bluuebunny/crossref_metadata_2025_split huggingface dataset:
Research Article – BMC Health Service Research (IF -1.93) Barriers and Facilitators to Implementing Evidence Based Bleeding Management in Australian Cardiac Surgery Units: A Qualitative Interview Study Analysed With the Theoretical Domains Framework and COM-B Model
Authors: Pearse Bronwyn Louise , Keogh Samantha Louise , Rickard Claire , Fung Lin Yoke 
Published: May 2020

Abstract
BackgroundBleeding during cardiac surgery is a common complication that often requires the transfusion of blood products. The combination of bleeding and blood product transfusion incrementally increases adverse outcomes including infection and mortality. Following bleeding management guideline recommendationscould assist with minimising risk but adherence is not high, and the cause for lack of adherence is not well understood. This study aimed to identify barriers and facilitators to practicing and implementing evidenced-based bleeding management in Australian cardiac surgery units. MethodsWe used a qualitative descriptive design to conduct semi-structuredinterviews with Australian cardiac surgeons, anaesthetists and perfusionists.The Theoretical Domains Framework (TDF) was utilised toguide interviews and thematically analyse the data. Categorised data were then linkedwith the three key domains of the COM-B model (capability, opportunity, and motivation) to explore and understand behaviour.ResultsSeventeen interviews were completed. Nine of the 14 TDF domains emerged as significant. Analysis revealedkey themesto improving capabilityincluded, standardisation, monitoring, auditing, and feedback of data and cross discipline training. Opportunity for change was improved with interpersonal and interdepartmental collaboration through shared goals, and more efficient and supportive processes allowing clinicians to navigate unfamiliar business and financial models of health care. Results suggest as individuals, clinicians had the motivation to make change and healthcare organisations have an obligation and a responsibility to partner with clinicians to support change and improve goal directed best practice. ConclusionUsing a theory-based approachit was possible to identifyfactors which may be positively or negatively influencing clinicians ability to implement best practice bleeding management in Australian cardiac surgical units.
Toward a Recognition of Key Role Players in Community Pharmacy
Authors: Afzali Monireh , Rajabzadeh Ali , Soleymani Fatemeh , Kebriaeezadeh Abbas , Nikfar Shekoufeh 
Published: May 2020

Abstract
Background: Although private community pharmacies are identified as health care facilities, they are highly affected by business management issues and different stakeholders. This study aims to identify, classify and analyze private community pharmacy stakeholders.Methods: A focus group was conducted with key informants to analyze and classify stakeholders using three-dimensional matrix. Identified stakeholders were analyzed regarding three attributes of power, legitimacy and urgency. The results of the focus group were converted to a structured questionnaire and confirmed in several face-to-face interviews until the saturation level.Results: four main levels of relationship and eight category of stakeholders differentiated through an analysis. The core stakeholders group possesses all the attributes and include pharmacy licensee, licensee-owner, responsible pharmacist, customer, prescriber, health insurance, regulatory body, and staff.Conclusion: The core stakeholders are directly involved in decision making. Further deliberations are necessary to analyze the behavior of stakeholders and investigate the communication model.
Dynamic Service Migration in Ultra-Dense Multi-Access Edge Computing network for High Mobility Scenarios
Authors: Lin Haowei , Xu Xiaolong , Zhao Juan , Wang Xinheng 
Published: May 2020

Abstract
The Multi-Access Edge Computing (MEC) has higher computing power than user equipment and lower latency than remote cloud computing, making new types of services and mobile applications keep emerging. However, the movement of users could induce service migration or interruption in the MEC network. Especially for highly mobile users, they accelerate the frequency of services' migration and handover, impacting on the stability of the total MEC network. In this paper, we propose a hierarchical multi-access edge computing architecture, setting up the Infrastructure for dynamic service migration in the ultra-dense MEC networks. Moreover, we propose a new mechanism for users with high mobility in the ultra-dense MEC network, efficiently arranging service migrations for users with high mobility and ordinary users together. Then, we propose an algorithm for evaluating migrated services to contribute to choose the suitable MEC servers for migrated services. The results show that the proposed mechanism can efficiently arrange service migrations and more quickly restore the services even in the blockage. On the other hand, the proposed algorithm is able to make a supplement to the existing algorithms for selecting MEC servers because it can better reflect the capability of migrated services.
Racial and Socioeconomic Disparities in Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement among elderly patients with dementia in the United States from the National inpatient sample
Authors: Kochar Tanureet , Abugroun Ashraf , Nayyar Asma , Rahman Manar Abdel- , Patel Pragnesh J 
Published: May 2020

