bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reshaping the tumor microenvironment: extracellular vesicles as messengers of cancer cells
Authors: Bhatta Bibek , Cooks Tomer 
Published: October 2020

AbstractThe tumor microenvironment (TME) comprises an assortment of immune and non-immune cells. The interactions between the cancer cells and their surrounding TME are known to be a cardinal factor in all stages of cancer progression, from initiation to metastasis. Tumor-associated macrophages (TAMs) and cancer-associated fibroblasts (CAFs) are considered two of the most abundant TME members associated with poor prognosis in various cancer types. Intercellular communication between the cancer cells and TME cells might occur via direct cell–cell contact or achieved through secreted factors such as cytokines, growth factors and extracellular vesicles (EVs). EVs are released by almost every cell type and by cancer cells in particular. EVs are loaded with unique molecular cargos that might include DNA, proteins, RNA and lipids, commonly reflecting the physiological traits of their donor cells. Once released, EVs are capable of initiating short- and long-distance communication in an autocrine, paracrine and endocrine fashion. The molecular cargos within the EVs are able to impart phenotypic changes at the receiving end thus allowing EV-releasing cancer cells to deliver messages to TME cells and tighten their grasp over the cancerous tissue. In this concise review, we aim to document the bidirectional EV-based communication between cancer cell, TAMs and CAFs, tilting the balance in favor of cancer progression and metastasis.
Symptoms in Blastomycosis, Coccidioidomycosis, and Histoplasmosis Versus Other Respiratory Illnesses in Commercially Insured Adult Outpatients—United States, 2016–2017
Authors: Benedict Kaitlin , Kobayashi Miwako , Garg Shikha , Chiller Tom , Jackson Brendan R 
Published: October 2020

Abstract

Background
Blastomycosis, coccidioidomycosis, and histoplasmosis cause various symptoms and syndromes, which may present similarly to other infections such as bacterial or viral community-acquired pneumonia, influenza, and tuberculosis.

Methods
We used the IBM MarketScan Research Databases to identify adult outpatients with International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), diagnosis codes during 2016–2017 for blastomycosis, coccidioidomycosis, histoplasmosis, pneumonia (viral, bacterial, Streptococcus pneumoniae, and unspecified pneumonia), influenza; tuberculosis, and other lower and upper respiratory infections. We compared symptoms on and in the 90 days before diagnosis between patients with these diagnosis codes.

Results
Fever was less common in blastomycosis (2.6%), histoplasmosis (5.3%), and coccidioidomycosis (9.4%) than in patients with influenza (18.5%) or pneumonia (12.6–16.3%). Fungal diseases resembled bacterial, viral, and unspecified pneumonias for many pulmonary symptoms. However, cough was more common with coccidioidomycosis (31.4%) and less common with histoplasmosis (14.0%) and blastomycosis (13.1%) versus influenza (20.2%). Although less frequent, solitary pulmonary nodule (5.2–14.4%), enlarged lymph nodes (3.7–9.0%), hyperhidrosis (&lt;2%), and erythema nodosum (&lt;2%) were particularly suggestive of fungal diseases.

Conclusions
Despite limitations inherent in administrative coding, this analysis of symptom codes across disease types suggests that fungal diseases may be difficult to clinically distinguish from other causes of pneumonia except when certain uncommon symptoms are present. Healthcare providers caring for patients with pneumonia, especially if nonresponsive to conventional treatment, should consider fungal diseases as possible etiologies.
Management of Inflammatory Bowel Disease Patients With Clinical Care Pathways Reduces Emergency Department Utilization
Authors: Lytvyak Ellina , Sutton Reed T , Dieleman Levinus A , Peerani Farhad , Fedorak Richard N , Kroeker Karen I 
Published: October 2020

AbstractBackgroundStandardizing care through pathways has the potential to reduce emergency department (ED) utilization. We developed and evaluated inflammatory bowel disease (IBD) care pathways for that purpose.MethodsOver 2014–2016, IBD patients were retrospectively stratified into those managed and not managed by pathways. Patient data were extracted, and negative binomial regression used to predict the annual number of ED visits.ResultsThere was a difference of 30.7 ED visits/100 patients between managed and nonmanaged at 12 months (P &lt; 0.001). The incidence rate ratio of total ED visits occurring annually was 0.750 (P = 0.008).ConclusionsManagement with IBD care pathways reduces ED utilization.
Characterization of G-quadruplex antibody reveals differential specificity for G4 DNA forms
Authors: Javadekar Saniya M , Nilavar Namrata M , Paranjape Amita , Das Kohal , Raghavan Sathees C 
Published: October 2020

