bluuebunny/crossref_metadata_2025_split huggingface dataset:
Wrist pain: a systematic review of prevalence and risk factors– what is the role of occupation and activity?
Authors: Ferguson R. , Riley N. D. , Wijendra A. , Thurley N. , Carr A. J. , BJF Dean 
Published: November 2019

AbstractObjectiveTo evaluate the prevalence and risk factors of wrist pain.MethodsSystematic review. Data sources: The MEDLINE and EMBASE via OVID, CINAHL and SPORTDiscus via EBSCO databases were searched from database inception to 9th March 2018. Specific criteria were used to define inclusion and exclusion. Data was extracted independently by a pair of reviewers.ResultsIn total 32 cross sectional studies were identified for inclusion (1 with a longitudinal component). The median prevalence of wrist pain in the general population and non-manual workers within the short term (within last week) was 6 and 4.2% within the medium term (> 1 week and within a year). The median prevalence of wrist pain in physically demanding occupations and sports people was 10% within the short term and 24% within the medium term. Non-modifiable factors associated with wrist pain included increased age (1 study in adults and 3 studies in children/adolescents) and female sex (2 studies). Modifiable risk factors included high job physical strain (2 studies), high job psychological strain (1 study), abnormal physeal morphology in children/adolescents (2 studies), high frequency impact tool use (1 study) and effort reward imbalance (1 study).ConclusionsWrist pain is highly prevalent in groups who partake in physically demanding activities from day to day such as manual labourers and sportspeople. It is less prevalent in the general population and non-manual workers, although there is a relative lack of research in the general population.Trial registrationThe review protocol was registered with PROSPERO under the registration numberCRD42018090834.Level of Evidence1 (Prognostic study).
Effectiveness of flipped classroom combined with team-, case-, lecture- and evidence-based learning on ophthalmology teaching for eight-year program students
Authors: Ding Chun , Li Shengguo , Chen Baihua 
Published: November 2019

Abstract
Background
This study aimed to investigate the benefits and challenges of the flipped classroom combined with team-, case-, lecture- and evidence-based learning (FC-TCLEBL) for ophthalmology teaching for eight-year program students.

Methods
FC-TCLEBL and the traditional lecture-based classroom (LBC) were compared based on student and teacher feedback questionnaires, student learning burden, and scores on standardized tests as well as their effects on the abilities of clinical thinking, scientific research, active-learning, practical application, humanistic care and communication with patients.

Results
Both the students and teachers were more satisfied with the FC-TCLEBL model. More students in the FC-TCLEBL group agreed that the course helped them to develop skills in creative thinking, problem solving, and teamwork. Students in the FC-TCLEBL group spent significantly more time preparing for class than those in the LBC group, but the time spent on review was significantly lower in the FC-TCLEBL group. The students from the FC-TCLEBL group performed better in a post-test on diabetic retinopathy (DR) as compared to the LBC group.

Conclusions
FC-TCLEBL teaching model is effective and suitable for ophthalmology teaching.
Evaluation of safety attitudes of hospitals and the effects of demographic factors on safety attitudes: a psychometric validation of the safety attitudes and safety climate questionnaire
Authors: Zhao Chuang , Chang Qing , Zhang Xi , Wu Qijun , Wu Nan , He Jiao , Zhao Yuhong 
Published: November 2019

Abstract
Background
The objectives of this study are to test the psychometric properties of the safety attitudes and safety climate questionnaire Chinese simplified version (SAQ-CS), to test the safety attitudes of health professionals in tertiary hospitals in the Liaoning province and to explore the effects of demographic factors on safety attitudes.

Methods
The SAQ-CS was used to conduct a cross-sectional survey in nine tertiary hospitals in Liaoning province.

Results
Cronbach’s alpha of each subscale of SAQ-CS were > 0.7, the values of GFI, TLI, and CFI were > 0.8, and RMSEA values ranged from 0.048–0.199. The mean of the safety attitudes of 2157 health professionals was 4.00, indicating a good safety attitude, with a positive response rate (% of items that scored ≥4) of 51.1%. The stress recognition subscale had the lowest score, with a mean of 2.73 and a positive response rate of 17.8%. A multiple linear regression equation revealed that demographic factors like gender, age, and training participation significantly affected the scores (βgender > 0.06, βage < − 0.08, βtraining < − 0.07, p < 0.05).

