bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cotton roots are the major source of gossypol biosynthesis and accumulation
Authors: Zhao Tianlun , Xie Qianwen , Li Cong , Li Cheng , Mei Lei , Yu John Z. , Chen Jinhong , Zhu Shuijin 
Published: February 2020

Abstract
Background
Gossypol is a specific secondary metabolite in Gossypium species. It not only plays a critical role in development and self-protection of cotton plants, but also can be used as important anti-cancer and male contraceptive compound. However, due to the toxicity of gossypol for human beings and monogastric animals, the consumption of cottonseeds was limited. To date, little is known about the gossypol metabolism in cotton plants.

Results
In this study, we found that cotyledon was the primary source of gossypol at the seed germination stage. But thereafter, it was mainly originated from developing roots. Grafting between glanded and glandless cotton as well as sunflower rootstocks and cotton scion revealed that gossypol was mainly synthesized in the root systems of cotton plants. And both glanded and glandless cotton roots had the ability of gossypol biosynthesis. But the pigment glands, the main storage of gossypol, had indirect effects on gossypol biosynthesis. In vitro culture of root and rootless seedling confirmed the strong gossypol biosynthesis ability in root system and the relatively weak gossypol biosynthesis ability in other organs of the seedling. Expression profiling of the key genes involved in the gossypol biosynthetic pathway also supported the root as the major organ of gossypol biosynthesis.

Conclusions
Our study provide evidence that the cotton root system is the major source of gossypol in both glanded and glandless cottons, while other organs have a relatively weak ability to synthesize gossypol. Gossypol biosynthesis is not directed related to the expression of pigment glands, but the presence of pigment glands is essential for gossypol accumulation. These findings can not only clarify the complex regulation network of gossypol metabolism, but it could also accelerate the crop breeding process with enhanced commercial values.
Contamination in complex healthcare trials: the falls in care homes (FinCH) study experience
Authors: Robinson K. , Allen F. , Darby J. , Fox C. , Gordon A. L. , Horne J. C. , Leighton P. , Sims E. , Logan P. A. 
Published: February 2020

Abstract
Background
Trials are at risk of contamination bias which can occur when participants in the control group are inadvertently exposed to the intervention. This is a particular risk in rehabilitation studies where it is easy for trial interventions to be either intentionally or inadvertently adopted in control settings. The Falls in Care Homes (FinCH) trial is used in this paper as an example of a large randomised controlled trial of a complex intervention to explore the potential risks of contamination bias. We outline the FinCH trial design, present the potential risks from contamination bias, and the strategies used in the design of the trial to minimise or mitigate against this. The FinCH trial was a multi-centre randomised controlled trial, with embedded process evaluation, which evaluated whether systematic training in the use of the Guide to Action Tool for Care Homes reduced falls in care home residents.
Data were collected from a number of sources to explore contamination in the FinCH trial. Where specific procedures were adopted to reduce risk of, or mitigate against, contamination, this was recorded. Data were collected from study e-mails, meetings with clinicians, research assistant and clinician network communications, and an embedded process evaluation in six intervention care homes.
During the FinCH trial, there were six new falls prevention initiatives implemented outside the study which could have contaminated our intervention and findings. Methods used to minimise contamination were: cluster randomisation at the level of care home; engagement with the clinical community to highlight the risks of early adoption; establishing local collaborators in each site familiar with the local context; signing agreements with NHS falls specialists that they would maintain confidentiality regarding details of the intervention; opening additional research sites; and by raising awareness about the importance of contamination in research among participants.

Conclusion
Complex rehabilitation trials are at risk of contamination bias. The potential for contamination bias in studies can be minimized by strengthening collaboration and dialogue with the clinical community. Researchers should recognise that clinicians may contaminate a study through lack of research expertise.
Prevalence, associated factors and medication for symptoms related to gastroesophageal reflux disease among 1114 private-tuition students of Anuradhapura, Sri Lanka
Authors: Gunasinghe Darsha , Gunawardhana Chathurika , Halahakoon Shakthi , Haneeka Ali , Hanim Najiyya , Hapuarachchi Chamara , Rathish Devarajan 
Published: February 2020

Abstract
Background
Gastroesophageal reflux disease (GORD) is a chronic and a common condition worldwide which causes mild to severe symptoms. Private tuition attendees are a group which could have potential risk factors for GORD. Therefore, we aimed to determine the prevalence, associated factors and medication for symptoms related to GORD among advanced level private-tuition attendees of Anuradhapura, Sri Lanka.

