bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of immune response and haematological parameters in infected male albino rats by giardiasis
Authors: Abo‐Zaid Mabrouk A. , Hamdi Aishah Ali 
Published: February 2022

AbstractThe present work aimed to study the effects ofGiardia lambliainfection on immunological and haematological studies and to evaluate immunoglobulins and some cytokines. Fifty male albino rats were divided into six groups. The control group includes 20 rats and the infected group includes 30 rats. All the estimations were checked all over five checkpoints (CP) (7, 14, 21, 28 and 35 days post‐infection). Serum levels of IgA, IgG, IgM and IgE. Cytokines INF‐γ, TNF‐alpha, IL‐4, IL‐10 and haematological parameters were determined. Cyst and trophozoite were counted. A considerable increase in the level of immunoglobulins and cytokines in all infected groups compared with the control group was documented. Furthermore, a significant decrease in red blood corpuscles, haemoglobin and mean corpuscular haemoglobin concentration levels was observed, whereas substantial increases in mean corpuscular volume, mean corpuscular haemoglobin and platelets were observed. Moreover, infected rats had a substantial rise in WBCs, lymphocytes and eosinophil counts compared with the control group, whereas neutrophils and monocytes had a significant decrease. The number of trophozoites and cysts was significantly increased in infected groups before diminishing after day 28. The current results showed that Th1 and Th2 immune responses, which are characterized by the production of TNF‐α, IFN‐γ, IL‐4 and IL‐10, are important for protection againstGiardiainfections and also verified the balance between these cytokines and the timing of their production was crucial inG. lambliaimmune response.
Management and prevention of soft tissue complications in implant dentistry
Authors: Thoma Daniel S. , Gil Alfonso , Hämmerle Christoph H. F. , Jung Ronald E. 
Published: February 2022

AbstractThe management and prevention of soft tissue complications is of key importance in modern implant dentistry and influences biologic and esthetic outcomes. The assessment of the soft tissue conditions from a quantitative and qualitative perspective should, therefore, be part of the overall treatment plan. Such an assessment dictates a potential indication as well as an ideal time point for additional soft tissue management. A proper risk assessment and management of the soft tissues at the planned implant site are of key importance prior to any implant‐related surgery. Cases with peri‐implant soft tissue complications generally involve: (a) a lack of attached and keratinized mucosa; (b) insufficient volume; (c) development of mucosal dehiscences; or (d) a combination of (a), (b), and (c). In case of soft tissue deficiencies, these should be addressed as early as possible to increase the predictability of the surgical interventions. This article reviews the main causes for peri‐implant soft tissue complications and presents different therapeutic options for the management of various clinical scenarios.
Surgical therapy of peri‐implantitis
Authors: Schwarz Frank , Jepsen Søren , Obreja Karina , Galarraga‐Vinueza Maria Elisa , Ramanauskaite Ausra 
Published: February 2022

AbstractPeri‐implantitis is caused by a bacterial challenge; therefore, anti‐infective treatment strategies should be employed to manage the disease. As nonsurgical approaches demonstrate limited efficacy in most cases of peri‐implantitis, surgical interventions are often required. Treatment outcomes improve following access flap surgery, with or without adjunctive resective and/or augmentation measures. Whereas nonaugmentative therapies (ie, access flap surgery and resective techniques) primarily aim to resolve inflammation and arrest further disease progression, augmentation approaches also seek to regenerate the bony defect and achieve reosseointegration. Currently, limited evidence supports the superiority of augmentative surgical techniques for peri‐implantitis treatment over nonaugmentation methods, and human histologic evidence for reosseointegration is sparse. For patients involved in regular postoperative maintenance programs, success of peri‐implantitis surgical treatment based on various definitions of success was obtained in over half of the cases after 5‐7 years. Despite surgical treatment, cases of further disease progression that required retreatment or led to implant loss were reported.
The ethical dilemmas of risky decisions
Authors: Ale Ben J.M. , Slater David H. , Hartford Des N.D. 
Published: February 2022

