bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stakeholders’ perspectives on training over the counter medicine sellers and Community-based Health Planning and Services facilities to dispense antibiotics in Ghana
Authors: Afari-Asiedu Samuel , Hulscher Marlies , Abdulai Martha Ali , Boamah-Kaali Ellen , Wertheim Heiman F. L. , Asante Kwaku Poku 
Published: July 2021

Abstract
Background
Dispensing of antibiotics by over the counter medicine sellers (OTCMS) is a major driver of inappropriate use and resistance in low and middle income countries. Recent studies in Ghana revealed the need to consider training OTCMS and Community-based Health Planning and Services (CHPS)/health posts to dispense some antibiotics. Feasibility of training OTCMS and CHPS to dispense some antibiotics was explored in this study.

Methods
This was an explorative study involving 10 in-depth interviews (IDIs) among staff of Ghana health services (GHS), pharmacy council and the association of OTCMS at the district and regional levels. Next, findings were presented to the Ghana Antimicrobial Resistance (AMR) platform for further discussions at the national level. Five IDIs were also performed among selected members of the AMR platform as a follow-up on emerging issues. Data were thematically analysed and presented as narratives with quotes to support the findings.

Results
Two opposing views were found in our study. Leadership of OTCMS and GHS staff at the district health directorate supported the suggestion that OTCMS and CHPS should be trained to dispense specific antibiotics because they are already dispensing them. The leadership of OTCMS explained that some of their members are experienced and could be trained to improve their practices. In contrast, participants from pharmacy council, GHS in the region and national AMR platform generally alluded that OTCMS and CHPS should not be trained to dispense antibiotics because their level of education is inadequate. GHS personnel from the region further explained that training OTCMS could further compromise inappropriate antibiotic use in the context of already weak regulation enforcement. GHS and pharmacy council in the region rather suggested that OTCMS and CHPS should focus on public health education on disease prevention and appropriate antibiotic use.

Conclusions
There is general lack of consensus among stakeholders on whether OTCMS and CHPS should be trained to dispense specific antibiotics. Further stakeholder engagement is required to carefully consider this suggestion as views on feasibility differ. Ministries of health and healthcare agencies in Ghana and LMIC should improve access to approved health services to improve antibiotic use in rural settings.
Conservative oxygen therapy for critically ill patients: a meta-analysis of randomized controlled trials
Authors: Chen Xiao-Li , Zhang Bei-Lei , Meng Chang , Huang Hui-Bin , Du Bin 
Published: July 2021

Abstract
Objective
Conservative oxygen strategy is recommended in acute illness while its benefit in ICU patients remains controversial. Therefore, we sought to conduct a systematic review and meta-analysis to examine such oxygen strategies’ effect and safety in ICU patients.

Methods
We searched PubMed, Embase, and the Cochrane database from inception to Feb 15, 2021. Randomized controlled trials (RCTs) that compared a conservative oxygen strategy to a conventional strategy in critically ill patients were included. Results were expressed as mean difference (MD) and risk ratio (RR) with a 95% confidence interval (CI). The primary outcome was the longest follow-up mortality. Heterogeneity, sensitivity analysis, and publication bias were also investigated to test the robustness of the primary outcome.

Results
We included seven trials with a total of 5265 patients. In general, the conventional group had significantly higher SpO2 or PaO2 than that in the conservative group. No statistically significant differences were found in the longest follow-up mortality (RR, 1.03; 95% CI, 0.97–1.10; I2=18%; P=0.34) between the two oxygen strategies when pooling studies enrolling subjects with various degrees of hypoxemia. Further sensitivity analysis showed that ICU patients with mild-to-moderate hypoxemia (PaO2/FiO2 >100 mmHg) had significantly lower mortality (RR, 1.24; 95% CI, 1.05–1.46; I2=0%; P=0.01) when receiving conservative oxygen therapy. These findings were also confirmed in other study periods. Additional, secondary outcomes of the duration of mechanical ventilation, the length of stay in the ICU and hospital, change in sequential organ failure assessment score, and adverse events were comparable between the two strategies.

