bluuebunny/crossref_metadata_2025_split huggingface dataset:
Applying Random Forest Model Algorithm to GFR Estimation
Authors: Liu Peijia , Yang Dong , Li Shaomin , Chong Yutian , Hu Wentao , Wang Bohan , Liu Xun 
Published: October 2020

Abstract
Background The utilization of estimating-GFR equations is critical for kidney disease in the clinic. However, the performance of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation has not improved substantially in the past eight years. Here we hypothesized that random forest regression(RF) method could go beyond revised linear regression, which is used to build the CKD-EPI equationMethods 1732 participants were enrolled in this study totally (1333 in development data set from Tianhe District and 399 in external data set Luogang District). Recursive feature elimination (RFE) is applied to the development data to select important variables and build random forest models. Then same variables were used to develop the estimated GFR equation with linear regression as a comparison. The performances of these equations are measured by bias, 30% accuracy , precision and root mean square error(RMSE).Results Of all the variables, creatinine, cystatin C, weight, body mass index (BMI), age, uric acid(UA), blood urea nitrogen(BUN), hematocrit(HCT) and apolipoprotein B(APOB) were selected by RFE method. The results revealed that the overall performance of random forest regression models ascended the revised regression models based on the same variables. In the 9-variable model, RF model was better than revised linear regression in term of bias, precision ,30%accuracy and RMSE(0.78 vs 2.98, 16.90 vs 23.62, 0.84 vs 0.80, 16.88 vs 18.70, all P<0.01 ). In the 4-variable model, random forest regression model showed an improvement in precision and RMSE compared with revised regression model. (20.82 vs 25.25, P<0.01, 19.08 vs 20.60, P<0.001). Bias and 30%accurancy were preferable, but the results were not statistically significant (0.34 vs 2.07, P=0.10, 0.8 vs 0.78, P=0.19, respectively).Conclusions The performances of random forest regression models are better than revised linear regression models when it comes to GFR estimation.
Maximal Stress Ergometry Performance is Associated with Troponin T and Abdominal Aortic Calcification Score in Severe Chronic Kidney Disease
Authors: Lankinen Roosa , Hakamäki Markus , Metsärinne Kaj , Koivuviita Niina S , Pärkkä Jussi P , Saarenhovi Maria , Hellman Tapio , Järvisalo Mikko J 
Published: October 2020

Abstract
Background Cardiac biomarkers Troponin T (TnT) and N-terminal pro-B-type natriuretic peptide (proBNP) and abdominal aortic calcification score (AAC) are associated with cardiovascular events and mortality in patients with chronic kidney disease (CKD). The effects of cardiac biomarkers and AAC on maximal exercise capacity in CKD are unknown and were studied. Methods 174 CKD 4-5 patients not on maintenance dialysis underwent maximal bicycle ergometry stress testing, lateral lumbar radiograph to study AAC, echocardiography and biochemical assessments. Results The subjects with proportional maximal ergometry workload (WMAX%) less than 50% of the expected values had higher TnT, proBNP, AAC, left ventricular end-diastolic diameter, left ventricular mass index, E/e’ and pulse pressure, and lower global longitudinal strain compared to the better performing patients. TnT (β= -0.09, p=0.02), AAC (β= -1.67, p<0.0001) and diabetes (β= -11.07, p<0.0001) remained significantly associated with WMAX% in the multivariable model. Maximal ergometry workload (in Watts) was similarly associated with TnT and AAC in addition to age, male gender, hemoglobin and diastolic blood pressure in a respective multivariate model. AAC and TnT showed fair predictive power for WMAX% less than 50% of the expected value with AUCs of 0.70 and 0.75, respectivelyConclusions TnT and AAC are independent determinants of maximal ergometry stress test workload in patients with advanced CKD.http://www.ClinicalTrials.gov NCT04223726
Cultural adaptation, translation and validation of the Spanish version of Past-day Adults’ Sedentary Time
Authors: Aguilar-Farias Nicolas , Martino-Fuentealba Pía , Chandia-Poblete Damian 
Published: October 2020

