bluuebunny/crossref_metadata_2025_split huggingface dataset:
Availability and affordability of priority lifesaving maternal health medicines in Addis Ababa, Ethiopia
Authors: Dinkashe Fantaye Teka , Haile Kinfe , Adem Fatimetu Mohammed 
Published: April 2022

Abstract
Background
Access to life-saving medicines for maternal health remains a major challenge in numerous developing nations. Periodic and continuous assessment of access to lifesaving commodities is of enormous importance to measure progress and ensure sustainable supply. This study aimed to assess the availability and affordability of priority lifesaving maternal medicines in Addis Ababa in January 2021.

Methods
An institutional-based cross-sectional study design was employed to assess 33 representative private pharmacies, public health facilities, NGO and private hospitals providing maternal health care and dispensing medicines from January 12 to 27, 2021 in Addis Ababa, the capital city of Ethiopia. WHO and Health Action International procedures were followed to determine sample size, sampling of health facilities, and data collection. WHO and UNFPA priority lifesaving maternal health medicines included in the Ethiopia essential medicine list were included in the study. Data were cleaned and entered into SPSS version 25 for analysis.

Result
The overall mean availability of maternal health medicines was fairly high, 59% (range 6%-94%), as per the WHO availability index. Among the four sectors, the private pharmacy had the lowest availability (40%), while the mean availability in private hospitals, public and NGO/mission sector facilities were 70%, 72% and 72% respectively. Medicines used only for the management of maternal health conditions had lower availability (47%) compared to commodities used for the broader indication (65%). Compared based on source, the average availability of maternal health medicines which could be sourced locally was (68%) higher than imported medicines (55%). Affordability was not an issue in the public sector, public facilities offered maternal health medicines at no cost to the client. On the other hand, the private hospitals dispensed only 13% of the medicines at affordable prices followed by the private pharmacies (17%) and NGO/Mission facilities (29%). Furthermore, key challenges to access maternal health medicines were frequent stockouts in the public sector and the high cost of medicines in the private sector.

Conclusion
Even though it was below the recommended 80% availability, fairly high availability with variabilities across sectors was observed. Except in the public sector, maternal health medicines were unaffordable in Addis Ababa.
Organizational readiness to implement the Serious Illness Care Program in hospital settings in Sweden
Authors: Andersson Sofia , Sandgren Anna 
Published: April 2022

Abstract
Background
The Serious Illness Care Program (SICP) is a model developed for structured communication, identifying patients, and training physicians to use a structured guide for conversations with patients and family members. However, there is a lack of knowledge regarding the sustainable implementation of this conversation model. Therefore, the aim of this study was to identify barriers and enablers during the implementation of the SICP in hospital settings.

Methods
The SICP was implemented at 20 units in two hospitals in Sweden. During the implementation process, seven individual interviews and two group interviews were conducted with seven facilitators (five physicians, one behavioral therapist, and one administrator). Data were analyzed using qualitative content analysis, first inductively, and then deductively using the organizational readiness for change as a theoretical framework.

Result
The analysis resulted in three factors acting as enablers and eight factors acting as enablers and/or barriers during the implementation of the SICP. The three factors considered as enablers were preliminaries, identifying patients, and facilitator’s role. The eight factors considered as enablers and/or barriers were broad implementation, leadership, time, confidence, building foundation, motivation to work change, motivation for training in serious illness conversations, and attitudes.

Conclusion
This study indicates limited readiness to implement the SICP in hospital settings due to considerable variation in organizational contextual factors, change efficacy, and change commitment. The identified enablers and barriers for implementation of the SICP could guide and support future implementations to be sustainable over time.
Molecular investigation and clinical management of Hepatozoon Canis infection in an Indian jackal – a case report
Authors: Kolangath S.M. , Upadhye S.V. , Dhoot V.M. , Pawshe M.D. , Shalini A.S. , Kolangath R.M. 
Published: April 2022

