bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health care personnel’s perception of guideline implementation for musculoskeletal imaging: a process evaluation
Authors: Gransjøen Ann Mari , Wiig Siri , Lysdahl Kristin Bakke , Hofmann Bjørn Morten 
Published: May 2020

AbstractBackgroundThe increasing complexity and variability in radiology have significantly fueled the need for guidelines. There are many methods for disseminating and implementing guidelines however; and obtaining lasting changes has been difficult. Implementation outcome is usually measured in a decrease in unwarranted examinations, and qualitative data are rarely used. This study’s aim was to evaluate a guideline implementation process and identify factors influencing implementation outcome using qualitative data.MethodsSeven general practitioners and five radiological personnel from a Norwegian county participated in four focus group interviews in 2019. The data were analyzed using qualitative content analysis, where some categories were predetermined, while most were drawn from the data.ResultsFour main categories were developed from the data material. 1) Successful/unsuccessful parts of the implementation, 2) perceived changes/lack of changes after the implementation, 3) environment-related factors that affected guideline use, and 4) User related factors that affect guideline use.ConclusionsOur findings show that clinical guideline implementation is difficult, despite the implementation strategy being tailored to the target groups. Several environment- and user-related factors contributed to the lack of changes experienced in practice for both general practitioners and radiological personnel.
Feasibility of training community health workers to conduct periodontal examinations: a validation study in rural Nepal
Authors: Erchick Daniel J. , Agrawal Nitin K. , Khatry Subarna K. , Katz Joanne , LeClerq Steven C. , Rai Bhola , Reynolds Mark A. , Mullany Luke C. 
Published: May 2020

Abstract
Background
In many low- and middle-income countries, insufficient human resources limit access to oral health services. Shifting clinical tasks to less specialized health professionals, such as community health workers, has been used as a strategy to expand the health workforce, especially in remote or underserved locations. The objective of this study was to evaluate the validity of periodontal examinations conducted by auxiliary nurse midwives in a rural home setting in Nepal.

Methods
Twenty-one pregnant women < 26 weeks gestation from Sarlahi District, Nepal, underwent full mouth periodontal examinations measuring probing depth (PD) and bleeding on probing (BOP) on 6 sites per tooth by one of five auxiliary nurse midwives, who were trained for this study but had no previous training in dentistry. After a 15-min break, each participant was examined again by an experienced dentist. Measures of validity for PD and BOP were calculated comparing the pooled and individual auxiliary nurse midwives to the dentist. A multivariable GEE model estimated the effect of periodontal characteristics on agreement between the auxiliary nurse midwives and the dentist.

Results
Participant mean age was 22 years (SD: ±3 years), mean PD was 1.4 mm (SD: 03 mm), and 86% of women had BOP (according to the dentist). Percent agreement, weighted kappa scores, and intraclass correlation coefficients for PD, with an allowance of ±1 mm, exceeded 99%, 0.7, and 0.9, respectively, indicating an acceptable level of agreement. Auxiliary nurse midwives tended to report higher PD scores relative to the dentist, although this over-estimation was small and unlikely to impact population-based estimates of important indicators of oral health status. GEE regression modeling indicated similar agreement for mandible vs. maxilla, left vs. right side, and PD (≤2 mm, > 2 mm), and lower agreement for posterior teeth and lingual and proximal sites.

Conclusion
Auxiliary nurse midwives were able to accurately conduct periodontal examinations in a rural home setting, suggesting the potential to shift tasks away from highly trained dentists and periodontal examiners in low-resource communities.

Trial registration
ClinicalTrials.gov Identifier: NCT01177111 (Nepal Oil Massage Study); registered on August 6th, 2010.
Barriers to managing and delivery of care to war-injured survivors or patients with non-communicable disease: a qualitative study of Palestinian patients’ and policy-makers’ perspectives
Authors: Mosleh Marwan , Al Jeesh Yousef , Dalal Koustuv , Eriksson Charli , Carlerby Heidi , Viitasara Eija 
Published: May 2020

Abstract
Background
Improving access to optimal quality of care is a core priority and ambitious health policy goal in spite of impediments, threats and challenges in Palestine. Understanding the factors that may impede quality of care is essential in developing an effective healthcare intervention for patient with non-communicable disease (NCD) or war-injured survivors.