Conclusions
Our findings indicate that conservative oxygen therapy strategy did not improve the prognosis of the overall ICU patients. The subgroup of ICU patients with mild to moderate hypoxemia might obtain prognosis benefit from such a strategy without affecting other critical clinical results.
Active learning through flipped classroom in mechanical engineering: improving students’ perception of learning and performance
Authors: Cho Hyun Jin , Zhao Kejie , Lee Cho Rong , Runshe Debra , Krousgrill Chuck 
Published: July 2021

Abstract
Background
To address some challenges that the large lecture-focused courses have faced in higher education, the flipped classroom model was implemented in mechanical engineering. The purpose of the study was to investigate mechanical engineering undergraduate students’ performance in the flipped classroom. A comprehensive analysis was conducted to investigate the pedagogical benefits of active learning in the flipped classroom from a self-determination theory perspective. To evaluate the effectiveness of the flipped classroom, students’ academic achievements in the flipped classroom were compared with the ones in the traditional lecture format. Moreover, to explore in-depth students’ learning experiences and their perceptions about the flipped classroom, students’ open-ended surveys were analyzed.

Results
Results demonstrated that students in the flipped classroom performed better and favored the new model, feeling that flipped classroom was useful and helpful in preparing for the course. The qualitative findings showed that students felt that they benefited from the pre-week online lectures in the flipped classroom to prepare for the course.

Conclusions
The current study shows that the flipped classroom model has the potential to create an autonomy-supportive learning environment and provide beneficial learning experiences. This study highlights the benefits of and future direction for implementing the flipped classroom in traditional mechanical engineering courses.
Mature stand developmental stage has ceased to constitute the most suitable habitat for the capercaillie in the Augustów Forest, Poland
Authors: Drozdowski Stanisław , Zawadzka Dorota , Zawadzki Grzegorz , Studnicki Marcin , Brzeziecki Bogdan 
Published: July 2021

AbstractBackgroundForest management affects the habitat conditions for many forest-dwelling species. Among them, the capercaillie (Tetrao urogallus) is a rare forest grouse inhabiting old, mature forests. We compared the structure of forest habitat among 9 active and 9 abandoned leks in the Augustów Forest (North-Eastern Poland), within a radius of 1 km of the leks, defined as the Key Areas for the capercaillie in lowland temperate forest. Habitat measurements were conducted on 1779 circular plots. Assessments made on all plots related to 13 habitat variables measured or noted in the field, including stand structure, canopy closure, stand developmental stage, percentage of Scots pine (Pinus sylvestris), soil fertility and soil moisture, the share of undergrowth, the cover of shrubs, the cover of bilberry (Vacciniumsp.), and the presence of certain habitat elements important to the capercaillie.ResultsTo compare the still-occupied and the abandoned KAs for the capercaillie, a logistic regression model was developed. The variables best explaining differences between these two categories were: the occurrence of undergrowth layers, canopy closure in the second canopy layer, and stand age. According to the model, with the increase of the shrub-layer cover as well as the density of trees, the probability of the presence of the capercaillie decreased. The capercaillie in the area of the Augustów Forest occupy mainly dry and poor, middle-aged, pine-dominated forests, with a moderate extent of stand canopy closure and only weakly-developed layers of undergrowth.ConclusionsThe filling-in of mature stands with sub-canopy trees and shrubs (the process which is stimulated by climate change and site eutrophication) causes structural changes, which are unfavourable to the capercaillie. This might explain why in the course of the recent decades the capercaillie has abandoned the oldest stands, distinguished by the presence of bigger shares of undergrowth. The capercaillie has shifted to younger stands, which reveal a lesser extent of canopy closure and a more limited development of understorey vegetation.
Immediate Bystander Cardiopulmonary Resuscitation to Sudden Cardiac Arrest During Sports is Associated with Improved Survival—a Video Analysis
Authors: Panhuyzen-Goedkoop Nicole M. , Wellens Hein J. , Verbeek André L. M. , Piek Jan J. , Peters Ron J. G. 
Published: July 2021

Abstract
Background
Sudden cardiac arrest (SCA) during sports can be the first symptom of yet undetected cardiovascular conditions. Immediate chest compressions and early defibrillation offer SCA victims the best chance of survival, which requires prompt bystander cardiopulmonary resuscitation (CPR).

Aims
To determine the effect of rapid bystander CPR to SCA during sports by searching for and analyzing videos of these SCA/SCD events from the internet.

