bluuebunny/crossref_metadata_2025 huggingface dataset:
Parvana’s Trilogy: A Study of Violence toward Afghanistan Women and Girls
Authors: Agustina Hiqma Nur , Ramalia Tenia
Published: March 2020

Afghan women and girls became the portray of the victim of violence in the last years until the recent years. The issue of violence toward Afghan women and girls often arise and being the debate in the international public. The news about the tragedy spread through the newspaper, printed and online, and also in the literature world. The exposure of their sufferings as the impact of war, conflict among the ethnics, Talizam rezim reflected in the Parvana's Trilogy named The Breadwinner (2000), Parvana's Journey (2002), and Mud City (2003). These trilogy were wriiten by Deborah Ellis. How the women and girls became the most victim which received violence caused by all of the trigger displayed obviously show the social facts of violence and the structure of violence toward happened to them. Those will be discussed in this paper to get the deep comprehension about the woman and girls' impact after they get the violence. The theory of violence and framing analysis will be used to analyze in order to get the result of the cause by the viooence and abuse itself. The outcome of the study shows that many efforts done by women and girls to overcome their difficult lives, such as pretending being boys, human trafficking, and living as refugees are the ways to survive from the worst violence caused by the war, conflict between ethnics and Taliban rezime.
PERAN POLITIK PEREMPUAN MELALUI SINOMAN DI DESA GROBOG WETAN TEGAL DALAM PERSPEKTIF GENDER
Authors: Mubarok Zaki
Published: March 2020

Sinoman dirumuskan sebagai tradisi saling membantu antar anggota masyarakat dalam aspek politik, sosial dan agama. Sinoman lazim dilakukan perempuan baik berupa pemberian materi atau pekerjaan nir transaksional. Dalam konteks politik pemilihan kepala desa, sinoman menjadi mekanisme vote gatter, kampaye, memberi dan menyajikan logistik selama pemilihan kepala desa. Meski berperan penting, perempuan tidak otomatis menjadi figur yang berada di tengah kekuasaan atau masuk dalam inti struktur kekuasaan. Sebaliknya, ia menjadi bagian luar dari sistem kekuasaan atau politik yang berjalan. Peran penting mereka dalam politik desa didasarkan pada semangat ibadah yang bersumber pada ajaran patuh kepada perintah suami atau laki-laki yang berkedudukan sebagai imam. Karena pilihan politik suami menjadi pilihan politik yang harus dipatuhi istri atau saudara perempuan lainnya. Peran perempuan dalam Sinoman memiliki pengaruh atas pembagian kekuasaan untuk suami atau saudara laki-lakinya di desa.
Crosswalks Between Knee and Hip Arthroplasty Short Forms
Authors: Polascik Breanna A. , Hidaka Chisa , Thompson Madison C. , Tong-Ngork Sarani , Wagner Jessica L. , Plummer Otho , Lyman Stephen
Published: March 2020

Background:

The Oxford Knee Score (OKS); Oxford Hip Score (OHS); Knee injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS JR); and Hip disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS JR) are well-validated and widely used short-form patient-reported outcome measures (PROMs) for assessing outcomes after total knee arthroplasty (TKA) and total hip arthroplasty (THA). We are not aware of the existence of any crosswalks to convert scores between these PROMs. We aimed to develop and validate crosswalks that will permit the comparison of scores between studies using different PROMs and the pooling of results for meta-analyses.

Methods:

We retrospectively analyzed scores from patients (486 in the knee cohort and 340 in the hip cohort) from the Syracuse Orthopedic Specialists Joint Registry who had completed the appropriate PROMs (OKS and KOOS JR in the knee cohort and OHS and HOOS JR in the hip cohort) as the standard of care before undergoing primary TKA or unicompartmental knee arthroplasty (UKA) between January 9, 2016, and June 19, 2017, or primary THA or hip resurfacing between November 29, 2010, and October 30, 2017, or when returning for postoperative care. Using the equipercentile equating method, we created 4 crosswalks: OKS to KOOS JR, KOOS JR to OKS, OHS to HOOS JR, and HOOS JR to OHS. To assess validity, Spearman coefficients were calculated using bootstrapping methods, and means for actual and crosswalk-derived scores were compared.

Results:

There were minimal differences between the means of the known and crosswalk-derived scores. As calculated with the use of bootstrapping methods, Spearman coefficients between the actual and derived scores were strong and positive for both knee arthroplasty crosswalks (0.888 to 0.889; 95% confidence interval [CI], 0.887 to 0.891) and hip arthroplasty crosswalks (0.916 to 0.918; 95% CI, 0.914 to 0.919).

Conclusions:

We successfully created 4 crosswalks that allow conversion of Oxford scores to KOOS and HOOS JR scores and vice versa. These crosswalks will allow harmonization of PROMs assessment regardless of which of the short forms are used, which may facilitate multicenter collaboration or allow sites to switch PROMs without loss of historic comparison data.

Level of Evidence:

Level III. See Instructions for Authors for a complete description of levels of evidence.
Use of Computerized Adaptive Testing to Develop More Concise Patient-Reported Outcome Measures
Authors: Kane Liam T. , Namdari Surena , Plummer Otho R. , Beredjiklian Pedro , Vaccaro Alexander , Abboud Joseph A.
Published: March 2020

Background:

Patient-reported outcome measures (PROMs) are essential tools that are used to assess health status and treatment outcomes in orthopaedic care. Use of PROMs can burden patients with lengthy and cumbersome questionnaires. Predictive models using machine learning known as computerized adaptive testing (CAT) offer a potential solution. The purpose of this study was to evaluate the ability of CAT to improve efficiency of the Veterans RAND 12 Item Health Survey (VR-12) by decreasing the question burden while maintaining the accuracy of the outcome score.