Abstract
Background

Placement of percutaneous endoscopic gastrostomy (PEG) tube in patients of advanced dementia has not been shown to improve nutritional status or mortality. The objective is to assess racial and socioeconomic disparities for PEG tube placement from National Inpatient Sample.
Methods

In a cross-sectional study, the National inpatient sample (NIS) registry was queried for all patients aged ≥ 70 who were diagnosed with dementia during the year 2016. Patients with dementia were identified using the Tenth revision (ICD-10) codes (F0150, F0151, F0280, F0281, F0390, F0391, G300, G301, G308, G309, G3109, G3183). Patients who received PEG tube were identified using ICD-10 diagnosis codes (Z431). Multivariable logistic regression models were utilized to determine the likelihood of PEG tube placement with adjustment for Patients demographics, socioeconomic factors, degree of frailty and comorbidities.
Results

Out of 1,745,028 patients with dementia, 35,075 patients had PEG tube placed. Majority of patients who received PEG tube were females (54.8%), of white race (45.5%) with a mean age of 82.3 years (SEM 0.02). Compared to controls, those who had PEG tube placement were more frail, had higher prevalence of chronic lung disease, diabetes, stroke, psychosis and nutritional deficiency anemias. On multivariable analysis, higher risk for PEG tube placement was seen in African Americans and Hispanics compared to Caucasians with a-OR 3.76 [95%CI: 3.47–4.07], p < 0.001 and 2.59 [95%CI:2.33–2.88], p < 0.001 respectively. A higher risk was also seen in patients with low income with a-OR 1.1(95%CI: 1.04–1.19), p = 0.002 and among those having Medicaid compared to Medicare insurance with a-OR 1.53 [95%CI: 1.30–1.80], p < 0.001. Compared to males, females were found to have low chances for PEG tube placement with a-OR: 0.78 [95%CO:0.74–0.82], p < 0.001. Hospital ownership, bed size and teaching status were found to have no impact on PEG tube utilization.
Conclusion

Despite the evidence against placement of PEG tubes in dementia patients, our findings confirm that PEG tubes are still being placed in frail and demented elderly. Apart from these, elderly patients with low income, African American origin and Medicaid enrollees have higher incidence of PEG tube placements. Efforts are needed to educate clinicians and community about worse outcomes of PEG tube placement in advanced dementia.
Low Carb (LCD) and Ketogenic (KD) Diets Increase Quality of Life, Physical Performance, Body Composition and Metabolic Health of Women with Breast Cancer Better Than a Standard Diet (SD)
Authors: Kämmerer Ulrike , Klement Rainer J. , Sütterlin Marc , Reuss-Borst Monika 
Published: May 2020

Abstract
Background: Breast Cancer (BC) patients often ask for a healthy diet. Here, we compared three different diets which could support BC patients during the rehabilitation process: a healthy standard diet (SD), a low carb diet (LCD) and a ketogenic diet (KD).Patients and Methods:KOLIBRI was a one-site nutritional intervention trial, combining inpatient and outhouse phases for 20 weeks. Female BC patients (n=152; mean age 51.7 years) could select their diet. Data collected were: quality of life (QoL), spiroergometry, body composition, blood biochemistry. 30, 92 and 30 patients started the KD, LCD and SD, respectively. Of those, 20, 72 and 25 completed the final examination.Results:Patients rated all diets as feasible in daily life. No adverse effects occurred in any diet group. KD offered the highest amount of energy and protein. All groups improved in QoL, body composition and physical performance. KD was superior in improving fatigue, insomnia and physical functioning. KD participants finished with the best physical performance and the highest muscle/fat ratio. Despite their increased cholesterol, KD patients had the best triglyceride/HDL ratio and HOMA-IR. Most metabolic parameters significantly improved in the LCD group. SD participants ended with remarkably low cholesterol levels, but did not improve triglyceride/HDL or HOMA-IR.Conclusions:A well-defined KD and LCD are safe and beneficial for BC. Both diets could thus be recommended for patients wanting to self-support their rehabilitation process.Trial registration IDNCT02092753 Protocol Registration date:02/26/2014Ketogenic Or LOGI Diet In a Breast Cancer Rehabilitation Intervention (KOLIBRI)URL: https://clinicaltrials.gov/ct2/show/NCT02092753?cond=KOLIBRI&draw=2&rank=1
TLR2 deficiency promotes IgE and inhibits IgG1 class-switching following ovalbumin sensitization
Authors: Li Yuqin , Chen Qiu , Ji Wei , Fan Yujie , Huang Li , Chu Chu , Zhou Wei-fang 
Published: May 2020

