bluuebunny/crossref_metadata_2025_split huggingface dataset:
The MOMANT study, a caregiver support programme with activities at home for people with dementia: a study protocol of a randomised controlled trial
Authors: Balvert S. C. E. , Milders M. V. , Bosmans J. E. , Heymans M. W. , van Bommel S. , Dröes R.-M. , Scherder E. J. A. 
Published: April 2022

Abstract
Background
Because of the expected increase in the number of people with dementia, and the associated social and economic costs, there is an urgent need to develop effective and cost-effective care for people with dementia and their caregivers. The intervention proposed here combines two approaches to caregiver support that have shown to be effective in empowering caregivers, i.e., multiple components for caregiver support and actively engaging caregivers to involve the person with dementia in activities at home. The aim is to investigate whether the intervention is effective in improving quality of life in the caregiver and the person with dementia. A further aim will be to investigate whether this intervention can improve caregivers’ feeling of competence, experience of caregiving, and mood.

Methods
The study design is a pragmatic, cluster randomised controlled trial with cost-effectiveness analysis. The study participants are informal caregivers and home-living persons with dementia for whom they care, recruited in various regions in the Netherlands. The trial will compare outcomes in two groups of participants: 85 dyads who receive the intervention, and 85 dyads who receive care as usual. The intervention is a caregiver support training that is manual based and consists of 6 group sessions over 2 months. Training takes place in small groups of caregivers led by a health care professional presented at dementia day care centres. Randomisation occurs at the level of the day care centre. Participants are assessed on the outcome measures at baseline, prior to the intervention, and at 3 and 6 months after baseline.

Discussion
The study will provide insight into effectiveness and cost-effectiveness of an intervention that has not previously been evaluated or implemented in the Netherlands. The intervention potentially adds to the effective support options for informal caregivers of people with dementia without greatly increasing the workload for health- or social care professionals.

Trial registration
The trial is registered at the Dutch Trial Register at NTR6643; August 22nd, 2017.
Effects of a staged integral art-based cognitive intervention (SIACI) program in older adults with cognitive impairments: protocol for a randomized controlled trial
Authors: Yan Yuan-jiao , Ma Ming-ping , Cai Wen-chao , Huang Chen-shan , Lin Rong , Chen Yu-fei , Li Hong 
Published: April 2022

AbstractBackgroundGiven the aging population worldwide and the COVID-19 pandemic, which has been found to be associated with a deterioration in Alzheimer’s disease (AD) symptoms, investigating methods to prevent or delay cognitive decline in preclinical AD and AD itself is important. The trial described in this protocol aims to evaluate the effects of a staged integral art-based cognitive intervention (SIACI) in older adults with CIs (preclinical AD [SCD or MCI] and mild AD), in order to gather evidence on the effects of SIACI on cognition and psychological/psychosocial health gains and determine the mechanisms.MethodsThe planned study is a single-center, parallel-arm, randomized controlled trial with allocation concealment and outcome assessor blinding. A total of 88 participants will be randomized to two groups: (i) an intervention group that receives the 16-week, 24-session SIACI program and (ii) a waitlist control group (which will receive the SIACI program after completing the follow-up assessment). Global cognitive function, specific domains of cognition (memory, language, executive function, and visuospatial skills), and other health-related outcomes (quality of life, anxiety, depression, sleep quality, and physical activity level) will be measured at baseline, immediately after the intervention, and at the 6-month follow-up. Blood biomarkers, event-related potential (ERP)-P300, and magnetic resonance imaging (MRI) data will be collected at baseline and immediately after the intervention to explore the mechanisms of SIACI.DiscussionThe trial will elucidate the immediate and long-term effects of SIACI based on neuropsychological testing and blood biomarkers, and neuroscience involving ERP-P300 and MRI parameters will make it possible to explore the mechanisms of SIACI in older adults with CIs. The results will provide evidence on the effectiveness of an AT-based cognitive intervention, which may delay or even halt cognitive decline in preclinical AD and AD itself.Trial registrationChiCTR,ChiCTR2100044959. Registered 03 April 2021.
Early-life exposure to Chinese famine and stroke risk in mid- to late life: the mediating roles of cognitive function and depression
Authors: Zhou Zi , Zhang Wei , Fang Ya 
Published: April 2022

Abstract
Background
Limited research has examined the role that famine exposure plays in adulthood stroke risk. We aim to explore the causal implications of early exposure to the Great Chinese Famine on stroke risk and determine whether these associations were mediated by cognitive function, and depression.

Methods
We sampled 12,681 individuals aged 45 years and older from the China Health and Retirement Longitudinal Study (CHARLS) and divided them into fetally exposed, childhood-exposed, adolescence/adulthood-exposed and unexposed groups. Stroke was defined by self- or proxy-reported physician diagnosis. Based on a counterfactual framework, marginal structural models were used to estimate the natural direct effect and the natural indirect effects through cognitive function and depression for causal inference.

