bluuebunny/crossref_metadata_2025_split huggingface dataset:
Estimating the pattern of causes of death in Papua New Guinea
Authors: Kitur Urarang , Adair Tim , Riley Ian , Lopez Alan D. 
Published: October 2019

Abstract

Background
Papua New Guinea (PNG) is a diverse country with high mortality and evidence of increased prevalence of non-communicable diseases (NCDs), but there is no reliable cause of death (COD) data because civil registration is insufficient and routine health data comprise only a small proportion of deaths. This study aims to estimate cause-specific mortality fractions (CSMFs) for five broad groups of causes (endemic infections, emerging infections, endemic NCDs, emerging NCDs and injuries), by sex for each of PNG’s provinces.

Methods
CSMFs are calculated as the average of estimates obtained from: (1) Empirical cause method: Utilising available Verbal Autopsy (VA) data and Discharge Health Information System (DHIS) data, and applying statistical models of community versus facility CODs; and (2) Expected cause patterns method: Utilising existing estimates of mortality levels in each province and statistical models of the relationship between all-cause and cause-specific mortality using Global Burden of Disease (GBD) data.

Results
An estimated 41% of male and 49% of female deaths in PNG are due to infectious, maternal (female only), neonatal and nutritional causes. Furthermore, 45% of male and 42% of female deaths arise from NCDs. Infectious diseases, maternal, neonatal and nutritional conditions account for more than half the deaths in a number of provinces, including lower socioeconomic status provinces of Gulf and Sandaun, while provinces with higher CSMFs from emerging NCDs (e.g. ischemic heart disease, stroke) tend to be those where socioeconomic status is comparatively high (e.g. National Capital District, Western Highlands Province, Manus Province, New Ireland Province and East New Britain Province). Provinces with the highest estimated proportion of deaths from emerging infectious diseases are readily accessible by road and have the highest rates of sexually transmitted infections (STIs), while provinces with the highest CSMFs from endemic infectious, maternal, neonatal and nutritional causes are geographically isolated, have high malaria and high all-cause mortality.

Conclusions
Infectious, maternal, neonatal and nutritional causes continue to be an important COD in PNG, and are likely to be higher than what is estimated by the GBD. Nonetheless, there is evidence of the emergence of NCDs in provinces with higher socioeconomic status. The introduction of routine VA for non-facility deaths should improve COD data quality to support health policy and planning to control both infectious and NCDs.
Materials for pulpotomy in immature permanent teeth: a systematic review and meta-analysis
Authors: Chen Yuan , Chen Xinlei , Zhang Yali , Zhou Fangjie , Deng Jiaxin , Zou Jing , Wang Yan 
Published: October 2019

Abstract

Background
Pulpotomy is one of the most widely used methods in preserving vital pulp in teeth, which is of great significance in achieving continue root formation in immature permanent teeth suffering from dental caries or trauma. The aim of this meta-analysis and systemic review is to synthesize the available evidences to compare different pulpotomy dressing agents for pulpotomy treatment in immature permanent teeth.

Methods
Electronic databases including MEDLINE (via Pubmed), EMBASE, the Cochrane library (CENTRAL) and the clinicaltrials.gov database were searched. The references of all included articles or relevant reviews were cross-checked. Only randomized controlled trials (RCTs) comparing two or more pulp dressing agent in permanent teeth with open apex would be included. Also, the studies should have at least 6 months of follow-up, report clinical and radiographic success in detail and publish in English.

Results
Five RCTs were included for a systematic review, and all of them had a high risk of bias. There is little difference in success rate between mineral trioxide aggregate (MTA) and calcium hydroxide (CH) at 6-month follow-up (risk ratio (RR) 1; 95% confidence interval (CI) 0.94 to 1.06) and 12-month follow-up (RR 1.04; 95% CI 0.96 to 1.13). There is no difference between MTA versus platelet-rich fibrin and MTA versus calcium-enriched mixture (CEM). There is only weak evidence of increased success rate in using MTA and triple antibiotic paste (TAP) rather than abscess remedy.

