bluuebunny/crossref_metadata_2025_split huggingface dataset:
Serum chitinase‐like protein YKL‐40 is linked to small airway function in children with asthmatic symptoms
Authors: Knihtilä Hanna , Kotaniemi‐Syrjänen Anne , Pelkonen Anna S. , Savinko Terhi , Malmberg Leo Pekka , Mäkelä Mika J. 
Published: September 2019

AbstractBackgroundLung function impairment among asthmatic children begins in early life, and biomarkers for identifying this impairment are needed. The chitinase‐like protein YKL‐40 has been associated with asthma and lung function in adults, but studies in children have yielded conflicting results. We evaluated the potential of YKL‐40 and other systemic biomarkers for identifying lung function deficits in children with asthmatic symptoms.MethodsWe determined the levels of serum YKL‐40, periostin, and high‐sensitivity C‐reactive protein (hs‐CRP) from the blood samples of 49 children with asthmatic symptoms. Lung function was assessed with impulse oscillometry (IOS) and spirometry, combined with an exercise challenge and a bronchodilator test. Fractional exhaled nitric oxide was measured at multiple flow rates.ResultsSerum levels of YKL‐40 showed significant correlations with most IOS indices at baseline (P = .008‐.039), but there was no association between YKL‐40 and spirometry parameters. Neither periostin nor hs‐CRP were associated with baseline lung function. Children with a significant response in either the exercise challenge or the bronchodilator test had increased serum levels of YKL‐40 (P = .003) and periostin (P = .035). YKL‐40 correlated significantly with the blood neutrophil count (rs = .397, P = .005) but was not associated with biomarkers of eosinophilic inflammation.ConclusionSerum YKL‐40 is a potential biomarker for lung function deficits in children with asthmatic symptoms. These deficits appear to be focused on small airways and may remain undetected with spirometry.
Epidemiology of regional anesthesia in children: Lessons learned from the European Multi‐Institutional Study APRICOT
Authors: Dadure Christophe , Veyckemans Francis , Bringuier Sophie , Habre Walid 
Published: September 2019

AbstractBackgroundRecently, the European prospective observational multicenter cohort study, APRICOT, reported anesthesia techniques and complications in more than 31 000 pediatric procedures. The main objective of this study was to analyze the current practice in regional anesthesia in the 33 countries that participated to APRICOT.MethodsData on regional anesthesia techniques were extracted from the database of APRICOT (261 centers across 33 European countries). All children, aged from birth to 16 years old, were eligible for inclusion during a 2‐week period. Type of regional anesthesia, whether used awake or with sedation or general anesthesia, techniques of guidance, and the drugs administered were analyzed.ResultsRegional anesthesia was used in 4377 pediatric surgical procedures. The large majority was performed under general anesthesia with central blocks and truncal blocks, representing, respectively, 42.6% and 41.8% of performed techniques. Caudal blocks represented 76.9% of all central blocks. The penile and ilioinguinal/iliohypogastric blocks were the most commonly performed truncal blocks. Anesthetists used mainly anatomical landmarks; ultrasound guidance was applied in only 23.8% of cases. A wide variability of practices was observed in terms of regional anesthesia techniques and local anesthetics among the participating European countries. No serious complications were reported.ConclusionThese data show a large predominance of central and truncal blocks in APRICOT study. Ultrasound guidance was mainly used for peripheral nerve blocks while central blocks were performed using landmark techniques.
Operationalism and realism in psychometrics
Authors: Vessonen Elina 
Published: September 2019

AbstractPsychometrics is one of the main approaches to social scientific measurement. It is relied upon in drug testing, economic policymaking, recruitment, and other decision‐making contexts. The first aim of this article is to introduce philosophers to key aspects of psychometrics, namely, classical test theory, item response theory, and construct validity. The second aim is to show how a debate on the nature of psychological attributes manifests in psychometrics. In this debate, realists claim that psychometric measures are indicators of independently existing qualities, while operationalists argue that a measure defines its target attribute. The third and final aim is to argue that despite its poor reputation among philosophers, operationalism is a viable approach to psychometrics.
Public health nurses' experiences of assessing disruptive behaviour in children and supporting the use of an Internet‐based parent training programme
Authors: Ristkari Terja , Mishina Kaisa , Lehtola Milka‐Maija , Sourander Andre , Kurki Marjo 
Published: September 2019

