bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validation of the Psychometric Properties of the Malay Advance Care Planning Questionnaire
Authors: Lim Mun Kit , Lai Pauline Siew Mei , Wong Pei Se , Othman Sajaratulnisah , Mydin Fadzilah Hanum Mohd 
Published: April 2020

Abstract
Background There is a growing interest among the developing countries on advance care planning (ACP) due to the reported benefits of planning ahead in the developed countries. Validated instruments in various languages have been developed to facilitate study on the views of public prior to its implementation. However, instrument to explore the views on advance care planning (ACP) in Malay has not been developed and validated yet, even though Malay is spoken extensively by approximately 220 million people in the Malay Archipelago. There is also a need for instrument in Malay language to facilitate the assessment of knowledge, attitude and practice (KAP) of Malaysians regarding advance care planning (ACP). Therefore, the aim of this study was to validate the psychometric properties of the Malay Advance Care Planning Questionnaire (ACPQ-M) to assess the knowledge, attitude and practice of Malaysians regarding advance care planning Methods The ACPQ was translated according to international guidelines. This validation study was conducted from January to June 2018. Participants who were ≥21 years old, and able to understand Malay were recruited from an urban primary care clinic and a tertiary education institution in Malaysia. A researcher administered the ACPQ-M to participants via a face-to-face interview at baseline and two weeks later. Each interview took approximately 15-20 minutes. Results A total of 222/232 participants agreed to participate (response rate=96.0%). Exploratory factor analysis and confirmatory factor analysis found that the ACPQ-M was a 4-factor model. The Cronbach’s α values for the four domains ranged from 0.674-0.947. Only 157/222 participants completed the test-retest (response rate=71%). At test-retest, quadratic weighted kappa values for all domains ranged from 0.340-0.674, except for two domains which ranged from -0.200-0.467. Conclusions The ACPQ-M was found to be a 4-factor model, and a valid and reliable instrument to assess the KAP regarding ACP. This instrument can contribute to profound understanding of the KAP of Malaysians regarding ACP, and assist policy makers in determining the readiness for legislation of ACP in Malaysia.
Circular RNAs Serve as Prognostic, Diagnostic and Clinicopathological Markers in Lung Cancer: An Updated Systematic Review and Meta-Analysis
Authors: Liang Zhuozheng , Chen Cui , Guo Cheng , Meng Ping , Zou Manman , Zhang Liyi , Liu Hui , Zhang Tiantuo 
Published: April 2020

Abstract
Background: In recent years, the roles of circular RNAs (circRNAs) in the biogenesis and clinical application have gradually garnered much interest in the field of cancer research. However, high-quality studies evaluating the roles of circRNAs in clinicopathological features and clinical application of lung cancer are still unrevealed. Herein, we aimed to elucidate the functions of circRNAs in the association with clinicopathology, diagnosis and prognosis in lung cancer. Methods: Comprehensive and reasonable search strategies were used in four databases up to Nov. 24th, 2019. The odds ratio (OR) was used to analyze the risks of circRNAs in lung cancer. Sensitivity (Sen), specificity (Spe) and area under curve (AUC) were used to assess the diagnostic value. What’s more, the hazard ratio (HR) was used for the analysis of survival outcomes. A fixed-effect model was firstly used in data analysis. If I2 >50% in heterogeneity, the random-effect model was chosen. Results: A total of 50 studies with 3815 samples were incorporated into our meta-analysis, in which 40 focused on clinical characteristics, 10 related to diagnosis and 31 were aimed at prognosis. In terms of clinical characteristics, both OR and 95% confidence interval (95%CI) were shown that circRNAs were significantly associated with TNM, tumor differentiation, lymph node metastasis, distal metastasis and tumor size in lung cancer. For diagnosis, both upregulated and downregulated circRNAs distinguished patients with lung cancer from healthy people with pooled Sen, Spe and AUC, of which the values were 0.78, 0.76 and 0.81 respectively. In the section of prognosis, circRNAs can better predict the survival time of patients with lung cancer (overall survival, OS: HR=0.46, 95%Cl: 0.33–0.65 in downregulated circRNAs; HR=2.23, 95%CI: 1.97-2.53 in upregulated circRNAs). Conclusions: The results presented here suggested that circRNAs were the potential cancer biomarkers in clinicopathology, diagnosis and prognosis of lung cancer patients, which deserve further application in clinical practice.
Building Towards Common Psychosocial Measures in U.S. Cohort Studies: Principal Investigators’ Views Regarding the Role of Religiosity and Spirituality in Human Health
Authors: Shields Alexandra E. , Balboni Tracy 
Published: April 2020

