bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of chlorhexidine cleansing on healthcare-associated infections in neonates: a systematic review and meta-analysis
Authors: Zhou Jinyan , Mei Lingli , Chen Shuohui 
Published: December 2021

BackgroundHealthcare-associated infections (HAIs) have a significant impact on neonatal morbidity, mortality and long-term prognosis, which have a high incidence in neonates. Many studies have shown that chlorhexidine cleansing is effective in reducing HAIs in adults, but the effect of chlorhexidine cleansing on HAIs in neonates remains controversial.AimThe purpose of this study was to conduct a systematic review and meta-analysis of the effect of chlorhexidine cleansing on HAIs in neonates. The protocol of this review has been registered with the PROSPERO international prospective register of systematic reviews.MethodsA systematic literature search was performed on five medical literature databases, namely MEDLINE, Web of Science, Embase, Scopus and Cumulative Index to Nursing and Allied Health Literature (CINAHL), published up until 3 March 2021. In the end, six studies were eligible for inclusion, including four randomised controlled trials and two quasi-experimental studies. Version 2 of the Cochrane tool for assessing risk of bias in randomised trials and the Joanna Briggs Institute critical appraisal checklist for quasi-experimental studies were used for quality assessment. Pooled risk ratios (RRs) and their associated 95% CIs were calculated using the fixed effects model (I2 <50%) or the random effects model (I2 ≥50%).Findings and conclusionsThe results of the meta-analysis revealed that chlorhexidine cleansing had no significant effect on neonatal sepsis (RR: 0.49, 95% CI 0.18 to 1.38, p=0.18, I2=0%), but significantly reduced neonatal skin bacterial colonisation (RR: 0.61, 95% CI 0.42 to 0.90, p=0.01, I2=50%). In addition, this systematic review showed that chlorhexidine cleansing could significantly reduce central line-associated bloodstream infection in neonates based on large-sample studies. However, more studies are needed to determine the optimal concentration and frequency of chlorhexidine cleansing.PROSPERO registration number CRD42021243858.
Guided self-determination intervention versus attention control for people with type 2 diabetes in outpatient clinics: a protocol for a randomised clinical trial
Authors: Mathiesen Anne Sophie , Zoffmann Vibeke , Skytte Tine Bruhn , Jakobsen Janus C , Gluud Christian , Lindschou Jane , Rasmussen Bodil , Marqvorsen Emilie , Thomsen Thordis , Rothmann Mette 
Published: December 2021

IntroductionIn the management of type 2 diabetes, autonomy-supporting interventions may be a prerequisite to achieving more long-term improvement. Preliminary evidence has shown that the guided self-determination (GSD) method might have an effect on haemoglobin A1c and diabetes distress in people with type 1 diabetes. Previous trials were at risk of uncertainty. Thus, the objective is to investigate the benefits and harms of a GSD intervention versus an attention control group intervention in adults with type 2 diabetes.Methods and analysisThis trial protocol is guided by the The Standard Protocol Items: Recommendations for International Trials Statement. We describe the protocol for a pragmatic randomised, dual-centre, parallel-group, superiority clinical trial testing a GSD intervention versus an attention control for people with type 2 diabetes in outpatient clinics. The participants (n=224) will be recruited from two diverse regions of Denmark. The experimental stepped-care intervention will consist of three to five GSD sessions lasting up to 1 hour with a trained GSD facilitator. The sessions will be conducted face to face, by video conference or over the telephone. The attention controls will receive three to five sessions lasting up to an hour with a communication-trained healthcare professional provided face to-face, by video conference, or over the telephone. Participants will be included if they have type 2 diabetes,>18 years old, are not pregnant. Participants will be assessed before randomisation, at 5-month, and 12-month follow-up, the latter being the primary. The primary outcome is diabetes distress. Secondary outcomes are quality of life, depressive symptoms and non-serious adverse events. Exploratory outcomes are haemoglobin A1c, motivation and serious adverse events. Data will be collected using REDCap and analysed using Stata V.16.Ethics and disseminationThe trial will be conducted in compliance with the protocol, the Helsinki Declaration in its latest form, International Harmonisation of Good Clinical Practice guidelines and the applicable regulatory requirement(s). The trial has been approved by the Danish Data Protection Agency (P-2020-864). The Ethics Committee of the Capital Region of Denmark reviewed the trial protocol, but exempted the trial protocol from full review (H-20003638). The results of the trial will be presented at the outpatient clinics treating people with type 2 diabetes, at national and international conferences as well as to associations for people with diabetes and their relatives.Trial registration numberClinicalTrials.gov identifier:NCT04601311.
Prevalence of myopia and high myopia, and the association with education: Shanghai Child and Adolescent Large-scale Eye Study (SCALE): a cross-sectional study
Authors: He Xiangui , Sankaridurg Padmaja , Xiong Shuyu , Li Wayne , Naduvilath Thomas , Lin Senlin , Weng Rebecca , Lv Minzhi , Ma Yingyan , Lu Lina , Wang Jingjing , Zhao Rong , Resnikoff Serge , Zhu Jianfeng , Zou Haidong , Xu Xun 
Published: December 2021