Methods
A descriptive cross-sectional study was conducted among students aged ≥18 years. A self-administered questionnaire was used to collect data. Students scoring ≥ eight on the Frequency Scale for Symptoms of GORD were categorised to have symptoms related to GORD. Logistic regression was performed to determine the significant association between the variables of interest and the presence of symptoms related to GORD (P < 0.05).

Results
Data of 1114 students were included for the analysis. A high prevalence of symptoms related to GORD (52% - 580/1114) was noted. Heartburn received the highest score among GORD symptoms. Biology students had the highest prevalence of GORD symptoms (63% - 127/201). Also, Biology students had the highest percentage for the utilisation of overall (17% - 35/201) and prescribed (13% - 27/201) medication for GORD symptoms. Presence of symptoms related to GORD was significantly associated with female sex [OR - 0.436 (95% CI 0.342–0.555)], being boarded [OR - 2.021 (95% CI 1.325–3.083)], chronic illness [OR - 2.632 (95% CI 1.439–4.813)], midnight snack [OR - 1.776 (95% CI 1.379–2.287)], frequent lack of breakfast [OR - 2.145 (95% CI 1.688, 2.725)], quick eating [OR - 1.394 (95% CI 1.091–1.780)] and inadequate sleep [OR - 2.077 (95% CI 1.624–2.655)].

Conclusion
A high prevalence of symptoms related to GORD in comparison to previous literature was found among private tuition attendees. Possible reasons for the above findings were discussed.
Fructo-oligosaccharides ameliorate steatohepatitis, visceral adiposity, and associated chronic inflammation via increased production of short-chain fatty acids in a mouse model of non-alcoholic steatohepatitis
Authors: Takai Atsuko , Kikuchi Kentaro , Ichimura Mayuko , Tsuneyama Koichi , Moritoki Yuki , Matsumoto Kotaro , Tsunashima Hiromichi , Onda Takeshi , Kuniyoshi Noriyuki , Nariyama Tomoyuki , Ohyatsu Sho , Kubota Juri , Nagumo Kozue , Sato Shinpei , Hara Masumi , Miyakawa Hiroshi 
Published: February 2020

Abstract
Background
Non-alcoholic fatty liver disease (NAFLD) is a hepatic manifestation of metabolic syndrome. Within the spectrum of NAFLD, non-alcoholic steatohepatitis (NASH) in combination with hepatic inflammation and fibrosis can lead to liver cirrhosis and hepatocellular carcinoma. Dysbiosis was reported to contribute to NASH pathogenesis. This study aimed to determine the effects of fructo-oligosaccharides (FOS) on steatohepatitis and visceral adiposity in an obese mouse model of NASH.

Methods
Twelve newborn C57BL/6 J male mice were subcutaneously injected with monosodium glutamate (MSG) to induce obesity on a conventional diet. Six mice were also administered 5% FOS via drinking water from 10 weeks of age. At 18 weeks, histological characteristics of the liver and epididymal fat were compared between the groups. Hepatic mRNA expression of lipid metabolism enzymes and SCFA in feces and sera were measured.

Results
Hepatic steatosis, inflammatory cell infiltration, and hepatocyte ballooning in the liver and increased hepatic mRNA expression of fatty acid synthase and glycerol-3-phosphate acyltransferase were observed in the MSG-treated mice. FOS treatment improved the liver pathology and blunted the increases in the mRNA expression levels of lipid metabolism enzymes. In addition, FOS inhibited adipocyte enlargement and formation of crown-like structures and reduced the M1 macrophage frequency in the epididymal fat of the MSG mice (39.4% ± 3.0% vs. 22.8% ± 0.7%; P = 0.001). FOS increased not only the fecal concentrations of n-butyric acid (0.04 ± 0.01 vs. 0.38 ± 0.14 mg/g, P = 0.02), propionic acid (0.09 ± 0.03 vs. 0.42 ± 0.16 mg/g, P = 0.02), and acetic acid (0.65 ± 0.16 vs. 1.48 ± 0.29 mg/g, P = 0.03) but also the serum concentration of propionic acid (3.9 ± 0.5 vs. 8.2 ± 0.5 μmol/L, P = 0.001).

