bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early oral protein-containing diets following elective lower gastrointestinal tract surgery in adults: A meta-analysis of randomized clinical trials.
Authors: PU Hong , Heighes Philippa T. , Simpson Fiona , WANG Yaoli , LIANG Zeping , Wischmeyer Paul , Hugh Thomas J. , Doig Gordon S. 
Published: January 2021

Abstract
Background: Although current guidelines make consensus recommendations for the early resumption of oral intake after surgery, a recent comprehensive meta-analysis failed to identify any patient-centred benefits. We hypothesized this finding was attributable to pooling studies providing effective protein-containing diets with ineffective non-protein liquid diets. Therefore, the aim of this paper was to investigate the safety and efficacy of early oral protein-containing diets versus later (traditional) feeding after elective lower gastrointestinal tract surgery in adults.Methods: PubMed, Embase and the China National Knowledge Infrastructure databases were searched from inception until 1 August 2019. Reference lists of retrieved studies were hand searched to identify randomized clinical trials reporting mortality. No language restrictions were applied. Study selection, risk of bias appraisal and data abstraction were undertaken independently by two authors. Disagreements were settled by obtaining an opinion of a third author. Majority decisions prevailed. After assessment of underlying assumptions, a fixed-effects method was used for analysis. The primary outcome was mortality. Secondary outcomes included surgical site infections, postoperative nausea and vomiting, serious postoperative complications and other key measures of safety and efficacy.Results: Eight randomized clinical trials recruiting 657 patients were included. Compared with later (traditional) feeding, commencing an early oral protein-containing diet resulted in a statistically significant reduction in mortality (Odds Ratio [OR] 0.31, P=0.02, I2=0%). An early oral protein-containing diet also significantly reduced surgical site infections (OR 0.39, P=0.002, I2=32%), postoperative nausea and vomiting (OR 0.62, P=0.04, I2=37%), serious postoperative complications (OR 0.60, P=0.01, I2=25%) and significantly improved other major outcomes. No harms attributable to an early oral protein-containing diet were identified.Conclusions: The results of this systematic review can be used to upgrade current guideline statements to a Grade A recommendation supporting an oral protein-containing diet commenced before the end of postoperative day 1 after elective lower gastrointestinal surgery in adults.
Lateral lumbar interbody fusion after reduction using the percutaneous pedicle screw system in the lateral position for Meyerding grade II spondylolisthesis: a preliminary report of a new lumbar reconstruction strategy
Authors: Takami Masanari , Taiji Ryo , Okada Motohiro , Minamide Akihito , Hashizume Hiroshi , Yamada Hiroshi 
Published: January 2021

Abstract
Background: Utilization of a cage with a large footprint in lateral lumbar interbody fusion (LLIF) for the treatment of spondylolisthesis leads to a high fusion rate and neurological improvement owing to the indirect decompression effect and excellent alignment correction. However, if an interbody space is too narrow for insertion of an LLIF cage for cases of spondylolisthesis of Meyerding grade II or higher, LLIF cannot be used. Therefore, we developed a novel strategy, LLIF after reduction by the percutaneous pedicle screw (PPS) insertion system in the lateral position (LIFARL), for surgeons to perform accurate and safe LLIF with PPS in patients with such pathology. This study aimed to introduce the new surgical strategy and to present preliminary clinical and radiological results of patients with spondylolisthesis of Meyerding grade II.Methods: Six consecutive patients (four men and two women; mean age, 72.7 years-old; mean follow-up period, 15.3 months) with L4 spondylolisthesis of Meyerding grade II were included. Regarding the surgical procedure, first, PPSs were inserted into the L4 and L5 vertebrae fluoroscopically, and both rods were placed in the lateral position. The L5 set screws were fixed tightly, and the L4 side of the rod was floated. Second, the L4 vertebra was reduced by fastening the L4 set screws so that they expanded the anteroposterior width of the interbody space. At that time, the L4 set screws were not fully tightened to the rods to prevent the endplate injury. Finally, the LLIF procedure was started. After inserting the cage, a compression force was added to the PPSs, and the L4 set screws were completely fastened. Results: The mean operative time was 183 min, and the mean blood loss was 90.8 mL. All cages were positioned properly. Visual analog scale score and Oswestry disability index improved postoperatively. Bone union was observed using computed tomography 12 months after surgery.Conclusion: For cases with difficulty in LLIF cage insertion for Meyerding grade II spondylolisthesis due to the narrow anteroposterior width of interbody space, LIFARL is an option to achieve LLIF combined with posterior PPS accurately and safely.Trial registration: UMIN-Clinical Trials Registry, UMIN000040268, Registered 29 April 2020, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000045938
Lung ultrasound score assessing the pulmonary edema in pediatric acute respiratory distress syndrome received continuous hemofiltration therapy: A prospective observational study
Authors: Wang Fei , Wang Chunxia , Shi Jingyi , Shan Yijun , Miao Huijie , Sun Ting , Zhou Yiping , Zhang Yucai 
Published: January 2021

