bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can quality improvement improve the quality of care? A systematic review of reported effects and methodological rigor in plan-do-study-act projects
Authors: Knudsen Søren Valgreen , Laursen Henrik Vitus Bering , Johnsen Søren Paaske , Bartels Paul Daniel , Ehlers Lars Holger , Mainz Jan 
Published: October 2019

AbstractBackgroundThe Plan-Do-Study-Act (PDSA) method is widely used in quality improvement (QI) strategies. However, previous studies have indicated that methodological problems are frequent in PDSA-based QI projects. Furthermore, it has been difficult to establish an association between the use of PDSA and improvements in clinical practices and patient outcomes. The aim of this systematic review was to examine whether recently published PDSA-based QI projects show self-reported effects and are conducted according to key features of the method.MethodsA systematic literature search was performed in the PubMed, Embase and CINAHL databases. QI projects using PDSA published in peer-reviewed journals in 2015 and 2016 were included. Projects were assessed to determine the reported effects and the use of the following key methodological features; iterative cyclic method, continuous data collection, small-scale testing and use of a theoretical rationale.ResultsOf the 120 QI projects included, almost all reported improvement (98%). However, only 32 (27%) described a specific, quantitative aim and reached it. A total of 72 projects (60%) documented PDSA cycles sufficiently for inclusion in a full analysis of key features. Of these only three (4%) adhered to all four key methodological features.ConclusionEven though a majority of the QI projects reported improvements, the widespread challenges with low adherence to key methodological features in the individual projects pose a challenge for the legitimacy of PDSA-based QI. This review indicates that there is a continued need for improvement in quality improvement methodology.
Isolating phyllotactic patterns embedded in the secondary growth of sweet cherry (Prunus avium L.) using magnetic resonance imaging
Authors: Eithun Mitchell , Larson James , Lang Gregory , Chitwood Daniel H. , Munch Elizabeth 
Published: October 2019

Abstract

Background
Epicormic branches arise from dormant buds patterned during the growth of previous years. Dormant epicormic buds remain just below the surface of trees, pushed outward from the pith during secondary growth, but maintain vascular connections. Epicormic buds can be activated to elongate into a new shoot, either through natural processes or horticultural intervention, to potentially rejuvenate orchards and restructure tree architecture. Because epicormic structures are embedded within secondary growth, tomographic approaches are a useful method to study them and understand their development.

Results
We apply techniques from image processing to determine the locations of epicormic vascular traces embedded within secondary growth of sweet cherry (Prunus avium L.), revealing the juvenile phyllotactic pattern in the trunk of an adult tree. Techniques include the flood fill algorithm to find the pith of the tree, edge detection to approximate the radius, and a conversion to polar coordinates to threshold and segment phyllotactic features. Intensity values from magnetic resonance imaging (MRI) of the trunk are projected onto the surface of a perfect cylinder to find the locations of traces in the “boundary image”. Mathematical phyllotaxy provides a means to capture the patterns in the boundary image by modeling phyllotactic parameters. Our cherry tree specimen has the conspicuous parastichy pair (2,3), phyllotactic fraction 2/5, and divergence angle of approximately 143°.

Conclusions
The methods described provide a framework not only for studying phyllotaxy, but also for processing of volumetric image data in plants. Our results have practical implications for orchard rejuvenation and directed approaches to influence tree architecture. The study of epicormic structures, which are hidden within secondary growth, using tomographic methods also opens the possibility of studying genetic and environmental influences such structures.
Prospective intra/inter-observer evaluation of pre-brachytherapy cervical cancer tumor width measured in TRUS and MR imaging
Authors: Federico Mario , Hernandez-Socorro Carmen Rosa , Ribeiro Ivone , Martin Jesus Gonzalez , Oramas Maria Dolores Rey-Baltar , Saez-Bravo Marta Lloret , Jimenez Pedro Carlos Lara 
Published: October 2019

Abstract

Background
Ultrasound (US) imaging has been proved as an excellent diagnostic tool in gynecology and, due to its wide availability and limited cost, is under intense investigation as base for dose adaptation in cervical cancer brachytherapy. Purpose of this work is to test inter/intra-observer uncertainties between magnetic resonance (MR) and trans-rectal ultrasound (TRUS) imaging in defining maximum tumor width before first brachytherapy (BT) application in a prospective cohort of cervical cancer patients undergoing image-guided adaptive brachytherapy (IGABT).