Abstract
Background. The goal of this study was to understand prospective cohort Principal Investigators’ (PIs’) attitudes regarding the importance of religion and spirituality (R/S) on disease etiology in order to identify barriers and opportunities for greater inclusion of these domains in high-quality epidemiological research. Methods. One-hour, semi-structured qualitative interviews were conducted with 20 PIs, who represent 24 different National Institutes of Health (NIH)-funded prospective cohort studies in the U.S. Collectively, these PIs collect detailed health data on approximately 1.25 of every 100 adult Americans. Sample size was calculated to achieve thematic saturation. Results. The majority of PIs we interviewed viewed R/S as potentially important factors influencing disease etiology, particularly among minority communities that report higher levels of R/S. Yet nearly all PIs interviewed felt there was not yet a compelling body of evidence elucidating R/S influences on health, and the potential mechanisms through which R/S may be operating to affect health outcomes. PIs identified 5 key areas that would need to be addressed before they would be persuaded to collect more R/S measures in their cohorts: (1) high-quality, prospective studies that include all appropriate covariates; (2) studies that posit a plausible biological mechanism; (3) well-validated R/S measures, collected in common across multiple cohorts; (4) the need to address bias against R/S research; and (5) NIH funding for R/S research. Conclusions. Results of this study provide a roadmap for future R/S research investigating the impact of R/S influences on disease etiology within the context of U.S. prospective cohort studies. Identifying significant R/S influences on health could inform novel interventions to improve population health. Given the higher levels of religiosity/spirituality among minority communities, R/S research may also provide a new leverage points for reducing health disparities.
Substances use and its association with sociodemographic, family and environment-related factors among technical and vocational education and training College students in Ataye, Ethiopia, 2019.
Authors: Wubetu Abate Dargie , Getachew Sintayehu , Negash Wassie 
Published: April 2020

Abstract
Background: Legal substances use is prevalent in Ethiopia. Substance use can have several health problems that are potentially harmful in educational performance, social issues, psychological and physical wellbeing. This study aimed to know prevalence of lifetime and last month substances use and its associated factors among technical and vocational education and training College students in Ataye town. Methods: an institution based cross-sectional study conducted from 1 March to last May 2019. Participants selected by using simple random sampling technique. Chi-square with its p-value used to identify correlates for each legal/illegal substance use. Bivariate and multivariate binary logistic regression analysis performed to identify associated factors. Backward logistic regression method used. Odds ratio with their 95% confidence interval, and p value less than 0.05 used to declare the statistical significance of associated factors. Results: Four hundred eighty three individuals participated in the study, which was a response rate of 94%. The prevalence of lifetime legal substances use was 32.5% (95% CI: 28.2, 36.5). The prevalence of last month's legal substances use was 21.9% (95% CI= 18.2, 25.5). Among lifetime legal substance users, the majority (25.5%) chewed khat. The others, (19.5%) drunk alcohol, and, 15.3% smoked cigarette. Cannabis and cocaine users were 2.5%, and 7.2% respectively. Among last month's legal substance users, (21.9%) chewed khat followed by alcohol drinking (16.6%), and cigarette smoking (15.3%). In the last month, 1.2% and 3.3% of students used cannabis and cocaine respectively. Multivariate logistic regression showed that, being male, having divorced family, living greater than twenty years in the town, having substance user family member, having intimate friend substance user, and easily availability of substances were independent predictors of lifetime legal substances use. Conclusions: The prevalence of last month and lifetime legal substance use at Ataye technical and vocational education and training (TVET) College students were analogous with most studies done in Ethiopia. Cannabis and cocaine are illegal drugs in Ethiopia. Nevertheless, the reported proportion of these illegal drug uses informs us there may not be under reporting of legal substances use. It is advisable if furthers emphasis is given for TVET students with the predictor variables.
The geno-spatio analysis of Mycobacterium tuberculosis complex in hot and cold spots of Guangxi, China
Authors: Lin Dingwen , Cui Zhezhe , Virasakdi Virasakdi , Palittapongarnpim Prasit , Chaiprasert Angkana , Ruangchai Wuthiwat , Ou Jing , Huang Liwen 
Published: April 2020

