bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and psychometric testing of the FLW-MSC scale for measuring frontline worker multisectoral collaboration in rural India
Authors: Glandon Douglas , Leoutsakos Jeannie-Marie , Gupta Shivam , Marsteller Jill , Paina Ligia , Bennett Sara 
Published: March 2021

ObjectivesMultisectoral collaboration (MSC) is widely recognised as a critical aspect of policies, programmes and interventions addressing complex public health issues, yet it is undertheorised and difficult to measure. Limited understanding of the intermediate steps linking MSC formation to intended health outcomes leaves a substantial knowledge gap about the types of strategies that may be most effective in making such collaborations successful. This paper, which reports the quantitative strand of a broader mixed-methods study, takes a step toward filling in this ‘missing middle’ of MSC evaluation by developing and testing the FLW-MSC scale, an instrument to assess collaboration among the frontline workers of one of India’s largest and most widely known MSCs: the Integrated Child Development Services (ICDS) scheme.DesignThis study involved development, field-testing and psychometric testing of an 18-item, Likert-type frontline worker collaboration scale, including internal consistency, construct validity and criterion validity.SettingVillage-level primary healthcare in rural Uttar Pradesh, India.Participants281 anganwadi workers, 266 accredited social health activists and 124 auxiliary nurse midwives selected based on random sampling of anganwadi catchment areas from 346 gram panchayats (GPs), including 173 intervention GPs and 173 pair-matched control GPs from a parent evaluation study.ResultsResults support the scale’s internal consistency (ordinal α=0.92–0.95), construct validity (reasonable exploratory factor analysis model fit for five of the six dyadic relationships Tucker-Lewis Index=0.84–0.88; Root Mean Squared Error of Approximation=0.09–0.11), and criterion validity (regression of collaboration score on an information-sharing indicator β=3.528; p=0.006).ConclusionsThe scale may be useful for ICDS managers to detect and address poor collaboration as the Indian government redoubles its efforts to strengthen and monitor MSC, or ‘convergence’, with important implications for the critical priority of child development. Further, the FLW-MSC scale may be adapted for measuring frontline worker collaboration across sectors in many other scenarios and low/middle-income country contexts.
Determinants of health insurance ownership in Jordan: a cross-sectional study of population and family health survey 2017–2018
Authors: Liu Meilian , Luo Zhaoxin , Zhou Donghua , Ji Lu , Zhang Huilin , Ghose Bishwajit , Tang Shangfeng , Wang Ruoxi , Feng Da 
Published: March 2021

ObjectivesWith about one-third of the population living below the poverty line, Jordan faces major healthcare, social and national development issues. Low insurance coverage among the poor and high out-of-pocket expenditure worsens the financial insecurity especially for the marginalised population. The Government of Jordan aims to achieve universal coverage of health insurance—a bold plan that requires research evidence for successful implementation. In this study, we aimed to assess the proportion of the population covered by any health insurance, and the determinants owing a health insurance.DesignA population-based prospective cohort study.SettingJordan.MethodsData for this study were derived from the Jordan Population and Family Health Survey, which was implemented by the Department of Statistics from early October 2017 to January 2018. Sample characteristics were described as percentages with 95% CIs. Binary logistic regression models were used to estimate OR of health insurance ownership. Parsimonious model was employed to assess the sex and geographical differences.ResultsData revealed that in 2017–2018, 73.13% of the 12 992 men and women had health insurance. There was no indication of age of sex difference in health insurance ownership; however, marital status and socioeconomic factors such as wealth and education as well as internet access and geographical location appeared to be the important predictors of non-use of health insurance. The associations differed by sex and urbanicity for certain variables. Addressing these inequities may help achieve universal coverage in health insurance ownership in the population.ConclusionsMore than one-quarter of the population in Jordan were not insured. Efforts to decrease disparities in insurance coverage should focus on minimising socioeconomic and geographical disparities to promote equity in terms of healthcare services.
Clinical performance and acceptability of self-collected vaginal and urine samples compared with clinician-taken cervical samples for HPV testing among women referred for colposcopy. A cross-sectional study
Authors: Ørnskov Dorthe , Jochumsen Kirsten , Steiner Pernille Husted , Grunnet Ivan Moulun , Lykkebo Annemette Wildfang , Waldstrøm Marianne 
Published: March 2021