Methods
One hundred ten consecutive cervical cancer patients treated between 2013 and 2016 were included. Before the first BT implant patients underwent MR and TRUS scan with no applicator in place. Images were independently analyzed by three examiners, blinded to the other’s results. With clinical information at hand, maximum tumor width was measured on preBT TRUS and MR. Quantitative agreement analysis was undertaken. Intra-class correlation coefficient (ICC), Passing-Bablok and Bland Altman plots were used to evaluate the intra/inter-observers measurement agreement.

Results
Average difference between tumor width measured on MR (HRCTVMR) and TRUS (HRCTVTRUS) was 1.3 ± 3.2 mm (p <  0.001); 1.1 ± 4.6 mm (p = 0.01) and 0.7 ± 3 mm (p = 0.01). The error was less than 3 mm in 79, 82 and 80% of the measurements for the three observers, respectively. Intra-observer ICC was 0.96 (CI95% 0.94–0.97), 0.93 (CI95% 0.9–0.95) and 0.96 (CI95% 0.95–0.98) respectively. Inter-observer ICC for HRCTVMR width measures was 0.92 (CI95% 0.89–0.94) with no difference among FIGO stages. Inter-observer ICC for HRCTVTRUS was 0.86 (CI95% 0.81–0.9). For FIGO stage I and II tumors, ICC HRCTVTRUS values were comparable to respective HRCTVMR ICC values. For larger tumors HRCTVTRUS inter-observer ICC values were lower than respective HRCTVMR although remaining acceptable.

Conclusions
Our results suggest that TRUS is equivalent to MR in assessing preBT tumor maximum width in cervical cancer FIGO stage I/II. In more advanced stages TRUS seems to be slightly inferior to MR although maintaining a good agreement to gold standard imaging.
Urocortins in the mammalian endocrine system
Authors: Squillacioti Caterina , Pelagalli Alessandra , Liguori Giovanna , Mirabella Nicola 
Published: October 2019

AbstractUrocortins (Ucns), peptides belonging to the corticotropin-releasing hormone (CRH) family, are classified into Ucn1, Ucn2, and Ucn3. They are involved in regulating several body functions by binding to two G protein-coupled receptors: receptor type 1 (CRHR1) and type 2 (CRHR2). In this review, we provide a historical overview of research on Ucns and their receptors in the mammalian endocrine system. Although the literature on the topic is limited, we focused our attention particularly on the main role of Ucns and their receptors in regulating the hypothalamic–pituitary–adrenal and thyroid axes, reproductive organs, pancreas, gastrointestinal tract, and other tissues characterized by “diffuse” endocrine cells in mammals. The prominent function of these peptides in health conditions led us to also hypothesize an action of Ucn agonists/antagonists in stress and in various diseases with its critical consequences on behavior and physiology. The potential role of the urocortinergic system is an intriguing topic that deserves further in-depth investigations to develop novel strategies for preventing stress-related conditions and treating endocrine diseases.
Reducing Asthma Attacks in Children using Exhaled Nitric Oxide as a biomarker to inform treatment strategy: a randomised trial (RAACENO)
Authors: Turner S. , Cotton S. C. , Emele C. D. , Thomas R. , Fielding S. , Gaillard E. A. , de Jongste J. C. , Morgan H. , Neilson A. R. , Norrie J. , Pijnenburg M. , Price D. , Thomas M. 
Published: October 2019

Abstract

Background
Childhood asthma is a common condition. Currently there is no validated objective test which can be used to guide asthma treatment in children. This study tests the hypothesis that the addition of fractional exhaled nitric oxide (FENO) monitoring in addition to standard care reduces the number of exacerbations (or attacks) in children with asthma.

Methods
This is a multi-centre, randomised controlled study. Children will be included of age 6–16 years who have a diagnosis of asthma, currently use inhaled corticosteroids (ICSs) and have had an exacerbation in the previous 12 months. Exclusion criteria include being unable to provide FENO measurement at baseline assessment, having another chronic respiratory condition and being currently treated with maintenance oral steroids. Participants will be recruited in both primary and secondary care settings and will be randomised to either receive asthma treatment guided by FENO plus symptoms (FENO group) or asthma treatment guided by symptoms only (standard care group). Within the FENO group, different treatment decisions will be made dependent on changes in FENO. Participants will attend assessments 3, 6, 9 and 12 months post randomisation. The primary outcome is asthma exacerbation requiring prescription and/or use of an oral corticosteroid over 12 months as recorded by the participant/parent or in general practitioner records. Secondary outcomes include time to first attack, number of attacks, asthma control score and quality of life. Adherence to ICS treatment is objectively measured by an electronic logging device. Participants are invited to participate in a “phenotyping” assessment where skin prick reactivity and bronchodilator response are determined and a saliva sample is collected for DNA extraction. Qualitative interviews will be held with participants and research nurses. A health economic evaluation will take place.

