bluuebunny/crossref_metadata_2025_split huggingface dataset:
Translation, Cultural Adaptation and Psychometric Properties of the Ghanaian language (Akan; AsanteTwi) version of the Health Literacy Questionnaire.
Authors: Boateng Millicent Addai , Angel Sanne , Agyei-Baffour Peter , Enemark Ulrika 
Published: December 2020

Abstract
Background: Patients’ competencies and resources to manage their own health, which is termed health literacy, is a necessity for better health outcomes. Thus, it is relevant to have a comprehensive health literacy measurement tool suitable for populations of interest. The Health Literacy Questionnaire (HLQ) is a tool useful for health literacy assessment covering nine dimensions/scales of health literacy. The HLQ has been translated and validated in diverse contexts but has so far not been assessed in any country in sub-Saharan Africa. We sought to translate this tool into the most common language used in Ghana and assess its validity. Methods: We carried out a cross-sectional study using the HLQ concurrently with an assessment of a malaria programme for caregivers with children under five years. The HLQ was translated using a systematic translation procedure. We analysed the psychometric properties of the HLQ based on data collected by face-to-face interview of 1234 caregivers. The analysis covered tests on difficulty level of scales, composite reliability, Cronbach’s alpha and confirmatory factor analysis (CFA). Results: Cognitive testing showed that some words were ambiguous, which led to minor rewording of the questionnaire. A nine-factor CFA model was fitted to the 44 question items with no cross-loadings or correlated residuals allowed. Given the very restricted nature of the model, the fit was quite satisfactory: χ2 DWLS (866 df) = 17177.58, p < 0.000, CFI = 0.971, TLI = 0.969, RMSEA = 0.126 and SRMR = 0.107. Composite reliability and Cronbach’s alpha were >0.65 for all scales except Cronbach’s alpha for scale 9, ‘Understanding health information well enough to know what to do’ (0.57). The mean differences between most demographic groups among health literacy scales were statistically significant. Conclusion: The Akan-Twi version of HLQ proved relevant in our description of the health literacy levels among the caregivers in our study. This validated tool will be useful to conduct health literacy needs assessments to guide policies addressing such needs. Further work is needed to validate this tool for use in Ghana and similar contexts.
Barriers in Implementing the Dying Patient Law: The Israeli Experience - A Qualitative Study
Authors: Zigdon Avi , Nissanholtz-Gannot Rachel 
Published: December 2020

Abstract
Background: Coping with end-of-life issues is a major challenge for governments and health systems. Despite progress in legislation, many barriers exist to its full implementation. This study is aimed at identifying these end-of-life barriers in relation to Israel.Methods: Qualitative in-depth interviews using professionals and decision makers in the health-care and related systems (n=37) were carried out, along with two focus groups based on brainstorming techniques consisting of nurses (n=10) and social workers (n=10). Data was managed and analyzed using Naralyzer software.Results: Qualitative analysis showed identification of six primary barriers: 1) law, procedures, and forms; 2) clinical aspects; 3) human aspects; 4) knowledge and skills of medical teams; 5) communication; and 6) resource allocation. These were further divided into 44 sub area barriers.Conclusions: This study highlights the role of the family doctor in end-of-life by training physicians in decision-making workshops and increasing their knowledge in the field of palliative medicine. Effectively channeling resources, knowledge, and support for medical teams, by accounting for the structure and response of the units for home treatment will improve patient's access to information on and support for end-of-life laws, as well as reduce legislative barriers in other countries that face the same issues.
Cost-effectiveness of Out-of-Hospital Continuous Positive Airway Pressure for Acute Respiratory Failure: Decision analytic modelling using data from a feasibility trial
Authors: Thokala Praveen , Fuller Gordon W , Goodacre Steve , Keating Samuel , Herbert Esther , Perkins Gavin , Rosser Andy , Gunson Imogen , Miller Joshua , Ward Matthew , Bradburn Mike , Harris Tim , Marsh Maggie , Ren Kate , Cooper Cindy 
Published: December 2020

