bluuebunny/crossref_metadata_2025_split huggingface dataset:
Electronic consultations (eConsults): a proof of concept trial in Australia
Authors: Russell Anthony W. , Adkins Peter , Hayes Lisa , Prior Erin , McCormack Christine , DiGregorio John 
Published: August 2021

AbstractBackgroundElectronic consultations (eConsults) allow general practitioners (GP) to seek the advice of a specialist via secure asynchronous digital communication.AimsTo report the outcomes of a proof of concept (POC) trial of eConsults for patients with diabetes and endocrine disorders.MethodsA prospective observational study conducted from November 2020 to May 2021. eConsults were provided by endocrinologists from the Princess Alexandra Hospital, Brisbane. The requests for advice were from GP in Brisbane South. An online questionnaire was completed by the GP and endocrinologist after each eConsult.ResultsForty eConsults were performed over 7 months. The majority were in relation to type 2 diabetes (30%) or thyroid conditions (30%). All eConsult responses were performed within the target of 72 h with 92.5% responses provided within 24 h. The average time taken for the endocrinologist to perform the eConsult was 14.2 ± 4.4 min. The GP rated the value of eConsults as excellent 97% of the time. The eConsult resulted in a new or additional course of action 68% (19/28) of the time and confirmed a course of action 32% (9/28) of the time. The eConsult avoided the need for referral of the patient for a face‐to‐face specialist review in 55% of the eConsults.ConclusionAn eConsult service was able to be delivered by endocrinologists from a tertiary hospital to GP in Brisbane South. With an appropriate funding model, the broader implementation and adoption of eConsults has the potential to address specialist waiting lists and facilitate models of integrated care.
Antenatal FibroScan® assessment for metabolic‐associated fatty liver in pregnant women at risk of gestational diabetes from a multiethnic population: a pilot study
Authors: Deng Difei , George Jacob , Pasupathy Dharmintra , Cheung Ngai Wah 
Published: August 2021

AbstractBackgroundMetabolic‐associated fatty liver disease (MAFLD) is a leading cause of chronic liver disease with increasingly recognised associations with gestational diabetes (GDM), including within the antenatal period.AimsTo assess the relationship between MAFLD in pregnancy and development of GDM.MethodsFifty pregnant women were enrolled before 24 weeks gestation from a multiethnic obstetrics service in Sydney, Australia. Two FibroScan® assessments were performed, one prior to 24 weeks and one after 30 weeks gestation, to assess hepatic steatosis and stiffness. A control attenuated parameter (CAP) score ≥ 233.5 dB/m signified MAFLD. GDM was determined by an antenatal 75‐g oral glucose tolerance testing.ResultsSix (12%) women had evidence of FibroScan®‐detected MAFLD in early pregnancy, while none had abnormal hepatic stiffness. Sixteen (32%) women developed GDM. No significant difference was observed in GDM rates (50% vs 29.5%; P = 0.37) between those with MAFLD in early pregnancy and those without. At the second scan (completed by 34 women), those who developed GDM had a lower observed mean increase in CAP scores (11.1 ± 23.3 dB/m vs −14.9 ± 26.0 dB/m; P = 0.004) and lower maternal weight gain (0.6 ± 0.2 kg/week vs 0.4 ± 0.2 kg/week; P = 0.04).ConclusionsThere was no statistically significant association between FibroScan®‐detected MAFLD in early pregnancy and subsequent development of GDM in this pilot study. Maternal weight gain may be associated with changes in the CAP scores, which reflect steatosis, during pregnancy.
Metabolomic and lipidomic signatures associated with activation of human cDC1 (BDCA3+/CD141+) dendritic cells
Authors: Basit Farhan , van Oorschot Tom , van Buggenum Jessie , Derks Rico J. E. , Kostidis Sarantos , Giera Martin , de Vries I. Jolanda. M. 
Published: August 2021

