacted after new genetic information becomes available has been investigated extensively. However, the issue of how to handle the changing nature of genetic information remains underexplored in a laboratory setting, despite it being the first stage at which changes in genetic data are identified and managed.

Methods
The authors organized a 7-day online focus group discussion. Fifteen clinical laboratory geneticists took part. All (nine) Dutch clinical molecular genetics diagnostic laboratories were represented.

Results
Laboratories in our study reinterpret genetic variants reactively, e.g. at the request of a clinician or following identification of a previously classified variant in a new patient. Participants currently deemed active, periodic reinterpretation to be unfeasible and opinions differed on whether it is desirable, particularly regarding patient autonomy and the main responsibilities of the laboratory. The efficacy of reinterpretation was questioned in the presence of other strategies, such as reanalysis and resequencing of DNA. Despite absence of formal policy regarding when to issue a new report for clinicians due to reclassified genetic data, participants indicated similar practice across all laboratories. However, practice differed significantly between laboratory geneticists regarding the reporting of VUS reclassifications.

Conclusion
Based on the results, the authors formulated five challenges needing to be addressed in future laboratory guidelines: 1. Should active reinterpretation of variants be conducted by the laboratory as a routine practice? 2. How does reinterpretation initiated by the laboratory relate to patient expectations and consent? 3. When should reinterpreted data be considered clinically significant and communicated from laboratory to clinician? 4. Should reinterpretation, reanalysis or a new test be conducted? 5. How are reclassifications perceived and how might this affect laboratory practice?
Advances and opportunities in gene editing and gene regulation technology for Yarrowia lipolytica
Authors: Ganesan Vijaydev , Spagnuolo Michael , Agrawal Ayushi , Smith Spencer , Gao Difeng , Blenner Mark 
Published: November 2019

AbstractYarrowia lipolytica has emerged as a biomanufacturing platform for a variety of industrial applications. It has been demonstrated to be a robust cell factory for the production of renewable chemicals and enzymes for fuel, feed, oleochemical, nutraceutical and pharmaceutical applications. Metabolic engineering of this non-conventional yeast started through conventional molecular genetic engineering tools; however, recent advances in gene/genome editing systems, such as CRISPR–Cas9, transposons, and TALENs, has greatly expanded the applications of synthetic biology, metabolic engineering and functional genomics of Y. lipolytica. In this review we summarize the work to develop these tools and their demonstrated uses in engineering Y. lipolytica, discuss important subtleties and challenges to using these tools, and give our perspective on important gaps in gene/genome editing tools in Y. lipolytica.