bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring barriers and enablers for scaling up a community‐based grain bank intervention for improved infant and young child feeding in Ethiopia: A qualitative process evaluation
Authors: Sako Binta , Leerlooijer Joanne N. , Lelisa Azeb , Hailemariam Abebe , Brouwer Inge D. , Tucker Brown Amal , Osendarp Saskia J. M. 
Published: October 2017

AbstractChild malnutrition remains high in Ethiopia, and inadequate complementary feeding is a contributing factor. In this context, a community‐based intervention was designed to provide locally made complementary food for children 6–23 months, using a bartering system, in four Ethiopian regions. After a pilot phase, the intervention was scaled up from 8 to 180 localities. We conducted a process evaluation to determine enablers and barriers for the scaling up of this intervention. Eight study sites were selected to perform 52 key informant interviews and 31 focus group discussions with purposely selected informants. For analysis, we used a framework describing six elements of successful scaling up: socio‐political context, attributes of the intervention, attributes of the implementers, appropriate delivery strategy, the adopting community, and use of research to inform the scale‐up process. A strong political will, alignment of the intervention with national priorities, and integration with the health care system were instrumental in the scaling up. The participatory approach in decision‐making reinforced ownership at community level, and training about complementary feeding motivated mothers and women's groups to participate. However, the management of the complex intervention, limited human resources, and lack of incentives for female volunteers proved challenging. In the bartering model, the barter rate was accepted, but the bartering was hindered by unavailability of cereals and limited financial and material resources to contribute, threatening the project's sustainability. Scaling up strategies for nutrition interventions require sufficient time, thorough planning, and assessment of the community's capacity to contribute human, financial, and material resources.
Use of cell surface protein typing for genotyping of azole‐resistant and ‐susceptible Aspergillus fumigatus isolates in Iran
Authors: Falahatinejad Mahsa , Vaezi Afsane , Fakhim Hamed , Abastabar Mahdi , Shokohi Tahereh , Zahedi Nina , Ansari Saham , Meis Jacques F. , Badali Hamid 
Published: October 2017

SummaryAspergillus fumigatus is the leading cause of mortality in severely immunocompromised individuals. Understanding pathogen dispersion and relatedness is essential for determining the epidemiology of nosocomial infections. Therefore, the aim of this study was to investigate the diversity and putative origins of clinical and environmental azole‐susceptible and ‐resistant A. fumigatus isolates from Iran. In all, 79 isolates, including 64 azole‐susceptible and 15 ‐resistant isolates, were genotyped using the cell surface protein (CSP) gene. Seven distinct repeat types (r01, r02, r03, r04, r05, r06 and r07) and 11 different CSP variants (t01, t02, t03, t04A, t06A, t06B, t08, t10, t18A, t18B and t22) were observed. Interestingly, t06B, t18A and t18B were exclusively present in azole‐resistant isolates. The Simpson's index of diversity (D) was calculated at 0.78. Resistant isolates were genetically less diverse than azole‐susceptible isolates. However, azole‐resistant A. fumigatus without TR34/L98H were more diverse than with TR34/L98H. The limited CSP type diversity of the TR34/L98H isolates versus azole‐susceptible isolates suggests that repeated independent emergence of the TR34/L98H mechanism is unlikely. It has been suggested that CSP types might have a common ancestor that developed locally and subsequently migrated worldwide.
Role of dietary phosphate restriction in chronic kidney disease
Authors: Elder Grahame J , Malik Avya , Lambert Kelly 
Published: October 2017

