bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sunlight exposed body surface area is associated with serum 25-hydroxyvitamin D (25(OH)D) level in pregnant Minangkabau women, Indonesia
Authors: Ilmiawati Cimi , Oviana Athica , Friadi Andi , Reza Mohamad 
Published: May 2020

Abstract
Background
Vitamin D deficiency is highly prevalent in women, and living in a tropical country with a year-round abundance of sunlight as the primary source of vitamin D does not seem to guarantee adequate serum 25(OH)D. While living in the tropics, Minangkabau women are known to dress specifically according to their culture. This study was aimed to elucidate the association of sunlight exposed body surface area with serum 25(OH)D in pregnant Minangkabau women of Indonesia.

Methods
We performed a cross-sectional study on 88 Minangkabau women in late pregnancy. Lifestyle data were collected using a questionnaire, and dietary intake of vitamin D was calculated from 24-h food recall. The skin pigmentation type was determined by the Fitzpatrick scale, and the body surface area exposed to sunlight was estimated. Serum 25(OH)D was quantified by ELISA method. Serum 25(OH)D differences according to the duration of sunlight exposure, skin pigmentation type, and sunscreen use were statistically analyzed by ANOVA. The correlation of sunlight exposed body surface area and serum 25(OH)D was analyzed by Spearman’s correlation.

Results
Nearly half of the subjects (n = 40; 45.5%) were deficient in vitamin D (< 20 ng/ml) with serum 25(OH)D level 23.0 ± 10.0 ng/ml (mean ± SD) and the estimated daily intake of vitamin D was 5.6 ± 3.9 μg/1000 kcal/day (mean ± SD). The median percentage of body area exposed to sunlight was 15.8%. There were no differences in serum 25(OH)D levels according to sunlight exposure time, skin pigmentation type, and sunscreen use. The percentage of body area exposed to sunlight was positively correlated with serum 25(OH)D level (Spearman’s ρ = 0.403; p < 0.001).

Conclusions
Vitamin D deficiency is prevalent in pregnant Minangkabau women. Since increasing body surface area exposed to sunlight may not be culturally acceptable, vitamin D supplementation needs to be considered in this population.
Making the equivocal unequivocal: standardization of clean margins in diabetic foot osteomyelitis
Authors: Schmidt Brian M. , Jarocki Christine 
Published: May 2020

Abstract
Background
The prevalence of diabetes mellitus continues to rise. Diabetic foot ulcers with osteomyelitis are a diabetes-related complication presenting a significant burden to this cohort. A cure to diabetic foot osteomyelitis remains elusive and standard of care has failed to improve outcomes. To advance research and better patient outcomes, the authors offer specific guidance with terminology to enhance operative dictations which may improve surgical practice and guide treatment.

Methods
A consecutive review of podiatric surgical dictations for inpatient diabetic foot osteomyelitis within a tertiary care facility was performed. Surgical descriptors of bone were standardized: density, anatomic structure, vascular thrombosis, color, and draining sinus. Correlations between the five categories and histopathological results were performed after kappa analysis for interrater reliability was performed.

Results
Kappa coefficient demonstrated high inter-reliability of surgical findings. This suggests potential agreement amongst surgeons performing similar procedures. It was also found that specific bone descriptors had moderate to strong correlation with clean histopathologic bone margins when biopsied. This further suggests that the use of standardized terms may help guide definitive therapy.

Conclusions
The authors suggest a standardized approach which includes consistent descriptors of intraoperative bone. With use of standardized terms, vague and blanket descriptors are eliminated. This has potential to improve understanding of changes within bone as a result of infection and diabetes. Early and improved communication of intraoperative findings will enhance the multidisciplinary approach. This could potentially lead to changes in diabetic foot management and may limit hospital waste waiting for final cultures and pathology reports.
When predictions are used to allocate scarce health care resources: three considerations for models in the era of Covid-19
Authors: Kent David M. , Paulus Jessica K. , Sharp Richard R. , Hajizadeh Negin 
Published: May 2020

Abstract
Background
The need for life-saving interventions such as mechanical ventilation may threaten to outstrip resources during the Covid-19 pandemic. Allocation of these resources to those most likely to benefit can be supported by clinical prediction models. The ethical and practical considerations relevant to predictions supporting decisions about microallocation are distinct from those that inform shared decision-making in ways important for model design.

