bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and Validation of the Psychometric Properties of the Perceived Barriers of Mammography Scale
Authors: Shirzadi Shayesteh , Asghari-Jafarabadi Mohammad , Harrison Mahnaz M. , Allahverdipour Hamid 
Published: August 2020

Abstract

Background: To improve women’s participation in early detection of breast cancer we need to understand women’s perceived barriers to Mammography. Due to lack of women participation in referrals to mammography centers, this study aims to develop and test the psychometric properties of the Perceived Barriers of Mammography Scale (PBMS-23) for Iranian women.Methods: A mixed method design was performed to develop the PBMS-23 during 2016-2017. The item pool was mainly generated through qualitative data and literature review. Next, the developed questionnaire was answered by 500 women ages 40 to 69 years. The internal consistency, test-retest reliability, content and face validity and construct validity (both exploratory and confirmatory) were assessed.Results: Twenty eight items were initially extracted and next, based on content validity assessment, twenty three items (PBMS-23) were remained. The exploratory factor analysis revealed eight factors of believe in fate and destiny, breast conflict, defense avoidance, inconveniences/difficulties of mammography screening, contrasting/competing priorities, fear, distrust of mammography, and lack of knowledge in the PBMS-23 that accounted for 59.20 of the total variance. The confirmatory factor analysis also showed a model with appropriate fitness for the data. The Cronbach’s alpha coefficient and the intra-class correlation coefficient were 0.68, 0.90 respectively.Conclusion: The findings showed that the developed PBMS-23 instrument was a valid and reliable instrument for assessing perceived barriers of mammography screening that can be used both in practice and in future studies especially in the Middle East.
Integrating Pathology, Chromosomal Instability and Mutations for Risk Stratification in Early-stage Endometrioid Endometrial Carcinoma
Authors: Li Yuan , Li Jiaqi , Guo Ensong , Huang Jia , Fang Guangguang , Chen Shaohua , Yang Bin , Fu Yu , Li Fuxia , Wang Zizhuo , Xiao Rourou , Liu Chen , Huang Yuhan , Wu Xue , Lu Funian , You Lixin , Feng Ling , Xi Ling , Wu Peng , Ma Ding , Sun Chaoyang , Wang Beibei , Chen Gang 
Published: August 2020

Abstract
Background: Risk stratifications for endometrial carcinoma (EC) depend on histopathology and molecular pathology. Histopathological risk stratification lacks reproducibility, neglects heterogeneity and contributes little to surgical procedures. Existing molecular stratification is useless in patient with specific pathological or molecular characteristics, and cannot guide postoperative adjuvant radiotherapies. Chromosomal instability (CIN), the numerical and structural alterations of chromosome resulting from ongoing errors of chromosome segregation, is an intrinsic biological mechanism for the evolution of different prognostic factors of histopathology and molecular pathology, which may be applicable to the risk stratification of EC.Results: By analysis of CIN25 and CIN70, two reliable gene expression signatures for CIN, we found that EC with unfavorable prognostic factors of histopathology or molecular pathology had serious CIN. However, POLE-mutant, as a favorable prognostic factor, had elevated CIN signatures, and CTNNB1-mutant, as an unfavorable prognostic factor, had decreased CIN signatures. Only if these two mutations were excluded were CIN signatures strongly prognostic for outcomes in different adjuvant radiotherapy subgroups. Integrating pathology, CIN signatures and POLE / CTNNB1 mutation stratified stageⅠendometrioid EC into four groups with improved risk prognostication and treatment recommendations.Conclusions:We revealed the possibility of integrating histopathology and molecular pathology by CIN for risk stratification in early-stage EC. Our integrated risk model deserves for further improvement and validation.
Role of NR2B/ERK signaling in the neuroprotective effect of dexmedetomidine against sevoflurane induced neurological dysfunction in the developing rat brain
Authors: Li Guohua , Jin Yanwu , Cao Fang , Wang Dawei , Zhou Limin 
Published: August 2020