ObjectivesTo report on: (a) overall myopia and high myopia prevalence, and (b) the impact of education on the spherical equivalent refractive error in children across Shanghai.DesignCross-sectional study.SettingAcross all 17 districts of Shanghai.Participants910 245 children aged 4–14 years from a school-based survey conducted between 2012 and 2013.Main outcome measuresData of children with non-cycloplegic autorefraction, visual acuity assessment and questionnaire were analysed (67%, n=6 06 476). Prevalence of myopia (≤−1.0 D) and high myopia (≤−5.0 D) was determined. We used a regression discontinuity design to determine the impact of school entry cut-off date (1 September) by comparing refractive errors at each age, for children born pre-September to post-1 September, and performed a multivariate analysis to explore risk factors associated with myopia. Data analysis was performed in 2017–2018.ResultsPrevalence rates of myopia and high myopia were 32.9% (95% CI: 32.8% to 33.1%) and 4.2% (95% CI: 4.1% to 4.2%), respectively. From 6 years of age onwards, children born pre-September were more myopic compared with those born post-1 September (ahead in school by 1 year, discontinuity at 6 years: −0.19 D (95% CI: −0.09 to −0.30 D); 14 years: −0.67 D (95% CI: −0.21 to −1.14 D)).ConclusionsOur findings suggest that myopia is associated with education, that is primarily focused on near-based activities. Efforts to reduce the burden should be directed to public awareness, reform of education and health systems.
Inequalities in excess premature mortality in England during the COVID-19 pandemic: a cross-sectional analysis of cumulative excess mortality by area deprivation and ethnicity
Authors: Barnard Sharmani , Fryers Paul , Fitzpatrick Justine , Fox Sebastian , Waller Zachary , Baker Allan , Burton Paul , Newton John , Doyle Yvonne , Goldblatt Peter 
Published: December 2021

ObjectivesTo examine magnitude of the impact of the COVID-19 pandemic on inequalities in premature mortality in England by deprivation and ethnicity.DesignA statistical model to estimate increased mortality in population subgroups during the COVID-19 pandemic by comparing observed with expected mortality in each group based on trends over the previous 5 years.SettingInformation on deaths registered in England since 2015 was used, including age, sex, area of residence and cause of death. Ethnicity was obtained from Hospital Episode Statistics records linked to death data.ParticipantsPopulation study of England, including all 569 824 deaths from all causes registered between 21 March 2020 and 26 February 2021.Main outcome measuresExcess mortality in each subgroup over and above the number expected based on trends in mortality in that group over the previous 5 years.ResultsThe gradient in excess mortality by area deprivation was greater in the under 75s (the most deprived areas had 1.25 times as many deaths as expected, least deprived 1.14) than in all ages (most deprived had 1.24 times as many deaths as expected, least deprived 1.20). Among the black and Asian groups, all area deprivation quintiles had significantly larger excesses than white groups in the most deprived quintiles and there were no clear gradients across quintiles. Among the white group, only those in the most deprived quintile had more excess deaths than deaths directly involving COVID-19.ConclusionThe COVID-19 pandemic has widened inequalities in premature mortality by area deprivation. Among those under 75, the direct and indirect effects of the pandemic on deaths have disproportionately impacted ethnic minority groups irrespective of area deprivation, and the white group the most deprived areas. Statistics limited to deaths directly involving COVID-19 understate the pandemic’s impact on inequalities by area deprivation and ethnic group at younger ages.
Multistakeholder perspectives on the strengthening and embedding of mandatory continuing medical education in Georgia: a qualitative study
Authors: Ruadze Ekaterine , Cherkezishvili Ekaterine , Roma Elisa , Walsh Kieran , Gabunia Tamar , Gamkrelidze Amiran 
Published: December 2021