Conclusions
The psychometric properties of SAQ-CS are good and stable. Health professionals rate teamwork climate, safety climate, perception of management, and work conditions in Liaoning province are perceived as good; however, the stress of the health professionals is poor. To improve safety attitudes, it is necessary to not only reduce the stress of health professionals, but also to pay more attention to men, older health professionals, and health professionals who have not participated in safety training.
Make it complicated: a qualitative study utilizing a complexity framework to explain improvement in health care
Authors: Storkholm Marie Höjriis , Mazzocato Pamela , Savage Carl 
Published: November 2019

AbstractBackgroundSuccessful application of Quality Improvement (QI) methods is challenging, and awareness of the role context plays has increased. Complexity science has been advocated as a way to inform change efforts. However, empirical support is scarce, and it is still difficult to grasp the practical implications for QI interventions. The aim of this study was to use a complexity-based leadership framework to explain how managers in a clinical department addressed external requirements to cut costs without compromising patient outcomes and experience.MethodsExplanatory case study design of a Danish OB/GYN department tasked to improve efficiency. Data came from documents, 30 interviews, and 250 h of observations over 3 years. A Complexity Analysis Framework that combined two complexity-based leadership frameworks was developed to analyze all changes implemented to reduce cost, while maintaining clinical quality.ResultsManagers reframed the efficiency requirement as an opportunity for quality improvement. Multiple simple, complicated, and complex situations were addressed with an adaptive approach to quality improvement. Changes were made to clinical pathways for individual conditions (n = 37), multiple conditions (n = 7), and at the organizational level (n = 9). At the organizational level, changes addressed referral practice, physical space in the department, flow and capacity, discharge speed, and managerial support. Managers shared responsibility with staff; together they took a “professional path” and systematically analyzed each clinical pathway through process mapping, attentive to patterns that emerged, before deciding on the next steps, such as a engaging in a complex process of probing – the iterative development and testing of new responses.ConclusionsQuality improvement efforts could benefit from an understanding of the importance of learning and sharing responsibility to deal with the co-existing degrees of contextual complexity in modern health care. By “making things complicated” through a systematic analysis that engages staff in an open and reflective dialog, clinical praxis and established organizational structures can be questioned and improved. The Complexity Analysis Framework could then help managers to identify improvement opportunities, know when to implement technical solutions, and when to keep abreast of emerging patterns and allow appropriate responses to complex challenges to evolve.
The association of cognitive functioning as measured by the DemTect with functional and clinical characteristics of COPD: results from the COSYCONET cohort
Authors:   the COSYCONET study group, von Siemens Sarah Marietta , Perneczky Robert , Vogelmeier Claus F. , Behr Jürgen , Kauffmann-Guerrero Diego , Alter Peter , Trudzinski Franziska C. , Bals Robert , Grohé Christian , Söhler Sandra , Waschki Benjamin , Lutter Johanna I. , Welte Tobias , Jörres Rudolf A. , Kahnert Kathrin 
Published: November 2019

AbstractAlterations of cognitive functions have been described in COPD. Our study aimed to disentangle the relationship between the degree of cognitive function and COPD characteristics including quality of life (QoL).Data from 1969 COPD patients of the COSYCONET cohort (GOLD grades 1–4; 1216 male/ 753 female; mean (SD) age 64.9 ± 8.4 years) were analysed using regression and path analysis. The DemTect screening tool was used to measure cognitive function, and the St. George‘s respiratory questionnaire (SGRQ) to assess disease-specific QoL.DemTect scores were < 9 points in 1.6% of patients and < 13 points in 12% when using the original evaluation algorithm distinguishing between < 60 or > =60 years of age. For statistical reasons, we used the average of both algorithms independent of age in all subsequent analyses. The DemTect scores were associated with oxygen content, 6-min-walking distance (6-MWD), C-reactive protein (CRP), modified Medical Research Council dyspnoea scale (mMRC) and the SGRQ impact score. Conversely, the SGRQ impact score was independently associated with 6-MWD, FVC, mMRC and DemTect. These results were combined into a path analysis model to account for direct and indirect effects. The DemTect score had a small, but independent impact on QoL, irrespective of the inclusion of COPD-specific influencing factors or a diagnosis of cognitive impairment.We conclude that in patients with stable COPD lower oxygen content of blood as a measure of peripheral oxygen supply, lower exercise capacity in terms of 6-MWD, and higher CRP levels were associated with reduced cognitive capacity. Furthermore, a reduction in cognitive capacity was associated with reduced disease-specific quality of life. As a potential clinical implication of this work, we suggest to screen especially patients with low oxygen content and low 6-MWD for cognitive impairment.
Restructured Lactococcus lactis strains with emergent properties constructed by a novel highly efficient screening system
Authors: Liu Fulu , Zhang Yating , Qiao Wanjin , Zhu Duolong , Xu Haijin , Saris Per Erik Joakim , Qiao Mingqiang 
Published: November 2019

