bluuebunny/crossref_metadata_2025_split huggingface dataset:
Re-energising the way we manage change in healthcare: the case for soft systems methodology and its application to evidence-based practice
Authors: Augustsson Hanna , Churruca Kate , Braithwaite Jeffrey 
Published: September 2019

Abstract

Background
Updating, improving and spreading the evidence base for healthcare practices has proven to be a challenge of considerable magnitude – a wicked, multi-dimensional problem. There are many interlinked factors which determine how, why and whether any particular implementation effort or intervention succeeds. Soft Systems Methodology (SSM), strongly grounded in systems ideas and complexity science, offers a structured, yet flexible process for dealing with situations that are perceived as problematical and in need of improvement. The aim of this paper is to propose the use of SSM for managing change in healthcare by way of addressing some of the complexities. The aim is further to illustrate examples of how SSM has been used in healthcare and discuss the features of the methodology that we believe can be harnessed to improve healthcare.

Discussion
SSM is particularly suited for tackling real world problems that are difficult to define and where stakeholders may have divergent views on the situation and the objectives of change. SSM engages stakeholders in a learning cycle including: finding out about the problematical situation, i.e. the context in which the problem exists, by developing a rich picture of the situation; defining it by developing conceptual models and comparing these with the real world; taking action to improve it by deciding on desirable and feasible improvements; and implementing these in an iterative manner. Although SSM has been widely used in other sectors, it has not been extensively used in healthcare. We make the case for applying SSM to implementation and improvement endeavours in healthcare using the example of getting clinicians at the hospital level to use evidence-based guidelines.

Conclusion
Applying SSM means taking account of the multi-dimensional nature of care settings, and dealing with entrenched and unique contexts, cultures and socio-political ecosystems – precisely those that manifest in healthcare. There are gains to be made in appreciating complexity and facilitating contextualization of interventions, and by approaching improvements in an iterative learning cycle.
Performance of family planning clinics in conducting recommended HIV counseling and testing in Mombasa County, Kenya: a cross-sectional study
Authors: Eastment McKenna C. , Wanje George , Richardson Barbra A. , Nassir Faiza , Mwaringa Emily , Barnabas Ruanne V. , Sherr Kenneth , Mandaliya Kishorchandra , Jaoko Walter , McClelland R. Scott 
Published: September 2019

Abstract

Background
A high proportion of African women utilize family planning (FP) services. Accordingly, incorporating HIV testing into FP services may strategically target the first WHO 90–90-90 goal of 90% of people living with HIV knowing their status.

Methods
The objective of this analysis was to determine the proportion of new FP clients counseled and tested for HIV, as well as correlates of HIV testing, in a random sample of 58 FP clinics in Mombasa County, Kenya. Structured interviews of FP clinic managers collected data on characteristics of FP clinics and staff. Study staff performed a 3-month review of FP registers, summarizing new client HIV testing and counseling (HTC). Because overall rates of HTC were quite low, a binary variable was created comparing clinics performing any HIV counseling and/or testing to clinics performing none. Generalized linear models were used to calculate prevalence ratios (PR) and identify correlates of HTC. Factors associated with any HTC with a p-value < 0.10 in univariate analysis were included in a multivariate analysis.

Results
Of the 58 FP clinics, 26 (45%) performed any counseling for HIV testing, and 23 (40%) performed any HIV testing. Counseling for HIV testing was conducted for 815/4389 (19%) new clients, and HIV testing was performed for 420/4389 (10%). Clinics without trained HIV testing providers uniformly did not conduct HIV counseling and/or testing (0/12 [0%]), while 27/46 (59%) of clinics with ≥1 provider performed some HTC (p < 0.001). In the subset of 46 clinics with ≥1 trained HIV testing provider, correlates of performing HTC included being a public versus non-public clinic (PR 1.70 95%CI 1.01–2.88), and having an HIV comprehensive care center (CCC) onsite (PR 2.05, 95%CI 1.04–4.06).