ABSTRACTAimPatients with progressive chronic kidney disease (CKD) develop positive phosphate balance that is associated with increased cardiovascular risk and mortality. Modification of dietary phosphate is a commonly used strategy to improve outcomes but is complicated by the need for adequate dietary protein. Surprisingly, the evidence for patient‐level benefits from phosphate restriction is tenuous, and the justification for using any phosphate binder for pre‐dialysis patients is questionable.MethodsThe evidence for dietary phosphate modification was reviewed, along with the possible role of a smart phone application (app) that provides information on phosphate, sodium, potassium and nutrients in over 50 000 Australian foods. A pilot study of healthy participants assigned to dietetic advice and standard diet sheets, or dietetic advice, diet sheets and use of the smart phone app was performed.ResultsFollowing baseline studies, 25 participants commenced the sodium and phosphate restricted diet. After 2 weeks, both groups showed non‐significant trends to reduction in urinary phosphate and sodium. App users referred to information on the app more frequently than the control group participants referred to written instructions, found referring to the app more convenient, felt they learned more new information, were more motivated to maintain the diet and were more likely to recommend their information source to family or friends (all P < 0.05).ConclusionsMaintaining phosphate balance remains an important goal of CKD management, although diets incorporating very low phosphate and protein contents may worsen patient outcomes. For selected patients, a smart phone app may improve dietary acceptance and compliance.
Learning from the past: reflections on recently completed myasthenia gravis trials
Authors: Benatar Michael , Howard James F. , Barohn Richard , Wolfe Gil I. , Cutter Gary 
Published: October 2017

AbstractRecently competed clinical trials of therapeutics for myasthenia gravis have varied widely in design, but also perhaps in less explicit ways. We explore ways in which these design characteristics may have influenced recruitment and results, as well as the implications for forthcoming studies. Trial eligibility criteria may inadvertently select for incident versus prevalent cases or patients with relatively mild versus more severe disease. Trial enrichment with patients who have relatively mild disease may limit the sensitivity of the trial to detect a therapeutic effect. Enrichment for patients with more severe disease may introduce confounds caused by regression toward the mean. Overly narrow eligibility may limit the generalizability of results. An exclusive focus on incident cases may hamper recruitment, as may many other factors, such as access to the experimental therapeutic treatment outside of the trial or following completion of the double‐blind treatment period. We illustrate how other design characteristics (e.g., treatment duration, strategy for steroid tapering, selection of the primary outcome, and principal analytic approach) may affect the sensitivity of a trial to demonstrate therapeutic effects. Finally, we consider the importance of placebo effects, being careful to differentiate these from therapeutic effects observed in the placebo group, and discuss how the use of combined outcome measures may minimize placebo effects.
A diagnosis and treatment gap for thiamine deficiency disorders in sub‐Saharan Africa?
Authors: Adamolekun Bola , Hiffler Laurent 
Published: October 2017

AbstractStaple diets that are deficient in thiamine can result in low body thiamine levels, which may be subclinical or may manifest as a thiamine‐deficiency syndrome. In many communities in the developing countries of Africa, the staple diets of polished rice or processed cassava are deficient in thiamine, and thus the communities are at high risk for marginal or frank thiamine deficiency unless their diets are supplemented by other sources of thiamine, such as protein meals and vegetables. African communities with large numbers of individuals in low socioeconomic strata are more likely to subsist on a monotonous diet of rice or cassava with minimal or no protein supplementation and are therefore particularly at risk of thiamine‐deficiency disorders. Indeed, there is evidence of widespread biochemical thiamine deficiency from community‐based studies in Africa. The protean manifestations of thiamine deficiency disorders in the developing countries of Africa are presented in this paper. We present evidence supporting the contention that there is a diagnosis and treatment gap for thiamine‐deficiency disorders in Africa. We discuss research and clinical options for bridging the putative diagnosis and treatment gap for thiamine‐deficiency disorders in the developing countries of Africa.
Utility of preoperative Holter monitoring in children undergoing extracardiac conduit Fontan operation
Authors: Sasaki Jun , Lopez Michael M. , Baysa Sherrie J. , Kanter Ronald J. , Rossi Anthony F. 
Published: October 2017