Results
We found that early-life exposure to Chinese famine was directly related to increased stroke risk in mid- to late life. Cognitive function and depression accounted for a greater part of the effect for childhood famine exposure, mediating 36.35% (95%CI: 14.19, 96.19%) of the overall association between famine exposure and incident stroke, than for the fetal, adolescence/adulthood famine exposure groups. However, the natural indirect effect through depression was not significant in the fetally exposed group. The results were robust in the sensitivity analysis of model specification and unobserved confounding.

Conclusions
Our findings are consistent with the latency, pathway, and accumulation models, supporting the life-course theory. Early stages of life exposed to the Chinese Famine were associated with higher risk of stroke in mid- to late life. Enhanced cognitive and depression interventions may reduce stroke risk in middle-aged and older Chinese adults who exposure to famine in early life.
Translation of the geriatric emergency department intervention into other emergency departments: a post implementation evaluation of outcomes for older adults
Authors: Marsden Elizabeth , Craswell Alison , Taylor Andrea , Barnett Adrian , Wong Pan-Kar , Wallis Marianne 
Published: April 2022

Abstract
Background
Increasing numbers of older adults with complex health deficits presenting to emergency departments has prompted the development of innovative models of care. One such model designed to reduce poor outcomes associated with acute healthcare, is the Geriatric Emergency Department Intervention. This intervention is a nurse-led, physician-championed, Emergency Department intervention that improves the health outcomes for frail older adults in the emergency department.

Methods
This quantitative cohort study aimed to evaluate the healthcare outcomes and costs associated with the implementation of the Geriatric Emergency Department Intervention (GEDI) for adults aged 70 years and over at two hospital sites that implemented the model using the integrated-Promoting Action on Research Implementation in Health Services (i-PARHIS) framework. Hospital A was large teaching hospital located in the tropical north of Australia. Hospital B was a medium sized teaching hospital near Brisbane, Queensland Australia.
The effect of the intervention was examined in two ways. Outcomes were compared between: 1) all patients in the pre- and post- implementation periods, and 2) patients seen or not seen by the Geriatric Emergency Department Intervention team in the post-implementation period. The outcomes measured were disposition (discharged home, admitted); emergency department length of stay; hospital length of stay; all cause in-hospital mortality within 28 days; time to re-presentation up to 28 days post-discharge; emergency department and in-hospital costs.
Survival analyses were used for the primary and secondary outcome variables and a Cox survival model was used to estimate the associations between variables and outcomes. Multiple regression models were used to examine other secondary outcomes whilst controlling for a range of confounders.

Results
The Geriatric Emergency Department Intervention was successfully translated into two different emergency departments. Both demonstrated an increased likelihood of discharge, decreased emergency department length of stay, decreased hospital costs for those who were admitted, with an associated reduction in risk of mortality, for adults aged 70 years and over.

Conclusions
The Geriatric Emergency Department Intervention was successfully translated into new sites that adapted the model design. Improvement in healthcare outcomes for older adults presenting to the emergency department was demonstrated, although this was more subtle than in the original model setting.
Teleworking from home experiences during the COVID-19 pandemic among public health workers (TelEx COVID-19 study)
Authors: Chow Josephine Sau Fan , Palamidas Dimetrious , Marshall Sonia , Loomes Wendy , Snook Suzie , Leon Rebecca 
Published: April 2022

Abstract
Background
When working from home (WFH) became temporarily necessary for staff as a result of the COVID-19 pandemic in 2020, it had to be implemented without significant organisational experience or understanding of WFH and its complexities. This study aims to determine the impacts experienced by staff who have undertaken WFH during the COVID-19 pandemic.

Methods
This was an observational cross-sectional study using survey with a purposive sampling strategy for staff from corporate and non-clinical departments. These staff undertook WFH during COVID-19 pandemic in 2020. None of these staff had any direct operational roles in a hospital facility and clinical service. Participants’ self-reports of their mood while working in their normal workplace and while WFH were collected via the Scale of Positive and Negative Experience (SPANE), a validated affect balance questionnaire. The responses from the open-ended question were analysed using thematic analysis approach.

