bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of the informed health choices educational intervention to improve secondary students’ ability to think critically about health interventions in Uganda: A cluster‐randomized trial
Authors: Ssenyonga Ronald , Oxman Andrew D , Nakyejwe Esther , Chesire Faith , Mugisha Michael , Nsangi Allen , Semakula Daniel , Oxman Matt , Rose Christopher James , Rosenbaum Sarah E , Moberg Jenny , Kaseje Margaret , Nyirazinyoye Laetitia , Dahlgren Astrid , Lewin Simon , Sewankambo Nelson K 
Published: September 2023

AbstractAim:The aim was to evaluate the effect of the Informed Health Choices (IHC) educational intervention on secondary students’ ability to assess health‐related claims and make informed choices.Methods:In a cluster‐randomized trial, we randomized 80 secondary schools (students aged 13–17 years) in Uganda to the intervention or control (usual curriculum). The intervention included a 2‐day teacher training workshop, 10 lessons accessed online by teachers and delivered in one school term. The lesson plans were developed for classrooms equipped with a blackboard or a blackboard and projector. The lessons addressed nine prioritized concepts. We used two multiple‐choice questions for each concept to evaluate the students’ ability to assess claims and make informed choices. The primary outcome was the proportion of students with a passing score (≥9 of 18 questions answered correctly).Results:Eighty schools consented and were randomly allocated. A total of 2477 students in the 40 intervention schools and 2376 students in the 40 control schools participated in this trial. In the intervention schools, 1364 (55%) of students that completed the test had a passing score compared with 586 (25%) of students in the control schools (adjusted difference 33%, 95% CI 26%–39%).Conclusions:The IHC secondary school intervention improved students’ ability to think critically and make informed choices. Well‐designed digital resources may improve access to educational material, even in schools without computers or other information and communication technology (ICT). This could facilitate scaling‐up use of the resources and help to address inequities associated with limited ICT access.
Using Systems Thinking and Complexity Theory to understand and improve Emergency Medicine: Lessons from COVID‐19 in a safety net health system
Authors: Rusoja Evan , Chad Swanson R. , Swift Mini 
Published: September 2023

AbstractRationaleCOVID‐19 has fundamentally changed the practice of Emergency Medicine (EM). Care delivery on the front lines has historically depended upon ostensibly reliable input‐output models for staffing, supplies, policies, and therapies. Challenged by the complexity of healthcare during the pandemic, the fallibility of these reductionist models was quickly revealed. Providers and systems quickly had to reconceptualize their dependence on the wider, complex system in which healthcare operates and find adaptive solutions to rapid changes.Aims/MethodThis papers seeks to review and describe how Systems Thinking and Complexity Theory (ST/CT)—concepts, principles, and tools that can be used to understand and impact our constantly evolving health system—can be applied to better understand and enact change in complex settings such as during COVID‐19. Some of these ST/CT are described through the real world example of the Alameda Health System Vaccine Taskforce.ResultsST/CT concepts such as Unintended Consequences, Interrelationships, Emergent Behavior, Feedback Loops, and Path Dependence can help EM providers and planners understand the context in which their system operates. Key principles such as Collaboration, Iterative Learning, and Transformational Leadership can help these actors respond to current and future challenges. The integration of these concepts and principles into the Learning Health System offers a model for tying these key concepts and principles together into an adaptive, cross‐sectoral organizational approach.ConclusionBy integrating ST/CT into the practice of EM, we can not only improve our ability to care for patients but also our capacity to understand and strengthen our wider systems of care.
Evaluating shared decision making for dialysis initiation: A qualitative study on patient refusal of long‐term dialysis in Taiwan
Authors: Kuo Yi‐Ting , Jenq Chang‐Chyi , Li Uen Shuen , Lin Ya‐Ping 
Published: September 2023