Abstract
Background: Lung ultrasound score is a potential method for determining pulmonary edema in acute respiratory distress syndrome (ARDS). Continuous renal replacement therapy (CRRT) has become the preferred modality to manage fluid overload during ARDS. The aim of this study was to evaluate the value of lung ultrasound (LUS) score on assessing the effects of CRRT on pulmonary edema and pulmonary function in pediatric ARDS. Methods: We conducted a prospective cohort study in 70 children with moderate to severe ARDS in a tertiary university pediatric intensive care unit from January 2016 to December 2019. 37 patients received CRRT (CRRT group) and 33 patients treated by conventional therapy (Non-CRRT group). LUS score was measured within 2 hours identified ARDS as the value of 1st，and the following three days as the 2nd, 3rd, and 4th. We used Spearman correlation analysis to develop the relationship between LUS score and parameters related to respiratory dynamics, clinical outcomes as well as daily fluid balance during the first four days after ARDS diagnosed.Results: The 1st LUS score in CRRT group were significantly higher than Non-CRRT group (P < 0.001), but the LUS score decreased gradually following CRRT (P < 0.001). LUS score was significantly correlated with Cdyn (1st: r =-0.757, 2nd: r =-0.906, 3rd: r =-0.885, 4th: r =-0.834), OI (1st: r =0.678, 2nd: r =0.689, 3rd: r =0.486, 4th: r =0.324) based on 1st to 4th values (all P <0.05). Only values of the 3rd and 4th LUS score after ARDS diagnosed were correlated with duration of mechanical ventilation [1st: r = 0.167, P = 0.325; 2nd: r = 0.299, P = 0.072; 3rd: r = 0.579, P < 0.001; 4th: r = 0.483, P = 0.002]. LUS score decreased from 22 (18 - 25) to 15 (13 - 18) and OI decreased from 15.92 (14.07 -17.73) to 9.49 (8.70 -10.58) after CRRT for four days (both P < 0.001).Conclusions: LUS score is significantly correlated with lung function parameters in pediatric ARDS. The improvement of pulmonary edema in patient with ARDS received CRRT can be assessed by the LUS score.Trial registration: CCTR, ChiCTR-ONC-16009698. Registered 1 November 2016, prospectively registered, http://www.chictr.org.cn/edit.aspx?pid=16535&htm=4. This study adheres to CONSORT guidelines.
Increased acquired protease inhibitor drug resistance mutations in minor HIV-1 quasispecies from infected patients suspected of failing on national second-line therapy in South Africa
Authors: Obasa Adetayo Emmanuel , Ambikan Anoop T , Gupta Soham , Neogi Ujjwal , Jacobs Graeme Brendon 
Published: January 2021

