bluuebunny/crossref_metadata_2025_split huggingface dataset:
A comparison of effectiveness between oral rapid testing and routine serum-based testing for HIV in an outpatient dental clinic in Yuxi Prefecture, China: a case–control study
Authors: Li Shifu , Su Shu , Li Shunxiang , Gao Liangmin , Cai Ying , Fu Jincui , Guo Chunyuan , Lu Wei , Cheng Feng , Jing Jun , Chen Liang , Zhang Lei 
Published: July 2017

ObjectiveTo compare the outcomes of routine provider-initiated HIV testing and counselling (PITC) and oral rapid HIV testing for dental clinic outpatients in a hospital.DesignWe employed a case–control study design and recruited dental outpatients into routine serum-based and oral rapid testing groups. We compared the acceptance, completion and result notification rate between groups.SettingA dental outpatient clinic in the Yuxi People's Hospital, Yunnan.ParticipantsA total of 758 and 816 dental outpatients were enrolled for routine and oral rapid testing, respectively.ResultsThe percentage of participants willing to receive routine HIV testing was 28.1% (95% CI 24.9% to 31.3%) and 96.1% (95% CI 94.8% to 97.4%,χ2=186.4, p<0.001) for the rapid testing. Among accepted participants, the percentage of participants who received HIV testing was 26.8% (95% CI 20.9% to 32.7%) in the routine testing group and 100.0% in the oral rapid HIV testing group (χ2=77.5, p<0.001). About 93.0% of routine testers returned for the test results on the next day, whereas all rapid testers received their test results on the same day (χ2=34.6, p<0.001). These correspond to an overall completion rate of 7.0% (95% CI 5.2% to 8.8%) and 96.1% (95% CI 94.8% to 97.4%, p<0.001), respectively. Among the 545 patients who declined routine serum-based HIV testing, the main reasons included, an unnecessary hassle (254/545, 46.6%), having been previously tested (124/545, 22.8%) and self-perceived low risk of HIV infection (103/545, 18.9%). In contrast, only 32 individuals declined oral rapid testing, and having received a previous test was the primary reason. Three patients in the rapid testing group were later confirmed HIV-positive, yielding an HIV prevalence of 0.38%.ConclusionOral rapid HIV testing is a feasible and efficient approach in a clinical setting.
198: THE EFFECT OF INSTRUCTING PELVIC FLOOR MUSCLE TRAINING FOR CONTROLLING URINARY INCONTINENCE AND ITS RESULTING STRESS, ANXIETY AND DEPRESSION IN PATIENTS WITH MULTIPLE SCLEROSIS
Authors: Shareinia Habib , Rafii Forough , Sarraf Payam , Seyedalshohahadaee Mahnaz 
Published: July 2017

Background and aims:Urinary disorders are common problems in patients with multiple sclerosis (MS). Urinary incontinence largely affects the physical, social, and emotional characteristics and activities of these patients. The aim of this study was to identify the effect of pelvic floor muscle Training on urinary incontinence and its resulting stress, anxiety and depression in MS patients.Methods:The present clinical trial with a pre-post design was conducted on 50 MS patients presenting to the MS clinic of Imam Khomeini Hospital in Tehran (Iran) who had been selected by convenience sampling method. Participants received instructions on pelvic floor muscle exercises and then practiced them for three consecutive months. The International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (ICIQ-UI SF) was used to measure participants' urinary incontinence and the 21-item Depression, Anxiety and Stress Scale (DASS-21) then used to measure their depression, anxiety and stress, both before the intervention and at the end of the third month of exercising. The data obtained were analyzed in SPSS16 using descriptive statistics and the dependentttest.Results:About 45 (90%) participants practiced pelvic floor muscle exercises up until the end of the third month. The frequency and amount of urine leakage and the effect of urinary incontinence on the quality of life differed significantly in the patients after the instructions compared to before (P<0.001). The mean score of stress (P<0.001), anxiety (P=0.04) and depression (P=0.003) decreased significantly after the intervention.Conclusion:According to the findings, instructing pelvic floor muscle exercises is effective in reducing urinary incontinence and its resulting stress, anxiety and depression in MS patients. These exercises are therefore recommended as a non-pharmacological, non-invasive and cost-effective method for controlling urinary incontinence in MS patients.
Promoting Optimal Physical Exercise for Life (PROPEL): aerobic exercise and self-management early after stroke to increase daily physical activity—study protocol for a stepped-wedge randomised trial
Authors: Mansfield Avril , Brooks Dina , Tang Ada , Taylor Denise , Inness Elizabeth L , Kiss Alex , Middleton Laura , Biasin Louis , Fleck Rebecca , French Esmé , LeBlanc Kathryn , Aqui Anthony , Danells Cynthia 
Published: July 2017

