bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of a decision support intervention for family members of adults who lack capacity to consent to trials
Authors: Shepherd Victoria , Wood Fiona , Griffith Richard , Sheehan Mark , Hood Kerenza 
Published: January 2021

Abstract
Background
Informed consent is required for participation in clinical trials, however trials involving adults who lack capacity to consent require different enrolment processes. A family member usually acts as a proxy to make a decision based on the patient’s ‘presumed will’, but these decisions can be challenging and families may experience an emotional and decisional burden. Decisions made on behalf of others are conceptually different from those made for ourselves. Innovations have been developed to improve informed consent processes for research, including a number of decision aids, however there are no interventions for proxies who are faced with more complex decisions. This article outlines the development of a novel decision aid to support families making decisions about research participation on behalf of an adult who lacks capacity to consent.

Methods
Decision support interventions should be developed using rigorous and evidence-based methods. This intervention was developed using MRC guidance for the development of complex interventions, and a conceptual framework for the development and evaluation of decision aids for people considering taking part in a clinical trial. The intervention was informed by a systematic review and analysis of existing information provision. Previous qualitative research with families who acted as proxies enabled the development of a theoretical framework to underpin the intervention. The intervention was iteratively developed with the involvement of lay advisors and relevant stakeholders.

Results
Previous research, theoretical frameworks, and decision aid development frameworks were used to identify and develop the intervention components. The decision aid includes information about the proxy’s role and utilises a values clarification exercise and decision support methods to enable a more informed and better-quality decision. Stakeholders, including those representing implementers and receivers of the intervention, contributed to the design and comprehensibility of the decision aid to ensure that it would be acceptable for use.

Conclusions
Frameworks for the development of decision aids for people considering participating in a clinical trial can be used to develop interventions for family members acting as proxy decision-makers. The decision support tool is acceptable to users. Feasibility testing and outcome measure development is required prior to any evaluation of its effectiveness.
Are health websites credible enough for elderly self-education in the most prevalent elderly diseases?
Authors: Valizadeh-Haghi Saeideh , Rahmatizadeh Shahabedin , Soleimaninejad Ali , Mousavi Shirazi Seyedeh Fatemeh , Mollaei Parisa 
Published: January 2021

Abstract
Background
The Elderly and their caregivers need credible health information to manage elderly chronic diseases and help them to be involved in health decision making. In this regard, health websites are considered as a potential source of information for elderlies as well as their caregivers. Nevertheless, the credibility of these websites has not been identified yet. Thus, this study aimed to evaluate the credibility of the health websites on the most prevalent chronic diseases of the elderly.

Methods
The terms “Chronic obstructive pulmonary disease”, “Alzheimer's”, “Ischemic heart disease”, and “Stroke” were searched using the three popular search engines. A total of 216 unique websites were eligible for evaluation. The study was carried out using the HONcode of conduct. The chi-square test was carried out to determine the difference between conforming and nonconforming websites with HONcode principles and website categories.

Results
The findings showed that half of the evaluated websites had fully considered the HONcode principles. Furthermore, there was a significant difference between websites category and compliance with HONcode principles (p value < .05).

Conclusion
Regarding the poor credibility of most prevalent elderly diseases’ websites, the potential online health information users should be aware of the low credibility of such websites, which may seriously threaten their health. Furthermore, educating the elderly and their caregivers to evaluate the credibility of websites by the use of popular tools such as HONcode of conducts before utilizing their information seems to be necessary.
Use of a quantitative data report in a hypothetical decision scenario for health policymaking: a computer-assisted laboratory study
Authors: Wronski Pamela , Wensing Michel , Ghosh Sucheta , Gärttner Lukas , Müller Wolfgang , Koetsenruijter Jan 
Published: January 2021

Abstract
Background
Quantitative data reports are widely produced to inform health policy decisions. Policymakers are expected to critically assess provided information in order to incorporate the best available evidence into the decision-making process. Many other factors are known to influence this process, but little is known about how quantitative data reports are actually read. We explored the reading behavior of (future) health policy decision-makers, using innovative methods.

Methods
We conducted a computer-assisted laboratory study, involving starting and advanced students in medicine and health sciences, and professionals as participants. They read a quantitative data report to inform a decision on the use of resources for long-term care in dementia in a hypothetical decision scenario. Data were collected through eye-tracking, questionnaires, and a brief interview. Eye-tracking data were used to generate ‘heatmaps’ and five measures of reading behavior. The questionnaires provided participants’ perceptions of understandability and helpfulness as well as individual characteristics. Interviews documented reasons for attention to specific report sections. The quantitative analysis was largely descriptive, complemented by Pearson correlations. Interviews were analyzed by qualitative content analysis.