Results
A total of 143 participants completed the survey responses. Majority (61%) WFH for four or more months as a result of the COVID-19 pandemic. Participants rated their skills very highly on the technologies with an average rating of 9 (out of 10) for computer skills, smartphones and videoconferencing/teleconferencing applications. Participants felt WFH was an improvement on normal working, in particular in relation to their ability to concentrate and be productive. The “SPANE” relating to affect balance while WFH was completed by 124 participants (85.7%), resulting in a mean score of 5.45 (S.D. 2.98). The SPANE relating to normal working conditions was completed by 127 participant (88.8%) resulting in a mean score of 2.70 (S.D 3.69). This indicated that while participants’ positive emotions typically predominated in both situations, they felt slightly more positive on average with WFH. Over 90% participants reported that they would take the opportunity to WFH again if it were offered. Data obtained from the open-ended questions had complimented the findings of the structure close-ended questions in the benefits of remote working and support for their health and wellbeing. The open-ended questions had provided additional information on challenges which the participants encountered during the WFH experience and their suggested preference to sustain this workplace practice.

Conclusions
This study highlighted factors that impacted workers’ work processes, productivity, physical and mental health well-being while WFH and provided a foundation for considering how to best support a positive WFH experience.
Efficacy of liraglutide in patients with diabetic nephropathy: a meta-analysis of randomized controlled trials
Authors: Mali Niroj , Su Feng , Ge Jie , Fan Wen Xing , Zhang Jing , Ma Jingyuan 
Published: April 2022

Abstract
Background
The efficacy of liraglutide to treat type 2 diabetic nephropathy (T2DN) remains controversial. Thus, we conducted this meta-analysis to systematically evaluate the clinical effect of liraglutide on T2DN patients.

Methods
Eight databases (PubMed, Web of Science, the Cochrane Library, EMBASE, Chinese National Knowledge Infrastructure (CNKI), Wanfang database, China Science and Technology Journal Database, and China Biology Medicine Database (CBM)) were searched for published articles to evaluate the clinical efficacy of liraglutide in subjects with T2DN. The Revman 5.3 and Stata 13 software were used for analyses and plotting.

Results
A total of 18 randomized controlled trials (RCTs) with 1580 diabetic nephropathy patients were screened. We found that the levels of UACR, Scr, Cysc were lower in the experimental group of T2DN patients treated with liraglutide than in the control group intervened without liraglutide. Liraglutide also reduced the levels of blood glucose (including FBG, PBG, and HbA1c), body mass index (BMI), and anti-inflammatory indicators (TNF–α, IL-6). However, there was no significant difference in BUN and eGFR between the experimental group and the control group.

Conclusions
Liraglutide reduced the levels of Blood Glucose, BMI, renal outcome indicators, and serum inflammatory factors of patients with T2DN, suggesting the beneficial effects of liraglutide on renal function.
T-shaped toothbrush for plaque removal and gingival health in children: a randomized controlled trial
Authors: Mamat Noraida , Mani Shani Ann , Danaee Mahmoud 
Published: April 2022

Abstract
Background
To evaluate an experimental T-shaped toothbrush for plaque removal and gingival health when compared to a conventional toothbrush among children.

Methods
This single blind parallel randomized controlled trial was conducted on 8–10-year-old healthy schoolchildren with no history of recent antibiotic intake, proximal caries or more than 3 missing teeth per quadrant. A computer-generated randomization list allocated child to the 2 groups. Each child received detailed instructions for tooth brushing. Gingival health and plaque scores were recorded in school at baseline, 2 weeks, 1 month and 3 months in a portable dental chair by an examiner who was blind to the allocated toothbrush. A general feedback on the use of the T-shaped toothbrush was obtained at 3 months. Data was analyzed using two-way repeated measure ANOVA, Generalized estimating equation and Bonferroni test.

Results
A total of 195 eligible children were invited, 110 parents gave consent and 100 children completed the study; 50 in each group. There were statistically significant reductions in mean gingival and plaque scores at each visit when compared to baseline for both toothbrushes (p < 0.05). There were no statistically significant differences between scores for the two toothbrushes at each visit (p > 0.05). Majority of participants gave positive feedback regarding the T-shaped toothbrush.

Conclusions
Both toothbrushes had similar efficacy in removing plaque and improving gingival health among children. The T-shaped toothbrush is an alternative to the conventional toothbrush for oral hygiene in children.
Trial registration Retrospectively registered at ClinicalTrials.gov Registry—NCT03989479 18/06/2019.
Provider perspectives on emergency department initiation of medication assisted treatment for alcohol use disorder
Authors: Philippine Thibault , Forsgren Ethan , DeWitt Cassandra , Carter Inanna , McCollough Maureen , Taira Breena R. 
Published: April 2022

