bluuebunny/crossref_metadata_2025_split huggingface dataset:
“It’s really no more difficult than putting on fluoride varnish”: A qualitative exploration of dental professionals’ views of silver diamine fluoride for the management of carious lesions in children
Authors: Seifo Nassar , Cassie Heather , Radford John , Innes Nicola 
Published: September 2020

Abstract
BackgroundDespite evidence that Silver Diamine Fluoride (SDF) can be effective in managing carious lesions in primary teeth, the use of SDF in the UK remains limited. This study explored dental professionals’ views and experiences of using SDF for managing carious lesions in children. In addition, it explored what they perceived to be the advantages, disadvantages, barriers and enablers to the use of SDF in practice.MethodsFifteen semi-structured face-to-face or over-the-phone interviews were conducted with 14 dental professionals from NHS Tayside and NHS Grampian in Scotland. Interviews were transcribed verbatim, coded and analysed using a thematic approach.ResultsThirteen of 14 dental professionals interviewed were familiar with, or had some existing knowledge of, SDF. Four had used it to treat patients. The majority of participants thought that the main advantage of SDF was that it required minimal patient cooperation. SDF was also perceived as a simple, pain-free and non-invasive treatment approach that could help acclimatise children to the dental environment. However, SDF-induced black staining of arrested carious lesions was most commonly reported as the main disadvantage and greatest barrier to using it in practice. Participants believed that this discolouration would concern some parents who may fear that the black appearance may instigate bullying at school and that others may judge parents as neglecting their child’s oral health. Participants thought that education of clinicians about SDF use and information sheets for parents would enhance the uptake of SDF in dental practice. Participants believed that younger children might not be as bothered by the discolouration as older ones and they anticipated greater acceptance of SDF for posterior primary teeth by both parents and children.ConclusionDental professionals were aware that SDF can be used for arresting carious lesions. They pointed out that the staining effect of carious lesions is a major disadvantage that could be a barrier for many parents. Participants considered the application process to be simple and non-invasive and requires a minimum level of child cooperation. Participants appreciated the potential of SDF in paediatric dentistry and suggested actions that could help overcome the barriers they highlighted.
Infection deteriorating hepatitis B virus related acute-on-chronic liver failure: a retrospective cohort study
Authors: Zhai Xing-Ran , Tong Jing-Jing , Wang Hong-Min , Xu Xiang , Mu Xiu-Ying , Chen Jing , Liu Zi-Feng , Wang Yu , Su Hai-Bin , Hu Jin-Hua 
Published: September 2020

Abstract
Background: Infection is common in acute-on-chronic liver failure (ACLF), which may worsen the clinical condition and prognosis. However, the characteristics of infection and its influence on prognosis in hepatitis B virus related ACLF (HBV-ACLF) as defined by the European Association for the Study of the Liver (EASL) have not been clarified. We aimed to investigate the characteristics of infection and its influence on mortality in patients with HBV-ACLF defined by EASL in China.Methods: We performed a retrospective cohort study in patients with HBV-ACLF defined by EASL in a single center from January 2015 to December 2017. These patients were divided into two groups with and without infection. The incidence, sites of infection, isolated strains, and risk factors associated with mortality were evaluated. Results: A total of 289 patients were included, among them 185 (64.0%) were diagnosed with an infection. The most common type of infection was pneumonia (55.7%), followed by spontaneous bacterial peritonitis (47.6%) and others. The gram-negative bacteria were the most frequent (58.3%). Patients with one, two, and three or more infection sites had a gradually increasing incidence of sepsis (P<0.01), septic shock (P<0.001), and ACLF-3 (P<0.05). Also, patients with infection isolated one, two, and three or more strains showed a growing incidence of sepsis (P<0.01) and septic shock (P<0.001). Patients with infection showed a significantly higher 28-day mortality than those without (P<0.01), especially in patients with ACLF-3. Infection was identified as an independent risk factor for 28-day mortality in all HBV-ACLF patients. Pneumonia and sepsis were identified as independent predictors of 28-day mortality for patients with infection.Conclusions: Infection is associated with severe clinical course and high mortality in HBV-ACLF defined by EASL. The increased number of infection sites or isolated strains was associated with the occurrence of sepsis and septic shock. Pneumonia and sepsis were independent predictors for mortality in HBV-ACLF patients with infection.
Appropriate insertion point for percutaneous pedicle screw placement in the lumbar spine using c-arm fluoroscopy: a cadaveric study
Authors: Xu Wei-Xing , Ding wei-guo , Xu Bin , Hu Tian-Hong , Sheng Hong-Feng , Zhu Jia-Fu , Zhu Xiao-Long 
Published: September 2020

