bluuebunny/crossref_metadata_2025_split huggingface dataset:
Familial Atypical Hemolytic Uremic Syndrome with Positive pS1191L (c.3572C&gt; T) Mutation in CFH A Single-Center Experience
Authors: DURSUN Fadime ERSOY , YESIL Gözde , DURSUN Hasan , SASAK Gülşah 
Published: August 2019

Abstract
Background: Atypical hemolytic uremic syndrome is a condition characterized by thrombocytopenia, microangiopathic hemolytic anemia, and acute kidney injury, which can exhibit a poor prognosis. Gene mutations play a key role in this disease, which may be sporadic or familial. Methods: We studied, 13 people from the same family were investigated retrospectively for gene mutations of familial atypical hemolytic uremic syndrome after a patient presented to our emergency clinic with atypical hemolytic uremic syndrome and reported a family history of chronic renal failure. Results: The pS1191L mutation in the complement factor H gene was heterozygous in 6 people from the family of the patient with atypical hemolytic uremic syndrome. One of these people was our patient with acute renal failure and the other two are followed up by the Nephrology Clinic due to chronic renal failure. The other 3 persons showed no evidence of renal failure. The index case had a history of 6 sibling deaths; two of them died of chronic renal failure. Plasmapheresis and fresh frozen plasma treatment was given to our patient. When patient showed no response to this treatment, eculizumab therapy was started. Conclusions: The study demonstrated that a thorough family history should be taken in patients with atypical hemolytic uremic syndrome. These patients may have familial type of the disease and they should be screened genetically. Eculizumab should be the first choice in the treatment with plasmapheresis. It should be kept in mind that the use of eculizumab as prophylaxis in post-transplant therapy is extremely important for prevention of rejection.
Hospital Accreditation: A solution for developing countries challenges or a challenge for the hospitals?
Authors: Bordbar Najme , Manesh Fatemeh Golestan , Kavosi Zahra , Pourmohammadi Kimia , Ravangard Ramin , Kashefian-Naeeini Sara , Bastani Peivand 
Published: August 2019

Abstract
Background

Inasmuch as accreditation is of great significance for hospitals, this study aimed to explain the accreditation challenges of Iranian hospitals through a content analysis approach.

Methods

A qualitative study was run through the content analysis method in 2018. 19 semi-structured interviews were conducted with experts and data were saturated in this level. To increase the accuracy and precision of the study, Guba and Lincoln’s four criteria including credibility, dependability, conformability and transferability were used. MAX QDA10 was used for data analysis via 5-step framework analysis approach.

Results

The findings of the interview analysis led to the identification of 5 main themes and 29 subthemes. The main themes included macro problems and policy making, evaluators' problems, structural and process problems, executive problems, and problems with the accreditation measures.

Conclusion

The results shed light on the fact that Iranian hospitals need to experience major changes in applying accreditation as a quality assurance mechanism. In other words, it seems necessary for policy makers affiliated with Ministry of Health and Medical education to revise accreditation measures according to hospital needs and try to clarify the structure and executive process of the accreditation. Moreover, improving and standardizing the evaluators` skills is recommended.
Financial catastrophism inherent with out-of-pocket payments in long term care for households: a latent impoverishment
Authors: Pozo-Rubio Raul del , Pardo Isabel , Escribano-Sotos Francisco 
Published: August 2019

Abstract
Background

Out-of-pocket (OOP) payments are configured as an important source of financing long-term care (LTC). However, very few studies have analyzed the risk of impoverishment and catastrophic effects of OOP in LTC.

Objective

To estimate the contribution of users to the financing of LTC and to analyze the economic consequences for households in terms of impoverishment and catastrophism.

Data and Methods

The data base which was used is 2008 Spanish Disability and Dependency Survey, projected to 2012. We analyze the OOP payments effect associated to the impoverishment of households comparing volume and financial situation before and after OOP payment. At the same time, the extent to which OOP payment had led to catastrophism was analyzed using different thresholds.

Results

The results show that contribution of dependent people to the financing of the services they receive exceeds by 50% the costs of these services. This expenditure entails an increase in the number of households that live below the poverty. In terms of catastrophism, more than 80% of households dedicate more than 10% of their income to dependency OOP payments. In annual terms, the catastrophe gap generated by devoting more than 10% of the household income to dependent care OOP payment reached €3,955, 1 million (0,38% of GDP).

