bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epstein-Barr viral corneal stromal keratitis occurring during rheumatoid arthritis treatment: a case report
Authors: Yamashita Kazuya , Sato Rio , Fukumoto Ryuki , Ofuji Yoshiko , Nagamoto Takashi , Kubono Hirohisa , Kawamura Mari , Suzuki Kotaro 
Published: January 2022

Abstract
Background
A case of Epstein-Barr viral (EBV) corneal stromal keratitis during rheumatoid arthritis (RA) treatment is presented.

Case presentation
A 74-year-old female undergoing RA treatment was previously treated for bacterial corneal ulcer and herpetic keratitis and healed with antibiotic eye drops and topical anti-herpes ointment. At the first visit to our hospital, she presented with findings of monocular posterior interstitial keratitis with neovascularization mostly located in the inferior cornea with a corneal epithelial defect. The right eye showed no thinning of the corneal periphery and anterior uveitis. Her RA had subsided with oral steroid treatment, and infectious mononucleosis (IM) had not developed. EBV DNA could be detected in her corneal sample. After an extended but ineffective period to antibiotic treatment the corneal infiltrate responded rapidly to topical corticosteroids.

Conclusion
EBV can cause stromal keratitis without IM during treatment for RA.
Evaluating ‘Power 4 a Healthy Pregnancy’ (P4HP) – protocol for a cluster randomized controlled trial and process evaluation to empower pregnant women towards improved diet quality
Authors: van Lonkhuijzen Renske M. , Cremers Susanne , de Vries Jeanne H. M. , Feskens Edith J. M. , Wagemakers Annemarie 
Published: January 2022

Abstract
Background
In general during pregnancy, women are aware of the importance of good diet quality, interested in nutrition, and receptive to changing dietary intake. However, adherence to dietary guidelines is sub-optimal. A pregnant woman’s first information source regarding nutrition information is her midwife. Healthy nutrition promotion by midwives may therefore be very promising, but midwives face multiple barriers in providing nutritional support. Empowering pregnant women to improve their diet quality is expected to improve their health. Therefore an empowerment intervention has been developed to improve diet quality among pregnant women. The objective of this study is to evaluate the effectiveness and feasibility of Power 4 a Healthy Pregnancy (P4HP). P4HP aims to empower pregnant women to have a healthier diet quality.

Methods/design
This study applies a mixed methodology consisting of a non-blinded cluster randomized trial with an intervention (P4HP) group and a control group and a process evaluation. Midwifery practices, the clusters, will be randomly allocated to the intervention arm (n = 7) and control arm (n = 7). Participating women are placed in intervention or control conditions based on their midwifery practice. Each midwifery practice includes 25 pregnant women, making 350 participants in total. Health related outcomes, diet quality, empowerment, Sense of Coherence, Quality of Life, and Self-Rated Health of participants will be assessed before (T0) and after (T1) the intervention. The process evaluation focuses on multidisciplinary collaboration, facilitators, and barriers, and consists of in-depth interviews with midwives, dieticians and pregnant women.

Discussion
This study is the first to evaluate an empowerment intervention to improve diet quality in this target population. This mixed method evaluation will contribute to knowledge about the effectiveness and feasibility regarding diet quality, empowerment, health-related outcomes, multidisciplinary collaboration, facilitators and barriers of the empowerment intervention P4HP. Results will help inform how to empower pregnant women to achieve improved diet quality by midwives and dieticians. If proven effective, P4HP has the potential to be implemented nationally and scaled up to a long-term trajectory from preconception to the postnatal phase.

