bluuebunny/crossref_metadata_2025_split huggingface dataset:
How do care providers evaluate collaboration? - qualitative process evaluation of a cluster-randomized controlled trial of collaborative and stepped care for patients with mental disorders
Authors: Maehder Kerstin , Werner Silke , Weigel Angelika , Löwe Bernd , Heddaeus Daniela , Härter Martin , von dem Knesebeck Olaf 
Published: June 2021

Abstract
Background
Collaborative and stepped care (CSC) models are recommended for mental disorders. Their successful implementation depends on effective collaboration between involved care providers from primary and specialist care. To gain insights into the collaboration experiences of care providers in CSC against the backdrop of usual mental health care, a qualitative process evaluation was realized as part of a cluster-randomized controlled trial (COMET) of a collaborative and stepped care model in Hamburg (Germany).

Methods
Semi-structured interviews were conducted with N = 24 care providers from primary and specialist care (outpatient psychotherapists and psychiatrists, inpatient/ day clinic mental health providers) within and outside of COMET at the trial’s beginning and 12 months later. Interviews were analyzed applying a qualitative structuring content analysis approach, combining deductive and inductive category development.

Results
Usual mental health care was considered deficient in resources, with collaboration being scarce and mainly taking place in small informal networks. Within the COMET trial, quicker referral paths were welcomed, as were quarterly COMET network meetings which provided room for exchange and fostered mutual understanding. Yet, also in COMET, collaboration remained difficult due to communication problems, the unfavorable regional distribution of the COMET care providers and interprofessional discrepancies regarding each profession’s role, competencies and mutual esteem. Ideas for improvement included more localized networks, the inclusion of further professions and the overall amelioration of mental health care regarding resources and remuneration, especially for collaborative activities.

Conclusions
The process evaluation of the COMET trial revealed the benefits of creating room for interprofessional encounter to foster collaborative care. Despite the benefits of faster patient referrals, the COMET network did not fulfill all care providers’ prior expectations. A focus should be set on interprofessional competencies, mutual perception and role clarification, as these have been revealed as significant barriers to collaboration within CSC models such as COMET.

Trial registration
The COMET trial (Collaborative and Stepped Care in Mental Health by Overcoming Treatment Sector Barriers) has been registered on July 24, 2017 under the trial registration number NCT03226743.
Evaluation of a mobile safety center’s impact on pediatric home safety behaviors
Authors: Furman Leah , Strotmeyer Stephen , Vitale Christine , Gaines Barbara A. 
Published: June 2021

Abstract
Background
A Mobile Safety Center (MSC) provides safety resources to families to prevent pediatric injury. The primary objective of this study was to assess the impact of an MSC on home safety behaviors.

Methods
We conducted a prospective observational study with 50 parents and guardians recruited at community events attended by an MSC. Participants completed a pre-test assessing demographics and home safety behaviors prior to participating in the MSC’s home safety educational program. We conducted follow-up with participants 4 weeks (follow-up 1) and 6 months (follow-up 2) after their visit to the MSC to reassess home safety behaviors. We used descriptive statistics in addition to Friedman, Wilcoxon sum-rank, and Fisher’s exact testing to analyze respondent demographics and changes in home safety practices. Friedman and Wilcoxon sum-rank testing was performed only for participants who completed all surveys.

Results
Of our 50 participants, 29 (58%) completed follow-up 1, 30 (60%) completed follow-up 2, and 26 (52%) completed both. Participants were more likely to have a fire-escape plan at follow-up 1 than on the pre-test (p = 0.014). They were also more likely to have the Poison Control Hotline number accessible in their cellphone or near a home phone at follow-up 1 compared to the pre-test (p = 0.002) and follow-up 2 compared to the pre-test (p < 0.001). Families with at least one household member who smoked or used e-cigarettes at any point during the study (n = 16 for the total population, n = 9 for those who completed both surveys) were less likely to have more than two smoke detectors installed at home during the pre-test (p = 0.049). However, this significantly changed across timepoints (p = 0.018), and while 44.4% reported more than two detectors during the pre-test, 88.9% reported this at both follow-ups.

