bluuebunny/crossref_metadata_2025_split huggingface dataset:
Solidarity, vulnerability and mistrust: how context, information and government affect the lives of women in times of Zika
Authors: Linde-Arias Ana Rosa , Roura Maria , Siqueira Eduardo 
Published: April 2020

AbstractBackgroundThe public health response to Zika outbreak has mostly focused on epidemiological surveillance, vector control, and individual level preventative measures. This qualitative study employs a social-ecological framework to examine how macro (historical, legislative, political, socio-economic factors), meso (sources of information, social support, social mobilization) and micro level factors (individual actions, behavioral changes) interacted to influence the response and behavior of women with respect to Zika in different contexts.MethodsA qualitative study was carried out. Women were recruited through the snowball sampling technique from various locations in Brazil, Puerto Rico, and the United States. They were of different nationalities and ethnicities. Data were collected through semi-structured interviews. The data transcripts were analyzed using thematic analysis.ResultsWomen in this study deemed the information provided as insufficient, which led them to actively reach out and access a variety of media sources. Social networks played a vital role in sharing information but also resulted in the spread of hoaxes or rumors. Participants in our research perceived socio-economic inequities but focused on how to remedy their microenvironments. They did not engage in major social activities. Lack of trust in governments placed women in vulnerable situations by preventing them to follow the guidance of health authorities. These impacts were also a result of the response tactics of health and government administrations in their failed attempts to ensure the well-being of their countries’ populations.ConclusionsOur findings call for public health interventions that go beyond individual level behavioral change campaigns, to more comprehensively address the broader meso and macro level factors that influence women’ willingness and possibility to protect themselves.
Novel foetal echocardiographic image processing software (5D Heart) improves the display of key diagnostic elements in foetal echocardiography
Authors: Hu Wan-Yu , Zhou Jin-Hong , Tao Xiao-Ying , Li Shi-Yan , Wang Bei , Zhao Bo-Wen 
Published: April 2020

AbstractBackgroundTo evaluate the clinical value of foetal intelligent navigation echocardiography (5D Heart) for the display of key diagnostic elements in basic sections.Methods3D volume datasets of 182 normal singleton foetuses were acquired with a four chamber view by using a volume probe. After processing the datasets by using 5D Heart, eight cardiac diagnostic planes were demonstrated, and the image qualities of the key diagnostic elements were graded by 3 doctors with different experiences in performing foetal echocardiography.ResultsA total of 231 volume datasets acquired from the 182 normal foetuses were used for 5D Heart analysis and display. The success rate of 8 standard diagnostic views was 88.2%, and the success rate of each diagnostic view was 55.8–99.2% and 70.7–99.0% for the random four chamber view as the initial section and for the apical four chamber view as the initial section, respectively. The success rate of each diagnostic element in the 8 diagnostic sections obtained by 5D Heart was 58.9%~ 100%. Excellent agreement was found between experienced sonographers and less-experienced sonographers (kappa> 0.769). Inter- and intra-observer agreement were substantial to near-perfect, kappa values ranging from 0.612 to 1.000 (Cohen’s kappa).Conclusions5D Heart can significantly improve the image quality of key diagnostic elements in foetal echocardiography with low operator dependency and good reproducibility.
Association of acute kidney injury with readmissions after hospitalization for acute exacerbation of chronic obstructive pulmonary disease: a population-based study
Authors: Hirayama Atsushi , Goto Tadahiro , Hasegawa Kohei 
Published: April 2020

Abstract
Background
Little is known about the relationship between acute kidney injury (AKI) and outcomes after acute exacerbation of chronic obstructive pulmonary disease (AECOPD). We aimed to investigate associations between AKI and readmission risks after hospitalization for AECOPD.

Methods
A retrospective, population-based cohort study using State Inpatient Databases from seven U.S. states (Arkansas, California, Florida, Iowa, Nebraska, New York, and Utah) from 2010 through 2013. We identified all adults (aged ≥40 years) hospitalized for AECOPD during the study period. Among them, we further identified patients with a concurrent diagnosis of new AKI. The outcome measures were any-cause readmissions within 30 days and 90 days after hospitalization for AECOPD. To determine associations between AKI and readmission risk, we constructed Cox proportional hazards models examining the time-to-readmission. We also identified the primary reason of readmission.

