bluuebunny/crossref_metadata_2025_split huggingface dataset:
The emotional labour of quality improvement work in end of life care: a qualitative study of Patient and Family Centred Care in England
Authors: Boulton Richard , Boaz Annette 
Published: October 2019

Abstract
BACKGROUND

There is a growing emphasis on understanding patient experience in order to inform efforts to support improvement. This paper reports findings from an implementation study of an evidence-based intervention called Patient and Family Centred Care (PFCC) designed to tap into patient experiences as a basis for improvement. In this study the PFCC intervention was spread to a new service area (end of life care) and delivered at scale in England. The findings presented here focus specifically on one key aspect of the intervention: staff shadowing of patients, and the experiences of staff carrying out shadowing for the purposes of service improvements.METHODS

The study methods were ethnographic observations of key events, semi-structured interviews with members of participating teams and the programme implementation support team and managers, and a review of the documents used in the set up and running of the programme.RESULTS

One of the key strengths of the PFCC approach is to encourage staff through shadowing to engage with patient experience of services. Many staff described the process of shadowing as a transformative experience that alerted them to immediate areas where their services could be improved. However, engaging with patient experience of end of life care services also had unintended consequences for some staff in the form of emotional labour. Furthermore, we observed difficulties encountered by staff that are not accounted for in the existing PFCC literature relating to how care service structures may unevenly distribute the amount of ‘emotional labour’ that staff members need to invest in implementing the programme.CONCLUSIONS

Connecting with patient experience is a crucial aspect of a number of quality improvement interventions that aim to help staff to engage with the lived experience of their services and reconnect their motivations for working in the health care system. However, there may be unintended consequences for health care service staff, particularly in sensitive areas of service delivery such as end of life care. The ‘emotional labour’ for staff of engaging in quality improvement work informed by patient experience should be considered in planning and supporting patient experience led quality improvement.
Functional analysis of GhCHS, GhANR and GhLAR in colored fiber formation of Gossypium hirsutum L.
Authors: Jianfang Gao , Li Shen , Jingli Yuan , Hongli Zheng , Quansheng Su , Weiguang Yang , Liqiang Zhang , Vitalis Nnaemeka Ekene , Sun Jie , Liping Ke , Sun Yuqiang 
Published: October 2019

Abstract
Background
The formation of natural colored fibers mainly results from the accumulation of different anthocyanidins and their derivatives in the fibers of Gossypium hirsutum L. Chalcone synthase (CHS) is the first committed enzyme of flavonoid biosynthesis, and anthocyanidins are transported into fiber cell after biosynthesis mainly by Anthocyanidin reductase (ANR) and Leucoanthocyanidin reductase (LAR) to present diverse colors with distinct stability. The biochemical and molecular mechanism of pigment formation in natural colored cotton fiber is not clear.
Results
The three key genes of GhCHS , GhANR and GhLAR were predominantly expressed in the developing fibers of colored cotton. In the GhCHSi , GhANRi and GhLARi transgenic cottons, the expression levels of GhCHS , GhANR and GhLAR significantly decreased in the developing cotton fiber, negatively correlated with the content of anthocyanidins and the color depth of cotton fiber. In colored cotton Zongxu1 (ZX1) and the GhCHSi , GhANRi and GhLARi transgenic lines of ZX1, HZ and ZH, the anthocyanidin contents of the leaves, cotton kernels, the mixture of fiber and seedcoat were all changed and positively correlated with the fiber color.
Conclusion
The three genes of GhCHS , GhANR and GhLAR were predominantly expressed early in developing colored cotton fibers and identified to be a key genes of cotton fiber color formation. The expression levels of the three genes affected the anthocyanidin contents and fiber color depth. So the three genes played a crucial part in cotton fiber color formation and has important significant to improve natural colored cotton quality and create new colored cotton germplasm resources by genetic engineering.
Partnering with patients in quality improvement: towards renewed practices for healthcare organization managers?
Authors: Clavel Nathalie , Pomey Marie-Pascale , Ghadiri Djahanchah Philip (Sacha) 
Published: October 2019