Abstract
Background
After 2.83% genome reduction in Lactococcus lactis NZ9000, a good candidate host for proteins production was obtained in our previous work. However, the gene deletion process was time consuming and laborious. Here, we proposed a convenient gene deletion method suitable for large-scale genome reduction in L. lactis NZ9000.

Results
Plasmid pNZ5417 containing a visually selectable marker PnisZ-lacZ was constructed, which allowed more efficient and convenient screening of gene deletion mutants. Using this plasmid, two large nonessential DNA regions, L-4A and L-5A, accounting for 1.25% of the chromosome were deleted stepwise in L. lactis 9k-3. When compared with the parent strain, the mutant L. lactis 9k-5A showed better growth characteristics, transformability, carbon metabolic capacity, and amino acids biosynthesis.

Conclusions
Thus, this study provides a convenient and efficient system for large-scale genome deletion in L. lactis through application of visually selectable marker, which could be helpful for rapid genome streamlining and generation of restructured L. lactis strains that can be used as cell factories.
Circ_ZNF124 promotes non-small cell lung cancer progression by abolishing miR-337-3p mediated downregulation of JAK2/STAT3 signaling pathway
Authors: Li Qianping , Huang Qin , Cheng Shaofei , Wu Song , Sang Hongyang , Hou Junyi 
Published: November 2019

Abstract
Background
Previous genome-wide transcriptome profiling found circ_ZNF124 was highly expressed in lung adenocarcinoma, however, the role of circ_ZNF124 in non-small cell lung cancer (NSCLC) is still unknown. The purpose of this study was to investigate the role and molecular mechanism of circ_ZNF124 in NSCLC development.

Methods
The expression of circ_ZNF124, miR-337-3p and JAK2 (Janus Kinase 2) in lung cancer cell lines and normal epithelial cells were detected by qRT-PCR (quantitative real-time PCR). siRNA was used to knockdown circ_ZNF124 expression in cells. The effects of circ_ZNF124 in NSCLC cells were determined by cell growth, cell migration, cell cycle analysis and colony formation. Bioinformatics analysis, RNA immunoprecipitation, luciferase assay and western blots were used to study the molecular mechanism of circ_ZNF124 in NSCLC.

Results
The results showed that circ_ZNF124 expression was highly upregulated in NSCLC cells than in normal epithelial cells. Knockdown of circ_ZNF124 by using siRNA significantly decreased cell growth, promoted cell cycle arrested in sub-G1 phase, impaired cell migration and colony formation. Bioinformatic analysis discovered that miR-337-3p was a direct target of circ_ZNF124. In contrast to circ_ZNF124, miR-337-3p expression was significantly downregulated in NSCLC cells. Biotin labeled circ_ZNF124 immunoprecipitation and luciferase assay showed that miR-337-3p could directly bind to and affect circ_ZNF124 activity. The regulation of circ_ZNF124 on miR-337-3p was also investigated. Further analysis showed that despite STAT3 (signal transducer and activator of transcription 3), JAK2 was also a target of miR-337-3p, overexpression of miR-337-3p greatly downregulated JAK2, STAT3 and JAK2/STAT3 downstream regulated oncogenes HIF1a (Hypoxia-inducible factor 1-alpha), BCL2 (B cell lymphoma 2) and c-FOS expression, however, the roles of miR-337-3p in JAK2/STAT3 signaling pathway were greatly inhibited in the presence of circ_ZNF124.