Conclusion
Trained HIV testing providers are crucial for FP clinics to perform any HTC. Approaches are needed to increase routine HTC in FP clinics including staffing changes and/or linkages with other testing services (in standalone VCT services or lab facilities) in order to improve the implementation of existing national guidelines. A future cluster randomized trial is planned to test an implementation strategy, the Systems Analysis and Improvement Approach (SAIA) to increase HTC in FP clinics.
Quantitative structure–activity relationship to predict the anti-malarial activity in a set of new imidazolopiperazines based on artificial neural networks
Authors: Yousefinejad Saeed , Mahboubifar Marjan , Eskandari Rayhaneh 
Published: September 2019

Abstract

Background
After years of efforts on the control of malaria, it remains as a most deadly infectious disease. A major problem for the available anti-malarial drugs is the occurrence of drug resistance in Plasmodium. Developing of new compounds or modification of existing anti-malarial drugs is an effective approach to face this challenge. Quantitative structure activity relationship (QSAR) modelling plays an important role in design and modification of anti-malarial compounds by estimation of the activity of the compounds.

Methods
In this research, the QSAR study was done on anti-malarial activity of 33 imidazolopiperazine compounds based on artificial neural networks (ANN). The structural descriptors of imidazolopiperazine molecules was used as the independents variables and their activity against 3D7 and W2 strains was used as the dependent variables. During modelling process, 70% of compound was used as the training and two 15% of imidazolopiperazines were used as the validation and external test sets. In this work, stepwise multiple linear regression was applied as the valuable selection and ANN with Levenberg–Marquardt algorithm was utilized as an efficient non-linear approach to correlate between structural information of molecules and their anti-malarial activity.

Results
The sufficiency of the suggested method to estimate the anti-malarial activity of imidazolopiperazine compounds at two 3D7 and W2 strains was demonstrated using statistical parameters, such as correlation coefficient (R2), mean square error (MSE). For instance R2train = 0.947, R2val = 0.959, R2test = 0.920 shows the potential of the suggested model for the prediction of 3D7 activity. Different statistical approaches such as and applicability domain (AD) and y-scrambling was also showed the validity of models.

Conclusion
QSAR can be an efficient way to virtual screening the molecules to design more efficient compounds with activity against malaria (3D7 and W2 strains). Imidazolopiperazines can be good candidates and change in the structure and functional groups can be done intelligently using QSAR approach to rich more efficient compounds with decreasing trial–error runs during synthesis.
Relationship between S100A4 protein expression and pre-operative serum CA19.9 levels in pancreatic carcinoma and its prognostic significance
Authors: Jia Fuxin , Liu Mengmeng , Li Xiao , Zhang Fen , Yue Shuqiang , Liu Jiangwei 
Published: September 2019

AbstractBackgroundPancreatic carcinoma (PC) is one of the most lethal malignancies, and its poor prognosis is strongly associated with invasion and metastasis. CA19.9 is considered to be the most sensitive serum marker for PC in clinical practice; however, the detection of CA19.9 in PC has a certain false positive and false negative rate. The expression of the calcium-binding protein S100A4 has been reported to be associated with poor prognosis in various cancers. This study aimed to investigate the relationship between S100A4 and CA19.9 and its prognostic significance in PC.MethodsWe performed immunohistochemical staining for S100A4 in formalin-fixed, paraffin-embedded blocks of 128 PC tissues. The levels of S100A4 expression and pre-operative serum CA19.9 were correlated with clinicopathological parameters. The possible correlation between S100A4 protein expression and pre-operative serum CA19.9 levels were evaluated using the chi-square test and Spearman correlation. Survival was assessed by Kaplan–Meier analysis together with a single variable or multivariate Cox analysis.ResultsA significant positive correlation between S100A4 expression and pre-operative serum CA19.9 level was observed in PC tissues (ρ= 0.202,P= 0.022). The co-expression of both proteins correlated significantly with tumor differentiation (ρ= − 0.280,P= 0.001), TNM stage (ρ= − 0.389,P= 0.000), and lymph node metastasis (ρ= 0.254,P= 0.008). Upregulation of S100A4 was identified as a significant, independent predictor of poor overall survival (P= 0.000). Moreover, higher serum CA19.9 levels (≥ 35 U/mL) were also recognized as an independent predictor of inferior overall survival (P= 0.001). Additionally, upregulation of S100A4 and higher pre-operative serum CA19.9 levels (≥ 35 U/mL) in patients with PC contributed to a significant decrease in overall survival (P= 0.000).ConclusionsThe expression levels of S100A4 in PC tissues were positively correlated with pre-operative serum CA19.9 levels. S100A4 expression and pre-operative serum CA19.9 levels were significant, independent prognostic factors for the overall survival of patients with PC. S100A4 expression/pre-operative serum CA19.9 levels may prove useful as dual prognostic biomarkers for PC. Analysis of CA19.9 in combination with S100A4 can better predict the prognosis of PC.
Effects of metformin and Exenatide on insulin resistance and AMPKα-SIRT1 molecular pathway in PCOS rats
Authors: Tao Xin , Cai Lisi , Chen Lei , Ge Shuqi , Deng Xuanying 
Published: September 2019

