bluuebunny/crossref_metadata_2025_split huggingface dataset:
Longitudinal mixed methods study assessing caregivers of seniors across diverse populations: research protocol
Authors: Mahboob Afifa , Relyea Erin , Cameron Jill I. , Manuel Lisa , St. John Alex , Huijbregts Maria 
Published: May 2020

Abstract
Background
Canada’s aging population is increasing, along with the number of caregivers providing support to seniors. Caregiving is a taxing responsibility that often results in loneliness and distress. Creating awareness of available supports for caregivers is essential for their health and to provide the best support to the care recipients. This study aims to better understand and improve the caregiving experience for caregivers from diverse ethnic communities and the LGBTQI2S+ communities. The goal is to improve the well-being and resilience of caregivers and optimize outcomes for care recipients by delivering educational workshops that resemble the design of existing workshops currently offered by the participating social service agency. Content will be adapted based on identified participant learning needs. These workshops will be offered to the English-speaking community, diverse newcomer ethnic groups and the LGBTQI2S+ community.

Methods
This mixed-methods, longitudinal study includes two streams of caregivers; Stream One consists of English-speaking caregivers and care recipients while Stream Two includes individuals from the Afghan, Iranian, Somali-, Tamil- and Spanish-speaking populations and those belonging to LGBTQI2S+ communities. Each stream has two phases; Phase One includes needs assessments using focus groups and semi-structured interviews with caregivers and care recipients while Phase Two includes a pre-test post-test evaluation of educational workshops. The anticipated sample size for Phase One is 30 caregivers from the English-speaking community, 150 from the five linguistic/cultural communities combined and 30 from the LGBTQI2S+ group. For Phase Two, we plan to recruit 250 caregivers from the English-speaking community, 250 from the five linguistic/cultural communities, and 50 from the LGBTQI2S+ group.

Discussion
To provide caregivers with optimal support, we must acknowledge the caregivers and care recipients from diverse communities. Currently, at least two focus groups have been conducted with caregivers from each of the seven targeted groups and workshops have begun for all communities. Recruitment has been a challenge for all groups, but our team continues to conduct outreach with caregivers and will use our learning to inform the delivery of educational caregiver workshops.
Community perspectives on the extent to which transactional sex is viewed as sexual exploitation in Central Uganda
Authors: Kyegombe N. , Meiksin R. , Namakula S. , Mulindwa J. , Muhumuza R. , Wamoyi J. , Heise L. , Buller A. M. 
Published: May 2020

Abstract
Background
Definitions of child sexual exploitation vary. Sexual exploitation violates children’s rights and exposes them to mental and physical harm. There exist differences in views of behaviour that is considered exploitative, including transactional sex. This paper explores community perspectives on the extent to which transactional sex is considered exploitative.

Methods
In 2014, we conducted 19 focus group discussions and 44 in-depth interviews with young people and adults in two communities in Uganda. Participants were presented with vignettes describing sexual encounters between adolescent girls and young women and men to explore under what conditions participants considered the scenario to be exploitative and why. Interviews were conducted in Luganda using a semi-structured tool, audio recorded and transcribed verbatim. Analysis was thematic and complemented by constant comparison and deviant case analysis techniques.

Results
Definitions by multilateral, bilateral, and non-governmental organisations of the sexual exploitation of children shared similarities with community conceptualisations of wrong or unfair sex. Although in community conceptualisations there was no consensus on what constituted sexual exploitation, transactional sex was condemned to the extent to which it involved sex with a minor or misled a naïve or immature girl; involved lack of consent, particularly in relationships characterised by power differentials; or worsened the pre-existing status of the girl. Also relevant was the extent to which a man’s intentions were considered inappropriate; the adolescent girl or young woman was considered vulnerable; and the adolescent girl or young woman was considered responsible for ‘her situation’.

