bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison between minimally invasive plate osteosynthesis and open reduction–internal fixation for proximal humeral fractures: a meta-analysis based on 1050 individuals
Authors: Li Feilong , Nie Tao , Liu Xuqiang , Wang Fuqiang , Gu Zhiping , Tao Qianyuan , Yao Cong , Luo Xuwen 
Published: July 2019

Abstract
Background

This meta-analysis aimed to compare the clinical outcomes and complications of minimally invasive plate osteosynthesis (MIPO) and open reduction–internal fixation (ORIF) in patients with proximal humeral fractures.

Methods

We searched PubMed, EMBASE, Ovid, and the Cochrane Library to identify all relevant studies from inception to April 2019. Cochrane Collaboration’s Review Manage 5.3 was used for meta-analysis.

Results

Sixteen studies involving 1050 patients (464 patients in the MIPO group and 586 patients in the ORIF group) were finally included. According to the meta-analysis, MIPO was superior to ORIF in operation time, blood loss, postoperative pain, fracture union time, and constant score. However, MIPO was associated with more exposure to radiation and axillary nerve injury. No significant differences were found in length of hospital stays and complication except for axillary nerve injury.

Conclusion

The present evidence indicates that MIPO offers superior outcomes in comparison to ORIF. However, surgeons should pay attention to reducing radiation exposure and avoiding axillary nerve injury.
Evaluation of a bundled care approach to preventing surgical site infections post caesarean section in an Australian Rural Hospital
Authors: Bolte Michelle , Knapman Blake , Leibenson Lilach , Ball Jean , Giles Michelle 
Published: July 2019

Abstract
Background

Elective and non-elective caesarean section (CS) rates have been increasing in Australia over the past 20 years. Increasing antenatal morbidity, has meant that surgical site infection (SSI) post CS is an important issue effecting Australian women. Populations most impacted include low socioeconomic and regional communities where high rates of antenatal comorbidity increase the incidence of SSI. Despite a recent trend towards supporting the development of evidence based bundled approaches to SSI reduction, there remains a paucity of data proving efficacy and supporting bundle implementation.

Aims

This study aimed to develop, implement and assess an evidence based caesarean infection prevention “CIP” bundled intervention to reduce SSI rates following CS in a high risk rural population.

Methods

The study was a pre-post-intervention study with 3 phases and included all women undergoing CS at a regional referral hospital between December 1st 2016 and December 31st 2018. A 12 month retrospective pre-intervention review identified all women who developed a post CS SSI. A comprehensive literature review informed the development of the intervention, which was implemented in December 2017. Prospective data was collected for a subsequent 12 month period on all women who underwent CS with pre and post comparative data analysis.

Results

A total of 710 procedures were monitored as part of the study with 346 and 364 women in the pre and post-intervention groups respectively. Demographic and comorbidity variables remained consistent between the two time periods. Rates of CS associated SSI reduced significantly post-intervention (5.5% vs. 1.6%, p=0.007), the greatest benefit seen in class II and III obese patients (12.2% vs. 2.5%, p=0.019). Higher rates of hypertension (24% vs. 9%, p=0.01) and lower maternal age (mean age 27 vs. 30, p=0.01) were seen in patients with SSI. Rates of smoking were higher in women effected by SSI (24% vs 9%) but did not reach statistical significance.

Conclusion

The “CIP” bundle is an effective method of reducing caesarean associated surgical site infections in a high risk population. Our findings highlight the necessity for the development and evaluation of multifaceted, evidenced based interventions to reduce SSI in women requiring caesarean delivery.
The heterogeneous health state profiles of high-risk healthcare utilizers and their longitudinal hospital readmission and mortality patterns
Authors: Ng Shawn Choon Wee , Kwan Yu Heng , Yan Shi , Tan Chuen Seng , Low Lian Leng 
Published: July 2019

Abstract
Background:
High-risks patients are vulnerable during transitions of care. Segmentation of such heterogenous patients into distinct subgroups help facilitate healthcare resource planning. We aimed to segment a high-risk population using latent class analysis (LCA) and assess its association with 30-day and 90-day hospital readmission and mortality.

Methods:
We extracted data from all H2H program participants from June to November 2018. LCA was used to determine the optimal number and characteristics of latent subgroups, assessed based on model fit and clinical interpretability. Regression analysis was performed to assess association of class membership on 30- and 90-day all-cause readmission and mortality.

