bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prioritizing the healthcare access concerns of Canadians with MS
Authors: Pétrin Julie , McColl Mary Ann , Donnelly Catherine , French Simon , Finlayson Marcia 
Published: July 2021

Background Canadians with MS are high users of healthcare services, yet they report multiple unmet needs, high disease burden, and low satisfaction with care. Engaging patients in healthcare planning can lead to improvements in access and care. There is currently limited evidence that has harnessed the perspectives of Canadians with MS. Objective To identify and prioritize the healthcare access concerns of Canadians with MS. Methods A cross-sectional online survey informed by the Concerns Report Methodology was used to address the objective. Participants were recruited through multiple methods. Descriptive statistics were used to identify the main barriers to healthcare providers, and concerns report methods were used to calculate needs indexes to prioritize concerns of participants. Results 324 Canadians with MS participated in the study between November 18, 2019 and March 27, 2020. The most pressing healthcare access concerns of Canadians with MS were related to availability of healthcare providers with MS knowledge and affordability of services that aim to improve wellness. Conclusion These findings provide healthcare planners with prioritized access concerns of Canadians with MS, which can be used to guide strategic planning to improve the quality of life of these individuals.
FACTORS THAT INFLUENCE PATIENTS’ RECOMMENDATION OF ORTHOPAEDIC SURGEONS: AN ANALYSIS OF A POPULAR ONLINE RATING WEBSITE
Authors: Para Ashok , Hanna Gabriel , Luis Justin , Ezzat Bishoy , Batko Brian D. , Edobor-Osula Folorunsho 
Published: July 2021

Background: In the modern digital age, patients are increasingly consulting online physician reviews prior to making healthcare decisions. Physician review websites are being used in many medical fields including orthopaedic surgery. The purpose of this study is to investigate trends in online physician reviews and determine which factors are most strongly correlated with the likelihood that an orthopaedic surgeon is to be recommended by patients. Methods: Healthgrades.com, the most comprehensive physician rating and comparison database, was queried for “orthopaedic surgery” in the state of New Jersey. Demographic information, fellowship training status, years of experience, malpractice/disciplinary actions, physician ratings and the likelihood to recommend score (LTRS) was collected for all physicians. Quantitative analysis was conducted using descriptive statistics, student t-test, and one-way ANOVA. Qualitative analysis of randomly selected positive comments and all negative comments was conducted. Common themes were identified using frequency-based word cloud generator. Results: 834 board certified orthopaedic surgeons (800 Males, 34 Females), with a mean age of 55.7±12.5 years and an average LTRS of 4.1±0.84 were included for analysis. Compared with non-fellowship trained orthopaedic surgeons, fellowship trained surgeons were more likely to be recommend by patients [3.8 vs. 4.3; P< 0.0001]. Physicians with waiting time <10min were more likely to be recommended compared with their counterparts with waiting time >10min (P< 0.0001). No differences were observed in LTRS between male and female orthopaedic surgeons (P= 0.79) or based on malpractice status (P= 0.61). Qualitative analysis of a randomly selected sample of 4,151 out of a total of 12,168 positive comments and 1,113 total negative comments revealed that positive comments centered on surgeon competence and professionalism, while negative comments centered on surgeon personality and waiting time. Conclusion: Orthopaedic surgeons have generally favorable ratings and mostly positive comments. Fellowship status and waiting time are important factors that impact LTRS. Patients were more likely to write positive comments about surgeon competence and professionalism, and negative comments pertaining to surgeon personality and waiting time. Knowledge of surgeon specific attributes that are important to patients may help educate orthopaedic surgeons to improve patient care, patient satisfaction and online ratings. Tables and Figures [Table: see text][Table: see text][Figure: see text]
History of anemia and long-term mortality due to infection: a cohort study with 12 years follow-up in South Korea
Authors: Oh Tak Kyu , Song Kyung-Ho , Song In-Ae 
Published: July 2021

Abstract
Background
Anemia, which is a condition with reduced healthy red blood cells, is reported to be closely related to the development of infectious diseases. We aimed to investigate the association between history of anemia and 12-year mortality rate due to infections, and compare it with that among non-anemic individuals.

