bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of an Electronic Medication System in a large tertiary hospital: A case of qualitative inquiry
Authors: Vaghasiya Milan , Penm Jonathan , Kuan Kevin , Gunja Naren , Liu Yiren , Kim Edward , Patrina Neysa , Poon Simon 
Published: July 2019

Abstract
Introduction

There is a growing interest in the use of technology in the health sector in Australia. Hospitals across Australia are implementing Clinical Information Systems (CIS) e.g. Electronic Medication Systems (EMS) at a rapid space to moderate health service delivery. The implementation of an EMS is crucial in a big hospital organisation. The benefits of the EMS depend on the acceptance of the system by the clinicians. The study hospital used a unique patient-centric implementation strategy. This paper aims to study the factors facilitating or hindering the adoption of EMS as viewed by clinicians and the implementation team.

Method

Four focus group, one each for 1) doctors, 2) nurses 3) pharmacists 4) implementation team were conducted. A guide for the focus group was created based on the Unified Theory of Acceptance and Use of Technology (UTAUT).

Results

A total of 23 unique codes were identified and were grouped into five main themes 1) Implementation strategy 2) Organisational outcome of EMS 3) Individual impact of EMS 4) IT product and 5) Organisational culture. Clinicians reported improvement in their workflow efficiency post-EMS implementation. They also reported some challenges in using the EMS that centered around the area of infrastructure, technical and design issues. Additionally, the implementation team highlighted two crucial factors influencing the success of EMS implementation, namely: 1) the patient-centric implementation strategy, and 2) the organisation readiness.

Conclusion

Overall, this study provides substantial evidence of the use of the behavior theory of UTAUT in explaining the implementation process of EMS in a large healthcare facility by using clinicians’ and the implementation team’s perspectives. A unique implementation strategy with the patient-centric approach and clinical leadership in the implementation team played a crucial role in clinicians’ acceptance of the EMS. Perceived and realised benefits helped clinicians to form a positive attitude in the adoption of EMS. On the other hand, general training instead of customised training based on local needs, technical and design issues and lack of availability of computer systems can act as a barrier to the adoption of the system. Promptly resolving these issues can improve the adoption of the EMS.
In depth analysis of the association of FTO SNP (rs9939609) with expression of the classical phenotype of PCOS: a Sri Lankan study
Authors: Branavan Umayal , Wijesundera Sulochana , Chandrasekharan Visvanath , Arambepola Carukshi , Wijeyaratne Chandrika 
Published: July 2019

Abstract
Background: PCOS is a common disorder of women due to genetic, endocrine and environmental effects that manifests from puberty. The rs9939609 variant of fat mass and obesity associated (FTO) gene is linked to metabolic derangement in PCOS. We previously identified FTO (rs9939609) as a susceptibility locus for PCOS among Sri Lankan women and also explored the role of kisspeptin. Associated factors of the FTO candidate gene among South Asians with PCOS are unknown.
Methods: This study aimed to determine the association between FTO (rs9939609) polymorphism with clinical (BMI, acanthosis nigricans, hirsutism) and biochemical (serum kisspeptin and testosterone levels) characteristics of PCOS in a cohort of Sri Lankan women. Genetic and clinical data including serum kisspeptin and testosterone concentrations of our previously reported cases (n=55) and controls (n=110) were re-analyzed, specifically for an association with rs9939609 variant of FTO gene.
Results: Logistic regression analysis (AA – OR=5.7, 95% CI=2.41-13.63, p<0.05) and genetic inheritance analysis (AA – OR=5.49, 95%CI=2.34-12.88, p<0.05) showed that FTO (rs9939609) polymorphism is significantly associated with PCOS and its metabolic manifestations. Serum testosterone was significantly higher in affected women with mutant genotypes (AA+AT) than the normal allele (TT) (p<0.05). Although serum kisspetin was higher in subjects with PCOS and mutant alleles than controls, this difference was not significant (p>0.05).
Conclusion: FTO gene variant rs9939609 is associated with hyperandrogenemia and metabolic manifestations of PCOS among women of Sri Lankan descent with the well-characterized phenotype. Serum kisspeptin and the FTO genotypes lack a significant association when adjusted for confounders.
Association among cytokine profiles of innate and adaptive immune responses and clinical-virological features in untreated patients with chronic hepatitis B
Authors: Gu Yurong , Lian Yifan , Zheng Qiaolan , Huang Zexuan , Gu Lin , Bi Yanhua , Li Jing , Huang Yanlin , Wu Yuankai , Huang Yuehua 
Published: July 2019

