bluuebunny/crossref_metadata_2025_split huggingface dataset:
Detailed Cost of Robotic-assisted Surgery in the Australian Public Health Sector: From Implementation to a Multi-specialty Caseload
Authors: McBride Kate , Steffens Daniel , Stanislaus Christina , Solomon Michael , Anderson Teresa , Thanigasalam Ruban , Leslie Scott , Bannon Paul G. 
Published: September 2020

Abstract
Background: A barrier to the uptake of robotic-assisted surgery (RAS) continues to be the perceived high costs. A lack of detailed costing information has made it difficult for public hospitals in particular to determine whether use of the technology is justified. This study aims to provide a detailed description of the patient episode costs and the contribution of RAS specific costs for multiple specialties in the public sector. Methods: A retrospective descriptive costing review of all RAS cases undertaken at a large public tertiary referral hospital in Sydney, Australia from August 2016 to December 2018 was completed. This included RAS cases within benign gynaecology, cardiothoracic, colorectal and urology, with the total costs described utilizing various inpatient costing data, and RAS specific implementation, maintenance and consumable costs.Results: Of 211 RAS patients, substantial variation was found between specialties with the overall median cost per patient being $19,269 (IQR: $15,445 to $32,199). The RAS specific costs were $8,828 (46%) made up of fixed costs including $4,691 (24%) implementation and $2,290 (12%) maintenance, both of which are volume dependent; and $1,848 (10%) RAS consumable costs. This was in the context of 37% robotic theatre utilisation. Conclusions: There is considerable variation across surgical specialties for the cost of RAS. It is important to highlight the different cost components and drivers associated with a RAS program including its dependence on volume and how it fits within funding systems in the public sector.
Functional improvement in hip pathology improves anxiety, depression, and pain catastrophizing: an intricate link between physical and mental well-being
Authors: Gudmundsson Paul , Nakonezny Paul , Lin Jason , Owhonda Rebisi , Richard Heather , Wells Joel E. 
Published: September 2020

Abstract
BackgroundPain catastrophizing, anxiety, and depression represent risk factors that can be treated alongside physical care given to orthopedic patients. While these factors have been shown to be common in patients with hip pathology, there is limited literature that follows these conditions throughout treatment. The purpose of this study was to track psychological factors in patients with various hip pathology to determine if they improved alongside functional measures following treatment.MethodsPatients presenting to a specialist hip clinic were prospectively evaluated for outcomes of pain catastrophizing, anxiety, depression, and hip function. Pre- and post-treatment assessments were undertaken: Pain Catastrophizing Scale, the Hospital Anxiety Depression Scale, the Hip Outcome Survey, and Hip Disability and Osteoarthritis Outcome Score (HOOS). Patient characteristics were recorded. A correlation analysis, using the Spearman partial correlation coefficient (rs), was conducted to evaluate the relationship between change in psychological factors with change in functional outcomes.ResultsA total of 201 patients (78 male, 123 female) were included, with diagnoses of hip dysplasia (n = 35), femoroacetabular impingement (n = 35), lateral trochanteric pain syndrome (n = 9), osteoarthrosis (n = 109), and avascular necrosis of the hip (n = 13). Statistical analysis revealed a significant negative relationship between change in function level (as measured by HOOS ADL) and change in pain catastrophizing (rs = -0.373, p < 0.0001), depression (rs = -0.363, p < 0.0001), and anxiety (rs = -0.264, p = 0.0002). Pain catastrophizing, depression, and anxiety improved with function. Spearman correlation coefficients also revealed that pain catastrophizing, HADS anxiety, and HADS depression improved with improvement in other patient-reported functional outcomes.ConclusionsPatients with hip pathology often exhibit pain catastrophizing, anxiety, and depression, but improvements in hip functionality are associated with decreased severity of these psychological comorbidities. Establishing this connection demonstrates the impact that musculoskeletal impairment has on psychosocial outcomes and mental health. Perioperative multidisciplinary assessment may be a beneficial part of comprehensive orthopaedic hip care.
Antitumor effects of lactate transport inhibition on esophageal adenocarcinoma cells
Authors: Chueca Eduardo , Grasa Laura , Arechavaleta Samanta , García-González María Asunción , Sáenz María Ángeles , Lanas Ángel , Piazuelo Elena 
Published: September 2020