Abstract
Accumulating evidence suggests that human genome can fold into non-B DNA structures, when appropriate sequence and favourable conditions are present. Among these, G-quadruplexes (G4-DNA) are associated with gene regulation, chromosome fragility and telomere maintenance. Although several techniques are used in detecting such structures in vitro, understanding their intracellular existence has been challenging. Recently, an antibody, BG4, was described to study G4 structures within cells. Here, we characterize BG4 for its affinity towards G4-DNA, using several biochemical and biophysical tools. BG4 bound to G-rich DNA derived from multiple genes that form G-quadruplexes, unlike complementary C-rich or random sequences. BLI studies revealed robust binding affinity (Kd = 17.4 nM). Gel shift assays show BG4 binds to inter- and intramolecular G4-DNA, when it is in parallel orientation. Mere presence of G4-motif in duplex DNA is insufficient for antibody recognition. Importantly, BG4 can bind to G4-DNA within telomere sequence in a supercoiled plasmid. Finally, we show that BG4 binds to form efficient foci in four cell lines, irrespective of their lineage, demonstrating presence of G4-DNA in genome. Importantly, number of BG4 foci within the cells can be modulated, upon knockdown of G4-resolvase, WRN. Thus, we establish specificity of BG4 towards G4-DNA and discuss its potential applications.
Old friends meet a new foe
Authors: Cepon-Robins Tara J , Gildner Theresa E 
Published: October 2020

Abstract
The novel virus, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), and the associated Coronavirus Disease 2019 (COVID-19) represent a pathogen to which human beings have limited to no evolved immune response. The most severe symptoms are associated with overactive inflammatory immune responses, leading to a cytokine storm, tissue damage, and death, if not balanced and controlled. Hypotheses within Evolutionary Medicine, including the Hygiene/Old Friends Hypothesis, provide an important lens through which to understand and possibly control this overactive immune response. In this article, we explore the role that infection with soil-transmitted helminths (STHs; i.e. intestinal parasitic worms) may play in dampening SARS-CoV-2 symptoms and mitigating the worst COVID-19 outcomes. Specifically, STHs stimulate the immunosuppressive and regulatory T-helper 2 (TH2) branch of the immune system, which decreases ACE2-receptor expression (i.e. receptors SARS-CoV-2 uses to infect host cells), balances the inflammatory TH1/TH17 branches of the immune system triggered by SARS-CoV-2 infection, and reduces inflammation through the release of anti-inflammatory/regulatory cytokines. Because STHs are common and affect the most vulnerable and marginalized members of society, it is especially important to consider how these parasites may impact COVID-19 outcomes. Areas experiencing endemic STH infections are often characterized by a lack of preventative infrastructure and medical care, which may further exacerbate risk of SARS-CoV-2 infection and COVID-19 development. For this reason, we also explore biocultural factors that contribute to disease outcomes for both SARS-CoV-2 and STH infections. Biocultural and Evolutionary Medicine perspectives on COVID-19 are crucial for understanding the global impact of the disease.
Lay summary: An evolutionary perspective is required to understand the global impact and various presentations of COVID-19. We consider how coinfection with soil-transmitted helminths (common parasitic worms that coevolved with humans) may suppress inflammatory immune activity, thereby potentially reducing COVID-19 disease severity. Structural and lifestyle factors shaping coinfection patterns are also discussed.
The Nutri-Score in France and beyond: development, validation and transfer
Authors: Julia C 
Published: October 2020

Abstract
The Nutri-Score is a summary graded front-of-pack nutritional label, providing a synthetic information to consumers on the overall nutritional quality of a food product, based on its composition in several key unfavourable (energy, saturates, sugars, salt) and favourable (proteins, fibers, fruit, vegetables, nuts, legumes and certain vegetable oils (olive, rapeseed and nuts)). The Nutri-Score was developed by a team of independent scientists, and initially proposed in France in 2014. Following intense opposition by industry and considerable arguments, a 2-yearlong debate, the Nutri-Score was selected to be the official French front-of-pack nutrition label. In parallel, more than 40 publications in peer-reviewed journals investigated its validity on multiple dimensions, further supporting its implementation. Following the implementation of the Nutri-Score, consumer groups' pressure and a growing interest from the public pushed manufacturers to adopt the label, with more than 300 pledges of adoption from industry in 2020. After France, neighbouring countries (Belgium, Spain, Switzerland, Germany and the Netherlands) have now also adopted the scheme, prompting new challenges for development at a larger scale. The implementation of the system in France was made possible by strong public support for such a measure - relayed by consumer groups and disseminated in the media and a strong political will from the Health ministry to put together a validated and helpful system, which finally prevailed upon economic interests. Sustained support from consumers in particular helped turn the tide from a relatively low engagement of stakeholders towards the acknowledgement of the Nutri-Score as a standard for front-of-pack labelling in France and several EU countries. The Nutri-Score is an example of a public health measure informed by scientific evidence that may have a clear impact on the nutritional quality of diets in the population.
Our climate and health emergency - Future role for global public health
Authors: Rispel L 
Published: October 2020