AbstractBackgroundHepatozoonosis is a common tick-borne illness reported from all over the world. The infection has been well documented in dogs and cats, and has also been identified in wild canids and felids. India is home to many canid species; however, the incidence of Hepatozoonosis in wild canids is rarely reported. A wide variety of protocols have been discussed for the clinical management of the infection in companion animals; however, the suitability of treatment protocols in wild canids is understudied. The current case report highlights the clinical management of Hepatozoonosis in an Indian jackal and molecular investigation to provide vital insights into the epidemiology of the disease.Case PresentationA paraplegic Indian jackal was rescued from Melghat Tiger Reserve, Maharashtra, India. The animal had extensive decubital ulcers on the left pin bone and could not walk; however, the animal was active and dragged the hindlimb during locomotion. The vital parameters, blood and serum investigations were normal. Post physiotherapy, massage and infrared therapy, the animal could walk but started knuckling, resulting in injuries. Eight weeks into rehabilitation, the animal had a steep fall in haemoglobin concentration, platelet count, weight loss and was diagnosed with Hepatozoonosis. Considering the altered vital parameters, the jackal was rationally treated with Doxycyclin @ 20 mg/Kg O.D. (Once Daily) for 45 days along with supportive therapy. The jackal recovered after the treatment and led a normal life.ConclusionMono-drug regime using Doxycycline was effective in the alleviation ofH.canisinfection in jackal. The drug was effective in alleviating the clinical presentation without alteration of vital parameters. The molecular investigation provided qualitative inputs in understanding the epidemiology ofHepatozoonin wild canids.
The association between health-promoting-lifestyles, and socioeconomic, family relationships, social support, health-related quality of life among older adults in china: a cross sectional study
Authors: Zheng Xiao , Xue Yaqing , Dong Fang , Shi Lei , Xiao Shujuan , Zhang Jiachi , Xue Benli , Qian Yi , Zhu Hong , Man Qiang , Zhang Chichen 
Published: April 2022

Abstract
Objectives
Lifestyles, accounting for 53% in determining death, play a vital role in improving the health of older adults. Thus, this study aimed to explore the influencing factors of the health-promoting-lifestyles and interaction mechanisms among older adults.

Methods
A total of 8526 elders were selected by a three-stage stratified random cluster sampling method. Socioeconomic status, family relationships, social support, health-related quality of life (QOL), and health-promoting-lifestyles (HPLP) of older adults were assessed with the Social Support Rating Scale, the short form 36 health survey (SF-36) and Health-Promoting Lifestyle Profile. A structural equation model (SEM) was conducted to test the direct and indirect association between influencing factors with HPLP.

Results
In this study, there were 4901 older adults who were empty nesters, and 3625 were non-empty nesters. Of all respondents, the average QOL score of older adults was 62.28 ± 16.51, average social support score was 78.06 ± 7.50. The HPLP score of older adults was 105.9 ± 19.6, and the average score of subscales was 2.5 ± 0.5, which was at the medium level. Social support had a positive and direct effect on HPLP of older adults (total effect, 0.34). Meanwhile, social support mediated the relationship between socioeconomic (total effect, 0.17), QOL (total effect, 0.33) and HPLP. Family relationships had a small indirect effect on HPLP via social support (0.01).

Conclusions
Social support is the strongest influencing factor in the health-promoting-lifestyles among older adults, followed by socioeconomic, health-related quality of life and family support. Thus, maintaining higher social support was important to improve the HPLP of older adults.
Applying pytorch toolkit to plan optimization for circular cone based robotic radiotherapy
Authors: Liang Bin , Wei Ran , Zhang Jianghu , Li Yongbao , Yang Tao , Xu Shouping , Zhang Ke , Xia Wenlong , Guo Bin , Liu Bo , Zhou Fugen , Wu Qiuwen , Dai Jianrong 
Published: April 2022