Conclusion
In NSCLC, highly expressed circ_ZNF124 promoted the activation of JAK2/STAT3 signaling pathway by acting as a sponge of miR-337-3p, thus promoting the occurrence and development of NSCLC. Circ_ZNF124 could be a potential biomarker or target for the treatment of NSCLC patients in the future.
Clinical-biological characteristics and treatment outcomes of pediatric pro-B ALL patients enrolled in BCH-2003 and CCLG-2008 protocol: a study of 121 Chinese children
Authors: Gao Chao , Liu Shu-Guang , Yue Zhi-Xia , Liu Yi , Liang Jing , Li Jun , Zhang Yuan-Yuan , Yu Jiao-Le , Wu Ying , Lin Wei , Zheng Hu-Yong , Zhang Rui-Dong 
Published: November 2019

Abstract
Background
Although leukemic blast cells of Pro-B cell acute lymphoblastic leukemia (ALL) are arrested at the same stage of B cell differentiation, the immature B cell subtype is still biologically heterogeneous and is associated with diverse outcomes. This study aimed to explore the clinical-biological characteristics of pediatric pro-B ALL and factors associated with outcomes.

Methods
This study enrolled 121 pediatric patients aged 6 months to 14 years with newly diagnosed CD19+CD10− pro-B cell acute lymphoblastic leukemia (pro-B ALL) treated at Beijing Children’s Hospital from March 2003 to October 2018. Genetic abnormalities, immunophenotypic markers, minimal residual disease (MRD) at early treatment stage and long-term outcomes of children treated on two consecutive protocols were analyzed.

Results
KMT2A rearrangements were the most frequent abnormalities (incidence rate 33.06%), and were associated with lower frequency of CD13, CD33, CD22 and CD34 expression and higher frequency of CD7 and NG2 expression. Higher frequency of CD15 and CD133 expression was found in KMT2A-AFF1+ patients, exclusively. Presence of CD15 and absence of CD34 at diagnosis correlated with the high burden of MRD at the early stage of treatment. Outcomes were more favorable in patients older than 1 year, with absence of CD20 expression and KMT2A rearrangements, and with MRD lower than 1% at the end of induction and 0.1% before consolidation. Increased intensity of chemotherapy based on MRD analysis did not improve outcomes significantly (5-year EFS 73.9 ± 6.5% for BCH-2003 and 76.1 ± 5.3% for CCLG-2008, P = 0.975). Independent adverse prognostic factors were MRD ≥ 0.1% before consolidation and presence of KMT2A gene rearrangements (odds ratios [ORs] 9.424 [95% confidence interval (CI) 3.210, 27.662; P < 0.001]; 4.142 [1.535, 11.715, P = 0.005]; respectively).

Conclusions
Pediatric pro-B ALL is a heterogeneous disease. Genetic analysis and MRD evaluation can predict patients with dismal prognosis; however, intensive chemotherapy alone does not improve outcomes of these patients and targeted therapy or hematopoietic stem cell transplantation may be required.
The relationship between vitamin D and risk of atrial fibrillation: a dose-response analysis of observational studies
Authors: Liu Xiao , Wang Wei , Tan Zhaochong , Zhu Xin , Liu Menglu , Wan Rong , Hong Kui 
Published: November 2019

Abstract
Background
The relationship between serum vitamin D and atrial fibrillation (AF) or postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass graft (CABG) is still debated. It is also unclear whether there is a dose-response relationship between circulating vitamin D and the risk of AF or POAF.

Methods
The Cochrane Library, PubMed, and Embase databases were searched for relevant studies. We used a “one-stage approach” with a restricted cubic spline model to summarize the dose-specific relationships between serum vitamin D and AF. Relative risk (RR) was used to measure the effects in this meta-analysis.