Results
We identified 356,990 patients hospitalized for AECOPD. The median age was 71 years and 41.9% were male. Of these, 24,833 (7.0%) had a concurrent diagnosis of AKI. Overall, patients with AKI had significantly higher risk of 30-day all-cause readmission compared to those without AKI (hazard ratio 1.47; 95% CI 1.43–1.51; P < 0.001). Likewise, patients with AKI had significantly higher risk of 90-day all-cause readmission (hazard ratio 1.35; 95% CI 1.32–1.38; P < 0.001). These associations remained significant after adjustment for confounders (both P < 0.05). Additionally, patients with AKI were likely to be readmitted for non-respiratory reasons including sepsis, acute renal failure, and congestive heart failure.

Conclusions
Among patients hospitalized for AECOPD, patients with AKI were at higher risk of 30-day and 90-day readmission, particularly with non-respiratory reasons.
Stem/progenitor cell marker expression in clear cell renal cell carcinoma: a potential relationship with the immune microenvironment to be explored
Authors: Yoon Ju-Yoon , Gedye Craig , Paterson Joshua , Ailles Laurie 
Published: April 2020

Abstract
Background
Clear cell renal cell carcinoma (ccRCC) is a markedly heterogeneous disease in many aspects, including the tumour microenvironment. Our previous study showed the importance of the tumour microenvironment in ccRCC xeno-transplant success rates. In order to better understand the potential relationship between TICs and the immune microenvironment, we employed a multi-modal approach, examining RNA and protein expression (flow cytometry, immunohistochemistry).

Methods
We first examined the gene expression pattern of 18 stem/progenitor marker genes in the cancer genome atlas (TCGA) ccRCC cohort. Flow cytometry was next employed to examine lineage-specific expression levels of stem/progenitor markers and immune population makeup in six, disaggregated, primary ccRCC specimens. Immunohistochemistry was performed on a commercial ccRCC tissue microarray (TMA).

Results
The 18 genes differed with respect to their correlation patterns with one another and to their prognostic significance. By flow cytometry, correlating expression frequency of 12 stem/progenitor markers and CD10 resulted in two clusters—one with CD10 (marker of proximal tubular differentiation), and second cluster containing mostly mesenchymal stem cell (MSC) markers, including CD146. In turn, these clusters differed with respect to their correlation with different CD45+ lineage markers and their expression of immune checkpoint pathway proteins. To confirm these findings, four stem/progenitor marker expression patterns were compared with CD4, CD8 and CD20 in a ccRCC TMA which showed a number of similar trends with respect to frequency of the different tumour-infiltrating leukocytes.

Conclusion
Taken together, we observed heterogeneous but patterned expression levels of different stem/progenitor markers. Our results suggest a non-random relationship between their expression patterns with the immune microenvironment populations in ccRCC.
Internet addiction mediates the association between cyber victimization and psychological and physical symptoms:moderation by physical exercise
Authors: Lin Ling , Liu Jianbo , Cao Xiaolan , Wen Siying , Xu Jianchang , Xue Zhenpeng , Lu Jianping 
Published: April 2020

Abstract
Background
The potential mechanisms underlying cyber victimization and the resulting psychological and physical symptoms remain unclear. Thus, the present study investigated whether Internet addiction mediates the association between peer victimization (e.g., cyberbullying) and psychological and physical symptoms. Furthermore, it was assessed whether physical exercise moderates the hypothetical mediation.

Methods
1854 students from 11 middle and high schools in Shenzhen, Guangdong Province, China, were sampled for this study. Psychological and physical symptoms were assessed using the World Health Organization Quality of Life-BREF, while Internet addiction was evaluated using the Internet addiction test by Young. Cyber victimization was measured using a single question. In addition, this study examined whether Internet addiction mediated the association between cyber victimization and both psychological and physical symptoms. Additional work was conducted to test if physical exercise played a moderating role in the mediation hypothesized above. Mediation and moderation were analyzed using PROCESS macro for SPSS.