AbstractBackgroundRobotic linac is ideally suited to deliver hypo-fractionated radiotherapy due to its compact head and flexible positioning. The non-coplanar treatment space improves the delivery versatility but the complexity also leads to prolonged optimization and treatment time.MethodsIn this study, we attempted to use the deep learning (pytorch) framework for the plan optimization of circular cone based robotic radiotherapy. The optimization problem was topologized into a simple feedforward neural network, thus the treatment plan optimization was transformed into network training. With this transformation, the pytorch toolkit with high-efficiency automatic differentiation (AD) for gradient calculation was used as the optimization solver. To improve the treatment efficiency, plans with fewer nodes and beams were sought. The least absolute shrinkage and selection operator (lasso) and thegroup lassowere employed to address the “sparsity” issue.ResultsThe AD-S (AD sparse) approach was validated on 6 brain and 6 liver cancer cases and the results were compared with the commercial MultiPlan (MLP) system. It was found that the AD-S plans achieved rapid dose fall-off and satisfactory sparing of organs at risk (OARs). Treatment efficiency was improved by the reduction in the number of nodes (28%) and beams (18%), and monitor unit (MU, 24%), respectively. The computational time was shortened to 47.3 s on average.ConclusionsIn summary, this first attempt of applying deep learning framework to the robotic radiotherapy plan optimization is promising and has the potential to be used clinically.
Treatment results for patients with squamous-cell carcinoma of the anus, a single institution retrospective analysis
Authors: Neelis Karen J. , Kip Django M. , Speetjens Frank M. , van der Linden Yvette M. 
Published: April 2022

Abstract
Background and purpose
To gain insight into the treatment outcomes for anal cancer a retrospective analysis was performed with a special emphasis on trends in outcome and toxicities over time and on treatment of elderly patients.

Materials and methods
Medical records of 98 consecutive patients with squamous cell carcinoma of the anus of all stages treated with curative intent between 01-01-2009 and 31-12-2018 were analyzed with follow up until 31-12-2020. Standard tumor and pathological lymph node dose were 59.4 Gy (median 59.4 Gy, range 59.4–70 Gy) or 60 Gy (no deviation from intended dose), elective nodal regions were treated with 45 Gy (no deviations). Radiotherapy techniques in this period evolved from 3D-conformal to IMRT and VMAT. In 23 patients electron beams were used.

Results
Median age was 63 years (range 41–88), the majority of patients were female (60%). Twenty three patients were > 75 years old. The TNM stages were I, II, IIIA, and IIIB in 18%, 40%, 15% and 27%, 58% of patients had N0 status. Concurrent mitomycin C and 5-fluoruracil-based chemotherapy was given in 63 patients (64%). Five-year overall survival (OS), disease free survival (DFS), locoregional control (LRC) and colostomy free survival (CFS) were 71%, 80%, 82%, and 82% for the whole group. Results in patients > 75 years of age were not statistically different from those in younger patients. With the introduction of more conformal techniques DFS did not change and toxicities decreased.

Conclusion
Real word treatment outcomes per disease stage were in line with what is reported in literature. Older patients should also be offered treatment with curative intent.
A clinical randomized controlled trial: moxibustion at Laogong interval with Panax notoginseng promoted the maturation of arteriovenous fistulae
Authors: Chen Yurou , Xu Lin , Huang Di , Chen Dongping , Wu Feng , Wang Luobing , Zhou Jie , Lan Tianying , Qin Xuehua , Ye Chaoyang 
Published: April 2022

Abstract
Background
We aim to study the clinical effect of moxibustion at Laogong interval with Panax notoginseng on the short-term maturation and long-term patency of arteriovenous fistula.

Methods
Seventy-four pre-dialysis uremic patients who received distal forearm radial-cephalic fistula creations were enrolled in this study and randomly assigned to the control group and experimental group. After arteriovenous fistula creations, the control group underwent handgrip exercise, and the experimental group received moxibustion at Laogong acupoint interval with Panax notoginseng. Both groups received a 12-week treatment and were followed up for 24 weeks in all at the following time points: before creations and 2, 4, 8, 12, 24 weeks after creations. The diameter of anastomosis, the diameter and outflow of draining-veins 5 cm above anastomosis, the diameter and outflow of brachial arteries evaluated the maturation and patency of arteriovenous fistula. Enzyme linked immunosorbent assay determined serum levels of endothelin and nitric oxide.