Conclusions
Existing social norms that condemn sex with a minor or sex that involves deception, sexual coercion or misleading an immature girl, present opportunities to mobilise communities to protect adolescent girls and young women at risk. Any intervention must, however, be designed with full cognisance of the social and structural drivers that underlie transactional sex and limit adolescent girls’ and young women’s opportunities to provide for themselves without recourse to sexual relationships with men. Interventions must also be designed to recognise that girls in transactional sex relationships may not consider themselves as exploited, thus requiring engagement with them based on their own concerns, aspirations, and expectations.
Validation of a method to assess emphysema severity by spirometry in the COPDGene study
Authors: Occhipinti Mariaelena , Paoletti Matteo , Crapo James D. , Make Barry J. , Lynch David A. , Brusasco Vito , Lavorini Federico , Silverman Edwin K. , Regan Elizabeth A. , Pistolesi Massimo 
Published: May 2020

Abstract
Background
Standard spirometry cannot identify the predominant mechanism underlying airflow obstruction in COPD, namely emphysema or airway disease. We aimed at validating a previously developed methodology to detect emphysema by mathematical analysis of the maximal expiratory flow-volume (MEFV) curve in standard spirometry.

Methods
From the COPDGene population we selected those 5930 subjects with MEFV curve and inspiratory-expiratory CT obtained on the same day. The MEFV curve descending limb was fit real-time using forced vital capacity (FVC), peak expiratory flow, and forced expiratory flows at 25, 50 and 75% of FVC to derive an emphysema severity index (ESI), expressed as a continuous positive numeric parameter ranging from 0 to 10. According to inspiratory CT percent lung attenuation area below − 950 HU we defined three emphysema severity subgroups (%LAA-950insp < 6, 6–14, ≥14). By co-registration of inspiratory-expiratory CT we quantified persistent (%pLDA) and functional (%fLDA) low-density areas as CT metrics of emphysema and airway disease, respectively.

Results
ESI differentiated CT emphysema severity subgroups increasing in parallel with GOLD stages (p < .001), but with high variability within each stage. ESI had significantly higher correlations (p < .001) with emphysema than with airway disease CT metrics, explaining 67% of %pLDA variability. Conversely, standard spirometric variables (FEV1, FEV1/FVC) had significantly lower correlations than ESI with emphysema CT metrics and did not differentiate between emphysema and airways CT metrics.

Conclusions
ESI adds to standard spirometry the power to discriminate whether emphysema is the predominant mechanism of airway obstruction. ESI methodology has been validated in the large multiethnic population of smokers of the COPDGene study and therefore it could be applied for clinical and research purposes in the general population of smokers, using a readily available online website.
LncRNA MIR4435-2HG triggers ovarian cancer progression by regulating miR-128-3p/CKD14 axis
Authors: Zhu Lijuan , Wang Aihua , Gao Mei , Duan Xiaoyan , Li Zehua 
Published: May 2020

Abstract
Background
Accumulating studies showed that long noncoding RNAs (lncRNAs) played vital roles in cancer progression. LncRNA MIR4435-2HG was proved to act as an oncogene in various tumors. However, the underlying function of MIR4435-2HG in ovarian cancer (OC) remains unclear.

Methods
The expression levels of MIR4435-2HG, miR-128-3p and cyclin-dependent kinase 14 (CDK14) were analyzed by quantitative real-time polymerase chain reaction (qRT-PCR). Cell proliferation and apoptosis in OC cells were detected by 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay and flow cytometric analysis, respectively. Transwell assay was applied to evaluate cell migration and invasion. Wound healing assay was performed to monitor the migration rate. Western blot assay was performed to detect the protein levels of Bcl-2, Cleaved PARP, E-cadherin, Vimentin and CDK14 in OC cells. The binding sites between miR-128-3p and MIR4435-2HG or CDK14 were predicted by online tool starBase and their relationship was confirmed by dual-luciferase reporter assay, RIP assay and pull-down experiment.