Methods
Qualitative interviews were performed using a purposive sampling strategy of 18 political-key informants, 10 patients with NCD and 7 war-injured survivors from different health facilities in Gaza Strip. A semi-structured interview guide was developed for data collection. The interviews were audio recorded and transcribed verbatim. Important field notes of the individual interviews were also reported. Thematic-driven analytic approach was used to identify key themes and patterns.

Results
From the policy maker’s perspective, the following important barriers to accessing optimal healthcare for patients with NCD or war-injured survivors’ treatment were identified; 1) organizational/structural 2) availability 3) communication 4) personnel/lack of staff 5) financial and political barriers. Patient with NCD or war-injury had similar experiences of barriers as the policy makers. In addition, they also identified socioeconomic, physical and psychological barriers for accessing optimal healthcare and treatment.

Conclusions
The main perceived barriers explored through this study will be very interesting and useful if they are considered seriously and handled carefully, in order to ensure efficient, productive, cost-effective intervention and delivery of a high-standard quality of care and better disease management.
Profiling Italian cat and dog owners’ perceptions of pet food quality traits
Authors: Vinassa Marica , Vergnano Diana , Valle Emanuela , Giribaldi Marzia , Nery Joana , Prola Liviana , Bergero Domenico , Schiavone Achille 
Published: May 2020

Abstract
Background
Over recent years, pet owners have started to demonstrate increased sensitivity toward their companion animals, which includes an increase in the attention paid towards their nutrition, seen as a way of safeguarding their pets’ welfare. The aim of this study was to identify how pet food quality traits are perceived as being the most important by dog and cat owners. To this end, a survey of dog and cat owners was conducted by means of a questionnaire distributed in pet stores and trade fairs throughout Italy.

Results
A total of 935 surveys were collected; 61.8% of which were compiled by female pet owners. The respondents were relatively homogeneously distributed between cat (30.8%), dog (39.4%), and cat and dog (29.8%) owners. A quarter of the owners (25.5%) reported to have asked their veterinarian for advice on which pet food to buy, and almost a third (30.4%) trusted the advice posted on the web sites of well-known brands. “Contains natural ingredients” was the characteristic that obtained the highest mean score (4.3 out of 5).
Elderly owners (> 65 years) placed most importance on whether a product had a high price, and least on feed appearance, animal satisfaction, and stool quality. Young owners (< 35y) paid most attention to the stool quality, the percentage of protein in the feed, and the presence of recyclable packaging, and least attention to feed appearance, smell, and animal satisfaction. Feed appearance, smell, a higher cost, and certain label indications (protein content, presence of fresh meat, grain free) were mostly important among the buyers of wet pet food. Some specific differences also emerged between dog, cat, and dog and cat owners.

Conclusions
In this survey of Italian pet food buyers, the presence of “natural” ingredients was considered to be the most important indicator of pet food quality, whereas characterized by a high price was considered least important. The data obtained from this survey could be used to help pet food companies identify which pet food quality traits are perceived as important by dog and cat owners.
A Gleason score-related outcome model for human prostate cancer: a comprehensive study based on weighted gene co-expression network analysis
Authors: Wang Yongzhi , Yang Zhonghua 
Published: May 2020

Abstract
Background
Prostate cancer (PCa) is the second leading cause of cancer death in men in 2018. Thus, the evaluation of prognosis is crucial for clinical treatment decision of human PCa patients. We aim to establishing an effective and reliable model to predict the outcome of PCa patients.

Methods
We first identified differentially expressed genes between prostate cancer and normal prostate in TCGA-PRAD and then performed WGCNA to initially identify the candidate Gleason score related genes. Then, the candidate genes were applied to construct a LASSO Cox regression analysis model. Numerous independent validation cohorts, time-dependent receiver operating characteristic (ROC), univariate cox regression analysis, nomogram were used to test the effectiveness, accuracy and clinical utility of the prognostic model. Furthermore, functional analysis and immune cells infiltration were performed.