IntroductionPhysical exercise after stroke is essential for improving recovery and general health, and reducing future stroke risk. However, people with stroke are not sufficiently active on return to the community after rehabilitation. We developed the Promoting Optimal Physical Exercise for Life (PROPEL) programme, which combines exercise with self-management strategies within rehabilitation to promote ongoing physical activity in the community after rehabilitation. This study aims to evaluate the effect of PROPEL on long-term participation in exercise after discharge from stroke rehabilitation. We hypothesise that individuals who complete PROPEL will be more likely to meet recommended frequency, duration and intensity of exercise compared with individuals who do not complete the programme up to 6 months post discharge from stroke rehabilitation.Methods and analysisIndividuals undergoing outpatient stroke rehabilitation at one of six hospitals will be recruited (target n=192 total). A stepped-wedge design will be employed; that is, the PROPEL intervention (group exercise plus self-management) will be ‘rolled out’ to each site at a random time within the study period. Prior to roll-out of the PROPEL intervention, sites will complete the control intervention (group aerobic exercise only). Participation in physical activity for 6 months post discharge will be measured via activity and heart rate monitors, and standardised physical activity questionnaire. Adherence to exercise guidelines will be evaluated by (1) number of ‘active minutes’ per week (from the activity monitor), (2) amount of time per week when heart rate is within a target range (ie, 55%–80% of age-predicted maximum) and (3) amount of time per week completing ‘moderate’ or ‘strenuous’ physical activities (from the questionnaire). We will compare the proportion of active and inactive individuals at 6 months post intervention using mixed-model logistic regression, with fixed effects of time and phase and random effect of cluster (site).Ethics and disseminationTo date, research ethics approval has been received from five of the six sites, with conditional approval granted by the sixth site. Results will be disseminated directly to study participants at the end of the trial, and to other stake holders via publication in a peer-reviewed journal.Trial registration numberNCT02951338; Pre-results.
Lipid-lowering drugs and risk of new-onset diabetes: a cohort study using Japanese healthcare data linked to clinical data for health screening
Authors: Ooba Nobuhiro , Setoguchi Soko , Sato Tsugumichi , Kubota Kiyoshi 
Published: July 2017

ObjectiveTo investigate whether lipid-lowering drugs are associated with new-onset diabetes after adjusting for baseline clinical risk factors for diabetes.DesignA retrospective cohort study.SettingJapanese employees of large corporations and their dependents using health insurance claims data linked to clinical and laboratory data for annual health screenings.ParticipantsAll persons aged 20 to 74 years with dyslipidaemia between 1 January 2005 and 31 March 2011. We defined the index date as the first date when the person met the criteria for dyslipidaemia. Persons were excluded if they had lipid-lowering drugs, or had a diagnosis, a treatment or a laboratory test result (haemoglobin A1c ≥6.5% or fasting blood glucose ≥126 mg/dL) indicating diabetes during the 6-month period before the index date.Main outcome measuresNew-onset diabetes.ResultsWe identified 68 620 persons with dyslipidaemia. During the mean follow-up period of 1.96 years, 3674 persons started treatment with a lipid-lowering drug: 979 with a low potency statin, 2208 with a high potency statin and 487 with a fibrate. Of 3674 new users of a lipid-lowering drug, 3621 had a period of non-use of any lipid-lowering drugs before starting a lipid-lowering drug. Among statin users, the incidence rate of new-onset diabetes was 124.6 per 1000 person-years compared with 22.6 per 1000 person-years in non-users. After adjusting for confounding factors including clinical data in health screening using Cox proportional hazards models, the HR was 1.91 (95% CI 1.38 to 2.64) for low potency statins and 2.61 (2.11 to 3.23) for high potency statins.ConclusionThe use of statins was associated with a 1.9-fold to 2.6-fold increase in the risk of new-onset diabetes in a Japanese population of working age, despite adjusting for clinical risk factors for diabetes.
Improving patient safety through better teamwork: how effective are different methods of simulation debriefing? Protocol for a pragmatic, prospective and randomised study
Authors: Freytag Julia , Stroben Fabian , Hautz Wolf E , Eisenmann Dorothea , Kämmer Juliane E 
Published: July 2017