Trial registration
The trial is prospectively registered at the Netherlands Trial Register (NL9551). Date registered: 19/05/2021.
Heart rate and heart rate variability in patients with chronic inflammatory joint disease: the role of pain duration and the insular cortex
Authors: Danilin Leona Katharin , Spindler Melanie , Sörös Peter , Bantel Carsten 
Published: January 2022

Abstract
Background
Chronic inflammatory joint diseases (CIJD) have been linked to increased cardiovascular morbidity and mortality. A decisive reason could be a dysregulation of the autonomic nervous system, which is responsible for the control of cardiovascular function. So far, the cause of changes in autonomic nervous system functions remains elusive. In this study, we investigate the role of chronic pain and the insular cortex in autonomic control of cardiac functioning in patients with CIJD.

Methods
We studied the autonomic nervous system through the assessment of heart rate and heart rate variability (HRV) at rest and under cognitive stimulation. Furthermore, we investigated insular cortex volume by performing surface-based brain morphometry with FreeSurfer. For this study, 47 participants were recruited, 22 individual age- and sex-matched pairs for the magnetic resonance imaging analyses and 14 for the HRV analyses. All available patients’ data were used for analysis.

Results
Pain duration was negatively correlated with the resting heart rate in patients with chronic inflammatory joint diseases (n = 20). In a multiple linear regression model including only CIJD patients with heart rate at rest as a dependent variable, we found a significant positive relationship between heart rate at rest and the volume of the left insular cortex and a significant negative relationship between heart rate at rest and the volume of the right insular cortex. However, we found no significant differences in HRV parameters or insular cortex volumes between both groups.

Conclusions
In this study we provide evidence to suggest insular cortex involvement in the process of ANS changes due to chronic pain in CIJD patients.
The study was preregistered with the German Clinical Trials Register (https://www.drks.de; DRKS00012791; date of registration: 28 July 2017).
Interprofessional identity: an ethnography of clinical simulation learning in New Zealand
Authors: Cooper-Ioelu Pauline , Jowsey Tanisha 
Published: January 2022

Abstract
Background
This article explores the experiences of clinical healthcare students on an interprofessional simulation course in Auckland, New Zealand. The four-day course aims to provide a formative learning experience for final year medical, pharmacy, nursing, and paramedicine students. It focuses on building skills in professionalism, communication, leadership and interprofessional safe teamwork through structured learning activities and clinical simulation scenarios.

Methods
In 2018, we commenced focused ethnographic research involving participant observation, field notes, interviews, photography and ethnographic film.

Results
A total of 112 students participated in this research from the disciplines of medicine (n = 53), nursing (n = 27), pharmacy (n = 17), and paramedicine (n = 15). In a revisit to Van Gennep’s (1972) seminal work on liminality, we suggest that the course represents a liminal space where students’ ideas about what it means to be a healthcare ‘professional’ are challenged, disrupted and reconstructed. We observed students emerging from the course with transformed professional and interprofessional identities.

Conclusions
We posit that the ritualised and liminal nature of the course plays a role in the development of interprofessional identities by interrupting the reproduction of siloed biomedical culture. Students are challenged to become effective team members alongside other students and experts from other professions. We discuss these findings as they relate to medical and health sciences education.
Association of a longitudinal, preclinical ultrasound curriculum with medical student performance
Authors: Haidar David A , Kessler Ross , Khanna Neil K , Cover Michael T , Burkhardt John C , Theyyunni Nik , Tucker Ryan V , Huang Rob D , Holman Elizabeth , Bridge Patrick D , Klein Katherine A , Fung Christopher M 
Published: January 2022

Abstract
Introduction
Point-of-care ultrasound (US) is used in clinical practice across many specialties. Ultrasound (US) curricula for medical students are increasingly common. Optimal timing, structure, and effect of ultrasound education during medical school remains poorly understood. This study aims to retrospectively determine the association between participation in a preclinical, longitudinal US curriculum and medical student academic performance.