Abstract
Background: We studied the characteristics and regularity of appropriate insertion points for percutaneous pedicle screw placement in the lumbar spine using C-arm X-ray fluoroscopy. The purpose of this study was to improve the accuracy of percutaneous pedicle screw placement and reduce the incidence of superior-level facet joint violation. Methods: Six normal spinal specimens were included. Three different methods for placing percutaneous pedicle screws in the lumbar spine were applied, including the Roy-Camille method, Magerl method and Weinstein method. The relationships among the insertion point, pedicle projection and proximal facet joint on C-arm X-ray films were studied. The projection morphology of the vertebral pedicle in different segments of the lumbar spine was observed. The relationship between the outer edge of the pedicle projection and the outer edge of the cranial articular process was also studied. The distance between the insertion point and the facet joint (M1), the distance between the insertion point and outer edge of the cranial articular process (M2), and the distance between the insertion point and the projection center of the pedicle (M) were measured. Results: In this study, we found that the projection shape of the vertebral pedicle differed across segments of the lumbar spine: the shape for L1-L3 was oval, and that for L4-L5 was round. The radiographic study showed that the outer edge of the cranial articular process was located on the lateral side of the outer edge of the pedicle projection and did not overlap with the pedicle projection. M for the Weinstein group was larger than that for the Roy-Camille group (P < 0.05). M1 for the Weinstein group was larger than that for the Roy-Camille and Magerl groups (P < 0.05). M2 for the Roy-Camille group was negative, M2 for the Magerl group was 0, and M2 for the Weinstein group was positive. Conclusion: Under C-arm X-ray fluoroscopy, we were able to accurately identify the characteristics and regularity of the appropriate insertion point for percutaneous pedicle screw placement in the lumbar spine, which was important for improving the accuracy of percutaneous pedicle screw placement and reducing the incidence of superior-level facet joint violation.
Characterization of the Serum Levels of Meteorin-like in Patients with Inflammatory Bowel Disease and its Association with Inflammatory Cytokines
Authors: Gholamrezayi Afsane , Mohamadinarab Maryam , Rahbarinejad Pegah , Fallah Soudabeh , Barez Shekufe Rezghi , Setayesh Leila , Moradi Nariman , Fadaei Reza , Chamani Elham , Tavakoli Tahmine 
Published: September 2020