BackgroundIn Finland, although families generally receive support from child health clinics, some need more help in dealing with their child's emotions, behaviour and psychosocial development. Public health nurses play a central role in providing vital psychosocial support for families, but they often lack the confidence and competence to tackle mental health problems.AimTo describe how public health nurses used and experienced a working model that combined a psychosocial tool (Strengths and Difficulties Questionnaire, SDQ) to identify disruptive behaviour in four‐year‐old children and an Internet‐based parent training programme with telephone coaching.MethodsThis is a descriptive, cross‐sectional survey study. The sample consists of public health nurses (n = 138) who were working in child health clinics in Finland that had used the working model. Statistical data were analysed using SPSS Statistics for Windows. The responses to an open‐ended question were analysed using inductive content analysis.ResultsThe experiences about the working model were mainly positive. The public health nurses felt that the psychosocial tool, the SDQ, was easy and suitable to use in child health clinics. The availability of an Internet‐based parent training programme provided greater support for parents by overcoming practical barriers. Overall, the working model helped nurses to develop their mental health competencies.ConclusionWithin primary care, the need to tackle psychosocial problems is increasing, and for this, public health nurses need extra support and tools. It seems that the working model, including the SDQ and the online and telephone coaching programme, worked well in child health clinics. This working model can be used to provide parental support and improve nurses' mental health competencies.
How to … use qualitative research to change practice
Authors: Kajamaa Anu , de la Croix Anne , Mattick Karen 
Published: September 2019

SummaryThe ‘How to …’ series focuses on how to do qualitative research. But how can qualitative research enhance patient care? This paper aims to support health care practitioners, educators and researchers who are interested in bridging the gap between research and practice (both clinical and educational), to guide improvements that can ultimately benefit patients. We present action research and The Change Laboratory method as two approaches that typically involve qualitative research and have potential to change practice, blending scientific inquiry with social action. These approaches establish close research–practice partnerships and help answer tricky ‘why’ and ‘how’ questions that may unlock deep insights to enhance learning and patient care.… how can qualitative research enhance patient care?
Exploring threshold concepts in population health
Authors: Neve Hilary , Hothersall Eleanor J , Rodrigues Veena 
Published: September 2019

SummaryBackgroundDoctors are increasingly expected to improve the health and well‐being of populations, as well as to care for individuals. However, despite extensive efforts to integrate population health into undergraduate programmes, engaging students in such learning is notoriously challenging. Threshold concepts are transformative, integrative, irreversible and fundamental to understanding a discipline. Grasping such concepts requires learners to cross a liminal space, which often involves struggle.MethodsWe employed a form of transactional curriculum enquiry, involving qualitative and quantitative methods, with experienced population health medical educators to identify and explore threshold and troublesome concepts in population health.ResultsAttributing causality, inequalities in health and doctors’ responsibility for populations not just individuals were the concepts most participants thought were threshold. The value of qualitative research, health as politically and socially determined and not taking evidence at face value were the concepts ranked as most troublesome for learners. Participants found the notions of threshold and troublesome concepts helpful and empowering. They described ways these new ideas would influence how they taught population health.DiscussionTransactional curriculum enquiry can offer insights into which population health concepts may be threshold and troublesome. The number of such concepts identified in this study may help explain why students often struggle to engage in population health learning. Understanding which concepts are threshold and particularly which are troublesome can help teachers to better support learners and can also inform curriculum design.If our students are to … take responsibility for populations as well as individuals … it is vital that they cross these fundamental thresholds in learning
Sustained virological response with 16‐week glecaprevir/pibrentasvir after failure to sofosbuvir/velpatasvir in post‐transplant severe HCV recurrence in HIV
Authors: Merli Marco , Rossotti Roberto , Travi Giovanna , Ferla Fabio , Lauterio Andrea , Angelini Zucchetti Teresa , Alcantarini Chiara , Bargiacchi Olivia , De Carlis Luciano , Puoti Massimo 
Published: September 2019