Abstract
Background: HIV-1C has been shown to have a greater risk of virological failure and reduced susceptibility towards boosted protease inhibitors (bPIs), a component of second-line combination antiretroviral therapy (cART) in South Africa. This study entailed an evaluation of HIV-1 drug resistance-associated mutations (RAMs) among minor viral populations through high-throughput sequencing genotypic resistance testing (HTS-GRT) in patients on the South African national second-line cART regimen receiving bPIs.Methods: During 2017 and 2018, 67 patient samples were sequenced using high throughput sequencing (HTS), of which 56 samples were included in the analysis because the patient’s treatment regimen were available at the time of sampling. All patients were receiving bPIs as part of their cART. Viral RNA was extracted, and complete pol genes were amplified and sequenced using Illumina HiSeq2500, followed by bioinformatics analysis to quantify the RAMs according to the Stanford HIV Drug Resistance Database.Results: Statistically significantly higher PI RAMs were observed in minor viral quasispecies (25%; 14/56) compared to non-nucleoside reverse transcriptase inhibitors (9%; 5/56; p=0.042) and integrase inhibitor RAM (4%; 2/56; p=0.002). The majority of the drug resistance mutations in the minor viral quasispecies were observed in the V82A mutation (n=13) in protease and K65R (n=5), K103N (n=7) and M184V (n=5) in reverse transcriptase.Conclusions: HTS-GRT improved the identification of PI and reverse transcriptase inhibitor (RTI) RAMs in second-line cART patients from South Africa compared to the conventional GRT with ≥20% used in Sanger-based sequencing. Several RTI RAMs, such as K65R, M184V or K103N and PI RAM V82A, were identified in <20% of the population. Deep sequencing could be of greater value in detecting acquired resistance mutations early.
Qualitative views of Nigerian School Principals and Teachers on the barriers and opportunities for promoting students’ physical activity behaviour within the school settings
Authors: Oluwasanu Mojisola , Oladepo Oladimeji , Ibitoye Segun Emmanuel 
Published: January 2021

Abstract
Background: Insufficient physical activity is a growing public health challenge among Nigerian adolescents. Significant information gap exists on the school-related factors and its implication on the school-based physical activity participation of adolescents in Nigeria. This study was conducted to document the qualitative views of school principals and teachers on the barriers and opportunities for promoting the physical activity behaviours of adolescents within the school settings in light of the socio-ecological model.Methods: This was a qualitative study conducted in 12 public and private schools in two local government areas of Oyo state, Nigeria. Two key sources and data collection methods (i.e key informant interviews and focus group discussions) were used. Six key informant interviews were held with school principals and six focus group discussions with classroom teachers using pre-tested guides. Data was analysed using thematic analysis.Results: Fourteen sub-themes were identified as barriers to PA and linked to different levels of the socio-ecological model. Three themes were categorized as parental factors, three themes as socio-cultural and religious factors while the school-related factors had eight sub-themes. Specifically, the school related barriers were the declining number of trained physical health education teachers, limited opportunities for continuing education and low prioritisation of physical health education. Other school-related factors such as increasing demand for classroom academic time, negative attitudinal dispositions of other teachers and inadequate funding for schools which hampered the provision of facilities and equipment were identified as factors that limit the effective implementation of policies and programs for physical activity in schools. Opportunities to promote PA within the school settings during assemblies, breaktime, after-school and inter house sports competition exists. However; these opportunities are hampered by competing academic time, security threats, fear of causalities to students due to poor supervision after school, poor funding and brawling associated with competitive school-based sporting events. Conclusions: Factors that contribute to insufficient physical activity among in-school adolescents in the school settings are multifactorial. Implementation of holistic, multi-component interventions which address the social-cultural and school-level factors and enhance students’ opportunities for physical activity in schools are recommended.
The Effectiveness of Prolotherapy for Recalcitrant Medial Tibial Stress Syndrome: a Prospective Consecutive Case Series.
Authors: Padhiar Nat , Curtin Mark , Aweid Osama , Awied Bashaar , Morrissey Dylan , Chan Otto , Malliaras Peter , Crisp Tom 
Published: January 2021