Conclusions
Home safety education through an MSC positively changed some reported safety behaviors and maintained these changes at long-term follow-up. By encouraging the adoption of better home safety practices, education at an MSC may decrease pediatric injury rates.
Does concurrent adenoidectomy or tonsillectomy affect the graft success rate of cartilage myringoplasty in adults?
Authors: Lou Zhengcai 
Published: June 2021

Abstract
Background
The objective of this study was to evaluate the graft success and hearing outcomes of concurrent adenoidectomy or tonsillectomy and myringoplasty.

Methods
Medical case notes were reviewed for all adult patients with dry perforations who had undergone myringoplasty, with or without concurrent throat surgery, from December 2015 to February 2018. The study population was divided into concurrent myringoplasty and throat surgery (Group A) and single myringoplasty (Group B) groups. The air–bone gap (ABG) and graft success rate were evaluated in both groups.

Results
A total of 131 ears of 131 patients were included in this study. In total, 33 ears of 33 patients were assigned to Group A and 98 to Group B. Of the 33 patients in Group A, adenoid residue was detected in 3, chronic tonsillitis in 21, and tonsil hypertrophy in 9. The graft success rate was 96.9 % in Group A and 96.9 % in Group B at 6 months postoperatively (p = 0.993). In addition, the graft success rate was 87.9 % in Group A and 92.8 % in Group B at 24 months postoperatively (p = 0.372). Reperforation occurred in three patients in Group A and four in Group B; the difference was not significant. No significant group differences were observed in preoperative (p = 0.654) or postoperative (p = 0.791) ABG values or mean ABG gain (p = 0.439). No patient in either group developed cholesteatoma of the middle ear.

Conclusions
Simultaneous adenoidectomy or tonsillectomy and myringoplasty is feasible but does not improve the graft success rate or hearing outcome.
Hand hygiene behavior among Sri Lankan medical students during COVID-19 pandemic
Authors: Liyanage Guwani , Dewasurendra Madushika , Athapathu Ashan , Magodarathne Lakmini 
Published: June 2021

Abstract
Background
Poor compliance with hand hygiene practices among medical students poses a risk for cross-infection. It has become more critical during the COVID-19 pandemic than ever before. This study aimed to determine the knowledge, attitudes, practices of hand hygiene among final-year medical students. It also explored reported hand hygiene behavior before the COVID-19 pandemic and the need for educational strategies to correct the deficiencies.

Methods
A concurrent mixed-method approach was used. In the quantitative strand, a cross-sectional online survey was carried out via a Google form. Mann-Whitney U test and Chi-squared test were used for comparisons. In the qualitative strand, twelve participants were interviewed, based on a semi-structured interview guide and audio recorded. Transcribed data were evaluated with thematic content analysis.

Results
A total of 225 final-year medical students were studied in the quantitative strand. Most were females. The mean score for knowledge was 3.35 ± 0.795 out of six. Of them, 31.6 % of participants scored below 3 points (< 50 % of the total). Most (78.9 %) had positive attitudes (score of > 80 %). Only 36.4 % reported “adequate” hand hygiene performance in all eight dimensions of the behavior domain. Noticeably, fewer participants reported to clean their hands after checking blood pressure (55.6 %), and only 66.2 % stated carrying a hand sanitizer in their pocket. Significant correlations were not found between reported behavior and attitudes (p = 0.821) or knowledge (p = 0.794). The qualitative strand with 12 respondents revealed the positive influence of both hierarchical and non-hierarchal role models. Time constraints, skin irritation, and workload pressures were the main barriers. Frequent reminders, supervision, and interactive teaching were suggested as methods to improve hand hygiene compliance. They also stated that increased enthusiasm was noted on hand hygiene during the COVID-19 pandemic compared to the pre-pandemic period.

