bluuebunny/crossref_metadata_2025_split huggingface dataset:
Barriers and facilitators to diabetic retinopathy screening within Australian primary care
Authors: Watson Matthew J. G. , McCluskey Peter J. , Grigg John R. , Kanagasingam Yogesan , Daire Judith , Estai Mohamed 
Published: November 2021

Abstract
Background
Despite recent incentives through Medicare (Australia’s universal health insurance scheme) to increase retinal screening rates in primary care, comprehensive diabetic retinopathy (DR) screening has not been reached in Australia. The current study aimed to identify key factors affecting the delivery of diabetic retinopathy (DR) screening in Australian general practices.

Methods
A descriptive qualitative study involving in-depth interviews was carried out from November 2019 to March 2020. Using purposive snowballing sampling, 15 general practitioners (GPs) were recruited from urban and rural general practices in New South Wales and Western Australia. A semi-structured interview guide was used to collect data from participants. All interviews were conducted over the phone by one facilitator, and each interview lasted up to 45 min. The Socio-Ecological Model was used to inform the content of the interview topic guides and subsequent data analysis. Recorded data were transcribed verbatim, and thematic analysis was conducted to identify and classify recurrent themes.

Results
Of 15 GPs interviewed, 13 were male doctors, and the mean age was 54.7 ± 15.5 years. Seven participants were practising in urban areas, while eight were practising in regional or remote areas. All participants had access to a direct ophthalmoscope, but none owned retinal cameras. None of the participants reported performing DR screening. Only three participants were aware of the Medicare Benefits Schedule (MBS) items 12,325 and 12,326 that allow GPs to bill for retinal screening. Seven themes, a combination of facilitators and barriers, emerged from interviews with the GPs. Despite the strong belief in their role in managing chronic diseases, barriers such as costs of retinal cameras, time constraints, lack of skills to make DR diagnosis, and unawareness of Medicare incentives for non-mydriatic retinal photography made it difficult to conduct DR screening in general practice. However, several enabling strategies to deliver DR screening within primary care include increasing GPs’ access to continuing professional development, subsidising the cost of retinal cameras, and the need for a champion ace to take the responsibility of retinal photography.

Conclusion
This study identified essential areas at the system level that require addressing to promote the broader implementation of DR screening, in particular, a nationwide awareness campaign to maximise the use of MBS items, improve GPs’ competency, and subsidise costs of the retinal cameras for small and rural general practices.
Total polyunsaturated fatty acid intake and the risk of non-alcoholic fatty liver disease in Chinese Han adults: a secondary analysis based on a case–control study
Authors: Xie Yong , Tian Huan , Xiang Bin , Li Ding , Liu Jian , Cai Zhuoyan , Liu Yuzhou , Xiang Hua 
Published: November 2021

AbstractBackgroundPrevious studies have revealed obesity, nutrition, lifestyle, genetic and epigenetic factors may be risk factors for the occurrence and development of non-alcoholic fatty liver disease (NAFLD). However, the effect of total polyunsaturated fatty acid (PUFA) consumption on the risk of NAFLD is uncertain. Therefore, this study aimed to determine whether the total PUFA intake is independently associated with the risk of NAFLD and explore the threshold of PUFA intake better illustrate the correlation between them in Chinese Han adults.MethodsThe present study was a retrospective case–control study. A total of 534 NAFLD patients and 534 controls matched by gender and age in the same center were included in this study. Using a semi-quantitative food frequency questionnaire in a health examination center in China to collect information about dietary intake and calculate nutrient consumption. A multivariate logistic regression model was used to estimate the association between total PUFA daily intake and its quartile and the incidence of NAFLD.ResultsMultivariate analyses suggested a significant association between total PUFA intake and the occurrence of NAFLD. A non-linear relationship between total PUFA consumption and NAFLD risk was detected after adjusting for potential confounding factors. There was a significant connection between PUFA and the risk of NAFLD (OR: 1.32, 95% CI: 1.23–1.41,P < 0.0001) when PUFA intake is between 18.8 and 29.3 g/day.ConclusionsThe relationship between total PUFA intake and NAFLD is non-linear. Total PUFA was positively related to the risk of NAFLD when PUFA intake is between 18.8 and 29.3 g/day among Chinese Han adults.
Impact of the SARS-CoV-2 pandemic and first lockdown on pregnancy monitoring in France: the COVIMATER cross-sectional study
Authors: Doncarli Alexandra , Araujo-Chaveron Lucia , Crenn-Hebert Catherine , Demiguel Virginie , Boudet-Berquier Julie , Barry Yaya , Gomes Do Espirito Santo Maria-Eugênia , Guajardo-Villar Andrea , Menguy Claudie , Tabaï Anouk , Wyndels Karine , Benachi Alexandra , Regnault Nolwenn 
Published: November 2021