Abstract
Background: Medial tibial stress syndrome (MTSS) is one of the most common lower leg injuries in sporting populations. It accounts for between 6%-16% of all running injuries, and up to 53% of lower leg injuries in military recruits. Various treatment modalities are available with varying degrees of success. In recalcitrant cases, surgery is often the only option.Objective: To evaluate whether ultrasound-guided injection of 15% dextrose for treatment of recalcitrant MTSS decreases pain and facilitates a return to desired activity levels for those who may otherwise be considering surgery or giving up the sport.Method: The study design was a prospective consecutive case series involving eighteen patients: fifteen male and three female; (mean age=31.2 years) with recalcitrant MTSS. They were referred from sports injury clinics across the UK, having failed all available conservative treatment.Intervention: An ultrasound-guided sub-periosteal injection of 15% dextrose was administered by the same clinician (NP) along the length of the symptomatic area. Typically, 1 mL of solution was injected per cm of the symptomatic area. Main Outcome Measures: Pain was assessed using a 10-cm visual analog scale (VAS) at baseline, short-term, medium-term (mean 18 weeks), and long-term (mean 52 weeks) follow-up. Symptom resolution and return to activity were measured using a Likert scale at medium and long-term follow-up. Statistical analyses were performed using SPSS for Mac version 19.0.0 (IBM, New York, NY, US). The Shapiro-Wilk test was used to evaluate the normality of the distribution of data. Friedman's non-parametric test was used to compare the within-patient treatment response over time. Post-hoc Wilcoxon signed-rank tests with Bonferroni corrections were performed to determine VAS average pain response to treatment over five paired periods.Results: Patients reported a significant (p<0.01) reduction in median VAS pain score at medium and long-term follow-up compared to baseline. Median improvement per patient was 4.5/10. Patients rated their condition as 'much improved' at medium-term follow-up and the median return to sports score was 'returned to desired but not pre-injury level' at medium-term and long-term follow-up. No adverse events were reported.Conclusions: Ultrasound-guided 15% dextrose prolotherapy injection has a significant medium-term effect on pain in MTSS. This benefit may be maintained long-term; however, more robust trials are required to validate these findings in the absence of controls.Clinical Relevance: Clinicians should consider the use of ultrasound-guided injection of 15% dextrose as a viable treatment option to reduce pain and aid return to activity for patients with recalcitrant MTSS.
Promoting the propensity for blood donation through the understanding of its determinants.
Authors: Mugion Roberta Guglielmetti , Giovina Pasca Maria , Laura Di Pietro , Renzi Maria Francesca 
Published: January 2021

Abstract
Background. The paper aims to understand the main antecedents related to the blood donation propensity related to both donors and non-donors. With our research, we will analyse the two perspectives to identify similarities and differences concentrating on the Italian context. Blood is a vital resource that strongly affects every national healthcare system's efficacy and sustainability and the system's ability to achieve the goal of universal coverage. Methods. The purpose of this paper is to understand the main antecedents of citizens' blood donation intention and the propensity to encourage communication about blood donation among both donors and non-donors. The Theory of Planned Behaviour is adopted as a theoretical lens. An empirical investigation was performed in Italy, adopting a mixed methods research design. First, a qualitative analysis was carried out through 30 in-depth interviews. Then, a survey was used to quantitatively investigate the intention to donate among both donors (N=173) and non-donors (N=87). A conceptual model was developed and tested through Structural Equation Modelling, developing a multi-group approach. Results. The present study confirms the relations proposed by the Theory of Planned Behaviour, even though some differences between the two groups are shown. The construct Information and Communication is crucial for donors, non-donors, whereas for non-donor inhibitors is vital. Service quality has an impact on the propensity to recommend and communicate the value of blood donation.Conclusion. This paper reveals the main differences between donor and non-donor perspectives. Fruitful insights for enhancing blood donation awareness are provided.
A comparative study on effect of different methods of recycling orthodontic brackets on shear bond strength
Authors: Khanal Purna Prasad , Shrestha Basanta Kumar , Yadav Rajiv , Gupta Sanjay Prasad 
Published: January 2021