Abstract
Background Standard prehospital management for Acute respiratory failure (ARF) involves controlled oxygen therapy. Continuous positive airway pressure (CPAP) is a potentially beneficial alternative treatment, however, it is uncertain whether this could improve outcomes and provide value for money. This study aimed to evaluate the cost-effectiveness of prehospital CPAP in ARF.Methods A cost-utility economic evaluation was performed using a probabilistic decision tree model synthesising available evidence. The model consisted of a hypothetical cohort of patients in a representative ambulance service with undifferentiated ARF, receiving standard oxygen therapy or prehospital CPAP. Costs and quality adjusted life years (QALYs) were estimated using methods recommended by NICE.Results In the base case analysis, using CPAP effectiveness estimates form the ACUTE trial, the mean expected costs of standard care and prehospital CPAP were £15,201 and £14,850 respectively and the corresponding mean expected QALYs were 1.190 and 1.128, respectively. The mean ICER estimated as standard oxygen therapy compared to prehospital CPAP was £5,685 per QALY which indicated that standard oxygen therapy strategy was likely to be cost-effective at a threshold of £20,000 per QALY (67% probability). The scenario analysis, using effectiveness estimates from an updated meta-analysis, suggested that prehospital CPAP was more effective (mean incremental QALYs of 0.157), but also more expensive (mean incremental costs of £1,522), than standard care. The mean ICER, estimated as prehospital CPAP compared to standard care, was £9,712 per QALY. At the £20,000 per QALY prehospital CPAP was highly likely to be the most cost-effective strategy (94%). Conclusions Cost-effectiveness of prehospital CPAP depends upon the estimate of effectiveness. When based on a small pragmatic feasibility trial, standard oxygen therapy is cost-effective. When based on meta-analysis of heterogeneous trials, CPAP is cost-effective. Value of information analyses support commissioning of a large pragmatic effectiveness trial, providing feasibility and plausibility conditions are met.
Evaluation of laparoscopic-assisted transanal total mesorectal excision (Ta-TME) for locally advanced distal rectal cancer in men with difficult pelvic conditions after neoadjuvant chemoradiation therapy
Authors: Li Yingjie , He Guoli , Wang Lin , Dong Qiushi , Liu Xinzhi , Leng Jiahua , Zhang Xiao , Sun Tingting , Zhang Yue , Yao Yunfeng , Wu Aiwen 
Published: December 2020

Abstract
Background: To evaluate the use of laparoscopic-assisted transanal and total mesorectal excision (Ta-TME) in men with difficult pelvic anatomy in an attempt to optimize anal sphincteric preservation, determine the completeness of TME, and determine postoperative morbidity and mortality.Methods: Twenty male patients (TA group) with difficult pelvic anatomy (narrow pelvis) who were diagnosed with rectal cancer underwent Ta-TME surgery from January 2017 to January 2018 at Peking University Cancer Hospital. We matched these 20 patients with 2 other groups of patients who underwent either a laparoscopic transabdominal TME (LA group) or an open transabdominal TME (OP group) according to age, sex, BMI, distance of tumour from the anal verge, and diameter of the tumour. All 3 groups of patients had undergone preoperative neoadjuvant chemoradiation therapy. The efficacy and safety of Ta-TME were evaluated according to operative time, blood loss, postoperative hospital stay, and postoperative complications. Outcomes of Ta-TME were evaluated by comparing the rate of a positive circumferential resection margin, the integrity of the TME, and the rate of sphincter preservation among the 3 groups. Results: When comparing Ta-TME (TA group), laparoscopic transabdominal TME (LA group), and open transabdominal TME (OP group), the respective mean blood loss (100 mL, 100 mL, 100 mL, p=0.335), postoperative hospital stay (9 days, 9 days, 7 days), number of harvested lymph nodes (7, 6, 7), positive circumferential resection margin rate (0%, 0%, 5%), rate of pathologic complete response (5%,10%,10%), and integrity of TME showed no significant differences across groups (p>0.5 for all). In contrast, there were significant differences in operation time (302 min, 253 min, 135 min), rate of preservation of the anal sphincter (100%, 30%, 45%), and the creation of a protective diverting ileostomy (100%, 30%, 45%, p<0.05 for all).Conclusion: The rate of anal sphincter preservation in the Ta-TME group was considerably greater than that in the other groups, but the safety of the operation did not differ among the 3 groups. Ta-TME required a diverting ileostomy in all cases, and the total operation time for Ta-TME was greater than that of laparoscopic and open transabdominal TME.
Initial description of the Genome of Aeluropus littoralis, a halophile grass
Authors: Hashemi Seyyed Hamidreza , Arab Mojhdeh , Dolatabadi Behnaz , Kuo Yi-Tzu , Baez Mariana Alejandra , Himmelbach Axel , Nematzadeh Ghorbanali , Maibody Seyed Ali Mohammad Mirmohammady , Schmutzer Thomas , Mälzer Michael , Altmann Thomas , Kuhlmann Markus 
Published: December 2020

