bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neurological manifestations of scrub typhus infection: A systematic review and meta-analysis of clinical features and case fatality
Authors: Alam Ali M. , Gillespie Conor S. , Goodall Jack , Damodar Tina , Turtle Lance , Vasanthapuram Ravi , Solomon Tom , Michael Benedict D. 
Published: November 2022

Background
Scrub typhus has become a leading cause of central nervous system (CNS) infection in endemic regions. As a treatable condition, prompt recognition is vital. However, few studies have focused on describing the symptomology and outcomes of neurological scrub typhus infection. We conducted a systematic review and meta-analysis to report the clinical features and case fatality ratio (CFR) in patients with CNS scrub typhus infection.

Methods
A search and analysis plan was published in PROSPERO [ID 328732]. A systematic search of PubMed and Scopus was performed and studies describing patients with CNS manifestations of proven scrub typhus infection were included. The outcomes studied were weighted pooled prevalence (WPP) of clinical features during illness and weighted CFR.

Results
Nineteen studies with 1,221 (656 adults and 565 paediatric) patients were included. The most common clinical features in CNS scrub typhus were those consistent with non-specific acute encephalitis syndromes (AES), such as fever (WPP 100.0% [99.5%-100.0%, I2 = 47.8%]), altered sensorium (67.4% [54.9–78.8%, I2 = 93.3%]), headache (65.0% [51.5–77.6%, I2 = 95.1%]) and neck stiffness 56.6% (29.4–80.4%, I2 = 96.3%). Classical features of scrub typhus were infrequently identified; an eschar was found in only 20.8% (9.8%-34.3%, I2 = 95.4%) and lymphadenopathy in 24.1% (95% CI 11.8% - 38.9%, I2 = 87.8%). The pooled CFR (95% CI) was 3.6% (1.5%– 6.4%, I2 = 67.3%). Paediatric cohorts had a CFR of 6.1% (1.9–12.1%, I2 = 77%) whilst adult cohorts reported 2.6% (0.7–5.3%, I2 = 43%).

Conclusion
Our meta-analyses illustrate that 3.6% of patients with CNS manifestations of scrub typhus die. Clinicians should have a high index of suspicion for scrub typhus in patients presenting with AES in endemic regions and consider starting empiric treatment whilst awaiting results of investigations, even in the absence of classical signs such as an eschar or lymphadenopathy.
Facing flood disaster: A cluster randomized trial assessing communities’ knowledge, skills and preparedness utilizing a health model intervention
Authors: Mhd Noor Mohd Tariq , Kadir Shahar Hayati , Baharudin Mohd Rafee , Syed Ismail Sharifah Norkhadijah , Abdul Manaf Rosliza , Md Said Salmiah , Ahmad Jamilah , Muthiah Sri Ganesh 
Published: November 2022

Floods occur when a body of water overflows and submerges normally dry terrain. Tropical cyclones or tsunamis cause flooding. Health and safety are jeopardized during a flood. As a result, proactive flood mitigation measures are required. This study aimed to increase flood disaster preparedness among Selangor communities in Malaysia by implementing a Health Belief Model-Based Intervention (HEBI). Selangor’s six districts were involved in a single-blinded cluster randomized controlled trial Community-wide implementation of a Health Belief Model-Based Intervention (HEBI). A self-administered questionnaire was used. The intervention group received a HEBI module, while the control group received a health talk on non-communicable disease. The baseline variables were compared. Immediate and six-month post-intervention impacts on outcome indicators were assessed. 284 responses with a 100% response rate. At the baseline, there were no significant differences in ethnicity, monthly household income, or past disaster experience between groups (p>0.05). There were significant differences between-group for intervention on knowledge, skills, preparedness (p<0.001), Perceived Benefit Score (p = 0.02), Perceived Barrier Score (p = 0.03), and Cues to Action (p = 0.04). GEE analysis showed receiving the HEBI module had effectively improved knowledge, skills, preparedness, Perceived Benefit Score, Perceived Barrier Score, and Cues to Action in the intervention group after controlling the covariate. Finally, community flood preparedness ensured that every crisis decision had the least impact on humans. The HEBI module improved community flood preparedness by increasing knowledge, skill, preparedness, perceived benefit, perceived barrier, and action cues. As a result, the community should be aware of this module.
Clinical trial registration: The trial registry name is Thai Clinical Trials Registry, trial number TCTR20200202002.
Prevalence of Schistosoma mansoni infection among fishermen in Busega district, Tanzania
Authors: Mang’ara Revocatus J. L. , Ngasala Billy , John Winfrida 
Published: November 2022

Background
Schistosoma (S.) mansoni infection is endemic in all regions around Lake Victoria and affects all age groups to different degrees. In most endemic areas, less attention has been paid to determining the prevalence of infection, sanitation status, and knowledge about intestinal schistosomiasis (KIS) in fishermen. Therefore, the purpose of this study was to establish the prevalence of S. mansoni infection and associated factors among fishermen in the Busega district.