AbstractBackgroundIn patients undergoing extracardiac conduit Fontan (ECF) who require postoperative pacing, epicardial leads are usually required because of anatomical constraints. If indicated, these could be conveniently placed at the time of ECF. We have routinely performed ambulatory 24‐hour Holter monitoring before ECF to determine the presence or absence of preoperative sinus node dysfunction, in an attempt to avoid repeat sternotomy at a later time.MethodsWe performed a retrospective study of all patients undergoing ECF from January 2000 to December 2015.ResultsTwo hundred sixteen patients met inclusion criteria. Patients were separated into two groups, those with preoperative Holter monitoring (PHM, n = 150) and those without (No‐PHM, n = 66). Ten patients (4.6%) underwent permanent pacemaker implantation at the time of ECF (eight patients [5.3%] in PHM vs two patients [3.0%] in No‐PHM, P = 0.46). There were seven (3.2%) patients who underwent pacemaker implantation after ECF requiring repeat sternotomy (four patients [2.7%] in PHM vs three patients [4.5%] in No‐PHM, P = 0.47). Fourteen (6.5%) patients underwent permanent epicardial lead placement without a pulse generator at the time of ECF. None from this group underwent pacemaker implantation to date (median follow‐up of 5.7 years). The overall incidence of pacemaker implantation was 9.3% (20 patients).ConclusionsIn our series, arrhythmia disturbances requiring pacing after ECF occurred in just over 9% of patients. While PHM in those patients may help predict which patients might require postoperative pacing, this approach did not result in a significant decrease in those patients requiring repeat sternotomy for pacemaker implantation.
Nurse‐driven analgesia and sedation in pediatric patients with univentricular hearts requiring extracorporeal life support after first‐stage palliation surgery: A pilot study
Authors: Michel Jörg , Hofbeck Michael , Gerbig Ines , Icheva Vanya , Heimberg Ellen , Jost Walter , Schlensak Christian , Kumpf Matthias , Blumenstock Gunnar , Neunhoeffer Felix 
Published: October 2017

SummaryBackgroundFew data are available regarding requirements of sedation and analgesia in children during extracorporeal life support.AimsThe aim of this study was to evaluate if children with functionally univentricular hearts on extracorporeal life support after first‐stage palliation surgery have higher requirement of analgesics and sedatives compared with children without extracorporeal life support using a goal‐directed nurse‐driven analgesia and sedation protocol.MethodsThis prospective observational matched case‐control pilot study was conducted at a cardiac pediatric intensive care unit of a tertiary referral center. Seventeen patients with functionally univentricular hearts including hypoplastic left heart syndrome who were on extracorporeal life support after first‐stage palliation surgery were enrolled from July 2012 to January 2017. Seventeen matched patients served as controls. Doses of morphine, midazolam, clonidine, and muscle relaxants as well as sedation scores (COMFORT behavior scale and the nurse interpretation of sedation scale) were assessed according to a nurse‐driven protocol every 8 hours up to 120 hours after first‐stage palliation surgery.ResultsSedation scores were equal in the extracorporeal life support group and in the control group at most points in time. There was no significant difference in cumulative doses of morphine and midazolam. However, children of the extracorporeal life support group received higher doses of midazolam and morphine at some points in time.ConclusionA nurse‐driven protocol for analgesia and sedation of children with extracorporeal life support is feasible. Patients with extracorporeal life support do not need deeper sedation levels and have not higher cumulative sedation requirements than children without extracorporeal life support.
Interpreting the Effectiveness of Opioids and Pregabalin for Pain Severity, Pain Interference, and Fatigue in Fibromyalgia Patients
Authors: Davis Fred , Gostine Mark , Roberts Bradley A. , Risko Rebecca , Cappelleri Joseph C. , Sadosky Alesia 
Published: October 2017