Abstract
Background
To better understand sedentary behaviour and favour international comparisons, more evidence from different countries are needed. However, there are a few tools available in Spanish to measure sedentary behaviour. This study aimed to culturally adapt, translate and validate the Past-day Adults' Sedentary Time (PAST) questionnaire in Chilean adults compared with the ActivPAL (AP).
Method:
101 workers wore an AP for one week and were asked to respond to the Spanish version of the PAST twice on different visits at a 7-day interval. The PAST assesses sedentary behaviour in several domains, including working time, during the previous day. Reliability was assessed with the intraclass correlation coefficient (ICC). Correlations and Bland-Altman methods were used to determine accuracy properties of the PAST compared with the AP.
Results
77 participants provided valid data (51.0% male; age = 39.0 ± 12.39 years). The PAST showed moderate reliability (ICC = 0.63). For the total time in sedentary behavior per day, the PAST showed no correlation (r = 0.21, p = 0.07) and a mean bias of 54.9 min/day (LoA 95%: -484.3, 594.2 min/day) with the AP. For the total time in SB at work, the PAST showed moderate reliability (ICC = 0.40), weak correlation (r = 0.37, p < 0.002), and mean bias was 33.8 min/day (LoA 95%: -285.7, 353.3 min/day).
Conclusions
The PAST performed better when estimating sedentary behaviour during working hours compared with the whole day. In this setting, accuracy properties were comparable with other self-report tools.
Adverse Childhood Experiences and Depression Among Women in Rural Pakistan
Authors: LeMasters Katherine , Bates Lisa M , Chung Esther O , Gallis John A , Hagaman Ashley , Scherer Elissa , Sikander Siham , Staley Brooke S , Zalla Lauren C , Zivich Paul N , Maselko Joanna 
Published: October 2020

Abstract
BackgroundAdverse Childhood Experiences (ACEs) are a common pathway to adult depression. This pathway is particularly important during the perinatal period when women are at an elevated risk for depression. However, this relationship has not been explored in South Asia. This study estimates the association between ACEs and women’s (N=889) depression at 36 months postpartum in rural Pakistan.MethodData come from the Bachpan Cohort study. To capture ACEs, an adapted version of the ACE-International Questionnaire was used. Women’s depression was measured using both major depressive episodes (MDE) and depressive symptom severity. To assess the relationship between ACEs and depression, log-Poisson models were used for MDE and linear regression models for symptom severity.ResultsThe majority (58%) of women experienced at least one ACE domain, most commonly home violence (38.3%), followed by neglect (20.1%). Women experiencing four or more ACEs had the most pronounced elevation of symptom severity (β=3.90; 95% CL=2.13, 5.67) and MDE (PR=2.43; 95% CL=1.37, 4.32). Symptom severity (β=2.88; 95% CL=1.46, 4.31), and MDE (PR=2.01; 95% CL=1.27, 3.18) were greater for those experiencing community violence or family distress (β=2.04; 95%; CL=0.83, 3.25) (PR=1.77; 95% CL=1.12, 2.79). ConclusionsFindings suggest that ACEs are substantively distinct and have unique relationships to depression. They signal a need to address women’s ACEs as part of perinatal mental health interventions and highlight women’s lifelong experiences as important factors to understanding current mental health.Trial RegistrationNCT02111915. Registered 11 April 2014. NCT02658994. Registered 22 January 2016. Both trials were prospectively registered.
Association Between Social Support and Mental Health Status Among College Students: A Nationwide Survey
Authors: Wang Chao , Yan Shijiao , Gan Yong , Jiang Heng , Guo Yingying , Xu Hongbin , Lv Chuanzhu , Lu Zuxun 
Published: October 2020