Abstract
Background: Around the world, many healthcare organizations engage patients as a quality improvement strategy. In Canada, the University of Montreal has developed a model which consists in partnering with patient advisors, providers, and managers in quality improvement. This model was introduced through its Partners in Care Programs tested with several quality improvement teams in Quebec, Canada. Partnering with patients in quality improvement brings about new challenges for healthcare managers. This model is recent, and little is known about how managers contribute to implementing and sustaining it using key practices. Methods: In-depth multi-level case studies were conducted within two healthcare organizations which have implemented a Partners in Care Program in quality improvement. The longitudinal design of this research enabled us to monitor the implementation of patient partnership initiatives from 2015 to 2017. In total, 38 interviews were carried out with managers at different levels (top-level, mid-level, and front-line) involved in the implementation of Partners in Care Programs. Additionally, seven focus groups were conducted with patients and providers. Results: Our findings show that managers are engaged in four main types of practices: 1-designing the patient partnership approach so that it makes sense to the entire organization; 2-structuring patient partnership to support its implementation and sustainability; 3-managing patient advisor integration in quality improvement to avoid tokenistic involvement; 4-evaluating patient advisor integration to support continuous improvement. Designing and structuring patient partnership are based on typical management practices used to implement change initiatives in healthcare organizations, whereas managing and evaluating patient advisor integration require new daily practices from managers. Our results reveal that managers at all levels, from top to front-line, are concerned with the implementation of patient partnership in quality improvement. Conclusion: This research adds empirical support to the evidence regarding daily managerial practices used for implementing patient partnership initiatives in quality improvement and contributes to guiding healthcare organizations and managers when integrating such approaches.
Clinical and pathological features of idiopathic membranous nephropathy with focal segmental sclerosis
Authors: li jiatong , Chen Bing , Gao Caifeng , Huang Jing , Wang Yongmei , Zhang Shiyin , Xu Ying , Guo Wenkai , Wang Rong 
Published: October 2019

Abstract
Background Our goal was to investigate the clinical and pathological features and prognosis of idiopathic membranous nephropathy (IMN) with focal segmental lesions.
Methods In our hospital, 305 patients with nephrotic syndrome confirmed by renal biopsy as IMN were divided into a non-focal segmental lesion group (FSGS- group) and a focal segmental glomerulosclerosis (FSGS) group (FSGS+ group) and retrospectively analyzed. A total of 180 patients were followed for periods ranging from six months to two years. The general clinical and pathological data of both groups were compared, and the effects of different treatment schemes on the prognosis of both groups were observed.
Results The FSGS+ group had a longer disease course, higher blood pressure levels, and higher serum creatinine and β 2 -microglobulin levels than the FSGS- group (all P < 0.05). Pathologically, the FSGS+ group had increased glomerular sclerosis, glomerular mesangial hyperplasia, acute tubular lesion and chronic tubular lesion rates (all P< 0.05). The remission rate was lower in the FSGS+ group than in the FSGS- group (64.7% vs 82.2%) and was lower in patients treated with calmodulin inhibitors than in those treated with cyclophosphamide in the FSGS+ group (P < 0.01). Survival analysis showed that the FSGS+ group had a poor prognosis (χ 2 =4.377，P=0.036). Risk factor analysis suggested that age at renal biopsy (P=0.006), 24-hour urinary protein quantity (P=0.01), chronic tubulointerstitial lesions (P=0.055), and FSGS lesions (P= 0.062) were risk factors for worsening renal condition; 24-hour urinary protein quantity was an independent risk factor for worsening renal condition.
Conclusions Membranous nephropathy with FSGS is a risk factor, but not an independent risk factor, for IMN. Patients with membranous nephropathy with FSGS often present hypertension and tubule injury. The nonselective drug cyclophosphamide is preferred, and calcineurin inhibitors should be used with caution.
Key words Idiopathic membranous nephropathy; focal segmental sclerosis; cyclophosphamide; calmodulin inhibitor; prognosis;
Anti-PD-1 antibody decreases tumour-infiltrating regulatory T cells
Authors: Yoshida Kazushige , Okamoto Masanori , Sasaki Jun , Kuroda Chika , Ishida Haruka , Ueda Katsuya , Ideta Hirokazu , Kamanaka Takayuki , Sobajima Atsushi , Takizawa Takashi , Tanaka Manabu , Aoki Kaoru , Uemura Takeshi , Kato Hiroyuki , Haniu Hisao , Saito Naoto 
Published: October 2019