Discussion
This study will evaluate whether FENO can provide an objective index to guide and stratify asthma treatment in children.

Trial registration
ISRCTN, ISRCTN67875351. Registered on 12 April 2017. Prospectively registered.
Malaria outbreak investigation in Tanquae Abergelle district, Tigray region of Ethiopia: a case–control study
Authors: Tesfay Kissanet , Assefa Belete , Addisu Alefech 
Published: October 2019

Abstract

Objective
We investigated this outbreak to describe the magnitude and associated risk factors due to the malaria outbreak in Tanquae Abergelle district, Tigray, Ethiopia, in 2017.

Result
Case fatality rate of this study was zero. Among the 62 cases and 124 controls, the presence of mosquito breeding sites [OR = 6.56 CI (2.09–20.58) P value = 0.001], sleeping outside a home [OR = 5.06 CI (1.75–14.61) P-value = 0.003] and having unscreened window [OR = 14.89 CI (1.87–118.25) P-value = 0.011] were associated with illness in multivariate analysis.
A new PacBio genome sequence of an Australian Pyrenophora tritici-repentis race 1 isolate
Authors: Moolhuijzen Paula , See Pao Theen , Moffat Caroline S. 
Published: October 2019

Abstract

Objectives
The necrotrophic fungal pathogen Pyrenophora tritici-repentis (Ptr) is the causal agent of tan spot a major disease of wheat. We have generated a new genome resource for an Australian Ptr race 1 isolate V1 to support comparative ‘omics analyses. In particular, the V1 PacBio Biosciences long-read sequence assembly was generated to confirm the stability of large-scale genome rearrangements of the Australian race 1 isolate M4 when compared to the North American race 1 isolate Pt-1C-BFP.

Results
Over 1.3 million reads were sequenced by PacBio Sequel small-molecule real-time sequencing (SRMT) cell to yield 11.4 Gb for the genome assembly of V1 (285X coverage), with median and maximum read lengths of 8959 bp and 72,292 bp respectively. The V1 genome was assembled into 33 contiguous sequences with a of total length 40.4 Mb and GC content of 50.44%. A total of 14,050 protein coding genes were predicted and annotated for V1. Of these 11,519 genes were orthologous to both Pt-1C-BFP and M4. Whole genome alignment of the Australian long-read assemblies (V1 to M4) confirmed previously identified large-scale genome rearrangements between M4 and Pt-1C-BFP and presented small scale variations, which included a sequence break within a race-specific region for ToxA, a well-known necrotrophic effector gene.
Treatment of bipolar depression with supraphysiologic doses of levothyroxine: a randomized, placebo-controlled study of comorbid anxiety symptoms
Authors: Pilhatsch Maximilian , J Stamm Thomas , Stahl Petra , Lewitzka Ute , Berghöfer Anne , Sauer Cathrin , Gitlin Michael , Frye Mark A. , Whybrow Peter C. , Bauer Michael 
Published: October 2019

Abstract
Background
Symptoms of anxiety co-occur in a variety of disorders including in depressive episodes of bipolar disorder and in patients with thyrotoxicosis. Treatment of refractory bipolar disorder with supraphysiologic doses of levothyroxine (L-T4) has been shown to improve the phenotypic expression of the disorder and is associated with an increase of circulating thyroid hormones. However, it might be associated with somatic and mental adverse effects. Here we report the investigation of the influence of treatment with supraphysiologic doses of L-T4 on symptoms of anxiety in patients with refractory bipolar depression.

Methods
Post-hoc analysis from a 6-week, multi-center, randomized, double-blind, placebo-controlled study of the effects of supraphysiologic L-T4 treatment on anxiety symptoms in bipolar depression. Anxiety symptoms were measured weekly with the Hamilton anxiety/somatization factor (HASF) score of the Hamilton Depression Rating Scale (HAMD) and the State- and Trait Anxiety Inventory (STAI).