Conclusions
Most of the participants had positive attitudes towards hand hygiene. Yet, a considerable gap between attitudes and knowledge and reported hand hygiene behavior was evident. Coupling educational programs that use cognitive and behavioral methods, including role modeling, supervision, and frequent reminders, is recommended to bridge the knowledge-attitude-behavior gap.
The regulation of healthcare professions and support workers in international context
Authors: Saks Mike 
Published: June 2021

Abstract
Background
The objective of this paper is to outline and compare the regulation of paid healthcare professions and associated support workers in international context, bringing out the lessons to be learned as appropriate. Modern neo-liberal societies have sought to enhance healthcare through greater professional regulation, albeit in different ways and at variable pace. This general trend is illustrated with reference to medicine in the UK. However, although such reforms have helpfully cascaded to other health professions, government policy in high-income countries has not yet adequately regulated the interrelated group of non-professionalised health support workers who form the largest and least recognised part of the workforce. Nonetheless, in low- and middle-income (LMIC) countries—aside from the greater need for regulation of health professions—there is even more of an imperative to regulate the disparate, largely invisible support workforce.

Methods
With reference to existing studies of the medical and wider health professions in the UK and selected other higher income societies, the importance of health professional regulation to the public is underlined in the Global North. The larger gap in the regulation of support workers in modern neo-liberal countries is also emphasised on a similar basis, with an increasingly ageing population and advances in healthcare. It is argued from the very limited patchwork of secondary literature, though, that policy-makers may want to focus even more on enhancing regulation of both the professional and non-professional workforce in LMIC societies centred mainly in the Global South, drawing on lessons from the Global North.

Results/conclusions
Efforts to reform health professional regulatory approaches in more economically developed countries, while needing refinement, are likely to have had a positive effect. However, even in these societies there are still substantial shortfalls in the regulation of health support workers. There are even larger gaps in LMICs where there are fewer health professional staff and a greater dependence on support workers. With higher rates of morbidity and mortality, there is much more scope here for reforming health regulation in the public interest to extend standards and mitigate risk, following the pattern for healthcare professions in the Global North.
Implementation of deep learning-based auto-segmentation for radiotherapy planning structures: a workflow study at two cancer centers
Authors: Wong Jordan , Huang Vicky , Wells Derek , Giambattista Joshua , Giambattista Jonathan , Kolbeck Carter , Otto Karl , Saibishkumar Elantholi P. , Alexander Abraham 
Published: June 2021

Abstract
Purpose
We recently described the validation of deep learning-based auto-segmented contour (DC) models for organs at risk (OAR) and clinical target volumes (CTV). In this study, we evaluate the performance of implemented DC models in the clinical radiotherapy (RT) planning workflow and report on user experience.

Methods and materials
DC models were implemented at two cancer centers and used to generate OAR and CTVs for all patients undergoing RT for a central nervous system (CNS), head and neck (H&N), or prostate cancer. Radiation Therapists/Dosimetrists and Radiation Oncologists completed post-contouring surveys rating the degree of edits required for DCs (1 = minimal, 5 = significant) and overall DC satisfaction (1 = poor, 5 = high). Unedited DCs were compared to the edited treatment approved contours using Dice similarity coefficient (DSC) and 95% Hausdorff distance (HD).

Results
Between September 19, 2019 and March 6, 2020, DCs were generated on approximately 551 eligible cases. 203 surveys were collected on 27 CNS, 54 H&N, and 93 prostate RT plans, resulting in an overall survey compliance rate of 32%. The majority of OAR DCs required minimal edits subjectively (mean editing score ≤ 2) and objectively (mean DSC and 95% HD was ≥ 0.90 and ≤ 2.0 mm). Mean OAR satisfaction score was 4.1 for CNS, 4.4 for H&N, and 4.6 for prostate structures. Overall CTV satisfaction score (n = 25), which encompassed the prostate, seminal vesicles, and neck lymph node volumes, was 4.1.

