bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mixed effect of increasing outflow of medical patients from an emergency department
Authors: Mendlovic Joseph , Zalut Todd , Munter Gabriel , Merin Ofer , Yinnon Amos M. , Katz David E. 
Published: October 2021

Abstract
Background and aim
Since 2014, the annual number of patients entering our emergency department (ED) has increased significantly. These were primarily Internal Medicine (IM) patients, and of these, 25–30% were admitted. The present governmental policy presents a deterrent to adding IM beds for these patients, and Emergency and IM departments cope with ever-increasing number of IM patients. We describe a quality improvement intervention to increase outflow of IM patients from the ED to the IM departments.

Methods
We conducted a quality improvement intervention at the Shaare Zedek Medical Center from 2014 to 2018. The first stage consisted of an effort to increase morning discharges from the IM departments. The second stage consisted of establishing a process to increase the number of admissions to the IM departments from the ED.

Results
Implementation of the first stage led to an increased morning discharge rate from a baseline of 2–4 to 18%. The second stage led to an immediate mean (± SD) morning transfer of 35 ± 7 patients to the medical departments (8–12 per department), providing significant relief for the ED. However, the additional workload for the IM departments’ medical and nursing staff led to a rapid decrease in morning discharges, returning to pre-intervention rates. Throughout the period of the new throughput intervention, morning admissions increased from 30 to > 70%, and were sustained. The number of patients in each department increased from 36 to 38 to a new steady state of 42–44, included constant hallway housing, and often midday peaks of 48–50 patients. Mean length of stay did not change. IM physician and nurse dissatisfaction led to increased number of patients being admitted during the evening and night hours and fewer during the morning.

Conclusion
We describe a quality improvement intervention to improve outflow of medical patients from the ED in the morning hours. The new ED practices had mixed effects. They led to less ED crowding in the morning hours but increased dissatisfaction among the IM department medical and nursing staff due to an increased number of admissions in a limited number of hours. The present governmental reimbursement policy needs to address hospital overcrowding as it relates to limited community healthcare beds and an aging population.
The relevance of target product profiles for manufacturers, experiences from the World Health Organization initiative for point-of-care testing for sexually transmitted infections
Authors: Murtagh Maurine , Blondeel Karel , Peeling Rosanna W. , Kiarie James , Toskin Igor 
Published: October 2021

Abstract
Background
Sexually transmitted infections (STIs) are a significant global public health issue that cause a high burden of disease, especially in low- and middle-income countries. Screening of key populations and early and accurate diagnosis of infection are critical. Testing for syphilis, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, curable STIs, as well as the human papillomavirus (HPV), is frequently unavailable in low-resource settings. Tests for these STIs that can be used at the point of patient care (POCTs) are needed.
In recent years, there has been increased attention for STI POCTs, but technical guidance, financial resources and advocacy for additional platforms/tests are required in order to foster the development of STI POCTs. The WHO Department of Sexual and Reproductive Health and Research (SRH) has developed target product profiles (TPPs), a form of technical guidance, for these STI diagnostics.

Methods
SRH conducted a survey of selected companies that are developing POCTs for one or more of the STIs mentioned above to better understand how these TPPs influence the diagnostic development process – to assess their impact.

Results
Survey respondents indicated that the STI POCT TPPs provided good guidance with respect to performance expectations and operational characteristics for the tests/platforms. In particular, optimal metrics for sensitivity, specificity, sample types, and time to result were considered to be very useful.
Respondents also suggested ways to improve the relevance of the STI POCT TPPs. For example, since it is often not possible for developers to achieve every desired standard, it would be useful to prioritize each performance/operational characteristic of the test and to provide a rationale as to why certain characteristics are considered important.
Respondents also emphasized the need to encourage industry participation in the TPP development process and to find creative ways, including via targeted emails, a WHO webpage directed at industry, or a coordinated communications plan to increase awareness of the TPPs.