Results:
Among 752 patients, a 3-class best fit model was selected: Class 1 “Frail, cognitively impaired and physically dependent”, Class 2 “Pre-frail, but physically independent” and Class 3 “Physically independent”. The 3 classes have distinct demographics, medical and socioeconomic characteristics (p<0.05), 30- and 90-day readmission (p<0.05) and mortality (p<0.01). Class 1 patients have the highest age-adjusted 90-day readmission (OR=2.04, 95%CI: 1.21-3.46, p= 0.008), 30- (OR=6.92, 95%CI: 1.76-27.21, p=0.006) and 90-day mortality (OR=11.51, 95%CI: 4.57-29.02, p<0.001).

Conclusions:
We demonstrated the applicability of LCA in identifying 3 unique subgroups with distinct readmission and mortality risks among high-risk patients, providing important information for tailoring future integrated care interventions.
Factors affecting on the leaving job and reentry for the Japanese dental hygienist
Authors: Nomura Yoshiaki , Okada Ayako , Yamamoto Yuko , Kakuta Erika , Tomonari Hiroshi , Hosoya Noriyasu , Hanada Nobuhiro , Yoshida Naomi , Takei Noriko 
Published: July 2019

Abstract
Background

Working dental hygienists is not sufficient. About 40% licensed dental hygienist are leaving their professional jobs. Re-entry of leaving dental hygienist is expected to compensate the unbalance of demand and supply. The purpose of this study was to identify the obstacles for re-entry of leaving dental hygienists and propose the countermeasures for supporting re-entry

Methods

The Japan Dental Hygienists Association has been conducted survey of the Employment Status of Japanese dental hygienist every 5 years since 1981. Questionnaires were distributed for all members of the Japan Dental Hygienists Association. Among the 94 items, following eight specific items were used for analysis: 1. The reason of leaving the job. 2. How long have you been leaving the job? 3. Willingness to reentry. 4. How do you find your work for re-entry? 5. Is there any obstacle for the reentry? 6. What is your obstacle for reentry? 7. Do you need lecture course for reentry? 8. What kind of lecture course contents do you want to attend?

Results

Questioners were distributed for 16,113 members of Appeases Dental hygienist Association, and 8,780 were responded (collection rate: 54.5%). By log-linear analysis, for the reason of leaving the job, dissatisfaction with work content and marriage were significant in age groups ≤29 and 30-39. Child birth / child rearing were significant in age groups of ≤29, 30-39 and 40-49. Payment were significant in 30-39 and 40-49.Child birth / rearing and working hours were most important impact on the leaving job and obstacle for reentry. In this study, number of dental hygienist who leave the job by child birth / rearing was highest.

Conclusion

Workplace improvement including flexible working time may be most important factors or the reentry for the dental hygienist with leaving jobs. Social support system is indispensable to improve women's working environment.
Determinants of overburdening among informal carers: A systematic review
Authors: Lindt Nienke , Berkel Jantien van , Mulder Bob 
Published: July 2019

Abstract
Background and Objective: The Dutch population is ageing, resulting in rising care demands and healthcare costs, which in turn led to a shift from formal to informal care. However, not only is the number of potential informal carers fastly decreasing, informal caregivers also experience higher caregiver burden. This literature review aimed at identifying the determinants of caregiver burden, to inform future interventions and foster informal care activities.

Research Design and Methods: A systematic review of peer-reviewed articles included in either PubMed, Scopus and/or PsychInfo has been conducted.

Results: 17 articles have been included. The most important predictors were the duration of caregiving and the dependency level of the patient, both in terms of physical dependency and mental dependency stemming from decreased cognitive capacity or behavioral problems. Some specific illnesses and role conflicts or captivity also increased burden, while social support lowered it. Being a female caregiver or having an adult-childrelationhip led to higher burden.