Conclusion

This article informs about consequences of OOP in LCT and supplements previous research that focus on health. Our results should serve to develop strategic for protection against the financial risk resulting from facing the costs of a situation of dependence.
Association of Daily Copayments with Use of Hospital Care among Medicare Advantage Enrollees
Authors: McHugh John , Keohane Laura , Grebla Regina , Lee Yoojin , Trivedi Amal 
Published: August 2019

Abstract
Background: While the traditional Medicare program imposes a deductible for hospital admissions, many Medicare Advantage plans have instituted per-diem copayments for hospital care. Little evidence exists about the effects of changes in cost-sharing for hospital care among the elderly. Changing inpatient benefits from a deductible to a per diem may benefit enrollees with shorter lengths of stay, but adversely affect the out-of-pocket burden for hospitalized enrollees with longer lengths of stay.

Methods: We used a quasi-experimental difference-in-differences study to compare longitudinal changes in proportion hospitalized, inpatient admissions and days per 100 enrollees, and hospital length of stay between enrollees in MA plans that changed inpatient benefit from deductible at admission to per diem, intervention plans, and enrollees in matched control plans – similar plans that maintained inpatient deductibles. The study population included 423,634 unique beneficiaries enrolled in 23 intervention plans and 36 matched control plans in the 2007-2010 period.

Results: The imposition of per-diem copayments were associated with adjusted declines of 1.3 admissions/100 enrollees (95% CI -1.8 to -0.9), 6.9 inpatient days/100 enrollees (95% CI -10.1 to -3.8) and 0.7 percentage points in the probability of hospital admission (95% CI -1.0 to -0.4), with no significant change in adjusted length of stay in intervention plans relative to control plans. For persons with 2 or more hospitalizations in the year prior to the cost-sharing change, adjusted declines were 3.5 admissions/100 (95% CI -8.4 to 1.4), 31.1 days/100 (95% CI -75.2 to 13.0) and 2.2 percentage points in the probability of hospitalization (95% CI -3.8 to -0.6) in intervention plans relative to control plans.

Conclusions: Instituting per-diem copayments was associated with reductions in number of admissions and hospital stays, but not length of stay once admitted. Effects of inpatient cost-sharing changes were magnified for persons with greater baseline use of hospital care.
Institutional strategies as a mechanism to rationalize the negative effects of judicialization of access to medicine in brazil
Authors: Chagas Virginia Oliveira , Provin Mércia Pandolfo , Mota Pedro Augusto Prado , Guimarães Rafael Alves , Amaral Rita Goreti 
Published: August 2019

Abstract
Recently, the Executive Branch and Judiciary in Brazil increased spending due to larger numbers of lawsuits that forced the State to provide health goods and services. This phenomenon, known as health judicialization, is related to flaws in policies and to insufficient funds available for the State to meet every demand, and it has created challenges. These challenges required the Executive Branch and Judiciary to create institutional strategies such as technical chambers and departments to reduce the social, economic and political distortions caused by this phenomenon. This study aims to evaluate the effects of two institutional strategies deployed by a Brazilian municipality in order to cope with the economic, social and political distortions caused by the phenomenon of health judicialization regarding access to medicines. A longitudinal study was carried out in a capital in the Central-West Region of Brazil. A sample of 511 lawsuits was analyzed. The variables were placed into three groups: the sociodemographic characteristics and the plaintiffs’ disease, the characteristics of the claimed medical products and the institutional strategies. To analyze the effect of the interventions on the total cost of the medicines in the lawsuits, bivariate and multivariate linear regressions with variance were performed. For the categorical outcomes, Poisson regressions were performed with robust variance, using a significance level of 5%. A reduction in the costs of medicines in the lawsuits and of the requests for medicines within the SUS formulary was verified after the deployment of the Department of Assessment of Non-Standardized Medicines (DAMNP) and the Technical Chamber of Health Assessment (CATS); an increase in processed prescriptions from the Brazilian Universal Health System was observed after the deployment of the CATS; and an increase in medicines outside the SUS formulary without a therapeutic alternative was verified after the CATS. The institutional strategies deployed were important tools to reduce the high costs of the medicines in the lawsuits. In addition, they represented a step forward for the State, provided a benefit to society and indicated a potential path for the health and justice systems of other countries that also face problems caused by the judicialization of health.
Effectiveness of the psychoeducation module for screened positive cases of depression among elderly females in rural South India, a Quasi experimental study
Authors: Puttur Anushree , Rao Chythra R 
Published: August 2019