IntroductionMedical errors have an incidence of 9% and may lead to worse patient outcome. Teamwork training has the capacity to significantly reduce medical errors and therefore improve patient outcome. One common framework for teamwork training is crisis resource management, adapted from aviation and usually trained in simulation settings. Debriefing after simulation is thought to be crucial to learning teamwork-related concepts and behaviours but it remains unclear how best to debrief these aspects. Furthermore, teamwork-training sessions and studies examining education effects on undergraduates are rare. The study aims to evaluate the effects of two teamwork-focused debriefings on team performance after an extensive medical student teamwork training.Methods and analysesA prospective experimental study has been designed to compare a well-established three-phase debriefing method (gather–analyse–summarise; theGAS method) to a newly developed and more structured debriefing approach that extends the GAS method withTeamTAG(teamwork techniques analysis grid). TeamTAG is a cognitive aid listing preselected teamwork principles and descriptions of behavioural anchors that serve as observable patterns of teamwork and is supposed to help structure teamwork-focused debriefing. Both debriefing methods will be tested during an emergency room teamwork-training simulation comprising six emergency medicine cases faced by 35 final-year medical students in teams of five. Teams will be randomised into the two debriefing conditions. Team performance during simulation and the number of principles discussed during debriefing will be evaluated. Learning opportunities, helpfulness and feasibility will be rated by participants and instructors. Analyses will include descriptive, inferential and explorative statistics.Ethics and disseminationThe study protocol was approved by the institutional office for data protection and the ethics committee of Charité Medical School Berlin and registered under EA2/172/16. All students will participate voluntarily and will sign an informed consent after receiving written and oral information about the study. Results will be published.
P101 Cutting the time to treatment of chlamydia trachomatis (CT) and neisseria gonorrhoeae (NG) with near-patient molecular diagnostics: the utility of the cepheid genexpert system
Authors: Mandlik Emily , Plaha Komal , Jones Rachael , Rayment Michael 
Published: July 2017

IntroductionThe Cepheid GeneXpert® provides near-patient molecular detection of CT/NG, with results available in 90 minutes. Previous studies have illustrated the benefits to asymptomatic individuals and their partners in reducing time to treatment.MethodsA case-control study was undertaken to investigate the impact of introducing GeneXpert to a Level 3 symptomatic service. 100 patients diagnosed with CT+/-NG before and after introduction were identified. Time from attendance to treatment was measured. Using self-report over the previous three months and assuming that rate of new sexual partners remained the same and spaced equally in time, we modelled the number of partners spared exposure due to earlier treatment of CT/NG.ResultsCharacteristics of the study populations, and of the time to treatment and partners spared analyses are shown in the table:Abstract P101 Table 1Time to treatmentPre-implementation of GeneXpert (n=100)Post-implementation of GeneXpert (n=100)Male (%)4061Age (median [range])28.1 [15–69]30.6 [14–70]MSM/WSW (%)33/037/1Symptomatic (%)5028Time to treatment (days (mean) [SD])9.5 [13.23]3.3 [4.94]Sexual partners in preceding 3 months (mean [SD])2.1 [1.71]4.0 [10.48]Partners exposed in interval between test and treatment/100 index cases19.99.12The time from testing to treatment was reduced by 6.2 days. The number of partners exposed/100 index patients was 19.9 pre-GeneXpert and 9.12 post-GeneXpert.DiscussionUse of GeneXpert reduced time to treatment by 66%, and 54% fewer partners were exposed to CT/NG. This study supports the personal and public health benefits of innovative, near-patient molecular diagnostics coupled with effective recall mechanisms.
Comments on “Regional Impacts of Irrigation in Mexico and the Southwestern United States on Hydrometeorological Fields in the North American Monsoon Region”
Authors: Bohn Theodore J. , Vivoni Enrique R. 
Published: July 2017