Results
Regression analysis showed that both cyber victimization (β = − 0.102, p < 0.05) and Internet addiction (β = − 0.278, p < 0.05) significantly predicted psychological and physical symptoms and demographic variables were controlled. Further mediation analysis suggested that Internet addiction mediated the relationship between cyber victimization and psychological and physical symptoms. The 95% CI (confidence interval) of the direct effect was (− 4.283, − 1.696) and the indirect effect (− 1.904, − 0.820), respectively, excluding zero. Finally, moderation analysis indicated that physical exercise moderated the relationship between Internet addiction and psychological and physical symptoms (p = 0.047).

Conclusions
Internet addiction plays a mediating role in the association between cyber victimization and both psychological and physical symptoms, Thus, addressing Internet addiction among cyberbullying victims is worthwhile. Furthermore, physical exercise alleviates negative impacts on health and should thus be promoted.
What are the drivers of recurrent cholera transmission in Nigeria? Evidence from a scoping review
Authors: Elimian Kelly Osezele , Mezue Somto , Musah Anwar , Oyebanji Oyeronke , Fall Ibrahima Soce , Yennan Sebastian , Yao Michel , Abok Patrick Okumu , Williams Nanpring , Omar Lynda Haj , Balde Thieno , Ampah Kobina , Okudo Ifeanyi , Ibrahim Luka , Jinadu Arisekola , Alemu Wondimagegnehu , Peter Clement , Ihekweazu Chikwe 
Published: April 2020

AbstractBackgroundThe 2018 cholera outbreak in Nigeria affected over half of the states in the country, and was characterised by high attack and case fatality rates. The country continues to record cholera cases and related deaths to date. However, there is a dearth of evidence on context-specific drivers and their operational mechanisms in mediating recurrent cholera transmission in Nigeria. This study therefore aimed to fill this important research gap, with a view to informing the design and implementation of appropriate preventive and control measures.MethodsFour bibliographic literature sources (CINAHL (Plus with full text), Web of Science, Google Scholar and PubMed), and one journal (African Journals Online) were searched to retrieve documents relating to cholera transmission in Nigeria. Titles and abstracts of the identified documents were screened according to a predefined study protocol. Data extraction and bibliometric analysis of all eligible documents were conducted, which was followed by thematic and systematic analyses.ResultsForty-five documents met the inclusion criteria and were included in the final analysis. The majority of the documents were peer-reviewed journal articles (89%) and conducted predominantly in the context of cholera epidemics (64%). The narrative analysis indicates that social, biological, environmental and climatic, health systems, and a combination of two or more factors appear to drive cholera transmission in Nigeria. Regarding operational dynamics, a substantial number of the identified drivers appear to be functionally interdependent of each other.ConclusionThe drivers of recurring cholera transmission in Nigeria are diverse but functionally interdependent; thus, underlining the importance of adopting a multi-sectoral approach for cholera prevention and control.
The analysis of groundwater nitrate pollution and health risk assessment in rural areas of Yantai, China
Authors: Yu Guimei , Wang Jiu , Liu Lei , Li Yun , Zhang Yi , Wang Songsong 
Published: April 2020

Abstract
Background
Nitrate is one of the most common chemical contaminants of groundwater, and it is an important unqualified factor of rural groundwater in Yantai. In order to assess the risk of exposure to drinking water nitrate for adults and juveniles, in recent years, we monitored the nitrate concentrations in rural drinking water,a model was also used to assess the human health risk of nitrate pollution in groundwater.

Methods
From the year 2015 to 2018, the drinking water in rural areas of Yantai was tested according to the “Sanitary Standard for Drinking Water” (GB5749–2006). The principal component analysis was used to analyze the relationship between groundwater chemicals and nitrate. The model was used to assess human health risks of groundwater nitrate through the drinking water and skin contact.

Results
A total of 2348 samples were tested during the year 2015–2018.Nitrate and total dissolved solids, total hardness, chloride are all relevant, the above indicators may come from the same source of pollution; The median nitrate content (CEXP50) was 17.8 mg / L; the risk of exposure in each group was ranked as: Juveniles > Adult female > Adult male;the median health risk (HQ50) for minors and adults exceed 1.