Methods
Data from the National Health Insurance Service Health Screening Cohort were used in this population-based cohort study. Adults who underwent standardized medical examination between and 2002–2003 were included, and the mortality rate due to infection between 2004 and 2015 was analyzed. Individuals were considered to have a history of anemia if the serum hemoglobin level in 2002–2003 was < 12 g/dL for women and < 13 g/dL for men. The severity of anemia at that time was categorized as mild (12 g/dL > hemoglobin ≥11 g/dL in women and 13 g/dL > hemoglobin ≥11 g/dL in men), moderate (hemoglobin 8–10.9 g/dL), or severe (hemoglobin < 8 g/dL). Propensity score (PS) matching and Cox regression analysis were used as statistical methods.

Results
Overall, 512,905 individuals were included in this study. The mean age of the participants was 54.5 years old (range: 40–98), and 49,042 (9.6%) individuals were classified in the anemic group, which comprised of 36,383 (7.1%), 11,787 (2.3%), and 872 (0.2%) participants in the mild, moderate, and severe sub-groups, respectively. After PS matching, 49,039 individuals in each group were included in the analysis. The risk of mortality due to infection in the anemic group was 1.77-fold higher (hazard ratio [HR]: 1.77, 95% confidence interval [CI]: 1.52–2.60; P < 0.001) than that in the non-anemic group. In the subgroup analysis, the mild and moderate anemia groups had 1.38-fold (HR: 1.38, 95% CI: 1.23 to 1.55; P < 0.001) and 2.02-fold (HR: 2.02, 95% CI: 1.62 to 2.50; P < 0.001) risk of mortality due to infection compared to that of the non-anemic group, respectively. The severe anemia group did not have a significantly different risk of mortality due to infection (P = 0.448).

Conclusions
History of anemia was associated with increased mortality rate due to infection at 12-year follow-up.
Prevalence of postpartum depression and associated factors among women in Mbarara and Rwampara districts of south-western Uganda
Authors: Atuhaire Catherine , Rukundo Godfrey Zari , Nambozi Grace , Ngonzi Joseph , Atwine Daniel , Cumber Samuel Nambile , Brennaman Laura 
Published: July 2021

Abstract
Background
Postpartum depression (PPD) is a significant cause of maternal morbidity and has severe consequences on the well-being of mothers, new-borns, families, and communities. PPD reduces the mother’s response to the child’s needs. In severe cases, mothers suffering from PPD are prone to postpartum psychosis, commit suicide and, in rare cases, infanticide. We aimed to determine the prevalence and understand the factors associated with PPD among mothers in southwestern Uganda.

Methods
This was a cross-sectional study between November 2019 and June 2020 among 292 mothers, 6 to 8 weeks’ postpartum. Mothers were selected from three health facilities in southwestern Uganda and enrolled using stratified consecutive sampling. Postpartum depression was clinically diagnosed using the Diagnostic and Statistical Manual of Mental Disorders V. The factors associated with PPD were assessed by using a structured interviewer administered questionnaire. The factors were analyzed using bivariate chi square analyses and multivariate logistic regression.

Results
Overall prevalence of PPD was 27.1% (95% CI: 22.2–32.5). This did not vary by the number of previous births or mode of birth. Five factors associated with PPD were low perceived social support, HIV positive status, rural residence, obstetrical complications and the baby crying excessively.

Conclusion and recommendations
Prevalence of PPD in Mbarara and Rwampara districts is higher than what has previously been reported in Uganda indicating an urgent need to identify pregnant women who are at increased risk of PPD to mitigate their risk or implement therapies to manage the condition. Midwives who attend to these mothers need to be empowered with available methods of mitigating prevalence and consequences of PPD. Women who are HIV positive, residing in rural settings, whose babies cry excessively, having low social support systems and who have birth complications may be a particularly important focus for Ugandan intervention strategies to prevent and reduce the prevalence of PPD.
Impact of a medical scribe on clinical efficiency and quality in an academic general internal medicine practice
Authors: Piersa Anastasia Pozdnyakova , Laiteerapong Neda , Ham Sandra A. , del Castillo Felipe Fernandez , Shah Sachin , Burnet Deborah L. , Lee Wei Wei 
Published: July 2021

Abstract
Background
Scribes have been proposed as an intervention to decrease physician electronic health record (EHR) workload and improve clinical quality. We aimed to assess the impact of a scribe on clinical efficiency and quality in an academic internal medicine practice.