Abstract
Background: There are many types of therapies for cancer. In these days, immunotherapies, especially immune checkpoint inhibitors, are focused on. Though many types of immune checkpoint inhibitors are there, the difference of effect and its mechanism are unclear. Some reports suggest the response rate of anti-PD-1 antibody is superior to that of anti-PD-L1 antibody and could potentially produce different mechanisms of action. On the other hand, Treg also express PD-1; however, their relationship remains unclear. Methods: In this study, we used osteosarcoma cell lines in vitro and osteosarcoma mouse model in vivo. In vitro, we analyzed the effect of IFNγ for expression of PD-L1 on the surface of cell lines by flowcytometry. In vivo, murine osteosarcoma cell line LM8 was subcutaneously transplanted into the dorsum of mice. Mouse anti-PD-1 antibody was intraperitoneally administered. we analysed the effect for survival of anti-PD-1 antibody and proportion of T cells in the tumor by Flowcytometry. Results: We discovered that IFNγ increased PD-L1 expression on the surface of osteosarcoma cell lines. In assessing the relationship between anti-PD-1 antibody and Treg, we discovered the administration of anti-PD-1 antibody suppresses increases in tumour volume and prolongs overall survival time. In the tumor microenvironment, we found that the administration of anti-PD-1 antibody decreased Treg within the tumour and increased tumour-infiltrating lymphocytes. Conclusions: Here we clarify for the first time an additional mechanism of anti-tumour effect—as exerted by anti-PD-1 antibody decreasing Treg— we anticipate that our findings will lead to the development of new methods for cancer treatment. keywords: PD-1, Treg, osteosarcoma, anti-PD-1 antibody.
Sudden Intrauterine Unexplained Death: Time To Adopt Uniform Postmortem Investigative Guidelines?
Authors: Lavezzi Anna , Piscioli Francesco , Pusiol Teresa , Jorizzo Gianfranco , Ferrero Stefano 
Published: October 2019

Abstract
Background: In developed countries, one in 100–200 pregnancies ends in stillbirth, in the great part unexplained. The evenness and standardisation of the diagnostic criteria are prerequisites to understand the pathogenesis of these deaths. The core goal of this article is to propose new investigative post-mortem guidelines that should be adopted in all the Institutions especially when a fetal death, after a routine autopsy procedure, is diagnosed as “unexplained”. Methods: Updated investigative guidelines for the examination of unexplained stillbirths, prevalently focused on the histological examination of the brainstem, where the main centers that are involved in monitoring the vital functions are located, are here presented. A section of this protocol concerns the Immunohistochemical evaluation of specific functional markers such as the neuronal nuclear antigen, nicotinic acetylcholine receptors, serotonin, orexin, apoptosis and gliosis. The important role of risk factors, having regard in particular to maternal smoking and air pollution is also contemplated in these guidelines. Results: Specific morphological and/or functional alterations of vital brainstem structures have been found with high incidence in about 100 cases of unexplained fetal death sent to the “Lino Rossi Research Center” of the Milan University according to the Italian law. These alterations were rarely detected in a group of control cases. Conclusions: We hope this protocol can be adopted in all the Institutions notably for the examination of unexplained fetal deaths, in order to make uniform investigations. This will lead to identify a plausible explanation of the pathogenetic mechanism behind the unexplained fetal deaths and to design preventive strategies to decrease the incidence of these very distressing events for both parents and clinicians .
Prevalence and characteristics of COPD among residents in an urban informal settlement in Dar es Salaam, Tanzania
Authors: Magitta Ngweina Francis , Shimwela Meshack Denson , Madas Sapna Jitendra , Mwaiselage Julius David , Sanga Anna Alphonce , Apte Komalkirti Keshavkiran , Pharm Lucy Andrew Namkinga MSc , Salvi Sundeep Santoshi 
Published: October 2019