Results
Treatment of both groups was associated with a significant reduction in anxiety symptoms (p < 0.001) with no statistical difference between groups (LT-4: from 5.9 (SD = 2.0) at baseline to 3.7 (SD = 2.4) at study end; placebo: from 6.1 (SD = 2.4) at baseline to 4.4 (SD = 2.8) at study end; p = 0.717). Severity of anxiety at baseline did not show a statistically significant correlation to the antidepressive effect of treatment with supraphysiologic doses of L-T4 (p = 0.811). Gender did not show an influence on the reduction of anxiety symptoms (females: from 5.6 (SD = 1.7) at baseline to 3.5 (SD = 2.4) at study end; males: from 6.1 (SD = 2.3) at baseline to 4.0 (SD = 2.4) at study end; p = 0.877).

Conclusions
This study failed to detect a difference in change of anxiety between bipolar depressed patients treated with supraphysiologic doses of L-T4 or placebo. Comorbid anxiety symptoms should not be considered a limitation for the administration of supraphysiologic doses of L-T4 refractory bipolar depressed patients.
Trial registration ClinicalTrials, ClinicalTrials.gov identifier: NCT01528839. Registered 2 June 2012—Retrospectively registered, https://clinicaltrials.gov/ct2/show/study/NCT01528839
Ammonium alum in alum-treated wooden artefacts: discovery, origins and consequences
Authors: McQueen Caitlin M. A. , Łucejko Jeannette J. , Flåte Ingrid M. T. , Modugno Francesca , Braovac Susan 
Published: October 2019

Abstract
Alum-treatment was extensively applied to archaeological wood from the Oseberg collection in the early 1900s, and was a common conservation method at the time involving impregnating objects with hot concentrated solutions of potassium alum (KAl(SO4)2⋅12H2O). This now obsolete consolidation method has led to dramatic long-term consequences, heavily affecting the state of preservation of the historical wooden artefacts, and dedicated chemical characterisation campaigns have been undertaken to better understand the degradation processes and aid development of re-treatment strategies. Analyses with Fourier transform infrared spectroscopy (FTIR), elemental microanalysis, and ion chromatography (IC) was performed, suggesting the presence of ammonium alum (NH4Al(SO4)2·12H2O) in many alum-treated wood samples, though no record exists of use of ammonium compounds during treatment of the artefacts. C/N rations of 1.70–68.8 in wood samples, and ammonium alum contents between 8 and 84% of the alum component and 23–168 mmol/100 g of total sample suggested that objects were actually treated with various mixes of potassium and ammonium alum. The two alums have similar properties, and in model studies of their behaviour under the conditions of alum-treatment appeared to form similarly acidic solutions, thus the different alum mixtures probably did not significantly influence object treatment. Nor have we observed other indications of unusual degradation pathways related specifically to the presence of ammonium alum. Nonetheless, investigations into potential re-treatment of the archaeological objects must be adjusted accordingly.
Egg recognition in Cinereous Tits (Parus cinereus): eggshell spots matter
Authors: Liu Jianping , Yang Canchao , Yu Jiangping , Wang Haitao , Liang Wei 
Published: October 2019

AbstractBackgroundBrood parasitic birds such as cuckoos (Cuculusspp.) can reduce their host’s reproductive success. Such selection pressure on the hosts has driven the evolution of defense behaviors such as egg rejection against cuckoo parasitism. Studies have shown that Cinereous Tits (Parus cinereus) in China have a good ability for recognizing foreign eggs. However, it is unclear whether egg spots play a role in egg recognition. The aims of our study were to investigate the egg recognition ability of two Cinereous Tit populations in China and to explore the role of spots in egg recognition.MethodsTo test the effect of eggshell spots on egg recognition, pure white eggs of the White-rumped Munia (Lonchura striata) and eggs of White-rumped Munia painted with red brown spots were used to simulate experimental parasitism.ResultsEgg experiments showed that Cinereous Tits rejected 51.5% of pure white eggs of the White-rumped Munia, but only 14.3% of spotted eggs of the White-rumped Munia. There was a significant difference in egg recognition and rejection rate between the two egg types.ConclusionsWe conclude that eggshell spots on Cinereous Tit eggs had a signaling function and may be essential to tits for recognizing and rejecting parasitic eggs.
Knowledge and Use of Cervical Cancer Screening Among University Female Students at Kilimanjaro, Tanzania
Authors: Joel Hollo , Mduma Dorcas , Mawolle Jackline , Rogathi Jane 
Published: October 2019