Conclusions
Companies value the STI POCT TPPs and want them to continue. In order to maximize impact, WHO should consider the proposals from the manufacturers in the interest of increasing and accelerating access to STI diagnostics and treatment in low-resource settings.
Roles of the intestinal microbiota and microbial metabolites in acute GVHD
Authors: Lin Dandan , Hu Bo , Li Pengfei , Zhao Ye , Xu Yang , Wu Depei 
Published: October 2021

AbstractAllogeneic hematopoietic stem cell transplantation (allo-HSCT) is one of the most curative strategies for the treatment of many hematologic malignancies and diseases. However, acute graft-versus-host disease (GVHD) limits the success of allo-HSCT. The prevention and treatment of acute GVHD is the key issue for improving the efficacy of allo-HSCT and has become a research hotspot. The intestine is the primary organ targeted by acute GVHD, and the intestinal microbiota is critical for maintaining the homeostasis of the intestinal microenvironment and the immune response. Many studies have demonstrated the close association between the intestinal microbiota and the pathogenesis of acute GVHD. Furthermore, dysbiosis of the microbiota, which manifests as alterations in the diversity and composition of the intestinal microbiota, and alterations of microbial metabolites are pronounced in acute GVHD and associated with poor patient prognosis. The microbiota interacts with the host directly via microbial surface antigens or microbiota-derived metabolites to regulate intestinal homeostasis and the immune response. Therefore, intervention strategies targeting the intestinal microbiota, including antibiotics, prebiotics, probiotics, postbiotics and fecal microbiota transplantation (FMT), are potential new treatment options for acute GVHD. In this review, we discuss the alterations and roles of the intestinal microbiota and its metabolites in acute GVHD, as well as interventions targeting microbiota for the prevention and treatment of acute GVHD.
Five transition pathways to renewable energy futures—scenarios from a Delphi study on key drivers and policy options
Authors: Rikkonen Pasi , Lauttamäki Ville , Parkkinen Marjukka , Varho Vilja , Tapio Petri 
Published: October 2021

AbstractAt many levels of society—in regions, corporations, and among citizens—awareness is increasing, and actions towards more sustainable energy are being taken. The key drivers of this transition have been climate change, the scarcity of resources, and environmental consciousness. The speed of change and its impacts on the energy system transition are still unknown. It is therefore important to anticipate probable, preferable, or avoidable future paths that will contribute to the discussion of the direction and conditions of such futures. In this article, five energy scenarios are presented for Finland until 2030. The scenarios are based on a two-round Delphi application, in which energy experts were first interviewed and then a survey phase was conducted. We used cluster analysis to construct the scenarios and arranged the responses to open-ended questions as narratives to deepen the scenarios. Based on the cluster analysis, five clusters were constructed, namely, (1) business as usual, (2) energy saving and decarbonisation, (3) climate-friendly transformation, (4) green growth, and (5) degrowth. These scenarios illustrate how varying sets of drivers of change in society, and a set of energy policy measures, are connected with energy futures. Expert information thus organised can be used to advise policymakers when designing future climate and energy policy.
Burnout among staff on specialized eating disorder units in Norway
Authors: Hage Trine Wiig , Isaksson Rø Karin , Rø Øyvind 
Published: October 2021

Abstract
Objective
Burnout is commonly associated with low workplace wellbeing. Patients with eating disorders are frequently referred to as a particularly challenging group to treat. It is therefore important to study healthcare providers´ workplace wellbeing in settings which treat eating disorders. The aims of the current study were to (a) measure burnout among healthcare providers working on specialized eating disorder units in Norway, and (b) explore factors predicting burnout.

Methods
186 participants from 11 specialized eating disorder units in Norway completed an online survey including the Mashlach Burnout Inventory, and eating disorder-specific factors related to burnout, job satisfaction, work environment, emotional dissonance and stress. Multiple regression analysis was used to identify predictors of burnout.

Results
Overall, low levels of burnout were found among the participants. Eating disorder-specific factors and emotional dissonance predicted the three central aspects of burnout, namely, emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment.