Methods
We searched images.google.com, video.google.com, and YouTube.com, and included any camera-witnessed non-traumatic SCA during sports. The rapidity of starting bystander chest compressions and defibrillation was classified as < 3, 3–5, or > 5 min.

Results
We identified and included 29 victims of average age 27.6 ± 8.5 years. Twenty-eight were males, 23 performed at an elite level, and 18 participated in soccer. Bystander CPR < 3 min (7/29) or 3–5 min (1/29) and defibrillation < 3 min was associated with 100% survival. Not performing chest compressions and defibrillation was associated with death (14/29), and > 5 min delay of intervention with worse outcome (death 4/29, severe neurologic dysfunction 1/29).

Conclusions
Analysis of internet videos showed that immediate bystander CPR to non-traumatic SCA during sports was associated with improved survival. This suggests that immediate chest compressions and early defibrillation are crucially important in SCA during sport, as they are in other settings. Optimal use of both will most likely result in survival. Most videos showing recent events did not show an improvement in the proportion of athletes who received early resuscitation, suggesting that the problem of cardiac arrest during sports activity is poorly recognized.
Urgent surgery for COVID-19–positive pediatric patient
Authors: Rivera-Calonje Franchesca , Chen Shiu-Yi Emily , Lo Carl , Le Sang , Nagoshi Makoto 
Published: July 2021

Abstract
Background
We present a case of COVID-19–positive pediatric patient for urgent urological surgery by spinal anesthesia to avoid aerosolizing procedure.

Case presentation
A 12-year-old, COVID-19–positive boy presented for urgent wound incision and drainage at the circumcision site. Our anesthetic plan consisted of spinal anesthesia with sedation. He was transported from the COVID-19 isolation floor to the negative pressure operating room. He was placed in lateral decubitus position and oxygen was delivered through facemask. Under sedation, spinal anesthesia was achieved at first attempt. The patient maintained spontaneous ventilation without airway intervention. Patient was recovered in the operation room then transported back to the floor.

Conclusion
Spinal anesthesia is a safe alternative to general endotracheal anesthesia for many pediatric urology procedures. Effective team communication and preparation are keys when caring COVID-19–positive patient in perioperative setting to avoid minimize the risk to healthcare providers.
Sustainability in dialysis therapy: Japanese local and global challenge
Authors: Nagai Kei , Barraclough Katherine , Ueda Atsushi , Itsubo Norihiro 
Published: July 2021

AbstractHuman-induced climate change is considered the greatest health threat of the 21st century. The health effects of climate change are becoming increasingly apparent, and there is substantial evidence indicating increased risk of kidney injury due to heat illness and other climate change-related meteorological abnormalities. On the other hand, healthcare itself is responsible for environmental burdens and has been estimated to generate between 3 and 10% of total national CO2 equivalent emissions. Dialysis has been estimated as one of the major contributors to healthcare’s carbon footprint. Especially in Australia and the UK, nations that have high awareness regarding environmental research, “Green Nephrology” has emerged as a new discipline. From both of these countries, a series of papers have been produced outlining the carbon footprint of hemodialysis, the results of surveys of specialists’ awareness of environmental issues, and proposals for how to save resources in dialysis therapy. Following on from this, several national and international nephrology societies have committed themselves to a range of initiatives aiming at “greening” the kidney sector. In Japan, where water and electricity supplies currently are stable, we occasionally are reminded of the potential for shortages of water and energy and of waste disposal problems. These issues particularly come to the fore in times of disasters, when hemodialysis patients need to be evacuated to distant dialysis facilities. Irrespective of the current state of resource availability, however, continuous efforts and the establishment of resource-saving procedures as a part of Japanese culture are highly desirable and would contribute to environmentally friendly healthcare. Japan needs to build awareness of these issues before the country faces a catastrophic situation of resource shortages. This review is intended as a call to action regarding environmental sustainability in kidney healthcare in Japan and the world.
Plant of the Millennium, Caper (Capparis spinosa L.), chemical composition and medicinal uses
Authors: Shahrajabian Mohamad Hesam , Sun Wenli , Cheng Qi 
Published: July 2021

Abstract
Background
Caper (Capparis spinosa L.) is a common member of the genus Capparis, which is a perennial shrub and thorny, and a common aromatic plant in many parts of the world, especially the Mediterranean regions.