Abstract
Background: COPD is an important public health problem globally. To-date, indoor air pollution resulting from biomass fuel use is an important risk factor for COPD, particularly in Africa. The poor communities in informal settlements in major cities are likely to be exposed to higher pollution rates and could disproportionately develop COPD. Methods: We collected demographic data, respiratory symptoms and exposure history to air pollution using BOLD validated questionnaire and further performed spirometry using NDD EasyOneTM spirometer, with COPD diagnosed based on a post-bronchodilator FEV1/FVC <70%. The study was approved by the National Ethics committee. Results: A total of 1021 participants completed the questionnaire and had acceptable post-bronchodilator spirometry [(861 female, 66.70%)], with mean age of 52.16 ± 11.59 years. About 15.48% of respondents were smokers, of whom 6.46% were current smokers and 16.67% had significant nicotine dependency. Of all respondents, 11.71% reported living with a smoker and 5.31% reported a history of tuberculosis. The overall prevalence of COPD was estimated at 8.13% [(14.2% male, 5.14% female)], and found to be associated with age (p =0.005), gender (p=0.001), BMI (p=0.001) and smoking status (p=0.001). Over 98% of respondents reported significant exposure to biomass fuel. Over 78% of COPD patients had mild to moderate obstruction and the female had comparatively severe obstruction.Conclusion: In this population, COPD is relatively low compared to previous reports in Africa. Though multiple risk factors are responsible for COPD development, indoor pollution remains the most important factor. In this regard, access to affordable clean energy for domestic use is the most important strategy for COPD control.
Chronic Alcoholic Toxic Cerebral Encephalopathy manifested as Acute Marchiafava-Bignami Disease: a case report
Authors: Zhang Zhixiao , Liu Xiaofang , Jia Xiayan , Wang Li , Niu Jinliang , Cui Sha 
Published: October 2019

Abstract
Background: Marchiafava-Bignami Disease (MBD) is a alcohol-related disorder, its acute form is rather rare that is characterized by acute edema and demyelination of the corpus callosum, manifested as severe disorder of consciousness like coma, which can be accompanied by an increase in muscle tone. Case presentation: We report a 57-year-old man with a 40-year history of chronic and heavy alcohol abuse who progressively developed bilateral lower limb weakness and slurred speech for 3 days. On admission, neurological examination revealed abnormal mental status and cognitive deficits. His left nasolabial groove appeared shallow. The muscle power of the bilateral upper and lower limbs was only grade 4+ with lead-pipe rigidity of muscle. Deep tendon reflexes in the lower limbs were increased, and babinski reflexes were positive bilaterally ，and negative Hoffmann reflexes and the forced grasp reflex . He was diagnosed with erosive gastritis two years ago without any treatment. The immediate brain computed tomography(CT) showed hypodensity in the genu and splenium of the corpus callosum, which suggested an acute cerebrovascular disease, however, the laboratory tests were almost normal except for decreased serum level of folic acid (7.63mmol/L; normal range 11.8-56.2mmol/L), and MRI revealed bilateral hyperintensity on T2 , T2 FLAIR and DWI in the entire corpus callosum, with corresponding hypointensity on ADC images . Based on his medical history, physical examination, and imaging features, the definitive diagnosis of acute MBD was reasonable. But after nearly 5 months of treatment, the symptoms did not relieve significantly, which could be attributed to entire callosal lesion etc. Conclusions: MBD is mainly caused by chronic alcoholism. MRI findings, especially the DWI sequence, are critical for the early diagnosis of MBD in the acute stage, which prevent disease progression from irreversible callosal lesion.
Effect of Antiretroviral Therapy With Tenofovir, Lamivudine And Dolutegravir On Respiratory And Peripheral Muscles Strengh In People Living With Hiv/Aids
Authors: Cardoso Renata de Oliveira , Araújo Paulo Sérgio Ramos de , Maranhão Juliana Barros , Júnior Marco Aurélio de Valois Correia , Costa Eduarda Lubambo 
Published: October 2019