Conclusions
Findings suggest a relatively low level of burnout across age, gender, and professional categories working at specialized eating disorder units, contrary to commonly-held assumptions pertaining to the challenges involved in treating individuals with eating disorders.
Biological anomalies in the sugarcane leafhopper, Pyrilla perpusilla (Walker) due to parasitism by Fulgoraecia melanoleuca (Fletcher) (Lepidoptera: Epipyropidae)
Authors: Sharma Tarun , Shera P. S. 
Published: October 2021

Abstract
Background
Fulgoraecia melanoleuca (Fletcher) (Lepidoptera: Epipyropidae) (= Epipyrops or Epiricania melanoleuca) is an important koinobiont nymphal and adult ectoparasitoid of sugarcane leafhopper, Pyrilla perpusilla (Walker) (Hemiptera: Lophopidae). The study aimed to evaluate whether and to what extent this parasitoid effects the fitness of immature (five nymphal stages) and adult (♂ and ♀) stages of its host P. perpusilla.

Results
The nymphal mortality was significantly more in the younger nymphs, and it decreased as the host aged. The exposure of the first stage host nymphs to the parasitoid resulted in 100% mortality. However, the nymphal mortality rates in second, third, fourth and fifth nymphal stage were 94.0, 75.0, 38.0 and 41.0%, respectively. Furthermore, the longevity of surviving nymphs was prolonged significantly in the later stages. None of the parasitized first to fourth stage nymphs survived as normal adult. In case of the parasitized fifth nymphal stage, 18.0% adults were normal; however, their longevity was comparatively shorter than their un-parasitized counter parts. When male and female adults of leafhopper were offered to the parasitoid, significant differences were found in mortality of parasitized and un-parasitized adults for both sexes. Further, parasitoid-induced prolongation in the longevity of the surviving parasitized adults was also observed.

Conclusions
Overall, the parasitoid F. melanoleuca had detrimental effects on host fitness and thus played a significant role as a biological control agent in suppressing the sugarcane leafhopper population. This study will clarify host-parasitoid relationship, developing mass rearing protocol under laboratory conditions and implementing effective strategies for augmentative releases of parasitoids in biological control program against P. perpusilla in sugarcane ecosystem.
Iron oxide nanoparticles effect on growth, physiological traits and nutritional contents of Moringa oleifera grown in saline environment
Authors: Tawfik M. M. , Mohamed Magda H. , Sadak Mervat Sh. , Thalooth Alice T. 
Published: October 2021

AbstractBackgroundUsing of nanoparticles in various aspects of life including agriculture, medicine and industry is very crucial. One of the important source for Fe nutrition in plants is Iron oxide nanoparticles (Fe3O4NPs) due to its efficiency in releasing under different pH range. Thus, in the Model Farm of National Research Centre Egypt at El Tour South Sinai, a field experiment was carried out, to study the effect of different concentration of Fe3O4NPs (0, 20, 40, 60 ppm) on the physiological parameters and the nutritive value of Moringa under saline condition.ResultsThe obtained results indicate that foliar spraying of Fe3O4NPs significantly promote growth (plant height, branches leaves number per plant, leaf area, stem diameter and biomass). Foliar treatment also increased photosynthetic pigments (chlo.a,chlob,chloa/b and carotenoids) and indole acetic acid (IAA) contents comparing with control. Hydrogen peroxide and lipid peroxidation contents ofMoringa oleiferaleaves were decreased significantly as compared with control plant. The maximum activities of antioxidant enzymes Peroxidase (POX), poly phenol oxidase (PPO), super oxide dismutase (SOD) and nitrate reductase (NR) were observed in plants treated with 40 ppm. Different concentrations of Fe3O4NPs increased significantly crude protein, crude fiber and ash percentages as well as, some nutrient contents of moringa leaves (N, P, K and K/Na) compared with untreated control plants, meanwhile decreased Na contents.ConclusionTreatment ofMoringa oleiferaplant with Fe3O4NPs at different concentrations greatly decrease the harmful effect of salinity on growth by its promotive role on different studied biochemical and physiological aspects.
The long-term prognosis and predictors of epilepsy: a retrospective study in 820 patients
Authors: Yang Haoran , Zhang Jun , Yang Chenxi , Wu Dan , Liu Xiaoyun , Lu Hongjuan , Zhou Wei , Sun Wei 
Published: October 2021