Results
MIR4435-2HG and CDK14 were over-expressed in OC tissues and cells. Patients with high MIR4435-2HG expression had poorer overall survival (OS) than patients with low MIR4435-2HG expression. MIR4435-2HG knockdown inhibited proliferation, invasion and migration but induced apoptosis of OC cells via miR-128-3p/CDK14 axis. In conclusion, MIR4435-2HG knockdown suppressed the progression of OC cells through downregulating CDK14 expression by the promotion of miR-128-3p.
Preventable admissions and emergency-department-visits in pediatric asylum-seeking and non-asylum-seeking patients
Authors: Brandenberger Julia , Bozorgmehr Kayvan , Vogt Florian , Tylleskär Thorkild , Ritz Nicole 
Published: May 2020

Abstract
Background
Migrant health has become an essential part of public health. According to the World Health Organization, many health systems in Europe have not yet adapted adequately to the needs of asylum-seekers, which might result in untimely and inefficient health care for asylum-seeking patients. The aim of this study was to assess the number of preventable hospital admissions and emergency department visits in asylum-seeking and non-asylum-seeking pediatric patients.

Methods
This is a retrospective, hospital-based study. The study was done at the University Children’s Hospital Basel in Switzerland. Patients admitted or presenting to the emergency department were included and split into the groups of asylum-seeking and non-asylum-seeking patients.
All admissions and emergency-department visits were extracted from the administrative electronic health records from 1st Jan 2016-31st Dec 2017. The main outcome was the proportion of admissions due to ambulatory-care-sensitive conditions (which refer to conditions for which admission can be prevented by early interventions in primary care) in asylum-seeking and non-asylum-seeking patients. Ambulatory-care-sensitive conditions were defined by a validated list of ICD-10 codes.
The secondary objective was to assess the number of preventable emergency-department visits by asylum-seeking patients defined as proportion of visits with a non-urgent triage score.

Results
A total of 75′199 hospital visits were included, of which 63′405 were emergency department visits and 11′794 were admissions. Ambulatory-care-sensitive conditions accounted for 12.1% (18/149) of asylum-seeking and 10.9% (1270/11645) of non-asylum seeking patients’ admissions. Among the emergency department visits by asylum-seeking patients, non-urgent conditions accounted for 82.2% (244/297).

Conclusions
Admissions due to ambulatory-care-sensitive conditions are comparable in asylum-seeking and non-asylum-seeking children, suggesting few delayed presentations to ambulatory care facilities. Strategies to prevent non-urgent visits at pediatric emergency department facilities are needed.
Treatment patterns and survival outcomes of advanced hypopharyngeal squamous cell carcinoma
Authors: Tsai Yao-Te , Chen Wen-Cheng , Chien Chih-Yen , Hsu Cheng-Ming , Lee Yi-Chan , Tsai Ming-Shao , Lin Meng-Hung , Lai Chia-Hsuan , Chang Kai-Ping 
Published: May 2020

Abstract
Background
This study evaluated the treatment outcomes of the primary surgery (PS) or concurrent chemoradiotherapy (CCRT) as the initial treatment for hypopharyngeal squamous cell carcinoma (HPSCC).

Methods
This retrospective cohort study included patients with stages III–IV HPSCC from four tertiary referral centers consecutively enrolled from 2003 to 2012; of them, 213 (32.6%) and 439 (67.4%) had received PS and CCRT as their primary treatments, respectively. The 5-year overall survival (OS) and disease-free survival (DFS) rates were analyzed using the Kaplan–Meier method and Cox regression models.

Results
In patients undergoing PS and CCRT, OS rates were 45.0% and 33.1% (p < 0.001), respectively, and DFS rates were 36.2% and 28.9% (p = 0.003), respectively. In subgroup analysis, in patients with stage IVA HPSCC, PS was associated with higher OS rate (p = 0.002), particularly in those with T4 or N2 classification (p = 0.021 and 0.002, respectively). Multivariate analysis indicated that stage IVA HPSCC, stage IVB HPSCC, and CCRT were independent adverse prognostic factors for OS rate (p = 0.004, < 0.001, and 0.014, respectively). Furthermore, in patients with stage IVA HPSCC aged ≥ 65 years and with N2 classification, CCRT was significantly associated with lower OS rates than was PS (p = 0.027 and 0.010, respectively).