ObjectivesTo increase effectiveness of the cervical cancer screening program, self-sampling can be an option. Both self-collected vaginal samples (SCV) and urine samples may be useful alternatives to clinician-taken cervical samples (CS).DesignCross-sectional study.SettingColposcopy clinic.ParticipantsWomen (n=305) referred to colposcopy after abnormal cervical screening result or conditions like postcoital bleeding.InterventionAll women self-collected a urine and a vaginal sample prior to colposcopy, where a CS and biopsies were taken. All samples were tested for high-risk human papillomavirus (HPV) using the Cobas HPV assay. The gold standard was histology diagnoses (CIN2+/CIN3+) from biopsies obtained at the same examination.Primary outcomeAbsolute and relative sensitivity and specificity of HPV testing on SCV and urine to detect CIN2+/CIN3+ compared with the CS.Secondary outcomeThe acceptability by women of self-sampling.ResultsBoth the vaginal and urine sample were comparable to the CS in identifying severe intraepithelial neoplasia (CIN2+/CIN3+). Absolute sensitivity ranged from 93% for urine samples to 96% for SCV for detecting CIN2+, which is comparable to the sensitivity of CS (overlapping 95% CI).The relative sensitivity for detecting CIN2+ was 1.00 (95% CI 0.96 to 1.04) for SCV and 0.96 (95% CI 0.91 to 1.03) for urine samples. At CIN3+, the relative sensitivity was 1.00 (95% CI 0.96 to 1.08) and 0.97 (95% CI 0.89 to 1.07) for SCV and urine samples, respectively. There were no statistical differences between the self-collected samples and the CS (McNemar’s test >0.05). The relative specificity was also similar (1.03 (95% CI 0.95 to 1.12) for SCV and 0.98 (95% CI 0.89 to 1.09) for urine samples) (McNemar’s test >0.05).The acceptability of self-sampling was evaluated by questionnaire. The women found the instructions on sample collection easy to understand and were positive about self-sampling with a preference for the urine sample.ConclusionSelf-sampling by SCV and urine is a clinically safe alternative to CS with a high degree of acceptability.
Niche differentiation among genetic lineages in the Mediterranean Pond turtle, Mauremys leprosa, across its geographical range
Authors: Loulida Soumia , Segurado Pedro , Naimi Mohamed , Znari Mohammed 
Published: March 2021

Abstract
Ecological niche modelling provides a useful tool to measure niche properties such as niche breadth, niche overlap and niche conservatism among genetic lineages, with relevant implications for conservation. The Mediterranean pond turtle Mauremys leprosa occurs on both sides of the Strait of Gibraltar over most Iberia and the Maghreb Region of north-western Africa, where it shows a complex genetic structure as the result of Pleistocene climatic oscillations and the particular geographical features of this region. We analyzed the overlap of the climate niche of genetic lineages and sublineages of Mauremys leprosa, based on confirmed records across the known geographical range of the species. We also compared the accuracy of environmental niche models obtained by splitting the two lineages into subunits and lumping across lineages. Results revealed an overall niche overlap between the two main lineages and among most sublineages, indicating no relationship between genetic variation and niche divergence. Likewise, the environmental niche modelling revealed an extensive geographical overlap of climatic suitability between the two lineages. However, some ecological differentiation occurs for some sublineage pairs, in particular involving a sublineage whose occurrence corresponds to a particular morphotype – the Sahara blue-eyed pond turtle – which occupies very isolated habitats along the Draa basin in Morocco. These populations are currently threatened by fragmentation of habitats, drought and water salinization. This study will help assessing more effectively the impacts of ongoing climate change on Mauremys leprosa that along with local human activities are likely to increase in the southernmost limit of its distribution.
LDH, CRP and ALB predict nucleic acid turn negative within 14 days in symptomatic patients with COVID-19
Authors: Liu Gaoli , Zhang Bicheng , Zhang Shaowen , Hu Haifeng , Liu TingTing 
Published: March 2021