AbstractObjectiveTo evaluate the effectiveness of opioids and/or pregabalin on patient‐reported outcomes among fibromyalgia (FM) patients based on levels of improvement.MethodsA total of 1,421 FM patients were identified, with 3,082 observational periods of opioids with or without pregabalin use between April 2008 and February 2015. Patients were categorized by opioids, and pregabalin with and without opioids; opioids were designated by morphine equivalent dose (MED) of ≤ 20 (low MED), > 20 to < 100 (moderate MED), ≥ 100 (high MED), and pregabalin doses of ≤ 150 mg, 151 to 300 mg, and 301 to 450 mg. Proportions of patients meeting clinically relevant thresholds of ≥ 30% and ≥ 50% improvement for pain interference (ability to enjoy life; activity; mood; relationships; sleep), pain severity, and fatigue were compared among treatments, and area under the curve (AUC) for improvement and worsening of effects was determined, enabling ranking of treatments. Further analysis compared pregabalin doses.ResultsPregabalin without opioids resulted in the highest proportions of patients with ≥ 30% improvement on all pain items and pain interference with “ability to enjoy life,” “activity” “mood,” and “sleep.” For the ≥ 50% threshold, pregabalin alone was highest for all pain interference items and for “average pain” and “worst pain.” Pregabalin was consistently lowest across thresholds for fatigue, but showed better results combined with moderate MED opioids. Pregabalin doses recommended for treatment of FM (151 to 450 mg) generally resulted in the highest proportion of patients achieving thresholds relative to opioids. The AUC results were consistent with thresholds; pregabalin without opioids resulted in the greatest benefits with regard to improvement, with the highest ranking for overall improvement and overall effects.ConclusionPregabalin without opioids provided the most favorable outcomes overall based on ≥ 30% and ≥ 50% improvement thresholds and AUC, with support for moderate MED opioids + pregabalin in patients suffering from fatigue. While most patients took less than recommended pregabalin doses, higher doses may lead to improved outcomes.
Phenological match drives pollen‐mediated gene flow in a temporally dimorphic tree
Authors: Gleiser G. , Chybicki I. J. , González‐Martínez S. C. , Aizen M. A. 
Published: October 2017

AbstractVariation in flowering phenology is common in natural populations, and is expected to be, together with inter‐mate distance, an important driver of effective pollen dispersal. In populations composed of plants with temporally separated sexual phases (i.e. dichogamous or heterodichogamous populations), pollen‐mediated gene flow is assumed to reflect phenological overlap between complementary sexual phases. In this study, we conducted paternity analyses to test this hypothesis in the temporally dimorphic treeAcer opalus.We performed spatially explicit analyses based on categorical and fractional paternity assignment, and included tree size, pair‐wise genetic relatedness and morph type as additional predictors. Because differences between morphs in flowering phenology may also influence pollination distances, we modelled separate pollen dispersal kernels for the two morphs.Extended phenological overlap between male and female phases (mainly associated with inter‐morph crosses) resulted in higher siring success after accounting for the effects of genetic relatedness, morph type and tree size, while reduced phenological overlap (mainly associated with intra‐morph crosses) resulted in longer pollination distances achieved. Siring success also increased in larger trees.Mating patterns could not be predicted by phenology alone. However, as heterogeneity in flowering phenology was the single morph‐specific predictor of siring success, it is expected to be key in maintaining the temporal dimorphism inA. opalus, by promoting not only a prevalent pattern of inter‐morph mating, but also long‐distance pollination resulting from intra‐morph mating events.
Biogeography and diversification of Holarctic water striders: Cenozoic temperature variation, habitat shifting and multiple intercontinental dispersals
Authors: YE ZHEN , ZHEN YAHUI , DAMGAARD JAKOB , CHEN PINGPING , ZHU LIN , ZHENG CHENGUANG , BU WENJUN 
Published: October 2017