Abstract
BackgroundSocial support could improve college students’ mental health status. However, mental health varies across different geographic areas, and most of previous studies only included small sample sizes, thus the nationwide survey are warranted. This study sought to estimate the association between social support quality (SSQ) and mental health among Chinese college students using data yielding from a nationwide survey.MethodsA cross-sectional study with a web-based questionnaire survey was conducted in Wuhan, China, from October 2017 to February 2018. A total of 11093 college students were recruited from 18 colleges or universities through multi-stage random cluster sampling method. The Multidimensional Scale of Perceived Social Support scale and 12-items General Health Questionnaire were used to estimate students’ SSQ and mental health status, respectively. Logistic regression analysis was used to identify the association between SSQ and the mental health disorder in college students.ResultsA total of 10,676 (96.24%) college students were included in this study. Of them, 21.4% were identified as having a mental disorder. Students being a female, aged 18-22 years old, whose mother held a college degree and above, and drinking alcohol had more risks of being mental health problems (P <0.05). However, having general or higher family economic levels, working and resting regularly, and sleeping ≥ 7 hours could be preventive factors for mental health problem (P <0.05). Especially, with the improvement of SSQ, there was a decreasing trend in the risk of being mental disorder.ConclusionMental health disorder is an important public health challenge among college students in China. Improving SSQ could be the practical and valuable method to prevent college students’ mental problem.
Recruiting General Practitioners and Patients with Dementia into a Cluster Randomised Controlled Trial: Strategies, Barriers and Facilitators
Authors: Lech Sonia , O'Sullivan Julie Lorraine , Wellmann Leonard , Supplieth Juliana , Döpfmer Susanne , Gellert Paul , Kuhlmey Adelheid , Nordheim Johanna 
Published: October 2020

Abstract
Background: Recruitment of general practitioners (GPs) and their patients is reported as one of the most challenging steps when undertaking primary care research. The present paper describes the recruitment process of a cluster randomised controlled trial (cRCT) aiming to improve dementia care in the primary care setting.Methods: Recruitment data was analysed descriptively using frequency tables to investigate comparisons of recruitment rates and results of different recruitment strategies as well as reasons for participation and non-participation of GPs, patients with dementia (PwD) and their caregivers.Results: Over a period of 23 months, N = 28 GPs were successfully included in the cRCT. This represents an overall recruitment rate of 4.6%. The most efficient strategy in terms of high response and low labour-intensity involved the dissemination of calls for participation in a GP research network. Most frequently reported reasons for GP’s participation were Improvement of patient’s well-being (n = 22, 79%) followed by Interest in dementia research (n = 18, 64%). The most common reasons for non-participation were Lack of time (n = 71, 34%) followed by Not interested in participation (n = 63, 30%). On a patient level, N = 102 PwD were successfully recruited. On average, each GP referred about n = 7 PwD (range: 1-17; mdn = 6; IQR = 3.5) and successfully recruited about n = 4 PwD (range: 1-11; mdn = 3; IQR = 3.5).Conclusion: First, our findings propose GP research networks as a promising strategy to promote recruitment and participation of GPs and their patients in research. Second, present findings highlight the importance of including GPs and their interests in specific research topics in early stages of research in order to ensure a successful recruitment. Finally, results do not support cold calls as a successful strategy in the recruitment of GPs. Trial registration: The trial was prospectively registered with the ISRCTN registry (Trial registration number: ISRCTN15854413). Registered 01 April 2019, http://www.isrctn.com/ISRCTN15854413
Development of Multifactor Index for Assessing Quality of Life of a Tribal Population of India: Multilevel Analysis Approach
Authors: m Bagavandas 
Published: October 2020

Abstract
BackgroundThe main objective of this study is to develop multilevel multi-factor index to assess the quality of life of Malayali tribal population of India at the individual and village levels based on nine domains, namely, Demography, Economy, Health, Human Development, Infrastructure Development, Work Participation, Recreation, Social Capital and Self Perception. Also, an attempt is made to classify the individuals as well as villages on the basis of the overall scores of multifactor index within a community which will help policy makers to develop concrete policy recommendations for the improvement of quality of life of this tribal group.MethodMultilevel factor analysis is utilized to determine uncorrelated meaningful factors and their respective weights using Mplus software from the nested dataset consists of values of nine domains of 1096 individuals collected from 19 villages. Multilevel multifactor index is constructed using the weights of these factors. The qualities of lives of different households and of different villages are assessed using the scores of this index.ResultsThree different factors are identified at household as well as village levels. The quality of life at Households and at villages levels are classified as poor, low, moderate, good and excellent based on five quintiles of the scores of the multifactor index and the contribution of each domain in this classification is ascertained.DiscussionThis study finds that at household as well as at village levels, the quality of life of the individuals of this tribal population increases with increase in education, income and occupation status which make them to lead a healthy life and also make them to find time and money to spend on recreation. Infrastructure does not play a significant role at the house hold level whereas it is a matter at village level. ConclusionThe main purpose of developing this kind of multifactor index at different levels is to provide a tool for tribal development based on realistic data which can be used to monitor the key factors that encompass the social, health, environmental and economic dimensions of quality of lives at the individual/household and community levels of this tribal people.
A Systems Thinking Approach to Understanding Public Trust in Healthcare Services and Doctor-patient Relationship in the Contexts of Medical Errors
Authors: Kaewkamjonchai Phanuwich , Piancharoen Peeraya , Saringkarisate Kornkanok , Rojcheewin Sorrawit , Wananukul Pongpat , Suttawas Adithep , Sriyudtha Gunkawee , Limpanyalert Piyawan , Leerapan Borwornsom 
Published: October 2020