Methods:

A previously developed CAT model was applied to the responses of 19,523 patients who had completed a full VR-12 survey while presenting to 1 of 5 subspecialty orthopaedic clinics. This resulted in the calculation of both a full-survey and CAT-model physical component summary score (PCS) and mental component summary score (MCS). Several analyses compared the accuracy of the CAT model scores with that of the full scores by comparing the means and standard deviations, calculating a Pearson correlation coefficient and intraclass correlation coefficient, plotting the frequency distributions of the 2 score sets and the score differences, and performing a Bland-Altman assessment of scoring patterns.

Results:

The CAT model required 4 fewer questions to be answered by each subject (33% decrease in question burden). The mean PCS was 1.3 points lower in the CAT model than with the full VR-12 (41.5 ± 11.0 versus 42.8 ± 10.4), and the mean MCS was 0.3 point higher (57.3 ± 9.4 versus 57.0 ± 9.6). The Pearson correlation coefficients were 0.97 for PCS and 0.98 for MCS, and the intraclass correlation coefficients were 0.96 and 0.97, respectively. The frequency distribution of the CAT and full scores showed significant overlap for both the PCS and the MCS. The difference between the CAT and full scores was less than the minimum clinically important difference (MCID) in >95% of cases for the PCS and MCS.

Conclusions:

The application of CAT to the VR-12 survey demonstrated an ability to lessen the response burden for patients with a negligible effect on score integrity.
Asset Mapping: A Case Study
Authors: Gaspard Valencia , Brown Scott , Hernandez Gongora Lissel , Le Roux Renee
Published: March 2020

Four Rural Studies students from The University of Guelph were asked to develop a community-based tool that fosters strategic, transparent, sustainable decision-making in the rural Ontario municipality of Grey Highlands. In this presentation, we would like to unpack both the processes of collaboration with the Municipal sub-committee and the processes of community engagement that went into building the deliverable of the project -- a framework connecting community-identified assets to the community capitals framework. Our presentation is broadly related to the notion of regional development and more specifically, the capacity of regional governments and communities to "maintain a pulse" on and build connections between their own regional assets.
Regional and Rural Broadband Policy and Programming
Authors: Mamun Chowdury
Published: March 2020

Higher speed broadband services are considered as fundamental requirement for digital economy. Availability and usability of internet connected applications is now demanding more bandwidth and capacity in broadband services. Rural people are not excluded from this wave of usage. Focusing on SW Ontario, my research project will employ continuously updated datasets and develops and conducts outcome analysis for public broadband investment, primarily with partners in the Southwest Integrated Fibre Technology (SWIFT) network. The research will combine empirical research methods with an underlying action research process recommended by relevant literature that encourages analytical tools and findings for relevant stakeholders. The research will advance existing efforts to conduct collaborative, well-structured and systematically updated quantitative data analysis for reporting on opportunities and obstacles in current and prospective digital economy infrastructure, applications and adoption in SW Ontario. This analysis will inform evidence-based policy and decision making in various governments. This research will also support other agri-food/rural related policy and programming focused on specific digital investments including identifying connectivity for new ICT applications useful for cost-savings in rural public services or 'next generation' agri-food network technologies (e.g. Precision agriculture research). Health and education sector applications are also relevant. This analysis will support job growth and economic benefits in rural Ontario.
Essex County Agri-Tourism: Exploring Regional and Farm-Level Diversification
Authors: Heather Reid
Published: March 2020

The character of many Canadian rural regions is changing rapidly as farms continue to become larger and more specialized and new (ex)urban actors influence rural economies with new expectations of rural space. In Essex County, Ontario, this changing character is being directed, in part, through tourism promotion and by leveraging its location within a designated wine appellation. As tourism is being pushed to a more prominent position within the County’s brand, farmers are provided opportunities to capitalize on increased visitation and an evolving perception of the region. Considering this regional context, this research aims to explore the uses of and motivations behind agri-tourism in Essex County, Ontario by three stakeholder groups: farmers, winery owners, and the Destination Marketing Organization (DMO). To accomplish this, document analysis was conducted alongside interviews with agri-tourism providers and DMO representatives. The dominant narrative emerging from analysis is the development of an emerging tourism destination. While winery owners actively collaborate to co-create a wine destination with the help of the DMO, farmers who have diversified into agri-tourism provision are more likely to work in silos and cultivate a personal niche without regard for a regional brand or destination creation. Though tourism promotional materials emphasize local food and beverages, it is questionable if farmers are actively buying into or are aware of this potential tourism opportunity. This research contributes to an understanding of Canadian farm diversification, particularly within the context of an emerging tourism destination.
Rural Educational Tourism's Potential
Authors: Danielle Robinson
Published: March 2020