Abstract
BackgroundAs a consequence of altered glucose metabolism, cancer cells intake is increased, producing large amounts of lactate which is pumped out the cytosol by monocarboxylate transporters (MCTs).MCTs are frequently overexpressed in tumors, MCT1 in the well oxygenated areas and MCT4 in hypoxic regions, and recent evidence has reported that MCT inhibition can exert antineoplastic effects, but this aspect has not been investigated in esophageal adenocarcinoma (EAC) yet. In the present study, MCT1 and MCT4 levels were assessed in EAC cells and the effects of MCT-1 selective inhibitor AZD3965, hypoxia and a glucose overload were evaluated in vitro .MethodsTwo EAC cell lines (OE33 and OACM5.1C) were treated with different concentrations of AZD3965 (10-100nM) in the presence or absence of a glucose overload under normoxic or hypoxic conditions and parameters of cytotoxicity, oxidative stress, intracellular pH (pHi) and lactate levels were evaluated.ResultsMCT1 was present in both cell lines whereas MCT4 was expressed in OE33 cells and only in a small population of the metastatic cells.Glucose addition did not have any effect on apoptosis nor cell proliferation.AZD3965 increased apoptosis and reduced proliferation of OACM5.1C cells, effects which were abrogated when cells were growing in hypoxia.MCT1 inhibition increased intracellular lactate levels in all the cells evaluated, but this increase was higher in cells expressing only MCT1 and did not affect oxidative stress.AZD3965 induced a decrease in pHi of cells displaying low levels of MCT4, and also increased NHE-1 expression on these cells. ConclusionThese data provide in vitro evidence supporting the potential of MCT inhibitors as novel antineoplastic drugs for EAC and highlight the importance of achieving a complete MCT inhibition.
Views of medical residents on a research training program: a qualitative study
Authors: Khalil Pamela Abi , Honein-AbouHaidar Gladys , Achi Dina El , Al-Hakim Lara , Tamim Hani , Akl Elie A. 
Published: September 2020

Abstract
Background
The American University of Beirut Medical Center (AUBMC) developed the Fellowship and Residency Research Program (FRRP) to provide residents and clinical fellows with a supervised and structured research experience.
Objective
To explore the views of FRRP participants about the training program and how to enhance it.
Methods
We conducted a qualitative study targeting residents in one of the post-graduate training programs at AUBMC. We invited potential participants through email and via snowball sampling. We continued the data collection until we reached data saturation. We used a thematic analysis to identify emerging themes.
Results
Four themes emerged from the content analysis: expectations of residents, coordination, mentorship, and capacity building. Residents expected the FRRP to provide them with capacity building activities in conducting research since they perceived themselves as novice researchers. In terms of coordination, few residents complained that the deadlines to submit the deliverables are not evenly distributed across the years, so they suggested moving the deadlines earlier to give more time to address any challenges. In terms of mentorship, participants appreciated the flexibility in choosing the mentor and the ability to choose their own research question in agreement with their mentor, however, they thought that there were few faculty members who conducted research and some lacked commitment due to either being busy or travelling, resulting in the slowing of their progress. In terms of capacity building activities, the participants found the lecture series, both real time and virtual, to be helpful and they were satisfied with the topics of the lectures. Finally, participants pointed out that the FRRP program is very supportive and most of them thought it should be mandatory.
Conclusion
In order to provide residents and clinical fellows with a supervised and structured research experience, we have built on our findings to introduce several changes to our program such as ensuring the availability and commitment of faculty mentors, providing capacity building activities to the program participants and revising the program educational offerings to better cover the ABCs of research using mostly interactive and hands on sessions.
Cost Analysis of Pediatric Intensive Care: A Low-Middle Income Country Perspective
Authors: Kaur Amrit , Jayashree Muralidharan , Prinja Shankar , Singh Ranjana , Baranwal Arun K. 
Published: September 2020