Conclusions
The concentrations of nitrate is stable and does not change over time. The high concentration of nitrate in rural areas of Yantai may be the result of the interaction of fertilizers and geological factors. The risk of exposure to nitrate in juveniles and adults is above the limit, so it is necessary to be on the alert for the high levels of nitrate.
Sexually transmitted disease among street dwellers in southern Ethiopia: a mixed methods study design
Authors: Wakgari Negash , Woyo Terefe , Kebede Emnet , Gemeda Hirut , Gebremedhin Samson 
Published: April 2020

Abstract
Background
Lack of knowledge about sexual violence, its consequences, substance use and homelessness are major problems that make street dwellers susceptible to sexually transmitted diseases. Hence, this study assessed knowledge, attitudes and treatment-seeking behaviors related to sexually transmitted diseases among street dwellers in southern Ethiopia.

Methods
An explanatory sequential mixed-methods study design was conducted among 842 respondents. A simple random sampling technique was used to select seven cities among fourteen major cities of the region. The sample was allocated proportionally to each selected city. In order to identify and fill in the required sample size, a snowball sampling technique was used. A pre-tested and structured interviewer-administered questionnaire was used to collect quantitative data. The collected data were entered using Epidata and exported to SPSS version 23.0 for further analysis. Unstructured questionnaires were also used to collect 21 in-depth interviews and 10 key informants’ interviews. Respondents for in-depth interviews were selected purposively during quantitative data collection.

Results
Most street dwellers were aware of (86.7%) and had a favourable attitude towards (84.4%) prevention and management of sexually transmitted diseases. A portion of respondents experienced bad-smelling genital discharge (13.8%), genital ulcers (11.2%) and a burning sensation (14.5%) during urination, in the previous year. Among those who experienced symptoms of sexually transmitted disease, only 15.3% of them received treatment from a health care provider. Fear of questions raised by providers was one of the reasons for not seeking care according to our qualitative findings.

Conclusions
In this study, a significant number of street dwellers reported experiencing symptoms of a sexually transmitted disease. Despite having awareness about sexually transmitted diseases, seeking treatment from a health center was found to be low based on both quantitative and qualitative findings. We recommend that health care providers should undergo special training to address the sexual and reproductive health problems of street dwellers.
How do combinations of unhealthy behaviors relate to attitudinal factors and subjective health among the adult population in the Netherlands?
Authors: Dieteren Charlotte M. , Brouwer Werner B. F. , van Exel Job 
Published: April 2020

Abstract
Background
Health behaviours like smoking, nutrition, alcohol consumption and physical activity (SNAP) are often studied separately, while combinations can be particularly harmful. This study aims to contribute to a better understanding of lifestyle choices by studying the prevalence of (combinations of) unhealthy SNAP behaviours in relation to attitudinal factors (time orientation, risk attitude) and subjective health (self-rated health, life expectancy) among the adult Dutch population.

Methods
In total 1006 respondents, representative of the Dutch adult population (18–75 years) in terms of sex, age, and education, were drawn from a panel in 2016. They completed an online questionnaire. Groups comparisons and logistic regression analyses (crude and adjusted) were applied to analyse (combinations of) SNAP behaviours in relation to time orientation (using the Consideration of Future Consequences scale comprising Immediate (CFC-I) and Future (CFC-F) scales) and risk attitude (Health-Risk Attitude Scale; HRAS-6), as well as subjective health (visual analogue scale and subjective life expectancy).

Results
In the analyses, 989 respondents (51% men, average 52 years, 22% low, 48% middle, and 30% high educated) were included. About 8% of respondents engaged in four unhealthy SNAP behaviours and 18% in none. Self-rated health varied from 5.5 to 7.6 in these groups, whilst subjective life expectancy ranged between 73.7 and 85.5 years. Logistic regression analyses, adjusted for socio-demographic variables, showed that smoking, excessive drinking and combining two or more unhealthy SNAP behaviours were significantly associated with CFC-I scores, which increased the odds by 30%, 18% and 19%, respectively. Only physical inactivity was significantly associated with CFC-F scores, which increased the odds by 20%. Three out of the four SNAP behaviours were significantly associated with HRAS-6, which increased the odds between 6% and 12%. An unhealthy diet, excessive drinking, and physical inactivity were significantly associated with SRH, which decreased the odds by 11%. Only smoking was significantly associated with subjective life expectancy, which decreased the odds by 3%.