Results
In total, 46 individuals participated [students (85%), professionals (15%)]. Eye-tracking observations showed that the participants spent equal time and attention for most parts of the presented report, but were less focused when reading the methods section. The qualitative content analysis identified 29 reasons for attention to a report section related to four topics. Eye-tracking measures were largely unrelated to participants’ perceptions of understandability and helpfulness of the report.

Conclusions
Eye-tracking data added information on reading behaviors that were not captured by questionnaires or interviews with health decision-makers.
On the move: exploring Inuit and non-Inuit health service providers’ perspectives about youth, family and community participation in care in Nunavik
Authors: Fraser Sarah Louise , Moulin Louise , Gaulin Dominique , Thompson Jennifer 
Published: January 2021

AbstractBackgroundLiterature about participation in health and social services suggests that youth, and more specifically Indigenous youth, are difficult to engage within health and social services. Youth are less likely to access services or to actively participate in decision-making regarding their personal care. Service providers play a crucial role in engaging youth based on the ways in which they seek, establish, and maintain relationships with youth and their families. The way in which providers engage with youth will depend on various factors including their own perceptions of the roles and relationships of the various people involved in youth’s lives. In this article, we analyze health and social service providers’ perspectives, experiences and expectations regarding the roles of Indigenous youth, families and community in care settings in Nunavik, Quebec.MethodsUsing a snowball sampling approach, we recruited 58 interview participants (39 non-Inuit and 19 Inuit), including psychiatrists, general practitioners, nurses, social workers, school principals, teachers, student counsellors, representatives of local committees, and police officers. The interviews focused on three broad areas: 1) participants’ current and past positions and roles; 2) participants’ perceptions of the clientele they work with (youth and their families); and 3) participants’ understandings of how collaboration takes place within and between services and the community. We conducted inductive applied thematic analyses and then analyzed the interview transcripts of Inuit and non-Inuit participants separately to explore the similarities and differences in perceptions based on positionality.ResultsWe organized the findings around three themes: I) the most commonly described interventions, II) different types of challenges to and within participation; and III) what successful participation can look like according to service providers. Participants identified the challenges that families face in moving towards services as well as the challenges that services providers face in moving towards youth and families, including personal, organizational and historical factors.ConclusionWe adopt a critical lens to reflect on the key findings in order to tease out points of tension and paradoxes that might hinder the participation of youth and families, specifically in a social context of decolonization and self-governance of services.
Cost‐effectiveness analysis of dabigatran, rivaroxaban and warfarin in the prevention of stroke in patients with atrial fibrillation in China
Authors: Wei Hongtao , Cui Can , Cui Xiangli , Liu Yi , Li Dandan 
Published: January 2021

Abstract
Background and objective
To evaluate the cost-effectiveness of new anticoagulants and warfarin in the prevention of stroke in Chinese patients with atrial fibrillation (AF).

Methods
The Markov model was constructed to compare patients’ quality-adjusted life-years (QALYs) using drug cost, the cost of the examination after taking a drug, and the incremental cost of other treatments. Both dabigatran (110 and 150 mg, twice a day) and rivaroxaban (20 mg, once a day) were compared with warfarin (3–6 mg, once a day). Willingness to pay, three times the 2018 China GDP per capita (9481.88 $), was the cost-effect threshold in our study.

Results
The total cost were was 5317.31$, 29673.33$, 23615.49$, and 34324.91$ for warfarin, rivaroxaban, dabigatran 110 mg bid, and dabigatran 150 mg bid, respectively. The QALYs for each of the four interventions were 11.07 years, 15.46 years, 12.4 years, and 15 years, respectively. The cost-effectiveness analysis of the three new oral anticoagulants and warfarin showed that the incremental cost-effectiveness ratio (ICER) was 5548.07$/QALY when rivaroxaban was compared with warfarin. Rivaroxaban was the most cost-effective choice and warfarin was the least.