Results
Gleason score-related differentially expressed candidates were identified and used to build up the outcome model in TCGA-PRAD cohort and was validated in MSKCC cohort. We found the 3-gene outcome model (CDC45, ESPL1 and RAD54L) had good performance in predicting recurrence free survival, metastasis free survival and overall survival of PCa patients. Time-dependent ROC and nomogram indicated an ideal predictive accuracy and clinical utility of the outcome model. Moreover, outcome model was enriched in 28 pathways by GSVA and GSEA. In addition, the risk score was positively correlated with memory B cells, native CD4 T cells, activated CD4 memory T cells and eosinophil, and negatively correlated with plasma cells, resting CD4 memory T cells, resting mast cells and neutrophil.

Conclusions
In summary, our outcome model proves to be an effective prognostic model for predicting the risk of prognosis in PCa.
Estimated postnatal p,p’-DDT and p,p’-DDE levels and body mass index at 42 months of age in a longitudinal study of Japanese children
Authors: Plouffe Laurence , Bosson-Rieutort Delphine , Madaniyazi Lina , Iwai-Shimada Miyuki , Nakai Kunihiko , Tatsuta Nozomi , Nakayama Shoji F. , Verner Marc-André 
Published: May 2020

AbstractBackgroundChildren are exposed top,p’-dichlorodiphenyltrichloroethane (p,p’-DDT) andp,p’-dichlorodiphenyldichloroethylene (p,p’-DDE) through placental and lactational transfer. Some studies have suggested that early-life exposure to these compounds could lead to increased body mass index (BMI) during childhood. Our aim was to assess whether children’s exposure during the first 2 years of life is associated with BMI z-score in Japanese children at 42 months of age.MethodsWe used data from a birth cohort (n = 290) of the Tohoku Study of Child Development.p,p’-DDT andp,p’-DDE levels were measured in breast milk samples collected 1 month after birth, and levels in children were estimated using a toxicokinetic model for three exposure periods (0–6 months, 6–12 months, 12–24 months). Associations between exposure estimates and BMI z-score at 42 months of age were assessed using multivariate linear regression models.ResultsWe found no significant association between levels ofp,p’-DDT measured in breast milk or estimated in children and BMI z-score. However, we observed associations between estimatedp,p’-DDE levels in girls during all postnatal exposure periods and BMI z-score; for each log increase in the estimatedp,p’-DDE levels, BMI z-score increased by 0.23 (C.I. 95%: 0.01, 0.45) for the 0–6 months exposure period, 0.26 (C.I. 95%: 0.06, 0.47) for the 6–12 months exposure period, and 0.24 (C.I. 95%: 0.05, 0.43) for the 12–24 months exposure period.ConclusionIn this study of Japanese children, estimated postnatalp,p’-DDE levels were associated with increased BMI z-score at 42 months of age, mostly in girls. These results are in line with previous studies supporting that early-life exposure top,p’-DDE may be associated with higher BMI during childhood.
Metabolic effects of PCSK9 inhibition with Evolocumab in subjects with elevated Lp(a)
Authors: Zhang Xiang , Stiekema Lotte C. A. , Stroes Erik S. G. , Groen Albert K. 
Published: May 2020

Abstract
Background
Epidemiological studies substantiated that subjects with elevated lipoprotein(a) [Lp(a)] have a markedly increased cardiovascular risk. Inhibition of proprotein convertase subtilisin/kexin type 9 (PCSK9) lowers both LDL cholesterol (LDL-C) as well as Lp(a), albeit modestly. Effects of PCSK9 inhibition on circulating metabolites such as lipoprotein subclasses, amino acids and fatty acids remain to be characterized.

Methods
We performed nuclear magnetic resonance (NMR) metabolomics on plasma samples derived from 30 individuals with elevated Lp(a) (> 150 mg/dL). The 30 participants were randomly assigned into two groups, placebo (N = 14) and evolocumab (N = 16). We assessed the effect of 16 weeks of evolocumab 420 mg Q4W treatment on circulating metabolites by running lognormal regression analyses, and compared this to placebo. Subsequently, we assessed the interrelationship between Lp(a) and 14 lipoprotein subclasses in response to treatment with evolocumab, by running multilevel multivariate regression analyses.

