bluuebunny/crossref_metadata_2025_split huggingface dataset:
Current Tread in Ear Syringing In Enugu
Authors: Anekpo Chijioke c. , Onuorah Akpeh James 
Published: September 2021

Background:
Ear syringing is a clinical procedure mostly seen in ear, nose and throat (ENT) clinics. It involves irrigating the external auditory canal with normal saline at body temperature. The air of this study is to highlight the current trend in ear syringing in a tertiary health institution in Enugu, South East Nigeria.
Method:
This was a prospective study of all patients that were managed for ear syringing in the ENT clinic of Enugu State University of Sciences and Technology, Teaching Hospital Park Lane, Enugu over a period of one year (January to December 2019)
Result:
A total of 211 patients consisting of 97males and 120 females with M:F ratio of 1:1:3 were seen. The ages of the patients ranged from below 1-85years. The indications for ear syringing were cerumen auris 142 patients (67.3%), Otomycosis 57 patients (27.7%) and foreign bodies in the ear (FB ear) 12patients (5.7%). Ear syringing was done in the right ear (19.4%), left ear (24.6%) and both ear (55.9%). Most of the syringing were done by the ENT trained nurses in the clinic. No complication occurred during the period of study.
Conclusion:
Current trend in ear syringing in Enugu involves the use of economic ear syringe Kits, training and retraining of nurses in the ENT clinic and application of ceruminolytic agents prior to syringing.
“Efficacy and Safety of Deferasirox in Pediatric Thalassemia Patients: Experience from a Tertiary Care Children Hospital of Bangladesh”
Authors: Hossain Belayet , Man Selimuzza , Chowdhury Banu Nilufer Akhter , Wahab Abdul 
Published: September 2021

Background: Thalassemia is an inherited hemoglobin disorder; mostly require life-long blood transfusions, leading to chronic iron overload which causes growth failure, delayed sexual development in adolescents and vital organ dysfunctions. So, children with thalassemia need lifelong iron chelation therapy. Hence, this study conducted with the aim of to evaluate efficacy and safety of Deferasirox in pediatric thalassemia patients.
Materials and methods: This is an observational, prospective, single-centered hospital-based study conducted in a tertiary care teaching hospital from June 2018 to December 2019. Total sixty children (age 2-18 years) with beta thalassemia major and hemoglobin E beta thalassemia with iron overload were enrolled to commence deferasirox. Efficacy and safety we observed by measuring serum ferritin three monthly and SGPT, SGOT & serum creatinine monthly.
Results: The serum ferritin level of 72% patients reduced significantly after 12 months in comparison to baseline level. There was no serious adverse effect except mild abdominal pain, nausea & vomiting and transaminitis.
Conclusion: Deferasirox is efficacious in reducing iron overload of the body when administer at optimum dose over at least one year and presenting a safe as well as convenient alternative for most of the transfusion dependent pediatric thalassemia patients.
Do papillomaviruses cause feline cutaneous squamous cell carcinoma?
Authors: Teh Alexander , Krockenberger Mark 
Published: September 2021

PICO question
In cats infected with papillomavirus, is the risk of developing feline cutaneous squamous cell carcinoma greater than cats that are not infected with papillomavirus?

Clinical bottom line
Category of research question
Risk
The number and type of study designs reviewed
Eleven papers were critically reviewed, nine were case-control studies and two were experimental in vitro studies
Strength of evidence
Moderate
Outcomes reported
Infection of feline epithelial skin cells with Felis catus papillomavirus type 2 (FcaPV-2) is a risk factor for the development of feline cutaneous squamous cell carcinoma. The pathogenesis of FcaPV-2 infection and neoplastic transformation into malignant cells shares similar pathways to the human papillomavirus (HPV) model of pathogenesis and carcinogenesis with some differences
Conclusion
In conclusion, there is moderate strength of evidence in the literature to support a role of FcaPV-2 in the development of cutaneous squamous cell carcinomas in cats. Therefore, prevention of infection with FcaPV-2 should prevent some cancers