Abstract
Background

Complete clearance of intracellular viruses depends on effector cells of innate and adaptive immune system. This study aimed to identify the relationship between antiviral cytokines produced by natural killer (NK) and T cells and clinical-virological characteristics in untreated chronic hepatitis B (CHB) patients.

Methods

We measured antiviral cytokines interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), and interleukin-2 (IL-2) produced by T, NK and natural killer T (NKT) cells in a cohort of chronic hepatitis B virus (HBV) infection (CHB). We also correlated these cytokines with clinical-virological characteristics using a linear regression model.

Results

IFN-γ+ and TNF-α+ by CD4+ and CD8+ T cells were significantly higher in immune active (IA) than other phases. Immune tolerant (IT) patients showed the least expression of IFN-γ+ by NK and NKT cells, and TNF-α+ by NK cells. IFN-γ+, TNF-α+ and IL-2+ by CD4+ and CD8+ T cells were comparable between IA and gray zones (GZ) phases. Principal component analysis based on cytokines confirmed that most IT patients significantly differ from inactive carriers (IC) and IA patients, while GZ patients were widely scattered. Multivariate analysis showed both T and NK cells producing IFN-γ+ and TNF-α+, but not IL-2+, had significant association with serum alanine aminotransferase (ALT). Moreover, IFN-γ+ by NKT cells was associated with HBV DNA, while IFN-γ+ by CD4+ and CD8+ T cells had correlation with age.

Conclusion

HBV clinical phases are characterized by distinct cytokines signatures, which showed little relationship to viral features at a single time point in these untreated CHB patients.
Prevalence of Methicillin-Resistant Staphylococcus Aureus (MRSA) infection in patients with Cystic Fibrosis: a meta-analysis
Authors: Mohamed Sagad Omer Obeid , Ali Almigdad H. M. , Ibrahim Abazr A. H. , Elnil Mahmoud , Elhassan Almutasim B. E. , Salman Mohammed Suliman Tawer , Elkhidir Ibrahim H. E. , Ali Osman Omer , Elhassan Mazin A.M. , Elbathani Mohamed Elata Hassan 
Published: July 2019

Abstract
Background

Methicillin-resistant staphylococcus aureus (MRSA) infection is increasingly being reported among patients with cystic fibrosis (CF) and contributes to pulmonary morbidity in CF, with poorer prognosis. The aim of this study was to assess the prevalence of MRSA infection in patients with CF.

Methods

We conducted this study according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases of MEDLINE/PubMed, WHO-Virtual Health Library (VHL), ScienceDirect, Google Scholar and OpenGrey were searched to recruit the relevant articles. Pooled prevalence with the corresponding 95% confidence interval (CI) was calculated using OpenMeta Analyst software, and heterogeneity among studies was estimated using the I2 statistics.

Results

According to our inclusion criteria, 27 studies included a total of 47,413 patients were analyzed. The pooled prevalence of MRSA in patients with CF was 15.2% (95% CI 9.70%– 20.7%). Subgroup analyses and meta-regression showed that the prevalence of MRSA in patients with CF was significantly associated with different geographical areas (P<0.001), data collection method (P<0.001), sample obtaining source (P<0.001), and study year (P = 0.006).

Conclusions

prevalence of MRSA infection is increasing in patients with CF. the results of this study could provide a reference for further controlling transmission and the management of patients with CF. Healthcare providers need to be aware of the clinically important association between MRSA infection and CF to ensure effective management.
The impact of medication reviews conducted in primary care on hospital admissions and mortality - a randomized controlled trial
Authors: Nymberg Veronica Milos , Lenander Cecilia , Bolmsjö Beata Borgström 
Published: July 2019

Abstract
Background
Drug-related problems among the elderly population are common and increasing. Multi-professional medication reviews (MR) have arisen as a method to optimize drug therapy for frail elderly patients. Research has not yet been able to show conclusive evidence of the effect of MRs on mortality or hospital admissions.
Aim
The aim of this study was to assess the impact of MRs’ on hospital admissions and mortality after six and 12 months in a frail population of 369 patients in primary care in a randomized controlled study.