AbstractBackgroundTo investigate the prognosis and predictors for seizure control in epileptic patients in China.MethodsEight hundred and twenty patients with epilepsy who visited Xuanwu Hospital from October 2017 to January 2020, were enrolled. The clinical information of the patients was obtained by retrospectively reviewing medical records. Prognostic measures of seizure control included remission, relapse and occurrence of drug resistance. The relationship of prognosis of seizure control with factors such as demographics, clinical characteristics and initial electroencephalography (EEG) features was investigated.ResultsA total of 503 (61.3%) patients experienced a 1-year remission and 330 (49.3% of 669) had a 2-year remission. Idiopathic type of epilepsy (P <  0.001), normal EEG (P <  0.05), number of antiepileptic drugs (P <  0.05) and seizure frequency of < 1 /month (P <  0.001) at the first arrival predicted a remission independently. Of the 503 patients who achieved a 1-year remission, 184 (36.6%) experienced a relapse, due to external reversible causes (58 patients) or with unknown reversible triggers (126 patients). No factors were found to be associated with a relapse (P > 0.05). At the end of the study, 322 patients (39.3%) developed drug resistance. The development of drug resistance was associated with the following factors: symptomatic aetiology of epilepsy, epileptiform abnormality in EEG, number of antiepileptic drugs and seizure frequency of ≥1 /month at first arrival (P <  0.001). For symptomatic epilepsy, patients with meningitis/encephalitis (P = 0.007) were more likely to develop drug-resistant epilepsy than these with other causes.ConclusionsRemission is a common process. The type of epilepsy (idiopathic or symptomatic), EEG features, seizure frequency and treatment history at first arrival are related to both remission and terminal drug resistance. Among various causes of symptomatic epilepsy, meningitis/encephalitis is associated with the worst prognosis of epilepsy.
Value of HRCT of the chest in evaluation of ankylosing spondylitis: correlation between pleuro-parenchymal abnormalities and disease activity
Authors: Ibrahim Iman Mohamed Hamdy , Alaqel Ahlam Ahmed Hussein , Ghobashy Nehal El , Azzam Adel Ibrahim , Abd El-Mageed Mohammed Raafat 
Published: October 2021

Abstract
Background
Ankylosing spondylitis (AS) is a chronic inflammatory disorder primarily involving the sacroiliac joints and spine. It is associated with both articular and extra-articular clinical manifestations. Pulmonary involvement is a well-recognized comorbidity of AS, even among patients with early disease. The availability of high-resolution computed tomography (HRCT) has enabled better visualization of the entire lung parenchyma and earlier identification of lung pathologies, ranging from mild to more severe involvement, which were previously missed on X-rays. The aim of the study is to establish the role of HRCT in the detection of pleuro-parenchymal manifestations of AS and to look for correlations between these findings and AS activity.

Results
Lung CT scans were done for all our patients and 27 patients (90%) had positive HRCT thoracic findings, while the remaining 3 patients (10%) had a normal HRCT thoracic study. Lower lobe fibrotic changes were the most common finding seen in 20 patients (66.7%) followed by bronchial wall thickening in 13 patients (43.3%) and upper and lower fibrotic changes seen in 9 patients (30%). HRCT thoracic findings were more prominent in late AS (disease duration ≥ 10 years) (13 of 13 patients); while 14 of 17 patients with early AS (disease duration < 10 years) had mildly abnormal HRCT findings. The result of statistical analysis showed that there was negative correlation between thoracic findings and disease activity assessed by BASDAI and this correlation was insignificant (p value = 0.5).

Conclusion
HRCT offers an accurate and safe method of assessment of lung disease in patients with AS and without respiratory symptoms. Although there was no correlation between pulmonary findings and AS activity assessed by BASDAI, a positive correlation, albeit insignificant, between pulmonary involvement and disease duration had been found.
Efficacy of TheraTogs orthotic undergarment on modulation of spinal geometry in children with diplegic cerebral palsy
Authors: El Kafy Ehab Mohamed Abd , El-Shamy Shamekh Mohamed 
Published: October 2021

Abstract
Background
The use of TheraTogs orthotic undergarments has been suggested to improve the ability to stabilize the posture, to correct or prevent deformities, to improve functionality, and to enable the user a more appropriate functional pattern. The aim of this study was to investigate the efficacy of TheraTogs orthotic undergarment on modulation of spinal geometry in children with diplegic cerebral palsy. Forty children with diplegic cerebral palsy, with ages ranging from 6 to 9 years, were selected for this randomized controlled study. They were randomly assigned to (1) an experimental group that received TheraTogs orthotic undergarment (12 h/day, 3 days/week) plus traditional physical therapy for 3 successive months and (2) a control group that received only traditional physical therapy program for the same time period. Spinal geometry was measured at baseline and after 3 months of intervention using the Formetric system.