AbstractBackgroundIn the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, consultations and pregnancy monitoring examinations had to be reorganised urgently. In addition, women themselves may have postponed or cancelled their medical monitoring for organisational reasons, for fear of contracting the disease caused by SARS-CoV-2 (COVID-19) or for other reasons of their own. Delayed care can have deleterious consequences for both the mother and the child. Our objective was therefore to study the impact of the SARS-CoV-2 pandemic and the first lockdown in France on voluntary changes by pregnant women in the medical monitoring of their pregnancy and the associated factors.MethodsA cross-sectional study was conducted in July 2020 using a web-questionnaire completed by 500 adult (> 18 years old) pregnant women during the first French lockdown (March–May 2020). A robust variance Poisson regression model was used to estimate adjusted prevalence ratios (aPRs).ResultsAlmost one women of five (23.4%) reported having voluntarily postponed or foregone at least one consultation or pregnancy check-up during the lockdown. Women who were professionally inactive (aPR = 1.98, CI95%[1.24–3.16]), who had experienced serious disputes or violence during the lockdown (1.47, [1.00–2.16]), who felt they received little or no support (1.71, [1.07–2.71]), and those who changed health professionals during the lockdown (1.57, [1.04–2.36]) were all more likely to have voluntarily changed their pregnancy monitoring. Higher level of worry about the pandemic was associated with a lower probability of voluntarily changing pregnancy monitoring (0.66, [0.46–0.96]).ConclusionsOur results can guide prevention and support policies for pregnant women in the current and future pandemics.
Comparison of radiotherapy combined with nimotuzumab vs. chemoradiotherapy for locally recurrent nasopharyngeal carcinoma
Authors: Zong Jing-Feng , Liang Qian-Dong , Lu Qiong-Jiao , Liu Yu-Hong , Xu Han-Chuan , Chen Bi-Juan , Guo Qiao-Juan , Xu Yun , Hu Cai-Rong , Pan Jian-Ji , Lin Shao-Jun 
Published: November 2021

Abstract
Background
The present study compared the effectiveness and toxicity of two treatment modalities, namely radiotherapy combined with nimotuzumab (N) and chemoradiotherapy (CRT) in patients with locally recurrent nasopharyngeal carcinoma (LR-NPC).

Methods
Patients with LR-NPC who were treated with radiotherapy were retrospectively enrolled from January 2015 to December 2018. The treatment included radiotherapy combined with N or platinum-based induction chemotherapy and/or concurrent chemotherapy. The comparison of survival and toxicity between the two treatment modalities was evaluated using the log-rank and chi-squared tests. Overall survival (OS) was the primary endpoint.

Results
A total of 87 patients were included, of whom 32 and 55 were divided into the N group and the CRT group, respectively. No significant differences were noted in the survival rate between the N and the CRT groups (4-year OS rates, 37.1% vs. 40.7%, respectively; P = 0.735). Mild to moderate acute complications were common during the radiation period and mainly included mucositis and xerostomia. The majority of the acute toxic reactions were tolerated well. A total of 48 patients (55.2%) demonstrated late radiation injuries of grade ≥ 3, including 12 patients (37.5%) in the N group and 36 patients (66.5%) in the CRT group. The CRT group exhibited significantly higher incidence of severe late radiation injuries compared with that of the N group (P = 0.011).