Abstract
Background: To explore the roles of Toll-like receptor (TLR)2 in Th2 cytokine production and immunoglobulin (Ig) class switching following ovalbumin (OVA) sensitization. Methods: TLR2-/- and wild-type C57BL/6 mice were sensitized by intraperitoneal injection with OVA. Lung pathology was assessed by hematoxylin and eosin staining. Abundance of interleukin (IL)4, IL5, IL13, and IL21 transcripts in the lungs was quantified by RT-PCR. OVA-specific IgG1, IgG2a, IgG2b, IgE and IgM were quantified by enzyme-linked immunosorbent assay. Phosphorylated signal transducer and activator of transcription (STAT)3 in lung tissue was detected by immunohistochemistry staining and nuclear factor (NF) κB activation was measured by immunofluorescence staining. STAT3 activation was inhibited using cryptotanshinone (CPT) treatment. Germline transcripts (Iμ-Cμ, Iγ-Cγ, Iα-Cα or Iε-Cε), post-recombination transcripts (Iμ-Cγ, Iμ-Cα or Iμ- Cε) and mature transcripts (VHDJH-Cγ, VHDJH-Cα or VHDJH-Cε) were analyzed from splenic B cells of OVA-sensitized wild-type mice (with or without CPT treatment) and TLR2-/- mice (with or without IL21 treatment). Results: The lungs of TLR2-/- mice showed a lesser degree of inflammation than wild-type mice after OVA sensitization. Following OVA sensitization, levels of IL4, IL13, and IL21, but not IL5, were significantly lower in TLR2-/- compared with wild-type mice. Moreover, OVA-specific IgG1 and IgE titers were markedly lower and higher, respectively, in TLR2-/- mice. TLR2 deficiency inhibited STAT3 activation but not NF-κB p65 activation. CPT treatment reduced IgG1 titers via inhibition of Stat3 phosphorylation. Both TLR2 knockout and CPT treatment reduced the frequencies of Iγ1-Cγ1, Iγ3-Cγ3 and Iα-Cα transcripts, but IL21 treatment compensated for the effects of TLR2 deficiency. Conclusion: These results suggest a role of TLR2 in restricting OVA-sensitized lung inflammation via promotion of IgG1 and inhibition of IgE class switching regulated by IL21 and STAT3.
Comprehensive analysis of DNA methylation and gene expression profiles in rectal cancer
Authors: Zhang Cheng , Meng Di , Chao Songjie , Ge Chunlin 
Published: May 2020

Abstract
BackgroundAbnormal hypomethylation of oncogenes and hypermethylation of tumor suppressor genes play important roles in human tumorigenesis and cancer progression, including those of rectal cancer (RC). However, conjoint analysis of RC involving both gene expression and methylation profiling datasets remains rare. This study aimed to identify methylation-regulated differentially expressed genes (MeDEGs) and to evaluate their prognostic value in RC through bioinformatics analysis.MethodsGene expression (GSE20842 and GSE68204) and gene methylation (GSE75546) profiling datasets were obtained from the Gene Expression Omnibus database. GEO2R was adopted to identify differentially expressed genes (DEGs) and differentially methylated genes (DMGs). MeDEGs were obtained by overlapping the DEGs and DMGs and then subjected to protein–protein interaction (PPI) network analysis using STRING. Modules and hub genes within the network were identified using MCODE and CytoHubba, respectively. Prognostic MeDEGs were selected by univariate Cox regression. Finally, our findings were validated based on The Cancer Genome Atlas (TCGA) database.ResultsIn total, 243 upregulated-hypomethylated and 51 downregulated-hypermethylated genes were identified as MeDEGs. A PPI network of MeDEGs was constructed with 290 nodes and 578 edges. Three modules and three hub genes—COL3A1, FPR1, and PLK1—within the network were identified. Three MeDEGs—NFE2, COMP, and LAMA1—were found to be survival-related. Furthermore, the expression and methylation status of two hub genes (excluding FPR1) and the three prognostic MeDEGs were also significantly altered in TCGA and were consistent with our findings.ConclusionsWe identified novel MeDEGs and explored their relationship with survival in RC. Our methodology may provide an effective bioinformatics basis for further understanding of the methylation-mediated regulatory mechanisms in RC.
Lenvatinib Promotes the Antitumor Effects of Doxorubicin in Anaplastic Thyroid Cancer
Authors: Su Xi , Liu Jiaxin , Zhang Haihong , Gu Qingqing , Zhou Xinrui , Ji Meiju , Yao Demao 
Published: May 2020

