bluuebunny/crossref_metadata_2025_split huggingface dataset:
Determinants of dispensing antibiotics without prescription in Eritrea: a mixed-method qualitative study on pharmacy professionals’ perspective
Authors: Bahta Merhawi , Weldemariam Dawit G , Tesfamariam Sirak , Tesfamariam Eyasu H , Russom Mulugeta 
Published: August 2021

ObjectiveAntimicrobial resistance is a global public health challenge. Dispensing of antibiotics without prescription (DAWP), a major contributor to antibiotic resistance, is extensive in Eritrea. This study was, therefore, aimed at deeply understanding, qualitatively, the pharmacy professionals’ perspective on the factors that trigger DAWP and how this practice could be mitigated.DesignA qualitative exploratory study design was employed.SettingDrug retail outlets of Asmara, capital of Eritrea, and pharmaceutical services of Eritrea.ParticipantsThirty pharmacy professionals who were owners and employees of the drug retail outlets stationed in Asmara and six key informants from the pharmaceutical services of all administrative regions of Eritrea, selected purposively, were the study participants.Data collection and analysisThe data were collected using focus group discussions and key informant interviews between March and September 2020. The collected data were transcribed verbatim, translated to English and finally thematically analysed using an inductive approach.ResultsThe main triggering factors were related to the drug retail outlet owners, dispensers, healthcare system and patients. Knowledge and attitude-based motivation, economic interest, inadequate services in health facilities, weak regulatory enforcement, inadequate training, trust and satisfaction of patients, previous successful experience, seriousness of a condition and saving time and money were reported among others as determinants of DAWP.ConclusionsThe triggering factors to DAWP were found to be very complex and some of them were important that might require immediate attention from policymakers. Ensuring readily available and accessible healthcare services, empowering medicines regulation and continuing sensitisation of dispensers are highly recommended to minimise DAWP.
Implementation of a provincial acute stroke pathway and its impact on access to advanced stroke care in Saskatchewan
Authors: Holodinsky Jessalyn K , Onaemo Vivian N , Whelan Ruth , Hunter Gary , Graham Brett R , Hamilton Jessica , Schwartz Laura , Latta Lori , Peeling Lissa , Kelly Michael E 
Published: August 2021

BackgroundFor ischaemic stroke, outcome severity is heavily time dependent. Systems of care need to be in place to ensure that patients with stroke are treated quickly and appropriately across entire health regions. Prior to this study, the province of Saskatchewan, Canada did not have a provincial stroke strategy in place.MethodsA quality improvement project was undertaken to create and evaluate a provincial stroke strategy. The Saskatchewan Acute Stroke Pathway was created using a multidisciplinary team of experts, piloted at five stroke centres and then implemented provincially. The number of stroke alerts, door-to-imaging, door-to-needle, door-to-groin puncture times and treatment rates were collected at all centres. Improvements over time were analysed using run charts and individuals control charts.ResultsThe number of stroke alerts province-wide trended upwards in the last 6 months of the study. There were no clear trends or shifts in the proportion of stroke alerts treated with alteplase or endovascular therapy. Across the province, the weighted mean door-to-imaging time decreased from 21 to 15 min, the weighted mean door-to-needle time decreased from 62 to 47 min and the mean door-to-groin puncture time decreased from 83 to 70 min. There was high variability in the degree of improvement from centre to centre.ConclusionsThe implementation of a province wide acute stroke pathway has led to improvement in stroke care on a provincial basis. Further work addressing intercentre variability is ongoing.
Goldilocks Days: optimising children’s time use for health and well-being
Authors: Dumuid Dorothea , Olds Timothy , Lange Katherine , Edwards Ben , Lycett Kate , Burgner David P , Simm Peter , Dwyer Terence , Le Ha , Wake Melissa 
Published: August 2021

