bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ethical perceptions towards real-world use of companion robots with older people and people with dementia: survey opinions among younger adults
Authors: Bradwell Hannah L. , Winnington Rhona , Thill Serge , Jones Ray B. 
Published: July 2020

AbstractBackgroundUse of companion robots may reduce older people’s depression, loneliness and agitation. This benefit has to be contrasted against possible ethical concerns raised by philosophers in the field around issues such as deceit, infantilisation, reduced human contact and accountability. Research directly assessing prevalence of such concerns among relevant stakeholders, however, remains limited, even though their views clearly have relevance in the debate. For example, any discrepancies between ethicists and stakeholders might in itself be a relevant ethical consideration while concerns perceived by stakeholders might identify immediate barriers to successful implementation.MethodsWe surveyed 67 younger adults after they had live interactions with companion robot pets while attending an exhibition on intimacy, including the context of intimacy for older people. We asked about their perceptions of ethical issues. Participants generally had older family members, some with dementia.ResultsMost participants (40/67, 60%) reported having no ethical concerns towards companion robot use when surveyed with an open question. Twenty (30%) had some concern, the most common being reduced human contact (10%), followed by deception (6%). However, when choosing from a list, the issue perceived as most concerning was equality of access to devices based on socioeconomic factors (m = 4.72 on a scale 1–7), exceeding more commonly hypothesized issues such as infantilising (m = 3.45), and deception (m = 3.44). The lowest-scoring issues were potential for injury or harm (m = 2.38) and privacy concerns (m = 2.17). Over half (39/67 (58%)) would have bought a device for an older relative. Cost was a common reason for choosing not to purchase a device.ConclusionsAlthough a relatively small study, we demonstrated discrepancies between ethical concerns raised in the philosophical literature and those likely to make the decision to buy a companion robot. Such discrepancies, between philosophers and ‘end-users’ in care of older people, and in methods of ascertainment, are worthy of further empirical research and discussion. Our participants were more concerned about economic issues and equality of access, an important consideration for those involved with care of older people. On the other hand the concerns proposed by ethicists seem unlikely to be a barrier to use of companion robots.
Pre- and during-labour predictors of low birth satisfaction among Iranian women: a prospective analytical study
Authors: Nahaee Jila , Mohammad-Alizadeh-Charandabi Sakineh , Abbas-Alizadeh Fatemeh , Martin Colin R. , Hollins Martin Caroline J. , Mirghafourvand Mojgan , Hassankhani Hadi 
Published: July 2020

AbstractBackgroundMaternal childbirth dissatisfaction has short- and long-term negative effects on the mothers’ health and life, as well as on relation with her child and family. Due to lack of studies in Iran and other counties, we aimed to determine pre- and during- labour predictors of low birth satisfaction.MethodsSeven hundred women with low risk singleton pregnancy participated in this prospective analytical study. The participants were hospitalized for vaginal delivery with fetus in cephalic presentation and gestational age of 370–416at two teaching centers in Tabriz (Iran). Woman characteristics, anxiety state (using Spielberger inventory) and dehydration were assessed at cervical dilatation of 4–6 cm. Iranian (Persian) birth satisfaction scale-revised was applied 12–24 h after birth. Multiple linear regression was used to determine the predictors.ResultsExcluding 26 women who were outliers, 674 women were analyzed. The mean birth satisfaction score was 23.8 (SD 6.5) from an attainable score of 0–40. The during-labour predictors of low birth satisfaction score were severe and moderate anxiety, labour dystocia, insufficient support by staff, vaginal birth with episiotomy and tear, emergency cesarean section, labour induction and labour augmentation with oxytocin, and woman dehydration. The pre-labour predictors included being primiparous, sexual and emotional violence during pregnancy, gestational age of 400–416, preference for cesarean section, no attendance at pregnancy classes, and insufficient household income. The proportion of the variance explained by the during-labour variables was 75%, by pre-labour variables was 14% and by overall was 76%.ConclusionsThe controllable during-labour predictors explains most of the variance of the satisfaction score. It seems that responding to women’s physical and psychological needs during labour and applying less interventions could improve women’s childbirth satisfaction.
Protect MSM from HIV and other sexually transmitted diseases by providing mobile health services of partner notification: protocol for a pragmatic stepped wedge cluster randomized controlled trial
Authors: Yan Xiangyu , Li Yongjie , Su Hexuan , Xing Yi , Zhang Bo , Lu Zuhong , Jia Zhongwei 
Published: July 2020