Conclusions
In Chinese patients with AF, although warfarin is cheaper, rivaroxaban has a better cost-effectiveness advantage from an economic point of view.
A longitudinal study of the turning points and trajectories of therapeutic relationship development in occupational and physical therapy
Authors: Horton Ayana , Hebson Gail , Holman David 
Published: January 2021

AbstractBackgroundThe importance of the therapeutic relationship is widely recognised across healthcare professions. Despite the importance of therapeutic relationships, there are significant gaps in the knowledge base on how these relationships develop. To address these gaps, this study explores relationship dynamics by identifying relational turning points and trajectories in therapeutic relationships between occupational therapists and physical therapists and their patients. The implications for how a focus on these relational aspects can enhance clinical practice will be discussed.MethodsData collection was based on the Retrospective Interview Technique and consisted of two phases. In the first phase patients and therapists were asked to tell the story of their therapeutic relationship development and as part of this, identify the turning points that occurred. In the second phase, therapists-patient dyads were observed from their first interaction to their last to identify potential turning points and at the end of the relationship a participant verification interview was conducted with both dyadic partners individually. Template analysis was used to analyse the data.ResultsTherapists identified 6 distinct categories of turning points; Progress Towards Goals, Set-backs in Progress Towards Goals, Interpersonal Affective Bonding with Patients, Interpersonal Problems with Patients, Positive Feedback, and Negative Feedback. Patients identified 5 categories of turning points; Progress Towards Goals, Set-backs in Progress Towards Goals, Interpersonal Affective Bonding with Therapists, Agreement with Therapist and Change in Treatment. These turning points varied regarding their impact on the trajectory of the therapeutic relationship. The trajectory patterns identified were stable, upward, downward, and multidirectional.ConclusionThis study makes an important contribution to our understanding of therapeutic relationship dynamics in the occupational and physical therapy context. The results expose the challenges that therapists and patients face in building high-quality therapeutic relationships, the diversity of therapeutic relationships, and how these relationships develop over time. This is the first study to use a turning point analysis in research on therapeutic relationships.
The impact of introducing ambulance and delivery fees in a rural hospital in Tanzania
Authors: Vossius Corinna , Mduma Estomih , Moshiro Robert , Mdoe Paschal , Kvaløy Jan Terje , Kidanto Hussein , Lyanga Sara , Ersdal Hege 
Published: January 2021

Abstract
Background
Access to health care facilities is a key requirement to enhance safety for mothers and newborns during labour and delivery. Haydom Lutheran Hospital (HLH) is a regional hospital in rural Tanzania with a catchment area of about two million inhabitants. Up to June 2013 ambulance transport and delivery at HLH were free of charge, while a user fee for both services was introduced from January 2014. We aimed to explore the impact of introducing user fees on the population of women giving birth at HLH in order to document potentially unwanted consequences in the period after introduction of fees.

Methods
Retrospective analysis of data from a prospective observational study. Data was compared between the period before introduction of fees from February 2010 through June 2013 and the period after from January 2014 through January 2017. Logistic regression modelling was used to construct risk-adjusted variable-life adjusted display (VLAD) and cumulative sum (CUSUM) plots to monitor changes.

Results
A total of 28,601 births were observed. The monthly number of births was reduced by 17.3% during the post-introduction period. Spontaneous vaginal deliveries were registered less frequently with a decrease of about 17/1000 births in non-cephalic presentations. Labour complications and caesarean sections increased with about 80/1000 births. There was a reduction in newborns with birth weight less than 2500 g. The observed changes were stable over time. For most variables, a significant change could be detected after a few weeks.

Conclusion
After the introduction of ambulance and delivery fees, an increase in labour complications and caesarean sections and a decrease in newborns with low birthweight were observed. This might indicate that women delay the decision to seek skilled birth attendance or do not seek help at all, possibly due to financial reasons. Lower rates of births in a safe health care facility like HLH is of great concern, as access to skilled birth attendance is a key requirement in order to further reduce perinatal mortality. Therefore, free delivery care should be a high priority.
Development of the reproduction number from coronavirus SARS-CoV-2 case data in Germany and implications for political measures
Authors: Khailaie Sahamoddin , Mitra Tanmay , Bandyopadhyay Arnab , Schips Marta , Mascheroni Pietro , Vanella Patrizio , Lange Berit , Binder Sebastian C. , Meyer-Hermann Michael 
Published: January 2021