Results
Children in both groups showed significant improvements in the spinal geometry (P < 0.05), with significantly greater improvements in the experimental group than the control group. The post-treatment mean values of lateral deviation (mm), pelvic tilt (mm), trunk imbalance (mm), and surface rotation (mm) were 5.45, 6.35, 8.8, and 3.65 and 8, 8.9, 11.2, and 5.9 for the experimental and control group, respectively.

Conclusions
TheraTogs orthotic undergarment may be a useful tool for improving spinal geometry in children with diplegic cerebral palsy.

Trial registration
This study was registered in the ClinicalTrial.gov PRS (NCT04271618).
The post-pandemic era: will physical distancing be a perceived way of life?
Authors: Khan Soban Qadir , Al-Humaid Jehan , Farooqi Faraz Ahmed , Gad Mohammed M. , Al-Hareky Muhanad , Al-Onaizan Faisal , Al-Harbi Fahad A. 
Published: October 2021

Background: This study aimed to determine whether people living in the Eastern Region of Saudi Arabia would prefer to continue the practice of physical distancing after the coronavirus disease 2019 (COVID-19) pandemic or to return to their previous way of life. Methods: This cross-sectional study was conducted from August 2020 to October 2020 in the Eastern Region of Saudi Arabia. A pre-tested questionnaire was sent electronically through social media. Data on participants’ demographics and their perspectives regarding post-pandemic physical distancing were collected. The calculated sample size was 1,066; however, the total number of responses included in the analysis was 989. Results: The average age of the participants was 31.15±11.93 years. There were 435 men and 554 women in the study. Participants showed significantly high levels of disagreement with statements indicating that they were willing to use public transportation (61%), attend social gatherings (36%), and hug relatives or colleagues (40%) after the pandemic (p<0.001); however, 43% agreed that they would spend time with family or friends (p<0.001). The level of education was also found to be significantly related to the responses, and the level of disagreement increased as the level of education increased (p<0.001). Conclusions: One-third of the study participants planned to continue engaging in physical distancing even after the current pandemic. This clearly indicates that our lives are not returning to how they were before the pandemic. However, it cannot be concluded whether or not this behavior will prevail in the long run. If so, it may greatly affect some businesses and perhaps some social norms and values as well.
Myofunctional training with negative airway pressure for obstructive sleep apnea: a prospective non-randomized cohort feasibility study
Authors: Karan Suzanne , Voter William A. , Ward Denham 
Published: October 2021

Background: Orofacial myofunctional therapy (OMT), for obstructive sleep apnea (OSA) is emerging with recognition of specific phenotypes. Since many OSA sufferers are already familiar with positive airway pressure machines, we designed an OMT protocol involving the modification of such a machine to deliver negative airway pressure. We hypothesized that a three-month trial of using this protocol while awake would reduce the signs and symptoms of OSA. Methods: Fifteen adults with OSA enrolled for 30-minute sessions/three days a week for a three-month trial of “upper airway muscle physical therapy” while awake. Overnight sleep studies were performed before and after the intervention to determine each subject’s apnea hypopnea index (AHI), the primary outcome measure. Negative airway pressure application was determined by estimation of each subject’s one-repetition maximum (an exercise physiology measure of strength capacity). Exercise sessions consisted of subjects breathing against this pressure for a series of repetitions, and sets. Results: While the mean post study AHI was slightly improved (-4.3 ± 12.0 [ -10.9, 2.3], mean ± standard deviation, 95% confidence interval), it was not statistically significant. The results were similar when the AHI was divided by the sleep state (REM vs. non-REM). The nadir saturation was also essentially unchanged. The eight subjects with mild or moderate OSA (AHI < 30) showed similar results. Conclusions: Though there was no significant reduction in AHI in this small cohort, the methods elucidate a new daytime use for a machine with which many OSA sufferers are familiar. Trial registration: ClinicalTrials.gov NCT02109731 (registered on April 10th 2015)