Abstract
Prof Laetitia Rispel is Immediate past President of the WFPHA, and Professor of Public Health at the University of the Witwatersrand: Johannesburg. She has a strong research background and publication record on public health governance, health workforce education, ethics, policy and practice.
Following talks on the relationship between climate change and food and water insecurity presenting a public health emergency, and case examples of recent disasters, Professor Rispel will outline the WFPHA vision for the public health sector's role in the coming decades. The expanding need for well resourced, and well-trained public health sector at national and regional levels will be outlined.
As the world careers ever closer to existential threats from unabated climate change, a key theme covered will be the imperative for multilateral climate negotiations to include public health experts
Following this presentation, the panel will invite questions and discussion from the floor to share experience and develop solutions-based model for expanded role of public health, and how we transition to that new world.
Incentives for smoking cessation in pregnancy
Authors: Tappin D , Bauld L 
Published: October 2020

Abstract

Issue/problem
Most pregnant smokers reply ‘Yes' when asked ‘Do you want to stop smoking?'. This is usually an honest answer but often without intention. About 10% who intend to quit are likely to attend smoking cessation services. Even with good quality counselling and the offer of nicotine replacement therapy only about 3-5% quit. How can the other 90% be reached?
There are two approaches: Redirect counselling away from specialist cessation practitioners and build capacity among all health care workers. This is attractive spreading counselling to health care workers who meet pregnant smokers during routine consultations requiring little resource after training for example General Practitioners, Midwives and Obstetricians. However limited time for training and subsequent counselling endangers the quality and quantity of counselling delivered.Increase the proportion of women who intend to quit smoking during pregnancy by providing a financial incentive payment for engaging with specialist cessation practitioners and quitting.
This policy allows counselling to be delivered by specialists and potentially draws in a larger proportion of pregnant smokers, as many as 50%.

Results
Financial incentives have increased the proportion of smokers who quit by late pregnancy in two large randomised controlled trials. The proportion increased by more than 100%. Local service pilots of financial incentives have seen marked increases in smokers who attend and quit.

Lessons
There are a number of ways to increase smoking cessation among pregnant women. Research evidence should be translated into effective service models to decide which strategy is most cost-effective.

Key messages
Counselling is important; however, it has to be sufficient and of good quality. Drawing more pregnant smokers into cessation services will increase the proportion who intend and manage to quit. This may work better than expecting all health care workers to give effective counselling.
The choices and consequences of seeking care for chronic conditions for disadvantaged populations in Malaysia and the Philippines
Authors: Palafox B 
Published: October 2020

Abstract
Disadvantaged populations in LMICs suffering from chronic conditions are often forced to make care choices that increase the risk of receiving substandard care and facing catastrophic bills. These negative impacts widen health disparities across social, economic and urban-rural lines. This study aimed to understand the economic consequences of the choices made by those living with NCD in disadvantaged communities in Malaysia and the Philippines.
Using hypertension as a tracer condition, we analysed longitudinal data from surveys of 1200 hypertensive adults from low-income communities in both countries to estimate the prevalence and drivers of catastrophic health expenditure and the coping strategies employed. Interviews and digital diary data from a sub-sample of 80 participants was analysed thematically to elicit how such choices lead to sub-optimal management of their condition.
More Filipino households with at least one hypertensive adult experienced catastrophic health spending (40% threshold) than in Malaysia (14.3% vs. 0.4%). Although the average cost of clinic visits in the Philippines was much higher than what was observed in the public sector-dominated system in Malaysia, consultation fees were main drivers of costs in Malaysia, while medication costs predominated in the Philippines (accounting for 38.6% and 70.5% of typical household health expenditure respectively). In both countries, nearly all diagnosed participants were taking antihypertensive medications, however, levels of adherence varied. Participants cited the unavailability, cost and adverse effects of antihypertensives as reasons for poor adherence, delaying treatment and substituting prescriptions.
Understanding the barriers faced by disadvantaged populations in LMICs and the ways that they overcome them as they seek care for a chronic disorder may challenge the assumptions of decision makers, and is crucial for designing responsive and equitable health systems that leave none behind.
Towards understanding power and agency in policy implementation: A stakeholder analysis of a primary care NCD policy in the Philippines
Authors: Balane M 
Published: October 2020