Materials and methods
A cross-sectional study was conducted among fishermen in July, 2020 in five fishing villages in the Busega district located along Lake Victoria. A total of 352 fishermen were interviewed with regard to their sanitation status and level of KIS. A single stool sample from fishermen was examined for S.mansoni eggs by using the Formalin-Ether Concentration technique. The potential factors associated with S. mansoni infection were explored using multivariable logistic regression.

Results
The prevalence of S. mansoni infection was high (65.0%) among fishermen and varied with age, whereby fishermen aged ≤36 years had the highest prevalence. Fishermen had a low level of KIS and the majority of them reported practicing open defecation during fishing (81%). These fishermen with a low level of KIS and who reported defecating in open areas during fishing had 2.8 times (95% CI: 1.0–7.2) and 2.1 times (95% CI: 1.1–3.9) higher odds of being infected with S. mansoni than those with a high level of KIS and those who did not report defecating in open areas during fishing, respectively.

Conclusion
S. mansoni infection was high among fishermen in the Busega district. Furthermore, fishermen had a low level of KIS and were reported to have defecated in open areas during fishing. Infection with S. mansoni was associated with age, a low level of KIS and open defecation behaviour during fishing. Therefore, mass drug administration (MDA) with praziquantel, health education, and sanitation behaviour change interventions were needed.
Perception of Health Care Workers (HCWs) towards early antenatal booking in Fiji: A qualitative study
Authors: Maharaj Renita , Mohammadnezhad Masoud 
Published: November 2022

Background
Early booking or registration into Antenatal Care (ANC) can be defined as initiation of ANC before 12 weeks of gestation and is important for the best health outcome of the mother and the baby. Delayed initiation of ANC has been linked to increased rate of maternal and fetal mortality. There is international consensus that ANC should begin within first trimester yet pregnant women delay initiation of ANC. Health Care Workers (HCWs) understanding of reasons for this can improve patient provider relationship.

Objectives
This study aims to explore the perception of the HCWs in Fiji towards early antenatal booking.

Methods
A qualitative study was employed using four Focus-Group Discussions (FGDs)with the HCWs who provide health care service for pregnant women in Ba Mission Hospital (BMH) in 2020. Each group comprised of medical officers, mid-wives and registered nurse who were chosen purposively. A semi-structured open ended questionnaire was used to guide the discussion. Data was transcribed and analyzed manually using thematic content analysis using the following process: familiarization, coding, identifying themes, reviewing and refining, integration and interpretation.

Results
There was a total of 18 HCWs for the FGDs. The mean age of the participants was 37.4±11.8years. The three themes identified were: knowledge of HCWs on early booking, their perceived barriers and perceived enabling factors to early antenatal booking. The FGDs identified that the HCWs had adequate knowledge on early initiation of ANC and that there were a range of barriers to early initiation of ANC. The HCWs also suggested factors that could enable women to book early.

Conclusion
Based on the study it can be concluded that the HCWs have a positive perception of early antenatal booking, however, there are various factors that contribute to delayed antenatal booking. The barriers to early ANC are both an opportunity and a challenge to strengthen and review the maternal services offered. The enabling factors should be reinforced from an individual level to the health system and the general context. The implications of the barriers and enabling factors identified in this study is to implement evidence-based policies to improve early antenatal booking in Ba, Fiji.
Investigating the effects of antipsychotics on brain insulin action: Study protocol for a multi-modality magnetic resonance imaging (MRI) study in healthy controls
Authors: Stogios Nicolette , Hamel Laurie , Smith Emily , Sanches Marcos , Remington Gary , Voineskos Aristotle , Dash Satya , Graff-Guerrero Ariel , Hahn Margaret , Agarwal Sri Mahavir 
Published: November 2022