Conclusion
Our findings suggest that attitudinal factors and subjective health are relevant in the context of understanding unhealthy SNAP behaviours and their clustering. This emphasizes the relevance of a holistic approach to health prevention rather than focusing on a single unhealthy SNAP behaviour.
Measuring character strengths as possible protective factors against suicidal ideation in older Chinese adults: a cross-sectional study
Authors: Cheng Xinfeng , Bu He , Duan Wenjie , He Along , Zhang Yaping 
Published: April 2020

Abstract
Background
Suicide is a global issue among the elderly. The number of older people committing suicide is proliferating, and the elderly suicide rate is the highest among all age groups in China. A better understanding of the possible protective factors against suicidal ideation is necessary to facilitate prevention and intervention efforts. The objectives of the present study are threefold. First, this study aims to examine the psychometric properties of the three-dimensional inventory of character strengths (TICS) with a sample of older adults. Second, this study intends to investigate correlations among suicide ideation, wellbeing, and character strengths. Third, the study seeks to explore the possible protective roles of the three character strengths and wellbeing in explaining suicidal ideation among older adults.

Methods
A cross-sectional study comprising 308 older adults aged at least 50 years old from nursing homes was conducted. Four questionnaires, namely, the TICS, the Geriatric Suicide Ideation Scale—10 items, the Brief Inventory of Thriving, and the Satisfaction with Life Scale, were used. Exploratory structural equation modeling, intraclass correlation coefficients, partial correlations, and sets of hierarchical regressions were adopted to estimate and report the results.

Results
TICS could be used to assess the character strengths (i.e., caring, inquisitiveness, and self-control) among older adults with an acceptable goodness-of-fit (chi square = 157.30, df = 63, p < 0.001, CFI = 0.94, TLI = 0.90, RMSEA = 0.07, 90% CI = [0.06, 0.08]). Wellbeing and character strengths exhibited a negative association with suicidal ideation among older adults. Moreover, character strengths showed an independently cross-sectional relationship with suicidal ideation, explaining 65.1% of the variance of suicidal ideation after controlling for the wellbeing and demographics.

Conclusion
This study indicated that character strengths were associated with low levels of suicidal ideation. Therefore, the protective factors against suicidal ideation among older adults should be given additional attention.
The effect of a centralization procedure for extruded lateral meniscus on load distribution in porcine knee joints at different flexion angles
Authors: Kubota Rei , Koga Hideyuki , Ozeki Nobutake , Matsuda Junpei , Kohno Yuji , Mizuno Mitsuru , Katano Hisako , Sekiya Ichiro 
Published: April 2020

Abstract
Background
Meniscal extrusion results in loss of the ability to resist hoop strain and biomechanical overload on the joint articular surface. A centralization technique has been developed to overcome these problems. In this study, we analyzed the biomechanics of the extruded and centralized lateral meniscus (LM) in porcine knee joints at different flexion angles.

Methods
Porcine knee joints (n = 8) were set in the universal tester and each knee was tested under the following states: 1) intact; 2) extrusion—meniscal extrusion was created by resecting the posterior root of the LM and posterior synovial capsule; and 3) centralization—centralization was performed by two anchors inserted in the lateral tibial plateau. Deviation distance of the meniscus, contact pressure, and contact area in the anterior LM, middle LM, posterior LM, and the contact pressure of the tibial cartilage were evaluated with an axial compressive force of 200 N at knee flexion angles of 30°, 45°, 60°, and 90°.

Results
The deviation distance of LM significantly increased in extrusion but was restored to the intact status after centralization at all angles. Both the contact pressure and area significantly decreased in extrusion and were restored after centralization close to the intact status in the anterior and middle LM; in the posterior LM, however, decreased contact pressure and area were not restored after centralization. The contact pressure of the tibial cartilage increased significantly in extrusion but decreased close to the intact status after centralization.

Conclusions
This centralization procedure could reduce extrusion of the LM and restore the load-distributing function of the anterior-middle LM. However, the procedure itself could not restore hoop function in cases where the defect lies in the posterior LM.