bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and validation of dust exposure prevention questionnaire for cardiovascular patients based on the health belief model
Authors: Noroozi Farzaneh , Eisapareh Kumars , Bahadori Alireza , Ghahremani Leila , Cousins Rosanna , Mokarami Hamidreza 
Published: November 2020

AbstractBackgroundMany cardiovascular patients suffer from respiratory failure. Environmental conditions can exacerbate symptomatology. It is necessary to prevent exposure to dust by taking educational steps to identify and modify patient behavior. This study aimed to develop and validate a dust exposure behavior questionnaire based on the Health Belief Model.MethodsA mixture of qualitative and quantitative methods was employed to design and develop the desired tool. Qualitative methods were used to identify the preventive behaviors needed by cardiovascular patients at risk of dust exposure using the opinions of two expert panels and a literature review. The quantitative phase of the research was performed to evaluate the psychometric properties of the research tool. The research population comprised 417 people with cardiovascular disease referred to a heart hospital in Bushehr, Iran in 2018. Consenting participants entered the study through consecutive sampling.ResultsThe final version of the questionnaire included 27 items across six domains, namely perceived susceptibility, perceived barriers, perceived severity, perceived benefits, cues to action, and self-efficacy. The mean values of the content validity ratio and content validity index were 0.93 and 0.9, respectively. In addition, all items had a good correlation with the total score of their parent domain (P < 0.01). The model fit was initially unsuitable, according to the related indices. Hence, to achieve a better model fit, the model was improved by releasing some parameters based on the modifications suggested by the AMOS software. The modified model featured an acceptable fit (χ2/df = 2.2,P < 0.001). Cronbach’s alpha coefficients also confirmed appropriate reliability for all six domains.ConclusionThe Dust Exposure Prevention questionnaire has desirable psychometric properties and appropriate validity to determine the behavioral factors involved in harm from dust exposure among cardiovascular disease patients. This marks an effective step toward evaluating the factors effective in preventing complications related to dust exposure among such patients.
Can counter-advertising diminish persuasive effects of conventional and pseudo-healthy unhealthy food product advertising on parents?: an experimental study
Authors: Dixon Helen , Scully Maree , Gascoyne Claudia , Wakefield Melanie 
Published: November 2020

Abstract
Background
To help address rising rates of obesity in children, evidence is needed concerning impacts of common forms of marketing for unhealthy child-oriented food products and the efficacy of educational interventions in counteracting any detrimental impacts of such marketing. This study aims to explore parents’ responses to advertising for unhealthy children’s food products that employ different types of persuasive appeals and test whether a counter-advertising intervention exposing industry motives and marketing strategies can bolster parents’ resistance to influence by unhealthy product advertising.

Methods
N = 1613 Australian parents were randomly assigned to view online either a: (A) non-food ad (control); (B) conventional confectionery ad (highlighting sensory benefits of the product); (C) pseudo-healthy confectionery ad (promoting sensory benefits and health attributes of the product); (D) conventional confectionery ad + counter-ad (employing inoculation-style messaging and narrative communication elements); (E) pseudo-healthy confectionery ad + counter-ad. Parents then viewed various snacks, including those promoted in the food ads and counter-ad. Parents nominated their preferred product, then rated the products.

Results
Exposure to the conventional confectionery ad increased parents’ preference for the advertised product, enhanced perceptions of the product’s healthiness and reduced sugar content and boosted brand attitude. Exposure to the pseudo-healthy confectionery ad increased parents’ preference for the advertised product, and enhanced perceptions of healthiness, fibre content and lower sugar content. The counter-ad diminished, but did not eliminate, product ad effects on parents’ purchasing preference, product perceptions and brand attitudes. The counter-ad also prompted parents to perceive processed foods as less healthy, higher in sugar and lower in fibre and may have increased support for advertising regulation.

Conclusions
Exposure to unhealthy product advertising promoted favourable perceptions of products and increased preferences for advertised products among parents. Counter-advertising interventions may bolster parents’ resistance to persuasion by unhealthy product advertising and empower parents to more accurately evaluate advertised food products.
Employment changes among Chinese family caregivers of long-term cancer survivors
Authors: Liu Siqi , Su Mingzhu , Yao Nengliang , Zhang Nan , Wang Jialin , Anderson Roger T. , Sun Xiaojie 
Published: November 2020

Abstract
Background
Family caregivers (FCGs) play a key role in the plan of care provision for long-term cancer survivors, yet few studies have been conducted on the impact of long-term caregiving on FCGs and their employment patterns. This study aims to further our understanding of the effect that caregiving role has on FCGs by identifying what cancer-related characteristics influence reduction of employment hours among FCGs in the post-treatment phase in China.