Results
On average, evolocumab treatment for 16 weeks resulted in a 17% (95% credible interval: 8 to 26%, P < 0.001) reduction of circulating Lp(a), coupled with substantial reduction of VLDL, IDL and LDL particles as well as their lipid contents. Interestingly, increasing concentrations of baseline Lp(a) were associated with larger reduction in triglyceride-rich VLDL particles after evolocumab treatment.

Conclusions
Inhibition of PCSK9 with evolocumab markedly reduced VLDL particle concentrations in addition to lowering LDL-C. The extent of reduction in VLDL particles depended on the baseline level of Lp(a). Our findings suggest a marked effect of evolocumab on VLDL metabolism in subjects with elevated Lp(a).

Trial registration
Clinical trial registration information is registered at ClinicalTrials.gov on April 14, 2016 with the registration number NCT02729025.
High tumor mutation burden is associated with DNA damage repair gene mutation in breast carcinomas
Authors: Mei Ping , Freitag C. Eric , Wei Lai , Zhang Yunxiang , Parwani Anil V. , Li Zaibo 
Published: May 2020

Abstract
Background
Immunotherapy has demonstrated encouraging clinical benefits in patients with advanced breast carcinomas and Programmed death ligand 1 (PD-L1) expression has been proposed as an immunotherapy biomarker. Challenges with current PD-L1 testing exist and tumor mutation burden (TMB) is emerging as a biomarker to predict clinical response to immunotherapy in melanoma and non-small cell lung cancer patients. However, TMB has not been well characterized in breast carcinomas.

Methods
The study cohort included 62 advanced breast cancer patients (13 primary and 49 metastatic). Genetic alterations and TMB were determined by FoundationOne CDx next generation sequencing (NGS) and the association with clinicopathologic features was analyzed.

Results
High TMB was observed in a relatively low frequency (3/62, 4.8%). TMB levels were positively associated tumor infiltrating lymphocytes and significantly higher TMB was observed in breast carcinomas with DNA damage repair gene mutation(s). There was no significant association between TMB levels and other analyzed clinicopathologic characteristics.

Conclusions
Our data indicate the importance of DNA damage repair proteins in maintaining DNA integrity and immune reaction and breast carcinoma patients with DDR mutation may benefit from immunotherapy.
Mentored training and its association with dissemination and implementation research output: a quasi-experimental evaluation
Authors: Jacob Rebekah R. , Gacad Angeline , Padek Margaret , Colditz Graham A. , Emmons Karen M. , Kerner Jon F. , Chambers David A. , Brownson Ross C. 
Published: May 2020

AbstractBackgroundThere is a continued need to evaluate training programs in dissemination and implementation (D&I) research. Scientific products yielded from trainees are an important and objective measure to understand the capacity growth within the D&I field. This study evaluates our mentored training program in terms of scientific productivity among applicants.MethodsPost-doctoral and early-career cancer researchers were recruited and applied to the R25 Mentored Training for Dissemination and Implementation Research in Cancer (MT-DIRC) between 2014 and 2017. Using application details and publicly available bibliometric and funding data, we compared selected fellows with unsuccessful applicants (nonfellows). We extracted Scopus citations and US federal grant funding records for all applicants (N= 102). Funding and publication abstracts were de-identified and coded for D&I focus and aggregated to the applicant level for analysis. Logistic regression models were explored separately for the odds of (1) a D&I publication and (2) US federal grant funding post year of application among fellows (N= 55) and nonfellows (N= 47). Additional models were constructed to include independent variables that attenuated the program’s association by 5% or more. Only US-based applicants (N= 87) were included in the grant funding analysis.ResultsFellows and nonfellows were similar across several demographic characteristics. Fellows were more than 3 times more likely than nonfellows to have grant funding after MT-DIRC application year (OR 3.2; 95% CI 1.1–11.0) while controlling for time since application year; the association estimate was 3.1 (95% CI 0.98–11.0) after adjusting for both cancer research area and previous grant funding. For publications, fellows were almost 4 times more likely to publish D&I-focused work adjusting for time (OR 3.8; 95% CI 1.7–9.0). This association lessened after adjusting for previous D&I publication and years since undergraduate degree (OR 2.9; 95% CI 1.2–7.5).ConclusionsWe document the association of a mentored training approach with built-in networks of peers to yield productive D&I researchers. Future evaluation efforts could be expanded to include other forms of longer-term productivity such as policy or practice change as additional objective measures. D&I research trainings in the USA and internationally should consider common evaluation measures.
Design and fabrication of a Nano-based neutron shield for fast neutrons from medical linear accelerators in radiation therapy
Authors: Afkham Younes , Mesbahi Asghar , Alemi Abdolali , Zolfagharpour Farhad , Jabbari Nasrollah 
Published: May 2020