Aims To search for biochemical indicators that can identify symptomatic patients with COVID-19 whose nucleic acid could turn negative within 14 days, and assess the prognostic value of these biochemical indicators in patients with COVID-19. Patients and methods We collected the clinical data of patients with COVID-19 admitted to our hospital, by using logistic regression analysis and AUC curves, explored the relationship between biochemical indicators and nucleic acid positive duration, the severity of COVID-19, and hospital stay respectively. Results A total of two hundred and thirty-three patients with COVID-19 were enrolled in the study. We found patients whose nucleic acid turned negative within 14 days had lower LDH, CRP and higher ALB ( P < 0.05). ROC curve results indicated that lower LDH, TP, CRP and higher ALB predicted the nucleic acid of patients turned negative within 14 days with statistical significance( P < 0.05), AST, LDH, CRP and PCT predicted the severe COVID-19 with statistical significance, and CRP predicted hospital stay >31days with statistical significance ( P < 0.05). After verification, the probability of nucleic acid turning negative within 14 days in patients with low LDH (<256 U/L), CRP (<44.5 mg/L) and high ALB (>35.8 g/L) was about 4 times higher than that in patients with high LDH, CRP and low ALB ( P < 0.05). Conclusions LDH, CRP and ALB are useful prognostic marker for predicting nucleic acid turn negative within 14 days in symptomatic patients with COVID-19.
Diagnostic accuracy of ultra-low-dose chest computed tomography in an emergency department
Authors: Tækker Maria , Kristjánsdóttir Björg , Andersen Michael B , Fransen Maja L , Greisen Pernille W , Laursen Christian B , Mussmann Bo , Posth Stefan , Graumann Ole 
Published: March 2021

Background This study examined whether ultra-low-dose chest computed tomography (ULD-CT) could improve detection of acute chest conditions. Purpose To determine (i) whether diagnostic accuracy of ULD-CT is superior to supine chest X-ray (sCXR) for acute chest conditions and (ii) the feasibility of ULD-CT in an emergency department. Material and Methods From 1 February to 31 July 2019, 91 non-traumatic patients from the Emergency Department were prospectively enrolled in the study if they received an sCXR. An ULD-CT and a non-contrast chest CT (NCCT) scan were then performed. Three radiologists assessed the sCXR and ULD-CT examinations for cardiogenic pulmonary edema, pneumonia, pneumothorax, and pleural effusion. Resources and effort were compared for sCXR and ULD-CT to evaluate feasibility. Diagnostic accuracy was calculated for sCXR and ULD-CT using NCCT as the reference standard. Results The mean effective dose of ULD-CT was 0.05±0.01 mSv. For pleural effusion and cardiogenic pulmonary edema, no difference in diagnostic accuracy between ULD-CT and sCXR was observed. For pneumonia and pneumothorax, sensitivities were 100% (95% confidence interval [CI] 69–100) and 50% (95% CI 7–93) for ULD-CT and 60% (95% CI 26–88) and 0% (95% CI 0–0) for sCXR, respectively. Median examination time was 10 min for ULD-CT vs. 5 min for sCXR ( P<0.001). For ULD-CT 1–2 more staff members were needed compared to sCXR ( P<0.001). ULD-CT was rated more challenging to perform than sCXR ( P<0.001). Conclusion ULD-CT seems equal or better in detecting acute chest conditions compared to sCXR. However, ULD-CT examinations demand more effort and resources.
A Nationwide Study of Skiing and Snowboarding-Related Facial Trauma
Authors: Sorenson Thomas J. , Borad Vedant , Schubert Warren 
Published: March 2021

Study Design: Retrospective descriptive observational study. Purpose: Skiing and snowboarding offers valuable opportunities for outdoor physical activity throughout the cold winter months, but these activities can result in substantial personally injury. This study aimed to analyze trends in skiing and snowboarding-related facial trauma epidemiology. Methods: The National Electronic Injury Surveillance System (NEISS) was queried for facial trauma related to skiing and snowboarding treated in United States (US) emergency departments between 2010 and 2019. These data and weighted estimates were used to analyze patient demographics, injury location, and etiology. Results: A total of 361 skiing or snowboarding-related facial injuries were recorded. Lacerations were most common injury (165/361; 45.7%), and facial fractures occurred in 21.6% (78/261) of patients. The most common facial fracture locations are the nose (38/78; 48.7%), orbit (17/78; 21.8%), and mandible (15/78; 19.2%). Pediatric patients accounted for 52% (187/361) of these injuries and had higher rates of lacerations (51.9% vs 39.1%, P < 0.05) and hospital admission (4.8% vs 1.15%, P < 0.05) than adults. Adults had a higher rate of facial fracture (30% vs 13.9%, P < 0.001) than children. Conclusions: Skiing and snowboarding-related facial trauma is relatively uncommon in the US. In general, these injuries are largely decreasing, but facial fractures still occur not infrequently during these activities. Based on our data, we strongly urge helmet manufacturers to increase the availability of recreational snowsport helmets that include nose, orbit, and mandible protections, which could help to prevent many of these injuries.
Automated Classification of Radiographic Positioning of Hand X-Rays Using a Deep Neural Network
Authors: Saun Tomas J. 
Published: March 2021