AbstractDirect‐acting antivirals (DAAs) demonstrated high efficacy and safety even in the post‐liver transplant (LT) setting and in HIV‐infected patients, but data are very limited in the early post‐LT period with the most recently available DAA. Two HIV/HCV‐coinfected LT recipients (both grafts from HIV/HCV‐negative donors) experienced early HCV recurrence with severe hepatitis and were treated with sofosbuvir/velpatasvir for 12 weeks. Unfortunately, both patients failed: one (genotype 4d) showed virological breakthrough at week 3 with resistance‐associated substitutions (RASs) for both NS5A and NS5B, while the other (genotype 1a) experienced virological relapse without RAS. Both progressed to fibrosing cholestatic hepatitis and were successfully retreated with glecaprevir/pibrentasvir for 16 weeks achieving sustained virological response. The higher prevalence of RAS in experienced genotype 4 patients and the long time to viral suppression observed in subjects with fibrosing cholestatic hepatitis should be taken into account, considering longer treatment duration to increase the chances of achieving sustained virological response.
Single‐center experience with use of letermovir for CMV prophylaxis or treatment in thoracic organ transplant recipients
Authors: Aryal Shambhu , Katugaha Shalika B. , Cochrane Adam , Brown Anne Whitney , Nathan Steven D. , Shlobin Oksana A. , Ahmad Kareem , Marinak Lauren , Chun Jessica , Fregoso Margaret , Desai Shashank , King Christopher 
Published: September 2019

AbstractBackgroundCytomegalovirus (CMV) infection is common in thoracic organ transplant recipients. Valganciclovir and ganciclovir are used for both prophylaxis and treatment of this infection, but intolerance and treatment failure are common. Letermovir has been demonstrated to reduce the risk of CMV infection when used for prophylaxis in allogeneic hematopoietic cell transplantation. However, there are no data on its efficacy in thoracic organ transplantation.MethodsWe examined the use of letermovir for either CMV prophylaxis (primary and secondary) or treatment in heart and lung transplant recipients at our institution from February 1, 2018, through December 31, 2018.ResultsNine total patients received letermovir at our institution (8 lung transplant, 1 heart transplant) during the study period. Letermovir was prescribed for CMV prophylaxis in eight patients (primary prophylaxis in two patients and secondary prophylaxis in 6 patients), and for treatment of CMV DNAemia in two cases. One patient received letermovir for both secondary prophylaxis and treatment on separate occasions. Three out of 8 (37.5%) patients receiving letermovir for prophylaxis developed CMV DNAemia during prophylaxis. One patient treated for CMV disease had clinical failure with a sharp rise in serum CMV DNA PCR. The other patient treated for low‐grade CMV DNAemia initially had a slight rise in CMV DNA PCR, but has since had a sustained response. No major side effects were experienced, and 2 patients reported minor side effects.ConclusionLetermovir was well tolerated with only minor side effects reported; however, the rate of development of CMV DNAemia on prophylaxis was considerable. Further study of the dosing and efficacy of letermovir for CMV prophylaxis or treatment in thoracic organ transplant recipients is warranted.
Drug dose and drug choice: Optimizing medical therapy for veterinary cancer
Authors: Thamm Douglas H. , Gustafson Daniel L. 
Published: September 2019

AbstractAlthough novel agents hold great promise for the treatment of animal neoplasia, there may be room for significant improvement in the use of currently available agents. These improvements include altered dosing schemes, novel combinations, and patient‐specific dosing or selection of agents. Previous studies have identified surrogates for “individualized dose intensity,”, for example, patient size, development of adverse effects, and pharmacokinetic parameters, as potential indicators of treatment efficacy in canine lymphoma, and strategies for patient‐specific dose escalation are discussed. Strategies for treatment selection in individual patients include conventional histopathology, protein‐based target assessment (eg, flow cytometry, immunohistochemistry, and mass spectrometry), and gene‐based target assessment (gene expression profiling and targeted or global sequencing strategies). Currently available data in animal cancer evaluating these strategies are reviewed, as well as ongoing studies and suggestions for future directions.
Dermal arteritis of the nasal philtrum: a retrospective study of 23 dogs
Authors: Souza Clarissa P. , Torres Sheila M. F. , Koch Sandra N. , Bernardi de Souza Lucilene 
Published: September 2019