Abstract
For their investigation of the impact of irrigated agriculture on hydrometeorological fields in the North American monsoon (NAM) region, Mahalov et al. used the Weather Research and Forecasting (WRF) Model to simulate weather over the NAM region in the summer periods of 2000 and 2012, with and without irrigation applied to the regional croplands. Unfortunately, while the authors found that irrigated agriculture may indeed influence summer precipitation, the magnitude, location, and seasonality of their irrigation inputs were substantially inaccurate because of 1) the assumption that pixels classified as “irrigated cropland” are irrigated during the summer and 2) an outdated land cover map that misrepresents known agricultural districts. The combined effects of these errors are 1) an overestimation of irrigated croplands by a factor of 3–10 along the coast of the Gulf of California and by a factor of 1.5 near the Colorado River delta and 2) a large underestimation of irrigation by a factor of 7–10 in Chihuahua, particularly in 2012. Given the sensitivity of the WRF simulations conducted by Mahalov et al. to the presence of irrigated agriculture, it is expected that the identified errors would significantly impact surface moisture and energy fluxes, resulting in noticeably different effects on precipitation. The authors suggest that the analysis of irrigation effects on precipitation using coupled land–atmospheric modeling systems requires careful specification of the spatiotemporal distribution of irrigated croplands.
The Soviet Union and Population
Authors: DiMaio Alfred J. 
Published: July 2017

Until the important public dialogue on Third World population issues began in the Soviet Union in 1965, ideological limitations and bureaucratic interests prevented policy makers from recognizing the existence of a world or national “population problem.” Since then, freer discussions of the Soviet Union's surprising decline in birth rate and labor shortages have led to serious policy questions. Conflicting policy goals, however, have resulted in only modest pronatalist policies. The Soviet population problem is a result of interregional disparities in population growth rates between the highly urbanized Soviet European populations with low birth rates and the least urbanized Central Asians with dramatically higher birth rates. As a result, these essentially Muslim people will provide the only major increases in labor resources and an increasing percentage of Soviet armed forces recruits. Policy planners are thus faced with difficult options. Current policies stressing technological transfers from the West and greater labor productivity, however, are unlikely to solve further labor shortages and regional imbalances. Ultimately, non-European regions will be in an improved bargaining position for more favorable unionwide economic policies and for a greater role in policy-planning.
An Experimental Analysis of the Relative Importance of Pitch, Quantity, and Intensity as Cues to Phonemic Distinctions in Southern Swedish
Authors: Westin Kjell , Buddenhagen R.G. , Obrecht Dean H. 
Published: July 2017

This paper, following introductory comments on previous experiments involving prosodic features of speech, reports an experiment designed to indicate the relative importance of pitch, quantity, and intensity as cues for syllabic prominence in Southern Swedish. Spectrographic analysis of the particular minimal pair used in this experiment revealed that one, or any combination, of three possible prosodic features, pitch, quantity, and intensity, could account for the contrast in meaning of the pair, the written representation of which is HÄLSA PA. Stimuli were prepared in which all possible binarily opposed combinations of pitch, quantity, and intensity in the last syllable were represented. Additional stimuli were prepared to test whether the contrastive pitch level of the first syllable might also contribute to the identification of the minimal pair. Native speakers of Swedish were asked to identify each stimulus item as either greet or visit, the two concepts which the written form HÄLSA PA represented. Analysis of the results showed that pitch provided the primary cue for identifications. Significantly, the pitch of the first syllable was the most potent cue, overriding opposing cues of pitch, quantity, and intensity on the final syllable. Accordingly, the conclusion was drawn that perception followed primarily the first syllable, that subjects made their identifications on the basis of the pitch of the first syllable, and that they could not be dissuaded in their identifications by contradictory information present in the prosody of the final syllable. It could not be established with certainty which of the two remaining cues, quantity or intensity, was the more important.
Claims of Forgotten Trauma
Authors: Harris G. Christian 
Published: July 2017