Methods
Patients were blindly randomized to an intervention group (receiving MRs) and a control group (receiving usual care). Descriptive data on mortality and hospital admissions at six and 12 months were collected. Survival analysis was performed for time to death and time to the first hospital admission within 12 months.

Results
Of the total number of 369 included patients, 182 were randomized to the intervention group and 187 to the control group. Most of the patients (75%) were females and lived in nursing homes. At six months, 50 patients of the baseline population (27%) in the control group had been admitted to hospital at least once, compared to 40 patients (21%) in the intervention group. At 12 months, the percentage had increased to 70 (37%) in the control group compared to 53 (29%) in the intervention group. Compared to usual care, we found that MRs reduced the risk of hospital admissions within 12 months by 36% (HR = 0.64, 95% CI 0.45-0.90), but found no difference on mortality (HR = 1.12, 95% CI 0.78-1.61) between the groups.
Conclusion
We suggest that MRs should be recommended in the care of frail elderly patients with expected benefits on hospital admissions.
Prevalence of geriatric depression in Kavre district, Nepal: Findings from a cross sectional community survey
Authors: Manandhar Kedar , Risal Ajay , Shrestha Oshin , Manandhar Nirmala , Kunwar Dipak , Koju Rajendra , Holen Are 
Published: July 2019

Abstract
Background

The increasing elderly population worldwide is likely to increase mental health problems such as geriatric depression, which has mostly been studied in high-income countries. Similar studies are scarce in low-and-middle-income-countries like Nepal.

Methods

A cross-sectional, population-based, door-to-door survey was conducted in randomly selected rural and urban population clusters of the Kavre district, Nepal. Trained nurses (field interviewers) administered structured questionnaires that included a validated Nepali version of the Geriatric Depression Scale short form (GDS-15) for identifying geriatric depression among elderly (≥60 years) participants (N=460). Those scoring ≥6 on GDS-15 were considered depressed. Logistic regression analysis explored the associations of geriatric depression with regard to socio-demographic information, life style, family support and physical well-being variables.

Results

Of the total 460 selected elderly participants, 439 took part in the study. More than half of them were females (54.2%). The mean age was 70.9 (± 8.6) years. Approximately half (50.6%) were rural inhabitants, the majority (86.1%) were illiterate, and about three-fifths (60.1%) were living with their spouses. The gender-and-age adjusted prevalence of geriatric depression was 53.1%. Geriatric depression was significantly associated with rural habitation (AOR 1.6), illiteracy (AOR 2.1), limited time provided by families (AOR 1.8), and exposure to verbal and/or physical abuse (AOR 1.7).

Conclusion

Geriatric depression is highly prevalent in the Kavre, Nepal. The findings call for urgent prioritization of delivery of elderly mental health care services in the country. [Word count 230]
Non breathing-related sleep fragmentation and imaging markers in patients with atherosclerotic cerebral small vessel disease (CSVD), a cross-sectional case-control study
Authors: wang jihui , Chen Xiaodong , Liao Jinchi , Zhou Li , Han Hongying , Tao Jiong , Lu Zhengqi 
Published: July 2019

Abstract
Objective:
Evidence of a relationship between non breathing-related sleep fragmentation and imaging markers of the brain in cerebral small vessel disease (CSVD) patients is scarce. The purpose of the present study was to investigate the relationship in CSVD patients living in China, where CSVD is a major pathogenesis underlying stroke.

Methods:
A group of 84 CSVD patients were prospectively recruited along with 24 age and sex matched normal controls. 3.0 T superconducting magnetic resonance imaging and overnight polysomnography were conducted in all the participants. Polysomnography parameters including sleep onset latency, total sleep time; sleep efficiency, wake after sleep onset, percentage of each sleep stage (N1, N2, N3 and REM) and arousal index were compared between the CSVD patients and normal controls, and the relationship between arousal index and CSVD markers was explored in the CSVD group.