Abstract
Background
Recently, more and more men who have sex with men (MSM) look for casual partners through online dating platforms in China. However, most are unable to know their partners’ HIV and other sexually transmitted diseases (STD) statuses, leading to the rapid increase in HIV infection among Chinese MSM. Effective partner notification is urgently needed to increase the risk awareness of MSM and prevent HIV and other STDs transmission. However, the traditional intervention mainly targets to the HIV-positive MSM and the effect is not promising. Our study aims to provide Internet-based partner notification, along with a series of health services for HIV-negative MSM to protect them from HIV and other STDs.

Methods
A pragmatic stepped wedge cluster randomized controlled trial design is used to evaluate the effectiveness of a new intervention paradigm, which aims to reduce HIV and other STDs incidences among MSM in China. Through integrating a mobile health (mHealth) service application (app) to the current HIV and other STDs prevention and control methods, the new paradigm provides partner notification of HIV, syphilis, hepatitis B, and hepatitis C statuses. A total of 6172 MSM in 16 districts of Beijing, China will be recruited and randomized to sequentially receive partner notification intervention through the app at 6-month intervals. The primary outcomes are HIV incidence and the additional cost of the intervention. The secondary outcomes include incidences of syphilis, hepatitis B, and hepatitis C, disease transmission social networks, testing adherence, knowledge of HIV and STDs control, health self-responsibility awareness, changes of high risk behaviors and other related outcomes. The generalized linear mixed models (GLMM) will be used to analyze the differences of outcomes in the control period and in the intervention period.

Discussion
We expect that the HIV incidence will be significantly lower and the secondary outcomes will also be improved with providing health service of partner notification through mhealth intervention. The feasible and affordable public health intervention paradigm will have implications for HIV and STDs prevention and control among MSM and other key populations.

Trial registration
ClinicalTrials.gov, NCT04349748. Registered on 16 April 2020.
Barriers to childhood immunization in sub-Saharan Africa: A systematic review
Authors: Bangura Joseph Benjamin , Xiao Shuiyuan , Qiu Dan , Ouyang Feiyun , Chen Lei 
Published: July 2020

AbstractBackgroundImmunization to prevent infectious diseases is a core strategy to improve childhood health as well as survival. It remains a challenge for some African countries to attain the required childhood immunization coverage. We aim at identifying individual barriers confronting parents/caretakers, providers, and health systems that hinder childhood immunization coverage in Sub-Saharan Africa.MethodThis systematic review searched PubMed/MEDLINE, Web of Science and EMBASE. We restricted to published articles in English that focused on childhood immunization barriers in sub-Saharan Africa from January 1988 to December 2019. We excluded studies if: focused on barriers to immunization for children in other regions of the world, studied adult immunization barriers; studies not available on the university library, they were editorial, reports, reviews, supplement, and bulletins. Study designs included were cross-sectional, second-hand data analysis; and case control.ResultsOf the 2652 items identified, 48 met inclusion criteria. Parents/caretakers were the most common subjects. Nine articles were of moderate and 39 were of high methodological quality. Nine studies analyzed secondary data; 36 used cross-sectional designs and three employed case control method. Thirty studies reported national immunization coverage of key vaccines for children under one, eighteen did not. When reported, national immunization coverage of childhood vaccines is reported to be low. Parents/caretaker’ barriers included lack of knowledge of immunization, distance to access point, financial deprivation, lack of partners support, and distrust in vaccines and immunization programs. Other associated factors for low vaccine rates included the number of off-springs, lifestyle, migration, occupation and parent’s forgetfulness, inconvenient time and language barrier. Barriers at health system level cited by healthcare providers included limited human resources and inadequate infrastructures to maintain the cold chain and adequate supply of vaccines.ConclusionIn this review we identified more thoroughly the parents/caretakers’ barriers than those of providers and health systems. Factors that influenced decisions to get children vaccinated were mainly their gender, beliefs, socio-culture factors in the communities in which they live. Thus it is vital that immunization programs consider these barriers and address the people and societies in their communities across sub-Saharan Africa.
A circRNA-miRNA-mRNA network plays a role in the protective effect of diosgenin on alveolar bone loss in ovariectomized rats
Authors: Zhang Zhiguo , Yue Lifeng , Wang Yuhan , Jiang Yanhua , Xiang Lihua , Cheng Yin , Ju Dahong , Chen Yanjing 
Published: July 2020