Abstract
Background Some antiretrovirals (ARVs) cause muscle toxicity and their use has been attributed to beginning of respiratory and peripheral muscle weakness in people living with HIV/AIDS (PLWHA) on treatment. Dolutegravir (DTG) has been adopted by Brazil as a first-line regimen with Tenofovir/Lamivudine (TDF/3TC) since 2017, with low toxicity profile. Due to the short use of this regimen, we have not found data in the literature regarding its effects in the respiratory and peripheral muscles in PLWHA. The aim of this study was to compare respiratory and peripheral muscle strength before and after start of this new combined ART (TDF/3TC/DTG).Methods Descriptive, longitudinal and prospective study, observational and analytical with 41 PLWHA evaluated before the initiation of antiretroviral therapy (ART) (T0) which of these, 28 were reevaluated after more than 50 days of treatment (T1).The assessments of maximum functional capacity (six-minute walk test distance), maximal inspiratory (MIP) and expiratory (MEP) pressures and handgrip strength (HGS) were performed using standardized methods. In addition, laboratory data (CD4, CD4/CD8 ratio and viral load-VL) were collected. Shapiro-Wilk test was applied for normality while Fisher's exact test and t-test or Wilcoxon test were used for comparisons of categorical and continuous variables, respectively. Pearson or Spearman correlations were used according to data normality and p-value < 0.05 were considered significant for all analyzes.Results The frequency of peripheral muscle weakness in patients evaluated at T0 was 97.6%, while 31.7% had inspiratory and / or expiratory muscle weakness. HGS was positively correlated with CD4 (p = 0.027) and negatively correlated with VL (p = 0.046). Both MIP (p = 0.0176) and HGS (p = 0.0018) showed improvement in T1.Conclusion ART combined with TDF / 3TC / DTG increased MIP and HGS after more than 50 days of treatment. Cohort studies are needed to better understand the action of these medications on PLWHA musculature under treatment.
Persistent pain of distal clavicle fractures with a large lateral angle acromion treated with a clavicle hook plate: Report on 9 cases
Authors: Wu Kailun , Xu Hao , Xu Yingjie , Yang Huilin , Guo Jiong Jiong 
Published: October 2019

Abstract
Background: The clavicular hook plate was a popular surgical treatment for distal clavicle fractures. The relationship among characteristics of the hook plate, acromioclavicular joint morphology and clinical outcome has remained poorly understood. We reviewed the clinical records of patients who had distal clavicle fractures with large lateral angle of acromion treated using a clavicle hook plate and evaluated the feasibility of this technique.Methods: Between 2010 and 2017, 9 patients (4 male and 5 female; mean age, 43 years) who had distal clavicle fractures with a large lateral angle of acromion were treated by clavicle hook plate at our institute. Follow-up ranged from 18 to 28 months (mean, 23 months). We examined clinical characteristics, MRI findings, treatments, and outcomes.Results: All patients complained of implant-related symptoms postoperatively. Clinical subacromial impingement was observed in all of them. Two patients had relief after removing the device. The symptoms in the remaining seven patients did not subside after removal of plate. Rotator cuff lesions were found in these cases, five of whom received rotator cuff repair and achieved remission of their symptoms.Conclusion: Distal clavicle–acromion coronal angle is an important factor for postoperative efficacy of the hook plate. The selection of a hook plate that makes the contact position between the hook and acromion more proximal may be helpful. Early limited mobility and removal of the implant may improve the prognosis and reduce the rate of impingement and rotator cuff lesions.Study Design: Restropective Review, Level of evidence, 4.
Screening And Quantification Of Anti-Quorum Sensing And Antibiofilm Activities Of Phyllosphere Bacteria Against Biofilm Forming Bacteria
Authors: THEODORA NADINE AMABEL , DOMINIKA VANIA , Waturangi Diana Elizabeth 
Published: October 2019

Abstract
Objective The objectives of this research were to screen anti-quorum sensing activity of phyllosphere bacteria and quantify their antibiofilm activity against biofilm forming bacteria ( Bacillus cereus, Staphylococcus aureus, Enterococcus faecalis, Salmonella typhimurium, Vibrio cholerae, Pseudomonas aeruginosa). Results We found 11 phyllosphere bacteria isolates with potential anti-quorum sensing activity. Most of the crude extracts from phyllosphere bacteria isolates had anti-quorum sensing activity against Chromobacterium violaceum at certain concentration (20 and 10 mg/mL), but not crude extract from isolate JB 7F. Crude extracts showed various antibiofilm activities against all tested pathogenic bacteria.