Abstract
Background
Dexmedetomidine (DEX) is a new-generation, and has been widely applied in clinic. The present study confirmed the protective effect of DEX on sevoflurane induced learning and cognitive impairment and examined its underlying mechanism.
Methods
Sprague-Dawley rats were exposed to 0.85% sevoflurane for 6 h and injected with DEX in different dose. Morris water maze (MWM) test was performed to evaluate the learning and memory function of rats. Western blot was used for the measurement of protein levels.
Results
MWM results indicated that sevoflurane treatment increased the escape latency but reduced the time spent in original quadrant of rats. The protein levels of NR2B, phosphorylated ERK were significantly influenced by sevoflurane. Ifenprodil administration alleviated sevoflurane induced neurological impairment. DEX treatment reversed the effect of sevoflurane on both escape latency and time in original quadrant in a dose manner, and pretreatment with 75 µg/kg DEX had the most dramatic effect. DEX regulates the NR2B/ERK signaling in sevoflurane treated rats.
Conclusion
NR2B/ERK signaling is involved in sevoflurane induced neurological impairment. DEX may protect against sevoflurane induced neurological dysfunction in the developing rat brain via regulating the NR2B/ERK signaling.
Why do some inter-organisational collaborations in healthcare work when others do not? A realist review
Authors: Aunger Justin Avery , Millar Ross , Greenhalgh Joanne , Mannion Russell , Rafferty Anne Marie , McLeod Hugh 
Published: August 2020

Abstract
BackgroundInter-organisational collaboration is increasingly prominent within contemporary healthcare systems. A range of collaboration types such as alliances, networks, and mergers have been proposed as a means to turnaround organisations, by reducing duplication of effort, and enabling resource sharing, greater influence, and novel innovations. However, in practice, due to the complexity of the process, such efforts are often rife with difficulty. Notable contributions have sought to make sense of this area, however further understanding is needed in order to gain a better understanding of why some inter-organisational collaborations work when others do not, to be able to more effectively implement collaborations in the future.MethodsRealist review methodology was used, combining systematically searched papers and purposively searched ‘middle-range’ theories. The systematic review encompassed searches for reviews, commentaries, opinion pieces and case studies on HMIC, Medline, PsychINFO, and Social Policy and Practice databases and further searches were conducted using Google Scholar. Data were extracted from included studies according to relevance to the realist review.ResultsThirty-eight systematically-identified studies were included, in addition to twelve purposively-identified papers, informing the development of programme theories of how, why, and when partnerships in healthcare work. The findings led to the proposal of programme theories formulated as context-mechanism-outcome configurations, which outline what outcomes may be expected when partnerships are attempted in differing contexts. We found that it was essential to consider mechanisms underlying partnership functioning, such as building trust and faith in the collaboration, in a context of strong initial trust, to enable maximal synergy and thus collaborative performance.ConclusionAs the first realist review of inter-organisational collaborations in healthcare as an intervention for improvement, this review provides actionable evidence for policymakers and implementers, enhancing understanding of mechanisms underlying the functioning and performing of inter-organisational collaborations, as well as configuring context and entry point to aid success. Next steps in this research will test the results against further case studies and primary data to produce a further refined theory. Review registrationThis review is registered at PROSPERO with ID CRD42019149009.
Effect of primary decompressive craniectomy on outcomes in severe traumatic brain injury with mass lesions and the independent predictors for operation decision
Authors: Yang Chen , Zhang Jia-Rui , Zhu Gang , Guo Hao , Gao Fei , Wang Bao , Cui Wen-Xing , Shi Ying-Wu , Du Yong , Li Zhi-Hong , Wang Liang , Ma Lian-Ting , Qu Yan , Ge Shunnan 
Published: August 2020