AbstractRationalePrevious studies have explored shared decision making (SDM) implementation to determine the renal replacement therapy modality; however, the SDM approach for dialysis initiation, especially when patients refuse physician suggestions for long‐term dialysis, remains unclear.Aims and ObjectivesThis study aimed to explore physicians' responses towards patients' refusal of long‐term dialysis during the SDM process and the thinking processes of both physicians and patients regarding dialysis refusal.MethodWe conducted in‐depth semi‐structured interviews with 10 patients diagnosed with end‐stage renal disease, each of whom refused long‐term dialysis after physicians employed the SDM framework, and nine nephrologists at the Chang Gung Memorial Hospital, Taiwan, from March to May 2020. Interviews were audio‐recorded, transcribed, and translated from Mandarin to English. They were then thematically analysed.ResultsThree main themes on dialysis initiation SDM implementation and the differences between physician and patient perceptions on patient treatment refusal were yielded. While the SDM approach for dialysis initiation developed by nephrologists in Taiwan respects patient decisions, physicians often actively persuade patients to undergo dialysis in case of treatment refusal. The motivation behind this approach is to promote the patient's best medical interests, particularly post‐dialysis life quality, and to ensure a ‘rational’ medical decision is made. However, patients' perceptions of treatment refusal differ significantly from those of physicians, and their decision‐making process is often iterative and based on comprehensive evaluation of immediate concerns beyond biomedical factors.ConclusionsFindings suggest that the current physician‐led SDM approach for dialysis initiation characterises active persuasion with physicians' perspectives predominating the clinical encounter. To improve SDM implementation, we propose that physicians should acknowledge and understand patients' reasoning for dialysis refusal and the distinction between objective health and subjective well‐being during the decision‐making process.
The role of the lived body during the integration of the traumatic experience of the sternotomy scar: A case study
Authors: Tomán Edina , Pintér Judit Nóra , Hargitai Rita 
Published: September 2023

AbstractBackgroundOpen heart surgery is a potentially traumatic experience for patients, thus posing a real risk to both the patient's physical and mental health as well as bodily integrity. All of these can greatly affect the emotional relationship to the sternotomy scar, the physical aspect of self‐representation. Sternotomy scars mark patients for life, yet our knowledge of patients' subjective experiences is unknown.MethodIn our case study, we explore the embodied experiences of a woman (42) who underwent open heart surgery with the method of interpretative phenomenological analysis combined with drawings.Results:The body and the bodily experiences play a prominent role in the formation, healing process, and symbolism of a scar. The central core of the traumatic experience of open heart surgery is the attack against the patient's sensation of bodily integrity. The interviewee experiences the surgery as abuse committed on her body, a memory that is deeply etched both in the physical memory and in the form of a scar on the skin.Conclusion:Based on our study, it seems that the corporeal dimension of posttraumatic growth may develop after the traumatic experience of heart surgery, in which bodily intimacy with oneself and Significant Others plays a major role. In this case study, the objective reality of the heart as “sick” flesh and the “broken, pierced” bone (Körper), as well as the dissociation—and then its integration—of the lived, living body experience (Leib) are outlined. Our case study was analysed in the theoretical framework of phenomenology and psychoanalysis.
Intended and unintended consequences of strategies to meet performance benchmarks for rheumatologist referrals in a centralized intake system
Authors: Marshall Deborah A. , Tagimacruz Toni , Barber Claire E. H. , Cepoiu‐Martin Monica , Lopatina Elena , Robert Jill , Lupton Terri , Patel Jatin , Mosher Diane P. 
Published: September 2023

AbstractRationaleTimely assessment of a chronic condition is critical to prevent long‐term irreversible consequences. Patients with inflammatory arthritis (IA) symptoms require diagnosis by a rheumatologist and intervention initiation to minimize potential joint damage. With limited rheumatologist capacity, meeting urgency wait time benchmarks can be challenging. We investigate the impact of the maximum wait time guarantee (MWTG) policy and referral volume changes in a rheumatology central intake (CI) system on meeting this challenge.MethodsWe applied a system simulation approach to model a high‐volume CI rheumatology clinic. Model parameters were based on the referral and triage data from the CI and clinic appointment data. We compare the wait time performance of the current distribution policy MWTG and when referral volumes change.ResultsThe MWTG policy ensures 100% of new patients see a rheumatologist within their urgency wait time benchmark. However, the average wait time for new patients increased by 51% (178–269 days). A 10% decrease in referrals resulted in a 76% decrease on average wait times (178–43 days) for new patients and an increase in the number of patients seen by a rheumatologist within 1 year of the initial visit.ConclusionAn MWTG policy can result in intended and unintended consequences—ensuring that all patients meet the wait time benchmarks but increasing wait times overall. Relatively small changes in referral volume significantly impact wait times. These relationships can assist clinic managers and policymakers decide on the best approach to manage referrals for better system performance.
Isolation and identification of Chryseobacterium indologenes and its pathological changes in Pelodiscus sinensis
Authors: Xing Yangyang , Xue Mingyang , Xiao Zidong , Hu Xiaowei , Zhai Jiale , Zhang Chunjie , Jiang Nan , Fan Yuding , Meng Yan , Zhou Yong 
Published: September 2023