Conclusion
Radiotherapy combined with N did not appear to enhance treatment efficacy compared with CRT in patients with LR-NPC. However, radiotherapy combined with N may be superior to CRT due to its lower incidence of acute and late toxicities. Further studies are required to confirm the current findings.
Management of pleural empyema in a 12-year-old obese patient with COVID-19: a pediatric case report
Authors: Abbasi Reza , Javanmardi Farnaz Sadat , Mokhtari Ahmad , Hosseinpour Parisa , Shahriarirad Reza , Ebrahimi Kamyar 
Published: November 2021

Abstract
Background
With the ongoing coronavirus disease (COVID-19) pandemic, along with the development of new mutations of the virus and an increase in the number of cases among pediatrics, physicians should be aware and alerted on the atypical presentations of the disease, especially in less expected individuals.

Case presentation
Here we present a 12-year-old obese boy (BMI = 37.5 kg/m2) who presented with empyema, which was following SARS-CoV-2 infection. The patient had no history of fever. Due to the onset of dyspnea, a chest tube was inserted for him which was later altered to a pleural drainage needle catheter.

Conclusion
Our case is the first report of COVID-19 presenting as empyema among pediatrics. Pleural empyema should be considered as a rare complication of COVID-19. Since there is still no guideline in the management of empyema in the context of COVID-19, delay in diagnosis and intervention may cause morbidity and mortality in children.
Collective imaginaries of caring landscapes for rural youth: a concept mapping study in northern Sweden
Authors: Jonsson Frida , Christianson Monica , Wiklund Maria , Hurtig Anna-Karin , Goicolea Isabel 
Published: November 2021

AbstractBackgroundIn the current study, the approach of ‘utopia as method’ was combined with the concept ‘landscapes of care’ to explore collective imaginaries of caring landscapes in relation to young people living in rural northern Sweden, while focusing specifically on what such landscapes should ideally look like, and how various strategies could help to realise the visions.MethodsThe research was conducted using a modified concept mapping methodology comprising three phases of data collection and analysis. This facilitated the integration of tacit knowledge and utopian visions of young people, professionals and policymakers living and working in various parts of northern Sweden.ResultsThe results indicated that caring landscapes should: ‘provide services responsive to young people’s wishes and needs’, ‘be organised around values of safety, equity and youth participation’, and ‘rework metro-centredness’ in order to carefor,withandaboutrural youth.ConclusionsThe findings can be viewed as an imaginary reconstitution of communities in rural northern Sweden, but also as hypothetical building blocks to be used for developing caring landscapes and a ‘good countryside’ where young people have the possibility to live a good life in decent health.
Usefulness of procalcitonin (PCT), C-reactive protein (CRP), and white blood cell (WBC) levels in the differential diagnosis of acute bacterial, viral, and mycoplasmal respiratory tract infections in children
Authors: Li Yang , Min Lanfang , Zhang Xin 
Published: November 2021

Abstract
Background
There is a lack of studies comparing PCT, CRP and WBC levels in the differential diagnosis of acute bacterial, viral, and mycoplasmal respiratory tract infections. It is necessary to explore the correlation between above markers and different types of ARTI.

Methods
108 children with confirmed bacterial infection were regarded as group A, 116 children with virus infection were regarded as group B, and 122 children with mycoplasmal infection were regarded as group C. The levels of PCT, CRP and WBC of the three groups were detected and compared.

Results
The levels of PCT, CRP and WBC in group A were significantly higher than those in groups B and C (p < 0.05). The positive rate of combined detection of PCT, CRP and WBC was significant higher than that of single detection. There was no significant difference in PCT, CRP and WBC levels between the group of G+ bacterial infection and G− bacterial infection (p > 0.05). ROC curve results showed that the AUC of PCT, CRP and WBC for the diagnosis of bacterial respiratory infections were 0.65, 0.55, and 0.58, respectively.