How to apply this evidence in practice
The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
Surgical Treatment of Osteochondral Lesions of the Tibial Plafond
Authors: Rikken Q.G.H. , Dahmen J. , Altink J.N. , Buck T.M.F. , Stufkens S.A.S. , Kerkhoffs G.M.M.J. 
Published: September 2021

Background:The literature on osteochondral lesions of the tibial plafond (OLTPs) is sparse. The aim of this study was therefore to provide an overview of clinical and radiological outcomes following treatment of OLTPs.Methods:We performed a systematic search of the MEDLINE, Embase, and Cochrane library databases. The review was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines and included all original articles on treatment outcomes for OLTPs. The methodological quality of the articles was assessed using the Methodological Index for Non-Randomized Studies (MINORS). Baseline patient and lesion characteristics were pooled and weighted according to the number of lesions per study. The primary outcome was any clinical or patient-reported outcome measure pooled by treatment method when separable data were available. Secondary outcomes were complications, reoperation rates, radiological outcomes, and sport outcomes.Results:The search yielded 2,079 articles, of which 10 studies (1 prospective case series, 1 retrospective comparative study, and 8 retrospective case series) with a total of 175 patients were included. The overall methodological quality of the studies was low. All patients were treated surgically; 96% of the lesions were primary cases (i.e., first-time surgery) and 58% were solitary tibial lesions (i.e., no opposing talar lesion). Arthroscopic bone marrow stimulation was the most frequently used treatment strategy (51%), followed by cartilage transplantation (17%), chondrogenesis-inducing techniques (11%), osteochondral transplantation (3%), retrograde drilling (3%), and mixed (i.e., inseparable) treatments (15%). The clinical outcomes of the different surgical therapies were considered to be moderate to good. The pooled postoperative AOFAS (American Orthopaedic Foot & Ankle Society) score for bone marrow stimulation and osteochondral transplantation was 54.8 (95% confidence interval [CI], 49.5 to 85.0) (n = 14) and 85.3 (95% CI, 56 to 100) (n = 3), respectively. Overall, complications and reoperations were rarely reported. The pooled complication and reoperation rates could only be calculated for bone marrow stimulation and were 5% and 7%, respectively.Conclusions:Surgical interventions for OLTPs appear to yield moderate to good clinical outcomes. Bone marrow stimulation resulted in a moderate AOFAS score. Complications and reintervention rates were found to be low. The current evidence in the literature is limited because of the underreporting of clinical, radiological, and sport data and the heterogenous outcome scores reported.Level of Evidence:TherapeuticLevel IV. See Instructions for Authors for a complete description of levels of evidence.
A New Approach for Automatic Optimization of Complex Fracture Network in Shale Reservoirs
Authors: Wang Haibo , Zhou Tong , Li Fengxia 
Published: September 2021

AbstractShale gas reservoirs have gradually become the main source for oil and gas production. The automatic optimization technology of complex fracture network in fractured horizontal wells is the key technology to realize the efficient development of shale gas reservoirs. In this paper, based on the flow model of shale gas reservoirs, the porosity/permeability of the matrix system and natural fracture system is characterized. The fracture network morphology is finely characterized by the fracture network expansion calculation method, and the flow model was proposed and solved. On this basis, the influence of matrix permeability, matrix porosity, fracture permeability, fracture porosity, and fracture length on the production of shale gas reservoirs is studied. The optimal design of fracture length and fracture location was carried, and the automatic optimization method of complex fracture network parameters based on simultaneous perturbation stochastic approximation (SPSA) was proposed. The method was applied in a shale gas reservoir, and the results showed that the proposed automatic optimization method of the complex fracture network in shale gas reservoirs can automatically optimize the parameters such as fracture location and fracture length and obtain the optimal fracture network distribution matching with geological conditions.
A scoping review on the key elements and effects of cardiovascular disease management programmes based on community-based participatory research
Authors: Park Bohyun , Yang Juhyeon 
Published: September 2021