Methods
All first-year medical students at a medical school in the Midwest region of the United States were offered a voluntary longitudinal US curriculum. Participants were selected by random lottery. The curriculum consisted of five three-hour hands on-sessions with matching asynchronous content covering anatomy and pathologic findings. Content was paired with organ system blocks in the standard first year curriculum at our medical school. Exam scores between the participating and non-participating students were compared to evaluate the objective impact of US education on performance in an existing curriculum. We hypothesized that there would be an association between participation in the curriculum and improved medical student performance. Secondary outcomes included shelf exam scores for the surgery, internal medicine, neurology clerkships and USMLE Step 1. A multivariable linear regression model was used to evaluate the association of US curriculum participation with student performance. Scores were adjusted for age, gender, MCAT percentile, and science or engineering degree.

Results
76 of 178 students applied to participate in the curriculum, of which 51 were accepted. US curriculum students were compared to non-participating students (n = 127) from the same class. The US curriculum students performed better in cardiovascular anatomy (mean score 92.1 vs. 88.7, p = 0.048 after adjustment for multiple comparisons). There were no significant differences in cumulative cardiovascular exam scores, or in anatomy and cumulative exam scores for the gastroenterology and neurology blocks. The effect of US curriculum participation on cardiovascular anatomy scores was estimated to be an improvement of 3.48 points (95% CI 0.78-6.18). No significant differences were observed for USMLE Step 1 or clerkship shelf exams. There were no significant differences in either preclinical, clerkship or Step 1 score for the 25 students who applied and were not accepted and the 102 who did not apply.

Conclusions
Participation in a preclinical longitudinal US curriculum was associated with improved exam performance in cardiovascular anatomy but not examination of other cardiovascular system concepts. Neither anatomy or comprehensive exam scores for neurology and gastrointestinal organ system blocks were improved.
Understanding low-value care and associated de-implementation processes: a qualitative study of Choosing Wisely Interventions across Canadian hospitals
Authors: Parker Gillian , Kastner Monika , Born Karen , Shahid Nida , Berta Whitney 
Published: January 2022

Abstract
Background
Choosing Wisely (CW) is an international movement comprised of campaigns in more than 20 countries to reduce low-value care (LVC). De-implementation, the reduction or removal of a healthcare practice that offers little to no benefit or causes harm, is an emerging field of research. Little is known about the factors which (i) sustain LVC; and (ii) the magnitude of the problem of LVC. In addition, little is known about the processes of de-implementation, and if and how these processes differ from implementation endeavours. The objective of this study was to explicate the myriad factors which impact the processes and outcomes of de-implementation initiatives that are designed to address national Choosing Wisely campaign recommendations.

Methods
Semi-structured interviews were conducted with individuals implementing Choosing Wisely Canada recommendations in healthcare settings in four provinces. The interview guide was developed using concepts from the literature and the Implementation Process Model (IPM) as a framework. All interviews were conducted virtually, recorded, and transcribed verbatim. Data were analysed using thematic analysis.

Findings
Seventeen Choosing Wisely team members were interviewed. Participants identified numerous provider factors, most notably habit, which sustain LVC. Contrary to reporting in recent studies, the majority of LVC in the sample was not ‘patient facing’; therefore, patients were not a significant driver for the LVC, nor a barrier to reducing it. Participants detailed aspects of the magnitude of the problems of LVC, providing insight into the complexities and nuances of harm, resources and prevalence. Harm from potential or common infections, reactions, or overtreatment was viewed as the most significant types of harm. Unique factors influencing the processes of de-implementation reported were: influence of Choosing Wisely campaigns, availability of data, lack of targets and hard-coded interventions.

Conclusions
This study explicates factors ranging from those which impact the maintenance of LVC to factors that impact the success of de-implementation interventions intended to reduce them. The findings draw attention to the significance of unintentional factors, highlight the importance of understanding the impact of harm and resources to reduce LVC and illuminate the overstated impact of patients in de-implementation literature. These findings illustrate the complexities of de-implementation.
Humoral immune response after different SARS-CoV-2 vaccination regimens
Authors: Rose Ruben , Neumann Franziska , Grobe Olaf , Lorentz Thomas , Fickenscher Helmut , Krumbholz Andi 
Published: January 2022

Abstract
Background
The humoral immune response after primary immunisation with a SARS-CoV-2 vector vaccine (AstraZeneca AZD1222, ChAdOx1 nCoV-19, Vaxzevria) followed by an mRNA vaccine boost (Pfizer/BioNTech, BNT162b2; Moderna, m-1273) was examined and compared with the antibody response after homologous vaccination schemes (AZD1222/AZD1222 or BNT162b2/BNT162b2).