Growth trends in life-long learning, and rural tourism indicate potential for the rural educational tourism sector; however; there is very little empirical research on how this niche tourism, which may include activities such as, agricultural school excursions/exchange programmes, “farm-to-table” culinary courses, artisan craft programs, etc., might build local capacity, support sustainable rural economies, and mobilize place-based ways of learning that are required for global sustainability. This research project, which is at the conceptual/exploratory stage, aims to explore the economic, social and environmental impacts of rural educational tourism. There is no existing research that brings together rural development and place-based educational tourism in a Canadian context. Sub-questions with particular relevance to rural development policy and planning include: How was rural educational tourism integrated within a greater economic and learning development strategy? What new roles and competencies did stakeholders require and how were they developed? What changes from traditional forms of policy development were required? How were issues of sustainability, environmental impact, and conservation addressed? How did the quality and quantity of interconnections change? Since educational tourism has received very little research attention, comparative case studies with mixed methods are a suitable approach. I hope to include educational tourism activities in rural Aboriginal communities, pending consultation, and with an understanding of Aboriginal research as being research by and with Aboriginal Peoples. My approach emphasizes and values the existing strengths, assets and knowledge systems of rural communities.
Radio+ and Open Source Software for Mobilizing Knowledge for Sustainable Agriculture in Sri Lanka
Authors: Faria Rashid
Published: March 2020

Information and Communications Technologies (ICTs) considered an important platform towards sustainable agriculture, specifically when mobile and Free and Open Source (FOSS) applications are used to broadcast radio referred to here as Radio+.

Radio+ plays an important role in educating and entertaining farmers and give beneficial farming information. Radio+ can encourage younger farmers to increase their participation in the agricultural sector and motivate them to use new ideas and techniques for agriculture. In order to boost sustainable agricultural systems, Free and Open Source (FOSS) applications recognized for low cost and user-friendly platform used on mobile devices such as Smart Phones.

In Sri Lanka, partners including the Department of Export Agriculture, Wayamba University and LIRNEasia collaborating with researchers at the University of Alberta and University of Guelph have created a community of practice for farmer media convergence. A partnership development grant from the Social Sciences and Humanities Research Council of Canada (SSHRC) in 2012 enabled the partners to establish a community-university research partnership in order to explore the potential for low cost ICTs to enhance knowledge mobilization practices within agricultural communities of practice in Sri Lanka. This paper outlines the experiences of the initiative and its use of Open Source (FOSS) and radio+ for sustainable agriculture in Sri Lanka.
Prognostic value of TP53 concurrent mutations for EGFR- TKIs and ALK-TKIs based targeted therapy in advanced non-small cell lung cancer: a meta-analysis
Authors: Qin Kang , Hou Helei , Liang Yu , Zhang Xiaochun
Published: March 2020

Background The prognostic significance of TP53 concurrent mutations in patients with epidermal growth factor receptor (EGFR)- or anaplastic lymphoma kinase (ALK)- mutated advanced non–small-cell lung cancer (NSCLC) who received EGFR-tyrosine kinase inhibitors (TKIs) or ALK-TKIs based targeted therapy remains controversial. Therefore, the present meta-analysis was performed to investigate the association between TP53 concurrent mutations and prognosis of patients with advanced NSCLC undergoing EGFR-TKIs or ALK-TKIs treatments. Methods Eligible studies were identified by searching the online databases PubMed, Embase, Medline, The Cochrane library and Web of Science. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to clarify the correlation between TP53 mutation status and prognosis of patients. This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results In total, 15 studies with 1342 patients were included for final analysis. Overall, concurrent TP53 mutation was associated with unfavorable progression-free survival (PFS) (HR=1.88, 95%CI: 1.59-2.23, p<0.001, I2=0.0%, P=0.792) and overall survival (OS) (HR=1.92, 95%CI: 1.55-2.38, p<0.001, I2=0.0%, P=0.515). Subgroup analysis based on type of targeted therapy (EGFR-TKIs or ALK-TKIs, pathological type of cancer (adenocarcinoma only or all NSCLC subtypes) and line of treatment (first-line only or all lines) all showed that TP53 mutations was associated with shorter survivals of patients with EGFR-TKIs or ALK-TKIs treatments. Particularly, in patients with first-line EGFR-TKIs treatment, significantly poorer prognosis was observed in patients with TP53 concurrent mutations (pooled HR for PFS: 1.69, 95% CI 1.25-2.27, P<0.001, I2=0.0%, P=0.473; pooled HR for OS: 1.94, 95% CI 1.36-2.76, P<0.001, I2=0.0%, P=0.484). Begg’s funnel plots and Egger’s tests indicated no significant publication bias in this study. Conclusions This meta-analysis indicated that concurrent TP53 mutations was a negative prognostic factor and associated with poorer outcomes of patients with EGFR-TKIs or ALK-TKIs treatments in advanced NSCLC. In addition, our study provided evidence that TP53 mutations might be involved in primary resistance to EGFR-TKIs treatments in patients with sensitive EGFR mutations in advanced NSCLC.
Post-Discharge survival status and predictors of mortality among severely malnourished children <5 years of age admitted to Minia University Maternity and Children Hospital
Authors: Ghazawy Eman , Bebars Gihan , Eshak Ehab Salah
Published: March 2020