Abstract
Background At present, there are few studies on polymorphism of Mycobacterium tuberculosis (Mtb) gene and how it affects the TB epidemic. This study aimed to document the differences of polymorphisms between tuberculosis hot and cold spot areas of Guangxi Zhuang Autonomous Region, China. Methods The cold and hot spot areas, each with 3 counties, had been pre-identified by TB incidence for 5 years from the surveillance database. Whole genome sequencing analysis was performed on all sputum Mtb isolates from the detected cases during January and June 2018. Single nucleotide polymorphism (SNP) of each isolate compared to the H37Rv strain were called and used for lineage and sub-lineage identification. Pairwise SNP differences between every pair of isolates were computed. Analyses of Molecular Variance (AMOVA) across counties of the same hot or cold spot area and between the two areas were performed. Results As a whole, 59.8% (57.7% sub-lineage 2.2 and 2.1% sub-lineage 2.1) and 39.8% (17.8% sub-lineage 4.4, 6.5% sub-lineage 4.2 and 15.5% sub-lineage 4.5) of the Mtb strains were Lineage 2 and Lineage 4 respectively. The percentages of sub-lineage 2.2 (Beijing family strains) are significantly higher in hot spots. Through the MDS dimension reduction, the genomic population structure in the three hot spot counties is significantly different from those three cold spot counties (T-test p = 0.05). The median of SNPs distances among Mtb isolates in cold spots was greater than that in hot spots (897 vs 746, Rank-sum test p < 0.001). Three genomic clusters, each with genomic distance ≤ 12 SNPs, were identified with 2, 3 and 4 consanguineous strains. Two clusters were from hot spots and one was from cold spots. Conclusion Narrower genotype diversity in the hot area may indicate higher transmissibility of the Mtb strains in the area compared to those in the cold spot area.
Risk factors for esophagitis after hypofractionated palliative (chemo)radiotherapy for non-small cell lung cancer
Authors: Nieder Carsten , Imingen Kristian S. , Mannsåker Bård , Yobuta Rosalba , Haukland Ellinor 
Published: April 2020

Abstract
Introduction: Esophagitis influences quality of life and might cause treatment interruption and hospitalization. Previous studies of risk factors focused on curative treatment for non-small cell lung cancer (NSCLC), which often involves concomitant chemoradiation (CRT). Given the uncertainty around extrapolation of dose constraints, we analyzed risk factors in patients treated with hypofractionated palliative regimens. Patients and Methods: A retrospective review of 106 patients treated with palliative radiotherapy or CRT between 2009 and 2017 was performed. Inclusion criteria: prescribed total dose 30-54 Gy, dose per fraction 2.5-4 Gy, esophageal dose >1 Gy. Uni- and multivariate analyses were performed in 97 eligible patients to identify predictive factors for acute esophagitis grade ≥1 (CTCAE 5.0). Results: Forty percent of patients were treated with 15 fractions of 2.8 Gy (42 Gy) and 28% also received chemotherapy according to the CONRAD study regimen (induction and concomitant Carboplatin/Vinorelbine) published by the Norwegian Lung Cancer Group. Thirty-four percent were treated with 10 fractions of 3 Gy. Stage IV NSCLC was present in 47%. Esophagus Dmax was 39 Gy (population median) and Dmean 15 Gy. Overall 31% of patients developed esophagitis (26% grade 2-3, no grade 4-5). Several dosimetric parameters correlated with the risk of esophagitis (Dmax, Dmean, D5cc, V20, V30, V35, V40). Dmax outperformed other dosimetric variables in multivariate analysis. Furthermore, concomitant chemotherapy significantly increased the risk of esophagitis, while oral steroid medication reduced it. In patients with Dmax ≥40 Gy a reduced Dmean (≤20 Gy) was beneficial.Conclusion: In order to reduce esophagitis after hypofractionated palliative treatment lower doses than those recommended in curative NSCLC settings are preferable. Besides esophageal dose, CRT is the main risk factor for esophagitis. Additional work is needed to confirm that steroids are able to modify the risk (or to rule out confounding effects of baseline variables not included in our database).
Highly variable chloroplast genome from two endangered Papaveraceae lithophytes Corydalis saxicola and C. tomentella
Authors: Ren fengming , Wang Liqiang , Li Ying , Zhuo Wei , Xu Zhichao , Guo Haojie , Liu Yan , Gao Ranran , Song Jingyuan 
Published: April 2020