Abstract
Background: Medical malpractice lawsuits in Thailand have been increasing, often leading to conflicts among stakeholders that could deteriorate the doctor-patient relationship and the public trust in healthcare services. To address this complex problem, we report on a systems thinking approach to developing a mutual understanding among stakeholders on the root causes of deteriorating trust in healthcare services and weakening doctor-patient relationships in the contexts of medical errors.Methods: We adopted a systems thinking approach and conducted a series of group model building sessions with participating stakeholders from various organizations in Thailand (n=20), including policymakers, administrators of healthcare organizations, healthcare providers, advocates of patient rights, and the victims of medical errors. The initial causal loop diagram was mutually created during the group model building workshop. It was then reviewed and elaborated by community leaders and experts in patient safety and health systems development. Results: The group model building process revealed that the shared understanding of what causes this persistent problem is lacking, and that multiple perspectives are needed to create sustainable solutions. The final model of our causal loop diagram, which explains why both the public trust in healthcare services and the doctor-patient relationship have been deteriorating over time, consists of four domains: 1) medical errors and malpractice lawsuits; 2) the roles of third-party beneficiaries in medical lawsuits and the conflicts presented on mass and social media; 3) the public trust of healthcare services; 4) the healthcare quality improvement efforts.Conclusions: Our findings provide an insight into the potential high-leverage points within health systems for reducing medical errors, improving public trust in healthcare services, and strengthening the doctor-patient relationship in Thailand. One of the emerging policy recommendations was to change the existing law towards a balance of monetary and non-monetary remedies for victims of medical errors.
The Lymph Node Ratio Predicts Cancer-specific Survival of Node-positive Non-small Cell Lung Cancer Patients: a Population-based SEER&nbsp;Analysis
Authors: Kai Liu , Chen Zhoumiao , Shaohua Xun , Zhao Chen , Zhijun Li , Zhengfu He , Cai Xiujun 
Published: October 2020

Abstract
Background: Lymph node ratio (LNR) has been suggested to be an effective prognostic tool for stratifying non-small cell lung cancer (NSCLC) cases. In this study, we sought to determine cancer-specific survival (CCS) of NSCLC cases from the SEER registry and used the X-tile method to optimize CCS-based LNR cut-off points for prognostic stratification of node-positive NSCLC.Methods: CSS and other clinicopathologic variables were retrieved from the SEER registry. Kaplan-Meier methods were used to calculate CSS. The optimal cut-off points for LNR classification were determined by the X-tile approach. Multivariate Cox regression analysis was performed to identify independent risks of CSS. Results: Totally 11,341 lung cancer patients were included. Their median CSS was 22 months (range 0,143). The median LNR was 0.22 (Q1,Q3: 0.11, 0.50). X-tile analysis showed that the optimal LNR cut-off points were 0.28 and 0.81, dividing the cohort into low (LNR1≤0.28; n=6580, 58%), middle (0.28<LNR2<0.81; n=3025, 26.7%), and high (LNR3>0.81; n=1736, 15.3%) subsets. Kaplan-Meier analysis showed that patients with a low LNR had a significantly higher CCS versus patients with middle or high LNR (P<0.001). Multivariate competing risks regression analysis revealed that LNR was an independent and significant adverse predictor of CSS (LNR2 vs. LNR1: SHR: 1.56, 95%CI: 1.47,1.67, P<0.001; LNR3 vs. LNR1: SHR: 2.54, 95%CI: 2.30,2.80, P<0.001).Conclusions: LNR is an independent prognostic factor of node-positive NSCLC and its optimal cut-off values established using the robust x-tile method effectively define subpopulations of node-positive NSCLC cases, which is important in guiding selection of treatment strategies clinically.
Identification and Verification of the Molecular Mechanisms and Prognostic Values of the Cadherin Gene Family in Gastric Cancer
Authors: Luo Shanshan , Liao Xiwen , Mo Xianwei , Li Daimou , Qin Yuzhou 
Published: October 2020