ObjectiveContinuing medical education (CME) is a vital component of health systems. Setting up a CME system is a complex task, requiring involvement of stakeholders including educators, learners, institutions and policy makers. The aim of the study was to conduct qualitative research involving multiple stakeholders to explore the perceived effectiveness and shortcomings of the CME system in Georgia, its place in the health system and potential means of improving it.DesignThis is a qualitative study. All data were collected using semistructured individual interviews. The questions were derived from the relevant literature. Data analysis was conducted using comparative strategy.ParticipantsWe interviewed individuals from CME providers, medical establishments, the professional development board (PDB), and the Regulatory Agency for Medical and Pharmaceutical Activities. We thus interviewed 23 people (11 people from CME providers, 8 people from medical establishments, 3 PDB members and 1 person from Legal Entity under Public Law Regulatory Agency for Medical and Pharmaceutical Activities).ResultsGeorgia has had experience of mandatory CME in the past, which had been criticised for its poor quality and bureaucratic processes. CME is viewed as an essential developmental process for medical professionals, the outcome of which is to deliver high-quality medical care. Our interviewees identified a clear need for high-quality CME courses. However, significant challenges that need to be overcome include financial barriers, doctors’ attitudes to CME, a lack of CME courses in all medical specialties and relatively weak professional associations.ConclusionCME is widely recognised as an essential pillar in providing quality medical care. Establishing high-quality CME requires a strategic and holistic approach. In order to ensure the sustainable and effective implementation of the CME process, we need to take into account stakeholders’ interests and expectations, the socioeconomic status and development of the country, and past experiences of all relevant individuals and organisations.
Factors associated with the timely initiation of antenatal care: findings from a cross-sectional study in Northern Bangladesh
Authors: Sarker Bidhan Krishna , Rahman Tawhidur , Rahman Tanjina , Rahman Musfikur 
Published: December 2021

ObjectiveThis paper explored the factors that influence the timely initiation of antenatal care (ANC) in Bangladesh.DesignThis was a cross-sectional survey.SettingThis study conducted in two rural subdistricts and one urban area from three Northern districts of Bangladesh from August to November 2016.ParticipantsWomen who had a live birth in the last 1 year prior to data collection were enrolled for this study. In each study area, around 900 women were interviewed, and finally, we completed 2731 interviews.Primary outcome measuresThe primary outcome was timely first ANC from a Medically Trained Provider (MTP).ResultsAbout 43% of pregnancies were detected at their earliest time. The majority of participants (82%) received at least one ANC from an MTP. Only 11% received timely first ANC from an MTP as per the WHO FANC model. The women who detected pregnancy earlier were more likely (adj.OR 1.99, 95% CI 1.31 to 3.01) to receive the timely first ANC. The urban women were more likely (adj.OR 1.78, 95% CI 1.13 to 2.80) to receive the timely first ANC from an MTP than those of the rural women. Besides, their husbands’ educational status (adj.OR 1.61, 95% CI 1.0 to 2.60) was significantly associated with the timely first ANC.ConclusionApart from sociodemographic factors, early pregnancy detection was strongly associated with the timely first ANC visit. Timely initiation of ANC is an opportunity to adhere to all the WHO recommended timely ANC visits for a pregnant woman. The findings suggest maternal, neonatal, and child health programmes to focus on the early detection of pregnancy to ensure universal ANC coverage and its timeliness.
Adequacy and timeliness of antenatal care visits among Ethiopian women: a community-based panel study
Authors: Shiferaw Kasiye , Mengistie Bezatu , Gobena Tesfaye , Dheresa Merga , Seme Assefa 
Published: December 2021

