bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mental distress among frontline healthcare workers outside the central epidemic area during the novel coronavirus disease (COVID-19) outbreak in China:A cross-sectional study
Authors: Liu YaYun , Liu XinSheng , Gao Bai , Li chengzhong , Liang xuesong 
Published: June 2020

Abstract
Background and aim:At the initial stage of the fight against COVID-19, a large number of medical staff and materials were dispatched to Wuhan City and Hubei Province to contain the outbreak quickly and effectively. The national infection prevention and control strategy posed a challenge to the physical and psychological resilience of frontline healthcare workers(HCWs) outside the central epidemic area.This study aims to survey frontline HCWs outside the central epidemic area in China to understand their levels of perceived stress, anxiety, and depression during the initial stage of the fight against the COVID-19 outbreak. Methods: From February 11 to February14, 2020, an online survey was conducted in Jinzhong, Shanxi Province using snowball sampling techniques. The survey consisted of two parts, namely, demographic data and psychological screening. Demographic information included gender, age, hospital classification, working department, profession type, and working experience. Perceived stress was assessed by Chinese simple Perceived Stress Scale 10, general anxiety was assessed by the General Anxiety Disorder Scale, and depression was evaluated by the Patient Health Questionnaire-9. Results: A total of 1,315 HCWs were included, of which 646(49.1%) reported a moderate to severe stress (scores≥14), 141(10.7%) reported moderate to severe anxiety (score≥10), and 164(12.4%) reported a major depression (score≥10). Female gender was significantly associated with high levels of perceived stress, anxiety, and depression (P<0.05), and working time was negatively correlated with the level of perceived stress, anxiety, and depression (P<0.05). Statistical difference was observed in perceived stress score among different age groups, levels of hospital group, and working departments (P<0.05). Conclusion: During the initial stage of the fight against COVID-19 in China, more than half of the frontline HCWs outside the central epidemic area rated perceived stress as moderate to severe, and nearly 23% of them reported moderate to severe anxiety or depression. Female gender, low hospital level, and emergency department were associated with a high level of perceived stress.
Performance Test on a 5kw Sofc System Under High Fuel Utility With Practical Syngas Feeding
Authors: xu ming , Wang Hanlin , Liu Mingxian , Zhao Jianning , Zhang Yuqiong , Li Pingping , Shi Mingliang , Gong Siqi , Zhang Zhaohuan , Li Chufu 
Published: June 2020

Abstract
With increasing demand of green energy supply with high efficiency and low CO2 emission, Solid oxide fuel cell (SOFC) has been intensively developed in recent years. And the integration of gasification with fuel cell (IGFC) shows potential in large scale power generation to further increase the system efficiency. Reliable design of multi-stacks for large system and long term stability of stacks with practical fuel gas from industrial equipment are the key for commercial application of IGFC. In this work, a test rig of 5kW SOFC system was fabricated using practical syngas from industrial gasifiers as fuel and long term test under high fuel utility was conducted to investigate the system performance. The results show that the maximum steady output power of system is 5700W for hydrogen case and 5660W for syngas case, and the maximum steady electrical efficiency is 61.24% while the fuel utility efficiency is 89.25%. The test lasted for more than 500h as the fuel utility efficiency was larger than 83%. The performances of each stack tower are almost identical at both initial stage and after long term operation. After 500h operation, the performances of stack towers just slight decrease under lower current and almost not change under higher current. Therefore, the results illustrate that the reliability of multi-stacks design and the prospect of SOFC power generation system for further enlarging its application in a MWth demonstration.
Serum level of salusin β as an indicator of metabolic disorders in Acute Lymphoblastic Leucaemia and Wilms Tumour survivors
Authors: Janecka Aleksandra , Stefanowicz Joanna , Owczarzak Anna , Rapala Malgorzata , Adamkiewicz-Drożyńska Elżbieta 
Published: June 2020