Abstract
Background: Globally, Pediatric Intensive Care Unit (PICU) admissions are amongst the most expensive. This makes it important to gain insights into the cost of pediatric intensive care units. We undertook this study to calculate the health system cost and out of pocket expenditure incurred per patient during Pediatric Intensive Care Unit (PICU) stayMethods: Prospective study conducted in a state of art tertiary level PICU of a teaching and referral hospital. Bottom-up micro costing methods were used to assess the health system cost. Annual data regarding hospital resources used for PICU care was collected from January 2018 to December 2018. Data regarding out of pocket expenditure (OOP) was collected from 299 patients who were admitted from July 2017 to December 2018. The study period was divided into four intervals, each of 4 and a half months duration and data was collected for 1 month in each interval. Per patient and per bed day costs for treatment were estimated both from health system and patient’s perspective. Results: The median (inter-quartile range, IQR) length of PICU stay was 5(3–8) days. Mean ± SD PRISM score of the study cohort was 22.23 ± 7.3. Of the total patients, 55.9% (167) were ventilated. Mean cost per patient treated was US$ 2,078(₹ 144,566). Of this, health system cost and OOP expenditure per patient were US$ 1,731 (₹ 120,425) and 352 (₹ 24,535) respectively. OOP expenditure of a ventilated child was twice that of a non‐ ventilated child. Conclusions: The fixed cost of PICU care were 3.5 times more than variable costs. Major portion of cost is borne by hospital. Severe illness, longer ICU stay and ventilation were associated with increased costs. This study can be used to set the reimbursement package rates under Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). Tertiary care state of art intensive care in a public sector teaching hospital in India is far less expensive than developed countries.
Biomarkers in the rock outcrop of the Kazusa Group reveal paleoenvironments of the Kuroshio region
Authors: KAJITA HIROTO , Maeda Ayumi , Utsunomiya Masayuki , Yoshimura Toshihiro , Ohkouchi Naohiko , Suzuki Atsushi , Kawahata Hodaka 
Published: September 2020

Abstract
The classical biomarkers of long-chain alkenones and n-alkanes preserved in marine and lake sediment cores are widely used to reconstruct paleoenvironments. Here, we detected these biomarkers are preserved in the rock outcrop of the Kazusa Group exposed in central Japan, the most continuous sedimentary succession in the world, covering almost the entire Pleistocene. The alkenone unsaturation ratio and average chain length of n-alkanes appeared to reflect the glacial-interglacial changes in the sea surface temperature (SST) and terrestrial climate, respectively. Alkenone-based SSTs during 1.1–1.0 Ma were significantly higher than present-day SSTs in the same area, as supported by foraminiferal Mg/Ca-based temperatures, possibly reflecting the direct intrusion of the warm Kuroshio Current. Applying these biomarkers, which might be circumstantially preserved owing to their immunity to high temperature and consolidation stress during burial and uplift, we expect that the Kazusa Group should reveal detailed oceanic and atmospheric changes of the Kuroshio region.
Changes and Prognostic Impact of Inflammatory Nutritional Factors During Neoadjuvant Chemoradiotherapy for Patients with Resectable and Borderline Resectable Pancreatic Cancer
Authors: Oshima Minoru , Okano Keiichi , Suto Hironobu , Ando Yasuhisa , Kamada Hideki , Masaki Tsutomu , Takahashi Shigeo , Shibata Toru , Suzuki Yasuyuki 
Published: September 2020

Abstract
BackgroundInflammatory nutritional factors, such as the neutrophil/lymphocyte ratio (NLR), Glasgow Prognostic Score (GPS), modified GPS (mGPS), and C-reactive protein/albumin (CRP/Alb) ratio, have prognostic values in many types of cancer. In this study, the prognostic values of inflammatory nutritional scores were evaluated in the patients with resectable or borderline resectable pancreatic ductal adenocarcinoma (PDAC) after neoadjuvant chemoradiotherapy (NACRT).MethodsA total of 49 patients who underwent pancreatectomy after NACRT from September 2009 to May 2016 were enrolled. The NACRT consisted of hypofractionated external-beam radiotherapy (30 Gy in 10 fractions) with concurrent S-1 (60 mg/m2) delivered 5 days/week for 2 weeks before pancreatectomy. Inflammatory nutritional scores were determined before and after NACRT in this series. ResultsThe median NLR increased after NACRT (from 2.067 to 3.302), with statistical difference (p<0.001). In multivariate Cox regression analysis, high pre-NACRT mGPS (2 or 1; p=0.0478) and significant increase in CRP/Alb ratio after NACRT (≧0.077; p=0.0036) were associated with shorter overall survival. All patients were divided into two groups according to the ΔCRP/Alb ratio after NACRT: the group with high ΔCRP/Alb ratio (≧0.077) and the group with low ΔCRP/Alb ratio (<0.077). The group with high ΔCRP/Alb ratio after NACRT (n=13) not only had higher post-NACRT CRP levels (p<0.001) but also had lower post-NACRT Alb levels (p=0.002). Patients in the group with high ΔCRP/Alb ratio lost more body weight during NACRT (p=0.03).ConclusionIn addition to pre-NACRT mGPS, ΔCRP/Alb after NACRT could provide prognostic value in the patients with PDAC treated by NACRT.
Health Service Use of Australian Unemployment and Disability Benefit Recipients: A National, Cross-Sectional Study.
Authors: Collie Alex , Sheehan Luke , McAllister Ashley 
Published: September 2020