AbstractBackgroundAlcohol use disorder (AUD) is ubiquitous and its sequelae contribute to high levels of healthcare utilization, yet AUD remains undertreated. The ED encounter represents a missed opportunity to initiate medication assisted treatment (MAT) for patients with AUD. The aims of this study are to identify barriers and facilitators to the treatment of AUD in the ED, and to design interventions to address identified barriers.MethodsUsing an implementation science approach based on the Behavior Change Wheel framework, we conducted qualitative interviews with staff to interrogate their perspectives on ED initiation of AUD treatment. Subjects included physicians, nurses, nurse practitioners, clinical social workers, and pharmacists. Interviews were thematically coded using both inductive and deductive approaches and constant comparative analysis. Themes were further categorized as relating to providers’ capabilities, opportunities, or motivations. Barriers were then mapped to corresponding intervention functions.ResultsFacilitators at our institution included time allotted for continuing education, the availability of clinical social workers, and favorable opinions of MAT based on previous experiences implementing buprenorphine for opioid use disorder. Capability barriers included limited familiarity with naltrexone and difficulty determining which patients are candidates for therapy. Opportunity barriers included the limited supply of naltrexone and a lack of clarity as to who should introduce naltrexone and assess readiness for change. Motivation barriers included a sense of futility in treating patients with AUD and stigmas associated with alcohol use. Evidence-based interventions included multi-modal provider education, a standardized treatment algorithm and order set, selection of clinical champions, and clarification of roles among providers on the team.ConclusionsA large evidence-practice gap exists for the treatment of AUD with Naltrexone, and the ED visit is a missed opportunity for intervention. ED providers are optimistic about implementing AUD treatment in the ED but described many barriers, especially related to knowledge, clarification of roles, and stigma associated with AUD. Applying a formal implementation science approach guided by the Behavior Change Wheel allowed us to transform qualitative interview data into evidence-based interventions for the implementation of an ED-based program for the treatment of AUD.
Protein purification strategies must consider downstream applications and individual biological characteristics
Authors: Remans Kim , Lebendiker Mario , Abreu Celeste , Maffei Mariano , Sellathurai Shaila , May Marina M. , Vaněk Ondřej , de Marco Ario 
Published: April 2022

Abstract
Background
Proteins are used as reagents in a broad range of scientific fields. The reliability and reproducibility of experimental data will largely depend on the quality of the (recombinant) proteins and, consequently, these should undergo thorough structural and functional controls. Depending on the downstream application and the biochemical characteristics of the protein, different sets of specific features will need to be checked.

Results
A number of examples, representative of recurrent issues and previously published strategies, has been reported that illustrate real cases of recombinant protein production in which careful strategy design at the start of the project combined with quality controls throughout the production process was imperative to obtain high-quality samples compatible with the planned downstream applications. Some proteins possess intrinsic properties (e.g., prone to aggregation, rich in cysteines, or a high affinity for nucleic acids) that require certain precautions during the expression and purification process. For other proteins, the downstream application might demand specific conditions, such as for proteins intended for animal use that need to be endotoxin-free.

Conclusions
This review has been designed to act as a practical reference list for researchers who wish to produce and evaluate recombinant proteins with certain specific requirements or that need particular care for their preparation and storage.
Medical education interventions influencing physician distribution into underserved communities: a scoping review
Authors: Elma Asiana , Nasser Muhammadhasan , Yang Laurie , Chang Irene , Bakker Dorothy , Grierson Lawrence 
Published: April 2022

Abstract
Background and objective
Physician maldistribution is a global problem that hinders patients’ abilities to access healthcare services. Medical education presents an opportunity to influence physicians towards meeting the healthcare needs of underserved communities when establishing their practice. Understanding the impact of educational interventions designed to offset physician maldistribution is crucial to informing health human resource strategies aimed at ensuring that the disposition of the physician workforce best serves the diverse needs of all patients and communities.

Methods
A scoping review was conducted using a six-stage framework to help map current evidence on educational interventions designed to influence physicians’ decisions or intention to establish practice in underserved areas. A search strategy was developed and used to conduct database searches. Data were synthesized according to the types of interventions and the location in the medical education professional development trajectory, that influence physician intention or decision for rural and underserved practice locations.

Results
There were 130 articles included in the review, categorized according to four categories: preferential admissions criteria, undergraduate training in underserved areas, postgraduate training in underserved areas, and financial incentives. A fifth category was constructed to reflect initiatives comprised of various combinations of these four interventions. Most studies demonstrated a positive impact on practice location, suggesting that selecting students from underserved or rural areas, requiring them to attend rural campuses, and/or participate in rural clerkships or rotations are influential in distributing physicians in underserved or rural locations. However, these studies may be confounded by various factors including rural origin, pre-existing interest in rural practice, and lifestyle. Articles also had various limitations including self-selection bias, and a lack of standard definition for underservedness.

Conclusions
Various educational interventions can influence physician practice location: preferential admissions criteria, rural experiences during undergraduate and postgraduate medical training, and financial incentives. Educators and policymakers should consider the social identity, preferences, and motivations of aspiring physicians as they have considerable impact on the effectiveness of education initiatives designed to influence physician distribution in underserved locations.