Abstract
Background : Meteorin-like (Metrnl) is a newly discovered adipokine with insulin sensitizing and anti-inflammatory properties. The relation among Metrnl, Inflammatory Bowel Disease (IBD), and obesity still remained unexplored. Methods : The present study was conducted on 54 healthy control, 42 Ulcerative Colitis (UC), and 43 Crohn's disease (CD) patients who were diagnosed by pathological examination. In all participants, serum levels of adiponectin, Metrnl, interleukin (IL)-6, and Tumor necrosis factor (TNF-α) were measured using ELISA kits.Results: Metrnl concentration was considerably decreased in both UC (85.25±36.55 pg/mL) and CD (76.93±27.92 pg/mL) patients in comparison to control group (107.52±35.33 pg/mL). In addition, the level of adiponectin decreased in these two patient groups compared to the controls. However, IL-6 and TNF-α significantly elevated in the patient groups. Moreover, Metrnl showed an inverse correlation with body mass index (BMI) in the controls and the patients. In addition, there was an inverse correlation among Metrnl, IL-6, and TNF-α in both of the patient groups. Conclusions : The current study is the first one reporting the decreased serum levels of Metrnl in patients with IBD, which is inversely related with BMI, TNF-α, and IL-6. These results suggested a possible relation of Metrnl with the pathogenesis of IBD, particularly through inflammatory process that need further study to dissect the possible mechanism. Keywords : Meteorin-like, Inflammatory Bowel Disease, Ulcerative Colitis, Crohn's disease, Interleukin, Tumor necrosis factor, Adiponectin
“If you are on duty, you may be afraid to come out to attend to a person”: Fear of crime and security challenges in maternal acute care in Nigeria from a realist perspective.
Authors: Etiaba Enyi , Manzano Ana , Agbawodikeizu Uju , Ogu Udochukwu , Ebenso Bassey , Uzochukwu Benjamin , Onwujekwe Obinna , Ezumah Nkoli , Mirzoev Tolib 
Published: September 2020

Abstract
Background Maternal and Child Health is a global priority. Access and utilization of facility-based health services remain a challenge in low and middle-income countries. Evidence on barriers to providing and accessing services omits information on the role of security within facilities. This paper explores the role of security in the provision and use of maternal health services in primary healthcare facilities in Nigeria. Methods Study was carried out in Anambra state, Nigeria. Qualitative data were initially collected from 35 in-depth interviews and 24 focus groups with purposively identified key informants. Information gathered was used to build a programme theory that was tested with another round of interviews (17) and focus group (4) discussions. Data analysis and reporting were based on the Context-Mechanism-Outcome heuristic of Realist Evaluation methodology. Results The presence of a male security guard in the facility was the most important security factor that facilitated provision and uptake of services. Others include perimeter fencing, lighting and staff accommodation. Lack of these components constrained provision and use of services, by impacting on behaviour of staff and patients. Security concerns of facility staff who did not feel safe to let in people into unguarded facilities, mirrored those of pregnant women who did not utilize health facilities because of fear of not being let in and attended to by facility staff. Conclusion Health facility security should be key consideration in programme planning, to avert staff and women’s fear of crime which currently constrains provision and use of maternal healthcare at health facilities.
Nomogram for Prediction of fatal outcome in Patients with Severe COVID-19: A Multicenter Study
Authors: Yang Yun , Zhu Xiaofei , Huang Jian , Chen Cui , Zheng Yang , He Wei , Zhao Linghao , Gao Qian , Huang Xuanxuan , Fu Lijuan , Zhang Yu , Chang Yanqin , Zhang Huojun , Lu Zhijie 
Published: September 2020

Abstract
Background & Aims: To develop an effective model of predicting fatalOutcome in the severe coronavirus disease 2019 (COVID-19) patients.Methods: Between February 20, 2020 and April 4, 2020, consecutive COVID-19 patients from three designated hospitals were enrolled in this study. Independent high- risk factors associated with death were analyzed using Cox proportional hazard model. A prognostic nomogram was constructed to predict the survival of severe COVID-19 patients.Results: There were 124 severe patients in the training cohort, and there were 71 and 76 severe patients in the two independent validation cohorts, respectively. Multivariate Cox analysis indicated that age ≥ 70 years (HR 1.184, 95% CI 1.061-1.321), Panting(breathing rate ≥ 30/min) (HR 3.300, 95% CI 2.509-6.286), lymphocyte count < 1.0 × 109/L (HR 2.283, 95% CI 1.779-3.267), and IL-6 >10pg/mL (HR 3.029, 95% CI 1.567-7.116) were independent high-risk factors associated with fatal outcome. We developed the nomogram for identifying survival of severe COVID-19 patients in the training cohort (AUC 0.900, [95% CI 0.841-0.960], sensitivity 95.5%, specificity 77.5%); in validation cohort 1 (AUC 0.811, [95% CI 0.698-0.924], sensitivity 77.3%, specificity 73.5); in validation cohort 2 (AUC 0.862, [95% CI 0.763-0.961], sensitivity 92.9%, specificity 64.5%). The calibration curve for probability of death indicated a good consistence between prediction by the nomogram and the actual observation. The prognosis of severe COVID-19 patients with high levels of interleukin-6 (IL-6) receiving tocilizumab was better than that of those patients without tocilizumab both in the training and validation cohorts, but without difference (p = 0.105 for training cohort, p = 0.133 for validation cohort 1, and p = 0.210 for validation cohort 2).Conclusions: This nomogram could help clinicians to identify severe patients who have high risk of death, and to develop more appropriate treatment strategies to reduce the mortality of severe patients. Tocilizumab may improve the prognosis of severe COVID-19 patients with high levels of IL-6.
Conceptualizations of Clinical Decision-Making: A scoping review in geriatric emergency medicine
Authors: Gamborg Maria Louise , Mehlsen Mimi , Paltved Charlotte , Tramm Gitte , Musaeus Peter 
Published: September 2020