BackgroundDermal arteritis of the nasal philtrum (DANP) is a cutaneous vascular condition that selectively targets large vessels of the nasal philtrum of dogs; little information is published about this disease.ObjectiveThe aim of this study was to report the signalment, clinical signs, treatment options and outcome of dogs with DANP, and to propose a rationale for the clinical diagnosis.AnimalsTwenty‐three dogs from four referral veterinary clinics from January 2002 to July 2018.Methods and materialsRetrospective analysis of medical records of dogs with diagnosis of DANP.ResultsThe mean age at disease onset was 5.3 years. Nineteen dogs were pure‐bred (11 different breeds) and four were mixed breed. Twenty‐three dogs had a clinical diagnosis of DANP and three of these had histopathological confirmation. Eight dogs had episodes of profuse arterial bleeding from the lesion, nine had minor bleeding and six no bleeding. Twenty dogs were managed medically with monotherapy or combined therapy of topical tacrolimus, prednisolone, doxycycline and niacinamide, and/or pentoxifylline. Long‐term tacrolimus was prescribed for 15 cases, eight of those cases as sole therapy. Treatment was declined for three dogs and four dogs were lost to follow‐up. The lesion was satisfactorily controlled in 12 dogs and well‐controlled in four dogs.Conclusions and clinical importanceThe distinctive presentation of DANP substantiates the clinical diagnosis. Medical treatment seems to be effective in controlling DANP and tacrolimus used as sole or adjunctive therapy appears to manage the disease satisfactorily.
Isolation of Neisseria dumasiana from a deep bite wound infection in a dog
Authors: Cobiella Danielle , Gram Dunbar , Santoro Domenico 
Published: September 2019

BackgroundNeisseria spp. is a common inhabitant of the oral flora of cats and dogs; it is a potential cause of cutaneous infections in people secondary to animal bites. Neisseria dumasiana is a new species identified in the oral cavity of dogs. It has not been linked to cutaneous infections in people.ObjectiveTo describe the clinical and microbiological features of Neisseria dumasiana isolated from the skin of a dog.AnimalA 3‐year‐old male neutered mixed breed dog from Florida, USA.Methods and materialsThe dog had no travel history within or outside the United States; the dog was presented with draining tracts on the dorsum. Five months before the initial examination the dog was involved in a fight with another dog.ResultsAn aerobic bacterial culture was performed and isolated multiple small, grey, moist, circular, convex and nonhaemolytic colonies. A Gram stain showed Gram‐negative coccobacilli present in pairs. The bacteria were oxidase‐ and catalase‐positive and negative for indole and fermentation of fructose, xylose, sucrose, mannitol and sorbitol. Polymerase chain reaction, using 16S rDNA sequencing, was positive for Neisseria dumasiana. Clinical and microbiological resolution occurred within three months of treatment.Conclusions and clinical importanceTo the best of the authors’ knowledge, this is the first report of a deep cutaneous dermatitis associated with Neisseria dumasiana in a dog. This case should stimulate veterinary clinicians and microbiologists to consider Neisseria spp. among the differential diagnoses of nonhealing wounds in dogs, particularly those associated with bite wounds.
Development of a Parallel Manipulator-Based Multifunction Mobility Assistive Device
Authors: Asker Ahmed , Assal Samy F. M. 
Published: September 2019

Abstract
Developing robotic systems for reducing the dependence of elderly on personal assistance is one of the most recent hot topics in robotics research. This paper proposes a multifunction mobility assistive device, which consists of an assisting parallel manipulator carried over an active walker. It is developed to interactively assist in various lower limb activities, namely, sit-to-stand, walking, bed or toilet to wheelchair transfer, and support in the upright position. The assisting parallel manipulator is constructed based on two of the nonconventional structure of the 3-RPR parallel manipulator. This structure offers kinematic decoupling between the position and orientation and free of singularity suitable workspace as well as high rigidity and payload capability. Kinematic, dynamic, and finite element analyses are performed to ensure the functionality of the device. A prototype of the device is constructed to verify the applicability of the device. The prototype is shown to be suitable for assisting subjects to stand up in a natural manner.
Effects of Iranian healthcare transformation plan on discharge against medical advice rate and related factors in 2012 and 2016
Authors: Taghizadieh Ali , Azami-Aghdash Saber , Piri Reza , Naghavi-Behzad Mohammad , Jabbari Beyrami Hossein 
Published: September 2019