Conclusions
PCT, CRP and WBC can be combined as effective indicators for the identification of acute bacterial or no-bacterial infections in children. The levels of PCT and CRP have higher differential diagnostic value than that of WBC in infection, and the combined examination of the three is more valuable in clinic.
A novel nomogram for predicting 3-year mortality in critically ill patients after coronary artery bypass grafting
Authors: Zhang HuanRui , Tian Wen , Sun YuJiao 
Published: November 2021

AbstractBackgroundThe long-term outcomes for patients after coronary artery bypass grafting (CABG) have been received more and more concern. The existing prediction models are mostly focused on in-hospital operative mortality after CABG, but there is still little research on long-term mortality prediction model for patients after CABG.ObjectiveTo develop and validate a novel nomogram for predicting 3-year mortality in critically ill patients after CABG.MethodsData for developing novel predictive model were extracted from Medical Information Mart for Intensive cart III (MIMIC-III), of which 2929 critically ill patients who underwent CABG at the first admission were enrolled.ResultsA novel prognostic nomogram for 3-year mortality was constructed with the seven independent prognostic factors, including age, congestive heart failure, white blood cell, creatinine, SpO2, anion gap, and continuous renal replacement treatment derived from the multivariable logistic regression. The nomogram indicated accurate discrimination in primary (AUC: 0.81) and validation cohort (AUC: 0.802), which were better than traditional severity scores. And good consistency between the predictive and observed outcome was showed by the calibration curve for 3-year mortality. The decision curve analysis also showed higher clinical net benefit than traditional severity scores.ConclusionThe novel nomogram had well performance to predict 3-year mortality in critically ill patients after CABG. The prediction model provided valuable information for treatment strategy and postdischarge management, which may be helpful in improving the long-term prognosis in critically ill patients after CABG.
Community education and health promotion activities of naturopathic practitioners: results of an international cross-sectional survey
Authors: Steel Amie , Lloyd Iva 
Published: November 2021

Abstract
Background
Health promotion and patient education are crucial to improved population health and are also among the core principles that define naturopathy. Yet, the activities of naturopathic practitioners (NPs) with regards to health promotion and community education have not been widely studied.

Methods
A cross-sectional online survey of an international convenience sample of NPs was conducted through disseminating a 15-item questionnaire prepared in five languages. Correlates of most frequently mentioned NP activities were studied.

Results
The survey was completed by 813 NPs representing all world regions. Almost all participants (98%) reported at least one health promotion activity. Most reported were information sheets and handouts (92.7%) or social and professional network communications (91.8%) and information talks presented to community members (84.9%). The majority of NPs (79.5%) indicated that the ‘health issues individuals in NPs’ community have said they need help with’ were a ‘very important’ consideration when they designed health promotion activities. NP characteristics associated with the likelihood of engaging in specific health promotion activities varied between activities but include gender, time since first qualification, factors considered to identify need when designing an activity, and stakeholder involvement in activity design.

Conclusions
Health promotion is a key activity of the global naturopathic profession. There are a wide range of patient education tools utilized by NPs.
A machine learning based two-stage clinical decision support system for predicting patients’ discontinuation from opioid use disorder treatment: retrospective observational study
Authors: Hasan Md Mahmudul , Young Gary J. , Shi Jiesheng , Mohite Prathamesh , Young Leonard D. , Weiner Scott G. , Noor-E-Alam Md. 
Published: November 2021

Abstract
Background
Buprenorphine is a widely used treatment option for patients with opioid use disorder (OUD). Premature discontinuation from this treatment has many negative health and societal consequences.

Objective
To develop and evaluate a machine learning based two-stage clinical decision-making framework for predicting which patients will discontinue OUD treatment within less than a year. The proposed framework performs such prediction in two stages: (i) at the time of initiating the treatment, and (ii) after two/three months following treatment initiation.