AbstractDendritic cells (DCs) bridge the connection between innate and adaptive immunity. DCs present antigens to T cells and stimulate potent cytotoxic T‐cell responses. Metabolic reprogramming is critical for DC development and activation; however, metabolic adaptations and regulation in DC subsets remains largely uncharacterized. Here, we mapped metabolomic and lipidomic signatures associated with the activation phenotype of human conventional DC type 1, a DC subset specialized in cross‐presentation and therefore of major importance for the stimulation of CD8+ T cells. Our metabolomics and lipidomic analyses showed that Toll‐like receptor (TLR) stimulation altered glycerolipids and amino acids in cDC1. Poly I:C or pRNA stimulation reduced triglycerides and cholesterol esters, as well as various amino acids. Moreover, TLR stimulation reduced expression of glycolysis‐regulating genes and did not induce glycolysis. Conversely, cDC1 exhibited increased mitochondrial content and oxidative phosphorylation (OXPHOS) upon TLR3 or TLR7/8 stimulation. Our findings highlight the metabolic adaptations required for cDC1 maturation.
Incidence and seasonality of respiratory viruses among medically attended children with acute respiratory infections in an Ecuador birth cohort, 2011–2014
Authors: Azziz‐Baumgartner Eduardo , Bruno Alfredo , Daugherty Michael , Chico Martha E. , Lopez Andrea , Arriola Carmen Sofia , de Mora Domenica , Ropero Alba María , Davis William W. , McMorrow Meredith , Cooper Philip J. 
Published: August 2021

AbstractBackgroundEcuador annually has handwashing and respiratory hygiene campaigns and seasonal influenza vaccination to prevent respiratory virus illnesses but has yet to quantify disease burden and determine epidemic timing.MethodsTo identify respiratory virus burden and assess months with epidemic activity, we followed a birth cohort in northwest Ecuador during 2011–2014. Mothers brought children to the study clinic for routine checkups at ages 1, 2, 3, 5, and 8 years or if children experienced any acute respiratory illness symptoms (e.g., cough, fever, or difficulty breathing); clinical care was provided free of charge. Those with medically attended acute respiratory infections (MAARIs) were tested for common respiratory viruses via real‐time reverse‐transcription polymerase chain reaction (rRT‐PCR).ResultsIn 2011, 2376 children aged 1–4 years (median 35 months) were enrolled in the respiratory cohort and monitored for 7017.5 child‐years (cy). The incidence of respiratory syncytial virus (RSV) was 23.9 (95% CI 17.3–30.5), influenza 10.6 (2.4–18.8), adenoviruses 6.7 (4.6–28.0), parainfluenzas 5.0 (2.3–10.5), and rhinoviruses, bocaviruses, human metapneumoviruses, seasonal coronaviruses, and enteroviruses <3/100 cy among children aged 12–23 months and declined with age. Most (75%) influenza detections occurred April–September.ConclusionCohort children frequently had MAARIs, and while the incidence decreased rapidly among older children, more than one in five children aged 12–23 months tested positive for RSV, and one in 10 tested positive for influenza. Our findings suggest this substantial burden of influenza occurred more commonly during the winter Southern Hemisphere influenza season.
Position statement on classification of basal cell carcinomas. Part 1: unsupervised clustering of experts as a way to build an operational classification of advanced basal cell carcinoma based on pattern recognition
Authors: Grob J.J. , Guminski A. , Malvehy J. , Basset‐seguin N. , Bertrand B. , Fernandez‐Penas P. , Kaufmann R. , Zalaudek I. , Gaudy‐Marqueste C. , Fargnoli M.C. , Tagliaferri L. , Fertil B. , Del Marmol V. , Stratigos A. , Garbe C. , Peris K. 
Published: August 2021

AbstractBackgroundNo simple classification system has emerged for ‘advanced basal cell carcinomas’, and more generally for all difficult‐to‐treat BCCs (DTT‐BCCs), due to the heterogeneity of situations, TNM inappropriateness to BCCs, and different approaches of different specialists.ObjectiveTo generate an operational classification, using the unconscious ability of experts to simplify the great heterogeneity of the clinical situations into a few relevant groups, which drive their treatment decisions.MethodNon‐supervised independent and blinded clustering of real clinical cases of DTT‐BCCs was used. Fourteen international experts from different specialties independently partitioned 199 patient cases considered ‘difficult to treat’ into as many clusters they want (≤10), choosing their own criteria for partitioning. Convergences and divergences between the individual partitions were analyzed using the similarity matrix, K‐mean approach, and average silhouette method.ResultsThere was a rather consensual clustering of cases, regardless of the specialty and nationality of the experts. Mathematical analysis showed that consensus between experts was best represented by a partition of DTT‐BCCs into five clusters, easily recognizeda posteriorias five clear‐cut patterns of clinical situations. The concept of ‘locally advanced’ did not appear consistent between experts.ConclusionAlthough convergence between experts was not granted, this experiment shows that clinicians dealing with BCCs all tend to work by a similar pattern recognition based on the overall analysis of the situation. This study thus provides the first consensual classification of DTT‐BCCs. This experimental approach using mathematical analysis of independent and blinded clustering of cases by experts can probably be applied to many other situations in dermatology and oncology.
Immersion immunization of common carp with bacterial ghost‐based DNA vaccine inducing prophylactic protective immunity against spring viraemia of carp virus
Authors: Zheng Yu‐Ying , Zhang Chen , Li Yang , Zhang Peng‐Qi , Chen Guo , Wang Gao‐Xue , Zhu Bin 
Published: August 2021