Results
The maturity rate in the experimental group was significantly higher than that in the control group at 4 weeks after arteriovenous fistula creations (P = 0.048). The diameter of anastomosis, the diameter of draining veins, and the blood flow of draining veins increased in both groups during the whole 24 weeks. The diameter and blood flow of brachial arteries ascended in both groups during the previous 12 weeks. Compared with the control group, moxibustion at Laogong interval with Panax notoginseng significantly improved the value of the diameter of draining-veins (P = 0.016), the blood flow of draining-veins (P = 0.015), the diameter of brachial arteries (P < 0.001), and the blood flow of brachial arteries (P = 0. 012) at 2 weeks, and enhanced the blood flow of draining-veins (P = 0.029) and brachial arteries (P < 0.001) at 12 weeks. Serum levels of endothelin were significantly lower (P = 0.047), and serum levels of nitric oxide were markedly higher (P < 0.001) in the experimental group than that in the control group at 2 weeks after creations.

Conclusions
Moxibustion at Laogong interval with Panax notoginseng was non-invasive and promoted the maturation of arteriovenous fistula at 4 weeks after creations. However, its long-term beneficial effect on patency at 24 weeks after creations was not significant.
Trial registration Chinese Clinical Trial Registry, No. ChiCTR1900024042. Registered, http://www.chictr.org.cn/index.aspx
Developing a taxonomy of care coordination for people living with rare conditions: a qualitative study
Authors: Walton Holly , Simpson Amy , Ramsay Angus I. G. , Hudson Emma , Hunter Amy , Jones Jennifer , Ng Pei Li , Leeson-Beevers Kerry , Bloom Lara , Kai Joe , Kerecuk Larissa , Kokocinska Maria , Sutcliffe Alastair G. , Morris Stephen , Fulop Naomi J. 
Published: April 2022

Abstract
Background
Improving care coordination is particularly important for individuals with rare conditions (who may experience multiple inputs into their care, across different providers and settings). To develop and evaluate strategies to potentially improve care coordination, it is necessary to develop a method for organising different ways of coordinating care for rare conditions. Developing a taxonomy would help to describe different ways of coordinating care and in turn facilitate development and evaluation of pre-existing and new models of care coordination for rare conditions. To the authors’ knowledge, no studies have previously developed taxonomies of care coordination for rare conditions. This research aimed to develop and refine a care coordination taxonomy for people with rare conditions.

Methods
This study had a qualitative design and was conducted in the United Kingdom. To develop a taxonomy, six stages of taxonomy development were followed. We conducted interviews (n = 30 health care professionals/charity representatives/commissioners) and focus groups (n = 4 focus groups, 22 patients/carers with rare/ultra-rare/undiagnosed conditions). Interviews and focus groups were audio-recorded with consent, and professionally transcribed. Findings were analysed using thematic analysis. Themes were used to develop a taxonomy, and to identify which types of coordination may work best in which situations. To refine the taxonomy, we conducted two workshops (n = 12 patients and carers group; n = 15 professional stakeholder group).

Results
Our taxonomy has six domains, each with different options. The six domains are: (1) Ways of organising care (local, hybrid, national), (2) Ways of organising those involved in care (collaboration between many or all individuals, collaboration between some individuals, a lack of collaborative approach), (3) Responsibility for coordination (administrative support, formal roles and responsibilities, supportive roles and no responsibility), (4) How often appointments and coordination take place (regular, on demand, hybrid), (5) Access to records (full or filtered access), and (6) Mode of care coordination (face-to-face, digital, telephone).

Conclusions
Findings indicate that there are different ways of coordinating care across the six domains outlined in our taxonomy. This may help to facilitate the development and evaluation of existing and new models of care coordination for people living with rare conditions.
Brown adipose tissue thermogenesis among a small sample of reindeer herders from sub-Arctic Finland
Authors: Ocobock Cara , Soppela Päivi , Turunen Minna , Stenbäck Ville , Herzig Karl-Heinz 
Published: April 2022

Abstract
Introduction
Interest in human physiological responses to cold stress have seen a resurgence in recent years with a focus on brown adipose tissue (BAT), a mitochondria dense fat specialized for heat production. However, a majority of the work examining BAT has been conducted among temperate climate populations.

Methods
To expand our understanding of BAT thermogenesis in a cold climate population, we measured, using indirect calorimetry and thermal imaging, metabolic rate and body surface temperatures of BAT-positive and BAT-negative regions at room temperature, and mild cold exposure of resting participants from a small sample of reindeer herders (N = 22, 6 females) from sub-Arctic Finland.