Main body
We review three issues of importance for microallocation: (1) Prediction of benefit (or of medical futility) may be technically very challenging; (2) When resources are scarce, calibration is less important for microallocation than is ranking to prioritize patients, since capacity determines thresholds for resource utilization; (3) The concept of group fairness, which is not germane in shared decision-making, is of central importance in microallocation. Therefore, model transparency is important.

Conclusion
Prediction supporting allocation of life-saving interventions should be explicit, data-driven, frequently updated and open to public scrutiny. This implies a preference for simple, easily understood and easily applied prognostic models.
Attitudes about cannabis mediate the relationship between cannabis knowledge and use in active adult athletes
Authors: Zeiger Joanna S. , Silvers William S. , Fleegler Edward M. , Zeiger Robert S. 
Published: May 2020

AbstractBackgroundLittle is known about how cannabis knowledge and attitudes impact cannabis use behavior.ObjectiveTo test the knowledge-attitudes-behavior paradigm in active adult athletes.DesignThe Athlete Pain, Exercise, and Cannabis Experience (PEACE) Survey, a cross-sectional survey study, used social media and email blasts to recruit participants and SurveyGizmo to collect data.ParticipantsSelf-defined active adult athletes (n = 1161).Main measuresKnowledge about cannabis was evaluated with four questions. Attitudes toward cannabis was evaluated with 11 questions. The attitudes questions were used in a TwoStep Cluster analysis in SPSS to assign group membership by attitudes. Chi-square was used to determine if there were differences in cluster membership by demographic factors and if knowledge about cannabis differed by cluster membership. Regression analysis was performed to determine if cannabis attitudes mediated the relationship between cannabis knowledge and cannabis use.Key resultsA three-cluster solution was the best fit to the data. The clusters were named Conservative (n = 374, 32.2%), Unsure (n = 533, 45.9%), and Liberal (n = 254, 21.9). There was a significant difference among the clusters for all 11 attitudesitems (allp < 0.001). Attitude cluster membership was significantly different by age (p < 0.001), primary sport (p < 0.05), and knowledge about cannabis (p < 0.001). Athletes in the liberal cluster answered the knowledge questions correctly most often. Attitudes mediated the relationship between cannabis knowledge and cannabis use [Never (32.4%), Past (41.6%), Current (26.0%)] with athletes in the liberal cluster showing more knowledge and greater likelihood to be a current cannabis user (p < 0.001). Among current cannabis users there were differential patterns of cannabis use depending on their attitudes and knowledge; liberal athletes tended to co-use THC and CBD and used cannabis longer. (p < 0.001).ConclusionsCannabis education needs to consider attitudes about cannabis, especially among those who might benefit from medical cannabis.
The associations among RARRES2 rs17173608 gene polymorphism, serum chemerin, and non-traditional lipid profile in patients with metabolic syndrome
Authors: Dahpy Marwa A. , Khairallah Marwa K. , Azoz Nashwa Mostafa A. , Ezzat Ghada M. 
Published: May 2020

Abstract
Background
The adipokine chemerin retinoic acid receptor responder protein 2 (RARRES2) has been associated with insulin resistance, type II diabetes mellitus (T2DM), obesity, and metabolic syndrome (MetS). The impact of RARRES2 rs17173608 gene polymorphism on MetS and chemerin levels is not completely elucidated. This study included 100 patients with MetS and 68 healthy subjects (non-MetS group). The RARRES2 rs17173608 gene variant was analyzed by tetra amplification refractory mutation system polymerase chain reaction (T-ARMS-PCR). Circulating chemerin levels were determined by ELISA. Serum urea, creatinine, fasting blood glucose, glycated hemoglobin, and traditional lipid profile were measured by colorimetric methods. The estimated glomerular filtration rate (eGFR) and non-traditional lipid parameters were calculated.