Conclusions
In patients with advanced HPSCC, PS was significantly associated with better prognosis than CCRT. PS could be a favorable primary treatment modality for the management of patients with stage IVA HPSCC, particularly those aged ≥ 65 years and with T4 and N2 classification.
FHF1 is a bona fide fibroblast growth factor that activates cellular signaling in FGFR-dependent manner
Authors: Sochacka Martyna , Opalinski Lukasz , Szymczyk Jakub , Zimoch Marta B. , Czyrek Aleksandra , Krowarsch Daniel , Otlewski Jacek , Zakrzewska Malgorzata 
Published: May 2020

Abstract
Fibroblast growth factors (FGFs) via their receptors (FGFRs) transduce signals from the extracellular space to the cell interior, modulating pivotal cellular processes such as cell proliferation, motility, metabolism and death. FGF superfamily includes a group of fibroblast growth factor homologous factors (FHFs), proteins whose function is still largely unknown. Since FHFs lack the signal sequence for secretion and are unable to induce FGFR-dependent cell proliferation, these proteins were considered as intracellular proteins that are not involved in signal transduction via FGFRs. Here we demonstrate for the first time that FHF1 directly interacts with all four major FGFRs. FHF1 binding causes efficient FGFR activation and initiation of receptor-dependent signaling cascades. However, the biological effect of FHF1 differs from the one elicited by canonical FGFs, as extracellular FHF1 protects cells from apoptosis, but is unable to stimulate cell division. Our data define FHF1 as a FGFR ligand, emphasizing much greater similarity between FHFs and canonical FGFs than previously indicated.

Graphical abstract
Gypenosides regulate farnesoid X receptor-mediated bile acid and lipid metabolism in a mouse model of non-alcoholic steatohepatitis
Authors: Li Hongshan , Xi Yingfei , Xin Xin , Tian Huajie , Hu Yiyang 
Published: May 2020

Abstract
Background
Gypenosides (Gyp) are the main ingredient of the Chinese medicine, Gynostemma pentaphyllum. They are widely used in Asia as a hepatoprotective agent. Here, we elucidated the mechanism of Gyp in non-alcoholic steatohepatitis (NASH) with a focus on farnesoid X receptor (FXR)-mediated bile acid and lipid metabolic pathways.

Methods
NASH was induced in mice by high-fat diet (HFD) feeding, while mice in the control group were given a normal diet. At the end of week 10, HFD-fed mice were randomly divided into HFD, HFD plus Gyp, and HFD plus obeticholic acid (OCA, FXR agonist) groups and were given the corresponding treatments for 4 weeks. Next, we analyzed the histopathological changes as well as the liver triglyceride (TG) level and serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), fasting blood glucose (FBG), fasting insulin (FINS), TG, total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) levels as well as the bile acid profile. We carried out RT-PCR and western blotting to detect HFD-induced alterations in gene/protein expression related to bile acid and lipid metabolism.

Results
The HFD group had histopathological signs of hepatic steatosis and vacuolar degeneration. The liver TG and serum ALT, AST, FBG, FINS, TC, and LDL-C levels as well as the total bile acid level were significantly higher in the HFD group than in the control group (P < 0.01). In addition, we observed significant changes in the expression of proteins involved in bile acid or lipid metabolism (P < 0.05). Upon treatment with Gyp or OCA, signs of hepatic steatosis and alterations in different biochemical parameters were significantly improved (P < 0.05). Further, HFD-induced alterations in the expression genes involved in bile acid and lipid metabolism, such as CYP7A1, BSEP, SREBP1, and FASN, were significantly alleviated.

Conclusions
Gyp can improve liver lipid and bile acid metabolism in a mouse model of NASH, and these effects may be related to activation of the FXR signaling pathway.
Understanding China’s growing involvement in global health and managing processes of change
Authors: Husain Lewis , Bloom Gerald 
Published: May 2020

Abstract
Background
Recent years have seen a rapid change in China’s global engagement and a recognition that solving global challenges will need to take the changing role of China into account. The paper discusses China’s growing involvement in global health. Health is an area where there is broad agreement over global priorities and, potentially, a fertile space to build new forms of collaboration that point the way towards the adaptation of global governance to a rapidly changing context.

Results
Drawing on previous analyses of China’s management of change in its domestic health reforms and interviews with a range of stakeholders in China, the UK and Switzerland, the paper argues that China’s engagement in global health is developing and diversifying rapidly in response to the central government’s desire to see a greater role for China in global health. This diversification is part of a pattern of change management familiar from China’s domestic reform experience. Explorations underway by a range of Chinese agencies form part of a process of rapid experimentation and experiential learning that are informing China’s search for (a) new global role(s).