Conclusions
Previously validated OAR DC models for CNS, H&N, and prostate RT planning required minimal subjective and objective edits and resulted in a positive user experience, although low survey compliance was a concern. CTV DC model evaluation was even more limited, but high user satisfaction suggests that they may have served as appropriate starting points for patient specific edits.
Fine-scale estimation of key life-history parameters of malaria vectors: implications for next-generation vector control technologies
Authors: Morris Aaron L. , Ghani Azra , Ferguson Neil 
Published: June 2021

AbstractBackgroundMosquito control has the potential to significantly reduce malaria burden on a region, but to influence public health policy must also show cost-effectiveness. Gaps in our knowledge of mosquito population dynamics mean that mathematical modelling of vector control interventions have typically made simplifying assumptions about key aspects of mosquito ecology. Often, these assumptions can distort the predicted efficacy of vector control, particularly next-generation tools such as gene drive, which are highly sensitive to local mosquito dynamics.MethodsWe developed a discrete-time stochastic mathematical model of mosquito population dynamics to explore the fine-scale behaviour of egg-laying and larval density dependence on parameter estimation. The model was fitted to longitudinal mosquito population count data using particle Markov chain Monte Carlo methods.ResultsBy modelling fine-scale behaviour of egg-laying under varying density dependence scenarios we refine our life history parameter estimates, and in particular we see how model assumptions affect population growth rate (Rm), a crucial determinate of vector control efficacy.ConclusionsSubsequent application of these new parameter estimates to gene drive models show how the understanding and implementation of fine-scale processes, when deriving parameter estimates, may have a profound influence on successful vector control. The consequences of this may be of crucial interest when devising future public health policy.Graphical abstract
Epigenetic mechanisms underlying prostate cancer radioresistance
Authors: Macedo-Silva Catarina , Benedetti Rosaria , Ciardiello Fortunato , Cappabianca Salvatore , Jerónimo Carmen , Altucci Lucia 
Published: June 2021

AbstractRadiotherapy (RT) is one of the mainstay treatments for prostate cancer (PCa), a highly prevalent neoplasm among males worldwide. About 30% of newly diagnosed PCa patients receive RT with a curative intent. However, biochemical relapse occurs in 20–40% of advanced PCa treated with RT either alone or in combination with adjuvant-hormonal therapy. Epigenetic alterations, frequently associated with molecular variations in PCa, contribute to the acquisition of a radioresistant phenotype. Increased DNA damage repair and cell cycle deregulation decreases radio-response in PCa patients. Moreover, the interplay between epigenome and cell growth pathways is extensively described in published literature. Importantly, as the clinical pattern of PCa ranges from an indolent tumor to an aggressive disease, discovering specific targetable epigenetic molecules able to overcome and predict PCa radioresistance is urgently needed. Currently, histone-deacetylase and DNA-methyltransferase inhibitors are the most studied classes of chromatin-modifying drugs (so-called ‘epidrugs’) within cancer radiosensitization context. Nonetheless, the lack of reliable validation trials is a foremost drawback. This review summarizes the major epigenetically induced changes in radioresistant-like PCa cells and describes recently reported targeted epigenetic therapies in pre-clinical and clinical settings.
New hepatitis C virus infection, re-infection and associated risk behaviour in male Irish prisoners: a cohort study, 2019
Authors: Crowley Des , Avramovic Gordana , Cullen Walter , Farrell Collette , Halpin Anne , Keevans Mary , Laird Eamon , McHugh Tina , McKiernan Susan , Miggin Sarah Jayne , Murtagh Ross , Connor Eileen O. , O’Meara Marie , Reilly Deirdre O. , Lambert John S. 
Published: June 2021

Abstract
Background
Prisoners are recognised as a high-risk population and prisons as high-risk locations for the transmission of hepatitis c virus (HCV) infection. Injecting drug use (IDU) is the main driver of HCV infection in prisoners and harm reduction services are often suboptimal in prison settings. HCV prevalence and incident data in prisoners is incomplete which impacts the public health opportunity that incarceration provides in identifying, treating and preventing HCV infection. The aim of this study is to identify new HCV infection and associated risk factors in an Irish male prison.

Methods
We conducted a follow up (18-month) cohort study on prisoners who had previously tested negative, self-cleared or had been successfully treated for HCV infection. We conducted the study in a male medium security prison located in Dublin Ireland (Mountjoy Prison) using HCV serology, a review of medical records and a researcher-administered questionnaire.