Main body
The aim of this mini-review was to outline the most significant health benefits of caper in both traditional and modern pharmaceutical medicine. Scientific databases such as PubMed, Science Direct, Scopus, Research Gate, and Google Scholar with emphasis on Science Direct and Scopus have been used. A review of literature was carried out using the keywords caper, Capparis spinosa, health benefits, pharmaceutical benefits, natural products, and caper bush. During the writing of the review, the time period in which the papers were published had not been selected since the focus was on significant researched selected for the areas covered in this mini-review. The main components of its aerial parts are cappariloside A, stachydrin, hypoxanthine, uracil, capparine A, capparine B, flazin, guanosine, 1H-indole-3-carboxaldehyde, 4-hydroxy-1H-indole-3-carboxaldehyde, kaempferol, thevetiaflavone, tetrahydroquinoline, rutin, kaempferol-3-glucoside, kaempferol-3-rutinoside, kaempferol-3-rhamnorutinoside, isorhamnetin 3-O-rutinoside, quercetin 3-O-glucoside, ginkgetin, isoginkgetin, sakuranetin and glucocapparin in aerial parts. The main components of root are capparispine, cadabicine 26-O-β-D-glucoside, capparispine 26-O-β-D-glucoside, and stachydrine, seeds contain glucocapparin. Traditional application of caper is for treatment of headache, fever, convulsions, diabetes, toothache, menstruation, skin disease, kidney disease, liver disease, rheumatism, ulcers, hemorrhoids and sciatica. Fruit and leaves have anti-diabetic effects, fruits have anti-obesity, cholesterol-lowering and anti-hypertensive effects, roots, fruits, stem barks and shoots have antimicrobial effects, leaves, roots and fruits contain anti-inflammatory activity, and aerial parts have antihepatotoxic effects.

Conclusion
On the basis of phytochemical advantages and pharmacological benefits, caper shows its importance as one of the most notable medicinal plant for prevention and treatment of various diseases, however, more researches are need on the usage of caper, especially in modern pharmaceutical science.
Techniques for postmortem tenderisation in meat processing: effectiveness, application and possible mechanisms
Authors: Shi Haibo , Shahidi Fereidoon , Wang Jiankang , Huang Yan , Zou Ye , Xu Weimin , Wang Daoying 
Published: July 2021

Abstract
Developing efficient and promising tenderising techniques for postmortem meat is a heavily researched topic among meat scientists as consumers are willing to pay more for guaranteed tender meat. However, emerging tenderising techniques are not broadly used in the meat industry and, to some degree, are controversial due to lack of theoretical support. Thus, understanding the mechanisms involved in postmortem tenderisation is essential. This article first provides an overview of the relationship of ageing tenderisation and calpain system, as well as proteomics applied to identify protein biomarkers characterizing tenderness. In general, the ageing tenderisation is mediated by multiple biochemical activities, and it can exhibit better palatability and commercial benefit by combining other interventions. The calpain system plays a key role in ageing tenderisation functions by rupturing myofibrils and regulating proteolysis, glycolysis, apoptosis and metabolic modification. Additionally, tenderising techniques from different aspects including exogenous enzymes, chemistry, physics and the combined methods are discussed in depth. Particularly, innovation of home cooking could be recommended to prepare relatively tender meat due to its convenience and ease of operation by consumers. Furthermore, the combined interventions provide better performance in controlled tenderness. Finally, future trends in developing new tenderising techniques, and applied consideration in the meat processing industry are proposed in order to improve meat quality with higher economical value.

Graphical abstract
Herniation of ureter: a rare cause of hydroureteronephrosis
Authors: Gupta Preeti , Sharma Pankaj , Maurya Vinay , Bhatia Mukul 
Published: July 2021

Abstract
Background
Omentum and bowel loops are commonly seen in inguinal hernia. An unusual case of extraperitoneal herniation of ureter was detected in hernial sac with other contents, on computed tomography (CT) urography.

Case presentation
A 54-year-old male presented with inguinal hernia, with no previous history of surgery or trauma. Pre-operative screening showed a unilateral hydroureteronephrosis involving the pelvicalyceal system and entire ureter. No calculus was visualized in the ureter on ultrasound. On non-contrast CT (NCCT) followed by CT urography, the ureter was seen descending into the hernia sac causing hydroureteronephrosis. The patient subsequently underwent mesh repair surgery of the inguinal hernia with meticulous reduction of the herniated contents including the ureter, resulting in complete resolution of the hydroureteronephrosis.