AbstractEven in a pandemic there seem to be inherent conflicts of interest between the individual and societal consequences of remedial actions and strategies. Actions taken in the sole interests of patients, as required by the Hippocratic oath, can have broadly inconvenient economic implications for the State. (“Average” benefits for a population can impose individual inconveniences for the vulnerable.). Understandably these decisions are not normally made explicitly and transparently by governments. This leads to seemingly illogical and inhumane strategies which are not understood and hence mistrusted and often ignored by the public. Vaccination sentiments on social media are often an unwanted symptom of this dilemma. This article outlines and discusses a number of examples of such situations with a focus on ethical aspects. It concludes that each case must be considered individually as to the issues that need to be weighed in these difficult decisions; and that there are no clear and universally acceptable ethical solutions. What can be learned from the COVID‐19 crisis is that short term utilitarianism has consequences that in the eyes of the population are unacceptable. This lesson seems equally valid for cost benefit evaluations regarding other risks, such as from hazardous industries, flood defenses, and air transport. Decisionmakers and politicians can learn that persuasion only goes so far. In the end the people appear to prioritize in terms of deontology.
Hybrid event bed character and distribution in the context of ancient deep‐lacustrine fan models
Authors: Dodd Thomas J. H. , McCarthy Dave J. , Amy Lawrence , Plenderleith Gayle E. , Clarke Stuart M. 
Published: February 2022

AbstractHybrid event beds are texturally and compositionally‐diverse deposits preserved within deepwater settings. They are deposited by flows exhibiting ‘mixed behaviour’, forming complex successions of sandstone and mudstone, which are often challenging to predict. Hybrid event beds are documented in deep‐marine settings, where they have been thoroughly characterized, and are well‐known as effective fluid transmissibility barriers and baffles in reservoirs. By comparison, there are far‐fewer studies of hybrid event beds from deep‐lacustrine settings, where their character and distribution remains relatively under‐explored. In order to provide insights into these deposits, this study presents the detailed analysis of three‐dimensional seismic data, wireline logs and core from a series of ancient deep‐lacustrine fan systems in the North Falkland Basin. Results confirm that deep‐lacustrine hybrid event beds comprise the same idealized sequence of the ‘H1–H5’ divisions. However, in this study H3 ‘debrite’ units can be sub‐divided into ‘H3a–H3c’, based on: sharp or erosional intra‐H3 contacts, bulk lithology, mud‐content and discrete sedimentary textures. This study interprets the H3a–H3c sub‐units as the products of multiple flow components formed through significant rearward longitudinal flow transformation processes, during the emplacement of a single hybrid event bed. Hybrid event beds are observed within lobe fringes, where flow types, energies and transport mechanisms diversify as a result of flow transformation. The temporal context of hybrid event bed occurrences is considered in relation to stages of fan evolution, including: the Initiation; Growth (I); Growth (II); By‐pass; Abandonment; and Termination phases. Hybrid event beds are mainly found in either the initiation phase where flow interaction and erosion of initial substrates promoted mixed flow behaviour, or in the abandonment phase as facies belts retreated landward. The results of this study have important implications in terms of flow processes of hybrid event bed emplacement, in particular sub‐division of the H3 unit, as well as the prediction of hybrid event bed occurrence and character within ancient deep‐lacustrine fan settings, in general.
iQbD: A Technological Readiness Level-Indexed Quality-by-Design Paradigm for Medical Device Engineering
Authors: Bastogne Thierry 
Published: February 2022