Conclusions
Based on the present evidence, similar success rates with MTA were found between the dressing agents CH, CEM, RPF and TAP as pulpotomy-dressing agents in the treatment of immature permanent teeth. More high-quality RCTs are needed in this field in future studies.
Stigma among healthcare workers towards hepatitis B infection in Bangalore, India: a qualitative study
Authors: van der Scheun F. C. , Nagelkerke M. C. M. , Kilaru A. , Shridhar V. , Prasad R. , van der Werf T. S. 
Published: October 2019

Abstract

Background
With about 50 million people infected with hepatitis B (HBV) in India the burden of disease is high. Stigma has been identified to have a major negative impact on screening, diagnosis and treatment of hepatitis B patients. The aim of this study was to assess the stigma in nurses and physicians in Bangalore, India; studies on stigma in HBV have only been published outside of India.

Methods
Semi-structured in-depth-interviews were conducted in the period of March 20th and April 16th 2018 to study stigma and other problems in the care of hepatitis B patients. Stigma was pragmatically defined as a mark of disgrace associated with having a hepatitis B infection. Thirty physicians and nurses in different clinics and hospitals across the city of Bangalore were selected by purposeful sampling and snowball effect until theoretical saturation was reached.

Results
The following themes were identified during the interviews: feelings when treating a patient; pregnancy and marriage; confidentiality; morality; improvement in care and the difference with HIV. The most stigma was discovered in the theme morality. The majority of our participants mentioned lack of awareness as biggest obstacle in health care of hepatitis B patients.

Conclusions
This is the first qualitative study in India exploring hepatitis B stigma among health care workers. Stigma was found in certain themes, such as morality. Though, no unwillingness to treat was found. There was a general lack of awareness amongst patients according to our participants and could jeopardize proper treatment. These results will further help in developing strategies to tackle hepatitis B in India.
Inhibition of Aurora A enhances radiosensitivity in selected lung cancer cell lines
Authors: Liu Ningbo , Wang Yong Antican , Sun Yunguang , Ecsedy Jeffrey , Sun Jifeng , Li Xue , Wang Ping 
Published: October 2019

Abstract

Background
In mammalian cells, Aurora serine/threonine kinases (Aurora A, B, and C) are expressed in a cell cycle-dependent fashion as key mitotic regulators required for the maintenance of chromosomal stability. Aurora-A (AURKA) has been proven to be an oncogene in a variety of cancers; however, whether its expression relates to patient survival and the association with radiotherapy remains unclear in non-small cell lung cancer (NSCLC).

Methods
Here, we first analyzed AURKA expression in 63 NSCLC tumor samples by immunohistochemistry (IHC) and used an MTS assay to compare cell survival by targeting AURKA with MLN8237 (Alisertib) in H460 and HCC2429 (P53-competent), and H1299 (P53-deficient) cell lines. The radiosensitivity of MLN8237 was further evaluated by clonogenic assay. Finally, we examined the effect of combining radiation and AURKA inhibition in vivo with a xenograft model and explored the potential mechanism.

Results
We found that increased AURKA expression correlated with decreased time to progression and overall survival (p = 0.0447 and 0.0096, respectively). AURKA inhibition using 100 nM MLN8237 for 48 h decreases cell growth in a partially P53-dependent manner, and the survival rates of H460, HCC2429, and H1299 cells were 56, 50, and 77%, respectively. In addition, the survival of H1299 cells decreased 27% after ectopic restoration of P53 expression, and the radiotherapy enhancement was also influenced by P53 expression (DER H460 = 1.33; HCC2429 = 1.35; H1299 = 1.02). Furthermore, tumor growth of H460 was delayed significantly in a subcutaneous mouse model exposed to both MLN8237 and radiation.