BackgroundOne size rarely fits all in population health. Differing outcomes may compete for best allocations of time. Among children aged 11–12 years, we aimed to (1) describe optimal 24-hour time use for diverse physical, cognitive/academic and well-being outcomes, (2) pinpoint the ‘Goldilocks Day’ that optimises all outcomes and (3) develop a tool to customise time-use recommendations.MethodsIn 2004, the Longitudinal Study of Australian Children recruited a nationally-representative cohort of 5107 infants with biennial follow-up waves. We used data from the cross-sectional Child Health CheckPoint module (2015–2016, n=1874, 11–12 years, 51% males). Time use was from 7-day 24-hour accelerometry. Outcomes included life satisfaction, psychosocial health, depressive symptoms, emotional problems, non-verbal IQ; vocabulary, academic performance, adiposity, fitness, blood pressure, inflammatory biomarkers, bone strength. Relationships between time use and outcomes were modelled using compositional regression.ResultsOptimal daily durations varied widely for different health outcomes (sleep: 8.3–11.4 hours; sedentary: 7.3–12.2 hours; light physical activity: 1.7–5.1 hours; moderate-to-vigorous physical activity (MVPA): 0.3–2.7 hours, all models p≤0.04). In general, days with highest physical activity (predominantly MVPA) and low sedentary time were optimal for physical health, while days with highest sleep and lowest sedentary time were optimal for mental health. Days with highest sedentary time and lowest physical activity were optimal for cognitive health. The overall Goldilocks Day had 10 hours 21 min sleep, 9 hours 44 min sedentary time, 2 hours 26 min light physical activity and 1 hour 29 min MVPA. Our interactive interface allows personalisation of Goldilocks Days to an individual’s outcome priorities.Conclusion‘Goldilocks Days’ necessitate compromises based on hierarchies of priorities for health, social and economic outcomes.
Do expert clinicians make the best managers? Evidence from hospitals in Denmark, Australia and Switzerland
Authors: Bäker Agnes , Goodall Amanda H 
Published: August 2021

IntroductionHospital quality rests on the morale and productivity of those who work in them. It is therefore important to try to understand the kinds of team leaders that create high morale within hospitals.MethodsThis study collects and examines data on 3000 physicians in hospitals from Denmark, Australia and Switzerland. It estimates regression equations to study the statistical predictors of levels of doctors’ job satisfaction, their intentions to quit or stay in their current hospital and their assessment of the leadership quality of their immediate manager. A particular concern of this study is to probe the potential role played by clinical expertise among those in charge of other physicians.ResultsWhen led by managers with high clinical expertise, hospital physicians are (1) more satisfied with their jobs, (2) more satisfied with their supervisors’ effectiveness and (3) less likely to wish to quit their current job. These findings are robust to adjustment for potential confounders, including age and job seniority, and pass a variety of statistical checks (including clustering of SEs and checking for omitted variable bias). They are replicated in each of the three nations.ConclusionPhysicians are happier with their jobs when led by outstanding clinical experts. It is not sufficient, it appears from this evidence, for leaders merely to be clinicians. This suggests that—though only an idealised and presumably infeasible randomised experiment could allow complete certainty—there is a natural case for managers within a hospital hierarchy to be drawn from the ranks of those who are themselves outstanding clinicians.
Efficacy and safety of filgotinib in methotrexate-naive patients with rheumatoid arthritis with poor prognostic factors: post hoc analysis of FINCH 3
Authors: Aletaha Daniel , Westhovens René , Gaujoux-Viala Cecile , Adami Giovanni , Matsumoto Alan , Bird Paul , Messina Osvaldo Daniel , Buch Maya H , Bartok Beatrix , Yin Zhaoyu , Guo Ying , Hendrikx Thijs , Burmester Gerd R 
Published: August 2021

ObjectiveThis analysis evaluated efficacy and safety of filgotinib, a Janus-associated kinase 1-preferential inhibitor, in methotrexate (MTX)-naive patients with rheumatoid arthritis (RA) with multiple poor prognostic factors (PPFs).MethodsThis was a post hoc analysis of the phase III, randomised, double-blind, active-controlled, FINCH 3 study (clinicaltrials.govNCT02886728). Patients received once-daily oral filgotinib 200 or 100 mg plus once-weekly oral MTX ≤20 mg (FIL200 + MTX and FIL100 + MTX), filgotinib 200 mg monotherapy (FIL200), or oral MTX monotherapy (MTX-mono) for up to 52 weeks. PPFs investigated were seropositivity for rheumatoid factor or anticyclic citrullinated peptide antibodies, high-sensitivity C reactive protein (CRP) ≥4 mg/L, Disease Activity Score in 28 joints with CRP (DAS28(CRP)) >5.1, and presence of erosions. Filgotinib efficacy and safety in patients with all four PPFs at baseline were explored versus MTX-mono within this subgroup and compared informally with the overall population.ResultsOf 1249 patients in FINCH 3, 510 (40.8%) had all PPFs. Efficacy of FIL200 + MTX among these patients was comparable to the overall population, with higher rates of 20%/50%/70% improvement from baseline by American College of Rheumatology criteria, DAS28(CRP) <2.6, and remission; greater improvement in physical function and pain; and better inhibition of structural damage relative to MTX-mono. FIL100 + MTX and FIL200 were not consistently more efficacious versus MTX-mono. Safety of filgotinib in patients with PPFs was comparable to the overall population; no new safety signals were observed.ConclusionFIL200 + MTX efficacy and safety in patients with multiple PPFs were similar to the overall population.
The consequences of dam passage for downstream-migrating American eel in the Penobscot River, Maine
Authors: Mensinger Matthew A. , Blomberg Erik J. , Zydlewski Joseph D. 
Published: August 2021