Discussion and Implications: Firstly, it is recommended that specific interventions are designed for carers most at risk and that they focus on increasing the patient’s physical and mental independency. Moreover, interventions need to be adapted to the illness trajectory of specific diseases and the adhering needs for social support of both the recipient and caregiver. Lastly, role expectations should be changed, leading to men being more involved. Future research could focus on determining causality, the concept of ‘time’ and the relevance of cultural expectations.
Increased songbird nest depredation due to invasive Aleppo pine (Pinus halepensis) encroachment in Mediterranean shrubland
Authors: Ben-David Asaf , Shamoon Hila , Izhaki Ido , Efronny Roni , Maor Roi , Dayan Tamar 
Published: July 2019

Abstract
Background In recent decates, a decrease of passerine densities was documented in Mediterenean shrublands. At the same time, a widspread encroachment of Aleppo pines (Pinus halepensis) to Mediterranean shrubland occurred. Such changes in vegetation structure may effect passerine predator assemblage and densities, and in turn impact passerine densities. Depredation during the nesting season is an important factor to influence passerine population size. Understanding the effects of changes in vegetation structure (pine encroachment) on passerine nesting success is the main objective of this study. We do so by assesing the effects of Aleppo pine encroachment on Sardinian warbler (Sylvia melanocephala) nest depredation in Mediterranean shrublands.
Methods We examined direct and indirect predation pressures throught a gradients of pine density, using four methods: (1) placing dummy nests; (2) acoustic monitoring of mobbing events; (3) direct observations on nest predation using cameras; and (4) observation of Eurasian jay (Garrulus glandarius) behaviour as indirect evidence of predation risk.
Results We found that Aleppo pine encroachment to Mediterranean shrublands increased nest predation by Eurasian jays. Nest predation was highest in with median encroaching pine. These areas are suitable for warblers, but had high occurrence rate of Eurasian jays.
Conclusions Invasive pines directly increase activity of avian predators in shrubland habitats which impacted shrubland songbird nesting success. These findings are supported by multiple methodologies, illustrating different predation pressures along a gradient of pine densities in natural shrublands. Management of Aleppo pine seedlings and removal of unwanted trees in natural shrubland might mitigate arrival and expansion of native-invasive predators and decrease the predation pressure on passerine nests.
Assessment of knowledge and practice of breast self-examination among young women in tertiary education: Addis Ababa, Ethiopia.
Authors: Dinegde Negalign Getahun 
Published: July 2019

Abstract
Abstract
Background: Breast cancer is the top cancer in women both in the developed and the developing world. The Addis Ababa Cancer registry reported that breast cancer accounts for 34% of all female cancer cases. Many deaths can be avoided if the cancer can be detected and treated early. Practice of breast self-examination is a convenient, no-cost tool that can be used on a regular basis for detecting breast illness at an early stage. Therefore, this study sought to assess the knowledge and practice of BSE among young females at Addis Ababa, Ethiopia.
Methods: Institutional based cross sectional study was conducted on the total sample size of 381 females using self-administered questionnaire adapted from other studies. The data were entered using Epi-data software version 4.1.1 and then exported to SPSS version 24 for further statistical analysis. The study analysis was done by descriptive and inferential statistics: namely frequency, mean, student t-test, ANOVA, linear & logistic regression.
Results: Majority of the participants were single (85.2%), orthodox Christian (67%), and grew up in urban (77.7%) with mean age of 20.84 years. The majority (94.1%) of the participants had no any family history of breast cancer. Almost half (52.5%) of the respondents had heard about breast cancer self-examination, while the media were the main source of information. The study revealed that only as little as 47 (13.1%) respondents did appropriate BSE, while two third of the females not practicing BSE reported that the reasons were, they didn’t know how to do it, forgetfulness, and didn’t have any breast problem. In addition, the females’ previous information about BSE makes the greatest unique contribution to explaining the BSE knowledge level. Moreover, the study indicates that the more age and knowledge the females have, the more likely it is that they will report practicing BSE.
Conclusion: Further implementations are needed in addressing young females, making awareness and advocacy campaigns about BSE in order to increase early diagnosis of breast cancer which raises the chances for successful treatment in Ethiopia.
Key words: Breast cancer, Breast cancer self-examination, Knowledge, Practice, Ethiopia.
Combining the Platelet-to-Albumin Ratio with Serum and Pathologic Variables to Establish a Risk Assessment Model for Lymph Node Metastasis of Gastric Cancer and Evaluation of Its Predictive Value
Authors: Huang Chao , Xia Yongqiang , Xiao Li , Liu Zitao , Huang Jun , Luo Hongliang , Zong Zhen , Zhu Zhengming 
Published: July 2019

Abstract
Background

The preoperative platelet count and serum tumor markers have been shown to correlate with the lymph node metastasis (LNM) of gastric cancer (GC).The aim of this study was to establish a risk assessment model that incorporated the platelet-to-albumin ratio (PAR) for LNM of GC and to evaluate its clinical significance.