Antipsychotics (APs) are the cornerstone of treatment for schizophrenia (SCZ) but are unfortunately associated with serious metabolic adverse effects including weight gain and type 2 diabetes. The pathophysiology of AP-induced metabolic dysfunction is largely undetermined. Brain insulin resistance has been posited to be at the cross-roads of many cognitive and metabolic disorders, and disruption of central insulin action has emerged as a possible explanatory mechanism underlying AP induced metabolic dysfunction. Previous studies suggest that change in neuroimaging-based parameters with intranasal insulin administration can be leveraged to investigate brain insulin resistance. In this proof-of-concept study, we will utilize neural signatures of insulin action in the brain to examine if APs disrupt brain insulin signaling. It is hypothesized that: 1) intranasal insulin (INI), but not intranasal placebo (INP), will change cerebral blood flow and resting state connectivity, as well as increase glutamate levels in the striatum and dorsolateral prefrontal cortex; 2) oral olanzapine (OLA), but not oral placebo (PL), will inhibit the effect of INI on these parameters. Thirty-two healthy volunteers will undergo a single blind, cross-over design, wherein all participants receive the following four treatment combinations, 2–6 weeks apart, in a random sequence: INP + PL, INP + OLA, INI + PL, and INI + OLA. Participants will undergo an MRI-based assay of brain insulin resistance 15 minutes after administering 160 IU INI or INP. The scanning protocol includes resting and task-based functional MRI, arterial spin labelling, and proton magnetic resonance spectroscopy. Demonstrating that OLA can acutely induce brain insulin resistance is clinically relevant to metabolic health in SCZ. Evidence of brain insulin resistance induced by acute AP dosing can inform the early use of adjunctive insulin sensitizers for the treatment of metabolic comorbidities associated with AP treatment in severe mental illness.
Trial registration
ClinicalTrials.gov Registration: NCT03741478.
The effects of competency-based training model in the training of new nurses: A meta-analysis and systematic review
Authors: Chen Suqing , Zhang Chenxia , Li Wanling 
Published: November 2022

Background
It is necessary to evaluate the effects of competency-based training (CBT) model in the clinical training of new nurses, to provide insights to the management of nurses.

Methods
We searched PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database, Wanfang and Weipu Databases for the randomized controlled trials (RCTs) on the application effect of CBT in new nurse training up to December 15, 2021. Two investigators independently screened the literature, extracted the data and evaluated the quality of the literatures. RevMan 5.3 software was used for meta-analysis.

Results
A total of 7 RCTs involving 639 new nurses were included. Meta-analyses indicated that CBT improved the ability of clinical nursing care [SMD = 1.52, 95%CI (0.13~2.90), P = 0.03], critical thinking and innovation[SMD = 0.69, 95%CI (0.43~0.95), P<0.001], interpersonal communication[SMD = 0.74, 95%CI (0.51~0.97), P<0.001], professional construction and development[SMD = 1.92, 95%CI (1.41~2.42), P<0.001], level of comprehensive knowledge[SMD = 1.20, 95%CI (0.63~1.76), P<0.001] and level of good personal traits[SMD = 1.89, 95%CI (1.27~2.50), P<0.001].The results of Egger regression tests indicated that there were no statistical biases amongst the synthesized outcomes (all P>0.05).

Conclusions
CBT is beneficial for improving the competency of newly recruited nurses. More RCTs from different population and regions are needed to further elucidate the role of CBT in nurse management.
Diagnostic accuracy of a SARS-CoV-2 rapid antigen test among military and civilian personnel of an Air Force airport in central Italy
Authors: Verde Paola , Marcantonio Cinzia , Costantino Angela , Martina Antonio , Simeoni Matteo , Taffon Stefania , Tritarelli Elena , Campanella Carmelo , Cresta Raffaele , Bruni Roberto , Ciccaglione Anna Rita , Pisani Giulio , Nisini Roberto , Spada Enea 
Published: November 2022

Background
Most SARS-CoV-2 rapid antigen detection tests (RADTs) validation studies have been performed on specimens from COVID-19 patients and negative controls or from mostly symptomatic individuals. Herein we evaluated the diagnostic accuracy of AFIAS COVID-19 Ag, hereinafter denominated as AFIAS, during a COVID-19 screening program surveillance testing conducted among personnel of an Italian military airport.

Methods
Nasopharyngeal swabs (NPSs) were collected from study participants and were analysed by both AFIAS and RT-PCR assay. A questionnaire collecting demographic and exposure data were administered to all participants. AFIAS accuracy parameters including Cohen’s kappa (K) were determined.