Abstract
Background. This scoping review aims to analyse the literature on community based participatory research (CBPR) -based cardio vascular disease (CVD) management programmes, examining the key elements of their development and implementation and exploring their effectiveness. Methods. This study is based on the scoping review methodology, consisted of six stages: 1) identifying the research question; 2) identifying relevant studies—search strategy; 3) study selection; 4) charting the data; 5) collating, summarising, and reporting the results; and 6) consultation exercise. The electronic databases used for the literature search were PubMed, Cochrane, and CINAHL. The search period was from 4 March to 3 April 2020. We selected studies that: 1) were published after 2000; 2) targeted community residents over the age of 18; and 3) proposed a CBPR-based CVD management programme, described its development process, or evaluated its effects based on its application. The data were extracted independently by two researchers according to the standardised form. Results. Among the key elements of such programmes, there were many cases in which community organisations played the leading role in establishing partnerships and cases in which a decision-making committee was formed. Regarding the application of the CBPR principles, community partners participated only in executing the research and not in the process of analyzing and interpreting research results. In addition, In all six RCT studies, the experimental groups showed significantly positive effects compared to the control groups. Conclusion. It is necessary to develop strategies to improve the criteria based on which CBPR principles cannot be implemented during the development and implementation of a CBPR-based CVD management programme. In addition, more attempts to verify the effectiveness of high-quality research methodology should be made when evaluating the effectiveness of programmes.
A Local Perspective: Experiences And Handling of Mental Health Burden During The COVID-19 Pandemic In Uganda.
Authors: Muzyamba Choolwe , Munyati Bob Mwiinga , Makova Ogylive , Mushibi Geofrey 
Published: September 2021

Abstract
BackgroundThe COVID-19 pandemic has increased the prevalence of mental health illness around the world. While research has espoused these realities from the context of western countries, however, similar evidence from low income countries like Uganda is still missing. This is despite the fact that scholars have pointed out that given inadequate funding, health facilities and personnel to treat people with mental health challenges, the impact of the COVID-19 pandemic could be severe. Further, it is still unclear how locals in low income countries like Uganda manage to cope with mental health challenges given the lack of adequate skilled response, especially during a pandemic that has increased the pressure on the healthcare system. Therefore, this study aims to fill this gap by investigating local people’s experience and handling of mental health burden during the COVID-19 pandemic n Uganda. Methods Qualitative primary data was collected from Uganda in November and December 2020. The sample selection involved a two-staged cluster sampling technique via the AfriSight online platform. Our study included a total of 1249 participants picked from the 4 different regions of Uganda. On the basis of this, thematic analysis was used to analyze the data. Results Our study revealed that the COVID-19 pandemic and its associated interventions contributed to the increasing mental health burden in Uganda. The four most pronounced forms of mental health illnesses included stress, anxiety, depression and traumatic disorders with the leading causes being closure of income-generating activities, fear of dying, sexual and domestic abuse. While a few people had access to skilled mantel health care, the majority of the people struggled to access this form of care. Skilled maternal care remained an attractive yet unattainable form of care for many. Thus, most people relied on various forms of local strategies that were feasible. ConclusionOur study revealed that Uganda was home to various local survival strategies that counter the inadequacies presented by the weak health care system. Particularly, a culture of reciprocity, family and community network forms important coping avenues for many left stranded by the lack of adequate skilled care. Thus, in the context of Uganda during the COVID-19 pandemic, it seemed more logical to promote scaling up feasibly and locally-available solutions rather than idealistically focusing on attractive yet unattainable forms of care.
Physician Reported Challenges to Medical Professionalism: A Qualitative Study of Clinicians From Northern China
Authors: Liu Yutong , Zhao Weiyue , Ding Ning , Li Honghe , Song Wenwen , Zhang Xu , Wang Bin , Wen Deliang 
Published: September 2021