Abstract
Backgroud: Corydalis DC., the largest genus of Papaveraceae, is recognized as one of the most taxonomically challenging plant taxa. However, no complete chloroplast (cp) genome for this genus has been reported to date. Results: We sequenced four complete cp genomes of two affinities Corydalis saxicola and C. tomentellav of the genus Corydalis, compared these cp genomes with each other and others from Papaveraceae, and analyzed the phylogenetic relationships based on the sequences of common CDS. The cp genomes are 189,029 to 190,247 bp in length, possessing a quadripartite structure and with two highly expanded inverted repeat (IR) regions (length: 41,955 to 42,350 bp). Comparison between the cp genomes of C. tomentella, C. saxicola and Papaveraceae species revealed high variability in genome sizes, genome structures, gene content, and gene arrangements. Five NADH dehydrogenase-like genes with psaC, rpl32, ccsA and trnL-UAG normally located in the SSC region have migrated to IRs resulting in IR expansion and gene duplication. An up to 9 kb inversion involving five genes (rpl23, ycf2, ycf15, trnI-CAU and trnL-CAA) was found within IR regions. In addition, the accD gene was found to be absent. The ycf1 gene has shifted from the IR/SSC border to the SSC region as a single copy. Phylogenetic analysis showed that genus Corydalis is quite distantly related to the other genera of Papaveraceae, supporting for recent advocacy to establish a separate Fumariaceae family. Conclusions: Our results provide a useful resource for classification of this taxonomically complicated genus, and will be valuable for understanding Papaveraceae evolutionary relationships.
Racial Residential Segregation and Colorectal Cancer Mortality in the Mississippi Delta Region
Authors: Kruse-Diehr Aaron J , McDaniel Justin T , Lewis-Thames Marquita W , James Aimee , Yahaya Musa 
Published: April 2020

Abstract
Background
Few studies have examined the effects of segregation on colorectal cancer (CRC) outcomes, and none has determined if rurality moderates the effect of segregation on CRC mortality. We examined whether the effect of segregation on CRC mortality was moderated by rurality in the Mississippi Delta Region, an economically distressed and historically segregated region of the United States.
Methods
Using data from the US Census Bureau and the Surveillance, Epidemiology, and End Results (SEER) program, we estimated linear mixed-effects models with state-level random effects in which Black and White CRC mortality rates in Delta Region counties (N = 252) were regressed on county rurality, White-Black residential segregation indices, an interaction term for these two variables, and a vector of socioeconomic control variables. Missing data were replaced with values generated via random forest imputation.
Results
Segregation was a risk factor for Black CRC mortality in urban Delta counties but was associated with lower Black CRC mortality in rural counties (B = − 23.30 [95% CI = − 38.51, − 7.92]). For Whites, living in a rural area did not moderate the relationship between segregation and CRC mortality, though White CRC mortality was inversely associated with White population proportion (B = − 7.12 [95% CI = − 10.66, − 3.43]).
Conclusions
Health outcomes related to segregation vary by racial, contextual and community factors. We give possible explanations for our findings and provide implications for practice and recommendations for further research to better understand the CRC mortality burden in segregated communities.
The Development of Clinical Thinking in Physicians in Training: The Educator Perspective
Authors: LOCKE RACHEL , Mason Alice , Coles Colin , Lusznat Rosie M , Masding Mike G 
Published: April 2020