Abstract
Background: While cadherin (CDH) genes are aberrantly expressed in cancers, the functions of CDH genes in gastric cancer (GC) remain poorly understood. The clinical significance and molecular mechanisms of CDH genes in GC were assessed in this study.Methods: Data from a total of 1226 GC patients included in The Cancer Genome Atlas (TCGA) and Kaplan-Meier plotter database were used to independently explore the value of CDH genes in clinical application. The TCGA RNA sequencing dataset was used to explore the molecular mechanisms of CDH genes in GC.Results: Using enrichment analysis tools, CDH genes were found to be related to cell adhesion and calcium ion binding in function. In TCGA cohort, 12 genes were found to be differentially expressed between GC para-carcinoma and tumor tissue. By analyzing GC patients in two independent cohorts, we identified and verified that CDH2, CDH6, CDH7 and CDH10 were significantly associated with a poor GC prognosis. In addition, CDH2 and CDH6 were used to construct a GC risk score signature that can significantly improve the accuracy of predicting the 5-year survival of GC patients. The GSEA approach was used to explore the functional mechanisms of the four prognostic CDH genes and their associated risk scores. It was found that these genes may be involved in multiple classic cancer-related signaling pathways, such as the Wnt and phosphoinositide 3-kinase signaling pathways in GC. In the subsequent CMap analysis, three small molecule compounds (anisomycin, nystatin and bumetanide) that may be the target molecules that determine the risk score in GC, were initially screened. Conclusions: Our current study suggests that four CDH genes can be used as potential biomarkers for GC prognosis. In addition, a prognostic signature based on the CDH2 and CDH6 genes was constructed, and their potential functional mechanisms and drug interactions explored.
Effects of Repeated Inhalation of Sevoflurane During Infancy on Cognitive Function and Hippocampal Volume of SD Rats in Childhood and Adulthood
Authors: Zhu YuHang , Ren JuanJuan , Zhang Chao , Gong TaoWu , Zhao PengCheng , Lin XiaFei , Yang Yang , Liu DeXing , Zhu ZhaoQiong 
Published: October 2020

Abstract
Background: It has been reported that repeated exposure to sevoflurane, a widely used general anesthesia in pediatric surgeries, may lead to brain defect in infant. However, the long-term effect of repeated exposure to sevoflurane during infancy on the learning behavior and neuro-development is less investigated yet.Methods: Sixty-four SD (sprague dawley) rats were randomly divided in to two groups, the experimental group (n=32) was exposed to sevoflurane (2.6%, 2 h) and the control group (n=32) was exposed to carrier gas (1 L/min O2 + 1 L/min Air, 2 h) for three times at infancy (P (postnatal day) 7, P14, and P21). At childhood (P32 to P36), SD rats in each group (n=16) received Morris Water Maze (MWM) test, and then Magnetic Resonance Imaging (MRI) was used to scan their brain and hippocampus at P37. Subsequently, the same NWM test and MRI scanning was conducted for the remaining SD rats in their adulthood (P92 to P97) (n = 16/group).Results: After being exposed to sevoflurane in infancy, the hippocampal volume of SD rats significantly decreased in their childhood and adulthood, their whole brain volume was also shrunken in adulthood; however, MWM test showed there is no obvious change in their spatial learning and memory recall performance either in childhood or in adulthood.Conclusions: Although repeated exposure to sevoflurane in infancy did not affect the spatial learning and memory performance of rats, however, it could result in the decease of hippocampal and brain volume in their adulthood. This study suggests that repetitive sevoflurane exposure in infancy may exert long-term risk in brain development.