Abstract
BackgroundDespite efforts to promote professionalism among physicians, many studies have confirmed the ongoing prevalence of unprofessional behaviours in medicine and alluded to the challenges to professionalism that physicians may encounter. Physicians may regularly witness unprofessional events and may even participate in unprofessional practices. Therefore, the current study aims to identify common challenges to professionalism and physicians’ priorities when coping with such challenges，in hopes of shedding light on the East Asian environment with respect to physician professionalism. MethodsFive focus groups were conducted with a total of 49 clinical physicians from two tertiary hospitals in Shenyang, the largest city in northern China. Socio-demographic data were obtained through a brief questionnaire, and participants were de-identified after being linked to verbal data from the focus groups. Focus group interviews were audio-recorded and later transcribed and subjected to an inductive thematic analysis.ResultsA content analysis of the focus groups demonstrated that common professionalism challenges could be classified into five categories, namely: patients and their families (38%), society (22%), peers or teams (21%), institutions (13%), and education (n = 6%). Physicians failed to find current remediation measures, such as, discussing with supervisors, or reporting challenges to hospital or health authorities very effective.ConclusionsThe current study suggests that challenges from patients and their families contributed the most to professionalism challenges in the hospitals in northern China. In terms of the systematic reform of medical education and the healthcare delivery system, health authorities and hospital administrators should aim at addressing challenges to physician professionalism by building up a protective atmosphere.
Kinetic Analysis of Crude Enzyme Extract Produced Via Solid State Fermentation of Banana Pseudo Stem Waste
Authors: Subash Mira Chares , Perumalsamy Muthiah 
Published: September 2021

Abstract
Banana Pseudo stem waste after each harvest contributes about 70–80 Milli Tons Per hector. The banana pseudo stem will be thrown as waste biomass after each harvest as it is unstable for the upcoming harvest. The biggest challenge in banana cultivation is the utilization of biomass of banana pseusostem waste into valuable products. In this study, Xylano-pectinase enzyme extract was produced from banana pseudo stem waste under solid-state fermentation by Enterobacter cloacae PMC04. The highest pectinase and xylanase activities obtained using banana pseudo stem as carbon source were 124.62 U/ml and 173.81 U/ml respectively. Thermodynamics stated that range 40-50oC were considered to be the optimal temperature for xylano-pectinase enzyme production and subsequent degumming of banana fibers. The crude enzyme extract were then used in the degumming of banana fibers for textile application. Textile processing of banana fiber necessitates the removal of hemicellulose substance which can be achieved by crude xylano-pectinase enzyme. It was found that crude xylano-pectinase was efficient in the removal of hemicellulose substance from the fibers. Results obtained from this study demonstrate that the proposed bioprocess could be successfully applied for the degumming of banana fibers sustainably.
Diagnostic Biomarker KIF23 is Associated With Immune Infiltration in Gastric Cancer
Authors: Bai Maoshu , Liu Xin 
Published: September 2021

Abstract
Background: Kinesin family member 23 (KIF23), an index of tumor proliferation, can serve as a prognostic marker in numerous tumors. However, the relationship between KIF23 expression and immune infiltration and the diagnostic value of KIF23 remain unclear in GC (gastric cancer). This study aimed to explored the diagnostic value of KIF23 and its interactions with tumor-infiltrating immune cells in GC by bioinformatics analysis. Mothods: The relationship between clinicopathologic features and KIF23 expression was also analyzed using the Wilcoxon rank-sum test and logistic regression. And the expression level of KIF23 was validated by IHC and GEO databases, which was consistent with informatics results. Receiver operating characteristic (ROC) curves were generated to evaluate the value of KIF23 as a binary classifier using the area under the curve (AUC value).Results: High expression of KIF23 was significantly associated with longer overall survival and progression-free survival in GC. The mutations of KIF23 in GC were analyzed using cBioPortal and the Catalogue of Somatic Mutations in Cancer database. Enrichment analysis of co-expressed genes and KIF23 analysis was performed using LinkedOmics. By using STRING and GeneMANIA databases, we investigated the protein-coding genes related to KIF23 and its co-expression genes in GC tissues. Then, the relationship between KIF23 expression and immune infiltration in GC was investigated using Timer and GEPIA. We found that KIF23 might be used as a potential diagnostic biomarker in GC. Subsequently, KIF23 expression level was correlated with the infiltration levels of CD8 + T cells, macrophages, neutrophils, and more obviously with B cells and dendritic cells. In addition, KIF23 expression was significantly associated with T cell exhaustion (CTLA-4 and GZMB). KIF23 expression showed correlations with the infiltration of diverse immune markers in GC. Conclusions: Our findings suggest KIF23 can serve as a marker for immune infiltration and diagnostic in GC, making it a potential treatment of target.
Regression of Liver Fibrosis and Hepatocellular Carcinoma Development After HCV Eradication With Oral Antiviral Agents; A Prospective Multi-center Study
Authors: Yoo Hae Won , Park Jun Yong , Kim Sang Gyune , Jung Young Kul , Lee Sae Hwan , Kim Moon Young , Jeon Dae Won , Jang Jae Young , Lee Jin Woo , Kwon Oh Sang 
Published: September 2021