AbstractThe Chinese revered a species of aquatic reptile known as Pelodiscus sinensis as both an edible and medicinal species. When artificially breeding, many deaths occurred at the farmed P. sinensis, mainly due to excessive breeding density, water contamination, and turtles biting each other secondary to bacterial infections. In this study, an isolate of gram‐negative bacteria WH0623 was isolated from the liver and kidney of diseased P. sinensis to trace the potential pathogen of this disease. Based on biochemical characteristics and 16S rRNA gene sequencing analyses, this isolated strain of WH0623 was identified as Chryseobacterium indologenes. The strain's median lethal dose (LD50) was 3.3 × 105 colony‐forming units (CFU)/g per fish weight tested using artificial infection. Histopathological analysis revealed pathological changes, including cell swelling, hyperaemia, and necrosis in many tissues. Antibiotic susceptibility tests revealed that the bacteria WH0623 was susceptible to doxycycline, sulphonamides, ceftazidime, norfloxacin, and ciprofloxacin. These antibiotics could treat the disease. In conclusion, the pathogen causing the death of farmed P. sinensis was isolated and identified, and a drug‐sensitive test was conducted. Our findings contribute to the future diagnosis and treatment of the disease.
Frailty as a risk factor for post‐acute sequelae of COVID‐19 among US veterans during the Delta and Omicron waves
Authors: Hammel Iriana S. , Tosi Dominique M. , Tang Fei , Pott Henrique , Ruiz Jorge G. 
Published: September 2023

AbstractBackgroundOlder populations have suffered the highest rates of SARS‐CoV‐2 infection and associated complications, including Post‐Acute Sequelae of SARS‐CoV‐2 infection (PASC). Frailty is a geriatric syndrome that often coexists with COVID‐19 infection. The vulnerability to stressors caused by multisystemic dysfunction that characterizes frailty may predispose older adults to develop PASC.MethodsRetrospective cohort study using the VA COVID‐19 Shared Data Resource to identify US veterans testing positive for SARS‐CoV‐2 between July 2021 and February 2022, without prior positive tests and who were alive 30 days after infection. Frailty was calculated using a 31‐item VA Frailty Index generated from electronic health records. We categorized Veterans into robust (FI ≤ 0.10), prefrail (FI: >0.10‐ < 0.21), and frail (FI ≥ 0.21). We assessed the association between frailty and PASC and vaccination and PASC using Cox survival model, adjusting for covariates.ResultsWe identified 245,857 COVID‐19‐positive veterans surviving 30 days after infection. The mean age was 57.5 ± 16.5 years; 87.2% were males, 68.1% were white, and 9.0% were Hispanic. Almost half of the sample (48.9%) were classified as robust, while 28.3% were pre‐frail and 22.7% were frail; 99,886 (40.6%) were fully vaccinated, and 33,516 (13.6%) received booster doses. Over a median follow‐up of 143 days (IQR = 101), 23,890 (9.7%) patients developed PASC. Within 6 months after infection, frailty and pre‐frailty were associated with a 41% (adjusted HR [aHR]:1.40 (95% CI: 1.35–1.47) and 15% (aHR: 1.17 (95% CI: 1.11–1.19) increase in the risk of PASC compared with the robust, respectively. Vaccination and booster doses before infection were associated with a 27% (aHR: 0.73 (95% CI: 0.71–0.75) and 33% (aHR: 0.66 (95% CI: 0.63–0.69) reduction in the risk of developing PASC, respectively.ConclusionsFrailty was associated with an increased risk of developing PASC. Vaccination was associated with a decreased risk of PASC, further reduced by booster doses. Early recognition of frailty in patients with COVID‐19 may assist in the early identification and management of PASC.
The affordability and obtainability of gluten‐free foods for adults with coeliac disease following their withdrawal on prescription in England: A qualitative study
Authors: Crocker Helen , Lewis Thomas , Violato Mara , Peters Michele 
Published: September 2023