Abstract

Aims
This study was designed to evaluate the protective effects of AMPKα and SIRT1 on insulin resistance in PCOS rats, and to illuminate the underlying mechanisms.

Methods
An in vitro PCOS model was established by DHEA (6 mg/(100 g•d)), and the rats were randomly divided into the metformin group (MF group, n = 11), the exenatide group (EX group, n = 11), the PCOS group (n = 10), and the normal control group (NC group, n = 10). The MF group was administered MF 300 mg/(kg•d) daily. The EX group was subcutaneously injected EX 10μg/(kg•d) daily. After 4 weeks of continuous administration, fasting blood glucose and serum androgen, luteinizing hormone and other biochemical indicators were measured. Western and Real-time PCR were used to determine the expression of AMPKα and SIRT1 in the ovaries of each group.

Results
After 4 weeks of drug intervention, compared with untreated PCOS group, EX group and MF group had visibly decreased body weight (222.64 ± 16.57, 218.63 ± 13.18 vs 238.30 ± 12.26 g, P = 0.026), fasting blood glucose (7.71 ± 0.72, 8.17 ± 0.54 vs 8.68 ± 0.47 mmol/L, P < 0.01), HOMA-IR (8.26 ± 2.50, 7.44 ± 1.23 vs 12.66 ± 1.44, P < 0.01) and serum androgen (0.09 ± 0.03, 0.09 ± 0.03 vs 0.53 ± 0.41 ng/ml, P < 0.01) and the expressions of AMPKα and SIRT11 were increased progressively (P < 0.05).

Conclusions
Both metformin and exenatide can improve the reproductive and endocrine functions of rats with PCOS via the AMPKα-SIRT1 pathway, which may be the molecular mechanism for IR in PCOS and could possibly serve as a therapeutic target.
Effective continuous acetone–butanol–ethanol production with full utilization of cassava by immobilized symbiotic TSH06
Authors: Lin Zhangnan , Liu Hongjuan , Wu Jing , Patakova Petra , Branska Barbora , Zhang Jianan 
Published: September 2019

Abstract

Background
Butanol production by fermentation has recently attracted increasingly more attention because of its mild reaction conditions and environmentally friendly properties. However, traditional feedstocks, such as corn, are food supplies for human beings and are expensive and not suitable for butanol production at a large scale. In this study, acetone, butanol, and ethanol (ABE) fermentation with non-pretreated cassava using a symbiotic TSH06 was investigated.

Results
In batch fermentation, the butanol concentration of 11.6 g/L was obtained with a productivity of 0.16 g/L/h, which was similar to that obtained from glucose system. A full utilization system of cassava was constructed to improve the fermentation performance, cassava flour was used as the substrate and cassava peel residue was used as the immobilization carrier. ABE fermentation with immobilized cells resulted in total ABE and butanol concentrations of 20 g/L and 13.3 g/L, which were 13.6% and 14.7% higher, respectively, than those of free cells. To further improve the solvent productivity, continuous fermentation was conducted with immobilized cells. In single-stage continuous fermentation, the concentrations of total ABE and butanol reached 9.3 g/L and 6.3 g/L with ABE and butanol productivities of 1.86 g/L/h and 1.26 g/L/h, respectively. In addition, both of the high product concentration and high solvent productivity were achieved in a three-stage continuous fermentation. The ABE productivity and concentration was 1.12 g/L/h and 16.8 g/L, respectively.