Results:
Polysomnography measures showed that CSVD patients had significantly higher arousal index and wake after sleep onset, lower sleep efficiency and N-3 ratio compared to normal controls (p< 0.05). The results of ordinal logistic regression showed that higher arousal index was positively associated with the severity of periventricular white matter hyperintensity (OR 1.177, 95% CI 0.170 to 2.295) and perivascular space (OR 1.245, 95% CI 0.485 to 2.124) in CSVD patients, after adjusting for all the independent variables.

Conclusions:
These preliminary results indicate that non breathing-related sleep fragmentation is common and related to the pathological markers of CSVD patients. Future prospective research is invited to establish the causal relationship between sleep parameters and CSVD pathology.
Accelerometry Assessed Physical Activity of Elderly Adults Hospitalized with Acute Medical Illness - an Observational Study
Authors: Tasheva Plamena , Kraege Vanessa , Vollenweider Peter , Roulet Guillaume , Méan Marie , Marques-Vidal Pedro 
Published: July 2019

Abstract
Background: In a hospital setting and among elderly patients, inactivity and bedrest are associated with a wide range of negative outcomes such as functional decline, increased risk of falls, longer hospitalization and new institutionalization. Our aim was to assess the distribution and determinants of physical activity (PA) levels using wrist-worn accelerometers in elderly adults hospitalized with acute medical illness.
Methods: Observational study conducted from February to November 2018 at an acute internal medicine unit in the University hospital of Lausanne, Switzerland. We enrolled 177 patients aged ≥65 years, able to walk independently prior to admission. PA during acute hospital stay was continuously recorded via a 3D wrist accelerometer. As previously suggested, PA was defined as an acceleration ≥12 mg. Clinical data was collected from medical records or by interview. Autonomy level prior to inclusion was assessed using Barthel Index score.
Results: Median [interquartile range - IQR] age was 83 [74-87] years and 60% of participants were male. The median [IQR] time spent inactive and in PA was 485 [404-563] and 177 [114-255] minutes/day, respectively. PA was distributed into three peak periods during the day: between 8 and 10 am, at 12 am and at 6 pm. Approximately 50% of patients were considered physically active. Stepwise logistic regression identified Barthel index [odds ratio and (95% confidence interval) for increase in category [1.85 (1.09-3.14)], prescription of sedatives [0.31 (0.12-0.80)] and prescription of physiotherapy [2.16 (1.08-4.58)] as significantly and independently associated with inactivity.
Conclusion: Elderly hospitalized patients are physically active only one quarter of the day and concentrate their PA around eating periods. A Barthel Index below 91 could be used to identify patients at risk of physical inactivity.
Overexpression of MfSAMS1 Improves Chilling Tolerance in Transgenic Stylo
Authors: Qiu Hong , Zhou Min , Huang Lei , Guo Zhenfei , Lu Shaoyun 
Published: July 2019

Stylo [Stylosanthes guianensis (Aublet) Sw.] is an important forage legume and cover crop in tropical and southern subtropical regions. Its growth and survival are largely affected by low temperature in winter in subtropical regions. It is important to improve its chilling tolerance. S‐adenosylmethionine synthetase (SAMS) is the key enzyme catalyzing the formation of S‐adenosylmethionine (SAM), a precursor of polyamines synthesis. To improve chilling tolerance in stylo, MfSAMS1 from Medicago falcata was overexpressed in stylo plants. DNA gel blot hybridization and quantitative reverse transcription PCR analysis showed that MfSAMS1 was inserted into the genomes of transgenic plants and expressed. Compared to the wild‐type, transgenic plants had enhanced SAM and spermidine levels and increased chilling tolerance with higher level of the maximum photochemical efficiency of photosystem II (Fv/Fm) and lower ion leakage after chilling treatment. Polyamine oxidase activity and H2O2 levels were increased in transgenic plants compared with the wild‐type. In addition, higher activities of superoxide dismutase and catalase were observed in transgenic plants than in the wild‐type. The results suggest that overexpression of MfSAMS1 promoted polyamine synthesis and oxidation, which in turn improved H2O2–induced antioxidant protection and protected transgenic plants against chilling stress.Core Ideas