Methods
A total of 1155 cancer survivors participated in this study. Patients reported changes in the employment patterns of their FCGs. Descriptive analysis looked at demographic and cancer-related characteristics of cancer survivors and types of FCGs’ employment changes in both primary- and post-treatment phases. Chi-square test was used to statistically test the association between survivors’ characteristics and changes in FCGs’ hours of labor force work in post-treatment phase. Separate multivariable logistic regression models were used to examine the relationship between cancer-related characteristics of participants and employment reduction patterns among FCGs in post-treatment phase while controlling for demographic factors.

Results
In the primary-treatment phase, 45.6% of all FCGs reduced their working hours and 17.4% stopped working altogether. In the post-treatment phase, 25.2% of FCGs worked fewer hours and 6.6% left the workforce completely. The results show that a higher probability of change in employment hours among FCGs is associated with the following patient characteristics: having comorbidities, receiving chemotherapy treatment, limited ability to perform physical tasks, limited ability to perform mental tasks, and diagnosis of stage II of cancer.

Conclusions
Care for cancer patients in both primary- and post- treatment phases may have substantial impacts on hours of formal employment of Chinese FCGs. Interventions helping FCGs balance caregiving duties with labor force work are warranted.
Clinical application of pedicled thoracoacromial artery perforator flaps for tracheal reconstruction
Authors: Deng Di , Xu Feng , Liu Jifeng , Li Bo , Li Linke , Liu Jun , Chen Fei 
Published: November 2020

Abstract
Background
Large or complex trachea defects often require some tissue to reconstruct, various flaps have been reported for reconstructing this defect. However, pedicled thoracoacromial artery perforator flap have not been reported in tracheal reconstruction. Therefore, this study is to assess the efficacy and clinical application of pedicled thoracoacromial artery perforator flaps for tracheal reconstruction.

Methods
Eight patients who underwent tracheal reconstructions with pedicled TAAP flaps between December 2017 and October 2019 were retrospectively reviewed.

Results
All of the pedicled TAAP flaps in our study survived. The flap size ranged from 2 cm × 5 cm to 4 cm × 10 cm, and the size of each island of one double-island flap was 2 cm × 2.5 cm. The mean thickness was 0.6 cm, and the pedicle length varied between 6 and 9 cm (mean 7.9 cm). The mean time of flap harvest was 17 min. The mean age of the patients was 62.4 years and five elderly patients had comorbidities, such as diabetes, hypertension and asthma. One patient received a double-island flap for tracheal and esophageal reconstruction, and the other patient received simple tracheal reconstruction. One patient died due to cancer metastasis. Six patients obtained functional recovery of breathing, except one patients who did not experience closure of the tracheostomy opening due to uncompleted I131 treatment.

Conclusion
Pedicled TAAP flaps provide a short harvesting time, thin thickness and stable blood supply, and they do not require microsurgical skills. This flap is a good choice for the reconstruction of tracheal defects, especially in the aged or patients with comorbidities who are not able to tolerate prolonged surgery.
Medical students’ attitudes towards careers in primary care in Singapore
Authors: Zainal Humairah , Smith Helen Elizabeth 
Published: November 2020

AbstractBackgroundSingapore needs more family doctors to care for its ageing population and their chronic conditions. While there is a shifting of care from acute care settings to more community care, this has not been reflected in the primary care training in local medical schools. Furthermore, no research has explored how different aspects of the medical school curricula in Singapore influence students’ perceptions of careers in General Practice and Family Medicine- a gap that is filled by this study.MethodsSix focus groups involving 54 students from all three medical schools in Singapore were conducted. Discussions focused on their primary care experience, their professional and career aspirations, and perceptions towards the opportunities and challenges of primary care careers. Qualitative content analysis was used to interpret the data.ResultsThe respondents shared eight key concerns of pursuing primary care careers including limited professional opportunities, emphasis on lifestyle benefits rather than professional characteristics, need for business acumen, conflicts created by business in clinical care, mundane case mix, lack of continuity of care, limited consultation time, and specialists’ negative attitudes towards family doctors. The positive views articulated included the opportunities for entrepreneurialism and a portfolio career, breadth of clinical problems presented, and an improved future for primary care.ConclusionsImproving students’ perceptions of careers in primary care in Singapore would benefit from a concerted effort from multiple stakeholders; medical schools, healthcare providers, professional and regulatory bodies, and government.
An effective frequency-domain feature of atrial fibrillation based on time–frequency analysis
Authors: Hu Yusong , Zhao Yantao , Liu Jihong , Pang Jin , Zhang Chen , Li Peizhe 
Published: November 2020

Abstract
Background
Atrial fibrillation is a type of persistent arrhythmia that can lead to serious complications. Therefore, accurate and quick detection of atrial fibrillation by surface electrocardiogram has great importance on further treatment. The practical electrocardiogram signals contain various interferences in different frequencies, such as myoelectricity interference, power interference and so on. Detection speed and accuracy largely depend on the atrial fibrillation signal features extracted by the algorithm. But some of the discovered atrial fibrillation features are not well distinguishable, resulting in poor classification effect.