American eel (Anguilla rostrata) often pass hydropower dams during adult spawning migrations. We conducted a 4-year acoustic telemetry study that characterized passage risks through two dams (West Enfield and Milford) in the Penobscot River, Maine, USA. We released tagged fish (n = 355) at two sites, estimated survival and delay under variable river conditions, and compared performance among dammed and free-flowing river sections. Survival rates (standardized per river kilometre, rkm) were lower at West Enfield (Φrkm = 0.984 ± 0.006 SE) and Milford (Φrkm = 0.966 ± 0.007 SE) compared with undammed River sections (Φrkm = 0.998 ± 0.0003 SE). Cumulative mortality was 8.7% (4.4 km) and 14.2% (5.5 km) through dammed sections and 8.7% throughout the rest of the river (58.1 km). Fish that already passed an upstream dam incurred higher downstream mortality compared with individuals without passage experience. Additionally, fish endured long delays at dams, and >10% of fish were delayed >24 h. Low flows exacerbated the risk of mortality and delay. These results offer evidence for direct, latent, and sublethal consequences of dam passage for migrating eels.
Hand and Upper Limb Malformations in Italy: A Multicentric Study
Authors: Senes Filippo M. , Calevo Maria Grazia , Adani Roberto , Baldrighi Carla , Bassetto Franco , Corain Massimo , Landi Antonio , Lando Mario , Monticelli Andrea , Novelli Chiara , Pajardi Giorgio , Rosanda Elisa , Rossello Mario Igor , Santecchia Luigino , Zoccolan Andrea , Catena Nunzio 
Published: August 2021

Background: Although hand and upper limb malformations are quite frequent, up to now very few reports have been published on epidemiology. The aim of this study is to evaluate the number of infants who presented with hand and upper limb malformations from 2010 to 2015 in Italy. Methods: A retrospective analysis of a pediatric population presenting with hand and upper extremity malformations was carried out, gathering reports achieved from eight Italian Centers of pediatric hand surgery. Other factors such as gender, date and region of birth, family distribution of malformations and associated syndromes, were analysed. Results: Out of 3,100,421 live births, 765 children presented with hand and upper limb malformations. The incidence was 2,5/10,000 live births with a predominance of males and the right side. Radial polydactyly was the anomaly with the highest percentage, closely followed by simple syndactyly, simbrachidactyly and complex syndactyly. Less common conditions were the triphalangic thumb, thumb in palm, proximal radioulnar synostosis and Sprengel deformity. Inheritance of and familial predisposition to those malformations was recorded in 25 cases, while 84 children presented with syndromes related to hand anomalies. Conclusions: In conclusion the incidence of hand and upper extremity malformations in Italy is lower than that registered in other countries. The retrospective nature of the study combined with the fact that some defects frequently evade pediatric hand surgeon consultations are some possible limitations of the study. However, our data confirmed that, in spite of the decrease in the birth rate in Italy, the trend of congenital hand disorders maintained a stable trend. We aim to integrate this study with a prospective analysis and to involve the institutional health authorities in other countries so as to register the correct incidence of hand and upper extremity defects.
Non-Vascularized Tri-Cortical Iliac Crest Graft–A Reliable Option in the Management of Scaphoid Waist Non-Unions
Authors: Singh Vivek , Moger Nagaraj Manju , Jaisankar Pragadeeshwaran , Rajkumar Surjala , Chaudhary Sunny , Azam Quamar 
Published: August 2021