Abstract
Background Clinical decision-making (CDM) is an important competency for young doctors especially under complex and uncertain conditions in geriatric emergency medicine (GEM). However, research in this field is characterized by a vague conceptualization of CDM. To evolve and evaluate evidence-based knowledge of CDM, it is important to identify different definitions and their operationalisations in studies on GEM. Objective A scoping review of empirical articles was conducted to provide an overview of the documented evidence of findings and conceptualizations of CDM in GEM. Methods A detailed search for empirical studies focusing on CDM in a GEM setting was conducted in PubMed, ProQuest, Scopus, EMBASE and Web of Science. In total, 52 publications were included in the analysis, utilizing a data extraction sheet, following the PRISMA guidelines. Reported outcomes were summarized. Results Four themes of operationalization of CDM emerged: CDM as dispositional decisions, CDM as cognition, CDM as a model, and CDM as clinical judgement. Study results and conclusions naturally differed according to how CDM was conceptualized. Thus, frailty-heuristics lead to biases in treatment of geriatric patients and the complexity of this patient group was seen as a challenge for young physicians engaging in CDM. Conclusions This scoping review summarizes how different studies in GEM use the term CDM. It provides an analysis of findings in GEM and call for more stringent definitions of CDM in future research, so that it might lead to better clinical practice.
Infertility policy analysis: a comparative study of selected lower middle- middle- and high-income countries
Authors: Morshed-Behbahani Bahar , Lamyian Minoor , Joulaei Hassan , Rashidi Batool Hossein , Montazeri Ali 
Published: September 2020

Abstract
BackgroundInfertility has recently become a salient but neglected global issue. Policies to address the sexual and reproductive health and rights (SRHR) are vital, especially in lower middle and middle-income countries (LMICs). Hence, the aim of this study was to compare the national infertility policies in the selected countries (LMICs comparing with high-income) to determine gaps or to confirm desirable policies in the given health systems.MethodsThis study has executed a comparative policy analysis of infertility services using the universal health coverage framework (financial protection, population coverage, and service features) in three scopes (prevention, treatment, and supportive care). Seven countries that had infertility programs in their health sectors were selected.ResultsThe results showed that financial protection was good in high and middle-income countries, but in a lower middle income, and in one high-income country was poor. The findings also showed that health systems in the same countries had no infertility services for men. Preventive and supportive care services were neglected in LMICs by governments.ConclusionThe findings indicate that income is not the only factor that fulfills universal health coverage for infertility care services. Perhaps to achieve equity in infertility care services, it should be seen as a universal human right to accomplish the right to have a child and to have a life with physical and mental health for all men and women.
Differential gene expression in skin RNA of horses affected with degenerative suspensory ligament desmitis
Authors: Haythorn Abigail , Young Madeline , Stanton James , Zhang Jian , Mueller P.O.E. , Halper Jaroslava 
Published: September 2020