PURPOSE Cervical cancer is a major public and global health problem. According to the WHO, it is the fourth leading cancer among women worldwide, with most women being from low- or middle-income countries. It is the leading cause of cancer-related morbidity and mortality among women of reproductive age in Tanzania, where approximately 4,216 women die as a result of the disease annually. Women with HIV/AIDS, multiple sexual partners, history of human papillomavirus infections, contraceptive use, and early onset of sexual activity have increased risk of the disease, including among university students. Poor knowledge and limited screening programs are major contributors. This study was aimed at assessing the level of knowledge and use of cervical cancer screening among university female students in Moshi municipality. METHODS A cross-sectional study was conducted from June to July 2018 involving undergraduate female students age 18 years and older at three different universities in the Moshi municipality. A total of 322 participants were identified using multistage sampling; data were collected through a self-administered semistructured questionnaire and analyzed using SPSS version 20. RESULTS Ninety-two participants (28.6%) had good knowledge, 104 (32.3%) had satisfactory knowledge, and 126 (39.1%) had poor knowledge. About 299 (92.9%) had heard about cervical cancer. The most frequent sources of information were the media (168 [52.2%]); family, neighbors, and friends (106 [32.9%]), health workers (102 [31.7%]); and teachers (75 [23.3%]). Few reported other sources of information. Only 31 women (9.6%) had been screened for cervical cancer. The reasons given for not attending cervical cancer screening were “I have just not decided” (114 [30.4%]), “I am healthy” (81 [21.6%]), “I’m not informed” (49 [13.0%]), and “It may be painful” (42 [11.2%]); 89 women (23.7%) reported other reasons. CONCLUSION Lack of proper knowledge about cervical cancer contributes to low-screening use. Promotion to increase awareness about cervical cancer screening through radio, television, social media, and clubs would be of great importance. Although a lot has been done by the government and other stakeholders regarding screening, the campaigns should focus not only on women but also on university students specifically, who are more likely to have multiple sexual partners and to have engaged in sexual activity at younger than 18 years.
Breast Cancer and the Environment: A Pilot Study of Nigerian Women
Authors: Li Suellen , Huo Dezheng , Ojengbede Oladosu , Olopade Olufunmilayo 
Published: October 2019

PURPOSE Breast cancer remains the leading cause of cancer in women throughout the world, and its incidence has been increasing markedly in Africa. Women of African ancestry not only develop breast cancer at earlier ages but also have more aggressive breast cancers, with higher prevalence of TP53 mutations and triple-negative breast cancer. Although environment-induced TP53 mutagenesis has been well described in liver and lung cancers, few studies have explored its role in breast cancer. In addition, most prior studies were done in white populations and lacked generalizability to women of other ancestries. This pilot study aimed to investigate the association between environmental risk factors and somatic mutation status. A sub-aim was to evaluate the feasibility and effectiveness of a questionnaire-based method for gathering environmental exposure data. METHODS Twenty-nine patients with breast cancer and 33 patients from Ibadan, Nigeria, who had participated in the Nigerian Breast Cancer Study, were contacted to complete an environmental risks questionnaire that assessed household air pollution, diet, occupational hazards, and sleep habits. The questionnaire was translated into Yoruba and conducted with local interpreters, who obtained informed consent from all participants. Both the institutional review boards at the University of Chicago and the University of Ibadan approved the project. RESULTS The results showed that cases were more likely to report living close to a major road, waste incinerator, or factory ( P = .046). There were also significant differences in occupation ( P = .000), with cases more likely to report professional occupations. They were also more likely to report occupational exposures to mineral dust, exhaust, chemicals, and endocrine disruptors; night shift work; and preference for well-done meat, although these did not reach statistical significance. CONCLUSION This study suggests that examining exposures to environmental risk factors may be a promising avenue for future breast cancer research. The study design limited the validity of comparing exposures between cases and controls but demonstrated that a questionnaire-based method is both feasible and effective at gathering environmental exposure data. Future studies would benefit from more formal interviewer training to improve the quality of the data collection, more culturally relevant questions to assess stressful life events, and a prospective design to reduce recall bias and loss to follow-up.