Background: Though effective treatment programs for severely malnourished children are available, little is known about long-term outcomes and potential predictors of post-discharge mortality. The aim of this study was to assess the post-discharge survival status and predictors for post-discharge mortality in severely malnourished children admitted to Minia University Maternity and Children HospitalMethods: A retrospective cohort study which included 135 children under five years of age who were admitted to the nutrition rehabilitation ward with severe acute malnutrition (SAM) during the period from January to December 2018. Data were collected from the inpatient’s hospital records and the children’s parents/guardians were interviewed using a detailed structured questionnaire that inquired about demographic and socioeconomic variables. The Cox proportional hazard model was used to assess the factors associated with the SAM’s post-discharge mortality.Results: A total of 135 children were enrolled into the study. Death rate during hospitalization was 9.6%. The cumulative probability of survival beyond eight weeks and at least for 24 weeks after discharge was 89.3% with a cumulative probability of post-discharge mortality of 10.7% and all deaths occurred within eight weeks after discharge. The main predictor for the SAM’s post-discharge mortality was illiteracy of mothers; the multivariable HR (95%CI) was 7.10 (1.58-31.93; p=0.01).Conclusions: Mothers’ education and edema at admission are independent predictors for post-discharge mortality in under-five children with SAM. The identification of predictors for post-discharge mortality is an important preliminary step for interventions aiming to reduce morbidity and mortality following discharge.
Maternal and neonatal outcome of births planned in alongside midwifery units: A cohort study from a tertiary center in Germany
Authors: Merz Waltraut Maria , Tascon-Padron Laura , Puth Marie-Therese , Heep Andrea , Tietjen Sophia L. , Schmid Matthias , Gembruch Ulrich
Published: March 2020

Background
For healthy women entering birth after uneventful pregnancy, midwife-led models of care have the potential to reduce interventions and increase the vaginal birth rate. In Germany, 98.4% of women are giving birth in consultant-led obstetric units. Alongside midwifery units (AMU) have been established in 2003. We compared the maternal and perinatal outcome of women registered for planned birth in the AMU at our hospital with a matched group of low-risk women who gave birth in standard obstetric care during the same period of time.
Methods
We used a retrospective cohort study design. The study group consisted of all women admitted to labor ward who had registered for birth in AMU from 2010 to 2017. For the control group, low-risk women were selected; additionally, matching was performed for parity. Mode of birth was chosen as primary outcome parameter for the mother. For the neonate, a composite primary outcome (5-minute Apgar <7 or umbilical cord arterial pH < 7.10 or transfer to specialist neonatal care) was defined. Secondary outcomes included epidural anesthesia, duration of the second stage of labor, episiotomy, obstetric injury, and postpartum hemorrhage. Non-inferiority was assessed, and multiple logistic regression analysis was performed.
Results
612 women were admitted for labor in AMU, the control group consisted of 612 women giving birth in standard obstetric care. Women in the study group were on average older and had a higher BMI. Birthweight was on average 95 g higher in the study group. Non-inferiority could be established for the primary outcome parameters. In the study group, less interventions were performed (epidural anesthesia rate 19.1% vs. 41.2%; episiotomy rate 4.7% vs. 8.6%). The duration of the second stage of labor was shorter (47.4 min. vs. 55.6 min.), and second-degree perineal tears were less common in the study group (34.4% vs. 46.4%), higher-order obstetric lacerations occurred more frequently in the study group (2.3% vs. 0.9%). There was no difference in the postpartum hemorrhage rate.
Long-term survival trends in patients with unresectable stage III non-small cell lung cancer receiving chemotherapy and radiation therapy: a SEER cancer registry analysis
Authors: Hansen Ryan N , Zhang Yiduo , Seal Brian , Ryan Kellie , Yong Candice , Darilay Annie , Ramsey Scott D
Published: March 2020

Background: To evaluate the value of new therapies for non-small cell lung cancer (NSCLC), it is necessary to understand overall survival (OS) rates associated with previous standard therapies and how these rates have evolved over time. Methods: We retrospectively analyzed data from patients enrolled in the Surveillance, Epidemiology, and End Results (SEER) cancer registry. Adults with unresectable, stage III NSCLC treated with chemoradiotherapy were grouped by diagnosis year (2000–2002; 2003–2005; 2006–2008; 2009–2011; 2012–2013). The primary endpoint was OS (data cut-off, December 31, 2014), estimated using the Kaplan–Meier estimator. Temporal survival-trend significance was tested using a two-sided log-rank trend test. Results: Of 12,865 eligible patients, 59.1% were male, 59.9% had stage IIIB disease, and 62.7% had non-squamous histology. Median age at diagnosis was 67 years. Overall, 10,899 (84.7%) patients died and 1,966 (15.3%) were censored/lost to follow-up. Median follow-up (95% confidence interval [CI]) was 80 (77–82) months; median OS (95% CI) was 15 (15–16) months; 1- and 3-year survival probabilities (95% CI) were 57.7% (56.9–58.6) and 24.1% (23.3–24.8), respectively. Stratification by diagnosis year showed consistent improvements in survival over time ( p < 0.0001 for trend). Median OS was 12, 14, 15, 18, and 19 months in successive cohorts. Conclusions: OS in patients diagnosed with unresectable, stage III NSCLC between 2003 and 2013 was consistent with that from clinical studies of sequential/concurrent chemoradiotherapy. Despite improvement over time, median OS was <2 years and mortality remained high during the first year post-diagnosis.
The Effects of Changing Meteorological Parameters on Fatal Aortic Catastrophes
Authors: Szilágyi Brigitta , Berczeli Márton , Lovas Attila , Oláh Zoltán , Törő Klára , Sótonyi Péter
Published: March 2020