Methods
This paper proposed a high distinguishable frequency feature—the frequency corresponding to the maximum amplitude in the frequency spectrum. We used the R–R interval detection method optimized with the mathematical morphology method and combined with the wavelet transform method for analysis. According to the two features—the maximum amplitude in the frequency spectrum and R–R interval irregular, we could recognize atrial fibrillation signals in electrocardiogram signals by decision tree classification algorithm.

Results
The data used in the experiment come from the MIT-BIH database, which is publicly accessible via the web and with ethical approval and consent. Based on the input of time-domain and frequency-domain features, we classified sinus rhythm signals and AF signals using the decision tree generated by classification and regression tree (CART) algorithm. From the confusion matrix, we got the accuracy was 98.9%, sensitivity was 97.93% and specificity was 99.63%.

Conclusions
The experimental results can prove the validity of the maximum amplitude in the frequency spectrum and the practicability and accuracy of the detection method, which applied this frequency-domain feature. Through the detection method, we obtained good accuracy of classifying sinus rhythm signals and atrial fibrillation signals. And the sensitivity and specificity of our method were pretty good by comparison with other studies.
Risk for cardiovascular disease associated with metabolic syndrome and its components: a 13-year prospective study in the RIVANA cohort
Authors: Guembe María J. , Fernandez-Lazaro Cesar I. , Sayon-Orea Carmen , Toledo Estefanía , Moreno-Iribas Conchi ,   for the RIVANA Study Investigators, Cosials Joaquín Barba , Reyero Jesús Berjón , Martínez Javier Díez , Diego Paulino González , Uche Ana Ma Grijalba , Setas David Guerrero , Vila Eduardo Martínez , Martínez Manuel Serrano , Tornos Isabel Sobejano , Rueda José Javier Viñes 
Published: November 2020

Abstract
Background
We aimed to investigate the association of metabolic syndrome (MetS) and its single components with cardiovascular risk and estimated their impact on the prematurity of occurrence of cardiovascular events using rate advancement periods (RAPs).

Methods
We performed prospective analyses among 3976 participants (age range: 35–84, 55% female) in the Vascular Risk in Navarre (RIVANA) Study, a Mediterranean population-based cohort. MetS was defined based on the modified criteria of the American Heart Association/National Heart, Lung, and Blood Institute and the International Diabetes Federation. The primary endpoint was major cardiovascular event (a composite of myocardial infarction, stroke, or mortality from cardiovascular causes). Secondary endpoints were incidence of non-fatal myocardial infarction and non-fatal stroke, cardiovascular mortality, and all-cause mortality. Cox proportional hazards models, adjusted for potential confounders, were fitted to evaluate the association between MetS and its single components at baseline with primary and secondary endpoints.

Results
During a median follow-up of 12.8 years (interquartile range, 12.5–13.1), we identified 228 primary endpoint events. MetS was associated with higher risk of incidence of major cardiovascular event, cardiovascular and all-cause mortality, but was neither associated with higher risk of myocardial infarction nor stroke. Compared with participants without MetS, the multivariable hazard ratio (95% confidence interval [CI]) among participants with MetS was 1.32 (1.01–1.74) with RAP (95% CI) of 3.23 years (0.03, 6.42) for major cardiovascular event, 1.64 (1.03–2.60) with RAP of 3.73 years (0.02, 7.45) for cardiovascular mortality, and 1.45 (1.17–1.80) with RAP of 3.24 years (1.21, 5.27) for all-cause mortality. The magnitude of the associations of the single components of MetS was similar than the predicted by MetS. Additionally, for each additional trait of MetS, incidence of major cardiovascular event relatively increased by 22% (1.22, 95% CI 1.09–1.36) with RAP of 2.31 years (0.88, 3.74).