Abstract
Risk assessment is a critical step in the roadmap of medical device development (MDD). Failure modes, effects and criticality analysis is a common approach based on declarative prior information that proved beneficial in the risk assessment of well-established processes. But at early steps of development when innovative materials or technologies are embedded, the lack of experience on those innovations introduces too much subjectivity in failure modes, effects, and criticality analysis (FMECA) for a robust risk assessment. Since mid-2000, the quality-by-design (QbD) guideline has been proposed within the pharmaceutical industry as a pro-active engineering approach to drug development. This paradigm enables a data-driven risk assessment throughout the development workflow, which completes the risk assessment provided by FMECA. Nevertheless, its implementation guide is unclear and not flexible enough to be efficiently applied to the development of medical devices. To address this issue, a new quality by design (QbD) paradigm indexed on the technological readiness level of the innovative product is proposed. It covers the development of medical devices throughout the whole preclinical phase and is composed of at least nine learning cycles. The first part of this medical device QbD layout, composed of three consecutive risk assessment cycles, is evaluated through a real study case with the objective to demonstrate the proof of concept of a photobleaching controller in photodynamic therapy. Beyond this experimental result, this application has confirmed practical ability of the indexed quality by design (iQbD) approach to complete FMECA and to provide an alternative solution to risk assessment when prior knowledge on the technological innovation is not available.
Time series analysis of the incidence of acute upper respiratory tract infections, COVID-19 and the use of antibiotics in Finland during the COVID-19 epidemic: a cohort study of 833 444 patients
Authors: Niemenoja Oskar , Taalas Ara , Taimela Simo , Bono Petri , Huovinen Pentti , Riihijärvi Sari 
Published: February 2022

ObjectiveTo evaluate the trajectories of acute upper respiratory tract infections (URTIs), COVID-19, and the use of antibiotics in Finland during the COVID-19 epidemic.DesignPopulation-based cohort study.SettingElectronic medical records from a nationwide healthcare chain in Finland.Participants833 444 patients from a cohort of 1 970 013 Finns who had used medical services between 2017 and 2020.Main outcome measuresNumber of weekly patients of acute URTIs, COVID-19, and the prescribed number of antibiotics in Finland between 6 January 2020 and 21 June 2020. We estimated the respective expected numbers from 1 March 2020 onward using autoregressive integrated moving average model from 1 January 2017 to 1 March 2020. We assessed the public interest in COVID-19 by collecting Google search trend frequencies.ResultsThere was a rapid increase in COVID-related internet searches between weeks 10 and 12. At the same time, there was a 106% increase in diagnoses of acute URTIs, from 410 per 100 000 inhabitants to 845 per 100 000. The first COVID-19 cases were diagnosed on week 11. Prescriptions for URTI-related antibiotics declined by 71% (403 per 100 000 to 117 per 100 000) between weeks 11 and 15 while no relevant change took place in prescriptions of antibiotics for urinary tract infections.ConclusionsAt the beginning of the epidemic, many people contacted healthcare professionals with relatively mild symptoms, as indicated by the reduced rate of URTI-antibiotics prescriptions. Our findings indicate that health service providers should be prepared for rapid variations in service demand. Securing access of true COVID-19 patients to proper diagnostics, care and isolation measures may help in preventing the spread of the disease.
Potential impact of encounter patient decision aids on the patient–clinician dialogue: a qualitative study on Dutch and American medical specialists’ experiences
Authors: Rake Ester A. , Dreesens Dunja , Venhorst Kristie , Meinders Marjan J. , Geltink Tessa , Wolswinkel Jenny T. , Dannenberg Michelle , Kremer Jan A.M. , Elwyn Glyn , Aarts Johanna W. M. 
Published: February 2022

ObjectivesTo examine the experiences among Dutch and American clinicians on the impact of using encounter patient decision aids (ePDAs) on their clinical practice, and subsequently to formulate recommendations for sustained ePDA use in clinical practice.DesignQualitative study using semi-structured interviews with clinicians who used 11 different ePDAs (applicable to their specialty) for 3 months after a short training. The verbatim transcribed interviews were coded with thematic analysis by six researchers via ATLAS.ti.SettingNine hospitals in the Netherlands and two hospitals in the USA.ParticipantsTwenty-five clinicians were interviewed: 16 Dutch medical specialists from four different disciplines (gynaecologists, ear-nose-throat specialists, neurologists and orthopaedic surgeon), 5 American gynaecologists and 4 American gynaecology medical trainees.ResultsThe interviews showed that the ePDA potentially impacted the patient–clinician dialogue in several ways. We identified six themes that illustrate this: that is, (1) communication style, for example, structuring the conversation; (2) the patient’s role, for example, encouraging patients to ask more questions; (3) the clinician’s role, for example, prompting clinicians to discuss more information; (4) workflow, for example, familiarity with the ePDA’s content helped to integrate it into practice; (5) shared decision-making (SDM), for example, mixed experiences whether the ePDA contributed to SDM; and (6) content of the ePDA. Recommendations to possibly improve ePDA use based on the clinician’s experiences: (1) add pictorial health information to the ePDA instead of text only and (2) instruct clinicians how to use the ePDA in a flexible (depending on their discipline and setting) and personalised way adapting the ePDA to the patients’ needs (e.g., mark off irrelevant options).ConclusionsePDAs contributed to the patient–clinician dialogue in several ways according to medical specialists. A flexible and personalised approach appeared appropriate to integrate the use of ePDAs into the clinician’s workflow, and customise their use to individual patients’ needs.
Loop and thiazide diuretic use and risk of chronic kidney disease progression: a multicentre observational cohort study
Authors: Fitzpatrick Jesse K , Yang Jingrong , Ambrosy Andrew P , Cabrera Claudia , Stefansson Bergur V , Greasley Peter J , Patel Jignesh , Tan Thida C , Go Alan S 
Published: February 2022