ObjectivesThe purposes of the study are; (A) to identify whether Ethiopian women’s antenatal care (ANC) visits are adequate and timely and (B) to explore factors that determine these.DesignPanel study design.SettingEthiopia.ParticipantsA total of 2855 women nested within 217 enumeration areas.Primary outcome measuresAdequacy and timeliness of ANC visits.ResultsOf all the 2855 respondents, 65% had made an ANC visit once, while 26.8% initiated ANC visits in a timely way and 43.3% attended adequate ANC visits. Rural residence (adjusted OR (AOR)=0.55, 95% CI: 0.36 to 0.84), attending higher level of education (AOR=2.64, 95% CI: 1.47 to 4.77), being multipara (AOR=0.53, 95% CI: 0.32 to 0.89) and encouragement by partners to attend clinic for ANC (AOR=1.98, 95% CI: 1.14 to 3.44) were significantly associated with timeliness of ANC visit. Similarly, residing in rural areas (AOR=0.20, 95% CI: 0.12 to 0.35), attending higher level of education (AOR=2.96, 95% CI: 1.38 to 6.15), encouragement by partners to attend clinic for ANC (AOR=2.11, 95% CI: 1.31 to 3.40) and timeliness of ANC visit (AOR=4.59, 95% CI: 2.93 to 7.21) were significantly associated with adequacy of ANC visits.ConclusionsA quarter of the pregnant women started ANC visits during the first trimester and nearly half attended adequate ANC visits with wider disparities across regions of their origin and their background characteristics. Concerted efforts on tailored interventions for rural residents, female education and partner involvement are recommended for early and adequate ANC visit(s).
Spectral triples on irreversible C∗-dynamical systems
Authors: Aiello Valeriano , Guido Daniele , Isola Tommaso 
Published: December 2021

Given a spectral triple on a [Formula: see text]-algebra [Formula: see text] together with a unital injective endomorphism [Formula: see text], the problem of defining a suitable crossed product [Formula: see text]-algebra endowed with a spectral triple is addressed. The proposed construction is mainly based on the works of Cuntz and [A. Hawkins, A. Skalski, S. White and J. Zacharias, On spectral triples on crossed products arising from equicontinuous actions, Math. Scand. 113(2) (2013) 262–291], and on our previous papers [V. Aiello, D. Guido and T. Isola, Spectral triples for noncommutative solenoidal spaces from self-coverings, J. Math. Anal. Appl. 448(2) (2017) 1378–1412; V. Aiello, D. Guido and T. Isola, A spectral triple for a solenoid based on the Sierpinski gasket, SIGMA Symmetry Integrability Geom. Methods Appl. 17(20) (2021) 21]. The embedding of [Formula: see text] in [Formula: see text] can be considered as the dual form of a covering projection between noncommutative spaces. A main assumption is the expansiveness of the endomorphism, which takes the form of the local isometricity of the covering projection, and is expressed via the compatibility of the Lip-norms on [Formula: see text] and [Formula: see text].
Identifying non-pseudo-alternating knots by using the free factor property of minimal genus Seifert surfaces
Authors: Himeno Keisuke , Teragaito Masakazu 
Published: December 2021

Pseudo-alternating knots and links are defined constructively via their Seifert surfaces. By performing Murasugi sums of primitive flat surfaces, such a knot or link is obtained as the boundary of the resulting surface. Conversely, it is hard to determine whether a given knot or link is pseudo-alternating or not. A major difficulty is the lack of criteria to recognize whether a given Seifert surface is decomposable as a Murasugi sum. In this paper, we propose a new idea to identify non-pseudo-alternating knots. Combining with the uniqueness of minimal genus Seifert surface obtained through sutured manifold theory, we demonstrate that two infinite classes of pretzel knots are not pseudo-alternating.
Complexity of Shift Bribery in Committee Elections
Authors: Bredereck Robert , Faliszewski Piotr , Niedermeier Rolf , Talmon Nimrod 
Published: December 2021