Results
99 prisoners with a mean age of 33.2 yrs. participated in the study and 82(82.8%) completed a research-administered questionnaire. Over half (51%) had a history of drug use from a young age (14.8 yrs.), 49.9% a history of heroin use and 39% a history of IDU. The prevalence of HIV and hepatitis B virus core antibody was 3% and HCV antibody was 22.2%. No new HCV infections were identified in those who had never been infected (n = 77), had self-cleared (n = 9) or achieved sustained virological response (n = 12). Small numbers of prisoners continued to engage in risk-behaviour including, IDU both in the prison (n = 2) and the community (n = 3), sharing syringes (n = 1) and drug taking paraphernalia (n = 6) and receiving non-sterile tattoos (n = 3).

Conclusion
Despite the high numbers of Irish prisoners with a history of IDU and HCV infection, new HCV infection is low or non-existent in this population. Small numbers of prisoners continue to engage in risk behaviour and larger studies are required to further understand HCV transmission in this cohort in an Irish and international context.
Different responses of soil respiration and its components to nitrogen and phosphorus addition in a subtropical secondary forest
Authors: Zhang Junjun , Li Yong , Wang Jinsong , Chen Weinan , Tian Dashuan , Niu Shuli 
Published: June 2021

AbstractBackgroundNitrogen (N) and phosphorus (P) deposition have largely affected soil respiration (Rs) in forest ecosystems. However, few studies have explored how N and P individually or in combination to influenceRsand its components (autotrophic respiration,Ra; heterotrophic respiration,Rh), especially in highly P-limited subtropical forests. To address this question, we conducted a field manipulation experiment with N and/or P addition in a 50-year-old subtropical secondary forest.ResultsWe found that N addition on average reducedRs,Ra, andRhby 15.2%, 15%, and 11.7%, respectively during 2-year field study. P addition had an inconsistent effect onRa, withRaincreasing by 50.5% in the first year but reducing by 26.6% in the second year. Moreover, P addition on average decreasedRhby 8.9%–30.9% andRsby 6.7%–15.6% across 2 years. In contrast, N and P co-addition on average increasedRs,Ra, andRhby 1.9%, 7.9%, and 2.1% during the experimental period. ThoughRsandRhwere significantly correlated with soil temperature, their temperature sensitivities were not significantly changed by fertilization.Rawas predominantly regulated by soil nitrogen availability (NH4+and NO3−), soil dissolved organic carbon (DOC), and enzyme activities, while the variation inRhwas mainly attributable to changes in soil microbial community composition and soil β-D-Cellubiosidase (CB) and β-Xylosidase (XYL) activities.ConclusionOur findings highlight the contrasting responses ofRsand its components to N or P addition against N and P co-addition, which should be differentially considered in biogeochemical models in order to improve prediction of forest carbon dynamics in the context of N and P enrichment in terrestrial ecosystems.
Smartphone fundus photography: a narrative review
Authors: Iqbal Usama 
Published: June 2021

Abstract
Background
The idea to use smartphone for fundus photography was put forward in 2010. Over the last decade, there has been a dramatic development in this field. This narrative review focuses on the principle of smartphone fundus photography, how to master this technique, problems encountered by the beginners, camera applications/devices designed for this purpose and the safety profile of smartphone flashlights for retinal photoreceptors.

Discussion
Smartphone fundus photography using a condensing lens is based on the same principle as indirect ophthalmoscopy. Smartphone flashlight serves the purpose of light source or illuminating system. Real and inverted image of the retina is focused by the smartphone camera after adjustment of the filming distance. Beginners can face difficulties like adjustment of the filming distance, glare from condensing lens and reflection from the ceiling lights. Mobile camera applications and holding devices designed for this purpose can help the beginners to address these difficulties. There have been safety concerns about photo-biological risk for retinal photoreceptors by flashlight. Although the spectral irradiance on the retina, while using smartphone for fundus imaging is within the safety limits set by ISO 15004-2.2. The safety profile of latest model flashlights which deliver more power compared to older flashlights, need to be assessed.

Conclusion
Smartphone fundus photography is a cheap, cost effective, portable and a convenient method for retinal imaging. With practice and use of smartphone camera applications designed for this purpose, the beginners can master this technique. By training young ophthalmology residents and ophthalmic primary caretakers, this retinal imaging technique can be utilized for artificial intelligence, patient diagnostic and educational purposes.