Abstract
Background: Healthcare is funded and delivered separately from social care programs such as unemployment and disability insurance. Greater understanding of the health service use (HSU) of social assistance benefit recipients would support more effective design and delivery of health and social care. This study aimed to characterise the HSU of disability and unemployment benefit recipients relative to people earning wages, and to identify personal, household and health-related factors associated with HSU in disability benefit recipients.Methods: A cross-sectional national survey of 9,520 working age Australian adults in three groups: (1) 638 receiving the disability support pension (DSP); (2) 442 receiving unemployment benefits; and (3) 8440 earning wages. Outcomes included count and frequency of health professional consultations, hospital attendance and admission in the past 12 months, as well as medication and supplement use in the past 2 weeks. Analyses compared DSP and unemployment benefit recipients to wage earners using age and sex adjusted risk ratios and incident rate ratios. Negative binomial regression models were constructed to examine factors associated with hospitalisation and general practitioner services in DSP recipients. Results: DSP recipients were significantly more likely than wage earners to have consulted 15 of 22 types of health professionals, had 2.5 times greater risk and 3.8 times higher rate of hospital admission, and 3.4 times greater risk of prescription medication use. Unemployment benefit recipients were significantly more likely than wage earners to have consulted 5 of 22 types of health professionals, had 1.5 times greater risk of hospital admission and 1.2 times greater risk of prescription medication use. Younger age, hypertension, more co-morbid conditions and poorer self-assessed health were associated with higher rate of hospital admission among DSP recipients. Conclusions: People receiving unemployment and disability insurance benefits use significantly more health services than wage earners. A range of personal and clinical characteristics are associated with greater HSU among disability benefit recipients. Greater coordination between health and social care systems may improve health, reduce HSU and improve work ability in unemployed and working age people.
Influenza Vaccination During Pregnancy And Influencing Factors In Korea: A Multicenter Questionnaires Study of Pregnant Women and Obstetrics and Gynecology Doctors.
Authors: Kang Byung Soo , Lee San Ha , Kim Woo Jeng , Wie Jeong Ha , Park In Yang , Ko Hyun Sun 
Published: September 2020

Abstract
BackgroundOur objective was to investigate: (1) the proportion of influenza vaccination, attitudes, and barriers among pregnant women, (2) the proportion of obstetrics and gynecology (OBGYN) doctors who routinely recommend influenza vaccination in pregnant women, and (3) the influencing factors in Korea, during the flu season of 2019-2020, following the introduction of free influenza vaccination program for pregnant women.MethodsTwo separate anonymized questionnaires were developed for pregnant or postpartum women and physicians, and distributed to public or private healthcare centers and clinics, in South Korea. The proportions of women who received influenza vaccination during pregnancy and OBGYN doctors who routinely recommend influenza vaccine for pregnant women were analyzed. Independent influencing factors of influenza vaccination and OBGYN doctors’ routine recommendation for pregnant women were analyzed using multivariate logistic regression analysis, respectively.Result The self-reported proportion of influenza vaccination during pregnancy among 522 women was 63.2%. Independent factors influencing maternal influenza vaccination were ‘(ever) received information about influenza vaccination during pregnancy’, ‘information obtained from OBGYN doctors’, and ‘2nd/3rd trimester or postpartum period’ (OR 8.988, 95% CI 4.21–19.188, p < 0.001, OR 2.611, 95% CI 1.705-3.998, p < 0.001 and OR 3.082, 95% CI 1.508–6.297, p < 0.001, respectively).In 372 OBGYN doctors, the proportion of doctors with the routine recommendation of influenza vaccine for pregnant women was 76.9%. Independent factors affecting the routine recommendation were: 1) affiliation with private hospital or clinic (OR 4.508, 95% CI 2.225–9.133, p<0.001); 2) awareness of guidelines (OR 3.153, 95% CI 1.118–8.894, p=0.03); (3) awareness of 2019 National free influenza vaccination program for pregnant women (OR 4.955, 95%CI 2.377–10.329, p<0.001). For a future recommendation of influenza vaccine for pregnant women, the guidelines proposed by the government or public health care [108 (46%)] and academic committees [59 (25%)] were most commonly chosen by OBGYN doctors.Conclusion This study demonstrated that providing information about maternal influenza vaccination and the recommendation by OBGYN doctors are crucial for increasing the vaccination coverage in pregnant women.
Systematic Profiling of Diagnostic and Prognostic Value of Autophagy-Related Genes for Sarcoma Patients
Authors: Wang Yuanhe , Li Jianyi , Shao Cheng , Tang Xiaojie , Du Yukun , Xu Tongshuai , Zhao Zheng , Hu Huiqiang , Sheng Yingyi , Hu Chuan , Xi Yongming 
Published: September 2020