ObjectivesTo evaluate the association between diuretic use by class with chronic kidney disease (CKD) progression and onset of end-stage renal disease (ESRD).DesignRetrospective cohort study.SettingLarge integrated healthcare delivery system in Northern California.ParticipantsAdults with an estimated glomerular filtration rate (eGFR) 15–59 min/1.73 m2 by the CKD-Epidemiology Collaboration equation with no prior diuretic use.Main outcome measuresESRD and a renal composite outcome including eGFR <15 mL/min/1.73 m2, 50% reduction in eGFR and/or ESRD.ResultsAmong 47 666 eligible adults with eGFR 15–59 min/1.73 m2 and no previous receipt of loop or thiazide diuretics, mean age was 71 years, 49% were women and 26% were persons of colour. Overall, the rate (per 100 person-years) of the renal composite outcome was 1.35 (95% CI: 1.30 to 1.41) and 0.42 (95% CI: 0.39 to 0.45) for ESRD. Crude rates (per 100 person-years) of the composite renal outcome were higher in patients who initiated loop diuretics (12.85 (95% CI: 11.81 to 13.98) vs 1.06 (95% CI: 1.02 to 1.12)) and thiazide diuretics (2.68 (95% CI: 2.33 to 3.08) vs 1.29 (95% CI: 1.24 to 1.35)) compared with those who did not. Crude rates (per 100-person years) of ESRD where higher in patients who initiated loop diuretics (4.92 (95% CI: 4.34 to 5.59) vs 0.30 (95% CI: 0.28 to 0.33)), but not in those who initiated thiazide diuretics (0.30 (95% CI: 0.20 to 0.46) vs 0.43 (95% CI: 0.40 to 0.46)). However, neither initiation of diuretics or type of diuretic were significantly associated with CKD progression or ESRD after accounting for receipt of other medications and time-dependent confounders using causal inference methods.ConclusionsThe use of thiazide and loop diuretics was not independently associated with an increased risk of CKD progression and/or ESRD in adults with stage 3/4 CKD.
Examining positive views from students, trainees and GPs about general practice: a generational problem? A set of qualitative studies in France
Authors: Le Floc'h Bernard , Bastiaens Hilde , Le Reste Jean-Yves , Nabbe Patrice , Montier Tristan , Peremans Lieve 
Published: February 2022