Background: Scaphoid non-union often leads to a change in biomechanics of the wrist joint. Various types of bone grafts and different sites of harvest have been described in the literature for scaphoid reconstruction. This study was conducted to assess the clinical and radiological outcome after non-vascularised tri-cortical iliac crest bone graft for non-union of scaphoid waist fractures. Methods: 12 adult patients who underwent reconstruction of scaphoid waist non-union with tricortical iliac crest grafting and internal fixation with headless compression screws (11 cases) and k-wires (1 case) were prospectively analysed. There were 11 males and 1 female (mean age 23.9 years). The mean duration of presentation was 5.7 months following injury. Outcome following surgery were analyzed clinically by range of movements (ROM) and functional scores like DASH and modified Mayo wrist score and radiologically by X-rays and Non contrast CT of the wrist. Radiological assessment included scaphoid length, radio-lunate (RL) angle and scapho-lunate (SL) angle at latest 6 months follow up. Results: Bony union was achieved in 10 cases (union rate 83%). All the cases which achieved union had a significant improvement in radiological and clinical outcome criterias at 6-month follow-up interval. 1 patient had persistent non-union and 1 had k-wire back out with fixation failure. Conclusions: It is important to restore scaphoid length and to correct flexion deformity for a successful outcome. This can reliably be acheived by a carefully planned wedge-shaped iliac crest graft along with secure fixation with a headless compression screw.
Artery-Only Fingertip Replantation Distal to the Lunula: A Retrospective Analysis of Clinical Results
Authors: Kaneshiro Yasunori , Yano Koichi , Hyun Seungho , Sakanaka Hideki , Hidaka Noriaki 
Published: August 2021

Background: Both arterial and venous repair are crucial for optimal results in digital replantation. However, anastomosis of veins becomes challenging in very distal fingertip amputation. This study aimed to report the clinical results of an artery-only replantation without vein repair for a distal fingertip amputation and to analyze the survival rate and clinical outcomes based on the amputation level. Methods: We performed a retrospective review of 47 digits in 38 patients who had undergone fingertip replantation with a mean follow-up period of 12 months. All patients had complete fingertip amputation distal to the lunula. Only one central artery repair distal to the arch was performed. All patients received the postoperative protocol including external bleeding and anticoagulation therapy. Results: By Ishilawa’s classification, 12 digits in subzone I, and 35 digits in subzone II. 31 of the 47 fingertip replantations (66%) were successful, and a significantly higher survival rate was observed in subzone I than in subzone II. The mean total active motion of surviving digits was 86% of normal side. The mean grip strength was 82% of normal side. The sensory recovery according to modified Highet and Saunders’ classification was S4, S3+, S3, and S2 in fingers 19, 2, 5 and 3, respectively. Conclusions: 66% of survival rate was achieved in fingertip replantation distal to lunula which including large number of crushing/avulsion injury. The result of comparison for the survival rate based on amputation level, a significantly higher survival rate was observed in subzone I compared to subzone II. Therefore, the artery-only fingertip replantation had a better indication for distal amputation, and an aggressive attempt for venous anastomosis or drainage, including a secondary surgery for proximal amputation could be attributed to a higher success rate.
Chasing Convex Bodies with Linear Competitive Ratio
Authors: Argue C. J. , Gupta Anupam , Tang Ziye , Guruganesh Guru 
Published: August 2021

We study the problem of chasing convex bodies online: given a sequence of convex bodies

the algorithm must respond with points

in an online fashion (i.e.,

is chosen before

is revealed). The objective is to minimize the sum of distances between successive points in this sequence. Bubeck et al. (STOC 2019) gave a

-competitive algorithm for this problem. We give an algorithm that is

-competitive for any sequence of length

.
Hardware Context Switch-based Cryptographic Accelerator for Handling Multiple Streams
Authors: Sasongko Arif , Kumara I. M. Narendra , Wicaksana Arief , Rousseau Frédéric , Muller Olivier 
Published: August 2021