Conclusions
FOS ameliorates steatohepatitis, visceral adiposity, and chronic inflammation by increasing SCFA production.
Predictors of healthcare utilisation among poor older people under the livelihood empowerment against poverty programme in the Atwima Nwabiagya District of Ghana
Authors: Agyemang-Duah Williams , Peprah Charles , Arthur-Holmes Francis 
Published: February 2020

AbstractBackgroundLike many other low- and middle-income countries (LMICs), the Ghanaian healthcare system remains poor which is likely to affect the utilisation of healthcare services, especially among poor older people who are faced with multiple health problems. Yet, factors that explain healthcare use among poor older people in LMICs, particularly Ghana remain largely unexplored. Understanding the predictors of healthcare use among poor older people could have a huge impact on health policies in LMICs including Ghana. This study, therefore, examined factors associated with healthcare use among poor older people under the Livelihood Empowerment Against Poverty (LEAP) programme in the Atwima Nwabiagya District of Ghana.MethodsCross-sectional data were obtained from an Ageing, Health, Lifestyle and Health Services (AHLHS) study conducted between 1 and 20 June 2018 (N = 200) in Atwima Nwabiagya District, Ghana. Sequential logistic regression models were performed to estimate the variables that predict healthcare use among poor older people. All test results were considered significant at 0.05 or less.ResultsThe fully adjusted model showed that respondents aged 85–89 years (AOR = 0.094, CI: 0.007–1.170), acquired basic education (AOR =0.251, CI: 0.085–0.987), received no family support (AOR = 0.771, CI: 0.120–0.620), with no past illness records (AOR = 0.236, CI: 0.057–0.197) and who were not diagnosed of chronic non-communicable diseases (AOR = 0.418, CI: 0.101–0.723) were significantly less likely to utilise health facility compared with their respective counterparts. Moreover, those with no disability (AOR = 19.245, CI: 2.415–29.921) and who consumed low fruits (AOR = 1.435 = CI: 0.552–8.740) and vegetables (AOR = 1.202 = CI: 0.362–10.20) had a higher likelihood to use healthcare.ConclusionThe study has outlined multiple factors influencing utilisation of healthcare among poor older people under the LEAP programme in Ghana. The results, therefore, validate the importance of social and behavioural determinants of healthcare use in the Ghanaian poor older population. We highlight the need for health planners and stakeholders to consider demographic, socio-economic, health-related and lifestyle factors when formulating health policy for poor older people in Ghana.
Do healthcare needs-based population segments predict outcomes among the elderly? Findings from a prospective cohort study in an urbanized low-income community
Authors: Chong Jia Loon , Low Lian Leng , Matchar David Bruce , Malhotra Rahul , Lee Kheng Hock , Thumboo Julian , Chan Angelique Wei-Ming 
Published: February 2020

AbstractBackgroundA rapidly ageing population with increasing prevalence of chronic disease presents policymakers the urgent task of tailoring healthcare services to optimally meet changing needs. While healthcare needs-based segmentation is a promising approach to efficiently assessing and responding to healthcare needs at the population level, it is not clear how available schemes perform in the context of community-based surveys administered by non-medically trained personnel. The aim of this prospective cohort, community setting study is to evaluate 4 segmentation schemes in terms of practicality and predictive validity for future health outcomes and service utilization.MethodsA cohort was identified from a cross-sectional health and social characteristics survey of Singapore public rental housing residents aged 60 years and above. Baseline survey data was used to assign individuals into segments as defined by 4 predefined population segmentation schemes developed in Singapore, Delaware, Lombardy and North-West London. From electronic data records, mortality, hospital admissions, emergency department visits, and specialist outpatient clinic visits were assessed for 180 days after baseline segment assignment and compared to segment membership for each segmentation scheme.ResultsOf 1324 residents contacted, 928 agreed to participate in the survey (70% response). All subjects could be assigned an exclusive segment for each segmentation scheme. Individuals in more severe segments tended to have lower quality of life as assessed by the EQ-5D Index for health utility. All population segmentation schemes were observed to exhibit an ability to differentiate different levels of mortality and healthcare utilization.ConclusionsIt is practical to assign individuals to healthcare needs-based population segments through community surveys by non-medically trained personnel. The resulting segments for all 4 schemes evaluated in this way have an ability to predict health outcomes and utilization over the medium term (180 days), with significant overlap for some segments. Healthcare needs-based segmentation schemes which are designed to guide action hold particular promise for promoting efficient allocation of services to meet the needs of salient population groups. Further evaluation is needed to determine if these schemes also predict responsiveness to interventions to meet needs implied by segment membership.
Associations with rates of falls among home care clients in Ontario, Canada: a population-based, cross-sectional study
Authors: Manis Derek R. , McArthur Caitlin , Costa Andrew P. 
Published: February 2020