Methods
Six faculty physicians worked with one scribe at an urban academic general internal medicine clinic April through June 2017. Patient visits during the 3 months prior to intervention (baseline, n = 789), unscribed visits during the intervention (concurrent control, n = 605), and scribed visits (n = 579) were included in the study. Clinical efficiency outcomes included time to close encounter, patient time in clinic, and number of visits per clinic session. Quality outcomes included EHR note quality, rates of medication and immunization review, population of patient instructions, reconciliation of outside information, and completion of preventative health recommendations.

Results
Median time to close encounter (IQR) was lower for scribed visits [0.4 (4.8) days] compared to baseline and unscribed visits [1.2 (5.9) and 2.9 (5.4) days, both p < 0.001]. Scribed notes were more likely to have a clear history of present illness (HPI) [OR = 7.30 (2.35–22.7), p = 0.001] and sufficient HPI information [OR = 2.21 (1.13–4.35), p = 0.02] compared to unscribed notes. Physicians were more likely to review the medication list during scribed vs. baseline visits [OR = 1.70 (1.22–2.35), p = 0.002]. No differences were found in the number of visits per clinic session, patient time in clinic, completion of preventative health recommendations, or other outcomes.

Conclusions
Working with a scribe in an academic internal medicine practice was associated with more timely documentation.
Cost-effectiveness and feasibility of conditional economic incentives and motivational interviewing to improve HIV health outcomes of adolescents living with HIV in Anambra State, Nigeria
Authors: Ekwunife Obinna Ikechukwu , Ofomata Chinelo Janefrances , Okafor Charles Ebuka , Anetoh Maureen Ugonwa , Kalu Stephen Okorafor , Ele Prince Udegbunam , Eleje George Uchenna 
Published: July 2021

Abstract
Background
In sub-Saharan Africa, there is increasing mortality and morbidity of adolescents due to poor linkage, retention in HIV care and adherence to antiretroviral therapy (ART). This is a result of limited adolescent-centred service delivery interventions. This cost-effectiveness and feasibility study were piggybacked on a cluster-randomized trial that assessed the impact of an adolescent-centred service delivery intervention. The service delivery intervention examined the impact of an incentive scheme consisting of conditional economic incentives and motivational interviewing on the health outcomes of adolescents living with HIV in Nigeria.

Method
A cost-effectiveness analysis from the healthcare provider’s perspective was performed to assess the cost per additional patient achieving undetected viral load through the proposed intervention. The cost-effectiveness of the incentive scheme over routine care was estimated using the incremental cost-effectiveness ratio (ICER), expressed as cost/patient who achieved an undetectable viral load. We performed a univariate sensitivity analysis to examine the effect of key parameters on the ICER. An in-depth interview was conducted on the healthcare personnel in the intervention arm to explore the feasibility of implementing the service delivery intervention in HIV treatment hospitals in Nigeria.

Result
The ICER of the Incentive Scheme intervention compared to routine care was US$1419 per additional patient with undetectable viral load. Going by the cost-effectiveness threshold of US$1137 per quality-adjusted life-years suggested by Woods et al., 2016, the intervention was not cost-effective. The sensitivity test showed that the intervention will be cost-effective if the frequency of CD4 count and viral load tests are reduced from quarterly to triannually. Healthcare professionals reported that patients’ acceptance of the intervention was very high.

Conclusion
The conditional economic incentives and motivational interviewing was not cost-effective, but can become cost-effective if the frequency of HIV quality of life indicator tests are performed 1–3 times per annum. Patients’ acceptance of the intervention was very high. However, healthcare professionals believed that sustaining the intervention may be difficult unless factors such as government commitment and healthcare provider diligence are duly addressed.

Trial registration
This trial is registered in the WHO International Clinical Trials Registry through the WHO International Registry Network (PACTR201806003040425).
Atherogenic index of plasma is related to coronary atherosclerotic disease in elderly individuals: a cross-sectional study
Authors: Huang Haomin , Yu Xiaolong , Li Lamei , Shi Ganwei , Li Feng , Xiao Jianqiang , Yun Zhihua , Cai Gaojun 
Published: July 2021

Abstract
Background
Dyslipidaemia plays an important role in coronary atherosclerotic disease (CAD). The relationship between the atherogenic index of plasma (AIP) and CAD in elderly individuals was explored in this study.

Methods
Elderly individuals (age ≥ 65 years) who underwent coronary angiography from January 2016 to October 2020 were consecutively enrolled in the study.