Abstract
Background Cardiovascular diseases (CVD) are one of long-term side effects of the childhood cancers treatment. Salusin β is an indicator of developing atherosclerosis. Aim To assess the prevalence of established risk factors for CVD and the assessment of new indicator for CVD risk - salusin β in long-term acute lymphoblastic leukemia (ALLs) and Wilms tumour (WTs) survivors. Methods 37 ALLs and 11 WTs at least 5 years after the end of oncological treatment undergone physical examination and laboratory tests after an overnight fast. Laboratory tests included lipid profile, serum level of glucose, renal parameters and salusin β. Results The both groups didn’t vary in age, time from the end of the treatment, number of obese persons, BP, lipid profile, serum creatinine and glucose level. ALLs had higher weight and greater waist circumference. Serum cystatin was higher and cystatin-based eGFR lower among WTs. Salusin β was higher in group WTs, but the result was not statistically significant. Conclusions ALLs and WTs differ in types of long-term side effects. ALLs present rather metabolic problems, WTs - lower eGFR. Salusin β seems to implicate development of hypertension rather than metabolic disorders like obesity. Further investigations are necessary to confirm this statement.
Home-based physical activity in breast cancer patients and cardiorespiratory fitness: during and/or after chemotherapy? A three-arm randomized controlled trial (APAC)
Authors: Vincent Francois , Deluche Elise , Bonis Joelle , Leobon Sophie , Antonini Marie-Thérèse , Laval Caroline , Favard Florent , Dobbels Eloïse , Lavau-Denes Sandrine , labrunie Anaïs , Thuillier Frédéric , Venat Laurence , Tubiana-Mathieu Nicole 
Published: June 2020

Abstract
ObjectivesAdapted physical activity (APA) program is recommended for breast cancer care. However, their modalities have not been defined. The aim of this study was to determine the best time to begin APA. This randomized controlled trial evaluated at 12 months the effect of home-based APA performed during and/or after treatment on cardiorespiratory fitness. The primary endpoint was peak oxygen consumption (VO2peak) compared at 12 months (group A vs C and B vs C). Secondary endpoints included the 6-min walking test (6MWT), assessment of muscular strength, fatigue, quality of life, anxiety, and depression, and a questionnaire of PA levels. All tests were evaluated at baseline, 6 months, and 12 months.MethodA total of 94 patients with breast cancer were randomized to three different groups: group A, performing 6 months of APA during adjuvant care; group B, 6 months of APA after adjuvant care; and group C, 12 months of APA during and after specific care. The program combined one resistance session and two aerobic sessions per week. Analysis of variance was used for repeated measures, Student’s t-test or the Mann–Whitney U-test for continuous variables, and χ2 test for binary or categorical variables.Results A total of 81 participants were assessed at 6 months and 73 participants at 12 months. The majority of patients completed more than 85% of the exercise sessions. The baseline for VO2peak and secondary outcomes did not differ among the groups. VO2peak increased during the exercise period and decreased during the chemotherapy period without APA, but at 12 months no significant difference was observed. The same variations were observed in the 6MWT, with a significance at 6 months between A+C vs. B (p=0.04), but no difference among the groups at 12 months. In the three groups, no decrease in other studied parameters were noted, except at 6 months in group B without APA. ConclusionsHome-based APA in breast cancer survivors can decrease some of the negative side effects of cancer treatment and has a positive effect on physical function with no differences based on the timing of this program.TRIAL REGISTRATION﻿ClinicalTrials.gouv.fr (NCT01795612). Registered 20 February 2013,https://clinicaltrials.gov/ct2/show/NCT01795612?term=APAC&draw=2&rank=3
Factors Leading to the Success of Social Participation Promotion Programs for People with Intellectual Disability: A Protocol for A Systematic Review
Authors: Aparicio Andrés , Arango Paulina , Espinoza Rosario , Villate Vicente , Tenorio Marcela 
Published: June 2020