Transgenic stylo plants overexpressing MfSAMS1 were produced.
Plants showed promoted polyamine synthesis and oxidation.
Transgenic plants had increased chilling tolerance with higher antioxidant levels.
Greenhouse Gas Mitigation through Dairy Manure Acidification
Authors: Sokolov Vera , VanderZaag Andrew , Habtewold Jermaneh , Dunfield Kari , Wagner‐Riddle Claudia , Venkiteswaran Jason J. , Gordon Robert 
Published: July 2019

Liquid dairy manure storages are sources of methane (CH4), nitrous oxide (N2O), and ammonia (NH3) emissions. Both CH4 and N2O are greenhouse gases (GHGs), whereas NH3 is an indirect source of N2O emissions. Manure acidification is a strategy used to reduce NH3 emissions from swine manure; however, limited research has expanded this strategy to reducing CH4 and N2O emissions by acidifying dairy manure. This study compared control dairy manure (pH 7.4) with two treatments of acidified manure using 70% sulfuric acid (H2SO4). These included a medium pH treatment (pH 6.5, 1.4 mL acid L−1 manure) and a low pH treatment (pH 6, 2.4 mL acid L−1 manure). Emissions were measured using replicated mesoscale manure tanks (6.6 m2) enclosed by large steady state chambers. Both CH4 and N2O were continuously measured (June–December 2017) using tunable diode laser trace gas analyzers. Ammonia emissions were measured three times weekly for 24 h using acid traps. On a CO2 equivalent basis, the medium pH treatment reduced total GHG emissions by 85%, whereas the low pH treatment reduced emissions by 88%, relative to untreated (control) manure. Total CH4 emissions were reduced by 87 and 89% from medium and low pH tanks, respectively. Ammonia emissions were reduced by 41 and 53% from medium and low pH tanks, respectively. Additional research is necessary to make acidification an accessible option for farmers by optimizing acid dosage. More research is need to describe the manure buffering capacity and emission reductions and ultimately find the best approaches for treating farm‐scale liquid dairy manure tanks.Core Ideas
Acidification reduced total CO2–eq GHGs from liquid dairy manure by 85 to 88%.
Total CH4 emissions were reduced by 87 to 89% from acidified manure.
NH3 emissions were reduced by 41 to 53% from acidified manure.
A range of yearly H2SO4 cost was estimated to be Can$6.55 to $19.6 cow−1.
Specific Heat Capacity of Soil Solids: Influences of Clay Content, Organic Matter, and Tightly Bound Water
Authors: Wang Yajing , Lu Yili , Horton Robert , Ren Tusheng 
Published: July 2019

The specific heat capacity of soil solids (cs) is a key parameter affecting heat storage and transfer in soils. In soil and geophysical applications,csis often assumed to be a constant with little variations across soils. In this study, we determined the specific heat capacities of nine soils by using differential scanning calorimetry (DSC), evaluated the effects of clay and organic matter (OM) contents on thecsof original and OM‐free soil samples at room temperature, and quantified the changes ofcscaused by the existence of tightly bound water (TBW). On average, the nine mineral soils had acsof 0.750 MJ Mg−1K−1, close to the commonly acceptedcsvalue. However, for the original soils dried at 105°C, clay content did not obviously influence thecsvalue andcsincreased linearly with both OM and TBW contents, indicating that inaccuratecsdata were likely if the changes in the OM fraction in soil solids and adsorbed TBW were ignored. In addition, relatively large values for the specific heat capacity of soil minerals (cm) were observed in fine‐textured soils compared with coarse‐textured soils. Two preliminary functions were developed for estimatingcmandcsfrom the soil's clay and OM contents.Core IdeasSoil specific heat capacity was measured via differential scanning calorimetry.The influences of clay, organic matter (OM), and tightly bound water on specific heat capacity were evaluated quantitatively.A linear relationship was developed between the specific heat of soil minerals dried at 200°C and clay content.The specific heat of soil solids dried at 105°C had a nonlinear relationship with clay and OM contents.