Background: Hand X-rays are ordered in outpatient, inpatient, and emergency settings, the results of which are often initially interpreted by non-radiology trained health care providers. There may be utility in automating upper extremity X-ray analysis to aid with rapid initial analysis. Deep neural networks have been effective in several medical imaging analysis applications. The purpose of this work was to apply a deep learning framework to automatically classify the radiographic positioning of hand X-rays. Methods: A 152-layer deep neural network was trained using the musculoskeletal radiographs data set. This data set contains 6003 hand X-rays. The data set was filtered to remove pediatric X-rays and atypical views. The X-rays were all labeled as either posteroanterior (PA), lateral, or oblique views. A subset of images was set aside for model validation and testing. Data set augmentation was performed, including horizontal and vertical flips, rotations, as well as modifications in image brightness and contrast. The model was evaluated, and performance was reported as a confusion matrix from which accuracy, precision, sensitivity, and specificity were calculated. Results: The augmented training data set consisted of 80 672 images. Their distribution was 38% PA, 35% lateral, and 27% oblique projections. When evaluated on the test data set, the model performed with overall 96.0% accuracy, 93.6% precision, 93.6% sensitivity, and 97.1% specificity. Conclusions: Radiographic positioning of hand X-rays can be effectively classified by a deep neural network. Further work will be performed on localization of abnormalities, automated assessment of standard radiographic measures and eventually on computer-aided diagnosis and management guidance of skeletal pathology.
Ticks infesting humans and associated pathogens: a cross-sectional study in a 3-year period (2017–2019) in northwest Italy
Authors: Audino Tania , Pautasso Alessandra , Bellavia Veronica , Carta Valerio , Ferrari Alessio , Verna Federica , Grattarola Carla , Iulini Barbara , Pintore Maria Domenica , Bardelli Mauro , Cassina Germano , Tomassone Laura , Peletto Simone , Blanda Valeria , Torina Alessandra , Caramelli Maria , Casalone Cristina , Desiato Rosanna 
Published: March 2021

Abstract
Background
Tick-borne diseases are common throughout Europe. Ticks transmit pathogens to the host while feeding and together with mosquitoes, they are major vectors of infectious agents worldwide. In recent years, there has been a marked increase in the incidence of tick-bite events and tick-borne disease in northwest Italy, but information on the prevalence of tick-borne pathogens in ticks removed from humans remains scarce. To fill this gap, we report here the prevalence of tick bites and tick-borne pathogens documented for humans in Piedmont, northwest Italy, in the 3-year period 2017–2019.

Methods
Ticks attached to humans during 2017–2019 were collected from residents of urban and rural area by physicians and veterinarians working with local veterinary agencies. All ticks (n = 1290) were morphologically identified to the species level. A subset of ticks removed from children (age 0–18 years) and the elderly (> 70 years), both age groups considered to be at-risk populations, was screened by biomolecular analysis to detect pathogens (e.g. Rickettsia spp., Borrelia spp., Anaplasma spp.). Pathogen identity was confirmed by Sanger sequencing.

Results
Ticks were taxonomically assigned to ten species of six genera (Amblyomma, Dermacentor, Haemaphysalis, Hyalomma, Ixodes and Rhipicephalus). Most belonged to the genus Ixodes: 1009 ticks (78.22%) were classified as Ixodes ricinus. A subset of 500 ticks collected from the two at-risk populations were subjected to PCR assay to determine the presence of Rickettsia spp., Borrelia spp., and Anaplasma spp. The overall prevalence of infection was 22.8% (n = 114; 95% confidence interval [CI]: 19.19–26.73%), meaning that at least one pathogen was detected: Rickettsia spp. (prevalence 15%, n = 76; 95% CI 12.17–18.65%); Borrelia spp. (prevalence 6.4%, n = 32; 95% CI 4.42–8.92%); and Anaplasma spp. (prevalence 1.2%, n = 6; 95% CI 0.44–2.6%).