Results
In total, 13 studies were included with a total of 6519 cases of AF among 74,885 participants. Vitamin D deficiency (< 20 ng/ml) was associated with increased risks of AF (RR: 1.23, 95% CI: 1.05–1.43). In the dose-response analysis, the summary RR for a 10 ng/ml increased in vitamin D was 0.88 (95% CI: 0.78–0.98) and there was no evidence of a non-linear association, Pnon-linearity = 0.86. In the age subgroup, high vitamin D (per 10 ng/ml increase) reduced the risk of AF in the older group (> 65 years) (RR = 0.68, 95% CI = 0.52–0.89) but not among young individuals (< 65 years) (RR = 0.87, 95% CI = 0.72–1.06). In addition, a strong association was found between a 10 ng/ml increased in vitamin D and POAF incident in the patient after CABG (RR: 0.44, 95% CI: 0.24–0.82).

Conclusion
Our dose-response meta-analysis suggested serum vitamin D deficiency was associated with an increased risk of AF in the general population and POAF in patients after CABG. Further studies are needed to explore the age difference in the association between serum vitamin D level and the risk of AF and whether vitamin D supplements will prevent AF.

Trial registration
This study has been registered with PROSPERO (International prospective register of systematic reviews)-registration number-CRD42019119258.
The regulatory roles of neutrophils in adaptive immunity
Authors: Li Yang , Wang Wei , Yang Fan , Xu Yanan , Feng Chang , Zhao Yong 
Published: November 2019

AbstractNeutrophils have long been considered as cells playing a crucial role in the immune defence against invading pathogens. Accumulating evidence strongly supported the direct and indirect regulatory effects of neutrophils on adaptive immunity. Exogenous cytokines or cytokines produced in an autocrine manner as well as a cell-to-cell contact between neutrophils and T cells could induce the expression of MHC-II and costimulatory molecules on neutrophils, supporting that neutrophils may function as antigen-presenting cells (APCs) in respects of presenting antigens and activating T cells. In addition to the inflammatory roles, neutrophils also have the propensity and ability to suppress the immune response through different mechanisms. In this review, we will mainly highlight the heterogeneity and functional plasticity of neutrophils and the antigen-presenting capacity of different neutrophil subsets. We also discuss mechanisms relevant to the regulatory effects of neutrophils on adaptive immunity. Understanding how neutrophils modulate adaptive immunity may provide novel strategies and new therapeutic approaches for diseases associated with neutrophils.Graphical abstract
Screen time and problem behaviors in children: exploring the mediating role of sleep duration
Authors: Guerrero Michelle D. , Barnes Joel D. , Chaput Jean-Philippe , Tremblay Mark S. 
Published: November 2019

Abstract
Background
Previous research examining the relationship between screen time (ST) and psychological health outcomes have primarily focused on one type of ST (i.e., television), while little research has considered other types of screens (e.g., videos, movies, social media), screen content (e.g., violent video games), or potential mediating variables. Therefore, the purpose of the present study was to assess ST types and content and their association with problem behaviors, and to determine whether these relationships were mediated by sleep duration.

Methods
Parents and children provided cross-sectional baseline data (2016–18) as part of the Adolescent Brain Cognitive Development study, a broadly US representative sample of 11,875 children aged 9 to 10 years. Parents self-reported their children’s emotional and behavioral syndromes via the Child Behavior Checklist and sleep duration using one item from the Parent Sleep Disturbance Scale. Children self-reported their ST behavior, which comprised ST types (television/movies, videos, video games, and social media) and content (mature-rated video games and R-rated movies).

Results
Time spent in various ST types was positively associated with problem behaviors: watching television/movies was associated with a 5.9% increase in rule-breaking behavior (incidence rate ratio [IRR] = 1.059), 5% increase in social problems (IRR = 1.050), 4% increase in aggressive behavior (IRR = 1.040), and 3.7% increase in thought problems (IRR = 1.037). Greater time spent playing mature-rated video games was associated with greater somatic complaints (IRR = 1.041), aggressive behavior (IRR = 1.039), and reduced sleep duration (IRR = .938). Sleep duration mediated the relationship between ST (type and content) and problem behaviors, albeit the effect sizes were small. The largest effects were observed between sleep duration and all problem behaviors, with greater sleep duration predicting an 8.8–16.6% decrease in problem behaviors (IRRs ranging from .834 to .905).

Conclusion
Greater time spent in ST behavior was associated with greater problem behaviors among children. There was strong evidence that longer sleep duration was associated with reduced problem behaviors. While sleep duration mediated the effects of ST on problem behaviors, other potential mediating variables need to be investigated in future research.