Introduction: Over the spam of the last decade, medical research has been increasingly putting greater emphasis on the study of meteorological parameters due to their connection to cardiovascular diseases. The main goal of this study was to explore the relationship between fatal aortic catastrophes and changes in atmospheric pressure and temperature. Methods: We used a Cox process model to quantify the effects of environmental factors on sudden deaths resulting from aortic catastrophes. We used transfer entropy to draw conclusion about the causal connection between mortality and meteorological parameters. Our main tool is a computer program which we developed earlier in order to evaluate the relationship between pulmonary embolism mortality and the weather on data sets comprised of aortic aneurysm (AA) and acute aortic dissection (AAD) cases, where one of these two medical conditions had led to the fatal rupture of the aorta. Our source for these cases were the autopsy databases of Semmelweis University, from the time period of 1994 to 2014. We have examined 160 aneurysm and 130 dissection cases in relation to changes in meteorological parameters. The algorithm implemented in our program is based on a non-parametric a Cox process model. It is capable to split slowly varying unknown global trends from fluctuations potentially caused by weather. Furthermore, it allows us to explore complex non-linear interactions between meteorological parameters and mortality. Results: The model measures the relative growth of the expected number of events on the n th day caused by the deviation of environmental parameters from its mean value. The connection between ruptured aortic aneurysms (rAA) and changes in atmospheric pressure is more significant than their connection with mean daily temperatures. With the increase in atmospheric pressure, the rate of rAA mortality also increased. The effects of meteorological parameters were weaker for deaths resulting from acute aortic dissections (AAD), although low mean daily temperatures increased the intensity of occurrence for AAD-related deaths. Conclusion: The occurrence rate of fatal aortic catastrophes showed a slight dependence on the two examined parameters within our groups.
The prognostic value of IDO expression in solid tumors: a systematic review and meta-analysis
Authors: Wang Sen , Wu Jia , Shen Han , Wang Junjun
Published: March 2020

Background: Indoleamine 2,3-dioxygenase (IDO) is a rate-limiting enzyme in the metabolism of tryptophan into kynurenine. It is considered to be an immunosuppressive molecule that plays an important role in the development of tumors. However, the association between IDO and solid tumor prognosis remains unclear. Herein, we retrieved relevant published literature and analyzed the association between IDO expression and prognosis in solid tumors.Methods: Studies related to IDO expression and tumor prognosis were retrieved using PMC, EMbase and web of science database. Overall survival (OS), time to tumor progression (TTP) and other data in each study were extracted. Hazard ratio (HR) was used for analysis and calculation, while heterogeneity and publication bias between studies were also analyzed.Results: A total of 31 studies were included in this meta-analysis. Overall, high expression of IDO was significantly associated with poor OS (HR 1.92, 95% CI 1.52–2.43, P<0.001) and TTP (HR 2.25 95% CI 1.58–3.22, P<0.001). However, there was significant heterogeneity between studies on OS (I2=81.1%, P<0.001) and TTP (I2=54.8%, P=0.007). Subgroup analysis showed lower heterogeneity among prospective studies, studies of the same tumor type, and studies with follow-up periods longer than 45 months.Conclusions: The high expression of IDO was significantly associated with the poor prognosis of solid tumors, suggesting that it can be used as a biomarker for tumor prognosis and as a potential target for tumor therapy.
Untreated dental caries prevalence and impact on the quality of life among 11 to14-year-old Egyptian schoolchildren: A cross-sectional study
Authors: Eid Samar , Khattab Nagwa , Elheeny Ahmad
Published: March 2020

Background
This study aimed to assess caries prevalence and experience among 11 to 14 years, school children, analyze demographic, socioeconomic, personal and professional dental care in relation to untreated carious lesions, and evaluates the effect of decayed teeth on early adolescents’ oral health-related quality of life (OHRQoL).
Methods
A cross-sectional analytical investigation was conducted on 1020 preparatory schoolchildren selected on the basis of a multistage sampling technique. Caries status of the participants detected via recording their caries experience and untreated cavities using DMFT and DT indices. OHRQoL was determined using a validated Arabic CPQ 11-14 short-form questionnaire. Statistical methods for descriptive analysis, chi-square test, Independent-Samples t test and one-way analysis of variance (ANOVA) were used. Multivariate Poisson regression analysis through a hierarchical approach was used to detect the influence of independent variables on DT scores. To declare the association between independent variables and QoL, a step-by-step, multivariate regression analysis was conducted.
Results
The average scores of DMFT and DT in this study were 2.97±1.29 and 1.66±1.24. Poisson regression analysis demonstrated that early adolescents whom their mothers with a lower level of education and of low socioeconomic status were 1.41 and 1.27 times respectively had higher DT scores when compared with their peers. Untreated cavities affected mainly by mother education, school type, family income, and regular dental appointments. Children with DMFT≤3) or DT=0 recorded a statistically significant lower CPQ 11-14 average score (p˂0.01) and (p˂0.0001) respectively.
Conclusions
Untreated carious cavities and caries experience were associated with lower socioeconomic, maternal education andl ess frequent tooth brushing. Untreated carious cavities have a significant negative impact on schoolchildren’s QoL.