Conclusions
MetS was independently associated with CVD risk, cardiovascular and all-cause mortality. Components of the MetS were associated with similar magnitude of increased CVD, which suggests that MetS was not in excess of the level explained by the presence of its single components. Further research should explore the association of different combinations of the components of MetS with CVD.
The accuracy and safety of CT-guided iodine-125 seed implantation assisted by 3D non-coplanar template for retroperitoneal recurrent carcinoma
Authors: Jiang Weijuan , Jiang Ping , Wei Shuhua , Jiang Yuliang , Ji Zhe , Sun Haitao , Fan Jinghong , Li Weiyan , Shao Yuxia , Wang Junjie 
Published: November 2020

AbstractPurposeTo investigate the accuracy, dosimetric parameters, and safety of 3D-printing non-coplanar template (3D-PNCT)-assisted CT guidance for radioactive iodine-125 (125I) seed implantation brachytherapy (RSI-BT) for retroperitoneal recurrent carcinomasMethods and materialsWe enrolled 15 patients with 17 retroperitoneal recurrent carcinomas after external beam radiotherapy (EBRT). All patients received CT-guided 125I RSI-BT assisted by 3D-PNCT successfully. We compared the original needle insertion position, angular, and the needle tip distance deviations of preoperative plan with that of intraoperative in brachytherapy treatment planning system (B-TPS). The dosimetric parameters of RSI-BT were evaluated on preoperative plan, intraoperative real-time plan, and postoperative plan, including D90, D100 (the dose to 90% and 100% of the target volume), V100, V150, and V200 (the volume receives 100%, 150%, and 200% of the prescribed doses). The quality assurance of RSI-BT evaluated on conformal index (CI), external index (EI), and homogeneity index (HI) of the targets were compared among preoperative plan, intraoperative real-time plan, and postoperative plan. The perioperation complications and RSI-BT-related toxicity were assessed.ResultsThe median follow-up was 8.2 months (range 1–18.5 months). One patient was lost to follow-up after RSI-BT. Fourteen patients were assessed for response rate and toxicity. The mean entrance point distance deviation for all 165 needles was 4.50 ± 4.10 mm (range, 0–30). The mean angular deviation was 2.70 ± 3.00° (range, 0–20). The needle tip distance deviation was 6.90 ± 6.00 mm (range, − 30–28). D90 for preoperative plan, intraoperative plan, and postoperative plan were 140.55 ± 23.93, 124.25 ± 28.04, and 128.98 ± 22.75, respectively. There was significant difference between D90 of preoperative plan with that of intraoperative plan (p= 0.036). Four lesions reached CR, six lesions reached PR, three lesions were SD, and three lesions were PD. Four patients with moderate pain became mild, and two with mild pain relieved completely after RSI-BT. The other parameters showed no differences among preoperative plan, intraoperative plan, and postoperative plan. The perioperative complications were observed in four patients, including three patients of grade 1 and one patient of grade 2. No ≥ grade 3 side effects were observed.ConclusionCT-guided 125I RSI-BT assisted by 3D-PNCT was a safe, accurate, and feasible strategy for recurrent carcinomas located in the retroperitoneal regions.
Evaluation of different airway tests to determine difficult intubation in apparently normal adult patients undergoing surgical procedures
Authors: El-Radaideh Khaled , Dheeb Ehab , Shbool Hamzeh , Garaibeh Saif , Bataineh Adel , Khraise Wail , EL-Radaideh Basil 
Published: November 2020

AbstractBackgroundInadequate maintenance of a patient’s airway represents a major cause of anesthesia-related morbidity and mortality. This study was designed to evaluate common preoperative clinical tests to determine the risk of difficult endotracheal intubation in apparent “normal” adult patients undergoing surgical procedures.MethodsA prospective observational cohort study was performed on 160 consecutive adult patients undergoing surgical procedures at an academic medical center in Jordan from 20 May 2019 until 11 February 2020.Preoperative assessment of airway risk stratification was performed by the following clinical tests: the mandible protrusion test (MPT), thyromental (TMD) and sternomental (SMD) distances, inter-incisor gap (IIG), and the modified Mallampati tests with tongue protrusion (MMT-TP) and without tongue protrusion (MMT-NTP). Grade C on the MPT, TMD ≤ 6 cm, SMD ≤ 12 cm, and MMT grades III and IV were considered to be predictors of difficult endotracheal intubations. A modified Cormack-Lehane grading (MCLG) of laryngoscopic views with backward, upward, and right-sided pressure on the thyroid and cricoid cartilages (BURP) maneuver was also documented, with grades 2B, 3, and 4 considered to be difficult airways for intubation.ResultsFifteen patients (9.4%) were classified as MCLG 2B, 3, and 4, with age significantly associated with the MCLG grade (P = 0.028). The sensitivity and Youden’s index of MMT-TP were found to be the lowest (40% and 0.29, respectively). The MPT was the most accurate and specific test (90.63 and 95.17%, respectively), with the highest PPV (50%), Youden’s index (0.42), and area under the curve (AUC) (0.781). Bivariant analysis of MPT and thet-test of the mean TMDs and SMDs revealed significant associations between these airway tests and the difficulty of intubation (Pvalues: < 0.001, 0.02, < 0.01, respectively).ConclusionThe MPT, with its highest accuracy, specificity, positive predictive value, and good sensitivity may be used as a routine screening test for preoperative prediction of difficult endotracheal intubations.