Abstract
Purpose: We prospectively investigated the changes of liver stiffness (LS) and the occurrence of hepatocellular carcinoma (HCC) after hepatitis C virus (HCV) eradication using direct antiviral agents (DAA) over three years.Method: LS measurement using transient elastography and serum fibrosis surrogate markers before treatment and at 48, 96, 144 weeks after starting direct-acting antivirals (DAA) according to the protocol were evaluated. Patients were also compared with historical cohort treated with pegylated interferon (peg-IFN).Result: Sustained viral response (SVR) was observed in 95.8%. LS value in the patients achieving SVR significantly decreased over time (19.4 ± 12.9 kPa [baseline], 13.9 ± 9.1 kPa [48 weeks], 11.7 ± 8.2 kPa [96 weeks], 10.09 ± 6.23 [144 weeks], all p < 0.001). With matched analysis, the decrease in LS value was significantly larger in DAA group than peg-IFN group at both 48 weeks (29% vs. 9%) and 96 weeks (39% vs. 17%). The incidence of HCC was not significantly different between DAA and peg-IFN groups (5.5% vs. 5.4%) at 144 weeks.Conclusion: HCV eradication with DAA can lead to improvement of liver stiffness over time. The regression of fibrosis was greater in the group with DAA than peg-IFN.
Effect of Practice Environment on Nurse Reported Quality and Patient Safety: The Mediation Role of Person-Centeredness
Authors: Jarrar Mu’taman , Al-Bsheish Mohammad , Aldhmadi Badr , Albaker Waleed , Meri Ahmed , Dauwed Mohammed , Minai Mohd 
Published: September 2021

Abstract
Background
Patient safety and quality are concerns of healthcare systems, and several reforms and efforts have focused on this concern. Person-centeredness and nurse work environment are key elements for providing high quality and safe patient care, as structural and process factors. Limited existing studies suggest a mediation role of person-centeredness from a nursing perspective. Accordingly, this study aim to explore the potential mediation role of person-centeredness between the effects of the work environment and nurse reported quality and patient safety.
Methods
A quantitative cross-sectional survey collected data from 1,055 nurses working in medical and surgical units in twelve Malaysian private hospitals. The data collection used structured questionnaires. The Hayes macro explored the mediation effect of person-centeredness between the associations of work environment dimensions and care outcomes, controlling nurses’ demographics and practice characteristics.
Results
A total of 652 nurses responded completely to the survey (61.8% response rate). About 47.7% of nurses worked 7-hour shifts, and 37.0% were assigned more than 15 patients. Higher workload was associated with unfavorable outcomes. Nurses working in 12-hour shifts reported a lower work environment rating (3.46 ± 0.41, p < 0.01) and person-centered care (3.55 ± 0.35, p < 0.01). Nurses assigned for more than 15 patients were less likely to report a favorable practice environment (3.53 ± 0.41, p < 0.05), perceived lower person-centered care (3.61 ± 0.36, p < 0.01), and rated lower patient safety (3.54 ± 0.62, p < 0.05). Person-centeredness mediates the effect of nurse work environment dimensions on quality and patient safety.
Conclusion
Medical and surgical nurses working in a healthy environment had a high level of person-centeredness, which is, in turn, positively affected the reported outcomes. The function of person-centeredness was to complement the effects of the nurse work environment on care outcomes. Improving the nurse work environment (task-oriented) with a high level of person-centeredness (patient-oriented) was a mechanism through which future initiatives could improve nursing care and preventing patient harm.