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Incidence of deep venous thrombosis (DVT) of lower extremity in patients undergoing surgeries for ankle fractures
Authors: Luo Zixuan , Chen Wei , Li Yansen , Wang Xiaomeng , Wang Weili , Zhu Yanbin , Zhang Fengqi
Published: March 2020

Objective To investigate the incidence of postoperative deep venous thrombosis (DVP) in patients undergoing surgeries for ankle fractures and identify the associated risk factors. Methods This was a retrospective study. A total of 1451 patients undergoing surgery of ankle fractures from January 2016 to June 2019 were included. The inpatient medical record system was inquired for data collection, including demographics, comorbidities, injury and surgery-related data and laboratory biomarkers. DVT of lower extremity was diagnosed by routine doppler examination. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors. Results Among the 1451 patients, DVT was confirmed in 38 cases, indicating an incidence of 2.6%. DVT involved both the operated and non-operated limbs in 8 patients (21.1%). DVT involved superficial femoral vein in 4 cases (6.6%), deep femoral vein in 2 (3.3%), popliteal vein in 5 (8.2%), posterior tibial vein in 11 (18.0%) and peroneal vein in 39 (63.9%). The median interval between operation and diagnosis of DVT was7 days. Six risk factors were identified to be independently associated with DVT, including age (10-year increase) (OR, 1.44), preoperative stay (delay of each day) (OR, 1.11), anesthesia (general vs regional) (OR, 3.51), lower hemoglobin level (OR, 2.02), total cholesterol >5.2mmol/L (OR, 3.20) and reduced lymphocyte count (OR, 3.16). Conclusion These identified factors, although not easily modifiable, do help counsel patients about the risk of DVT and help individualized assessment of the risk factors and accordingly the risk stratification.
Association between Dietary Energy Density with Mental Health and Sleep Quality in Women with Overweight/Obesity
Authors: Maddahi Niloofarsadat , Yarizadeh Habib , Setayesh Leila , Nasir Yasaman , Alizadeh Shahab , Mirzaei Khadijeh
Published: March 2020

Objectives : Mental health, sleep quality and dietary intake are interlinked. Impairment of mental health and low sleep quality may contribute to obesity through the consumption of diets high in energy density. Nevertheless, it is not clear whether dietary energy density (DED) influences mental health. This study aimed to examine the association of DED with mental health indices, including depression, anxiety, stress, and sleep quality in overweight/obese women. Results: After adjustment for age, BMI, and physical activity, subjects in the highest quartile of DED had higher systolic and diastolic blood pressure, but lower serum triglyceride, than those in the lowest quartile (p <0.05). DED was significantly associated with increased odds of stress in the crude (OR =2.15, 95%CI: 1.01-4.56, p= 0.04) and adjusted model for age, BMI, and physical activity (OR = 2.56, 95%CI: 1.13-5.79, p=0.02). No significant relationship was observed between DED and depression, anxiety and sleep quality.
Lifestyle Factors Associated with Prevalent and Exacerbated Musculoskeletal Pain After the Great East Japan Earthquake: A Cross-Sectional Study from the Fukushima Health Management Survey
Authors: Jinnouchi Hiroshige , Ohira Tetsuya , Kakihana Hironobu , Matsudaira Ko , Maeda Masaharu , Yabe Hirooki , Suzuki Yuriko , Harigane Mayumi , Iso Hiroyasu , Kawada Tomoyuki , Yasumura Seiji , Kamiya Kenji
Published: March 2020

Background: While the prevalence of post-disaster musculoskeletal pain has been documented, its associated disaster-related factors have not been investigated. This study was to investigate the association of lifestyle factors associated with musculoskeletal pain after the Great East Japan Earthquake. Methods: We conducted a cross-sectional study of 34,919 participants, aged 40-89 years, without any major disabilities at about 1 year after the disaster. The participants were asked about their musculoskeletal pain (low back and limb pain) and lifestyle factors: use of evacuation shelters or temporary housing at any point of time, job loss after the disaster, decreased income after the disaster, current smoking status, current drinking status, lack of sleep, regular exercise, and participation in recreational or community activities. Furthermore, psychological factors, such as traumatic reactions, psychological distress, and uncomfortable symptoms, affecting musculoskeletal pain were assessed. We used multinomial logistic regression analysis to calculate odds ratios of each lifestyle factor for prevalent and prevalent plus exacerbated musculoskeletal pain. Results: Musculoskeletal pain prevalence was 32.8%: 27.6% for prevalent and 5.2% for prevalent plus exacerbated musculoskeletal pain. Multivariable adjusted odds ratios and 95% confidence intervals of lifestyle factors associated with prevalent and prevalent plus exacerbated musculoskeletal pain were as follows: shelter use (prevalent: 1.02, 0.96-1.08; exacerbated: 1.44, 1.29-1.60), job loss (prevalent: 1.03, 0.96-1.10; exacerbated: 1.30, 1.16-1.47), decreased income (prevalent: 1.13, 1.05-1.21; exacerbated: 1.29, 1.14-1.45), current heavy drinking (prevalent: 1.33, 1.21-1.47; exacerbated: 1.38, 1.14-1.68), insomnia (prevalent: 1.22, 1.15-1.29; exacerbated: 1.50, 1.36-1.65), exercising almost daily (prevalent: 0.83, 0.77-0.91; exacerbated: 0.80, 0.68-0.95), and participating in community activities often (prevalent: 0.83, 0.75-0.92; exacerbated: 0.76, 0.61-0.95). Conclusions: Prevalent and exacerbated musculoskeletal pain were inversely associated with exercising almost daily and participating in recreational or community activities sometimes or often, and positively associated with decreased income, current heavy drinking, and insomnia. Besides, the use of evacuation shelters or temporary housing/job loss was positively associated only with exacerbated musculoskeletal pain. These results suggest that post-disaster lifestyle factors are potentially associated with musculoskeletal pain. To achieve better post-disaster pain management, further studies are needed to confirm the consistency of these results in other disasters and to highlight the underlying causative mechanisms.
Cause and Predictors of Neonatal Mortality among Neonates Admitted to the Neonatal Intensive Care Units of Public Hospitals in Eastern Ethiopia: Facilities Based Prospective Follow-up Study
Authors: Desalew Assefa , Sintayehu Yitagesu , Teferi Nardos , Amare Firehiwot , Geda Bifitu , Worku Teshager , Abera Kebebush , Asefaw Abiyot
Published: March 2020