Given an election, a preferred candidate
p
, and a budget, the S
HIFT
B
RIBERY
problem asks whether
p
can win the election after shifting
p
higher in some voters’ preference orders. Of course, shifting comes at a price (depending on the voter and on the extent of the shift) and one must not exceed the given budget. We study the (parameterized) computational complexity of S
HIFT
B
RIBERY
for multiwinner voting rules where winning the election means to be part of some winning committee. We focus on the well-established SNTV, Bloc,
k
-Borda, and Chamberlin-Courant rules, as well as on approximate variants of the Chamberlin-Courant rule. We show that S
HIFT
B
RIBERY
tends to be harder in the multiwinner setting than in the single-winner one by showing settings where S
HIFT
B
RIBERY
is computationally easy in the single-winner cases, but is hard (and hard to approximate) in the multiwinner ones.
Effect of Electromyographic Biofeedback Therapy on Muscle Strength Recovery in Children with Guillain–Barré Syndrome
Authors: Liu Qianqian , Xue Jianhua , Zhao Pingping , Ling Yue , Liu Suzhe , Du Yakun , Han Ning , Liu Mingxia , Di Wei 
Published: December 2021

GBS, as an immune-mediated acute inflammatory peripheral neuropathy (Tan and Halpin et al.), with the characteristics of acute onset and rapid progression, is mainly manifested with damages in nerve root and peripheral nerve. The purpose of the study was to investigate the effect of electromyographic biofeedback therapy on muscle strength recovery in children with Guillain–Barré syndrome (GBS). A total of 62 GBS children patients admitted to our hospital from June 2014 to December 2018 were selected and divided into control group (n = 30) and experimental group (n = 32) according to the order of admission. The children patients in the control group received physical therapy combined with occupational therapy (PT + OT), while based on the treatment in the control group, the experimental group children patients were treated with electromyographic biofeedback therapy. After that, the recovery of nerve and muscle at different time points, muscle strength score, gross motor function measure (GMFM) score, and Barthel index (BI) score of the children patients before and after treatment were compared between the two groups. There were no significant differences in the recovery of nerve and muscle of the children patients between the two groups at T0 and T1 (

P

> 0.05), and the recovery of nerve and muscle of the children patients in the experimental group was significantly better than that in the control group at T2, T3, and T4 (P < 0.001); the muscle strength score, GMFM score, and BI score of the children patients in the experimental group were significantly better than those in the control group after treatment (

P

< 0.001). The application of electromyographic biofeedback therapy for the treatment of GBS can effectively relieve clinical symptoms, promote rapid recovery, and improve treatment efficacy in children patients, which is worthy of application and promotion.
Posterior Dynamic Stabilization with Limited Rediscectomy for Recurrent Lumbar Disc Herniation
Authors: Luo Lei , Zhao Chen , Li Pei , Liu Liehua , Zhou Qiang , Luo Fei , Liang Lichuan 
Published: December 2021

Objective. Recurrent lumbar disc herniation (RLDH) is the most common cause of sciatica after primary discectomy. The purpose of this study was to evaluate the efficacy of transpedicular dynamic stabilization (TDS) combined with limited rediscectomy in the treatment of single-level RLDH. Methods. We retrospectively evaluated a consecutive series of 24 middle-aged patients who underwent TDS (Dynesys system) combined with limited rediscectomy (i.e., removing only extruded or loose disc fragments) for single-level Carragee type II and type IV RLDH between April 2012 and September 2017. Clinical results were evaluated with visual analog scale (VAS) for leg and low back pain, Oswestry Disability Index (ODI) scores, and complications. Imaging data include lumbar segment motion and intervertebral height. Results. The mean follow-up period was 38 months. The VAS and ODI scores were significantly improved at the last follow-up. The average range of motion (ROM) at the stabilized segment was 6.4° before surgery and 4.2° at the last follow-up, with a 78.6% mean preservation (

P

< 0.05). Intervertebral height at the stabilized segment decreased slightly after surgery (

P

< 0.05). However, there was no further decline at the last follow-up. There were no cases of reherniation, screw loosening, or segmental instability. Conclusions. TDS combined with limited rediscectomy resulted in an effective procedure in middle-aged patients with Carragee type II and type IV RLDH. It was able to stabilize the operated segment with partial motion preservation. Moreover, it could maintain disc height and decrease the risk of recurrence in patients with a large posterior annular defect.