Abstract
Background
Anaplastic thyroid cancer (ATC) is a kind of rare thyroid cancer with very poor prognosis. It is one of the deadliest cancers in human due to the aggressive behavior and resistance to treatment. Doxorubicin has been approved in ATC treatment as a single agent, but monotherapy still shows no improvement of the total survival in advanced ATC. Lenvatinib was investigated with encouraging results in treating the patients with radioiodine-refractory differentiated thyroid cancer (DTC). However, antitumor efficacy of combination therapy with lenvatinib and doxorubicin remains largely unclear.
Methods
The antitumor efficacy of combination therapy with lenvatinib and doxorubicin on ATC cell proliferation and was assessed by the MTT assay and colony formation. Flow cytometry were employed to assess ATC cells’ apoptosis and cell cycle arrest in response to combination therapy. Xenograft models were used to test its in vivo antitumor activity.
Result
Lenvatinib monotherapy was less effective than doxorubicin in treating ATC cell lines and xenografts model. The combination therapy of lenvatinib and doxorubicin significantly inhibited ATC cell proliferation and tumor growth in nude mice, and induced cell apoptosis and cell cycle arrest in compared to lenvatinib or doxorubicin monotherapy.
Conclusion
Lenvatinib promotes the antitumor effects of doxorubicin in ATC cell and xenografts model. Lenvatinib/doxorubicin combination may be a potential candidate therapeutic approach for ATC.
­ Comprehensive analysis of key genes associated with ceRNA networks in nasopharyngeal carcinoma based on bioinformatics analysis
Authors: Xu Yuanji , Huang Xinyi , Ye Wangzhong , Zhang Yangfan , Li Changkun , Bai Penggang , Lin Zhizhong , Chen Chuanben 
Published: May 2020

Abstract
Background

Nasopharyngeal carcinoma (NPC) is an epithelial malignancy with high morbidity rates in the east and southeast Asia. The molecular mechanisms of NPC remain largely unknown. We explored the pathogenesis, potential biomarkers, and prognostic indicators of NPC.

Methods

We analyzed mRNAs, long non-coding RNAs (lncRNAs), and microRNAs (miRNAs) in the whole transcriptome sequencing dataset of our hospital (five normal tissues vs. five NPC tissues) and six microarray datasets (62 normal tissues vs. 334 NPC tissues) downloaded from the Gene Expression Omnibus (GSE12452, GSE13597, GSE95166, GSE126683, and GSE70970, GSE43039). Differential expression analyses, gene ontology (GO) enrichment, kyoto encyclopedia of genes and genomes (KEGG) analysis, and gene set enrichment analysis (GSEA) were conducted. The lncRNA-miRNA-mRNA competing endogenous RNA (ceRNA) networks were constructed using the miRanda and TargetScan database, and a protein-protein interaction (PPI) network of differentially expressed genes (DEGs) was built using Search Tool for the Retrieval of Interacting Genes (STRING) software. Hub genes were identified using Molecular Complex Detection (MCODE), NetworkAnalyzer, and CytoHubba.

Results

We identified 61 mRNAs, 14miRNAs, and 10 lncRNAs as DEGs related to NPC. Changes in NPC were enriched in the chromosomal region, sister chromatid segregation, and nuclear chromosome segregation. GSEA indicated that the mitogen-activated protein kinase (MAPK) pathway, phosphatidylinositol-3 OH kinase/protein kinase B (PI3K-Akt) pathway, apoptotic pathway, and tumor necrosis factor (TNF) were involved in the initiation and development of NPC. Finally, 20 hub genes were screened out via the PPI network.