Background

The first month is the most crucial period for child survival. Neonatal mortality continues to remain high with little improvement over the years in Sub-Saharan Africa including Ethiopia. This region shows the least progress to reducing neonatal mortality and it continues to be a significant public health issue. The facilities-based causes and predictors of neonatal death in the neonatal intensive care unit are not well documented in this study setting. Hence, the aim of this study was to determine the causes and predictors of neonatal mortality among infants admitted to the neonatal intensive care units in Eastern Ethiopia.

Methods

Facilities-based prospective follow-up study was conducted among neonates admitted to the neonatal intensive care units of public hospitals in Eastern Ethiopia from November to December 2018. Data were collected using a pre-tested, structured questionnaire and a follow-up checklist. The main outcomes and causes of death were set by pediatricians and medical residents. Epi-Data 3.1 and Statistical Package for Social Sciences Version 25 software were used for data entry and analysis respectively. Multivariable logistic regression was used to find out the predictors of facilities-based neonatal mortality.

Results

The proportion of facilities-based neonatal mortality was 20%(95% CI: 16.7-23.8%) The causes of death were complications of preterm birth 28.58%, birth asphyxia 22.45%, infection 18.36%, meconium aspiration syndrome 9.18%, respiratory distress syndrome 7.14% and congenital malformation 4.08%. Low birth weight, preterm births, length of stay in NICU, low 5 minute Apgar score, hyperthermia and initiation of feeding were predictors of neonatal death among infants admitted to the neonatal intensive care units in public hospitals, Eastern Ethiopia.

Conclusion

The proportion of facilities-based neonatal deaths was unacceptably high. The main causes of death were preventable and treatable. Hence, improving timing and quality of ANC is essential for early detection, anticipating high-risk newborns and timely interventions. Furthermore, early initiation of feeding and a better referral linkage to tertiary facilities could lead to a reduction of neonatal death in this setting.
Dental expenditure, Progressivity and Horizontal inequality in Chinese adults：Based on the 4th National Oral Health Epidemiology Survey
Authors: CHENG MengLin , WANG ChunXiao , WANG Xing , FENG XiPing , TAI BaoJun , HU DeYu , LIN HuanCai , WANG Bo , ZHENG ShuGuo , LIU XueNan , RONG WenSheng , WANG WeiJian , Si Yan , Xu Tao
Published: March 2020

Background:
The financial burden of oral diseases is getting more important. The aim of this study was to describe the dental expenditure, analyze its progressivity and horizontal inequality under the general health finance and insurance system, and identify the key social determinants of this inequality for Chinese adults.
Methods:
A secondary analysis used the data of 13,464 adults from the 4 th National Oral Health Epidemiological Survey (NOHES) in China was undertook. The dental expenditure in the past year divided into out-of-pocket and health insurance payments was collected. Horizontal inequality index and Kakwani index were used to analyze the horizontal inequality and progressivity, respectively. Decomposition of concentration index was made to explore the associated socioeconomic determinants.
Results:
Mean dental expenditure per capita of Chinese adults was $20.55 (95% CI: 18.83,22.26) and for those who used dental service in the past year, the number was $100.95(95%CI: 93.22,108.68). More than 90% of the expenditure was out-of-pocket. Horizontal inequality indices and Kakwani indices were both negative and that indicated inequalities were in favor of the rich. The socioeconomic factors including income, urban or rural area and educational attainment were the main contributors to the inequality of dental expenditure.
Conclusion:
Dental expenditure for Chinese adults was not too much under a pretty low utilization. The payments of dental expenditure were regressive. People with the most oral health need didn’t meet appropriate dental services. Socioeconomic characteristic including household income, area and education was the main determinant while oral hygiene practice and oral health status were the main individual determinants for the inequality of dental expenditure.
Arsenic trioxide ameliorates experimental autoimmune encephalomyelitis in C57BL/6 mice through inducing apoptosis of CD4+ T cells
Authors: An Ke , Xue Mengjiao , Zhong Jiaying , Yu Shengnan , Qi Zhongquan , Xia Junjie
Published: March 2020