Methods
For this retrospective observational analysis, we utilized Massachusetts All Payer Claims Data (MA APCD) from the year 2013 to 2015. Study sample included 5190 patients who were commercially insured, initiated buprenorphine treatment between January and December 2014, and did not have any buprenorphine prescription at least one year prior to the date of treatment initiation in 2014. Treatment discontinuation was defined as at least two consecutive months without a prescription for buprenorphine. Six machine learning models (i.e., logistic regression, decision tree, random forest, extreme-gradient boosting, support vector machine, and artificial neural network) were tested using a five-fold cross validation on the input data. The first-stage models used patients’ demographic information. The second-stage models included information on medication adherence during the early phase of treatment based on the proportion of days covered (PDC) measure.

Results
A substantial percentage of patients (48.7%) who started on buprenorphine discontinued the treatment within one year. The area under receiving operating characteristic curve (C-statistic) for the first stage models varied within a range of 0.55 to 0.59. The inclusion of knowledge regarding patients’ adherence at the early treatment phase in terms of two-months and three-months PDC resulted in a statistically significant increase in the models’ discriminative power (p-value < 0.001) based on the C-statistic. We also constructed interpretable decision classification rules using the decision tree model.

Conclusion
Machine learning models can predict which patients are most at-risk of premature treatment discontinuation with reasonable discriminative power. The proposed machine learning framework can be used as a tool to help inform a clinical decision support system following further validation. This can potentially help prescribers allocate limited healthcare resources optimally among different groups of patients based on their vulnerability to treatment discontinuation and design personalized support systems for improving patients’ long-term adherence to OUD treatment.
Using text mining techniques to extract prostate cancer predictive information (Gleason score) from semi-structured narrative laboratory reports in the Gauteng province, South Africa
Authors: Cassim Naseem , Mapundu Michael , Olago Victor , Celik Turgay , George Jaya Anna , Glencross Deborah Kim 
Published: November 2021

Abstract
Background
Prostate cancer (PCa) is the leading male neoplasm in South Africa with an age-standardised incidence rate of 68.0 per 100,000 population in 2018. The Gleason score (GS) is the strongest predictive factor for PCa treatment and is embedded within semi-structured prostate biopsy narrative reports. The manual extraction of the GS is labour-intensive. The objective of our study was to explore the use of text mining techniques to automate the extraction of the GS from irregularly reported text-intensive patient reports.

Methods
We used the associated Systematized Nomenclature of Medicine clinical terms morphology and topography codes to identify prostate biopsies with a PCa diagnosis for men aged > 30 years between 2006 and 2016 in the Gauteng Province, South Africa. We developed a text mining algorithm to extract the GS from 1000 biopsy reports with a PCa diagnosis from the National Health Laboratory Service database and validated the algorithm using 1000 biopsies from the private sector. The logical steps for the algorithm were data acquisition, pre-processing, feature extraction, feature value representation, feature selection, information extraction, classification, and discovered knowledge. We evaluated the algorithm using precision, recall and F-score. The GS was manually coded by two experts for both datasets. The top five GS were reported, with the remaining scores categorised as “Other” for both datasets. The percentage of biopsies with a high-risk GS (≥ 8) was also reported.

Results
The first output reported an F-score of 0.99 that improved to 1.00 after the algorithm was amended (the GS reported in clinical history was ignored). For the validation dataset, an F-score of 0.99 was reported. The most commonly reported GS were 5 + 4 = 9 (17.6%), 3 + 3 = 6 (17.5%), 4 + 3 = 7 (16.4%), 3 + 4 = 7 (14.7%) and 4 + 4 = 8 (14.2%). For the validation dataset, the most commonly reported GS were: (i) 3 + 3 = 6 (37.7%), (ii) 3 + 4 = 7 (19.4%), (iii) 4 + 3 = 7 (14.9%), (iv) 4 + 4 = 8 (10.0%) and (v) 4 + 5 = 9 (7.4%). A high-risk GS was reported for 31.8% compared to 17.4% for the validation dataset.

Conclusions
We demonstrated reliable extraction of information about GS from narrative text-based patient reports using an in-house developed text mining algorithm. A secondary outcome was that late presentation could be assessed.