Conclusions

Our findings could offer insights into the biological mechanisms underlying NPC and identify potential therapeutic targets, biomarkers and prognostic indicators for NPC.
Investigation of the genetic variation in ACE2 on the structural recognition by the novel coronavirus (SARS-CoV-2)
Authors: Guo Xingyi , Chen Zhishan , Xia Yumin , Lin Weiqiang , Li Hongzhi 
Published: May 2020

Abstract
Background: The outbreak of coronavirus disease (COVID-19) was caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), through its surface spike glycoprotein (S protein) recognition on the receptor Angiotensin-converting enzyme 2 (ACE2) in humans. However, it remains unclear how genetic variations in ACE2 may affect its function and structure, and consequently alter the recognition by SARS-CoV-2. Methods: We have systemically characterized missense variants in the gene ACE2 using data from the Genome Aggregation Database (gnomAD; N = 141,456). To investigate the putative deleterious role of missense variants, six existing functional prediction tools were applied to evaluate their impact. We further analyzed structural flexibility of ACE2 and the protein-protein interface with the S protein of SARS-CoV-2 using our developed Legion Interfaces Analysis (LiAn) program. Results: Here, we characterized a total of 12 ACE2 putative deleterious missense variants. Of those 12 variants, we further showed that p.His378Arg could directly weaken the binding of catalytic metal atom to decrease ACE2 activity and p.Ser19Pro could distort the most important helix to the S-protein. Another seven missense variants may affect secondary structures (i.e. p.Gly211Arg; p.Asp206Gly; p.Arg219Cys; p.Arg219His, p.Lys341Arg, p.Ile468Val, and p.Ser547Cys), whereas p.Ile468Val with AF = 0.01 is only present in Asian. Conclusions: We provide strong evidence of putative deleterious missense variants in ACE2 that are present in specific populations, which could disrupt the function and structure of ACE2. These findings provide novel insight into the genetic variation in ACE2 which may affect the SARS-CoV-2 recognition and infection, and COVID-19 susceptibility and treatment.
The Added Value of An Open Narrative in Verbal Autopsies – A Mixed-Methods Evaluation from Malawi
Authors: Loh Patricia , Fottrell Edward , Beard James , Bar-Zeev Naor , Phiri Tambosi , Banda Masford , Makwenda Charles , Bird Jon , King Carina 
Published: May 2020

Abstract
Background: The World Health Organization’s standardised verbal autopsy (VA) instrument consists of closed questions, ascertaining signs and symptoms of illness preceding death, and an optional open narrative. As VA analyses increasingly use automated algorithms, the inclusion of narratives should be justified. We evaluated the role of open narratives on VA processes, data quality and respondent emotion.Methods: A mixed-methods analysis was conducted using VA process data for deaths of children aged 0–59 months between April 2013 and November 2016 in Mchinji district, Malawi. Deaths were randomised at the point of interview to receive closed questions only or an open narrative followed by closed questions. Upon concluding the VA, interviewers self-completed questions relating to respondent emotions. Logistic regression was conducted to determine associations with visible emotions during VAs. A group discussion with the interviewers was conducted at the project end, to understand field experiences and explore future recommendations. Qualitative data were coded using deductive themes.Results: A total of 2509 VAs were included, with 49.8% (n = 1341) allocated to open narratives. Narratives lasted a median of 7 minutes (range: 1–113 minutes). Interviewers reported improved respondent rapport and felt narratives improved data quality, although there was no difference in the proportion of deaths with an indeterminate cause (5.3% vs. 6.1%). The majority of respondents did not display visible emotions during VA (81%). Those with a narrative had higher, but not statistically significant, odds of displaying emotion (aOR: 1.20; 95% CI: 0.98, 1.47). Factors associated with visible emotions were: infant deaths compared to neonates; deaths at a health centre or en-route to hospital versus home; and higher socio-economic status. Non-parental respondents and increased time between death and interview were associated with lower odds of emotion.Conclusion: Conducting an open narrative at the start of the VA to build rapport, something valued by the interviewers, may outweigh the additional time taken and slight increase in respondents becoming emotional. However, undue burdens associated with narratives may be further justified if the quality and utility of information from the narrative was promoted through standardised recommendations.