Abstract
Background
Accidental falls among older adults are a leading cause of injury-related hospitalizations. Reducing falls is an ongoing quality improvement priority for home care, given that many home care clients experience falls. In this study, we identify factors associated with the rate of falls among home care clients.

Methods
We conducted a population-based, cross-sectional study using secondary data from the Hamilton, Niagara, Haldimand, and Brant health region of Ontario, Canada from January 1 – March 31, 2018. We captured person-level characteristics with falls from the Resident Assessment Instrument – Home Care (RAI-HC). Negative binomial regression was used to model the rate of falls.

Results
Functional characteristics of home care clients had strong, statistically significant associations with the rate of falls. Declines in activities of daily living, assistive device use for locomotion indoors, polypharmacy, and health conditions, such as dizziness or lightheadedness, and parkinsonism, were associated with a higher rate of falls. Males who used assistive devices had a higher rate of falls compared to females; however, males with neurological and cardiovascular health conditions had a decrease in the rate of falls compared to females. Home care clients with parkinsonism who used a cane and took eight or more drugs had stronger associations with an increased rate of falls compared to those who do not have parkinsonism.

Conclusions
Functional characteristics, polypharmacy, and health conditions are associated with increased rates of falls among home care clients. Home care clients who are at a greater risk of falls may require environmental adjustments in their home to reduce or eliminate the possibility of falling.
Undiagnosed HIV, hepatitis B, and hepatitis C infections in people with severe psychiatric disorders in Ethiopia
Authors: Ayano Getinet , Haile Kibrom , Tesfaye Abel , Haile Kelemua , Demelash Sileshi , Tulu Mikias , Tsegaye Belachew , Solomon Melat , Kebede Alem , Biru Aynalem , Birhanu Habte , Zenawi Gebresilassie , Habtamu Yodit , Kibron Esias , Eshetu Seneshet , Sefiw Meseret , Assefa Dawit , Yohannes Zegeye 
Published: February 2020

Abstract
Background
Worldwide, there is limited epidemiologic evidence on the seroprevalence of undiagnosed chronic viral infections including HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among patients with severe psychiatric disorders. To our knowledge, this is the first study to explore and compare undiagnosed seroprevalence rates of HIV, HBV, and HCV infections among patients with severe psychiatric disorders.

Method
In this study, we included a random sample of 309 patients with severe psychiatric disorders selected by systematic sampling technique. We used a structured clinical interview for DSM-IV (SCID) to confirm the diagnosis of severe psychiatric disorders among the participants. Binary and multivariable logistic regression models, adjusting for the potential confounding factors was used to explore the potential determinants of chronic viral infections.

Result
The prevalence estimates of HIV infection among patients with severe psychiatric disorders in this study (3.24%) was roughly 3 times the estimated population prevalence of HIV infection in Ethiopia (1.1%). This study showed that the prevalence rates of HBV and HCV infections among patients with severe psychiatric disorders were 4.85 and 1.29%, respectively. Our results also showed that among patients with chronic viral infections, HIV, HBV and HCV, 76.92, 60, 80, and 75% respectively were undiagnosed. Regarding associated factors, the presence of chronic viral infection was found to be significantly associated with the age of the participants (ranging between 30 and 40 years) after adjusting for the possible confounding factors [AOR = 3.95 (95%CI.18–13.17)].