Methods

The clinical data of 314 patients with GC diagnosed by postoperative pathology were collected in our hospital. According to whether there was LNM in the pathological specimens of the operation, the patients were divided into the group without LNM and the group with LNM. Univariate analysis and multivariate logistic regression were used to analyze the relevant factors affecting LNM of GC and to identify independent risk factors for LNM of GC. The random forest algorithm was used to extract the important risk factors of LNM in GC. A nomogram model of the risk assessment of LNM of GC was constructed by the “rms” package of R software. The receiver operating characteristic (ROC) curve was used to evaluate the accuracy, sensitivity and specificity of the model for predicting LNM of GC.

Results

Univariate analysis showed that the factors associated with LNM of GC were sex (P=0.015), smoking (P=0.027), lesion size (P=0.000), pathological type (P=0.001), differentiation degree (P=0.000), infiltration depth (P=0.000), PAR (P=0.005), carbohydrate antigen (CA) 19-9 (P=0.017), CA125 (P=0.000) and CA72-4 (P=0.005). Multivariate logistic regression showed that lesion size [odds ratio (OR): 1.322; P = 0.000], differentiation degree (OR: 0.582; P = 0.001), and depth of invasion (OR: 1.734; P = 0.000) were independent risk factors for LNM in GC. The risk assessment model of LNM in GC was established according to the ranking of variables shown by the random forest algorithm. The C statistic of the model evaluation was 0.827, the sensitivity was77.2%, and the specificity was 74.8%.

Conclusion

Lesion diameter larger than 2.65 cm, poor differentiation and deep infiltration were high-risk factors for LNM in GC. The nomogram model constructed by PAR, lesion size, infiltration depth, CA125, CA19-9, CA72-4, and differentiation degree, can well predict the risk of LNM in GC.
Impact of dose reduction and treatment delay of neoadjuvant chemotherapy in gastric and esophageal adenocarcinoma
Authors: Borg David , Hedner Charlotta , Jirström Karin , Johnsson Anders 
Published: July 2019

Abstract
Background

Neoadjuvant chemotherapy in resectable gastric and esophageal adenocarcinoma is often hampered by toxicities and fragile patients resulting in dose reductions and/or treatment delays. The aim of this study was to assess how these treatment modifications affect outcome.

Methods

A series of 63 consecutive patients treated 2008-2014 with neoadjuvant EOX (epirubicin, oxaliplatin and capecitabine) and surgical resection, with or without adjuvant treatment, were reviewed. Chemotherapy dose index (DI), i.e. the ratio of actual to planned cumulative dose, and time index (TI), i.e. the ratio of planned to actual total duration, were calculated. Associations of neoadjuvant EOX DI and TI with histopathologic response were analysed with binary logistic regression. Time to recurrence (TTR) and overall survival (OS) were estimated using Kaplan-Meier analyses.

Results

Statistically significant associations were found between neoadjuvant EOX TI >= 0.95 and a major histopathologic response (0-10% residual cancer cells) and between neoadjuvant EOX DI >= 0.95 and a response with 0-50% residual cancer cells. Significantly improved TTR and OS were seen in patients with a major histopathologic response.

Conclusions

Our results suggest that treatment delays of neoadjuvant chemotherapy in gastric or esophageal adenocarcinoma should be avoided in order to achieve a major response.
Pruning from spheroidal to cubic canopy induced aphid outbreak by altering the plant performance in spindle tree
Authors: Liu Yinzhan , Xuan Juan , Chen Anqun , Qiao Chunlian , Miao Renhui , Zhao Cancan 
Published: July 2019