Background: Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system characterized by severe demyelination of white matter. There is no definite cure for MS owing to its complex pathogenesis. Experimental autoimmune encephalomyelitis (EAE) is an ideal animal model for the study of MS. Arsenic trioxide (ATO) is an ancient Chinese medicine used for its therapeutic properties for several autoimmune diseases. It is also used to inhibit acute immune rejection due to its anti-inflammatory and immunosuppressive properties. However, it is unclear whether ATO has a therapeutic effect on EAE, and the underlying mechanisms have not been clearly elucidated. In this study, we attempted to explore the possibility of using ATO to ameliorate EAE in mice.Methods: ATO (0.5 mg/kg/day) was administered intraperitoneally to EAE mice 10 days post-immunization for 8 days. On day 22 post-immunization, the spinal cord, spleen, and blood were collected to analyze demyelination, inflammation, microglia activation, and proportion of CD4+ T cells. In vitro, for mechanistic studies, CD4+ T cells were sorted from the spleen of naïve C57BL/6 mice and treated with ATO and then used for apoptosis assay, JC-1 staining, transmission electron microscope, and western blotting.Results: ATO delayed the onset of EAE and alleviated the severity of EAE in mice. Treatment with ATO also attenuated demyelination, alleviated inflammation, reduced microglia activation and decreased the expression of IL-2, IFN-γ, IL-1β, IL-6, and TNF-α in EAE mice. Moreover, the number and proportion of CD4+ T cells in the spinal cord, spleen, and peripheral blood were reduced in ATO-treated EAE mice. Finally, ATO induced CD4+ T cells apoptosis through the mitochondrial pathway both in vitro and in vivo. Additionally, the administration of ATO had no adverse effect on the heart, liver, and kidney function and did not induce apoptosis in the spinal cord.Conclusions: Overall, our findings indicated that ATO plays a protective role in the initiation and progression of EAE and has the potential to be a novel drug in the treatment of MS.
Clinical and microbiological characteristics of Cryptococcus gattii isolated from 7 hospitals in China
Authors: Jin Liang , Cao Jingrong , Xue Xinying , Wu Hua , Wang Lifeng , Guo Ling , Shen Dingxia
Published: March 2020

Background: Infection, even outbreak, caused by Cryptococcus gattii (C. gattii ) has been reported in Canada and the United States, but there were sparsely-reported cases of C. gattii in China. Our interest in occurrence, clinical manifestation, laboratory identification and molecular characterization of Chinese C. gattii strains leads us to this research.
Results: Out of 254 clinical isolates, initially identified as Cryptococcus neoformans (C. neoformans ), eight strains were re-identified as C. gattii. Multi-locus sequence typing (MLST) showed genotype VGI accounted for the most (6 / 8), the other two strains were genotype VGII（VGIIa and VGIIb respectively）with 3 specific spectra of molecular weight about 4342, 8686, 9611 Dalton by MALDI-TOF MS. The minimal inhibitory concentrations (MICs) of Fluconazole with Yeast one was 2～4 times higher than that with ATB fungus 3 and MICs of antifungal agents against VGII strains were higher than against VGI strains. Comparative proteome analysis showed that 329 and 180 proteins were highly expressed by C. gattii VGI and VGII respectively. The enrichment of differentially expressed proteins was directed to Golgi complex.Conclusions: Infection by C. gattii in China occurred sparsely. Genotype VGI was predominant but VGII was more resistant to antifungal agents. There was significant difference in protein expression profile between isolates of VGI and VGII C. gattii.
Key words: Cryptococcus gattii, Genotype, Antifungal agents, Spectrum, differential protein
Polymorphisms in endoplasmic reticulum aminopeptidase genes are associated with cervical cancer risk in a Chinese Han population
Authors: Li Chuanyin , Li Yaheng , Yan Zhiling , Dai Shuying , Liu Shuyuan , Wang Xia , Wang Jun , Zhang Xinwen , Shi Li , Yao Yufeng
Published: March 2020

Background: Antigen-processing machinery molecules play crucial roles in infectious diseases and cancers. Studies have shown that variants in endoplasmic reticulum aminopeptidase (ERAP) genes can influence the enzymatic activity of ERAP proteins and are associated with the risk of diseases. In the current study, we evaluated the influence of ERAP gene (ERAP1 and ERAP2) variants on susceptibility to cervical intraepithelial neoplasia (CIN) and cervical cancer.
Methods: Six single nucleotide polymorphisms (SNPs) in ERAP1 and 5 SNPs in ERAP2 were selected and genotyped in 556 CIN patients, 1072 cervical cancer patients, and 1262 healthy control individuals. Candidate SNPs were genotyped using SNaPshot assay. And the association of these SNPs with CIN and cervical cancer was analysed.
Results: The results showed that allelic and genotypic frequencies of rs26653 in ERAP1 were significantly different between cervical cancer and control groups (P=0.001 and 0.004). The allelic frequencies of rs27044 in ERAP1 and rs2287988 in ERAP2 were significantly different between control and cervical cancer groups (P=0.003 and 0.004). Inheritance model analysis showed that genotypes of rs27044, rs26618, rs26653 and rs2287988 SNPs may be associated with the risk of cervical cancer (P=0.003, 0.004, 0.001 and 0.002). Additionally, haplotype analysis results showed that the ERAP1 haplotype, rs27044C-rs30187T-rs26618T-rs26653G-rs3734016C, was associated with a lower risk of cervical cancer (P=0.001). The ERAP2 haplotypes rs2549782G- rs2548538A-rs2248374A-rs2287988G-rs1056893T (P=0.009 and 0.006) and rs2549782T-rs2548538T-rs2248374G-rs2287988A-rs1056893T (P=0.003 and 0.009) might be associated with cervical cancer and the development from CIN to cervical cancer. Conclusion: Our results indicated that rs27044, rs26618 and rs26653 in ERAP1 and rs2287988 in ERAP2 influenced susceptibility to cervical cancer.