Conclusions
Taken together, our results confirmed that the expression of AURKA correlated with decreased NSCLC patient survival, and it might be a promising inhibition target when combined with radiotherapy, especially for P53-competent lung cancer cells. Modulation of P53 function could provide a new option for reversing cell resistance to the AURKA inhibitor MLN8237, which deserves further investigation.
In silico-guided engineering of Pseudomonas putida towards growth under micro-oxic conditions
Authors: Kampers Linde F. C. , van Heck Ruben G. A. , Donati Stefano , Saccenti Edoardo , Volkers Rita J. M. , Schaap Peter J. , Suarez-Diez Maria , Nikel Pablo I. , Martins dos Santos Vitor A. P. 
Published: October 2019

Abstract

Background
Pseudomonas putida is a metabolically versatile, genetically accessible, and stress-robust species with outstanding potential to be used as a workhorse for industrial applications. While industry recognises the importance of robustness under micro-oxic conditions for a stable production process, the obligate aerobic nature of P. putida, attributed to its inability to produce sufficient ATP and maintain its redox balance without molecular oxygen, severely limits its use for biotechnology applications.

Results
Here, a combination of genome-scale metabolic modelling and comparative genomics is used to pinpoint essential $$\text {O}_{2}$$

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2

-dependent processes. These explain the inability of the strain to grow under anoxic conditions: a deficient ATP generation and an inability to synthesize essential metabolites. Based on this, several P. putida recombinant strains were constructed harbouring acetate kinase from Escherichia coli for ATP production, and a class I dihydroorotate dehydrogenase and a class III anaerobic ribonucleotide triphosphate reductase from Lactobacillus lactis for the synthesis of essential metabolites. Initial computational designs were fine-tuned by means of adaptive laboratory evolution.

Conclusions
We demonstrated the value of combining in silico approaches, experimental validation and adaptive laboratory evolution for microbial design by making the strictly aerobic Pseudomonas putida able to grow under micro-oxic conditions.
Methodological limitations in experimental studies on symptom development in individuals with idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF) – a systematic review
Authors: Schmiedchen Kristina , Driessen Sarah , Oftedal Gunnhild 
Published: October 2019

AbstractBackgroundHypersensitivity to electromagnetic fields (EMF) is a controversial condition. While individuals with idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF) claim to experience health complaints upon EMF exposure, many experimental studies have found no convincing evidence for a physical relation. The aim of this systematic review was to evaluate methodological limitations in experimental studies on symptom development in IEI-EMF individuals that might have fostered false positive or false negative results. Furthermore, we compared the profiles of these limitations between studies with positive and negative results.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guided the methodological conduct and reporting. Eligible were blinded experimental studies that exposed individuals with IEI-EMF to different EMF exposure levels and queried the development of symptoms during or after each exposure trial. Strengths and limitations in design, conduct and analysis of individual studies were assessed using a customized rating tool.ResultsTwenty-eight studies met the eligibility criteria and were included in this review. In many studies, both with positive and negative results, we identified methodological limitations that might have either fostered false or masked real effects of exposure. The most common limitations were related to the selection of study participants, the counterbalancing of the exposure sequence and the effectiveness of blinding. Many studies further lacked statistical power estimates. Methodically sound studies indicated that an effect of exposure is unlikely.ConclusionOverall, the evidence points towards no effect of exposure. If physical effects exist, previous findings suggest that they must be very weak or affect only few individuals with IEI-EMF. Given the evidence that the nocebo effect or medical/mental disorders may explain the symptoms in many individuals with IEI-EMF, additional research is required to identify the various factors that may be important for developing IEI-EMF and for provoking the symptoms. We recommend the identification of subgroups and exploring IEI-EMF in the context of other idiopathic environmental intolerances. If further experimental studies are conducted, they should preferably be performed at the individual level. In particular, to increase the likelihood of detecting hypersensitive individuals, if they exist, we encourage researchers to achieve a high credibility of the results by minimizing sources of risk of bias and imprecision.
What do Accredited Social Health Activists need to provide comprehensive care that incorporates non-communicable diseases? Findings from a qualitative study in Andhra Pradesh, India
Authors: Abdel-All Marwa , Abimbola Seye , Praveen D. , Joshi Rohina 
Published: October 2019

Abstract

Background
The Indian National Program for Cardiovascular Disease, Diabetes, Cancer and Stroke (NPCDCS) was introduced to provide non-communicable disease (NCD) care through primary healthcare teams including Accredited Social Health Activists (ASHAs). Since ASHAs are being deployed to provide NCD care on top of their regular work for the first time, there is a need to understand the current capacity and challenges faced by them.