Results
A total of 1313 individuals, including 354 controls (non-CAD) and 959 CAD patients, were enrolled. In univariate analysis of all populations, the adjusted AIP (aAIP) in the CAD group was 1.13 (0.96, 1.3), which was significantly higher than that in the controls [1.07 (0.89, 1.26)]. However, in subgroup analyses, this phenomenon was only present in males. In addition, further study showed that aAIP was positively related to CAD severity. In binary logistic regression analyses, after adjusting for sex, age, smoking status, primary hypertension (PH), type 2 diabetes mellitus (T2DM), heart rate (HR), white blood cell (WBC) and platelet (PLT), AIP remained independently related to CAD in elderly individuals and was superior to traditional and other nontraditional lipid indices. Subgroup analyses showed that AIP independently influenced CAD risk in males. Ultimately, sensitivity analyses were performed excluding all coronary emergencies, and the final results were similar.

Conclusions
AIP was positively related to the risk and severity of CAD in elderly individuals and was superior to traditional and other nontraditional lipid profiles. However, this association only exists in elderly males.
Central mucoepidermoid carcinoma arising directly from a glandular odontogenic cyst of the mandible: a case report
Authors: Maruyama Satoshi , Mori Taisuke , Yamazaki Manabu , Abé Tatsuya , Ryo Eijitsu , Kano Hiroyuki , Hasegawa Go , Tanuma Jun-ichi 
Published: July 2021

Abstract
Background
Central mucoepidermoid carcinoma (MEC) is a rare salivary gland tumor that affects the jawbone. Glandular odontogenic cyst (GOC) is also a rare odontogenic developmental cyst with glandular differentiation. GOC shares some histological features with central MEC, and a pre-existing GOC can develop into central MEC. Here, we present a rare case of central MEC developed directly from a pre-existing GOC of the mandible.

Case presentation
A 67-year-old Japanese man presented with a cystic lesion in the right third molar region. Histologically, the biopsy specimen demonstrated both typical findings of a GOC component lined with non-keratinized squamous epithelium and a recognizable component of central MEC consisting of polycystic nests with mucous cells, intermediate cells, and epidermoid cells in the cyst wall. The results from the immunohistochemistry for cytokeratin (CK) profiling demonstrated that, while both central MEC and GOC expressed CKs 7, 14, 18, and 19, CK13 was interestingly exclusively expressed in GOC. Fluorescence in-situ hybridization (FISH) revealed the rearrangement of the Mastermind like (MAML)-2 gene in both the MEC and GOC components.

Conclusions
Our case suggests that central MEC and GOC may be in the same spectrum of diseases caused by the rearrangement of the MAML-2 gene. However, given that the expression profile of CK13 was completely different between central MEC and GOC, they can be considered as separate tumors. Overall, we demonstrated a rare case in which central MEC may have originated directly from the GOC.
Nonoperative treatment of recalcitrant neuritis of the infrapatellar saphenous nerve: a case series
Authors: Pearce Beth 
Published: July 2021

Abstract
Background
Neuritis of the infrapatellar branch of the saphenous nerve can result from iatrogenic injury, entrapment, bursitis, or patellar dislocation. Currently, there is an unmet clinical need for treating refractory neuritis nonsurgically.

Case presentation
Three patients presented with persistent anterior knee pain caused by neuritis of the infrapatellar branch of the saphenous nerve that had got excellent but only temporary relief from steroid and local anesthetic nerve block. The neuropathic pain diagnostic Douleur Neuropathique 4 questionnaire and painDETECT questionnaire confirmed presence of neuropathic pain. After injection with 25 mg amniotic and umbilical cord particulate, the patient’s pain decreased from 7.3 before injection to 0.3 at 6 weeks postinjection. In addition, neuropathic symptoms significantly improved at 2 weeks and were not present by 6 weeks. By 63 weeks, two of the patients reported continued complete pain relief, while one patient underwent total knee replacement due to an allergy of a previously implanted unicondylar implant.

Conclusions
This case series suggests that amniotic and umbilical cord particulate may be a viable alternative to reduce pain in patients with neuropathic pain.
Ruptured arterial aneurysm in Wegener’s granulomatosis: a case report
Authors: Gravos A. , Katsifa K. , Tselioti P. , Grammatikopoulou V. , Sakellaridis K. , Kanakaki S. , Tsapas C. , Destounis A. , Moschouris H. , Athanasiadou I. , Chatzivasiloglou F. , Ivanova E. , Prekates A. 
Published: July 2021

Abstract
Background
Aneurysm formation is a possible, but rare, complication of granulomatosis with polyangiitis, known as Wegener’s granulomatosis. Urgent diagnosis and therapy is very important because a ruptured aneurysm could be life threatening.