ObjectiveThis study aimed to explore the positive factors related to working in general practice in France, from a student studying medicine, trainee general practitioner (GP) and GP point of view.SettingPrimary care, France.DesignNine different qualitative studies involving medical students, trainees and GPs.ParticipantsSixty-seven medical students, 22 trainees in general practice and 71 GPs.ResultsThe final codebook contained 66 interpretative codes and 8 positive themes. The themes were general practice as a commitment, doctor–patient care and relationships, skills and competencies in general practice, practice organisation and work–life balance, relationship with the professional community, GPs and university, GPs in the social community and private life, relatives and family. Positive feelings about being a GP are similar throughout the different age groups, from young students to older professionals.Discussion and conclusionThis study provided a comprehensive picture of the satisfied GP across different ages. This picture describes GPs as patient-centred professionals who need to have the freedom to choose an efficient working environment, organise their practice, have opportunities for professional development and acquire specific competencies. Both younger and older GPs believe in the future of general practice.
Cohort profile: InTraUterine sampling in early pregnancy (ITU), a prospective pregnancy cohort study in Finland: study design and baseline characteristics
Authors: Kvist Tuomas , Sammallahti Sara , Lahti-Pulkkinen Marius , Cruceanu Cristiana , Czamara Darina , Dieckmann Linda , Tontsch Alina , Röh Simone , Rex-Haffner Monika , Wolford Eiina , Reynolds Rebecca , Eriksson Johan , Suomalainen-König Sanna , Laivuori Hannele , Kajantie Eero , Lahdensuo Eija , Binder Elisabeth , Räikkönen Katri 
Published: February 2022

PurposeThe InTraUterine sampling in early pregnancy (ITU) is a prospective pregnancy cohort study. The overarching aim of ITU is to unravel genomic, epigenomic, transcriptomic, endocrine, inflammatory and metabolic maternal-placental-fetal mechanisms involved in the programming of health and disease after exposure to prenatal environmental adversity, such as maternal malnutrition, cardiometabolic disorders, infections, medical interventions, mental disorders and psychosocial stress. This paper describes the study protocol, design and baseline characteristics of the cohort.ParticipantsWe included 944 pregnant Finnish women, their partners and children born alive between April 2012 and December 2017. The women were recruited through the national, voluntary trisomy 21 screening between 9+0 and 21+6 gestational weeks. Of the participating women, 543 were screen positive and underwent fetal chromosomal testing. Test result of these women suggested no fetal chromosomal abnormality. Further, we recruited 401 women who were screen negative and who did not undergo fetal chromosomal testing.Findings to dateWe have collected chorionic villi and amniotic fluid from the screen-positive women; blood, urine, buccal swabs and diurnal salivary samples from all women; blood and buccal swabs from all partners; and placenta, cord blood and buccal swabs from all newborns for analyses of the genome, epigenome, transcriptome, and endocrine, inflammatory and metabolic markers. These data are coupled with comprehensive phenotypes, including questions on demographic characteristics, health and well-being of the women and their partners during pregnancy and of the women and their children at the child’s age of 1.7 and 3 years. Data also come from patient records and nationwide registers covering health, lifestyle and medication data.Future plansMultiple layers of ITU data allow integrative data analyses, which translate to biomarker identification and allow risk stratification and understanding of the biological mechanisms involved in prenatal programming of health and disease.
Is a novel diagnostic pathway for cardiology outpatient clinics in Singapore lower cost than existing practice: a cost modelling study
Authors: Weiting Huang , Karthik Gaya , Chua Terrance , Graves Nicholas 
Published: February 2022

ObjectiveTo evaluate the potential for change to costs from a decision to adopt a novel diagnostic pathway for referrals to cardiology outpatients with symptoms of chest pain.DesignCosts modelling study using existing observational data, with a cost year of 2018.SettingSpecialist Heart Centre in Singapore.ParticipantsAll new referrals (n=10 622) to the outpatient clinics for investigation between January 2017 and December 2017.InterventionsTwo competing testing regimes are compared in a decision tree model. Current practice includes classification of patients by their risk and the use of treadmill tests, calcium scores, functional testing and CT angiogram. New practice offers a fundamental difference in use of diagnostics for patients, with some offered angiogram directly and for low-risk patients a calcium score is used to refine risk stratification.Outcome measuresThe expected cost difference between testing alternatives.ResultsThe expected cost saving from ‘New Practice’ as compared with ‘Current Practice’ is $S764 per patient. There is a 50% probability the savings per patient range between $S764 and $S824 and a 90% probability they are between $S616 and $S912. The expected savings to Singapore national health services are $S26.8 million annually, with a range of $S16.2 to $S41.1 million.ConclusionsWe find some evidence that using a coronary calcium score, which can be performed with a fraction of the time and cost of a CT coronary angiogram, saves costs to health services.