Abstract
Background People with intellectual disabilities have been historically excluded from decision-making processes. Previous literature indicates that social participation may be an effective tool to increase social inclusion, but no systematic review of interventions focused on social participation of people with intellectual disabilities have been conducted. This study aims to identify and organize the factors associated with social participation interventions having a positive impact on social inclusion of people with intellectual disabilities; and to provide a set of best of practices for future interventions. Methods/design This systematic review of the literature will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) recommendations. The databases Web of Science, EBSCO, Scopus, LILACS and PubMed will be searched for articles between January 1 st , 2004 and December 31 st , 2019; a grey literature search will also be conducted. Randomized control trials, nonrandomized control trials, and controlled before and after studies will be included. If necessary, noncontrolled before and after studies will also be included. Observational or qualitative studies will be excluded. The primary outcome is success of intervention. Secondary outcomes include measures of social participation. Two reviewers will independently screen articles, extract relevant data and assess the quality of the studies. Discussion This systematic review will add to our understanding of successful social participation interventions for people with intellectual disability. It will allow us to identify and organize which factors lead to an increase in social participation and help us define a set of best practices to be followed by future interventions. Systematic review registration This protocol is submitted to the PROSPERO registry of the University of York (reference number: 189093).
Degree of Coronal Alignment Correction Can’t Predict Knee Function in Total Knee Replacement
Authors: Zhu Shibai , Chen Xi , Wang Yiou , Qian Wenwei , Peng Huiming , Wang Wei , Lin Jin , Jin Jin , Weng Xisheng 
Published: June 2020

Abstract
Background: Whether neutral alignment brings better clinical outcomes is controversial. Consideration of the preoperative knee condition of patients and some limitations of previous studies, we suggested that other index may be more important than a generic target of 0° ± 3° of a neutral axis to reflect changes in coronal alignment after total knee replacement (TKR). The purpose of this study was to explore the relationship between alignment and functional outcome with a new grouping method and the concept of correction rate. Methods: A new grouping method was adopted to divide patients into three groups based on the degree of correction of mechanical femoral-tibial angle (MFTA): neutral, under and over-correction. Hospital for Special Surgery (HSS) score were compared among the 3 groups. In addition, we also attempt to further explore whether the concept of correction rate can predict postoperative functional score. Results: HSS showed significant improvement in all groups. There was no difference in HSS or incremental scores based on the postoperative alignment category for the degree of correction of MFTA. The correlational analyses also didn’t find any relevant results.Conclusion: TKR is a soft tissue procedure and clinical outcome depends on many factors, only reaching neutral alignment after surgery may not mean a good clinical result. Therefore, categorization of optimal coronal alignment after TKR may be impractical. But we still believe that the concept of correction rate and new grouping method are worthy of research which can reflects the preoperative knee condition and the change of coronal alignment. Perhaps it can be better used in TKR in the future. Level of evidence: III.
Association of NAFLD Fibrosis Score with Subclinical Myocardial Remodeling in Patients with Type 2 Diabetes: A Cross-Sectional Study in China
Authors: Fan Nengguang , Ding Xiaoying , Li Na , Zhen Qin , Gu Liping , Fang Fang , Yan Shuai , Pan Lin , Zhang Aifang , Shen Tingting , Wang Yufan , Peng Yongde 
Published: June 2020