Results
We found that most herders experienced a significant mean 8.7% increase in metabolic rates, preferentially metabolized fatty acids, and maintained relatively warmer body surface temperatures at the supraclavicular region (known BAT location) compared to the sternum, which has no associated BAT. These results indicate that the herders in this sample exhibit active BAT thermogenesis in response to mild cold exposure.

Conclusions
This study adds to the rapidly growing body of work looking at the physiological and thermoregulatory significance of BAT and the important role it may play among cold stressed populations.
Amino Acid Metabolism and Protein Turnover in Lean and Obese Humans During Exercise—Effect of IL-6 Receptor Blockade
Authors: Trinh Beckey , Peletier Merel , Simonsen Casper , Plomgaard Peter , Karstoft Kristian , Pedersen Bente Klarlund , van Hall Gerrit , Ellingsgaard Helga 
Published: April 2022

AbstractContextInterleukin-6 (IL-6) is implicated in skeletal muscle wasting and in regulating skeletal muscle hypertrophy in the healthy state.ObjectiveThis work aimed to determine the role of IL-6 in regulating systemic protein and amino acid metabolism during rest, exercise, and recovery in lean and obese humans.MethodsIn a nonrandomized, single-blind design, 12 lean and 9 obese individuals were infused first with 0.9% saline (Saline), secondly with the IL-6 receptor antibody tocilizumab (Acute IL-6R ab), and 21 days later with saline while still under tocilizumab influence (Chronic IL-6R ab). Outcome measures were determined before, during, and after 90 minutes of exercise at 40% Wattmax by isotope dilution technique, using primed continuous infusion of L-[ring-D5]phenylalanine and L-[D2]tyrosine. Main outcomes measures included systemic protein turnover and plasma amino acid concentrations.ResultsWe saw no effect of acute or chronic IL-6 receptor blockade on protein turnover. In lean individuals, chronic IL-6 receptor blockade increased plasma concentrations of total amino acids (rest Δ + 186 μmol/L; 95% CI, 40-332; recovery Δ + 201 μmol/L; 95% CI, 55-347) and essential amino acids (rest Δ + 43 μmol/L; 95% CI, 12-76; recovery Δ + 45 μmol/L; 95% CI, 13-77) independently of exercise but had no such effect in obese individuals (total amino acids rest Δ + 63 μmol/L; 95% CI, –170 to 295, recovery Δ – 23 μmol/L, 95% CI, –256 to 210; essential amino acids rest Δ + 26 μmol/L; 95% CI, –21 to 73, recovery Δ + 11 μmol/L; 95% CI, –36 to 58).ConclusionIL-6 receptor blockade has no effect on protein turnover in fasting lean and obese humans during rest, exercise, and recovery. Chronic IL-6 receptor blockade increases total and essential amino acid concentrations only in lean individuals.
PENDEKATAN SAINTIFIK TERHADAP KEMAMPUAN HOTS SISWA DI SEKOLAH DASAR
Authors: Indrati Mega Arlisyah Giri , Wardani Imas Srinana , Irianto Apri 
Published: April 2022

This research is motivated by the low HOTS ability of students in elementary schools because during the learning process students are less accustomed to critical thinking, creative thinking, solving problems, and making decisions during the learning process. The application of HOTS in teaching and mentoring teachers about HOTS learning is still lacking. The aim of this research is to know the effect of the scientific approach on the HOTS ability of students in elementary schools. This study uses quantitative research with experimental and control research types. The research subjects consisted of 27 students in grade IV A and IV B 25 students at SDN Kebondalem Mojosari. The collection method uses tests. The study used the normality test, homogeneity test and t-test using the SPSS version 25 application. The results of the normality test for the experimental class (0.188) and the control class (0.156). The result of the homogeneity test is (0.668).Â From the results of the normality test and the homogeneity test, it shows that the t-test results obtained, namely the Sig (2-tailed) value is (0,000) so that the value is less than (0.05). So it can be concluded that the scientific approach has a good impact on the HOTS ability of students in elementary schools.