Conclusions
China is undergoing rapid institutional innovation and developing capacity for greater global engagement, including in health; however, substantial, recent leadership commitments make clear Chinese agencies’ need for continued exploration, innovation and rapid learning. How China engages globally is of significance to the world, not just China. The challenge for China, other global actors and multilateral organisations is to incorporate new approaches into existing global governance arrangements, including for the management of global health. This will require a willingness on all sides to learn from each other and invest the effort needed to build governance arrangements appropriate for the coming decades. This is not only important as a means of protecting global public health, but also as a demonstration of how governance arrangements can be adapted to the needs of a pluralistic global order in a context of rapid change.
Randomized control trial comparing an Alvarado Score-based management algorithm and current best practice in the evaluation of suspected appendicitis
Authors: Tan Winson Jianhong , Acharyya Sanchalika , Chew Min Hoe , Foo Fung Joon , Chan Weng Hoong , Wong Wai Keong , Ooi London Lucien , Ng Jeremy Chung Fai , Ong Hock Soo 
Published: May 2020

Abstract
Background
An objective algorithm for the management of suspected appendicitis guided by the Alvarado Score had previously been proposed. This algorithm was expected to reduce computed tomography (CT) utilization without compromising the negative appendectomy rate. This study attempts to validate the proposed algorithm in a randomized control trial.

Methods
A randomized control trial comparing the management of suspected acute appendicitis using the proposed algorithm compared to current best practice, with the rate of CT utilization as the primary outcome of interest. Secondary outcomes included the percentage of missed diagnosis, negative appendectomies, length of stay in days, and overall cost of stay in dollars.

Results
One hundred sixty patients were randomized. Characteristics such as age, ethnic group, American Society of Anesthesiologist score, white cell count, and symptom duration were similar between the two groups. The overall CT utilization rate of the intervention arm and the usual care arm were similar (93.7% vs 92.5%, p = 0.999). There were no differences in terms of negative appendectomy rate, length of stay, and cost of stay between the intervention arm as compared to the usual care arm (p = 0.926, p = 0.705, and p = 0.886, respectively). Among patients evaluated with CT, 75% (112 out of 149) revealed diagnoses for the presenting symptoms.

Conclusion
The proposed AS-based management algorithm did not reduce the CT utilization rate. Outcomes such as missed diagnoses, negative appendectomy rates, length of stay, and cost of stay were also largely similar. CT utilization was prevalent as 93% of the study cohort was evaluated by CT scan.

Trial registration
The study has been registered at ClinicalTrials.gov (NCT03324165, Registered October 27 2017).
The curative effects of the traditional Chinese herbal medicine “Jinchuang ointment” on excisional wounds
Authors: Ho Tsung-Jung , Chen Jhong-Kuei , Li Tzong Shiun , Lin Jung-Hsing , Hsu Yung-Hsiang , Wu Jia-Ru , Tsai Wan-Ting , Chen Hao-Ping 
Published: May 2020

AbstractBackground“Jinchuang ointment” is a traditional Chinese herbal medicine for external incised wounds. This herbal medicine has been successfully used to treat patients with diabetic foot ulcers and pressure sores in Taiwan for several decades. We previously examined its biological activities on cell-based in vitro assay platforms. Because some patients refused to use animal-derived ingredients ointment during our clinical practice, the efficacy of plant oil-based reconstituted “Jinchuang ointment” was also investigated.MethodsA porcine excisional wound model was established and used to evaluate its efficacy in vivo in this study. Besides, an unusual clinical case is also present.ResultsAs judged from the wound appearance of animal studies on day 14 and the results of blood flow flux at the wound sites on day 28, “Jinchuang ointment” accelerated wound closure significantly better than the control group.ConclusionsThe results from clinical treatment, histopathological evaluation, and the animal study showed that “Jinchung ointment” promotes wound healing significantly better than the control group. Also, sesame oil-reconstituted ointment can be a choice for patients who refuse to use lard-containing ointment.