Abstract
Background:

With the increasing population of geriatric women in India, it has become more necessary to identify morbidities in this population as well as potential interventions to treat them. In this study, we estimate the prevalence of depression in geriatric women living in a district in rural South India, and evaluate the effectiveness of a psycho education on improving knowledge and awareness on depression.

Methods:
This cross sectional study was performed among 218 females above the age of 60 years in rural areas who were interviewed using Beck’s Depression Inventory and evaluated for depression. A questionnaire was then administered to assess knowledge and attitudes regarding depression once prior to and once after the psychoeducation module was presented to assess the effectiveness of the module. Multivariate analysis was performed to identify key variables that predisposed participants for depression as well as those variables that affected the effectiveness of the psychoeducation module.

Results: The study showed 31.7% of the participants to have depression using Beck’s Depression Inventory. Low education status [ AOR: 5.95(1.04-34.10), p = 0.04], decreased social interactions [AOR: 10.97 (1.43-84.13), p = .02.], daily concerns regarding health [AO: R5.09 (1.031-25.10), p = 0.05), loans to settle [AOR: 18.55(2.65-129.64), p = 0.003] and poor sleep quality [AOR:94.82 (13.97-643.72, p < .001] were positively correlated with the presence of depression. Of those participants diagnosed with depression, the psychoeducation module was less effective in those who engaged in hobbies/social activities, had good relationships with family and had concerns about their health.

Conclusion:
Of those interviewed, one-third were estimated to have depression. Administration of a psycho-education was seen to reduce stigma and improve health-seeking behavior. As this stigma is particularly pervasive in geriatric women in rural south India, population specific interventions need to be identified in order to improve knowledge and health seeking behavior.
Keywords: Depression, Elderly, Rural India, Women, Geriatric, Psychoeducation, Intervention
Pregnancy options counselling in Ghana: A case study of women with unintended pregnancies in Kumasi metropolis, Ghana
Authors: Agbeno Evans Kofi , Gbagbo Fred Yao , Morhe ESK , Maltima Soale Issah , Sarbeng Kwadwo 
Published: August 2019

Abstract
Background
Unintended pregnancies have significantly contributed to maternal deaths and illnesses globally. Although good clinical practices show that options counselling enable clients to make informed decisions for healthy pregnancy outcomes, studies on this practice remain a grey area in Ghana.

Aim of the study
The study examines proportions of women exposed to pregnancy options counselling before decision-making, effects of counselling on pregnancy outcomes and associations between women characteristics and counselling.

Methods
Analytical cross-sectional study design was done in selected specialised public and NGO health facilities within Kumasi Metropolis of Ghana, using self-administered structured questionnaires for data collection from 1st January to 30th April, 2014. Participants were 442 women with unintended pregnancies seeking abortion services. Data was analysed using Epi-Info (7.1.1.14) and STATA 12 to generate descriptive statistics, Pearson chi-square and multivariable logistic regressions. The Kwame Nkrumah University of Science and Technology approved the study.

Results
Respondents had divergent reproductive and socio-demographic profiles. Majority (about 58%) of them had been pregnant more than twice, but about 53% of this population had no biological children. (Although about 90% of respondents held perceptions that the index and previous pregnancies were mistimed/unintended, the majority (72%) had no induced abortion history. Induced abortion (208, 49%) and parenting (216, 51%) were mentioned as the only available options to unintended pregnancy in hospitals. Exposure to options counselling was observed to be significantly associated with parity (P= <0.001), gestational age (P= <0.001), previous induced abortions (P= <0.001), perception of pregnancy at conception (P= <0.001) and level of education (P= 0.002). The logistic regression analysis also shows that higher education has statistically significant effect on being exposed to options counselling (P= <0.001). Majority of respondents (95%) were not aware that giving a child up for adoption is an option to pregnancy crisis management.