Methods
Sera from 59 vaccinees were tested for anti-SARS-CoV-2 immunoglobulin G (IgG) and virus-neutralising antibodies (VNA) with three IgG assays based on (parts of) the SARS-CoV-2 spike (S)-protein as antigen, an IgG immunoblot (additionally contains the SARS-CoV-2 nucleoprotein (NP) as an antigen), a surrogate neutralisation test (sVNT), and a Vero-cell-based virus-neutralisation test (cVNT) with the B.1.1.7 variant of concern (VOC; alpha) as antigen. Investigation was done before and after heterologous (n = 30 and 42) or homologous booster vaccination (AZD1222/AZD1222, n = 8/9; BNT162b2/BNT162b2, n = 8/8). After the second immunisation, a subgroup of 26 age- and gender-matched sera (AZD1222/mRNA, n = 9; AZD1222/AZD1222, n = 9; BNT162b2/BNT162b2, n = 8) was also tested for VNA against VOC B.1.617.2 (delta) in the cVNT. The strength of IgG binding to separate SARS-CoV-2 antigens was measured by avidity.

Results
After the first vaccination, the prevalence of IgG directed against the (trimeric) SARS-CoV-2 S-protein and its receptor binding domain (RBD) varied from 55–95% (AZD1222) to 100% (BNT162b2), depending on the vaccine regimen and the SARS-CoV-2 antigen used. The booster vaccination resulted in 100% seroconversion and the occurrence of highly avid IgG, which is directed against the S-protein subunit 1 and the RBD, as well as VNA against VOC B.1.1.7, while anti-NP IgGs were not detected. The results of the three anti-SARS-CoV-2 IgG tests showed an excellent correlation to the VNA titres against this VOC. The agreement of cVNT and sVNT results was good. However, the sVNT seems to overestimate non- and weak B.1.1.7-neutralising titres. The anti-SARS-CoV-2 IgG concentrations and the B.1.1.7-neutralising titres were significantly higher after heterologous vaccination compared to the homologous AZD1222 scheme. If VOC B.1.617.2 was used as antigen, significantly lower VNA titres were measured in the cVNT, and three (33.3%) vector vaccine recipients had a VNA titre < 1:10.

Conclusions
Heterologous SARS-CoV-2 vaccination leads to a strong antibody response with anti-SARS-CoV-2 IgG concentrations and VNA titres at a level comparable to that of a homologous BNT162b2 vaccination scheme. Irrespective of the chosen immunisation regime, highly avid IgG antibodies can be detected just 2 weeks after the second vaccine dose indicating the development of a robust humoral immunity. The reduction in the VNA titre against VOC B.1.617.2 observed in the subgroup of 26 individuals is remarkable and confirms the immune escape of the delta variant.
Gender difference in the incidence of malaria diagnosed at public health facilities in Uganda
Authors: Okiring Jaffer , Epstein Adrienne , Namuganga Jane F. , Kamya Emmanuel V. , Nabende Isaiah , Nassali Martha , Sserwanga Asadu , Gonahasa Samuel , Muwema Mercy , Kiwuwa Steven M. , Staedke Sarah G. , Kamya Moses R. , Nankabirwa Joaniter I. , Briggs Jessica , Jagannathan Prasanna , Dorsey Grant 
Published: January 2022

Abstract
Background
Routine malaria surveillance data in Africa primarily come from public health facilities reporting to national health management information systems. Although information on gender is routinely collected from patients presenting to these health facilities, stratification of malaria surveillance data by gender is rarely done. This study evaluated gender difference among patients diagnosed with parasitological confirmed malaria at public health facilities in Uganda.