Abstract
The growing NCD burden of demands collective action from many stakeholders. This is often difficult to achieve, largely due to the limited understanding of how actors interact and shape policy processes, especially in LMICs. CVD accounts for a third of deaths in the Philippines, where a national primary care policy for NCD control has been enacted. We describe how we assessed the capacities, power and level of stakeholder engagement in implementing the programme within the Philippine health system and identified ways to support implementation.
A scoping review developed an analytical framework for stakeholder analysis, peer reviewed by health policy experts. Four characteristics were identified: level of knowledge, interest, power, and position of stakeholders. Interviews and a consensus building exercise were used to operationalize it. Respondents were purposively sampled via document review and a snowball technique.
National government has high power but offers moderate support for implementation. Decentralized local governments also have high power but offer varying degrees of support for implementation given competing priorities and limited resources. Frontline health workers and civil society are both supportive but have little power. Professional societies have only moderate power but are an important conduit to reach private providers. The capacities of some actors are not fully mobilized.
Understanding of the power and capacity of actors facilitates approaches to control NCDs in the Philippines. Engagement with national and local governments must be strengthened to improve uptake of the NCD control policy. Frontline health workers, if empowered, can make a key contribution to policy implementation. Professional societies can play an important facilitating and convening role to build collaborations across public and private sectors. Finding the optimal balance and synergies between these diverse roles may be critical for NCD programme implementation.
New MPH curriculum in the United States: Report on successes and challenges
Authors: King L 
Published: October 2020

Abstract

Background
In October 2016, the Council on Education for Public Health, the US accreditation agency for Master of Public Health (MPH) programs, revised its criteria. The new curricular model transitions a nearly 100-year-old knowledge-based curriculum to a competency-based curriculum tailored to today's public health needs in a global society. This presentation will highlight the new content and format of MPH curricula, including programs outside the US that have participated in US accreditation.

Objectives
CEPH has tracked implementation of the new curriculum as well as overall redesign of MPH programs. The presentation will describe strengths and challenges faced by programs implementing new curricula and will describe innovative curricular models.

Results
Data show that MPH programs are strong in epidemiological methods (99%), interpreting data (99%), and designing population-based policies or programs (93%). Programs have struggled to incorporate interprofessional practice (57%), systems thinking tools (55%), and negotiation skills (59%). Data indicate that 13% retained coursework in the traditional five core disciplines; 69% added to or adjusted the core; and 18% created a new or integrated core. Examples of each structure will be provided.

Conclusions
MPH programs in the US are experiencing a major change focused on development of competencies and skills for practice. While methodological skills remain strong, “soft” skills that are important for global public health practice are more of a challenge for faculty to integrate into the current training structure. Successful programs are incorporating innovative and cross-cutting curricula to meet these new requirements.

Key messages
MPH curricular requirements in the US have changed to focus on competencies and skills for public health practice. Critical public health leadership skills such as negotiation and interprofessional communication are lagging behind in integration into the new curriculum.
Public Health Informatics Workforce Skills and Needs: A Descriptive Analysis using the 2017 PH WINS
Authors: Dixon B E , McFarlane T D , Grannis S J , Gibson P J 
Published: October 2020

Abstract
In 2017, the Association of State and Territorial Health Officials fielded the Public Health Workforce Interests and Needs Survey (PH WINS), a nationally representative sample of state-level (SHA) and local health department (LHD) public health workers in the United States. The survey was an opportunity to measure the PHI workforce as well as assess the informatics needs of the broader PH workforce.
We performed a cross-sectional study using the nationally representative 2017 PH WINS. A total of 17,136 SHA and 26,533 LHD employees participated in the survey.
Respondents were asked to rate selected PH competencies with respect to the importance to their day-to-day work (i.e., not important to very important) and their current skill level (e.g., unable to perform, beginner, proficient, expert). We examined skill gaps, defined as discordance between self-reported importance (i.e., need) and skill level, for example, those reporting the competency as “somewhat important” or “very important” and “unable to perform” or “beginner.”
Informaticians accounted for 1.1% of SHA respondents and 0.5% of LHD respondents working in a Big City Health Coalition agency, those that serve the top 30 most populous urban areas in the United States. While informaticians generally reported having the skills they needed for their jobs, other PH roles identified gaps. For example, 22.9% of clinical and laboratory workers felt the ability to “identify appropriate sources of data and information to assess the health of a community” was an important skill but they currently possessed low competency. This group similarly identified a gap with respect to collecting ‘valid data for use in decision making.'
An informatics-savvy health department requires PHI competencies not just among PHI specialists but also among front line workers, program area managers, and executive leadership. Discordance suggests that agencies should examine ways to enhance training for PHI-related competencies for all PH workers.

Key messages
The informatics specialists’ role is rare in public health agencies. Significant data and informatics skills gaps persist among the broader public health workforce.