AbstractThe interactive applications of immunization route, vaccine type and delivery vectors are emerging as a key area of research within the field of mass immunization in fishery production. In an effort to improve DNA vaccine's immune efficiency in large‐scale immunization, a promising bacterial ghost‐loaded DNA vaccine was constructed based on Escherichia coli DH5α. In common carp was investigated the immune response to immersion immunization via related indicator analysis, and the challenge test of spring viraemia of carp virus (SVCV) was carried out. The result indicated that BG‐loaded DNA vaccine induced higher serum antibody level than naked pEG‐G. Simultaneously, the immunophysiological indicators and genes change at the more advanced levels in the BG/pEG‐G immune group. At the treatment concentration of 20 mg/L of the BG/pEG‐G group, IgM and IgZ expressions in vivo were markedly increased by 21.62 times and 6.91 times, respectively, and the relative percentage survival reached the peak of 59.57%. This study paves the way for future aquatic animal vaccine research, which aimed to develop the highly effective immersion vaccine system by delivery vectors, with the ultimate aim to prevent and restrict SVCV in actual production.
Diagnostic performance of endoscopic ultrasound‐artificial intelligence using deep learning analysis of gallbladder polypoid lesions
Authors: Jang Sung Ill , Kim Young Jae , Kim Eui Joo , Kang Huapyong , Shon Seung Jin , Seol Yu Jin , Lee Dong Ki , Kim Kwang Gi , Cho Jae Hee 
Published: August 2021

AbstractBackground and AimEndoscopic ultrasound (EUS) is the most accurate diagnostic modality for polypoid lesions of the gallbladder (GB), but is limited by subjective interpretation. Deep learning‐based artificial intelligence (AI) algorithms are under development. We evaluated the diagnostic performance of AI in differentiating polypoid lesions using EUS images.MethodsThe diagnostic performance of the EUS‐AI system with ResNet50 architecture was evaluated via three processes: training, internal validation, and testing using an AI development cohort of 1039 EUS images (836 GB polyps and 203 gallstones). The diagnostic performance was verified using an external validation cohort of 83 patients and compared with the performance of EUS endoscopists.ResultsIn the AI development cohort, we developed an EUS‐AI algorithm and evaluated the diagnostic performance of the EUS‐AI including sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. For the differential diagnosis of neoplastic and non‐neoplastic GB polyps, these values for EUS‐AI were 57.9%, 96.5%, 77.8%, 91.6%, and 89.8%, respectively. In the external validation cohort, we compared diagnostic performances between EUS‐AI and endoscopists. For the differential diagnosis of neoplastic and non‐neoplastic GB polyps, the sensitivity and specificity were 33.3% and 96.1% for EUS‐AI; they were 74.2% and 44.9%, respectively, for the endoscopists. Besides, the accuracy of the EUS‐AI was between the accuracies of mid‐level (66.7%) and expert EUS endoscopists (77.5%).ConclusionsThis newly developed EUS‐AI system showed favorable performance for the diagnosis of neoplastic GB polyps, with a performance comparable to that of EUS endoscopists.
A generalized framework for analyzing car lifetime effects on stock, flow, and carbon footprint
Authors: Nakamoto Yuya , Kagawa Shigemi 
Published: August 2021

AbstractThis study proposes a new framework for estimating the effects of changes in the physical lifespan (PHL) of cars and the possession lifespan (POL) of new and used cars on stock, flow, and carbon footprint (CF). Applying this framework to all new and used cars registered in Japan from 1990 to 2016 showed that a 10% extension of the PHL of cars reduced the CF of cars by 30.7 Mt, while a 10% extension of the POL of new cars reduced the CF of cars by 26.4 Mt, and a 10% extension of the POL of used cars produced a 5.2 Mt CF reduction. On the other hand, a 10% lifetime reduction in the three cases increased CF by 42.2, 29.4, and 6.0 Mt, respectively. These results indicate that increasing the lifetime of new and used cars could contribute significantly to the mitigation of global warming. To achieve a large reduction in life cycle emissions, car designers should focus on ways to extend vehicle lifetimes.
Experiences of Quality Perinatal Care During the US COVID‐19 Pandemic
Authors: Basile Ibrahim Bridget , Kennedy Holly Powell , Combellick Joan 
Published: August 2021