Abstract
Background: Autophagy-related genes (ARGs) have been confirmed to have an important role in tumorigenesis and tumor microenvironment formation. Nevertheless, a systematic analysis of ARGs and their clinical significance in sarcoma patients is lacking.Methods: Gene expression files from The Cancer Genome Atlas (TCGA) database and Genotype-Tissue Expression (GTEx) were used to select differentially expressed genes (DEGs). Differentially expressed ARGs (DEARGs) were determined by matching the DEG and HADb gene sets, which were evaluated by functional enrichment analysis. Unsupervised clustering of the identified DEARGs was conducted, and associations with tumor microenvironment (TME), immune checkpoints, and immune cells were analyzed simultaneously. Two prognostic signatures, one for overall survival (OS) and one for disease-free survival (DFS), were established and validated in an independent set. Results: In total, 84 DEIRGs and two clusters were identified. TME scores, five immune checkpoints, and several types of immune cells were found to be significantly different between twp clusters. Two prognostic signatures incorporating DEARGs showed favorable discrimination and were successfully validated. Two nomograms combining signature and clinical variables were generated. The C-indexes were 0.818 and 0.636 for the OS and DFS nomograms, respectively.Conclusion: This comprehensive analyses of the ARG landscape in sarcoma showed novel ARGs related to carcinogenesis and the immune microenvironment. These findings have implications for prognosis and therapeutic responses, which reveal novel potential prognostic biomarkers, promote precision medicine, and provide potential novel targets for immunotherapy.
COL1A1, COL1A2, COL3A1 and DCN are Potential Biomarkers to Predict Progression from Smokers to Suffering from Lung Adenocarcinoma
Authors: Chen Jixin , Chen Shuqi , Wang Feiye , Wang Sumei , Wu Wanyin 
Published: September 2020

Abstract
Background: To explore novel related genes and potential biomarkers that predict progression from smokers to lung adenocarcinoma (LA). Methods: Three datasets from GEO (Gene Expression Omnibus) database were used to identify differentially expressed genes (DEGs) between LA tissue (LAT) and normal tumor adjacent tissue (TAT). The overlap of DEGs could be found and enriched in gene oncology (GO) and pathways to discover the potential biological mechanisms. Protein-protein interaction (PPI) network was applied to find the relationship among proteins. Survival analysis contributed to the definiteness of key genes. The expression of key genes in LA patients who smoke was verified. Furthermore, genetic alterations, co-expression and pathways of key genes were explored. To obtain more information, key genes were further analyzed in immune infiltration, drug target and the distribution of single cell in LA. Results: 245 DEGs were revealed in 3 datasets from GEO. In Kaplan Meier plotter, we found that high expression of COL1A1, COL1A2 and COL3A1 was associated with poorer survival while low expression of DCN was contributed to poorer survival in LAs who smoke. Thus, three up-regulated genes (COL1A1, COL1A2, COL3A1) and one down-regulated gene (DCN) were defined as key genes. Their genetic alterations were more common in female LA smokers and co-expression genes/proteins of them mainly functioned at extracellular matrix. Furthermore, COL1A1, COL1A2, COL3A1 genes had a common targeted drug called Collagenase clostridium histolyticum (DB00048) and DCN gene had a targeted drug called Tromethamine (DB03754). In the Single Cell Expression Atlas of EMBL-EBL, COL3A1 gene was specifically highly expressed in female LA patients with brain metastasis. Conclusions: COL1A1, COL1A2, COL3A1 and DCN could be regarded as novel potential biomarkers that predict progression from smokers to lung adenocarcinoma.