AbstractBackgroundChanges to prescribing policies in England have restricted or stopped access to gluten‐free food on prescription for people with coeliac disease in some geographical areas. The present study aimed to explore the impact of these changes on the affordability and obtainability of gluten‐free foods for adults with coeliac disease.MethodsSemi‐structured qualitative interviews (n = 24) were conducted with people with coeliac disease living in areas where prescriptions for gluten‐free foods were no longer available, were restricted or followed national guidelines. Interviews explored the impact of gluten‐free prescribing changes on the affordability and obtainability of gluten‐free food, as well as dietary adherence.ResultsAll participants considered gluten‐free substitute foods to be expensive. Participants felt the availability of gluten‐free foods has improved over time, also acknowledging some challenges remain, such as limited local availability. For most, the withdrawal of prescriptions had minimal impact requiring small adjustments such as reducing the quantity of foods obtained. However, greater challenges were faced by those less mobile, permanently sick or disabled and/or on lower incomes.ConclusionsThe majority of participants affected by the withdrawal of prescriptions were able to adapt to cope with these changes. However, participants with mobility issues, who are permanently sick or disabled and/or on lower incomes were struggling to afford and obtain gluten‐free substitute foods from elsewhere. The withdrawal of prescriptions may further widen health inequalities. Further research should focus on the long‐term impacts of prescription withdrawal for the vulnerable groups identified.
Antenatal healthcare providers' knowledge, attitudes and practices regarding food insecurity in pregnancy: A qualitative investigation based at a specialist antenatal hospital in Melbourne, Australia
Authors: Dickson Amanda , McKay Fiona , Zinga Julia , van der Pligt Paige 
Published: September 2023

AbstractBackgroundFood insecurity exists when accessibility and availability of nutritious food is restricted, increasing the risk of adverse health outcomes. Pregnant women are especially vulnerable to food insecurity, which is concerning as optimal nutrition to support both their own health and the health and growth of their unborn child is critical. Antenatal healthcare providers (AHPs) are central to provision of pregnancy care. We aimed to assess AHPs' knowledge, attitudes and management of food insecurity.MethodsSemi‐structured interviews were conducted face‐to‐face, via telephone or online via Webex with 16 AHPs at the Royal Women's Hospital located in Melbourne, Australia. Interviews were thematically analysed according to Charmaz's constructivist grounded theory approach to ascertain AHPs' knowledge, attitudes and practices regarding food insecurity during pregnancy.ResultsAHPs had limited knowledge and awareness of food insecurity in pregnancy. Lack of experience in managing food insecurity and time constraints limit their capacity to support and deliver care to food‐insecure women. There was a reported lack of structure and clarity surrounding referral pathways for effective management of food insecurity during pregnancy, as well as a lack of clarity regarding practitioner responsibility in managing this issue.ConclusionsCurrent assessment and management of food insecurity during pregnancy in the antenatal setting is suboptimal. Professional development strategies targeted to AHPs are urgently needed to assist optimal care of women who are food insecure during pregnancy to assist with supporting best maternal and child health.
A standardised nutritional drink as a test meal for the 13C mixed triglyceride breath test for pancreatic exocrine insufficiency: A randomised, two‐arm crossover comparative study
Authors: Powell‐Brett Sarah , Hall Lewis A. , Roberts Keith J. 
Published: September 2023