Abstract
Background: The use of wild plant species or their halophytic relatives has been considered in plant breeding programs to improve salt and drought tolerance in crop plants. Aeluropus littoralis serves as halophyte model for identification and isolation of novel stress adaptation genes. This species is described as perennial monocot grass. A. littoralis grows in damp or arid areas, often salt-impregnated places and waste land in cultivated areas. A. littoralis can survive where the water salinity is periodically high and tolerate high salt concentrations in the soil up to 1100 mM sodium chloride. Therefore, it serves as valuable genetic resource to understand molecular mechanisms of stress-responses in monocots. The knowledge can potentially be used for improving tolerance to abiotic stresses in economically important crops. Several morphological, anatomical, ecological, and physiological traits of A. littoralis have been investigated so far and also the transfer of stress related genes to other species resulted in enhanced stress resistance. After watering with salt water the grass is able to excrete salt via its salt glands. Meanwhile, a number of ESTs (expressed sequence tag), genes and promoters induced by the salt and drought stresses were isolated, sequenced and annotated at a molecular level.Results: Here we describe the genome sequence and structure of A. littoralis analyzed by whole genome sequencing and histological analysis. The chromosome number was determined to be 20 (2n = 2X = 20), absence of B chromsomes shown, and the genome size calculated to be 354 Megabasepairs.Conclusions: This genomic information provided here, will support the functional investigation and application of novel genes improving salt stress resistance in crop plants.
Dual species dynamic transcripts reveal the interaction mechanisms between&nbsp;Chrysanthemum morifolium&nbsp;and&nbsp;Alternaria alternata
Authors: Liu Lina , Chen Fadi , Chen Sumei , Fang Weimin , Liu Ye , Guan Zhiyong 
Published: December 2020

Abstract
Background: Chrysanthemum (C. morifolium) black spot disease caused by Alternaria alternata is one of the plant’s most destructive diseases. Dual RNA-seq was performed to simultaneously assess their transcriptomes to analyze the potential interaction mechanism between the two species, i.e., host and pathogen. Results: C. morifolium and A. alternata were subjected to dual RNA-seq at 1, 12, and 24 hours after inoculation, and differential expression genes (DEGs) in both species were identified. This analysis confirmed 153,532 DEGs in chrysanthemum and 14,932 DEGs in A. alternata, that were involved in plant-fungal interactions and phytohormone signaling. Fungal DEGs such as toxin synthesis related enzyme and cell wall degrading enzyme genes played important roles during chrysanthemum infecton. Moreover, a series of key genes highly correlated with the early, middle, or late infection stage was identified, together with the regulatory network of key genes annotated in PRG or PPI databases. Highly correlated genes were identified at the late infection stage, expanding our understanding of the interplay between C. morifolium and A. alternata. Additionally, six DEGs each from chrysanthemum and A. alternata were selected for qRT-PCR assays to validate the RNA-seq output. Conclusions: Collectively, data obtained in this study enriches the resources available for research into the interactions that exist between chrysanthemum and A. alternata, thereby providing a theoretical basis for the development of new chrysanthemum cultivars with resistance to pathogen.
Understanding the barriers to using oral anticoagulants among long-term aspirin users with atrial fibrillation – A qualitative study&nbsp;
Authors: Ng Vanessa WS , Siu Chung-Wah , Chiu Patrick KC , Kng Carolyn PL , Jamieson Elizabeth , Wong Ian CK , Lam May PS 
Published: December 2020