AbstractBackgroundThe present study aimed to assess the perturbation in circular RNA (circRNA)/mRNA expression profiles and a circRNA-miRNA-mRNA coexpression network involved in the potential protective effect of diosgenin (DIO) on alveolar bone loss in rats subjected to ovariectomy (OVX).MethodsThe Wistar rats (female) manipulated with sham operation were classified as the SHAM group and the grouping of OVX rats administered with DIO, estradiol valerate or vehicle for 12 weeks was DIO group, EV group and OVX group respectively. Following treatments, the plasmatic levels of osteocalcin and tumor necrosis factor-alpha and the microstructure of alveolar bone were assayed. Based on microarray analyses, we identified differentially expressed (DE) circRNAs and mRNAs in alveolar bone of rats in both OVX and DIO group. The DE circRNAs and DE mRNAs involved in the bone metabolism pathway validated by RT-qPCR were considered key circRNAs/mRNAs. On the basis of these key circRNAs/mRNAs, we predicted the overlapping relative miRNAs of key circRNAs/mRNAs, and a circRNA-miRNA-mRNA network was built.ResultsDIO showed an anti-osteopenic effect on the rat alveolar bone loss induced by OVX. In total, we found 10 DE circRNAs (6 downregulated and 4 upregulated) and 614 DE mRNAs (314 downregulated and 300 upregulated) in samples of the DIO group compared with those of the OVX group. However, only one circRNA (rno_circRNA_016717) and seven mRNAs (Sfrp1,Csf1,Il1rl1,Nfatc4,Tnfrsf1a,Pik3c2g, andWnt9b) were validated by qRT-PCR and therefore considered key circRNA/mRNAs. According to these key circRNA/mRNAs and overlapping predicted miRNAs, a coexpression network was constructed. After network analysis, one circRNA-miRNA-mRNA axis (circRNA_016717/miR-501-5p/Sfrp1) was identified.ConclusionThe mechanism of DIO inhibiting alveolar bone loss after OVX is possibly relevant to the simultaneous inhibition of osteogenesis and osteoclastogenesis by mediating the expression of important molecules in the Wnt, PI3K, RANK/RANKL or osteoclastogenic cytokine pathways. The circRNA_016717/miR-501-5p/Sfrp1axis may play important roles in these processes.
Repeatedly heated mix vegetable oils-induced atherosclerosis and effects of Murraya koenigii
Authors: Ambreen Gul , Siddiq Afshan , Hussain Kashif , Hussain Abdul Saboor , Naz Zara 
Published: July 2020

Abstract
Background
Statins are considered as standard drugs to control cholesterol levels, but their use is also associated with renal hypertrophy, hemorrhagic stroke, hepatomegaly, and myopathy. Murraya koenigii is an herb that is used in traditional cuisine and as a medicine in South Asia. Here we assessed the antidyslipidemic and antiatherosclerotic effects of this spice in repeated heated mix vegetable oils (RHMVO)-induced atherosclerotic models.

Methods
Aqueous extract of M. koenigii leaves (Mk LE) was prepared and its phytoconstituents were determined. Rabbits were divided into 5 groups (n = 10). Except for the control group, all the other four groups were treated with RHMVO for 16 weeks (dose = 2 ml/kg/day) to induce dyslipidemia and atherosclerosis. These groups were further treated for 10 weeks either with 300 and 500 mg/kg/day Mk LE, lovastatin, RHMVO, or left untreated. Body and organ weights were measured along with oxidative stress and tissue damage parameters. Lipid profile and hepatic function markers were studied. Atheroma measurement and histopathological examination were also performed in control and treated groups.