Abstract
Aim: The aim of this study was to evaluate and compare the effect of different methods of recycling stainless steel orthodontic brackets on shear bond strength.Methods: One hundred twenty human premolars extracted for orthodontic purpose were randomly divided into four groups. Standard MBT (0.022”) brackets were bonded on buccal surface of all samples with light cured adhesive primer using LED curing unit for 10 seconds. Group-I was assigned as control and the brackets of Group-II, Group-III and Group-IV were subjected to recycling by flaming, flaming with sandblasting and flaming with ultrasonic cleaning respectively. The recycled brackets were rebonded and final debonding of all brackets was done with universal testing machine at a crosshead speed of 0.5mm/min and shear bond strength was determined. Data were analyzed with descriptive statistics, ANOVA and post hoc test. The adhesive remnant index was evaluated by stereomicroscope at 10X magnification.Results: The highest shear bond strength was obtained with Group I (10.35 ± 0.46 MPa), followed by Group III (9.36 ± 0.55 MPa), Group IV (5.97 ± 0.66 MPa) and the least value was obtained with Group II (4.30 ± 0.55 Mpa). Significant differences among the groups were detected by analysis of variance. Tukey post hoc multiple comparison test showed that the shear bond strength of each group was significantly different from one another (p < 0.001). Conclusions: Shear bond strength of new brackets was significantly higher than that of the recycled brackets. Among recycled brackets, flaming with sandblasting provided adequate shear bond strength, flaming with ultrasonic cleaning provided borderline value for clinical use while flaming alone led to significantly lower value.
Developing a complex intervention whilst considering implementation: the TANDEM (Tailored intervention for ANxiety and DEpression Management) intervention for patients with chronic obstructive pulmonary disease (COPD)&nbsp;
Authors: Steed Liz , Heslop-Marshall Karen , Sohanpal Ratna , Saqi-Waseem Sarah , Kelly Moira , Pinnock Hilary , Taylor Stephanie 
Published: January 2021

Abstract
Background Guidelines now call for a thorough and comprehensive description of the development of healthcare interventions to aid evaluation and understanding of the processes of change. This was the primary aim of this study but we also recognized that effective interventions are commonly not implemented in clinical practice. It is suggested that insufficient attention is given to the implementation process at the development phase of interventions. This study outlines the 5 step iterative process we adopted for considering both implementation and effectiveness issues from the outset of intervention development. We use the development of a complex intervention Tailored intervention for ANxiety and DEpression Management (TANDEM) in patients with chronic obstructive pulmonary disease to illustrate this process. Methods Intervention development built upon the Medical Research Council framework for developing complex interventions and the Person Based Approach for development of behavioural interventions. Building an expert team, specifying theory, qualitative data collection and pre-piloting were all critical steps in our intervention development and are described here.Results Contact with experts in the field, and explicitly building on previous work, ensured efficiency of design. Qualitative work suggested guiding principles for the intervention such as introducing mood in relation to breathlessness, and providing flexible tailoring to patients’ needs, whilst implementation principles focused on training selected respiratory professionals and requiring supervision to ensure standards of care. Subsequent steps of intervention development, pre-piloting and intervention refinement led to an intervention that was deemed acceptable and if successful will be ready for implementation. Conclusions The TANDEM study was developed efficiently by building on previous work and considering implementation issues from the outset, with the aim that if shown to be effective it will have more rapid translation in to the health care system with accelerated patient benefits. Trial Registration ISRCTN, ID: ISRCTN59537391. Registered on 20 March 2017. Protocol version 6.0, 22 April 2018.
Growth and Elasticity of Output of MSMEs in India
Authors: PALAKA SETAKA , Das Sandhyarani 
Published: January 2021

Abstract
In the last few years, the phenomenon of a marked slowdown in the growth of employment has been noticed in many countries across the world including India. An important objective of development planning in India has been to provide for increasing employment opportunities not only to meet the backlog of the unemployed but also the new additions to the labour force. Micro, small and medium enterprises (MSMEs), including khadi and village industries generate the highest rates of employment growth and account for a significant share of industrial production and exports. The core objective of the present paper is to analyse the growth and elasticity output in the MSMEs sector. Extended Cobb Douglas Production Function has been utilized based on the secondary data. The study reveals that the output elasticity of employment during the study period is very low as compared to the output elasticity of export.