Background: A review of the literature was made concerning repressed memory phenomena and recovered memory therapy, and data from six psychiatric case histories were examined specifically with regard to repressed memory phenomena. The ramifications of repressed memory phenomena were examined regarding cultural origins and legal consequences, the role of the therapists in such cases, and the effects of repressed memory claims on the patients. Methods: A discussion of the literature regarding repressed memory phenomena and their cultural significance and legal applications precedes an examination of six cases involving repressed memory claims—three clinical psychiatric case histories and three forensic psychiatric case histories. Each case was evaluated with regard to its ultimate forensic resolution and/or its psychological impact on the patients and their families. Results: Repressed memory claims have gained cultural ascendancy during the last decade and have proliferated within the legal system, beginning with the late 1980s. Claims of repressed memory phenomena and methods of recovered memory therapy at the present time have shown little regard for substantiated proof or sound critical thinking in the pursuit of assigning blame for a wide array of adult mental illnesses and disorders. Conclusions: A method must be developed as a standard for repressed memory cases that will preserve the best interests of the patient and the integrity of the therapist's treatment plan. Recommendations are made for safeguarding the well-being of the patient and for defining the objective and credible role of the therapist in repressed memory cases.
Osteoporosis services in secondary care: A UK survey
Authors: Rowe R E , Cooper C C 
Published: July 2017

Summary A 1994 survey indicated that only 13 health authorities in the UK were purchasing access to dual X-ray absorptiometry (DXA), the most accurate measure of osteoporosis risk. By 1998 the number of centres (including private facilities providing DXA) was 161. All these were sent a questionnaire concerning their activities. 124 (77%) responded, and the survey found that DXA machines operate, on average, for only 3.6 days a week. Funding of and access to diagnostic services for osteoporosis varies greatly. There is clear scope for greater efficiency in the use of existing DXA machines and more equitable access to diagnostic services is required for effective management of osteoporosis.
Underutilization of antithrombotic therapy in atrial fibrillation
Authors: Adhiyaman V , Kamalakannan D , Oke A , Shah I U , White A D 
Published: July 2017

Summary Most patients with atrial fibrillation should be considered for antithrombotic therapy. In a retrospective survey we investigated practice in two hospitals. For patients at high risk, established guidelines recommend warfarin, or aspirin if anticoagulants are contraindicated; for those at medium risk, either may be used. Of 156 with atrial fibrillation (acute, chronic or paroxysmal), 119 were at high risk, mean age 79 years. According to the guidelines, 89 of these were suitable for anticoagulation but only 49 (55%) received warfarin; 27 received aspirin and 13 neither. Of 27 patients at medium risk (mean age 70 years), 6 were not prescribed any antithrombotic therapy. This survey indicates that guidelines on antithrombotic therapy are commonly disregarded and that, in particular, warfarin is underutilized in the group for whom it is most indicated.
A randomized controlled study of reviewer bias against an unconventional therapy
Authors: Resch K I , Ernst E , Garrow J 
Published: July 2017

Summary A study was designed to test the hypothesis that experts who review papers for publication are prejudiced against an unconventional form of therapy. Two versions were produced (A and B) of a ‘short report’ that related to treatments of obesity, identical except for the nature of the intervention. Version A related to an orthodox treatment, version B to an unconventional treatment. 398 reviewers were randomized to receive one or the other version for peer review. The primary outcomes were the reviewers’ rating of ‘importance’ on a scale of 1-5 and their verdict regarding rejection or acceptance of the paper. Reviewers were unaware that they were taking part in a study. The overall response rate was 41.7%, and 141 assessment forms were suitable for statistical evaluation. After dichotomization of the rating scale, a significant difference in favour of the orthodox version with an odds ratio of 3.01 (95% confidence interval, 1.03 to 8.25), was found. This observation mirrored that of the visual analogue scale for which the respective medians and interquartile ranges were 67% (51% to 78.5%) for version A and 57% (29.7% to 72.6%) for version B. Reviewers showed a wide range of responses to both versions of the paper, with a significant bias in favour of the orthodox version. Authors of technically good unconventional papers may therefore be at a disadvantage in the peer review process. Yet the effect is probably too small to preclude publication of their work in peer-reviewed orthodox journals.