Conclusion
Even though the prevalence estimates of HIV (3.24%), HBV (4.85%), and HCV (1.29%) infections were high among patients with severe psychiatric disorders, the majority of them remained undiagnosed. HBV was found to be the commonly undiagnosed infection (4 out of 5) followed by HCV (3 out of 4) and HIV (6 out of 10). The present study provided evidence of a significant association between the age of the participant (between 30 and 40 years) and chronic viral infections in patients with severe psychiatric disorders. Increasing the awareness of psychiatry professionals and early screening, as well as interventions of chronic viral infections among patients with severe psychiatric disorders are imperative.
Cramping, crashing, cannulating, and clotting: a qualitative study of patients’ definitions of a “bad run” on hemodialysis
Authors: Kuo Pei-Yi , Saran Rajiv , Argentina Marissa , Heung Michael , Bragg-Gresham Jennifer , Krein Sarah , Gillespie Brenda W. , Zheng Kai , Veinot Tiffany C. 
Published: February 2020

AbstractBackgroundHemodialysis sessions frequently become unstable from complications such as intradialytic hypotension and untoward symptoms. Previous patient safety initiatives promote prevention of treatment complications; yet, they have placed little specific focus on avoidable session instability. A patient-centered definition of session instability grounded in patient experiences, and an understanding of patient perceptions of causes and solutions to instability, may enable such efforts.MethodsTwenty-five participants participated in three focus groups and/or a survey. They were purposively sampled for variation in region of residence, and sensitivity to patient well-being. Focus group recordings were analyzed using descriptive coding, in vivo coding, and thematic analysis.ResultsPatients define unstable sessions (“bad runs”) as those in which they experience severe discomfort or unanticipated events that interfere with their ability to receive therapy. Bad runs were characterized primarily by cramping, low blood pressure (“crashing”), cannulation-related difficulties (“bad sticks”), and clotting of the dialysis circuit or vascular access. Patients believed that cramping and crashing could be explained by both patient and clinician behavior: patient fluid consumption and providers’ fluid removal goals. Patients felt that the responsibility for cannulation-related problems lay with dialysis staff, and they asked for different staff or self-cannulated as solutions. Clotting was viewed as an idiosyncratic issue with one’s body, and perceived solutions were clinician-driven. Patients expressed concern about “bad runs” on their ability to achieve fluid balance.ConclusionsFindings point to novel priorities for efforts to enhance hemodialysis session stability, and areas in which patients can be supported to become involved in such efforts.
Elevated C-reactive protein and complement C3 levels are associated with preterm birth: a nested case–control study in Chinese women
Authors: Huang Shengzhu , Tian Jiarong , Liu Chaoqun , Long Yu , Cao Dehao , Wei Luyun , Zhu Xiujuan , Tang Ruiqiang , Liu Weiwu , Zeng Dingyuan , Li Mujun , Yang Xiaobo , Mo Zengnan 
Published: February 2020

Abstract
Background
Currently, there are many studies researched the associations between maternal serum inflammatory indicators (i.e. ferritin, C-reactive protein [CRP], C3 and C4) and preterm birth (PTB). The results, however, are inconsistent. Therefore, the aim of this study was to estimate the relationship between maternal serum inflammatory indicators and PTB in a nested case-control (NCC)study.

Methods
A NCC study was conducted by Guangxi Birth Cohort Study which enrolled a total of 6203 pregnant women between 50/7 and 346/7 weeks of gestational age (wGA) from six cities in China between 2015 and 2016. There were 206women who delivered preterm (< 370/7 wGA), and 412 women who delivered term birth, those women were matched by maternal age, birth place, gender of infants, and wGA at blood collection.
The inflammatory indicators were quantified by immunoturbidimetric methods.

Results
Highest quartile concentrations of all inflammatory indicators were determined versus median. After adjusting for maternal age, high levels of CRP (CRP > 16.60 mg/L) are related to the risk of PTB (OR = 2.16, 95% CI: 1.02–4.56, p = 0.044) in the first trimester. The association of C3 was extremely related to those who delivered PTB (OR = 2.53, 95% CI: 1.14–5.64, p = 0.023) in the first trimester. Moreover, no significant associations were found in C4 (p = 0.079) and ferritin (p = 0.067) between PTB.

Conclusions
Elevated concentrations of CRP and C3 in the first trimester were associated with increased risk of PTB. Inflammatory indicators may act a pivotal part in early diagnosis and prognosis of PTB.