AbstractIt is now rare to find a semi‐aquatic organism group with which to vigorously test whether their diversification model and distribution pattern are closely related to the Cenozoic temperature variation. This hypothesis is explored for water striders of the generaAquariusSchellenberg,GerrisFabricius andLimnoporusStål, which comprise a monophyletic clade with primarily Holarctic distribution. We sample almost 90% of the currently recognizedAquarius,GerrisandLimnoporusspecies. Five DNA fragments from 62 species are used to reconstruct a phylogram. Divergence time is estimated using Bayesian relaxed‐clock method and three fossil calibrations. We investigate diversification dynamics, biogeography and ancestral state reconstruction by using maximum‐likelihood, Bayesian and parsimony approaches. Our results showed that the crown of the three genera originated and underwent an initial diversification in Asia at 72 Ma (HPD: 59–86 Ma) in the Late Cretaceous, subsequently expanding into other regions via dispersal. The Bering Land Bridge was the major migration route between Eurasia and North America but was interrupted before the early Oligocene (34 Ma). Ancestors most likely used lentic habitats, and a minimum of two independent shifts to lotic habitats occurred in the initial diversification. Cenozoic temperature variation regulated the evolutionary history of Holarctic water striders of the generaAquarius,GerrisandLimnoporus. Temperature warming during Stage I (52–66 Ma) was associated with the disappearance of shallow lentic habitats; this phenomenon forced certain lentic lineages to colonize new lotic habitats and promoted the diversification of lineages. Temperature cooling during Stage II (after 34 Ma) was associated with the fragmentation of water habitats of the ‘mixed‐mesophytic’ belt, resulting in the extinction of historical taxa and influencing close lineages that shaped the present disjunct Eurasian–North American distribution.
Disagreeing with Confidence
Authors: Besong Brian 
Published: October 2017

AbstractDoes having an initially high level of justified confidence in a belief vindicate remaining steadfast in the face of disagreement? According to one prominent view in the literature, namely Jennifer Lackey's justificationist position, the answer is yes so long as one also has personal information that provides a symmetry‐breaker. In this article, I raise a problem for the justificationist view. On the most straightforward reading of the justificationist position, personal informationalwaysprovides a symmetry‐breaker in a peer dispute over a belief in which one has high justified confidence. However, this position is implausibly strong because it renders epistemically permissible a dogmatic attitude in a relevant set of peer disagreements. Alternatively, weaker readings of the view fail to provide a perspicuous account of when high justified confidence matters in a disagreement.
Treatment of self‐poisoning at a tertiary‐level hospital in Bangladesh: cost to patients and government
Authors: Verma Vasundhara , Paul Sujat , Ghose Aniruddha , Eddleston Michael , Konradsen Flemming 
Published: October 2017

AbstractObjectivesApproximately 10 000 people die from suicide annually in Bangladesh, many from pesticide poisoning. We aimed to estimate financial costs to patients and health services of treating patients with self‐poisoning.MethodsData on direct costs to families, sources of funds for treatment and family wealth were collected prospectively over a one‐month period in 2016 at the tertiary Chittagong Medical College Hospital, Bangladesh. Aggregate operational costs to the government were calculated using annual budget, bed occupancy and length‐of‐stay data.ResultsAgrochemicals were the most common substances ingested (58.8%). Median duration of stay and of illness was 2 and 5 days, respectively. Median total cost to patients was conservatively estimated at US$ 98.40, highest in agrochemical poisoning (US$ 179.50), with the greatest cost due to medicines and equipment. Misdiagnosis as organophosphorus poisoning in 17.0% of agrochemical cases resulted in increased cost to patients. Only 51.9% of patients had indicators of wealth; 78.1% borrowed money to cover costs. Conservatively estimated median healthcare costs (US$ 21.30 per patient) were markedly lower than costs to patients.ConclusionsCost to patients of treating a case of agrochemical poisoning was approximately three times the cost of one month's essential items basket. Incorrect diagnosis at admission costs families substantial sums of money and increased length of stay; it costs the national government an estimated US$ 80 428.80 annually. Widespread access to a list of pesticides used in self‐poisoning plus greater focus on training doctors to better manage different forms of agrochemical poisoning should reduce the financial burden to patients and healthcare systems.