Abstract
Background: Although operative indications for traumatic brain injury (TBI) have been evaluated, neurosurgeons often face a dilemma of whether or not to remove the bone flap after mass lesion evacuation, and a useful predictive scoring model for which patients should be decompressive craniectomy (DC) has yet to be developed. The aim of this study was firstly to compare the outcomes of craniotomy and DC, and secondly to determine independent predictors and develop a multivariate logistic regression equation to determine whom should perform primary DC in TBI patients with mass lesions.Methods: A total of nine different variables were evaluated. All 245 patients with severe TBI in this study were retrospectively evaluated between June 2015 and May 2019 and all underwent decompressive craniectomy (DC) or craniotomy for mass lesion removal. The 6-month mortality and Extended Glasgow Outcome Scale (GOSE) were compared between DC and craniotomy. By using univariate, multiple logistic regression and prognostic regression scoring equations it was possible to draw Receiver Operating Characteristic curves (ROC) to predict the decision for DC.Results: The overall 6-month mortality in the entire cohort was 11.43% (28/245). DC patients had a lower mean preoperative Glasgow Coma Scale (GCS) (p = 0.01); more patients with GCS of 6 (p=0.007);more unresponsive pupillary light reflex (p< 0.001); more closed basal cisterns (p< 0.001); and more patients with diffuse injury (p=0.025) than craniotomy patients. Given the greater severity, patients undergoing primary DC had higher 6-month mortality than the remainder of the cohort. However, in the surviving patients, the favorable GOSE rate was similar in two groups. We found that pupillary light reflex and basal cisterns were independent predictors for DC decision. Using ROC curve to predict the probability of DC, the sensitivity was 81.6% and the specificity was 84.9%.Conclusion: Our preliminary findings showed that the primary DC may benefit subgroups of sTBI with mass lesions, and unresponsive pre-op pupil reaction, and closed basal cistern to predict the DC decision were useful. These sensitive variables can be used as a referential guideline in our daily practice to decide to perform or avoid primary DC.
Factors Associated with Prolonged Hospitalization Among Patients Transported by Emergency Medical Services: A Population-based Study in Osaka, Japan
Authors: Katayama Yusuke , Kitamura Tetsuhisa , Tanaka Jun , Nakao Shota , Nitta Masahiko , Fujimi Satoshi , Kuwagata Yasuyuki , Shimazu Takeshi , Matsuoka Tetsuya 
Published: August 2020

Abstract
Background
The emergency medical system, one of the essential elements of public health, has been around for more than 50 years. Although many studies have assessed the factors associated with overcrowding and prolonged length of stay in emergency departments, whether the clinical characteristics and background of a patient are associated with prolonged hospitalization among patients transported by ambulance is unknown. The purpose of this study was to reveal factors associated with the continuation of hospitalization at 21 days after hospital admission among patients transported by ambulance using a population-based patient registry in Osaka, Japan.
Method:
This was a retrospective observational study whose study period was the three years from January 2016 to December 2018. In this study, we included patients who were hospitalized after transportation by ambulance as determined using cleaned data that was recorded in the ORION system. The main outcome was continuation of hospitalization at 21 days after hospital admission. We calculated the adjusted odds ratios (AOR) and 95% confidence interval (CI) with a multivariable logistic regression model to assess factors associated with the outcome.
Results
We included 481,886 patients in this study, of whom 158,551 remained hospitalized at 21 days after hospital admission and 323,335 had been discharged home by 21 days after hospital admission. Factors associated with prolonged hospitalization were elderly (AOR: 1.767 [95% CI: 1.730–1.805]), traffic accident (AOR: 1.231 [95% CI: 1.183–1.282]), no fixed address (AOR: 4.494 [95% CI: 3.632–5.314]), need for nursing care (AOR: 1.420 [95% CI: 1.397–1.443]) and solitary person (AOR: 1.085 [95% CI: 1.050–1.120]).
Conclusion
In this study, the elderly, traffic accidents, no fixed address, need for nursing care, and solitary person were the factors associated with prolonged hospitalization of patients transported by ambulance in Japan.
Association between autoimmune diseases and COVID-19 as assessed in both a test-negative case-control and population case-control design
Authors: Murtas Rossella , Andreano Anita , Gervasi Federico , Guido Davide , Consolazio David , Tunesi Sara , Andreoni Laura , Greco Maria Teresa , Gattoni Maria Elena , Sandrini Monica , Riussi Antonio , Russo Antonio Giampiero 
Published: August 2020