Abstract
Background

Equine Degenerative Suspensory Desmitis (DSLD) is a systemic connective tissue disorder first identified in Peruvian Paso horses, but afflicting other horse breeds as well. Inappropriate accumulation of proteoglycans in connective tissues, most prominently in tendons and ligaments leads to progressive and debilitating lameness and pain. It is largely unknown what drives the overproduction of proteoglycans, but our previous studies suggest involvement of bone morphogenetic protein 2 (BMP2), a member of the transforming growth factor β (TGFβ) family, impacting synthesis of proteoglycans. To identify potential players in pathogenesis of DSLD a new approach utilizing next generation sequencing was undertaken.

Methods

Next generation sequencing was performed using RNA extracted from skin biopsies of six control Peruvian Pasos and six horses with DSLD (4 Peruvian Pasos and 2 Warmbloods). The CuffDiff result sets were validated with algorithms used to run them. This was based on the determined False Discovery Rates derived from the P-values adjusted for multiple testing for any given result.

Results

Bioinformatics analysis of transcriptomes revealed differential expression of over 1500 genes, including increased expression of genes for several growth factors (most prominently BMP2, FGF5, CTGF, members of the EGF family), of mediators of signaling (Fos, Myc, MAPK system), and keratins. Two genes encoding for enzymes involved in synthesis of hyaluronan were also overexpressed. Gene expression was decreased for protein cores of many proteoglycans, several growth factors, most collagens and many peptides with immune function.

Conclusions

The overexpression of BMP2 correlates well with our previous data. However, the decrease in expression of numerous proteoglycans was unexpected. A mutation in a gene of a less characterized proteoglycan and/or glycosyltransferase with subsequent increased production of hyaluronan and/or a proteoglycan(s) undetected in our study could account for the systemic proteoglycan deposition. Decreased collagen gene expression indicates abnormal connective tissue metabolism. The increased expression of keratin genes and FGF5 supports reports of skin abnormalities in DSLD. Underexpression of immune function genes corresponds with lack of inflammation in DSLD tissues. Finally, though the proteoglycan and/or glycosaminoglycan abundant in DSLD has not been identified, we validated our previous data, including overexpression of BMP2 , and systemic nature of DSLD due to disturbed metabolism of the extracellular matrix.
Vitamin D status in adults and children in Transcarpathia, Ukrainein 2019
Authors: Shchubelka Khrystyna 
Published: September 2020

Abstract
Background: Vitamin D deficiency is a global health problem, it is assessed by measuring serum 25-hydroxivitamin D (25(OH) D), nevertheless epidemiological data for many countries remains underreported.Objectives:To study the prevalence of vitamin D deficiency throughout the calendar year in a large cohort recruited ina multiethnic Transcarpathian region of Ukraine.Methods: In this retrospective study 25(OH)D serum concentration was measured during all 12 months of the year 2019 by electrochemoluminescent assay on the automatic analyzer Cobas e411 in 1,823 subjects, including both children and adults (1551 females (85.03%) and 273 males (14.97%)). ResultsThe mean 25(OH) D concentration in adults demonstrates significantly lower levels compared to children (22.67±8.63 ng/ml vs. 26.00±10.72 ng/ml respectively, p<0.001). Adult women expressed significantly lower mean annual serum 25 (OH) D concentrations in comparison to men (22.29±8.46 ng/ml vs. 25.75±9.38 ng/ml respectively, p< 0.001). In contrast, children did not show a significant difference between sexes (girls 24.98±10.38 ng/ml vs. boys 27.01±11.01 ng/ml, p=0.2003). In the winter months, 25(OH)D levels fell below 20 ng/ml in 51,74 % of adult population of Thranscarpathia, and in 12.91%, - below 12 ng/ml.ConclusionsThe results of this study contradict the previously reported evaluations of the vitamin D levels in Ukraine which were assessed by measuring serum 25(OH) D. Specifically, only approximately half of the studied population is vitamin D deficient during winter season. This study features the most representative sample size in Ukraine to date.