Conclusions
Pregnancy options counselling remains a major challenge in some Ghanaian health facilities as evident by the study results. Multi-sectorial collaboration for education on pregnancy options counselling and further research to assess the type and depth of counselling services provided pregnant women in health facilities is recommended to inform reproductive health policy and program decisions.
Virtual Implant Rehabilitation Of The Severely Atrophic Maxilla: A Radiological Study
Authors: Manacorda Michele , Chaurand Bianca Poletti de , Merlone Alberto , Tetè Giulia , Capparè Paolo , Vinci Raffaele 
Published: August 2019

Abstract
Background : Advanced maxillary atrophy is often observed and implant placement could become difficult. Nevertheless, a volumetric evaluation using a proper diagnostic software could facilitate the implant planning. The purpose of the present study is to reveal the existence of a sufficient bone volume in the maxilla also in patients presenting a severely atrophic maxilla.
Methods: A sample of CBCT images of 59 patients was evaluated. After a 3D anatomical evaluation, tilted implants has been virtually positioned in the retro-canine regions. All the implants were inserted with the same procedure at 30° and 45° degrees of tilting. The length, the palatal angulation and the diameter of the placed implant were identified.
Results: 220 tilted implants were placed. An average implant measurement of 13,508 mm of length and 3,42 mm of diameter were calculated. Also, an average buccal-palatal angulation of 6° was identified. After the statistical analysis implant length was found significantly higher at 45° degrees than at 30° degree (<0.0001).
Conclusions: A considerable amount of patients show a significant degree of bone atrophy. The implant-supported treatment plan can rely on the three dimensional imaging of the residual bone as a guiding tool to establish the most effective implant position for each specific case. In this study it is founded that in the majority of the maxillary atrophy the volumetric evaluation of the bone near the lateral wall of the nasal cavity could suggest the presence of an adequate basal bone volume for tilted implants placement.
Development of a Prognosis Nomogram of Treatment Outcomes for MDR-Tuberculosis in Guinea (Conakry): A retrospective cohort analysis
Authors: Diallo Alhassane , Diallo Boubacar Djelo , Camara Lansana Mady , Diallo Mafouné , Camara Souleymane , Bah Boubacar , Camara Aboubacar , Magassouba Aboubacar Sidiki , Barry Alpha Oumar , Diallo Thierno Hassane , Miguel Lotshutshu , Diallo Mamadou Hassimiou , Sow Oumou Younoussa 
Published: August 2019

Abstract
Abstract

Background: Despite the availability of the drug treatment for tuberculosis (TB) more than 75 years, mortality and drug resistance are increasing. Therefore, little data is available in Guinea. We aimed to develop and validate a prognosis nomogram of MDR-TB treatment outcomes.

Methods:A retrospective cohort study was conducted among men and women, aged 18 years or older, with MDR-TB, from three major drug-resistance TB centres in Guinea. We used the logistic regression to analyse treatment outcomes. Prognostic factors with a p value less than 0.05 from a multivariate model were used to build nomogram and assessed their performance based on discriminative c-index, and calibration using the Hosmer-Lemeshow (H-L) test. To derive the optimal cut-off point score, the Youden’s index method was used.

Results:Among 232 patients with MDR-TBenrolled and followed between June 07, 2016 and June 22, 2018, 218 were analyzed. All patients were resistant to rifampicin, which diagnosed by the Xpert MTB/RIF. The overall rate of success was 73%.Factors associated with successful treatment in drug-resistant TB patients were higher BMI more than 18.5 kg/m2(p = 0.0253; aOR = 2.94), good adherence to treatment (p = < 0.0001; aOR = 33.92), normal platelets count (p = 0.0053; OR = 1.004), and the absence of clinical symptoms such as chest pain (p = 0.0083; aOR = 3.19) and depression (p = 0.0308; aOR = 8.62). The discrimination (c-index= 0.848 [95% bootstrap CI, 0.780 – 0.916] in the derivation sample and 0.803 after correction for optimism) and calibration (H-LX2= 2.91 [p = 0.94]) were good. The optimal absolute risk threshold was 20%, corresponding to a sensibility of 95% and specificity of 58%.