Abstract
Background: COVID-19 epidemic has paralleled with the so called infodemic, where countless pieces of information have been disseminated on putative risk factors for COVID-19. Among those, emerged the notion that people suffering from autoimmune diseases (AIDs) have a higher risk of SARS-CoV-2 infection. Methods: The cohort included all COVID-19 cases residents in the Agency for Health Protection (AHP) of Milan that, from the beginning of the outbreak, developed a web-based platform that traced positive and negative cases as well as related contacts. AIDs subjects were defined ad having one the following autoimmune disease: rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, Sjogren disease, ankylosing spondylitis, myasthenia gravis, Hashimoto's disease, acquired autoimmune hemolytic anemia, and psoriatic arthritis. To investigate whether AID subjects are at increased risk of SARS-CoV-2 infection, and whether they have worse prognosis than AIDs-free subjects once infected, we performed a combined analysis of a test-negative design case-control study, a case-control with test-positive as cases, and one with test-negative as cases (CC-NEG). Results: During the outbreak, the Milan AHP endured, up to April 27th 2020, 20,364 test-positive and 34,697 test-negative subjects. We found no association between AIDs and being positive to COVID-19, but a statistically significant association between AIDs and being negative to COVID-19 in the CC-NEG. If, as likely, test-negative subjects underwent testing because of respiratory infection symptoms, these results imply that autoimmune diseases may be a risk factor for respiratory infections in general (including COVID-19), but they are not a specific risk factor for COVID-19. Furthermore, when infected by SARS-CoV-2, AIDs subjects did not have a worse prognosis compared to non-AIDs subjects. Results highlighted a potential unbalance in the testing campaign, which may be correlated to the characteristics of the tested person, leading specific frail population to be particularly tested.Conclusions: Lack of availability of sound scientific knowledge inevitably lead unreliable news to spread over the population, preventing people to disentangle them form reliable information. Even if additional studies are needed to replicate and strengthen our results, these findings represent initial evidence to derive recommendations based on actual data for subjects with autoimmune diseases.
Utilization of apnea-hypopnea index as a novel predictive factor for difficult mask ventilation in the Chinese population under general anesthesia
Authors: Wang Jia-Yi , Li Jing-Jie , Zhao Peng-Cheng , Peng Jia-Li , Hu Rong , Xuan Pu , Jiang Hong 
Published: August 2020

Abstract
Background: Difficult Mask Ventilation (DMV) is a potentially life-threatening situation that can arise during anesthesia. Accordingly, the majority of current airway management guidelines include risk assessments for DMV. Although Obstructive Sleep Apnea (OSA) is among the most important risk factors associated with DMV, other measurements such as the Apnea-Hypopnea Index (AHI) may play an important role in determining patient risk.This study investigated the relationship between DMV and AHI, and determined preoperative risk factors for DMV in Chinese patients.Methods: A prospective cohort trial enrolled patients scheduled for elective surgery. After obtaining informed consent, patient demographic information was collected, and patients were tested with pre-operative polysomnography. Inclusion criteria: Patients >18 years of age, American Society of Anesthesiologists Physical Status Classification (ASA) I-III, and planned elective surgery with general anesthesia. Exclusion criteria: malformations of the airway, patients undergoing regional anesthesia, and patients with contraindications to mask ventilation (i.e. planned awake intubation). A logistic regression model was used to analyze the association between AHI and DMV. Results: A total of 159 patients were analyzed. For both primary and secondary outcomes, the unadjusted and adjusted odds ratio for DMV showed significant increases of 5 AHI units. AHI, age, and the Mallampati classification were found to be independent predictive factors for DMV.Conclusions AHI is associated with DMV as a novel independent risk factor in Chinese patients. Along with age and Mallampati classification, AHI should be included in establishing a superior predictive strategy DMV screening.Trial registration: Chinese Clinical Trial Registry (Registration number # ChiCTR17013076; Date of Registration on October 22nd, 2017).
Impact Resistance of Steel Materials to Ballistic Ejecta and Shelter Development Using Steel Deck Plates
Authors: Yamada Hiroyuki , Tateyama Kohei , Naruke Shino , Sasaki Hisashi , Torigata Shinichi , Honda Ryou , Kubo Tomohiro , Yoshimoto Mitsuhiro , Fujii Toshitsugu 
Published: August 2020