Results
Serum chemerin levels were significantly higher in MetS than in non-MetS subjects, type II diabetics (T2DM) than non-diabetics, and overweight compared to lean subjects, but it did not differ significantly between patients with and without hypertension. Strikingly, newly diagnosed diabetic patients had significantly higher serum chermerin levels. Correlation and multiple linear regression analysis showed that serum chemerin levels and non-traditional lipid parameters were correlated significantly with the clinical criteria of MetS. Genotyping and allelic frequency distribution of RARRES2 rs17173608 gene polymorphism showed its significant association with MetS. The TT genotype of RARRES2 rs17173608 SNP was more distributed in T2DM in comparison with non-diabetics, and it was associated significantly with higher serum chemerin and higher glycated hemoglobin levels. RARRES2 rs17173608 GG genotype and G allele frequency were less distributed in T2DM patients than in non-diabetic patients.

Conclusions
The RARRES2 rs17173608 SNP might have an impact on chemerin levels and lipid parameters. The GG genotype and G allele may have a protective role towards the risk of T2DM but not for MetS. Serum chemerin and non-traditional lipid profile are significantly associated with MetS.
Management of Cancer Cachexia: ASCO Guideline
Authors: Roeland Eric J. , Bohlke Kari , Baracos Vickie E. , Bruera Eduardo , del Fabbro Egidio , Dixon Suzanne , Fallon Marie , Herrstedt Jørn , Lau Harold , Platek Mary , Rugo Hope S. , Schnipper Hester H. , Smith Thomas J. , Tan Winston , Loprinzi Charles L. 
Published: May 2020

PURPOSETo provide evidence-based guidance on the clinical management of cancer cachexia in adult patients with advanced cancer.METHODSA systematic review of the literature collected evidence regarding nutritional, pharmacologic, and other interventions, such as exercise, for cancer cachexia. PubMed and the Cochrane Library were searched for randomized controlled trials (RCTs) and systematic reviews of RCTs published from 1966 through October 17, 2019. ASCO convened an Expert Panel to review the evidence and formulate recommendations.RESULTSThe review included 20 systematic reviews and 13 additional RCTs. Dietary counseling, with or without oral nutritional supplements, was reported to increase body weight in some trials, but evidence remains limited. Pharmacologic interventions associated with improvements in appetite and/or body weight include progesterone analogs and corticosteroids. The other evaluated interventions either had no benefit or insufficient evidence of benefit to draw conclusions on efficacy. Limitations of the evidence include high drop-out rates, consistent with advanced cancer, as well as variability across studies in outcomes of interest and methods for outcome assessment.RECOMMENDATIONSDietary counseling may be offered with the goals of providing patients and caregivers with advice for the management of cachexia. Enteral feeding tubes and parenteral nutrition should not be used routinely. In the absence of more robust evidence, no specific pharmacological intervention can be recommended as the standard of care; therefore, clinicians may choose not to prescribe medications specifically for the treatment of cancer cachexia. Nonetheless, when it is decided to trial a drug to improve appetite and/or improve weight gain, currently available pharmacologic interventions that may be used include progesterone analogs and short-term (weeks) corticosteroids.
MUCO-DIS: a New AFM-Based Nanoscale Dissolution Technique
Authors: Ghori Muhammad Usman , Nirwan Jorabar Singh , Asim Taimoor , Chahid Younes , Farhaj Samia , Khizer Zara , Timmins Peter , Conway Barbara R. 
Published: May 2020