Methods
This study utilized individual level patient data collected from January 2020 through April 2021 at 12 public health facilities in Uganda and cross-sectional surveys conducted in target areas around these facilities in April 2021. Associations between gender and the incidence of malaria and non-malarial visits captured at the health facilities from patients residing within the target areas were estimated using poisson regression models controlling for seasonality. Associations between gender and data on health-seeking behaviour from the cross-sectional surveys were estimated using poisson regression models controlling for seasonality.

Results
Overall, incidence of malaria diagnosed per 1000 person years was 735 among females and 449 among males (IRR = 1.72, 95% CI 1.68–1.77, p < 0.001), with larger differences among those 15–39 years (IRR = 2.46, 95% CI 2.34–2.58, p < 0.001) and over 39 years (IRR = 2.26, 95% CI 2.05–2.50, p < 0.001) compared to those under 15 years (IRR = 1.46, 95% CI 1.41–1.50, p < 0.001). Female gender was also associated with a higher incidence of visits where malaria was not suspected (IRR = 1.77, 95% CI 1.71–1.83, p < 0.001), with a similar pattern across age strata. These associations were consistent across the 12 individual health centres. From the cross-sectional surveys, females were more likely than males to report fever in the past 2 weeks and seek care at the local health centre (7.5% vs. 4.7%, p = 0.001) with these associations significant for those 15–39 years (RR = 2.49, 95% CI 1.17–5.31, p = 0.018) and over 39 years (RR = 2.56, 95% CI 1.00–6.54, p = 0.049).

Conclusions
Females disproportionately contribute to the burden of malaria diagnosed at public health facilities in Uganda, especially once they reach childbearing age. Contributing factors included more frequent visits to these facilities independent of malaria and a higher reported risk of seeking care at these facilities for febrile illnesses.
Ezidi voices: The communication of COVID-19 information amongst a refugee community in rural Australia- a qualitative study
Authors: Healey Sunita Joann Rebecca , Ghafournia Nafiseh , Massey Peter D , Andrich Karinne , Harrison Joy , Taylor Kathryn , Bolsewicz Katarzyna 
Published: January 2022

Abstract
Background
There is growing evidence that government health information related to COVID-19 has failed to adequately reach culturally and linguistically diverse (CALD) populations in Australia. Refugees are a unique sub-set of the CALD communities and are subject to numerous barriers preventing adequate health care, both pre- and post-migration. The barriers are accentuated during emergencies, such as a pandemic, as a result of an intersection of various social and economic inequalities. The recently resettled Ezidi refugee community in a regional area of Australia is an example of a community sitting at the intersection of various inequities and thus at greater risk from COVID-19. The purpose of this study is to describe the experiences of the Ezidi in a regional area with COVID-19 information and how this has been communicated to and shared within this group; what barriers the community may experience in accessing COVID-19 information; and how the government-led COVID-19 information communication could be improved.

Methods
This qualitative study was designed to explore the perceptions and views of the Ezidi and service providers regarding COVID-19 messaging. Multicultural and Refugee Health staff facilitated interviews with four local service providers and ten Ezidi community members, including seven influential leaders. Thematic analysis was employed across individual, pair and group data analysis. Similar categories were grouped into themes.

Results
The main findings of the study are: the refugee experience influences the communication of COVID-19 messages; cultural, social and gender norms influence responses to COVID-19; trusted individuals and service providers are key in communities’ uptake of COVID-19 messages; currently available governmental COVID-19 information resources and sharing strategies were found unhelpful and inappropriate; COVID-19 communiqués and message delivery for this regional minority refugee community can be improved.

Conclusion
The recently resettled Ezidi community, and likely other similar communities, would benefit from tailored engagement by government organisations, as well as settlement services to improve the communication of COVID-19 health information and reduce related inequities.