Conclusions
The results indicate that TSH06 could produce solvents from cassava effectively. This study shows that ABE fermentation with cassava as a substrate could be an efficient and economical method of butanol production.
ESR statement on portable ultrasound devices
Authors:   European Society of Radiology (ESR)
Published: September 2019

AbstractThe use of portable ultrasound (US) devices has increased in recent years and the market has been flourishing. Portable US devices can be subdivided into three groups: laptop-associated devices, hand-carried US, and handheld US devices. Almost all companies we investigated offer at least one portable US device. Portable US can also be associated with the use of different US techniques such as colour Doppler US and pulse wave (PW)-Doppler. Laptop systems will also be available with contrast-enhanced US and high-end cardiac functionality.Portable US devices are effective in the hands of experienced examiners. Imaging quality is predictably inferior to so-called high-end devices.The present paper is focused on portable US devices and clinical applications describing their possible use in different organs and clinical settings, keeping in mind that patient safety must never be compromised. Hence, portable devices must undergo the same decontamination assessment and protocols as the standard equipment, especially smartphones and tablets.
Health risk assessment of potentially toxic elements via consumption of vegetables irrigated with polluted river water in Addis Ababa, Ethiopia
Authors: Aschale Minbale , Sileshi Yilma , Kelly-Quinn Mary 
Published: September 2019

Abstract

Background
Vegetables grown at contaminated sites can take up and accumulate toxic and potentially toxic elements at concentrations that are toxic to human health. The present study determined the levels of potentially toxic elements/PTEs in irrigation water, soil and vegetable samples grown along contaminated river and assessed the potential health risks to consumers.

Results
The average concentrations of Mn, Sr and Cr in the irrigation water were higher than the international guideline values. The levels of As, Cr, B and Ni in most of the farm soils were also found to be higher than the guideline values. Other PTEs, although not exceeding the recommended limits were relatively high in the soil and water samples. The study also revealed that the mean levels of Cr, Cd and Fe in most vegetables were higher than the maximum recommended limits. Swiss chard was maximally contaminated with PTEs followed by lettuce, cabbage, Ethiopian kale, carrot and potato. Hence, frequent consumption of lettuce and Swiss chard may cause serious health risks to consumers.

Conclusion
The levels of many elements were varied with location, suggesting localized inputs of the various contaminants related to industrial and other activities that generate wastewater.
Splits in students’ beliefs about learning classical and quantum physics
Authors: Dreyfus Benjamin W. , Hoehn Jessica R. , Elby Andrew , Finkelstein Noah D. , Gupta Ayush 
Published: September 2019

Abstract

Background
While there has been increasing recognition of the importance of attending to students’ views about what counts as knowing and learning a STEM field, surveys that measure these “epistemological” beliefs are often used in ways that implicitly assume the fields, e.g., “physics,” to be a single domain about which students might have sophisticated or naïve beliefs. We demonstrate this is not necessarily the case and argue for attending to possible differences in students’ epistemological beliefs across different sub-domains of physics. In modern physics and quantum mechanics courses for engineering and physics students, we administered a set of modified Colorado Learning Attitudes about Science Survey (CLASS) items. Each selected item was turned into two items, with the word “physics” changed to “classical physics” in one and “quantum physics” in the other.

Results
We found significant splits between students’ survey responses about classical vs. quantum physics on some items, both pre- and post-instruction. In classical physics, as compared to quantum physics, students were more likely to report the salience of real-world connections and the possibility of combining mathematical and conceptual reasoning during problem solving.

Conclusions
These findings suggest that attending to sub-domain specificity of students’ beliefs about physics can be fruitful and ought to influence our instructional choices.
Similar bacterial communities on healthy and injured skin of black tip reef sharks
Authors: Pogoreutz Claudia , Gore Mauvis A. , Perna Gabriela , Millar Catriona , Nestler Robert , Ormond Rupert F. , Clarke Christopher R. , Voolstra Christian R. 
Published: September 2019

Abstract

Background
Sharks are in severe global decline due to human exploitation. The additional concern of emerging diseases for this ancient group of fish, however, remains poorly understood. While wild-caught and captive sharks may be susceptible to bacterial and transmissible diseases, recent reports suggest that shark skin may harbor properties that prevent infection, such as a specialized ultrastructure or innate immune properties, possibly related to associated microbial assemblages. To assess whether bacterial community composition differs between visibly healthy and insulted (injured) shark skin, we compared bacterial assemblages of skin covering the gills and the back from 44 wild-caught black-tip reef sharks (Carcharhinus melanopterus) from the Amirante Islands (Seychelles) via 16S rRNA gene amplicon sequencing.