Methods
A desktop review of NPCDCS and ASHA policy documents was conducted. This was followed by group discussions with ASHAs, in-depth interviews with their supervisors and medical officers and group discussions with community members in Guntur, Andhra Pradesh, India. The multi-stakeholder data were analysed for themes related to needs, capacity, and challenges of ASHAs in providing NCD services.

Results
This study identified three key themes—first, ASHAs are unrecognised as part of the formal NPCDCS service delivery team. Second, they are overburdened, since they deliver several NPCDCS activities without receiving training or remuneration. Third, they aspire to be formally recognised as employees of the health system. However, ASHAs are enthusiastic about the services they provide and remain an essential link between the health system and the community.

Conclusion
ASHAs play a key role in providing comprehensive and culturally appropriate care to communities; however, they are unrecognised and overburdened and aspire to be part of the health system. ASHAs have the potential to deliver a broad range of services, if supported by the health system appropriately.

Trial registration
The study was registered with “Clinical Trials Registry – India” (identifier CTRI/2018/03/012425).
Better transport accessibility, better health: a health economic impact assessment study for Melbourne, Australia
Authors: Brown Vicki , Barr Alison , Scheurer Jan , Magnus Anne , Zapata-Diomedi Belen , Bentley Rebecca 
Published: October 2019

Abstract

Background
Physical inactivity is a global public health problem, partly due to urbanization and increased use of passive modes of transport such as private motor vehicles. Improving accessibility to public transport could be an effective policy for Governments to promote equity and efficiency within transportation systems, increase population levels of physical activity and reduce the negative externalities of motor vehicle use. Quantitative estimates of the health impacts of improvements to public transport accessibility may be useful for resource allocation and priority-setting, however few studies have been published to inform this decision-making. This paper aims to estimate the physical activity, obesity, injury, health and healthcare cost-saving outcomes of scenario-based improvements to public transport accessibility in Melbourne, Australia.

Methods
Baseline and two hypothetical future scenario estimates of improved public transport accessibility for Melbourne, Australia, were derived using a spatial planning and decision tool designed to simulate accessibility performance (the Spatial Network Analysis for Multimodal Urban Transport Systems (SNAMUTS)). Public transport related physical activity was quantified by strata of age group and sex from Melbourne travel survey data (VISTA survey) and used with the SNAMUTS Composite Index to estimate input data for health impact modelling for the Melbourne population aged 20–74 years. A proportional multi-state, multiple cohort lifetable Markov model quantified the potential health gains and healthcare cost-savings from estimated changes in physical activity, body weight and injuries related to walking to access/egress public transport under two scenarios: (S1) public transport accessibility under current policy directions, and (S2) multi-directional, high-frequency network improvements.

Results
Multi-directional, high-frequency improvements to the public transport network (S2) resulted in significantly greater health and economic gains than current policy directions (S1) in relation to physical activity (mean 6.4 more MET minutes/week), body weight (mean 0.05 kg differential), health-adjusted life years gained (absolute difference of 4878 HALYs gained) and healthcare cost-savings (absolute difference of AUD43M), as compared to business as usual under both scenarios (n = 2,832,241 adults, over the lifecourse).