IntroductionQuality perinatal care is recognized as an important birth process and outcome. During the coronavirus disease 2019 (COVID‐19) pandemic, quality of perinatal care was compromised as the health care system grappled with adapting to an ever‐changing, uncertain, and unprecedented public health crisis.MethodsThe aim of this study was to explore the quality of perinatal care received during the COVID‐19 pandemic in the United States. Data were collected via an online questionnaire completed by people who gave birth in the United States after March 15, 2020. The questionnaire included the Mothers on Respect Index and the Mothers Autonomy in Decision Making validated measures. Low‐quality perinatal care was defined as decreased respect and/or autonomy in the perinatal care received. Responses were geocoded by zip code to determine COVID‐19 case‐load in the county on the date of birth. Multivariate regression analyses described associations between respect and autonomy in decision‐making for perinatal care and levels of COVID‐19 outbreak across the United States.ResultsParticipants (N = 707) from 46 states and the District of Columbia completed the questionnaire. As COVID‐19 cases increased, participants’ experiences of autonomy in decision‐making for perinatal care decreased significantly (P = .04). Participants who identified as Black, Indigenous, and people of color, those who had an obstetrician provider, and those who gave birth in a hospital were more likely to experience low‐quality perinatal care. Those with a midwife provider or who had a home birth were more likely to experience high‐quality perinatal care in adjusted models.DiscussionVariability in experiences of high‐quality perinatal care by sociodemographic characteristics, birth setting, and provider type may relate to implicit bias, structural racism, and inequities in maternal health and COVID‐19 outcomes for birthing people from marginalized communities.
Interventions to Increase Moderate‐to‐Vigorous Physical Activity in Elementary School Physical Education Lessons: Systematic Review
Authors: Wong Lan S. , Gibson Ann‐Marie , Farooq Abdulaziz , Reilly John J. 
Published: August 2021

ABSTRACTBACKGROUNDThis systematic review aimed to synthesize recent evidence on interventions to increase moderate‐to‐vigorous physical activity (MVPA) content of physical education (PE) in children age 8 to 11.METHODSA search of 6 databases was conducted in December 2019. Controlled intervention studies were included so long as they used objective measures of MVPA. Methodological quality was assessed using the appropriate Joanna Briggs Institute (JBI) Checklist. Random effects meta‐analysis was used where appropriate.RESULTSOf the 5459 records, only 5 studies met all inclusion criteria, reporting on 1452 participants; 3 quasi‐experimental studies and 2 RCTs. All 5 eligible studies reported favorable intervention effects. Meta‐analysis was possible from 4/5 studies: the mean difference between intervention and control groups at follow‐up was +14.3% of lesson time in MVPA (confidence interval [CI] 2.7 to 25.8).CONCLUSIONSEfforts to increase the MVPA content of elementary school PE are achievable. Two studies employed PE specialist teachers and 1 study used an expert instructor as their intervention, 2 studies worked with the class teachers using self‐determination theory. All studies focused on health (MVPA) outcomes and included either “fitness infusions” or physically active games to engage students' in physical activities and increase their activity level.
Using cognitive interviewing to bridge the intent‐interpretation gap for nutrition coverage survey questions in India
Authors: Ashok Sattvika , Kim Sunny S. , Heidkamp Rebecca A. , Munos Melinda K. , Menon Purnima , Avula Rasmi 
Published: August 2021