Abstract
Background An important element of effective clinical practice is the way physicians ‘think’ when they encounter a clinical situation, with a significant number of physicians in training challenged by translating their learning into professional practice in the clinical setting. This research explores the perceptions of educators about how physicians in training develop their clinical thinking in clinical settings. It considers what educators and their colleagues did to help, as well as the nature of the ‘context’ in which they worked. Method A qualitative approach was used in this study with in depth interviews carried out with educators as ‘key informants’. Rich data derived from fifteen interview transcripts were analysed thematically in a rigorous and iterative process. Results Three broad and overlapping themes were identified: working in an educationally minded culture; proximity of the educator to the physician in training; and trajectory of the physician in training. The departments in which these educators worked emphasised the importance on the education of physicians in training. All members of the team were responsible for education of the team, and all members, particularly senior nurses, were able to give feedback upon the physicians’ in training progress. Educators described working side by side with their physician in training and frequently being in close proximity to them, which means that the educator was both easily accessible and spent more time with their physicians in training. They described a trajectory of the physicians in training through the placement with close monitoring and informal assessment throughout. Conclusion Recommendations are made as to how physicians in training can be supported to develop their clinical thinking. Educators and managers can analysis their own and department’s practice and select the recommendations relevant to their local circumstances in order to make change. This study adds the educator perspective to a body of literature about the importance of context and supportive learning environments. As such the discussion is applicable to the education of other health professionals.
Transcultural Adaptation and Validation of the Fonseca Anamnestic Index in a Spanish Population with Temporomandibular Disorders.
Authors: Sánchez-Torrelo Carmen María , Zagalaz-Anula Noelia , Alonso-Royo Roger , Ibáñez-Vera Alfonso Javier , López-Collantes Jesús , Rodríguez-Almagro Daniel , Obrero-Gaitán Esteban , Lomas-Vega Rafael 
Published: April 2020

Abstract

Background. The Fonseca Anamnestic Index (FAI) offers a simple method to screen temporomandibular disorders (TMD). This study aimed to validate the standard version of the FAI in a Spanish population and to analyze the clinimetric properties of the Spanish version of the FAI in patients with TMD.Methods. The sample consisted of 179 subjects aged over 18 years, of which 119 were diagnosed with TMD and 60 were healthy controls. Construct validity (exploratory factor analysis), internal consistency, test-retest reliability, and concurrent validity were analyzed. To discriminate between patients with and without TMD, Receiver Operating Characteristic (ROC) curve analysis was performed.Results. The Spanish version of the FAI showed construct validity formed by three factors. Cronbach’s alpha was 0.820, indicating good internal consistency. The reliability of the items measured with the weighted kappa coefficient was between 0.588 and 0.899, varying between moderate to almost perfect. The intraclass correlation coefficient (ICC) of the total score was 0.938, indicating excellent reliability. The standard error of measurement (SEM) was 6.42, with a minimum detectable change (MDC) of 12.59 points. The concurrent validity showed a significant correlation with headache, neck pain, vertigo and the Mental Component Summary (SF-12 MCS) of the SF-12. However, the relationship with the Physical Component Summary (SF-12 PCS) was not significant. The ROC curve analysis showed a good accuracy of the FAI in differentiating between healthy and TMD patients with an area under the curve (AUC) = 0.869, corresponding to a cut-off point for the FAI of >35 points, with a sensitivity = 83.19% and a specificity = 78.33%.Conclusions. The Spanish version of the FAI is a valid and reliable instrument for diagnosing people with TMD, with appropriate general clinimetric properties. Discrimination between patients with and without TMD is excellent.