Conclusions
Based on our conservative analyses, improving accessibility to public transport will improve population health by facilitating physical activity and lead to healthcare cost savings compared with business-as-usual. These wider health benefits should be better considered in transport planning and policy decisions.
A rare simultaneous coexistence of epithelioid gastrointestinal stromal tumors and schwannoma in the stomach: a case report
Authors: Li Yuxin , Teng Yongliang , Wei Xiaofei , Tian Zhuang , Cao Yuqing , Liu Xiaona , Duan Xiumei 
Published: October 2019

AbstractBackgroundGastrointestinal stromal tumors (GISTs), a type of mesenchymal tumor in the gastrointestinal tract, are believed to be closely associated with PDGFRA and C-KIT mutations. Schwannoma in the stomach, which is an unusual location, is a rare disorder. The simultaneous occurrence of the two diseases is rarer than metachronous occurrences, and its pathological characteristics have not been reported to date. We present a case report on a patient with simultaneous coexistence of gastric schwannoma and GISTs.Case presentationA 39-year-old female visited our hospital complaining of intermittent abdominal pain for the previous 3 months. CT revealed a 3.4 cm slight homogeneous enhancement in the lesser curvature of the stomach; the mass was nodular soft tissue, which was removed by radical surgery. Two solid tumors with different volumes were located in the stomach. Histologically and immunohistochemically different, the larger tumor consisted of spindle cells surrounded by a peripheral lymphoid cuff, and was positive for S-100. The larger tumor was therefore classified as a gastric schwannoma. The smaller tumor was composed of medium-sized round, oval cells with amphiphilic granular cytoplasm; vacuolization was also observed. The tumor cells were positive for DOG1 and sporadically positive for CD34 and CD117. Hence, the smaller tumor was diagnosed as epithelioid GISTs. Sanger sequencing revealed that the GIST tumor cells contained a deletion mutation (c.2527_2538 del12,843–846del4), which was located in exon 18 of PDGFRA.ConclusionGISTs combined with gastric schwannoma are a considerably rare subgroup of gastric tumors. Related clinical research is comparatively weak, and the mechanism remains unknown. We reviewed related articles to provide knowledge to improve the correct identification, diagnosis and management of patients with gastric cancer. All pathologists involved in the diagnosis and clinicians involved in the treatment should be aware of this new kind of disease pattern to improve their understanding of the disease.
Stereotactic ablative radiotherapy versus conventionally fractionated radiotherapy in the treatment of hepatocellular carcinoma with portal vein invasion: a retrospective analysis
Authors: Yang Jen-Fu , Lo Cheng-Hsiang , Lee Meei-Shyuan , Lin Chun-Shu , Dai Yang-Hong , Shen Po-Chien , Chao Hsing-Lung , Huang Wen-Yen 
Published: October 2019

Abstract

Background
This study aimed to compare the clinical outcomes of stereotactic ablative radiotherapy (SABR) and conventionally fractionated radiotherapy (CFRT) in hepatocellular carcinoma (HCC) patients with portal vein invasion (PVI).

Methods
HCC patients with PVI treated with radiotherapy from 2007 to 2016 were analysed. CFRT was administered at a median dose of 51.5 Gy (interquartile range, 45–54 Gy) with 1.8–3 Gy per fraction. SABR was administered at a median dose of 45 Gy (interquartile range, 40–48 Gy) with 6–12.5 Gy per fraction. Treatment efficacy, toxicity, and associated predictors were assessed.

Results
Among the 104 evaluable patients (45 in the SABR group and 59 in the CFRT group), the overall response rate (ORR, complete and partial response) was significantly higher in the SABR group than the CFRT group (62.2% vs. 33.8%, p = 0.003). The 1-year overall survival (OS) rate (34.9% vs. 15.3%, p = 0.012) and in-field progression-free survival (IFPS) rate (69.6% vs. 32.2%, p = 0.007) were also significantly higher in the SABR vs. CFRT group. All 3 rates remained higher in the SABR group after propensity score matching. Multivariable analysis identified SABR and a biologically effective dose ≥65 Gy as favourable predicators of OS. There was no difference between treatment groups in the incidence of radiation-induced liver disease or increase of Child-Pugh score ≥ 2 within 3 months of radiotherapy.

Conclusions
SABR was superior to CFRT in terms of ORR, OS, and IFPS. We suggest that SABR should be the preferred technique for HCC patients with PVI.