The confidentiality and integrity of a stream has become one of the biggest issues in telecommunication. The best available algorithm handling the confidentiality of a data stream is the symmetric key block cipher combined with a chaining mode of operation such as cipher block chaining (CBC) or counter mode (CTR). This scheme is difficult to accelerate using hardware when multiple streams coexist. This is caused by the computation time requirement and mainly by management of the streams. In most accelerators, computation is treated at the block-level rather than as a stream, making the management of multiple streams complex.
This article presents a solution combining CBC and CTR modes of operation with a hardware context switching. The hardware context switching allows the accelerator to treat the data as a stream. Each stream can have different parameters: key, initialization value, state of counter. Stream switching was managed by the hardware context switching mechanism. A high-level synthesis tool was used to generate the context switching circuit. The scheme was tested on three cryptographic algorithms: AES, DES, and BC3. The hardware context switching allowed the software to manage multiple streams easily, efficiently, and rapidly. The software was freed of the task of managing the stream state. Compared to the original algorithm, about 18%–38% additional logic elements were required to implement the CBC or CTR mode and the additional circuits to support context switching. Using this method, the performance overhead when treating multiple streams was low, and the performance was comparable to that of existing hardware accelerators not supporting multiple streams.
An Efficient and Robust Method to Predict Multifractured Horizontal Well Production in Shale Oil and Gas Reservoirs
Authors: Chen Ling , Bai Yuhu , Xu Bingxiang , Li Yanzun , Dong Zhiqiang , Wang Suran 
Published: August 2021

Shale oil and gas reservoirs are developed by MFHWs. After large-scale hydraulic fracturing, it is hard to forecast the production rate using the theoretical method. In the engineering application field, the empirical method of DCA is often used to forecast the production rate of shale oil and gas produced by MFHWs. However, there are some problems in using DCA, like how to find out the proper decline model and switch point of two contiguous flowing periods and how to deal with the unsteady operation condition which causes a lot of uncertainty in production forecast. In order to solve these problems, firstly, a straight line model, representing the linear flow period in the life cycle of shale oil and gas produced by MFHWs, in the

Q
,
lg

q

coordinate system is proven to be theoretically proper. Secondly, the duration of the linear flow period is verified to be over 10~15 years by using an analytical model to do the calculation with the method of Monte Carlo random sampling taking a large amount of parameter combinations of Eagle Ford shale oil and gas reservoirs into calculation. And a field data analysis of Barnett and Eagle Ford also shows that the duration of linear flow period can be more than 10~15 years. Thus, a method of production forecast taking advantage of the straight line feature in the

Q
,
lg

q

coordinate system is raised. After practical use, it is found that the method is robust and can increase the forecast efficiency and decrease the manual error. Moreover, it can increase the accuracy of production forecast and deal with some unsteady operation conditions. Therefore, this new method has good promotional value in the engineering field.
iPSC-Derived Neoantigen-Specific CTL Therapy for Ewing Sarcoma
Authors: Ishii Midori , Ando Jun , Yamazaki Satoshi , Toyota Tokuko , Ohara Kazuo , Furukawa Yoshiki , Suehara Yoshiyuki , Nakanishi Mahito , Nakashima Kazutaka , Ohshima Koichi , Nakauchi Hiromitsu , Ando Miki 
Published: August 2021

Abstract

The prognosis of Ewing sarcoma caused by EWS/FLI1 fusion is poor, especially after metastasis. Although therapy with CTLs targeted against altered EWS/FLI1 sequences at the gene break/fusion site may be effective, CTLs generated from peripheral blood are often exhausted because of continuous exposure to tumor antigens. We addressed this by generating induced pluripotent stem cell (iPSC)–derived functionally rejuvenated CTLs (rejT) directed against the neoantigen encoded by the EWS/FLI1 fusion gene. In this study, we examined the antitumor effects of EWS/FLI1-rejTs against Ewing sarcoma. The altered amino acid sequence at the break/fusion point of EWS/FLI1, when presented as a neoantigen, evokes an immune response that targets EWS/FLI1+ sarcoma. Although the frequency of generated EWS/FLI1-specific CTLs was only 0.003%, we successfully established CTL clones from a healthy donor. We established iPSCs from a EWS/FLI1-specific CTL clone and redifferentiated them into EWS/FLI1-specific rejTs. To evaluate cytotoxicity, we cocultured EWS/FLI1-rejTs with Ewing sarcoma cell lines. EWS/FLI1-rejTs rapidly and continuously suppressed the proliferation of Ewing sarcoma for &gt;40 hours. Using a Ewing sarcoma xenograft mouse model, we verified the antitumor effect of EWS/FLI1-rejTs via imaging, and EWS/FLI1-rejTs conferred a statistically significant survival advantage. “Off-the-shelf” therapy is less destructive and disruptive than chemotherapy, and radiation is always desirable, particularly in adolescents, whom Ewing sarcoma most often affects. Thus, EWS/FLI1-rejTs targeting a Ewing sarcoma neoantigen could be a promising new therapeutic tool.