ObjectiveDischarge against medical advice (DAMA) is a critical problem in hospitals and has several consequences for healthcare systems. The aim of this study was to determine and compare the rate of DAMA and its related factors before and after executing the healthcare transformation plan (HTP) in Iran.MethodsIn a two-phase, cross-sectional study, the DAMA information of 200 patients in 2016 (after HTP) and the patients of a previous study in 2012 (before HTP) was compared. Samples were randomly selected from the main referral centre in the north-west of Iran. Data were collected using a validated and reliable questionnaire and analysed using the SPSS V.16 software.ResultsIn the post-HTP plan period, the rate of DAMA was 3.9%, while this rate was 5.49% in 2012 (p=0.029). A total of 15% (108 out of 721) of patients in the postreform group and 13.5% (101 out of 747) in the prereform group were rehospitalised (p=0.411). The three main categories of reasons for DAMA in 2012 and 2016 were as follows: patient-related factors, 27% vs 45%; staff-related factors, 33% vs 30%; and hospital-related factors (basic amenities), 40% vs 25%. In both periods, the average scores of patient satisfaction were almost the same; however, satisfaction regarding environmental and human factors in hospitals had changed significantly after HTP (p<0.05).ConclusionsThere was a decrease in the rate of DAMA after HTP in Iran. Considering DAMA as a multifactorial phenomenon, this might be due to the higher relative satisfaction after HTP, indicating an increase in public confidence in general hospitals.
Impact of caesarean section on breastfeeding indicators: within-country and meta-analyses of nationally representative data from 33 countries in sub-Saharan Africa
Authors: Yisma Engida , Mol Ben W , Lynch John W , Smithers Lisa G 
Published: September 2019

ObjectiveTo examine the impact of caesarean section on breastfeeding indicators—early initiation of breastfeeding, exclusive breastfeeding under 6 months and children ever breastfed (at least once)—in sub-Saharan Africa.DesignSecondary analysis of Demographic and Health Surveys (DHS).SettingThirty-three low-income and middle-income countries with a survey conducted between 2010 and 2017/2018.ParticipantsWomen aged 15–49 years with a singleton live last birth during the 2 years preceding the survey.Main outcome measuresWe analysed the DHS data to examine the impact of caesarean section on breastfeeding indicators using the modified Poisson regression models for each country adjusted for potential confounders. For each breastfeeding indicator, the within-country adjusted prevalence ratios (aPR) were pooled in random-effects meta-analysis.ResultsThe within-country analyses showed, compared with vaginal birth, caesarean section was associated with aPR for early initiation of breastfeeding that ranged from 0.24 (95% CI 0.17 to 0.33) in Tanzania to 0.89 (95% CI 0.78 to 1.00) in South Africa. The aPR for exclusive breastfeeding under 6 months ranged from 0.58 (95% CI 0.34 to 0.98) in Angola to 1.93 (95% CI 0.46 to 8.10) in Cote d'Ivoire, while the aPR for children ever breastfed ranged from 0.91 (95% CI 0.82 to 1.02) in Gabon to 1.02 (95% CI 0.99 to 1.04) in Gambia. The meta-analysis showed caesarean section was associated with a 46% lower prevalence of early initiation of breastfeeding (pooled aPR, 0.54 (95% CI 0.48 to 0.60)). However, meta-analysis indicated little association with exclusive breastfeeding under 6 months (pooled aPR, 0.94 (95% CI 0.88 to 1.01)) and children ever breastfed (pooled aPR, 0.98 (95% CI 0.98 to 0.99)) among caesarean versus vaginally born children.ConclusionsCaesarean section had a negative influence on early initiation of breastfeeding but showed little difference in exclusive breastfeeding under 6 months and children ever breastfed in sub-Saharan Africa.