Abstract
The destruction caused by ballistic ejecta from the phreatic eruptions of Mt. Ontake in 2014 and Mt. Kusatsu-Shirane (Mt. Moto-Shirane) in 2018 in Japan, which resulted in numerous casualties, highlighted the need for better evacuation facilities. In response, some mountain huts were reinforced with aramid fabric to convert them into shelters. However, a number of decisions must be made when working to increase the number of shelters, which depend on the location where they are to be built. In this study, we propose a method of using high-strength steel to reinforce wooden buildings for use as shelters. More specifically, assuming that ballistic ejecta has an impact energy of 9 kJ or more, as in previous studies, we developed a method that utilizes SUS304 and SS400 unprocessed steel plates based on existing impact test data. We found that SUS304 is particularly suitable for use as a reinforcing material because it has excellent impact energy absorption characteristics due to its high ductility as well as excellent corrosion resistance. With the aim of increasing the structural strength of steel shelters, we also conducted an impact test on a shelter fabricated from SS400 deck plates (i.e., steel with improved flexural strength provided by work-hardened trapezoidal corrugated plates) . The results show that the shelter could withstand impact with an energy of 13.5 kJ (2.66 kg of simulated ballistic ejecta at 101 m/s on impact). In addition, it was confirmed the impact absorption energy is further increased when artificial pumice is used. Observations of the shelter after the impact test show that there is still some allowance for deformation caused by projectile impact, which means that the proposed steel shelter holds promise, not only structurally, but also from the aspects of transportation and assembly. Hence, the usefulness of shelters that use steel was shown experimentally. However, shelter construction should be suitable for the target environment.
Variable Expressed Methylation Sites of Aging-related Genes in Asthma
Authors: Yang Yu , Yuan Lin , Yang Ming , Du Xizi , Qin Ling , Wang Leyuan , Wu Shuangyan , Wu Mingping , He Ruoxi , Feng JunTao , Xiang Ynag , Qu Xiangping , Liu Huijun , Qin Xiaoqun , Liu Chi 
Published: August 2020

Abstract
Background: Asthma is a complex pulmonary inflammatory disease which is common in the elderly. Aging-related alterations have also been found in the structural cells and immune cells of asthma patients although the pathological mechanism of the differential aging-related gene in the development of asthma is still obscure. Of note, DNA methylation (DNAm) have been proven to play an important role in the regulation of aging-related genes. However, the methylation levels of aging-related genes in asthma patients are largely unclear.Methods: First, the mRNA levels and DNAm level of the previous screened 9 aging-related genes in peripheral blood of 51 healthy controls (HCs) and 55 asthmatic patients were detected by multiple targeted bisulfite enrichment sequencing (MethTarget) and qPCR. Secondly, the correlation between the DNAm level of specific altered CpG sites and the pulmonary function indicators of asthma patients was evaluated. Lastly, the Receiver Operator Characteristic (ROC) curve and Principal Component Analysis (PCA) were used to identify the feasibility of the candidate CpG sites as asthma markers.Results: The mRNA expression of the 9 aging-related gene in peripheral blood of asthma patients was significantly different from those of HCs. Besides, the methylation level of the 9 aging-related genes also altered in asthma patients, and a total of 68 CpG sites were related to the severity of asthma. Notably, 10 of the 68 CpG sites had a significant relationship with pulmonary function parameters. Moreover, ROC curve and PCA analysis showed that the candidate differential methylation sites (DMSs) can be used as potential biomarkers for asthma.Conclusions:In summary, this study confirmed the changes in the mRNA expression and DNAm level of aging-related genes in asthma patients. The differential DMSs are associated with the clinical evaluation indicators of asthma, which may indicate the involvement of aging-related genes in the pathogenesis of asthma and provide some new possible biomarker of asthma.