Case presentation
We, therefore, present the case of a 63-year-old Greek man who was diagnosed with granulomatosis with polyangiitis and retroperitoneal hematoma due to ruptured aneurysm in renal artery and upper pancreaticoduodenal artery. His clinical course was complicated by acute renal failure and acute respiratory failure due to alveolar hemorrhage. Emergency coil embolization was performed. Postembolization recovery was uneventful; no bleeding occurred. The patient underwent mechanical ventilation and continuous veno-venous hemofiltration and received combined immunosuppression and supportive therapy, but eventually died 30 days after admission to hospital from severe septic shock and multiple organ failure.

Conclusion
Endovascular treatment is the therapy of choice, especially for patients with ruptured aneurysms that are hemodynamically stable. Early diagnosis is very important, as urgent embolization and early initiation of immunosuppression therapy are the treatment of choice.
Can vegetation index track the interannual variation in gross primary production of temperate deciduous forests?
Authors: Liu Fan , Wang Chuankuan , Wang Xingchang 
Published: July 2021

AbstractBackgroundVegetation indices (VIs) by remote sensing are widely used as simple proxies of the gross primary production (GPP) of vegetation, but their performances in capturing the inter-annual variation (IAV) in GPP remain uncertain.MethodsWe evaluated the performances of various VIs in tracking the IAV in GPP estimated by eddy covariance in a temperate deciduous forest of Northeast China. The VIs assessed included the normalized difference vegetation index (NDVI), the enhanced vegetation index (EVI), and the near-infrared reflectance of vegetation (NIRv) obtained from tower-radiometers (broadband) and the Moderate Resolution Imaging Spectroradiometer (MODIS), respectively.ResultsWe found that 25%–35% amplitude of the broadband EVI tracked the start of growing season derived by GPP (R2: 0.56–0.60, bias < 4 d), while 45% (or 50%) amplitudes of broadband (or MODIS) NDVI represented the end of growing season estimated by GPP (R2: 0.58–0.67, bias < 3 d). However, all the VIs failed to characterize the summer peaks of GPP. The growing-season integrals but not averaged values of the broadband NDVI, MODIS NIRv and EVI were robust surrogates of the IAV in GPP (R2: 0.40–0.67).ConclusionThese findings illustrate that specific VIs are effective only to capture the GPP phenology but not the GPP peak, while the integral VIs have the potential to mirror the IAV in GPP.
Identification of bone morphogenetic protein 4 in the saliva after the placement of fixed orthodontic appliance
Authors: Grgurevic Lovorka , Novak Ruder , Salai Grgur , Trkulja Vladimir , Hamzic Lejla Ferhatovic , Popovic Vojka Zgombic , Bozic Darko 
Published: July 2021

Abstract
Background
This study was conducted in order to explore the effects of orthodontic tooth movement (OTM) on the changes of salivary proteome. This prospective observational pilot study recruited 12 healthy teenage boys with malocclusion treated with a fixed orthodontic appliance and 6 appropriate control participants. Saliva samples were collected a day before and at 0, 2, 7, and 30 days after initialization of treatment, corresponding to the initial, lag, and post-lag phases of OTM. Pooled samples were analyzed by liquid chromatography-mass spectrometry, ELISA, and Western blotting. To date, there is no published data on the presence of BMP molecules or their antagonists in the saliva or in the gingival cervical fluid related to orthodontic conditions.

Results
A total of 198 identified saliva proteins were classified based on their functional characteristics. Proteins involved in bone remodeling were observed exclusively 30 days post appliance placement, including bone morphogenetic protein 4 (BMP4), a BMP antagonist BMP-binding endothelial regulator, insulin-like growth factor-binding protein 3, cytoskeleton-associated protein 4, and fibroblast growth factor 5. Based on the analysis of protein interactions, BMP4 was found to have a central position in this OTM-related protein network.

Conclusions
The placement of a fixed orthodontic appliance induced occurrence of proteins involved in bone remodeling in the saliva at a time corresponding to the post-lag period of OTM. Limitations of this study include a relatively small sample size, limited time of monitoring patients, and the lack of interindividual variability assessment.