Results
Shark skin-associated bacterial communities were diverse (5971 bacterial taxa from 375 families) and dominated by three families of the phylum Proteobacteria typical of marine organisms and environments (Rhodobacteraceae, Alteromonadaceae, Halomonadaceae). Significant differences in bacterial community composition of skin were observed for sharks collected from different sites, but not between healthy or injured skin samples or skin type (gills vs. back). The core microbiome (defined as bacterial taxa present in ≥50% of all samples) consisted of 12 bacterial taxa, which are commonly observed in marine organisms, some of which may be associated with animal host health.

Conclusion
The conserved bacterial community composition of healthy and injured shark skin samples suggests absence of severe bacterial infections or substantial pathogen propagation upon skin insult. While a mild bacterial infection may have gone undetected, the overall conserved bacterial community implies that bacterial function(s) may be maintained in injured skin. At present, the contribution of bacteria, besides intrinsic animal host factors, to counter skin infection and support rapid wound healing in sharks are unknown. This represents clear knowledge gaps that should be addressed in future work, e.g. by screening for antimicrobial properties of skin-associated bacterial isolates.
Psychiatric disturbances in patients undergoing open-heart surgery
Authors: Younes Osama , Amer Reham , Fawzy Hosam , Shama Gamal 
Published: September 2019

AbstractBackgroundEmotional and behavioral problems have been noted in a considerable number of patients after open-heart surgery. However, great discrepancy exists in the literature regarding the frequency and the course of psychiatric symptoms, cognitive performance, and quality of life among those patients. This prospective study was designed to assess the pre- and postoperative psychiatric profile, as well as the quality of life of patients undergoing open-heart surgery.MethodsOne hundred patients who were prepared for cardiac surgery and met our selection criteria were recruited in this study. Each patient was subjected to the Hospital Anxiety and Depression Scale, the Mini-Mental State Examination with selective subtests of Wechsler Adult intelligence scale, and the Short Form 36 questionnaire to assess psychiatric symptoms, cognitive performance, and quality of life respectively. Assessment was done for each of the evaluated items before surgery as well as at 1 week and 6 months postoperatively.ResultsThe anxiety and depressive symptoms were significantly lower at 6 months postoperatively than preoperatively. The cognitive performance declined after 1 week, then improved significantly at the 6-month follow-up. The quality of life scale was significantly lower preoperatively than after surgery.ConclusionsAnxiety and depressive symptoms, which occurred in substantial percentage of patients undergoing open-heart surgery, were gradually improved with time. Cognitive functions showed early deterioration with significant improvement at 6 months. Psychiatric problems had an adverse impact on patients’ quality of life which raised the importance of psychiatric consultation before and after cardiac surgeries to shorten recovery time.
Beyond lymph nodes: 18F-FDG PET/CT in detection of unusual sites of extranodal lymphoma
Authors: Othman Amal Ibrahim Ahmed , Nasr Merhan , Abdel-Kawi Moustafa 
Published: September 2019

Abstract

Background
The purpose of this study was to compare between contrast-enhanced computer tomography (CE CT) and 18F-FDG PET/CT in the detection of extranodal involvement in lymphoma and to correlate between SUVmax of the extranodal lesion and the hottest LN. One hundred patients with pathologically proven lymphoma underwent whole body 18F-FDG PET/CT and CECT scans. Images were compared regarding the ability of detection of extranodal lymphomatous sites. Kappa agreement was applied to find the degree of agreement between both modalities. Pearson’s correlation was used for correlating SUVmax of the extranodal lesions and hottest LN. The degree of FDG uptake was correlated with histopathological type.

Results
There was a poor agreement between PET/CT and CECT in the detection of extranodal sites (k = 0.32). There was a significant positive moderate correlation between SUVmax of the extranodal lesions and hottest LN (r = 0.45). PET/CT study resulted in up staging of 10% and down staging of 5% of cases.

Conclusion
In lymphoma staging, FDG PET/CT enables more detection of extranodal involved sites that show normal morphology at CECT. It differentiates lymphomatous infiltration from benign causes of increased FDG uptake with subsequent proper disease staging.