AbstractDesigning survey questions that clearly and precisely communicate the question's intent and elicit responses based on the intended interpretation is critical but often undervalued. We used cognitive interviewing to qualitatively assess respondents' interpretation of and responses to questions pertaining to maternal and child nutrition intervention coverage. We conducted interviews to cognitively test 25 survey questions with mothers (N = 21) with children less than 1 year in Madhya Pradesh, India. Each question was followed by probes to capture information on four cognitive stages—comprehension, retrieval, judgement, and response. Data were analysed for common and unique patterns across the survey questions. We identified four types of cognitive challenges: (1) retention of multiple concepts in long questions: difficulty in comprehending and retaining questions with three or more key concepts; (2) temporal confusion: difficulty in conceptualizing recall periods such as “in the last 6 months” as compared to life stages such as pregnancy; (3) interpretation of concepts: mismatch of information being asked, meaning of certain terms and intervention scope; and (4) understanding of technical terms: difficulty in understanding commonly used technical words such as “breastfeeding” and “antenatal care” and requiring use of simple alternative language. Findings from this study will be useful for stakeholders involved in survey design and implementation, especially those conducting large‐scale household surveys to measure coverage of essential nutrition interventions.
Patient‐present teaching in the clinic: Effect on agency and professional behaviour
Authors: Cheema Bavenjit , Li Meredith , Ho Daniel , Amari Erica , Buckley Heather , Canfield Carolyn , Cuncic Cary , Nimmon Laura , Van Enk Anneke , Veerapen Kiran , Wisener Katherine M. , Holmes Cheryl Lynn 
Published: August 2021

AbstractBackground/PurposeAlthough much has been written about the medical learning environment, the patient, who is the focus of care, is rarely the focus in this literature. The purpose of this study was to explore the role of the patient as an active participant with agency in the medical learning environment from the standpoint of the learner, the attending physician, and most importantly, the patient. We hoped to gain insights into the mechanisms that can reinforce professional values such as patient‐centred and respectful behaviours in a patient‐present learning environment.MethodsWe conducted this study in an ambulatory internal medicine clinic using ‘patient‐present’ clinic visits. All case presentations occurred in examination rooms with the patient. We invited participants (attending physicians, undergraduate and postgraduate learners, patients and family members) to participate in semistructured interviews after each clinic visit to explore the impact of the patient‐present learning environment. We recruited 34 participants in the study; 10 attending physicians, 12 learners, 10 patients and 2 family members. We analysed the data deductively using a conceptual framework of agency.Summary/ResultsWe identified three major insights: (1) Patients felt engaged and valued opportunities to be heard; (2) Attending physicians and learners reported a more respectful learning environment and a positive though challenging teaching and learning experience; and (3) A hidden curriculum emerged in a performance‐based view of professional behaviour.ConclusionsPatient‐present teaching engaged patients and enhanced their agency by recasting the patient as the central focus within the healthcare encounter. We identified a tension between performing and learning. This study adds new insights to the concept of patient centredness and professionalism from the perspectives of all participants in the medical teaching and learning environment.
Barostat or syringe‐assisted sensory biofeedback training for constipation with rectal hyposensitivity: A randomized controlled trial
Authors: Rao Satish S. C. , Yan Yun , Erdogan Askin , Coss‐Adame Enrique , Patcharatrakul Tanisa , Valestin Jessica , Nag Ayyala Deepak 
Published: August 2021

AbstractBackgroundRectal hyposensitivity (RH) is a well‐known pathophysiological dysfunction in chronic constipation. Whether biofeedback training improves RH and restores bowel function is unknown.AimTo investigate the efficacy of barostat‐assisted sensory training (BAST) with syringe‐assisted sensory training (SAST) in patients with RH in a randomized controlled trial.MethodsPatients with RH and chronic constipation (Rome III) were randomized to receive 6 biweekly sessions of BAST or SAST. Verbal/visual feedback was provided during repeated rectal distensions to improve defecation desire/urge and first sensations with either 10‐cm balloon connected to barostat (BAST) or 4‐cm balloon connected to syringe and manometry probe (SAST). Sensory thresholds, bowel symptoms, and therapist and patient's rating of treatments were compared. The primary outcome (responders) was the improvement in ≥2 sensory thresholds.ResultsSixty‐six patients were enrolled: 32 received BAST, 34 received SAST, and 56 completed study. There were significantly more responders in BAST group than SAST (78% vs. 53%, p = 0.0320). Rectal sensation normalized in 81% with BAST compared to 56% with SAST (p = 0.0270). When compared to baseline, desire and urge to defecate thresholds and bowel satisfaction improved with BAST (p = 0.0013; p = 0.0002; p = 0.0001) and SAST (p = 0.0012; p = 0.0001; p < 0.0001) and number of complete spontaneous bowel movements with BAST (p = 0.0029) but without inter‐group differences. Therapists rated BAST as superior to SAST (p < 0.0001), but patients rated both equally.ConclusionsSensory biofeedback training was effective and significantly improved rectal sensation and constipation symptoms. Although both techniques were useful, the novel BAST was more efficacious and easier to administer for treating RH.