Results
Overall, from November 2020 to April 2021, 1294 (NPSs) were collected from 1183 participants (88.6% males, 11.4% females; mean age were 41.3, median age 42). Forty-nine NPSs (3.78%) were positive by RT-PCR, while 54 NPSs were positive by AFIAS. Overall baseline sensitivity, specificity, positive and negative predictive values were 0.633, 0.981, 0.574, 0.985, respectively and K was 0.585 (moderate). AFIAS sensitivity tended to be higher for NPSs with higher viral load. A higher sensitivity (0.944) compared to the overall baseline sensitivity (0.633) was also found for NPSs from participants with COVID-19 compatible symptoms, for which K was 0.891 (almost perfect). Instead, AFIAS sensitivity was quite poor for NPSs from asymptomatic participants. Most false negative NPSs in this group had moderate viral load.

Conclusion
Overall, AFIAS showed high specificity but only moderate sensitivity, mainly because of the high proportion of asymptomatic participants. However, AFIAS showed good sensitivity for NPSs with high viral load and nearly optimal accuracy parameters for NPSs from participants with COVID-19 compatible symptoms. Thus, taking into consideration its performance features, this test can be useful for COVID-19 case identification and management as well as for infection control.
Cost-effectiveness analysis of robotic-arm assisted total knee arthroplasty
Authors: Hua Yechu , Salcedo Jonathan 
Published: November 2022

Purpose
Total knee arthroplasty (TKA) is widely recognized as an effective treatment for end-stage knee osteoarthritis (OA). Compared with conventional TKA, robotic-arm assisted TKA may improve patients’ functionality and resulting quality of life by more accurate and precise component placement. Currently, the literature on cost-effectiveness of robotic-arm assisted TKA in the US is limited. The objective of this study was to assess the cost-effectiveness of robotic-arm assisted TKA relative to TKA in the Medicare-aged population including exploring the impact of hospital volume on cost-effectiveness outcomes.

Methods
We developed a decision-analytic model to evaluate the costs, health outcomes, and incremental cost-effectiveness ratio (ICER) of robotic-arm assisted TKA vs TKA in Medicare population with OA. We evaluated cost-effectiveness at a willingness-to-pay (WTP) threshold of $50,000 per quality-adjusted life-year (QALY). We sourced costs from the literature including episode-of-care (EOC) costs from a Medicare study. We assessed cost-effectiveness of robotic-arm assisted TKA by hospital procedure volume and conducted deterministic (DSA) and probabilistic sensitivity analysis (PSA).

Results
For the average patient treated in a hospital with an annual volume of 50 procedures, robotic-arm assisted TKA resulted in a total QALY of 6.18 relative to 6.17 under conventional TKA. Total discounted costs per patient were $32,535 and $31,917 for robotic-arm assisted TKA and conventional TKA, respectively. Robotic-arm assisted TKA was cost-effective in the base case with an ICER of $41,331/QALY. In univariate DSA, cost-effectiveness outcomes were most sensitive to the annual hospital procedure volume. Robotic-arm assisted TKA was cost-effective at a WTP of $50,000/QALY only when hospital volume exceeded 49 procedures per year. In PSA, robotic-arm assisted TKA was cost-effective at a $50,000/QALY WTP threshold in 50.4% of 10,000 simulations.

Conclusions
Despite high robotic purchase costs, robotic-arm assisted TKA is likely to be cost-effective relative to TKA in the Medicare population with knee OA in high-volume hospitals through lowering revision rates and decreasing post-acute care costs. Higher-volume hospitals may deliver higher value in performing in robotic-arm assisted TKA.
Drug utilization patterns before and during COVID-19 pandemic in Manitoba, Canada: A population-based study
Authors: Aboulatta Laila , Peymani Payam , Vaccaro Christine , Leong Christine , Kowalec Kaarina , Delaney Joseph , Falk Jamie , Alessi-Severini Silvia , Aloud Basma , Eltonsy Sherif 
Published: November 2022

Background
The COVID-19 pandemic has led the Canadian provincial governments to take unprecedented measures, including restrictions to healthcare services and pharmacists. Limited evidence exists on changes in prescription trends in Canada during the pandemic period.

Objectives
To examine the trend of prescription medications’ utilization before and during COVID-19, among incident and prevalent users in the general population. We examined 18 major classes of medications.

Methods
We used the administrative health databases from the province of Manitoba, Canada, to conduct a province-wide cross-sectional study. Incident and prevalent use was compared between two time periods; pre-COVID-19: July 2016-March 2020 and during COVID-19: April 2020-March 2021. Interrupted time series analysis using autoregressive models was used to quantify the change in level and slope in quarterly medication use among incident and prevalent users.