Abstract
Background: Nonalcoholic fatty liver disease (NAFLD), especially with liver fibrosis, is associated with cardiovascular diseases (CVD). NAFLD fibrosis score (NFS), a noninvasive marker of advanced fibrosis first developed in patients with NAFLD, has found to be associated with CVD in different populations including with diabetes, regardless of the presence of NAFLD. The aim of the present study was to determine whether NFS is associated with subclinical myocardial remodeling in type 2 diabetic patients.Methods: A cross-sectional study was performed in type 2 diabetic patients. NFS derived from available parameters was calculated and the subjects were divided into four groups according to the quartiles of NFS. Subclinical myocardial remodeling was examined by echocardiography and its association with NFS was analyzed.Results: A total of 1878 type 2 diabetic patients were enrolled in the present study. Subjects with higher NFS were older, had a longer duration of diabetes and higher levels of body mass index (BMI), systolic blood pressure (SBP) and serum creatinine (Scr) than those with lower NFS (P < 0.01). Multiple linear regression analysis revealed that sex, age, BMI, LDL-C and HbA1c were independent determiners of NFS in type 2 diabetic patients. Parameters of subclinical myocardial remodeling including left atrial dimension (LAD), interventricular septum thickness (IST), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD) and left ventricular posterior wall thickness (LVPWT) were all gradually increased with the increment of NFS. Linear regression analysis further revealed that NFS was positively associated with LAD, IST, LVEDD, LVESD and LVPWT after adjustment for the confounding factors.Conclusions: NFS is independently associated with subclinical myocardial remodeling in type 2 diabetic subjects.
Barriers to Therapeutic Use of Hydroxyurea for Sickle Cell Disease in Nigeria: A Cross-sectional Survey
Authors: Chide Okocha Emmanuel , Gyamfi Joyce , Ryan Nessa , Oluwatoyin Babalola , Eno-Abasi Etuk , Chianumba Reuben , Nwegbu Maxwell , Isa Hezekiah , Madu Anazoeze Jude , Adegoke Samuel , Nnebe-Agumandu Uche , Peprah Emmanuel , Nnodu Obiageli 
Published: June 2020

Abstract
Background: Sickle cell disease, the inherited blood disorder characterized by anemia, severe pain and other vaso-occlusive complications, acute chest syndrome, disproportionate hospitalization, and early mortality, has significant financial, social, and psychosocial impacts and drains individuals, families, and health systems globally. Hydroxyurea could improve the health of the 300,000individuals borneach year with sickle cell disease in sub-Saharan Africa; however, challenges to adoption and adherence persist. This study assessed the barriersto therapeutic use of hydroxyurea forsickle cell diseasewithin the Nigerian healthcare system, specifically from the level of the patient, provider, and health system.Methods:A cross-sectionalsurvey was administered to physicians (n=70), nurses or counselors (n=17), and patients or their caregivers (n=33) at 13 health centers.Results: The majority of physicians (74.3%) prescribe hydroxyurea, and half stated hydroxyurea is the standard of care. Among clinicians, barriers includedlimited knowledge of the drug, as well as low self-efficacy to prescribe among physicians and to counsel among nurses;perceived side effects;perceived patient preference for traditional medicine;cost for patient and expense of accompanying laboratory monitoring;and limited availability of the drug and equipment for laboratory monitoring. Among patients and caregivers, barriers included lack of knowledge; perceived side effects; cost;religious beliefs of disease causation; and lack of pediatric formulation.Conclusions: Findings suggest that patient, provider, and health systems-level interventionsare needed to improve hydroxyurea uptake among providers and adherence among patients with sickle cell disease in Nigeria. Interventions such as patient education, provider training, and policy change could address the disproportionate burden of sickle cell disease in sub-Saharan Africa and thus improve health equity.
Development and Characterization of a Thermoforming Apparatus Using Axiomatic Design Theory and Taguchi Method
Authors: Nguyen Trieu Khoa , Pham Anh-Duc , Chau Minh Quang , Nguyen Xuan Chien , Pham Hoang Anh Duong , Pham Manh Hung , Nguyen Trung Phi , Nguyen Hai Son 
Published: June 2020