Abstract
Background: Despite international treatment guidelines currently advocating oral anticoagulants (OACs) as the only appropriate stroke prevention therapy for patients with atrial fibrillation (AF) and evidence that OACs can greatly reduce the risk of stroke with similar risk of bleeding compared with aspirin, the underuse of OACs in patients with AF is common globally, especially in Asia. This study aimed to identify the barriers to prescribing and using OACs among long-term aspirin users with AF.Method: Face-to-face interviews were conducted with fourteen eligible patients with AF using a semi-structured interview guide. The interview recordings were transcribed verbatim and data was analyzed according to the principles of thematic analysis.Results: Five themes were developed: awareness of AF symptoms and diagnosis; knowledge and understanding of AF and stroke prevention therapy; role of decision-making in prescribing; willingness to switch from aspirin to OACs; and impact of OAC regimen on daily living. The majority of the patients were not aware of the symptoms and diagnosis of AF and only had a vague understanding of the illness and stroke prevention therapy, leading to their minimal involvement in decisions relating to their treatment. Some patients and their caregivers were particularly concerned about the bleeding complications from OACs and perceived aspirin to be a suitable alternative as they find the adverse effects from aspirin manageable and so preferred to remain on aspirin if switching to OACs was not compulsory. Lastly, the lifestyle modifications required when using warfarin, e.g. alternative dosing regimen, diet restriction, were seen as barriers to some patients and caregivers. Conclusion: The findings revealed patients’ knowledge gap in AF management which may be targeted using educational interventions to improve patients’ understanding of AF and its management and hence encourage active participation in the decision-making of their treatment in the future.
Multiple freeze-thaw cycles lead to a loss of consistency in poly(A)-enriched RNA sequencing
Authors: Kellman Benjamin , Baghdassarian Hratch , Pramparo Tiziano , Shamie Isaac , Gazestani Vahid , Begzati Arjana , Li Shengzhong , Nalabolu Srinivasa , Murray Sarah , Lopez Linda , Pierce Karen , Courchesne Eric , Lewis Nathan 
Published: December 2020

Abstract
Background: Both RNA-Seq and sample freeze-thaw are ubiquitous. However, knowledge about the impact of freeze-thaw on downstream analyses is limited. The lack of common quality metrics that are sufficiently sensitive to freeze-thaw and RNA degradation, e.g. the RNA Integrity Score, makes such assessments challenging.Results: Here we quantify the impact of repeated freeze-thaw cycles on the reliability of RNA-Seq by examining poly(A)-enriched and ribosomal RNA depleted RNA-seq from frozen leukocytes drawn from a toddler Autism cohort. To do so, we estimate the relative noise, or percentage of random counts, separating technical replicates. Using this approach we measured noise associated with RIN and freeze-thaw cycles. As expected, RIN does not fully capture sample degradation due to freeze-thaw. We further examined differential expression results and found that three freeze-thaws should extinguish the differential expression reproducibility of similar experiments. Freeze-thaw also resulted in a 3’ shift in the read coverage distribution along the gene body of poly(A)-enriched samples compared to ribosomal RNA depleted samples, suggesting that library preparation may exacerbate freeze-thaw-induced sample degradation.Conclusion: The use of poly(A)-enrichment for RNA sequencing is pervasive in library preparation of frozen tissue, and thus, it is important during experimental design and data analysis to consider the impact of repeated freeze-thaw cycles on reproducibility.
Development of a risk scoring system for prognostication in HIV-related toxoplasma encephalitis
Authors: Li Yao , Zeng Yanming , Liu Min , Lu Yanqiu , Liu Xueyan , Zhang Yulin , Jiang Zhongsheng , Yang Tongtong , Sun Yan , Lan Ke , Chen Yaokai 
Published: December 2020