AbstractBackgroundThe 13C mixed triglyceride breath test (13C MTGT) is a diagnostic test for pancreatic exocrine insufficiency (PEI). It is poorly standardised with much heterogeneity of the test meal, the commonest being toast and butter. A standardised oral nutritional supplement that could be easily transported, stored and made up would be valuable for making this test accessible outside of specialist centres.MethodsA prospective, randomised, two‐arm crossover study of different test meals was carried out in 14 healthy controls. The 13C MTGT was performed in identical conditions on two separate days. Two test meals were given in random order, either standard (toast and butter) or novel (oral nutritional supplement), with 250 mg of 13C‐labelled mixed triglyceride incorporated. Breath samples were taken postprandially to calculate cumulative percentage dose recovery (cPDR) of 13C at 6 h.ResultsAll 14 participants completed both arms of the study with no protocol deviations. The mean cPDR was 39.39% (standard deviation [SD] 5.19) for the standard test meal and 39.93% (SD 5.20) for the novel test meal. A one‐way repeated measures analysis of variance (ANOVA) found no significant difference in cPDR between the two meals, F(1, 13) = 0.18, p = 0.68 (minimum detectable difference of 0.81 at 80% power).ConclusionThis study demonstrates that a standardised oral nutritional supplement can be used without compromising 13C recovery. Using this test meal provides a standardised dietary stimulus to the pancreas, avoiding possible variation in quantity of dietary components with other test meals. Further, the ease of use of this method would help establish the 13C MTGT test more widely.
Two pregnant women with immune‐mediated thrombotic thrombocytopenic purpura: A case report
Authors: Uchida Akiko , Tanimura Kenji , Sasagawa Yuki , Yamada Hirotaka , Katayama Yoshio , Matsumoto Masanori 
Published: September 2023

AbstractThrombotic thrombocytopenic purpura (TTP) during pregnancy is life‐threatening. We encountered two pregnant women with immune‐mediated TTP (iTTP). A 40‐year‐old primigravida woman was referred at 19 gestational weeks (GWs) owing to iTTP. She received plasma exchange (PE) and steroid therapies and delivered a live infant at 27 GWs by cesarean delivery. A 29‐year‐old primigravida woman was referred owing to intrauterine fetal death and thrombocytopenia at 20 GWs. She was diagnosed with iTTP and received PE therapy. She required additional PE and steroid therapies owing to relapse. Before her second pregnancy, she received prednisolone and hydroxychloroquine according to the therapy for systemic lupus erythematosus (SLE). She had induced labor at 37 GWs owing to decrease plasma level of a disintegrin‐like and metalloproteinase with thrombospondin type 1 motif 13 (ADAMTS13) activity. Close monitoring of plasma ADAMTS13 activity level and treatments for underlying SLE may prevent iTTP relapse and lead to a good prognosis.
Multiple change point detection under serial dependence: Wild contrast maximisation and gappy Schwarz algorithm
Authors: Cho Haeran , Fryzlewicz Piotr 
Published: September 2023

We propose a methodology for detecting multiple change points in the mean of an otherwise stationary, autocorrelated, linear time series. It combines solution path generation based on the wild contrast maximisation principle, and an information criterion‐based model selection strategy termed gappy Schwarz algorithm. The former is well‐suited to separating shifts in the mean from fluctuations due to serial correlations, while the latter simultaneously estimates the dependence structure and the number of change points without performing the difficult task of estimating the level of the noise as quantified e.g. by the long‐run variance. We provide modular investigation into their theoretical properties and show that the combined methodology, named WCM.gSa, achieves consistency in estimating both the total number and the locations of the change points. The good performance of WCM.gSa is demonstrated via extensive simulation studies, and we further illustrate its usefulness by applying the methodology to London air quality data.
Rheology of liquid foods under shear flow conditions: Recently used models
Authors: Martínez‐Padilla Laura Patricia 
Published: September 2023

AbstractProper modeling of flow or viscosity curves as a function of shear rate is a useful tool in any engineering activity. The rheology of foods depends on the composition, processing to which they have been subjected and the state of dispersion in which they are found. Liquid foods are complex biosystems, that show non‐Newtonian behavior under flow conditions. This review presents models used in recent decades to describe the experimental rheological behavior of various liquid foods, ranging from Newtonian fluids to the most complex. Some non‐Newtonian parameters such as those of the Ostwald‐de Waele, Bingham, Herschel–Bulkley, Casson, Cross, and Carreau models are summarized. Examples of thixotropic behavior described by the Weltman and Abu‐Jdayil models are also presented. In each model, explanations based on the composition and dispersion state of the food are made. This is useful in innovative processing technologies and for scientists new to the field of food rheology. An attempt is made to exemplify and group the expected behavior for most fluid foods, including some for a dysphagia diet, depending on their composition or the dispersed system formed, which will be useful for professionals who wish to compare reported rheological parameters with those obtained experimentally.