Abstract
Background
Photo-neutrons are produced at the head of the medical linear accelerators (linac) by the interaction of high-energy photons, and patients receive a whole-body-absorbed dose from these neutrons. The current study aimed to find an efficient shielding material for fast neutrons.

Methods
Nanoparticles (NPs) of Fe3O4 and B4C were applied in a matrix of silicone resin to design a proper shield against fast neutrons produced by the 18 MeV photon beam of a Varian 2100 C/D linac. Neutron macroscopic cross-sections for three types of samples were calculated by the Monte Carlo (MC) method and experimentally measured for neutrons of an Am-Be source. The designed shields in different concentrations were tested by MCNPX MC code, and the proper concentration was chosen for the experimental test. A shield was designed with two layers, including nano-iron oxide and a layer of nano-boron carbide for eliminating fast neutrons.

Results
MC simulation results with uncertainty less than 1% showed that for discrete energies and 50% nanomaterial concentration, the macroscopic cross-sections for iron oxide and boron carbide at the energy of 1 MeV were 0.36 cm− 1 and 0.32 cm− 1, respectively. For 30% nanomaterial concentration, the calculated macroscopic cross-sections for iron oxide and boron carbide shields for Am-Be spectrum equaled 0.12 cm− 1 and 0.15 cm− 1, respectively, while they are 0.15 cm− 1 and 0.18 cm− 1 for the linac spectrum. In the experiment with the Am-Be spectrum, the macroscopic cross-sections for 30% nanomaterial concentration were 0.17 ± 0.01 cm− 1 for iron oxide and 0.21 ± 0.02 cm− 1 for boron carbide. The measured transmission factors for 30% nanomaterial concentration with the Am-Be spectrum were 0.71 ± 0.01, 0.66 ± 0.02, and 0.62 ± 0.01 for the iron oxide, boron carbide, and double-layer shields, respectively. In addition, these values were 0.74, 0.69, and 0.67, respectively, for MC simulation for the linac spectrum at the same concentration and thickness of 2 cm.

Conclusion
Results achieved from MC simulation and experimental tests were in a satisfactory agreement. The difference between MC and measurements was in the range of 10%. Our results demonstrated that the designed double-layer shield has a superior macroscopic cross-section compared with two single-layer nanoshields and more efficiently eliminates fast photo-neutrons.
Anterior mediastinal metastasis of primary fallopian tube adenocarcinoma: a case report
Authors: Zhang Bo , Liu Renwang , Li Tong , Chen Feng , Huo Huandong , Ren Dian , Ren Fan , Xu Song , Xu Xiaohong , Song Zuoqing 
Published: May 2020

Abstract
Background
Primary fallopian tube carcinoma (PFTC) is a malignant tumor of the female genital tract that mostly presents intraperitoneal dissemination in clinical practice. The incidence of upper anterior mediastinal metastasis in PFTCs is extremely rare. We herein report a rare case of PFTC mediastinal metastasis after radical resection. When anterior mediastinal metastasis of an unknown origin is encountered, the possibility of PFTC should be considered.

Case presentation
A 68-year-old female who was previously diagnosed with PFTC after radical resection of a primary tumor in the fallopian tube was admitted to our department with a right anterior mediastinum mass. Radical resection of the mediastinal mass was performed, and poorly differentiated metastatic adenocarcinoma of the fallopian tube was confirmed. There was no recurrence in the 24 months after the curative operation.

Conclusion
To our knowledge, no mediastinal metastasis of PFTC has been reported yet. Thus, we presented this rare case indicating the heterogeneity of this malignant disease and to draw attention to the occasional distant metastasis of PFTC in clinical practice.