Abstract
In this study, an experimental investigation of the development of a thermoforming apparatus and the thickness uniformity of its samples was performed based on the axiomatic design theory in conjunction with the Taguchi method. Thermoforming is a powerful tool for both consumer product needs and packaging industry. Such traditional technology has been investigated in many aspects for a long time ago. However, there are still needs for the development and characterization of thermoforming devices aiming at shorter construction time and less cost involved. Therefore, an experimental analysis was performed to systematically realize all the functional structures of the device using axiomatic design theory. The combination of orthogonal array (OA) and analysis of variance revealed the influences of the relatival processing factors, showing that the thickness of the plastic sheet and areal draw ratio had crucial roles to play. Furthermore, an optimization process using the Taguchi method was utilized to determine all accurate and optimum processing parameters. The outcomes obviously verified that the present combination method can overcome the current development and optimization method’s limitation and also conclusively give accurate optimal outcomes without using complicated algorithms and software solutions. Therefore, it promises a simple and powerful tool for engineers on-site in medium or small scale manufactories.
Construct Validity of a Dietary Protein Assessment Questionnaire to Explore College Students' Attitudes Towards Dietary Protein
Authors: Ackerman Parker , Warren Cynthia , Miketinas Derek 
Published: June 2020

Abstract
Background: Misconceptions about consuming dietary protein may exist due to unscientific dietary information from the Internet and social media sites, as well as lack of knowledge about evidence-based dietary recommendations. Understanding attitudes towards protein is important for developing effective educational interventions, which may ultimately improve the health of U.S. adults. The objective of this study was to develop a questionnaire to evaluate college students’ attitudes and knowledge towards dietary protein. Methods: The questionnaire had 64 questions, including 8 demographic, 24 knowledge, 14 attitude, and 18 behavior questions. Exploratory factor analysis (EFA) with a principal axis factoring and promax rotation was used to explore the attitude constructs’ dimensionality. Nutrition students’ knowledge responses were compared to non-nutrition students’ responses to assess the knowledge validity. Results: Four hundred seventy participants (87.3% female) provided responses for attitude questions. Fifty-five nutrition and 51 non-nutrition students provided responses for the knowledge questions. Three factors were retained: animal versus plant protein sources relationship with human and environmental health (Factor 1); organic protein sources (Factor 2); and protein RDA adequacy for weight loss and vegetarian diets (Factor 3). Mean knowledge responses were 66.4 + 11.5% and 47.6 + 16.4% for nutrition and non-nutrition students, respectively (t-test p-value for difference < 0.001). Conclusions: Protein attitudes appear multidimensional and correlated. Further testing is needed to confirm the three-factor model and to estimate test-retest reliability.
Educational inequalities in adverse pregnancy outcomes in rural China, 2010-2018
Authors: Wu Yanpeng , Li Lixin , Wu Yanfei , Liao Rui , Liu Zijie , Tan Ming , Zhuang Yan , Chen Pingyan , Wu Ying , You Dingyun 
Published: June 2020

Abstract
Background:

Educational inequalities have been found in adverse pregnancy outcomes, but no previous study has investigated in China. This study examined the patterns of educational inequalities in the risk of adverse pregnancy outcomes in rural China and examined the mediations of birthweight and gestational age in the stillbirth and neonatal mortality.
Methods:

The study population consisted of 217,070 registered pregnancies in Yunnan Province during 2010–2018. Logistic regression models were performed on the association studies between education and adverse pregnancy outcomes including stillbirth, neonatal mortality, preterm birth (PTB), and low birth weight (LBW). The subgroup analysis by ethnicity was further carried out.
Results:

Compared to women with mid education, least educated women had a significantly increased risk of stillbirth (Adjusted OR (AOR) 1.36 [95%CI 1.19–1.56]), neonatal mortality (AOR 1.55 [1.29–1.87]), PTB (AOR 1.10 [1.04–1.16]), and LBW (AOR 1.30 [1.19–1.41]). Highly educated women showed a similar risk to least educated women in LBW. The magnitude of these associations differed among ethnic groups, among which education had a larger impact on neonatal mortality of Yi women and a smaller impact on stillbirth of Dai women. Low education level lead to stillbirth and neonatal mortality mainly by acting through birthweight.
Conclusions:

Education had the strongest link to neonatal mortality and the weakest link to PTB. Highly educated women also need concern on LBW. Improving education may reduce adverse pregnancy outcomes especially for Yi women in rural China.