Conclusion
An isolated extraperitoneal inguinal herniation of the ureter without concomitant urinary bladder involvement is extremely rare, especially with no prior history of trauma or surgery, as seen in our case. The case also exemplifies the role of pre-operative imaging as a protocol in cases of inguinal hernia to prevent per-operative complications.
Trauma and post-traumatic stress disorder in patients treated for opioid use disorder: findings from a 12-month cohort study
Authors: Rosic Tea , Au Vivian Y. O. , Worster Andrew , Marsh David C. , Thabane Lehana , Samaan Zainab 
Published: July 2021

Background
Exposure to traumatic events is both a risk factor for substance use and an adverse outcome of substance use disorders. Identifying and managing post-traumatic stress disorder (PTSD) in patients with addiction requires attention.

Aims
To examine the lifetime prevalence of traumatic events and past-month prevalence of PSTD in patients treated for opioid use disorder, and explore the association between trauma, PTSD and treatment outcomes.

Method
Participants (n = 674) receiving methadone treatment in 20 community clinics across Ontario, Canada, were administered the Mini-International Neuropsychiatric Interview to identify self-reported traumatic events and PTSD. Drug use was measured for 12 months by urine drug screens.

Results
Eleven per cent of participants met past-month criteria for PTSD (n = 72), and 48% reported history of traumatic events with no current PTSD (n = 323). Participants with PTSD were more likely to be female (odds ratio 2.13, 95% CI 1.20–3.76) and less likely to be employed (odds ratio 0.31, 95% CI 0.16–0.61) or married (odds ratio 0.51, 95% CI 0.26–0.90) than those with no trauma history. Antidepressants (39 v. 24%) and benzodiazepines (36 v. 18%) were differentially prescribed to patients with and without PTSD. Length of time in treatment and opioid use were not associated with trauma; however, suicidal ideation was more common in PTSD (odds ratio 2.29, 95% CI 1.04–5.01).

Conclusions
Trauma and PTSD are prevalent among patients with opioid use disorder, and consideration of trauma symptoms and associated characteristics is warranted. Patients with and without comorbid PTSD differ clinically and psychosocially, highlighting the relevance of integrating addiction and mental health services for this population.
Spectrum of BCR-ABL Mutations and Treatment Outcomes in Ethiopian Imatinib-Resistant Patients With Chronic Myeloid Leukemia
Authors: Tadesse Fisihatsion , Asres Getahun , Abubeker Abdulaziz , Gebremedhin Amha , Radich Jerald 
Published: July 2021

PURPOSE Despite the successes achieved in chronic myeloid leukemia (CML) with tyrosine kinase inhibitor (TKI) therapy, resistance remains an obstacle. The most common mechanism of resistance is the acquisition of a point mutation in the BCR-ABL kinase domain. Few studies have reported African patients with CML in regard to such mutations. We here report the types of BCR-ABL mutations in Ethiopian imatinib-resistant patients with CML and their outcome. PATIENTS AND METHODS Patients with CML with a diagnosis of imatinib resistance who were tested for BCR-ABL mutation between 2014 and September 2019 were included. RESULTS A total of 962 cases of CML on imatinib therapy were reviewed and 164 cases of failure were found. Of these, only 31 cases (19%) had mutation analysis performed. Most cases (94%) were secondary failures. At the time of CML diagnosis, the median age was 33 years and the majority presented with features of advanced-phase disease. Of the 31 patients, 22 mutations were found (65%). The types of mutations detected were as follows: non–P-loop mutations 36% (11), P-loop mutations 13% (four), and alternatively spliced BCR-ABL variants 23% (seven). The splice variant frequently detected was BCR-ABL35INS (20%). Twenty-six of the 31 patients (84%) were switched to second-line TKIs, whereas in four patients (13%), imatinib dose escalation was done. Overall, the outcome revealed that 16 patients (52%) were alive with complete hematologic response, whereas 12 patients (39%) had died. All patients who expressed BCR-ABL135INS were treated with second-line TKIs, and two of them (33%) had died because of disease progression. CONCLUSION In Ethiopia, CML affects the young and point mutations were frequently detected in imatinib-resistant patients. BCR-ABL1 35INS was also prevalent and associated with disease progression.