Abstract
Background: This study aims to evaluate specific risk factors influencing prognosis of HIV-infected patients with toxoplasma encephalitis (TE) in order to develop a prognostic risk scoring system for them. Methods: This is a six-center retrospective study of hospitalized HIV/TE patients. Data including six-week mortality after diagnosis, baseline characteristics, clinical features, laboratory tests and radiological characteristics of eligible patients were assimilated for risk model establishing.Results: In this study, the six-week mortality among 94 retrospective cases was 11.7% (11/94). Seven specific risk factors, viz. time from symptom onset to presentation, fever, dizziness, CD4+ T-cell counts, memory deficits, patchy brain lesions, and disorders of consciousness were calculated to be statistically associated with mortality. A criterion value of ‘9’ was selected as the optimal cut-off value of the established model. The AUC of the ROC curve of this scoring model was 0.976 (p<0.001). The sensitivity and specificity of the risk scoring model was 100.0% and 86.9%, respectively, which were 81.8% and 94.1% of this scoring model in the verification cohort, respectively. Conclusions: The developed scoring system was established with simple risk factors, which also allows expeditious implementation of accurate prognostication, and appropriate therapeutic interventions in HIV-infected patients with TE.
Transcriptome dynamics in early in vivo developing and in vitro produced porcine embryos
Authors: Weijden Vera A van der , Schmidhauser Meret , Kurome Mayuko , Knubben Johannes , Flöter Veronika L , Wolf Eckhard , Ulbrich Susanne 
Published: December 2020

Abstract
Background: The transcriptional changes around the time of embryonic genome activation in pre-implantation embryos indicate that this process is highly dynamic. In vitro produced porcine blastocysts are known to be less competent than in vivo developed blastocysts. To understand the conditions that compromise developmental competence of in vitro embryos, it is crucial to evaluate the transcriptional profile of porcine embryos during pre-implantation stages. In this study, we investigated the transcriptome dynamics in in vivo developed and in vitro produced 4-cell embryos, morulae and hatched blastocysts.Results: In vivo developed and in vitro produced embryos displayed largely similar transcriptome profiles during development. Enriched canonical pathways from the 4-cell to the morula transition that were shared between in vivo developed and in vitro produced embryos included oxidative phosphorylation, tRNA charging, and EIF2 signaling. The shared canonical pathways from the morula to the hatched blastocyst transition were 14-3-3-mediated signaling, signaling of Rho family GTPases, and NRF2-mediated oxidative stress response. The in vivo developed and in vitro produced hatched blastocysts were compared to identify molecular signaling pathways indicative of lower developmental competence of in vitro produced hatched blastocysts. A higher metabolic rate and expression of the arginine transporter SLC7A1 were found in in vitro produced hatched blastocysts.Conclusions: Our findings suggest that embryos with compromised developmental potential are arrested at an early stage of development, while embryos developing to the hatched blastocyst stage display largely similar transcriptome profiles, irrespective of the embryo source. The hatched blastocysts derived from the in vitro fertilization-pipeline showed an enrichment in molecular signaling pathways associated with lower developmental competence, compared to the in vivo developed embryos.
RNA m6A demethylase ALKBH5 regulates the development of γδ T cells
Authors: Flavell Richard , Ding Chenbo , Yu Zhibin , Xu Hao , Roulis Manolis , Qu Rihao , Zhou Jing , Jarret Abigail , Jackson Ruaidhrí , Wei Zheng , Gao Yimeng , Skadow Mathias , Sefik Esen , Yin Zhinan , Zou Qiang , Su Bing , Xia Qiang , Li Hua-Bing 
Published: December 2020

Abstract
γδ T cells are abundant T cell population at the mucosa and are important in providing immune surveillance as well as maintaining tissue homeostasis. However, despite γδ T cells origin in thymus, detailed mechanisms regulating γδ T cell development remain poorly understood. N6-methyladenosine (m6A) represents one of the most common post-transcriptional modifications of mRNA in mammalian cells, but whether it plays a role in γδ T cell biology is still unclear. Here we show that depletion of m6A demethylase ALKBH5 in lymphocytes specifically induces an expansion of γδ T cells, which confers enhanced protection against gastrointestinal S. typhimurium infection. Mechanistically, loss of ALKBH5 favors the development of γδ T cell precursors by increasing the abundance of m6A RNA modification in thymocytes, which further reduces the expression of several target genes including Notch signaling components Jagged1 and Notch2. As a result, impairment of Jagged1/Notch2 signaling contributes to enhanced proliferation and differentiation of γδ T cell precursors, leading to an expanded mature γδ T cell repertoire. Taken together, our results indicate a checkpoint role of ALKBH5 and m6A modification in the regulation of γδ T cell early development.