Results
The quarterly study population ranged from 1,353,485 to 1,411,630 Manitobans. The most common comorbidities were asthma (26.67%), hypertension (20.64%), and diabetes (8.31%). On average, the pandemic restrictions resulted in a 45.55% and 12.17% relative decline in the aggregated utilization of all drugs among both incident and prevalent users, respectively. Subclass analysis showed a 46.83%, 23.05%, and 30.98% relative drop among incident users of antibiotics, cardiovascular drugs and opioids use, respectively. We observed a significant slope increase during COVID-19 among the quarterly cardiovascular, antidiabetics, alpha-1 blockers, and statins incident users compared to the pre-COVID-19 period. We noted a significant decrease in level among NSAIDs, opioids, and antibiotic prevalent users, however, no significant changes in slope were observed.

Conclusion
Our findings show a significant impact of COVID-19 measures on prescription trends in the general population. The observed decline among several medication classes was temporary. Further research is needed to monitor prescription trends and better understand if those changes were associated with increased health services and worsened outcomes.
Sarcopenia in head and neck cancer: A scoping review
Authors: Jovanovic Nedeljko , Chinnery Tricia , Mattonen Sarah A. , Palma David A. , Doyle Philip C. , Theurer Julie A. 
Published: November 2022

Objectives
In those undergoing treatment for head and neck cancer (HNC), sarcopenia is a strong prognostic factor for outcomes and mortality. This review identified working definitions and methods used to objectively assess sarcopenia in HNC.

Method
The scoping review was performed in accordance with Arksey and O’Malley’s five-stage methodology and the Joanna Briggs Institute guidelines.

Information sources
Eligible studies were identified using MEDLINE, Embase, Scopus, Cochrane Library, and CINAHL databases.

Study selection
Inclusion criteria represented studies of adult HNC patients in which sarcopenia was listed as an outcome, full-text articles written in English, and empirical research studies with a quantitative design.

Data extraction
Eligible studies were assessed using a proprietary data extraction form. General information, article details and characteristics, and details related to the concept of the scoping review were extracted in an iterative process.

Results
Seventy-six studies published internationally from 2016 to 2021 on sarcopenia in HNC were included. The majority were retrospective (n = 56; 74%) and the prevalence of sarcopenia ranged from 3.8% to 78.7%. Approximately two-thirds of studies used computed tomography (CT) to assess sarcopenia. Skeletal muscle index (SMI) at the third lumbar vertebra (L3) (n = 53; 70%) was the most prevalent metric used to identify sarcopenia, followed by SMI at the third cervical vertebra (C3) (n = 4; 5%).

Conclusions
Currently, the most effective strategy to assess sarcopenia in HNC depends on several factors, including access to resources, patient and treatment characteristics, and the prognostic significance of outcomes used to represent sarcopenia. Skeletal muscle mass (SMM) measured at C3 may represent a practical, precise, and cost-effective biomarker for the detection of sarcopenia. However, combining SMM measurements at C3 with other sarcopenic parameters—including muscle strength and physical performance–may provide a more accurate risk profile for sarcopenia assessment and allow for a greater understanding of this condition in HNC.
PROPOSTA DE TERMOHIGROMÊTRO DE BAIXO CUSTO PARA COLETA DE DADOS CLIMÁTICOS EM CAMPO
Authors: Castelhano Francisco Jablinski 
Published: November 2022

A discussão a respeito das mudanças climáticas mantém como um dos temas de maior debate nos âmbitos científico, político e cotidiano. Pensando neste cenário, faz-se necessário o desenvolvimento de estudos climáticos em múltiplas escalas e com alto nível de qualidade. A qualidade dos trabalhos por sua vez, perpassa na necessidade da utilização de equipamentos de alto nível e que, na maioria das vezes, tem um preço condizente. Pensando na necessidade qualificar as pesquisas no âmbito da climatologia geográfica, o presente artigo visa apresentar o desenvolvimento de um termo-higromêtro de baixo custo para coletas de dados. O equipamento foi desenvolvido com componentes de prototipagem Arduino e levado a campo durante sete dias na cidade de Curitiba, Sul do Brasil. Os dados coletados pelo presente equipamento foram correlacionados com os dados da estação meteorológica oficial e devidamente calibrados. Os resultados validaram o equipamento de baixo custo para coleta de dados em campo