Conclusions
Our data underline the importance of surveillance in the epidemiology of tick-borne diseases and the implementation of strategies to control tick infestation and associated pathogens.

Graphical Abstract
Molecular and morphological characterization of three new species of avian Onchocercidae (Nematoda) with emphasis on circulating microfilariae
Authors: Binkienė Rasa , Chagas Carolina Romeiro Fernandes , Bernotienė Rasa , Valkiūnas Gediminas 
Published: March 2021

AbstractBackgroundBlood parasites have been the subject of much research, with numerous reports of the presence of microfilariae in the peripheral blood (circulating microfilariae) of birds belonging to many orders. Current limitations in molecular characterization methods and species identification using morphological characters of circulating microfilariae are major obstacles to improving our understanding the biology of Filarioidea species, particularly in wildlife. The aim of this study was to partially fill these gaps, with particular emphasis on morphological features of microfilariae, which are the most readily accessible stages of these pathogens.MethodsPeripheral blood samples of 206 birds belonging to generaAcrocephalus(five species) andSylvia(five species) were examined using the buffy coat method to process the blood samples for the presence of microfilariae. Positive birds were dissected to collect adult nematodes. Microfilariae and adult nematodes were described, and sequences of their mitochondrial cytochromecoxidase subunit I and nuclear28SrDNA gene fragments were obtained and used for molecular characterization and Bayesian phylogenetic inferences.ResultsOverall prevalence of microfilariae was 2.9%. Microfilariae were found in the blood samples from six birds (2Acrocephalus scirpaceusand 1 each ofA. arundinaceus,Sylvia atricapilla,S. borinandS. curruca), which were dissected. All parasite species observed were new.Eufilaria acrocephalusisp. n. andEufilaria sylviaesp. n. were present in subcutaneous, peritracheal and periesophageal connective tissues inA. scirpaceusandS. borin,respectively.Splendidofilaria bartlettisp. n. was found in finger joins ofS. atricapilla.Illustrations of microfilariae and adult nematodes are shown, and morphological and phylogenetic analyses identified the DNA barcode haplotypes that are associated with these species. Phylogenetic analysis places the parasites of different genera in different closely related clades.ConclusionsAdult nematode morphological characters, which have been traditionally used in the taxonomy of Filarioidea species, have a phylogenetic value. Importantly, in our study parasites of different genera were readily distinguishable based on the morphology of their microfilariae. The link between molecular and morphology data requires more study in Filarioidea species research, particularly because this approach provides new knowledge on species identity using only readily accessible blood stages (microfilariae), thereby avoiding host dissection and thus minimizing harm to wildlife during research.Graphical Abstract
Remote interference management in 5G new radio: methods and performance
Authors: Peralta Elena , Levanen Toni , Mäenpää Mikko , Yuk Youngsoo , Pedersen Klaus , Nielsen Sari , Valkama Mikko 
Published: March 2021

AbstractIn time division duplexing based mobile networks, under certain atmospheric ducting conditions, the uplink reception may be interfered by the downlink transmissions of remote base-stations (gNBs) located hundreds of kilometers away. This paper addresses such remote interference problem in a 5G new radio (NR) macro deployment context. Specifically, two potential reference signal (RS) designs for remote interference management (RIM) are described. The first signal structure, denoted as the one OFDM symbol (1OS) based RIM-RS, is building on the channel state information reference signals of 5G NR. The second candidate is referred to as the two OFDM symbol based RIM-RS design, which builds on the design principles of LTE RIM-RS. The achievable detection performance is evaluated by introducing enhanced receiver algorithms together with three feasible propagation delay based gNB grouping and corresponding RIM-RS transmissions schemes. The performance results in terms of the receiver processing gain highlight that the improved detection algorithm assures sufficient performance to detect the remote interference for both RIM-RSs with all evaluated frequency domain comb-like patterns. The benefit of grouping corresponding RIM-RS transmissions from gNBs located on the same area is greater when using same frequency domain resources per transmitted sequence in practical interference scenarios. Furthermore, applying a common base sequence for all gNBs within a group allows to identify the group based on detected sequence and enables adaptive RIM mitigation schemes. On the other hand, it is shown that the 1OS RIM-RS provides smaller overhead and can be frequency multiplexed with the physical downlink shared channel, which opens up the possibility of using gNB group wise 1OS RIM-RS also for UE interference measurements.