AbstractMucoadhesion-based drug delivery systems have recently gained interest because of their bio-adhesion capability, which results in enhanced residence time leading to prolonged duration of action with the mucosal surface, potentially improving compliance and convenience. Mucoadhesion testing of these formulations is widely reported; however, this is technically challenging due to the absence of any standard methods and difficulty in conducting mucoadhesion, formulation-mucosal surface interaction, mucosal surface topography and drug release in a single experiment. As these measurements are currently conducted separately, on replicate formulations, results can often be subjective and difficult to correlate. Hence, the aim of the present study was to develop a new AFM-based single-entity ex vivo muco-dissolution (MUCO-DIS) technique to simultaneously evaluate mucoadhesion force, 3D surface topography, polymer dissolution and drug release characteristics. To demonstrate the potential of the current technique, the interactions between model pectin microparticles containing metformin HCl and a range of gastrointestinal mucosal surfaces (gastric, small intestine, large intestine and buccal) were studied. This novel system has not only successfully determined the mucoadhesion force, polymer dissolution and drug release information but has also highlighted the difference in microparticle performance with different mucosal targets. The current work has highlighted the potential of this newly developed MUCO-DIS system and we believe this will be a valuable tool for characterising these popular pharmaceutical formulations. This technique could also provide an opportunity to other scientific fields to evaluate materials, substrate behaviour and their interactions in their hydrated state at nanoscale with real-time chemical and surface mapping.
Knowledge and factors influencing long-acting reversible contraceptives use among women of reproductive age in Nigeria
Authors: Bolarinwa Obasanjo Afolabi , Olagunju Olalekan Seun 
Published: May 2020

Background: Approximately 48% of unintended pregnancies occur as a result of contraceptives failure around the world, which is mostly due to incorrect use, poor adherence, and/or technology failure. Long-acting reversible contraceptive (LARC) methods have been developed to close this gap. The main aim of this study is to identify factors associated with the use of LARCs among women of reproductive age and to examine the relationship between knowledge of LARCs and the current use of LARCs in Nigeria. Methods: This study assessed the PMA2020 methodology and secondary dataset using female datasets from PMA 2016 (Round 3) exercise. The survey was conducted out in seven states of Nigeria. The target population for this study was women of reproductive age (15-49 years) currently using contraception prior to the survey. The sample size of women that met the inclusion criteria was 1927. The data were analyzed using frequency distribution, chi-square, and logistic regression at a 5% level of significance. Results: The results showed that 21.0% of women were using traditional methods. 14.8% of the sampled women were using LARCs methods. Findings further showed that at both levels of analyses, there is a significant relationship (P<0.05 and P=0.00 for binary and logistic regression, respectively) between knowledge of LARCs and the use of LARCs. This means that knowledge of LARCs and socio-demographic variables among women of reproductive age in Nigeria can influence the use of LARCs. Conclusions: We concluded in this study that 14.8% of women using contraception were using LARCs. Additionally, the level of education, age of women, household wealth, and the number of living children were significantly associated with using LARCs in Nigeria. Also, when discussing contraception with women, health care practitioners should discuss the risks and benefits of LARCs with women of reproductive age and recommend them as a first-line method.
Hand Hygiene Practices and the Risk of Human Coronavirus Infections in a UK Community Cohort
Authors: Beale Sarah , Johnson Anne M. , Zambon Maria ,   Flu Watch Group, Hayward Andrew C. , Fragaszy Ellen B. 
Published: May 2020

Background: Hand hygiene may mitigate the spread of COVID-19 in community settings; however, empirical evidence is limited. Given reports of similar transmission mechanisms for COVID-19 and seasonal coronaviruses, we investigated whether hand hygiene impacted the risk of acquiring seasonal coronavirus infections. Methods: Data were drawn from three successive winter cohorts (2006-2009) of the England-wide Flu Watch study. Participants (n=1633) provided baseline estimates of hand hygiene behaviour. Coronavirus infections were identified from nasal swabs using RT-PCR. Poisson mixed models estimated the effect of hand hygiene on personal risk of coronavirus illness, both unadjusted and adjusted for confounding by age and healthcare worker status. Results: Moderate-frequency handwashing (6-10 times per day) predicted a lower personal risk of coronavirus infection (adjusted incidence rate ratio (aIRR) =0.64, p=0.04). There was no evidence for a dose-response effect of handwashing, with results for higher levels of hand hygiene (>10 times per day) not significant (aIRR =0.83, p=0.42). Conclusions: This is the first empirical evidence that regular handwashing can reduce personal risk of acquiring seasonal coronavirus infection. These findings support clear public health messaging around the protective effects of hand washing in the context of the current COVID-19 pandemic.
Global development of children’s palliative care: the picture in 2017
Authors: Clelland David , van Steijn Danny , Macdonald Mary Ellen , Connor Stephen , Centeno Carlos , Clark David 
Published: May 2020