Abstract
The effects of pruning on animal-plant interactions have rarely been studied. We thus conducted field experiments to examine the impact of artificially-pruned shapes (e.g. cubic and spheroidal canopy) on the performance of the spindle tree and the resulting aphid abundance at three sites; on a university campus, at a road green belt, and in a residential area. The results showed aphid abundance was 89.9 times higher in plants with a cubic canopy than with a spheroidal canopy. Plants with a cubic canopy had lower leaf dry mass content and inflorescence numbers, but greater fresh twig length than the plants with a spheroidal canopy. The aphid abundance was negatively correlated with the leaf dry mass content and inflorescence numbers, and positively correlated with the fresh twig length. The results can provide data support for human actives can alter plant performance, and thereby to change insect preference.
Investigation of cerebrospinal fluid electrolytes and acid-base expressions in Asian adults
Authors: Yu Huang-Ping , Liao Chia-Chih , Yeh Jiun-Ting , Li Allen , Liu Fu Chao 
Published: July 2019

Abstract
Background:
Analysis of cerebrospinal fluid (CSF) parameters helps clinicians identify patients with central nervous system (CNS) disease. In previous literature, reference values for CSF may be based on patients who were not truly healthy, other species, or outdated information. In the present study, we performed lumbar puncture in patients requiring spinal anesthesia by a reasonable indication to evaluate CSF parameters in healthy adults.
Methods:
All patients between the ages of 20 and 70 years scheduled for elective orthopedic or urologic surgery requiring spinal anesthesia were enrolled in this study. We measured electrolytes and gas tension analysis in CSF and whole blood samples in adult humans.
Results:
A total of 28 patients were included with an average age of 44.2 years. The pH of blood and CSF were both neutral, but it was slightly lower in blood. The concentration of Na+ in blood was slightly lower compared with that in CSF. There were significantly higher levels of K+ and Ca2+ in the blood compared with CSF. Significantly lower levels of Cl- and Mg2+ in the blood were observed compared with CSF. The glucose level of CSF was about half of that in blood.
Conclusions:
We provided updated reference values for various solutes in blood and CSF in adults. Although normal CSF constituents are quite similar to that of blood, there is still a small difference in normal values between them. Analysis of CSF parameters and relevant paired blood samples is highly informative, helping clinicians diagnose a variety of CNS diseases.
Trial registration:
This present study was approved by the Institutional Review Board of Chang Gung Medical Foundation, Taiwan (approval number: 201600122A3), and is registered under Clinical Trials Registry (ClinicalTrials.gov Identifier: NCT03725709).
Seroprevalence and the associated risk factors of Toxoplasma gondii infection among pregnant women in the middle belt of Ghana
Authors: MENSAH DERRICK ADU , Debrah Linda Batsa , Aryee Clement Evans , DEBRAH ALEXANDER YAW YAW 
Published: July 2019

Abstract
Background
Exposure to Toxoplasma gondii infection is prevalent in up to 90% of the world’s population. Severe infections can be fatal and deforming in neonates. Cats serve as reservoirs for T. gondii infections. Even though many Ghanaians have cats as pets in their homes only few studies have been undertaken to assess the prevalence of the disease in Ghana. The objective of the study was to determine the seroprevalence of T. gondii infection and its associated risk factors among pregnant women seeking antenatal care at the Goaso Municipal Hospital, in Asunafo North District of the Ahafo Region and the St. Michael’s Catholic Mission Hospital in the Bosomtwe District in the Ashanti Region of Ghana.

Methods
A cross-sectional study involving 266 (146 from Asunafo North District and 120 from Bosomtwe District) pregnant women who consented to participate in the study was undertaken. To gather information on associated risk factors, structured questionnaire was administered to the participants. In addition, 3 mls of venous blood was collected from each participant for anti-T. gondii IgG and anti-T. gondii IgM antibody analyses using ELISA.

Results
A total of 64.3% (171/266) of the study participant were positive for anti-T. gondii IgG and 26.3% (70/266) were positive for anti-T. gondii IgM antibodies. This signifies that 64.3% of the study population have been exposed to the infection and 26.3% were actively infected. There were no differences (P=0.383) between the overall T. gondii seroprevalences in the two Districts. There was a significant difference between antibody concentration levels and age in the Bosomtwe District in Ashanti Region. No association (OR<1) was found between the seroprevalences and the suspected risk factors assessed in this study.

Conclusion
The study showed that the seroprevalence of T. gondii among pregnant women visiting the two health facilities in the two Regions was higher compared to the 30%-65% reported as the global population infection status. This study provides baseline data for future studies in the other Districts and Regions in the country to ascertain the overall seroprevalence in Ghana.