AbstractBackgroundSARS-CoV-2 has induced a worldwide pandemic and subsequent non-pharmaceutical interventions (NPIs) to control the spread of the virus. As in many countries, the SARS-CoV-2 pandemic in Germany has led to a consecutive roll-out of different NPIs. As these NPIs have (largely unknown) adverse effects, targeting them precisely and monitoring their effectiveness are essential. We developed a compartmental infection dynamics model with specific features of SARS-CoV-2 that allows daily estimation of a time-varying reproduction number and published this information openly since the beginning of April 2020. Here, we present the transmission dynamics in Germany over time to understand the effect of NPIs and allow adaptive forecasts of the epidemic progression.MethodsWe used a data-driven estimation of the evolution of the reproduction number for viral spreading in Germany as well as in all its federal states using our model. Using parameter estimates from literature and, alternatively, with parameters derived from a fit to the initial phase of COVID-19 spread in different regions of Italy, the model was optimized to fit data from the Robert Koch Institute.ResultsThe time-varying reproduction number (Rt) in Germany decreased to <1 in early April 2020, 2–3 weeks after the implementation of NPIs. Partial release of NPIs both nationally and on federal state level correlated with moderate increases inRtuntil August 2020. Implications of state-specificRton other states and on national level are characterized. Retrospective evaluation of the model shows excellent agreement with the data and usage of inpatient facilities well within the healthcare limit. While short-term predictions may work for a few weeks, long-term projections are complicated by unpredictable structural changes.ConclusionsThe estimated fraction of immunized population by August 2020 warns of a renewed outbreak upon release of measures. A low detection rate prolongs the delay reaching a low case incidence number upon release, showing the importance of an effective testing-quarantine strategy. We show that real-time monitoring of transmission dynamics is important to evaluate the extent of the outbreak, short-term projections for the burden on the healthcare system, and their response to policy changes.
A cross-sectional study of owner-reported health in Canadian and American cats fed meat- and plant-based diets
Authors: Dodd Sarah A. S. , Dewey Cate , Khosa Deep , Verbrugghe Adronie 
Published: January 2021

Abstract
Background
Cats, being obligate carnivores, have unique dietary requirements for nutrients most commonly found in dietary ingredients of animal origin. As such, feeding a diet devoid of animal-derived ingredients has been postulated as a possible cause of nutrient imbalances and adverse health outcomes. A small proportion of cat owners feed strictly plant-based diets to the cats in their care, yet the health and wellness of cats fed these diets has not been well documented.

Results
A total of 1325 questionnaires were complete enough for inclusion. The only exclusion criterion was failure to answer all questions. Most cats, 65% (667/1026), represented in the survey were fed a meat-based diet and 18.2% (187/1026) were fed a plant-based diet, with the rest fed either a combination of plant-based with meat-based (69/1026, 6.7%) or indeterminable (103/1026, 10%). Cat age ranged from 4 months to 23 years, with a median of 7 years, and was not associated with diet type. No differences in reported lifespan were detected between diet types. Fewer cats fed plant-based diets reported to have gastrointestinal and hepatic disorders. Cats fed plant-based diets were reported to have more ideal body condition scores than cats fed a meat-based diet. More owners of cats fed plant-based diets reported their cat to be in very good health.

Conclusions
Cat owner perception of the health and wellness of cats does not appear to be adversely affected by being fed a plant-based diet. Contrary to expectations, owners perceived no body system or disorder to be at particular risk when feeding a plant-based diet to cats. This study collected information from cat owners and is subject to bias, as well as methodological limitations. Further research is warranted to determine if these results are replicable in a prospective investigation.
Metabolomic profiles of plasma and uterine luminal fluids from healthy and repeat breeder Holstein cows
Authors: Funeshima Natsumi , Miura Ryotaro , Katoh Taiga , Yaginuma Hikari , Kitou Takeshi , Yoshimura Itaru , Konda Kunitoshi , Hamano Seizo , Shirasuna Koumei 
Published: January 2021

Abstract
Background
Repeat breeding is a critical reproductive disorder in cattle. The problem of repeat breeder cattle remains largely unmanageable due to a lack of informative biomarkers. Here, we utilized metabolomic profiling in an attempt to identify metabolites in the blood plasma and uterine luminal fluids. We collected blood and uterine fluid from repeat breeder and healthy cows on day 7 of the estrous cycle.

Results
Metabolomic analysis identified 17 plasma metabolites detected at concentrations that distinguished between the two groups, including decreased various bile acids among the repeat breeders. However, no metabolites that varied significantly were detected in the uterine luminal fluids between two groups. Among the plasma samples, kynurenine was identified as undergoing the most significant variation. Kynurenine is a metabolite produced from tryptophan via the actions of indoleamine 2,3-dioxygenase (IDO). As IDO is key for maternal immune tolerance and induced in response to interferon tau (IFNT, ruminant maternal recognition of pregnancy factor), we examined the responsiveness to IFNT on peripheral blood mononuclear cells (PBMC) isolated from healthy and repeat breeder cows. The mRNA expression of IFNT-response makers (ISG15 and MX2) were significantly increased by IFNT treatment in a dose-dependent manner in both groups. Although treatment with IFNT promoted the expression of IDO in PBMCs from both groups, it did so at a substantially reduced rate among the repeat breeder cows, suggesting that decreased levels of kynurenine may relate to the reduced IDO expression in repeat breeder cows.

Conclusions
These findings provide valuable information towards the identification of critical biomarkers for repeat breeding syndrome in cattle.