Conclusion:Treatment success outcomes was lower than those recommended by the World Health Organization (75%). We recommend to improve the MDR-TB patient monitoring during treatment, nutritional status, and considering the psychological state. Our prognosis nomogram needs to be validated in an external population before it can be used in clinical practice.

Keywords:Nomogram, Multidrug-resistant, Tuberculosis, Guinea.
Preliminary Assessment of Ferrate Treatment of Metals in Acid Mine Drainage
Authors: Goodwill Joseph E. , LaBar Julie , Slovikosky Debbie , Strosnider William H. J. 
Published: August 2019

We report a preliminary assessment of ferrate [Fe(VI)] for the treatment of acid mine drainage (AMD), focused on precipitation of metals (i.e., iron [Fe] and manganese [Mn]) and subsequent removal. Two dosing approaches were studied to simulate the two commercially viable forms of Fe(VI) production: Fe(VI) only, and Fe(VI) with sodium hydroxide (NaOH). Subsequent metal speciation was assessed via filter fractionation. When only Fe(VI) was added, the pH remained <3.6, and the precipitation of Mn and Fe was <30 and <70%, respectively, at the highest, stoichiometrically excessive Fe(VI) dose. When NaOH and Fe(VI) were added simultaneously, precipitation of Mn was much more complete, at doses near the predicted oxidation stoichiometric requirement. The optimal dosage of Fe(VI) for Mn treatment was 25 μM. The formation of Mn(VII) was noted at Fe(VI) dosages above the stoichiometric requirement, which would be problematic in full‐scale AMD treatment systems. Precipitation of Fe was >99% when only NaOH was added, indicating that oxidation by Fe(VI) did not play a significant role when added. The Fe(III) and Al(III) particles were relatively large, suggesting probable success in subsequent removal through sedimentation. Resultant Mn‐oxide particles were relatively small, indicating that additional particle destabilization may be required to meet Mn effluent goals. Ferrate seems viable for the treatment of AMD, especially when sourced through onsite generation due to the coexistence of NaOH in the product stream. More research on the use of Fe(VI) for AMD treatment is required to answer extant questions.Core Ideas
Ferrate is likely a viable option for acid mine drainage treatment.
Oxidation of manganese with ferrate and NaOH approached stoichiometric prediction.
Resultant particles may challenge downstream clarification.
Phosphorus and the Chesapeake Bay: Lingering Issues and Emerging Concerns for Agriculture
Authors: Kleinman Peter J. A. , Fanelli Rosemary M. , Hirsch Robert M. , Buda Anthony R. , Easton Zachary M. , Wainger Lisa A. , Brosch Chris , Lowenfish Martin , Collick Amy S. , Shirmohammadi Adel , Boomer Kathy , Hubbart Jason A. , Bryant Ray B. , Shenk Gary W. 
Published: August 2019

Hennig Brandt's discovery of phosphorus (P) occurred during the early European colonization of the Chesapeake Bay region. Today, P, an essential nutrient on land and water alike, is one of the principal threats to the health of the bay. Despite widespread implementation of best management practices across the Chesapeake Bay watershed following the implementation in 2010 of a total maximum daily load (TMDL) to improve the health of the bay, P load reductions across the bay's 166,000‐km2 watershed have been uneven, and dissolved P loads have increased in a number of the bay's tributaries. As the midpoint of the 15‐yr TMDL process has now passed, some of the more stubborn sources of P must now be tackled. For nonpoint agricultural sources, strategies that not only address particulate P but also mitigate dissolved P losses are essential. Lingering concerns include legacy P stored in soils and reservoir sediments, mitigation of P in artificial drainage and stormwater from hotspots and converted farmland, manure management and animal heavy use areas, and critical source areas of P in agricultural landscapes. While opportunities exist to curtail transport of all forms of P, greater attention is required toward adapting P management to new hydrologic regimes and transport pathways imposed by climate change.Core Ideas
At the midpoint of the Chesapeake TMDL, dissolved P is increasing in some tributaries.
Lingering concerns include legacy P, artificial drainage, animal heavy use areas.
Extreme events represent an acute risk to water quality.