Background:The growing interest in tracking the global development of palliative care provision is not matched by research on the development of palliative care services specifically for children. Yet it is estimated that worldwide, 21 million children annually could benefit from the provision of palliative care. We report on a global study of children’s palliative care development and offer suggestions for further improvement in design and method.Methods:Primary data on the level of children’s palliative care development in 2017 was collected from in-country experts through a specific question in an online questionnaire that sought to measure the overall level of palliative care provision globally. Countries were assigned to one of six categories on the basis of the responses obtained. Conflicting responses from the same country were resolved with reference to a hierarchy of preferred respondents.Results:Our data allowed the categorisation of 113 countries, accounting for 65% of the global population aged under 20. Number of countries (% of global child population) in each category were as follows: 1) no known activity, 21 (4%); 2) capacity-building, 16 (24%); 3a) isolated provision, 55 (30%); 3b) generalized provision, 5 (1%); 4a) preliminary integration into mainstream provision, 14 (8%); 4b) advanced integration, 7 (2%).Conclusions:Children’s palliative care at the highest level of provision is available in just 21 countries, accounting for fewer than 10% of the global population aged under 20. It is concentrated in high income settings, whilst the majority of the global need for such care is in low- and middle-income countries. Our study is a useful tool for global advocacy relating to children’s palliative care and a stimulus for the creation of improved indicators to measure it at the country level.
Opportunities for the use of natural and preformed physical factors in the complex treatment of patients with chronic viral hepatitis C with associated non-alcoholic fatty liver disease
Authors: Izha Аnna 
Published: May 2020

One of the urgent problems of modern hepatology remains the treatment of patients with chronic viral hepatitis C, which is associated with an increase in the incidence and development of complications - cirrhosis of the liver and hepatocellular carcinoma. The presence of non-alcoholic fatty liver disease in patients accelerates the progression rate of HCV infection and reduces the effectiveness and tolerability of antiviral therapy. The above circumstances initiated us to the search for new non-drug technologies for the treatment of this category of patients. The work aimed to evaluate the effectiveness of the integrated use of standard antiviral therapy, drinking silicon low-mineralized sodium bicarbonate mineral water, and EHF-therapy in patients with chronic viral hepatitis C with concomitant non-alcoholic fatty liver disease. We used the following methods: anamnestic, general clinical, biochemical, serological, immunological, Ultrasonographic examination of the digestive organs. We examined 42 patients who were divided into two groups. The control group (22 people) received the basic treatment complex, which included dietary nutrition, standard antiviral therapy for 12 months, and an internal intake of mineral water during the first month of treatment. The main group (20 people), in addition to the basic complex of treatment, additionally received EHF-therapy procedures for three months. Evaluation of the effectiveness of treatment was carried out after 1 and 3 months from the start of treatment. The treatment was accompanied by the positive dynamics of most signs of the disease in both groups, with a predominance of EHF-therapy. In patients of main group, the disappearance of complications of antiviral therapy was established - the absence of cytopenic syndrome, normalization of immunological status, stimulation of interferonogenesis, restoration of equilibrium in the lipid peroxidation system and antioxidant system. These positive results made it possible to complete the course of therapy for all patients and obtain a virological response in 50% of patients.
Removable Prosthodontics for the Management of Severe Toothwear
Authors: Addy Liam , Thomas Matthew , Cummings Carly , King Elizabeth 
Published: May 2020

Toothwear is becoming increasingly more common for dentists to manage as the population is maintaining its teeth for longer. A large proportion of cases can be managed by means of adhesive dentistry in conjunction with preventive advice. There are, however, patients with severe toothwear alone, or toothwear in conjunction with missing teeth, which would be best served with a removable prosthodontic approach. This is particularly the case where dental implants are not indicated or appropriate. This article illustrates the use of removable prosthodontics for the management of toothwear and highlights the importance of these restorations in certain cases. It also considers the supportive programme required to ensure success of this treatment modality. CPD/Clinical Relevance: Toothwear is a prevalent dental problem that cannot always be addressed with an adhesive restorative or fixed prosthodontic approach, particularly when the toothwear is severe and or in combination with existing missing teeth.