Results
Mk LE significantly (p < 0.05) attenuated RHMVO-induced dyslipidemia and atheroma formation. Furthermore, fat accumulation and lipid peroxidation in hepatic tissues were reduced by Mk LE in a dose-dependent manner. Our results indicated that the antidyslipidemic effects of Mk LE in 500 mg/kg/day dose were comparable to lovastatin. Additionally, oxidative stress markers were reduced much more significantly in Mk LE-500 than in the statin group (p < 0.05).

Conclusions
This study recommends Mk LE as a potent antioxidant and lipid-lowering natural medicine that can attenuate the RHMVO-induced atherosclerotic in optimal doses and duration. Therefore, Mk LE can be accessible, cheap, and free of adverse effects alternate to statins.
Breast Cancer knowledge and perceived barriers to help seeking among pre-clinical and clinical female medical students of King Edward Medical University, Lahore: a cross-sectional study
Authors: Qasim Saleha , Tayyab Hamnah , Zulqadar Kainat , Masood Somer , Qasim Tahira Bano , Zubair Zainab 
Published: July 2020

Abstract
Background
Breast cancer is the most common form of cancer in women and second most common cancer after lung cancer. The prognosis of breast cancer depends on early detection and intervention which in turn relies upon awareness. Health workers in all communities are responsible for educating the population at risk. This study evaluates the knowledge regarding breast cancer, personal judgment of confidence, perceived barriers to help seeking and breast self-examination practices among Pakistani female medical students and studies the impact of clinical training on the studied variables.

Methods
Descriptive cross-sectional study design using self-administered validated questionnaires (BCAM-Breast Cancer Awareness Measure designed by Cancer Research UK) was employed. Female medical students enrolled in clinical and pre-clinical classes of King Edward Medical University, Lahore were targeted and questioned regarding symptoms, risk factors and their practices regarding breast cancer. Possible barriers to seeking help were also studied.

Result
The mean number of symptoms correctly identified was 6.7 ± 3.2 (5.5 ± 3.2 for pre-clinical and 7.8 ± 2.9 for clinical students) and for risk factors it was 4.3 ± 2.1 (3.7 ± 2.1 for pre-clinical and 4.7 ± 2.2 for clinical students). The difference in the level of perception of two groups was found to be significant (p < 0.001 for symptoms and p < 0.001 for risk factors). 38.7% of the subjects responded that they check their breasts rarely, 33.1% were fairly confident while 8.6% were very confident about detecting a change in their breast, 50.0% never noticed a change in their breast, and 77.4% will contact a doctor within a week or less of finding a change in their breast. Confidence about detecting a change significantly improved (p < 0.001) after the start of clinical training.

Conclusion
This study suggests that clinical training may have improved knowledge of female medical students regarding breast cancer; yet the knowledge related to the symptoms and risk factors of breast cancer and frequency of breast self-examination of female medical students is less than anticipated.
Data mining application to healthcare fraud detection: a two-step unsupervised clustering method for outlier detection with administrative databases
Authors: Massi Michela Carlotta , Ieva Francesca , Lettieri Emanuele 
Published: July 2020

Abstract
Background
The healthcare sector is an interesting target for fraudsters. The availability of a great amount of data makes it possible to tackle this issue with the adoption of data mining techniques, making the auditing process more efficient and effective. This research has the objective of developing a novel data mining model devoted to fraud detection among hospitals using Hospital Discharge Charts (HDC) in Administrative Databases. In particular, it is focused on the DRG upcoding practice, i.e., the tendency of registering codes for provided services and inpatients health status so to make the hospitalization fall within a more remunerative DRG class.

Methods
We propose a two-step algorithm: the first step entails kmeans clustering of providers to identify locally consistent and locally similar groups of hospitals, according to their characteristics and behavior treating a specific disease, in order to spot outliers within this groups of peers. An initial grid search for the best number of features to be selected (through Principal Feature Analysis) and the best number of local groups makes the algorithm extremely flexible. In the second step, we propose a human-decision support system that helps auditors cross-validating the identified outliers, analyzing them w.r.t. fraud-related variables, and the complexity of patients’ casemix they treated. The proposed algorithm was tested on a database relative to HDC collected by Regione Lombardia (Italy) in a time period of three years (2013-2015), focusing on the treatment of Heart Failure.

Results
The model identified 6 clusters of hospitals and 10 outliers among the 183 units. Out of those providers, we report the in depth the application of Step Two on three Hospitals (two private and one public). Cross-validating with the patients’ population and the hospitals’ characteristics, the public hospital seemed justified in its outlierness, while the two private providers were deemed interesting for a further investigation by auditors.

Conclusions
The proposed model is promising in identifying anomalous DRG coding behavior and it is easily transferrable to all diseases and contexts of interest. Our proposal contributes to the limited literature regarding behavioral models for fraud detection, identifying the most ’cautious’ fraudsters. The results of the first and the second Steps together represent a valuable set of information for auditors in their preliminary investigation.
Epidemiology and short-term outcomes of acute kidney injury among patients in the intensive care unit in Laos: a nationwide multicenter, prospective, and observational study
Authors: Sengthavisouk Noot , Lumlertgul Nuttha , Keomany Chanmaly , Banouvong Phonepadith , Senavong Phetvilay , Sayyaphet Sidavone , Binbundith Sakountala , Kulvichit Win , Peerapornratana Sadudee , Praditpornsilpa Kearkiat , Tungsanga Kriang , Eiam-Ong Somchai , Srisawat Nattachai 
Published: July 2020

AbstractBackgroundAcute kidney injury (AKI) has become a global health issue. Little is known about the disease burden in Laos. We aimed to evaluate the burden and outcomes of AKI as well as assess the availability of AKI treatment in Laos.MethodsWe performed a multicentric prospective observational study in adult patients who had been admitted to 5 intensive care units (ICU) in Laos. The data was serially collected on the first 28 days of ICU admission. Patients were diagnosed by the KDIGO 2012 criteria for AKI. We used AKI occurrence as the primary outcome and explored risk factors on the development and outcomes of AKI.ResultsWe enrolled 1480 patients from 5 ICU centers across Laos from January to December 2016. After excluding patients with end-stage renal disease and those with incomplete data, AKI occurred in 508 of the 1460 enrolled patients (34.8%). Overall, the rates of maximum AKI staging were 4% for stage 1, 10.3% for stage 2, and 20.5% for stage 3. Risk factors for AKI were older age, obesity, cardiovascular diseases, respiratory diseases, renal diseases, oncologic diseases, and chronic kidney diseases. Only 1.8% of all participants received RRT. The mortality rate was 28.4% in non-AKI patients compared to 44.5% in AKI patients, which increased according to the stage of AKI (stage 1, 4.9%; stage 2, 28.3%; stage 3 66.8%;P < 0.001). There were 13.6% who were discharged against medical advice.ConclusionsAKI is a huge burden in Laos with under-recognition and poor outcomes.
Evaluation of buccal damage associated with acute inhalation exposure to 2,4-dichlorophenoxyacetic acid (2,4-D) in mice
Authors: Parizi José Luiz Santos , Tolardo Amanda Jodas , Lisboa Ana Carolina Gomes , Barravieira Bruna , de Azevedo Mello Fabíola , Rossi Renata Calciolari , Nai Gisele Alborghetti 
Published: July 2020

Abstract
Background
The herbicide dichlorophenoxyacetic acid (2,4-D) is one of the most widely used crop spraying products in the world. Some pesticides induce the degranulation of mast cells and increase allergic responses. This is the first study to evaluate the damage to the oral mucosa after an experimental simulation of environmental inhalation exposure to the 2,4-D herbicide. The aim of this study was evaluate the possible oral damage caused by acute inhalation exposure to the herbicide 2,4-D.

Results
There was a difference between the exposure concentrations in relation to tissue congestion intensity (p = 0.002) and mast cell counts (p = 0.002), a difference in the evaluation of the interaction between the exposure concentrations and nebulization time in the dorsum epithelium thickness (p = 0.013), and a significant correlation between the epithelial thickness and the number of nucleoli organizing regions on the dorsum of the tongue (p = 0.048).

Conclusions
Even after acute exposure, the herbicide 2,4-D had the potential to damage the oral epithelium, especially at higher doses.